Latest / Life Lived Better / Episode 145: Addiction: Fact vs. Fiction

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Episode 145: Addiction: Fact vs. Fiction · Life Lived Better

0:03
Hi, this is Paula. And I'm Joseph, and you're
0:06
listening to Life Lived Better. Hey everybody, welcome back to
0:12
the Life Live Better podcast where we have real conversations
0:15
about important topics that impact our lives.
0:18
But before we get into our topic today, I want to check in and
0:21
see how things are going with you, Joseph.
0:23
Hey, everything is going well for me.
0:26
Just staying busy that's all I feel like I ever check in with
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as I'm just staying busy. Umm, holidays are past us and
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settling into this new year. Just got through some crazy
0:38
weather and yeah everything seems to be doing pretty well.
0:42
I'm happy to be here recording today.
0:45
How about you? How are things going with you?
0:46
Doing well. I think that I want to listen.
0:49
I use that neighborhood app and I watch people who aren't from
0:52
Texas like what? Why are y'all all shut down?
0:55
I don't understand. Why can't you like, well, this
0:58
isn't snow, it's ice. It's a little different.
1:01
Yeah. So it's a lot of fun to see
1:03
people's different reactions to the weather.
1:05
But I think the first reaction is let's buy everything in the
1:09
grocery store. Oh my gosh, it's crazy.
1:11
We could go hungry. Totally empty shells and
1:15
terrible. I know, I know.
1:18
I think we think back to COVID. I don't know how the toilet
1:21
paper was looking, but. Right.
1:23
My sister was telling me it's negative.
1:26
I think she said -18 or -15 something like that there in
1:29
North Dakota. It's like it hurts to breathe,
1:32
it's so cold. That is, yeah.
1:34
My son was staying in Oklahoma when we had ice.
1:38
They were having powdery snow, like about a foot.
1:40
And it was beautiful and fun and like, oh, that's not what we
1:44
have. We have a better, We have a
1:46
better foot, but it's all eyes, looks pretty, but it's not.
1:51
You can't get into it exactly. Yeah.
1:55
So what are we talking about in this episode?
1:57
So one of our most popular episodes was on Addiction way,
2:03
way back when we started the podcast.
2:05
I think I want to say it was like 14 or.
2:08
Way. Back.
2:09
It was way back there, but yeah, so that was one of our most
2:13
popular episodes and we thought we would do a little bit of an
2:16
expansion on that talk a little bit more.
2:19
That is what you and I both do. And it's our profession, it's
2:23
our lives. We've got some great
2:25
information. So we're going to break this
2:27
down into a couple of different parts to get through everything,
2:30
but addiction is the topic. All right.
2:33
Well, hopefully we'll cover everything there is to know
2:35
about it. Yeah, I think one reason you and
2:39
I want to cover this topic is we know that it's pretty
2:42
misunderstood and there's just so much stigma around it.
2:46
And it, the stigma really can prevent people from getting help
2:50
that they need. So I thought we could break down
2:52
and explore, like, the facts about addiction and then look at
2:57
some treatment options and recovery pathways.
3:00
So what do you think about starting with some of the
3:02
misconceptions people have about addiction?
3:05
I think that's a great place to start so we can break them down.
3:09
And I would say the first one would probably be the thinking
3:12
that addiction is just a lack of willpower.
3:15
You know, I think that's a pretty, pretty common one.
3:17
People think you just got a, you know, pull your big boy pants on
3:21
and get it together. But there's more to it than
3:25
that. It's it's a pretty common myth.
3:27
And most of us have our own opinions.
3:29
Many of us have heard, you know, lots of debates about addiction
3:32
being a disease, a mental health condition, a brain disorder.
3:36
And no matter which school of thought you come from, at the
3:40
end of the day, the idea of addiction being simply a lack of
3:43
willpower is definitely not true, definitely a myth.
3:47
So the reality is addiction is a chronic condition that changes
3:51
how the brain works, especially in areas tied to our reward
3:55
system. Our motivation, our memory, and
3:57
our self-control and personal choices may play a role early
4:01
on, but once addiction develops, it's not about just stopping the
4:05
using we really become. It really becomes part of us and
4:09
part of our pattern. Judgment and self-control
4:11
literally just come impaired at that point.
