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<p> </p> <p>SANA QADAR 4:47 </p> <p>Hello, everyone. Before we begin, I would like to start by acknowledging the Gadigal people of the Eora Nation, whose lands we gather on today, and pay my respects to elders, past and present, and extend that respect to any Aboriginal or Torres Strait Islander people here today. As we share knowledge and research, we also pay respect to the knowledge embedded forever within Aboriginal custodianship of country. Welcome to Sydney Ideas, the Sydney University of Sydney's flagship public talks program. My name is Sana Qadar. I host and produce a podcast called All in the Mind on ABC Radio National. It's a show all about mental health, psychology, neuroscience, all that good stuff. And I'm also your host for tonight's event, Unravelling Addiction and the Mind, and which is presented by the university's Brain and Mind Center. And I believe we're sold out tonight, which I'm not entirely surprised by, because unfortunately, as many of us would know, addiction is an issue that cuts across race, geography, class. We live in a world, you know, riddled with addictive substances and activities that are readily available, and the ripple effects across families and communities is devastating. So the question tonight is: How much is within our power to control and change, and what does the latest research on treating addiction tell us? To help us answer these questions, we have great minds from the Brain and Mind Institute on stage with us tonight. You're going to hear from neuro economist Agnieszka Tymula at the end over here, digital interventions and mental health researcher Louise Thornton, and neuroscientist Morgan James. Please give them a round of applause to welcome them. And two final notes before we launch into it, we are obviously going to touch on substance use and mental health. If you have concerns about yourself or anyone you love or know, there are support services available, and the details are on the screen now. And finally, we're going to have about 20 minutes at the end of our chat today for audience questions, so please have think about what you might like to ask. All right. Hello. How are we? I wanted to start with a slightly unconventional first question. I'm wondering when you guys are out in the world at dinner parties or you know events, whatever else, and you tell people you work in addiction research. I'm curious to know if there's like a particular question that most commonly gets asked of you, Louise. I might start with you.</p> <p> </p> <p>LOUISE THORNTON 7:25 </p> <p>Sure. So it's less of a question usually, but it's usually something like, "Oh, you should study me, or "You should study my brother, or "You should talk to my mum, and it's usually said like with a laugh and as a joke. But you know, it kind of I think highlights just you know how many people know someone who's struggling in addiction.</p> <p> </p> <p>SANA QADAR 7:46 </p> <p>Okay, well try not to let that pop happen again. I don't know how it happened, but Morgan.</p> <p> </p> <p>MORGAN JAMES 7:51 </p> <p>Yeah. Hi. Good evening, everyone. Thanks for being here. You know, when I tell people that my job is pretty much looking at how the brain responds to injections of cocaine or heroin or fentanyl. Most people are pretty interested in where we get the drug from, but usually that's the start of a bigger conversation. I think, like Louise was mentioning, and we often hear stories that are compelling and really remind us of why we do what we do. And if I can indulge for one second, one story that's really stuck with me is when I was a young postdoc. Just started my job over in the U.S. I was working at a research hospital. We were working on trying to find new targets for medications to treat addictions. And just down the road, we had this concert venue, which was very popular. It was on the circuit of all the you know the bands in the U.S. And it was very easy to get tickets and go down there after work. So I did that one night. And standing in line, there was this older couple behind me. They were about my parents' age, so a little, I guess, older than the rest of the crowd, and they were very interested in why a kid from Australia was there. And I told them what I did, and they were very interested. Anyway, concert started. We went our separate ways, and at the end of the night, that same couple tapped me on the shoulder as we're leaving, and the lady turned to me and she said, "Look, I didn't want to like bring things down at the beginning of the night, but I just want to let you know that we were here because this band was my son's favorite band, and he he died a few weeks earlier from a drug overdose. And she looked at me with this sincerity that I'll never forget, and she said, "I just want to say thank you for the work that you're doing. She knew better than me, the problems of not having adequate treatments for these conditions, and yeah, that's that's carried me through my work the last 15 to 20 years. </p> <p> </p> <p>SANA QADAR 9:29 </p> <p>Yeah, that's incredible, Agnieszka - You don't work directly in addiction research, but a lot of your work touches on gambling. What do people ask you?</p> <p> </p> <p>AGNIESZKA TYMULA 9:39 </p> <p>So I always get the same question when I tell people that I work with data that includes online transactions of people who place bets on sports. Everybody always asks me how much money can I make when I place bets, and I, you know, the question may seem funny and you're laughing and maybe too trivial for this discussion today, which is serious, but I think it already tells us a lot why people end up making decisions that lead to addiction in gambling. Despite the odds, despite every ad telling people that in expectation they will lose money when they gamble. They ask me not how much I will have to pay, how much out of my pocket I will have to spend to engage in this activity. They ask me how much they will make.</p> <p> </p> <p>AGNIESZKA TYMULA 10:35 </p> <p>That's always what we're thinking of, isn't it? Okay, so a range of really kind of funny interactions, but also deeply heartfelt ones, and we've sort of jumped ahead, but let's backtrack to basics, I suppose. I think everyone here will probably have an instinctual understanding of what addiction is, but let's just define it. At what point does a behavior transfer over to addiction, Morgan?</p> <p> </p> <p>MORGAN JAMES 10:57 </p> <p>Yeah, I think it's important to distinguish from the outset that there is a distinction between drug use and addiction, as you've just alluded to. So we know why people use drugs. Drugs-they have benefits, right? They have medicinal benefits. We may break our leg, and in that case, oxycodone is a fantastic analgesic. My kids woke me up at 4:45 this morning for whatever reason. I had a big coffee, sorry, tea before I started here. Caffeine is helpful for keeping me awake. My wife has a deathly like fear of flying, so she takes a benzodiazepine before she flies each time. Thinking about illicit drugs, cocaine, for example, some could argue that there's a real benefit to taking cocaine a night out can enhance your night, and you know one story we hear a lot in the unhoused populations, so people who are sleeping in precarious positions, they tell us they take methamphetamine at night to keep them awake because they want to be able to guard their possessions and make sure that they're not stolen. So many many ways, drug use has benefits, and in the sense of controlled drug use, recreational use, those those benefits outweigh the negatives. At least the way that I think about addiction is when those negatives outweigh the positives. So when you can't have a good time with alcohol, without alcohol, when you're spending everything you have to buy cocaine, you can't pay rent, you can't buy groceries. When that balance shifts, that's what I consider addiction.</p> <p> </p> <p>SANA QADAR 12:27 </p> <p>Yeah, that's really fascinating to hear about that reframe of methamphetamine use with unhoused populations. That makes a lot of sense, really, at night time. And I guess how common is addiction, Louise? Do we know?