By now, we all know that the opioid crisis and epidemic is out of control. Ninety-one people die every day in this country from overdose. And between 2002 and 2015, the number of deaths from heroin increased by a factor of six. And something about the way that we treat addiction isn’t working, at least not for everyone.
It is a fact that people suffering from addiction have lost free will when it comes to their behavior around drugs, alcohol, food or other reward-system stimulating behaviors. That addiction is a brain-based disease state is a medical, neurobiological reality. But how we relate to that disease — indeed, how we relate to the concept of disease when it comes to addiction — makes an enormous difference for how we treat people with addictions.
So, we tend to think of pretty much everything we do as entirely voluntary. But it turns out that the brain’s default state is really more like a car idling in drive than a car in park. Some of what we think we choose to do is actually things that we have become programmed to do when the brakes are released.
Have you ever joked that your brain was running on autopilot? Guess what? It probably was. OK? And the brain’s autopilot is in a structure called the Striatum.
So the striatum detects emotional and sensory motor conditions and it knows to trigger whatever behavior you have done most often in the past under those same conditions.
Do you know why I became a neuroscientist? Because I wanted to learn what made me tic.
Thank you, thank you. I’ve been wanting to use that one in front of an audience for years.
So in graduate school, I studied genetic factors that orchestrate wiring to the striatum during development. And yes, that is my former license plate.
And for the record, I don’t recommend any PhD student get a license plate with their thesis topic printed on it, unless they’re prepared for their experiments not to work for the next two years.
I eventually did figure it out. So, my experiments were exploring how miswiring in the striatum relates to compulsive behaviors. Meaning, behaviors that are coerced by uncomfortable urges you can’t consciously resist.
So I was really excited when my mice developed this compulsive behavior, where they were rubbing their faces and they couldn’t seem to stop, even when they were wounding themselves. OK, excited is the wrong word, I actually felt terrible for them.
I thought that they had tics, evidence of striatal miswiring. And they were compulsive, but it turned out, on further testing, that these mice showed an aversion to interacting and getting to know other unfamiliar mice. Which was unusual, it was unexpected.
The results implied that the striatum, which, for sure, is involved in compulsive-spectrum disorders, is also involved in human social connection and our ability to — not human social connection, but our ability to connect.
So I delved deeper into a field called social neuroscience. And that is a newer, interdisciplinary field, and there I found reports that linked the striatum not just to social anomalies in mice, but also in people.
As it turns out, the social neurochemistry in the striatum is linked to things you’ve probably already heard of. Like oxytocin, which is that hormone that makes cuddling feel all warm and fuzzy. But it also implicates signaling at opioid receptors. There are naturally occurring opioids in your brain that are deeply linked to social processes.
Experiments with naloxone, which blocks opioid receptors, show us just how essential this opioid-receptor signaling is to social interaction. When people are given naloxone — it’s an ingredient in Narcan, that reverses opioid overdoses to save lives.
But when it’s given to healthy people, it actually interfered with their ability to feel connected to people they already knew and cared about. So, something about not having opioid-receptor binding makes it difficult for us to feel the rewards of social interaction.
Now, for the interest of time, I’ve necessarily gotten rid of some of the scientific details, but briefly, here’s where we’re at.
The effects of social disconnection through opioid receptors, the effects of addictive drugs and the effects of abnormal neurotransmission on involuntary movements and compulsive behaviors all converge in the striatum. And the striatum and opioid signaling in it has been deeply linked with loneliness.
When we don’t have enough signaling at opioid receptors, we can feel alone in a room full of people we care about and love, who love us. Social neuroscientists, like Dr. Cacioppo at the University of Chicago, have discovered that loneliness is very dangerous. And it predisposes people to entire spectrums of physical and mental illnesses.