Speaker A
This video is a collaboration with MAAD Digital. "Tomorrow, I will stop." Funny, I think I said that yesterday, a month or even a year ago, and I will probably say it again next month and next year.
Explores why quitting addictive behaviors is so difficult, explaining addiction as a brain disease, not a lack of willpower.
Ask about this video. Answers come from its transcript only — with the timestamp, so you can check them.
Generated from the transcript and can be wrong — check the timestamp.
Key Takeaways
- Addiction is a disease involving brain changes, not a failure of willpower.
- Negative consequences define addiction, not the amount of substance used.
- The brain’s reward system is hijacked and behavior becomes automated, making quitting hard.
- Successful quitting often requires medical or professional support.
- Using 'addiction' loosely can dilute understanding of the illness.
What the video covers
- The phrase 'Tomorrow, I will stop' often fails because addiction is not simply a matter of willpower.
- Addiction is defined as compulsive behavior despite negative consequences, distinguishing it from habits.
- The transition from habit to addiction is gradual and measured by the impact on life, not substance amount.
- Addiction causes neurobiological changes that impair the brain's ability to regain control.
- Willpower is a misleading concept in neuroscience; addiction rewires the brain making self-control very difficult.
- The reward center (nucleus accumbens) plays a key role in reinforcing behaviors through dopamine.
- Addiction shifts control from reward-based learning to automated behavior controlled by the putamen.
- Research shows addicts have altered dopamine levels in brain areas responsible for automation.
- Recovery requires medical support and cannot rely solely on individual effort.
- Understanding addiction as a disease can reduce stigma and improve treatment approaches.
Chapters
- 00:00Introduction and Personal Reflection on Addiction
- 01:24Defining Addiction vs Habit
- 02:17When Does Consumption Become Addiction?
- 04:27Addiction as a Disease, Not Willpower
- 05:27Neuroscience Perspective on Willpower
- 06:26Neurobiological Changes in Addiction
- 07:33The Brain’s Reward System and Learning
- 08:33Automated Behavior and Addiction
- 09:45Research Findings on Dopamine and Addiction
- 16:59Summary and Broader Implications
Full Transcript — Download SRT & Markdown
Speaker A
And I'm sure you know exactly what I am talking about. We decide to quit smoking, drinking, taking drugs, or eating too much sugar in my case... we make the firm decision to stop a behavior we dislike... only to do it again an hour, a day, a week, or a month later.
Speaker A
What is this mental weakness? Why is it so hard? And what about actual addicts? When I am complaining about not being able to reduce my chocolate or sugar consumption, that's not the same challenge as someone who would like to quit smoking, I agree.
Speaker A
But what's happening in our brain that's keeping us from taking back control over ourselves? Moreover, at what point do we really talk about loss of control? Between a beer every now and then to one pack per evening, there is a margin...
Speaker A
At which point do we cross that limit? I met Salah El Mestikawi, who is a neurobiologist specializing in addictions.
Speaker A
I wanted to understand why we fail so often when we make that decision of "tomorrow, I'll quit."
Speaker A
So to be honest, I was going in there, convinced that I myself had an addiction to sugar.
Speaker A
And the first thing he did was to give me the definition of addiction... which kind of put me back in my place.
Speaker A
Addiction is a compulsive behavior to seek a drug or a behavior, despite the negative consequences, with numerous attempts to stop and failures, or relapses.
Speaker A
It's a somewhat complex definition, and what is really important in this definition is this part: despite the negative consequences.
Speaker A
This is really the very important point. What you call an addiction is actually a habit.
Speaker A
You have a job, you do complicated things, you drive your car, etc. You like sugar, but it doesn't destroy your life.
Speaker A
If it destroyed your life, you would weigh... you would be obese, you would have problems with diabetes, heart problems, etc.
Speaker A
So as long as you are not consuming sugar 'despite the negative consequences' and you still have the ability to take back control, you are not experiencing an illness.
