#82

Addiction: Exploring Causes, Consequences and Paths to Recovery with Dr. Colin O’Gara

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Content warning: this episode covers the topic of addiction. If you need resources or support, talk to your GP or a relevant health practitioner.

Dr Colin O’Gara is a Consultant Psychiatrist and Clinical Associate Professor at University College Dublin. He is a graduate of University College Cork medical school (1999) and has postgraduate qualifications from the Postgraduate Medical Education and Training Board (PMETB, UK) in General Adult Psychiatry and Substance Misuse Psychiatry. He trained within the NHS Maudsley Hospital rotational schemes at registrar and specialist registrar levels (2000-2006), attaining membership of the Royal College of Psychiatrists in 2003. 

During this time he also researched addiction genetics at the Institute of Psychiatry, London. He was awarded a PhD from King’s College London in 2010. He is a Consultant Psychiatrist and head of addiction services at Saint John of God Hospital since 2007, leading clinical activities, service development, research and teaching programmes in addiction. 

During this time, he has worked with a wide range of talented multidisciplinary clinical and management colleagues, building holistic non-confrontational detoxification and rehabilitation services. His recent academic and service development work has been featured in international journals and medical publications.

Summary

02:46 How has addiction become so accepted in society?

• Through the normalization of gambling in advertising
• Gaming and porn addiction has increased due the the improvement of broadband connections
• If you have impulsive traits, it’s easier to become addicted to things through the internet
• Tech development has lead to many difficulties in our society

06:33 Do addicts get easily addicted to other addictions?

• 50 – 80% of addiction presentations are complicated by some other disorder
• E.g an addict could also be suffering from depression, overuse of phone and hangovers
• It’s important to assess the person first – where they are at and what their needs are
• There is a need for risk assessment
• Substitution is when you withdraw from one abuse and move on to a different type (e.g. from alcohol to smoking)
• The most common substitution is chocolate or cigarettes
• It can lead to other behaviors, e.g. engaging in certain relationships as a means of distraction
• Ideally you want people to engage in adaptive as opposed to maladaptive responses
• Adaptive versus maladaptive – it’s about identifying if the response is causing harm to the individual or those around them

11:19 The relationship between personality types and addiction

• Personality type is not predictive of addiction
• Some classic traits are impulsivity and attention seeking
• They are not deterministic and can’t be simplified down to personality type

14:26 The legacy of Covid-19 on addiction rates

• There is a lot of misunderstanding about psychiatry and what they do
• Withdrawal from alcohol addiction can be fatal, so it needs to be closely monitored
• Covid provided “laboratory conditions” for mental disorders: physical isolation and stress

21:23 How can policymakers strike the balance between freedom of entertainment and rising addiction rates?

• In terms of gambling, if you complete prohibit it, it will still lead to other illegal and more dangerous options
• Banning gambling is completely unrealistic
• We need to look into what protections you can put in place
• If we continue to make AI more addictive, then we’re in trouble
• It would be incredibly powerful to use AI to help identify gamblers that are addicted and need help

25:33 Cultural views on alcohol versus gambling

• There are still cultural issues with alcohol consumption, despite many of the younger generations appearing to embody a healthier lifestyle
• Gambling has accelerated at an alarming rate compared to binge drinking, due to discrete and easy access with technology

27:59 Advice to parents whose children are entering the phase of experimenting as teenagers

• The message needs to be made clear that gambling can be a harmful activity
• Fantasy Leagues can pose as a risk, but they are generally considered to be harmless
• It’s about parents communicating and having conversations with their children
• You get nowhere with a confrontational approach
• Peer pressure doesn’t go away, no matter what age
• It helps to raise awareness of any family history with alcohol or gambling abuse
• It’s important to get down to the meaning of the abuse
• Gambling can also appeal to the ‘get rich quick’ messaging

36:17 Sports supplements with teenagers

• It’s hard to know what the best measure is
• There is a clear connection between addiction and ultra-running
• The line is about identifying what is the harm (e.g. physical, psychological, spiritual, etc.)

42:15 Sports used as a coping mechanism

• Mark Griffiths was one of the academic pioneers researching about exercise addiction

45:23 The neuroscience of addiction

• There are multiple theories on it
• The most accepted theory is the dopamine hypothesis: some individuals are predisposed to addiction because of dysfunctionality of dopamine circuitry
• Addiction is defined as a biologically driven brain disorder

51:00 Some of the key factors that contribute to successful recovery

• Have a support structure around that person
• Consider 12 Step Movement or Life Ring
• The key is to have one-to-one support as well group support
• Talking therapies like CBT, Dialectical Behavioural and Acceptance Commitment Therapy
• Human endeavor and determination gets people far
• It’s incredibly rewarding work for Colin to see people recover
• Yoga, pilates and mindfulness is an integral part of their program
• It’s important to be open to different approaches
• The role of self-compassion is important

59:54 The impact of well-known and public figures be open about their own addictions

• It has had a huge positive impact in raising awareness 
• The next level up is to remove the stigmas behind different addiction types
• We need to put mental health on the same level as physical health

01:04:23 What the future looks like for treatment and prevention

• Review how AI can benefit assessment
• Personalized medicine and develop targeted therapeutics

01:10:17 How Colin keeps a healthy separation between work and personal life

• It’s such a privilege to work closely with people and effect change in their lives
• Self-care is paramount, as well as work management and listening to what is going on in your world

Links Mentioned:

• ‘The Human Mind’ by Paul Bloom
• Colin’s Website
• ‘Gambling Addiction In Ireland’ by Professor Colin O’Gara