Unknown

cultivate the compa cultivate a capacity for kindness So Close Your Eyes take a few moments to breathe in and breathe out [Music] oh is [Music] [Applause] [Music] but I would say on a on a deeper level it's more like when when we say work on yourself that involves all kinds of like things about moving your life forward and they struggle with motivation in these things it's because when I don't think I'm worth it I'm not worth fixing [Music] [Music] [Music] h [Music] [Music] [Music] you [Music] when you develop empathy and compassion for other people there's

all righty chat let's get started welcome to another healthy gamer GG stream just a reminder that although I'm a psychiatrist nothing we discussed on stream today is intended to be taken as medical advice everything is for educational or entertainment purposes only so if you all have a medical concern or question please go see a licensed professional um I know that's you know we offer that disclaimer every single stream which is fair enough um but today we are going to be talking about a more clinical topic So today we're going to be doing a deep dive

into addiction and um just to be super clear about this so like I you know I've been doing some addiction Psychiatry work for several years now I got interested in technology addiction back in 2015 I know it sounds crazy to think about it so long ago but um and so I'm going to sort of be sharing with y'all today like my take on addiction right so as a psychiatrist who's worked in rehabs and things like that is someone who's been interested in technology addiction and treating it in some form for about n years how do

I understand addiction um so how does addiction work where does it come from what are the different layers to it and then also how to understand recovery from addiction so this is not meant to be a substitute for clinical care we're going to talk I mean this is a little bit closer to um you know if I was teaching a two-hour lecture to Psychiatry residents about an overview of addiction this is basically the lecture that I would give um so that's really how to take that and understand that this is not meant to be a

substitute for actual addiction treatment and hopefully by the end of this we'll make a strong case for those of yall that are struggling with addictions to really consider seeking treatment for it um and because it's hard to do on your own which will'll get to but also most people do it very successfully on their own which is kind of interesting um okay so before we dive in a couple of uh quick announcements so we've got coaching spots that are open um so we have uh just a few personal and career spots left um we've been

booked out for about 2 years so we really worked on increasing spots um so if yall are interested in in coaching you know it's kind of like we don't know when there will be spots open again I mean the spots open up every week but generally speaking they tend to like fill up and we tend to be at about 95 to 99% capacity we were at that for about two years so if yall are interested have been thinking about it want to give it a shot kind of like now is the time um so just

a quick heads up okay um yeah so today we're going to talk about addiction so we're going to do a deep dive into addiction and what does that mean so I've been doing some addiction Psychiatry work for many many years now um for about one year it was my full-time job so I was working at two different rehabs um as the psychiatrist kind of uh there and um it's been a really interesting Journey so I I started getting interested in technology addiction back in 2015 so that's also been very interesting because I think a lot

of the the assumptions that we have about addictions change a little bit when we're dealing with technology because technology is like fundamentally different right so there's there are substance use disorders and then there are behavioral addictions and these are things are actually not the same and not interchangeable so let's first talk a little bit about what do we mean by addiction okay so generally speaking if you're trying to figure out do I have an addiction or not the main question is whether the behavior is causing some kind of impairment in the function of your life

so as in Psychiatry when we think about okay is someone sad or is someone depressed the question is well how it's not even how sad are you are you like sad 10 out of 10 or five out of 10 that's not actually the question we ask we do ask that but the main question is what is the impact of this change in your mood on your life is it interfering with your ability to work is it interfering with your ability to do school is it interfering with your relationships it is is it interfering with your

physical health is it interfering with your mental health and if the answer to one of those questions is yes that's when we think about a pathology right so how do you draw the line between healthy gambling and unhealthy gambling it's not even how much money you lose it's what is the impact of the money that you lose right so if I have a million dollars and I lose 200,000 and I'm like okay that's enough I lost 200k but it's not negatively impacting my life like that may not be an addiction so when we when we

talk about addictions there are a couple of other features that we really look at so addictions are usually characterized by compulsive thinking so you can't get the the thing out of your mind right so despite the fact that you potentially even try to not think about it you can't really stop thinking about it another thing is continued engagement in whatever it is despite the negative consequences so even though I know that okay I'm smoke I'm getting high every day and I'm kind of like not really advancing in life I'm kind of working my deadend job

kind of just sort of existing every day like you know like I can't I can't really move forward in life but I'm just kind of here and existing so there tends to be a continued engagement in the behavior despite the consequences despite the setbacks and then the really challenging thing about a lot of addictions is that even though they are negatively impacting Our Lives often times we're in things like denial right so we have things like functional alcoholics where these are people who will say but it's not impairing my life right I drink 12 shots

of vodka a day throughout the day and like I hold a job just like anyone else or even I outperform the average person I'm still in a happy marriage I've got kids I'm not you know I don't have therosis of the liver I don't have liver cancer so like what's the problem with it right so this is what's really tricky about addiction is sometimes the impairment of function is hard to see but generally just to start off very simply an addiction is when you engage in a behavior it damages you and you can't stop you

don't stop okay so now the question becomes okay what is how does someone get addicted to something how why does someone get addicted to something so now we're going to dive into a little bit more about kind of the the roots or origins of addiction okay so the first thing that we're going to talk about oh hold on there we go okay so we're going to talk about something called the stress diathesis model so why do people get addicted to stuff so now there's a lot of research that shows that addictions are somewhat heritable which

means that you can inherit them genetically so one good example of this is we know that alcohol which I'll probably abbreviate e um acts on something called the Gaba receptor so the Gaba receptor is a chloride ion Channel receptor that hyperpolarizes a neuronal membrane and if yall are wondering do I need to know this is this going to be on the test not really so why do I go into this level of detail because at some point it may be important okay so basically what this does is prevents neurons from activating that's what hyperpolarization of

the membrane means depolarization means that we get an action potential and the neuron activates so what we know is that we can have certain changes in the Gaba receptor based on our genetics that will make alcohol incredibly addictive so some people who have a strong genetic predisposition to alcohol the first time they taste alcohol they'll be like this is amazing there's something about the substance that just hits their brain and they're hooked from the first zip it tastes like nectar of the Gods okay and that's there something about that who knows so there there's absolutely

a genetic component but what we know about addictions is that its genetic component plus environment so if I have a strong history of alcoholism in my family does it mean that I'm destined to be an alcoholic absolutely not right so we know there are a lot of people who have genetic predispositions who don't become alcoholics we know there are a lot of people who were alcoholics who are no longer alcoholics and it's not like their genetic predisposition changed right so they're able to develop sometimes usually not a healthy relationship with alcohol but usually an abstinence-only

approach um when it comes to alcoholism is usually what people advocate for but we'll talk about why that that may not be the only way but we what we basically know from medicine is that if you look at a disease any disease this can even be things like let's say you know myocardial infarction which is a heart attack okay if I look at a heart attack what causes a heart attack there's some amount of genetic predisposition so I have certain cholesterol metabolism that makes me high risk if you're Indian like I am you actually have

small arteries so this really sucks but Indians are prone to heart disease because we actually have very small arteries so when it comes to clogging up Our arteries if the diameter of my artery is smaller I don't need to clog it up much to get at 50% you know obstruction so there are genetic and factors but then they're also environmental factors like I eat fast food and I sit on my ass and I play video games all day and I was ordering fried rice by the pound in my 20s because that's what we did when

we're degenerate Gamers so that can lead to something like a myocardial infarction addiction is the same there's a super really interesting uh story about this so people will wonder okay but there's a genetic component what do you mean by environmental component so I'll just give you all a quick example then we'll talk about what we mean by environmental components so it's really interesting so if you look at things like the Vietnam War and things like World War II I don't know if you all know this but there was a lot of drug use in both

World War II and the Vietnam War like super super high levels of drug use basically basically the whole German Army was high on meth and there's a hilarious I wonder if I can find it actually um there there are hilarious videos of Hitler on meth let's see what happens if we can uh hold on Hitler on meth images can we find a gif you guys know what I'm talking about let's try YouTube one second chat now I'm like into finding this and I know that we're you know we have limited amount of time but Hitler

on meth uh hello Hitler on okay sure I won't show it okay all right bye I've just been informed that uh we should not show Hitler on meth on stream so um all right so we're not going to talk we're not going to show you that but it's anyway I I don't know what what the problem with it is but okay okay fair enough okay so we know for example that the German army army was using a lot of like methamphetamines and things like that to keep their soldiers awake we also know that during the

Vietnam war you know soldiers were uh like American soldiers were very regularly using like large quantities of morphine right so these are like um opiate addictions right that are basically in the work so people are in Vietnam they're using different kind kinds of stimulants Like Cocaine amphetamines opiates and then when they come back to the United States thankfully even though like basically most of them qualified as being addicts in the jungles of Vietnam when they came back to the United States many veterans still struggle with addiction problems but thankfully like despite the fact that they

were using like every day you know when they came back to the United States the majority of them just like stopped using so we know that addiction has a huge environmental component we also see this interestingly enough in American universities not quite sure how it is over the the rest of the world but if you like sample college students and you assess them for alcohol use disorder what you will find is like a ton of college students maybe 20% 30% 40% or even like 50% I'd guess it's somewhere around 30 or 40% meet criteria for

being alcoholics so they're usually in a binge drinking pattern like a lot of people will get hammered and do all kinds of like stupid things and it interferes with their academics it interferes with their relationships they get into fights they get into trouble they get kicked out of Apartments they get put on probation so a lot of like college kids will meet criteria for a clinical addiction now thankfully once they leave College most of these addictions go away some people remain addicted and that may be somewhat genetic so the key thing to understand is that

when we look at the development of an addiction we usually have some kind of genetic predisposition but then we have some kind of environmental factor that really activates and propagates the addiction and this in a way is really good but in a way really really sucks because if you are addicted to something it is probably going to be very hard to success sucessfully overcome that addiction if you keep the environment the same now I hate to say that but when I work with the ma the majority of people I work with who struggle with addictions

want their life to be what it is just minus the addiction right I want to live my life I want to I'm content with my job not really super content but I don't want to change my job I don't want to move I'm comfortable in my life I just want to use pornography less or I just want to stop drinking but I want to have my friends I want to keep my marriage I want to stay in this state I want to stay in my house I don't want to mix up my life I just

want this life minus the addiction and unfortunately that is very hard to do okay now the big caveat with a lot of what I'm going to say here which we really need to understand is that if you look at the majority majority of studies on how people overcome addictions the majority of of epidemiologic data shows that people who at one time in their life had an addiction and at a later time in their life did not have an addiction there's a good chance the the majority of people or not let's say the plurality of people

so most people who no longer have addictions did not actually go through formal treatment so the minority of people actually work with a psychiatrist some people will do the peer support thing but actually there's a pretty large chunk of humans who conquer addictions all on their own so that's a little bit you know we have to be careful with saying that I'm not advocating that y'all should do it on your own because we also have a ton of evidence and I hope youall can understand this Nuance that just because the majority people do it themselves

