>>> PRODUCTION FUNDING FOR "QED WITH DR. B" IS PROVIDED BY -- AMERICAN ELECTRIC POWER FOUNDATION.

BOUNDLESS ENERGY FOR BRIGHTER FUTURES.

AND BY VIEWERS LIKE YOU.

THANK YOU.

>> I'M DR. FREDERIC BERTLEY, IMMUNOLOGIST AND EDUCATOR.

SCIENCE IS EVERYWHERE AND FOR EVERYONE.

AND IT'S ALL AROUND US, SHAPING OUR LIVES EVERY SINGLE DAY.

IN THIS SERIES, WE'LL LOOK AT CUTTING-EDGE RESEARCH, TALK TO THE SCIENTISTS WHO ARE CHARTING NEW FRONTIERS, AND SOLVING TODAY'S PROBLEMS TO MAKE ALL OUR LIVES BETTER.

WHEN A SCIENTIST OR MATHEMATICIAN DEMONSTRATES A PROOF OF CONCEPT IN THEIR WORK, THEY OFTEN USE THE TERM "QED", QUOD ERAT DEMONSTRANDUM.

THAT ROUGHLY TRANSLATES TO "QUITE EASILY DEMONSTRATED."

WELCOME TO "QED WITH DR.

B."

>>> HEY DR. B.

HOW ARE YOU DOING TODAY?

>> GOOD.

HOW ARE YOU DOING DIANA?

WHAT ARE WE GONNA TALK ABOUT TODAY?

>> TODAY WE'RE GONNA TAKE ANOTHER LOOK AT ADDICTION.

SO, ADDICTION DOESN'T JUST IMPACT INDIVIDUALS.

IT IMPACTS FAMILIES AND WHOLE COMMUNITIES AND SOMETIMES HAS SOME DEVASTATING RESULTS.

SO, I GUESS THE QUESTION IS WHAT ROLE DOES THE ENVIRONMENT PLAY IN ADDICTION?

>> WE OFTEN THINK OF THE ADDICTED INDIVIDUAL, OR MAYBE THEIR FAMILY'S ADDICTED.

BUT, NOW WE CAN SEE IN OUR GREAT NATION THAT THERE ARE POCKETS THROUGHOUT THIS COUNTRY OF COMMUNITIES AND CITIES THAT ARE IMPACTED BY THIS.

IN PARTICULAR, HERE IN OHIO, THIS IS THE EPICENTER OF MANY DIFFERENT CITIES THAT ARE IMPACTED THROUGH ADDICTION.

AND SO, IF WE'RE THINKING ABOUT TREATING IT AND GETTING THROUGH THIS, WE CAN'T JUST LOOK AT THE INDIVIDUAL HERE IN THE FAMILY.

WE HAVE HOLISTICALLY LOOK AT THE COMMUNITY AND THINK ABOUT WHAT ARE THESE RESOURCES WE CAN BRING COLLECTIVELY TO MAKE A POSITIVE IMPACT.

>> AND OUR FIRST GUEST HAS PERSONAL EXPERIENCE ON HOW A WHOLE COMMUNITY CAN BECOME VULNERABLE TO DRUG ADDICTION.

>> THAT'S RIGHT.

YOU'RE TALKING ABOUT DR. CARL HART, NEUROSCIENTIST FROM COLUMBIA UNIVERSITY.

HE LOOKS AT ADDICTION NOT JUST AT THE INDIVIDUAL AND FAMILY LEVEL, BUT REALLY IN THAT GREATER COMMUNITY SPHERE.

>>> TELL US A LITTLE BIT ABOUT YOUR BACKGROUND AND HOW YOUR FIRST GOT INTO NEUROSCIENCE.

>> WELL, I CAME UP IN MIAMI, A PREDOMINANTLY BLACK NEIGHBORHOOD IN THE ë60s, ë70s AND THEN IN THE ë80s, CRACK COCAINE BECAME A BIG DEAL IN THE UNITED STATES.

PARTICULARLY IN CERTAIN BLACK COMMUNITIES.

WE WERE TOLD THAT CRACK COCAINE WAS DESTROYING THE COMMUNITY.

THAT IS ADDICTION TO CRACK COCAINE AND WHAT THAT ADDICTION LED TO.

LIKE HIGH UNEMPLOYMENT RATES, VIOLENCE, CRIMES; ALL OF THESE SORT OF THINGS.