4:15
People ask me that all the time, like, well, the it's the
4:17
person's fault, right? Because they started using like,
4:21
if you need, if you need their, if you need it to be at their
4:24
fault. OK, sure.
4:25
They are the ones who use the substances.
4:28
Yeah, but it's there. So it's so much more nuanced
4:31
than that. So another misconception is that
4:35
like only certain kinds of people get addicted.
4:38
I think we all at some point have an idea of what an quote UN
4:42
quote addict looks like. And we have heard a lot of
4:46
debate about that between like nature and nurture, and there's
4:51
debate about whether it's genetic or environmental.
4:54
But the one thing that I know to be true about addiction is that
4:59
it really doesn't care about your age, your income, your
5:02
personality, your education, genetics and trauma and stress
5:07
and environment and mental health conditions.
5:09
They play a role in addiction and it's equal opportunity.
5:13
Lots of people who develop addictions are actually pretty
5:16
high functioning, responsible, caring human beings who just you
5:20
would never expect to be the people who struggle.
5:23
And another big misconception is if you can hold a job and keep
5:27
things together, you're fine. You know, if you're functioning,
5:30
you're fine. Now, what's the big deal?
5:32
So functioning on the outside doesn't mean someone isn't
5:35
struggling, right? It's, it's very often we don't
5:38
really know what's going on with people.
5:40
They may seem very high functioning and have it all put
5:43
together, but inside there's a struggle and a battle happening.
5:46
And a lot of times that happens with, you know, functioning
5:49
addicts. Many people, like with substance
5:53
disorders, they're able to maintain jobs and relationships
5:56
and responsibilities for years at a time.
5:59
But it doesn't make the addiction less real or less
6:02
risky. The impact may look and present
6:04
differently, But holding on to a job does not mean someone is
6:07
unaffected. It just means that they have an
6:10
addiction and still are able to keep a job.
6:12
Yeah, a lot of times it depends on the kind of job too.
6:15
I mean, we can. And we know from social media
6:19
you do not know what's going on behind the scenes.
6:22
You just never do. Another misconception is that
6:26
prescription drugs are safer than St. drugs.
6:29
And I think the opioid and fentanyl crisis that we've seen
6:34
in the United States definitely kind of blows that myth up
6:37
because medications can be safe when they're used exactly as
6:41
they're prescribed. But opioids, benzodiazepines and
6:45
stimulants still carry some serious risk of addiction.
6:49
And the fact that something comes from a doctor does not
6:52
make it harmless. It just, it just doesn't.
6:54
And I mean, I guess any medication been can be misused.
6:59
And so one of the things I want my clients to look at when they
7:02
have an addiction, especially with prescription drugs, is why
7:06
are they mistaking their medications?
7:08
No matter which Med it is, why are they mistaking it?
7:11
And often I find it's like not the high blood pressure
7:14
medication that they're mistaking.
7:16
It's something that has a mood or mind altering effect.
7:20
And you know, devil's advocate, I think oftentimes people are
7:25
taking them, has prescribed, but they get to the point where they
7:28
have taken them for so long and it has been increased,
7:30
increased, increased. And then suddenly, you know,
7:33
like over the last few years, there's been such a crackdown on
7:35
doctors prescribing opioids in they just took them away from a
7:40
lot of people, right? Because they were worried about,
7:43
you know, getting in trouble and over prescribing.
7:45
And you had these pill mills and things like this kind of going
7:48
around. And so people are suddenly at a
7:50
point where they've been taking these medications for years and
7:52
years and years and then they're just taken away.
7:55
And so sometimes it's not even like mistaking the medication.
7:59
It's just the fact that you just there's no step down process.
8:02
There's no, you know, accountability with any of that.
8:05
It's just and. The part about that that really
8:08
frustrates me is there are people with chronic pain who
8:11
need meds that they have a some kind of situation.
