How isolation fuels opioid addiction | Rachel Wurzman

譯者: Lilian Chiu 審譯者: Helen Chang

What does it mean to be normal?

正常是什麼意思？

And what does it mean to be sick?

生病又是什麼意思？

I've asked myself this question from the time I was about seven,

我從七歲開始， 就在問我自己這個問題，

when I was diagnosed with Tourette syndrome.

那時我被診斷出妥瑞氏症。

Tourette's is a neurological disorder

妥瑞氏症是一種神經性失調，

characterized by stereotyped movements I perform against my will, called tics.

特徵就是我非刻意 也會做出刻板的動作，

稱為抽搐。

Now, tics are technically involuntary,

技術上來說，抽搐並不是自願的，

in the sense that they occur without any conscious attention

也就是，抽搐發生時

我並不會意識到， 我也沒有意圖要這麼做。

or intention on my part.

But there's a funny thing about how I experience tics.

但我對於抽搐的體驗 有一點十分有趣。

They feel more unvoluntary than involuntary,

覺得比較像是不由自主 而不是無意識的，

because I still feel like it's me moving my shoulder,

因為我仍然感覺得到我在動肩膀，

not some external force.

並不是外力造成的。

Also, I get this uncomfortable sensation, called premonitory urge,

此外，就在抽搐發生之前，

我會有一種不舒服的感覺， 叫做前驅性衝動，

right before tics happen,

and particularly when I'm trying to resist them.

特別是當我試圖抗拒時。

Now, I imagine most of you out there understand what I'm saying,

我相信在座大部分的人 都懂我所說的，

but unless you have Tourette's, you probably think you can't relate.

但除非你也有妥瑞氏症， 不然你可能會認為你無法體會。

But I bet you can.

但我敢說你可以。

So, let's try a little experiment here and see if I can give you

咱們來做個小實驗，看看我能否

a taste of what my experience feels like.

讓各位嚐到我的體驗是什麼滋味。

Alright, ready?

準備好了嗎？

Don't blink.

別眨眼。說真的，不要眨眼。

No, really, don't blink.

And besides dry eyes, what do you feel?

除了眼睛很乾之外， 你還感覺到什麼？

Phantom pressure?

不知哪來的壓力？

Eyelids tingling?

眼瞼刺痛？

A need?

有需求？

Are you holding your breath?

你有在憋氣嗎？

(Laughter)

（笑聲）

Aha.

啊哈。

(Laughter)

（笑聲）

That's approximately what my tics feels like.

我的抽搐大約就是這種感覺。

Now, tics and blinking, neurologically speaking, are not the same,

就神經學上來說， 抽搐和眨眼是不一樣的，

but my point is that you don't have to have Tourette's

但我的重點是， 你不用得妥瑞氏症，

to be able to relate to my experience of my premonitory urges,

也能夠感受我的前驅性衝動體驗，

because your brain can give you similar experiences and feelings.

因為你的大腦會給你 類似的體驗和感覺。

So, let's shift the conversation from what it means to be normal versus sick

咱們把話題從 「正常和生病是什麼意思」

to what it means that a majority of us are both normal and sick.

轉到「我們大部分人 既正常又生病是什麼意思」。

Because in the final analysis, we're all humans

因為到頭來，我們都是

whose brains provide for a spectrum of experiences.

大腦提供經驗光譜的人類。

And everything on that spectrum of human experiences

在人類經驗光譜上的一切

is ultimately produced by brain systems

最終都是由大腦系統所產生，

that assume a spectrum of different states.

這些系統假設存在不同狀態的光譜。

So again, what does it mean to be normal,

倘若生病位於正常光譜的最尾端，

and what does it mean to be sick,

那麼正常是什麼意思，

when sickness exists on the extreme end of a spectrum of normal?

生病又是什麼意思呢？

As both a researcher who studies differences in how individuals' brains

身為研究者，我研究個人的大腦

在自我串接和重新串接上的差異。

wire and rewire themselves,

and as a Touretter with other related diagnoses,

同時我也是個妥瑞氏症患者， 具有其他相關的診斷結果。

I have long been fascinated by failures of self-regulation

我一直都很著迷於

衝動性和強迫性行為光譜的 自我調節失靈。

on the impulsive and compulsive behavioral spectrums.

