 So this year's Nobel conference at Gustavus is addiction exploring the science and experience of an equal opportunity condition For over 50 years now. We've ridded the conference in science, but also examine the intersection of science and society As you can imagine, there's a long list of potential topics that encompass the traditional themes neuroscience medicine material science astronomy physics The world is a much different place now than it was in 1895 when Alfred Nobel left his fortune to sponsor the Nobel prizes The boundaries of the disciplines continue to blur and new disciplines have appeared Many of the problems we face are not easily defined by physics chemistry or physiology Addiction is one of these problems Addiction affects every one of us in some way But it can be really hard to define let alone understand on one hand Neuroscience continues to expand our understanding of the biochemical and physiological underpinnings But addiction seems to be more than just a brain disorder. It affects the whole person including their relationships with friends family and co-workers Their problems can cause problems for the community in which they live and the responses that these communities have in the form of laws and Political policies affect the addicted person to complete a feedback loop that could either provide help or further exacerbate the problems It's appropriate then that we should assemble speakers both in neuroscience and medical sociology To help us understand the nature of the problem It's important to ground the discussion in the human element. So moral philosophy should be represented, too and it's also important to include voices from addicts and And finally The conference presents a unique opportunity to bring together experts from various perspectives Experts who probably don't bump into each other that much on the lecture circuit To talk about how we can address addiction in light of what both the physical slash life sciences and social sciences have taught us The 51st Nobel conference will bring all of these elements together for what we think will be a particularly relevant and special conference It's now my pleasure to introduce the chair of the 51st Nobel conference on addiction Dr. Peg O'Connor Dr. O'Connor has a joint appointment with the Gustavus philosophy department and the gender women and sexuality studies program Dr. O'Connor scholarship has engaged issues of addiction and recovery. She was an AA Heckman Fellow at the Hazelden Foundation and one of her blogs Philosophy shaken not stirred appears on the psychology today website. The other appears on the rehabs.com website She has four pieces on addiction appearing in the New York Times and her book life on the rocks Finding meaning and addiction and recovery is currently in press Dr. O'Connor's scholarship is informed by her work with students and with the dean of students on drug and alcohol education programs So please welcome Dr. Peg O'Connor. I'm not going to stand behind the podium I'm going to be free-range peg and I invite any of you if you see me drifting off to one side Give me a gesture. I'm afraid I might fall off So I'm Peg O'Connor. I am trained in moral philosophy That's an important part of what I do and the other important part of me is that I myself am an alcoholic in recovery for a good long time and so this conference to me represents a Depersonal commitment and a professional commitment particularly as it relates to our location and to our student body because my Active alcoholism was during the time when I was a college student primarily and that makes me I think Very attentive to what's happening with our students and some of the changes that I've seen over time And as we think about how we might address that I want to start today by talking about our very cool poster I think this is one of the coolest Nobel posters that I have seen ever and If you look you will see in those little circles various kinds of substances or behaviors either that have been recognized by the American Psychiatric Association as Being addictive or are under the category of being investigated Are they addictive or others that haven't even reached that point yet? But many people would argue for the reality of them. So if you look closely, I I need to look at my screen here We have gambling gambling is a process addiction. That's recognized. I believe we have someone smoking I think that's a regular cigarette and not marijuana, but it could be We have sniffing cocaine. I think we're smoking some meth We have the internet The use of the internet right now is in the category of a behavior requiring further study Whether or not it will be included as a use disorder We have two people embraced in an intimate sort of way because many people are arguing that sex addiction Like gambling is a process addiction that that is real as well next to that I'm squinting. Maybe that's the marijuana is I don't have better vision than mine That's marijuana. Oh, and we have a kitty cat in the house. Hello kitty cat. That's appropriate. We have We have exercise many people argue that exercise can itself become addictive that something that is healthy and adaptive Can become maladaptive and then we also have Alcohol