I was surprised to hear all the drugs he did. I hadno idea that he was drinking that much, or that hewas high every day in school.
I'd get up some mornings and I'd be like, man,today's gonna suck. If I had some prescriptionpills left over from the weekend, I'd pop a coupleof those.
This is a disorder of young people. Very littleaddiction starts after the age of 30. It almostalways starts between the ages of 18 and 25.
How can we comprehend the concept of a personthat wants to stop doing something and theycannot, despite catastrophic consequences?We're not speaking of little consequences. Theseare catastrophic. And yet they cannot controltheir behavior.
There've been so many things that I haven'taccomplished because-- because of the problem, Ithink.
My drinking's killing me. I desperately need help.
The right medication with the right therapy reallycan give an individual a leg up in recovery.
There are more treatments available. There'sbetter understanding. There's more acceptancethat this is a medical condition with real medicalsolutions than there ever has been.
This whole addiction ruling your mind andthoughts-- even though I've lived through it, I stilldon't understand it.
How can we comprehend the concept of a personthat wants to stop doing something and theycannot, despite catastrophic consequences?We're not speaking of little consequences. Theseare catastrophic. And yet, they cannot controltheir behavior.
Drug addiction is a disease of the brain thattranslates-- that that disease translates intoabnormal behavior. Addiction is a result ofadaptations in the brain that leads to changes inbehavior that translate, among others, in theinability to control the intake of the drug. Theirbrains have been modified by the drug in such away that the drug makes a signal to their brainthat is equivalent to the signal-- if I have to comeup with a metaphor-- of when you are starving--the signal of seek the food and eat it when you arestarving. That's what the parent has tounderstand or the spouse has to understand, thatthere's been a change, an adaptation, from theuse of the drug that leads to the situation ofalmost as if the individual was in a state ofdeprivation, where taking the drug isindispensable for survival. It's as if their brainwere sensing that the drug is something that'snecessary for survival. It's as powerful as that.
It's likely to be multiple factors. But one of theones that is likely to be very important is geneticdifferences. We're all born differently. And likewith any other disease, there are some peoplethat are more vulnerable, for example, fordepression. Or they may be more vulnerable forhypertension or for cancer. The same thing withaddictions. There are some people that becauseof hereditary reasons are more likely to becomeaddicted to drugs. This is one of the elements.Environment-- we know that there are someenvironments that are actually higher risk whilethere are other environments that are protective.For example, which are high-risk environments?High-risk environments are ones where you havekids, for example, where they are in a householdwhere no parent surveillance, high levels of stress,high levels of abuse, high levels of accessibility ofdrugs. Well they have the drugs in front. Theyhave no constrains. They have little alternativebehaviors. They'll start to take it. They areadolescents. And that's a vulnerability period.You're more likely to become addicted if you startin adolescence or in childhood. So those areelements that are likely to be playing a role.
The answer is depends what drugs you've beentaking, depends how long you've been taking it.And also there are differences between people.One of the messages that I do say is very clearly--particularly young people-- our brain has atremendous capacity for recovery, much morethan what we thought in the past, even as adults.Our brain is what we call plastic. So even though,yes, that repeated use of drugs leads to damageof certain areas of the brain-- It leads to changesin the way that we may perceive emotions. Itleads to changes on the way that we makedecisions. It leads to changes in memory. It leadsto changes on your motor reflexes. So it makesyou slower. All of those things can recover to acertain extent.
They're going to have to take steps to minimizethe chances that they relapse, to minimize thechances that they will hurt others. That entails aseries of changes in their behavior that includesadherence to treatment, that includesrecognitions of situations where they can actuallyget back into the drug and relapse to avoid them,recognition of situations where there actuallycould lead to dangerous behavior like drinkingand driving. The person that's addicted has totake responsibility that they have a disease.
In diseases whether it's something like cancer orwhether it's something like addiction, you want todo an aggressive intervention that increases thelikelihood of helping the person. If that involves astrong behavioral intervention-- a 12-stepprogram and medications, why not? Why limit itto this or that? If a person can benefit from amedication to help them engage on the 12-stepprogram, why not explore it? Certainly medicationis not going to be by itself, in most instances,sufficient. You will require more than medication.You will require behavioral intervention.
