crack cocaine addiction

[music] we have threeneuroscientists...who are here. we'll call the first one, dr. judson brewer of the center ofmindfulness of umass medical. judson... welcome to le web... thank you. it's great to be here. let's get started. now, let's just think ofthe magnitude of the problem. my lab studies addictions.and if you take two addictions,

smoking and behavioral overeating,this accounts in the us for nearly half of the drivers ofhealthcare cost, half of them. now, you can't cure cancer withblood pressure medications, right? you can't cure cancer withblood pressure medications, and you can't fix behavioraladdictions by holding hands and singing kumbaya. so[laugh] what we're looking at is, what's the root of the problem, what's themechanism behind behavioral addictions, and how can we use things likemindfulness to help treat them?

so let's go through this together. i thought we could start with:why facebook is like crack cocaine... move on to mcdonald's... go on to how lolojones could have won the gold medal... and finish up with how we can all becomea buddha in nine minutes, and perhaps quit smoking as well. all right, so that'sa lot to do. let's see what we can do. so let's start with facebook.how are you feeling? now it turns out, when neuroscientists at harvard gavepeople the choice to self-disclose, or to earn money, while they scanned theirbrains, guess what they chose to do? that's right... talk about themselves...and it turns out that when

people talk about themselves, itactivates the reward parts of your brain. the one that that is arrow is pointedto is called the nucleus accumbens, the same part of the brain that getsactivated when you smoke crack cocaine. and another study showed that youcan actually predict the amount of time that people spend on facebook bythe amount that the nucleus accumbens gets activated when they self-disclose. okay, i took this picture atthe louvre a couple of days ago. for those of you that aren't familiar withone of the top 25 inventions of 2014, you can buy a selfie stick and takepictures of yourself. i love this picture

because the boyfriend is standing there,and he's been replaced by the selfie stick. >> [audience laughter]>> [laugh] so, let's go through this together. you're at the louvre, you think,oh, this is a great picture. i'm going to take a picture of myself andpost it to facebook. this is going to be great. and you think about all the likes that you'regoing to get, and all the comments, and how everybody's going to be jealous thatyou're in paris. so you take a picture, and you post it to facebook, and you getall these likes. and it feels really good,

and your brain says, yeah, do that again.[laugh] well, it turns out that this is one of the most evolutionarily conserved brainprocesses. it turns out that if you go back to the most primitive neuron system,the aplysia, the sea slug, with only 20,000 neurons, the sea sluglearns the same way that people learn when they're taking selfies at the louvre.basically, you do something, it makes you feel good, you get an urge tomake that good feeling continue, you lay down a memory, and then this reinforcesit. you probably all heard of positive and negative reinforcement, because this samething happens with negative reinforcement.

you do something unpleasant, you getyelled at by your boss, you have an urge to make that go away... you go out fora smoke, or you eat a good snack or some chocolate, you feel better andyou learn, oh, if i just eat chocolate, i'll feel better.now, typical treatments say, well, okay, you just avoid these things.so if you drink alcohol, avoid the bars. and if you smoke cigarettes, maybe youshould just eat carrot sticks instead. so you can actually target these pathways.well, it's interesting, these don't work particularly well.70% of smokers want to quit--it takes up to six quit attempts, and only5% stay abstinent at the end of a year.

so this is a very, very reinforcedprocess that's very hard... this behavior is very hard to change.now, it turns out that 2,500 years ago the buddhist psychologistsdescribed the exact same process, and they described it this way. they said,things get interpreted by the mind. they're either pleasant or unpleasant. wehave an urge for the pleasant to continue. we want to hold on to that stuff.we want the unpleasant to go away. we do a behavior to make those thingshappen. and then we lay down this self. we get a self identity. and the problem isthat this process reinforces itself. for those of you that aren't familiar with it,it's described as samsara. the literal