does not mean that the best way to do it is by yourself right we also have a ton of evidence that shows that people who engage with peer support models people who engage in psychiatric treatment people who go see a therapist their odds of success are way higher okay and then there's also other subtle epidemiologic things which we have to consider which is that even if the majority of people do it by on their own if you have tried to do it on your own and it doesn't work it doesn't mean that you'll be able

to do it on your own right because if we look at addictions there's I know this is going to be kind of like detailed but we're doing it I guess so just to give you all an example and and basically yeah okay right so let's say here's people who are addicted so this is people who are addicted so you know here's the average person with an addiction their addiction is like at the 50th percentile and there are some people over here who have really bad addiction so this is like the 90th percentile there's some people

over here who have less severe addictions right so there's a a range on the severity of our our addiction so it's very possible that the majority of people who conquer their addiction they're actually this group and so if you kind of haven't overcome your addiction already you may need a more intensive approach and that's just a combination of your genetics and your environment right where you end up on the Spectrum so um genetics plus environment causes addiction and we know that a lot of people can kind of do it on their own but today what

we're going to dive into is sort of what are the steps to do it and unfortunately changing your environment is a big step okay so now let's talk a little bit more about okay so if someone is addicted like what's going on right so we defined addiction but we can also try to understand addiction from a neuroscience level and this is by no means complete okay but it is what I would call a functional understanding of the Neuroscience of addiction so this is when I'm working with patients I try to I make certain shortcuts or

take certain shortcuts to try to improve make it easier to understand so let's try to understand the circuits that are involved with addictions okay so amydala limic system nucleus cumbent and Al lims so back when I was at mlan hospital and faculty at at Harvard Medical School um I was trying to develop a neuroscience program that targeted sorry a meditation program that targeted the Neuroscience deficits in addictions so that was something that I was working on a while ago and so like you know then I did this instead but thankfully there's a lot that I

learned that we're going to try to share with y'all okay so let's understand what these parts the brain do and how they contribute to addiction so our thamus Thalamus is our sensory gateway to the brain okay so what does this mean this means that we have five senses we have eyes nose ears sense of touch taste hearing did I say that Eyes Ears Nose taste yeah cover them all touch so all of these things have different cortices like the somata sensory cortex is where we feel things the occipital cortex which is in the back of

our brain is where we see things and all of our sensory cortices basically connect in this thing called the thalamus so we have occipital cortex auditory cortex we have um somat sensory cortex olfactory cortex gustatory cortex okay and these all feed into the thalamus and I don't know if this kind of makes sense but if youall want to understand what the thalamus does let's say I'm walking down the street and as I'm walking down the street I see all kinds of different things I see trees I see people I'm talking to a friend of mine

my attention is on what my friend is saying and then I get all this visual stimuli but I'm not really aware of it so even though a car drove by if you ask me hey what color was that car I was like I don't know I wasn't paying attention so thalmus determines what you pay attention to and then the in the middle of the road a snake Slither through the middle of the road and then what happens I stop talking and then I look at the snake and I'm like ah right this is what I

do so if you think about what happens in the Neuroscience of that the occipital cortex is sending info to the thalamus all the time I'm seeing all kinds of stuff and then the thalamus basically decides they're like hey this is important so it serves as a sensory Gateway and it decides which sensory stimulus to send forward to like your conscious awareness does that kind of make sense so it's like hey we're going to let the snake pass through the sensory Gateway and you will become aware of the snake and you will stop paying attention we're

going to not we're going to block the auditory cortex I don't care about your breakup right now I'm focused on the snake now what does this have to do with addiction so when we get addicted to something it Alters what the thalamus lets through okay so if you look at uh alcoholics or other people who are addicted to things they are often times Cravings are triggered by Associated sensory stimuli so if you're like you know if you struggle with alcohol it's like if if you go to a barbecue and everyone is drinking that induces the

Cravings right so we have to understand that from a neuroscience perspective that we've altered our Thalamus to be hyper sensitive and I want you all to just think about an addict's brain versus a non- addict's brain what's the difference if a non- addict's brain goes to a barbecue I kind of see that everyone's drinking but it's not like I'm staring at people guzzling that beautiful beautiful beer right like this I I just integrate it with all the other kind of stimuli so this is why and we'll get to how to you know fix an addiction

this is why the sensory input for people who are addicted to things is incredibly important we know from a ton of clinical studies that exposing yourself to Associated sensory stimuli will induce Cravings this is not just um it's not just about Cravings like you know even something as simple as if I'm walking down the street and someone is like grilling a burger right what will that do for me that'll I'll smell the burger and it's like man I want a burger advertisers understand this a lot they understand the association between thalamic input and wanting things

so a lot of our desires are rooted in our sensory organs okay so this gets altered in addiction next part of the brain that we're going to talk about is the amydala so this is our survival center and our negative emotional center of the brain okay so why is this important so if we look at basically any addiction addictions require two things they have to give us pleasure and they have to take away pain so when people say oh can you be addict icted to marijuana I think absolutely right we'll talk about physiology and withdrawal

and stuff like that in a minute but some people will say like oh you can't be addicted to marijuana because you don't withdraw withdrawal isn't necessary for an addiction it's not clear to me that you go through a physiologic withdrawal if you like stop playing Candy Crush but you will absolutely go through a change in your amydala if you stop playing Candy Crush okay so when addictions do this when when and when something does this we have the possibility of getting addicted to it okay so let's understand what's going on in the brain so here's

my nucleus cumb here's my amydala and here is the substance let's call it alcohol or we can call it THC or even we can use pornography or social media or VI games right so what effects do all three of these things have so all three of these things will go to our nucleus accumbens which by the way is where we get our dopamine for pleasure we'll go over here and they will activate it right porn is fun booze is fun sex is fun social media is sort of fun video games are fun alcohol is fun

right we enjoy it it's like enjoyable to spend time on Instagram or whatnot but then they also do something else is they go and they inhib IIT the amydala so when I'm feeling anxious and I drink alcohol remember that alcohol hyperpolarizes a neuron right so it keeps it from firing so where their Gaba receptors are fear neurons in our amydala get deactivated with alcohol right so alcohol is a Down which we'll talk about later so it will like make us less anxious will make us less fearful a lot of the reason that people become addicted

to alcohol is because they like the version of themselves that they are when they are drinking so I feel nervous at a party let me have a couple of beers right now I don't feel nervous anymore I'm not anxious anymore I'm not catastrophizing in my own head I can finally relax it's it's a liquid courage right and a social lubricant so what we see for from basically all of the addictions is that they will suppress the amydala and this creates a real problem because what happens is first of all they're really good at it that's

the problem is they're really really good at it man if you are having a bad day and you get high oh my God things are so much easier while you're high if I'm worried about my paper being late if I start playing DOTA I can guarantee you I'm not going to give two shits about my paper once I'm in the middle of a DOTA game right so what happens is that these addictive substances and behaviors will suppress our amydala and make our negative emotions go away until we stop using the substance and then those negative

emotions are there they're dormant and then they come back so how do we fix this problem and now this is where we have to understand that the brain operates unconsciously okay I know that sounds weird but let me explain so the brain is kind of like a cat where like once you feed it like the cat's going to come back like once you do something that works for the brain the brain is like great job let's do it again that's the fundamental nature of like neuroplasticity and reinforcement right the brain is capable of learning so

if it has a problem like let's say I feel hungry and I eat something and then the hunger goes away and then the brain is like that's great that worked well eating things worked well and then something tricky happens because if I'm really hungry and I eat like, 1500 calories the brain is like this is awesome can you this one Burger is worth so many pounds of broccoli like how many pounds of broccoli do I have to eat to get the calories out of a single burger so the Burger is more efficient brain also loves

efficiency this is why when you want a glass of water you don't walk 10 miles to your neighbor's house to a friend's house and get a glass of water over there you go get a glass of water from your own sink it doesn't do extra work it tries to reduce the amount of work we do because it's that's like life and biology and conservation of energy so now we have a problem because we have a substance like alcohol which because our Gaba receptor is altered to become hyperactivated by this alcohol right we can just shut

down that anxiety it's like boom anxiety gone GG finished now our brain is like this is fantastic and so it learns a very easy way to suppress our negative emotions and remember that the goal of negative emotions is to get rid of them okay that's why we have negative emotions so if I have a negative experience subjectively like hunger what does hunger driving me to do the correct behaviors get rid of The Hunger right that's why we have hunger why do we have thirst because our brain is telling us hey you should go drink some

water you should this is a problem to be fixed the goal of our negative emotions is to make them go away so if we feel guilty what is the goal of guilt the goal go of guilt is to point out to us that we did something wrong because we're human organisms who exist in a social situation and if I did not have some circuit in the brain that causes me to repair relationships that makes it uncomfortable to be like in a relationship where someone is unhappy with me if I had no signal to fix that

I would not survive maybe nowadays I can but in the past I wouldn't right because communal relationships are really important so these negative emotions are designed to be removed that's why they hurt and an addiction comes in and gives us a cheat code to remove negative emotions and this creates all kinds of problems for us the first thing that it creates is that now we become dependent on the substance of the behavior to remove the negative emotion but the even deeper which we'll get to later is that it short circuits our motivation for corrective action

so when I feel ashamed of myself for the way that I look for some people this shame is part of the motivation to start eating healthier adopt a skincare routine go to the gym get dressed better fix my hygiene but when I have that shame and I play a video game and then for 12 hours a day I'm just chain queuing on deadlock my hygiene doesn't matter none of the stuff matters and my shame goes away so one of the things that I see and and we'll get to this towards the end but like one

of the biggest problems with addiction is that they it's not just the addiction itself it's the way that it stops you from growing in life and your life begins to stall and why does it stall because you're actually short circuiting the most powerful motivator that you've got which is your negative emotional circuitry right so these are like really powerful motivators way stronger than our positive emotions by the way and you can see these like you know these clips of like some person walking down the street and they get pranked when like a hundred people run

around the corner and start running in the opposite direction like the world is ending and what does this person do they turn around and they start running with the pack and we all laugh that's not funny I mean it is funny but it's like that's the way our brain is wired when we have negative emotions our brain is like go go go when we get angry we start fighting when we feel afraid we run away and if we didn't feel afraid we'd be like eaten by a pack of lions so this creates another problem in

addiction a downstream problem which we'll get to but key thing to understand is that we get emotional suppression okay next man I really wish I could show that Hitler clip it's really something else okay okay which ones do we have next okay lyic system so we talked about lyic system a little bit so our lyic system is more broadly our emotional system and you may say but Dr K didn't you just say that the amydala is our emotional system so amydala is part of the lyic system but it's a very particular part where we experience

