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Transcript
00:00:02:17 – 00:00:32:11
Elliott Wald
Hello, my name is Elliot Ward and welcome to another episode of Coming Clean With Me. And in my studio today with me is Professor John Marsden. He’s the profession of addiction psychology for IOP and which is the Institute of Psychiatry, Psychology and Neuroscience. The IOP is a faculty of King’s College London, Europe’s largest center for research and education in psychiatry, psychology and clinical neuroscience.
00:00:32:13 – 00:00:57:11
Elliott Wald
And Professor Marston’s her professional appointments in the addiction field for over 30 years. He specializes in developing new medication and psychological therapies for people with opioid stimulant and alcohol dependance. He’s also the editor in chief at the Addiction Journal that publishes peer reviewed research reports on pharmacological and behavioral addictions. And John, welcome to Coming Clean with me. Thank you for being here.
00:00:57:15 – 00:00:58:21
Professor John Marsden
Elliot, what an introduction.
00:00:58:21 – 00:01:00:13
Elliott Wald
Well, you’re an impressive man.
00:01:00:13 – 00:01:06:00
Professor John Marsden
Well, it’s a joy to be with you, and I’ve been looking forward to meeting you. So thank you for this kind invitation.
00:01:06:00 – 00:01:19:10
Elliott Wald
Fantastic. I want to just dive strange on my first question is, you know, having studied all your background and everything about you, you could have gone into any career in psychotherapy or psychology. What took you down the route of dealing with addictions?
00:01:19:12 – 00:01:45:18
Professor John Marsden
it’s a lovely question. I appreciate it. And I guess there’s a mixture of accident and perhaps a bit of design and a bit of intention. When I look over my shoulder at my career and it has been over 30 years, I can certainly even now visualize quite vividly the developing alcohol problem that my dad had. Okay. So that was something that touched me as a boy.
00:01:45:19 – 00:01:47:03
Elliott Wald
You grew up in that environment.
00:01:47:03 – 00:02:26:21
Professor John Marsden
I did. And he he he really developed an alcohol problem over several decades from what looked and appear to be social drinking. I remember I have got an image even now of him, and he would arrive home quite late at night after leaving work at the normal time and at 536, whatever. And I remember we’d I’d be sitting in the front room with my mum watching TV or something, chatting and the, the front door would open and close and then the living room door would open and he would stand there and sort of stare, you know, very bright blue eyes.
00:02:26:21 – 00:02:46:10
Professor John Marsden
I remember he would, and they would be sort of sort of slightly teary, almost, and he would sort of gaze across the room and sort of glare at me and say, and then he would say, I’m going to bed, for example. And so I, I grew up in that environment and I studied psychology at University College in Bloomsbury.
00:02:46:12 – 00:02:54:18
Professor John Marsden
It’s now a sofa shop. But back then there was a there was an amusement arcade on Tottenham Court Road next to Gooch Street Tube Station.
00:02:54:18 – 00:02:57:02
Elliott Wald
And I sort of I went to London University. I know. Technical, right.
00:02:57:02 – 00:03:29:02
Professor John Marsden
Very well. There we go. So I used to walk past this amusement arcade and I sort of see the same characters sitting on stools, putting coins into the slot machines. And I remember being fascinated about what appeared to me to be a just a completely crazy pursuit, really. So I was interested in behavioral addictions, such as gambling. I then luckily I did a masters in Applied and Clinical Psychology.
00:03:29:02 – 00:03:56:10
Professor John Marsden
I got a scholarship to do a PhD that was in alcohol. I actually worked at the Occupational Health Department at London Transport and back then, this is a few decades ago, London Transport out of an employee workforce of about 40,000 people, and therefore it had a prevalence of problems that a mid-size English town would have. So I did my pay actually, and alcohol after that.
00:03:56:10 – 00:04:04:04
Professor John Marsden
I worked for a treatment agency that was very much on the street. And so that brought me really up close and personal.
00:04:04:04 – 00:04:05:08
Elliott Wald
With what type of addictions?
00:04:05:10 – 00:04:28:09
Professor John Marsden
Well, back then it was it was acute homelessness, right? That was then associated with a lot of heroin. Eventually we had crack cocaine. So smokable cocaine, as you know. And it and then we were also trying to help people who were vulnerable to acquiring HIV. And then I did see and then I’ve then I worked over at the institute where I haven’t left.
00:04:28:09 – 00:04:52:11
Professor John Marsden
So I’m I have had the pleasure of sticking to a career in this field, which is not that common. It’s not the most attractive profession for people to join. And there’s not a lot of funding, a lot of new doctors don’t see it as a career path that is attractive. But I’ve had so much, I’m great, I’m grateful.
00:04:52:13 – 00:05:08:05
Professor John Marsden
But I’ve had, I think, some successes and I’ve seen things occur and change that I’ve just been really inspirational to me. So I’ve sort of I’ve kept at it and maybe, you know, over the over the decades, I’ve been able to attract some money to do research and things and keep going.
00:05:08:05 – 00:05:10:22
Elliott Wald
It’s difficult to get funding for research in this field.
00:05:11:00 – 00:05:32:21
Professor John Marsden
It really is. And I sometimes I get a little bit chippy. I work with colleagues in North America, in the National Institutes of Health there. In a way, they have developed the most of the evidence for the effectiveness of treatments that we have through an agency called Neither National Institute Drug Abuse, and that’s needed because of the scale of the problem there.
00:05:32:23 – 00:05:47:10
Professor John Marsden
And over here, you know, we have had initiatives and there’s some at the moment that are very welcome. But a lot of the time we’ve had to propose studies that competing with other diseases.
00:05:47:12 – 00:05:49:12
Elliott Wald
You classify as a disease.
00:05:49:14 – 00:06:10:23
Professor John Marsden
I would say it’s a brain disease. I have no difficulty with that. If it’s not in the brain not going to where it is. I guess there’s two things that have happened to me. I’ve been just astonished, Eliot, by the development of science. The neuroscience of addiction has been a triumph of my career, and I’ve played a role in it.
00:06:11:00 – 00:06:35:14
Professor John Marsden
But at the same time, I think what I’ve learned and been impressed with almost at the same time has been the knowledge of the sort of social disadvantage that people experience, the structural inequalities that can correlate or underpin addiction. So I wouldn’t say I mean, it’s a sort of curious brain disease in which it’s got such a social manifestation.
00:06:35:16 – 00:06:39:23
Professor John Marsden
But we know a lot about the neuroscience of addiction, which is just amazing because there’s.
00:06:39:23 – 00:06:49:19
Elliott Wald
A lot of people who say it’s not a disease, you know, it’s just, you know, just quit just to stop. You know, they don’t quite understand that it is a disease that affects a lot of people, thousands of people.
00:06:49:21 – 00:07:29:21
Professor John Marsden
Well, I think the first thing that you if you come to this topic fresh and first of all, so many of us know about it, we we read about, unfortunately, you know, celebrities that die. We read about stories of people overdosing in the press. Last year, there was 100,000 poisonings, fatalities in the US. But I think the thing that I come to, I often use this clinically is that it is a puzzle why we should be addicted to drugs and alcohol doesn’t really make much sense why we would consume something that causes us harm.
00:07:29:23 – 00:07:45:02
Professor John Marsden
But I think and I think we’ve got answers to that riddle, but I think starting out with a curiosity that says, look, this, you know, working clinically with a patient, this is strange, isn’t there one like this have happened? Why hasn’t this gone away?
00:07:45:02 – 00:07:47:21
Elliott Wald
Do you think we’re a dopamine seeking nation?
00:07:47:23 – 00:08:04:06
Professor John Marsden
Well, I think the main drugs that we might talk about today, let’s say cocaine, for example. Yeah, just just to name one, they’re so common and harmful. It’s a very, very potent liberator of brain stores, of dopamine.
