TEDxMidAtlantic
Rachel Wurzman: How isolation fuels opioid addiction
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What do Tourette syndrome, heroin addiction and social media obsession all have in common? They converge in an area of the brain called the striatum, says neuroscientist Rachel Wurzman -- and this critical discovery could reshape our understanding of the opioid crisis. Sharing insights from her research, Wurzman shows how social isolation contributes to relapse and overdose rates and reveals how meaningful human connection could offer a potentially powerful source of recovery.
Rachel Wurzman - Neuroscientist
Through her nonprofit SeekHealing, Rachel Wurzman aims to reduce opioid overdose rates by building communities that are inherently resilient to addiction. Full bio
Through her nonprofit SeekHealing, Rachel Wurzman aims to reduce opioid overdose rates by building communities that are inherently resilient to addiction. Full bio
Double-click the English transcript below to play the video.
00:13
What does it mean to be normal?
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And what does it mean to be sick?
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I've asked myself this question
from the time I was about seven,
from the time I was about seven,
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when I was diagnosed
with Tourette syndrome.
with Tourette syndrome.
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Tourette's is a neurological disorder
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characterized by stereotyped movements
I perform against my will, called tics.
I perform against my will, called tics.
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Now, tics are technically involuntary,
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in the sense that they occur
without any conscious attention
without any conscious attention
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or intention on my part.
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But there's a funny thing
about how I experience tics.
about how I experience tics.
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They feel more unvoluntary
than involuntary,
than involuntary,
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because I still feel like it's me
moving my shoulder,
moving my shoulder,
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not some external force.
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Also, I get this uncomfortable sensation,
called premonitory urge,
called premonitory urge,
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right before tics happen,
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and particularly
when I'm trying to resist them.
when I'm trying to resist them.
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Now, I imagine most of you out there
understand what I'm saying,
understand what I'm saying,
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01:10
but unless you have Tourette's,
you probably think you can't relate.
you probably think you can't relate.
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01:15
But I bet you can.
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So, let's try a little experiment here
and see if I can give you
and see if I can give you
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a taste of what my experience feels like.
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Alright, ready?
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Don't blink.
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No, really, don't blink.
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And besides dry eyes, what do you feel?
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Phantom pressure?
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Eyelids tingling?
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A need?
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Are you holding your breath?
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(Laughter)
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Aha.
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01:43
(Laughter)
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That's approximately
what my tics feels like.
what my tics feels like.
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Now, tics and blinking,
neurologically speaking, are not the same,
neurologically speaking, are not the same,
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but my point is that you
don't have to have Tourette's
don't have to have Tourette's
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to be able to relate to my experience
of my premonitory urges,
of my premonitory urges,
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because your brain can give you
similar experiences and feelings.
similar experiences and feelings.
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So, let's shift the conversation from
what it means to be normal versus sick
what it means to be normal versus sick
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to what it means that a majority of us
are both normal and sick.
are both normal and sick.
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Because in the final analysis,
we're all humans
we're all humans
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whose brains provide
for a spectrum of experiences.
for a spectrum of experiences.
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And everything on that spectrum
of human experiences
of human experiences
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is ultimately produced by brain systems
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that assume a spectrum
of different states.
of different states.
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So again, what does it mean to be normal,
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and what does it mean to be sick,
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when sickness exists on the extreme end
of a spectrum of normal?
of a spectrum of normal?
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As both a researcher who studies
differences in how individuals' brains
differences in how individuals' brains
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wire and rewire themselves,
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and as a Touretter
with other related diagnoses,
with other related diagnoses,
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I have long been fascinated
by failures of self-regulation
by failures of self-regulation
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on the impulsive and compulsive
behavioral spectrums.
behavioral spectrums.
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Because so much of my own
experience of my own body
experience of my own body
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and my own behavior
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has existed all over that map.