Speaker A
The negative consequences are that I will be less beautiful at the beach, it's not the same thing as a pathological addict who loses his job.
Speaker A
Yeah... I felt a little silly to have self-labeled myself as an addict when it turns out that I just like chocolate.
Speaker A
But if I tell you about this (and I could have easily avoided telling you, by the way), it's because I don't think I'm the only one to use the term "addiction" to mean any and everything, when it really is an illness.
Speaker A
If the term "addiction" is a bit overused for us non-neuroscientists, it is also because the transition from non-addict to addict is not that straightforward.
Speaker A
In the bible of mental disorders, the DSM-5, the term "addiction" is not even mentioned; instead, the manual talks about substance use disorders.
Speaker A
There are 11 criteria. If you meet 2-3 criteria, you are considered to have a slight problem, medium if you meet 4-5, and high if you meet 6+.
Speaker A
So it's a spectrum, it's not straightforward as a transition. If you take the time to read these, you'll notice that there is not a single mention of a substance amount; the focus is really on the consequences of substance use.
Speaker A
So ultimately, we go beyond the limits when the consequences of our consumption become negative.
Speaker A
Whether that's after 1 beer per evening or 5… I couldn't tell you. But I would like to get back to the specific focus of this video, this idea of willing to stop that we can't stick with.
Speaker A
Why this "tomorrow I quit" decision does not work. And I'm speaking with an addiction expert, so obviously, we are mainly talking about people with severe substance use disorders, since that is the official term; those considered to be addicts.
Speaker A
But even if you or I haven't necessarily reached that point, I think we all have experienced a form of that loss of control sensation.
Speaker A
You know what I mean? For me, it's a chocolate bar that disappears while I only wanted one square (that's not true, I wanted a full row, but I didn't want the whole tablet), for others it's 1 beer that turns into
Speaker A
a 6-pack, 1 cigarette that turns into a whole pack, etc... Except that for a non-addict, you may have a “weakness” one evening from time to time, but we manage to take back control and not do it again the next day.
Speaker A
An addict cannot — emphasis on “cannot”; they don't have the ability to take control.
Speaker A
Addiction is a real disease, that is really something that people need to understand. It's a disease, it's not a matter of willpower.
Speaker A
We know that the success rate to quit smoking or drinking is about 5%. 95% of us will fail.
Speaker A
We'll fail repeatedly with on top of that a feeling of unease, a social stigma - “oh, get it together, you have no willpower," etc.
Speaker A
So if we look at the numbers in more detail, for cigarettes, it depends on the sources, but we would be around 6-7% of people who manage to wean themselves by sheer force of will.
Speaker A
For alcohol, it would be more around 20%. But these numbers are to be taken with a grain of salt because there are many variables, it depends on what we're looking at... and obviously all drugs are not on an equal footing, some are more addictive than others.
Speaker A
So take that with a grain of salt. But what stands out, the important point, is that deciding that tomorrow we will stop consuming without relying on any outside help, it's still super difficult.
Speaker A
Small parenthesis. The notion of willpower that I am using in this video actually doesn't make much sense in neuroscience.
Speaker A
Our brain is chemistry, biology; there is no such thing as a higher body which would be independent and could control how the chemistry of such and such a spot should behave.
Speaker A
So the notion of willpower, in neuroscience, is a bit tricky. But that would take us into philosophical notions that are a little too advanced and which go beyond the scope of the video.
Speaker A
So willpower, as I define it myself, as I'm using it in this video, is "the ability to stop consuming drugs by oneself.”
Speaker A
In fact, to think that we can just decide to no longer be addicted or to stop having a mental disorder in the broader sense, is like asking someone who broke their leg to stop making a fuss and just start walking like
Speaker A
everybody else. Or to someone who has normal vision to just start seeing UV rays as well.
Speaker A
"Come on, it would be so convenient..." It doesn't work like that. Physically, it doesn't work.
Speaker A
And this is probably the most important point to understand, which I would like you to get out of this video: an addiction or a mental disorder incurs a real physiological, neurobiological change.
