[Music]
hello everybody so glad to be here my
name is Gabe Zuckerman and my subject
today is addiction but first I want to
start off with the story of Ulysses now
Ulysses was the first stud in our
history he was Greece’s Chris Pine Chris
Hemsworth and Chris Pratt rolled into
one guy there anything that Chris’s
can’t do I don’t know we’ll talk about
that um but so Ulysses there was one
thing that Ulysses felt he couldn’t do
which was listen to the sound of the
sirens of the sea the sirens were this
mermaids who were dangerous and and
their songs were said to make people
crazy so what did he do he had himself
tied to the mast of a ship and then
asked his men to put their ears and fill
them with wax and then wit a ride
directly to the silence right wreckage
silence and he told them under penalty
of death they were not to allow him to
be let go from the ship under no
circumstances should they allow it now
many of us I’m sure all of us can relate
to the idea in our lives of being in a
situation where we feel like it’s not
how we would be in our sober self so
like wanting something when we’re sober
and then being different when we get in
a situation that’s particularly exciting
and probably the the one idea that most
exemplifies this I think is addiction
and you might be surprised of course
that addiction has been with us since
the beginning of time it comes in all
these cultures but you may also be
surprised at how serious of a problem it
is today the w-h-o estimates that over
800 million people are alcoholics around
the world 800 million people and if we
take a step back from this resume out
from this and we add other things to
this list technology-mediated addictions
screentime gambling shopping pornography
the numbers get exponentially larger and
if we zoom out one more time and we let
go of this definite
of addiction which is that people have
to reach rock bottom it’s like a very
vestige alai dia
of a scarce treatment modality and we
think about overuse people doing
something more than they would like the
binge drinker rather than the alcoholic
the numbers get even bigger and so I
wondered why is it that it’s been so
difficult to conquer addiction since
it’s been around for so long and my
research led me to a quick acronym best
and it stands for bias economy stigma
and technology and I want to talk about
these things so first technology we’ve
always used technology to make things
more addictive it’s how we make pot
stronger or weed an acre of weed more
potent it’s how we make fentanyl more
deadly technology’s always been part of
addiction but what’s different today is
that technology is now the end addiction
in and of itself right so minor
footnotes in psychology like porn
addiction didn’t exist basically 20
years ago and today they’re a thing that
affects tens of millions of people when
it comes to stigma you know we tend to
think of addicts as the other it’s poor
people people with mental illness people
live on the street but in fact science
today tells us that addiction is
connected to our dopamine loop in our
brain so every time we challenge
ourselves to something and we treat it
our brain secretes a little bit of
dopamine and that makes us want to do
that thing again this is how we got to
the moon this is how we build great
things this is why you eat this is why
you procreate this dopaminergic loop but
it’s hijacked in addiction it makes you
want to do that thing more and more and
more and so addiction is not something
that other people face you are born an
addict your evolutionary biology is
designed to make you addicted to those
things that will keep you alive and move
your family lineage forward it’s almost
like everyone’s an addict and the
economy of course capitalism has found a
way to really leverage that idea and
drive it deeply this is a KFC Double
Down it’s a crazy sandwich the bread is
actually made of chicken
and so KFC like most other food
companies employs tens of thousands of
people whose sole job it is to make the
stuff they eat more addictive if it were
up to them you would eat every single
meal at KFC breakfast lunch dinner and
two snacks in between and you know what
it’s not just the food business
literally every company on earth would
like for you to use their product and
service to the exclusion of everything
else you know people talk about our
economy is being driven by information
or being driven by attention but I
actually think no matter how we look at
it we live in an addiction economy now
what’s happened that’s made this more
extreme is the advent of algorithms so
maybe you like companies like Facebook
and Google who use algorithms to get you
kind of addicted to their products and
refreshing you know maybe you could
learn willpower to resist the KFC Double
Down but these algorithms are designed
to actually take your willpower and use
it against you they learn how you resist
them and they come up with alternatives
to overcome your willpower and I know
this you guys because I’ve spent the
better part of the last 10 years being a
staunch advocate for gamification I’ve
worked with many of these companies on
making their systems more addictive and
engaging and it’s become very clear to
me that things have gone a little too
far and the last element in this
discussion is about bias everybody is
sure they know why addiction exists oh
it’s trauma oh it’s like if we were just
more social and connected and we all got
to hang out there would be no addicts