AND I THOUGHT THAT IF I STUDIED THE BRAIN, LEARNING SOMETHING ABOUT HOW DRUGS EFFECT THE BRAIN I COULD CURE DRUG ADDICTION.

SPECIFICALLY, CRACK ADDICTION.

AND IF I COULD CURE CRACK ADDICTION, THEN I COULD SOLVE SOME OF THE PROBLEMS THAT MY COMMUNITY FACED AND THOSE PROBLEMS I BELIEVED TO BE DIRECTLY CAUSED BY CRACK COCAINE.

OF COURSE, OVER THE YEARS I REALIZED THAT IT WASN'T THAT SIMPLE.

AND, I WAS LARGELY WRONG.

>> HMM.

WHAT DO YOU MEAN BY THAT?

>> I THOUGHT THAT CRACK WAS TO BLAME FOR THE PROBLEMS THAT WE SAW IN THE COMMUNITY.

POOR EDUCATION.

LACK OF EMPLOYMENT.

WHEN IN FACT, CRACK WAS NOT TO BLAME.

THOSE PROBLEMS WERE THERE LONG BEFORE CRACK ARRIVED.

CRACK ARRIVED IN THE UNITED STATES ABOUT '85.

THE HIGHEST UNEMPLOYMENT RATES IN THE BLACK COMMUNITY WERE IN 1982, LONG BEFORE CRACK HIT THE STREETS.

AND SO, THE PROBLEMS THAT WE SAW -- SOME OF WHICH WE STILL SEE TODAY, WERE RELATED TO THE SAME OLD THING.

RACISM, PEOPLE BEING SHUT OUT, POOR EDUCATION, POOR HEALTHCARE.

TO WHERE PEOPLE JUST WERE NOT ALLOWED TO PARTICIPATE IN THE MAINSTREAM SOCIETY.

AND WHEN THAT HAPPENS, PEOPLE FIND ALTERNATIVES.

BUT, THAT HAD LITTLE TO DO WITH CRACK AND MORE TO DO WITH THE PSYCHOSOCIAL ENVIRONMENT IN WHICH THE DRUG WAS TAKEN.

BECAUSE CRACK ALSO APPEARED IN THE WHITE COMMUNITY.

AND THEN YOU DIDN'T SEE THE KIND OF DESTRUCTION THAT YOU SAW ON THE BLACK COMMUNITIES.

CRACK WAS NOT THE CAUSE.

CRACK WAS AN ILLUMINATOR.

>> IS THERE SOMETHING YOU WISH FOR THE GENERAL PUBLIC TO BETTER UNDERSTAND ABOUT ADDICTION?

>> THREE TO 30% OF PEOPLE WHO USE DRUGS WILL BECOME ADDICTED.

THAT MEANS THAT THE VAST MAJORITY OF PEOPLE WHO USE DRUGS WON'T BECOME ADDICTED.

THE VAST MAJORITY OF PEOPLE WHO USE ANY DRUG IS NOT BECOMING ADDICTED.

AND THAT TELLS US THAT WE MUST LOOK BEYOND THE DRUG WHEN WE'RE TRYING TO HELP THOSE WHO DO BECOME ADDICTED.

IT'S NOT ABOUT THE DRUG.

IT'S MORE ABOUT THE PSYCHOSOCIAL ENVIRONMENT IN WHICH THE DRUG USE TAKES PLACE.

SO, THAT MEANS WE HAVE TO LOOK AT THE WHOLE PERSON TO UNDERSTAND THE FACTORS THAT ARE MEDIATING THAT PERSON'S ADDICTIVE BEHAVIORS.

ONCE WE DO THAT, THEN WE CAN TARGET OUR TREATMENT.

FOR EXAMPLE -- A PERSON WHO HAS CO-OCCURRING DEPRESSION AND THEY ARE TREATING THEIR DEPRESSION WITH SOMETHING LIKE COCAINE -- THAT PERSON'S TREATMENT WILL LOOK DIFFERENTLY FROM THE PERSON'S TREATMENT WHO IS SOME YOUNG PERSON WHO DOESN'T REALLY UNDERSTAND HOW TO INHIBIT THEIR BEHAVIORS SO WE CAN TARGET PRECISELY THE FACTORS THAT ARE MEDIATING THE PERSON'S ADDICTION.

>> THERE ARE TIMES WHERE DESPITE ALL THE BEST EFFORTS, THEY STILL STRUGGLE TO QUIT.

