Transcript

Justin McMillen (00:00:00):

I am the experiment. You can write your own story. Not stop trying and don't give into the fear.

Justin McMillen (00:00:05):

So you're, you're applying to school?

Chuck Hudak (00:00:07):

Yes. Yeah. Yeah.

Justin McMillen (00:00:09):

And. For what?

Chuck Hudak (00:00:14):

Master's, master's in social work at three programs. And then master's in clinical psychology at Vanguard. So nice. When would you start? So it would be the fall of 26. So I'm in the application process right now. Just filling out, you know, it's like personal statements and all that kind of stuff. So I should have those in by January. Hear back about interviews and all the kind of like second follow up parts of the process and then get the admissions decision, hopefully by March. So look, I'm going in for fall.

Justin McMillen (00:00:40):

Yeah. Nice.

Chuck Hudak (00:00:41):

Yep. It'd be perfect timing with the baby and.

Justin McMillen (00:00:51):

Exactly.

Chuck Hudak (00:00:52):

Yeah. Yeah. I know, two years under my belt of learning to be a dad and then try to go back and start that whole process again.

Justin McMillen (00:01:00):

You're going to learn to be a dad for the rest of your life.

Chuck Hudak (00:01:03):

Yeah. Yeah.

Justin McMillen (00:01:05):

And this is part of the deal?

Chuck Hudak (00:01:07):

Yep. You guys are gonna have more. Yeah, we want to. Yeah. There's some recent scares, the usual that's usually occurring with me, but, not yet. Yeah. We want to hold off until probably at least halfway through grad school.

Justin McMillen (00:01:23):

Oh, yeah. So. Okay. Yeah. Cool.

Chuck Hudak (00:01:27):

Yep. Cool.

Justin McMillen (00:01:28):

Yeah. You, I mean, it's such a good student. People who know. Yeah. I mean, no, that's — you shine in school.

Chuck Hudak (00:01:39):

Yep.

Justin McMillen (00:01:40):

And so, and that's part of why I wanted to do this today. Yeah. Call this, chopping it up with Chuck.

Chuck Hudak (00:01:44):

Yeah. Yeah.

Justin McMillen (00:01:45):

Okay, cool. Yeah. And what I want to do is explore ideas. So, you know, I'm a pretty curious guy. And I dig into things, and most recently I've been looking into a theory — it's a theoretical framework that underpins Tree House's entire treatment model. Right. And you know this stuff. And it's the idea that there is a strong genetic component to, or factor in, substance use disorder. And the way that we look at it, that's different than most places, is that rather than looking for like the quote unquote addict gene, we start with the idea that addiction across different societies appears to be — you know, if you consider alcoholism, polysubstance, and then the combination — it's roughly 10% worldwide. So that's the strongest signal that there's a genetic factor at play. And so what does that mean? Well, then you can go downstream and go, okay, well genetics play a role. And then you know, you can maybe see the cover of Time magazine like, "We found the addict gene." That's — I think that's bullshit. What I do think is that we work in behavioral health. And what we're talking about is treating behaviors. So the question is, are there genes or a combination of genes that contribute to the types of behaviors that would make somebody more likely to use substances? Yeah. And so, some ideas and questions I have for you. And then I have this paper here I want to go through and talk to you about. But what sort of behaviors do you see — working in this field for quite some time now — what are the behaviors, or traits, that exist across all the people that we treat?

Chuck Hudak (00:03:40):

Okay. Well, first I want to start off by saying that the framework that Tree House is working with, and the hypothesis that you've formulated here, is pretty on point with what the science and the research and the frameworks of what people are learning when it comes to behavioral psychology, abnormal psychology — in general it's more of a multidimensional approach. Right? And so genetics play that piece of it. But we also have to take a look at culture. We have to look at environment, behaviors, socioeconomic status, all the different things that are going to contribute to substance use disorder. Right. And so we always look at it as a — like, the diathesis-stress model is what it's called. And so that's going to be — if you have two different cups here, each cup has a fill line for addiction based on a genetic predisposition. That's how high or low that line is going to be. And so someone who has a genetic predisposition, that line is going to be lower. And then the water that goes into that cup is going to be the life experiences, the traumas, the behaviors — the, what is this called.

Justin McMillen (00:04:56):

What's the name?

Chuck Hudak (00:04:58):

Diathesis-stress model. Okay. And so two different people — and they do a lot of like twin studies, large genetic kind of studies with that. That's the best kind of evidence that we have toward something, nature or nurture. And so two different people have the same exact life experiences happen, and that's that water that's filling those cups. And so if someone has that genetic predisposition, when they hit that fill line, that's when they actually kind of hit that mark. And it goes into like epigenetics and goes into other things that you kind of mentioned throughout your paper. That's when a gene expresses, or that's when the actual behavior that —

Justin McMillen (00:05:41):

Not, not the — our time with the word. Okay. What would you —

Chuck Hudak (00:05:45):

Keep going, like the — the trait that represents. Right? Not the actual genes, but the trait.

Justin McMillen (00:05:50):

The behavior.