Because so much of my own experience of my own body

因為我對於我自己身體 及自己行為的經驗當中，

and my own behavior

has existed all over that map.

有好大一部分都在 那地圖上處處可見。

So with the spotlight on the opioid crisis,

所以，當大家聚焦於 鴉片類藥物的危機上時，

I've really found myself wondering lately:

我發現自己在納悶：

Where on the spectrum of unvoluntary behavior

要把濫用類鴉片止痛藥物或海洛英

do we put something like abusing opioid painkillers or heroin?

放在不由自主行為光譜上的哪裡？

By now, we all know that the opioid crisis and epidemic is out of control.

目前，我們都知道類鴉片藥物的 危機和流行已經失控了。

Ninety-one people die every day in this country from overdose.

在這個國家裡，每天就有 91 人 因為用藥過量而死。

And between 2002 and 2015,

在 2002 年到 2015 年之間，

the number of deaths from heroin increased by a factor of six.

因為海洛英而死的 人數增加了六倍。

And something about the way that we treat addiction isn't working,

我們治療成癮的方式似乎無效，

at least not for everyone.

至少不是人人都有效。

It is a fact that people suffering from addiction

事實就是，飽受成癮之苦的人

have lost free will

已失去自由意志，

when it comes to their behavior around drugs, alcohol, food

無法控制他們與藥物、

酒精、食物相關的行為，

or other reward-system stimulating behaviors.

或其他由報償系統所刺激的行為。

That addiction is a brain-based disease state

成癮是以大腦為基礎的 一種疾病狀態，

is a medical, neurobiological reality.

在醫學和神經生物學上， 這都是現實。

But how we relate to that disease --

但我們如何看待那疾病——

indeed, how we relate to the concept of disease when it comes to addiction --

的確，涉及成癮與疾病相關的概念

makes an enormous difference for how we treat people with addictions.

會使我們治療成癮者的方式大大不同。

So, we tend to think of pretty much everything we do as entirely voluntary.

我們傾向於認為我們 所做的一切都是自願的。

But it turns out that the brain's default state

但結果發現大腦的預設狀態

is really more like a car idling in drive than a car in park.

其實比較像是空轉的汽車，

而不是關掉引擎的汽車。

Some of what we think we choose to do

有些我們認為是自己選擇去做的行為，

is actually things that we have become programmed to do

其實是鬆開煞車後

我們的內建機制讓我們去做的。

when the brakes are released.

Have you ever joked that your brain was running on autopilot?

你是否曾開玩笑說 你的大腦在「自動駕駛」？

Guess what?

你猜怎樣？很可能是真的。

It probably was.

OK?

好嗎？

And the brain's autopilot is in a structure called the striatum.

大腦的自動駕駛是在 所謂的紋狀體結構中。

So the striatum detects emotional and sensory motor conditions

紋狀體會偵測

情緒和感覺運動的狀態，

and it knows to trigger whatever behavior you have done most often

它知道要觸發你過去

在同樣的條件下最常做的行為。

in the past under those same conditions.

Do you know why I became a neuroscientist?

你們知道我為什麼 會成為神經科學家嗎？

Because I wanted to learn what made me tick.

因為我想了解是什麼讓我 做出行為（音同「抽搐」）。

(Laughter)

（笑聲）

Thank you, thank you.

謝謝，謝謝。（笑聲）

(Laughter)

I've been wanting to use that one in front of an audience for years.

多年來我一直想找機會 在觀眾面前用這個梗。

(Applause)

（掌聲）

So in graduate school, I studied genetic factors

在研究所時，我學的是基因因子

that orchestrate wiring to the striatum during development.

在發展過程中負責安排 紋狀體串接的因子。

And yes, that is my former license plate.

是的，那是我之前的 車牌（紋狀體）。

(Laughter)

（笑聲）

And for the record, I don't recommend

鄭重聲明，我並不建議

any PhD student get a license plate with their thesis topic printed on it,

任何博士生選取和他們 論文題目一樣的車牌，

unless they're prepared for their experiments not to work

除非他們已準備好接受自己的 實驗在接下來的兩年都不會成功。

for the next two years.