BEST KNOW?

>> YEAH, SO IF WE'RE STARTING FROM THE LANGUAGE, ìWELL, THEY CAN'T QUIT.î WE'VE ALREADY LOST.

IT'S NOT IMPORTANT THAT THEY QUIT.

THE MOST IMPORTANT THING IS THAT THEY GET BETTER.

WE WANT TO MAKE SURE THAT WE STOP THE DISRUPTIONS THAT'S GOING ON IN THEIR LIFE.

WE CAN'T GO INTO IT THINKING THAT THIS IS AN ìACCIDENTS ONLYî SORT OF MOTTO.

NO.

OUR FOCUS SHOULD BE ON HELPING THE PERSON AND WHAT THEY'RE USING IS NOT AS IMPORTANT OF COURSE, IF WE ARE CONCERNED IF THEY'RE PUTTING THEMSELVES AT RISK BY GETTING ILLEGAL SUBSTANCES.

BUT, IF THEY NEED A SUBSTANCE, WE SHOULD PROBABLY THINK ABOUT HOW CAN WE GET THEM THE SUBSTANCE THROUGH LEGAL MEANS.

AND THEN WE TARGET THE BEHAVIORS THAT TROUBLE US AND THAT TROUBLE THEM.

>> YOU'RE PASSIONATE ABOUT CREATING POLICIES AROUND DRUG USE THAT ARE BOTH HUMANE AND BASED IN SCIENTIFIC RESEARCH.

CAN YOU TELL US A LITTLE BIT MORE ABOUT THAT?

>> ONE OF THINGS THAT WE DO IN THE UNITED STATES IS THAT WE ARREST PEOPLE FOR WHAT THEY CHOOSE TO PUT IN THEIR BODIES.

EVEN IF THEY'RE NOT BOTHERING ANYONE ELSE.

SO, CAN YOU IMAGINE IF YOU GET ARRESTED FOR PUTTING SUGAR IN YOUR BODY?

THAT'S RIDICULOUS.

SO, THE QUESTION FOR ME IS -- WHY ARE WE ARRESTING PEOPLE FOR PUTTING A DRUG IN THEIR BODY WHEN THEY ARE SEEKING TO HAVE A GOOD TIME, PLEASURE, HAPPINESS, WHATEVER THEY'RE SEEKING.

AND SO, I WOULD LIKE OUR POLICIES TO REFLECT -- ALRIGHT, WE WON'T BE ARRESTING PEOPLE FOR WHAT THEY PUT IN THEIR BODIES.

AS LONG AS THEY ARE NOT BREAKING ANY OTHER LAWS OR BOTHERING OTHER PEOPLE.

YOU STILL HAVE TO SET LIMITS AND WE STILL HAVE LAWS THAT PEOPLE MUST OBEY.

YOU CAN'T ABUSE SOMEONE.

YOU CAN'T ASSAULT PEOPLE.

YOU CAN'T STEAL FROM PEOPLE.

ADDICTION DOESN'T EXCUSE PEOPLE CONFORMING TO THE NORMS OF SOCIETY.

AND THAT'S NOT WHAT I'M SUGGESTING.

I LIKE TO SEE THAT WE IMMEDIATELY STOP ARRESTING PEOPLE FOR WHAT THEY PUT IN THEIR BODIES BECAUSE WHAT IS HAS DONE IS THAT IT HAS ALLOWED OR INCREASED INTERACTIONS BETWEEN THE POLICE AND OVERPOLICED COMMUNITIES -- NAMELY THE BLACK COMMUNITY.

AND THAT'S AN IMPORTANT TOOL THAT'S BEING USED TO SUBJUGATE SPECIFIC POPULATIONS IN OUR COUNTRY.

ANOTHER SORT OF POLICY -- SORT OF RECOMMENDATION THAT I HAVE IS THAT -- WHEN I THINK ABOUT DRUGS, ILLICT DRUGS PEOPLE ARE BUYING ON THE STREETS.

I KNOW THAT, THAT'S A POTENTIALLY DEADLY SITUATION BECAUSE THERE ARE NO QUALITY CONTROLS ON THE STREETS, SO PEOPLE MAY GET DRUGS THAT ARE TAINTED WITH POISONS, OTHER TOXCINS, THINGS THAT CAN KILL YOU.

