Psychiatrist Explains: How An Addict's Brain Works
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So there's a lot of thinking, which I would call the addict's brain. And I'm just going to highlight some of these. There's a lot of them. So, you know, on the surface, we have things like

denial, or I would say deal-making is another form of denial, right? So I'll stop when this bad outcome happens. I don't have a problem yet. It's really going to be a problem if I start passing out at parties like this guy does. So if you notice that your mind is deal-making, think about that. Are you telling yourself, okay, if I do this kind of work, then I deserve a reward. And if I deserve a reward, then I can use it. So it's not that you don't deserve a reward.

It's just that this kind of, that basic idea of I worked really hard, I get to do something in life, that's fine. The problem is when it has to do with a substance. So here's a really simple test for whether your deal-making has been hijacked by your addictive brain.

Thank you.

So if the reward...

can consistently be not drugs or whatever you're addicted to, then it's fine. And if the reward that you're always giving yourself and you're like, oh yeah, so why don't you just reward yourself with like a massage instead of getting high on meth? And if you find yourself arguing against that over and over and over again, then you've got a problem. And you have to be careful because the addict's brain is subtle. It knows you, right?

So it'll do so. Oh, yeah, I can. I don't need meth today. You want me to do a massage? I'll do a massage. But next week, we'll do something else. Oh, we'll see next week. Yeah. Oh, yeah. See, I did it. I can handle it. I controlled it. It's fine. You can use.

Because I'm in control. Which brings us to another really common one, the perception of control. Oftentimes when people are addicted to things, they have this idea that they're in control. They do things to keep themselves in control. But it's like the thing that's in control is the addiction. Like that's really what's in control. So you got to be careful about that perception of control. And then there are a couple of like, so these are like the really like in your face ones, but there's a lot of really subtle ones that I've encountered that are like really tricky.

One is something called the weakness trap. So the weakness trap is when people view addiction as a weakness. And if I'm an addict, I'm weak. I'm going to just write this out, okay? Maybe you guys can follow. I should be strong. Therefore, I need to conquer my addiction. And if I don't, then I'm weak. Therefore, I am strong.

or will be strong. So I know this sounds kind of weird because this seems like really positive, but oftentimes people who think this way

Do not do all of the crap that needs to be done. So overcoming an addiction is not about being strong. It's about putting in lots of hours in stupid shit that you don't want to do. It's about going to meetings, going to therapy, meditating every day. And what these people have is they have this almost like this fantasy of strength where they don't want to be one of these weak people who has to rely on others, go to therapy, weak people go to therapy. Like I don't need any of that.

I think imagine this community will be somewhat different, but you know, those thoughts can still pop up. You want to be, you want to conquer it. And so oddly enough, the brain will tell you, you should conquer this. You can conquer this. You don't need to do all this other crap that people are telling you. Be strong, conquer it and do it without help. Very subtle, very dangerous, very insidious. That desire for strength gets hijacked. Oh, this is a big one. Waiting to be done.

and forever. So this is a really common thing that we see in especially post-acute withdrawal syndrome. So we talk about withdrawal, which is when you're losing your tolerance to the substance. And by the way, if y'all are going through withdrawal, especially from substances,

Really, really good idea to do it with a medical professional because sometimes withdrawal can be lethal. So withdrawal from alcohol and benzodiazepines can induce seizures and asystolein will literally kill people. So you don't want to do that. But then oftentimes what is really overlooked in the medical system is the post-acute withdrawal syndrome, which can last for months. So the way to explain this is that, you know, so we have tolerance and the development of adaptations at the cellular level.

But then we also have development of adaptations at the habitual level, development of adaptations at the psychological level, development of adaptations at the ego or identity level. And so all of those adaptations, which have been built on the addiction, also need to be recalibrated. And that is really difficult.

So this is the post-acute withdrawal syndrome. And I'll give you all a really simple example of this. When people are withdrawing or in the early stages of recovery, it's really hard because you have to go to meetings a lot. You have to go see your therapist. You're working through all these dormant emotions. And the problem with working through dormant emotions is that like I worked on dormant emotions this week. I worked on them the week after. I worked on them the week after. I worked on them for three months. There's just more and more and more and more and more of them.

My emotional regulation skills are level three now instead of level two. So my life sucks. Everything is hard. Everything sucks. And people think this is what being sober is. They think that this period of time will last forever. That's how it feels. And then they think, I can't do this. This is too hard. There's no way. And this is literally what it's like. And if you guys even pay attention, literally to our subreddit,

in other places in our community, you will see this thinking in all kinds of posts. Is this what it's supposed to be forever? Is this what life is? So we see this a lot, especially in like a lot of these burnout oriented tweets and things like that.