Speaker A
An addict can't decide to quit because they are no longer wired so that their willpower has the option, the possibility of regaining control.
Speaker A
They would have a really hard time doing so without medical help or support. Let me introduce you to George.
Speaker A
So yes, he's a walnut, but you have to admit that there is nothing in nature that looks so much like a brain.
Speaker A
Other than an actual brain... but it's harder to get your hands on one of those.
Speaker A
We will use George to understand how our internal wiring is altered when we lose control, when we become addicted.
Speaker A
Here is an area called the striatum. And I have to zoom in a little more to see in detail... There what you see is the nucleus accumbens, and this area is often called the reward center, which actually does many more things too, but this is the function that interests us.
Speaker A
And the reward center, I'm sure that you've heard of it before, is the area of the brain which, when we eat a raclette for the first time, find that it's a delight (a logical response), and sends us pleasure neurotransmitters, takes note of it and
Speaker A
achieves positive reinforcement, that a raclette night is something we don't want to miss. This is how most learning happens, through positive reinforcements (it's good and I want to do it again) or negative (it sucks, never again).
Speaker A
A
Speaker A
And I asked Salah if this vision, which is now a bit old, was partial.
Speaker A
That is the first step. Obviously any addiction starts with a reward. This is what confuses our brains.
Speaker A
I take my cocaine shoot, and ah! I have this dopamine, and then in addition there are stimulating psychomotor effects elsewhere in the cortex.
Speaker A
This is what we take for addiction. But that's not addiction, it's the first step.
Speaker A
To illustrate this, there was an experiment where rats were given cocaine, and we let them get used to it, but after a while, each time they would take cocaine, it would be associated with a small electric shock to discourage them.
Speaker A
Which represents the negative consequences of drug use. You see you have 4, 5 or 10% (I don't know the exact figures) who continue to self-administer despite the punishment.
Speaker A
Those are the addicts. They consume drugs despite the negative consequences. If every time we made a raclette, the living room would catch fire, we would stop making raclettes because in our brain, we would have a negative reinforcement mechanism.
Speaker A
It catches fire = I don't make raclettes anymore. Except that raclette addicts, if they existed, would make a raclette despite the living room being on fire.
Speaker A
That must be super clear, yes, we must repeat it, say it, repeat it. Addiction is not a problem of pleasure, it's a problem of compulsion, of loss of control.
Speaker A
Besides, if addiction was really a search for pleasure, then the addict would have more and more pleasure to consume.
Speaker A
And we have all experienced this... as much as I'm sure we really like our first beer, our first piece of cake... the 8th beer or the 5th cake?
Speaker A
They're not so pleasant anymore. It is no longer pleasure that drives the action. Besides, and this is really interesting, when we measure the evolution of pleasure that addicts feel when taking drugs, what we call "liking"... we observe something
Speaker A
that I is very counterintuitive: it's descending. They enjoy their drugs less and less. Can you imagine the sadness? Eating raclette compulsively and loving it less and less? And liking it less and less is not just an impression, it
Speaker A
results from a real physiological change in the brain. When the amount of drug is too high, the brain tries to compensate for this over-stimulation which is not normal, by producing a molecule that triggers the production of a neurotransmitter which inhibits the stimulation of our reward center: we end up experiencing
Speaker A
less pleasure with this substance. But the worst part is that our brain, while impressive in many ways, is not that smart on certain fronts...
Speaker A
It doesn't distinguish well between drug-related stimulation and stimulations related to seeing friends, managing to open an easy-ope package, or feeling the morning dew on our skin.
Speaker A
An addict's brain is used to getting over-stimulated, so it decreases the ability of the pleasure center to be stimulated; which makes everything feel bland.
Speaker A
Clearly it's not a choice, the brain has changed. An addict is not looking for pleasure; they get less and less of it.
Speaker A
On the other hand, what changes is wanting, it's "I want this drug", the wanting soars to massive heights.