and everybody has an idea about how to
treat it right there it’s a moral
failing it requires religion it requires
total abstinence just say no which was
probably the worst one of all of these
and the truth is there’s no one ring to
rule addiction addiction is not one
thing in fact the word tells us very
clearly so here’s an image of Rob Ford
Toronto’s famous crack smoking mayor it
is my hometown go vi okay so
Toronto’s and by the way if you’re from
Washington or various other cities you
can replace this with your own
cracked-out mayor you don’t have to use
Rob Ford
so we say Rob Ford on one side of this
image and on the other side of this
image you see two people obviously have
an issue with their phones now here’s
the thing every rational person looks at
this image and understands that there
are some similarities but that they are
not the same and you see how brute force
our idea is about this concept that we
use the same term to describe both of
them and so given all of these things
let me tell you something addiction
treatments are really poor now I’ve
pulled together this is hard to get data
I pulled together the best most
optimistic meta analysis of treatment
efficacy across various modalities and
the best that we’ve got to treat
addiction has a 30% success rate at 1
year 3 0% now some of you might be
saying oh that’s great that’s awesome uh
lung cancer has a 52 percent five-year
survival rate right now if we use 30
percent as our benchmark it’s no wonder
that we don’t move things forward like
we don’t ever get to that level and it’s
not much better than willpower by the
way which comes in at 22% and so I think
we need to think about this completely
differently right now we think of
addiction is like trauma right mobilize
the forces everyone in the emergency
room spend $25,000 a month on rehab and
what we need to do is start thinking of
it as preventative medicine because you
see if you successfully vaccinate
everyone despite what when it’s polish
or whatever tells you if you
successfully vaccinate everyone I guess
do Jenny McCarthy sorry Gwyneth’s sorry
glue look um if you successfully
vaccinate everybody right
you don’t need trauma medicine and that
that was the heart of an idea that we
had two years ago I got together with my
friend Adam singer both of us have
family and friend histories of addiction
assembled a amazing diverse team brought
in great advisors from UCLA Stanford and
Columbia and said can we do this thing
differently can we change the way that
this works and so we identified four
things that really matter a solution to
addiction has to be passive personalized
predictive and priced well and passive
means it has to report on you
automatically people are very bad at
self reporting personalized means that
the solution has to be tailored to you
individually so
people want to quit some people want to
reduce some people want to do things at
different times there’s no one way of
solving this and now I want to dig in a
little bit more on pricing and
prediction before we do that though let
me just tell you briefly what we built
so onward is the name of the company and
the way the product works is you install
it on your devices it tracks your
behavior and then produces a report of
your unwanted behaviors then we attempt
to predict when you’re gonna act out and
serve you up a just-in-time clinically
validated intervention before you do
okay and those interventions can include
cognitive behavioral therapy physical
activity mindfulness all the different
kinds of things and everything is
optimized using machine learning so that
we get to like you know the optimal
solution for each individual person um
so the pricing element of is really
important you guys let me break this
down for him sure you know we do a
really crappy job of dealing with mental
health in this country like really bad
now if we actually decided to get our
act together and solve the mental health
crisis in the United States and abroad
by the way mental health behavioral
health would be the single biggest
outlay in our healthcare system by a
country mile it would eat the entire
budget that we currently have and then
some because I’ll tell you what $100 an
hour therapy visits for every person
doesn’t scale $25,000 a month rehab for
people does not scale so a solution in
the space if we want to really reach
everybody it has to be dollars per user
per month and not hundreds of dollars
per user per hour now many people
believe and it probably makes total
sense as it relates to prediction that
how you feel your mood will likely
predict whether or not you’re gonna act
out this is a very commonly understood
heuristic for the first time in our
research we were able to demonstrate
unequivocally with observable empirical
data that in fact this is true so we did
a study with 1500 self-described porn
addicts and we were able to look at
their actual behavior and what happened
and what we found was that those who
said they were anxious were
two-and-a-half times more likely to act
out in the subsequent three hours and
those who said they were happy were much
less likely to act out and so we can see
the evidence of this for the
time now why is this important okay this
is a skinner box up on the board many of
you know these experiments from skinner
a rat presses a pedal food comes out the
main lesson there for us that’s
important is the idea that action and
reaction have to be closely tied