Chuck Hudak (00:05:52):

The behavior. Right. That's the one that will actually express. Right. And so again, two different experiences — or the same exact experience is going to lead to different results based on what the genetic makeup of that person is. Right. That being said, it also goes a lot further. Right. So like, to isolate one gene, or one neurotransmitter, or one chemical that's going to be the cause of that — it doesn't make sense, because it is more of a symphony. You know, like, this gene or this mechanism triggers ten different mechanisms to happen. And those different mechanisms are in charge of all different kinds of behaviors. It's going to be that mixture of these different behaviors, that mixture of these different genes, that, you know, you mentioned throughout the paper and that you already alluded to. So that's kind of the foundation. I think having an understanding of that multidimensional approach is what allows us to really take a look at this and understand — or isolate — factors that are really causal of addiction. Right. And so behaviors that I see that present very, very commonly throughout this population are going to be isolation. Disproportionate emotional responses is definitely one that I see all the time.

Justin McMillen (00:07:10):

How much do you think that's related to people going through — because we're working in treating people whose brains are coming back to balance. So how much of their disproportionate emotional responses are related to that, versus — like, do you think those existed before the person started using substances?

Chuck Hudak (00:07:34):

Yes I do, yeah. Yeah. I think to a certain degree, yeah. I think — because there's different factors. Again, they're going to go into that like attachment throughout early childhood, like those first prototypical caregivers that you have and those relationships you build with them. That's going to dictate your sense of self, your emotional regulation, your brain development, all that kind of stuff. And again, that's only one of the factors that are going to contribute to something like emotional dysregulation later in life.

Justin McMillen (00:08:13):

Got it. Here's another one. So how much do you know about the Big Five?

Chuck Hudak (00:08:15):

A lot. A lot.

Justin McMillen (00:08:16):

Yeah. Okay. And do you know enough about it to give a basic overview for the audience?

Chuck Hudak (00:08:17):

Yeah. Yeah. So the Big Five is — through factor analysis, I forget like when the research was actually done, but personality psychologists pretty much took traits — or, you know, obviously words, traits that they think are pretty common amongst people. And through statistical analysis, they kind of found that when they use a bunch of words, they'll all kind of fall into a specific category to describe different parts of a person's personality. Right? And so the Big Five is the OCEAN model. So it's openness, conscientiousness, extroversion, agreeableness, and neuroticism. And so under those five personality factors, you have a bunch of different facets and words that will kind of fall under the umbrella. So neuroticism can be like anxiety. It can also be emotional dysregulation, all that kind of stuff. And so through personality assessments and things like that, we could kind of find out where somebody lies on those five factors.

Justin McMillen (00:09:25):

Is, is the theory with the Big Five that people are born with these traits?

Chuck Hudak (00:09:27):

So it's again the multidimensional approach. And that's why I kind of want to start off this discussion with — where it's like, the things that you're describing are exactly in line with all of the disciplines that people are using for things like evolutionary psychology, personality psychology, and all that kind of stuff. So genes play a big part, but it's also like evolutionary psychology would be one of these things that people will study personality psychology from, to be like, is it genetics? Is it like gender roles that have kind of formed throughout society? Is it testosterone levels? Is it these different biological factors like aggression and things like that? What is it that's causing the personalities to actually present?

Justin McMillen (00:10:27):

Gotcha. Yeah, I'm very interested in this. And I was getting into a big discussion with this woman who used to work — and she just got a PhD in bioinformatics — and we were talking about nature versus nurture. She was going into — she was like, I think you're giving way too much weight to genetics. And we were talking about twin studies. And I can't help but think about my own children and watching them evolve over time, like being raised in the same house and how different they are. And there are so clearly genetic predispositions for behavioral traits or like behavioral phenotypes. Right. Like, there's things that are happening. And I wonder about how much of it is genetic versus not. For example, when you're born, is it predisposed that you're an introvert or an extrovert? Yeah. You know, now there's different ways that's expressed — which could be what, maybe that's like the cup being filled. You know, similar to neuroticism. Like you know, neuroticism as the broad category. But then there's different traits or characteristics within neuroticism that maybe — maybe that's the picture that's painted by environment. But maybe the amount of neuroticism someone has is predisposed by genetics.

Chuck Hudak (00:11:40):

Yeah. Yeah.

Justin McMillen (00:11:41):

I think that would be the consensus.

Chuck Hudak (00:11:46):

Yeah, that would be the consensus. And like you said — or like I said before — that's when it plays into the epigenetics. But that diathesis-stress model — like, a gene could be there. Like for me, I have an autoimmune disorder, I have rheumatoid arthritis in my back. I had the gene that predisposed me to that phenotype — or to that actually representing in my life. I didn't know it existed until I was 21. The stress that occurred when I was trying to get over — the stress that occurred when I started to care about life, and all that started to come up — made that gene activate. That gene turned on, and all of a sudden the phenotype starts to show. The pain, the things that were underlying actually start to present. Right? So I think that to me, it sounds like it could be very much the same when it comes to things like behavior and personality. And it all bleeds into like the mind-body dualist idea of like the soul versus — you know, like, "I think therefore I am," like Descartes — your thinking is contingent upon that hardware, you know, that what the genes are creating that actually presents. And that's why I act the way I do. What makes those kind of genes turn on, what —

Justin McMillen (00:13:05):

Gotcha. Yeah.

Chuck Hudak (00:13:07):

Or the other way around, like, I am and therefore I think.