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So with the spotlight
on the opioid crisis,
on the opioid crisis,
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I've really found myself
wondering lately:
wondering lately:
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Where on the spectrum
of unvoluntary behavior
of unvoluntary behavior
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do we put something like abusing
opioid painkillers or heroin?
opioid painkillers or heroin?
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By now, we all know that the opioid crisis
and epidemic is out of control.
and epidemic is out of control.
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Ninety-one people die every day
in this country from overdose.
in this country from overdose.
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And between 2002 and 2015,
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the number of deaths from heroin
increased by a factor of six.
increased by a factor of six.
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And something about the way
that we treat addiction isn't working,
that we treat addiction isn't working,
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at least not for everyone.
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It is a fact that people
suffering from addiction
suffering from addiction
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have lost free will
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when it comes to their behavior
around drugs, alcohol, food
around drugs, alcohol, food
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or other reward-system
stimulating behaviors.
stimulating behaviors.
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That addiction is a brain-based
disease state
disease state
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is a medical, neurobiological reality.
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But how we relate to that disease --
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indeed, how we relate to the concept
of disease when it comes to addiction --
of disease when it comes to addiction --
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makes an enormous difference
for how we treat people with addictions.
for how we treat people with addictions.
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So, we tend to think of pretty much
everything we do as entirely voluntary.
everything we do as entirely voluntary.
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But it turns out
that the brain's default state
that the brain's default state
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is really more like a car
idling in drive than a car in park.
idling in drive than a car in park.
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Some of what we think we choose to do
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is actually things that we
have become programmed to do
have become programmed to do
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when the brakes are released.
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Have you ever joked that your brain
was running on autopilot?
was running on autopilot?
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Guess what?
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It probably was.
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OK?
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And the brain's autopilot
is in a structure called the striatum.
is in a structure called the striatum.
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So the striatum detects
emotional and sensory motor conditions
emotional and sensory motor conditions
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and it knows to trigger
whatever behavior you have done most often
whatever behavior you have done most often
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in the past under those same conditions.
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Do you know why I became a neuroscientist?
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Because I wanted to learn
what made me tick.
what made me tick.
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(Laughter)
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06:00
Thank you, thank you.
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(Laughter)
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I've been wanting to use that one
in front of an audience for years.
in front of an audience for years.
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(Applause)
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So in graduate school,
I studied genetic factors
I studied genetic factors
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that orchestrate wiring
to the striatum during development.
to the striatum during development.
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And yes, that is my former license plate.
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(Laughter)
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And for the record, I don't recommend
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any PhD student get a license plate
with their thesis topic printed on it,
with their thesis topic printed on it,
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unless they're prepared
for their experiments not to work
for their experiments not to work
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for the next two years.
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(Laughter)
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I eventually did figure it out.
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So, my experiments were exploring
how miswiring in the striatum
how miswiring in the striatum
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relates to compulsive behaviors.
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Meaning, behaviors that are coerced
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by uncomfortable urges
you can't consciously resist.
you can't consciously resist.
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So I was really excited
when my mice developed
when my mice developed
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this compulsive behavior,
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where they were rubbing their faces
and they couldn't seem to stop,
and they couldn't seem to stop,
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even when they were wounding themselves.
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OK, excited is the wrong word,
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I actually felt terrible for them.
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I thought that they had tics,
evidence of striatal miswiring.
evidence of striatal miswiring.
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And they were compulsive,
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but it turned out, on further testing,
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that these mice showed
an aversion to interacting
an aversion to interacting
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and getting to know other unfamiliar mice.
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Which was unusual, it was unexpected.
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The results implied that the striatum,
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which, for sure, is involved
in compulsive-spectrum disorders,
in compulsive-spectrum disorders,
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is also involved in human
social connection and our ability to --
social connection and our ability to --
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not human social connection,
but our ability to connect.
but our ability to connect.
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So I delved deeper,
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into a field called social neuroscience.