Speaker A
So at that point we started to distinguish the difference between liking and wanting, and so it was no longer a case of our reward system getting hijacked, it was something else.
Speaker A
Let's go back to our raclette example. It's cold, we are at a chalet, with friends, there is a fire in the fireplace, we passed a cheese factory on our way back from a crazy carpet session… Raclette time!
Speaker A
All the indicators are there. But when you're addicted to raclette, it may be that only one of the 6 criteria would suffice to get you to crave raclette.
Speaker A
Addiction makes us hyper sensitive to markers that can lead to consumption. Again, this is not imagined, it's a real change in the brain.
Speaker A
Before getting addicted, you would have needed to meet all 6 criteria for your brain to think about raclette and to produce dopamine, which is sort of the neurotransmitter of expectation, of desire.
Speaker A
What makes us crave for a raclette or for a drug. In fact, I would like to insist this point.
Speaker A
Dopamine, we all know it as the “reward hormone”, and that's wrong. First off, it's not a hormone, it's a neurotransmitter.
Speaker A
And it's not associated with reward itself... It predicts the reward, so if I have a big dopamine signal, it means that I expect a big reward.
Speaker A
So dopamine represents the desire to obtain something, not the pleasure of getting it. And the production of dopamine has become so sensitive to the slightest clue, that we crave things much faster and for almost nothing.
Speaker A
So the urge to consume becomes irresistible because our brain is shooting neurotransmitters at us just when we're thinking about using... But, as we just saw, when we do take drugs, the pleasure is not so high since our pleasure response
Speaker A
has been physiologically reduced by our brain. So now we find ourselves in a wonderful situation: we crave for our drug for hours on end and don't even like it that much when we get it.
Speaker A
So we come to the pivotal question. Why are we not able to take back control, to stop this infernal cycle of craving that is never satisfied? Is our "will" somewhere in an area of the brain that we could trigger to stop this cycle? Suppose you are looking to
Speaker A
learn to drive a car for the very first time. The first time it's complicated, there are lots of things to monitor, you have to do each of the actions well one by one and in the right order... it takes a lot of mental effort.
Speaker A
And then suddenly I've practised enough, I know how to drive my car, and while I'm driving I'm thinking of something else.
Speaker A
Now it switches to a center that will allow me to automate my behavior and to be much more efficient because I do it automatically.
Speaker A
The paths are made in my brain, it's like pressing a button and it happens automatically.
Speaker A
It only takes a signal from the environment to trigger my behavior, that's our habits.
Speaker A
So this is the “conscious action” mode and “I want to get something”, and this something is that I want to have my driver's license, because at 18 I want to have my license, I'm going to impress my friends, and girls, etc...
Speaker A
Doing something for a purpose, that happens in the striatum too but in a different section.
Speaker A
It is no longer the nucleus accumbens that we mentioned earlier (the pleasure center) but it is in the caudate nucleus which is right next door.
Speaker A
This region of the brain also dialogues with the reward system, with the nucleus accumbens.
Speaker A
We drive the car, it's going well, we get rewarded... There is a positive loop between these two areas which reinforces our learning to drive.
Speaker A
Later, we drive every day, we go to work in super difficult conditions. I go to work from here, I'm in Notre-Dame-de-Grâce, I am going to Verdun; 10 km under the snow in the winter...
Speaker A
Sometimes I get to the lab and I can't remember what happened during the car ride, because I was on automatic mode and I was thinking about...
Speaker A
I write articles for example on my bike. And yet I never have an accident.
Speaker A
So this automation is a really good thing. And when we get into the habit, it's yet another area of the striatum which intervenes, this is the putamen, which is also next to the other two.
Speaker A
And here, it's very important to understand that there is no longer a connection with the reward center.
Speaker A
It's done. A habit in the putamen is not motivated by reward, nor is it affected by negative consequences.
Speaker A
There is no more positive reinforcement nor any negative reinforcement. When the putamen takes control, we go head down, we repeat the action even if it will cost us dearly afterwards.