</p> <p> </p> <p>LOUISE THORNTON 12:40 </p> <p>Well, it's we don't have statistics on addiction per se because you know as Morgan was just talking about like where is that line and that line of where benefits outweigh you know the negatives and you know vice versa it's an individual line to draw, but what we do know is say for substance use disorders so they're sort of the the condition that people might be diagnosed with when they're using substances in a way that they can't control or that's impairing their use. So we know that about just over 3% of the Australian population over 16 years have a substance use disorder. So that's about 650,000 Australians in any given year, so in any 12 months, it's about 3.3% of Australians. But I think that's not really quite the whole picture. There, we also know that say one in every 12 Australians smoke tobacco daily, so that's about one point was it 1.81, 1.6 million people who you could say have an addiction to nicotine, and then when we come to alcohol use, we know that just over 30% of Australians, so 6.6 million of us, drink alcohol in a way that is risky and harmful for our health, so not suggesting that 6.6 million of us are addicted to alcohol use, but it's probably safe to say that many of us could, you know, say that some point in our life, you know, we might, you know, meet some of those criteria around those negative effects. You know, not being able to stop drinking once we have, you know, you know, started drinking, or it, you know, alcohol use interfering with, you know, what we're supposed to do on a daily basis, you know, go to work or go to school, or even just the idea of that increased tolerance that the same amount of alcohol doesn't get you as drunk anymore, and you have to drink more to achieve that. So, it's a a broad, you know, sort of, it's a complicated story, but it does affects a lot of Australians.</p> <p> </p> <p>SANA QADAR 14:45 </p> <p>Would that make alcohol the most common sort of substance for addiction? Do we know?</p> <p> </p> <p>LOUISE THORNTON 14:51 </p> <p>Well, I mean, if we're not counting caffeine,</p> <p> </p> <p>SANA QADAR 14:54 </p> <p>right?</p> <p> </p> <p>LOUISE THORNTON 14:54 </p> <p>Perhaps. Yeah.</p> <p> </p> <p>SANA QADAR 14:55 </p> <p>Okay. Okay. Fair.</p> <p> </p> <p>MORGAN JAMES 14:56 </p> <p>And along with nicotine, the two most the two legal drugs, right? Yeah, yeah,</p> <p> </p> <p>LOUISE THORNTON 15:01 </p> <p>exactly.</p> <p> </p> <p>SANA QADAR 15:01 </p> <p>And I guess the other thing I'm wondering is: is there any sort of pattern to how addiction typically develops? Like, is it a gradual thing? Is it a you know quick thing, or is it purely individual? I don't know, Morgan, if you can answer that.</p> <p> </p> <p>MORGAN JAMES 15:14 </p> <p>Yeah, sure. I mean, certainly on the gradual end of things, but I think trajectories are different for different people. I think the important thing to note, and this has been alluded to before, is not everyone that uses a drug goes on to become addicted. And what determines whether or not somebody transitions from that controlled use to uncontrolled addicted use depends on a variety of things. So, the drug itself. So, some drugs are more addictive than others. The statistics tell us about 20% of people who try alcohol or cocaine will go on to develop something that looks like an addiction. That rate is higher for nicotine. Opioids sit at about 30%. The route of administration, so how you take the drug, the faster a drug gets into the brain and the faster it comes off, the more addictive a drug is, and that's why nicotine is so addictive. And then there's a whole range of, I guess, other factors, biological and non-biological. So genetics, there is a heritability aspect to addiction, roughly about 50% But I don't want to give the impression that you know there is an addiction gene. It's complicated. There's a whole bunch of genes that just increase your likelihood of transitioning. And then there's a whole bunch of social reasons that may contribute to one's vulnerability. One's environment can act as a protective factor, can also act as a facilitator, and I'm sure others have thoughts on that. But</p> <p> </p> <p>SANA QADAR 16:35 </p> <p>Agnieszka, you look like you wanted to say something.</p> <p> </p> <p>AGNIESZKA TYMULA 16:37 </p> <p>What we do see in the gambling data is that people escalate over time. So if I was to predict whether Morgan is going to gamble tomorrow more than he usually gambles, the single biggest predictor for that is whether he gambled more than he usually does yesterday. So I think that you know the big question is how do we then get out of that circle, and how do we stop? Right.</p> <p> </p> <p>SANA QADAR 17:03 </p> <p>So past behavior is the biggest predictor of future behavior.</p> <p> </p> <p>AGNIESZKA TYMULA 17:05 </p> <p>Future behavior, and that escalation of that going up and up and up.</p> <p> </p> <p>SANA QADAR 17:10 </p> <p>That's okay. That's fascinating. I also want to know about you know. There's been a lot written and said in the last several years about what happens in the brain as addiction takes hold. We know a lot about that now. People have heard about the role of dopamine, but if you could give us a refresher, what's going on in the brain as well when addiction is sort of taking hold, Morgan? Yes.</p> <p> </p> <p>MORGAN JAMES 17:31 </p> <p>Yeah. So I think you'd all agree that our brains evolutionarily are wired to seek out reward for our survival forever. It's been necessary for us to find food, for us to find water, for us to socially interact, for us to have sex, and therefore, the brain has these very strong inbuilt mechanisms which optimize our behavior to find a reward and to do it again and again, and so drugs tap into these same systems, but at a kind of stronger kind of level, and and not only does our brain learn; it's very exquisitely set up to learn about the reinforcement of the drug itself, but it also exhibits plasticity. We've all heard of that term: how the brain can change. It exhibits plasticity that allows us also to learn about all the things that predict that reward. So the places where we took the drug, the people we were with, the smells maybe that preceded us using the drug, and all over time that repeated pairing between the context or the environment and the drug use, those those cues, those stimulators, environmental context themselves become motivating. And so when we walk into that place or where we see those same people we use drugs with, they themselves motivate us and engage the same parts of our brain which previously turned on in response to the drug, and invigorate us towards pursuing the drug. You mentioned dopamine; that is the one that's, I guess, most commonly spoken about. I think, somewhat erroneously, we are sometimes told it's the pleasure chemical. There is some truth to that, but more I guess recent research over the last 20, 30 years tells us that actually dopamine's primary role is a learning signal. It's what tells us that those cues predict the drug reward, and that over time we actually see the dopamine response happening upon the presentation of the context or the cues, not so much the drug itself, and we end up in this kind of curious situation with addiction, where you can really want the drug because you have that dopamine surge around the presentation of the cues, the context, the environment, the people, but not so much with the drug itself over time. So you want the drug, but don't necessarily like it, and that's the weird paradox of addiction.</p> <p> </p> <p>SANA QADAR 19:40 </p> <p>And then, at what point do you reach anhedonia, the inability to feel pleasure?</p> <p> </p> <p>MORGAN JAMES 19:46 </p> <p>Yeah. So one of the predominant theories of addiction is that those euphoric effects of the drug become blunted with repeated drug use. That that liking becomes lower, but also during withdrawal, your your mood is dropping further and further and further. And then often people report using drug just chasing that kind of increase in mood to feel normal, and so it's not necessarily using the drug again because they like it; it's because they're just trying to relieve this negative mood state, this anecdotic.</p> <p> </p> <p>SANA QADAR 20:12 </p> <p>And so once these brain changes happen, what Agnieszka does your research tell us a bit more about how that impacts decision making?</p> <p> </p> <p>AGNIESZKA TYMULA 20:20 </p> <p>So I, you know, I I think there may be a misconception that when you're addicted, you behave in an irrational way. But I think addiction is very rational, and what changes is how much you value the thing that you are addicted to. So it suddenly becomes just more valuable than anything else. So you seek it over other things that you wanted before. You are willing to take more risk to get it, and you want it sooner. So, so we can, I think we should be thinking about it in this rational way, where just this one reward becomes super rewarding. So you want to have it.