so lawyers can be kind of geeky and I
got to confess that I get geeky about
big questions and big problems and
paradoxes like for example I’m a huge
fan of Thomas Jefferson Thomas Jefferson
was if you recall he was he was our
original he authored the Declaration of
Independence he led our country through
very difficult times he was a business
owner he was a deeply spiritual person
even wrote his own version of the Bible
he was wise he was intelligent and by
all accounts he was supremely ethical
but he had a blind spot when it came to
slavery
so does this diminish his greatness he
was a great man but I do think that
tarnishes him a little bit so I invite
you to enjoy me on a little thought
experiment think about how it is like
thinking about the future a hundred
years from now 200 years from now
what is it that we’re doing today that
our ancestors will judge us harshly for
think about this idea that I mean we’re
wives and we’re intelligent and we’re
smart yet there are things that we’re
doing today that will seem primitive to
our great-grandchildren so what when I
think about that the first thing that
comes to mind my mind is just this
ungodly amount of sugar that we feed
children but uh but that’s not what I’m
here to talk about I really do think
that we’ll be judged rather harshly
about how it is that we’ve Pete treat
people with the disease of addiction
because science is actually known for a
very long time that addiction is a
disease of the brain it interrupts an
addicts ability to make good choices and
make good decisions yet we generally
expect an addict who has a brain disease
to use that diseased brain to make
better choices
you know we accuse them of a lack of
willpower they don’t understand the
consequence of their actions
they wear their morals kind of loud you
know but we have healthy brains and what
we don’t really stop to think about what
is it where is it that this even
processed in the brain now as a
courthouse lawyer when I think about how
it is we treat addicts I think about it
through the frame of the criminal
justice system and the way we treat
addicts for a long time has been lock
them up now that’s been really the
dominant solution for probably 50 years
and you know it isn’t really working
very well now fortunately the science is
catching up we have some more are more
enlightened leaders and more in
forward-thinking leaders are innovating
and thinking of solutions but I really
think that we have a long way to go so
now and by the way I’m not I’m not
pointing the fingers anybody I I’m an
offender myself I started my legal
career as an assistant district attorney
and I am responsible for locking up many
many people with the disease of
addiction that probably would have been
better served in a therapeutic setting
but we didn’t know and by the way please
do not hear me say that I think we
should ignore people that break the law
or that we should somehow hand out free
passes it’s just we have to learn how to
respond in a different and better way so
when I was in the court house I handled
all the big cases that you’d see on the
media rapes robberies murders the kinds
of cases that give the public an
impression of what’s going on at the
courthouse but I’m tell you the media
really doesn’t scratch the surface of
what’s really going on and statistics do
not tell an accurate story well my
message to you is this the vast majority
of all criminal cases the underlying
issue is substance abuse alcoholism and
the disease of addiction my personal
beliefs is if we can solve the puzzle
that’s a disease of addiction we could
cut the crime rate by over 50% so that
today I represent
moms and dads sons and daughters people
that are suffering from the disease of
addiction they’re they’re remarkably
like us or normal people with normal mix
of good and bad they do tend to have a
quite a bit higher incidence of
childhood trauma but otherwise they’re
there they’re good people but they’re
trapped in a body and a damaged brain
that’s a version themselves but they
have profoundly profoundly damaged
brains now despite the fact that all I
mean the vast majority of criminal cases
that go before in the courthouse and the
lawyers and the judges the ones that are
tasked with you know solving you figure
out what’s right to do in this case have
zero training and addiction there’s no
training in law school for addiction yet
we’re the ones creating the dissolutions
it would be a little bit like what if
you went to a hospital to get cancer
treatment and know that doctors there
know anything about cancer well I think
you got cancer but I don’t never had any
formal training in cancer that’s kind of
what we’re facing I’m gonna tell you
this to you you can solve the criminal
problem but if you don’t solve the
underlying issue that got into the
courthouse to begin with it’s a
revolving door they’re just back again
probation violation a new case one step
closer to prison so now obviously not
every addict gets involved in the
criminal justice system I suspect most
down so the problem is actually much
larger than my small views which is the
court house last fall the US Surgeon
General did his report on addiction his
release last fall and came up with some
this is our first ever report on
addiction what they said there’s 66
million people that involved in binge
drinking in the last 30 days and 27
million people use illicit drugs or
misuse prescription drugs
that’s 93 million people now what is
that 93 million people what does that
look like that looks like if you were to
take every man woman and child in the in
the states in red that’s what that looks
like now I’m not suggesting that these
people are suffering from addiction
there they’re dancing with addiction
