Alcohol, addiction and the brain with Dr Marc Lewis

In this episode we talk to Dr Marc Lewis,  a neuroscientist and former professor of developmental psychology. We explore what addiction is from a neuroscience perspective, including why Marc does not consider it a disease, despite changes to the brain. We discuss how addiction relates to habit, compulsion, and how these can be understood as functions of the brain and human behaviour. Marc also talks about his own alcohol use and reflections about alcohol as a complex drug - both good and bad.

Marc has authored or co-authored more than fifty journal articles in neuroscience and developmental psychology.  His first book, Memoirs of an Addicted Brain, is the first to blend memoir and science in addiction studies. His last book, The Biology of Desire,  refutes the medical view of addiction as a brain disease through both neuroscience and real world explorations of addiction problems.

Transcript

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James Morris: 0:00

Thanks for joining me on the show, Mark. Can you tell me a bit about who you are and what your interests are,

Marc Lewis: 0:12

Sure. So I've had a few different careers that since I was a professor at the University of Toronto for 20 plus years, then moved to the Netherlands and did some teaching, research there for 10 years. So that was my academic life when I got back to Toronto, which is where I live now. But I'm old now I'm 71. So I've given up the academic entirely, pretty much I mean, the odd review, and so forth. But I keep I, you know, I keep somewhat alert to research that's relevant to my interests. And my interests have turned in the last 1510 to 15 years to addiction, mainly because I had a lot of addiction problems myself and my 20s, I was pretty serious opiate addict. And it wasn't until I could clear that up that I got back into graduate school, got a PhD in the academic route. And then Then I studied emotional development, cognitive development, cognition, emotion, interactions, neuroscience of emotion regulation, personality, development, all that kind of stuff. And then toward the end of that I got interested more in Okay, addictions are real concrete problem that I can focus on. I did a lot of, you know, a lot of research on the net, to figure out what's going on now with the neuroscience of addiction that interested me a great deal. I wrote published a couple of books on addiction. The first one was called Memoirs of an addicted brain, which was the story of my years of drug use, and interspersed with kind of user friendly ways of trying to understand how different drugs work in the brain, and psychologically as well, and just kind of follow the gamut and follow the progression of my own drug use from from alcohol to through, you know, marijuana, all the usual steps. And then on to hard drugs, which that was when I was living in California, and went to Berkeley, California, height of the the kind of hippie revolution, drugs, sex and rock and roll and there was lots to choose. So there was that hat. But I also got really interested in writing pop science, rather than writing journal articles, just for me a more interesting, more productive way to communicate with the world. So that was the first book Memoirs of an addicted brain. And then that came out in 2011, I think, at Random House. And then the second one is called biology of desire, why addiction is not a disease, at the subtitle, why addiction is not a disease became kind of my my argument, my pulpit banging response to the dominant model of addiction at the time, which I think still is dominant in many places, which is that addiction shouldn't be labelled as a disease is specifically a brain disease. And that's got all kinds of implications that I found to be really negative, not only did it not make much sense in terms of brain processes, but it didn't make much sense in terms of treatment processes. Because if you have a disease, and you go to the doctor, and you're a patient and to do what the doctor tells you to do, and you lose that sense of self efficacy, and empowerment, which I think is so important for recovery, or for control, I mean, whether it's us or whether it's just control us. So I became quite interested in this approach to addiction, which counters the disease model, and relies instead on looking at environmental factors, social factors, personal psychological factors, seeing addiction, not as just a thing in itself, but rather seeing it as part of a whole mental health, shall we say, matrix that that is gone wrong. And that's really the way to approach it, and to help people that need help.

James Morris: 3:58

Absolutely. And they're both great books. And I suppose what's unique about you is that you, you know, as a neuroscientist, a real understanding of the brain. And, you know, this idea of whether it can or should or shouldn't be called a disease based on the neuroscience, because, you know, that's the kind of context isn't it that, you know, the sort of, I think, in the biology of desire, you said that the 90s was kind of called the decade of the brain. And that was the rise of neuroscience. And when this kind of almost disease model certainly flourished under a kind of neuroscience paradigm.