</p> <p> </p> <p>SANA QADAR 21:00 </p> <p>Yeah, and just explain a bit more. Like, how does that compare to a healthy brain and its treatment of risk and reward?</p> <p> </p> <p>AGNIESZKA TYMULA 21:08 </p> <p>Maybe you will be able to explain better. Maybe I'm overstepping, but my understanding is that the parts of the brain that we use and the way that they make decisions are the same. It's just that the rewarding activity for that drug is biggie. Am I correct? </p> <p> </p> <p>MORGAN JAMES 21:31 </p> <p>I think that great, yeah I think the the longer you use drugs and the more you transition to this addicted like state, the cards become stacked against you. The decision to take a drug versus not take a drug becomes enormously difficult when everything in your brain is telling you, "Hey, everything here predicts this really rewarding drug. For example, and maybe you should do that at the expense of the other things you used to finally used to previously find rewarding, like going out with friends or going out for a nice meal.</p> <p> </p> <p>AGNIESZKA TYMULA 21:58 </p> <p>Yeah, I can. I can maybe add one more story. I've heard of from people who work with addicts in clinical settings. I've heard that you know there's this escalation. You have to consume more and more and more to get to the same level of satisfaction with the amount you're consuming. So at some point, the addiction may get out of hand and just become too expensive, so sometimes people actually will put themselves into rehab and put themselves through the withdrawal, so that they can regain that sensitivity to the drug.</p> <p> </p> <p>SANA QADAR 22:34 </p> <p>Okay, wow.</p> <p> </p> <p>LOUISE THORNTON 22:35 </p> <p>It's interesting. Sorry, go ahead. No, that's all right.</p> <p> </p> <p>LOUISE THORNTON 22:38 </p> <p>I was just going to, and I was going to add. It's like this, you know, we're talking about almost like these vicious cycles or these circuits that get reinforced over and over again with addiction, and but it's perhaps like worth noting as well. There is a hopeful story in there as well, you know, and that those sort of circuits, I suppose, can be broken. And so one of the really exciting things that's you know happening in the field of digital health at the moment is this idea around 'just in time interventions. So you know we all have our got my phone in my pocket. We all have our phones, for example, and you know whether we like it or not, you know they've got the GPS, they've got the accelerometers on there, they've got light sensors, they've got noise sensors, and all those sensors can come together and actually tell us a lot about what we're doing, where we are, who we're with, and things like that. And so, what some very clever people are doing is being able to take that information and you know work out okay when would be the best time to intervene to break that circuit. Okay, the GPS tells me that you know I'm about to walk into a pub. Now might be the exact right time to send me a little message saying, "Oh, you know, just if you're going to have a drink of alcohol today, just have a think about you know the consequences for the next day or whatever it might be, or perhaps using the phone to sense via like Bluetooth. How many other phones you know are around at the moment? Oh, Louise, I'm currently with a lot of people. She might be at a party. This might be a really good time to send another little notification. You've told us before that actually, when you're at a party, you find it really difficult to control your alcohol use. Just keep, you know, you might want to think about that. Keep that in mind. Have water with you. You know, do something else. So there are ways that people are working on to interrupt those circuits as they're happening, which I think is really exciting and a bit of a hopeful story.</p> <p> </p> <p>SANA QADAR 24:41 </p> <p>Okay. Well, let's come to treatment, and on that, so are you researching that particular intervention at the moment, or is that out there in the world now?</p> <p> </p> <p>LOUISE THORNTON 24:49 </p> <p>There's a few different interventions that do these 'just in time' adaptive interventions that are out there and being researched at the moment. I'm not doing that specific work myself. We are looking at ways we can also use digital health approaches to sort of bring, I suppose the best way to say it is bring a therapist or bring a psychologist, you know, into people's iPhones or into people's homes, because we know one of the big issues when it comes to addiction and mental health more generally is how difficult it is to access help. It's a big step to recognize that you have a problem, and it's a big step to seek that help out. But unfortunately, the way that the Australian health system is, wait times of over a you know month, two months is a very common story. So, working in ways to ensure that we can give people access to that same high quality treatment while they're on waiting lists, and or you know if they're in rural areas or something like that. The question I always have about digital interventions is how much do people stick to it, especially if they're struggling with addiction. Because even you know myself, I've done self-directed CBT online, and I like abandon it after two weeks. I'm like, this is annoying, and you know, there's no one to keep me accountable. Yeah. So especially when people are battling addiction, how likely are they to stick with the digital intervention. Well, you actually hit the nail on the head because you're talking about when there's no one there to keep me accountable. So we know that across the digital health field, when there is someone or something to keep you accountable, people are far more likely to sort of see the course through. So there's really good evidence that you know it's not even it's not support from a psychologist or psychiatrist that you need. This can be like a peer worker or a lay health coach, or there's even emerging evidence that even AI health coaches can actually do that same job. It's this idea of supportive accountability, just knowing that there's even an AI agent, just someone checking in to support, can help people see the course. But this is the other thing with digital health. Probably the program you did was, you know, required you to come back. You know, many over many weeks. </p> <p> </p> <p>AGNIESZKA TYMULA 27:16 </p> <p>Yeah, it made me wait a week before the next thing, and I made exactly.</p> <p> </p> <p>LOUISE THORNTON 27:20 </p> <p>And so this is something that you know in the digital health field we're realizing you know we can't just transplant weekly visits with a you know a psychologist and plomp it into a phone. It's not it's not going to work in the same way. And so there are lots of really you know good programs that are what we call brief interventions. So sort of shown to be effective, but maybe only require that person to, you know, it might be one to four sessions that they can maybe look at all in once. </p> <p> </p> <p>SANA QADAR 27:49 </p> <p>And so then the other question I have with digital interventions is: is that something that's sort of going to be more effective for people kind of before they're in the really deep end of addiction? Like if you're you know many years into the whole process, is is digital interventions going to work at all?</p> <p> </p> <p>MORGAN JAMES 28:06 </p> <p>There's evidence that even among people, say with who you know score really highly on say some of our measures for alcohol use, and so who would classify as having you know a severe substance use disorder, that they can still get benefit from engaging with a digital health program. I think it's remembering that you know, if the option is not having any help, it's going. It's you know, a digital health approach is always going to be better than nothing. Sometimes, just getting a little bit of even when you're in the depths of a severe addiction, sometimes getting that little bit of feedback or that tip can help people make the change or feel ready to go seek support elsewhere as well. So I would say, even though maybe it might not be as effective for people who are very severe, it's certainly better than nothing, which is sometimes going to be the case.</p> <p> </p> <p>SANA QADAR 29:03 </p> <p>Okay, Morgan, I'm going to come to you for your research in a second. But first, while we're on the topic of treatment, I actually want to throw two buzzwords your way. Because when it comes to treatment,</p> <p> </p> <p>MORGAN JAMES 29:13 </p> <p>one of them GLP one.