NOW, ONE OF THE THINGS THAT WE CAN DO AT A POLICY LEVEL IS THAT WE CAN DEVELOP, IMPLEMENT THESE THINGS CALLED DRUG CHECKING -- WHERE INDIVIDUALS IN A COMMUNITY CAN SUBMIT SMALL SAMPLES OF THEIR DRUG THAT THEY PURCHASED ON THE STREET.

THEY GET A CHEMICAL ANALYSIS, A PRINT-OUT OF WHAT THAT SUBSTANCE CONTAINS.

IF IT CONTAINS A POTENTIAL TOXCIN.

SOMETHING LIKE FENTANYL.

AND THE PERSON REALIZES THAT, THE PERSON WILL NOW KNOW NOT TO TAKE THAT SUBSTANCE EVEN IF THEY DECIDE TO TAKE THE SUBSTANCE, THEY WILL KNOW NOT TO TAKE SO MUCH OF THE SUBSTANCE, AND TAKE SMALLER AMOUNTS THAN THEY WOULD HAVE NORMALLY TAKEN.

THAT'S LIFESAVING.

THEY SEE THESE IN PLACES LIKE SPAIN, AUSTRIA, PORTUGAL, THE NETHERLANDS -- WHERE THESE SERVICES EXIST.

WHAT'S IMPORTANT IS THAT THEY DON'T HAVE THE OVERDOSE RATES THAT WE HAVE IN THE UNITED STATES.

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>> WHAT I REALLY LIKED ABOUT WHAT DR. HART SAID IS THAT, ìQUITTING ISN'T THE PRIMARY GOAL FOR ADDICTS, IT'S HELPING THEM TO GET BETTER.î RIGHT.

DR. HART'S SUGGESTING SOME BIG CHANGES TO THE CURRENT SYSTEM.

YOU KNOW, MAYBE WE REALLY NEED TO SHAKE UP HOW WE PERCEIVE AND HOW WE LOOK AT DEALING WITH ADDICTION.

RIGHT?

IF YOU THINK OF WHERE TECHNOLOGY'S TAKING US, WE MOVE FORWARD IN THE MEDICAL AND HEALTHCARE SYSTEM FROM A TECHNOLOGICAL STANDPOINT, IN INCREDIBLE WAYS.

WE NEED TO THINK AND AGGREGATE ALL OF THESE AMAZING RESOURCES AND APPLY IT TO THIS THING CALLED ADDICTION BECAUSE WE'RE USING ANTIQUATED TOOLS TO DEAL WITH A 21st CENTURY PROBLEM.

WE KNOW IT'S NO LONGER THE INDIVIDUAL OR JUST A FAMILY.

WE KNOW IT'S THE COMMUNITY.

WE KNOW IT'S NOT JUST -- A GENETIC FACTOR, BUT THERE'S SOCIAL CIRCUMSTANCES AND ENVIRONMENTAL FACTORS.

WELL, ALL OF THESE THINGS ADD UP TO MANY MORE TOOLS THAT WE KNOW FROM SCIENCE, FROM SOCIAL SCIENCE TO BETTER DEAL WITH THIS, AND WE NEED TO BRING THEM TOGETHER.

AND MOST IMPORTANTLY, WE NEED TO LOOK AT OTHER NATIONS THAT GOT IT RIGHT.

THERE ARE EXAMPLES OUTSIDE UNITED STATES OF PEOPLE DOING CUTTING-EDGE THINGS TO IMPACT POSITIVELY THE ISSUES OF ADDICTION THAT FRANKLY, AFFLICT THE ENTIRE PLANET.

>> AND DR. B, SOME TREATMENT PROGRAMS USE MEDICATIONS TO HELP RECOVERING ADDICTS STAY SOBER, LIKE METHADONE.

WHAT'S THE STORY THERE?

>> YEAH, ABSOLUTELY.

YOU'RE TALKING ABOUT THAT INTERSECTION BETWEEN DRUG TREATMENT AND POLICY, AND SO WE MET UP WITH DR. WADE BERRETTINI, PROFESSOR OF PSYCHIATRY AT THE PERELMAN SCHOOL OF MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA.

DR. BERRETTINI KNOWS THE HISTORY OF HOW THESE POLICY CAN CAUSE BREAKTHROUGH MEDICAL TREATMENTS TO BOTH SUCCEED, OR SOMETIMES FAIL.

>> HOW DOES OUR UNDERSTANDING OF SCIENCE IMPACT HOW WE TREAT ADDICTION, AND HOW DO WE THINK ABOUT AND ENFORCE POLICIES?