Marc Lewis: 4:32

Exactly. Yeah. And yeah, that was so as I kind of joined the camp of people who argued against the disease model, you're right, my perspective was a bit different, a bit unique because I didn't want to get the break out of the equation. A lot of people who said no, it's not a disease, it's a social issue, etc, etc. They don't want to think about the brain at all. I do. I think it's really important to try to understand the neural aspects of it. diction as a kind of high powered learning process, which becomes an extremely deep habit, but you know, why not understand in so much that we do know about how the brain works now, to help us understand learning in general, and help us understand habit formation, compulsion, the things that we know, psychologically, are really important aspects of addiction. So I really want to, you know, stay on both sides of that divide that divide. And I argue against people who say, if people like Sally Satel, say, well, we don't need to think about the brain anymore. That's kind of silly. No, silly at all, I think it can be quite helpful, you know,

James Morris: 5:41

And I think everybody knows that the brain is part of their body and part of their thoughts and the feelings and, you know, maybe we know that cognition is embodied, that is connected to our bodies and our environments and all of that. But yeah, absolutely, I'd agree that, you know, we will never convince people by saying we need to kind of ignore the brain altogether, because it is so central in in terms of many people's understandings themselves, but I suppose so, you know, for an advocate of a kind of brain disease model of an addiction, they would say that, that the neuro adaptations are so significant as a result of drug use, or maybe engaging in an addictive behaviour, that it fundamentally changes the brain. And that impairs control to such a significant degree that you would say that, then that it's diseased, you know, how would you respond to that?

Marc Lewis: 6:31

So yeah, I hear that a lot. Of course, you know, if you look at the specific neurochemical neurotransmitter interactions, and so forth, you do see differences, you see a certain amount of wiring up of tendencies or reactions, or kind of a Pavlovian learning response to stimulus response, you know, automaticity, and stuff like that. So some people might say, Well, isn't that kind of like a disease? Or is that kind of weird, but actually, when you look more deeply at the issue, it's not weird at all, a lot of deep learning works exactly like that. When we fought when we fall in love, when we join a religion, when we have children, there's all sorts of things when we develop strong habits of following a sports team, for example, you can have exactly the same brain changes. The whole dopamine issue opening is kind of the famous neurotransmitter in addiction is an important part of all kinds of learning and deep learning and learning that leads to direct actions. So drug use, and alcohol use just doesn't stand apart from some of these other deeply embedded habits.

James Morris: 7:41

So is it not the case, then the sort of quick fix of being able to take a drink or have a lot of alcohol that would affect the brain that that could be more of a dopamine release than other things that are non substance or less, arguably addictive behaviours or triggers? Or is there not people not say that there was the drug that way it kind of almost biochemically manufactures this release is so reinforcing that, that that's kind of kind of spurs it or pushes it into the realm of addiction?

Marc Lewis: 8:14

I think that's a good point. And it opens up another complexity here. I agree that with substance use, there's something special going on in the sense that the visceral reaction, the actual bodily, visceral reaction, the immediacy, whether it's alcohol, or drugs, or alcohol, is a drug. That's that special. I mean, there's just something about that. And when you combine that visceral response with the symbolism that takes over with addiction, this is my friend, this is my attachment object. This is what I need to feel better. This is what I, this is what I can trust. This is how I can control my mood, all of those psychological factors mixed with the visceral, immediate response, I think, yeah, that's a really powerful combination. But then I look at you know, the way people get completely, you know, obsessed with sports with their sports team, their favourite sports team. It's just not that different. That kind of obsession, that kind of compulsivity, I've got to watch this, I got to see this game, you know, the hub's drop whatever they're doing in order to do that. And of course, with now with the attraction to the, to the online world, people are compulsively getting, you know, browsing, like all the time and teenagers on their phones, et cetera, et cetera, we see a lot of stuff that looks so similar, despite the fact that it doesn't certainly have the same visceral punch, you know, you're not putting something in your blood, and yet, it doesn't look that different. So, you know, I think that's a it's sort of a fine point. It's important, but it's not the whole story.