</p> <p> </p> <p>SANA QADAR 29:14 </p> <p>Yeah, Ozempic, the other one psychedelics.</p> <p> </p> <p>MORGAN JAMES 29:17 </p> <p>So yeah, right.</p> <p> </p> <p>SANA QADAR 29:18 </p> <p>Where is the evidence at for that in addiction treatment?</p> <p> </p> <p>MORGAN JAMES 29:20 </p> <p>So Louise is 100% correct, and I certainly don't want to give the impression tonight that just because you've transitioned into this addiction-like state, that you've crossed this irreversible line and you can't go back. Just like the brain was plastic and that took you into addiction, the the brain remains plastic and malleable, so that you can go back the other way, and that's really important to keep in mind. I want to acknowledge that there are already good medications out there to treat things like opioid addiction, for example. Naloxone, many of you have probably heard of. That's the intranasal opioid antagonist. It has saved countless lives all over the world, and there are reasonable treatments available for opioids, nicotine, and alcohol, they don't work for everyone, though, and that's why I guess as a field we're interested in how we might be able to develop new medications that may work for the people that don't respond to the other drugs. And it's also worth noting that for cocaine and other stimulant use disorders there are no approved medications. So we've become interested, I guess, as a field in the GLP-1. So everyone probably knows what GLP-1s are. Yeah, Ozempics. Okay, I see a few nods, a few shakes. So, Ozempic is a GLP-1 receptor agonist. GLP-1 is a hormone that your gut secretes when you've had a meal, and it signals up to your brain that hey, you're full. It's time to stop eating. The half-life of that hormone in the body, though, the endogenous hormone, is very short. So, what very clever drug companies did was they made a very long-acting version of that, and that's called semaglutide, and that's what Ozempic is the brand name. And so, if you inject yourself with that, it will last for about a week, keeps your GLP-1 levels high, and it tones down your appetite for about a week while the drug's on board, so as many of you would know, the uptake of this drug has been crazy. There's a lot of people taking GLP-1s in the US. I think the last stat I saw was one in 12 or one in 14 people are now on a GLP-1 agonist, and that creates this really interesting real-world experiment, right? Where you got almost a 10th of the population taking these medications. Of course, a lot of people are also using drugs, and anecdotally, at least originally, it was anecdotal. People were saying, "Hey, I'm losing weight, but I'm also suddenly have no desire to drink. I have no desire to smoke my cigarettes, and this led to more structured clinical trials. The strongest support we have for these medications is in the case of alcohol use disorder. So large-scale trials are now indicating that probably they are reducing the number of days that somebody drinks alcohol if they have alcohol use disorder. Although the evidence are mixed, the evidence is mixed, and I want to make the point that all the studies that have been done so far have been in people with a higher BMI. So we're not sure how people with lower BMI might respond to these drugs. There is some evidence. Again, it's mixed for nicotine. There's there's actually a really nice study again looking at 10s of 1000s of people using these GLP anagonists, and there was a massive reduction in the risk of presenting to hospital with an opioid overdose, or I think presenting to treatment for for opioid use disorder. So there's there's signal there. I think at the moment I know about 17 to 20 trials that are ongoing, looking at this in a little bit more detail.</p> <p> </p> <p>SANA QADAR 32:34 </p> <p>So feels hopeful.</p> <p> </p> <p>MORGAN JAMES 32:35 </p> <p>Feels hopeful. Yeah, yeah. But again, I think it's probably not the case that there's going to be a silver bullet medication, right? So much like people don't respond, some people don't respond to the existing medications. Probably there'll be there'll be people that don't respond to the GLP ones. So shifting to psychedelics, this is kind of exciting because this is work that the Brain and Mind Center is really leading the way on. Not my work. Nick Everett, in particular, his group's really leading the charge on this. So many of you are probably familiar with psychedelics. The one that we hear about a lot is psilocybin. It's classical psychedelic. It acts on a receptor, which is known as the serotonin 2A receptor. And when we flood that receptor, it causes a change in our perception and our cognitions, and also induces this what's called self-referential thinking. You kind of have that out-of-body experience, and more importantly, it's thought that this actually sets up this window of plasticity in the brain. So all those circuits that were previously entrenched in like go get drug, maybe it creates this opportunity to rewire those circuits. And so what we're seeing in the literature is that by combining psychedelics, psilocybin, typically, with a directed therapeutic experience, CBT type experience, that combination seems to be doing some impressive things. </p> <p> </p> <p>SANA QADAR 32:35 </p> <p>For which types of addiction?</p> <p> </p> <p>MORGAN JAMES 32:35 </p> <p>So I've seen most evidence again for alcohol. I think there's some evidence out there for opioids and nicotine, but I think alcohol again. We have the bulk of data there. I think because alcohol, as we talked about before, is you know the one that affects a lot of people, and market-wise, the drug companies are interested in that because it's a big potential market. I will note that cocaine, methamphetamine, cannabis use disorder-they are drastically understudied across all these drugs. Okay, that needs to be fixed going forward.</p> <p> </p> <p>SANA QADAR 33:25 </p> <p>I will ask you about your research, but I'm mindful that Agnieszka has been silent for a moment. So one thing I wanted to ask you when it comes to treatment is I don't know if any of your research has looked at the willingness of people with gambling addiction to engage in treatment. Obviously, it's not going to be these kind of GLP ones and the rest, but it'll be more, you know, CBT or whatever else. But is there any research on decision making around engaging with treatment?</p> <p> </p> <p>AGNIESZKA TYMULA 34:50 </p> <p>So we have a gambling treatment clinic here at the University of Sydney, run by Sally Geinsbury. There are definitely people engaging with. We know that about 1.5% of gamblers develop problem gambling and should seek treatment. I think they are following up on what Louise said. I think one of the biggest problems with online gambling is the awareness that you have the problem, and that has to do with the selective memory that people have of what happened in the past. So, you know, if you ask, if you hear teenage or boys or young men talking about the sports betting, they keep talking about the bets that they made and how much they won. Right? They never talk about how much they lost. When we ask people about the previous gambling outcomes, they overestimate how much they made by just like a ton. Like all of them,</p> <p> </p> <p>AGNIESZKA TYMULA 35:51 </p> <p>their own losses and wins. They overestimate. </p> <p> </p> <p>AGNIESZKA TYMULA 35:54 </p> <p>No, they don't remember the losses. They just remember the gains, and this is a problem because this stops them from developing this awareness that they even have a problem.</p> <p> </p> <p>SANA QADAR 36:06 </p> <p>So there's something messed up in their self-perception about it.</p> <p> </p> <p>AGNIESZKA TYMULA 36:08 </p> <p>There's something messed up in their self-perception about how much they've lost and how much they've won, and and that's that's a huge problem because then these people will not seek the treatment because they do not think that they have a problem, but I think here technology can also help us. We've been working with one sports betting provider, and we found that if we give people feedback on the problematic gambling, if they are problem gamblers, they are much more likely to stay within the loss goal. So, with how much they are comfortable losing in the following month. So, if we highlight to them, listen: you have a problem with gambling. You are in the top, let's say, 1% of people when it comes to problem gambling. Next month, they are way more likely to gamble within what they are comfortable with. The problem is this goes away, like you were saying, Sana. So I think in the future we have to figure out when and how to remind them.