(Laughter)

（笑聲）我最終還是找出方法了。

I eventually did figure it out.

So, my experiments were exploring how miswiring in the striatum

我的實驗是要探討

紋狀體的錯誤串接 和強迫行為的關係。

relates to compulsive behaviors.

Meaning, behaviors that are coerced

意思就是，被你無法 有意識地抗拒的

by uncomfortable urges you can't consciously resist.

不舒服衝動所強制造成的行為。

So I was really excited when my mice developed

所以，我真的很興奮 看見我的小鼠發展出

this compulsive behavior,

這種強迫行為， 牠們一直在磨擦自己的臉，

where they were rubbing their faces and they couldn't seem to stop,

甚至弄傷自己似乎仍停止不了。

even when they were wounding themselves.

好吧，不該用興奮這個詞，

OK, excited is the wrong word,

I actually felt terrible for them.

我其實為牠們感到很難過。

I thought that they had tics, evidence of striatal miswiring.

我以為牠們抽搐，也就是 有紋狀體發生串接錯誤的證據。

And they were compulsive,

牠們是強迫性的，

but it turned out, on further testing,

但結果，進一步的測試發現，

that these mice showed an aversion to interacting

這些小鼠對於和其他 不熟悉的小鼠進行互動

或是去認識牠們產生出反感現象。

and getting to know other unfamiliar mice.

Which was unusual, it was unexpected.

這很不尋常，這是我們未預期的。

The results implied that the striatum,

這些結果意味著

which, for sure, is involved in compulsive-spectrum disorders,

肯定和強迫性光譜失調 有所關聯的紋狀體

is also involved in human social connection and our ability to --

也會影響人類的社會連結 以及我們的能力——

not human social connection, but our ability to connect.

不是人類的社會連結， 而是我們去連結的能力。

So I delved deeper,

所以我再深入鑽研，

into a field called social neuroscience.

進入到所謂社會神經科學的領域。

And that is a newer, interdisciplinary field,

那是一個更新的跨學科領域，

and there I found reports that linked the striatum

在那裡，我找到了 和紋狀體有關的報告，

not just to social anomalies in mice,

不只是和小鼠的社交異常有關，

but also in people.

也和人有關。

As it turns out, the social neurochemistry in the striatum

結果發現，

在紋狀體中的社交神經化學

is linked to things you've probably already heard of.

和一些你可能已經 聽過的東西有關。

Like oxytocin,

比如催產素，它是一種荷爾蒙，

which is that hormone that makes cuddling feel all warm and fuzzy.

會讓擁抱感覺起來很溫暖和柔軟。

But it also implicates signaling at opioid receptors.

但這也意味著對鴉片類 藥物的接受器發出訊號。

There are naturally occurring opioids in your brain

在你的大腦中有天然 產生的鴉片類藥物，

that are deeply linked to social processes.

它們和社交過程有很深的關聯性。

Experiments with naloxone, which blocks opioid receptors,

鈉洛酮會阻斷鴉片類藥物的 接受器，而鈉洛酮的實驗顯示

show us just how essential this opioid-receptor signaling is

鴉片類藥物的接受器的訊號發送

對於社交互動而言有多重要。

to social interaction.

When people are given naloxone -- it's an ingredient in Narcan,

當對人施用鈉洛酮——它是 鹽酸烯丙羥嗎啡酮的一種成分，

that reverses opioid overdoses to save lives.

能逆轉鴉片類藥物過量， 以拯救性命。

But when it's given to healthy people,

但給健康的人施用時，

it actually interfered with their ability to feel connected

它會干預他們感受自己和已相識

to people they already knew and cared about.

且在乎的人有所連結的能力。

So, something about not having opioid-receptor binding

所以，若無法和鴉片類 藥物的接受器連結，

就會出於某種原因，

makes it difficult for us to feel the rewards of social interaction.

讓我們很難感覺到 社交互動帶來的報償。

Now, for the interest of time,

基於時間考量，我必須 省略一些科學細節，

I've necessarily gotten rid of some of the scientific details,

but briefly, here's where we're at.