together an event and the response have
to be close you don’t need to be a
research psychologist to know this if
any of you have kids or a dog or even a
spouse you know that you can’t be like
honey you know what you did last week
I’m really angry with you right that
doesn’t work the interval has to be
really close together but it might
surprise you to know just how close this
is a chart of the firing of a neuron in
a person’s brain it happens to be a coke
addict looking at an image of cocaine
and what you can see in the firing of
this neuron in this ERP is that if 50
milliseconds in neuron fires 5-0
milliseconds that is a really short
period of time and by the time that
neuron fires you guys it’s too late to
stop that person it’s too late it’s like
when the person has the drink in their
hand is the wrong time to try to
persuade them to put the drink down this
is a very very small amount of time and
so it’s no wonder that all of those
things I showed you up on the board just
fail right they’re kind of ridiculous
the way that we treat behavior change we
ask people to be conscious of their
emotional state at any one time which
people are really bad at okay like
really bad like are you hungry are you
thirsty are you horny like you have no
idea and if you had like 10 minutes just
to sit down and like think about it
you’d probably figure it out right but
you’re going about your day okay so
first you have to be conscious of how
you feel then you have to preempt your
trigger response so 50 milliseconds or
less you’ve got an oh I saw cocaine
okay so you got to pray that it’s really
hard really hard you have to replace
this behavior with the new behavior
right so instead of snorting the cocaine
you’ve got to like go out for a jog and
then you have to do this thing only at
three to seven-day reinforcement
intervals right you only see the
therapist once a week and then you have
to say oh this would happen last week go
to the therapy so it’s no wonder this is
just such a setup for fail so we said
okay can we build behavioral prediction
using the phone started off with you
know your usage data but imagine over
time that you’re able to like
incorporate all these different sensors
that can get at your state of mind and
what’s going on how anxious you are how
hired you or how well you slept all this
stuff is in your phone okay so can we
take that data and actually predict
whether or not people are going to act
out and it turns out we can with 79
percent accuracy better than chance
we’re able to predict in this research
study whether or not somebody would act
out in a three-hour window this is the
beginnings of proof that machines can
know us better than we know ourselves
and that that connection is very
important because of the need to preempt
this behavior if we’re successful with
prediction we can actually stop people
from acting out so in this research
study we were able to stop two-thirds of
people who were triggered actually from
acting out as a result of getting out in
front of this particular behavior and at
a high level zooming out again in our
studies we were able to get 89% of
people to reduce their usage and 51% of
people to quit completely thank you I
want to I of course want a caution it’s
early days but what an exciting moment
for all of us back to Chris Pratt he’s
my favorite okay so back back to Ulysses
the idea of making a commitment with
yourself from when you were sober or
clear of mind to when you are in the
throes of something a trigger or a
passion whatever that concept in
psychology is actually called it Ulysses
pact after this particular myth and it’s
used in many different areas of
psychology but we’ve come to an
interesting new moment where if you
don’t have an army of people to lash you
to a post and you don’t have people in
your life who can figure you out
software can do that for you you can
make a contract with yourself when your
clear mind and have that enforced by
intelligent artificially intelligent
data-driven predictive software it is an
astonishing moment we are on the cusp of
curing addiction I know we are I’m
really confident about it but also we’re
an interesting moment overall because I
think one of the things that that our
research at onward shows is that we act
we can equip you with the tools
necessary to live your best life so we
can give you and you can have an
algorithm that is designed to protect
you against the algorithms of every
company and organization and government
that is attempting to influence your
behavior you can have your own army of
people sitting in your phone helping you
get what it is that you want out of life
and if we can do this right what we’re
talking about is we’re talking about
finally giving people control over their
behavior not in an abstract way not in a
like will you just behave kind of way
right famously no one who has ever told
to calm down actually calms down right
so so and my boyfriend always says that
whenever I tell him to calm down
Universal so so we know that this has
got to be a different situation and we
know that we are on the cusp I believe
that we are on the cusp of giving people
true control over their own behavior
giving them the tools to unlock the way
they want to be regardless of the
context regardless of who’s trying to
you know influence you or get what you
want
it is the unleashing of limitless human
potential and the future just feels
upward and onward thank you
hello everybody so glad to be here my
