How isolation fuels opioid addiction
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0:02 - 0:04What does it mean to be normal?
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0:05 - 0:07And what does it mean to be sick?
-
0:09 - 0:13I've asked myself this question
from the time I was about seven, -
0:13 - 0:15when I was diagnosed
with Tourette syndrome. -
0:15 - 0:17Tourette's is a neurological disorder
-
0:17 - 0:23characterized by stereotyped movements
I perform against my will, called tics. -
0:24 - 0:27Now, tics are technically involuntary,
-
0:27 - 0:30in the sense that they occur
without any conscious attention -
0:30 - 0:31or intention on my part.
-
0:32 - 0:37But there's a funny thing
about how I experience tics. -
0:37 - 0:42They feel more unvoluntary
than involuntary, -
0:42 - 0:45because I still feel like it's me
moving my shoulder, -
0:45 - 0:46not some external force.
-
0:47 - 0:52Also, I get this uncomfortable sensation,
called premonitory urge, -
0:52 - 0:53right before tics happen,
-
0:53 - 0:55and particularly
when I'm trying to resist them. -
0:56 - 0:59Now, I imagine most of you out there
understand what I'm saying, -
0:59 - 1:02but unless you have Tourette's,
you probably think you can't relate. -
1:04 - 1:05But I bet you can.
-
1:06 - 1:09So, let's try a little experiment here
and see if I can give you -
1:09 - 1:12a taste of what my experience feels like.
-
1:12 - 1:13Alright, ready?
-
1:14 - 1:15Don't blink.
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1:15 - 1:17No, really, don't blink.
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1:17 - 1:20And besides dry eyes, what do you feel?
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1:22 - 1:23Phantom pressure?
-
1:24 - 1:25Eyelids tingling?
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1:26 - 1:27A need?
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1:28 - 1:29Are you holding your breath?
-
1:29 - 1:31(Laughter)
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1:31 - 1:32Aha.
-
1:32 - 1:33(Laughter)
-
1:36 - 1:39That's approximately
what my tics feels like. -
1:40 - 1:44Now, tics and blinking,
neurologically speaking, are not the same, -
1:44 - 1:49but my point is that you
don't have to have Tourette's -
1:49 - 1:54to be able to relate to my experience
of my premonitory urges, -
1:54 - 1:59because your brain can give you
similar experiences and feelings. -
2:00 - 2:06So, let's shift the conversation from
what it means to be normal versus sick -
2:06 - 2:11to what it means that a majority of us
are both normal and sick. -
2:13 - 2:16Because in the final analysis,
we're all humans -
2:16 - 2:21whose brains provide
for a spectrum of experiences. -
2:23 - 2:25And everything on that spectrum
of human experiences -
2:25 - 2:30is ultimately produced by brain systems
-
2:30 - 2:33that assume a spectrum
of different states. -
2:34 - 2:36So again, what does it mean to be normal,
-
2:36 - 2:38and what does it mean to be sick,
-
2:38 - 2:43when sickness exists on the extreme end
of a spectrum of normal? -
2:46 - 2:50As both a researcher who studies
differences in how individuals' brains -
2:50 - 2:51wire and rewire themselves,
-
2:51 - 2:54and as a Touretter
with other related diagnoses, -
2:54 - 2:59I have long been fascinated
by failures of self-regulation -
2:59 - 3:03on the impulsive and compulsive
behavioral spectrums. -
3:03 - 3:07Because so much of my own
experience of my own body -
3:07 - 3:09and my own behavior
-
3:09 - 3:11has existed all over that map.
-
3:14 - 3:18So with the spotlight
on the opioid crisis, -
3:20 - 3:23I've really found myself
wondering lately: -
3:23 - 3:27Where on the spectrum
of unvoluntary behavior -
3:27 - 3:32do we put something like abusing
opioid painkillers or heroin? -
3:34 - 3:39By now, we all know that the opioid crisis
and epidemic is out of control. -
3:40 - 3:43Ninety-one people die every day
in this country from overdose. -
3:43 - 3:46And between 2002 and 2015,
-
3:46 - 3:50the number of deaths from heroin
increased by a factor of six. -
3:52 - 3:57And something about the way
that we treat addiction isn't working, -
3:57 - 3:58at least not for everyone.
