Factually! with Adam Conover - The Science of Addiction, How Brains React to Substance Abuse and Crossword Puzzles on Adderall with Judith Grisel

Episode Date: September 18, 2019

Renowned behavioral neuroscientist, recovering addict and author of the NY Times Bestseller Never Enough, Judith Grisel joins Adam to discuss her early battle with addiction, the neuroscience on how the brain adapts negatively to substance abuse, ending up in treatment by mistake and how life can be wonderful after recovery. This episode is brought to you by Kiwi Co (www.kiwico.com/FACTUALLY), Bombas (www.bombas.com/FACTUALLY), and Invitae (www.invitae.com). Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

You know, I got to confess, I have always been a sucker for Japanese treats. I love going down a little Tokyo, heading to a convenience store, and grabbing all those brightly colored, fun-packaged boxes off of the shelf. But you know what? I don't get the chance to go down there as often as I would like to. And that is why I am so thrilled that Bokksu, a Japanese snack subscription box, chose to sponsor this episode. What's gotten me so excited about Bokksu is that these aren't just your run-of-the-mill grocery store finds. Each box comes packed with 20 unique snacks that you can only find in Japan itself.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way I don't know what to think I don't know what to say Yeah, but that's alright Yeah, that's okay I don't know Hey everybody, welcome to Factually. My name is Adam Conover and for the last last year or so, I've been touring my show, Mind Parasites, all across the country.

One of the things I talk about in that show is about how last year I quit drinking. And here's the thing you need to know about me as a drinker. I was not what anybody was calling a, quote, alcoholic. I was a nightcap drinker. You know, I just had one or two drinks a night every night for the last 15 years. And, you know, to some of you that might sound like a lot, but I'm guessing that to most of you, it actually doesn't sound like that much because that kind of drinking is very normal in America. And for me, the habit was in really, really deep. You know, I wasn't like selling blood to buy Maker's Mark or anything like that, but you know, every night at about 9 p.m., my hand would form itself into a claw shape and I'd have to go find a rocks glass to put into it or I'd become very uncomfortable, you know.

Drinking was just woven into the fabric of my life. I had trouble imagining going to parties without drinking or doing stand-up without drinking or replying to work emails without drinking. That was the hardest one, to be honest. You know, I was very much in that habit, pour myself a double and start replying to Karen. Makes it go down easier. And, you know, the thought that kept me drinking all those years was that drinking made all those things better and more fun. I mean, that's why I was doing it, right? So if I stopped, ergo, they'd all get worse. But to my surprise, when I quit, all those things actually got better. Like I had more fun at parties and I didn't get hangovers afterwards. I became a little tighter and funnier on stage and my work emails had a lot less swears and minions gifts in them. And Karen was very

appreciative of that. So if it wasn't actually making any of those things better, why was I doing it every single night for 15 years? Well, what became obvious to me after I quit, and what might be obvious to you listening to me talk about it, is that I was addicted to it. In fact, I realized it was just like when I was addicted to smoking. It was an addictive drug. I did it too much. I became dependent on it and it was tough to quit. But here's the weird thing. I knew I was addicted to smoking the entire time, but I never knew I was addicted to alcohol. I didn't realize that for the entire time. And that's because we talk about those two drugs

completely differently in our society. Cigarettes, we know that anyone can get addicted to them if they smoke them long enough. But with alcohol, we talk about it as though you have to be a special type of person with a special disease, an alcoholic, to have a problem. Otherwise, you're a happy and healthy moderate drinker, which means you can drink as much as you want. Well, the problem with that model, with that cultural understanding of alcohol that we have, is that it's not true. that cultural understanding of alcohol that we have is that it's not true. Scientists now know that alcohol addiction exists on a spectrum and that even though there are people way out in the far ends, right, the really hard cases, the people who will never have a problem, there's also an

awful lot of folks somewhere in the middle who are chemically or psychologically dependent on the substance, but we don't have a label for what that kind of addiction is. We don't have a word for it. And because we don't have a word for it, I couldn't see it in myself. The truth is our cultural understanding of addiction is light years away from what science knows about addiction. And that becomes obvious when you look at how differently our culture treats different types of addiction. Some addictions are diseases like alcohol, but others, like gambling, we treat as a moral failing, even though gambling addiction is deliberately caused by the people who design our casino slot machines. And then, of course, there's caffeine, which almost everyone in America is hooked on,

but which we all accept as a completely normal part of life. I mean, hell, I'm high on a big cup of black tea right now. And finally, there are the gray areas like sex addiction, which is often treated like a disease by, you know, ashamed famous men who are trying to come up with an excuse for their misdeeds. The only problem with that is that the studies we have don't even agree on whether sex addiction even exists. So again, it is startling how much of what we think we know about addiction is based not on science, but on our weird cultural assumptions about it. And this is a problem because the effects of addiction on our society are profound. In the U.S., the total economic cost

of addiction is greater than that of diabetes and all types of cancer combined. And the opioid addiction epidemic is one of the most severe public health crises of our time. So if we want to have any hope of fighting addiction, of stopping it from killing and hurting us, it's critical that we understand it first. And no one knows that better than my guest today. She's a professor of psychology at Bucknell University and studies how addiction works in the brain. And she also has a direct lived experience with addiction that gives her personal insight into the topic and why it is so important. Her name is Judith Grizzell. Please welcome her to the show. Judy, thank you so much for being on the show. Glad to be here.