name is Gabe Zuckerman and my subject
today is addiction but first I want to
start off with the story of Ulysses now
Ulysses was the first stud in our
history he was Greece’s Chris Pine Chris
Hemsworth and Chris Pratt rolled into
one guy there anything that Chris’s
can’t do I don’t know we’ll talk about
that um but so Ulysses there was one
thing that Ulysses felt he couldn’t do
which was listen to the sound of the
sirens of the sea the sirens were this
mermaids who were dangerous and and
their songs were said to make people
crazy so what did he do he had himself
tied to the mast of a ship and then
asked his men to put their ears and fill
them with wax and then wit a ride
directly to the silence right wreckage
silence and he told them under penalty
of death they were not to allow him to
be let go from the ship under no
circumstances should they allow it now
many of us I’m sure all of us can relate
to the idea in our lives of being in a
situation where we feel like it’s not
how we would be in our sober self so
like wanting something when we’re sober
and then being different when we get in
a situation that’s particularly exciting
and probably the the one idea that most
exemplifies this I think is addiction
and you might be surprised of course
that addiction has been with us since
the beginning of time it comes in all
these cultures but you may also be
surprised at how serious of a problem it
is today the w-h-o estimates that over
800 million people are alcoholics around
the world 800 million people and if we
take a step back from this resume out
from this and we add other things to
this list technology-mediated addictions
screentime gambling shopping pornography
the numbers get exponentially larger and
if we zoom out one more time and we let
go of this definite
of addiction which is that people have
to reach rock bottom it’s like a very
vestige alai dia
of a scarce treatment modality and we
think about overuse people doing
something more than they would like the
binge drinker rather than the alcoholic
the numbers get even bigger and so I
wondered why is it that it’s been so
difficult to conquer addiction since
it’s been around for so long and my
research led me to a quick acronym best
and it stands for bias economy stigma
and technology and I want to talk about
these things so first technology we’ve
always used technology to make things
more addictive it’s how we make pot
stronger or weed an acre of weed more
potent it’s how we make fentanyl more
deadly technology’s always been part of
addiction but what’s different today is
that technology is now the end addiction
in and of itself right so minor
footnotes in psychology like porn
addiction didn’t exist basically 20
years ago and today they’re a thing that
affects tens of millions of people when
it comes to stigma you know we tend to
think of addicts as the other it’s poor
people people with mental illness people
live on the street but in fact science
today tells us that addiction is
connected to our dopamine loop in our
brain so every time we challenge
ourselves to something and we treat it
our brain secretes a little bit of
dopamine and that makes us want to do
that thing again this is how we got to
the moon this is how we build great
things this is why you eat this is why
you procreate this dopaminergic loop but
it’s hijacked in addiction it makes you
want to do that thing more and more and
more and so addiction is not something
that other people face you are born an
addict your evolutionary biology is
designed to make you addicted to those
things that will keep you alive and move
your family lineage forward it’s almost
like everyone’s an addict and the
economy of course capitalism has found a
way to really leverage that idea and
drive it deeply this is a KFC Double
Down it’s a crazy sandwich the bread is
actually made of chicken
and so KFC like most other food
companies employs tens of thousands of
people whose sole job it is to make the
stuff they eat more addictive if it were
up to them you would eat every single
meal at KFC breakfast lunch dinner and
two snacks in between and you know what
it’s not just the food business
literally every company on earth would
like for you to use their product and
service to the exclusion of everything
else you know people talk about our
economy is being driven by information
or being driven by attention but I
actually think no matter how we look at
it we live in an addiction economy now
what’s happened that’s made this more
extreme is the advent of algorithms so
maybe you like companies like Facebook
and Google who use algorithms to get you
kind of addicted to their products and
refreshing you know maybe you could
learn willpower to resist the KFC Double
Down but these algorithms are designed
to actually take your willpower and use
it against you they learn how you resist
them and they come up with alternatives
to overcome your willpower and I know
this you guys because I’ve spent the
better part of the last 10 years being a
staunch advocate for gamification I’ve
worked with many of these companies on
making their systems more addictive and
engaging and it’s become very clear to
me that things have gone a little too
far and the last element in this
discussion is about bias everybody is
sure they know why addiction exists oh
it’s trauma oh it’s like if we were just
more social and connected and we all got
to hang out there would be no addicts