Justin McMillen (00:13:09):

Yeah. Yeah. Exactly. Yeah.

Chuck Hudak (00:13:10):

Yeah. That's super interesting. Yeah.

Justin McMillen (00:13:11):

Yeah, I'll tell you what I see. I definitely see the disproportionate emotional response for sure. It appears that the people that struggle with substance use disorder — and I hope for people who are listening to this that it'd be interesting to hear in the comments what people think, because I've noticed it. So we do this experiment every month. In leadership class that we run here, where we do a thought experiment. We say, all right, let's pretend that we're on an island and there are no drugs and alcohol. And there's ten people on this island, and we identify that one out of ten of them has this predisposition — let's say — and we don't know what the genes are. So let's all work together. And this is a group of people that are recently new in recovery. And let's try to see if we can come to an agreement on what this person would do different, or how they would behave and act differently compared to the other nine. And without fail, it never takes more than a few minutes to come up with the same answers every time. The same. It's crazy. And this is people speaking from their own personal experience. And this is going back six years of running the class. And one of the things that they say is an inability to be satisfied, or like — they just, they can't stop. They go go go go go. They say, what everyone else is sitting around collecting coconuts and hiding them, eating them, you know.

Chuck Hudak (00:14:53):

Does that sound — yeah. Yeah, that's exactly what I was going to say.

Justin McMillen (00:14:55):

Yeah. So. So what would be the — and this kind of leads into the paper too — what, what sort of genes, what do you know, what could be causing this from a genetic standpoint? And would these people be like this from birth, you think?

Chuck Hudak (00:15:05):

Yeah. So the, just based off the research I've done — from Dr. John Ratey at Harvard — the specific gene is going to be the D2 allele. And that's the gene that, you know — so we have different kinds of receptors for each neurotransmitter. And so just kind of so the audience knows, what is dopamine? So, because the D2 allele is in charge of encoding a specific kind of receptor for dopamine. Dopamine is the neurotransmitter in charge of survival, in charge of reward, and in charge of memory. It's kind of what helps us to remember what kinds of behaviors are the ones that help us to survive. Right. That's important. The kinds of behaviors that help us remember what to do to survive. Yes. So this is, like, deeply rooted in survival. Yes. Yes. So arguably dopamine is really at the core of us maintaining our existence and not dying — motivation. Yeah. If, in mice where they knock out the genes that encode for dopamine receptors, they won't eat, they won't — they don't do anything. They just die. Right. And so dopamine is that motivation neurotransmitter. It's the thing that tells us like what to do, when to do it. It's that drive. Right. And so dopamine plays a role in movement too.

Justin McMillen (00:16:33):

Yeah.

Chuck Hudak (00:16:34):

Yes. Yeah. And like, so if people who have schizophrenia — it is a dopamine kind of thing, which is why people can induce schizophrenia with like smoking meth or doing too much cocaine. Too much stimulants, because those primarily act on dopamine. And when you give too much of that, it induces psychosis, things like that. So people who have Parkinson's disease, they have a deficit in dopamine. And so that is what leads to inhibited motor control — or, you know, a lack of inhibited motor control where they move too much and they shake and all that kind of stuff. And that's been seen — that giving them L-dopa can actually induce schizophrenia and other psychosis symptoms in people who have Parkinson's. And so why that's important is because it's also going to be in charge of habit formation. Right. And so if it's in charge of motor control, motivation, and survival, that's what's going to help to create different behaviors that become automatic, you know, of like — when I see a cue that, unconsciously in my limbic system and my memory centers, is like, "oh, when I see this, if I do this behavior, I survive" — it becomes a habit.

Justin McMillen (00:17:49):

Right. And so — that's so interesting. So like, what I think you're saying is that, yeah, we have this part of our brain, we have these neurotransmitters so that we can remember what works. Yeah. Like, foundationally for survival. And so it communicates to us through — this feels good. Right. Or this is that — that's probably how it translated into our psyche. Right. This is a behavior that's good, it's rewarding — that's why it's called the reward system — versus a behavior that's not good. And so this is a whole system that's working on this. And then you mentioned D2. Yeah. And then I'll keep going on that. But I want to talk about the TAQ-1A part of the gene. There's a combination — at least what you get from your mother or father is A1/A1, or A1/A2, or A2/A2. And in a certain population — I think the vast majority has A2/A2, I believe, like 70% of the population — but then there's 30% that has either A1/A1 or A1/A2. And if you have A1/A2 or A1/A1 — I believe, we need to look it up — but I think you end up with much less sensitive dopamine neurons. Is that right? Yeah. Like a deficiency.

Chuck Hudak (00:19:13):

Yeah. Like a mean deficiency. Right. Well, let's say less sensitive means that you're not able to re-uptake dopamine as quickly. And so what would that mean for a person that has that? So if a person has that — I always like to use the analogy of an adrenaline junkie. An adrenaline junkie is someone who would be kind of the same mechanism happening in the brain, to where some sort of gene is messing up — when it's encoding the receptors for adrenaline, it's messing it up. So where it's not able to utilize the adrenaline to the same capacity that a typical person would. Right. And so that's that lack of sensitivity that you're kind of talking about. Right. And so when the adrenaline junkie is doing something that the typical person — whose brain is able to use all the amounts of adrenaline — when they're doing something that that person would be scared out of their mind, they're kind of like, yeah, this is fun. You know, like, so where it's like, it's stimulating, they actually start to feel something. Right? And so that's the same way that the dopamine deficiency that you're discussing is going to work — someone who isn't experiencing dopamine and reward at the same level as the typical person in everyday life and relationships and rewards. It doesn't feel as rewarding. Right. And that's what — you know, the theory is — is part of what is going to drive people to seek out extra amounts of reward.