which is in some ways regard as a paradigm case of a use disorder and then we've got various kinds of pills Now if you also look closely, you'll see that all of these When to round they tie around and they tie a person in knots That what may be fun activities or the fun use of substances Over time becomes less fun and it becomes terribly Constricting and it ties a person up. It limits them They give themselves over to whatever these substances or processes are and do we have any students in a Latin class? Any classes this year? So the word addiction comes from the Latin verb a dickie. Oh a dick array That means to give over to yield to dispote to bestow And what does that mean in terms of how we think about addiction? Perhaps that a person bestows her agency her freedom over to these drugs or these substances Such that one is no longer free in a kind of way About the title of our conference Scott and I and others had some really interesting conversations about this addiction exploring the science and Experience of an equal opportunity condition the science has become the dominant paradigm for explaining what addiction is neuroscience brain science in particular The experience what is it like to suffer from an addiction? What is it like to experience perhaps what goes on in our brains? But then how does that manifest itself and our behaviors and our attitudes and in our life views? Equal opportunity condition it can happen to anyone no amount of Educational achievement no amount of money no amount of incredible Family love and security Inoculate someone against an addiction So the title really is meant to show the ways in which None of us is immune from the effects of addiction And that's not to say that all of us could be addicted But I'm sure if we were to do a survey here one of the things that we realized in framing this conference is that Everyone's life is touched by addiction if it's a family member if it's a friend if it's a co-worker If you're living in a dorm with someone so all of us have a stake in this question in this condition and figuring out what it is Now I'll move away from the podium. It makes me nervous behind there Historically addiction has been used or understood as a moral failure of some sort It's thought that addicts possessed a kind of weakness of will and we can go back to everyone's favorite philosopher Aristotle I warned you about that moral philosophy piece Aristotle who argued really that there are two kinds of weaknesses of will in Some people their appetites or desires completely take over everything So appetites and desires run awry. That's one kind of weakness of will Another kind of weakness of will is that we deliberate we have our rational capacity. We know what we should do But at the end we give into those appetites or those desires And what Aristotle talks about is each of us becomes who we are with respect to our moral character by what we do habitually and so when we think about addiction as a habit it Seems that some of us become addicts by what we do over and over and over and over again And for Aristotle that is a kind of moral failure. So we don't so much talk about weakness of will We talk now about a lack of willpower But it's the same sort of picture behind it that some people just are not exercising Their willpower to put the brakes on their use and because they don't do that They are therefore making some kind of choice and then responsibility attaches firmly to them And so we end up with really interesting accounts of Responsibility Attaching to a conception of free choice that it turns out may not be well founded or well grounded at all When we take a look at what happens in severe addiction with people's abilities to make good kinds of decisions The good news is that much of the moral disapproval about addiction is lifting in different ways I'm not going to say that it's now acceptable to be addicted to something but in many ways there seems to be both individually and more collectively a kind of compassion about addiction and That may have to do with our seeing populations becoming addicted that we never thought what someone like that could become Addicted one of the things we know is that addiction rates among the elderly is starting to increase a good deal Partly that has to do with prescription medications Partly that it has to do with increased alcohol use because perhaps many older people are living alone They're isolated. They're lonely in general people start to use for reasons And those reasons may be good and those Reasons and the use may make someone feel better for a while, but then go back to that graphic up there What feels really good over here doing it to this amount as you progressively do more and more and more Becomes more and more harmful, but then you're caught in a kind of feedback loop. We think about addiction actually that term doesn't appear in the Diagnostic and statistical manual edition five, which is really the Bible of the psychiatric association Instead we now talk about everything as a disorder. So we talk about substance use disorders And there are eight of them alcohol tobacco marijuana are the most common forms of them Stimulants sedatives Opioids hallucinogen and inhalants. Those are