So you, as I mentioned in the intro, you had your own personal experience with addiction. If you don't mind, I'd love it if you shared some of that story with us and sort of describe how that brought you to your work studying addiction as a neuroscientist. Sure. I grew up in a pretty typical family, I think, but was maybe a little more inclined to try new things than average, perhaps. So I got my first good drink at around 13, and I absolutely loved it. It changed the trajectory of my whole life. trajectory of my whole life. And for about the next 10 years, I never said no to another taste of alcohol or any other mind-altering drug. And as a result of that, by the time I was 23, I was homeless. I'd been kicked out of three schools. I contracted hepatitis C from sharing dirty needles. And I'd lost the respect of everybody I knew, including myself. So I ended up in treatment, which I thought at the time was going to be like a spa because it was in the 1980s. And I didn't know anything about drug treatment. But they said I had a disease and that if I wanted to live, which I wasn't so sure about, but if I wanted to,

I needed to stop using. And I thought actually that curing addiction would be easier than not picking up for the rest of my life. So that's how I ended up by persistence, getting into graduate school, obtaining a PhD, studying the brain to try to understand addiction. And it took about 10 or 12 years before it began to dawn on me that it wasn't so easy to cure. But then, you know, I didn't know what else to do. But your thought was literally, oh man, it's going to be hard staying clean through willpower or whatever. So I want to find a cure instead. That was your actual motivation? Yeah. I mean, it seemed impossible to stay clean for the rest of my life. I was so young, and I really thought at the time, why couldn't this happen to me when I'm 40 and my life is

already over or something, which is funny because I'm 56 now. But at the time, it seemed like, forget it. I had so much partying left to do. And I just couldn't imagine wanting to live without using, I thought, am I going to have to knit or bowl? I mean, what will people, what do people do who aren't spending all their time getting drugs and hiding them? So, yeah, it seemed relatively trivial to cure it, which is arrogant and ignorant. That's a young person's way of looking at the world. That's a good sort of optimism to have, I suppose. Well, it's optimism, but it's also reflecting, I think, the perseverance and the tenacity of most addicts.

So, you know, don't tell me there's no something to be found. I'm sure I can come up with it, even if I have to hitchhike to Houston. And how do you feel now being 56, that when you were 23, having that feeling of, oh, it's going to be so hard to stay clean for the rest of my life? Do you have a different relationship with that idea now? for the rest of my life. Do you have a different relationship with that idea now? Oh my gosh, do I ever. It's really funny because I thought life was just this boring thing to be gotten through without enhancing. And I have not been bored, literally, I have not been bored in probably 30 years. I have such a full, rich life right now that it would sound like I was bragging if I went through it, but I was completely wrong. I was just completely wrong because at the end of

my using, it was almost like living in a closet. All I did was worry about getting stuff and then having enough of it and then hiding that I was using and then getting more stuff and recovering from that. I mean, it was sort of like living in a small closet. It was just me and my misery that I was trying to escape less and less successfully, it seemed, every day. And now, you know, it's sort of like a big adventure. I feel like I have, and, you know, not just because I'm talking to you, which is fun, but just there's a lot of wonderful stuff to experience in the world, I think. And one of the ironies, I think, of regular drug use is that it seems at first like it's enhancing things, but pretty

soon it's actually diminishing them. And I think one of the questions, you know, I wonder if we could somehow do this calculus across the world, but if we figured out how much is it benefiting individuals and all of us and how much is it taking from individuals and everybody, I have a feeling it would come out not in our favor, the way we're medicating so much away. But it's such a, you're correct that the feeling while you're using is that it is enhancing. I mean, I have a very different experience with addiction, but I do consider myself to have been addicted to smoking for many years. And I just quit drinking in the last year, as I mentioned in the intro. And my feeling with both of those things, I relate so powerfully to what you said a little bit earlier about that thought when I was using those substances.

I would think, how do people enjoy life without doing this? Like, if you're not smoking, life must be bad, right? They're not enjoying what I'm enjoying out of it. And in the back of my mind with smoking, I think I knew that that wasn't true. And, you know, when I finally quit smoking, I had that realization of, oh, the way that I feel, the way I used to feel just after having a cigarette, that's actually how everybody else feels all the time. That's like their baseline state. And so that was easier to figure out about smoking. It took me an extra like 10 years to learn that about drinking. And it was the exact same lesson when I finally quit. I literally up until about a year and a half ago thought, well, everyone who isn't drinking at the party or every comic who isn't drinking right before they go up on stage and my own world of stand-up comedy, those people are having less fun than me.

And that's why I'm doing it. And now I know that that was wrong. And so it's so interesting you say, yeah, if we were to actually measure whether it's bringing us joy or misery, it would probably be misery, except that while we're using it, we're like incapable of seeing that. Well, we're incapable of seeing it, but I bet most smokers could relate to this. The best cigarette of the day is always the first one. And that one is kind of fun and enjoyable because the brain is kind of reset a little bit overnight. But the 10th or the 15th cigarette of the day is really smoked only to avoid the misery of not smoking it. And it's the same with alcohol. Initially, it makes us feel relaxed and feel some pleasure. But really, regular drinkers are drinking because if they

don't drink, sort of like I described about myself, then it feels like life is bleak and there's a lot of anxiety and tension. You can't have any fun. I remember thinking, how am I going to kiss somebody? How am I going to dance? How am I going to go to a concert if I'm not bloated? And in fact, it's kind of a myth because it makes it so that without drinking, you kind of fall into a hole and drinking just brings you up to normal, like you say. to normal, like you say. Yeah, I also had that same thought. I mean, again, I think we had probably different relationships with alcohol in many ways, but I had that association with, well, that's how I relax at the end of the day. I've been working hard all day long and having a drink is how I unwind. And if I don't have that drink, I won't be able to unwind because that's what it's doing for me. And now I unwind just as well. And in fact, a little bit better. A little bit better is the key thing because the brain adapts to your regular

using so that now it's tense and anxious and the alcohol only serves to bring you to the baseline. But you're right that in the long run, it just perpetuates its own habit. Well, tell me about, you said the first time you had a drink, it felt you loved it. What was it about it that gave it that reaction for you? Yeah. I don't know if I romanticize it. I know it sounds like I do, but I was 13. I was pretty, from the outside, everything looked great. But I think inside, I was as insecure and anxious as a typical 13-year-old girl anyway. And maybe more. But we were in the basement of my friend's house and our parents had quite a stock