但簡短來說，這是我們目前的進度。

The effects of social disconnection through opioid receptors,

鴉片類藥物接受器的 社會連結斷絕造成的效應、

the effects of addictive drugs

成癮性藥物的效應，

and the effects of abnormal neurotransmission

以及異常神經傳遞的效應，

on involuntary movements and compulsive behaviors

它們對於非自願性動作 和強迫行為的影響

all converge in the striatum.

都會合在紋狀體當中。

And the striatum and opioid signaling in it

而紋狀體以及紋狀體中的 鴉片類藥物訊號

has been deeply linked with loneliness.

和寂寞有很深的關聯性。

When we don't have enough signaling at opioid receptors,

若沒有足夠的訊號傳送到 鴉片類藥物的接受器，

we can feel alone in a room full of people we care about and love, who love us.

即使在一間房間中滿滿都是 我們在乎的人、愛的人，

同時也愛我們的人， 我們仍會感到孤獨。

Social neuroscientists, like Dr. Cacioppo at the University of Chicago,

社會神經科學家，比如 芝加哥大學的卡奇奧波，

have discovered that loneliness is very dangerous.

發現寂寞是非常危險的。

And it predisposes people

它會讓人傾向

to entire spectrums of physical and mental illnesses.

全部的光譜都是身體和心理疾病。

Think of it like this: when you're at your hungriest,

可以這樣想： 當你在最飢餓的時候，

pretty much any food tastes amazing, right?

幾乎任何食物吃起來 都是美味，對吧？

So similarly, loneliness creates a hunger in the brain

同樣的，寂寞會 在大腦中創造出飢餓，

which neurochemically hypersensitizes our reward system.

它會以神經化學的方式 將我們的報償系統做超增感。

And social isolation acts through receptors

而社會孤立會 透過接受器而產生影響，

for these naturally occurring opioids and other social neurotransmitters

讓這些自然產生的鴉片類藥物 和其他社交神經傳遞質

to leave the striatum in a state

造成紋狀體進入一種狀態，

where its response to things that signal reward and pleasure

它對於發送報償和愉悅訊號的事物

is completely, completely over the top.

會做出完全過火的反應。

And in this state of hypersensitivity,

在這種超增感的狀態中，

our brains signal deep dissatisfaction.

我們的大腦會發出深深不滿的訊號。

We become restless, irritable and impulsive.

我們會變得焦躁不安、 易怒，且容易衝動。

And that's pretty much when I want you to keep the bowl of Halloween chocolate

那時我大概就會請你們把房間中 整碗萬聖節巧克力都留給我，

entirely across the room for me, because I will eat it all.

因為我會把它們全部吃光。我會的。

I will.

And that brings up another thing that makes social disconnection

這就帶出了另一樣東西，

會讓社會連結斷絕變得很危險。

so dangerous.

If we don't have the ability to connect socially,

如果我們沒有建立社會連結的能力，

we are so ravenous for our social neurochemistry to be rebalanced,

我們會非常渴望我們的社交 神經化學能夠被重新平衡，

we're likely to seek relief from anywhere.

以致於我們很可能會 從其他地方尋求出口。

And if that anywhere is opioid painkillers or heroin,

如果那「其他地方」是

鴉片類止痛藥物或海洛英，

it is going to be a heat-seeking missile for our social reward system.

它會是我們社交報償系統的

導熱飛彈。

Is it any wonder people in today's world are becoming addicted so easily?

有沒有人納悶

為什麼現今世界上的人 這麼容易上癮？

Social isolation --

社會孤立——

excuse me --

抱歉——

contributes to relapse.

會造成復發。

Studies have shown that people who tend to avoid relapse

研究指出，比較能夠避免復發的人，

tend to be people who have broad, reciprocal social relationships

通常擁有廣闊且對等的社交關係，

where they can be of service to each other,

在這些關係中，他們能互相幫忙，

where they can be helpful.

能有所貢獻就會讓人連結。

Being of service lets people connect.