especially fear and anxiety okay but our broader lyic system also gives us access to social emotions so if you look at like a reptile like an alligator an alligator will have an amydala alligators are capable of things like fear and anxiety but they don't have some of the more broader social emotional circuitry that like mammals or primates have so if you look at like all these mammals that have like packs and stuff like alligators and crocodiles are like solo right they're like it's not a co-op game it's a solo game that's what life is and

so our broader emotional circuits like shame guilt Pride these are our social emotions and come from the broader lyic system okay so the lyic system includes the amydala but there are emotions that come out of places outside of the amydala and our lyic system also has our are positive emotions things like you know happiness joy curiosity right there isn't that doesn't come from the amigdala usually so this also gets affected so we already talked about shame and guilt and and these are actually very very important because when it comes to addictions these are often times

the Crux emotions that have to be dealt with when we're trying to overcome an addiction so what do I mean by that so when we have an addictive behavior consequence right but then this consequence so when I let's say I hopefully this never happens and hopefully it doesn't happen to you or anyone that you know so I've worked with people for example who have been operating a motor vehicle under the influence of a kind of substance they've had an accident and and someone has died sometimes it's the person in your car sometimes it's the person

in the other car like it's super super bad so you have this consequence and this consequence then leads you to feel shame or guilt now this creates a big problem because this shame or guilt is so profound right you can't just fix that so if I feel ashamed of the way that I look I mean this is hard enough is like going to the gym and eating healthy and working with a stylist and getting my hair did and hygiene like that's plenty of work but no amount of there's nothing you can do to bring someone

back to life so the shame and guilt that comes from like a motor vehicle accident that ends in someone dying there's no fix for that and then what is the way now we have a astronomic amount of let's say shame and guilt and if this is not fixable in the real world what does this do it just drives the addiction and then what happens is like because like I can't deal with it right so I'm going to drink because that's all I can do to make the pain which is so unbearable go away and then

what happens is I notice this cycle wow I someone died because I was drinking and driving and I can't even stop drinking and driving so when we get stuck in the cycle of addiction then that just feeds the shame and which in turn feeds the the so this just is a cycle that is very difficult to break this is not just reducing my anxiety when I'm drinking so there's like a different layer of this right so from a clinical perspective when I'm working with someone not all emotions are the same and you have to deal

with different emotions in different ways now let's talk about the nucleus succumbent so this is our dopaminergic circuitry so remember that dopamine gives us three things pleasure um anticipation and behavioral reinforcement so the first thing to understand about dopamine is that these three things come together there's no amount of can't separate them so because it's like all like this all comes together it's the same circuits so what we see is that you know when you play a video game for the first time you have fun right you get pleasure and then what happens you want

to play it again you start to Crave it right and then you do play it again you have motivation to play the video game again when you have fun so this is the big problem with addictions it's it's just that once something is good once our brain will literally anticipate or crave it and will drive us towards it right this is the problem with addiction is that we like it and even though we have these negative consequences these circuits of our brain are still acting so this is really important to really spend a moment on

okay so when I I work with patients A lot of times people people will wonder I don't know why I can't stop right they'll say like I I don't know why I can't stop for a second and the reason you can't stop is this is really important to understand you are not monolithic right you are not one thing so if you look at the Human Experience the human's experience is filled with internal conflict oh my God I want to stay in for 5 more minutes I really should get up oh my God I want a

second cup of coffee today but I really shouldn't oh my God like let me order dessert today no but I don't want to right the human brain is filled with conflicting stimuli the thalamus is telling you burger and the nucleus accumbens is telling you Burger but our frontal loes are telling us no Burger our lyic system in shame circuit is telling us no Burger right until the person you're with orders a burger and then your shame circuit is like thank God now I can order a burger too so if you don't know why you can't

overcome an addiction it's because you are like 10,000 people there's 10,000 voices inside you that are all fighting and you may focus in this one moment on the shame that you feel and you may say to yourself why can't I stop but you have to understand that your nucleus cumbent is a completely different like person it's like I don't give a what shame you feel I'm the nucleus ofum it's my job to get dopamine that's what I'm for and I'm going to Crave dopamine I'm going to give you a bunch of pleasure when you get

dopamine and I'm going to motivate you towards dopamine that's my job right we don't get mad at a trash can for not being able to grill a steak so like a grill is one thing a trash can is another thing so your different parts of the brain are doing what they know how to do best and that's how an addiction arises because the different parts of your brain don't know the broader stuff right they're only doing what they know how to do they're doing what a millions of years of evolution have taught them to do

what has designed them to do so if you want to overcome an addiction you have to understand these different parts of the brain understand how they act and once we understand the different parts of the brain we can in a sniper rifle way scope in and headshot each of these circuits so that we can get control of our life okay that's why it's important to understand this now the last part of the brain that we're going to talk about is something that I could spend a whole year talking about like literally I could put together

a 48 we class if yall wanted on the frontal lobes so the frontal loes are our source of executive function so what does executive function mean so executive function is the ability to plan and execute tasks our frontal lobes also govern our working a memory now this is kind of a weird concept but basically like what can you do in your head right so we got to talk about wait what okay let's talk about working memory for a second so working memory is like the work that in your head you can hold a certain number

of like thoughts right and like so you can't like plan a whole wedding in your head within 10 seconds there's only a certain amount of like Ram that you have that you can solve a problem with so working memory is our capacity to like deal with a problem so what we see in addiction so there's executive function which is planning and executing tasks there's L literally like what your computation power is in a second in a moment right so if we look at like mathematics there are some problems like if you ask me what's 2

plus two I can say four if you ask me what's 14 + 18 I can say 32 so the first one is memorized I'm not really doing any work working memory but 14 plus 18 is like working memory I calculate it out it's pretty easy but if you ask me like some complex like quadratic equation formula whatever physics like what is the coefficient of friction in this problem like I can't do that all in my head that's working memory so working memory is also really important because it relates to planning and and executing of action

so when I sequence tasks out so it's like okay I have to plan for a birthday party you know and then my work working memory generates a list and I write the list down so it's no longer in my working memory so the ability to plan and execute tasks is part of working memory okay now there are a couple of other aspects of the frontal loes that become important so our frontal loes also involve um let me think about how to say this so willp power let's just call it willpower so the ability to restrain

other parts of the brain they involve attentional control activating certain parts of the brain right so when I am when I want to Burger but I'm trying to study my frontal loes basically suppress my Thalamus and then they like Focus they plan and execute tasks so I'm like back to studying so what we tend to see is that there are lots of deficits in the frontal loes when someone has an addiction so I'll give you all a good example of this so people who have addictions their predictive error processing is impaired what does this mean

this means that if you take a human being who is not addicted and you take a human being who is addicted and you ask them if you do this thing what will happen their capacity to predict accurate consequences is way lower right so this is like something that's really kind of important once again to understand because it's like why do people who are addicted do things that are quote unquote stupid like you may Wonder okay why don't I just stop why can't I just stop or if you know someone who's got an addiction you may

Wonder like why can't they just stop so we have to understand that from a neuroscience perspective what does that mean just stop what that means is that your brain is making a calculation that if you engage in this Behavior the outcomes will be bad the benefit that you gain from the behavior will not be worth the cost now imagine for a moment that your brain wasn't able to make that calculation that the brain looks at this and is like there's no problem with this this is not about conscious awareness okay this is not about what

you think this is a neuroscience level so literally like when and this is what's so interesting is when I work with people who are addicted from a conscious awareness perspective they're confused they're like why am I so stupid why can't I learn my lesson why do I keep doing this I don't want to keep doing this which part of your brain wants to do it which part of your brain makes the predictions about what is doable and what is not doable okay so when we feel a lot of frustration with ourselves when we feel a

lot of Shame and guilt towards ourselves which part of the brain is that coming from oh that's coming from the emotional circuits of the brain the emotional circuits of the brain do not calculate what happens when I act like duh right when I get pissed off the part of my brain that calculates what will happen when I get pissed off doesn't function this a different part of the brain and in fact we know that the amydala hyperactivity of the amydala suppresses activity of the frontal loes so this is super cool so our emotions impair our

ability to calculate and that's a feature not a bug because when we're like afraid and anxious when we're seeing a snake slithering in front of us or we're being chased by a pack of lions or aund human beings feel seems like the end of the world is ending and they're running toward W you you're not like H I wonder what's going on here what should I do should I really like let's let's calculate this let's think about this like a snake what kind of snake is it is it a dangerous snake is it a poisonous

snake is it a friendly snake is it a hallucination am I psychotic am I delusional is it a sign from God maybe the Tiger's friendly maybe the pack of lions like I saw that YouTube video or that Tik Tok of that person cuddling with the line maybe they want to cuddle I wonder what's going on not what our brain does so there is a prediction error processing and this becomes important because like I like I try to help my patients it's not that you're stupid it's going to sound terrible it's that literally the consequences that

you predict and we'll get to this we'll give you guys like good psychological examples of this like I can handle it it right addicts will say I can handle it this will become a problem when I start using as much as this person and if I ever lose my job then it's a problem so that's the psychological manifestation of this right we tell ourselves all these different statements in our head we make justifications but what is the nature of that justification the nature of that justification is an is an incorrect prediction so in people who

are addicted we see a lot lot of frontal lobe deficits we see an inability to predict the consequences of your actions we see an inability to plan which is actually really really important right so a really big cause of addiction is having an insufficient plan to escape high-risk situations so literally in Psychotherapy with people who are have addictions we will like do that cognitive work formally in the session so it's like if someone invites you to a drink what are you gonna do if someone invites you to a barbecue what are you going to do

if someone some person that you swiped right on Tinder is like want to grab drinks and then we can smash what are you going to say so we see difficulty planning and executing tasks we see sometimes def deficits of working memory we see deficits of suppressive circuits in the brain we see attentional deficits so what is an attentional deficit mean this means once I start thinking about alcohol I can't stop right once I want to play a game I can't control myself so that's what we call broadly willpower all right so that's it's bothering me