00:08:04:10 – 00:08:05:08
Elliott Wald
You know.
00:08:05:10 – 00:08:24:04
Professor John Marsden
It also prevents the uptake of dopamine. That’s where dopamine goes naturally back into its storage site. So it sloshes around and it causes partially along with your epinephrine and other drug neurotransmitters, it causes the effects that people seek. You know, activation, there’s confidence, energy, etc..
00:08:24:10 – 00:08:25:20
Elliott Wald
It’s a nice feeling for people.
00:08:25:23 – 00:08:52:20
Professor John Marsden
If it didn’t give the reinforcement that people expect it to give at some degree, it wouldn’t be used, it wouldn’t be misused. But you talk about dopamine. I think we I think there’s a dopamine model of addiction that we know lots about. We have identified structures in the brain that are so important to the way we live our lives.
00:08:52:22 – 00:09:26:00
Professor John Marsden
And all of them are completely bashed by cocaine and other drugs of misuse. And that’s been an incredible discovery of what exactly goes on when we we take a drug repeatedly. It’s also helped us really develop some medications that are targeting to those brain systems. I think we ask a lot of ourselves, we expect a lot if we work, we we often want to change our mood rapidly.
00:09:26:02 – 00:09:32:20
Professor John Marsden
Our attention spans sometimes can be short. So we live in a very charged culture. I think the.
00:09:32:20 – 00:09:43:22
Elliott Wald
Very, very, very few times that we spend time being present and aware of ourselves without seeking some form of, you know, escape.
00:09:43:22 – 00:10:18:03
Professor John Marsden
Are you you say it so beautifully, really, because if only we could be peaceful and allow our thoughts to just arrive and to stay with us for a while and then just fly off into the ether and be calm and mindful and under the, if you like, the conditions, the vicious cycles of addiction. I think a lot of the drugs that people take this so distracting, they occupy our thoughts.
00:10:18:03 – 00:10:27:20
Professor John Marsden
Yeah, they direct our attention to places in the world in which we are sold. A view of the future that’s false.
00:10:28:01 – 00:10:28:23
Elliott Wald
Yes.
00:10:29:00 – 00:10:30:18
Professor John Marsden
You know, we are we are told our.
00:10:30:18 – 00:10:31:23
Elliott Wald
Perception of reality.
00:10:32:00 – 00:10:42:14
Professor John Marsden
Our thoughts are presented to us in which taking a drug is going to make things better or it’s going to make us feel less bad.
00:10:42:16 – 00:10:43:06
Elliott Wald
Yeah, just.
00:10:43:06 – 00:11:13:14
Professor John Marsden
As as you know, as you well know, there are there are cycles of motivation that move from sort of had donor pleasure into then relief of feeling unwell. Yes. And we get that duality is a vicious cycle. So, you know, in a way when as I’m sure you know, we know when you work with your patients, what’s so pleasurable is to hear people say that they’ve got their thoughts back.
00:11:13:19 – 00:11:14:17
Elliott Wald
Yet.
00:11:14:18 – 00:11:37:20
Professor John Marsden
You know, that they feel clean in the you. It’s like someone’s clean the windows, you know, and they are feeling once again able to make rational decisions, to evaluate stress and to be to be peaceful. And I suppose that’s the reinforcing thing for me is that that is so wonderful to to, to help someone achieve.
00:11:37:20 – 00:11:55:15
Elliott Wald
I also think to become reconnected. I think when you have an addiction, you become very disconnected. You know, eventually it becomes you and your usage of your drug on your own and you become disconnected from life, from your family, from friends. You know, I think I think reconnecting is a huge thing.
00:11:55:17 – 00:12:27:06
Professor John Marsden
Yeah, absolutely. There is this sort of narrowing, isn’t there? So as if we imagine someone moving through, not in a linear way, but progressively from, you know, occasional recreational use. It’s normally a progression and a narrowing towards a much more isolating setting where you’re often always you’re often using more alone than with in company, unless you’re with a bunch of people that yeah, in the same path to destruction as it were.
00:12:27:07 – 00:12:40:23
Professor John Marsden
And you know, I mentioned the brain structures that we know about and it is the perfect storm. Unfortunately, there are kind of three main bits of our brain that get.
00:12:41:01 – 00:12:42:05
Elliott Wald
What name those three for.
00:12:42:05 – 00:13:03:22
Professor John Marsden
Me. Okay, well well the if you, if we could take a slice through the middle of your your head right now and open up the kind of the section behind your eyes towards the middle, we would, we would be able to identify three areas and they’ve got funny names. So we’ve got one called the nucleus accumbens. Yep. Okay.
00:13:04:00 – 00:13:34:02
Professor John Marsden
It’s involved in reward and the signaling that something is worth doing because it makes us feel good food, sex, drugs. We then go another one that’s sort of wired to it called the amygdala. And there’s one called the extended amygdala that works forward that’s involved in the processing of emotion. And unfortunately, during drug dependance, it becomes maladaptive in terms of stress management.
00:13:34:04 – 00:14:06:21
Professor John Marsden
What an awful situation. No one wanted to feel more stress. Did they know and sets out to be addictive. But stress regulation goes. The other one in this little triangle is called the hippocampus. Yeah, and that’s involved in memory. And what we’ve got them, if we think of those as a little triangle, we’ve got a structure called the dorsolateral striatum, and that’s involved in habit formation, you know, and then we’ve got a projection right to the front of our heads called the prefrontal cortex that is involved in decision making.
00:14:06:21 – 00:14:22:20
Professor John Marsden
Yes. So you can if you imagine a simple story, we’ve now got a brain that is much more sensitive, raised to being rewarded by the ingestion of a drug. We’ve got a structure that’s laying down memories.
00:14:22:23 – 00:14:23:07
Elliott Wald
Yeah.
00:14:23:11 – 00:14:53:12
Professor John Marsden
That that experience should be repeated because. Yes, clearly important. And then we’ve got corruption really, of a structure that helps us process emotions and deal with with stress. All of that laying down very powerful learning memories. That signal when we chanced upon a place the time of day, a thought, an object, a feeling, a.
00:14:53:12 – 00:14:53:23
Elliott Wald
Hook.
00:14:54:00 – 00:15:23:07
Professor John Marsden
A hook. Yep. Those cues signal that whatever else we’re doing should cease because we need to obtain a drug. And that is just a perfect storm of brain structures that we need routinely to live. But the brain is the brain has obviously thought to itself. Okay, well, it looks like I appear to be big. I appear to have been given cocaine in my diet, parts of my liver synthesizing this.
00:15:23:07 – 00:15:37:17
Professor John Marsden
So I know what this substance is. It looks like it’s now an addition to my diet. Okay. I’m not quite sure why that is, but what will now do? This is the irony, I think, of dopamine. We’re now going to release less dopamine than we did before.
00:15:37:18 – 00:15:38:06
Elliott Wald
Yeah.
00:15:38:08 – 00:15:40:19
Professor John Marsden
Because we’re getting a source of it. External.
00:15:40:21 – 00:15:41:21
Elliott Wald
That’s right.
00:15:41:23 – 00:16:02:21
Professor John Marsden
And the terrible consequence of that is that the person who is now addicted finds the everyday things less pleasurable. Yeah. And that locks them in to talk about this idea of narrowing and then opening it up. It just locks them in to just doing the same thing over and over, but getting less and less for and.
00:16:02:21 – 00:16:06:07
Elliott Wald
Then the quantity increases and their frequency increases.
00:16:06:09 – 00:16:33:11
Professor John Marsden
To the to the point where through, you know, the metabolic process of tolerance, the quantities that some people could consume would completely floor someone like ourselves who has no drug tolerance, you know. Yeah. And that’s where I think we bring in a more medical or even public health concern that some of the drugs that are used now are so potent they can be fatal.