Speaker A
It's like having an invisible hand pushing on our back irresistibly. We no longer have control, there is no past, there is no future.
Speaker A
We take action, disconnected from everything. The problem with automation is that, let's say I'm driving, and suddenly there's a child crossing the road.
Speaker A
I gotta take back control, right? Taking back control, that's the key! For this to be possible, physiologically, there must be a connection between the area that was aware of its actions, the caudate, and the automation area, the putamen.
Speaker A
And in a non-addicted brain, that connection is there. The two areas are chatting away, no problem.
Speaker A
In particular, there is a conversation channel dedicated to increasing an action (e.g. driving automatically, or taking drugs), and another communication channel dedicated to inhibition (e.g. braking when a child crosses or quitting the consumption of a drug).
Speaker A
Illness exists either when the drive to automation is far too powerful, or when our ability to regain control on the other side is far too weak.
Speaker A
Physiologically, this also translates by a change. In Salah's research, he was able to show that his mice addicts (mice right, not humans) had a lot more dopamine in their automation center (the putamen) than in other areas (caudate and accumbens).
Speaker A
In this situation, regaining control is much more difficult. It’s like the putamen is yelling at us to keep using, while the caudate, the one that's supposed to let us regain control, is just whispering that it would be a good idea to stop using.
Speaker A
The imbalance is such that regaining control is near impossible. So all the explanations I just gave you is obviously partial.
Speaker A
Especially the last point since it was observed in mice. Does that apply to humans... that is yet to be confirmed.
Speaker A
And then there are other mechanisms involved. We only talked about the striatum, which is at the origin of the creation of an addiction, of an automation.
Speaker A
But the brain is complex and all areas of the brain interact with each other and the physiological consequences are more numerous than those I have just presented.
Speaker A
Particularly in the prefrontal cortex (which is the conductor of the brain), that is also an area that's affected by addiction.
Speaker A
We talked about a lot of things, and I would like to recap the main points and I would also like to open things up to a wider scope of understanding the brain and psychiatric illnesses.
Speaker A
So first we recap: a person who is experiencing addiction has 3 changes in the brain, in the striatum in particular, which are anchored physiologically.
Speaker A
First, there is a decrease or a stagnation of reward, of pleasure. The addict does not use out of pleasure but out of desire.
Speaker A
That's called wanting. Then, a hypersensitivity to consumption signals (what time it is, where they are, the environment) which makes them want to use more and more.
Speaker A
And finally, there is an automation which is too strong in the brain, and that prevents an addict to regain control.
Speaker A
In the end, the brain is not more powerful than any other part of our body.
Speaker A
We know, if I tell you that I've cut my tendon here, that I will no longer be able to contract my arm, even if I really want to.
Speaker A
I will need doctors, physiotherapy etc to regain the function of contracting my arm. And also lots of energy to manage to execute this function again.
Speaker A
But for the brain, we tend to think that by some miracle, even if there is no pathway, you just need to want them bad enough to create them.
Speaker A
No, it's the same thing, we also call on doctors, medication, psychotherapy, behavioral therapies and a lot of determination on the part of patients (this is essential) and then, yes, we can get out of addiction.
Speaker A
The brain is also a body part whose gears are chemical, biological, and if the system is broken… it doesn't work.
Speaker A
We don't understand the brain as well as we understand muscle, I'll give it to you.
Speaker A
But what is not yet known to us is not synonymous with superpower. What is interesting and encouraging in all this is that we're starting to have an increasingly clearer picture of what leads to addiction.
Speaker A
I know the vision that I gave you may seem hopeless. But it's actually full of hope.
Speaker A
Because the more we understand something, the more we will be able to develop effective treatments.
Speaker A
Salah also told me that addiction was probably the psychiatric illness that we understand best.
Speaker A
So we are no longer very far from finding solutions. Speaking of psychiatric illnesses... allow me to open the conversation a little wider and which takes us to the borders of current research, and even takes us into opinion rather than fact.