I can't stop thinking about it so those are the circuits of the brain that we're going to talk about okay so we covered these and this is what what is like there problems and there are particular things so when we figure out how to approach this we are going to like Target each of these things because each of these things if we give these parts of the brain the respect that they are due and instead of just blaming ourselves for being weak willed or lazy or a loser or whatever if we understand understand what's going

on within us it gives us a path forward okay now let's talk about physiology tolerance and withdrawal okay so I hate to break it to yall but the human brain is not not designed for happiness it is designed for survival and one of the most important aspects of survival is something called homeostasis so this is baked into biology baby so we have homeostasis of temperature human beings are 98.6 de on average if it gets up to 100° we're still 98.6 if it gets down to 60° we're still 98.6 how does that work so we have

temperature receptors that depending on the temperature that they detect they will activate certain parts so if I detect a high temperature I will engage in sweating and what happens when I sweat is I secrete liquid sweat through my sweat glands and then that sweat evaporates and the energy of evaporation gets absorb from the heat of my body and then essentially we're boiling water off of our skin and for the more water that we boil off of our skin the more our temperature drops because it's getting that energy from our skin when we have low temperature

we activate these that gets detected and it goes to our Brown fat cells and our Brown fat cells store all this fat and they just burn energy why do they burn energy to generate heat for the exothermic reaction so white fat which is our fat storage cells those are usually designed to like give us energy when we're not eating but Brown fat is a different kind of fat it just has a bunch of fat that it just burns for fuel to keep the place warm it's like a fireplace what we also see interesting side note

is that it as you move away from the equator our thyroid hormone generally speaking increases and as our thyroid hormone increases our Brown fat activation increases which is why you see more obesity around the equator than at Northern or Southern climates Northern or Southern climates have more extreme temperatures especially in terms of cold and since they're colder we require more Brown fat we burn more energy therefore we tend to be thinner super cool but this is homeostasis of temperature what are you talking about Dr K so the basic scam of the nucleus succumbent okay this

is the scam of the nucleus succumbent is that our dopamine develops tolerance and homeostasis so here is one neuron where I have vesicles of dopamine okay these are vesicles of dopamine and then I have my receptor I have receptors on the neuron across from the synapse this is where two this is where two neurons meet and if I do something dopaminergic I get a release of dopamine so let's say there at normal times I get three units of dopamine secreted I've got three receptors so I get a signal of three now if I use drugs

I get like a ton of units of dopamine and then they saturate all of these receptors they crowd around so even when one molecule of dopamine pops off there's immediately another one so now I get a signal of 10 and if I get a signal of 10 over and over and over again my brain is like hold on a second this is way too high we're supposed to be at three but instead we're at 30 so what it does is remove receptors so now what happens if I have only one receptor I can crowd a

bunch of dopamine right I can release a ton of dopamine but there's only one place for it to go so this results in back to a signal of three now here's the big problem once I only have one receptor and I've got a thing that releases dopamine so let's say here's like this is cocaine right cocaine is like 10 10x dopamine put a little D in there because there's too many circles and then I'm like you know what I should stop doing cocaine and instead I should do yoga because yoga is good for me and

what does yoga do One Yoga releases one measly molecule of dopamine and so this poor molecule of dopamine is floating around and since there aren't many receptors right cuz remember that like brownie in motion so the dopamine like doesn't have thrusters right you just dump all this stuff into the synapse and then it just floats around and so if I only have one receptor I'm actually going to get zero units of pleasure which means zero units of Behavioral reinforcement zero units of craving I don't crave yoga I crave Coke baby let's go so this is

why chasing dopamine will never work physiologically it is impossible to give you any kind of sustained happiness impossible just not phys it's not doable the more dopamine you activate the less dopamine works it's like a scam of the century so we see this as a big problem especially with technology use because now technology use is so pervasive it gives such a constant stream of dopamine that we're starting to see a lot of anhedonia anhedonia is the inability to experience pleasure so when people are addicted to video games they're not really fun at some point right

you're just playing and you don't know why and then the real problem is that other things become less fun reading books isn't fun hanging out with people isn't fun right and we'll also see by the way this physiologic tolerance principle happens in the amydala as well so when I constantly suppress the amydala what is the adaptation that the amydala makes it's like hey we're not feeling any anxiety we should be feeling some anxiety anxiety is important for us for survival so it actually amps up up the sensitivity of the amydala so as we suppress the

amydala we are buying ourselves more anxiety so this is where I'm going to take a quick karmic side note so as you suppress your anxiety all you're doing is buying more anxiety for yourself in the future you're just taking a loan of peace from the the future and when the peace goes away you'll get twice as much anxiety and so this is the Big Challenge so on a psychological level everyone tries to optimize their addiction how can I keep it how can I make it work what's the right way that I can extract the most

pleasure out of it right so when you're addicted to something especially something like pornography or sex your human body becomes a farm of pleasure it's like Mass agriculture of dopamine farming and you'll do whatever the it takes to get extract as much pleasure as you can from your body and I've worked with people who are addicted to things like cocaine and methamphetamines and stuff like that and I mean they will go to all kinds of lenss to just extract that from themselves the human organism the purpose of life becomes the extraction of pleasure and it's

never going to work it just physiologically is an impossibility which is why we go down these roads of meditation and things like that because in meditation we start to derve contentment and pleasure contentment there are different circuits of the brain the serotonergic circuits of the brain that give us a sense of peace and contentment and once we have that peace and contentment we don't need to to go chasing dopamine okay so this is the big scam it's it's never going to work so let's understand the stages of addiction so stage one pleasure stage two removal

of pain stage three dependence and absence of addiction leads to pain so this is what I kind of mean when we're first using let's say here's pleasure and here's pain so at the very beginning when we use a substance or some other kind of addiction we get a spike of pleasure from it but then what starts to happen is the pleasure we build tolerance to right so we start to build tolerance and as we build tolerance the pleasure that we get kind of goes down and then what happens is when we feel pain then when

I use the substance I get back over here and then I kind of go like this and I use again and I get back over here now the real problem is as we develop tolerance here something really scary happens which is that this Baseline disappears and we get a new Baseline so the new Baseline is down here this is our old Baseline so now what happens is the only place that I exist is in this round so now when I withdraw I feel more pain right so people who are withdrawing from opiates feel whole body

pain even though there's no injury so now now what happens is like I'm operating down here and this is what like what late stage addiction looks like this is due to the development of tolerance so now what happens is I become dependent on the substance just to get to Baseline and now it doesn't give me any positive sometimes it gives you the subjective experience of positive but generally speaking it doesn't work like that so if you look at people who are like you know playing video games for 12 hours a day and you ask them

like are you having fun they're like not really I just don't know how to stop so this is the basic sequence of addiction right so the first phase is great wonderful then it starts to help you remove move the negative and then it changes your Baseline to where your Baseline is no longer neutral the basine is negative so now you become dependent on the addiction to return you to neutral big problem okay now this has been studied in things like alcohol um I'm pretty confident that it's also the case in things like video games pornography

whatever right so this basically applies to all addictions and this is why like it's never going to work never going to work so now we're going to pause for a second and I'm just going to take a look at questions okay so what let's do questions for a couple of minutes and um I'm going to see you [Music] I'm going to try to pull up hold on a second one second one second oh don't need that okay CH yay for YouTube ads okay so like I'm going to just ask what questions yall have so far

okay um can you get back to a normal Baseline after stopping absolutely can the Baseline be restored 100% so let's remember that the Baseline alteration is a biological adaptation it's nowhere near permanent so in the first stage of adaptation we just remove the receptors from the membrane they actually still are sitting in the closet they're not even degraded they just get removed from the membran and so if we in the early stage like if you're not super addicted like you can just stick them back on after a brief period of like abstinence now over time

those receptors will get degraded and then the recovery from withdrawal like happens more slowly then you have to make more machinery and things like that but you can absolutely reset your circuits 100% there's like no scientific question about that there may be very very rare Ed cases where people don't can't do that but these are basically homeostatic mechanisms the whole point is to return to neutrality so you really can't screw it up so for example like you know I have detoxed a single patient off of alcohol like 10 times like over the course of four

years of residency I got to know some people really well and then detoxed once detox them again detox them like two and a half times per year on average and you can reset it over and over and over again the things that are not recoverable tend to be the direct damaging effects of the substance itself right so when we get DNA damage from drinking from 30 years and we develop liver cancer that's a whole different ball game but it's not a homeostatic mechanism okay so does the same apply to food yes and no so this

is where I want yall to once again be it's a great question but let's be precise why am I teaching you all this Neuroscience does this apply to food on the dopamine side in the nucleus accumbens 100% yes does this Supply to food on the gastric stretch side 100% no or I mean even that's homeostatic right so there's homeostatic mechanisms for gastric stretch so when I eat a lot of food there's a certain amount of volume that my stomach can handle and even if I eat like pounds and pounds of grass if there's no caloric

input my stomach will still tell me to stop eating because it's full so this is what I mean so like the effect of food on the on the body is like very multi-dimensional there's the insulin glucagon balance there are liver receptors there's gastric stretch there's gastric emptying there's dopamine in the brain right and that's why like you know so we don't are we addicted to food not really so there are systems within the body that will make us crave food on a regular basis like hunger but that doesn't mean we're addicted okay so is this

the same for anti-depressants it removes pain yeah we'll get to so there are a lot of questions I'm going to just address a couple of these so we're going to get to cutting down versus quitting cold turkey how to stop jumping from addiction to addiction we're going to get to those okay so I'm not answering some questions because they're already baked into the second half of the lecture we're halfway done by the way is it the same for anti-depressants it removes pain and we get dependent and tolerant so we need more and we can't stop

if if it's not the case why not very very very good question so the short answer is it's not the same because of the neuros circuits involved so remember that in order for us to get addicted to something what are the two main requirements give pleasure and take away pain we need both so remember that all addictions will activate the nucleus accumbent but if we don't activate the nucleus cumbent we do not get craving and we do not get behavioral reinforcement right this is why the Neuroscience is important anti-depressants do not activate the nucleus accumbent

therefore they don't give us pleasure they don't give us cravings and they don't give us behavioral reinforcement therefore we can't get addicted to them they can help us remove some degree of pain but the circuits involved are completely different right so if yall are wondering can I get addicted to this does it give does it activate the nucleus cumbent if the answer is yes it's possible to get addicted if it suppresses the amdal it's possible to get addicted right so then there are also like a c couple of other things like so for example can

you get addicted to hugs not really now the question is why it's because the amount of dopamine that a hug can release is nowhere near the amount of dopamine that cocaine releases hugs can do all kinds of stuff for us that are positive but they're not just from the nuclear nucleus accumbens we feel some degree of like pleasure from a hug but hugs activate other stuff they activate oxytocin they activate emotional bonding right so there's a difference between the activation of positive emotional circuitry and the suppression of negative emotional circuitry why would a gambling addict

that gambled paychecks for his whole life suddenly stop gambling once they win a big hundred million if they were truly addicted they would keep gambling yes that is correct and so do you guys know what happens to most people who win the lottery they end up broke so people who are addicted to gambling like you can look at this at any point so it's not just win $100 million at some point someone who's addicted to gambling is up right they're like up by 50,000 or 100,000 or 200,000 now why do people get addicted to gambling

because let's understand this so you may say once you wi $100 million why wouldn't you stop you're thinking about it in the wrong way we have to understand the Neuroscience so if I win $10 how much dopamine gets released if i w win 10 cents how much dopamine gets released if I win $100 million how much dopamine gets released and if a lot of dopamine gets released with a $ hundred million what does that do to craving and reinforcement it increases both by the same amount so the big irony about gambling addiction so when you

talk to people and work with people about gambling addiction there's a new version of this by the way which is Wall Street vets addiction right this is Diamond hands YOLO addiction people have lost all kinds of stuff in cryptos and nfts and stuff like that a couple of these industry people have really figured out how to exploit gambling addicts they've just given it a new face and they've also activated the dopamine circuits in a more profound way so what happens is the problem with gambling addicts is not that they lose money the problem with gambling