00:16:33:13 – 00:16:57:12
Professor John Marsden
You know, a single ingestion. Some of the strong fentanyl was the I believe, the opioids analogs that are being introduced so widely in the US and have been. But yet tolerance is a real problem. And you know, the idea of needing more and more to get what you’re wanting to get is an illusion because ultimately the brain has decided to adapt to the point where you’re not going to get it.
00:16:57:18 – 00:17:09:16
Elliott Wald
I’ve got a question for you that a lot of my listeners ask, though I thought I’d put to you. Do you think it’s nature or nurture? Do you think people are born with this addiction or, you know, do you think nature or nurture.
00:17:09:18 – 00:17:43:00
Professor John Marsden
Is a really, really interesting question, isn’t it? So I guess I would imagine your listeners would start with a position that I have when I think about this, which is that Well, it surely it’s it’s, it’s based on exposure. It’s based on coming in contact with this thing and that, you know, what I’ve just been talking about really is is a study or description, rather, of changes to the addition of a drug into the person’s head and that takes us some distance.
00:17:43:00 – 00:17:53:03
Professor John Marsden
But what we do know is that some of the processes that are part of the addiction story are heritable. So what that means is they are part of the molecular, biological.
00:17:53:05 – 00:17:54:12
Elliott Wald
Genetic predisposition.
00:17:54:12 – 00:18:08:19
Professor John Marsden
Genetic predisposition. And, you know, I may I might. I haven’t I’ve never tested it, but I might have a vulnerability marker for nicotine dependance, for example.
00:18:08:21 – 00:18:16:17
Professor John Marsden
We know about nicotine and we know about alcohol. So that does run Alcohol runs very heavily in families.
00:18:16:19 – 00:18:17:13
Elliott Wald
Genetically.
00:18:17:17 – 00:18:39:04
Professor John Marsden
Genetically. And then, of course, well, perhaps I mentioned my my own dad. You know, I was then aware of what was going on. I grew up knowing and seeing that. And that has an influence. You could have an influence in both directions. Could be true. It could make you seek out to explore and experience, or it could perhaps turn you away.
00:18:39:04 – 00:18:52:17
Elliott Wald
That’s definitely true. You can you could grow up being in that environment with a family member who uses a substance and go, I should repeat that process, or you could grow up and go, Wow, I’m never going to do that. my gosh, look at look at the terrible outcome that it brings.
00:18:52:17 – 00:19:11:10
Professor John Marsden
And I think you see that a lot. You know, sometimes you do a you could do an assessment with a person and you could. So tell me about your, you know, your family and stuff. And sometimes they say, well, yeah, I mean, my mum had a problem and my older brothers had a problem and so I’ve got one other times.
00:19:11:12 – 00:19:13:14
Professor John Marsden
You can find no trace of it.
00:19:13:17 – 00:19:14:01
Elliott Wald
Yeah.
00:19:14:02 – 00:19:31:18
Professor John Marsden
You know, you go back several generations and you think, well, why was that then. So, so I think the answer is clearly it is a heritable disorder, you know, to the extent we know. So nicotine, alcohol. Well studied, the other drugs are elusive.
00:19:31:20 – 00:19:32:18
Elliott Wald
You know.
00:19:32:20 – 00:19:59:18
Professor John Marsden
But there’s also huge amounts of shaping and experience. There’s a really interesting example, though, of if we’re thinking of personalized medicine, there is a hopeful future. And we’ve got one example in the alcohol arena at the moment. But there’s a hopeful future in which our molecular biological makeup should enable physicians of the near future to personalize the medicines that we we take for a condition.
00:19:59:21 – 00:20:00:10
Elliott Wald
Well.
00:20:00:12 – 00:20:17:12
Professor John Marsden
We’ve got one for alcohol. So there’s a genetic marker. And that has been shown in some studies that there’s mixed evidence, unfortunately. But in some studies it means that a particular medication for alcohol, if you have this marker, that medication, if.
00:20:17:12 – 00:20:27:22
Elliott Wald
You have a genetic predisposition, there is a way of testing the body to see if you have that. And what percentage of likelihood you are to have that addiction yet.
00:20:27:22 – 00:20:41:06
Professor John Marsden
And also what the likelihood is that a particular medication is going to work. And what’s great about that is that if you don’t have it, well, let’s not let’s not waste our money and your time on this medication. If you do.
00:20:41:08 – 00:20:43:08
Elliott Wald
That, why have they not got that for cocaine?
00:20:43:10 – 00:21:12:04
Professor John Marsden
We just haven’t that cocaine is is really elusive opioids as well. But there have been large genetic association studies done. There are a couple of what are called polymorphisms or genetic markers, but nothing that’s really reliable. Not clear why that is. And it could be a move nicotine. We’re dealing with a receptacle to set a colon, which has got a very sort of narrow band of action.
00:21:12:06 – 00:21:21:02
Professor John Marsden
Cocaine is all over the place. You know, we’ve got dopamine, we’ve got noradrenaline, we’ve got serotonin, we’ve got glutamate. It’s like a we’ve got a full suite.
00:21:21:02 – 00:21:23:00
Elliott Wald
There’s so many things to look at.
00:21:23:02 – 00:21:44:22
Professor John Marsden
In nature could have come up with a more complex and addictive stimulant. I don’t know what it is. Cocaine, really. If you wanted to come up with something that most people like, if exposed to it, you know, you know, it’s obviously dose related. A high dose would never be fun for anyone. But at low doses, a lot of people do like it.
00:21:45:00 – 00:21:49:09
Professor John Marsden
Probably about 10% of people that are exposed to it become addicted.
00:21:49:11 – 00:21:50:11
Elliott Wald
So we think 10%.
00:21:50:11 – 00:21:54:00
Professor John Marsden
I would say about that and really and really, really addicted.
00:21:54:02 – 00:22:19:09
Elliott Wald
It’s interesting because I think if I look at my feedback, my client base is and the kind of information I get back from the thousands of people out there, I’ve had very interesting response when I’ve asked, how long did it take you during your first line to become a regular use? When you find regular use as once a week, every week or 2 to 3 times a week or 5 to 7 days a week.
00:22:19:09 – 00:22:43:06
Elliott Wald
Okay. And I’ve had people say the average I would look at across the board is around about two years, so two years of dabbling before they suddenly became regular use. I have had very few people who have used and then immediately become regular users. But in the in the in the mainstay, most people have been using two, three, four or five years before they became regular users.
00:22:43:06 – 00:22:46:02
Elliott Wald
Why do you think that is?
00:22:46:04 – 00:23:05:06
Professor John Marsden
What happens, I think in terms of people that we both see, so we don’t see, thankfully, the person that uses for a few weekends with a certain bunch of people at a certain time and things change and they just they exit the system. We don’t see them again.
00:23:05:08 – 00:23:06:18
Elliott Wald
Okay, sure.
00:23:06:20 – 00:23:34:09
Professor John Marsden
And that’s fantastic. We that’s what we want in a way. So the people we see are the people that have moved through those gates. They’ve gone forwards. I think once you start to use that, the frequency you’re talking about, I have a habit of talking about low level withdrawal symptoms. Yeah. You know, if we’re talking about smoking, people understand, don’t they?
00:23:34:09 – 00:23:48:12
Professor John Marsden
Your listeners understand that someone is going to want to light up a cigaret to keep their nicotine levels? You know, it’s the classic motorcycle. It’s a cycle. Yeah. And deprived from it during a train or a plane ride or something.
00:23:48:18 – 00:23:49:14
Elliott Wald
They have withdrawals.
00:23:49:14 – 00:24:24:18
Professor John Marsden
They have an intense withdrawal. So the first thing they do when they get off is find the space in the airport outside the train station they have a cigaret. So I think we’re aware that there is another driving system for a lot of addiction, which is to prevent or manage or reduce withdrawal symptoms. I think sometimes that with the level you were talking about a moment ago kind of weekly pattern, there’s a sort of run over of several days in which the person’s decision making is down.