>> WELL, YOU KNOW -- THE IDEA OF HAVING DATA-DRIVEN POLICY IS A WONDERFUL THING.

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THROUGH DECADES OF PAINSTAKING RESEARCH, WE HAVE DEVELOPED A THREE, AT LEAST, COMPLETELY DIFFERENT TYPES OF MEDICINE THAT ARE ABLE TO HELP PEOPLE WITH OPIOID USE DISORDER -- STAY CLEAN.

AND, THESE MEDICATIONS HAVE BEEN IN USE -- AT LEAST ONE OF THEM, SINCE THE 1970s.

UNFORTUNATELY, THESE SEVERAL MEDICATIONS ARE NOT WIDELY AVAILABLE TO PEOPLE WITH OPIOID USE DISORDER.

FOR EXAMPLE, TREATMENT PROGRAMS FOR OPIOID USE DISORDER TEND TO BE LOCATED IN CITIES, BUT MOST OF AMERICA DOESN'T LIVE IN A CITY, THEY LIVE IN SMALL TOWNS AND RURAL AREAS, AND THAT CAN BE QUITE A BARRIER -- >> SO, WHERE DO WE GO FROM HERE, FROM A TREATMENT STANDPOINT?

>> WELL, THERE IS SEVERAL STEPS THAT WE CAN TAKE THAT WOULD IMPROVE ACCESS TO THESE SEVERAL DIFFERENT TREATMENTS.

REMOVE, LET'S SAY REGULATORY OBSTACLES.

WHEN METHADONE GOT FDA APPROVAL IN THE EARLY 1970s, OUR DRUG ENFORCEMENT AGENCY WAS VERY CONCERNED ABOUT THE IDEA THAT THIS WAS AN OPIOID, WHICH IT IS, SO THEY ESTABLISHED ALL OF THESE REGULATIONS THAT -- ARE REQUIRED, SO A PERSON WITH OPIOID USE DISORDER HAS TO GO TO A FEDERALLY, STATE, AND LOCALLY LICENSED CLINIC.

AND THEY HAVE TO GO THERE EVERYDAY TO GET THAT DAYS DOSE OF METHADONE.

THESE METHADONE CLINICS -- THEY HAVE TO KEEP REALLY EXTENSIVE RECORDS AND ACCOUNT FOR EVERY MILIGRAM OF METHADONE THAT THEY DISPENSE.

IN OTHER COUNTRIES, LIKE CANADA, THIS KIND OF REGULATION DOESN'T EXIST.

AND SO, METHADONE IS REALLY MUCH MORE AVAILABLE TO PEOPLE WITH OPIOID USE DISORDER.

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THERE ARE ALSO REGULATORY BARRIERS TO THE USE OF BUPRENORPHINE.

BUPRENORPHINE IS A WONDERFUL MEDICATION THAT HELPS PEOPLE WITH OPIOID USE DISORDER STAY CLEAN.

ONE OF THE MANY ADVANTAGES OF BUPRENORPHINE OVER METHADONE IS THAT YOU DON'T HAVE TO GO TO THE CLINIC EVERYDAY TO GET IT.

YOU CAN GET AMONGST SUPPLY FROM A QUALIFIED PRESCRIBER.

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THE PROBLEM IS, THERE AREN'T MANY QUALIFIED PRESCRIBERS, SO WE DO NEED -- TO HAVE SOME BETTER DATA-DRIVEN POLICIES AROUND THE PROVISION OF THESE MEDICINES TO HELP PEOPLE STAY CLEAN.

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ANOTHER POLICY, THAT UNTIL RECENTLY USED TO BE A FAIRLY SIGNIFICANT BARRIER WAS THE AVAILABILITY OF NARCAN.

NARCAN IS THIS LIFE-SAVING MEDICATION THAT CAN SAVE PEOPLE FROM OPIOID OVERDOSES.

YOU USED TO HAVE TO GET A PRESCRIPTION IN ORDER TO HAVE NARCAN.

IN MANY STATES, ACROSS THE UNITED STATES, AS A RESPONSE TO THE OPIOID EPIDEMIC, THE STATE DEPARTMENT OF HEALTH -- WE ISSUED A BLANKET PRESCRIPTION FOR ALL THE PHARMACIES IN THAT STATE.

AND ORDERED THAT ANY RESIDENT OF THE STATE COULD GO TO THAT PHARMACY AND PURCHASE THE NARCAN, AND THIS SAVED COUNTLESS LIVES.