So --

所以——

if we don't have the ability to authentically connect,

如果我們沒有進行真實連結的能力，

our society increasingly lacks this ability to authentically connect

我們的社會越來越缺乏 這種建立真實連結的能力，

and experience things that are transcendent and beyond ourselves.

越來越缺乏體驗超越己身 卓越事物的能力。

We used to get this transcendence

我們以前會從所屬家庭和社區的 歸屬感來得到這種超越。

from a feeling of belonging to our families and our communities.

But everywhere, communities are changing.

但，不論在哪裡，社區都在改變。

And social and economic disintegration is making this harder and harder.

而社會和經濟的崩解

讓它越來越困難。

I'm not the only person to point out

除了我以外還有其他人也指出，

that the areas in the country most economically hard hit,

在這個國家中最受到 經濟影響的區域，

where people feel most desolate about their life's meaning,

這裡的人對於自己 生命的意義最感到淒涼，

are also the places

這些區域正好也是

where there have been communities most ravaged by opioids.

受到鴉片類藥物蹂躪 最嚴重的社區所在的區域。

Social isolation acts through the brain's reward system

社會孤立會透過大腦的 報償系統產生影響，

to make this state of affairs literally painful.

會讓這種事情的狀態真的很痛苦。

So perhaps it's this pain, this loneliness,

所以，也許正是 這種痛苦、這種寂寞、

this despondence

這種失望，

that's driving so many of us to connect with whatever we can.

驅使許多人盡可能 去建立各種連結。

Like food.

比如食物。

Like handheld electronics.

比如手持式電子裝置。

And for too many people, to drugs like heroin and fentanyl.

也有太多人因此轉向 海洛因和芬太奴這類藥物。

I know someone who overdosed, who was revived by Narcan,

我認識一個人，她用藥過量， 鹽酸烯丙羥嗎啡酮讓她活過來，

and she was mostly angry that she wasn't simply allowed to die.

她最憤怒的一點就是 她連想死都不被允許。

Imagine for a second how that feels, that state of hopelessness, OK?

想像一下，那種沒有希望的狀態 是什麼樣的感覺，好嗎？

But the striatum is also a source of hope.

但紋狀體也是希望的來源。

Because the striatum gives us a clue of how to bring people back.

因為紋狀體給了我們一條線索， 讓我們知道要如何把人救回來。

So, remember that the striatum is our autopilot,

所以，記住紋狀體 是我們的自動駕駛，

running our behaviors on habit,

根據習慣來主導我們的行為，

and it's possible to rewire, to reprogram that autopilot,

而且能夠把那自動駕駛 重新串接、重新編程。

but it involves neuroplasticity.

但這會涉及到神經可塑性。

So, neuroplasticity is the ability of brains

神經可塑性是

讓大腦可以將自己 重新編程的一種能力，

to reprogram themselves,

and rewire themselves, so we can learn new things.

以及重新串接， 讓我們能學習新事物。

And maybe you've heard the classic adage of plasticity:

也許你們聽說過關於 可塑性的經典格言：

neurons that fire together, wire together.

神經元會一起發動、一起串接。

Right?

對吧？

So we need to practice social connective behaviors

因此，當我們寂寞時，

當我們不由自主地

instead of compulsive behaviors, when we're lonely,

被迫轉向藥物時，

when we are cued to remember our drug.

反而是要練習社會連結的行為。

We need neuronally firing repeated experiences

我們需要不斷重覆檢視 神經元發動的經驗，

in order for the striatum to undergo that necessary neuroplasticity

紋狀體才能產生必要的神經可塑性，

that allows it to take that "go find heroin" autopilot offline.

這種可塑性會關掉

「去找海洛英」的自動駕駛功能。

And what the convergence of social neuroscience, addiction

而社會神經科學、成癮， 以及衝動性光譜失調

通通在紋狀體中會合的現象，

and compulsive-spectrum disorders in the striatum suggests

is that it's not simply enough

意味著僅僅是教紋狀體 對強迫性的慾望

to teach the striatum healthier responses to compulsive urges.

做出比較健康的反應是不夠的。

We need social impulses to replace drug-cued compulsive behaviors,

我們需要用社交衝動

來取代會暗示我們 轉向藥物的強迫行為，

because we need to rebalance, neurochemically, our social reward system.