addicts is they win money if you just lost money all the time your brain wouldn't want to do it what creates the addiction the winning not the losing right because once you get that high what does it do it Alters your prediction error processing now when you think about gambling your brain doesn't know how to consider the downside it just sees the upside right and so people are talking about intermittent reinforcement so that's one of the other things that we figured out intermittent reinforcement increases dopaminergic release why because expectation decreases dopaminergic release simple if we

somehow derived pleasure from touching fire we would do it at the expense of existence how is our brain always choosing pleasure over sustenance 100% from a self-preservation point of view beautiful question Warcraft to dodo and let's understand this this is not a hypothetical we do derive pleasure from things that are bad for us we derive pleasure from Twinkies we derive pleasure from pornography we derive pleasure from methamphetamine we derive pleasure from fenil right we already do that the problem is that the parts the things that we get addicted to I think it's going to be

very hard to get addicted to fire but I've seen similar things so sometimes people will get addicted to self-injurious behavior and literally burning themselves right so like that kind of exists too and we'll get to that in in a minute a couple minutes too but like it already happens how is our brain always choosing pleasure over sustenance is a very good question it's because in the world world where our brain evolved pleasure and sustenance were together what's the basic reason why addictions are increasing so much in our society is because human beings have figured out

how to separate pleasure from sustenance this is what we discovered so if we look at calorically dense food when we were hunter gatherers foraging for tubers and it's like wow I found a taro root this is like 80 calories woohoo and then it's like man I found some bacon this is like 300 calories delicious why do we love bacon so much because it's fatty everything's better with bacon especially Tara root right what do we love with our potatoes bacon chopped up on top so now what's happened is we've figured out how to separate the sustenance

and just give the pleasure and that's like literally what a drug is and we're getting better at it so if we look at morphine opiates fenil what are these things our body makes them that's why we have receptors to them our body makes endogenous opioids this is why when you get an injury after a few minutes it hurts less like how does that work it's because your body is like oh my God this hurts a lot let me pump some morphine into my bloodstream good job buddy and so now what we've done is we've isolated

it right we've just given someone the morphine without the injury this is why we're getting addicted okay okay great questions what about ADHD meds we'll get to that at the end okay so now let's talk a little bit about okay so let me just take a minute okay well we'll have hopefully a little bit more time for questions at the end um but I got to be conscious of time hold on a second let me just check one thing okay um okay so uh let's keep going so now the question becomes oh whoops how do

we fix this so here's my take okay so if you've got an addiction what do we do so the first thing to remember is that addiction involves environment so I think it is very very hard when you are getting and we'll understand why this is we'll break this down but if you are hanging out with a lot of people who get high all the time it's really hard to stop if you're hanging out with a lot of people who drink all the time it's really hard to stop if you hang out with a bunch of

people who play games all the time and hang out on Discord it's really hard to stop so we know there's just a lot of studies that show that addiction is environmental so the first thing that we've got to do is change our environment and let's understand a little bit more about how this works so remember that AR Thalamus is our Gateway right and remember that once we get addicted to something once we get a spurt of dopamine what the nucleus accumbent does is goes over to Thalamus and they're like hey whatever you saw tasted touch

felt or heard in the last 60 seconds look out for it again because we need more of that literally what happens so we become sensitized to paraphernalia related to drugs or behaviors right so now it's like okay I'm addicted to pornography better be careful who I follow on Instagram because that's a slippery slope so why is environment important environment is important because thalamic input is very important so how do you recover from an addiction you have a certain level of Cravings right so like let's say this is our craving meter so since I am addicted

I have a level two resist craving I've leveled up my resist craving skill two times so what determines whether I use or not if I have a craving of level one right I overcome it if I have a craving of level two maybe it's 50/50 but if I have a craving up here I'm going to lose so where do Cravings come from Cravings in part come from the thalamus this is why environment is important so we're also creatures of habit right so when I you know it's kind of interesting I need to pee I need

to pee I need to pee I need to pee one side enter the bathroom what happens to my craving to pee goes up way up way up way up right so our our subjective experience of wanting things is shaped by the environment like literally and then if someone's in the stall then we're like oh my God this is impossible but if we were just sitting in the car for an extra 60 seconds waiting 60 seconds in front of a stall to go pee is way harder than waiting 60 seconds in your car right kind of

weird so if you are not controlling your thalamic inputs it's going to be very difficult so think about what are the triggers for cravings and this can be weird kind of stuff right so it's like get rid of your bong because the bong has no other purpose than to get high right so it's like if you see a bong you're going to want to get high if you're sitting at your computer doing nothing you're going to want to play video games like whatever so you have to control your thalamic inputs and the simplest way to

control your thalamic input is by changing your environment don't go to a bar if you're trying to quit drinking it's just going to amplify the Cravings second thing we're going to talk about emotional regulation there are two aspects of this so when I talk about emotional regulation I from a clinical perspective I work on present emotions and dormant emotions what does this mean so when my amydala is active right so I feel anxious I want to make the anxiety go away so what we have to have is an alternate emotional regulation Technique we have to

make the anxiety go away in the present without substances or behaviors okay so the problem with this is that all of the substances or behaviors that we will uh everything that we do that is not a substance or behavioral addiction sucks at regulating emotions so if we think about like you know if someone is having let's just be honest tell it how it is so if someone is having like a psychotic panic attack I don't even know what that means clinically I just made it up what do we do in the emergency room if they're

in a period of acute psychosis and they're having a panic attack what do we do we don't teach them deep breathing we give them 5250 5 milligrams of hdll 2 milligram of Adavan lorazapam and 50 milligrams of Benadryl or some kind of antihistamine okay that's what we give them and it works pretty well for agitation for all kinds of you know nasty nasty stuff so the problem with addictions is that is not that they're problems it's that they're really really really good Solutions and man marijuana works great for anxiety let me tell you what unbeatable

when it comes to anxiety so the challenge is that the emotional regulation skill cuz you have to deal with those negative emotions in some way it's got to be done and this is the real problem is that people who get used to addictions are used to instant gratification because that's what the addiction gives you right so it's like I want yall to think about this for a second when you go to a restaurant and you wait let's say an average of 15 minutes for your food how content would you be with the restaurant if you

had to wait 30 minutes 45 minutes 2 hours 3 hours would you go to that restaurant ever again of course not this is the struggle of people with addictions because the other crap that we want to teach you is the equivalent of waiting 3 hours at a restaurant it's not even 30 minutes even that is enough to make people never want to come back you see how impatient the brain is and we're like oh just be patient just think about that for a second it's just food waiting two hours nothing you're not going to die

or anything right it's not like that big of a deal oh my God it's a waste of my time what the are you doing with your time anyway you're talking listen to some guy talk about Addictions on Twitch or YouTube or whatever this is how you spend your time like what is the value of this you guys play video games for like 10 hours a day and yet you get so incensed if you have to wait 2 hours for your food is ridiculous so let's understand that's the brain works when the brain has an expectancy

of immediate benefit and it does not get what it wants it does not behaviorally reinforce what you're doing in fact it does the opposite it unin forces what you are doing it says F this we never want to do it again and at the same time you have to develop emotional regulation techniques you must deal with those emotions in some ways so how do we do this and clinical treatment we teach emotional regulation techniques we're going to teach you to breathe we're going to teach you to be patient we're going to teach you to meditate

the other thing that becomes really important about oftentimes clinical treatment is that we're going to help you process emotions so they don't they don't build up over time right so you're going to come in every week and we're going to talk about all the stuff that's crappy in your life so that you can vent it all out here the other thing that we tend to do when people really addicted to things is we stick them in rehab and why do we stick them in rehab because it's a controlled environment that triggers fewer emotions than your

general life because your emotion reg regulation skills are like at a level one or a level two and the emotional damage you're taking is like at a level eight or level nine so eight or nine of those DPS points are breaking through your armor and screwing you so what we have to do is we have to to put you back in the starter Zone we have to stick you back in the tutorial that's what we do in rehab it's like an emotional starter Zone it's like today is quesadilla day that's exciting the rest of the

day is just whatever no one's calling you no one's like bothering you about rent boss isn't asking for anything your spouse is far far far away hopefully and when they do come your psychiatrist and your therapist sit with you for 2 or three hours preparing for their visit they're also in the room with you and help keep things civilized so it's like you know you're you're calling you're parting up with some level 50 people to tank damage for you and they're like carrying you through talking with your spouse it's like a dungeon run except you've

got some super leveled person who's just caring and doing all this for you which is what you need because at the end of that run you still get the highle loot right you learn a little bit about the encounters you're like okay I got to Dodge here and this is how I do this and this is how I do this this is what therapists will help you with when you're in rehab and you have a family meeting this is how it works therapist will help you with your boss right it's like being carried and you

still get the benefits even if you're carried we both know this it's actually way harder to clear the dungeon on your own you wipe once and then you have to run through all the trash mobs again then you wipe again you have to run through all the trash mobs how about you level up find someone who's 50 who like you die they just res you die they just res you again because their Mana pool is like 10,000 that's why rehab is good so we have to reduce the amount of emotional regulation necessary ideally and teach

you emotional regulation skills so this can be everything from going from walk meditating whatever second thing that we have to do is deal with dormant emotions so what does this mean so remember that in your brain you have the emotions from the present which are coming from the outside right so in this moment my environment is giving me emotions so my environment is giving me three levels of negative emotion but then remember that we have a whole storage of crap that has been suppressed and now the problem is that on a given day when I'm

just going about my business let's say there's one level of emotional stress but if my mind is quiet some of this stuff I'm just minding my own business and then like the shame and the guilt are just like hey bro you and they just come over here and they just like you're not nothing even happened today so all these negative emotions activate and when these negative emotions activate your brain turns on and your brain is like okay what helps us deal with these negative emotions drugs let's go so what do we have to do it's

not just about stopping these emotions and regulating these emotions because how bad if you really think about it y'all how bad can a day be see I want youall to really think about this if you are sad every day or if you're anxious every day how much of that sadness and that anxiety is coming from the events of that day if you only lived for one day and that was the only day how much sadness or anxiety would you have there are rare exceptions to this so if we look at highly traumatic situations that's an

example where you can get a lot of emotion on that one day but for 90% of people 90% of their days or even 99% of people 99% of their days are not actually that emotional what really is the problem is that you carry all the emotions forward even if you look at something like an abusive relationship and you can say Dr K but an abusive relationship is really bad on this day I'm with you there but as someone who's worked with a lot of people in abusive relationships it's not the single day it is the

stacking of effect of that being your life day after day after day after day after day so if you're someone who's struggling with addictions and you are tired because the number one experience of people in my clinical experience the number one sign of this is tired dormant emotions manifest in the subjective experience as tiredness there's there's just so much to deal with you can only do so much today that's not what makes you tired what makes you tired is all of the dimension of the future or all of the dimension of the past so the

