Episode 72: Dr. Nicole Labor and the Science of Addiction

Dr. Nicole Labor practices addiction medicine at Summa Healthcare in Akron, Ohio. This is the old St. Thomas Hospital where Sister Ignatia opened the first alcoholic ward in the United States, and who with Dr. Bob Smith treated and cared for hundreds of suffering alcoholics. 

Dr. Nicole Labor

I first learned about Dr. Labor several months ago when a visitor to AA Beyond Belief recommended that we link to a video of a lecture she gave at Kent State on the topic of the neurobiology of addiction. I watched the video and found the presentation so compelling that I watched it several more times, and shared it with friends on Facebook. 

I think that understanding the science of addiction and why it’s a disease is essential. It was certainly important enough to include in the “Doctor’s Opinion” in the Big Book

So, if it was helpful for the alcoholic of 1939 to understand the nature of alcoholism as presented by a doctor who treated alcoholics at that time; then it is equally important for alcoholics living in the 21st Century to receive information from a doctor who treats alcoholics today. 

I would recommend that you take the time to watch the video of Dr. Labor’s talk at Kent State for a more comprehensive presentation on the topic of addiction than what we were able to cover during this podcast. Additionally, you should listen to the podcast at Cover2 Resources to learn more about Dr. Labor’s own personal journey and experience as an addict in recovery. 

In our podcast, Dr. Labor provides a brief explanation of the neurobiology of addiction and the effectiveness of 12 Step programs to treat addiction. Dr. Labor believes the 12 Steps are effective in treating addiction because they help us exercise and develop that part of our brain that is damaged through addiction.

It was an honor to have Dr. Labor as a guest on our podcast, and I thank her for her kindness and for being so generous with her time. 


Kent State Talk: Recovery Rocks

Cover2 Podcast

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  1. Gerald November 14, 2017 at 3:14 pm - Reply

    Thanks for the podcast. Before I listen to the other two links, the Kent State lecture and her personal journey, I just want to comment on a couple things (before I forget what I was going to say).

    I like how Dr. Labor explains how Chronic Stress can prep the mid-brain for addiction b.e.f.o.r.e. the addict ever tries a substance. And I like how she explains that neglect (I assume this includes childhood neglect) is enough of a trauma to create the addicted mid-brain.

    But where my opinion is very different is including eating disorders with all the other “process addictions.” I believe that, for individuals with an eating addiction, food is a substance and that they get high off of the substance, not the activity. And I have plenty of food addicts in the extended family, and I think that’s going be true in most alcoholics’ extended families, so I’ve observed a lot of what I’m going to briefly talk about, which is that agriculture is actually a mind alter inane mood altering substance for these people, “these people” being victims, of course, victims of a disease, not a moral failing.

    If you’re like me and you look at friends and loved ones who have food issues/ addictions/ disorders, the addiction is a.l.w.a.y.s. to Man made food, not God made food, and of course with this audience I’m saying God made tongue in cheek 🙂

    And by Man made, I don’t mean just factory foods & table sugar but I mean all those agricultural inventions that were foreign to our species in the tens of thousands of years that we walked this Earth as anatomically & p.s.y.c.h.o.l.o.g.i.c.a.l.l.y. modern human beings, those foods being the cereal grains (e.g. wheat, rice, corn), the legumes (e.g. beans, peas, lentils), starchy tubers (potatoes), and sugars including not just milk sugar but all kinds of super sweet food sources like the proverbial apple a day that keeps the doctor away, where we find out that the apple, as we know it today, didn’t even a few thousand years ago and has been so altered, by man, from its ancestral form to become a sugary food source that no longer resembles the kinds of plant foods that were native to our species a mere ten or five thousands years ago, before agriculture and the Dawn of Civilization.

    A Google search will lead you to credentialed people, MD’s, PhD’s, psychiatrists, researchers; you don’t have to take just my word for it, but here’s what I would like to add to the discussion: “these people,” victims of agricultural carbohydrate “maldigestion,” are always, always, always addicted to the sweet ‘n’ starchy Man made foods that do not resemble the kinds of God made plant foods that were native to our species. They never, ever, ever go off the deep end with animal flesh, for example, or fish head soup, Romaine lettuce, beef liver, parsley or some other kind of non-sweet, non- starchy plant food that resembles that kinds of plant foods that native to our species for several tens of thousands of years that we existed as psychologically modern human beings.