8:16
It's not going to go away. It can't be fixed and it will be
8:19
that way their whole life. And if some if people are afraid
8:22
to prescribe them meds or assume they're drug seeking just
8:26
because they need pain meds, that's a difficult place.
8:29
And I've seen a lot of clients get into that situation.
8:32
It's like they're, you know, CE OS or whatever and they have a
8:36
back injury and they begin meds and then when they're pulled
8:39
from them, they need meds and you can't just stop using them
8:43
because of withdrawal and stuff. So to just take it all away, we
8:47
just seem to swing from one pendulum.
8:50
You know, it's a pendulum from one way to another, like where
8:53
everybody can have them and you can have as many as you want to.
8:56
Nobody can have any, right? I just wish we could kind of
9:00
maybe make it assess the situation to see what works
9:04
best. I will tell you, a lot of the
9:06
folks that I've worked with over the years that have, you know,
9:08
been addicted to opioids, it's been a situation where they had
9:12
some kind of surgery or in a car accident and it just became, you
9:16
know, an addiction over time. So it's pretty common,
9:19
especially with with that one in particular, I would say it's.
9:22
Very sad. So another misconception is that
9:25
addiction only affects the person using it.
9:28
And I've said this forever and ever, ever.
9:31
I always, I'm a visual person. I always think of like dropping
9:33
a Pebble and a puddle of water and just watching the ripples
9:37
kind of ripple out. And that's what happens when our
9:40
addiction, it doesn't just affect the person, it affects
9:42
our family. It affects our friendships, our
9:44
workplaces, and even our communities.
9:47
It can really, really cause problems in the relationships
9:51
and finances. It can cause a lot of emotional
9:54
health issues. But at the same time, loved ones
9:57
deserve compassion and support. They, you know, they deserve our
10:01
best, not just the worst of us when we're, when we're actively
10:05
in it. The thing about the ripple
10:07
effect is it affects the family, obviously, and the family
10:10
system. And you treat just the person
10:12
struggling with the addiction, but that's not going to help the
10:15
overall problem, right? It's not going to help long
10:18
term. You really have to treat the
10:20
family as a whole in order to get to a place where everybody
10:25
understands. Everybody's kind of, at least in
10:27
the same book, not necessarily on the same page, but you know,
10:30
has a good idea of what's going on with the family member and
10:34
kind of what their role is. How to, you know, how to help in
10:36
a way that's not going to be the word destructive comes to mind,
10:40
but just a way to help in the recovery process that's gonna
10:44
actually help and not hinder the process.
10:47
Because I see a lot of folks in their family units that really
10:50
struggle with families, you know, oftentimes think this is
10:53
not the first time, it's not going to be the last time.
10:56
And so there's lots of feelings that is this really real?
11:00
Is this really happening this time?
11:02
And so it's important that the whole family's involved in the
11:05
process in order to understand where where everyone is in the
11:09
process. Does that make sense?
11:10
It does, and I like that term. That's what you said about if we
11:14
can get them in the on the same, in the same book, even not on
11:17
the same page, that would be amazing.
11:20
Treating an entire system is so much more effective than just an
11:25
individual. But it's difficult to get
11:28
everyone there and I'm, you know, ready to do it.
11:31
But I, I feel really, I really feel for people who are family
11:35
members because they have so many different reactions and
11:38
responses. Some are mad.
11:39
They think the person should just stop and quit hurting the
11:42
family. Some people feel like it's their
11:44
fault, and if everyone could understand addiction, they could
11:47
see it's nobody's fault, you know, and the person might not
11:51
be able to just quit using that. It's so much more than that.
11:55
Another misconception is that relapse means the treatment
11:59
failed and addiction professionals, many of us refer
12:02
now to relapse as a recurrence of use rather than relapse.
12:06
But I think most of us have heard the term relapse and are
12:09
more familiar with it. So I'm going to use that.
12:12
You know, relapse can happen and it doesn't mean someone is weak
12:15
or that recovery isn't possible or the recovery was the wrong
12:19
approach. It's just because addiction is a
12:21
chronic condition and relapse rates are kind of similar to
12:26
other illnesses that are chronic like diabetes and asthma.