-
4:00 - 4:03It is a fact that people
suffering from addiction -
4:03 - 4:05have lost free will
-
4:05 - 4:11when it comes to their behavior
around drugs, alcohol, food -
4:11 - 4:14or other reward-system
stimulating behaviors. -
4:15 - 4:19That addiction is a brain-based
disease state -
4:19 - 4:22is a medical, neurobiological reality.
-
4:24 - 4:26But how we relate to that disease --
-
4:26 - 4:32indeed, how we relate to the concept
of disease when it comes to addiction -- -
4:32 - 4:36makes an enormous difference
for how we treat people with addictions. -
4:37 - 4:42So, we tend to think of pretty much
everything we do as entirely voluntary. -
4:43 - 4:46But it turns out
that the brain's default state -
4:46 - 4:52is really more like a car
idling in drive than a car in park. -
4:53 - 4:55Some of what we think we choose to do
-
4:55 - 4:59is actually things that we
have become programmed to do -
4:59 - 5:01when the brakes are released.
-
5:03 - 5:07Have you ever joked that your brain
was running on autopilot? -
5:08 - 5:09Guess what?
-
5:10 - 5:11It probably was.
-
5:12 - 5:13OK?
-
5:13 - 5:18And the brain's autopilot
is in a structure called the striatum. -
5:20 - 5:26So the striatum detects
emotional and sensory motor conditions -
5:28 - 5:34and it knows to trigger
whatever behavior you have done most often -
5:34 - 5:37in the past under those same conditions.
-
5:40 - 5:42Do you know why I became a neuroscientist?
-
5:44 - 5:46Because I wanted to learn
what made me tick. -
5:46 - 5:48(Laughter)
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5:48 - 5:50Thank you, thank you.
-
5:50 - 5:51(Laughter)
-
5:51 - 5:54I've been wanting to use that one
in front of an audience for years. -
5:55 - 5:56(Applause)
-
5:56 - 5:59So in graduate school,
I studied genetic factors -
5:59 - 6:03that orchestrate wiring
to the striatum during development. -
6:04 - 6:08And yes, that is my former license plate.
-
6:08 - 6:09(Laughter)
-
6:09 - 6:11And for the record, I don't recommend
-
6:11 - 6:15any PhD student get a license plate
with their thesis topic printed on it, -
6:15 - 6:18unless they're prepared
for their experiments not to work -
6:18 - 6:19for the next two years.
-
6:19 - 6:20(Laughter)
-
6:21 - 6:22I eventually did figure it out.
-
6:22 - 6:28So, my experiments were exploring
how miswiring in the striatum -
6:28 - 6:30relates to compulsive behaviors.
-
6:30 - 6:32Meaning, behaviors that are coerced
-
6:32 - 6:36by uncomfortable urges
you can't consciously resist. -
6:36 - 6:40So I was really excited
when my mice developed -
6:40 - 6:42this compulsive behavior,
-
6:42 - 6:46where they were rubbing their faces
and they couldn't seem to stop, -
6:46 - 6:48even when they were wounding themselves.
-
6:48 - 6:50OK, excited is the wrong word,
-
6:51 - 6:53I actually felt terrible for them.
-
6:55 - 6:59I thought that they had tics,
evidence of striatal miswiring. -
7:00 - 7:02And they were compulsive,
-
7:02 - 7:06but it turned out, on further testing,
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7:06 - 7:10that these mice showed
an aversion to interacting -
7:10 - 7:13and getting to know other unfamiliar mice.
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7:13 - 7:15Which was unusual, it was unexpected.
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7:15 - 7:18The results implied that the striatum,
-
7:18 - 7:21which, for sure, is involved
in compulsive-spectrum disorders, -
7:21 - 7:26is also involved in human
social connection and our ability to -- -
7:26 - 7:29not human social connection,
but our ability to connect. -
7:32 - 7:34So I delved deeper,
-
7:34 - 7:37into a field called social neuroscience.