Justin McMillen (00:20:45):

That's so interesting.

Chuck Hudak (00:20:47):

Yeah. So I just saw here — it's, I was right on the money, but it's — the A1 is the polymorphism. So the vast majority of people would be A2/A2.

Justin McMillen (00:20:52):

And so A1 either means A1 with a double copy — A1/A1 — or A1/A2. But A2/A2 is 70% of the population, and 30% or fewer have this A1 version. Yep. And what's interesting about this is that's from birth. Yep. Now you could measure that at birth and say, you have this. And then according to this, when you have that, like you said, less dopamine. And so if a person has less baseline dopamine, they're going to have to go out into the world to find external things to bring it up, so they feel more.

Chuck Hudak (00:21:35):

Yep. Yep. Exactly.

Justin McMillen (00:21:36):

Yeah. That's crazy. Exactly.

Chuck Hudak (00:21:42):

Yeah. It's just to feel okay. Just to feel normal. Just to feel like the things that they're doing on a daily basis are worth it, that are rewarding and that it's enough, you know, and yeah, it's definitely crazy.

Justin McMillen (00:21:50):

And I wonder how many people listening to this know that that's them. Yeah. How many people are listening saying like, holy crap, why haven't I heard this before? Right.

Chuck Hudak (00:22:03):

Yeah.

Justin McMillen (00:22:04):

That's — yeah.

Chuck Hudak (00:22:06):

I mean, this is — so this is going to produce more impulsive behavior. It's going to be sensation seeking, weaker avoidance learning. And then, of course, an elevated risk of alcoholism and addiction.

Justin McMillen (00:22:23):

More impulsive. More. Yeah. Yeah.

Chuck Hudak (00:22:25):

And I think sensation seeking is interesting, too. It's like I have to do things that are going to allow me to feel normal.

Justin McMillen (00:22:30):

I wonder how much this plays into, you know, the classic thing you see at like AA meetings — is people smoking and drinking coffee. How much do you think nicotine is used by people that are in recovery because of this D2 polymorphism?

Chuck Hudak (00:22:52):

I see it all the time.

Justin McMillen (00:22:54):

I think — that's why you're going to see.

Chuck Hudak (00:22:59):

Because what I was going to say — when you ask before, what are also some behaviors that we're going to see from people who are in recovery, like on the majority — is all stimulation, all reward seeking behavior. So it shows up as nicotine use, shows up as caffeine, shows up as workaholism, shows up as sex addiction, shows up as gambling addiction — all these kind of things that, like you're saying, are going to add to the stimulation in life and the feel-good emotions that you're kind of going to get from those activities.

Justin McMillen (00:23:20):

So let's — so I think when we — we'll talk about each one of these. Are you like, into this format so far?

Chuck Hudak (00:23:31):

Yes. Yeah. Okay. Good. Yeah. I'm having fun.

Justin McMillen (00:23:32):

I think that, definitely — because, well, first of all, we're not doctors. And I'm not claiming — yeah, no, you don't. When Chuck says something about L-dopa or, you know, schizophrenia or causing psychotic symptoms, he's not giving medical advice. We're never giving medical advice. We're just sharing what we're learning. And then through that we'll share a little bit about what we do at Tree House. But what I think is interesting about this data, too, is that if you're listening to this and you think to yourself, my gosh, like, they're describing me — I bet if I was to get a genetic test, I would discover that I have this polymorphism. And if that's you, and we're talking about less dopamine — I don't want to sentence people to thinking that this is a bad thing. And I want to go one step even further and go back to this island. We talked about what would be the evolutionary advantage for people to have more sensation seeking, weaker avoidance learning, and a greater need for external stimulus to create a dopamine response. Like, how could that benefit people? Let's look at it through an evolutionary lens, and then let's get into modern society.

Chuck Hudak (00:24:55):

Yeah. Well, we got to remember what dopamine is, right? It's the survival — the survival neurotransmitter. And so in ancient society, on that island, there's a whole lot more things that you need to do to actually survive, right? Not able to order Uber Eats to your door, not able to basically never leave the house. You need to be on lookout for the weather. You need to be on lookout for animals. You need to be on lookout for threat all the time. And so the person that is more on the lookout, that's able to act faster, that's able to go out and hunt, able to go out and do the things that release higher amounts of dopamine so that they can feel normal, so that they can feel like life is enough — they're gonna do it over and over and over again. Right? And so their chances of survival are going to go up. So it could serve an adaptive purpose of helping that person to constantly be on the lookout for survival, constantly be on the lookout for the stuff that is going to help them to spread their seed. And because that's the ultimate form of survival, right, is being able to procreate. And because naturally, that is the activity that gives us the highest dopamine release. And so those are the guys that are going to be ahead of the pack, have the mates, life's going to be good. Yeah. And be — impregnating a lot of women. And then they're going to be constantly looking into the environment for the next thing that produces a satisfaction response through the dopaminergic system.

