How to Overcome Addiction to Substances or Behaviors | Dr. Keith Humphreys

In this podcast episode, Dr. Keith Humphreys, a professor of psychiatry and behavioral sciences, shares comprehensive insights into addiction, covering its biological, psychological, and societal dimensions. The conversation delves into various addictive substances and behaviors, including alcohol, cannabis, opioids, gambling, stimulants, and social media. They also explore treatment approaches, the neuroscience underpinning addiction, the impact of commercial industries promoting addictive products, and emerging therapies like psychedelics and GLP-1 agonists. The discussion further touches on the cultural and personal aspects of addiction, recovery, and the importance of social support systems.

Understanding Addiction

Dr. Humphreys opens by framing addiction not as a singular act or habit but as a progressive, harmful persistence of behavior despite adverse consequences. It entails a narrowing of pleasure sources until the addictive substance or behavior becomes the only perceived reward. He compares addiction to a form of maladaptive learning, where behaviors that once might have been enjoyable or manageable evolve into destructive compulsions. Genetics play an influential role in susceptibility to addiction, but addiction is never innate; instead, it's a learned, complex condition influenced by biology, environment, and individual experience. He stresses that addiction is distinct from casual heavy use or "use disorder," particularly emphasizing that severe use disorder aligns more with the clinical conception of addiction.

Alcohol Use and Addiction

Alcohol serves as a prime example for discussing addiction due to its legal status and social ubiquity. Dr. Humphreys highlights individual variability in alcohol response, pointing out that about 8 to 10% of people experience it as an energizing dopamine stimulus, increasing their risk of addiction. Genetic factors influence tolerance and subjective experience, shaping addiction risk. He clarifies the difference between "alcohol use disorder" and "alcoholism," noting that mild use disorder often does not resemble addiction and can be managed with light interventions. The widely debated idea of alcohol's heart health benefits is addressed critically, with Dr. Humphreys affirming that any potential cardiac advantages are eclipsed by increased cancer and other health risks. He also discusses gender differences, noting that women's drinking rates have risen due to targeted marketing campaigns and that women are more susceptible to alcohol-related cancers and harm per unit consumed. The social dynamics surrounding drinking — such as peer pressure and vulnerabilities in social situations — are also explored.

Cannabis: Changing Landscape and Risks

The episode contrasts older, low-THC cannabis with today's much more potent products, highlighting a roughly 65-fold increase in potency through legalization and commercial proliferation. Daily use of stronger cannabis raises addiction potential and associated risks like impaired cognition and life outcomes such as "failure to launch." Though some high-achieving users exist, they are exceptions rather than the norm. The risk of psychosis, especially in young men with familial susceptibility to schizophrenia or bipolar disorder, is examined with increasing evidentiary support. The complexity of medicinal versus recreational use, and the varying impacts of smoked versus edible cannabis, are discussed. Dr. Humphreys cautions about effective regulation and public health messaging given the powerful industry forces in play and the presence of gambling-like marketing tactics targeting youth and adults alike.

Other Addictions: Gambling, Stimulants, Social Media

Gambling addiction is uncovered as among the most devastating behavioral addictions, characterized by repeated losses and chasing novel stimuli, rather than purely financial rewards. The evolution of addictive design in slot machines and online gambling apps is discussed, with an emphasis on technological advances that augment addictive potential. Stimulant addiction, including prescription drugs like Adderall and illicit substances like cocaine and methamphetamines, is acknowledged as a pressing clinical challenge with limited effective pharmacotherapies. Behavioral contingency management emerges as the most promising approach for stimulant abstinence. Social media and digital addiction are recognized as pervasive new frontiers with unclear long-term impact but increasing reports of compulsive use interfering with life. The distinction between healthy versus pathological engagement remains murky, and public norms around usage are yet to fully develop.

Genetics, Vulnerability, and Developmental Factors

Dr. Humphreys emphasizes that early exposure and neurodevelopment play critical roles in addiction risk. Programs targeting youth prevention are vital because the brain exhibits heightened plasticity and vulnerability to addictive learning during adolescence. Genetic predispositions interact variably by sex, substance, and behavior, shaping personalized risk profiles. However, genetic risk is never deterministic, as environmental factors and personal decisions modulate outcomes. The idea that some addictions simply "switch" their manifestation over time — where recovery from one substance could see rise in other compulsive behaviors — highlights the complexity of underlying vulnerabilities.