CONSIDER THIS SCENARIO.

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WHEN A PERSON BEGINS TO USE AN OPIOID ON A DAILY BASIS, THEY START TO DEVELOP A TOLERANCE, THAT IS -- THEY NEED A HIGHER AND HIGHER DOSE IN ORDER TO ACHIEVE THAT SAME EUPHORIA.

PRETTY SOON, THEY'RE TAKING A DOSE A COUPLE TIMES A DAY THAT WOULD BE LETHAL FOR YOU AND FOR ME.

AND THEN, LET'S SUPPOSE THEY GET CLEAN FOR AWHILE.

AND, THEY HAVE A PERIOD OF ABSTINENCE.

LET'S SAY IT'S A MONTH OR TWO.

THEN, THEY ENCOUNTER SOME STRESSFUL EVENT IN LIFE, AND THEY RELAPSED OPIOID USE.

BUT, IN THE MEANTIME THEY'VE LOST THEIR TOLERANCE.

AND, THEY GO BACK TO USING THEIR USUAL DOSE FROM TWO MONTHS AGO WHICH IS NOW LETHAL.

AND THAT'S HOW SO MANY PEOPLE WITH OPIOID USE DISORDER DIE.

HAVING THE NARCAN AVAILABLE IN THE HOUSEHOLD CAN BE LIFESAVING.

AND SO, THIS IS A POLICY THAT WE'VE CHANGED.

AND, SO NARCAN IS MUCH MORE WIDELY AVAILABLE NOW.

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>> I THOUGHT IT WAS INTERESTING HOW DR. BERRETTINI TALKED ABOUT HOW DRUG TREATMENT CAN BE COMPLICATED BY BUREAUCRACY.

>> LET'S BE FAIR, THERE ARE SOME POLICIES THAT HAVE WORKED OVER THE PAST AND CLEARLY, HAVE SAVED LIVES.

BUT, THERE ARE MANY MORE POLICIES DATING BACK TO THE 70s THAT ARE ANTIQUATED, AND NOT ALLOWING US TO USE 21st CENTURY UNDERSTANDING OF THINGS TO BETTER DEAL WITH THIS.

WE WANT TO MAKE SURE THAT THESE MEDICATIONS CAN ACTUALLY GET TO THE PEOPLE THAT NEED THEM MOST.

>> AND DR. B, WHAT ABOUT RELAPSES?

GETTING SOBER IS HARD ENOUGH, BUT RELAPSING HAS ITS OWN SET OF DYNAMICS, RIGHT?

>> NOT ONLY IS THAT TRUE.

WE DUG INTO THAT BY SPEAKING TO DR. CODY BROOKS, ASSOCIATE PROFESSOR OF PSYCHOLOGY AT DENISON UNIVERSITY -- WHO TELLS US THAT LEARNING AND MEMORY SIGNIFICANTLY INFLUENCE TREATMENT OUTCOMES.

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>> RELAPSES ARE ALMOST IRRESTIBLE.

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CHRONIC DRUG USE IS A COMPLEX EXPERIENCE IN WHICH, FOR MANY USERS, MASSIVE AMOUNTS OF VERY SIMULATING SUBSTANCES ENTER THE NERVOUS SYSTEM, AND CHANGE PERMANENTLY -- THE WAY THAT NEURONAL SYSTEMS ACT.

IN MUCH THE SAME WAY THAT YOU OR I MIGHT ACQUIRE A PERMANENT MEMORY ABOUT SOMETHING ELSE IN OUR LIVES -- WHERE WE LIVE, THE NAMES OF OUR CHILDREN, THINGS LIKE THAT.

AND WE VERY SELDOM FORGET THOSE.

THAT'S THE WAY PERMANENT MEMORIES ARE.

DRUG USE CHANGES THE BRAIN IN A WAY THAT'S FAIRLY ANALOGOUS, WE THINK NOW, TO THE WAY THAT PERMANENT MEMORIES ABOUT OTHER ASPECTS OF LIFE ARE ACQUIRED.

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GOING OFF OF A DRUG DOESN'T NECESSARILY MEAN THAT THE BRAIN RESETS TO THE WAY THAT IT WAS BEFORE PEOPLE STARTING USING DRUGS.