Speaker A
From now on, your critical mind is required, although I hope it was already activated right? It’s a good reflex.
Speaker A
What I find fascinating about Salah's research is that he studies addiction in mice he modified genetically by changing one of the multiple genes which we suspect to be related to addiction.
Speaker A
And there... according to the protocol he applies on his mice... I can turn a mouse into an addict, I can make her compulsive.
Speaker A
I can make her bulimic. There is a pattern of bulimia in mice, I can also make her anorexic.
Speaker A
A change in a gene could lead to to different psychiatric illnesses. So be careful, let's not put the cart before the horse, this was observed in Salah's mice, that doesn't mean it's the same thing in humans.
Speaker A
Of course, we know that genetics offer a fertile ground for humans, but we haven't identified the ONE gene of addiction in humans, it is much more complex than that and there are also many environmental factors etc.
Speaker A
So let's limit our interpretation of this last result, but if I tell you about it, it's because I find it interesting to think that maybe several psychiatric illnesses could work similarly.
Speaker A
And it makes you wonder if we could watch this video again and replace the term addiction with OCD, anorexia or even depression.
Speaker A
So it's there for me, and this will irritate more than one person, I can't see the difference between addiction... if we have understood this mechanism of compulsion, it may be common to substances, to feelings, to emotions or behaviors.
Speaker A
This is the opinion of several researchers, including Salah, but not all. In the famous bible of psychiatric illnesses we talked about at the start of the video, there is no mention of addiction, it only talks about substance use disorders.
Speaker A
Which by definition excludes any addiction to sugar, to video games, to sex, to work, to sports...
Speaker A
Absolutely so that's a raging debate, the old school is completely against it. I think it's a misunderstanding of what addiction is.
Speaker A
And if we push the plug even further... I asked Salah for his opinion if, according to him, we could also be addicted to positive things.
Speaker A
Oh absolutely, it's super obvious. People who exercise too much are a classic example. You start running because you like it, then it becomes a real addiction to the point where you absolutely hurt yourself, you spend a lot of time running, you become
Speaker A
unsociable. You can also be a math engineer or a violinist etc, and have an absolutely awful social life, and be very miserable even though your addiction has high social value.
Speaker A
Competitive pianists or violinists, they begin at 5 years old, so... But it is better to have an addiction in this sense that an addiction to substances or to sex or poker.
Speaker A
It is better to play the violin or to do lots of math. This is a really interesting facet of psychiatric illnesses.
Speaker A
If you think about psychiatric illnesses, in fact we call it an illness when it becomes really negative.
Speaker A
But in truth when you look at where it comes from, it starts from something that is there to create diversity in human groups and allow adaptation if the conditions change.
Speaker A
In the last video I left you with more questions than answers. I'm guessing that's still the case with this one.
Speaker A
This video was a collaboration with MAAD Digital which is a scientific information media specialized in addiction and funded by French public funds.
Speaker A
Note that the last part on the borders of research and how far we can push the concept of addiction reflects the vision of the researcher I interviewed.
Speaker A
So you will have gathered that this partnership has nothing to sell, this is a free resource site.
Speaker A
There are articles, videos, infographics and if you or a loved one suffers from addiction, I think that's the kind of resource which can be very useful.
Speaker A
I know I left plenty of outstanding questions in this video because I wanted to focus on the aspect of will, and you might want to know if we all have the same likelihood to become addicted, maybe also questions
Speaker A
on the negative symptoms when you quit a drug, on methods of getting out of addiction, we didn't talk about acetylcholine either which is a super important neurotransmitter...
Speaker A
I've put some links in the description to answers to all of that to add to this video.
Speaker A
If you are interested in the brain, I have already made a video about it in at least one previous video (link in description).
Speaker A
In the next video we will also talk about neuroscience, but this time it will be related to music, so subscribe if you don't want to miss it.
Speaker A
See you next time. Bye!
Topics:addictionwillpowerneurosciencebrain diseasesubstance use disorderdopaminereward systembehavioral addictionrelapsemental health