Justin McMillen (00:26:21):

So okay. So let's take it one step further — and these, you can tell I'm leading you somewhere here. So just for you — but yeah, these people on this island that are that way, are they more apt for survival than everyone else?

Chuck Hudak (00:26:43):

Yeah, for sure. Yeah.

Justin McMillen (00:26:45):

Yeah. I think — and if you think about it — where genes are, you know, survival of the fittest, there's a reason as to why this gene is continuing to exist today.

Chuck Hudak (00:26:52):

Right. Because the people who had it, they did pass it on. Right. The people who had it were able to be more successful, be more fit in their environment, and to pass it on to the next generation. So for sure.

Justin McMillen (00:27:10):

Do you realize how big of a deal that is?

Chuck Hudak (00:27:12):

For sure.

Justin McMillen (00:27:17):

I mean, here — I think the consensus for most of society — not us, because we have more firsthand experience — but there's a massive stigma around addiction. But if people knew this to be true, that there's this sort of mismatch going on between the genes that were best suited for another time, and then their sort of modern day expression that doesn't work — then you might think that some of the best genes in our gene pool are actually dying off because of drugs, when they might have been the very genes that brought us to abundance and modernity.

Chuck Hudak (00:27:52):

Yeah. So where we had to be — yeah, yeah. That's unreal. Yeah. That's crazy. Yeah. Biggest difference is just that it's again the environment. Right. And so that again points to the multidimensional nature of these things. Right — where it used to be actual survival, I actually had to go out and hunt, I actually had to go out and do these things that — when I got the dopamine — it served a real purpose. That was good. And now it's an environment where I get dopamine from my phone. I get dopamine from watching YouTube. I get dopamine from all these different activities that really have nothing to do with survival, but that ancient brain doesn't know it.

Justin McMillen (00:28:30):

Man, that is mind blowing.

Chuck Hudak (00:28:31):

Yeah, yeah. I mean, it's such a cool talk.

Justin McMillen (00:28:36):

I mean, you know, there's — I'm super nerdy on this. Yeah. Love it. So, okay, so that's one gene. And so we're still on this island and we're talking about what makes people different. And in my research I discovered another gene that — there's a strong prevalence of this gene, or this polymorphism, in ADHD. Do you know what I mean? I'm referring to? No, I actually don't. DRD4. And so there's a VNTR — and that's an acronym that stands for — I think it's Variable Number Tandem Repeat, I gotta look it up. But basically certain genes have repeats on the chain, it's repeating. And the average person has four repeats. But there are some people with a polymorphism with seven or more. And then there can be less than four as well. But people who have seven or more have greater novelty seeking and exploratory behavior. The other one is more impulsivity. This one is novelty and exploration. So think like a conquering kind of approach. Right. And then a ton of awareness of environment, where they're bringing in the stimulus from the environment — which — can you see how ADHD can correlate?

Chuck Hudak (00:29:58):

But there's also a very strong correlation between people with this polymorphism and addiction as well. And DRD4 also encodes for dopamine receptors. So it's reduced D4 receptor sensitivity. And then D2 — is less — actually, when you have this polymorphism in D2, like we just talked about, you actually have less receptors. So D4 is less sensitivity of the receptor. The first one is just less density — less actual receptors that are receiving the dopamine. Yeah. So D4 means that people who have this repeat, they're going to have less sensitivity. And that's going to cause them to be more novelty seeking. And I was thinking — I don't know what you think about this, but more novelty seeking and exploratory behavior — that sounds like in the Big Five, it sounds like what? Openness.

Justin McMillen (00:31:07):

Yeah. Yeah, yeah.

Chuck Hudak (00:31:09):

Extroversion.

Justin McMillen (00:31:13):

Extroversion.

Chuck Hudak (00:31:14):

Openness. Yeah yeah yeah. New experiences. Yeah. So I'm super curious and I want to know the answer to this — like, how do these genes correlate to the Big Five? Like, could you give somebody a genetic test and get a pretty strong sense of where they land? Yeah, yeah. I think extroversion specifically. Right. And so with a lot of these traits, like your original question of like, are some of these kind of from birth and — like, you know, following the logic of that question of like, do they stay that way forever, kind of thing. Right. Obviously I know, you know, that like about epigenetics and stuff like that. And so if we're going with that train of logic, that it would still be able to change. But let's say epigenetics didn't exist — whatever you're kind of stuck with, there are some traits to where they won't change as much. But some of these traits are actually — they can change because of biological factors. Right. So aggression, part of neuroticism — let's say that will go down later in life, right, as your testosterone goes down and as other biological markers go down. Extroversion and openness are two that are fairly consistent throughout most of life. Right. And so yeah, so I would say that definitely there's going to be some sort of genetic predisposition.