SO, TRYING TO QUIT IS VERY, VERY HARD BECAUSE THE BRAIN IS BASICALLY SAYING, ìHEY, YOU WERE GIVING US THIS STUFF BEFORE, WE STILL NEED IT.î >> AND I THINK THAT'S ONE OF THE REASONS WHY, WHY RELAPSES ARE VERY, VERY COMMON.

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A LOT OF MY RESEARCH SUGGESTS THAT RELAPSES HAPPEN AFTER PEOPLE HAVE PERHAPS TRIED REALLY VIGOROUSLYM, VERY INTENTIONALLY TO SEEK AND GET TREATMENT.

TO LEARN STRATEGIES FOR DEALING WITH THIS CHANGE IN THEIR NERVOUS SYSTEM, AND BRAIN, IN PARTICULAR -- TO COPE.

PEOPLE TEND TO FORGET THOSE THINGS THAT THEY LEARNED DURING TREATMENT, SO WE HAVE A LOT OF DATA THAT SHOWS, YES, PRETTY CLEARLY -- THAT STRESSERS MAKE RELAPSES WORSE.

IN SPITE OF THAT OR IN THE FACE OF THAT, WE'VE ALSO BEEN ABLE TO SHOW PRETTY SYSTEMATICALLY THAT REMINDERS FOR A -- A TREATMENT PHASE IN AN INDIVIDUAL'S LIFE CAN STILL MINIMIZE THE IMPACT OF SOME OF THOSE STRESSERS.

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TREATMENTS DON'T NECESSARILY CURE.

THEY DON'T NECESSARILY, COMPLETELY ILLIMINATE THE REMNANTS OF SOME PROBLEM OR MENTAL ILLNESS THAT PEOPLE HAVE, BUT THEY OVERLAY NEW INFORMATION, NEW STRATEGIES, NEW BEHAVIORS.

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I THNK THERE'S REALLY, SORT OF A CONSTANT STRUGGLE OF TREATMENT, RELAPSE PREVENTION, HARM REDUCTION -- AGAINST THE ORIGINAL ADDICTION PROCESSES.

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WHEN IT COMES TO LAW-MAKING AND LAW ENFORCEMENT, THERE'S PROBABLY A MIDDLE GROUND.

THERE'S PROBABLY A GOLDYLOCKS EFFECT.

FOR MANY YEARS, IT'S MY VIEW THAT THE WAR ON DRUGS HAS BEEN SPENDING BY PROPORTION MORE MONEY THAN IS NECESSARY ON ENFORCEMENT, ON JUDICIAL PROCESSES, ON IMPRISONMENT, INCARCERATION, PRIMATIVE FORMS OF ìREHABILITATION.î I THINK THAT PEOPLE WHO GET CAUGHT UP IN THE JUDICIAL SYSTEM NEED TO BE PRESENTED WITH OPTIONS.

COULD YOU GO TO THIS COMMUNITY PROGRAM?

CHECK OUT OHIO HARM REDUCTION.

WORK WITH A CRISIS INTERVENTION LIST IN OUR COMMUNITY.

WE NEED MORE CRISIS INTERVENTION.

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ONE OPF THE THINGS THAT WE NEED TO GET OVER, AS A SOCIETY, PARTICULARLY IN THIS COUNTRY, IS THESE -- YOU KNOW, NOW REALLY, VERY OUTDATED NOTIONS.

CERTAINLY, IF YOU LOOK AT THE SCIENCE THAT, YOU KNOW -- WE'RE TALKING ABOUT PEOPLE WHO ARE WEAK-WILLED, OR THEY WERE JUST BORN THAT WAY, AND THEY JUST NEED TO SNAP OUT OF IT.

NO, THOSE ARE NOT HELPFUL WAYS TO THINK ABOUT ADDICTION.

THERE ARE NOT HELPFUL WAYS TO HELP PEOPLE TO MANAGE THE CHALLENGES OF ADDICTION.

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I DO THINK IT CAN BE USEFUL FOR EVERYONE TO BE OPENMINDED TO, ìI MIGHT NOT KNOW EVERYTHING I NEED TO KNOW ABOUT THIS PROBLEM IN THE WORLD, ABOUT THIS PERSON RIGHT IN FRONT OF ME WHO STRUGGLES AND HAS CHALLENGES, AND IF I ASK A LITTLE MORE, IF I READ A LITTLE MORE WIDELY, I MIGHT BEGIN TO BE A LITTLE MORE OPEN TO WHAT IS ADDICTION?

WHY IS IT SO HARD?