the eight categories. I think I hit eight. I wasn't counting on my fingers If I missed one I apologize The best numbers indicate that about 26 million US citizens are addicted the bulk alcohol Then tobacco and then marijuana 25 million people When you think about that number, it's rather mind-boggling and when you think about some of the related health concerns That arise with certain kinds of usages over time. It becomes even more frightening Now one of the two of the speakers that we have coming Eric and Denise Kandel Have done incredibly important work with respect to the brain Eric Kandel in particular a lot of his early work was about neurotransmitters and also about memory and Eric Kandel has now been working with his wife dr. Denise Kandel who is also one of our speakers About the molecular Basis for what Denise Kandel identified as the gateway drug hypothesis have people heard That that's the idea gateway is a word that doesn't maybe resonate with the younger crowd if I said on ramp Maybe that would get you there the idea that Young people or any people start using one type of drug and then whether by habit or now What Denise and Eric Kandel are looking at the molecular basis for it that those drugs in some ways prime the pump For the use of other kinds of drugs now. It's a fascinating hypothesis Here are some of the things we know Inhalants are used by young children what's included as inhalants shoe polish magic marker spray paint glue That you have kids 11 and 12 years old who are sniffing them And getting a high off them and now some might say if you've got that noted that that picture of habituation Well, you get used to looking for those sorts of highs or it's something fun to do with friends It's like hey, I've got a new can of spray paint What do you got the other thing that we see is that young kids are both smoking cigarettes Even though you're supposed to show an ID to get cigarettes, but you can get cigarettes anywhere and These new e-cigarettes that are packed full of nicotine are quite popular with the younger set And so one of the things that Denise and Eric Kandel in particular are looking for is the influence of nicotine as The gateway drug to future use Age of first use matters enormously When students or when children start using their substances, whatever they may be before they are 18 One in four stands a chance of becoming one in four becomes addicted. Let's put it that way when People start their substance use 21 or older. It's one out of 25 So those are really staggering numbers when you think about it And so when I think about it, I think about oh my gosh How are we enlisting elementary school teachers and counselors again to go back to the inhalant use to go back to the tobacco use How are we enlisting high school teachers and how and what are we doing here at a college that these are all crucial Questions so the science here is incredibly important. The science may help us to form some good educational programs Science isn't in crucial is a crucial component of our discussions about any kind of drug addiction and The the tale the explanation that's being given about how Drugs work in the brain. It seems that drugs work in one of three ways some of them will pose as a naturally occurring neuro transmitter and take the place of the naturally occurring Transmitter and act in exactly the same sort of way. So included in that would be Morphine morphine mimics naturally Occuring endorphins, which means those endorphins that occur naturally can't get there. They've been there's like a masquerade It's like fraud alert someone else is using your credit card some neurotransmitters Will block a natural or some drugs will block a naturally occurring neurotransmitter That's what happens with alcohol alcohol blocks glutamate glutamate is absolutely vital for memory for learning and Cognition so once again, that's when dr. Eric Kandel's work is vitally important here and some drugs augment They increase The naturally occurring transmitters so cocaine for dopamine that burst of pleasure and euphoria and Ecstasy for serotonin so last year at Wesleyan University, which is my alma mater There were Was it 11 or 12 students who overdosed on a bad batch of ecstasy and some I'd say there's no good Dose or good batch of ecstasy. It's an illegal drug so ecstasy Ecstasy when you have too much of it when you overload your body with serotonin the effects of ecstasy Include your blood pressure rises really suddenly Your heart rate accelerates really suddenly and your body temperature accelerates really Suddenly not to put too fine a point on it But when you overdose you're kind of cooking yourself from the inside out and that's a very graphic way of putting it But ecstasy is regarded as a party drug that there was a fair amount of it Available so we always at colleges need to pay attention to what are the illegal drugs that are floating around out there How do they intersect with? legal drugs, I mean even say nicotine or when you're of age with alcohol and How do we think about what the effects are of mixing all of them one of the ways that science has been talking about addiction? Is that the brain is hijacked and that's a very compelling image? The idea is that as