Dr. Rachel Wurzman is a Fellow with the Center for Neuroscience and Society, and a Postdoctoral Research Fellow in Neurology with the Laboratory for Cognition and Neural Stimulation at the University of Pennsylvania, Philadelphia, PA, USA. Previously, Rachel served as an Intern in the Science Division of the Office of Science and Technology Policy in the Executive Office of the President of the United States, an Independent Contractor for the World Technology Evaluation Center (dba WTEC, Inc.) in support of the National Nanotechnology Coordinating Center, a Neuroscience Scholar Program Fellow with the Society for Neuroscience, and a Researcher in Residence in the Neuroethics Studies Program of the Pellegrino Center for Clinical Bioethics at Georgetown University.
Rachel is the author of over 20 peer reviewed journal articles and book chapters on various topics in developmental, cognitive, and systems neuroscience, neuroethics, and science policy. Throughout her career, Rachel has investigated neurodevelopmental mechanisms for plasticity in brain circuits whose wiring, and sometimes mis-wiring, contribute to neuropsychiatric disorders on the addiction, obsessive-compulsive, and autistic spectrums. Her current research in the field of neurorehabilitation at the University of Pennsylvania seeks to understand mechanisms for neuroplasticity in brain networks, using non-invasive brain stimulation techniques, neuroimaging, and network neuroscience methods. Additionally, ongoing research in neuroethics addresses the implications of a biopsychosocial and systems-oriented perspective on neuropsychiatric spectrum phenomena (such as addiction) for research, treatment, and social policy.
Rachel received her PhD in Neuroscience from Georgetown University’s Interdisciplinary Program in Neuroscience, where her she was an NIH Ruth L. Kirschstein National Research Service Award Fellow. She received her M.S. in Physiology and Biophysics from Georgetown University, and her B.A. in Neuroscience from Smith College.
Even more than our primate cousins, homo sapiens have complex genetic and neurochemical factors that incentivize social connection. We have an evolutionary advantage for social behavior, social connection, and forming group bonds in order to survive and build civilizations and complex social structures. There’s a lot of complex neurochemistry happening to drive those behaviors, and
opioid compounds specifically are implicated in the neurochemistry of human social bonding.
It turns out that naturally-occurring opioid compounds are intricately involved in the reward systems our brains use to reinforce social connection. These naturally occurring opioids make social connection literally feel good: in a part of the brain called the striatum.
By Dr. Rachel Wurzman
Most people know that medical science considers addiction to be a disease. They say this because we know that the cycle of addiction starts with the brain and gets locked in by the brain. But that’s not the whole story. We know that the brain is plastic, which means that it is constantly being wired and re-wired by the way we experience the world around us. Science tends to think about how technologies like medications or physical brain stimulators can help encourage the brain to rewire itself away from neurological and psychological illness states and towards healthier ones. But we also know that there are some conditions— and addiction is one— where the most effective treatments known are things that help to change thoughts and behavior.
In studying brain plasticity, we use technology to help put brains in more plastic states. But we’re discovering something very interesting. It turns out that it’s not just about nudging the brain to start rewiring that induces healing— it matters very much what the person is doing when we’re tinkering about in there. What do I mean by this? I mean that the experiences that we have when the brain is primed to change determine what the very effect of that technology has. Our brains are very accommodating. If our thoughts and behaviors give us socially isolating experiences, our brains become set in that mode. But that doesn’t mean that we or our brains work well in that mode. Quite the opposite.
Let me tell you about another exciting thing that neuroscience is discovering. It turns out that certain brain networks are responsible for more than one type of experience or perception or behavior. And lately, three different sub-fields in neuroscience have come from different directions but recently have found themselves in the same space, zeroing in on this one critical system that’s essential for what they focus on.
One of the fields is addiction neuroscience. The neuroscience of addiction has long since identified the system responsible for drug and alcohol addiction, called the Reward System. This is the system that is hijacked so effectively by opiates like heroin.
Another sub-field is neuro-spirituality, or the study of how the brain processes spiritual experiences. It turns out that certain chemical pathways in the reward system are also activated when we have profound experiences of connectedness to something outside of ourselves and greater than ourselves, which makes us feel well and peaceful and whole and joyful. Spiritual experiences tend to create conditions in the brain that look like states where the brain becomes more plastic. In other words, we are starting to suspect that things that trigger spiritual experience herald a brain that can more easily rewire itself.
But the most surprising convergence comes from the field of Social Neuroscience, which studies how our cultural and interpersonal experiences are driven by brain, and why certain experiences have certain effects on the brain. It turns out that the brain system that drives mammals, and especially human, to form social bonds is— you guessed it— the reward system.
Certain hormones like oxytocin, which people have called the love hormone and the trust hormone, and other chemicals like endorphins and enkephalins, act on parts of those same reward circuits to make social interaction rewarding. This is a system that makes sure that we’re are ok— that we are going to survive as the puny, weak, limited biological creatures that humans are. We form groups, we support each other, we pick up the slack for the more vulnerable members of our group so that the group can get the nourishment it needs to survive and thrive. This system is so important to human survival, and other mammals that need to come together in groups to raise offspring, that we are hardwired to experience pain in the absence of connection.
Let me say that again. The same brain circuit that gives us experiences of profound connectedness also gives us very physical feelings of pain and emotional— even existential— suffering when we don’t have connection to things outside of ourselves. And guess what those physical feelings resemble? Withdrawal from opiates. Stomach upset. Muscle aches. Our skin crawls. We feel restless irritable discontent, and emotionally hopeless about our lives continuing. We feel like we’re dying because the truth is, we ARE dying.
