Rachel Wurzman: Can Social Isolation Lead To Opioid Addiction? Circumstances like who we are and where we live can impact our health. But Rachel Wurzman says another critical factor is loneliness. She studies the connection between isolation and opioid addiction.

Rachel Wurzman: Can Social Isolation Lead To Opioid Addiction?

  • Download
  • <iframe src="https://www.npr.org/player/embed/787420056/787760571" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


So far on the show, we've explored how external factors can impact our ability to be healthy, from where we live to what we do for work and even how our doctors treat us. But what about what's going on internally?

RACHEL WURZMAN: We believe treatment starts with being aware of what is happening in your own body and the way that your own internal physical experience is related to your emotion.

RAZ: This is Rachel Wurzman.

WURZMAN: So my name is Rachel Wurzman. I have a Ph.D. in neuroscience.

RAZ: Rachel studies and treats addiction. And more specifically, she researches the part of our brain that's connected to forming habits.

WURZMAN: That part of the brain is called the striatum. And I think I've just kind of had a love affair with that part of the brain since the early days of my studying neuroscience. It serves so many more functions than just preparing and chunking together habits, which is what it's normally known for. But it also, in a sense, serves as this filter for the rest of the brain to sort of recognize patterns of input coming around and the striatum gets activated in a particular way that it releases prepackaged programs of behavior. So you can imagine that it's really involved in something like addiction, for one thing - compulsive behaviors of a really wide variety.

RAZ: How would you describe what addiction is? One definition of addiction would be a choice that somebody makes. What is your description of what addiction is?

WURZMAN: I think addiction is a normal human response to pain and a certain internal state. And at its extreme manifestations, when it comes to things like substances, it becomes even less voluntary because what happens is as a result of the physiological effects of certain highly addictive substances, be it alcohol or opioids or amphetamines and the way that they activate the reward system, the brain wiring itself changes. And that makes it even harder to interrupt a particular behavior.

But I think that humans engage in substance use to try and feel a little OK when they're feeling restless or irritable or uncomfortable on some, sometimes, very subtle level. But we soothe ourselves. Some of us soothe ourselves by distracting ourselves with our phones. Or some people do it with food. But you continue to do a behavior despite it having negative effects on your social relationships, your family relationships, your employment, your job, your ability to function. Those criteria can really apply to a much broader set of behaviors than just injecting heroin or smoking methamphetamine or taking pills or drinking.

RAZ: Rachel Wurzman picks up the idea from the TED stage.


WURZMAN: My experiments were exploring how miswiring in the striatum relates to compulsive behaviors, meaning behaviors that are coerced by uncomfortable urges you can't consciously resist. So the striatum, which, for sure, is involved in compulsive spectrum disorders, is also involved in human social connection and our ability to connect. As it turns out, the social neurochemistry in the striatum is linked to things you've probably already heard of, like oxytocin, which is that hormone that makes cuddling feel all warm and fuzzy. But it also implicates signaling at opioid receptors. There are naturally occurring opioids in your brain that are deeply linked to social processes. The striatum and opioid signaling in it has been deeply linked with loneliness. When we don't have enough signaling at opioid receptors, we can feel alone in a room full of people we care about and love who love us.

Loneliness is very dangerous, and it predisposes people to entire spectrums of physical and mental illnesses. Think of it like this. Loneliness creates a hunger in the brain, and our brains signal deep dissatisfaction. We become restless, irritable and impulsive. If we don't have the ability to connect socially, we are so ravenous for our social neurochemistry to be rebalanced, we're likely to seek relief from anywhere. And if that anywhere is opioid painkillers or heroin, it is going to be a heat-seeking missile for our social rewards system. Is it any wonder people in today's world are becoming addicted so easily?

RAZ: You know, I'm curious about this idea around loneliness because loneliness is not really something that we think of as a public health crisis. But, I mean, as you point out in your talk, it seems like there's growing evidence to link loneliness to all kinds of psychological breakdowns, that being lonely and having, you know, little or no social interaction can really affect somebody who might ordinarily exhibit normal behavior, right?