I've just described these drugs go in and they mess with naturally occurring Neurotransmitters and receptors and they take over. I have read that the brain goes rogue I have read that the brain is commandeered It's been hijacked and I've been very critical of that analogy because it seems to take away Human agency in general it breaks down because when I get into my own car I don't understand myself to be hijacking my own car I understand myself to be driving my own car and there's always that question of a person has to take the drugs introduce the drugs into his or her system for all of that Neurochemical tsunami to get going so I've been very critical of that analogy Until I read about some of the drugs used to treat Parkinson's disease Parkinson's disease involves the People who have Parkinson's are no longer really able to produce their own Dopamine their own kind of it's it's it's part of the pleasure reward circuitry So these drugs were created that mimic Dopamine they mimic dopamine far too much though because what they found was that a Significant number of people taking these drugs one was I think re quip and one was Mara Mara pecs. I mean how they make up these names. I don't know People taking these drugs suddenly were engaging in compulsive gambling They were engaging in all kind of Cybersexual affairs and adultery. They were shopping and out-of-control kinds of ways and then when they stopped and the drugs exited their system their behavior Reverted to exactly where it was before but the fact their lives now were utterly decimated I Read about one man who lost his life savings and who had committed adultery and he gets off these drugs and his life is in a wreckage and that really did make me say I need to Reconsider what I believe about that hijacking analogy. It may be useful in some ways But it certainly has its limitations because if you run with that hijacking metaphor It becomes more difficult to talk about good robust notions of Responsibility how are addicts responsible for our addictions? And I'm really glad that one of our speakers is Owen Flanagan who's a moral philosopher at Duke And he has done a lot of work on shame That there seems to be a couple of kinds of shame at work with addiction and one is that there's a shame in Not using your rational capacity to make good decisions remember that weakness of will you've got rational capacity But then you always override it at the end that kind of shame that then gets built upon When you start to act in those kinds of ways You're not living up to be the kind of good moral person you want to be so that that shame Starts to multiply but what kinds of accounts can we generate for For responsibility and addiction and we always have to be very careful because always in that background as I said earlier Was the view that addicts are somehow moral failure? So how can we introduce moral responsibility without bringing a lot of that kind of baggage? So Owen Flanagan will have much to say about that if we think about the brain as diseased as addicted It seems as if we must pay attention To the environment though the brain is itself an environment So if we back it up to talk about neurotransmitters get mimicked or they get suppressed or they are augmented We have to take a look at the fact that Neurotransmitters are always an environment of neural pathways neural pathways are always in Parts of the brain regions of the brain that are themselves part of the entire brain and the brain is in a physical body And the physical body is in a physical world. It's in a social world. It's in a world of economics It's in a world of politics. It's in a world of race all those sorts of things Where does environment fit into our analyses of addiction? And this is one of the reasons why we're so excited about this conference You can't talk about addiction and just make it be a property or condition of an individual It is a public health concern. It is a legal concern. It is a public policy concern It's all these kinds of concerns. So how do we talk about them? One of our speakers is Dr. Carl Hart who's written a wonderful book part memoir called high price and He was raised as an African-American in a very poor part of Miami and he talks about all the things that that he did He was dealing drugs and doing drugs and yet he didn't become an addict But yet many of his friends he knows did what was different there and one of his messages is that it's vitally important That we not get our causality backwards So for instance, it's often assumed that addiction Causes a whole host of social ills and Carl Hart is going to turn that upside down and say Those social ills those social considerations the fact that some people are fundamentally marginalized discriminated against reviled that those perhaps Give people reasons to drink and that addiction is actually a symptom of much larger social problems and social ills and That raises the really interesting question if we want to address addiction What ends of the stick do we grab? We can treat individuals. We can say well, you know Peg get into rehab 28 days of rehab and do this and do that or Or we could also look again at those social political economic Environments in which people have reasons