We tend to think that in modern society, we don’t need tribes of humans to survive, because we have farms that grow food predictably and in luckier places in the world, we came just go to the grocery store to buy food. But the life-threatening epidemics in our society like opiate addictions, or obesity and diabetes from food and sugar addiction, and suicide rates resulting from depression and anxiety and PTSD tell us otherwise. Our society increasingly lacks ways to AUTHENTICALLY connect to other people and to experiences of something transcendent and beyond the boundaries of our small selves and limited minds. This state of affairs acts through the brain’s reward system to make life literally painful.
That pain drives us to bond to whatever we can. Like food, like electronics, and for too too many people— to drugs. Opiates are the most vicious hijackers of this system because they can directly produce the brain states that social and spiritual connection are supposed to give us. It’s a biological imperative— it is a neural process that is linked to our drive to do things to survive. And people who become addicted feel like they need the objects of their addiction to survive, and it becomes the thing that their strongest behavioral imperative. The drive to get high overwhelms our ability to consider risks of ruin or death. When we are bound to opiates and other drugs, we can’t bond to others, or to anything beyond ourselves. And trapped inside ourselves, we die. Heroin and fentanyl kill us most quickly of all.
Science has spent a lot of time looking at how technology can save us from the effects of our brains locked in states of addiction and depression, which are states that block us from connecting to anyone or anything else. Seek Healing is one of the first organizations to think differently. With your help, we are creating social and spiritual technologies. We are going to create scalable structures online and in the real world where people can access the spiritual and social connections they need to survive. Medicine can help people detox. But once the physical effects of the addiction fade, we must ensure that people have easily accessible opportunities to connect socially and spiritually— and not just in the confines of our bedrooms on our computers and phones. The systems for spiritual connection and social connection are so overlapping that social connection is a spiritual experience, and spiritual experiences and socially binding. This means we must have SHARED experiences, together, in each other’s company, not just reading words but hearing voices or seeing faces. It means we have to come together for authentic connection.
Drug Rehab is tragically incomplete unless it is followed by something that boosts connection. Seek Healing is going to fix this problem. And if we are successful, we will be building platforms for connections that can heal a lot of other social epidemics. But first, we need to save the lives of our friends, families, and neighbors who are dying fast from drug overdoses.
There's a classic experiment repeated time and time again where the scientist will put a rat in a cage with two options for drinking water: one clean and pure, one laced with heroin or other opiates. Time and time again, without fail, the rat will choose the drugged water and drink it until it dies.
The interpretation of this result was simple: the opiates were so powerful that a person would sacrifice everything, even at the risk of their own life, to continue to obtain them, and eventually, it will cost them their own life. The neuroscience of addiction set off to figure out what in the brain would support such behavior.
In the late 1970's, psychologist Dr. Bruce K. Alexander of Simon Fraser University in British Columbia interpreted the classic study differently. The problem as he saw it wasn't the drugs; it was the cage. There was only one rat. The rat had nothing to do. It was lonely and depressed. Maybe that is why it preferred the drugged water.
So he and his colleagues set up a different experiment: provide the same two drinking water options, but populate the cage with a whole community of rats, and give them nesting material, toys, and other diversions to give them an otherwise happy life. He called it "Rat Park."
In Dr. Alexander's experiments, published in the journal Psychopharmacology, the rats in Rat Park didn't prefer the opiate-laced water. None of them overdosed or died. And most remarkably, when he introduced rats into Rat Park who were already addicted to opiates, they preferred community connection; they stopped drinking the drugged water, and after exhibiting withdrawal symptoms, they enjoyed living in Rat Park just like the others.
Addiction neuroscience, in its quest to find out why a human would choose heroin to the point of his or her own death, bumped into social neuroscience, which was trying to figure out how the brain processes empathy and morality to the point that a person would sacrifice themselves for others or for something bigger than themselves.
It turns out that the exact same chemical pathways and circuits that are hijacked by addiction were evolved in mammals for a very different purpose: to make social interactions feel good. We don’t just need social interaction because it gives us economic advantages, like a better ability to find food or build shelters by working together. In humans, meaningful social connection is so important that babies will literally die without touch, even if all other biological needs are satisfied.
What does this have to do with addiction? Meaningful social interactions and connectedness with others release powerful hormones that can in turn modify activity in every brain system that sustains life, from metabolic circuits that also control "fight or flight" responses to executive control circuits that give us the ability to switch activities when we choose or override automatic behaviors, like habits. Hormones like oxytocin and neurotransmitters like dopamine do different things in different brain species' systems, and in humans, these systems are arranged so that empathy feels good, like the things we get compulsive about feel good, like the best ice cream, new love, and, yes, like being high. But there’s more. These brain systems are arranged so they make social disconnection feel bad, just like withdrawal feels bad, as it turns out. It is not an accident that grief and withdrawal have cause some of the same physical symptoms.
Programs that most successfully and lastingly transform addicts' lives may borrow medical language and metaphors, but they don’t work by providing a cure. Instead, what they do is provide a context full of opportunities for social connection, where the mechanism for healing is in the interactions between peers, some of whom might be further along their own journey of healing. The emphasis is on outward-focused living, and on taking practical steps to mitigate disconnection between addicted people and their families and social contacts, by repairing relationships and reclaiming personal responsibility.
But importantly, the healing can't be administered like medicine, it must be sought, and then it must be lived.