00:24:24:23 – 00:24:50:12
Professor John Marsden
They are feeling tired, a bit dysphoric, a bit fed up, and by the time 6 p.m. arrives or whenever it is, they’re they’re dosing again and then the dosing is dealing with some of those withdrawal symptoms. Yeah. But I think what happens after a while, I mean I deal a lot with a very severe smokable form of cocaine.
00:24:50:12 – 00:25:29:19
Professor John Marsden
Yep. I’m not cocaine powder or hydrochloride and that’s so powerful that it’s almost determined that people use in an intense but relatively brief runs. They just I mean, it’s so addictive and so consuming and so expensive, of course, that they really can’t use any more than that. I haven’t answered your question very well, I don’t think. But I think after a while people just reach a point where they have a moment of realization that it’s got to stop.
00:25:29:21 – 00:25:59:16
Professor John Marsden
And and that might be that they experience cocaine related chest pain, for example. So they might feel very unwell. And the cocaine obviously has a as a stimulant, has an acute increase in blood pressure, but it also doesn’t do any favors for our whole kind of cardio system. So I think there’s sometimes can be adverse health effects, anxiety and depression as well.
00:25:59:16 – 00:26:13:02
Professor John Marsden
On the mental side. Yes. I mean, people just sort of think, I just need to take some steps here. And hopefully then in therapy, it’s it’s really about trying to get underneath the thoughts.
00:26:13:06 – 00:26:28:07
Elliott Wald
And also, I think there’s a lot of people who reach a point where it’s affecting their families, is affecting the dynamics of the family. Their partner may have left them or is on the brink of leaving. It’s affecting them not being present with their children. I think that affects them a lot.
00:26:28:09 – 00:26:44:23
Professor John Marsden
Yeah. And you can have you can have a period of time when I’m not saying it’s a delusion, but maybe there’s a there’s a kind of hope that people aren’t noticing, you know, And there’s there’s a secretive aspect to it. You see that obviously with alcohol in particular.
00:26:44:23 – 00:26:57:00
Elliott Wald
Yes, I see a lot of people who use cocaine use secret uses. Yeah. That what I call the secret toilet flush. They’re at home. They go and line up at the toilet system to do a flush. They do a line, they go downstairs and they are perfectly normal watching TV with a partner.
00:26:57:02 – 00:27:19:06
Professor John Marsden
Yeah, except that what happens is this is the sign that things are awry, is that when it gets to wherever it is and the partner says, I’m going to big day tomorrow, I’ll turn in. The cocaine user says, I think I might just stay up a little bit. I tend to do something or read something or do something on my tablet or whatever, and then they’re up till three in the morning.
00:27:19:06 – 00:27:38:10
Elliott Wald
Yep. And then they have regret why they could have had this come down, you know. You know, I like to talk about pain and pleasure. It’s almost a seesaw as it’s co-located in the brain. You know, when you have when you have the pleasure, rise up and the pain comes down, it has to it’s almost an equilibrium always has to counterbalance itself.
00:27:38:12 – 00:27:57:06
Elliott Wald
So they have this big comedown and this big regret. And I think the interesting thing, John, is this this regret where at four or 5:00 in the morning, they go, my gosh, I wish I’d never done that. They actually believe at the time. The problem is it it dissipates so quickly. The other the next day, if they’re a daily use or two or three days or a week later, they’re using it again.
00:27:57:10 – 00:28:00:03
Elliott Wald
Why do you think that memory dissipates so quickly?
00:28:00:05 – 00:28:21:07
Professor John Marsden
Well, it’s the medium of conscious thought. You know, I can think of I think of a patient of mine. And he said I would I would riff all through these sort of busted up old DVDs looking for something to play at four in the morning. So I do it all the time with buyers regret or remorse, I think.
00:28:21:07 – 00:28:22:20
Elliott Wald
Yeah. You know.
00:28:22:22 – 00:28:53:20
Professor John Marsden
And but the point about that is that that ought to be actionable, you know? What’s that? Why is the half life of that like a New Year’s Eve resolution? It’s because the associative learning, the pairing of times of day places, objects, thoughts, feelings, people is so much more pure environmental factors. Yeah, they’re just they just come in and that thought out.
00:28:53:20 – 00:28:56:01
Elliott Wald
On his Friday at 6:00.
00:28:56:03 – 00:29:06:12
Professor John Marsden
And then and then you can sometimes have these permission giving thoughts you know and there are many for example Well, I’ve been good all week. a little wouldn’t.
00:29:06:12 – 00:29:06:20
Elliott Wald
Hurt.
00:29:06:21 – 00:29:17:02
Professor John Marsden
Yeah, everyone else is doing it. I’ve got a bit of money in the bank. I deserve it. I’ll just have one, you know? I mean, that’s just a few.
00:29:17:02 – 00:29:18:07
Elliott Wald
Is a rationalizing it.
00:29:18:13 – 00:29:23:00
Professor John Marsden
They’re rationalizing it and they’re giving permission to it as well. I mean, one of the things a.
00:29:23:00 – 00:29:25:02
Elliott Wald
Lot of that way of looking at giving permission to it.
00:29:25:03 – 00:29:49:21
Professor John Marsden
Yeah. And the other thing that is a torment is the some of the objects that become conditioned, though, the classic one with cocaine. I mean, we’re moving into the cashless society, but I think it still works as an example. But one of the things for cocaine that becomes incredibly associated is the ATM machine.
00:29:49:23 – 00:29:50:07
Elliott Wald
Yeah.
00:29:50:13 – 00:30:13:01
Professor John Marsden
Now to you and I, that’s a source of a couple of tenors for a, you know, takeaway or whatever. And to someone who is using cocaine as a source of money, of course. So the thing is that and some of my patients have a preferred ATM machine is the one they always use and and they visualize walking down to use it, etc..
00:30:13:07 – 00:30:40:04
Professor John Marsden
The trouble is with the ATM machine, of course, which is just an ATM machine to everyone else, but it becomes associated. There’s millions of them in the world. Right. And so you come across any one of those. Yeah, it can do the same thing. Trigger Yeah. I mean, you were talking I thought very interestingly about thinking forward to the negative outcome of a drug using event, for example.
00:30:40:04 – 00:30:45:10
Professor John Marsden
And I think, I think that can be an amazingly powerful therapeutic device.
00:30:45:10 – 00:30:47:02
Elliott Wald
Yeah.
00:30:47:04 – 00:30:51:23
Professor John Marsden
I feel sometimes like the things that I do, I kind of borrowed from other aspects.
00:30:51:23 – 00:30:53:11
Elliott Wald
I think we do that with everything.
00:30:53:13 – 00:31:23:02
Professor John Marsden
Yeah. And I think, you know, so I mean, we’ve applied some of the therapeutic techniques of helping people with post-traumatic stress disorder. Example. But one of the things that I think you can do if you have a strong urge, which is which often takes the form of feelings, you know, butterflies, slightly clammy palms, for example, often a mental image.
00:31:23:02 – 00:32:00:00
Professor John Marsden
So an image of the future occurs in which you’re using a drug. You might taste it, you might smell it. So craving is a kind of multi-sensory experience. One of the things that we try and do in our clinic is help the person think about that because you can’t block it. So just to think and ground yourself the various techniques of grounding, you know, you might have an object, you might get out of your wallet or like a playing card or there might be a perfume you would smell or whatever it is.
00:32:00:00 – 00:32:01:06
Elliott Wald
Your association, it was something.