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>> SO, DR. BROOKS SAID THAT STRESSERS PLAY A HUGE ROLE IN ADDICTION.

AND WHEN THOSE STRESSERS ARE STILL THERE AFTER A PERSON GETS OUT OF TREATMENT, RELAPSE ALMOST INEVITABLY HAPPENS.

>> YOU KNOW, WHAT'S SO INTERESTING IS THAT LEARNING PLAYS A SIGNIFICANT ROLE IN TREATMENT.

SO, WE REVISITED DR. EDMUND GRIFFIN, A HARVARD TRAINED NEUROSCIENTIST AND PHYSICIAN AND ASSISTANT PROFESSOR OF CLINICAL PSYCHIATRY AT COLUMBIA UNIVERSITY.

HE SAYS, ìIT'S NOT ENOUGH TO JUST ILLIMINATE THE ADDICTION.

WE NEED TO REPLACE THAT ADDICTIVE WITH ANOTHER HEALTHIER HABIT.î >> IS THERE SOMETHING YOU WOULD LIKE, YOU KNOW, AS BOTH A ENDING CLINICIAN AND A BASIC SCIENTIST, IS THERE SOMETHIHNG YOU WOULD LIKE THE GENERAL PUBLIC TO BETTER UNDERSTAND ABOUT ADDICTION?

>> OUR BRAINS DON'T DO WELL WITH TURNING THINGS OFF.

AND WHAT I MEAN BY THAT IS, IF YOU STOP THE DRUG, YOU CAN USE WILLPOWER -- KIND OF INHIBITORY CONTROL, GRIT YOUR TEETH, YEAH.

BUT IT IS A LOT EASIER TO START A NEW HABIT, THEN TO BREAK A BAD HABIT.

SO, THE REASON THAT IS SO IMPORTANT IS THAT A LOT OF FOLKS MIGHT GET INTO A CYCLE WHERE THEY STOP THE DRUG, HOORAY, AND THEY DON'T CHANGE ANYTHING ELSE, YEAH?

THEY DON'T REPLACE IT.

THEY DON'T PUT SOMETHING ELSE IN PLACE, AND NOW THEY'RE NOT FEELING JOY.

THEY STOPPED IT, AND THEY THINK EVERYTHING'S GONNA GET BETTER, BUT YOU TAKEN AWAY THE MOST IMPORTANT, TO YOUR BRAIN, AT LEAST, THE MOST IMPORTANT THING, AND THE CAPACITY TO ENJOY OTHER THINGS DOESN'T JUST SNAP BACK.

WE'RE SOCIAL ANIMALS AND THAT PART OF OUR BRAIN, OUR FRONTAL CORTEX IS SO PLASTIC, SO MALEABLE THAT CONNECTIONS WITH OTHERS, REALLY HELPS TO DRIVE THE PROCESS.

LEARNING A NEW BEHAVIOR IS ACCELERATED BY SOCIAL INTERACTION.

AND, I THINK THIS KIND OF -- AMERICAN ETHIC OF GRIT YOUR TEETH AND DO IT IN THE BACK ROOM, AND I BEAT THIS MYSELF, YEAH I THINK THAT IS ILL-ADVISED.

RIGHT?

WE'RE SOCIAL ANIMALS, AND WE DO A LOT BETTER WITH OTHERS.

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>> ALL RIGHT, SO TIME FOR TAKEAWAYS.

MINE IS THAT WE REALLY NEED TO LOOK AT THE WHOLE PERSON WHEN WE'RE ADDRESSING TREATMENTS FOR ADDICTION.

>> ABSOLUTELY.

WHILE THE INDIVIDUAL IS CRITICALLY IMPORTANT, WE NEED TO UNDERSTAND IT'S ABOUT COMMUNITIES AND WE NEED TO WORK WITH COMMUNITIES HOLISTICALLY TO HELP SOLVE THE SITUATION.

THAT'S QUITE EASILY DEMONSTRATED.

ìQED WITH DR. Bî.

JOIN US ON FACEBOOK, INSTAGRAM, AND TWITTER.

AND WE'LL SEE YOU NEX TIME.

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>> PRODUCTION FUNDING FOR ìQED WITH DR. Bî IS PROVIDED BY AMERICAN ELECTRIC POWER FOUNDATION.

BOUNDLESS ENERGY FOR BRIGHTER FUTURES.

AND BY VIEWERS LIKE YOU, THANK YOU.

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