</p> <p> </p> <p>SANA QADAR 37:15 </p> <p>It's really interesting that you talk about this warped sort of self-perception of the problem because that makes me wonder, like, what does it typically take for a person to realize they have a problem and then engage in treatment? Because you know like you can just imagine, especially with gambling. I mean all of these addictions we're talking about, but like everyone around the person is probably going mad, being like you have a problem, but unless they realize it, you know you can't make someone go to treatment.</p> <p> </p> <p>AGNIESZKA TYMULA 37:40 </p> <p>Yeah. So so we were interested in exactly that. There is a nice theory in economics that says, if you experienced like bad consequences of addiction often enough, then you will realize that you have a problem. So, in our gambling data, we can see how often, how many months a person lost more than they would like to, than they feel comfortable with. How how many months like this they had, or how long they have been gambling, really does not predict whether they are away that they have a gambling problem. It is only the interaction of memory with these experiences that leads them to the self-awareness. So people who have bad memory, they actually the more bad experiences they have, the less aware of the problem they are, because I think they just remember the positive. They don't remember the negative. People who have good memory, they learn. They realize that they have a problem. So I think this is a tool that we can use as well to help people realize, give them some awareness of how much they're actually spending in the government context. Like</p> <p> </p> <p>SANA QADAR 38:58 </p> <p>I imagine telling someone in an app or whatever, you know, having it pop up on their phone, you're in the top 1% of problem gamblers would be like a bit of a whoa moment. </p> <p> </p> <p>AGNIESZKA TYMULA 38:58 </p> <p>Exactly, and this is exactly what we did. And you know, we might be thinking, oh, everybody has a has a problem with memory, but I don't. But if I asked any of you how much time you actually are happy spending on social media, what is your limit? And then I ask you, how much did you spend yesterday? How much did you spend last week?</p> <p> </p> <p>AGNIESZKA TYMULA 39:28 </p> <p>Don't ask. </p> <p> </p> <p>AGNIESZKA TYMULA 39:29 </p> <p>And then you look at your phone. You figure out it's probably a problem with another day as well. Yeah, yeah.</p> <p> </p> <p>LOUISE THORNTON 39:35 </p> <p>And that tracks really well into other sort of addictive behaviors as well, from what we know from the literature, that self-reporting or say tracking of behaviors over time, and then sort of having you know looking and seeing that feedback over time is you know a really really well supported behavior change strategy across all different types of behaviors. Is it doing. Physical activity, eating better, but also reducing substance use as well. That sort of self-report and tracking, and so being presented with that sort of insight is a really powerful behavior change technique.</p> <p> </p> <p>SANA QADAR 40:12 </p> <p>Okay, Morgan, tell us about your work. What are you looking at?</p> <p> </p> <p>MORGAN JAMES 40:17 </p> <p>Thanks so much for asking. I'm banned from speaking about this at home, so captive audience. Tell us everything. No, I'll keep it brief. So we, my group's been really interested in this very small population of neurons that sit in the hypothalamus, sit in the middle of the brain, called the orexin neurons. These neurons are evolutionarily evolutionarily conserved. They've been there for a long time, and turns out they play a really important role in feeding and seeking out all things to do with reward. So we have shown if somebody uses cocaine or somebody uses heroin, for example, and they transition into this addicted.</p> <p> </p> <p>SANA QADAR 40:51 </p> <p>Hello. Might have to start. No, no.</p> <p> </p> <p>MORGAN JAMES 40:52 </p> <p>If they transition into addiction, there's actually not only an increase in the excitability of these neurons, but they actually become more numerous.</p> <p> </p> <p>SANA QADAR 41:00 </p> <p>Oh, they multiply.</p> <p> </p> <p>MORGAN JAMES 41:01 </p> <p>They multiply, yeah. In a way, we don't totally understand, but there are more of these neurons in a person's brain if they've had a history of drug use. There's other interesting side to these neurons, and that is that they also play an important role in wakefulness. So they have direct access to the other parts of our brain that control our wakefulness and our sleep wake patterns, and maybe some of you know that addiction has these two sides of the coin. There is this excessive motivation, reward-driven that we've talked about tonight, but also people who use drugs really struggle to sleep, and this is particularly true during abstinence. In fact, one of the strange paradoxes of abstinence is sleep. So if you if you quit cocaine today, your sleep in a month's time will be worse than it is today.</p> <p> </p> <p>MORGAN JAMES 41:45 </p> <p>There is this this really strong sleep disturbance that a lot of people report as being one of the major reasons as to why they relapse. They start using drugs again to regulate their sleep wake cycles. So we think, and we have evidence now to support that by targeting this one population of neurons, we can do two things at once: we can tone down their motivation, their excessive craving for the drug, but we can also normalize their sleep-wake cycles. And I think what's exciting is that we actually have pharmaceutical tools at our disposal now that have been developed and approved. They're TGA approved in Australia, for example, that were developed to treat other diseases. So these orexin antagonists, they block orexin signaling. They've been developed to treat insomnia in other conditions. We have found that if we just take those same drugs, we can normalize, as I said, not only the sleep cycles in people with addiction, but also reduce their craving. So we think that's exciting, and we think there's a good pathway to roll those out.</p> <p> </p> <p>SANA QADAR 42:43 </p> <p>So, how far are we away from having that implemented in people who have cocaine addiction or other addictions?</p> <p> </p> <p>MORGAN JAMES 42:49 </p> <p>Cocaine, hopefully soon. So, there was a really pivotal study done in the U.S. at Johns Hopkins a few years ago, where they took patients in inpatient setting who were withdrawing from heroin, and so many of you may know that the standard of care is buprenorphine. They combined that with this same drug, and there was another treatment group that had a placebo. And those patients that received this orexin receptor antagonist not only did they sleep better during this withdrawal period, this tapering period from heroin use, but they also reported significantly less craving. So the proof of principle is there. The challenge now is rolling it out in other drug settings, I suppose, and other for other drugs of abuse like cocaine, like you mentioned. The truth is, though, it's hard to get funding to do these kinds of studies. So we at the Brain and Mind Center are lucky to have the support from the university as well as some national fundings to pursue this, and hopefully we'll have results for you soon.</p> <p> </p> <p>SANA QADAR 43:44 </p> <p>Okay, so hopefully in a few years' time.</p> <p> </p> <p>MORGAN JAMES 43:46 </p> <p>Yeah, yeah, right. Yeah, you know, because it is a safe drug and is approved, we see a strong pathway to it being kind of rolled out more quickly than if we were starting de novo with a new drug. Yeah.</p> <p> </p> <p>SANA QADAR 43:58 </p> <p>Okay, we are going to open the floor to questions in a moment to submit. There's two ways you can do this. So first, you can go to Slido.com, enter the code Sydney Ideas, and you can submit a question there. And even if you don't have a question, head to Slido anyways. You can upvote and down. I think downvote questions as well. So if there's something there that you really want to hear about, upvote that. Otherwise, we're also going to have some roving mics in the room. If you want to get on mic and ask a question, just wait till the mic gets to you because we're recording tonight's chat. So just wait. And finally, please do ask a question rather than making a comment. I'll give everyone a moment to just gather their thoughts. I'll ask one final question of all of you. If you had a magic wand that you could wave to direct, you know, all available funding to one particular area of addiction research. What would that be? Where is the biggest gap that most urgently needs to be researched? Louise, I'll start with you.