James Morris: 9:47

Yeah, absolutely. And not just teenagers. You know, I certainly struggle with kind of modifying my smartphone use if you like, you know, I you know, there's motivation there to change it and I have put some strategies in place, you know, no Doom scrolling when I'm on the sofa. And that kind of works.

Marc Lewis: 10:06

I actually I have to this my second generation of kids, second, second marriage second generation of kids to 16 year old twin boys. And I was with one of them this morning and we had breakfast together. And it was the stuff that he watched on his phone. It's like, Julian, what? What is this doing for you? Like you're watching bunnies jumping through hoops or whatever, cats hanging upside down or wearing hats. I mean, just really stupid stuff. You know, a lot of his Tik Tok and Snapchat and what are some of the other ones, you know, Instagram, Reddit, I mean, all that stuff. It's like, it's it really, it's compulsive. Okay, that's best word for it. And when people become addicted to drugs, or alcohol, it's compulsive. And actually, I should have mentioned my present careers. I'm now a licenced clinical psychologist in Toronto. So I spend all my work time doing, as a psychologist doing psychotherapy, guy walked into my office yesterday with a gambling addiction, that was really serious. I mean, he spent almost all of their family money, his wife is completely ready to leave him. And there's nothing there's nothing visceral, there's nothing being pumped into the blood. And yet the compulsion was so strong. In you see that with gambling, of course, you know, quite frequently. So where do you draw the line? Right? And so

James Morris: 11:23

Going back to the, you know, what's going on inside the brain, then what would someone who's developed an addiction or a clinical addiction, however you want to define it? Would, whether it's gambling or alcohol, or whatever, would you say that there's, then there's always going to have been a degree of synaptic Genesis that that kind of is that was linked to the automaticity of it, that or the compulsion of it, whereby a kind of repeated use, and the expectancies around some kind of positive reward have generated, you know, laying down those pathways or the kind of what is it neurons that fire together wire together, that's the kind of think, you know, my understanding of the development of addiction, you know, I don't think that qualifies it as a disease, but that there's synaptic genesis, but in turn, there's also I think, you've described it as synaptic pruning before, where you can under as well. So, if you can undo it by, you know, changing the behaviour or doing any of the treatment intervention, things that kind of result in not doing addictive behaviour, the the pruning takes place. So is this that common to all addictions that are fundamentally that compulsiveness or pursuit of the behaviour or loss of control is underpinned, if you like by synaptic Genesis around certain rewarding behaviours, or expectations, at least of that reward?

Unknown: 12:45

Yes. But first of all, a, it's complicated, of course, be what you just described is, is fundamental to all learning, all learning. All learning depends on synaptogenesis, which means the the develop the formation of synaptic networks, so the neurons joined together through their dendrites and axons, and they become a configuration. And that configuration becomes activated more and more often. And alternative configurations have less chance to develop, or become weakened in competition. But that describes any learning the same thing with learning piano.

James Morris: 13:21

Yeah, I always think about learning to drive a car, you know, when you get in, you've got to think very consciously and follow the instructions about what you're doing putting it into gear, and then just the more you do it, you know, I can drive without thinking at all about it and have a conversation and listen to music and so on. So that's essentially synaptic Genesis that's automated, if you like part of my brain to know how to drive a car,