second thing that we have to do with our emotions is work on those dormant emotions has nothing to do with today it has everything to do with yesterday has everything to do with tomorrow it has to do with this shame that you've built up this guilt that you've built up for ruining your life falling behind all of these kinds of things and that stuff has to be worked through and once you work through it just think about this for a second right then you're just dealing with the emotions of today you're not dealing with the

shame of the past you've let go that you've fallen behind and you're making up ground now completely transforms people's experience and the main thing that I want yall to really take away is when someone thinks about an addiction they think about how do I stop this Behavior it's the wrong way to think about it there are so many different dimensions that play into this and this is why it's really hard because people don't do this stuff but if you look at programs like alcoholic synonymous they have a particular step which is like making amends so

you go back and you apologize you try to track down and apologize to all the people that you wronged for the stuff that you wronged them for and if we look at what is the psychological mechanism of this step it's literally working through all of that stuff right so this is a way of dealing with dormant emotions it's the next thing we have to do okay so Psychotherapy works really well for that 12 step can help for that but it must be done next thing let me just take a look at this what we have

time for okay so we talked about emotions so now we're going to kind of go in a couple of different directions okay so let's just talk about this next so this is more like practical clinical the next thing that becomes really important is purpose so if you look at studies on pornography addiction and you do a logistic regression analysis on pornography addiction and risk factors for pornography addiction which means if you look at what are the risk factors that contribute the most to someone being addicted to pornography one of the top two factors is a

sense of meaninglessness in life so one of the things we absolutely have to do is develop a purpose so we're going to talk about this for a minute so we just talked about how all these different circuits of the brain are pushing you towards addiction how do we defeat all these circuits well it turns out that we have one really good overriding mechanism so this is the ultimate brain hack there is one thing that can override all circuits of the brain and that is purpose let's just think about this right so when you are a

parent and your child is sick and you want to play a video game you have a reason you have a purpose to take care of your child which makes it easy to stop playing the video game when you are a parent and you have a child who's being attacked by a tiger normally the tiger would trigger fear and anxiety but now you have purpose and so the fear and anxiety get completely overcome and you step in front of the tiger and prot protect your child so we know from studies on things like motivational interviewing and

just studies on addiction recovery that you got to have a good reason a very good reason a reason that is more powerful than all of the advantages of the addiction you have to have a you have to make it worth it right so when you recover from an addiction this is not a good thing this is a bad thing the experience of it is negative you are signing yourself up for suffering not pleasure opioid withdrawal I've had patients who've gone through opioid withdrawal and had metastatic cancer and they said the worst part of the cancer

was going through the opioid withdrawal crazy awful feels worse than death apparently because death actually some people say it's very peaceful but whatever don't kill yourselves so if we think about this right so we have to have some reason to tolerate the negativity and that's where purpose really comes in so I tell this story a lot about this patient who was addicted to nicotine and cigarettes I tried to scare them by telling them about oh it's going to cause lung cancer and it's going to cause this and this and this and then finally one day

they told me you know oh I asked them what's important to you and they said you know I love my daughters I'll know I've done my job as a dad when I walk them down the aisle then I asked them when you walk your daughters down the aisle do you want to be Wheeling an oxygen tank behind you or do you want to be you want to have him pushing you in a wheelchair and he was like what so you have to have a good enough reason to quit and this is where like not wanting

it anymore can sometimes be a good enough reason I've honestly seen that where people like enough is enough I'm just done I'm tired of this life but that's actually really powerful purpose it's that I want a better life I don't want this life anymore I'm tired of this life and this is what gets really dangerous right so in Psychiatry like sometimes those people are suicidal but that's like part of their growth and so if I tell them if you don't want this life suicide isn't the answer build a different life dude I will help you

build a different life if you don't want this life I'm actually behind you 100% but suicide is not the right answer building a life fourth living is is the right answer the problem is that's hard and so the stronger your purpose is the better off you will be now finding your purpose is not this is where things become a little bit difficult because it's not something that you can just find through like mental analysis purpose feels a little bit more spiritual to me it's like just as emotional so you can do that mental analysis you

can do journaling but generally speaking working with a professional is the best way so there are certain techniques called in motivational interviewing where we draw that purpose out of you and it's just hard to do DIY why is it hard to do DIY because the circuits of the brain that are involved with DIY are different from the circuits of the brain when you involve another human being there's no EMP empathy in DIY empathy is very powerful there's very little thalamic input in DIY right because you have no sensory input in DIY usually whereas you have

sensory input when someone is speaking to you and the cool thing about thalamic input is Thal thalamic input is connected to our learning circuitry whereas our analytical capability isn't necess isn't as tightly connected to our learning circuitry emotion are connected to our learning circuitry but you must find a purpose you must really ask yourself what is worth quitting for and until you have a good enough answer for that it's going to be really hard to quit what's really worth it okay now we're going to get to a couple of other things so now we're going

to get to some like kind of nitty-gritty stuff so when we look at what causes people to trip up so we're going to cover tripping up and relapsing before we cover a plan for Success okay so the first thing is that there are emotional risk factors so remember we talked about all this emotional stuff but there are a couple of things so one is bottling up emotions so remember we've got present emotions and we've got dormant emotions so when you bottle up emotions you're adding to the dormant emotions and it just is going to overwhelm

you when they activate isolation is another emotional risk factors there are a couple of um other things like so we're going to actually talk about stressors so halt h hungry angry lonely tired sleep and food are huge so let's understand this so when we're hungry are it suppresses our frontal loes when we're angry it suppresses our frontal loes when we're lonely it activates our nucleus succumbent relief seeking behavior and this is also let's say limic right and this is what's really scary if we look at tired tired shuts down the frontal loes so if we

look at like fatigue what is the effect of fatigue on our brain basically disables our frontal Lo so you know I learned something the hard way as a parent so when you're putting your kids to bed they require a certain amount of willpower to stay in bed so something weird happens so with an adult actually this is not forget this true of adults too generally speaking as adults get more tired it's easier to go to sleep but with kids if you miss a certain tiredness window that it becomes very hard for them to go to

sleep because they can't control themselves and keep themselves in the damn bed they can't keep their head on the pillow they're up and they're twisting and they're getting up and now I need to go potty and now I need water and now I need this and now there's a this in the like there's a monster in the closet they become deliriously tired and then they become harder to put to bed then they're crying and then they're laughing and then they're you know smacking your butt and then they're doing this and then they're then you get

angry at them and then like they're crying and then finally they just pass out in like 60 seconds what is the adult version of this the more tired you are the harder it goes it becomes to go to sleep because of this guy oh my God I'm so tired it's it's 11 o'clock okay let me go to bed sleep by 11:30 oh my God I'm so tired it's 12:30 let me sit in my bed while I'm really tired and browse my phone for an hour and a half so we lose that last bit of willpower

that even allows us to restrain our impulses so sleep is critical for overcoming addiction because you're going to need every ounce willpower and frontal lob function you can get so another thing that becomes really important is a daily stress and emotional regimen right you got to manage this stuff on a day-to-day basis and when I work with patients who have relapsed often times what I find is that self-care disappears between two weeks and 3 months before relapse three months ago they stopped taking care of themselves and it kind of builds up and builds up and

builds up and then there's a relapse because it just got to be too much right what does that mean that means you haven't been taken care of it every day the week so it's absolutely required okay um and then another thing to keep in mind is that many relapses are opportunity based so usually what happens and you know it doesn't have to be this way is that we have all of this like we have our halt right so we have increased our risks factors and then like we're given an opport to use so my friends

are like hey bro you want to come party and like I've said no for the last six times but today it's been such a long week man and I deserve it and all this kind of stuff like it why not bro let's go that's usually how it happens and so another big part of this is we want to develop exit strategies for op opportunities and this is also especially important because remember our prediction error processing is not very good so we can't rely on our brain to make a risk assessment in the moment so instead

what we have to do is develop an exit strategy and stick to it no means no and the more tired you are the more you should be saying no not the less you should be saying no okay couple of other things um let's talk about cognitive traps so there's a lot of thinking which I would call the addict spring and I'm just going to highlight some of these there's a lot of them okay so you know on the surface we have things like denial or I would say deal making is another form of denial right

so I'll stop when this bad outcome happens I don't have a problem yet it's really going to be a problem if I start passing out at parties like this guy does so if you notice that your mind is deal making think about that are you telling yourself okay if I do this kind of work then I deserve a reward and if I deserve a reward then I can use it so it's not that you don't deserve a reward it's just that this kind of that basic idea of I worked really hard I get to do

something in life that's fine the problem is when it has to do with a substance so here's a really simple test for whether your deal making has been hijacked by your addictive brain simple test so if the reward can consistently be not drugs or whatever you're addicted to then it's fine and if the reward that you're always giving yourself and you're like oh yeah so why don't you just reward yourself with like a massage instead of getting high on meth and if you find yourself arguing against that over and over and over again then you've

got a problem and you have to be careful because the adct addict's brain is subtle it knows you right so it'll do is oh yeah I can I don't need meth today you want me to do a massage I'll do a massage but next week we'll do something else oh we'll see next week yeah oh yeah see I did it I can handle it I controlled it it's fine you can use because I'm in control which brings us to another really common one the perception of control so often times when people are addicted to things

they have this idea that they're in control they do things to keep themselves eles in control but it's like the thing that's in control is the addiction like that's really what's in control so you got to be careful about that perception of control and then there are a couple of like so these are like the really like inyour face ones but there's a lot of really subtle ones that I've encountered that are like really tricky one is something called the weakness trap so the weakness trap is when people view addiction as a weakness and if