There are many reasons why people may not becompliant to treatment. One of them, let'saddress it-- the program is not a good program, sothe person cannot be compliant. It doesn't havethe elements that will engage the patient.Another one may be that the treatment is verygood, but it's not actually fit the person. Andagain, we are in a situation that is not one-size-fits-all. So you can take a kid and push them into aprogram that it's predominantly of adults where itactually is not going to work properly. Thenthere's the other element, are their individualsthat are more resistant to treatment, or in otherwords, are there individuals that are moreaddicted for which it's much harder to stop them?And evidently there is. There are geneticdifferences that not just makes you, for example,more vulnerable to take drugs, but may make youmore vulnerable to actually become moreseverely addicted. The longer you have becomeaddicted to a drug, the harder it is for you torespond to treatment. And that's where theimportance of doing an early intervention is sokey. So it's much harder to treat someone that hasbeen addicted to cocaine for 30 years than it issomeone that has been addicted to five or six orseven or eight years. And the same thing pertainsfor other drugs like alcohol or cocaine or nicotine.
One of the surprises when I took this position-- Ialways was under the notion that to be able totreat the drug-addicted person, they have to bewilling to want to stop taking the drugs. One ofthe things that I rapidly learned was that I waswrong. But that was the prejudice of mine andmany of my colleagues. And I was-- and whatmade me realize was wrong was when I started toread about the successes that are coming upwhere-- from treatments from the drug-courtsystem or for programs that institute treatment inthe prison will show that mandated treatment iseffective. The data is there to prove it. When youlook at the numbers, and you see them replicatedunder very different conditions with differenttypes of drug addicts, and it works, you start tocome to recognize that the notion of voluntarytreatment is not indispensable for success.Mandatory treatment works. And that's why it's an extraordinary opportunity in the criminaljustice system to intervene and start treatingpeople that are addictive.
Mental disorders and drug addiction appears tobe almost more the rule than the exception.Which are those mental disorders that make youmore vulnerable to take drugs? You name it--schizophrenia, depression, anxiety disorders,post-traumatic stress disorder, conduct disorder,learning disabilities, attention deficithyperactivity disorder. In many instances, theperson may have started to take the drugs as amechanism to auto-medicate. Despite this, wetreat these two things as if they weren't co-occurring together. You treat the addiction, butyou don't deal with the depression, they'reactually going to, in fact, relapse in that instance.They are so closely intertwined that it has been a tremendous disservice for the field not torecognize the importance of actually treating bothof them.
Family and friends can play a very important rolein helping someone to go to treatment and toencourage them and motivate them to stay intreatment. And so they play a role at both thosestages-- number one, making the personrecognize that they do have a problem withaddiction, that they do need help, which is notsomething that occurs automatically. That is tosay it does require some insights to understandthat there is a disease going on, and that it isunlikely to go away by itself.
The anger that has been built up in a family whenthere is one of the individuals that's addictedleads to a confrontation. Either you do that oryou're out. And again, in some instances thatworks. But in others it alienates because whathappens is the person leaves the house. If it's anadolescent and it leaves the house they may bereally on their own. And they may be pushed intoan environmental condition of tremendous stress,that without a structure to support them can leadthem further into the drugs.
Once they go into the treatment, the family canplay an extremely important role to maintain themotivation to stay in the treatment. Again, thefamily many times needs to be treated. The familyitself-- because there's so much these disruptionthat there are very abnormal patterns in thecommunication of the family members thatdevelop as a result of the addiction. If not dealtwith, those abnormal patterns may contribute torelapse.
In many ways not completely different of how youevaluate if a physician that's recommended foryou for treatment is good or a hospital, you relyon what the track record of that particularprogram is. And how do you rely on that trackrecord? There's in certain instances, there isinformation about the particular center that doesprovide their history. There's information frompeople that have gone through those treatments.So you go about in many ways in a similar waythat you would go when you're seeking for asurgeon to do these procedures. So there is thataspect to it.
12-step programs are actually probably the mostfrequently utilized treatment variety for drug addiction and they are part of the recoveryprocess. And they are based on programs, 12-stepprograms, are based on taking advantage of thepeer influence in helping the person that'saddicted to drugs stop taking the drugs. So theyrely very much on a peer process.
Is it enough to have a 12-step program and whatwe know from past experience is that in certaininstances it is enough. But in others it's not. Itbrings forth the concept there is not onetreatment that fits all. And there is neither onetreatment that fits a given person at all stagesduring the addiction process. So while step-- 12-step programs may be very helpful for anaddicted person during the recovery phase, theymay not be sufficient to maintain them during thedetoxification.
So again you have to evaluate and tailor theneeds of the individual to where they are at todetermine at what stage, for example, a 12-stepprogram would be beneficial for them or whetherit could at all be beneficial. There are somepeople for whom the 12-step program does notwork, whereas in others they are very valuableand has been able to help them stay clean foryears.
