Addictions hijack the brain, subduing it until it gives up on its most basic needs. Even eating and drinking — essential for sustaining life — are no longer priorities. But that substance or behavior that generates such brain dysfunction is usually just the symptom of a deeper phenomenon… the tip of the iceberg of a complex network of vulnerability and poor mental health.
Rubén Baler agrees with this assessment. He’s an expert in public health and addiction neuroscience at the United States National Institute on Drug Abuse (NIDA): “We need to worry about what’s important, not just about what’s urgent,” the neuroscientist warns.
Baler, 64, has first-hand familiarity with the dimensions of the public health crisis facing the US, since his job consists of working to address it. And, perhaps precisely for this reason, he’s able to hone in on what’s behind the grotesque figures. It’s not about the substances, but rather the phenomenon behind them. He assures EL PAÍS that there are hidden interests and hands that pull the strings of the dynamics that are harmful to public health. From alcohol and tobacco, to junk food or digital content, “there are increasingly powerful forces that have an interest in these products becoming more and more addictive and popular,” the neuroscientist affirms.
Last week, he spoke with EL PAÍS while visiting Palma de Mallorca, Spain, to participate in the joint congress held by the Spanish Society of Dual Disorders and the World Association on Dual Disorders.
Question. What happens to an addicted brain?
Answer. Actually, it’s very simple. The brain is designed to identify what gives it a natural and healthy reward. When there’s something that increases our chance of survival, a little dopamine is released. [Hence], we learn from the experience and are better equipped for the next time. It’s a very delicate mechanism, which works like a thermostat: between minimum and maximum values. Evolution designed a thermostat that’s regulated by dopamine, which is what regulates reward learning. Now, in the modern world, there are things that can skew the thermostat and push dopamine release values to [unnatural] levels. Say, for instance, if sex takes your dopamine from one to 10, methamphetamines take it to a thousand. But the brain isn’t designed for that. So, if someone takes meth 10 times, the thermostat can break… and, in that case, the only thing that can offer a reward would be more meth. The brain adapts to that. This artificial learning is an addiction.
Q. Why do some brains become addicted and others don’t, when faced with the same behaviors?
TO. Each individual is a universe. This variation manifests itself in different vulnerabilities and [levels of] robustness. Interindividual differences are enormous, due to genes and life experience.
Q. What are the differences when you expose the brain of an adult or a teenager to these harmful substances?
TO. The adolescent brain is being programmed. It’s changing in a very malleable, rapid and dynamic way. All these changes program the circuits to prepare them for life. This programming is like running: any little trip can make us fall, distort the quality of that programming and take us down an unhealthy, harmful path. Drugs can very effectively corrupt the quality of programming.
Q. What are the biggest risks?
TO. One of the most obvious examples is the issue of [hardcore] pornography. In adults, their brain is developed and they have the ability to understand that, while the images are strange, they’re not normal, nor do they lead to healthy or lasting rewards. But a 12, 13, or 14-year-old boy who’s exposed to the same type of pornography could end up with sexual dysfunction, because the brain is programming the circuits that will serve sexual function. [If such material] is absorbed at a critical moment, this could become normalized, making real sex unable to trigger the response that it should, because one’s brain has already been programmed and adapted to bizarre and strange things. That’s why we’re starting to see sexual dysfunctions in younger and younger people.
Q. How have screens and new technologies impacted addictions?
TO. It’s very difficult to say, because science is very careful, very rigorous. It has its methods and its rhythm. And that pace has nothing to do with the technologies that we’re trying to prevent or regulate or understand. There’s a gap between what we can study and what’s relevant from a public health perspective. And that gap creates the potential for a [massive] experiment The possibility of an adverse relationship between some aspects of social media and mental health is so potentially harmful that we have to be much more cautious about what we’re doing. At the very least, we must postpone exposure to screens until [children reach] the age of 16.
Q. When you talk about potentially harmful, are you referring to the risk of addiction to screens?
TO. Yes, because algorithms are addictive. Who invented infinite scrolling? That’s addictive. The algorithms are a dopamine laboratory, which studies how to make these social media platforms more addictive. Especially for kids who gravitate so much towards social comparison — who depend so much on feedback from a community — all of this is extremely addictive and creates habits that are, in many cases, pathological.