Perhaps justified reasons to drink or to use That's why a multidisciplinary Focus when we talk about addiction about addiction is absolutely crucial Question of when we talk about treatment again to cease using whatever it is that she's using that may well be accurate However, there's really no set Understood shared understandings of what good effective treatment involves Does it involve abstinence or could it be? moderated well-managed use is that a possibility Does effective treatment involve considering we've got to treat certain kinds of social ills That's why sociology is incredibly important to any of the discussions that we have about addiction Talking about addicted populations again talking about those dynamics that are perhaps identity Deconferring where do we factor those into the mix? I'm gonna now move to my second and last PowerPoint slide. I don't like PowerPoint. Here it is So as I said Substance use disorder is the new term that we use and that it is on a spectrum It is progressive and the DSM 5 has come up with these 11 criteria That should be considered in a 12 month period There are four categories One asks is use somehow Becoming out of control Are you negotiating and bargaining with yourself to try to cut down? Do you make deals? Do you make promises? So the first category is about how much control do you have over your use? The second category is Your use getting in the way of important social roles or social functions that you have The third category is about risky use our bad things starting to happen to you is your health being affected other kinds of physical risks or hazards that you're finding yourself encountering because of your use and the fourth category pharmacological indicators in effect is it taking you is it taking more of the substance for you to reach a certain point of intoxication or highness or buzzedness and Do you experience withdrawal when you cut back or when do you stop using? So on the spectrum Meeting two to three criteria is considered a mild use disorder. So two to three of These 11 is a mild use disorder and this one up here is alcohol use but substitute in those different drugs Four to five is moderate. So you're starting to move down that spectrum six plus is Severe So now I'm going to raise that question again about treatment It seems that most of our treatment efforts have been geared towards that six plus on the extreme severe end There's very little in trying to hinder or stop or turn the bus around To move from a mild off the spectrum to move from a moderate back to mild There's very little work being done there It was incredibly important to us in structuring this conference that we raised these questions about treatment So our final Wednesday session is dedicated to the question What's effective? treatment What's working? What's not working and what might we need to do? differently as Our understandings of addiction become far more complex. We need far more complex and nuanced Understandings of treatment. We don't yet have them We need them No two addicts are identical Different addictions Manifest and present differently. So what may work to treat this addiction over here may not be an effective means for treating this addiction over here complicate the picture even more Of the 26 million who meet the diagnostic criteria for a substance use disorder Probably about 8 million of them also have a co-occurring mental disorder and that again raises a question. What do you treat first? What end of the stick? Do you grab first? Those are questions that are remarkably unsettled. They are undetermined So the discussion on that Wednesday afternoon session I think will be quite lively One other question that comes up about treatment So with respect to heroin is one of the worst drugs to try to get off The withdrawal is utterly terrible and sometimes heroin addiction is held up. You think it's just a brain disease Be a heroin addict and start going through withdrawal and you will find every part of your body Especially your bowels is really involved with it So what about drug replacement therapies? Suboxone and methadone are two drug replacement therapies for people with heroin addictions and those drugs in effect Stave off the effects of withdrawal without the high There are maintenance program That raises the question for many people. Are you shifting one drug and one addiction the illegal one? heroin For one that is yes medically supervised and hence not illegal But still you are dependent upon it in a kind of way And where do we take into account the voices of addicts who say? I don't want to be dependent on any kind of drug as a replacement therapy Versus those who say this is exactly what I need because it enables me to become a productive member of society Drug replacement therapies are the source of huge public health and public policy battles Because the perception is it's still some junkies looking to get drugs Legally by gaming the medical system and some of our panelists would talk about why we must Overcome that perception that that is incredibly important because that will keep people from getting help And there have been many concerns of people who go to clinics where it is dispensed that they believe they