Unknown: 13:43

right? So it's synaptic genesis, that's the first half and then pruning is the second half. So pruning is very interesting, people don't really get it, but it's once once you develop a more elaborate synaptic network, you learn new skills or new keys on the piano, you learn to drive a car, whatever, then you have to prune, which means that you get rid of weakened synapses, or you get rid of synapses that are less relevant to the beat to the rewarded behaviour. So you know, it isn't necessary to what our auto no change lanes when there's a truck coming or something so whatever. So pruning is a really important aspect of consolidating the learning, streamlining it consolidated, that's the case in addiction because really what you're doing is learning a habit of taking a substance or a drink that you more and more recognised as rewarding come to expect it and then the pruning kind of streamlines it makes makes it like the only game in town so to speak. But that's that's only part of it. And a lot of that stuff is general cortical information processing. The cortex is, especially the prefrontal cortex. Perhaps there's other aspects such as compulsion, which come from a different part of the brain called the striatum. We is an older part of the brain. It's not cortex. It's it's, it's more primitive, it's been around for probably two or 300 million years, it works directly to motivate the animal to pursue rewards, immediate rewards, low hanging fruit, so to speak. And that goes from being something like, you know, whether it's grabbing a piece of pizza or an apple to put in your mouth, or whether it's a sex partner, or whether it's whatever it is any kind of resource, which could You could call that impulsive behaviour, and that's also part of addiction, but then it becomes compulsive. So what's that about? And in fact, a lot of things tend to wire up from impulse to compulsion, with repeated use. And that all it's the same with driving, I mean, you know, you change lanes, when you have to change lanes immediately without thinking about it. So that's like, you know, that's compulsive in the same respect as taking a drink without really thinking about it. And, for me, the best, the best example of compulsive be of normal compulsive behaviour, is arguing with my wife, or my kids, like, I know that, you know, pursuing this argument is going to do absolutely no good at all. But the words come out anyway. That's compulsive. I mean, whatever, you know, picking your nose with holes, I mean, what there's so many things that are that are compulsive, we don't think about them. But they're all that means is, it's a well ingrained habit that you are no longer thinking about, or planning or anything like that. It just happens. It's stimulus bound, it's, it's triggered by the stimulus, so to speak, so that that's an important part of addiction, and that there's a certain amount of wiring that goes on in the striatum, when habits become hyper, consolidated, which involves that, and that's really useful information.

James Morris: 16:53

So what about the process of recovery, again, to use a kind of clunky term in some senses, but you know, people understand what we mean, when we say, you know, I always remember Robert West, saying, All behaviour is a competition of motivation. And I like that, because I think, you know, obviously, many kinds of theories of addiction with empirical support, and, and so on, but ultimately, you know, when when someone decides to change, and they're really motivated to do it, that's what what drives it drives the kind of change in behaviour and pursuing of things that they believe or hope will will help them in recovery, and then maybe brain change will kind of follows as a result of that. But you know, where maybe does motivation fit in from a kind of neurological point of view?

Marc Lewis: 17:41

Yeah, so so that's a good point. So a lot of people aren't familiar with Kahneman, system one and system two, fasting versus slow, slow thinking. So there's immediate rapid response which compulsion, okay, and slow responses, slow it down three or four seconds? And wait a minute, do I really want to do this, you know, because then I have to drive home or wake up in the morning. And once you slow things down a bit, then you have a chance to, shall we say, Try on multiple goals, I could have another drink, or I could not have another drink, I could go home and read a book or watch Netflix, or I could do various links. And then motivation is really the, shall we say, the way in which we select among these competing behavioural choices? What but you have to slow things down for that to happen. So I think one of the problems, we classically think of addiction, whether it's disease model or not, we think, Oh, it's all compulsive. No, it's not all compulsive. The fact that the striatum is firing away a compulsive, shall we say, command doesn't mean that the rest of the brain turns off, it doesn't. The rest of the brain is still going. So you still got your prefrontal cortex activated at the same time. And I think that's a really important perspective.

James Morris: 18:58

Yeah, and I think, you know, is really important as well to, you know, think about the kind of functional type of approach to addiction that, you know, still in relation to motivation, but, you know, if your life is really awful, and you've got, you know, very little prospects or you know, maybe a lot of physical or other illnesses or mental health problems, you know, your motivation to change or to let go of, or try and address and addictive behaviour that may not actually be causing you huge problems, you know, is understandably very low, you know, in many senses a rational choice to continue using drugs that make us feel better, even if there are some negative consequences, but the overall outlook is very poor.