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And that is a newer,
interdisciplinary field,
interdisciplinary field,
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and there I found reports
that linked the striatum
that linked the striatum
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not just to social anomalies in mice,
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but also in people.
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As it turns out, the social
neurochemistry in the striatum
neurochemistry in the striatum
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is linked to things
you've probably already heard of.
you've probably already heard of.
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Like oxytocin,
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which is that hormone that makes
cuddling feel all warm and fuzzy.
cuddling feel all warm and fuzzy.
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But it also implicates
signaling at opioid receptors.
signaling at opioid receptors.
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There are naturally occurring
opioids in your brain
opioids in your brain
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that are deeply linked
to social processes.
to social processes.
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Experiments with naloxone,
which blocks opioid receptors,
which blocks opioid receptors,
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show us just how essential
this opioid-receptor signaling is
this opioid-receptor signaling is
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to social interaction.
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When people are given naloxone --
it's an ingredient in Narcan,
it's an ingredient in Narcan,
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that reverses opioid overdoses
to save lives.
to save lives.
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But when it's given to healthy people,
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it actually interfered
with their ability to feel connected
with their ability to feel connected
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to people they already knew
and cared about.
and cared about.
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So, something about not having
opioid-receptor binding
opioid-receptor binding
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makes it difficult for us to feel
the rewards of social interaction.
the rewards of social interaction.
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Now, for the interest of time,
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I've necessarily gotten rid
of some of the scientific details,
of some of the scientific details,
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but briefly, here's where we're at.
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The effects of social disconnection
through opioid receptors,
through opioid receptors,
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the effects of addictive drugs
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and the effects of abnormal
neurotransmission
neurotransmission
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on involuntary movements
and compulsive behaviors
and compulsive behaviors
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all converge in the striatum.
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And the striatum
and opioid signaling in it
and opioid signaling in it
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has been deeply linked with loneliness.
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When we don't have enough signaling
at opioid receptors,
at opioid receptors,
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we can feel alone in a room full of people
we care about and love, who love us.
we care about and love, who love us.
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Social neuroscientists, like Dr. Cacioppo
at the University of Chicago,
at the University of Chicago,
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have discovered that loneliness
is very dangerous.
is very dangerous.
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And it predisposes people
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to entire spectrums
of physical and mental illnesses.
of physical and mental illnesses.
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Think of it like this:
when you're at your hungriest,
when you're at your hungriest,
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pretty much any food
tastes amazing, right?
tastes amazing, right?
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So similarly, loneliness
creates a hunger in the brain
creates a hunger in the brain
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which neurochemically hypersensitizes
our reward system.
our reward system.
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And social isolation
acts through receptors
acts through receptors
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for these naturally occurring opioids
and other social neurotransmitters
and other social neurotransmitters
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to leave the striatum in a state
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where its response to things
that signal reward and pleasure
that signal reward and pleasure
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is completely, completely over the top.
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And in this state of hypersensitivity,
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our brains signal deep dissatisfaction.
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We become restless,
irritable and impulsive.
irritable and impulsive.
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And that's pretty much when I want you
to keep the bowl of Halloween chocolate
to keep the bowl of Halloween chocolate
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entirely across the room for me,
because I will eat it all.
because I will eat it all.
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I will.
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And that brings up another thing
that makes social disconnection
that makes social disconnection
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so dangerous.
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If we don't have the ability
to connect socially,
to connect socially,
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we are so ravenous for our social
neurochemistry to be rebalanced,
neurochemistry to be rebalanced,
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we're likely to seek relief from anywhere.
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And if that anywhere
is opioid painkillers or heroin,
is opioid painkillers or heroin,
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it is going to be a heat-seeking missile
for our social reward system.
for our social reward system.
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Is it any wonder people in today's world
are becoming addicted so easily?
are becoming addicted so easily?
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Social isolation --
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excuse me --
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contributes to relapse.