Treatment and Recovery Approaches

The importance of personal motivation and individual reasons for change is underscored as foundational in treatment engagement. Clinicians must help patients articulate their desires to quit and build internal motivation rather than impose external judgments. Social support and accountability through group activities or recovery communities significantly boost success rates across addictions. Participation in groups such as AA or other fellowships provides immediate access to peer support and fulfills crucial psychological needs in recovery. Dr. Humphreys stresses the therapeutic power of belonging to a community on the same journey, offering both encouragement and practical accountability.

12-Step Programs and Their Impact

12-step fellowships such as Alcoholics Anonymous are discussed thoroughly, highlighting their unique strengths: accessibility, anonymity, peer-led support, and culturally adaptable frameworks. Extensive research reviewed by Dr. Humphreys and colleagues affirms that AA and related programs surpass many professional therapies in maintaining abstinence from alcohol. While criticisms exist about their religious framing, their spiritual interpretation is flexible and non-dogmatic, focusing on letting go of ego and accepting help beyond the self. Although evidence for 12-step efficacy in drug addiction is somewhat less clear, participation correlates with better outcomes for many. The social, psychological, and behavioral components of these programs play a critical role in sustaining recovery.

Emerging Therapies: Psychedelics, TMS, and GLP-1 Agonists

There is cautious optimism about novel treatment modalities. Controlled clinical use of psychedelics such as psilocybin shows promise for severe depression and addiction when combined with guided therapy, though challenges remain, including the risk of "bad trips," relapse of symptoms, and the need for more rigorous, standardized research. Non-hallucinogenic analogs and neurostimulation methods like transcranial magnetic stimulation (TMS) offer additional avenues with fewer risks and easier integration into clinical settings. Dr. Humphreys is particularly excited about GLP-1 receptor agonists, originally developed for diabetes and obesity, which have shown intriguing potential in reducing cravings and consumption of substances like alcohol. These drugs may help reduce the "wanting" or desire underlying addictive behaviors, providing new tools for treatment.

Addiction, Death, and Existential Dimensions

The discussion touches on the profound intersection between addiction and fear of death. Dr. Humphreys recounts his experience working in hospice, describing how acceptance of death enables care and peace rather than fear and avoidance. Addiction's temporary states of oblivion or euphoria can be seen as attempts to evade unpleasant realities, including mortality. Confronting mortality with acceptance and support may therefore serve as a powerful, though complex, dimension in addiction recovery. This existential aspect reinforces the importance of psychological and social interventions alongside biological treatments.

Public Health, Policy, and Industry Influence

The dialogue highlights how addiction industries—tobacco, alcohol, cannabis, gambling, and increasingly pharmaceuticals—intentionally optimize products for addictiveness due to profit motives. Marketing campaigns, especially toward vulnerable populations like youth and women, and regulatory capture pose severe public health challenges. Policy progress such as parity laws for addiction treatment coverage and Medicaid expansion have improved accessibility but face threats from budget cuts. Restricting advertising and implementing taxes targeting heavy users emerge as key regulatory strategies. Dr. Humphreys emphasizes realistic approaches blending compassion, evidence-based treatment, and intelligent regulation to mitigate harms.

Addiction's Social and Family Impacts

Addictive behaviors profoundly affect family systems and interpersonal relationships, often generating cycles of shame, mistrust, and dysfunction. The common notion of codependence, often applied to partners or families of addicts, is largely a reaction to living with addiction rather than a distinct personality type. Recovery frequently reveals the "real person" beneath the addiction, shining light on the change and hope possible for families and communities. Honest communication, empathy, and support sustain healing across affected individuals.

Gender Differences in Addiction

Men generally exhibit higher rates of substance use and addictive behaviors across cultures, but recent trends show rising female consumption influenced by targeted marketing. Women experience greater physiological harm per unit of alcohol or drug consumed, increasing cancer and other health risks. Understanding these sex differences is crucial for tailored prevention and treatment approaches. The episode also explores how social and cultural dynamics shape addiction pathways and recovery differently by gender.