    So, I’m returning to Dr. Labor’s podcast here shortly and relating this back to brain chemistry and the interplay between the diseased midbrain and the moral/ spiritual frontal cortex. The point is, models like Dr. Labor’s model, yes, can explain why 12-step does work to overcome addiction, but, the models fail to explain why, years sober, so many recovered addicts s.t.i.l.l. don’t feel good sober.

    The nutritional models, in contrast, can explain why, years later, recovered alcoholics are s.t.i.l.l. “sometimes up and sometimes down.” Paleo diet models, for example, very simply: millions of human beings, billions really, still today are actually not well adapted to high carb diets, and an agricultural diet, by the way, is super, super, way carbier than anything our ancestors ever consumed. The physical consequences of the improper digestion of these carbs include unnatural microbial waste products that enter our blood stream from the digestive tract and exert a deleterious effect upon the brain.

    That is just one mechanism that the credentialed professionals will suggest. There are other proposed mechanisms, and you can google that stuff if you’re interested.

    … You know, in my first home group they’d say things like “What step were you working when you picked up that drink?” That model of addiction and recovery, let me reiterate is incomplete. This is Dr. labor’s model, as it is the prevailing model in the medical communities. It’s not a bad model. It’s not all wrong, but you know, again, the nutritional models can explain why the psychological/ spiritual models aren’t entirely effective e.v.e.n. w.h.e.n.  the addict actually does follow the instructions in the Big Book, for example 🙂



  2. life-j November 8, 2017 at 8:41 pm - Reply

    Now I’m not going to be a doctor, so maybe it doesn’t matter much to me, but I’m still curious: Roy Eskapa, and Dr Sinclair (the Naltrexone people) talk about endorphines, dr Labor talks about dopamine  – though the mechanism they describe is the same. Dr Gabor Mate talks about both, in this excellent talk:

    – but still in such a way that i still can’t really tell what’s what, and why. Then there are apparently at least a couple more brain chemicals involved, serotonin, and oxytocin – i imagine all this will get sorted out over the next few years.


  3. Justin November 8, 2017 at 8:29 pm - Reply

    Great episode. Thanks to Nicole and you.

  4. life-j November 8, 2017 at 7:11 pm - Reply

    Didn’t listen to the podcast yet, but I did watch her Kent State talk, and it was very good. I learned a lot.

    I would say there seemed to be evidence that she was a bit too uncritical of the 12 step recovery model, but then again, she can’t get into everything in one talk.

    thanks for putting this on

  5. Jennifer November 8, 2017 at 10:11 am - Reply

    I just finished the Kent State lecture… WOW!! It put together all of my sober behaviors and explained why I got sober this time. Even leaving my husband of 12 years and moving out at 3 days. I needed detox. Now I know if a newcomer enters the rooms to recommend detox. Thank you.

    I am the parent of an addict and being the good Al-anon I am – I sent him the link… Now to get off the addiction of being addicted to the addict. Being an alcoholic/addict, I realized what step 1 meant to me in Al-anon after 3 years of attending at least two meetings per week. I realized, I called, checked on, obsessed about the addict like a drug. I do things I don’t want to do. I even run red lights if I am obsessing and stuck in the addiction pattern of thought. I do what I don’t want to do and don’t know when it will stop…. I feel like I am dying if I don’t hear from him. It’s horrible. I am not alone.

    Thank you for the information. It is so valuable for my recovery from “addiction”.

    • John S November 8, 2017 at 12:08 pm Reply

      Hi Jennifer. I’m glad you were able to listen to the Kent State lecture. I really enjoyed that. It was probably the first time that I heard someone explain the science of addiction in a way that I could comprehend. It makes sense to me.

      Thank you so much for listening and commenting. I appreciate that.