they’re dancing with
flirting with very high risk activity
but the Surgeon General says that people
that have that can be clinically
diagnosed that fit the criteria for
substance abuse disorder that actually
suffer from a brain disease of addiction
it’s 23 million people and if you would
plot it like this that’s every man woman
and child in this area has a disease of
the brain I mean this is this isn’t bad
water in Flint Michigan this is a
problem this is by any accounts it’s a
it’s an epidemic
so what’s going on before you can really
tackle addiction you have to understand
what’s going on that six inches between
your ears the addiction is always it’s
it’s a tension between these two areas
of the brain the prefrontal cortex this
guy right here prefrontal cortex that’s
the cool part that makes this human this
part down a little bit lower the nucleus
accumbens that’s the midbrain that’s a
more animalistic brain there’s a there’s
this tension always between the nucleus
accumbens and the prefrontal cortex
now the prefrontal cortex this is the
area that is the thinking brain this is
you know like apes are faster than us
and they’re stronger than us but because
of what this does for us we’re the
dominant species on this planet okay
this is goal-setting
this is executive function its
determining the difference being good
better and best
it’s where suppression of urges happen
now this other part of the brain this is
the more animalistic part of the brain
the midbrain this is the part that some
people call it a lizard brain it’s not
really as part of our subconscious it’s
not really a thinking part it’s more of
an instinctive part the little nucleus
accumbens I also call the pleasure
center and that’s that little structure
there has really kept our species alive
for about 200,000 years and what it
would do is that it helps the brain
obsess over things that would keep us
alive food water sex past the genetic
material of next generation and when it
does that by releasing dopamine whenever
it finds something it wants and and and
helps it focus and concentrate on that
but there are mood altering substances
that massively overstimulate this and
whenever you have a massively
overstimulated nucleus
company kiss accumbens takes over and it
literally cuts off the prefrontal cortex
from making a decision you literally
cannot think about what it is you you
know the answer you can talk to an
addict all day long they know the answer
they just can’t do it
it’s because this part of the structure
of the brain cuts it off and we all do
this every one of us we have this
dynamic tension between nucleus
accumbens and and the prefrontal cortex
so you know nooks accumbens or
prefrontal cortex will say I’m gonna
lose weight we’re gonna go a diet but by
the end of day you’ve had an ice cream
right prefrontal cortex says you know
I’m gonna get up and go work out at
seven o’clock and next thing you know
it’s really warm cozy in bed and you
don’t go it’s this we’re all doing it
it’s just not the disease of addiction
unless the nucleus accumbens takes over
so now what are the little things what
is the dopamine they do this with
dopamine by giving us these little
rewards so I want you to imagine like
your favorite meal your favorite meal
that you just have a great meal how does
that make you feel it makes you feel
good because you got a shot at dopamine
that’s about 50% more than normal your
dopamine level just went up that’s why
you do it
think about sex for a minute okay sex is
great you know why it’s great because
dopamine goes in your brain encouraging
you to do it it’s 200 I mean it doubles
them how to dopamine in your brain so
here’s what I’m suggesting
everybody in this room for the next year
go with let’s let’s all go on a diet any
only salad and there’s no sex for a year
no sex for you who’s in for that no we
want we want the dopamine right we’d
love that dopamine imagine what you just
felt like trying to give that up for a
year and opposed to somebody who’s has
the amount of heroin or methamphetamine
it’s it’s it’s five times harder than
giving up sex and none of us want to do
that so this is we know a little bit now
about what what’s going on in the brain
and what the problem is but the what are
one of the solutions I don’t really
know what all the solutions are but
there are some things that kind of
inform the way that I go about with Mike
working with my clients and one of them
there’s a fascinating series of
experiments that were done with recovery
and addictions called the rat part they
were done in the nineteen seventies and
you probably saw these first round of
experiments they would take a rat and
they put a rat in a cage and they were
given a choice between drug water and
regular water and a little rat in a cage
will do the drug water until it dies
proof addiction lock everybody up that
has that another researcher came along
and there’s a flaw with this experiment
I work with rats I know about rats rats
are highly social creatures they hate
being in small cages by themselves like
humans so he reworked the experiment he
created rat Park same experiment but
lots of room not one rat but many balls
tunnels little amusements part for rats
and this time he gave him a choice
between drug water and regular water and
guess what the vast majority of rats
never touched the drugged water didn’t
even use it didn’t want to use it only a
small number of rats used the drug water
and none of them music compulsively till
they died so because what they wanted to
do is they wanted to have like a little
rat fun with their little rat buddies in
rat Park okay they they want what we
want we want comfort and connection and
fun so when you think about how it is