and everybody has an idea about how to
treat it right there it’s a moral
failing it requires religion it requires
total abstinence just say no which was
probably the worst one of all of these
and the truth is there’s no one ring to
rule addiction addiction is not one
thing in fact the word tells us very
clearly so here’s an image of Rob Ford
Toronto’s famous crack smoking mayor it
is my hometown go vi okay so
Toronto’s and by the way if you’re from
Washington or various other cities you
can replace this with your own
cracked-out mayor you don’t have to use
Rob Ford
so we say Rob Ford on one side of this
image and on the other side of this
image you see two people obviously have
an issue with their phones now here’s
the thing every rational person looks at
this image and understands that there
are some similarities but that they are
not the same and you see how brute force
our idea is about this concept that we
use the same term to describe both of
them and so given all of these things
let me tell you something addiction
treatments are really poor now I’ve
pulled together this is hard to get data
I pulled together the best most
optimistic meta analysis of treatment
efficacy across various modalities and
the best that we’ve got to treat
addiction has a 30% success rate at 1
year 3 0% now some of you might be
saying oh that’s great that’s awesome uh
lung cancer has a 52 percent five-year
survival rate right now if we use 30
percent as our benchmark it’s no wonder
that we don’t move things forward like
we don’t ever get to that level and it’s
not much better than willpower by the
way which comes in at 22% and so I think
we need to think about this completely
differently right now we think of
addiction is like trauma right mobilize
the forces everyone in the emergency
room spend $25,000 a month on rehab and
what we need to do is start thinking of
it as preventative medicine because you
see if you successfully vaccinate
everyone despite what when it’s polish
or whatever tells you if you
successfully vaccinate everyone I guess
do Jenny McCarthy sorry Gwyneth’s sorry
glue look um if you successfully
vaccinate everybody right
you don’t need trauma medicine and that
that was the heart of an idea that we
had two years ago I got together with my
friend Adam singer both of us have
family and friend histories of addiction
assembled a amazing diverse team brought
in great advisors from UCLA Stanford and
Columbia and said can we do this thing
differently can we change the way that
this works and so we identified four
things that really matter a solution to
addiction has to be passive personalized
predictive and priced well and passive
means it has to report on you
automatically people are very bad at
self reporting personalized means that
the solution has to be tailored to you
individually so
people want to quit some people want to
reduce some people want to do things at
different times there’s no one way of
solving this and now I want to dig in a
little bit more on pricing and
prediction before we do that though let
me just tell you briefly what we built
so onward is the name of the company and
the way the product works is you install
it on your devices it tracks your
behavior and then produces a report of
your unwanted behaviors then we attempt
to predict when you’re gonna act out and
serve you up a just-in-time clinically
validated intervention before you do
okay and those interventions can include
cognitive behavioral therapy physical
activity mindfulness all the different
kinds of things and everything is
optimized using machine learning so that
we get to like you know the optimal
solution for each individual person um
so the pricing element of is really
important you guys let me break this
down for him sure you know we do a
really crappy job of dealing with mental
health in this country like really bad
now if we actually decided to get our
act together and solve the mental health
crisis in the United States and abroad
by the way mental health behavioral
health would be the single biggest
outlay in our healthcare system by a
country mile it would eat the entire
budget that we currently have and then
some because I’ll tell you what $100 an
hour therapy visits for every person
doesn’t scale $25,000 a month rehab for
people does not scale so a solution in
the space if we want to really reach
everybody it has to be dollars per user
per month and not hundreds of dollars
per user per hour now many people
believe and it probably makes total
sense as it relates to prediction that
how you feel your mood will likely
predict whether or not you’re gonna act
out this is a very commonly understood
heuristic for the first time in our
research we were able to demonstrate
unequivocally with observable empirical
data that in fact this is true so we did
a study with 1500 self-described porn
addicts and we were able to look at
their actual behavior and what happened
and what we found was that those who
said they were anxious were
two-and-a-half times more likely to act
out in the subsequent three hours and
those who said they were happy were much
less likely to act out and so we can see
the evidence of this for the
time now why is this important okay this
is a skinner box up on the board many of
you know these experiments from skinner
a rat presses a pedal food comes out the
main lesson there for us that’s
important is the idea that action and
reaction have to be closely tied
together an event and the response have