are the target of Police that's quite unjustified and quite unfair. I Want to end by bringing it right close back to Gustavus So one of the virtues of this conference is that we hope to create campus-wide discussion about drug and alcohol use and abuse and not just create Discussion, but maybe create some good educational programming raise awareness about alcohol and drug use on campus The best numbers indicate nationwide that 20 percent of college students Have an alcohol use disorder Now the majority of them are probably in the mild to the moderate, but we know that there is a significant number of Students who have already reached that six plus Educationally, what do we do there to help students try to back it off? Because it is true that many people are able to turn their use around that they can do that some of Us do it on our own others of us can't do it on our own. We need education That's important point one important point two Numbers also indicate that 40 percent of college students binge drink and that's the term that's used a lot when we talk about Alcohol use on college campuses. I don't particularly like that the definition of binge drinking for women over the course of two weeks How many drinks have you had in a two-hour sitting? And if it's four or more drinks in a two-hour setting that's considered a binge and for men It's five drinks over a two-hour setting How many times over the last two weeks? 40% I don't know how trustworthy that number is what we know is that a lot of athletes For example will not drink in season, but when they're out of season they will drink And so if you don't capture them then well, you're perhaps missing They are drinking in these problematic ways, but it won't show up Regardless of whether you want to talk about alcohol use disorders if you want to talk about binge drinking Imagine the numbers of that we can all do the math. Let's imagine we have 2,500 students 20% of 2,500 is 500 500 That's a lot We're going to complicate the picture even more Best numbers indicate that 17 so 1 7% of college students misuse prescription study aids that were prescribed for ADHD 17% of students misuse those study aids and by misuse We mean either they have a prescription But they take more of it in the belief if one pill works really well Three pills will work three times as well. That's bad math bad bad compounding or To misuse is to use someone else's prescription Here's the really interesting thing the major source For students to get these pills when they don't have their own prescription is other friends With friends like that. I mean, I just think about that tagline friends. Don't let friends drive drunk But friends do share their prescription study aids, which is a crime Which could lead to Significant legal consequences perhaps academic consequences perhaps life consequences Here's another thing we know Adderall is the most commonly prescribed prescription medication for ADHD of the students who misuse Adderall 90 90% also binge drink ADHD drugs dim one's perception of the effects of alcohol So if you're really wired up on the stimulant and you're drinking and you don't feel like you've got the buzz you want You drink so far Beyond it you could well drink to the point of alcohol poisoning and that's absolutely horrifying in frightening and Vi-vance for example Stays in your system for 13 hours. So you can still do everything right You can take your drug as prescribed and you think great I just I just nailed that bio exam and That's seven or eight hours later Vi-vance is in your system for up to 13 hours So your ability to perceive how much you're drinking and its effects has gone by So I want to close by bringing it back to Aristotle where we started with that weakness of will One of the really important things that Aristotle says in his moral philosophy is that friendship is the most important moral relationship that you can have with another person and I think Students want to be really good friends. They want to do good and right by their friends But it's also really hard if a friend says if I don't get an A on this test I may flunk out or if I don't if I don't maintain my GPA. I might lose my scholarship and so how do we Help students teach students about friendship and to really take seriously Future possible regret if you're the one who gives a friend a study aid that gets them in trouble or has life-harming consequences Your friends are Vital to your well-being they're vital to what Aristotle says Flourishing or success at living and I would love to see Gustavus Think about create some kind of educational programming. So then in effect We are equipping our students with the knowledge to make some good decisions about those drugs For their own benefit and for the benefit of the friends. That's one of the longer term Consequences I hope of this conference and I would ask all of you students to help make that happen as we think about where it might happen So I'm going to end. I would love to take questions Anything I'd love to hear from you. So, thank you. Let's see if a student has a question first I always favor the students first But if you want a faculty member to prime the pump, we can also do that. Yep prime the pump Our pop culture