The Biology of Self Control - Part I - An Interview With Addiction Psychiatrist and Author Dr Leslie Lundt

The following transcript and audio (below) is from an interview originally aired in July 07 , also visit LeslieLundt.com  and TurnToHelp.com.

Dr. Michael Schiesser: Good morning. This is Dr. Michael Schiesser, and I have with me today Dr. Leslie Lundt from Boise, Idaho. Dr. Lundt is a psychiatrist and addiction specialist, and if you haven't heard of her, she has a website: leslielundt.com. Her most famous book anyways is "Think Like a Psychiatrist." It's a book for the general public to understand how a psychiatrist views various mental disorders, as well as the treatments that are available.

Dr. Lundt, welcome to the show this morning.

Leslie Lundt: Hi, Michael. How are you?

Michael: I'm doing good. What I wanted to talk about today is the biology of self control. I look at addiction as on a spectrum with self control. What I think is really interesting or one of the things I've enjoyed learning about is how the brain has all sorts of mechanisms for signaling impulses and allowing us to choose which impulse to follow through on. Maybe I'll just throw it out there to you now. What can you tell us about this?

Leslie: Well, certainly our impulse management is a very, very complicated system in the brain. In any complicated system, of course, things can go haywire. So, you're absolutely right. Addictive disorders and other things that may not be considered true addictions, like compulsive gambling, compulsive shopping, even things like pulling your hair out compulsively, are also disruptions in the self control function.

Michael: This is Dr. Michael Schiesser with Dr. Leslie Lundt. Be sure to visit turntohelp.com where you can get fast and easy access to physicians who treat opioid dependence, as well as resources for family of someone who has trouble with addiction to prescription pain medications or street drugs like heroin.

Leslie Lundt. Be sure to visit leslielundt.com for more information on her books and seminars.

How is self control altered for a person who has addiction problems? I mean, I think that there's a stigma around addiction that in part stems from people assuming that one could control their compulsion to use drugs or all the things that go along with that. How does this get hijacked in a person who's having an addiction problem?

Leslie: Yeah. You know, that's a great question, and certainly one thing that I would like to talk about is that addiction is not a disease of will power. You can't just simply wish it away or pray it away or hope it away or, you know, control it away. That, notoriously, is not a very effective way to treat addiction.

But if we step back, we can help to see why that's the case, and looking at brain functioning, what we find in people that have addictive prevalences is... You know, Michael, this could be cigarette smokers, this could be alcoholics, this could be crystal meth addicts. This might even apply to over-eaters and obese people. All kinds of substances, and it really doesn't matter so much on the substance; it's the process.

We have this system in our brain that's very primitive, that we inherited way back from the dinosaurs and probably beyond that, and that is called the dopamine system. Dopamine is a neurotransmitter in your brain, and its job, among many things in the brain, is to kind of help reward us, give us pleasure. You think, "Gosh, why would the dinosaurs be interested in receiving pleasure?" Certainly us hedonistic humans are, but how does this date back so many millions of years?

Michael: Right.

Leslie: That's a great question, and it's really a simple answer in that any species has to do two things to survive and to stay on this planet. One is you have to eat. There's just no getting around that.

Michael: Right.

Leslie: And you have to reproduce.

Michael: Right.

Leslie: And if you don't reproduce, it doesn't matter how healthy you are. Your line is going to die immediately. So we're wired, again, back from millions of years ago, to find things that are essential for survival pleasurable. Eating and sex, procreation, are pleasurable for most of us, and that's for a reason. That is so we keep doing them, because anything that you find pleasurable, you're going to keep doing.

Michael: Now, what about other functions like breathing and drinking water? Is that all sort of that same part of the brain?

Leslie: Yeah, you know, that's a great question, too. It is not the same part of the brain. Breathing is under more of an automatic control that, you know, you don't have to think about breathing.

Michael: Or so much I guess having enough oxygen. In other words, if I were to cover your mouth with my hand--and your nose, and you began to panic, that need for oxygen--is that driven by the same system or is that somewhere else?

Leslie: No, that's completely different.

Michael: Got it.

Leslie: That's really an automatic part. That's on a different part of our brain even. That's what we call the brain stem, which is even more primitive than the dopamine system that I have.

Michael: So, eating and sex utilize the dopamine system. When somebody is having a problem with addiction, it also uses the dopamine system. Is that what you're saying?

Leslie: Exactly. So, what happens is people that are doing the things that may not necessarily be good for you. So, let's pick on crystal meth for example. A huge problem in the Northwest and the West in general. These people have really hijacked their dopamine system.

So, all you have to do is do crystal meth once, and you get this enormous rush of dopamine. Much more than you would ever do from say eating a hot fudge sundae, or even having really good sex. So you get this thread, this avalanche of dopamine. Your brain says, "Whoa! Holy smoke! That was really good!"

Michael: Right.

Leslie: "That was really cool! I think I'll do it again."

Michael: Right.

Leslie: So, it's a much more intense sort of dopamine surge than you can get from every day pleasures.

Michael: When someone is starting to notice negative consequences from that, they're having trouble with their teeth, or they are spending all their money, or nobody trusts them anymore, and they're seeing that--what keeps them from balancing those negative consequences, and having some self-control in the face of what sounds like just a couple of hours of a good time?

Leslie: Well hopefully when everything is working correctly, there is the judgment pathway. So these dopamine connections in your brain also connect to another part of your brain, which was responsible for higher level thinking thoughts, and kind of analyzing your behavior and looking at things like consequences.

So, this is something that most people that have never had an addiction just don't understand is, "Well, gosh! Why would you keep doing crystal meth?" Again we'll pick on that one. But fill in the blanks, it could be anything--marijuana, alcohol, cigarettes. Why would you keep doing meth if it rots your teeth, and you lost your job, and you've lost your marriage, and you've lost 200 pounds? All of these bad things happen to you. Any idiot would know that you just have to stop doing the drugs. What's wrong with you? That's sort of the natural response to someone that has problem with drugs.

The reason is their judgment pathways are also disrupted. So here we have not only the dopamine avalanche, but now your good common sense, your ability to say, "Gosh, this is really dumb. All these bad things happen to me when I do this behavior. I guess I better stop." But those neuronal, those brain connections, are also destroyed.

Michael: So, you used the word "Hijacked." So, really what's being hijacked primarily or most importantly is the person's sense of what's good for them or not.

Leslie: Right. Again because of all of these interconnections, your judgment is hijacked as well as your sense of pleasure is hijacked. So again if you think about the most wonderful experience you've ever had in your life. It may or not have been substance abuse. If you times that times 10 for what you can get from some of these over-the-counter, or not-over-the-counter, but non-prescription sort of experiences--so again let's say meth. That what we see is that normal pleasures just don't do it anymore, right? That going out for a run, or having a nice evening with your spouse, or seeing your kids graduate from high school--most of those things you find very pleasurable, but not if you've been to the mountain top.

Michael: Yeah. So there's a loss of interest, and nothing seems to compare.

Leslie: Exactly.

Michael: This is Dr. Michael Schiesser, with Dr. Leslie Lundt. Be sure to visit TurnToHealth.com where you can get fast and easy access to physicians who treat opioid dependence, as well as resources for family of someone who has trouble with addiction to prescription paid medications, or street drugs like heroin.

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