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Studies have shown that people
who tend to avoid relapse
who tend to avoid relapse
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tend to be people who have broad,
reciprocal social relationships
reciprocal social relationships
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where they can be
of service to each other,
of service to each other,
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where they can be helpful.
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Being of service lets people connect.
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So --
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if we don't have the ability
to authentically connect,
to authentically connect,
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our society increasingly lacks
this ability to authentically connect
this ability to authentically connect
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and experience things that
are transcendent and beyond ourselves.
are transcendent and beyond ourselves.
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We used to get this transcendence
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from a feeling of belonging
to our families and our communities.
to our families and our communities.
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But everywhere, communities are changing.
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And social and economic disintegration
is making this harder and harder.
is making this harder and harder.
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I'm not the only person to point out
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that the areas in the country
most economically hard hit,
most economically hard hit,
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where people feel most desolate
about their life's meaning,
about their life's meaning,
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are also the places
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where there have been communities
most ravaged by opioids.
most ravaged by opioids.
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Social isolation acts
through the brain's reward system
through the brain's reward system
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to make this state of affairs
literally painful.
literally painful.
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So perhaps it's this pain,
this loneliness,
this loneliness,
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this despondence
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that's driving so many of us
to connect with whatever we can.
to connect with whatever we can.
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Like food.
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Like handheld electronics.
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And for too many people,
to drugs like heroin and fentanyl.
to drugs like heroin and fentanyl.
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I know someone who overdosed,
who was revived by Narcan,
who was revived by Narcan,
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and she was mostly angry
that she wasn't simply allowed to die.
that she wasn't simply allowed to die.
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Imagine for a second how that feels,
that state of hopelessness, OK?
that state of hopelessness, OK?
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But the striatum is also a source of hope.
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Because the striatum gives us a clue
of how to bring people back.
of how to bring people back.
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So, remember that the striatum
is our autopilot,
is our autopilot,
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running our behaviors on habit,
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and it's possible to rewire,
to reprogram that autopilot,
to reprogram that autopilot,
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but it involves neuroplasticity.
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So, neuroplasticity
is the ability of brains
is the ability of brains
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to reprogram themselves,
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and rewire themselves,
so we can learn new things.
so we can learn new things.
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And maybe you've heard the classic
adage of plasticity:
adage of plasticity:
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neurons that fire together, wire together.
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Right?
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So we need to practice social
connective behaviors
connective behaviors
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instead of compulsive behaviors,
when we're lonely,
when we're lonely,
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when we are cued to remember our drug.
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We need neuronally firing
repeated experiences
repeated experiences
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in order for the striatum to undergo
that necessary neuroplasticity
that necessary neuroplasticity
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that allows it to take
that "go find heroin" autopilot offline.
that "go find heroin" autopilot offline.
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And what the convergence
of social neuroscience, addiction
of social neuroscience, addiction
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and compulsive-spectrum disorders
in the striatum suggests
in the striatum suggests
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is that it's not simply enough
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to teach the striatum healthier
responses to compulsive urges.
responses to compulsive urges.
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We need social impulses
to replace drug-cued compulsive behaviors,
to replace drug-cued compulsive behaviors,
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because we need to rebalance,
neurochemically, our social reward system.
neurochemically, our social reward system.
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And unless that happens,
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we're going to be left
in a state of craving.
in a state of craving.
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No matter what besides our drug
we repeatedly practice doing.
we repeatedly practice doing.
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I believe that the solution
to the opioid crisis
to the opioid crisis
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is to explore how social
and psychospiritual interventions
and psychospiritual interventions
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can act as neurotechnologies in circuits
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that process social
and drug-induced rewards.
and drug-induced rewards.
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One possibility is to create
and study scalable tools
and study scalable tools
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for people to connect with one another
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over a mutual interest
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in recovery through
psychospiritual practices.
psychospiritual practices.