representations of addiction are fascinating. So just as an example If you came in right before we started I had Amy Winehouse singing ain't gonna rehab with the lyrics there and Earlier this afternoon. I ran into Phil Bryant in the English department. I said, oh, yeah I'm gonna crank up Amy Winehouse and he said well you could also crank up and then he listed all these different songs and artists that were singing about their addiction either glorifying it or You know making it seem like like total fun and I think certainly we see that with respect to alcohol Arthur is a tragic character now, and this yeah Dudley Moore. So you people have no idea who that is Although I think it was made into a bad remake with them I said British comedian was it Russell Brand? Okay, some students go like this. Yes, I Think one of the reasons why we're kind of horrified by that now is that he's an older drunk But the you never see sort of bad younger drunks are younger intoxicated because it's all fun It's like welcome to the party. I mean Animal House I think is a really interesting cultural production about what college life should be and the assumption that Drinking and getting smashed. That's just to write a passage. That's what we do all the time You see absolutely no negative consequences from that kind of party use Let's see. I mean what what might be other examples. I don't know students can help me out. I mean Other recent movies where you you see someone's use of something and you think oh, that's bad or like, oh, yeah kind of normal whatever Doesn't matter the hangover. Yeah, that's right And that's a buddy movie right that they get so stupidly drunk And then they're doing all these stupid things trying to recover from their stupid drunken Adventures but it's all funny. Nobody really gets hurt or anything like that. Yeah, American pie Here's another thing to think about that when we look at these cultural productions It's usually guys getting really really drunk and that that's okay And we see the same things think about the expression drink like a real man That expression has some meaning doesn't it? What does that mean drink like a real man the vast quantities but not of wine? spritzers either beer or Hard liquor that's drinking like a real man if I said well shit drinks like a real woman It might give me the expression what and also I think there's more Social disapproval for women who are really really drunk Then men and then of course we have to think about the consequences So yeah, all the movies you mentioned were guys getting drunk with no problems. Oh White guys primarily too did I mention that a lot of drugs are racially coated again Carl Hart will be really Wonderful talking about that. Is there really any difference between snorting cocaine and smoking cocaine perhaps not but boy The sentencing guidelines sure made it seem like it was there were significant differences Other questions Yes So do we look at all addictions say to caffeine or to sugar as bad Now here's a dodge Caffeine is not regarded as a substance. That's addictive although they do recognize caffeine intoxication and caffeine withdrawal and caffeine is now in the category of warranting further study to see if it might be and sugar is an interesting one because that connects to discussions about food addiction and there's been I Would say some really good research done About foods that are what they call hyper palatable so the lovely union of sugar fat and Sodium that's what makes it yummy so the laze potato chip commercial from well Hello, white-haired people from The 1960s bet you can't just have one That's what a lot of food companies are now betting on so there There's a very vocal group arguing for the inclusion of food addiction Now a complicated a little bit more some people have asked well aren't there positive addictions Some things that are addictive, but yet to positive end I'd say given the way that we use the word addiction now I would say no and What's gained by saying that something that you love to do that you do a lot of it is an addiction Because in general bad consequences haven't followed from it nor has social Disapprobation disapproval and it hasn't necessarily Created enough for the kinds of problems that you see on those criteria So there was one person who argued for positive addictions There was at least one person currently identified as me who argued against the coherence of that notion that I wouldn't want to Turn too many things into addiction and in part that was a response to things I kept hearing Oh, I'm really addicted to the new salsa at the co-op or I'm just addicted to those trashy tabloids But I'm the grocery store magazine it seemed to trivialize addiction in a way that that I found really worrisome I mean to try to say that these things belong into the same category as heroin or alcohol particularly when you get down to that severe end it seemed to trivialize it Imagine that will come up somehow and that too is a function of the way that addiction runs through all these different levels You know the public policy the the the legal dimensions of it the public health dimensions And I think marijuana is really interesting so 22 states have medical marijuana and how