12:29
I mean, so it doesn't mean the treatment failed.
12:32
It might just mean maybe treatment needs to be adjusted.
12:34
But it doesn't mean you should abandoned treatment.
12:38
And it also doesn't mean that that the treatment didn't work
12:41
at all. And I think my personal opinion
12:44
is there are a lot of different paths to recovery.
12:47
And, you know, sometimes you have to try different routes and
12:50
define the path that works best for you.
12:52
I always say we're not gingerbread people would, you
12:55
know, look the same. We don't act the same and our
12:57
recovery is not the same. And so I think there's a lot of
12:59
people out there that believe that recovery looks like this,
13:02
this and this. You have to do AB and C and you
13:05
have to do it in this order. And anything outside of that is
13:09
you're not serious or you're not, you know, actively in
13:13
recovery. And that's just not, I don't
13:14
believe that that's true. I think that everybody has to
13:16
kind of work and figure out their own path.
13:19
And sometimes that that you have to do it a couple of different
13:22
tries different ways in order to to get to the one that works
13:26
best for. Exactly.
13:27
And I know the recovery movement has a great concept as they look
13:32
at any time in recovery is like recovery capital.
13:35
So it's like money that you know it's in the bank and you have
13:39
something to draw from instead of it.
13:41
You're just a failure. Like if you were able to stay in
13:44
recovery for a year, you know a lot about recovery.
13:47
You have a lot of tools to know what worked, what didn't work.
13:50
So when you come back to to begin again, you have all that
13:55
information to draw from. It's not just useless or
13:57
failure. I always think of it like the
14:00
toolbox. I'm constantly buying tools at
14:02
estate sales and things that I don't need, but then when I need
14:05
them, I have them, you know, I don't have to go out and get
14:08
them. They're, they're already there.
14:09
And I think of that, you know, when we're going through the
14:12
process, we're planting seeds, we're buying tools or doing all
14:15
the stuff to kind of like for the future.
14:18
And so it's not ever a waste of time or energy or, you know,
14:21
it's just it's an investment in your future, in my opinion.
14:25
So another big misconception is that people with addiction don't
14:28
care about others. Huge misconception because
14:31
people struggling with addiction, they feel deep, deep
14:34
levels of shame and guilt and really fear, I think hurting
14:39
other people that they love. And, you know, the behavior may
14:42
look selfish when they're in their addiction, but the reality
14:46
is it's very, very complicated. And, you know, compassion helps
14:49
a lot more than judgment. You can be compassionate towards
14:52
people. They're much more likely to be
14:55
responsive than if they're feeling judgment.
14:58
I agree. And I know at some point in this
15:01
series on addiction, we're going to talk about how you can
15:04
support somebody who has an addiction without enabling them
15:08
because you don't want to do that either.
15:10
And another misconception is that treatment for addiction is
15:14
1 size fits all and it isn't a cookie cutter.
15:17
Every person, like you said about the gingerbread people,
15:20
everybody's different. Treatment looks different for
15:23
everybody. Treatment can include therapy,
15:26
medication, peer support, lots of lifestyle changes, some kind
15:29
of structured programming. And usually it's a combination
15:33
of some of those things. Because what works for one
15:36
person may not right be right for another person.
15:39
And that's OK. You know, a life of recovery is
15:42
often about change and and growth.
15:44
People usually when they get into recovery, change it as it
15:48
goes. It isn't the same all the time.
15:50
And so now after we've talked about these misconceptions, I'd
15:54
like to venture into a big debate for just a little bit,
15:59
which is dangerous. Is addiction a disease?
16:04
I think every professional, probably every person has their
16:07
opinion about this. But let's kind of talk through
16:11
some of the views that are out there.
16:12
And if you want to begin with your thoughts, feel free.
16:15
I think, you know, it's, I honestly believe that it's kind
16:18
of a combination of things. I think the addiction model is,
16:22
is real and I think a lot of people do struggle with or the
16:26
disease model rather is, is something that is real.