Marc Lewis: 19:39

Absolutely. That's I mean, that yes, we would agree that I think that's the irony, so to speak, built into addiction at many scale, you know, whether it's whether it's alcohol or drugs, it does tend to make you feel better for a while and nothing is indisputable. That's why people take new things right. And the worse you feel in your Life, the more tempting and attractive that is. And then, of course, you know, you feel crap here later on or the next day, or, you know, the next week, whatever. And so there's one level of the irony, but it's, it's so fundamental to human behaviour. James, I mean, if you look at infants, like, I mean, we can call all this stuff, emotion regulation. Okay? How do you control your? How do you regulate your moods or emotions? Well, you know, six month old babies will, if they start to get to arouse, they will look away from, say, mother's face, just gaze aversion, because, you know, that makes them feel less or makes him feel calmer for for a few months, but then they lose some contact. So again, there's a double whammy of an immediate, an immediate benefit versus some kind of loss or possibly, you know, longer term change that is not that is not, well, I made it with babies, it's just the way they are. And that's fine. But, but but the certain attachment styles will develop around gaze aversion, insecure attachment, and it's just not that different. Some things that make us feel better right away, make us feel worse in the long term. And that's, that's the human condition.

James Morris: 21:11

There's a very strong literature on the function and the role of emotion regulation, positive and or negative, although interestingly, a recent meta analysis came out showing that positive emotion regulation is much more of a factor in, in alcohol use and problems, I think, then, you know, traditionally, we think that obviously, you know, managing anxiety or depressive symptoms drives much of addiction, but seems that that kind of use of uplifting your kind of mood, as well as controlling the kind of lower mood is playing a really key role.

Marc Lewis: 21:45

emotional regulation. I mean, it's such a big thing. It sounds like some little, you know, sub domain of psychology. But I mean, that's what we that's almost everything we do is emotion regulation, right.

James Morris: 21:55

And thinking about earlier as well, another thing I was thinking was around, you know, motivated reasoning. And when we're talking about motivation to change behaviours, but you know, like, emotions also influence our reasoning. And, you know, someone might say, well say that they don't believe the vaccine works, but it might be motivated by fear of needles and or like, you know, they might not feel that they want to say they're scared of needles. So there's lots of other kinds of rationalisations, or justifications for things we do. And yeah, huge literature on how emotions mediate so many kinds of thought processes or behaviours, right?

Marc Lewis: 22:30

Yeah. One of your countrymen, Keith Oatley, an emotion theorist, somebody I like and respect very much really emphasise the idea that we have multiple goals. At the same time, we don't just one goal, we have many we have several. And you know, when you like, just like, there's three pieces of pizza left in the box, or whatever. It's like, why should I have another one, but then if I did, then somebody else might not get their second or third or whatever. And then I probably feel too stuffed anyway. And there's so many little factors impinging on that one little decision.

James Morris: 23:02

Exactly, and just how your day has been, and you know, How hungry are and all these kind of things. And I guess, addictions, the same as 1000s of things that, you know, could mediate, or moderate, you know, the choice you ultimately make at any given moment,

Marc Lewis: 23:15

it does, but then it does that more at first, and then as the addiction settles in place, it becomes less. I mean, there's some really interesting research that shows that with with months and years of of addiction to various substances, including alcohol, you get less prefrontal activation in certain regions, measured by fMRI. And that's what that really means that those parts of the prefrontal cortex are involved in planning. Okay, so if you've been doing the same damn thing every day, for the last five years, or every evening, when you leave work, you go to the same pile, you don't, you're not doing much planning, just planning going on. You just do it

James Morris: 23:59

That being tied in with synaptic pruning, or is that kind of different?