因為在神經化學上， 我們需要重新平衡

我們的社交報償系統。

And unless that happens,

如果沒有重新平衡， 我們就會處於渴望的狀態，

we're going to be left in a state of craving.

No matter what besides our drug we repeatedly practice doing.

不論除了藥物之外， 我們不斷重覆練習做什麼。

I believe that the solution to the opioid crisis

我相信鴉片類藥物危機的解決方案

is to explore how social and psychospiritual interventions

就是要去探究社會和心理的干預方式

can act as neurotechnologies in circuits

如何能在負責處理社交 和藥物引發之報償的電路中

that process social and drug-induced rewards.

扮演神經技術的角色。

One possibility is to create and study scalable tools

一種可能性就是要創造並研究

可擴充的工具，

for people to connect with one another

讓大家能夠以相互利益 為基礎和彼此連結，

over a mutual interest

透過心理靈性的做法來恢復。

in recovery through psychospiritual practices.

And as such, psychospiritual practice could involve anything

因此，心理靈性的做法 什麼都有可能涉及，

from people getting together as megafans of touring jam bands,

從巡迴演出的搖滾樂團 超級粉絲聚集在一起，

or parkour jams, featuring shared experiences of vulnerability

或是跑酷大交流，

特色是關於脆弱 及個人成長的共同經驗，

and personal growth,

or more conventional things, like recovery yoga meetups,

或是比較常見的， 如復元式瑜伽聚會，

or meetings centered around more traditional conceptions

或是以比較傳統的靈性體驗 之概念為中心的聚會。

of spiritual experiences.

But whatever it is,

但，不論是什麼，

it needs to activate

都需要啟動紋狀體中

all of the neurotransmitter systems in the striatum

所有和處理社會連結有關的 神經傳遞質系統。

that are involved in processing social connection.

Social media can't go deep enough for this.

這方面，社交媒體 無法做到足夠的深度。

Social media doesn't so much encourage us to share,

社交媒體鼓勵我們做的，

主要是比較，而不是分享。

as it does to compare.

It's the difference between having superficial small talk with someone

和某人進行非常表面的小聊

and authentic, deeply connected conversation with eye contact.

不同於有著眼神接觸 和深刻連結的真實談話。

And stigma also keeps us separate.

汙名也讓我們保持著分離的狀態。

There's a lot of evidence that it keeps us sick.

有很多證據顯示， 它一直讓我們生病。

And stigma often makes it safer for addicts to connect with other addicts.

汙名通常會讓成癮者覺得 和其他成癮者連結是比較安全的。

But recovery groups centered around reestablishing social connections

但以重新建立社會連結 為重點的康復小組

could certainly be inclusive of people who are seeking recovery

肯定能接納

想從各種心理健康問題中康復的人。

for a range of mental health problems.

My point is, when we connect around what's broken,

我的重點是，當我們在破碎中連結，

we connect as human beings.

我們是以人類的身分在連結。

We heal ourselves from the compulsive self-destruction

我們對於社會連結斷絕造成的痛苦，

反應會是強迫性自我毀滅， 而我們能將我們自己從中治癒。

that was our response to the pain of disconnection.

When we think of neuropsychiatric illnesses as a spectrum of phenomenon

我們之所以會是人， 有部分是因為某些現象，

當我們把神經精神疾病想成 是這些現象的光譜，

that are part of what make us human,

then we remove the otherness of people who struggle with self-destruction.

那麼我們就會把在自我摧毀中 掙扎的人的相異性給除去了。

We remove the stigma

我們把醫生和病人以及照護者

between doctors and patients and caregivers.

之間的汙名除去了。

We put the question of what it means to be normal versus sick

我們把「正常和生病 是什麼意思」這個問題

back on the spectrum of the human condition.

放回了人類境況的光譜上。

And it is on that spectrum where we can all connect

在這個光譜上，

我們都能彼此聯繫，

and seek healing together, for all of our struggles with humanness.

一起爲人類的所有痛苦尋求療癒。

Thank you for letting me share.

謝謝各位我讓分享。

(Applause)

（掌聲）