and we found a bottle of Gallo wine, a gallon of it. And I don't think it was particularly wonderful wine, but- No, it definitely wasn't. A gallon of Gallo wine, I'm sure it was not delicious. But I took a big swig. I ended up having more than half of it, I know, because I always made sure I got at least my share, if not more. Wow. But the initial feeling, once it hit my brain, I guess, I thought it was my gut that it was filling, but it was really filling a void in my mind or my brain or my soul,

whatever you want to say, so that suddenly I felt, almost for the first time, that I could recall that life was just right, that I was enough, that I was okay, and that I could somehow manage to negotiate things. I remember thinking, manage to negotiate things, I remember thinking, this is how people do it. This is how adults get through the day because they can drink and it makes everything seem somehow well. It made my stomach warm and my chest warm and my head sort of overflowing with bliss in a way, like an oceanic sense of okayness. And, you know, it's funny because I didn't consciously realize that I wasn't okay until I had that. And then I suddenly, almost like a cat that lives outside and suddenly gets into the warmth in the middle of winter, you know, oh, this is what I've been missing. That's how I felt. Like, I'm never going outside again. And I drank.

I mean, we started drinking in school. I eventually, at 14, I got kicked out of school. It was a private little girls' school, and they didn't like drinking, and the nuns didn't like it. But anyway, they asked me to leave. And in their defense, they were correct. And in their defense, they were correct. Well, you know, I think if, yes, they were correct. But I think for someone like me, it was really an important tool. And I can see both how alcohol was a big pitfall, but also how, in a way, it helped me survive my adolescence because it gave me a relief valve.

And just like you said, at the end of the day, I had no real tools for getting through the stress and anxiety of my 1976 life. And I think I can't imagine for kids today, I think they have even maybe more stress and anxiety and fewer tools to get through it. So this was a way for me to cope. And from the very beginning, I used it like a tool. And I also, I liked the high, but more than that, I liked the way it took the edge off my reality. But was it still doing that so many years later? I mean, what you're describing sounds wonderful. And if that's what drinking was like all the time, then I don't think I would have quit either. You know, it was never that good again. So I had to smoke pot while I drank, and then I had to take Coke and

smoke pot while I drank. And then I had some downers to go with the Coke and the weed and the booze. So no, I never really could get quite there again. But I spent really 10 years trying to titrate that same feeling. And what ended I, you know, what ended up happening was that there were fewer and fewer days without it. But if I should have a day where I wasn't using, I, it was, it was tedious and frustrating and bleak and uninspired so that, you know, only altering my mind and psyche with drugs brought any, um, solace and, um, and joy. Like you said, I thought it was joy. Actually, I probably mistook, um, the thrill for joy, just like I mistook, umook being wasted for a sense of peace. When I passed out, I thought that meant I was okay with myself.

Yeah, maybe I overdid it. So yes, there were diminishing returns over time. So that by the very end, I got clean and sober on July 9th in 1986. My 23rd birthday was in June. And I remember about that time thinking, gosh, I'm just turning 23, but I feel like I'm 123. I feel like there's nothing left to live for. I've sort of seen it all, and it's either brutal or boring. And so talking about your work now as a neuroscientist, when you look back on that time in your life, do you now have more insight into what was actually going on with you? Like on those days where it felt so tedious, do you now know, oh, here's what was going on in my actual brain? Yes, I absolutely do. And it turns out it's a pretty simple fundamental principle that the brain adapts to any drug that alters the way it functions

by producing the exact opposite effect. So for example, alcohol, like we've been saying, helps produce relaxation. It helps you sleep. It helps you have some fun. The brain that is regularly exposed to alcohol makes your experience to be tense and insomniac and unhappy so that when you drink those um you kind of come out even so the brain is really about the business of homeostasis or keeping things stable in a sort of a middle state the reason that's so important is because you wouldn't be able to tell if something critical happened either something terrific or something terrible happened if you were kind of bouncing all over the place in terms of your feeling state, you know?

So, you know, if you're wasted on opiates, let's say, and your child gets hit by a bus, you know, you wouldn't be able to tell. Or you get hit by a bus. Let's say you get hit by a bus. So you can't tell because you're so, you know, you wouldn't be able to tell. Or you get hit by a bus. Let's say you get hit by a bus. So you can't tell because you're so, you know, nodding out. So therefore, the brain counteracts that so that you can have this stable baseline. So if the bus comes, you know it. Unfortunately, it does that by producing the opposite effect so that you only feel normal with the drug. so that you only feel normal with the drug.

I go back and forth about whether I'm a caffeine addict today. I drink caffeine every morning reliably first thing. And because of that, when I wake up in the morning, I don't wake up in the morning. I drag myself from bed. The dogs and cats and children and husband all get far away until I get about three-quarters of the way through the first cup, which only takes a few seconds, you know. And then I'm normal. Then I can put a sentence together.

Then I can, you know, smile and say good morning. But my brain is ready for that caffeine so that if I don't get it, I can't wake up. Just like if you don't get the alcohol that you regularly have, you can't relax and have fun. If you don't get the weed, nothing is interesting. If you don't get the heroin, you're suffering. Well, it strikes me that we, and I mentioned in the intro to this show, we talk about all those different drugs completely differently. I mean, first of all, I'm also addicted to caffeine. I've quit three different addictive drugs in my life. I was on Adderall, otherwise known as amphetamines, during college. I was addicted to that. I had to quit it. I quit smoking and I quit drinking. And I'm familiar with those feelings of what it feels like to quit those things.

And a little bit after I quit drinking, I tried quitting caffeine too, and I actually found that intolerable. And I said, I'm going to continue drinking. I switched from coffee to tea, but I otherwise, you know, I'm sort of right back up to my baseline. So that's an addiction that we sort of all accept. Well, I have great news for you. Oh, please. And the great news is that one of the criteria for addiction is that it has to be harmful to you and or society. And caffeine is actually beneficial overall, unless you're trying to get pregnant, which I don't think you are, or pregnant.