Marc Lewis: 24:03

Now that is, that's pretty much Well, I think it's very much tied in with it, from going to classic disease model perspective, they say, oh, that's brain damage. No, it's not brain damage. It's a habit. And so when you have habits, you have less choices to make fewer choices to make, when you have fewer choices to make, guess what your brain is actually doing its job most efficiently, as isn't wasting his time, or energy or metabolic and resources on making a whole bunch of decisions. Because you don't have to make a whole bunch of decisions a day to day life. You just have to make a few.

James Morris: 24:36

And I guess the other thing I'm interested in is, you know, where do we draw the line that you know, I think almost all of these things we're talking about can be seen on continuums or spectrums of severity and brain change can be included in that. So you know what if neuro adaptation did constitute a disease or lack of, you know, ability to respond or kind of exert control. And then presumably, you'd have to draw a line in the sand somewhere and say this is diseased, and this isn't. But then again, perhaps, you know, maybe it's just, you know, people don't like the idea of being a little bit diseased, whereas people would accept that you can be a little bit ill.

Marc Lewis: 25:15

Yeah, you know, it does get complicated, doesn't it? That when you think about it that way, I think there are other issues, mental health issues at which it's even more problematic. For example, depression, to depression and anxiety, as we know, are quite common. And most of us feel depression at some point. And some people feel depressed a lot of the time. At what point does it come become major depressive disorder? Well, once its major depressive disorder, it's a DSM category that, that then calls for antidepressant therapy, blah, blah, blah, SSRIs. And well, should we call it a disease, then is it actually fundamentally different? Are you just spending more of your time in a particular state and developing life habits, which tend to facilitate it

James Morris: 26:02

On a previous episode with Dr. Lucy, folks, you know, we talked about this, and, you know, her, her kind of specialism is, you know, kind of understanding, you know, the aetiology, and processes around mental health, and then the language and labelling that falls around that. And, you know, she says, you know, these are all kind of things that exists on continuums, as well. And these are, these are clinical functions, that we have to draw a line in the sand somewhere and put a diagnosis on it for utilitarian purpose of saying, These are the point at which they become problems where we need to try and design treatments around. I think, I think there's validity to that. But we also need to work very hard to try and improve understanding that although we have these kinds of diagnostic labels, and kind of disease orientated concepts, that there's a lot of costs to that, and actually, they are on on spectrums. And you know, we were kind of talking about, you know, there seems to be a correlation between things that people accept as existing on continuums, like autism and depression and anxiety and lower stigma, whereas things that are seen as fundamentally different schizophrenia, or if you call it alcoholism, people see it as two groups of people, you know, alcoholics and, and everybody else, that's when stigma really kicks in. Because, you know, a fundamental part of stigma is, you know, fundamental difference between different groups and dehumanising the outgroup, and so on. So but then, you know, addiction as a term is also problematic, because again, it's a binary, really, you know, people don't really think about addiction as kind of very mild or low severity is so heavily embedded within the idea of disease and recovery, and rock bottom, and all those kinds of things. So, you know, sometimes I use the term addiction, but again, I try and always say, Yeah, but we've got to also recognise that is a label that covers something ever so complex and spectral

Marc Lewis: 27:53

yes and on a spectrum, it's really important. And present culture. I mean, the term neuro diversity, right, it's become quite well, involved. Yeah. Yeah. And I think that's terrific. So people who have mild autism or Asperger's or whatever, it's like, okay, so you just think a little bit differently than then I do. You know, and then yes, it loses its stigma. And I think that's a better world. And I think it's a much more open and humanistic world.

James Morris: 28:22

Yeah, and I think I probably would also defend a disease model, you know, again, in another episode, in terms of not a brain disease model, but a disease model in the sense that a lot of people go through recovery by self identifying as, you know, disease, and you yourself, have self identified as an addict. And that can, you know, presumably, partly informs your kind of behaviours and, and your approaches to other substances, having had that past experience of what you describe as addiction,

Marc Lewis: 28:54

for sure, yeah. But then there's people like Sean Shelley, who, Sean is an addiction policy researcher in South Africa, wonderful guy. And for him, the word addiction is useless, is it? I don't even know what it means anymore. People, you know, make adaptations to their quality of life issues. And based on what's available, what's, you know, what's really just that what's available, which is partly economic, partly social, partly access, and all the rest of it. So what's addiction? I mean, if a certain thing is available, and other things are not available ever, then behaviour becomes highly, you know, consistent over time. Is that addiction? I don't know.