Q. What can be done?
TO. We cannot depend on politicians, nor can we wait for scientists to save us. I think the solution is at the local level, in the schools. For now, parents can stop the use of screens in bed, because it affects a child’s sleep. That’s a vicious circle that leads them to get into risky situations… a lack of sleep alters the brain. I don’t understand why kids are allowed to bring devices to class, because that interferes with learning, class dynamics and attention span. It makes no sense.
We have to educate ourselves about how the brain works and [understand] that we’re being taken advantage of. We’re guinea pigs – commodities. Our attention has become a profitable commodity.
Q. For the industry?
TO. Forks. We’re paying a price voluntarily and the decision is up to each one of us. Either we’re zombies and sleepwalkers, or we take the reins of our own lives. Right now, we’re selling our souls to the devil, both our privacy and our brains. I understand how difficult it is, because this little device (he points to his cell phone) is everywhere and we depend on it. But we have to make an effort to see the good and the evil. We must try to take advantage of what it offers us for our well-being, while discarding the harmful effects of these technologies.
Q. At NIDA, you focus on researching drug abuse. Which is the substance that worries you the most?
TO. In adolescents, the prevalence of alcohol is very problematic, especially in cultures in which it’s normalized. It’s an issue not only because it’s addictive, but because alcohol has neurodegenerative properties, producing holes in the brain over prolonged periods of consumption. The problem is that alcohol is combined with the perception of being low-risk — everyone makes it a normative behavior, as if no
thing happens [when you drink]. But something happens.
Q. And what substance concerns you the most when it comes to adults? In the US, there’s a major opioid crisis.
TO. Yes, but what the crisis teaches us is that it’s not about a drug — it’s a phenomenon. [The different drugs] are all symptoms: this epidemic started with prescription drugs (OxyContin, Vicodin, etc.). When we tightened the valve on doctors overprescribing these things, the curve of those prescriptions went down… and the curve of heroin began. When heroin started to rise, traffickers realized they could cut it with something much more powerful: they started creating fentanyl. Hence, synthetic opioids came along. Now, the fourth wave has to do with amphetamines that are cut with heroin and that appear mixed with fentanyl and a new drug — xylazine — which prolongs the psychoactive effects of fentanyl. But these are all symptoms.
We need to worry about what’s important, not just about what’s urgent. Why do people use drugs? What leads them to it? Misery? Hopelessness? Boredom? That’s what needs to be attacked. You have to look for the deep root causes.
Q. And what are they?
TO. There’s a financialization of the economy. There are groups that are very interested in the profitability of businesses: if we talk about junk food, these are industries that produce an incredible amount of profit, but the foods are addictive — they don’t help public health. [Digital content] platforms are addictive. The tobacco, cannabis, or alcohol industries produce enormous amounts of profits. And for the owners, for those who sit at shareholder meetings, the only thing that matters to them is the company’s profits… public health isn’t a priority. And, in that equation, the population will always lose. There are increasingly powerful forces that have an interest in making these products more addictive and popular.
Q. Is capitalism the problem?
TO. No, I think capitalism is the only system that works. I’m not against capitalism, but I’m against this form of overflowing capitalism that apparently has no sense of responsibility towards citizens.
Q. Can brains that have been made ill from addiction be cured? Can you go back to the beginning?
TO. No brain — healthy or sick — goes back to the beginning. If brains are characterized by something, it’s constant change. Learning changes the architecture of the brain, but it can be good or bad learning. And addictions are based on learning through rewards. It’s like riding a bike: can you imagine a situation where you unlearn how to ride a bike? No. Because what was learned that way — with that intensity, in those learning trenches in the brain — cannot be unlearned. Addiction is the same: it will never heal, it won’t go away. The learning trenches are going to stay there. They can be covered with new, better, more passionate, more natural, more evolutionarily appropriate learning… but the trenches are going to remain. That’s why there’s always the risk of relapse.
Translated by Avik Jain Chatlani.
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