</p> <p> </p> <p>LOUISE THORNTON 44:53 </p> <p>I would wave my magic wand and direct it towards precision medicine approach. For addiction, so these are the types of approaches that many of you might have heard of being, you know, used in areas more like, you know, for treatments of cancer and things like that, where it takes into consideration perhaps a person's genetic, you know, of course, other biological factors, social factors, and things like that. And so, of course, in cancer research, that's done so that you know the person can be given you know the drug, the at the dose that is most likely to work first time for that person. At the moment, that does not happen in addiction research, even though the you know we've talked about today, there are so many you know there are a lot of pharmacological you know, solutions, psychotherapy, digital solutions. Unfortunately, you know, the you know what gets chosen for an individual is all very much trial and error at the moment. So I would love to direct all of our funding to conduct research that allows us to sort of bring us, you know, bring us all together, bring all that data together so that we can sort of come in and see. Okay, this is your genetic profile. You're a woman in her 40s who I don't know. Yes, has you know poor sleep as well and mainly drinks alcohol for you know social reasons or to cope. Okay, this you know, drug or this, you know, sort of solution is the one that is most likely to work for you first time, because we see, you know, with that trial and error, that means people, you know, suffer the consequences and the harms of addiction for longer and longer, and they're sent off potentially, you know, further away from those sort of life trajectories of where they want to be, so we want to help people sooner, and I think that's the way precision medicine.</p> <p> </p> <p>SANA QADAR 46:46 </p> <p>medicine,</p> <p> </p> <p>MORGAN JAMES 46:46 </p> <p>precision medicine, bringing it to addiction. </p> <p> </p> <p>SANA QADAR 46:48 </p> <p>Cool - Morgan.</p> <p> </p> <p>MORGAN JAMES 46:50 </p> <p>I like her idea. Okay, two votes vote back, and you're upvoting. Can I go the other end of the spectrum? I guess, which is like preventing addiction before it occurs. Yeah. Look, this is a challenge, a big challenge. There's a lot of great work at the BMC being done through the Headspace Initiative, for example, trying to catch adolescents at risk. I'll take the opportunity to talk about our research just for one more second. One thing we've become interested in, really interested in, and some people in the audience have heard me speak about this before, is young women and what puts them at risk. Addiction's interesting for for women; they're at a lower risk of developing addiction per se, but when they do start using drugs, they kind of accelerate into addiction much more quickly. And if you look at the data, one of the things that really strongly predicts whether or not a woman is likely to transition into addiction, actually a whole raft of other mental health outcomes in adolescence is early puberty. So early puberty is really strongly linked with this, and for a long time we've been thinking that this is a sociological kind of phenomenon. But research in our lab shows that actually there's a change in that erection system I was mentioning before as a result of early puberty, and that may set up this predisposition in the brain to developing things like addiction and depression in adulthood, so or in adolescence. So, I guess I don't know. I'd love to be more broad than that. The intervention, early prevention, but that would be my starting point. I suppose.</p> <p> </p> <p>SANA QADAR 48:11 </p> <p>Okay. All right. That's fascinating. I'd never heard that before. Agnieszka, and then we'll go to audience questions.</p> <p> </p> <p>AGNIESZKA TYMULA 48:17 </p> <p>Well, I think the risk of going last is that you can only repeat what people before you said, but but I do agree that our medical system in general is quite broken. Not only when it comes to addiction, we treat people when they are really sick. We should focus more on prevention, and we should focus more more also on precision medicine, on providing treatments that are designed for the particular person that needs them.</p> <p> </p> <p>SANA QADAR 48:43 </p> <p>Upvotes for both answers. All right, let's go to audience questions. Is there anyone who wants to get on mic to begin with? We've got a couple. Andrea, do you want to head to this gentleman in the front? Just over here.</p> <p> </p> <p>Audience questioner 48:59 </p> <p>Thank you. My question relates to neuroplasticity and addiction. It occurs to me that how plastic one's brain is might be genetically determined. I can't think of any other mechanism, and I'm wondering if how plastic one's brain is is indicative of how quickly or how readily the brain habituates to some new neurotransmitter imposition or something, whether they become more readily addictive. So our addictive personalities, those who have a more active neuroplastic brain, and also does it follow then that the ones who are quick to become addicted are also the ones who are easiest to wean off again? So, what's the relationship between neuroplasticity and addiction?</p> <p> </p> <p>AGNIESZKA TYMULA 49:54 </p> <p>Thank you for asking this question. I wanted to ask Morgan the same question today.</p> <p> </p> <p>MORGAN JAMES 49:58 </p> <p>I'd say that at least two people. Thought about this question, I've never considered in my life. So I think your question is: Is there individual variability in how plastic the brain can be? Because everyone has neuroplasticity. It's how we learn, how we kind of operate in our daily lives. But I think your question is: Is there variability in that, and does that predict this kind of transition? It's a good question. I don't know. So, like you said, there is a genetic component to addiction, and we think probably 50% or so of addiction is heritable. Do those genes dictate how fast a neuron changes its firing pattern in results in response to cocaine? I don't know the answer to that. That's that's a great question and something for us to think about. You touched on addictive personalities. Yeah, that's</p> <p> </p> <p>SANA QADAR 50:32 </p> <p>that's the top of the slido list right now. Is there evidence for addictive personalities?</p> <p> </p> <p>MORGAN JAMES 50:36 </p> <p>Yeah, and does that relate to plasticity? I think that's a great question. I don't know the answer. I'll get back to you in 10 years' time. But you know, personality is an interesting one, right? So I don't think that there's the case that there's an addictive personality per se, but there are individual personality traits that probably heighten our risk of developing addiction. One thing we've focused on in our lab is this personality trait known sometimes as sensation seeking? So there are people, maybe in this room, who like enjoy throwing themselves out of planes, right? Like skydiving. I did it once. I would never do it again. It was awful. Like just not enjoyable. There are people who like driving fast. The data tell us that these sensation seekers are the ones that are more likely to experiment with drug, and of course, experimenting with drug is a prerequisite to potentially going on to develop addiction, and they probably transition a little bit more quickly as well. We find this in our lab. What we're trying to do now is to see what brain systems we should start looking at plasticity in a little bit more precise way, maybe differentiate those high sensation seekers from the low sensation seekers, so thank you for the idea, and I'll put you on the paper.</p> <p> </p> <p>AGNIESZKA TYMULA 51:46 </p> <p>I can maybe add to this a little bit. You made me think about a study that I read from from US that was showing that your tolerance towards ambiguity, so unknown risks, is very predictive of how likely you are to relapse? </p> <p> </p> <p>SANA QADAR 52:02 </p> <p>So if you're not tolerant of ambiguity, I think</p> <p> </p> <p>AGNIESZKA TYMULA 52:05 </p> <p>if you're more tolerant to ambiguity, you're more likely to relapse.