Addiction can happen to any kid, to any kid.There's no one really that is protected. There areprotected environments. But nobody'scompletely protected. So I think that the alertnessthat kids are at greater danger of drugs issomething that parents should be alerted about,not become paranoid, but be aware of this as areality.
There's nothing that I have seen that disruptsmore a family than having a kid who's addicted. Itcan be drugs or actually it could be alcohol. It canreally disrupt the family, so the parents becomevery angry at the kid. And the kid then reacts out.And then you start to create the dynamic that'svery negative. That's not going to help theadolescent. Nor is it going to help the parent,because the adolescent will rebel against thesenegative attitudes.
The family has to understand when they get veryfrustrated about-- well, my child is stealing fromme. He's lying to me left and right. I've got it. Icannot deal with that child anymore. First, theyhave to stand back and say, first of all their brainhas been affected by the drug. So a lot of thesebehaviors that are so unacceptable, in fact, areconsequences of the exposure to the drug.
Drug addiction is a disease that, in mostinstances, lasts for a very long period of time.There are many chronic diseases. We know, forexample, asthma. And you have asthma for many,many years. And that means-- what does it meanif you have a chronic disease? It means you needtreatment for a long, long period of time. So thesame thing happens with drug addiction. Youneed treatment for a long period of time.
So initially during the early detoxification phasesand the early stages of the recovery, you need amore intensive type of treatment. And as you startto restructure your life, the frequency at whichyou have to seek the treatment becomes less so.But still it improves the outcomes to maintainsome continuity in care, whether it's through agroup therapy to an individual therapy, whichevermechanisms have worked work for that person.
Clearly what studies have shown is that forprograms to really have effectiveness, they haveto be 90 days or longer. So in general, a 30-dayperiod does not appear to be sufficient for a treatment of a person that has a severe addictionproblem. Based on what studies looking at thelengths of intervention and outcomes haveshown-- that really it's at 90 days that you start toreally significantly improve the outcomes ofpeople that undergo treatment.
What does it mean when you have a chronicdisease, that while you may be doing very well, allof a sudden you may relapse? And see that, forexample classically with cancer where it also is achronic disease. Someone is being treated, andthen there is a relapse. Does that mean thattreatment does not work? No, it does not meanthat treatment does not work. We should beunderstood as a chronic nature of that disease.And what we're trying to achieve is rather thansaying, OK, treatment-- we will only considertreatment works if the person can stay clean forall of their life. No, let's be more realistic like we are more realistic with any of the diseases--hypertension, asthma cancer. We'll call itsuccessful if we can keep the person as clean aslong as possible. So if there is one or two relapses,we shouldn't give up on the fact that thattreatment is being effective most of the time.
We don't want to speak about drug addiction. Andwe don't want to speak about drug addiction ingeneral, because there's such a horrible stigma.So people say to me, Nora, don't speak aboutcomparing these diseases with drug addiction,because you're going to offend people that havemedical diseases. And I said, well, it's sad to see it.The person doesn't choose it. We need to startbringing down that stigma, because by notaddressing it, it's not going to go away. And it'slike at one point we had the stigma of leprosy.Nobody spoke about leprosy, right? We had astigma of cancer at one point. We had a stigma ofschizophrenia. There's still a significant stigmawith some of the mental diseases, but much lessso. The one that's lagging behind is addiction.
One of the elements that we need to recognizethat favors the stigmatization of addiction is thatbecause it's a disease that affects behavior, andwhere the main drive is procuring the drug, incertain instances it can lead to behaviors thataffect others. Stealing, robbing, when someone issmoking marijuana and driving while intoxicated,and they have an accident-- well, of course, that'svery enraging. And so that's where an elementthat does not help the field at all-- that someindividuals, because of the disease process andwhat happens, engage on behaviors that directlyaffect others. In many cases, most of the cases,these people that are addicted really have notharmed someone else. Others have, but most ofthem haven't. And yet there's no empathy, there'sno recognition of the enormous amounts of suffering that goes with the disease of addiction.It's much harder to recognize it.
Detoxification is that initial stage that allows aperson to stay clean. But that's just the beginningof the road. And then the rest is what is we'regoing to call recovery, that process by which theperson who has been addicted is re-integratedinto society without the need of drugs. And therecovery is when the person is able to do that. Soit's a long-lasting process. Recovery is notsomething that occurs over two or three months.It's a process that goes on for years, and it'salmost like a continuous aspect of the person whohas been addicted for a continuous aspect of hisor her life.
Ultimately there is the power of healing. There isthe power of healing. And we can recover. But it'snot in many instances happening automatically. Itdoes require intervention in most instances.
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