“We take care of the urgent, and we leave the important things for later. That is the great problem of modern life, very serious not only for society but for the economy. The opioid epidemic that exists in the United States and is expanding throughout the world has an annual cost, according to congressional research teams, of 1.5 trillion dollars! It is urgent, yes, but Wouldn’t it be wiser to try to understand the underlying issues and how to prevent these incalculably costly snowballs?”says passionately Rubén Baler, scientist and expert in public health and addiction neuroscience at the United States National Institute on Drug Abuse (NIDA).
According to the criteria of
A fervent prevention activist, he emigrated from Argentina after finishing high school, graduated in Biology and completed a master’s degree in Microbiology and Immunology in Israel. Since 2000 he is at NIDA, where he is health science administrator.
In a present already tormented by addictions, it is said that there is a new one, that of social networks.
They are not yet called addictions per se. Yes to video games and online betting, which are more studied and with more scientific evidence. Network addiction is called abusive or problematic use. But we know that the technologies behind the networks design them to make them increasingly addictive. Because algorithms are addictive.
How is that design made?
They know how the reward system works, they know what causes a habit, and they work on the emotional needs of human beings. Basically, they know the same things as us scientists and apply it to business. The food industry knows this too. They activate triggers so that one returns again and again to a stimulus that is pleasurable and produces reward.
Why do you understand this so well?
Well, they have dopamine labs and they know how to program those algorithms to be as addictive as possible. Today what is bought and sold is our attention. The great commodity, a profitable good. And the younger the customers, the more likely they are to be trapped for life.
Can you specify what the ‘trap’ is for the networks to be so hypnotic, no matter the age?
All platforms have a very similar architectural design, which is based on what is called the insider, the hook. The hook has four loops (loops). The first is the one that identifies what your emotional trigger is, what type of emotional hunger you have or need to extinguish or appease. The networks catch it quickly.
With the like?
Of course, because all the time one is ‘I like it, I don’t like it’. That’s the first loop. Conscious or unconscious internal triggers. And to appease those triggers there is the second loop, which is the action, which the user has to do to obtain the reward, which is the third loop. The action can be go to a page or do scrolling until you find what you like.
Commercial notices appear in the middle.
All the time, but this is kind of old-fashioned now. What is sold is our attention. The data obtained with these loops, personal information, is sold. A treasure.
We were in the third loop…
It’s the reward. It is calibrated just right so that one wants to come back and stay hooked. And the last loop is the investment. One has to invest something. Post a photo, share something, leave a mark, to later check what happened to that investment. How many like’s I had, if someone posts or looks at what I did. In young people, who need to compare themselves with others and whose brain is developing, this has an enormous influence. They come back and come back.
Those who know the mechanisms we are talking about will clearly want to protect their children.
Would that be the circuit of addiction?
Of course, it is the mechanism of those four hooks, which are the basic architecture of all addictions.
He has said that those who run the tech giants do not allow their children to use screens.
It is known that Bill Gates did it. And Steve Jobs himself, in an interview he gave in 2010 to The New York Times, admitted that he forbade his children from using his newly created iPad. Those who know the mechanisms we are talking about will clearly want to protect their children, because they know how the algorithms work. If we are going to wait for science to save us or for science to give us the final verdict saying that they are addictions, it will be too late.
So?
We have to appeal to common sense. Today we should avoid the screen in young people up to the age of 16. Or at least stop using it when they go to bed, because it affects sleep, and there is no healthy brain if it does not get the sleep it needs.
What common sense did you use with your two children?
They are already grown up, they are millennials and therefore they were not born with a phone. It also depends a lot on the child’s temperament.
He’s saying that not all boys are the same…
Completely. There are differences from one child to another, whether due to genes or the environment where they are. Parenting, like therapy, recovery, and diagnoses, always has to be individually designed.
And cell phones in schools?
In the US, where I live, nothing is done. They go to school with their cell phones. What stops a school from banning the use of telephone devices in class, something that should be mandatory? Obviously there is no political decision to do so. And those who must make that decision are the adults responsible for those institutions and the parents. I call it an experiment of epic dimensions, because no one knows what the result will be. But there is a lot of danger.
Palpable consequences for children?
Example: that of bizarre pornography. Before, sexual dysfunctions were not seen in adolescents and now they are. At 12, 13 or 14 years old, when the sexual function circuits are being formed, these scenes are incorporated into the programming as a habit. The impact in the more or less distant future, perhaps not in everyone, can be very serious dysfunctions in establishing healthy relationships. It is very likely that they tend to repeat what they see, more of the many pathologies that can be associated with addictions.