</p> <p> </p> <p>AGNIESZKA TYMULA 52:08 </p> <p>Okay, that's fascinating. The personality traits that are related. The sensation-seeking one freaks me out because I have a young boy who's going to be a teenager one day, and they're pretty sensation-seeking, I think. But yeah, so far, anyway. Well,</p> <p> </p> <p>MORGAN JAMES 52:20 </p> <p>I mean that corresponds with the greatest risk of addiction occurring during adolescence.</p> <p> </p> <p>AGNIESZKA TYMULA 52:23 </p> <p>Yeah, yeah, yeah, exactly. Okay, let's go to the question over here.</p> <p> </p> <p>Audience questioner 52:27 </p> <p>Thank you very much. I wish I was I had two hours, but all right. I know I have to. You've got two minutes. Very very short. As mathematician, I would never gamble because I know this losses game. As expert in informatics, I know how to to guard against the incertification algorithms that make us dependent more on iPhones and all those overhyped, overpriced gadgets. And now I will have the head with the help of my friend Slaves Zek. and the expert in addiction Gabor Mate, who says actually don't stress too much about your addictions because it's the system that constantly feeds those traumas. So my my question directly is: Aren't we as how to say pushing too much individualism, like individual rights or that stuff, and ignoring the social parts actually enabling these addictions because our unconscious brain, which is 95 percent, and it's much older than humans because it's like.</p> <p> </p> <p>SANA QADAR 53:39 </p> <p>That's a good point because I mean, especially with gambling, for example, like the environment is full of slot machines and opportunities to gamble. The entire environment is like leading people in this direction. So it's not so much necessarily an individual thing.</p> <p> </p> <p>Speaker 3 53:54 </p> <p>Many experts say it's avoiding the reality of those traumas. So practically, if we have much better social life, you have much less addictions, and my only addiction is I'm against addictions.</p> <p> </p> <p>AGNIESZKA TYMULA 54:06 </p> <p>So the question there is, yeah, do you think there's too much of a focus on individual behavior as opposed to the social factors contributing to this? Who wants to take that?</p> <p> </p> <p>LOUISE THORNTON 54:15 </p> <p>Well, I don't know about where you know if if we've got too much focus either way or the other, but only to say that, of course, social connection-you know-with other people again is a really powerful force, and so we know that, for example, when people feel lonely, you know, so they've got a lack of social connection, they're at greater risk of, you know, all types of mental health problems, but including, say, addiction and you know substance use as well. And when you know there's some evidence, and if you're helping someone, you know, feel not as lonely, you can you know also help say with their alcohol use as well. So just to highlight and agree, absolutely social connection and the those social aspects that include. Incredibly important part of you know all of those complex factors that come together to determine if and how someone might be addicted to a substance. I</p> <p> </p> <p>SANA QADAR 55:08 </p> <p>might move on just so we get some more. Do you have?</p> <p> </p> <p>MORGAN JAMES 55:10 </p> <p>I have two. You really want to say something? Okay, go on. Cut me off if you need to. So we had this real watershed moment in the addiction literature maybe five or 10 years ago where we used to, in the animal world at least, give animals you know the opportunity to take a bunch of cocaine, for example, and they'd keep taking the cocaine. But surprisingly, but if you introduce another option in the box where they can press a lever to get access to a little friend, they just go and interact with another little rat. Most rats will stop pressing the lever for cocaine, and they'll preferentially press the lever to go and play with their friends. Very cute. So</p> <p> </p> <p>SANA QADAR 55:47 </p> <p>and hopeful, right?</p> <p> </p> <p>MORGAN JAMES 55:49 </p> <p>And it's really made us rethink about like exactly what you're raising, the points you're raising, what Louise was reiterating there that the social environment can act as this protective factor. I'll just note that I think it can go the other way as well, and we maybe haven't talked about that as much tonight. As</p> <p> </p> <p>SANA QADAR 56:02 </p> <p>in, like friend environment, kind of leading people towards.</p> <p> </p> <p>MORGAN JAMES 56:05 </p> <p>And also, just so my story, and it's quite a sad one. I was in the U.S. earlier this year in a town. I won't name it because I don't think it's helpful. Which is known for having some some drug issues. And I walked down the main street, and inside a car, it's very confronting to think about. Still, there were what looked like a mum, a dad, grandma, and about a 20-year-old kid, and they're all unconscious with needles in their arms. Oh</p> <p> </p> <p>SANA QADAR 56:30 </p> <p>my gosh!</p> <p> </p> <p>MORGAN JAMES 56:31 </p> <p>And it was this real, like, obviously shocking moment. And once everyone was okay, I had this thought of, oh my goodness, like we are so far. Like these people could have the most resistant genes. We could have all the best medications in the world, but if that's the environment in which this 20-year-old is exposed to each day, I don't know that we can counteract that. So I guess my point is exactly what I think you're saying. There is individual responsibility, of course, but there's also these societal factors that contribute, that are very very hard and complex.</p> <p> </p> <p>SANA QADAR 57:02 </p> <p>That is just the most heartbreaking image you could paint. Like that's that's incredible. The intergenerational aspect of that, and this the question I want to follow with kind of touches on all of this. It's do you believe that addiction is a brain disease? So you know, in the last several decades, there's been a shift from seeing addiction as a moral failing as well to a brain disease, but I understand there's a bit of debate on that idea as well. Where do we stand on brain disease part?</p> <p> </p> <p>MORGAN JAMES 57:29 </p> <p>Do either of you want to jump in on that one?</p> <p> </p> <p>LOUISE THORNTON 57:31 </p> <p>I mean, I suppose I think as I'm just guessing where you're going with this, but perhaps where the conversation is going, that I think it's complex. We know exactly, you know, it can't just be a brain disease if social factors can play such a role. You know, we know that one of the biggest predictors of addiction, as well, is experiencing trauma in childhood, as it is with many other mental health problems. So, it's a my take is that it's a complex issue combining biology, social environments, individual you know personality differences, all those sort of things.</p> <p> </p> <p>MORGAN JAMES 58:10 </p> <p>Strongly graphic, perfectly said. I think</p> <p> </p> <p>SANA QADAR 58:12 </p> <p>let's</p> <p> </p> <p>MORGAN JAMES 58:12 </p> <p>yeah yeah.</p> <p> </p> <p>SANA QADAR 58:13 </p> <p>Shall we move on? I just want to get some more questions in before we run out of time. Yep, this gentleman Andrea, just over here. Yep.</p> <p> </p> <p>Audience questioner 58:20 </p> <p>Thank you for an amazing content. First of all, I have a very simple question: instant gratification. You mentioned that before, and how how that plays on the neurology of the brain, and we live in an environment where that is that is becoming more and more prevalent, particularly with this new technology that we've all been hearing about. So my question to you is talking about that same technology being artificial intelligence. What is the one individual breakthrough that you would that you think would change the game as far as it relates to addictions, and in particular, I'm more interested personally on the gambling addiction piece. But what is that one sort of breakthrough for you individually that you think, if you had the right resources, that you hyperscale this intelligence that we now have, that would completely shift the shift the dial. Thank you.