00:32:01:06 – 00:32:21:04
Professor John Marsden
Yeah, you would ground yourself, but one of the things you can do is you can play the tape forward. So you might say to yourself, okay, so really, you know, yes, I have been quite good this week, and rightly so, because I’ve made a commitment to stopping and the first thing I’ve done is I’ve cut down on my alcohol, quit altogether, and I’m eating better and I’m sleeping better.
00:32:21:06 – 00:33:00:12
Professor John Marsden
But I can feel that urge and this is the adversary I’m dealing with. And to play that tape forward and see yourself, I don’t know. 445 the next morning hearing the birds or, you know, thinking, no, I’ve got to go to work and just feeling that pairing, that future thought with the one that’s calling you like a siren, you know, towards using can really it does a couple of things I think first of all it checks the evidence for the current thought and finds that thought to be wanting because the thought, you know, a line is going to be great.
00:33:00:14 – 00:33:02:16
Professor John Marsden
Only one. There’s never one.
00:33:02:16 – 00:33:03:21
Elliott Wald
No. Never happened.
00:33:03:23 – 00:33:06:14
Professor John Marsden
No. You’d have the first three in the first hour and then.
00:33:06:15 – 00:33:08:03
Elliott Wald
You’re calling someone else for another and then.
00:33:08:03 – 00:33:09:18
Professor John Marsden
You’ve run out. Yeah, exactly.
00:33:09:18 – 00:33:11:00
Elliott Wald
Then you get in more, John, and.
00:33:11:00 – 00:33:11:22
Professor John Marsden
Then you’ll reloading.
00:33:11:22 – 00:33:12:14
Elliott Wald
That’s what happens.
00:33:12:15 – 00:33:19:05
Professor John Marsden
Exactly. And that cle And then. And then if you’re drinking, then really you’re buying cocaine so you can carry on.
00:33:19:05 – 00:33:21:15
Elliott Wald
Drinking that cocoa easily is then produce so.
00:33:21:15 – 00:33:48:17
Professor John Marsden
That you’ve got, that you’ve got that metabolite that’s maximizing both, That’s when a lot of the cardiovascular problems occur. But I think that idea of bringing that thought back in helps check the evidence and finds that the evidence for the thought is wanting. And actually it isn’t one, it isn’t going to be that noise. Dopamine reserves have been depleted for the time being, so it’s not going to feel so good, certainly not as it used to.
00:33:48:17 – 00:34:16:16
Professor John Marsden
That’s gone and all the time, literally, that that coping behavior strategy is occurring. And it’s interesting, isn’t it? You wouldn’t see it. You wouldn’t be able to you wouldn’t be in evidence of it. That person’s doing it. But as that process is happening, the seconds are relapsing. And as time moves on, the person suddenly thinks, well, that’s gone now, you know?
00:34:16:17 – 00:34:19:21
Professor John Marsden
And I often say, Well, the best thing you should do now is you need have some to eat.
00:34:19:23 – 00:34:35:11
Elliott Wald
Yes, I think I call that technique pseudo orientation where you’re putting someone future progression them are actually to put a spin on it because I like to turn around now and look back at the fact you didn’t take it and how much better you feel. So bring him back, ratchet those resources back with the.
00:34:35:16 – 00:35:03:04
Professor John Marsden
Perfect because you know, at the end of the day, it’s all about thoughts. They’re all about cognitions and emotions. Every single thing we do. Well, you know, when we on a Friday night, many people in this country will, will will have a drink they often the energy dense foods afterwards takeaways and so forth. Our ability to make good healthy decisions is dissolved in alcohol.
00:35:03:06 – 00:35:31:05
Professor John Marsden
Cocaine is an awful one for that because what cocaine wants is you to take more. It’s the greediest drug, probably more greedy than nicotine in a way, in that it just wants more consumption. And I think that’s one of the cruelest aspects of it. And I would I would, you know, when I ever I get the chance of, you know, being able to come away from my, you know, normal working environment and, talk to experts like yourself.
00:35:31:11 – 00:35:55:01
Professor John Marsden
I mean, I think it’s so important, isn’t it, to to help people realize there’s no blame here. There is change. You have to be responsible, patient, blame yourself because your brain has changed. And that is the reality of an addiction. The great thing about it is and I know you know, the evidence of looking at some of the neuro.
00:35:55:04 – 00:35:56:03
Elliott Wald
Neuroplasticity.
00:35:56:03 – 00:35:57:06
Professor John Marsden
Yeah the great for.
00:35:57:06 – 00:35:58:01
Elliott Wald
New this what you’re going to.
00:35:58:01 – 00:36:15:05
Professor John Marsden
Say and the great thing about the neuroplasticity so that little triangle of structures I mentioned all that jargon a few minutes ago, they go off line they don’t they don’t work. Well, the great thing with abstinence and you do have to stop, I’m afraid.
00:36:15:10 – 00:36:16:06
Elliott Wald
Yes, they.
00:36:16:06 – 00:36:17:10
Professor John Marsden
All come back online again.
00:36:17:12 – 00:36:22:01
Elliott Wald
How long how long before that in Europe. Let’s see, we regulation. So yeah, it’s interesting.
00:36:22:01 – 00:36:23:21
Professor John Marsden
I mean the you.
00:36:23:21 – 00:36:29:21
Elliott Wald
Know what so I’m going to just for the listeners at home who don’t understand neuroplasticity, can you explain that is in layman’s.
00:36:29:21 – 00:36:56:17
Professor John Marsden
Terms. Yeah I mean it’s I suppose it’s the idea if you think of a brain structure and you might get a look at it and there’s a picture of it, you might assume that it works only in a certain way and well, perhaps that, you know, after someone dies. It doesn’t work at all though, otherwise it’s working in the way it should do that The thing is that it adapts and it can generate a change in its function.
00:36:56:19 – 00:37:06:06
Professor John Marsden
And as a consequence, drug ingestion over time, it progressively changes in the way it works. It becomes, you know, plastic in terms of the meaning of change.
00:37:06:06 – 00:37:07:02
Elliott Wald
Like a molding.
00:37:07:05 – 00:37:48:21
Professor John Marsden
Yeah. And I think and as I say, the the I think the liberating and motivating thought about that which can have crushing consequences under the conditions of addiction is that with abstinence comes repair. And so studies have been done showing that you know, comparing say the the the the dopamine function functioning of someone that’s never taken a drug, you know, compared to someone who has abstained for a month, six months, nine months, a year, two years, etc., at two years, you can still see differences.
00:37:48:23 – 00:38:13:17
Professor John Marsden
But they are they are much, much narrower than than, say, at six months. So I think, you know, every day that someone isn’t using is a day of repair. But you are talking about a need for a huge I mean, you know, I’m conscious as I speak that some people listening might be saying, well, this guy’s just calling out for people to stop.
00:38:13:19 – 00:38:34:15
Professor John Marsden
You know, it’s not easy to stop everyday that you’re not using is a good thing because it means that your sleep architecture is improving and your diet perhaps. But I think under the under the conditions of that we’re talking about today, you need to stop. But the great thing about stopping is that you get your function back.
00:38:34:17 – 00:38:53:00
Elliott Wald
Okay. Here’s an interesting one. You know, let’s say somebody is a regular use of three or four times a week, and I come across this a lot and they go on holiday with a family for two weeks, someone where they can’t get it right. And the weirdest thing is they don’t even think about it until they’re on the flight back.
00:38:53:00 – 00:38:57:14
Elliott Wald
It’s the first thing that getting delivered. Why is that?
00:38:57:16 – 00:39:38:18
Professor John Marsden
But the thing is about what you just said, it it it is occurring thousands of times across the world right now. It’s a real thing. It is an absolute thing. How do we explain it? I agree in a way, some of the same triggers should have been exported to the holiday destination, but maybe there was distraction. Maybe there was there was other reinforcements, such as, you know, swimming, dancing, eating conversation that occupied connect it.