We were talking about dopamine, what role does it play?
It is the neurotransmitter responsible for regulating reward and reward learning. In Neanderthals it indicated what was important to survive: where the most nutritious food is, the strongest men, the most dangerous areas. It is a very delicate mechanism that works like a thermostat, with its minimum and maximum values. This regulates reward learning.
How exactly does it work?
It is usually related to food to feed or sex to reproduce, or to survive. It tells us, for example, that the meat is good by raising the thermostat from one to ten, which indicates that we must repeat it in the future. Methamphetamine takes it over the top. And if it is repeated ten times, the thermostat can break because the human brain is not prepared for that. Drugs take dopamine from the robust area to the fragile area, it is related to learning through euphoria.
Does addiction start there?
It starts in the reward zone, but it is a shock wave that disrupts emotion, memory, motivation and even control, as consumption is repeated. And each time he adapts more and asks for more. So you have to consume more to achieve the effect of the beginning. That is dependence and tolerance. The thermostat adapts to an abnormal situation and makes the brain dependent to feel normal.
Why is it more serious in the adolescent brain?
Because your brain is developing, it is a hardware which is programmed from the ages of ten to twenty to see how it reacts to different stimuli. If these are high-risk behaviors, it will be difficult to retrace the path. It is not that they are rebellious, it is just that, at that adolescent stage, the brain pushes them to make biased decisions.
In practice what happens?
It is the construction of information highways, the circuits that allow me to decide whether to eat one more cookie or stop. Continuing with the metaphor, we could say that the keyboard would be all the toxic influences to which the brain is exposed while this occurs: bullying, physical or emotional harassment, chronic pain… If you drink six beers at 25, the computer may give an error, but if you do it when you are programming it, you have to reinstall the program. For this reason, most mental disorders begin during adolescence, because these acts leave a mark that is difficult to erase, although the disorder may emerge later.
There is talk in some scientific circles of the trivialization of cannabis consumption, a drug that can cause psychosis in adolescents.
Medical cannabis cannot be legalized without monitoring the perception of risk in adolescents. It is very difficult to neutralize the perception that it is not dangerous when medications are being produced with that drug. A medicine can never be bad, it is thought. I am concerned about how to create a security fence around children, whose minds are very vulnerable. The issue is that there are always economic interests that are extremely powerful.
Do you know of success stories in addiction prevention?
Finland. It shouldn’t surprise us. They are smaller countries, it is easier to implement serious policies, and that is why they are very advanced. They work to extradite, let’s say, boredom, excommunicate it. They are very serious about the extracurricular activities that children do and methods to minimize frustration. They work with various types of learning, respecting different individualities.
Should we work on reducing supply?
Yes, of course, but it’s an equation. Working only and more than anything on the supply, and thinking that dealing with the traffickers will end the problem, is quite short-sighted. You have to operate on the reasons for the demand, why people turn to drugs.
What about treatments?
For decades there have been what are called partial agonists such as methadone, which turn off withdrawal symptoms and allow detoxification, although dependence on methadone continues, but they keep us functional, without the euphoria and the ups and downs. There is medication for nicotine and alcohol addiction, but we do not yet have it for marijuana, cocaine or amphetamines. There is a lot of research, but it has not yet borne fruit. Whether there are drugs or not, it is always recommended that they be accompanied by behavioral therapies that reprogram the brain to face external or internal challenges.
What do you recommend to someone who has children using drugs?
First of all, don’t confront. Talk, inform and understand the process they are going through. If the communication channels are not open, you have no chance of reversing the situation. At NIDA, a new philosophy has been added to the menu of options, totally different from what we did two or three years ago, it is a fourth leg to the bench of interventions. We talk about the police force to fight crime, prevention, treatment and, lastly, harm reduction. This is what people talk about today in scientific circles.
What is harm reduction?
For example, using instruments such as fentanyl strips to identify traces that are truly toxic… In the United States we have very specific problems with opioid overdoses due to the use of synthetic drugs, such as fentanyl. One of the most important harm reduction methods is to test drugs before using them. But be careful, at some point professionals will have to intervene.
Is it possible to reverse addiction?
It can be managed, but not cured. You have to become a non-dependent person again and restore the normal physiology of the thermostats. It is a re-education process.
ANA D’ONOFRIO
FOR THE NATION (ARGENTINA) – GDA