translation of this is endless wandering,because it's just self-reinforcing, and the problem is, with this skewed view,when we start seeing the world this way, and we start getting attached to thesethings, it just goes on and on and on. they described this, they said,just as a tree, though cut down, can grow again and again if its rootsare undamaged and strong, in the same way, if the roots of craving are not whollyuprooted, sorrows will come again and again. i like this modern-day interpretation a little bit more. now you get the idea. so, now on to oursecond one. well, the food industry says,

oh, evolutionary conserved process,we can make tons of money. we're actually going to flaunt this.so mcdonald's, they're after it... they craft their food to your craving.kellogg's cereal in the us now, they now have krave cereal. andif milk chocolate krave isn't good enough, don't worry, there's doublechocolate krave. and, of course, we all know where this leads...okay, so on to how we can work with this problem. westart to understand what the mechanism is, what can we do about it? now, mindfulnesshas become much more popular over the last couple of years. what actually is it? soyou can think of this as paying attention.

okay, we're paying attention, butwe're bringing a quality of our awareness to this experience. sowe're bringing an openness, a curiosity... we're not saying, oh, i know how this isgoing to go, or i don't like this, or i want this to go away... we're justgoing to see what we can do to work with the situation. andmindfulness is at least theorized to come in, andinstead of helping people avoid things or substitute, actually drive this wedgeof awareness in-between the craving, that urge to act, and the actual behavior.so let's see if this is actually true. now, it's been shownempirically to be helpful for

a number of conditions. just listinga few here--anxiety, depression, pain... my lab has done some work with addiction,even boosting of the immune system, and helping people score better ontheir graduate record exams, if you want to graduate school. buthow does actually paying attention work? does it actually helpyou change these very deep-seated behaviors?does paying attention, just by itself, actually do anything? so what we actuallydo in our smoking treatment is to have people smoke mindfully. that's thefirst exercise that they get. and the idea here is, when you really pay attention towhat you're doing, you see what you get.

and if it's helpful, you keep doing it,and if you don't, you stop doing it. here's an example from somebody with herfirst mindful smoking exercise. she said, smells like stinky cheese. she's obviouslynot french. smells like stinky cheese and tastes like chemicals. yuck! and the idea here is, she starts to seewhat she's actually getting in this moment from smoking. she doesn't have to thinkabout it. she knows smoking's not good for her. but in this moment, she sees, oh,this isn't actually as good as i thought it was. so we took this, we did somerandomized clinical trials, and found mindfulness training was actuallytwice as good as gold standard treatment

in the us for smoking cessation.we had twice as good. this is on the level with some of the best medicationsout there. and the effects lasted. at our four-month follow-up, they werestill largely, they had maintained their abstinence. so this was pretty good. we'reseeing a behavioral signal that you can't argue with, they either have quit or theyhaven't quit. so we ask ourselves, well, what's actually going on mechanistically?and the hypothesis is, that if craving is a fire and smoking is the fuel forthat fire, if you stop adding the fuel, that fire should be there fora bit but eventually die down. and we studied this mathematically, i won't gothrough all the details... but, basically,

you get a strong correlation betweencraving and smoking at the beginning of treatment. this is completelygone at the end of treatment. and if you do all the fancy math,it has nothing to do with craving, it has nothing to do with cigarette use...it's the amount of informal mindfulness practice that peopledo that decouples craving and smoking, and we can even see this in the raw data.if you look at the end of treatment, same level of craving for the peoplethat quit and the people that don't. and for the people that quit,their craving dies off over time. so that's really interesting.

it seems that mindfulness isactually driving this wedge in here. we can see this mathematically. we cansee this behaviorally, and importantly, we can start to get it to psychologicalmechanisms of how it's working. okay, so then how do we disseminate this?so, training a lot of people to facilitate mindfulness trainingis expensive, it's not scalable, so we turn to the technology. and we said,okay, let's develop an app that can actually deliver this at the point ofcontact. and this is really important, because context-dependent learningis where people learn to smoke. they don't learn to smoke intheir therapist's office.