many have recreational is it? three or five Okay, some number between two and five where Once again, I'm going to come down to the importance of Education there's a perception that marijuana isn't addictive and it's not harmful good studies show that When younger people start using marijuana and I'm going to say in this case younger is anyone less than 25 years of age that because of the ways the brain is developing You're more susceptible to do more long-term damage when you smoke marijuana Then if you start after you're the age of 25, so I have stood up in my classroom and said, you know something wins I'm like well if you are going to smoke marijuana legally Please don't start until you're 25 Because it won't harm you as much and I think one of the reasons for the Misperception that marijuana isn't addictive is that you don't necessarily see the same kind of really bad behavior That follows if someone is totally jacked up on cocaine or somebody is really really drunk I mean when you're really really stoned You're just to not to get into brawls Whatever you might eat a lot that's not the same kind of problem and you know interesting questions too about Colorado hasn't figured how to measure some ones intoxication from marijuana when they're driving So that's a an issue that needs to be addressed. Yeah, I'll hold that up there as an issue But marijuana is addictive. It's dangerous Certain mental disorders as I said go along with certain kinds of drugs What goes along with marijuana is schizophrenia? There's this question of do some people self-medicate before they have a diagnosis Do other people have a diagnosis and then they want to medicate to with these illegal kinds of drugs Let's see which other ones go together alcohol and antipersonality disorder I believe it's cocaine with PTSD So you want to be careful do these drugs cause those mental disorders? I'm not prepared to say that Is it somehow part of the mix and we don't really know how and they could exacerbate? I'm gonna say that that's for sure. And so that's why you know at the college. We're worried about Marijuana uses on the rise in part because well, it might be legal here someday or it's already medicalized Well, that's a different kettle of fish from what you're buying and smoking somewhere else Let's be clear on that and mixing with alcohol mixing with these other drugs The students who misuse Adderall who are also binge drinking are also three times more likely to use marijuana So now maybe we've got the perfect storm Well, some people are claiming that Disordered eating and oftentimes they're gonna separate anorexia out from binge eating disorder Some people say binge eating disorder is really food addiction the idea that you just start eating and you can't stop or you're eating certain kinds of substances and binge eating disorder is right now lodged in the compulsive use disorders And I'm not sure that that's fully accurate because it locates the problem on the individual once again Rather than in the substances of what they're eating as Playing an important role in that Yes Sure, and that's always an interesting question too. I mean a lot of people who quit drinking for example are sugar fiends Because alcohol has so much sugar so you go to AA meetings and there might be cookies and cupcakes and candy being passed around While we're sipping coffee and while you know smoking is no longer allowed in most places You talk to certain generations of AAers and they'll talk about the blue haze Because people would be smoking and then that became the question Well, is it more important to treat this addiction first get that one under control and then let's take on this other one That may be a matter of personal choice It may be a matter of a medical decision that you need to make in consultation with your physician or other health care provider Or whomever else how about one more question. I know we're coming towards the end To two more maybe okay. We'll defer to a student. I'll start here and then we'll go over there That's a good question. There may be some Genetic predisposition But the question always becomes what triggers or sets off that predisposition to become something actual and That's where a lot of people are saying you need to pay attention to the environmental factors and again Environment going all the way down into the tiniest part of the brain What is working there such that some gene expression gets switched on or switched off So yes, the neuroscience will help us there But unless and until we pay attention to these other kinds of causal factors We'll still have a very incomplete picture. I think that certainly Eric Kandel might talk about that If anybody can he will and if it doesn't raise it one of the things I love about Nobel is that there's a full dedicated half an hour for questions from the audience that you Can submit on paper or I think you could Twitter it in or whatever the verb is to Twitter Conjugate that however get that question out so that we can answer it well, shall we say good enough and Hopefully see a lot of you at the Nobel conference either live or live streaming. It's all good So thanks for taking the time out today Order your tickets order your tickets. They're going fast