James Morris: 29:39

Well, yeah. And I can, you know, certainly with the case of alcohol, it's the, you know, our society is so alco-genic. It's everywhere, and hugely normalised. Yeah. You know, you can argue that it's as, if not more harmful than almost any other illicit drugs. But it's just totally normalised in in many ways. I mean, we still have a, you know, a very stigmatised view of people who are deemed to have alcohol problems. But that I think, in part is a way in which people who are drinkers, often heavier drinkers protect themselves or normalise their own use by creating that out group of problem drinkers. And you briefly mentioned to me you kind of questioning your own alcohol use is that something you're happy to talk about? It's something that, you know, I'm always reflecting on having developed an alcohol problem at a pretty young age, I didn't drink throughout most of my 20s. And then I've kind of experimented against the the sort of common idea that you should never drink again, once you've had a problem. And I've now been drinking moderately, you know, pretty much within low risk guidelines for over 10 years now without any problems, but I don't feel like I've fundamentally changed, you know, I do feel like in a way, my brain has fundamentally changed in the sense that, you know, I used to drink very heavily to deal with Why didn't recognise but sort of think were problematic emotional states, or unresolved issues, or however you want to call it, whereas now I kind of have the opposite kind of instinct that if I feel stressed, or in a kind of low place, like that's the last time I actually want to drink now, but I think that's a it's been a long journey. And and a lot of that is the kind of thinking and restructuring of the role of alcohol and other things in my life.

Marc Lewis: 31:22

Yeah, that's really interesting. Very, very interesting. And yeah, yes, I don't mind talking about it my own. So yeah, what I actually when I gave up opiates, or cardiac keys, around the age of 3130 31, I actually started drinking, but at quite a reasonable level, like 333 drinks a night, and that was it. And it helped me as a bridge. But okay, so that lasted for a while. And then you know, life goes on. And there were times when dating and relationships and stuff and Martini bars and having lots of fun and all that. And now I still I drink, I usually drink two drinks a night or so. Maybe three. And I do find it kind of a habit that's hard to break. But it's it is within I think relatively normal, it's fairly safe range for men, but you know, I could probably cut it down and be a little better, especially as I'm ageing. You don't really want to waste any, any neurons. Right? And so, and there is some effect on on short term memory. But it's, it's fairly minor. So to me, that's kind of a long term, deep habit of I like having stuff, you know, I like having stuff. And even though it's a different stuff, it's still I do find it comforting and kind of fun. And but I don't like having more than that amount of alcohol guy just because it doesn't feel good to me. So that's pretty much where I'm at.

James Morris: 32:58

That's interesting. Yeah, and I think fairly safe was your phrasing, we did an episode where I spoke to a couple of people, you know, have expertise around? How do we try and assess the level of risk? You know, what are the recommended guidelines based on something like, you know, we have a limit of 41, a guideline of 14 units a week, which is like a bottle and a half of wine, and drinking at that level for an average adult healthy may or will increase your lifetime risk of an alcohol related death by 1%. But I think, you know, the idea is that most people who drink at that amount would would sort of take that level of risk. But then of course, the more you go above, the kind of risk exponentially rises. And now once you're kind of 15, it's a week as a man or 35 units a week as a woman, that risk is more like 20 or 30% of lifetime outcome and that your death which most people drink your level would not want to kind of kind of take so I think from a physical health point of view, less is always more we can't really deny the science on that. But yeah, you just have to factor in you know, I drink because I do enjoy it's a part of wine is a big part of food. And you know, in a social situation, being able to have a drink does maybe alleviate a bit of mild social anxiety, or just just having a glass of wine at home also does maybe just take away that background buzz of anxiety that I still have sometimes hanging there. So it is functional in that way. And yeah, we were kind of we you know, like everything in life. We're making a decision, aren't we pros and cons?