16:29
And, and you know, I do also think there are people that, you
16:33
know, become addicted because of learned behaviors and patterns
16:37
that they experience. And so it's difficult for me to
16:40
kind of stand on one or the other because I've worked in the
16:43
field for so long and I've seen so many different situations
16:47
where people have become addicted, either through, like I
16:49
mentioned earlier, being prescribed medications after an
16:52
accident or surgery, you know, versus someone who has grown up
16:56
with Alcoholics and addicts. And it just was kind of normal.
16:59
And then you have people that just one day took a drink and
17:03
that was it, you know, just kind of like flip that switch.
17:06
And so I believe it can kind of be a number of different things,
17:11
but I do believe that there is some some truth to the disease
17:15
model. I think it's valid.
17:17
And I think that that's definitely something that people
17:20
obviously struggle with. And I always think of like the
17:22
medicine as, you know, therapy meanings, you know, sometimes
17:26
medication like that's the treatment.
17:30
So what are your thoughts? I agree.
17:32
I think it's it's, it can be different for everyone.
17:35
Is it a disease? I think there's enough evidence
17:37
that says that it it is. I also see enough evidence that
17:41
it's a brain disorder. I see evidence that, like you
17:44
said, something just happened and something occur like the the
17:48
injuries that we talked about earlier, those people might not
17:51
have been headed down a path that would turn into it an
17:54
addiction. But that medication, it is
17:57
addictive. You know, I mean, it is, it can
18:00
become, you can become physically dependent on it, even
18:03
if you don't have quote UN quote an addictive nature.
18:06
So I think it's just lots of these things can be true.
18:11
And I don't think we are saying that's a cop out to say, well,
18:14
I'm not subscribing to any of them.
18:16
I think it truly is. It just depends.
18:19
Yeah, it's kind of I'm, I'm on that.
18:21
I'm on that side of things. It just depends.
18:24
Yes. So let's talk a little about,
18:27
you know, the addiction as a disease view.
18:29
So the core idea of that is addiction as a chronic medical
18:33
condition that changes the brain, similar to diabetes or a
18:37
heart disease. Some arguments look like brain
18:40
changes are measurable. Repeated substance use alters
18:44
our reward system, our motivation, our memory, our
18:47
stress response, and our overall impulse control system.
18:51
So overtime, these changes make stopping genuinely difficult,
18:55
even when someone wants to stop. Another one is a genetic and
18:59
biological matter. So family history greatly
19:01
increases your risk. So does factors like early
19:04
trauma, undiagnosed or untreated mental health conditions.
19:08
That's a huge one. I find a large number of folks
19:12
that I worked with over the years have untreated mental
19:14
health issues. And I'm a firm believer that you
19:17
have to treat all of the person and not just focus in on the
19:20
addiction. Yeah, Another one is chronic
19:23
course plus relapse patterns equal disease like addiction
19:28
frequently involves remission and relapse over time.
19:32
So similar to other long term illnesses, I can go into
19:35
remission, but you know, you can have a relapse month a year.
19:39
You know like if you have cancer you have to go what is it every
19:41
six months and then every year and then every five years.
19:44
I know you have to kind of stay on top of that.
19:47
Medical framing reduces shame. Seeing addiction as illness
19:51
encourages treatment rather than punishment or more moral blame.
19:55
So really important that, you know, you again, going back to
19:58
that kind of compassion over judgment.
20:01
The implications of this view is that treatment should be health
20:05
care, not criminal justice. I believe that.
20:08
Yeah, absolutely. Medications like buprenorphine,
20:12
methadone are legitimate and life saving.
20:15
I know there's a lot, a lot of opinions on these medications
20:19
and how, you know, a lot of people believe that abstinence
20:21
is the only way to be recovered, but these really are medications
20:26
that legitimately save lives. And then the recovery may be
20:30
long term and ongoing. It's not a one time event.
20:33
I believe that the physical part of recovery is short lived.
20:38
The long part of recovery is the mental side of it, the mental
20:42
addiction that that we have to manage a long term.
20:44
I don't think it just you're just healed and it goes away.