Is life supposed to be going to work 9 to 5, coming home, doing laundry, doing meal prep, eating, working out, having 30 minutes of recreation time and going to bed? Is that what is the next 40 years of my life like this? No, that's not how it works. Things are hard right now until you adapt, until you build habits, until you sort of get everything sorted out. This is the hardest period, but it doesn't stay like this. So there's a sense of foreverness which really induces hopelessness.

because people don't think that they can withstand this forever. But the good news is it's not forever. It's just your brain doesn't experience that. And why not? It's because for weeks at a time, it is this. So the post-acute withdrawal syndrome can last six months, maybe even up to a year. And so as the brain calculates that out, it says, I don't have the energy for this. And then it induces some degree of hopelessness. And then it starts telling itself things like, well, if I'm going to crack a year from now,

Why not crack today? So there are a couple of things that we strongly, strongly, strongly recommend. So let's go through the rules of recovery. So if you guys want to try to tackle this, here are a couple of things that y'all should really focus on. The first thing you got to do is change your mind.

Now you may say, but Dr. K, that sounds like a lot. And that's just step one. Absolutely, man. Because remember that your addiction is a product of your environment. Okay. So what's the pitfall? The pitfall is, first of all, people want the same life without the addiction. That's not usually possible. But the good news is that the new life is

is almost always, and I can't think of a single case. Let me think. I know I've heard this before, but nothing is coming to mind, is almost always better. But it's hard to get there. So this means changing your environment, changing your friends, also means changing your cognitive patterns, right? All this has to change. Changing the way that you deal with emotions. And so it's weird because I work with a lot of people who will say like addiction was the best thing that ever happened to me. And people are like, how on earth, like,

What do you mean? And what a lot of people will say is like, if it wasn't for the addiction, it becomes a wake up call, right? It certainly was for me. Like I started down this journey because my addiction to video games really screwed up my life. And I really had to change it. I was like,

In a fraternity, going to parties, eating fried rice by the pound, playing video games every day, hanging out with other friends who are pretty degenerate. And over time, like, I had to change all those aspects of my life. But that's not a bad thing. Is it hard? Sure. You get better at it. It goes slowly. But it's good. You should want that. Rule two, complete honesty.

And by the way, I didn't come up with these. These are things that I've learned. Beautiful wisdom. So there's a great saying in addiction recovery, which is you are as sick as your secrets. Love this. So true. Really important for things like trauma healing as well, because that's usually a secret. So we talk about this some in like Dr. K's guide. We talk about satya and truthfulness and there's YouTube videos and stuff. So addiction fundamentally requires lying. I

I've never seen an honest addict, I think. Can't think of one. Maybe I have. So usually on the surface, you lie to other people. You don't quite tell your family how much you're spending on crypto. When people ask you, what'd you do today? You don't say, I watched pornography for an hour and a half, right? And when people ask you, oh, like, how much did you have to drink? You downplay it. I had a couple of drinks, maybe a few. So as long as you lie, addiction has fertile soil to grow. And then...

The next thing is that like, if you lie to other people, the only way you can sustainably do that is by lying to yourself, right? So then you do little things like you stop paying attention intentionally, stop paying attention to how many drinks you have. The easiest way to not get caught in a lie is to be in denial. So lying becomes a huge part of it. So usually then the question becomes, how do you become honest? How can you learn honesty? I love the concept of something called a recovery circle.

So recovery circle starts really small and it is a group of people that you can be completely honest with. So oftentimes when I'm working with my patients, their recovery circle is me and that's where it starts. And then over time, you expand your recovery circle. You learn how to be honest. You're honest with one person. It feels good to have one person in your life that you don't have to lie to. It feels relieving. It's so scary, but it feels amazing. And you know, we say here,

In chat, I feel personally attacked. What does that mean? When y'all feel personally attacked, you feel seen, right? I see what you are and that's good. It feels good. It hurts. It's scary, but it feels good. And this is where peer support, I think, is really phenomenal. We have things like Alcoholics Anonymous where it's like everyone else is an alcoholic. So like,

I can be honest and they know they're, they understand what it's like. And then usually this expands outward, right? So you start with like one person, you start with maybe a sponsor,

You can go to meetings and you don't start sharing, but then you tell one person and you open up to them and then eventually you start sharing. And then you start telling some people who are close to you. And then eventually your recovery circle can be the whole world. You can go into your job and you can say, yeah, you guys want to go to happy hour? Totally fine. I'm fine with just seltzer. I've been in recovery for 15 years. And like, that's cool.

Like, I don't think people, the only people who get upset by other people in recovery are people who have addictions and feel bad about not being in recovery subconsciously. Rule number three is ask for help. So what are the things that get in the way of this? Shame, this whole weakness trap.