There's no deleterious effects for most people of a normal amount. In fact, it may protect against Parkinson's disease and give some benefit to other parts of our physiology. So you're kind of off the hook. Yeah, drink away. So it has positive effects beyond that bounce back, get yourself to baseline homeostasis effect that you were describing. Right. And the thing about nicotine and cigarette addiction is it'll kill you, as will alcohol addiction, as will others. Or they cause you to ignore your children or forget about your job. Whereas caffeine has all these physical and mental benefits. It makes us cognitively sharper. Now, I should say, in all fairness, that one of the other criteria of addiction is that you have a denial of the problem. So it's possible that, I know, and I think both of us are dependent on caffeine,

but whether or not we're addicted is still open because the drug is not hurting us or anybody else. So from a more medical perspective, it requires that definite harm. Yes. Well, I was going to say also, you mentioned marijuana THC earlier, and that's a drug that you included in that group of drugs that we have that homeostatic response to. But that's a drug that we are, in our discourse about it, we treat it as non-addictive people say oh no yeah pot's not addictive um but then i've known people throughout my life where i think wait maybe this person kind of does seem that they're addicted to it um despite that sort of folk wisdom about it is that is potive or not? Yes. Period.

Full stop. Because there's five criteria, so it has to be harmful. Usually there's denial, but then you have craving, tolerance, and dependence. And dependence happens when you take away the marijuana and you see the opposite effect so that you're in a kind of withdrawal state. And you see the opposite effect so that you're in a kind of withdrawal state. In my case, even though I loved alcohol, especially that first time, and I used everything I could get my hands on, I smoked marijuana all day, every day. It was my absolute favorite drug. And if I could only have one drug, it would be marijuana.

And it was so hard to give up. It took me actually nine years before I stopped craving it. So it was a really, probably my most important relationship was with marijuana. So I just thought it was perfect. Anyway, I won't go on and on about that. And the reason I loved it so much is I didn't really get anxious. I didn't really get paranoid. I got really interested. So the world was so much more interesting and I have a kind of a deficit in novelty. So I'm always looking for, you know, have a low tolerance for boredom, let's say. And marijuana was the perfect antidote to boredom, let's say, and marijuana was the perfect antidote to boredom because even if I was waitressing or just driving across town, you know, it could be a magical experience if I was stoned enough. What ended up happening though is that I got tolerant to that effect, so things were less

and less wonderful. I remember the first time I got stoned even more. So things were less and less wonderful. I remember the first time I got stoned even more fondly, maybe than I remember the first time I drank. I was at a mall. This was in the 80s, you know, so malls were, maybe it was in the 70s, but just coming on board. Yeah. They're kind of all the same, but it was just an absolute joy, better than Disney World for sure. It was just an absolute joy, better than Disney World for sure. And laughed and just thoroughly had probably the best time of my life. But after smoking, more or less chain smoking for about 10 years, I could only enjoy things a little bit if I was wasted.

And if I had to be straight, oh my gosh. I mean, it was as if the world was in black and white. There was just no color, no vitality, nothing at all interesting. In fact, I could sort of, like I am now, I could only drag myself out of bed with the promise of a bong hit, you know. And I know now why that happened, because the receptors in my brain, the proteins in my brain that respond to THC downregulate or kind of disappear with chronic using. that the THC has less and less of an effect, which is kind of not a huge problem today because people can get such high-potency THC that with the fewer receptors that are there, they can still stimulate them. It's only such a big problem, I think, when you take the drug away. And I have talked to hundreds of people who are parents or students or retirees for whom life without smoking is bleak and boring and colorless in a way. And so they can't withdraw, just like I'm sure quitting cigarettes was not fun. This is not fun.

And they feel like the returns are diminishing because the brain is adapted to produce the exact opposite state. If marijuana makes things interesting and seem really relevant and tasty, then without it, things are boring and bland and you know you're kind of stuck so unfortunately that is the message of all regular drug use and I think you know if you're a 50 year old and you start smoking now, it's probably not so harmful, but I am pretty concerned about people in their teens for two reasons, I guess. One is that their brains are developing, so when they're developing, they're laying down structures and pathways. under the influence of drugs, then the drugs influence that organization, and they do so in a permanent way, perhaps to make things less interesting for a lifetime. But also, kids are kids because they're supposed to be finding what is important to them, what is particularly exciting. Do they like this guy or that girl or this job or this artist or this music or this town?

Those sorts of explorative experiences help set their identity. And if you're exploring with a bong on the couch, you're less likely to figure out who and what you are and want to be. And I think you don't really get that opportunity again. Teen, the adolescent period is the adolescent period because the brain is primed to take those experiences and mark what you care about in a way that determines your trajectory, really, or helps at least constrain your trajectory. So I think we're missing an opportunity there. Well, let me ask because you were using that drug during those adolescent years

and you also talk about a lot of ways in which you felt it was helping you cope, that you were using it as a tool. Do you say that fear that you just expressed about teenagers because of your own experience? Yeah, I really do. I ended up in treatment by mistake. And for most kids, you know, they have a strong liver and they have, they're kind of adaptable. So they're resilient in a way. And I was pretty resilient. But I think that if I had gone another 10 years, I can't imagine that I would have been able to get through with anything like the, what looks like, you know, the success that I've had. So I think that the fact that I started early

drove me to an addictive state pretty early. But the fact that I stopped basically just about the time I was 23, I still had a few years of strong brain plasticity to depend on. And I think that really helped me get clean. So, and I, you know, I think I've done okay, but an N of one is no experiment, but I might've done better. You know, I've not taken so long to write my book

or maybe I'd have three books or, you know, there's a lot of ways, I think. So it's hard to know. But I will say, I guess one message sort of related to this is that, again, I think that the first little while without marijuana was so painful and so lonely because it was like I lost my best friend. Our relationships with those substances feel so personal. Like when you said you used the word relationship earlier and I related to that. Yeah. And I think in a lot of ways, it's better than a person because we control the dose. We control the time that it comes. We don't have to put up with it's shit so to, we get to use it the way we want. So, um,