that an attic how do they engage their
life you have to create a life that’s
full of fun and engagement and enjoy and
so but this got me thinking about I’m
back to this slide again sorry the so
the bad news of this 23 million this 23
million people only 10 percent treatment
and of the ones that get treatment only
about 40 to 50 percent of them stay
sober
a year later I mean 50 to 50 to 60
percent relapse and it’s even higher for
meth and heroin it’s the bane of
treatment relapses were why haven’t
clients they go to relapse are doing
great they come back and a couple months
later they relapse like what’s going on
you know what do you have
reason in the world to be sober what’s
going on so it got me very curious about
relapse prevention I wanted to do
something and really focus on what is it
that we can do in the area of relapse
prevention the conventional wisdom is
hey avoid your triggers and if you think
about what’s the reason for the relapse
there’s a lot of reasons for relapse but
one of them is encountering triggers in
your environment so what can you do well
I’ll tell you a story I have a client
he’s a very successful professional he
had an addiction to methamphetamine he’s
been sober now for well over a year he’s
doing really well but he bought into
this rat Park theory and we created a
life there was just things he loved to
do rebuilding the connections and the
fun and and you know the thing that he
loved more than anything he loved Kona
oh you football games I mean there’s
nothing better than college campus and
fall putting on your crimson sweater and
hanging out with like a hundred thousand
members of your tribe I mean that’s cool
the problem is that his trigger for use
for meth was beer does anybody been on
campus on a game day and had an urge to
have a beer right right this is
dangerous territory his rat Park is
dangerous you can’t avoid your triggers
there because you know what you can’t
get to this until you go through this
and this you know think about what if
your advice is many engage in your life
what if your I want you to imagine with
me for a minute you’re a recovering
addict and you’re trying to create a fun
and interesting life and you love sports
basketball football I don’t know what it
is but chances are it’s sponsored by a
beer a beer or a vodka what if you’re a
live music person it’s like music
anybody rent to the live music venue and
seeing drugs or alcohol there right you
know I think just avoid your triggers go
home go home until you turn on the
television even on social media I mean
you’re saturated with images of really
attractive people suggesting then the
good life is over here what you need is
a Heineken it hang out with a captain
right I mean what about this dude okay I
mean he who doesn’t want to be this guy
right
but I mean for I’m telling you for for
millions of people with the disease of
addiction this is the beginning of a
life of destruction so so what do you do
really avoiding your triggers isn’t
always possible there there so I’ve got
to think about how it is that we explore
a way to help people suffering with
addiction and avoid relapse and maybe
what we could do is engage that midbrain
in some way engage the midbrain
but then retrain it get it to think
about instead of maybe avoiding your
triggers is there a way to encounter
your triggers in real life so I started
looking at different disciplines and
discovered of be a hospital that was
treating burn patients with virtual
reality for a pain management tool
virtual burn patients are in a lot of
pain they have this excruciating ly
painful treatments daily whether if
their skin feels hot and raw and what
they figured out is they can actually
take a virtual reality and put a burn
patient in it and have them simulate
what it’s like to walk through a winter
landscape literally you feel like it
looks like you’re walking through snow
there’s ice on the trees you can see the
snow falling and all of a sudden their
pain level goes remarkably powerful tool
virtual reality right now the emphasis
has been on entertainment but I think
you’re gonna see a lot of therapeutic
uses coming I’m about to show you this
is my missus my 16 year old son the
first time ever he put on the VR and he
was watching a very short little
so that shows you a couple things one
there’s the power of virtual reality it
can really just take the brain it’s
completely different place but that’s
also the midbrain at work there I mean
he knows his prefrontal cortex notice
where it is he knows he’s like on a
piece of plastic on its head watching a
little image but it’s it’s a very
powerful tool now for the first time
what we can do is we can simulate what
it’s like for an addict to be in a
target-rich environment where they have
where they have cravings and have them
experience what it feels like to
actually get a craving what it’s like
did you experience like walking through
campus corner holding a beer or go into
a New Year’s Eve celebration or you know
sporting events sporting events the the
right now with this technology that
we’re pairing with a kind of a
mindfulness technique a meditation
technique called surfing the urge so the
conventional wisdom is distract yourself
this is different its focus on your urge
experience it get comfortable being
uncomfortable temporarily watch what
goes on in the body and you’ll notice
the urges come and they go and you’re
going to be okay so we’ve started a
technology company to develop this
technology and right now we’re building
out a library of video simulations that
simulate triggers that we can reproduce
in a therapeutic setting in a safe
environment and we really are optimistic
this will be an effective tool for
relapse prevention thank you [Applause]