00:39:38:19 – 00:40:06:00
Professor John Marsden
Yeah, but you’re so right. You get on that plane and suddenly there is this. yeah, that would be good, wouldn’t that are maybe there are more permission giving thoughts. You know, I’ll list them again, you know. Well I haven’t had any for two weeks. I’ve got more money than I did before. Let’s say I’ll be keen to catch up with my friends, etc. So it’s the depth of those associative learning changes.
00:40:06:00 – 00:40:28:22
Professor John Marsden
I think that I mean, really, really hard to to cope with. And I don’t know why, to be honest. Why there’s a little a break like that would do the trick. It’s possible that there are low level reminders and the person’s able to cope with them. But you’re right. Like you can imagine someone returning and using almost immediately.
00:40:29:02 – 00:40:44:19
Elliott Wald
Yeah, yeah, yeah. A question I like to ask most of the people who in professions who come on my shows and it’s it’s a personal thing because everyone has a slight different take on it. But how would you define an addiction? How would you define an addiction?
00:40:44:21 – 00:41:13:21
Professor John Marsden
I mean, I tend to say it’s an unwanted habit. So I would I would comment the that you don’t want that state. I mean, I think if someone is so involved in it and would be resistant to any discussion, then I do not want to apply the label. I don’t want to say, well, you know, I know you don’t want to quit, but you’re addicted.
00:41:13:21 – 00:41:15:12
Professor John Marsden
You know, that just, you know.
00:41:15:13 – 00:41:17:00
Elliott Wald
That is negative connotations.
00:41:17:02 – 00:41:23:21
Professor John Marsden
I personally do. So I think I think the idea of an unwanted, risky or harmful habit comes. This is how I.
00:41:23:21 – 00:41:41:10
Elliott Wald
Would define it. Yeah, I would define an addiction as a behavior to a substance or a behavior, a compulsion to behavior that has a temporary relief that has a negative consequence. Yeah, I think that’s how.
00:41:41:10 – 00:42:15:19
Professor John Marsden
I was very nice. And I like the way you brought in this idea of compulsion. Yeah. And I think I think, you know, when we’ve got our clinical we’ve a big manual of mental disorders that we, we diagnose and the one for addiction has at the center it has craving and that and I think the idea of this distressing commanding soul that I need I want I must have the strong desire does really capture it.
00:42:15:19 – 00:42:16:05
Professor John Marsden
Really?
00:42:16:07 – 00:42:34:20
Elliott Wald
Yeah. Yeah. I wanted to just pass by you to see what you think. I think a lot of human nature revolves around avoiding pain and seeking pleasure. Okay. You put your hand right, hovering, you burn yourself. That’s a physical pain to get at all. I’m not going to do that again. So we have this innate understanding of avoiding pain and we try and seek pleasure.
00:42:34:22 – 00:42:55:22
Elliott Wald
Now, most things in life, I would say have an element of pain. Okay, you got to work with that pain to get money, to buy nice things, to have pleasure. We learned to drive a car with all that pain, to have the freedom to get from A to Z. We call that pleasure. Okay. Now with cocaine and most drugs, but I’m going to use cocaine specifically here with cocaine, there is a perception of pleasure first, and the pain comes later.
00:42:56:03 – 00:43:01:05
Elliott Wald
The drivers all of a sudden or the wrong way round. I think that’s part of the problem. What do you think of that?
00:43:01:05 – 00:43:10:23
Professor John Marsden
Yeah, I think I think that works. I think that works. I mean, I possibly use just different language to say the same thing. I think. I think there is, there’s misdirection.
00:43:11:04 – 00:43:11:13
Elliott Wald
Yeah.
00:43:11:15 – 00:43:44:22
Professor John Marsden
So we are I think I said it earlier, we are sold, I’m presented with a version of the future that actually doesn’t stack up to the facts. Yeah. And and I think that is the nub of it really that the other thing is I think once, once you’ve taken cocaine it’s then got its own greedy motor. You know the drug is just it just wants more and more and more well beyond the ability of the brain to liberate any more dopamine.
00:43:44:22 – 00:44:00:03
Professor John Marsden
I mean, that’s gone. And I think that’s one of the cruel things there is. There is just this continued, I might call it reloading, you know, like, let’s let’s phone you know, Steve still up. Let’s see if he’ll come round And.
00:44:00:06 – 00:44:01:23
Elliott Wald
I might go three 400.
00:44:02:00 – 00:44:05:20
Professor John Marsden
Yeah. For tickets, all that stuff.
00:44:05:22 – 00:44:18:18
Elliott Wald
I’ve got an analogy that I read that you wrote that I think is fantastic. I love this. I’m going to steal this. By the way, just tell us the analogy about the playground bully who puts the pound in and gets.
00:44:18:20 – 00:44:45:07
Professor John Marsden
well, that this. Yeah. Thank you. That’s very kind of you. And by the way, Ali, it’s yours. Thank you. Know, it’s yours always was yours. Price. So I mentioned that I deliberately take therapeutic methods from other psychological areas and see if they work for addiction. I just make no apology of doing that. I think it’s I think it’s really important thing.
00:44:45:07 – 00:45:08:13
Professor John Marsden
And not not least because a lot of addiction problems are quite similar to the problems that don’t involve drugs, that are debilitating anxiety, depression, etc.. So the example of the playground bully is often used as an analogy for people with obsessive compulsive disorder.
00:45:08:15 – 00:45:10:19
Elliott Wald
Tell us what the analogy. Tell us what the what it is.
00:45:10:19 – 00:45:27:14
Professor John Marsden
So let’s imagine you you’re starting to develop OCD and before you go to bed, your you’re very worried about security. So you check the window latches.
00:45:27:15 – 00:45:28:20
Elliott Wald
Yep.
00:45:28:22 – 00:46:05:13
Professor John Marsden
And then you go to bed. And after a while, it just doesn’t seem to have, you know, quite sure, I’m reassured. So you you check more of the window latches. You also check them a second time just in case, to be sure. You then may check the rings on the gas stove, make sure they’re all off. And so after a while, a person with a safety related preoccupation, OCD can only go to bed by doing dozens of checks.
00:46:05:15 – 00:46:28:05
Professor John Marsden
And even most cruelly, I had a patient once who went to bed and then got up and did it all again. Yeah, before we had to go back to bed. And the playground bully example is just is basically saying, okay, well you know, it said, give me a dollar or I’ll beat you up and then you give a dollar and then a week later it’s $2.
00:46:28:05 – 00:46:37:12
Professor John Marsden
Now you give $2, $5 gone up for a beat you up. So the bully wants more and more and more.
00:46:37:14 – 00:46:38:16
Elliott Wald
That’s like addiction, right?
00:46:38:16 – 00:47:07:12
Professor John Marsden
And that’s like addiction. So the whole point about addiction is it wants you to to take more and more and more. And with the playground bully, if we take a stance and this is like David and Goliath, isn’t it? You take a stance against the bully. The bully shouts and screams and then just disappears. So I’ll use that a lot to try and evoke the idea of taking a stand.
00:47:07:14 – 00:47:29:10
Professor John Marsden
And of course, with OCD, the way we help people is by expose them to those triggers and then and then just not behaving. You know, what happens if we don’t? You know what happens if we leave the window latches open? I couldn’t do that. Well, why don’t we try? What’s what’s the worst that can happen? Well, someone would break in.
00:47:29:15 – 00:48:00:22
Professor John Marsden
should we? Should we try it? And they don’t know. Of course you want to lock the windows, but there’s that. So the idea I think the idea that I’ve used often with addiction, think about think about a phobia. Let’s say you’re a secondary school biology teacher and you’ve got an awful spider phobia, okay? You hate them. You’ve always hated them, your mum hated them, and she probably infected you with her hatred and, loathing of spiders.