I'm an addict I'm weak I'm going to just draw write this out okay maybe you guys can follow I should be strong therefore I need to conquer my addiction and if I don't then I'm weak therefore I am strong or will be strong so I know this sounds kind of weird because this seems like really positive but often times people who think this way do not do all of the crap that needs to be done so overcoming an addiction is not about being strong it's about putting in lots of hours in stupid that you don't

want to do it's about going to meetings going to therapy meditating every day and what these people have is they have this almost like this fantasy of strength where they don't want to be one of these weak people who has to rely on others go to therapy weak people go to therapy like I don't need need any of that I think imagine this community will be somewhat different but you know those thoughts can still pop up you want to be you want to conquer it and so oddly enough the brain will tell you you should

conquer this you can conquer this you don't need to do all this other crap that people are telling you be strong conquer it and do it without help very subtle very dangerous very Insidious that desire for strength gets hijacked oh this is a big one waiting to be done and forever so this is a really common thing that we see in especially postacute withdrawal syndrome so this is something I'm going to talk about for a minute we don't have too much time now but so we talk about withdrawal which is when you're losing your tolerance

to the substance and by the way if y'all are going through withdrawal especially from substances really really good idea to do it with a medical professional because sometimes withdrawal can be lethal so withdrawal from alcohol and benzo aines can induce seizures and ayine literally kill people so you don't want to do that but then oftentimes what is really overlooked in the medical system is the postacute withdrawal syndrome which can last for months so the way to explain this is that you know so we have tolerance and the development of adaptations at the cellular level but

then we also have development of adaptations at the habitual level development of adaptations at the psychological level development of adaptations at the ego or identity level and so all of those adaptations which have been built on the addiction also need to be re-calibrated and that is really difficult so this is the postacute withdrawal syndrome and I'll give you all a really simple example of this so we're going to give you all one example of postacute withdrawal syndrome when people are withdrawing or in the early stages of recovery it's really hard because you have to go

to meetings a lot you have to go see your therapist you're working through all these dormant emotions and the problem with working through dormant emotions is that like I worked on dormant emotions this week I worked on them the week after I worked on them the week after I worked on them for three months there's just more and more and more and more and more of them my emotional regulation skills are level three now instead of level two so my life sucks everything is hard everything sucks and people think this is what being sober is

they think that this period of time will last forever that's how it feels and then they think I can't do this this is too hard there's no way and this is literally what it's like and if you guys even pay attention literally to our subreddit and other places in our community you will see this thinking in all kinds of posts is this what it's supposed to be forever is this what life is so we see this a lot especially in like a lot of these burnout oriented tweets and things like that is life supposed to

be going to work 9: to 5 coming home doing laundry doing meal prep eating working out having 30 minutes of recreation time and going to bed is that what is the next 40 years of my life like this no that's not how it works things are hard right now until you adapt until you build habits until you sort of get everything sorted out this is the hardest period but it doesn't stay like this so there's a sense of foreverness which really induces hopelessness because people don't think that they can withstand this forever but the good

news is it's not forever it's just your brain doesn't experience that and why not it's because for weeks at a time it is this so the Post Acute withdrawal syndrome can last 6 months maybe even up to a year and so as the brain calculates that out it says I don't have the energy for this and then it induces some degree of hopelessness and then it starts telling itself things like well if I'm going to crack a year from now why not crack today okay um so there are a couple of things that we strongly

strongly strongly recommend let me just think about man there's so much okay so let's go through the rules of recovery okay so if you guys want to try to tackle this here are a couple of things that yall should really focus on the the first thing you got to do is change your life now you may say but Dr K that sounds like a lot and that's just step one absolutely man because remember that your addiction is a product of your environment okay so very very concretely what does this mean this mean so what's the

pitfall the pitfall is first of all people want the same life without the addiction that's not usually possible but the good news is that the new life is almost always and I can't think of a single case let me think I know I've heard this before but nothing is coming to mind is almost always better but it's hard to get there so this means changing your environment changing your friends also means changing your cognitive patterns right all this has to change changing the way that you deal with emotions and so it's weird because I I

work with a lot of people who will say like addiction was the best thing that ever happened to me and people are like how on Earth like what do you mean and what a lot of people will say is like if it wasn't for the addiction it it becomes a wakeup call right it certainly was for me like I started down this journey because my addiction to video games really screwed up my life and I really had to change it I was like in a fraternity going to parties eating fried rice by the pound playing

video games every day hanging out with other friends who are pretty degenerate and over time like I had to change all those aspects of my life but that's not a bad thing is it hard sure you get better at it it goes slowly but it's good you should want that rule two complete honesty and by the way I didn't come up with these these are things that I've learned beautiful wisdom so there's a great saying in addiction recovery which is you are as sick as your secrets love this so true really important for things like

trauma healing as well because that's usually a secret so we talk about this some in like Dr K's guide we talk about SATA and truthfulness and there's YouTube videos and stuff so addiction fundamentally requires lying I've never seen an honest addict I think can't think of one maybe I have so usually on the surface you lie to other people right you don't quite tell your family how much you're spending on crypto when people ask you what' you do today you don't say I watch pornography for an hour and a half right and when people ask

you oh like how much did you have to drink you downplay it I had a couple of drinks maybe a few so as long as you lie addiction has fertile soil to grow and then the next thing is that like if you lie to other people people the only way you can sustainably do that is by lying to yourself right so then you do little things like you stop paying attention intentionally stop paying attention to how many drinks you have the easiest way to not get caught in a lie is to be in denial so

lying becomes a huge part of it so usually the then the question becomes how do you become honest how can you learn honesty I love the concept of something called a recovery Circle so recovery Circle starts really small and it is a group of people that you can be completely honest with so often times when I'm working with my patients their recovery circle is me and that's where it starts and then over time you expand your recovery Circle you learn how to be honest you're honest with one person it feels good to have one person

in your life that you don't have to lie to feels relieving it's so scary but it feels amazing and you know we say here in chat I feel personally attacked what does that mean when youall feel personally attacked you feel seen right I see I mean I see what you are and that's good it feels good it hurts it's scary but it feels good and this is where peer support I think is really phenomenal we have things like Alcoholics Anonymous where it's like everyone else is an alcoholic so like I can be honest and they

know they're they understand what it's like and then usually this expands outward right so you start with like one person you start with maybe a sponsor you can go to meetings and you don't start sharing but then you tell one person and you open up to them and then eventually you start sharing and then you start telling some people who are close to you and then eventually your recovery Circle can be the whole world you can go into your job and you can say yeah you guys want to go to happy hour totally fine I'm

fine with just seltzer I've been in recovery for 15 years and like that's cool like I I don't think people the only people who get upset by other people in recovery are people who have addictions and feel bad about not being in recovery subconsciously rule number three is ask for help so what are the things that get in the way of this shame this whole weakness trap right so this is not a process that I I mean even though there's some evidence that shows that people kind of do it on their own we just don't

know right because we we don't measure them because they did it on their own but even on their own may have been with help we don't know right they may have confided in a friend who knows but I just can't tell you how much easier it is with help and a lot of people people think oh if I ask for help I'm weak or like I won't be able to do it on my own or am I just becoming dependent on this person no you're not how can I say that let's just think about it

for a little bit right so when I'm at the gym and I'm you know on my last rep and I have a spotter help me a little bit am I becoming dependent on the spotter no the spotter helping me a little bit means that my muscles are at maximal contraction I fin the rep and they're actually going to grow more the alternative of not using the spotter is that I don't do the rep at all and then my muscles will grow less using help accelerates your growth doesn't impede it now there are some situations where

you can sort of get dependent on help but that is almost never the case because usually the institutions that are good at helping people recognize that so as a psychiatrist I recognize when people are doing work with me towards independence and growth and using me as a crutch and then we address that people in recovery understand this really well see what leads to growth is doing the thing what leads to not growth is not doing the thing now if help means substituting your actions with someone else's actions then you won't grow but if they are

helping you and you are still acting you'll grow it'll work but there are challenges like shame and you know lying and embarrassment and all this kind of stuff rule number four is practice selfcare so I want you all to understand this right so addiction is environment plus you and you can focus on the environment and you can focus on you you really have to do both but as long as your brain your frontal loes are spending all their willpower you know I don't let me do that one differently so if you're if you're not sleeping

every day and you don't have enough willpower to resist the addiction that's going to be a problem if you don't eat properly then your brain is going to be using a lot of energy to suppress those hunger signals and then you won't have much energy left over to resist your addiction if you are living in a situation that is toxic if you have friends who are not really friends of yours if you are in an abusive relationship all of those things will add negative emotional energy and will drain your willpower it'll be way harder to

resist so you must take care of yourself addiction is very hard to beat in general so you might as well optimize yourself if you want to increase your chances of success and so a big part of what I teach is self-care go to yoga go to meditation do that stuff take care of your diet because it's going to be hard enough even without all that stuff give yourself every chance of success last rule most important rule is don't bend the rules right so the first rule of Fight Club is and the last rule of addiction

recovery is don't bend the rules see the moment that you start bending the rules the addiction can leak in I want youall to think about addiction is a poisonous gas that will fill whatever container you give it if you have a crack in the wall it'll slip through it right we gave you all a couple of examples of like oh I deserve it it'll use whatever it can oh you're ashamed of yourself you're pathetic you might as well use you're not worth it you deserve to destroy your life you feel weak you want to be

strong oh yeah don't get help be strong you want to be strong that's great let's go with that plan just do it all yourself you don't need to change your life oh it's too hard to change your life it's too much work to change your life oh you're feeling tired today and you're feeling like you can't do this forever thank God because you can't do it forever oh do you want 40 years of this no you don't nobody wants 40 years of this come back to me baby at least with me every day wasn't bad

if you're going to have a shitty life you might as well have the upsides by getting high every now and then don't bend the rules and recognize that as long as you stick with that the thalamus and the nucleus accumbens in the amydala in the lyic system have nowhere to run they have nowhere to act if a rule is a rule and it is impervious then you become impervious no means no I've been sober for a year I deserve it no means no sure I deserve it but I'm not going to do that and if

you focus on building the rule B I mean if you focus on not bending the rules that'll strengthen your frontal loes and it helps align your frontal loes since we're somewhat deficient in planning and executing tasks and predicting errors that's why we need to be stupid about it because the other dangerous thing that I often times see is that the worst addictions happen to the smartest people because the addiction turns the brain against you and so the more powerful the brain is it's like if I'm going to cast mind control on an enemy do I

want to use a level 60 enemy or a level what two enemy so when addiction casts mind control on you on a level 60 brain it's going to be way harder to beat that's why you need steer steadiness resilience unbending you can be weak you don't have to be strong we're just not going to bend the rules so I hope this has been helpful there's a lot more to say um so much more to say like I can't reduce a decade of work into two hours and at the same time for those of y'all that

are struggling with an addiction I really hope that this overview with hopefully a couple of nuggets can help yall go in the right direction so one thing I wanted to mention so I'll tell you guys how I wrote this um so I started working on this deep dive to addiction and it ended up being way longer than I could share so we're going to do our second Workshop second Workshop ever at HG on addictions it's going to be November 9th to 10th from 11 to 3 PS uh CST what does the addiction Workshop include couple

of things so it's going to go into more detail about a lot of the stuff that we talked about today there are lots of topics that we didn't get into go into so things like the difference between behavioral addictions and substance use disorders specifically other circuits of the brain that are affected by things like pornography so there's some circuits of the brain that we left out half of the workshop so the workshop is divided into two days day one is going to be a lot like today where it's like understanding so understanding Neuroscience Understanding Psychology

understanding physiology understanding different kinds of substances different kinds of Behavioral addictions day two is all about plan what to do what to do what to do what to do and broken down into lots of different formats so things like the rules for addiction but also like a 12-step plan which is not regular 12-step it's like breaking down all of the things that we talked about into a more actionable plan so what does environmental change mean what does working on dormant emotions mean what how do you emotionally regulate all that stuff um a couple of things