to be close you don’t need to be a
research psychologist to know this if
any of you have kids or a dog or even a
spouse you know that you can’t be like
honey you know what you did last week
I’m really angry with you right that
doesn’t work the interval has to be
really close together but it might
surprise you to know just how close this
is a chart of the firing of a neuron in
a person’s brain it happens to be a coke
addict looking at an image of cocaine
and what you can see in the firing of
this neuron in this ERP is that if 50
milliseconds in neuron fires 5-0
milliseconds that is a really short
period of time and by the time that
neuron fires you guys it’s too late to
stop that person it’s too late it’s like
when the person has the drink in their
hand is the wrong time to try to
persuade them to put the drink down this
is a very very small amount of time and
so it’s no wonder that all of those
things I showed you up on the board just
fail right they’re kind of ridiculous
the way that we treat behavior change we
ask people to be conscious of their
emotional state at any one time which
people are really bad at okay like
really bad like are you hungry are you
thirsty are you horny like you have no
idea and if you had like 10 minutes just
to sit down and like think about it
you’d probably figure it out right but
you’re going about your day okay so
first you have to be conscious of how
you feel then you have to preempt your
trigger response so 50 milliseconds or
less you’ve got an oh I saw cocaine
okay so you got to pray that it’s really
hard really hard you have to replace
this behavior with the new behavior
right so instead of snorting the cocaine
you’ve got to like go out for a jog and
then you have to do this thing only at
three to seven-day reinforcement
intervals right you only see the
therapist once a week and then you have
to say oh this would happen last week go
to the therapy so it’s no wonder this is
just such a setup for fail so we said
okay can we build behavioral prediction
using the phone started off with you
know your usage data but imagine over
time that you’re able to like
incorporate all these different sensors
that can get at your state of mind and
what’s going on how anxious you are how
hired you or how well you slept all this
stuff is in your phone okay so can we
take that data and actually predict
whether or not people are going to act
out and it turns out we can with 79
percent accuracy better than chance
we’re able to predict in this research
study whether or not somebody would act
out in a three-hour window this is the
beginnings of proof that machines can
know us better than we know ourselves
and that that connection is very
important because of the need to preempt
this behavior if we’re successful with
prediction we can actually stop people
from acting out so in this research
study we were able to stop two-thirds of
people who were triggered actually from
acting out as a result of getting out in
front of this particular behavior and at
a high level zooming out again in our
studies we were able to get 89% of
people to reduce their usage and 51% of
people to quit completely thank you I
want to I of course want a caution it’s
early days but what an exciting moment
for all of us back to Chris Pratt he’s
my favorite okay so back back to Ulysses
the idea of making a commitment with
yourself from when you were sober or
clear of mind to when you are in the
throes of something a trigger or a
passion whatever that concept in
psychology is actually called it Ulysses
pact after this particular myth and it’s
used in many different areas of
psychology but we’ve come to an
interesting new moment where if you
don’t have an army of people to lash you
to a post and you don’t have people in
your life who can figure you out
software can do that for you you can
make a contract with yourself when your
clear mind and have that enforced by
intelligent artificially intelligent
data-driven predictive software it is an
astonishing moment we are on the cusp of
curing addiction I know we are I’m
really confident about it but also we’re
an interesting moment overall because I
think one of the things that that our
research at onward shows is that we act
we can equip you with the tools
necessary to live your best life so we
can give you and you can have an
algorithm that is designed to protect
you against the algorithms of every
company and organization and government
that is attempting to influence your
behavior you can have your own army of
people sitting in your phone helping you
get what it is that you want out of life
and if we can do this right what we’re
talking about is we’re talking about
finally giving people control over their
behavior not in an abstract way not in a
like will you just behave kind of way
right famously no one who has ever told
to calm down actually calms down right
so so and my boyfriend always says that
whenever I tell him to calm down
Universal so so we know that this has
got to be a different situation and we
know that we are on the cusp I believe
that we are on the cusp of giving people
true control over their own behavior
giving them the tools to unlock the way
they want to be regardless of the
context regardless of who’s trying to
you know influence you or get what you
want
it is the unleashing of limitless human
potential and the future just feels
upward and onward thank you
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