00:48:01:00 – 00:48:16:01
Professor John Marsden
You can’t be in the same room as one. But it turns out you’re a biology teacher, right? So. And you teach a course that’s called spiders or whatever. I’m making it up a bit. That phobia will never go away through avoidance.
00:48:16:04 – 00:48:17:10
Elliott Wald
Yep.
00:48:17:12 – 00:48:41:00
Professor John Marsden
The only way it’s going to go away is through approach. So what we would do is we would we would negotiate together as to how far away you would tolerate my plastic spider that I’ve got here on the in my pocket. We would go and then we’d bring it closer and eventually we’d, we’d, I’d bring out my real spider and you’d have it on your hand, and then we’d treat it.
00:48:41:04 – 00:49:12:07
Professor John Marsden
Okay, so with addiction, we can’t avoid the triggers. They’re all over the place. So what we have to do, we have to expose ourselves to the triggers. We have to be able, for example, to hold in our hand a glass of wine and not gulp it in 25 seconds, you know, to smell it, notice it, place it back on the table, take our time, think, be thoughtful.
00:49:12:07 – 00:49:18:20
Professor John Marsden
You’ve mentioned earlier about the idea of mindful, you know, recapturing the beauty of our thoughts.
00:49:18:20 – 00:49:22:05
Elliott Wald
A small quantity for enormous gratification.
00:49:22:06 – 00:49:24:21
Professor John Marsden
Yeah. So anyway, that’s a long answer, but that’s my Phillip.
00:49:24:22 – 00:49:45:07
Elliott Wald
I love that you brought phobias because I know that you don’t know this. And I was smiling to myself. I used to do ITV this morning show live on air every single day, dealing with a phobia, live on air in under an hour. And then they had the stimuli presented to them being in a cage full of pigeons, spiders on their hands, snakes in a bath about no way.
00:49:45:07 – 00:49:48:20
Elliott Wald
Yeah, I used to do that every day. Wow. In under an hour.
00:49:48:22 – 00:49:51:02
Professor John Marsden
What would you do? Like rapid hypnotic induction of.
00:49:51:02 – 00:50:09:09
Elliott Wald
Rapid hypnotic induction when you called Funny enough, when you spoke about earlier about getting somebody to move into the future and see the outcome and bring it back, That’s what I would do. Getting to see that there was amazing what I did in Trafalgar Square. Once a lady had a fear of pigeons and they filmed this for ITV and she was terrified.
00:50:09:09 – 00:50:15:10
Elliott Wald
And then within an hour she was feeding the pigeons. She was hugging me. And I see that every day. They live on every well.
00:50:15:14 – 00:50:47:01
Professor John Marsden
Well, I had no idea. And that’s I mean that. But that is a great example of how we want people to have it’s a terrible jargon phrase, but for me, it’s all about cognitive control. Yes. And then with cognitive control, you look at someone who’s recovered from, say, an alcohol problem, the joy of that person being able to go out for a pizza with a bunch of mates, they’re all having bottles of beer with their pizza and, you know, the recovered person’s possibly drinking mineral water or something.
00:50:47:03 – 00:51:09:11
Professor John Marsden
But is quite happy, hasn’t had to run away and hide and, you know, have a white knuckle ride. Experience of sobriety is able to be close and personal, if you like, with the source of the addiction, but not to be upset by it. That is kind of what I mean. With cocaine, it’s different. You know, I rather wasn’t cocaine.
00:51:09:12 – 00:51:37:12
Professor John Marsden
I mean, we’ve got synthetic and we’ve got synthetic drugs that do peripheral anesthesia. We don’t need this one anymore, but it’s not going away anytime soon. But for example, someone being able to watch a TV drama and see it depicted or read a magazine article, let’s say listen to your podcast and not be activated to be able to sort of listen and potentially or not be triggered.
00:51:37:14 – 00:51:49:17
Elliott Wald
I think there’s a lot to do with the tribe mentality. I say this to my clients. I said, First you have to break your tribe. I always give the analogy. I say, if you sit in a barbers long enough, you’re going to get your haircut. You like that.
00:51:49:17 – 00:51:51:21
Professor John Marsden
One? I do like that. Well, that’s great because.
00:51:51:21 – 00:51:58:01
Elliott Wald
Like, it’s like if you go to the pub, you sit around people who are using the propensity to use is going to be increased.
00:51:58:03 – 00:52:04:06
Professor John Marsden
Yeah, Yeah. You go to a Land Rover dealership eventually you’re going to buy a Land Rover.
00:52:04:08 – 00:52:06:06
Elliott Wald
Yeah. Like the Baba.
00:52:06:08 – 00:52:07:22
Professor John Marsden
Yeah, I do. And I think I.
00:52:07:22 – 00:52:08:21
Elliott Wald
Can have that join.
00:52:08:23 – 00:52:38:14
Professor John Marsden
Is that one mind? Yes. Okay. I’m walking out on air today. Fantastic. No, I think. I think that’s right. I think that’s right. And we what I love about talking to you now is there’s there’s a bit of humor in your style, which I thoroughly approve of. I think I try myself also to be a credible practitioner. It’s my job to know.
00:52:38:16 – 00:53:09:02
Professor John Marsden
I think we’re still knowing, you know, still finding out, definitely. But and if someone’s not interested, then I wouldn’t I wouldn’t serve them up brain science. But it’s amazing how often people are interested. And the more you know, and the more you can impart, I think, the more people feel empowered to take a stand and to, you know, realign, reset free calibrate and get and get that outlook.
00:53:09:02 – 00:53:11:11
Professor John Marsden
And that’s that’s the that’s the job.
00:53:11:11 – 00:53:27:01
Elliott Wald
I think I was reading some research. I can’t remember who the author was because I was reading about four books at the same time. And it says that 30 days roughly resets the reward path system. Can you explain that?
00:53:27:04 – 00:53:29:17
Professor John Marsden
Well, I can’t put a month on it now.
00:53:29:17 – 00:53:30:15
Elliott Wald
I find that interesting.
00:53:30:15 – 00:53:40:20
Professor John Marsden
But yeah, I mean, not 90 days, three months. Okay. Is the one that we generally use for smoking, right? So if you can get to three months, actually.
00:53:40:20 – 00:53:43:17
Elliott Wald
Just explain to the listeners what a reward path system is.
00:53:43:20 – 00:54:13:15
Professor John Marsden
Well, the reward system is is is is a very ancient and survival supporting aspect of the way our brains work. So it was evolved to enable us survive and develop as a species. So its primary function is food and sex time. Okay. A lot.
00:54:13:17 – 00:54:14:22
Elliott Wald
Both.
00:54:15:00 – 00:54:45:11
Professor John Marsden
Generally your reward system is working well. Okay. Okay. So the idea is that we find food reinforcing. It therefore means we have a you know, we put enough energy in to do what we need to do and sex for procreation, etc.. And so the reward system is based on memory noticing when there’s a source of reinforcement like food and sex in the in the environment and acting accordingly.
00:54:45:13 – 00:54:50:11
Professor John Marsden
The very same system is is corrupted by drugs. Right. So just simple.
00:54:50:11 – 00:54:54:11
Elliott Wald
So so looking at nicotine, it’s a 90 day.
00:54:54:17 – 00:55:25:17
Professor John Marsden
Well, I think there is a huge amount of variability here, but I know there is some evidence. I’m not sure if there is for cocaine, but I know for nicotine if you’ve managed to quit for three months and let’s say 90 days, the likelihood that you’ll stay abstinent goes up hugely. Now, that is something, you know, that quote that you read and is speaking to the idea of this recovery of function.
00:55:25:19 – 00:55:29:06
Professor John Marsden
Yeah, I’ve worked with.
00:55:29:08 – 00:55:33:08
Elliott Wald
You. I also think environmental changes.