Right. So this is not a process that I mean, even though there's some evidence that shows that people kind of do it on their own, we just don't know. Right. Because we don't measure them because they did it on their own. But even on their own may have been with help. We don't know. Right. They may have confided in a friend who knows. But I just can't tell you how much easier it is with help. And a lot of people think, oh, if I ask for help, I'm weak or like I won't be able to do it on my own. Or am I just becoming dependent on this person? No. Right.

You're not. How can I say that? Let's just think about it for a little bit, right? So when I'm at the gym and I'm, you know, on my last rep and I have a spotter help me a little bit, am I becoming dependent on the spotter? No. The spotter helping me a little bit means that my muscles are at maximal contraction. I finish the rep and they're actually going to grow more. The alternative of not using the spotter is that I don't do the rep at all and then my muscles will grow less. Using help accelerates your growth, doesn't impede it.

Now, there are some situations where you can sort of get dependent on help, but that is almost never the case because usually the institutions that are good at helping people recognize that.

So as a psychiatrist, I recognize when people are doing work with me towards independence and growth and using me as a crutch. And then we address that. People in recovery understand this really well. See, what leads to growth is doing the thing. What leads to not growth is not doing the thing. Now, if help means substituting your actions with someone else's actions, then you won't grow. But

But if they are helping you and you are still acting, you'll grow. It'll work. But there are challenges like shame and, you know, lying and embarrassment and all this kind of stuff. Rule number four is practice self-care. So I want you all to understand this, right? So addiction is environment plus you. And

You can focus on the environment and you can focus on you. You really have to do both. So if you're not sleeping every day and you don't have enough willpower to resist the addiction, that's going to be a problem. If you don't eat properly, then your brain is going to be using a lot of energy to suppress those hunger signals. And then you won't have much energy left over to resist your addiction. If you are living in a situation that is toxic, if you have friends who are not really friends of yours, if you are in an abusive relationship,

All of those things will add negative emotional energy and will drain your willpower. It'll be way harder to resist. So you must take care of yourself. Addiction is very hard to beat in general. So you might as well optimize yourself if you want to increase your chances of success. And so a big part of what I teach is self-care. Go to yoga. Go to meditation. Do that stuff. Take care of your diet. Because it's going to be hard enough...

even without all that stuff, give yourself every chance of success. Last rule, most important rule is don't bend the rules, right? So the first rule of Fight Club is, and the last rule of addiction recovery is don't bend the rules. See, the moment that you start bending the rules, the addiction can leak in. I want you all to think about addiction is a poisonous gas, right?

that will fill whatever container you give it. If you have a crack in the wall, it'll slip through it, right? We gave you all a couple of examples of like, oh, I deserve it. It'll use whatever it can. Oh, you're ashamed of yourself. You're pathetic. You might as well use. You're not worth it. You deserve to destroy your life. You feel weak. You want to be strong. Oh yeah, don't get help.

Be strong. You want to be strong? That's great. Let's go with that plan. Just do it all yourself. You don't need to change your life. Oh, it's too hard to change your life. It's too much work to change your life. Oh, you're feeling tired today and you're feeling like you can't do this forever? Thank God, because you can't do it forever. Oh, do you want 40 years of this? No, you don't. Nobody wants 40 years of this. Come back to me, baby. At least with me, every day wasn't bad.

If you're going to have a shitty life, you might as well have the upsides by getting high every now and then. Don't bend the rules. And recognize that as long as you stick with that, the thalamus and the nucleus accumbens in the amygdala and the limbic system have nowhere to run. They have nowhere to act. If a rule is a rule and it is impervious, then you become impervious. No means no. I've been sober for a year. I deserve it. No means no. Sure, I deserve it, but I'm not going to do that.

And if you focus on not bending the rules, that'll strengthen your frontal lobes. And it helps align your frontal lobes. Since we're somewhat deficient in planning and executing tasks and predicting errors, that's why we need to be stupid about it. Because the other dangerous thing that I oftentimes see is that the worst addictions happen to the smartest people. Because the addiction turns the brain against you.

And so the more powerful the brain is, it's like, if I'm going to cast mind control on an enemy, do I want to use a level 60 enemy or a level 2 enemy? So when addiction casts mind control on you, on a level 60 brain, it's going to be way harder to beat. That's why you need stir, steadiness, resilience, unbending. You can be weak. You don't have to be strong. We're just not going to bend the rules. So I hope this has been helpful. Let's get to Q&A. What questions do you all have? How did you...

game later without it becoming addicting again? Great question. So let's understand a couple of things. Remember that an addiction requires giving pleasure and taking away pain. An addiction requires activation of all kinds of neurocircuitry. The short answer is I dealt with my dormant emotions. I found a purpose in life. So right now, I could be playing a video game. Why am I not playing a video game? Because this is more important to me.