Justin McMillen (00:32:26):

Not definitely. I don't want to — I'll talk in absolutes, and black and white thinking, you know — I'm just going to keep putting people across from me and I'm going to push on them, because I have this theory and we're going to — we're actually — this is part of what I want to talk to you about, is I'm super excited. I can't say too much about it, but there's — the final writing is being done on a very large proposal for one of the most comprehensive studies ever done on substance use disorder. And you are going to be a big part of it, which is really exciting. So I cannot wait for you to get your head wrapped around it. But we're going to be looking at these specific genes in the trial. So — yeah. So we're going to — we actually — there's a company that we've connected to that can produce a cheek swab test. And we'll actually be able to look to see if people have these polymorphisms. And so identifying these genes now is pretty cool.

Chuck Hudak (00:33:20):

Awesome.

Justin McMillen (00:33:23):

Yeah, yeah. I'm excited to test our kids.

Chuck Hudak (00:33:25):

Yeah, yeah. I'm looking forward to it. Yeah, yeah.

Justin McMillen (00:33:27):

What I like about this though is — and this goes back to, you know, the filling of the cup and those kinds of frameworks — what I think is interesting, like how I like to think about this, is it starts with just thinking about what addiction actually is. Like, so somebody says it's a chronic disease. That's what it's labeled as and categorized as. That means that if you have substance use disorder, they consider it a disease and chronic — meaning you're not going to get rid of it. Yep. Okay. The interesting thing about addiction that's different than other chronic conditions is that it has a cure.

Chuck Hudak (00:33:55):

We're going to be careful.

Justin McMillen (00:33:57):

Yeah. Or it has a very clear thing you can do, where it will — it'll stay in remission. Again, in remission you can stay there. Yeah. And you know what it is. It's very simple — behavioral change. Well, that's — you're going to get more specific. Connection. No. These are things that can contribute to this end result. But if you and I are sitting here and there is a glass of booze right here — yep — what's the difference between us drinking it and not drinking it? Impulse control, cognitive function. What is impulse control? What is that? Ultimately, what is happening? If I — I'm either going to take it or not. I'm going to take it based on — what is it based on.

Chuck Hudak (00:34:57):

Is — okay. I don't know. It's a decision.

Justin McMillen (00:35:07):

A decision.

Chuck Hudak (00:35:08):

Yeah. Like decision making. Yeah. It's literally a decision.

Justin McMillen (00:35:14):

Yeah. And so — this is this is crazy, but it's not. But in all reality, I don't know, this is oversimplified as hell, there's probably tons of people who would be pissed off, and maybe we're going to get comments about this. I don't care. At the end of the day, I'm making a decision to either drink this or not drink it. A decision not to drink it keeps me in remission. Yep, it's that simple, right? So let's use first principles or just look at exactly what this is. So it all comes down to a decision. So now there we go. If we look at it like on two dimensions — like if it's just a point saying that the very tip is the decision, and then you come back like this and you think about what all contributes to making a decision. Okay. So why would I make a decision to drink or not drink? So there's all these factors that play a role — and this is what we treat. Right. And this is what any substance use disorder treatment center should treat. You've got to figure out how to treat all the things that contribute to making a decision to do that versus do something else that produces the same dopamine response. If you're assuming that we have a predisposition, or our traits are there — yeah, regardless.

Chuck Hudak (00:36:56):

And then it's really like, what causes the person to choose this over that — and that's the environmental piece, I think.

Justin McMillen (00:37:10):

Yeah. Right.

Chuck Hudak (00:37:11):

So and you can't go back in time and change someone's past.

Justin McMillen (00:37:15):

Yep.

Chuck Hudak (00:37:16):

So — so what do you think about that.

Justin McMillen (00:37:18):

Yeah. I mean, yeah, it's like simplifying everything that we're talking about to make it extremely pragmatic. Right. And it's like — it's dominant down to, like, it's a decision. Right? It's a decision that you make, with the understanding that within that decision lies all the factors that create that decision, or the decision to do something else. Right. What are the things that contribute to A versus making —

Chuck Hudak (00:37:45):

Exactly.

Justin McMillen (00:37:46):

Yeah. So I think that — like, I was going to get into about — I mean, if you think about it, the typical biopsychosocial model, right — it's going to be like, what social connections do they have?

Chuck Hudak (00:37:52):

Like, it all comes down to, I think, beliefs. Right. All those other things — like beliefs, psychology, the way, like, your worldview, your self-image, the way that you see yourself. Right. And I think that all those other things — like the social, the biology, all that kind of stuff — is going to impact your worldview and your beliefs. Right? And so if I have meaningful connections, if I have people in my life who depend on me, who love me, that I love and are, you know, dependent on me for their survival — and they also help me with mine — that makes making that decision to take that drink a lot, a lot harder. Right. And I'm a lot more likely to say, no, I'm going to go to work today, or I'm going to go do this other thing, go apply to grad school, to be able to support this family that I care about. Right.

Justin McMillen (00:38:42):

Let me — let me — can we — I love this. So I want to take it one layer further. I want you to keep going. So let's say that you have everything that comes together to make a decision. All these things that you're mentioning — and there's so many more, right?

Chuck Hudak (00:38:53):

Yeah.

Justin McMillen (00:38:54):

And then the decision is to go right or left.

Chuck Hudak (00:38:58):

Yep. Every day.

Justin McMillen (00:39:01):

Yeah.

Chuck Hudak (00:39:02):

And one way is a way that is going to keep the disease of addiction in remission. Or it would be a healthy behavior. And the other one is to return to addiction. Yep. So so now let's consider — it's like the decision, instead of saying, not the decision is just not to drink — it's the decision for something that destroys you versus not — the decision to live or not to live.