20:48
Some people have have experienced that, though.
20:50
My parents tell me that they both, you know, got saved from
20:54
alcoholism through church and through God and, you know, never
20:57
had a problem with it again. You know, some people say that,
21:00
some people just, you know, argue that, dispute that.
21:04
I can't say what works for one person and and what's real for
21:07
one person versus another. Lots of the research out there
21:11
says that of all the people who report to be in recovery, the
21:15
highest number report that it was just natural recovery.
21:18
Like your parents talked about how just we just decided enough
21:23
is enough. And some people it's not that at
21:26
all. So it, it really, I think it, it
21:28
does depend. And why we need this to look so
21:32
specifically one way is really odd to me.
21:36
So I want to debate and this isn't my opinion.
21:39
It's just the one I was assigned that addiction is not a disease
21:44
view. And the core idea of that is
21:46
that addiction primarily reflects behavior.
21:49
It's a choice. It's about environment.
21:51
It's not a disease. And the main arguments people
21:54
have with this one is that you can, you can, and you do stop
21:58
without formal treatment. Like I said, if you go to church
22:02
and you're saved that way, so you didn't have to go to
22:04
treatment. So there are people who really
22:07
do reduce or quit substances over time, and there's a lot of
22:10
critics that would would say then that wasn't a true disease.
22:14
They didn't truly have it. Yeah, I was thinking that is
22:17
choice willpower. Exactly.
22:20
And so another argument here is that choice plays a role, you
22:23
know, and even if impaired decision making isn't completely
22:26
gone. So when you frame disease as as
22:30
only an illness, then you minimize the person's
22:32
responsibility in it. And so that it, I hear people
22:35
say that I hear you say like, well, if you can just say it's a
22:38
disease, then you don't have to take any responsibility for what
22:41
you did. That's that isn't, is one of the
22:45
is one of the main arguments. And another is that the brain
22:48
always changes with learning. So opponents argue that brain
22:52
changes aren't unique to addiction, that everything from
22:56
falling in love to learning how to play piano rewires the brain,
23:01
that that's the thought. And another is that the disease
23:04
framing just oversimplifies addiction because you're not
23:07
looking at social inequity, trauma, stigma, the economic
23:12
stress or lack of opportunities that can be contributors to a
23:17
person's addiction or recovery. So critics of of the disease
23:21
concept it say that this model, the model of a of disease kind
23:26
of ignores those situations. And the implications with this
23:31
viewpoint mean that we the focus should be more on behavioral
23:34
change and environment and social solutions.
23:37
And people shouldn't be seen just as patients or clients, but
23:41
people who are capable of making change.
23:44
So somebody in this camp would like you SMART Recovery or
23:47
something as a ACE recovery support instead of 12 step
23:52
programs like a a. And I think it's it's got valid
23:56
points. Yeah, Yeah.
23:58
Well, this next one I think probably is the middle path
24:00
view. So this is a very common no view
24:02
today. The core idea is that addiction
24:05
involves both biology and choice, unlike many other
24:08
chronic condition. Kind of.
24:10
The key ideas is substance use usually starts as a choice, but
24:13
repeated use alters the brain and reduces control.
24:17
Biology creates vulnerability, not destiny.
24:20
Environment shapes risks of trauma.
24:23
Poverty, isolation, stress, and availability all make a
24:27
difference in all matter. Recovery involves medical,
24:31
sociological, social support plus personal effort.
24:36
So all of those things are really important.
24:38
This perspective treats addiction much like depression,
24:41
hypertension, or even diabetes. Type 2 diabetes and personal
24:45
behaviors plus biology plus environment, equal conditions
24:50
that can be treated. These are all things that, you
24:52
know, we have some some control over.
24:56
Makes sense to me because like, if a person gets lung cancer and
24:59
it was provoked from smoking, then that doesn't mean they
25:03
don't have a have a a disease or, you know, a medical
25:06
condition they do. But did their behavior play a
25:09
role? It probably.
25:11
I also have always wondered why with addiction it matters.