00:55:33:10 – 00:55:40:21
Professor John Marsden
Yeah, I mean, I think I think, you know, for me, I’ve been doing some work recently with psychedelic assisted treatment.
00:55:40:21 – 00:55:41:13
Elliott Wald
Yeah, it’s a really.
00:55:41:13 – 00:56:11:15
Professor John Marsden
Interesting space and I think that’s an example where that appears to possibly induce some very interesting changes that we can use therapeutically. But I mean, the things that I would encourage people, you know, to do really focus on sleep diet if it’s cocaine, I think my prescription is often try to have a break from alcohol for a quite a while.
00:56:11:15 – 00:56:11:19
Elliott Wald
Yeah.
00:56:11:19 – 00:56:15:13
Professor John Marsden
I mean, they go they go terribly hand-in-hand.
00:56:15:15 – 00:56:24:07
Elliott Wald
I always say to the team and to my patients, three months in, no alcohol complete abstinence, and then let’s discuss it.
00:56:24:09 – 00:56:50:06
Professor John Marsden
I think that’s a wise counsel. Some people can’t do it. I’ve I’ve, I’ve had folk who have thought and lost possibly their confidence after a couple of months. And one of the problems with cocaine, for example, is that you can still detect it. We use a urine sample in the clinic. It’s only supposed to detect it for three days or so.
00:56:50:08 – 00:56:59:00
Professor John Marsden
And unfortunately, if you use a lot, we can still detect that for like two or even three weeks later. And it can be really dispiriting for someone who says,
00:56:59:02 – 00:57:01:00
Elliott Wald
Yeah, I’ve heard that was my patient.
00:57:01:01 – 00:57:31:08
Professor John Marsden
Much longer than you’d imagine. I’m functioning. And I but I’ve had people that have coming in and they’ve had they hating it. They, they had just, you know, this is just I’m not feeling better. I feel my mood is low and I’m not sleeping well, etc.. So but toughing through to goodness. Look, if we’re if we’re talking about someone that’s using four or five times a week, if they can not use for 30 days, good things are happening.
00:57:31:08 – 00:57:57:03
Professor John Marsden
Yeah. You know, there’s less. I guarantee their sleep is better, their mood will have lifted and they will beginning they will begin to have some of those thoughts that we’ve been talking about in our discussions. These more kind of appraising thoughts about resilience. This dress ability is going to improve so good things happen. Is that the magic number?
00:57:57:03 – 00:58:06:08
Professor John Marsden
I’m not sure, but I if someone has come in to me and said, look, I haven’t used for a month, I’d be surprised if it’s if they’re really hating it.
00:58:06:10 – 00:58:25:20
Elliott Wald
I’m a great advocate of exercise. I always get my patients to exercise. I think it makes you feel good about yourself. It releases serotonin. You know, gives you structure. I always go to the point where I say, Why don’t you swap one addiction for another? Why don’t you become addicted to feeling good about yourself? Why, when you become addicted to exercise, what do you think about that?
00:58:25:21 – 00:58:45:11
Professor John Marsden
Yeah, I think it’s a great thing, isn’t it? And it’s it’s common people who have the resources to do the you know, to get a gym membership or to use those machines. We see in many of the parks, certainly around this fair city of London, good things flow from exercise.
00:58:45:12 – 00:59:17:00
Professor John Marsden
You do get natural endorphins produced, so you can you can, you know, the runner’s high, the classic. I also find this is a little bit of self-disclosure, which I hope you’ll forgive, but I often find myself, on the one hand struggling to stay if I’m exercising in a gym, part of me is really hating it. And I have these little gremlins that are saying, Just stop.
00:59:17:02 – 00:59:18:05
Elliott Wald
Get out. Leave now.
00:59:18:05 – 00:59:44:18
Professor John Marsden
You’ve done enough. Yeah. And if I carry on with it, I often find that I get I get really interesting thoughts suddenly occur to me, you know, I hadn’t been thinking about a particular problem and suddenly a solution invented to me. And so interesting thoughts kind of arrive and I think good thoughts for recovery arrive in someone that’s, you know, been trapped by a cycle of addiction.
00:59:44:18 – 01:00:01:10
Professor John Marsden
So, yeah, I mean, it’s I think I think but even being outside, you know, walking to the bandstand on Clapham Common, you know, and just noticing the trees and the sounds and the.
01:00:01:12 – 01:00:02:16
Elliott Wald
Being in the moment, being.
01:00:02:16 – 01:00:26:08
Professor John Marsden
In the moment and, and feeling that that is enough and being grateful for that. Those are the changes that I think occur. And but I think a bit of, you know, as long as you’re fit and able and sometimes people do need to have an assessment but you know a little bit of cardio respiratory stress is actually a good thing as long as you know, as I say, you’re fit enough for it.
01:00:26:14 – 01:00:31:09
Elliott Wald
And a question I’m asked a lot. Do you think people have addictive personalities?
01:00:31:11 – 01:01:03:20
Professor John Marsden
It’s a great question again, isn’t it? Because there certainly appears to be studies that show that some of the what are called sensation seeking traits that appear to be exhibited in early adolescence are correlated with future drug use. So I suppose this idea of someone that is has a personality that is seeking reinforcement appear to be drawn into it.
01:01:03:20 – 01:01:37:19
Professor John Marsden
The other type personality type is the sort of sometimes called anxious avoidant. So it’s someone that has a much more kind of they, they have internally negative thinking styles. It’s a big mouthful. But, you know, this idea that they are they have a pessimistic outline outlook. So I think those two you can put those on the table and say, okay, well, you know, maybe we we should be concerned if someone exhibits, you know, personality aspects like that.
01:01:37:21 – 01:01:59:12
Professor John Marsden
We talked about the fact that you could you could look at a family history and find no evidence in the past. Yeah. We could also bring into the studio a thousand people with what looked like anxious avoidant personalities or sensation seeking who’ve never smoked a cigaret or drank alcohol. So they look like tendencies. Yeah, but it’s not fixed.
01:01:59:13 – 01:01:59:21
Professor John Marsden
Okay.
01:02:00:02 – 01:02:25:14
Elliott Wald
I mean, I think certainly from delirium, all my patients, it doesn’t discriminate cocaine you know, from your bricklayer, plasterer, laborer, lorry driver, warehouse man to your CEO or as I said to you earlier, I have an orthopedic surgeon. I helped. He was clean. Now two lawyers, barristers, judges, I’ve seen it all. So it doesn’t discriminate, does it?
01:02:25:14 – 01:02:51:15
Professor John Marsden
It doesn’t discriminate because they’ve all got the same brain structure. It doesn’t matter what we do, who we are, we are vulnerable to attack from this drug because it releases dopamine really efficiently. It stops it being taken back into the storage sites so efficiently and it creates the same kind of greedy, needy version of you no matter who you are.
01:02:51:16 – 01:03:04:15
Professor John Marsden
I think. I suppose the only thing is, you know, there are some that, you know, really, really can’t afford it. And there are some that possibly can for a while, but.
01:03:04:19 – 01:03:13:11
Elliott Wald
People getting on sick. John, do you know what that is? It’s tick. You’ve heard that. I know what happens is when the dealer gives it to you and you boot up, they take the slate.
01:03:13:14 – 01:03:14:15
Professor John Marsden
Yes, yes, yes.
01:03:14:15 – 01:03:16:14
Elliott Wald
And then they’re in debt. Then they’re working to pay the dealer.
01:03:16:14 – 01:03:32:09
Professor John Marsden
Of course. Of course. And then. Yeah. And then they find that they really can’t pay it back. Yeah. Yeah. But no, you’re absolutely right. All strata. we, we’ve got this across the world distributed everywhere really.
01:03:32:11 – 01:03:38:21
Elliott Wald
John. It’s been an absolute pleasure to have you coming clean with me. I really appreciate your time. Thank you so much for being here.