and addictions so let's give them a very warm welcome thank you kayla in the record can you hear me at the back ok yeah great if any problem just let us know so thank you for honoring me by showing up tonight and certainly evidence that has accumulated over the years i'm talking with the experience of thousands of people i'm done with the research that have been published on brain development going to be actions on physiology on psychology on on child development on trauma i'm talking about all that i'm talking about all that that is completely missing from the curricula of most medical schools most schools of psychology schools of education nursing programs public health programs and so on and not that's not a blanket statement but largely it is true so rather presenting you with as a perspective that it's rather different from the mainstream but which is that it's based on if there's one phrase i could eliminate from the medical lexicon it would be this evidence based practice because i only wish i only wish that we actually based our practice on the evidence then we would know that whenever we see cancer or wimsey arthritis and certain even to see mental health issues or addictions we're not looking at random isolated events individual we're looking at something that has a history that is rooted not just didn't the visual but in the history of that individual's family over the generations and in a larger society now removed at addictions we're somewhat flabbergasted clinic nine years ago and in march two thousand and five i had a discussion with alan in his forty's and with hiv allen has been to vancouver hospital with sharp chest pains a few days earlier river where he was assured that there was nothing wrong no he was in mice office for a third assessment on examination i can see that he's isn't acutely ill but is nevertheless in terrible shape what should i do doc he asks drug use i'm treating you for cardiac failure and even though your legs are swollen because your heart isn't pumping efficiently you h i v is controlled by strong medications and if you have a day to see you live in it just hang in there but you injecting rumor had it from a bad lot of methadone heisted in the break in at a local pharmacy and subsequently adulterated with crystal meth or who knows what according to the coroner's office that little enterprise  independent drug marketing caused the deaths of at least eight people i'm not afraid of dying a client told me sometimes i'm more afraid of living and that's the real issue that's a real issue keith richards the rolling stone guitarist who will as you know had a significant heroin habit in his autobiography life he says was all that partying heroin all the body says i suppose he says it was about the need for oblivion the contortions we go through just not to be ourselves for a few hours so the real issuers weisel people are free to be themselves and why they find life so challenging but they have to escape  their consciousness by of funding it with substances or certain behaviors now that's not a question that either the society at large or the the treatment industry really cares to ask we have are some patients of addiction and the most common and prevalent addiction and that's the one that informs the legal approach to greg use is that it's a choice that people are making is just a bad choice so if you're making a bad choice then what you do then you deter them from it basically is the punitive parent approach the kid misbehaves you punish him you're not interested in the why the what is the kid is actually portraying for that behavior you just want to stop the behavior so it's one of heavy and as you know in this country extremely heavy legal sanctions and the result of that approach is you probably are aware that the american population makes of five percent of the world's population as a whole but twenty five percent of the world's jail population and that means that every fourth person the world in jail is a citizen of the land of the free and that's a result of this idea that this is all about choices that people are making the second approach which is what you might call the medical approach which is that addiction is actually a disease of the brain and that it impairs brain functioning and decision making and so on i know there's a lot of truth in that of course but when you ask what causes a brain disease and if you go to the definition of addiction given by the american society of addiction medicine well addiction is a brain disease and because the but fifty percent by genetic predisposition know what the choice model and the addiction and the disease model have in common though as different as they are and they almost seem antithetical because if it's a choice then why are you punishing if it's a choice then why talk about a brain disease and if it's a brain disease then why punish people so the two seem contradictory but they have one thing in common and what they have in common is that they both take society off the hook if it's genes that we inherited or by choice the bad choices that we made as individuals then we don't to look at what actually happens to people in our culture we have to look at what happened in childhood and have to look at social policies that favor some groups over others we don't have to look at the history of certain minority groups in this country or in my country canada is just choice or genes so different as they are both of these perspectives allow us to avert our eyes from some very disturbing social questions and some very painful individual question there's only one problem with that approach both of both those approaches