25:16
You know, like if you have an addiction, it needs to be
25:19
treated just like if you have cancer, it doesn't really matter
25:22
what caused the cancer is, you know, unless we're looking for
25:25
like, like you have to stop whatever it was that caused it,
25:28
but it still needs to be treated.
25:31
Why the debate matters, I guess, beyond semantics is is like the
25:36
stigma, you know, disease reframing, like you mentioned,
25:40
reduces the moral blame, but the choice framing can it may
25:44
increase the shame, but it also empowers someone to make a
25:47
change. It also matters because of like
25:50
policy and law, because we have the disease model, there might
25:54
be more funding for treatment. If we look at the moral model,
25:57
there's harsher punishment, less access to care.
26:01
And I've seen this ebb and flow throughout my entire 30 years in
26:05
the field of which which one we kind of push to and what we're
26:08
funding is and laws are. And then if the treatment
26:12
approaches with like the disease model, they emphasize maybe
26:16
medication and therapy. And if it's looking from the non
26:20
disease model, they emphasize a lot of personal responsibility
26:23
and changing of habits. But the middle ground, like you
26:26
said, where you subscribe a little more is it uses all those
26:30
tools together, which I think is the winning combination.
26:33
Yeah, well, what's the science behind it?
26:36
Current where? Where does the science currently
26:38
stand? Most major medical organizations
26:41
classify addiction as a chronic brain disorder, but they also
26:44
stress the behavior and environment are essential parts
26:47
of the bigger picture. So the dominant view today is
26:50
essentially that addiction is a medical condition influenced by
26:54
choice and context. So summed up simply, addiction
26:58
isn't just a disease, and it definitely isn't a moral thing.
27:01
So important. I mean, it's a complex human
27:04
condition, you know, it involves brain changes, yes, that it also
27:08
involves vulnerability and risk factors and behavior and habits
27:12
and environment and what that means and relationships and even
27:16
the community, you know, So it's exactly why compassion and
27:21
evidence based care are just so important for people.
27:25
Absolutely. That's a lot.
27:26
That's so those are such debated things.
27:28
That's a big thing we just talked about.
27:31
Yeah, yeah. And we've talked about some
27:33
causes briefly that we're going to go a little bit more in
27:35
depth. So what causes it?
27:37
What causes addiction? So I've shared a little bit of
27:39
experience about kind of what I feel like causes it as we've
27:42
been talking. What what about you, Paul?
27:44
What's your? I think it's combination.
27:47
I mean, I've never seen two clients that are the same.
27:50
I've seen similarities, but I haven't seen anyone that just
27:53
has the same same story. I believe we used to think it
27:57
was. We used to say a drug is a drug
27:59
is a drug is a drug and quit acting unique.
28:03
You know, you're not any different than the addict
28:05
sitting right next to you. And that's just not true.
28:08
I mean, drugs do different things for different people.
28:11
People get addicted to different things.
28:13
Some people who get addicted, I mean, some people who use one
28:15
drug never get addicted while another person does the first
28:18
time. Just so we're human beings and
28:21
this wiring we have makes us all so different and the outcome of
28:27
of what happens to us when we enter and when we put a
28:30
substance inside of this unique system is just very different.
28:35
So there are many things people believe obviously, and one of
28:39
the first things is that the brain likes a reward a lot.
28:44
I always tell people like I feel like our brains operate on pain
28:47
or pleasure. If I'm feeling pain, how to feel
28:49
pleasure. And if you struggle with
28:51
addiction then you know pretty quickly what's going to trigger
28:54
that pleasure point. Most addictive substances and
28:57
behaviors like alcohol and nicotine, gambling, porn, even
29:01
social media trigger the brains rewards system.
29:04
And so there's a release of dopamine.
29:06
And dopamine is like our feel good, you know, motivational
29:09
chemical. And it's something that when we
29:12
get that release, we feel pleasure, we feel, you know, our
29:15
reward. And so over time, the brain
29:18
adapts to repeated dopamine spikes, natural rewards.
29:22
So food, relationship, hobbies, those don't hit as hard.