about it so this is a one time thing it's being done live and spots are limited there are a couple of things um the price tag is high our last price it's same as our last Workshop so a couple of just quick heads up about this stuff so our last Workshop filled up in about 24 hours um nine out of 10 people at the end of the workshop said I'm ready to sign up for your next one I don't even care what it is so it was an incredibly positive experience for most of the people

it's different because it's live so it's like there's time for Q&A and all that kind of stuff but it's it's really just a different kind of experience now y'all may be wondering why didn't we repeat it or why don't we hold more or things like that and that's because it's awesome but it also is limited in terms of its AOE so last time what we did and one of the other reasons that the price tag is what it is is that it funds us so we offer guides to mental health that are actually like more

in terms of hours and cost like 30 bucks and so part of the the good news is that these workshops they really fuel what we do it's a different kind of experience and you know sometimes you know we we wondered people keep on asking hey are you going to can we do an on demand version and things like that we we always consider that right because there's like if it's such a great experience should we make it more available to people and things like that but part of what makes the experience is that it's live

right so y all should show up and be prepared to take notes because we're going to go through it once and I think that changes the energy of the workshop is just different there's a certain luxury to being able to okay Dr K I have to go do something else and so I'm going to leave but people show up they're there to do the work we're going to do the work I'm going to I've worked really hard at it I've been scripting this out and putting this Workshop so it didn't start out as a workshop

by the way it started out as this stream and as I was making the stream I was like okay but then we got to add this and then we got to add this and then we got to add this and then we got to add this and then I was like you know can I just teach people from start to finish like basically the most important stuff that I know about addiction and also part of the problem that we and and make half of it like the plan like what to do to Tunnel down into

each of these things and explain how to do it so that's what the workshop is um we don't do them very frequently I think we did our last one like maybe 18 months ago or something like that and from a financial perspective it's like good for us but it doesn't quite I mean we really try to use it to fund particular things that we're building which is usually what our attitude here is so instead of taking capital investment or relying on donations or asking youall to do subathon or whatever like you know we're going to

offer something that we think is high value we're going to ask for money and then we're going to create thousands of hours of free stuff with the money that you give us so it's going to be held once at this point we never repeated the other one I don't know when the next one is going to be if you all are interested sign up let's get to Q&A what questions do yall have I'm working on two books someone asked about will I ever write books oh my God there's so many so someone's asking question how

did you gain later without it becoming addicting again great question so let's understand a couple of things so remember that an addiction requires giving pleasure and taking away pain an addiction requires activation of all kinds of neuros circuitry the short answer is I dealt with my dormant emotions I found a purpose in life so right now I could be playing a video game why am I not playing a video game because this is more important to me so I stopped using games as a source of emotional regulation when I feel bad about something I go

for a walk I started engaging in a lot of self-care started meditating a lot right so this is what I mean everyone thinks about addiction is I have this thing that I can't control and I lose the willpower battle against this thing but you can dismantle that addiction like One Table leg at a time and it'll just tip over and fall especially with the behavioral addictions substance use addictions with strong genetic predispositions may require abstance but it just became a source of pleasure and Recreation nothing else and when that's what it is then it becomes

healthy so I think sex and love addiction is another good example of this right so a lot of people who get addicted to sex will use it as a substitute for selfworth they use it as their source of feeling accepted by another human being and once those things go away you can have sex in a healthy way you can fall in love in a healthy way how can I know if my overeating is addiction or ADHD impulsivity I would not say how can you know if it's one or the other I think get both so

remember that and this is in the guide to addiction remember that people with ADHD their dopaminergic circuitry is more sensitive right so what that means is that your ADHD impulsivity makes you more vulnerable to cravings and thalamic input makes you more vulnerable to dopam energic reinforcement makes you more vulnerable to prediction errors we know this because ADHD affects the frontal loopes so I don't think it's one or the other it's the intersection of ADHD and by the way the comorbidity between ADHD and addiction is very high so it's probably both and then also in the

ADHD guide we also talk a lot about how ADHD is a very strong risk factor for depression for shame and so that'll fuel the addiction so the two are very intertwined okay let me see um so you were telling me that when I tell myself that I can quit snooze Nico addiction anytime I want I'm lying yes and no so I don't know if you can quit an addiction anytime you want but my point is that quitting an addiction is not a binary decision so this is hopefully yall have taken this away quitting an addiction

involves a hundred steps so can you quit it absolutely it's just about involving like doing to work and so nicotine addiction is a really good example of like we have very good treatments for nicotine addiction what we basically know is there's a medication called uh venin that reduces cravings and then when you use the patch and some kind of acute nicotine supplement like gum or lenes success rates are very high I think 60 or 70% so we have like addiction treatments for nicotine that are very successful but it involves asking for help what's the end

goal the end goal is freedom the end goal is freedom to live life the way it's supposed to be lived instead of living a version of life that is shaped by addiction should you quit it right now why not why not how about quitting SM SM uh smoking cold turkey way so let's understand this um so cold turkey is effective the thing is what determines whether someone who tries to quit cold turkey it works or doesn't work right so a lot of people try cold turkey some people it works and some people it doesn't and

when we say well some people have the willpower this is exactly my point is that having the willpower is a modifiable aspect of your life are you sleeping and eating are you meditating every day are you managing your emotions so often times when I'm working with people who are trying to quit cold turkey we'll do a lot of work before the quit date biggest mistake that a lot of people make when they're trying to quit turkey quit cold turkey is that they try to quit cold turkey now so it's kind of like you know going

on a road trip is a fantastic idea but like you don't need to drop everything you're doing and just go on the road trip now like you can do that but if you plan for a couple of weeks if you start meditating now if you start working with a therapist if you start getting meal prep in order if you start doing all that kind of stuff if you plan out your days then it becomes way easier so you can quit cold turkey but do it when you're ready or at least not when you're ready because

you'll never be ready but pick a date and then prepare for that as much as possible what kind of help should I ask for so I think two or three kinds of help come to mind one is you can go to a psychiatrist or therapist and you can say hey I think I may have an addiction and they'll take it from there the second thing that you can do is go to any kind of peer support recovery meeting Alcoholics Anonymous Narcotics Anonymous computer gaming addicts anonymous and say hi my name is whatever I may I

may have a problem with this kind of addiction that's it yeah so someone's saying I'm having it I'm having a hard hard time finding 12-step groups in my country so I know that there are some virtual 12-step groups but you know that's challenging I think it's like I don't have a clear answer Beyond try to find something that's maybe virtual and outside of your country uh the other actually here's a answer so you know 12-step groups can be started by you so if you're looking for a 12 STP group there's a decent chance that other

people are too and some groups like Refuge recovery or Alcoholics Anonymous will have some kind of chapter support I don't know quite know how that works because I've never really worked on that level but people will often times start one okay questions what about withdrawal from benzo so benzos are very very hard to kick very similar to alcohol um you know they can also be life-threatening so you should really work with a provider like a medical professional to detox off of benzos why is it so difficult to be dependent on them I I don't know

I mean so it depends on the benzo so you know the the pharmaco kinetics and dynamics of different benzo aines work in different ways so withdrawal from Kazaam is very different from withdrawal from alzalam but the short answer is you know why is it so hard because I think they work really well and that makes it hard does anxiety disorder uh disorders like OCD Gad specifically OCD affect addiction difficulty overcoming addiction if so will the meds for these disorders help yeah so there's absolutely intersections between anxiety disorders things like OCD and addiction um and the

short answer is the more things you have generally speaking the harder it is I hate to say that but that's kind of you know I've never heard of the only only thing that I can think of is that there's data that shows that nicotine use improves ulcerative colitis pretty sure that's correct but I can't think of many other things that you know rheumatoid arthritis doesn't make depression easier and depression doesn't make cancer easier like there's like you know the more like a flat tire doesn't make you know a broken windshield any easier generally speaking the

more stuff you have the harder it is to deal with the good news is that we have a really good understanding of that now in Psychiatry so most rehab or the all of the rehabs that I've worked at are are dual diagnosis facilities which means that they are staffed to deal with both problems at the same time and treating the depression absolutely helps the addiction and treating the addiction absolutely helps helps the uh depression all boats rise together so you just kind of kind of tackle everything at once is a fidget like fidgeting with twirling

hair related to addiction yes and no so those are probably a little bit closer to things like tick disorders so there are all kinds of like repetitive movements and things like that it's kind of like an addiction but not really so I don't think for example that twirling your hair has the same neurochemistry involving like shame in the lyic system right or the same thalamic input and all that kind of stuff so I think it's a little bit different probably closer to tick disorders in terms of its how it works in the brain and the

body okay time for one more question um yeah so this was a really really really good point so this is something that we'll cover in the workshop but we just didn't have time to cover so great point to end on so Vladimir is saying I quit smoking after 14 years and drinking after 19 years cold turkey both times confronting and dismantling the positive associations I had with my addictions was critical so we didn't talk about this too explicitly so let's talk about it now for a couple of seconds see the problem with addictions is that

they're Solutions not problems so when I say change your life right and I say everyone wants to have their life without the addiction the problem is that when we look at these substances we see a lot of good right I like being relaxed at parties I like being able to go on a bachelor party and get hammered with my friends I love being able to go to a bar barbecue and have a good time right I love partying with lines of coke like people like this stuff and especially if you look at some of these

fields like Finance it's like it's part of the socialization and people are like well when my boss when the managing director of my firm is like hey you want to do lines of Coke in the bathroom like I can't say no cuz he's the one who determines whether I get $300,000 of bonus this year or $450,000 of bonus this year so those lines Coke are worth $150,000 I've seen it as an addiction psychiatrist like it ain't pretty and you're you're spot on that a big part of this is dismantling the positive associations a big part

of this is the belief that you can't live without your addiction I've seen marriages end in divorce because people are addicted I've also seen marriages end in in divorce because people get sober I've seen relationships that are built on a shared addiction I found someone who won't judge me because they're just as addicted as I am and we're both going to go hard and I love this person so much because this person knows how to go on a bender and they'll protect me if I go too hard they'll keep things in check so there are

a ton of positive associations which are very hard to deal with and those absolutely need to be dismantled really great Point thank youall very much for coming today if yall are interested sign up for the workshop and then um you know most important thing though is that if y'all are struggling with something look at it a little bit CRI really try to understand what's going on ask for help and know that you can live without it that the life that you build without it is probably going to be better it's going to be missing certain

things and even as someone who's a degenerate gamer addict who's gaming in recovery I miss some of the stuff too like going hard in gaming is its own special pleasure there's there's own special pleasure of real just debauchery right when some expansion drops and like I'm going to stay up I'm going to skip all my classes for a week and I'm going to grind to 60 there's something that's fun about that I gave that up and I think the challenge with addiction is that you are giving things up I think the good news is that

you only have to give them up for a while and then you really don't want them anymore you really start to appreciate what you have so good luck y'all take care