Justin McMillen (00:39:27):

Right. There you go. Yeah. Okay. Yeah.

Chuck Hudak (00:39:31):

Yeah. I, I think that that's a — that's a purpose. Right. It's like that's the thing that either — the lack thereof or having a purpose is one of the main contributors to, if you're going to take that drink or not.

Justin McMillen (00:39:33):

So here's another part. For some people — and for people who aren't predisposed to addiction, it doesn't seem like the weight of that decision, or the force behind that decision, is as strong. It seems like it's very easy for them to make a decision. They almost don't care. Which just means that they're not even going to ever abuse substances — because maybe they'll choose to drink and then they don't care the next day and then they won't. Right. So what is the — there's like almost like pressure. It's like more pressure with people that are predisposed to addiction. That's pushing decisions toward — the decision is just stronger. There's a bigger weight to it. Can you talk about that? What do you think that is? Am I saying it the right way?

Chuck Hudak (00:40:30):

Yeah. Yeah, I totally understand what you're saying. I mean, I think that it's — it's like, to me, I think a lot of it's happening on an unconscious level. Like, I think that it's — 95% — again, don't quote me on it, but my research is 95% of the brain is going to happen unconsciously. Right. And so if again, dopamine is that driving factor in my motor functions and my habit formation and the decisions that I'm making, and my brain knows that once I kind of unlock Pandora's box and I got that dopamine response — which, again, naturally, the thing that's ever going to release the most dopamine in life is having an orgasm. Drugs and alcohol will release up to ten times the amount of that. Right? The second that my brain, on an unconscious level, understands that this equals survival — I think that's what creates that pressure, is that it's like it's always going to be there. You know, it's like dopamine exists with glutamate and like, with the neurotransmitters that help to create engrams and create memories in our brain. Right. And so it's like that survival, that appraisal of, like, what that equals unconsciously within that reward system — because that's not a conscious part of the brain — is going to exist and it's going to create that pressure.

Justin McMillen (00:41:50):

So I like what you're saying, but I want to push on this because I think it's important — because if what you're saying is absolutely true — yeah, I've got to make sure I understand it. So it's like — if the best dopamine response we have is an orgasm, 100%, 100% increase in dopamine. Yeah. Crystal meth, thousand percent. Yeah, that's the ten times, right? Yeah. So 250% cocaine. So if it's true that once that happens, your brain suddenly remembers it and now you have that pressure — that would mean that every single person who tries crystal meth would become a drug addict.

Chuck Hudak (00:42:28):

But that's — that's the difference of what we were discussing before, right? Of those genes, of the genes that encode those different alleles. Right. On the — they're responsible for receiving dopamine. Right. For those other people, that pressure doesn't exist, because that relationship — that orgasm is enough. It's fulfilling enough. Versus for us, it's like, it's cool. That's awesome. But no, what's really awesome is — and the brain remembers that. I'm using very cognitive and aware language to describe it, but the reward system is just like, more and more and more. You know. And because — again, all of a sudden it's not enough because of those underlying genetic factors.

Justin McMillen (00:43:07):

That's crazy. That's so interesting. I mean, here's another way to — hey, this analogy I've been using lately, I think I might have said this to you — but another, easier way to explain it is if you look at — and you know, we talk about this — like, the two parts of the brain. You have your limbic drive. This is kind of like the whole system that's dealing with the dopaminergic system, right? It's this survival, pain avoidance, pleasure seeking, fight or flight — the oldest part of our brain. And I think let's put some stage framing around this first and say that the amount of drive in that — which is, this is driving this life force — yeah, I think it's safe to say that not everyone has the same amount of drive. Okay. So that means that there are people who have more, and there are people who have less. Yeah. Naturally. Okay, so let's consider that drive — we'll call that wind. So like a sailboat — do you sail?

Chuck Hudak (00:44:05):

A little bit.

Justin McMillen (00:44:06):

A little bit, yeah. Yeah, yeah. So you have wind and then you have the sail.

Chuck Hudak (00:44:10):

Yep.

Justin McMillen (00:44:11):

Okay. So the wind, I think, would be how we're hardwired — and maybe how we condition ourselves through drug use as well over time. And that's the pressure, that's the force. And then you have the sail, which would be like the executive function. It's able to manipulate that force to your advantage. Yeah. And this is why these two parts of the brain have to work well together. This is my theory — I'm not saying that's absolutely true. But this is some of the framework we work off of — is that executive function needs to be strong enough and able to manage the wind, or the pressure, or the strength that's coming out of the dopaminergic system. In such a way that you can harness that energy to your greatest advantage. Yep. Right. And and never have the expectation that that energy is going to lessen. Yep. Like, I think that's the thing that we've got to make clear here — is that people that think that people who are predisposed to addiction are somehow going to start feeling less, or have less of that force — like, that doesn't happen.