-
7:37 - 7:40And that is a newer,
interdisciplinary field, -
7:40 - 7:42and there I found reports
that linked the striatum -
7:42 - 7:45not just to social anomalies in mice,
-
7:45 - 7:47but also in people.
-
7:47 - 7:53As it turns out, the social
neurochemistry in the striatum -
7:54 - 7:59is linked to things
you've probably already heard of. -
7:59 - 8:00Like oxytocin,
-
8:00 - 8:05which is that hormone that makes
cuddling feel all warm and fuzzy. -
8:05 - 8:09But it also implicates
signaling at opioid receptors. -
8:10 - 8:12There are naturally occurring
opioids in your brain -
8:12 - 8:16that are deeply linked
to social processes. -
8:19 - 8:23Experiments with naloxone,
which blocks opioid receptors, -
8:24 - 8:29show us just how essential
this opioid-receptor signaling is -
8:29 - 8:30to social interaction.
-
8:34 - 8:38When people are given naloxone --
it's an ingredient in Narcan, -
8:38 - 8:41that reverses opioid overdoses
to save lives. -
8:41 - 8:44But when it's given to healthy people,
-
8:44 - 8:48it actually interfered
with their ability to feel connected -
8:48 - 8:50to people they already knew
and cared about. -
8:51 - 8:57So, something about not having
opioid-receptor binding -
8:57 - 9:01makes it difficult for us to feel
the rewards of social interaction. -
9:02 - 9:04Now, for the interest of time,
-
9:04 - 9:07I've necessarily gotten rid
of some of the scientific details, -
9:07 - 9:09but briefly, here's where we're at.
-
9:10 - 9:14The effects of social disconnection
through opioid receptors, -
9:14 - 9:17the effects of addictive drugs
-
9:17 - 9:19and the effects of abnormal
neurotransmission -
9:19 - 9:22on involuntary movements
and compulsive behaviors -
9:22 - 9:25all converge in the striatum.
-
9:27 - 9:30And the striatum
and opioid signaling in it -
9:30 - 9:33has been deeply linked with loneliness.
-
9:37 - 9:40When we don't have enough signaling
at opioid receptors, -
9:40 - 9:46we can feel alone in a room full of people
we care about and love, who love us. -
9:47 - 9:51Social neuroscientists, like Dr. Cacioppo
at the University of Chicago, -
9:51 - 9:54have discovered that loneliness
is very dangerous. -
9:55 - 9:56And it predisposes people
-
9:56 - 10:00to entire spectrums
of physical and mental illnesses. -
10:05 - 10:08Think of it like this:
when you're at your hungriest, -
10:08 - 10:11pretty much any food
tastes amazing, right? -
10:11 - 10:16So similarly, loneliness
creates a hunger in the brain -
10:16 - 10:21which neurochemically hypersensitizes
our reward system. -
10:22 - 10:25And social isolation
acts through receptors -
10:25 - 10:29for these naturally occurring opioids
and other social neurotransmitters -
10:29 - 10:32to leave the striatum in a state
-
10:32 - 10:36where its response to things
that signal reward and pleasure -
10:36 - 10:39is completely, completely over the top.
-
10:39 - 10:42And in this state of hypersensitivity,
-
10:42 - 10:47our brains signal deep dissatisfaction.
-
10:48 - 10:53We become restless,
irritable and impulsive. -
10:54 - 10:57And that's pretty much when I want you
to keep the bowl of Halloween chocolate -
10:58 - 11:00entirely across the room for me,
because I will eat it all. -
11:00 - 11:02I will.
-
11:02 - 11:05And that brings up another thing
that makes social disconnection -
11:05 - 11:07so dangerous.
-
11:07 - 11:10If we don't have the ability
to connect socially, -
11:10 - 11:15we are so ravenous for our social
neurochemistry to be rebalanced, -
11:15 - 11:17we're likely to seek relief from anywhere.