Behavioral Addictions and Modern Challenges

As society confronts new forms of addictive behavior—excessive social media engagement, online gaming, pornography, and smartphone overuse—the evolving landscape poses novel public health questions. The addictive qualities of novelty, reward timing, and social reinforcement translate into digital contexts. There is presently limited understanding of long-term trajectories, but reports of dysfunction and "failure to launch" among youth highlight urgent need for research and intervention strategies. Community norms, parental guidance, and emerging technologies to limit compulsive use may be part of future solutions.

Relapse and Recovery Dynamics

Relapse is a frequent but complex component of addiction recovery, occurring not only in times of stress but also during periods of apparent stability and success. Understanding that relapse does not equate to failure but is part of the recovery process helps destigmatize and manage expectations. The neuroscience of craving, cue exposure, and brain circuit alterations underlines why insight alone is insufficient; patients may lack conscious control over implicit urges. Recovery strategies must incorporate behavioral skills, environmental modifications, and ongoing social accountability.

Clinical Perspectives on Stimulants, Prescription Medications, and Nicotine

Prescription stimulants for ADHD, while potentially beneficial, pose concerns about overprescription, side effects, and impact on growth and sleep. Non-medical use underscores the importance of careful diagnosis and management. Nicotine is a highly addictive stimulant with physiological effects producing both arousal and relaxation, commonly misunderstood due to withdrawal symptom relief masquerading as benefit. Despite its toxicity and aging effects, nicotine maintains high prevalence due to its psychoactive properties and industry influence.

Neuroscience of Addiction and Potential Treatments

Addiction rewires brain reward and control circuits, especially areas like the nucleus accumbens, leading to powerful cue-triggered cravings often beyond conscious awareness. Imaging studies reveal brain activation predicts relapse more reliably than self-report, explaining the common experience of ambivalence and failed intentions. New interventions including brain stimulation aim to modulate these circuits directly. Recovery ultimately depends on both neural plasticity and psychosocial support, reflecting the multidimensional nature of addiction.

Summary of Practical Treatment Advice

Helping individuals who wish to quit starts with affirming their courage and normalizing the difficulty of change. Motivation must be elicited internally rather than imposed, with tangible personal goals and strategies to reduce exposure to cues and triggers. Social support groups provide critical encouragement and accountability, helping sustain effort through withdrawal and early recovery challenges. Clinicians guide patients in identifying risky situations and building alternative fulfilling behaviors to replace harmful ones.

Addiction Across the Lifespan and Socioeconomic Context

Addiction disproportionately affects vulnerable populations, including the unhoused and socioeconomically disadvantaged. Policy efforts face tensions between civil liberties and mandated treatment, balancing protections with effective interventions. A combination of supportive housing, community programs, and legal leverage can facilitate recovery, but sustained political and social commitment is required. The episode notes the ongoing opioid and fentanyl crisis and stresses harm reduction and informed awareness as critical.

Impact of Media and Advertising

The role of advertising in shaping substance use norms and driving demand is examined, with alcohol and cannabis industries cited for targeted marketing. Comparisons with pharmaceutical ads reveal the unique challenges posed by omnipresent and persuasive messaging. Calls for stricter regulation of addictive product advertising and responsible social media design reflect broader public health goals. The societal normalization of drinking, gambling, and drug use underlines the need for preventative education and policy reform.

Addiction's Intersection with Mental Health Treatments

Discussion includes SSRIs and their debated relationship to violence or suicide, with scientific evidence disputing simplistic causal claims. The complexity of long-term medication side effects and patient experiences is acknowledged, underscoring the need for personalized care. Modern depression treatments including TMS and ketamine offer diverse options, but all require cautious evaluation of benefits and risks. Integration of behavioral therapy with pharmacology remains a cornerstone of effective mental health and addiction treatment.

Addiction as a Journey of Rediscovery

Recovery often entails profound personal transformation, including rebuilding relationships, regaining identity, and discovering new sources of joy and meaning. Successful individuals often highlight the shift from compulsion to choice and from despair to hope. This ongoing process is deeply personal and non-linear, reflecting the intertwined biological, psychological, and social facets of addiction. Finding one's "peeps," cultivating humility, and embracing sobriety as both challenge and gift exemplify this path.

Final Remarks

Throughout the discussion, Dr. Humphreys combines scientific rigor with compassion, underscoring addiction's complexity while offering practical wisdom to individuals and society alike. His emphasis on openness, evidence-based interventions, and human connection aims to demystify addiction and expand pathways to recovery for millions affected worldwide.