I think I did feel like I had lost my best friend and, uh, and, but now I can see that, uh, I have lots of interests and lots of kind of peak experiences that don't involve drugs. So I think the brain does, um, adapt back now, whether or not my brain, my husband is not an addict and, you know, he smoked some weed, I think, and he's, you know, occasionally drinks, but he, I think, um, would describe me as someone who has to step really hard on the pleasure pedal to get something out of it, which might be part of my strength too. But I think I did alter my brain in such a way that I'm less satisfied than he is with the same kinds of things. Now, that's not all bad, but it's not all good either.

That's not all bad, but it's not all good either. Well, that brings me to my next question because you describe this sort of very singular experience you had when you were 13 years old where the drug made you feel that you were okay. I did not have that profound of an experience the first time I had a drink. And I'm sure some folks listening probably feel the same way. But you're also describing how, in a way, our brains are hardwired for addiction, that these are, you know, the homeostasis is something that all of our brains do. So to what extent do you feel that you had your experience because you're a special type of person? That's how we talk about alcohol culturally, the sort of folk understanding of it is some people are alcoholics and everyone else is a moderate drinker who will never have a problem. There's that model. And I could see fitting your story into that, but you're also

describing a universal quality of our brains that lead anyone to addiction. So I'm curious about how you weigh those two ways of looking at it. Yeah, it's a great question and one that science is constantly trying to help understand. One way to think about it is, let's say you need 100 points to be a bona fide addict or alcoholic. Some people are probably born with 90-some. You know, they've got a long family history with lots of addiction in it. They got a bad set of genes. Maybe they also are born into a stressful environment with, you know, not a tight-knit family and lots of drugs and alcohol around.

So they really don't need much. Other people might be born with very few points, but if they use enough of any mind-altering substance, they will become dependent. And if that mind-altering substance is an addictive drug that's abused, like the ones we've been talking about, then they're going to have diminishing returns and they'll need the drug to feel normal. It doesn't. Addiction is not a single gene or a single cause. It's so complex that even though we know it runs in families, we think there are probably hundreds of genes each contributing a tiny, tiny amount. So you might have had some really protective genes. I'd be curious about your initial experience. Did you have a lot to drink or just a little? I mean,

I think when my, my story I tell is my, when I was 17 or 18, my, my cool punk friend, Noah took me to the woods and he told me if I drank four Zimas, I'd get drunk. And he was right.

I drank, I drank four Zimas and I remember throwing up and having a great time. And it was enjoyable, but I, you know But I was sort of, oh, I drink at parties and stuff like that. It wasn't until – it's really interesting. I started taking – I was diagnosed with ADD as a kid. And I was occasionally medicated for that. But in college, I decided to take it seriously.

And I was like, I'll get an Adderall prescription. I started taking that. And that led me to develop a daily habit of drinking and smoking because they sort of felt like they fit together. Like I would drink to sort of cool down at the end of the day. And I wasn't, you know, I was never a, you know, binge drinker who'd pass out or anything like that. But I would, you know, I'd have a couple of drinks every night, more while I was in college. And then by the time I was in my thirties, you know, two, a couple of whiskeys and then, you know, that's it. And so that was how those things sort of fit together. And it's funny for me because there was a point in my life where in my mid-twenties,

where I would start my day by taking an Adderall and then I would have a cup of coffee and then I would smoke a cigarette and then I would have a couple more cigarettes. Then later in the day, I'd take a little more Adderall and have some more coffee, some more cigarettes, and then I'd drink to fall asleep. Um, and there was, that was, I was about 25 and I realized, wait, this isn't, uh, sustainable. I realized this is, this is like maybe a little bit of a house of cards. And I started sort of systematically taking it apart. I quit Adderall first, which was like a week-long withdrawal period where I slept for a week and couldn't focus on anything. And then I quit smoking. And then it took me an extra 10 years to finally quit drinking.

But I think back at that time in my life, and I wonder, well, that was not super hardcore, but that was more than any of my friends were doing, and I wondered why didn't I fall further down the slippery slope, because in retrospect, it seems like I could have, but I'm not sure why I was able to sort of pull myself out of it without needing to go to, say, a treatment program or anything like that. Well, I can point to two things at least. One is that the fact that you threw up the first time you got drunk, even though you liked it, people who get sick or who don't feel wonderful are protected. So there's pretty good evidence that the first drink, the experience to the first using, predicts a little bit your outcome. And the second thing was that you were 25, which is barely mature probably, and yet you saw that you were on a

slippery slope. So I would suggest that you were smarter than me, too, because I... It took me longer than you, though. I would have had to be at least 55 to see it. Yeah, I didn't see it myself. But I think we reflect the two, we reflect kind of the two extremes. I think I might have been born an addict, and you might have been the kind that gets addicted by regular use, which is what will happen. And you were fortunate or smart enough to notice it and to sort of back off. But I think, you know, in both cases, what we described was that, you know, there was less and less benefit and more and more compulsion. And at that point, that's irrational. Well, I have so many more questions about this, but we have to take a really quick break. We'll I don't know anything

So Judith, I have so many more questions about this. One is, just going back to my own experience with Adderall specifically, I have such complex feelings about that drug because it was prescribed to me. Starting as a child, they prescribed me Ritalin and I went on and off of it. And then I finally ended up on Adderall. And when I first started taking it, I felt a huge benefit from it that I, again, was diagnosed with ADD. I had trouble focusing. I had trouble doing the things that I wanted to do. I wanted to be paying attention in school because I loved my college experience, but I found myself unable to focus the way I wanted to do. Like I wanted to be paying attention in school because I loved my college experience, but I found myself unable to focus the way I wanted to. And when I took it, I felt that benefit, right? But then years later, I realized, well, actually, maybe this isn't giving

me the benefit quite that I want. Now I'm trying to do creative work and, you know, it's very helpful for, I don't know, it was helpful for like programming a website or something like that, which I was doing freelance at the time, but not for writing or for the sort of spacious thinking I wanted to be doing as a creative. And I also knew that I was just straight up addicted to it, that if I didn't have it every single day, I would feel withdrawal symptoms and I'd be, you know, I'd sleepy and upset. And so when I look back at it, I'm like, well, on the one hand, I really felt that I benefited from it.