-
11:17 - 11:23And if that anywhere
is opioid painkillers or heroin, -
11:23 - 11:29it is going to be a heat-seeking missile
for our social reward system. -
11:31 - 11:36Is it any wonder people in today's world
are becoming addicted so easily? -
11:39 - 11:41Social isolation --
-
11:45 - 11:46excuse me --
-
11:48 - 11:49contributes to relapse.
-
11:50 - 11:54Studies have shown that people
who tend to avoid relapse -
11:54 - 11:59tend to be people who have broad,
reciprocal social relationships -
11:59 - 12:01where they can be
of service to each other, -
12:01 - 12:02where they can be helpful.
-
12:02 - 12:04Being of service lets people connect.
-
12:06 - 12:07So --
-
12:10 - 12:15if we don't have the ability
to authentically connect, -
12:15 - 12:20our society increasingly lacks
this ability to authentically connect -
12:21 - 12:25and experience things that
are transcendent and beyond ourselves. -
12:25 - 12:27We used to get this transcendence
-
12:27 - 12:30from a feeling of belonging
to our families and our communities. -
12:30 - 12:33But everywhere, communities are changing.
-
12:34 - 12:40And social and economic disintegration
is making this harder and harder. -
12:42 - 12:45I'm not the only person to point out
-
12:45 - 12:48that the areas in the country
most economically hard hit, -
12:48 - 12:52where people feel most desolate
about their life's meaning, -
12:52 - 12:54are also the places
-
12:54 - 13:01where there have been communities
most ravaged by opioids. -
13:02 - 13:06Social isolation acts
through the brain's reward system -
13:06 - 13:09to make this state of affairs
literally painful. -
13:10 - 13:14So perhaps it's this pain,
this loneliness, -
13:14 - 13:17this despondence
-
13:17 - 13:20that's driving so many of us
to connect with whatever we can. -
13:21 - 13:23Like food.
-
13:24 - 13:26Like handheld electronics.
-
13:26 - 13:30And for too many people,
to drugs like heroin and fentanyl. -
13:30 - 13:34I know someone who overdosed,
who was revived by Narcan, -
13:35 - 13:38and she was mostly angry
that she wasn't simply allowed to die. -
13:38 - 13:43Imagine for a second how that feels,
that state of hopelessness, OK? -
13:44 - 13:48But the striatum is also a source of hope.
-
13:48 - 13:52Because the striatum gives us a clue
of how to bring people back. -
13:54 - 13:57So, remember that the striatum
is our autopilot, -
13:57 - 13:58running our behaviors on habit,
-
13:58 - 14:03and it's possible to rewire,
to reprogram that autopilot, -
14:03 - 14:04but it involves neuroplasticity.
-
14:04 - 14:07So, neuroplasticity
is the ability of brains -
14:07 - 14:10to reprogram themselves,
-
14:10 - 14:12and rewire themselves,
so we can learn new things. -
14:12 - 14:15And maybe you've heard the classic
adage of plasticity: -
14:15 - 14:18neurons that fire together, wire together.
-
14:18 - 14:20Right?
-
14:20 - 14:24So we need to practice social
connective behaviors -
14:24 - 14:27instead of compulsive behaviors,
when we're lonely, -
14:27 - 14:31when we are cued to remember our drug.