  6. bob k November 8, 2017 at 9:59 am - Reply

    Kudos to Dr. Labor for a plain-spoken, and extremely articulate presentation. The dopamine rewards system theory may not be perfect, but it explains some things like “substitute” drugs and medications firing up the old cravings for one’s drug of choice, or drinking. Her explanation of “people, places, and things” as a 3rd promoter of relapse evoked memories of classical conditioning in Psych class. Pavlov’s dog’s salivating reaction to a bowl of food, eventually is elicited by just the bell. The old drugging buddies, and locales are the “bell” that stimulates an old reaction.

    I likes the steps talk, as I see great benefit in those. I didn’t care for the 100% success talk, “IF the steps are done 100%.” That drops our well-spoken friend pretty solidly into the fundamentalist camp.

    People of my ilk, do not do the steps 100%, or, as written. Of course, 99% of those claiming they do, don’t either.  😉

    • Jennifer November 9, 2017 at 9:28 am Reply

      “People of my ilk, do not do the steps 100%, or, as written. Of course, 99% of those claiming they do, don’t either. ” So true!

    • John S November 8, 2017 at 11:59 am Reply

      Yeah, I don’t know if she is very familiar with us heathen AAs. I’m like you in that I believe we need to change and the steps are a good way to achieve that change. However, it’s tough to say they are 100% effective.

      It makes sense to me that our brains are being rewired when we start forcing ourselves to think differently, and the Steps did this for me. I was at least willing to try to become less selfish and to be a little more introspective about how my actions impact others. Those are the so called “spiritual principles” that I think are healthy and do help with healing from addiction to alcohol.

  7. Jennifer Copper November 8, 2017 at 8:17 am - Reply

    Excellent! Thank you.

  8. John S November 8, 2017 at 7:24 am - Reply

    I was a bit nervous while interviewing Dr. Labor, but I don’t think it shows too bad and it came out pretty well. I had an outline for the conversation an was pretty much following a line of questions that I had written.

    Dr. Labor is a recovered addict who today practices addiction medicine at Summa Healthcare in Akron, Ohio. She works at the same hospital where Sister Ignatia and Dr. Bob set up the first alcoholic ward in any hospital in the US.

    I learned about her from a video posted by a reader of AA Beyond Belief. The video was a talk she gave for Recovery Rocks at Kent State about the neurobiology of addiction.

    Her presentation was really interesting and covered a subject matter of which I was for the most part ignorant. Since embracing atheism some years ago, I find that I value science more than I had in the past and I like to understand things. This, of course, isn’t true only of atheists, even back in 1939, it was important for people to understand alcoholism which Dr. Silkworth referred to as an illness and an allergy. His description of what was happening was really pretty accurate, but today we understand a lot more about what is happening.

    Alcoholism is an addiction, and addiction isn’t specific to a drug. In other words, according to Dr. Labor’s view, we shouldn’t think of it as alcohol addiction or cocaine addiction or heroin addiction, etc. It’s simply addiction. Regardless of the drug of choice, the brain is reacting the same and what’s happening is a change to how the brain is reacting to the significant increase in dopamine that is released after the drug of choice is ingested. What we have is not necessarily a drug or alcohol problem, but instead according to Dr. Labor, we have a brain disease a dysfunctioning reward system, we have a dopamine addiction. All addiction is the primitive portion of the brain thinking it needs more dopamine.

    All of this happens when a gene for addiction is activated and once activated we can no longer safely use any drug that people abuse, including marijuana.

    I was curious about relapse and why humans relapse after periods of sobriety. Dr. Labor said a lot of the time it happens innocently if we are given a medication for a legitimate need. She says it’s important if we are having to take something that increases dopamine levels to be sure to increase our meetings. She also says that we can be triggered by people, places and things that remind our brain of that dopamine effect.

    Dr. Labor is a firm believer in the 12 Steps and she doesn’t shy away from urging people to develop spiritually. However, she is not trying to use the word spirituality in a religious or supernatural sense. What she is talking about is the necessity to exercise and develop our frontal cortex, the part of our brain that is concerned with ethics, decision making, etc. Addiction was numbing our frontal cortex so it’s important that we develop it as part of our recovery.

    I hope you enjoy the podcast. I would also recommend that you check out the links to her talk at Kent State and the Cover2 Podcast.

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