</p> <p> </p> <p>AGNIESZKA TYMULA 59:09 </p> <p>I don't have the answer yet, but I can tell you what I'm planning to do over the next four years. I'm very interested in how changing the temporal aspect, so how quickly you get rewards affects your own decision to wait. I think I suspect that the way that the brain wakes, it adjusts to the expected wait times that you have to wait for a reward. And once you are in an environment where once you are exposed to an environment where rewards come really quickly. This is what you start expecting, and you become more impatient, and you have less self-control. So I don't have the answer yet, but this is exactly what I want to study over the next four years and figure out how we can interfere and how can we perhaps maybe even have some suggestions for how to change our. Digital world in which we operate to allow more of that forward future thinking before people make decisions,</p> <p> </p> <p>LOUISE THORNTON 1:00:08 </p> <p>and I think for me I would go back to the idea of the precision medicine idea, and the only way we can achieve that is by combining a whole host of data, you know, across you know many 1000s of studies, and it is the development of AI and machine learning, like analytical techniques, that makes that sort of thing possible. And models that learn based on you know what someone's doing day to day to give those updated sort of recommendations. So I think in terms of leveraging AI for good, you know that is maybe that one thing that might be able to make that difference, and that's the sort of work we're just starting to do and look at how we can use those AI models to look at our own data and you know bringing in other you know data to sort of start making those really personalized recommendations for people. So that would be my one thing.</p> <p> </p> <p>SANA QADAR 1:01:02 </p> <p>Do you have a quick answer? Sorry, I feel like I keep cutting you off.</p> <p> </p> <p>MORGAN JAMES 1:01:05 </p> <p>Yeah, as I have kids, they're seven years old. They they scroll on the YouTube things, and they're short, and they're like they just keep going from one to the next, next. So outside my lane, but potentially regulating</p> <p> </p> <p>SANA QADAR 1:01:20 </p> <p>that. Yeah. Okay, we have time for one more question. So there's someone's got their hand up in the back. That's the first one I saw. Sorry.</p> <p> </p> <p>Audience questioner 1:01:28 </p> <p>Hi team. Just following on from the brain disease question, which was the like the social environmental factors definitely would suggest that it's that it's not or not leaning that way. Can it tip into one? So, like, once you then like you have trauma, background, environmental factors, etc. Once you're in the throes of addiction, it sounds like from what I've heard today, like your brain chemistry's changed, your reward pathways are changed, which would be potentially okay. Now there is a neurological condition that's happening, and is there? If it can develop, it's kind of a two-parter. Does that then depend on your, I guess, flavor of dependence? So, like, it's like, and it's sort of another question as well. Is like, if it's heroin versus meth or something like that, is there a reason why then there's more study on one versus another? So, like, stimulant versus opioid, for instance, there's like kind of three questions in there. </p> <p> </p> <p>SANA QADAR 1:02:25 </p> <p>that. You have like a minute and a half. Go.</p> <p> </p> <p>MORGAN JAMES 1:02:27 </p> <p>Yeah. Sorry, I'm circling back in my brain. Can you summarize just questions?</p> <p> </p> <p>Speaker 4 1:02:32 </p> <p>So, can you tip into a brain disease?</p> <p> </p> <p>MORGAN JAMES 1:02:35 </p> <p>I think absolutely you do. The reason why, as a construct, people have started to resist against this so-called brain disease model of addiction. Is there is this argument that removes agency, right? So if one believes that it is their brain, it is a disease, in the same way that you can't help getting cancer, I can't help being addicted. The argument is that that removes the agency from the individual, who of course still has choice and still has agency. Just like I said before, the brain has changed in a way that it stacks the cards against them. Right? They are more likely than not to make the decision to take drug than to not take drug. So, absolutely, I think in all cases, addiction there is a shift into a brain disease. Yeah.</p> <p> </p> <p>Audience questioner 1:03:12 </p> <p>And then, does the does your predilection sort of like indicate that? So, like, I guess like meth versus coke versus gambling versus etc. Yeah. And then what does that disease then? Is it all?</p> <p> </p> <p>SANA QADAR 1:03:26 </p> <p>Is it all the same thing?</p> <p> </p> <p>Audience questioner 1:03:27 </p> <p>The same thing. Yeah. Yeah. In the</p> <p> </p> <p>MORGAN JAMES 1:03:28 </p> <p>brain. Yeah. So there are different pathways that contribute to addiction to different types of drugs or rewards like gambling. But ultimately, it is true they all converge on this dopamine system, and that dopamine system is what motivates you, regardless of whether or not that queue is predicting a cocaine reward or a heroin reward or a gambling reward, that's what invigorates your behavior towards that that reward.</p> <p> </p> <p>SANA QADAR 1:03:49 </p> <p>Folks, that's all the time we have for this evening. I think this has been such a fascinating discussion. We, I'm sure, all have plenty more questions, and we could keep going. But we have to wrap it there. Please join me in thanking Morgan, Louise, and Agnieszka. And thank you all so much for coming and for your questions. I'm sorry we couldn't get to more, but they were fantastic questions. Tonight's event has been presented by the University of Sydney's Brain and Mind Center, and if you want to find out about more upcoming talks. Please head to sydney.edu.au/sydney-ideas. I think it's up there. Okay. All right. This has been Sydney Ideas. I'm Sana Qadar. Thank you so much for coming tonight. Have a good night.</p> <p><br> <br> <br> </p>
Hear from Brain and Mind Centre experts as they reveal insights into how our brains are wired for risk and reward, and the ways this can work against us in environments with easy access to addictive stimuli such as drugs, nicotine, digital media and games, and more.
In this conversation, explore what we could do to stem this tide by harnessing technology and novel approaches. Featuring neuroeconomist Agnieszka Tymula, digital interventions and mental health researcher Louise Thornton, and neuroscientist Morgan James. Hosted by Sana Qadar.
This event was presented on Wednesday 23 September 2026 with the Brain and Mind Centre, a flagship multidisciplinary intiative at the University of Sydney addressing child development, youth mental health, and ageing and neurodegeneration.
Morgan James is a Sydney Horizon Fellow and leads a translational neuroscience lab at the Brain and Mind Centre. His research examines the neural basis of psychiatric disorders characterised by dysregulated motivation, including addictions, eating disorders, and depression. He runs an active drug discovery program that provides a direct pipeline from lab findings to potential treatments. Until December 2024, he held the position of Assistant Professor of Psychiatry at Rutgers in New Jersey, the largest multidisciplinary addiction research site in the US, where he remains an Adjunct Professor.
Louise Thornton is Program Lead for Digital Interventions and Engagement at the Matilda Centre for Research in Mental Health and Substance Use (Matilda Centre) and a Lead Researcher on Brain and Mind Centre’s Technology Addiction team at the University of Sydney. She is also Program Director for the Leggett Precision Hub for Alcohol Treatment and Director of Research and Strategy at the Mental Health Innovation Team at the University of Newcastle. She leads a program of research to identify and understand the most effective ways digital technologies can be leveraged to reduce chronic disease risk and improve people’s mental health.
Agnieszka Tymula is a neuroeconomist whose research integrates economics and neuroscience to explain how people make decisions under risk, time, and uncertainty—and how to design tools and policies that improve them.
Agnieszka is the recipient of 2025 Young Economist Award from the Economic Society of Australia, 2017 Society for Neuroeconomics Early Career Award for Contributions towards the Understanding of Decision-Making, and 2015 Australia Research Council Discovery Early Career Researcher Award. She has secured over A$34 million in competitive funding (ARC DECRA, Discovery, Linkage; Centre of Excellence) and leads large interdisciplinary teams.
Sana Qadar is an award-winning journalist and host of All in the Mind, ABC’s acclaimed podcast exploring the science of mental health. With a global career spanning ABC News, BBC, Al Jazeera and NPR, she has reported from London, Beijing and beyond. Holding an MA from the School of Oriental and African Studies at the University of London, Sana brings deep insight and curiosity to complex psychological and social topics.
Header image: Photo by Trixie Young for The University of Sydney