On the other hand, I think it was completely fucked up that it was given to me as a child. And so I have trouble knowing what to think about it. And you also described your experience with alcohol as something that helped you cope. And so I guess I'm wondering, how do we think about addictive substances when sometimes it does feel as though we're receiving a true benefit from them? Wow, it's a great question. First of all, I think alcohol helping me cope was helping me cope with because they aren't successful in fourth grade, then they aren't successful in eighth grade, and then they don't get into college. So it's a serious problem. On the other hand, it is treated with these drugs. And most people feel that if you take low doses as prescribed, the benefits outweigh the costs. And I think one of the criteria for addiction is that the costs outweigh the benefits. So in that way, it's nuanced and like you say, complex. But I do think that it's important to ask maybe why are so many kids unable to focus or be still and learn and um to answer that i think it's maybe you can remember uh the bell curve or the normal distribution and so our ability to focus and stay still is distributed normally some people are really great at it and natural programmers let's say and others uh like me are probably somewhere in the

middle. And then there are some people who are naturally less able to do that. And that's just not valued, that lower tail in our society and certainly in our schools and our curricula. So it's really important to be able to sit still for nine hours a day and keep sharp pencils and things. And I think we have to ask about the context for those kids too. I laughed a couple of years ago, there was a new treatment for ADHD, which was literally playing outside. I'm not kidding. Right. As if it suddenly dawned on medical science that maybe watching screens and having sugary snacks after being in school all day wasn't the best strategy. Yeah. And I think you bring up a couple of really important points. You said that when you quit, you slept for a week and couldn't focus on anything. Yeah. So there was this adaptive change.

Yes. week and couldn't focus on anything. So there was this adaptive change. By taking something that keeps you awake and keeps you focusing, your brain produces a tolerance to that. And so, you know, you have to kind of change things around and then, you know, wonder what it would be like. And importantly, if you wonder what it's like and you decide to stop taking it, what it's going to be like is the exact opposite state. So you wouldn't be able to tell if you had ADHD still, because the withdrawal from stimulants is an attention deficit and hyperactivity disorder, right? So, you know, in some cases, it's helpful. In some cases, maybe we're over prescribing and it might be better to find other strategies and i think the last thing that i really love about what you said is that

it was good for some things but not for your creativity yes and one of the things i've learned in 30 years of studying psychopharmacology is that there is no free lunch, that whatever we do, there's sort of something to be paid back. And I think that in this case, there is a cost and maybe, you know, I have a good friend who's on these, she's an adult and a very successful scientist who's been diagnosed and who takes these drugs. And she came to visit me for a while and she got involved in some project. And she was absolutely driven. And my house is kind of chaotic and there's a lot of messes and we're not great planners. And it was really obvious that we were on two totally different tracks.

So that I think maybe relationships take a little sloppiness. I mean, if you're really focused and crisp, it's hard to be in relationship because people are such a mess. And so it almost helps to be a little loose around the edges for certain things like creativity, maybe like relationships, maybe like exploration. So I have to wonder, what does society's values of productivity and efficiency have to do with the epidemic of attention deficit disorders? That's a really good question. And we'll move on from this. But yeah, I felt that, you know, one of the things, for instance, since you mentioned relationships was, it made me bad in a comedy writers room, because I'd become fixated on a certain idea and a certain

way of doing something and say, No, I want to execute that. Let's do that now. And other folks would be like, No, that idea is not the best. Let's think about something else, you know. And that's like a necessary part of being in a collaborative comedy environment is, you know, sort of having a looseness and being able to move from idea to idea and having spontaneous thoughts and not staying on one thing for too long. It's sort of the polar opposite of, you know, the thing that I was incredibly good at when I was on Adderall was solving crossword puzzles. I did so many crossword puzzles,

like that sort of focused attention. I would almost do them compulsively. And that's like kind of the opposite of creative work is ticking those boxes over and over again. And yeah, that was why I eventually stopped was I realized it was not helping me with that part of my life. Since I'm a professor at a liberal arts college, I might say that I wonder how the high use of these drugs is affecting higher education in

general. Less creativity, more focus, more filling in the blanks and jumping over the hurdles, but less kind of going around the edges and maybe real scholarship. Yeah. And the thing is that at the same time, those drugs I think are being taken because of the high work requirements that I was under a lot of pressure to produce at my very loosey-goosey liberal arts school, there was more work assigned than I could reasonably do. And so that was one of the reasons I was like, I'm trying to get ahead of this. So let me start getting a prescription for this drug. And again, it helped at some things, but not in others. Well, so speaking of, I just want to, I have so many questions about addiction

generally. One thing we haven't spoken about yet are addictions that we commonly understand, behaviors that we commonly understand as being addictive, but which aren't related to a particular drug. For instance, even on our show, Adam Ruins Everything, we've talked about how slot machines are designed to create an addictive response. And I want to know how that sort of fits into the framework you've laid out about how our brains are sort of designed for addiction in a way. Does that fit in? Oh, sure. Absolutely. Gambling is very addictive, and it's addictive like a substance for the same reason, which is that there is a very small group of neurons or nerve cells in the center of the brain, kind of going from the top of your spinal