WURZMAN: Right. So loneliness affects multiple systems in the brain. And I think that it's being much more widely recognized as potentially the biggest public health crisis that we have right now. And I really also want to differentiate between social isolation and the concept of just not being around other people because the thing about loneliness is that you can be surrounded by other people and still feel intensely lonely. There's a dimension of loneliness and social isolation that exists independently of how many people you are interacting with on a daily basis. So there's something, too, about the nature and the quality of our interactions and something about our internal experience and the way that those interactions are perceived that contribute to a crisis of loneliness.

RAZ: Yeah. Yeah. I mean, there are people who, you know, get injured and then get prescribed opioids and don't become addicted. And then there are people who do become addicted, right?


RAZ: What explains it? I mean, why does one kind of person become addicted, and another kind of person doesn't? Is - I mean, is loneliness part of that equation?

WURZMAN: That's such a good question. And this is where the reward system actually plays into it. Their reward systems may be hypersensitized, and social isolation is hypersensitizing people's reward systems. So you give it something that's rewarding. You give it something that's anesthetic. And it's like eating after fasting. That food, no matter what it is, is going to taste that much more amazing.

So while there are definitely biological predispositions to addiction - that some people have those factors more than others - a really reasonable hypothesis is that with our culture and the lack of connection and our changing lifestyles being the way they are, brain circuits in more people than just have genes classically that have been identified as associated with addiction are in a state where they are sort of hungry.

And if you give them relief by way of a rewarding substance, it's going to be that much more likely to become something that is a compulsion that escapes control. So we are treating addiction as part of a greater loneliness epidemic, and particularly the opioid overdose epidemic being symptomatic of a lack of connection and quite literally a state of affairs where people's lives are painful.

RAZ: I mean, it feels like such a creative way to think about addiction, right? Because we - addiction is not a new human phenomenon. Humans have been addicted to things since we've probably existed as a species. And at times, it was punished. At times, people were probably killed and obviously incarcerated in the modern era. But to me, it seems like the idea of creating more social interactions is really encouraging and inspiring and - but at the same time, really hard because, you know, many people don't have natural communities. I mean, it's - and this is now a feature of modern life - that no, communities just don't exist in quite the same way they did 20, 30, 40, 50, a hundred, a thousand years ago.

WURZMAN: Yes. And that creates a human condition where there is a low-level amount of pain that I think has been so common for so many centuries that we don't even recognize it. And I think that we tend to think that a lot of behaviors that humans are more likely to do with that background experience - we think of them as human nature. But really, they're artifacts of the way that we live and the kinds of communities we do or we don't have.

We evolved to be not just in a connected social circle for instrumental aims. You know, we need help gathering food and things like that. That's usually how people think of it. But it goes deeper than that. There is a certain kind of nourishment on a biochemical, physiological level that happens through social interventions. And what we really need to consider is that that puts brain circuits in a particular state.

But, like you said, we're not raised in a culture that knows how to connect. We're raised in a culture that has a lot of shame. And what shame does is shame keeps us isolated. Shame makes us afraid to be vulnerable with one another. Shame is the sense that we are not enough. And shame makes it very difficult for people to allow other people to see them.

RAZ: So how do you address that?

WURZMAN: So we've created a system where we can teach just ordinary people from all walks of life how to communicate with one another in ways that minimize shame and normalize the experience of being slightly anxious and awkward. We just make that normal. And so we create an environment that is radically free of judgment.

And in an environment where people are radically free of judgment, they feel more comfortable revealing themselves. And then they start to experience this connection where they can just be - exist with a person in whatever they're going through and communicate it in a way that the person knows that they are right there with them. It is a magical, powerful - I'm getting chills just talking about it. It's a really, really powerful experience. And frankly, it feels like an addictive drug.


RAZ: That's Rachel Wurzman. She's a neuroscientist and co-founder of SeekHealing, an addiction treatment center. You can see her full talk at ted.com. Thanks for listening to our show on accessing better health this week. If you want to find out more about who was on it, go to ted.npr.org. And to see hundreds more TED Talks, check out ted.com or the TED app.

Our production staff at NPR includes Jeff Rogers, Sanaz Meshkinpour, Rachel Faulkner, Diba Mohtasham, James Delahoussaye, J.C. Howard, Katie Monteleone and Maria Paz Gutierrez, with help from Daniel Shukin. Our intern is Kiara Brown. Our partners at TED are Chris Anderson, Colin Helms, Anna Phelan and Michelle Quint.

I'm Guy Raz, and you've been listening to ideas worth spreading right here on the TED Radio Hour from NPR.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.