Addictions: A Conversation With The Psychiatrist Alejandra Hallin And The Psychologist Lora Pavlova

Alcohol, substances, internet, social media... Addictions have been part of the history of humanity, and as part of history, they evolve and transform.

Alejandra Hallin began her career at Harvard Medical School. She worked as a psychiatrist, child psychopharmacologist, clinical psychiatrist until today being medical director and manager of her clinic, Hallin Mental Care. Today she is specialised above all in mental health, and therefore, our expert today to talk about addictions. With you, "Addictions", with Lora Pavlova —COO & Co- Founder of Webster&Co, and also, psychologist— and Alejandra Hallin. Welcome to the first edition of Webster Talks.

It's an honour to be part of Webster Talks. I'm half Spanish — my father is Swedish, but I grew up in Spain and studied medicine at the Universidad de Navarra. I then moved to New York to study general and adult psychology at NYU, followed by further training in Boston, where I was eventually offered a position and stayed. In the early 2000s I returned to Spain and began practising independently. The practice grew gradually, patient by patient, until we reached the point we're at today — over 800 visits a month and a team of six psychologists working alongside me. We have a very personalised clinic, and we love what we do.

For you, what is addiction? Because I think many people genuinely don't know the definition of the word.

It's an excellent question, because even patients who suffer from addiction don't really know the definition. Every day people sit in front of me and say, "I don't drink every day, so I'm not an alcoholic." I stop them immediately. That is not the definition. Addiction is a form of behaviour — and it is not tied to any substance. You can be addicted to gambling, to the internet, even to work. These are topics that dominate the lives of young people today, and those same young people don't realise that what they're experiencing is addiction. The term refers to a stage of behaviour in which you lose complete control, and in which that loss begins to take parts of your life away from you. I have worked with patients who flatly deny having an addiction — they hide it from themselves. In fact, one of the earliest stages of addiction is denial. The refusal to acknowledge being an addict is one of the most common reasons the subject stays hidden, stays unaddressed. There is an enormous knowledge gap that means that sometimes not even the addicts themselves are aware of their situation. That is a serious problem, addiction is.

Tell me about the stigmas and misconceptions that surround addiction.

There are quite a few. One of the most common is "if I don't consume it every day, I'm not an addict" — that is an absolute myth. Another is "if I stay below a certain quantity, I'm fine; if not, then I have a problem." Many people simply don't realise that what they are doing constitutes addiction, and that it is not normal. Both the addict and their environment overestimate the degree of control that exists. "I have control — I managed to do Dry January." Yes. But you have been drinking every day for the rest of the year. It has been affecting your life, you have been drifting away from the people around you, your relationship may be on the verge of collapse — but yes, you completed Dry January. There is some control, certainly. But the moment that control costs you your life, you have an addiction.

What do you think is at the root of an addiction? Is it the addiction itself, or is it always covering something else?

Both. Addiction is a multidimensional, multifactorial disorder. It is never only genetic, never only environmental, never only the result of a mental health condition. Many factors converge. In some cases you have people who are simply excessive consumers. In others, the substance use is a direct consequence of ADHD, depression, or a history of abuse. The addiction is real in both cases, but what drives it and how it must be treated can be very different.

Something many people overlook — and something I remember from my first days working alongside you — is the genetic component. Can you speak to that?

It's enormously important. After so many years in this field, I believe firmly that genetics play a significant role in how we behave. I am not saying we are dictated by our genes — we are not — but you must grow up knowing your genetic disposition. If your family has a long history of addiction, there is essential psychological work to be done so that the next generation does not normalise that as their path. Families have to be conscious of not passing down the same patterns, the same normalisation they have lived with, generation after generation. Genetics matter profoundly when it comes to substance abuse — they destroy families. The analogy I always use is diabetes: if it runs in your family, you educate yourself, you watch your diet carefully. The same logic applies here. Where you cannot prevent an illness, you must manage it; where behaviour is involved, education gives you genuine freedom to choose a different path.

And what about environment? How does it interact with the genetic component?

Environment is everything. You may carry a genetic predisposition and still never become an addict if your environment is healthy and stable. The probabilities of falling are dramatically lower. It doesn't eliminate the risk, but it transforms it. Just as genetic predisposition can be resisted through awareness and choice, the absence of it offers no protection if you begin consuming. If you start using substances purely by will, you can become an addict regardless of your family history. It is also very common to encounter what we call dual diagnosis — a psychiatric disorder alongside substance dependence. Someone who suffered from anxiety or depression in their youth and began drinking to feel calmer has, over time, converted a coping mechanism into a habit, and a habit into an addiction.

What do you think about alcohol as an addiction and as a gateway to other addictions?

Just this morning I was speaking with the first patient I treated, and talking with the family I told them exactly what I will say now. Alcohol in these cases is not THE problem, but it is a problem. Alcohol is an disinhibitor, it disinhibits the mind and it is the door that can open you up to consuming more substances. You have to be very careful because many substances open the door to consuming others and to more addictions, and alcohol is the most accepted and established substance. And above all, it is the substance where the most social pressure is exerted among young people. "Have a drink, you don't drink? How boring!"

How far does addiction take things from a person? How much does it actually take away?

It depends on the person. There are people whose addiction has taken everything from them and left them with nothing to recover. There are people whose brains have been so directly affected by substances that the damage reaches a point that is terrible and, in some cases, irreversible. Alcohol is one of the leading causes of dementia — it destroys neurons at a massive scale. And that destruction can begin even before birth: if a mother drinks during pregnancy, the alcohol can begin killing the neurons of the unborn child.

How deeply does addiction affect a person neurologically?

The moment you are caught in the grip of addiction and dopamine is flooding the system, that excess perpetuates the problem entirely. The prefrontal cortex — the part of the brain that governs rational decision-making, that tells you to stop — is, in effect, overruled. Dopamine is running the show. You need to stop consuming for a sustained period before dopamine levels begin to recalibrate and that rational part of the brain can regain any authority. And even then, nothing guarantees that those levels will remain stable. One in three relapses is associated with emotional triggers — which is precisely why learning to recognise your emotions and manage them differently is not peripheral to treatment. Dopamine is the hormone that addiction releases in excess — and it is that excess that perpetuates the cycle. The idea is not to substitute that excess with something else, because then we would simply be replacing one addiction with another. The goal is to become conscious of the fact that the excess will regulate itself over time, and to allow your life to reorganise around that process. Regulation, not substitution.

We have spoken about how addiction begins, how it takes control and how easily it can remain hidden — even from the person living through it.

But once addiction has taken hold, what does recovery really look like? Can the brain fully recover? Why do some people relapse while others manage to rebuild their lives? And, above all, what can families do before it is too late?

We continue the conversation with Alejandra Hallin in Part Two of Webster Talks.