they happen not to be true now if you look at the genetic perspective let me give you a clear example a tragic example actually that's shared by your country and mine which is the experience of the aboriginal people here now there were substances that changed consciousness known and used by the natives prior to the colonization from europe t as you know in some areas of north america in southern united states and in mexico whatever alcoholic spirit there was tobacco known to many of the native psychedelic mushrooms and so on and as i direct opposite of the addictive use because the addictive use is all about up thundering consciousness it's about going blotto it's about escaping it's the contortions we go through just not to be ourselves for a few hours to court again keith richards  was is to reach a higher level of consciousness is to be more connected is to be more aware it's a ritual thing that you engage in with community not in the isolation of your room in shame so it's a very direct opposite very strong alcoholic substances introduced by by europeans even then i didn't lead automatically to addiction like the into the so called eskimos of northern canada they drank the whisky and they loved it and they got drunk and so on but they were not alcoholics very able to live their lives go hunting fishing maintain their communities bring up children and a healthy way until something happened and that thing that happened is when they lost their right to live their lives the way they knew how to do it so addiction could not have been genetic as if it was they should have been addicted a long time ago a first problem with those perspectives is that they're not true secondly one way or the other they make an assumption and along the many mythologies that be devil  the addiction field is this idea that drugs are dictated when we know they're not i mean let me ask you this question is alcohol addictive well if i asked alcoholics most people who try most drugs whether it's heroin crystal meth cocaine cigarettes caffeine alcohol never become addicted therefore you cannot explain the addiction by the power of the drug itself nor can you therefore stop addiction by trying to stop the availability of substances really issue is why are some people driven to addictive behaviors what is the drug impels them in that direction and once they've had that experience why can't they give it up now for that you have to look at the individual lives and social issues in a broader context you're not going to resolve that on by doing brain scans on people and showing that they have impaired brain circuits which they do but how they get there that's the question and what i'm suggesting to you that if the choice model and the disease model are inadequate to individual is inseparable from the environment where that little baby there every second that i speak here she has millions of new connections being formed in the brain and all that is happening in the relationship to the environment and i'll explain something about that later on so that you can separate brain physiology from the environment and this is true for all of our lives so you can separate the mind from the body as we do in western medicine you can't separate individual from the environment and so what we're doing in the what we require is what's been called a bio cycle social perspective and bio psycho social means that the biology of people is shaped and influenced by their psychological and social relationships and it's really easy to show so we know for example that kids whose parents are stressed are more likely to have asthma from polluted areas where there's more asthma it's the kids whose parents are mo them and this goes on all of our lives and of course the more sensitive we are the more we affected by the environment and that sensitivity to my mental influence may be genetically influenced but that doesn't mean that you can inherit a certain disease it just means they can be more prone to be affected by the environment it's still the environment that shows up and does this or that or the other no end in my invited me to have coffee with her and she told me about her diagnosis i understood why she invited me to have coffee and i just recognize myself and then eventually i was diagnosed by a psychiatrist then i was given stimulant medication called ritalin but that may be depressed so i took dexidrine and i took it for a while what these stimulant medications do is they elevate the level of a chemical in the brain called opening meth caffeine and nicotine guess what a lot of people who get hooked on these substances are actually self medicating at the agency so on one level in the medical sense addictions are always about self people self medicate depression with cocaine people self medicate a d h the with alcohol and marijuana be sued the hyperactive brain people self medicate  after the foreign adventures that your country seems addicted to well supported by my country by the way a lot of the veterans come back with p t s d hooked on opiates it's a self medication so on one level on one level addiction is a self medication on and there are medical level but we have to go beyond that no medical model but we have to recognize what's going on here in other words and a when i go around speaking about this issue and i ask people i want to it now but i did this afternoon ask people well how many of you have an addictive relationship to a substance or to behavior and a number of people put their hand up and the next question is why not and what did it do for you what does it do for you well it gave me peace of mind it gave me a sense of control it