-
14:33 - 14:37We need neuronally firing
repeated experiences -
14:37 - 14:41in order for the striatum to undergo
that necessary neuroplasticity -
14:41 - 14:47that allows it to take
that "go find heroin" autopilot offline. -
14:47 - 14:52And what the convergence
of social neuroscience, addiction -
14:52 - 14:55and compulsive-spectrum disorders
in the striatum suggests -
14:55 - 14:57is that it's not simply enough
-
14:57 - 15:00to teach the striatum healthier
responses to compulsive urges. -
15:00 - 15:06We need social impulses
to replace drug-cued compulsive behaviors, -
15:06 - 15:12because we need to rebalance,
neurochemically, our social reward system. -
15:12 - 15:13And unless that happens,
-
15:13 - 15:16we're going to be left
in a state of craving. -
15:16 - 15:20No matter what besides our drug
we repeatedly practice doing. -
15:26 - 15:30I believe that the solution
to the opioid crisis -
15:30 - 15:34is to explore how social
and psychospiritual interventions -
15:34 - 15:38can act as neurotechnologies in circuits
-
15:38 - 15:41that process social
and drug-induced rewards. -
15:43 - 15:48One possibility is to create
and study scalable tools -
15:48 - 15:50for people to connect with one another
-
15:50 - 15:52over a mutual interest
-
15:52 - 15:54in recovery through
psychospiritual practices. -
15:54 - 15:58And as such, psychospiritual practice
could involve anything -
15:58 - 16:01from people getting together
as megafans of touring jam bands, -
16:03 - 16:07or parkour jams, featuring
shared experiences of vulnerability -
16:07 - 16:08and personal growth,
-
16:08 - 16:11or more conventional things,
like recovery yoga meetups, -
16:11 - 16:14or meetings centered
around more traditional conceptions -
16:14 - 16:16of spiritual experiences.
-
16:16 - 16:18But whatever it is,
-
16:18 - 16:21it needs to activate
-
16:21 - 16:24all of the neurotransmitter
systems in the striatum -
16:24 - 16:27that are involved
in processing social connection. -
16:29 - 16:32Social media can't go
deep enough for this. -
16:32 - 16:35Social media doesn't so much
encourage us to share, -
16:35 - 16:37as it does to compare.
-
16:37 - 16:41It's the difference between having
superficial small talk with someone -
16:41 - 16:46and authentic, deeply connected
conversation with eye contact. -
16:46 - 16:50And stigma also keeps us separate.
-
16:50 - 16:53There's a lot of evidence
that it keeps us sick. -
16:54 - 16:58And stigma often makes it safer
for addicts to connect with other addicts. -
16:59 - 17:03But recovery groups centered around
reestablishing social connections -
17:03 - 17:08could certainly be inclusive
of people who are seeking recovery -
17:08 - 17:11for a range of mental health problems.
-
17:12 - 17:16My point is, when we connect
around what's broken, -
17:18 - 17:21we connect as human beings.
-
17:22 - 17:28We heal ourselves
from the compulsive self-destruction -
17:28 - 17:31that was our response
to the pain of disconnection. -
17:32 - 17:38When we think of neuropsychiatric
illnesses as a spectrum of phenomenon -
17:38 - 17:41that are part of what make us human,
-
17:41 - 17:45then we remove the otherness of people
who struggle with self-destruction. -
17:45 - 17:49We remove the stigma
-
17:50 - 17:53between doctors and patients
and caregivers. -
17:54 - 17:59We put the question of what it means
to be normal versus sick -
17:59 - 18:02back on the spectrum
of the human condition. -
18:03 - 18:08And it is on that spectrum
where we can all connect -
18:08 - 18:12and seek healing together,
for all of our struggles with humanness. -
18:13 - 18:14Thank you for letting me share.
-
18:14 - 18:19(Applause)
- Title:
- How isolation fuels opioid addiction
- Speaker:
- Rachel Wurzman
- Description:
-
What do Tourette syndrome, heroin addiction and social media obsession all have in common? They converge in an area of the brain called the striatum, says neuroscientist Rachel Wurzman -- and this critical discovery could reshape our understanding of the opioid crisis. Sharing insights from her research, Wurzman shows how social isolation contributes to relapse and overdose rates and reveals how meaningful human connection could offer a potentially powerful source of recovery.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 18:31
Oliver Friedman edited English subtitles for How isolation fuels opioid addiction | ||
Oliver Friedman edited English subtitles for How isolation fuels opioid addiction | ||
Brian Greene approved English subtitles for How isolation fuels opioid addiction | ||
Brian Greene edited English subtitles for How isolation fuels opioid addiction | ||
Krystian Aparta accepted English subtitles for How isolation fuels opioid addiction | ||
Krystian Aparta edited English subtitles for How isolation fuels opioid addiction | ||
Krystian Aparta edited English subtitles for How isolation fuels opioid addiction | ||
Krystian Aparta edited English subtitles for How isolation fuels opioid addiction |