they don't learn to smoke in the hospital.they learn to smoke in their car, on their front porch, outside of work.and so, we put this manualized training together in 21 days of modules,where they can get daily playlists. they can have animations that helpwalk them through the core concepts. they can pair this with in-the-momentexercises. and they can even...we can collect data through experiencesampling to make sure that it works. we can also pair this with an onlinecommunity where they have access to me as the addiction psychiatrist,to peers, they can tell their stories, they can learn from each other,we can crowdsource this... so

just to show you a quick video that kindof shows how this all fits together. >> welcome to craving to quit, athree-week program that will help you quit smoking. this training delivered liveat yale university has been shown to be twice as effective as otherquit smoking therapies. now i'll walk you through the basicidea about how habits are formed. first, recognize that the wanting orcraving is coming on, and relax into it. >> now, it also turns out that sugaris more addictive than cocaine, and so our next app is going to be an eatingapp that'll come out early next year. more addictive than cocaine, which makessense because that's how this process was

set up, so we'd remember where food is.okay, so now let's get on to what's actually going on in the brain,and i'll start with a story. so lolo jones was an olympic hurdler...she was favored to win the 2008 olympics. in fact, she was in the finals, inthe lead at the ninth of ten hurdles. and what she said in an interview withtime magazine was, i was in the middle of a race, and at one point i realized iwas winning. and it wasn't like, oh, i'm about to win the olympic goldmedal--it just seemed like another race. and then at a point after that, i startedto notice that i was telling myself to make sure my legs were snapping out.that's when i hit the hurdle. so

i overtried. now, the idea here, it wasn't that she had thoughts, it's thatshe got caught up in thinking, right? she got caught up, she tripped herself up, literally. and it turns out[laugh] that this is a pretty common process. about half the time of the day,we're actually spent either daydreaming or getting caught up in ourexperience. and you can think of this as a continuum--daydreaming, stress, and,of course, the far end is addiction. and because we do this so much, we canactually study this in the brain, and it's

now aptly called the default mode network,because this is what we default to. and i'm going to highlighta particular part of the brain called the posterior cingulate, which you can see here in the backof the brain... which turns out, when you look at all the data, thereare a bunch of different things that will activate the posterior cingulate--whenwe're thinking about ourselves, when we're mind-wandering, when we'rethinking about the past and future, judging things... when we're thinkingabout ourselves in social situation, liking choices that we've made,when it's involved in prevention goals,

immoral behavior...i'm just going through this large list... and finally, of course, craving.what do all of these have in common? what does this brain region actually do?the idea is that this brain region gets activated when we get caught up inour experience. and, of course, with mindfulness training, the idea is tonotice what that feels like and to let go. so let's see if this is actually true.we did a study a couple of years ago where we took novice and experiencedmediators, and we scanned their brains while they were meditating. and wehad them do a number of different types of meditation to see what was common amongstall these different meditation practices.

and as you can see here,these two regions, these two main regions ofthe default mode network, are both deactivated in experiencedmediators compared to novices. so this was interesting, it wasrelatively novel. we didn't believe it. we wanted to see if we couldactually prove this more thoroughly. so we followed... this is actuallya technique that christopher decharms really piloted, and he'll talka little more about it in his talk, but the idea is that we can take real timeneural feedback to bring the subjective experience together,with brain activity. and we can

give people feedback of their ownbrains while their meditating. and this is what a typical graphlooks like. and the idea is, people can meditate with their eyes open,letting the graph rest in the background. and then they can check in from timeto time to see if it correlates with their experience of getting in their ownway, as well as when they're meditating, when they're concentrating on theirbreath. and our studies show that we have a very good correlation between this graphand people's subjective experience. now, that was a novice.here's an experienced meditator. now, i'm not very good at statistics,[laugh]

but i can tell the difference between these two people's brains. i'll justwalk you through what this looks like. here's a novice.these are three minute runs, so he says there's nothing special here.nothing special here, reporting that it was lining up with hisexperience. in his third run he said, i don't think your feedback works, becausei was thinking about my breath, and it was going red.so there must be something wrong here. and the very next run, his brain lookedcompletely different, and he said, oh, i get it...feeling the physical sensationof my breath rather than thinking about