Chuck Hudak (00:45:22):

Yeah, I know. I know from personal experience. Right. And it's connecting back to all the Big Five stuff, right, and the emotional dysregulation that we kind of talked about in the beginning. Right. It's like, emotional dysregulation is one way to put that. Or kind of with the framework that we're looking at now, it's like that emotional dysregulation is actually just a lot of emotions. It's actually — I could actually feel more, actually more intense, I'm actually more passionate. I'm actually — because I'm seeking out the reward, I'm seeking out that kind of drive. Right. And so me — in personal experience of what you're talking about, that it's never going away — is the neuroticism and the, you know, just kind of a little bit of that emotional dysregulation is something that I continue to experience. Right. But that — and again, the adaptive nature of these things — evolutionarily, I would have been that guy on the lookout for all the snakes. I would have been the guy on the lookout for that cliff, on the lookout for — and then when I avoid those snakes, when I avoid that cliff, I get reward, I survive, I'm more likely to survive. Right? Yeah. It's also still what today is pushing me to say, go to grad school, to become the best version of this that I could be. Right? Because I've learned — like I said — take those wins, those genetic predispositions, those neuroticism traits, those personality factors, and use it to my ability. Right.

Justin McMillen (00:46:50):

Yeah.

Chuck Hudak (00:46:51):

And so then the sail becomes — it's like if we accept that we have hurricane type —

Justin McMillen (00:46:56):

Yeah. Damn near hurricane winds.

Chuck Hudak (00:46:59):

Yes.

Justin McMillen (00:47:00):

Was so beautiful about this is that there's lots of places in different cultures where they talk about people — again, in Hawaii they call it mana. Right, like the amount of life force a person has. There's different cultures that have come up with different ways to explain this kind of energy. Right, that's pushing us — causing us to move — which can be explained in a very reductionist way, like looking at it through genetics, and there are things that cause this, but you can be more metaphorical and abstract and say, you've got a force and we have to learn to direct it. And I suppose when you're in active addiction, the sail is kind of just flopping all over the place. And a person doesn't know how to sail. Okay. And that's really — and then there are probably people — I believe, I don't know what you think about this — but I think there are people who never experience addiction, but actually — who are built the same way genetically, but learn how to sail at a young age, and they're just managing some really heavy winds, but they never end up becoming addicted. What do you think of that?

Chuck Hudak (00:48:10):

Yeah. I mean, I think that's totally possible. And I think it's speaking further to what we're talking about — of that symphony of mechanisms and genes and neurotransmitters. Right. It's — so where that person could have that gene, that person could have that predisposition that sets them up for addiction. But on the same side, they have a bunch of different predispositions that also set them up to be extremely resilient. Also set them up to — with their environment, with modeling, with all this kind of stuff — that allows them to learn to sail at that young age. Right. And so that genetic predisposition can still exist. But for whatever reason, they figure out that it's — they don't receive that dopamine, or they're not going to receive that, through substances — versus the other person who does.

Justin McMillen (00:48:51):

So this is so great. And this is going to be the first of many talks like this over the next couple of years. You and I are going to — we're going to test this and we're going to learn more about it. And if we can find a strong enough signal in people that have been diagnosed with SUD around these certain genes — then we could do something, Chuck, that could save the lives of millions of people. And the reason that we could do this — because we know that these genes don't mean you're going to be an addict, but these genes mean that you're built different. And if we could test this at a young age, and even bring this to market for people to buy, they could test their children, and they can understand — my child has more wind. And we need to set up the right environmental conditions to make sure they can sail, so they never have to experience substance use disorder — which would be the most powerful, one of the most powerful things we could do based on a decade of what we've learned, to truly make a difference in the world. So this will — consider this chopping it up with Chuck — as the first of a few different discussions around this. We're going to go through several different discussions around genes. We're going to talk about the dandelion versus the orchid gene, which is a really interesting subject. This is about sensitivity. But we're going to play with different genes. We're never going to say that we know for sure that these are this or that. I'll tell you what the data says, or what the research says — and research can always be challenged. Okay. That's the point, right? You've got to challenge it. But we're going to dig into it and we're going to work through some of these ideas so that we gain not just a fluent understanding, but an easy to communicate understanding for the audience. And then we'll just keep working through it and we'll share our experiences along the way.

Chuck Hudak (00:50:48):

Yeah. No, that sounds awesome.

Justin McMillen (00:50:52):

Yeah, yeah. Oh, the goal is saving lives, right?

Chuck Hudak (00:50:57):

Yeah. Yeah, I think that — again, that's why the research has to be challenged. That's why we have to have these conversations. So that we could, as an environment, as a culture or whatever, just create the best kind of treatment that we can for people and help to get that to the masses, you know? So, last thing I want to say really quick is — what you were saying about being able to find that gene at an early age and being able to kind of set up those preventing factors early in life is exactly what we're talking about too, with that multidimensional approach. Right. So it's like the guy who is raising the environment with healthy modeling, learning from people of like — this is a good thing — versus parents that are like, you know, you eat so much sugar all the time, you act out in class, you cry so much — all these kinds of things — having an environment where that kid learns to make it a superpower, to live with it, to use the sail, versus the environment that doesn't. Right. So just want to say that.

Justin McMillen (00:51:53):

All right. Yeah. Yeah. Awesome.

Chuck Hudak (00:51:54):

I love it.

Justin McMillen (00:51:55):

Yeah. Thank you.

Chuck Hudak (00:51:56):

Yeah. Thank you.

Justin McMillen (00:51:58):

All right.