connected to the me to other people it soothed my pain it made me re but what's wrong with any of that who does not want to be relaxed connected to other people have a sense of mastery and us and have less distress level us pain in other words you've got to get this the drug user input really that the drug user just wants to be a normal human being that's all they want they want what life should give them but for some reason has not they want something we all want now if we look at the drugs and there was a ship the brain physiology a bit more closely what do we find well let's look at the opiates not the opiates the right from the opium plant the goals in afghanistan they're the most powerful pain relievers that we have so in pellet of care workers looking after the terminally ill i could be really grateful for the opiate medications because without that a lot of people would suffer agony in their last weeks or months of life but the o p s daunte only sort of physical pain they also soothe emotional pain in fact on brain scans when you want people emotionally the same part of the brain lights up as if you wanted them physically theater pain relievers physical and emotional pain as a matter of fact if you look at the substance of abuse they are all pretty much of a pain relieving quality alcohol as you know as anal they'd used to be used before surgery for people before the days of anesthetic marijuana as you know as pain relieving qualities so the real question in addiction is and you get nothing from this lecture except as one line just please remember this one the real question is not why the addiction but why the pain and if you want to stand by the pain you can't look at  you can't look at choices you have to look at people's lives and as i said earlier their histories then a second question that arises well why did the opiates even work in the human brain or how come this product the ri can receive a messenger substance and if the messenger substance fits into the receptor then the two together will activate the cell to do something in fact the messenger receptor complex tells the a of the cell what to do in other words it's the environment that turns the genes on and off and there's a whole new science called epi genetics that looks at how and my mental influences actually trigger or turn off genetic activity and therefore write from a plant in afghanistan of course the answers we do not what we have accepted for our own and dodgin of morphine like substances which to put it in abbreviated breed abbreviated form are called endorphins so we have an endorphin system we have an internal opiate system but why do we have that well first of all for pain relief we need to a primitive so when you give people an inert medication for pain and twenty five percent actually experience genuine pain relief it's because of the belief that they're getting help released endorphins in their brains it's a physiological effect so we have our own endorphins to relieve pain which we have to that that's their first function their second major function equally important is the sense of pleasure and reward elation joy my measuring your life without that human life is difficult enough so that without that action we would be very miserable creatures and their third function is actually the most important one and the person who actually discovered the endorphin system can this per call them molecules of love because they make possible the loving interaction between two people especially between instant and packs up showed that if you take infant mice in a laboratory and you genetically knock out their endorphin receptor these little mice will not cry for their mothers and separation and what will that mean in the wild it would mean th so the opiates actually make life possible because the human infant is the most to mature the most helpless the least developed of any creature in the universe and therefore without that attachment relationship there's simply no life and so endorphins facilitate that attachment relationship and that was exemplified by a couple of so many conversations i have a drug addict but one of them the sex trade worker were caught in the book said she was twenty seven i asked her this question you know what is her and do for you she said the first time i did heroin it felt like a warm soft hog and this other fellow a six foot something had to his muscles scars the whole thing in detox and i said them all what does one do for you shoes that i don't know how to tell you it says but it's sort of like you're three years old and you're sick and you're shivering with fever and your mother puts you on her blanket and gives you chicken soup that's what heroin feels like well these people are talking about love so now picture a human being who comes to the conclusion for whatever reason that without this substance they're not going to have pain relief escape from their misery they're not going to a sense of reward and joy and they will not accept not experience loving connection what do you know to take it away from them you think a little most this is been done in the laboratory you put food in his mouth he said he chews it he swallows it but if you if you place the food a few inches away from his body he will not another chemical with which life is not possible and that's what the stimulant that excuse our giving themselves meant to do crystal meth or cocaine or nicotine or caffeine for that matter are other brain circuits implicated in addiction one of them has to do with the regulation of stress and i stress is necessary stress is not a bad word stress stress just means every sponson a body to a threat