it. sohe'd actually use this as neural feedback, even though this wasn't the experiment.now, i'll just walk you through how we can takethese data and bring them together so we can learn even more about what thesespecific brain regions are doing. here's an experienced meditatorgoing through the experiment. and after each, these are one-minute runsnow, they're describing their experience. and he said, i caught myself. i was tryingto guess when the words were going to end, and when the meditationwas going to begin. so i was trying to be like,ready, set, go. and

then there was an additional word thatpopped up, and i was like, oh, shit, and there's that red spike you see there. andthen i sort of immediately settled in and i was really getting into it. and theni thought, oh my gosh, this is amazing, it's describing exactly what i'm saying,and then you see this red spike. andi was like, okay, don't get distracted, and i got back into it and we got blueagain. and i was like, oh my gosh, this is unbelievable! it's doing exactly[laugh] what my mind's doing. so he was laughing at this point, and he said, so i find itreally funny because that's to the next

question. that's a perfect map, of what mymind was going through. that's a perfect map of what my mind was going through. so,what exactly was his mind going through? we can take all of these datafrom all these novice and experienced meditators, and bring themtogether, and, in a data-driven fashion, we can figure out what exactlythis brain region is doing. and we can confirm what other peoplehave found. so, when you're distracted, when you're thinking about yourself,the posterior cingulate gets activated. and you can see that here in this wholeline of distracted awareness. but we also found a new category, wherethey were describing controlling things,

trying to, effort, or when they'rediscontent, there was something that we hadn't noticed before. with deactivationof the posterior cingulate, again, when people are concentrated, theposterior cingulate gets deactivated, we know this already, but there's this wholeother category that came out as well. this effortless doing,when people weren't efforting... i'll give you a couple of examples.so this person said, i was worried that i wasn't usingthe graph as an object of meditation. so i tried to look at it harder, and[laugh] somehow pay attention more to it.

of course, it went red. harder, ahh,pay attention to it a little bit more... so here's some examples of deactivation.the first one, toward the middle, i had some thoughts which i don't seein the graph, maybe because i just let them flow by. the second personnoticed that, the more i relaxed and stopped even trying to do anything,the bluer it went. stopped trying... ahh, yoda... no, try not.do or do not, there is no try. so we're getting at this sense of flow. for thoseof you that aren't familiar with this, mihaly csikszentmihalyi' described thisseveral decades ago, as this mental state where we're fully immersed in the present,totally energized, we're selfless,

it's effortless... we're just, we're justdoing it. you can think of, you know, sports figures like michael jordan orother folks that are just really in it, and it just seems completely effortless.this is flow. and we even [laugh] had some exampleswhere experienced meditators were reporting getting intoflow in our scanner, and that this was correlating withdecreased activity in their posterior cingulate cortex.so this is pretty interesting. now, just to finish,we can take what we know mechanistically, we can think about what we know about thepsychological mechanisms behind addiction.

we can look at the exact pathways,and we can take targeted things like mindfulness that targetthe key components of the pathways, so we can target craving.we can help people work through craving so they can literally changethese addictions that are so hard to quit. we can take that,we can pair that with delivery platforms, like i showed you with the app plus onlinecommunity, in ways that are scalable, that are cost effective, andcan help reduce this healthcare burden that the world is feeling more and moreof. and eventually we can start to pair these scalable technologies with neuralfeedback, where we can give people

specific feedback from their brain regionsthat are associated with mindfulness. for example, we can give them this mentalmirror. it's not going to meditate or teach them, you know, for them, but it'sgoing to show them whether they're doing it correctly. and what we know as humansis that we learn the most, we learn most effectively through feedback. so, theseare just some examples of this new era, at least that we're working in, in termsof craving and addiction treatment. so i will stop there, andthank you very much for your attention. >> [applause]