So I stopped using games as a source of emotional regulation. When I feel bad about something, I go for a walk. I started engaging in a lot of self-care, started meditating a lot, right? So this is what I mean. Everyone thinks about addiction as, I have this thing that I can't control and I lose the willpower battle against this thing. But you can dismantle that addiction like one table leg at a time and it'll just tip over and fall, especially with the behavioral addiction.

Substance use addictions with strong genetic predispositions may require abstinence. But it just became a source of pleasure and recreation, nothing else. And when that's what it is, then it becomes healthy.

So I think sex and love addiction is another good example of this, right? So a lot of people who get addicted to sex will use it as a substitute for self-worth. They use it as their source of feeling accepted by another human being. And once those things go away, you can have sex.

in a healthy way. You can fall in love in a healthy way. So you're telling me that when I tell myself that I can quit snooze nicotine addiction anytime I want, I'm lying? Yes and no. So I don't know if you can quit an addiction anytime you want, but my point is that quitting an addiction is not a binary decision.

So this is hopefully all have taken this away. Quitting an addiction involves a hundred steps. So can you quit it? Absolutely. It's just about doing the work. And so nicotine addiction is a really good example of like, we have very good treatments for nicotine addiction. What we basically know is there's a medication called

vareniclin that reduces cravings. And then when you use the patch and some kind of acute nicotine supplement like gum or lozenges, success rates are very high. I think 60 or 70%. So we have like addiction treatments for nicotine that are very successful, but it involves asking for help. What kind of help should I ask for? So I think two or three kinds of help come to mind. One is you can go to a psychiatrist or therapist and you can say, hey, I think I may have an addiction and they'll take it from there.

The second thing that you can do is go to any kind of peer support recovery meeting, Alcoholics Anonymous, Narcotics Anonymous, Computer Gaming Addicts Anonymous, and say, hi, my name is whatever. I may have a problem with this kind of addiction. That's it. Yeah, so this was...

Really, really, really good point. So this is something that we'll cover in the workshop, but we just didn't have time to cover. So great point to end on. So Vladimir is saying, I quit smoking after 14 years and drinking after 19 years, cold turkey both times. Confronting and dismantling the positive associations I had with my addictions was critical. So we didn't talk about this too explicitly. So let's talk about it now for a couple of seconds. See, the problem with addictions is

is that there are solutions, not problems. So when I say change your life, right, and I say everyone wants to have their life without the addiction, the problem is that when we look at these substances—

We see a lot of good, right? I like being relaxed at parties. I like being able to go on a bachelor party and get hammered with my friends. I love being able to go to a barbecue and have a good time, right? I love partying with lines of Coke. Like people like this stuff. And especially if you look at some of these fields like finance, it's like, it's part of the socialization. And people are like, well, when my boss, when the managing director of my firm

is like, hey, you want to do lines of coke in the bathroom? Like, I can't say no, because he's the one who determines whether I get $300,000 of bonus this year or $450,000 of bonus this year. So those lines of coke are worth $150,000. I've seen it as an addiction psychiatrist. Like, it ain't pretty. And you're spot on that a big part of this is dismantling the positive associations. A big part of this is the belief

that you can't live without your addiction. I've seen marriages end in divorce because people are addicted. I've also seen marriages end in divorce because people get sober. I've seen relationships that are built on a shared addiction. I found someone who won't judge me because they're just as addicted as I am, and we're both going to go hard, and I love this person so much because this person knows how to go on a bender, and they'll protect me

If I go too hard, they'll keep things in check. So there are a ton of positive associations which are very hard to deal with. And those absolutely need to be dismantled. Really great point. Thank you all very much for coming today. If you all are struggling with something, look at it a little bit critically.

Really try to understand what's going on. Ask for help. And know that you can live without it. That the life that you build without it is probably going to be better. It's going to be missing certain things. And even as someone who's a degenerate gamer addict who's gaming in recovery, I miss some of the stuff too. Like...

Going hard in gaming is its own special pleasure. There's its own special pleasure of real just debauchery, right? When some expansion drops and like, I'm going to stay up, I'm going to skip all my classes for a week, and I'm going to grind to 60. There's something that's fun about that. I gave that up. And I think the challenge with addiction is that you are giving things up. I think the good news is that you only have to give them up for a while, and then you really don't want them anymore.

You really start to appreciate what you have. What's the end goal? The end goal is freedom. The end goal is freedom. To live life the way it's supposed to be lived instead of living a version of life that is shaped by an addiction. Should you quit it right now? Why not? Why not? Hey, y'all. Hope you enjoyed today's video. We talk about a bunch of topics like this on the channel, so be sure to subscribe for more. If you're already subscribed, GG, and we'll see you in chat.