Marc Lewis: 34:29

Yes, and no, I mean, habit is habit. And according to those standards, I drink more than that recommended. Right. So but you know, I'm 71 and healthy. And it's like, I'm sure you're aware of the kind of stance and peel argument that there are certain aspects to alcohol consumption that make make that are positive that you know, mood enhancing social flexibility and all that stuff. And I know how statistics work As a psychologist and so, so these these kinds of guidelines, I'm just not sure. I mean, I think he got to take them with a grain of salt. At the top, it was statistics at the population level, that when you apply them to individual level

James Morris: 35:14

Sure, but I mean, you know, you just accept that as a dose effect, isn't it, the more you consume, the greater the risk, I guess a bit like the argument with addiction, we can't say it's a disease because there's no categorical cutoff for which you say it becomes harmful, or it becomes addiction, even that, you know, that less is more from a purely physical health point of view. But we balanced that against all the reasons that the genuine the real positive effects that we may experience. And you know, even I think just kind of that reduced that relaxation and those positive effects, it's just, there's possibility that they may actually have some kind of health benefits, you know, if you feel kind of slowing down, or kind of overactive mind which some degree I benefit from, maybe when I have a drink, then there's probably some kind of benefit from that from a physiological point of view, other than just feeling relaxed in that moment, as well. So yeah, I'm by no means trying to say that, by no means a kind of advocate of tea totalism. For everyone that, you know, for some people that works as a recovery route. But alcohol has many benefits, as I guess you could argue for other drugs or other things that are kind of problematic when when we're maybe for the individual, the costs outweigh the benefits.

Marc Lewis: 36:30

Absolutely. Sure. I mean, opiates are kind of very interesting example, opiates are natural antidepressants, we, you know, we create opiates in our own body opioids. And they help to relax us and make us feel more safe and cosy and warm and less panicky and all that stuff. That's how they that's why they evolved. And, but, you know, if you go, if you develop an opiate habit, and you need to take stuff every day, and you're getting it and it costs money, or you're getting it off the street, or whatever it is, there's so much harm involved. So there's often really complex pros and cons to some of these things.

James Morris: 37:09

Absolutely. Yeah, I'd be lying if I said that. I didn't want to try, you know, kind of heroin recreationally, you know, but given the kind of context and all those things you mentioned, you know, it's just, it's something I just wouldn't entertain the way things are. But yeah, I can often think about how alcohol is regulated so differently from from, from heroin, that's, but it's kind of, you know, again, a very symbolic of the bizarreness of our regulatory system around drugs,

Marc Lewis: 37:40

is the cultural political system. I mean, actually taking opiates at moderate amounts for 30 years, is gonna have a lot less harm than taking alcohol for that period of time. I don't know if you knew that. But opiates actually don't cause any harm, unless you overdose. They just don't, but they happen to be addictive. I mean, fizzy physiologically addictive, which means that you get withdrawal symptoms, if you drink enough, you get withdrawal symptoms of a certain sort, you get seizure risk, and so on. But you know, it's, it's somewhat arbitrary. And there's a recent book that came out by Karl hearts, you know, about his book called The attributes for adults. It's like, it's not clear that these things should be regulated by political bodies for, for whatever reasons, political bodies for policies, which has a lot to do with all kinds of things profit and the rest of it. And so it's, it's, it's a complicated situation.

James Morris: 38:33

Absolutely. Yeah. Omar, thank you so, so much. always fascinated. I'm a huge fan of your work. And I think it's a really important contribution in terms of developing understanding of addiction and moving away from maybe some of the more kind of stereotyped or assumed ideas of what addiction is or isn't and yes, always a pleasure to talk to you. So thanks again, so much.