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And as such, psychospiritual practice
could involve anything
could involve anything
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from people getting together
as megafans of touring jam bands,
as megafans of touring jam bands,
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or parkour jams, featuring
shared experiences of vulnerability
shared experiences of vulnerability
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and personal growth,
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or more conventional things,
like recovery yoga meetups,
like recovery yoga meetups,
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or meetings centered
around more traditional conceptions
around more traditional conceptions
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of spiritual experiences.
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But whatever it is,
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it needs to activate
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all of the neurotransmitter
systems in the striatum
systems in the striatum
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that are involved
in processing social connection.
in processing social connection.
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Social media can't go
deep enough for this.
deep enough for this.
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Social media doesn't so much
encourage us to share,
encourage us to share,
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as it does to compare.
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It's the difference between having
superficial small talk with someone
superficial small talk with someone
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and authentic, deeply connected
conversation with eye contact.
conversation with eye contact.
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And stigma also keeps us separate.
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There's a lot of evidence
that it keeps us sick.
that it keeps us sick.
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And stigma often makes it safer
for addicts to connect with other addicts.
for addicts to connect with other addicts.
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But recovery groups centered around
reestablishing social connections
reestablishing social connections
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could certainly be inclusive
of people who are seeking recovery
of people who are seeking recovery
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for a range of mental health problems.
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My point is, when we connect
around what's broken,
around what's broken,
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we connect as human beings.
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We heal ourselves
from the compulsive self-destruction
from the compulsive self-destruction
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that was our response
to the pain of disconnection.
to the pain of disconnection.
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When we think of neuropsychiatric
illnesses as a spectrum of phenomenon
illnesses as a spectrum of phenomenon
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that are part of what make us human,
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then we remove the otherness of people
who struggle with self-destruction.
who struggle with self-destruction.
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We remove the stigma
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between doctors and patients
and caregivers.
and caregivers.
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We put the question of what it means
to be normal versus sick
to be normal versus sick
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back on the spectrum
of the human condition.
of the human condition.
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And it is on that spectrum
where we can all connect
where we can all connect
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and seek healing together,
for all of our struggles with humanness.
for all of our struggles with humanness.
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Thank you for letting me share.
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(Applause)
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ABOUT THE SPEAKER
Rachel Wurzman - NeuroscientistThrough her nonprofit SeekHealing, Rachel Wurzman aims to reduce opioid overdose rates by building communities that are inherently resilient to addiction.
Why you should listen
A neuroscientist and neuroethicist by training, Rachel Wurzman is passionate about two-way communication between the neuroscientific community and lay public that inspires transformative change in how human beings connect with each other, with technology and with institutions like medicine and government. She has authored more than 20 peer-reviewed articles and book chapters in the fields of neuroscience, neuroethics and policy, including Wiley's number one most frequently downloaded article out of over 20 neurology journals in 2016.
Wurzman serves as director of science for the nonprofit, SeekHealing, which implements creative ways to connect people intentionally and authentically in order to build communities that are inherently resilient to addiction. SeekHealing serves people at risk for overdose and provides free, connection-oriented support services to anyone at any stage in the addiction healing process.
Wurzman believes that an appreciation for how brain systems filter the various spectrums of human experience can be used to transform how society responds to current crises, ranging from the opioid epidemic to political hyperpolarization. In addition to studying the effects of SeekHealing's programs in opioid-ravaged lives and communities, Wurzman's ongoing research in neuroethics also addresses the implications of a biopsychosocial and "systems-oriented" perspective on neuropsychiatric spectrum phenomena (such as addiction) for research, treatment and social policy. Her advice and insights into neurocognition have been utilized to inform policy in past positions as a neuroscience and neuroethics advisor to the Pentagon, an intern in the White House Office of Science and Technology Policy under the Obama administration, and through her involvement with the International Neuroethics Society. Wurzman completed her doctoral and postdoctoral training at Georgetown University and the University of Pennsylvania, respectively.
Rachel Wurzman | Speaker | TED.com