cord or a little bit beyond it to about two inches behind your eyeballs. And these neurons release dopamine in the nucleus accumbens. And this is sometimes called the mesolimbic dopamine pathway. And every single drug that's addictive releases dopamine in that mesolimbic pathway. And so does gambling. And so does gambling. And it does so for the same reason, which is that it's giving the brain the idea that something meaningful or salient is happening. And one thing that's meaningful is the surprise of what's going to happen when I pull this slot arm one more time, or when I open the door, or when I push the button and these things stop. So it's a pathway designed to get us to pay attention to things that are newsworthy. And certainly gambling is designed to give you occasional news. In the same way that your email is designed to give you sort of regular news alerts, it's addictive. Yeah. And we could prevent addiction if we lesioned that pathway,

so we just got rid of those neurons, but then we wouldn't find life so interesting or meaningful. we wouldn't find life so interesting or meaningful. So you can see that drugs work and gambling and email in a way because they co-opt this pathway of interest and meaning. Right. Yeah, it's hijacking something that our brains do in order for us to survive. It's really interesting because the way you describe that, we so often talk about the substances as being addictive, that there's something inherent in the chemical, in the plant that is what causes the addiction. But really what you're describing is this is something the brain does to itself by the natural process of how it's evolved to work. That's right. Yes. The addiction occurs in the brain, just like if a tree falls in the forest

and there's no ear to hear it, does it make a sound? The answer is no, because the sound is in the ear, is in the brain responding to the ear. If there's heroin in a syringe, but no junkie in the, does there, I'm sorry, this is a terrible metaphor. I'm trying, I was trying to make it work. No, no, if there's no brain, if there's no opiate receptors to respond. So one of the things, just to clarify a little bit, so every single addictive drug activates that mesolimbic pathway to produce pleasure and meaning and import. And we like that so much, we keep going back, just like we go back for sex and chocolate cake.

However, drugs also have their own independent effects, like opiates interact with opiate receptors. THC interacts with cannabinoid receptors. Alcohol interacts with GABA receptors and other places in the brain. And those receptors and places in the brain will adapt too. So we lose the sensitivity to meaning, sort of like listening to very loud music makes us deaf to sound. Stimulating these, taking these addictive drugs or gambling over and over makes you kind of numb to pleasure and news.

But it also produces changes in other areas that make withdrawal unique. So for instance, with regular cigarette smoking, you can't concentrate when you're quitting. With regular opiate use, you't concentrate when you're quitting. With regular opiate use, you feel miserable when you're quitting. With regular marijuana use, the world is bleak and boring when you're quitting. And how should we think about behaviors that, there are certain behaviors that people seem to do compulsively, but it's less clear whether it's an addiction per se.

I'm thinking of sex addiction, which my understanding is there's conflicting studies on whether or not sex is something that we should consider addictive. Or, you know, for instance, I know there's a lot of debate about video game addiction, for example, which strikes me as a problematic classification because certainly a video game that mimicked a slot machine's addiction mechanics might be addictive.

But there are plenty of other games that don't have such mechanics, but yet which someone might play to the exclusion of their job, for example. How do we think about those gray area issues or are those gray areas for you? Yeah, I can point to three things, maybe. The first, when evaluating whether or not something's addictive, is to ask whether or not the costs outweigh the benefits. So I think a criteria for addiction is that it's taking more than it's giving. And in other words, there's diminishing returns. And the second thing is whether or not there's withdrawal when you put it away. So my way of saying this is whether or, you're satisfied and you look forward to it again, but you don't withdraw afterwards, then it's very different than a bag of cocaine, where the main effect of getting through the bag is that you want another bag.

So, if there's not this kind of evidence of dependence, you know, where you can enjoy things without it, then you're less likely to be addicted. And the third thing is that addictions go from having a choice about using to a compulsion. So for me, when I described the closet I was living in, it was because I was compelled to get high and use every day. It didn't matter kind of what it took. I had to escape my reality. And so I felt less and less free. It was not even possible for me. less and less free. It was not even possible for me. It would occur to me to get some alcohol, and then I was getting the alcohol if I had to dig around for coins in the gutter. And I think that if you're compulsively acting as people who are addicted to anything will, then yeah, it's a problem. And we know that this can happen with a wide range of substances and behaviors. But as we've already touched on, there is a really vast difference in the way that our society treats

all these different substances, you know, where, you know, we've talked about, you know, the difference between alcohol and cigarettes, or, you know, even in, again, I grew up in a world where everyone said, who was using pot, everyone said it wasn't addictive. That was like received wisdom. No one ever questioned that. Which strikes me as very odd now, considering what you've said about it. So how do these societal ideas of addiction form and how do they get in the way of our treating addiction properly? It's hard to say how they form. I would say as a bottom line that there is no relationship generally between the science, the neuroscience of the drug use

and the policy. And I think that there is maybe a strong relationship between the policy and people's beliefs. So I have a nephew who thinks that alcohol is pretty okay, but in his state, marijuana is illegal, so that's not okay. And I think that we don't have a great fidelity to science when it comes to making policy. We didn't think that cocaine was addictive until 1986. And that's because one of the criterion were dependence. That meant that you had withdrawal and we thought that the withdrawal had to be physical withdrawal like you see with alcohol or opiates where you're having the shakes or the sweats and diarrhea and cocaine doesn't produce physical withdrawal at all it just produces a kind of psychic misery. And because you couldn't see that from a half a block away,

we thought, well, cocaine must not be addictive. So I guess I think it's helpful maybe to just appreciate that whatever you take the drug to do, it produces the opposite effect. And the more you take it and the younger you are when you take it, the stronger the opposite effect will be. And so dependence is one of the criteria for addiction. And if you have dependence and it's hurting your life, which is the hardest part to see, you know, it's always the last thing people will acknowledge. Then it's addictive. So I guess I don't mean to sound quite so cynical, but I wouldn't trust the news pundits or the, you know, I would make your own informed decision. And, you know, for instance, marijuana was interesting because there was this belief that it caused kind of an amotivational syndrome. And the question for scientists was, do people sit on the couch watching cartoons all day because they're stoned? That's the stereotype of marijuana users is it makes you lazy,

which is very funny in contrast to what people thought it did when it first know, when it first came to the U.S., the reefer madness years where people thought it made you go become insane and violent. Even that cultural understanding has flipped over time. But sorry, please go on. Yeah, no, it's okay. So does marijuana make you lazy or does it just the case that people who like to sit around on the couch and watch cartoons also like to smoke weed, you know, which is it? Which is it? Yeah. So, in my case, I think that by regular smoking and downregulation of those places in the brain that respond to THC, I became less and less interested so that things that were pleasurable needed to be cartoons rather than my work or my regular friends or my family, for sure. So, yeah, I think

we're in a tough spot about that because what mostly seems to drive policy is economics, not neuroscience. Yeah. I mean, you mentioned cocaine and that makes me think of the incredibly disparate way that powder cocaine and crack cocaine were treated in the 80s and I think continuing today with really devastating effects. And that's largely an economic and of course racial difference between those drugs. For sure. And you can see it with THC, too. Many people are in prison for trafficking marijuana, and they're getting out now.

But all of a sudden, it's the greatest thing ever. getting out now, but all of a sudden it's the greatest thing ever. And who's got all the stock and all the farms and all the special shops? Mostly, yeah, not those people who were in prison. I mean, weed shops literally look like Apple stores now. Exactly. Yeah, because there's lots of money to be made. And I think that shouldn't be mistaken for saying that the drug is harmless. Yeah. Do you have an opinion on marijuana, say that the legalization of marijuana and other drugs, given your very nuanced understanding of the neurobiology behind them? neurobiology behind them? Well, laws didn't stop me from using, and I don't think they're all that effective. I do think we should be skeptical about who's benefiting from the laws.

But I'm more for education. So I guess my hope is that informed consumers will make better choices. And that's going to be increasingly hard because really the markets are sort of brutal and they, you know, push what's economically beneficial. And I guess people are going to have to think about whether or not this is good for them. Cigarettes are a perfect example. You know, when it finally got through that nicotine was addictive and causing cancer and so many deaths, we sort of slowly backed down, but then it spread to other countries. So now it's, you know, still increasing cigarette use in third world countries, for instance, and they're coming mostly from the U.S., but also from their own places.

Same with alcohol. We know it's really damaging, but there's so much money being made. So I hope that people just look a little bit critically at the benefits to themselves, to economic interests, and maybe to their communities before embracing everything wholeheartedly. Right. Well, I guess what I'd ask to finish this up here is even just thinking about alcohol. finish this up here is even just thinking about alcohol, it's so complex because we've talked about how alcohol negatively affected your life, affected my life. We know it causes enormous numbers of deaths every year, enormous amounts of misery are caused by alcohol addiction. But we also know that we tried a grand national experiment with eliminating it.

And honestly, if you go back and look at the history of the temperance movement, like a lot of the temperance movement had a good argument, you know, that alcohol was causing domestic abuse, for instance. And we know that it does. We know that alcohol is linked with domestic abuse now. And so we experimented with outlawing it. That was a failure. And so now we're in a place where we're awash in alcohol advertising. Drinking habitually, as habitually as I did, is completely normalized. And so it often sort of makes us feel a little rootless about how should we feel about this drug? Is this drug a normal part of life or is it not? drug? Is this drug a normal part of life or is it not?

Yeah, lots to say there. I think what happens when things are restricted is that some people, probably those already prone, used more. So when the speakeasies were in vogue, there were fewer people drinking, but those who did drink drank more. And I'm kind of that way. I think if I go on a diet, I always gain weight. So something about the restriction is not good. And in general, laws haven't worked. Laws haven't worked and the war on drugs hasn't worked. So I think the answer is maybe not on the supply side as much as it is on the demand side. And that is something that's

going to require a better understanding of ourselves and the long-term consequences. Unfortunately, we're doing the experiments on ourselves to find that out. But my hope is that by focusing on how the brain adapts to drugs, people will appreciate that, oh, you know, I took that sleeping pill. It worked great the first day. It worked really good the second day. The third day it was also good. But by the second week, I know I can't sleep without it and I'm not sleeping that great. So I think that is the way that the, it's just a function of how the brain is organized

and what it does. And so my, maybe it's naive, but I think that the way forward should definitely include education. And it would be terrible if we're building roads on all the tax money we're making from drugs and not putting it into treatment and education. person listening who is maybe having that realization about the substance or behavior of their choice where they're listening to this, where they're realizing, oh, maybe I am not sleeping that well or I'm not enjoying this that much and I've become dependent on it. Do you have any advice for a next step for that person? Well, I always like to start with the cheese. So let me go to the last step. And that is something that both of you and I have said, that once we're over the drug use, life is as wonderful or at least as it was before. So there is hope for the long term. In the meantime, though, it's a hard road to kind of climb out.

And my advice would be to get with other people who've managed to do it and talk to them. Yeah. Thank you so much. I could talk to you about this for another hour, but I'm afraid that's all the time we have. So thank you so much for coming on the show, Judith. It's really been wonderful. Thank you, Adam. It's been great. Bye-bye. Well, thank you again to Judith Grizzell for coming on the show. Her book, once again, which I highly recommend, is called Never Enough, The Neuroscience and Experience of Addiction. And that is it this week for us on Factually. I'd also like to thank our producer, Dana Wickens, our researcher, Sam Roudman, and Andrew WK for our ass-kicking theme song.

You can follow me on Twitter at Adam Conover or go to my website adamconover.net to sign up for my mailing list. Until next time, we'll see you next week on Factually. That was a HeadGum Podcast.