29:26
And you know, a person may need more of the substance or
29:30
behavior to feel normal. So that kind of tolerance starts
29:33
to build and so you need more of whatever it is that's triggering
29:37
the dopamine, and that's when the addictions can start to set
29:40
in. And again, addiction isn't about
29:43
being weak or about willpower. It's about brain rewiring and
29:47
being changed over time. Being rewarded feels good.
29:51
It typically feels good to all of us.
29:54
So of course, if we like it, we want more of it.
29:57
Absolutely. Of course I want more of what
30:00
feels. I was telling my classes the
30:02
other day, I'm like, if you eat a cake, it's just like, oh,
30:05
that's the best. You want to do it again.
30:08
You don't just want that to be a singular experience.
30:11
That's just how it works. Another reason that people note
30:15
is because genetics play a role. So some people are like, more
30:19
biologically vulnerable than others are to addiction.
30:22
Like if it runs in a family, that can cause the risk to go
30:26
up. And, and because genes influence
30:29
how rewarding A substance feels and, and genes might also affect
30:33
the impulse control and the the stress response there.
30:37
And so researchers say that genetics account for 60 to 40%
30:42
of addiction risk. So two people can use the same
30:45
substance. One walks away, the other one
30:47
gets hooked. I mean, not fair, but real.
30:50
You know, one of the stories I've heard a lot in my career is
30:53
about like twins who grew up with a father who had severe
30:58
alcohol use disorder. And one of the twins grew up to
31:01
have a severe alcohol use disorder and the other one grew
31:04
up to be totally abstinent from alcohol.
31:07
They became this highly successful businessman and, and
31:10
when they were together, they asked each other like, why did
31:12
you become addicted to alcohol and why didn't you?
31:17
And the first one was asked the reasons they they became an
31:20
alcoholic like their father. Second one was asked why they
31:23
didn't. Both of them answered the same
31:25
thing is I'm this way because my dad, my dad was.
31:30
So I'm not. My dad was so I am.
31:33
So genetics definitely play a role, but they also don't have
31:37
to. Yeah, that's.
31:38
Good. It's complicated it.
31:41
Is it really is so trauma and mental health matter a lot and
31:47
addiction is often a coping strategy before it becomes a
31:51
problem. And so, you know, we're dealing
31:54
with problems that we don't know how to cope with.
31:57
A lot of people choose, you know, a substance or you know,
32:00
something that again triggers that dopamine in order to to
32:04
cope. Some high risk groups include
32:06
people with things like anxiety, depression, PTSD, ADHD, grief,
32:12
loneliness, chronic stress. And often times the substances
32:17
or the behaviors maybe come away to numb the pain, escape
32:21
reality, quiet the mind. That's a big one.
32:25
Feel pleasure or just feel anything at all.
32:28
And I would say, you know, the numb, the pain and the feeling
32:31
anything like those are so pretty big ones.
32:33
So, you know, instead of asking why the addiction, a more
32:36
compassionate question often is why the pain?
32:39
You know, what's triggering this?
32:41
What's? Called, I think people believe
32:44
that people who use substances are just like partying, you
32:48
know, and so many people I've heard this especially with
32:51
opiates that after a time of opiate use, you just use them to
32:56
feel normal not to party, not even to get high, but just to be
33:00
normal to feel normal. And so I think we should keep
33:03
that in mind so the previous example I provided was about
33:07
genetics. This time I'm going to talk
33:09
about like environment and and early life experiences.
33:13
So where and how someone grows up, it really does matter.
33:17
And and the risk will increase when someone grows up in an
33:20
unstable home environment, if there was abuse or neglect, if
33:24
they had exposure to substance use, I mean, they saw it.
33:28
So it's kind of an option. And if they grow up with lack
33:32
and lack emotional support and interestingly, poverty and
33:37
chronic stress in a child's environment growing up also
33:41
makes a difference. And so does real high pressure
33:44
environments like work and school and sports.
33:48
And kids, I think today grow up in higher pressure environments
33:52
than I did. And just as where are you going
33:54
to college when you're in the eighth grade, you know, and your
33:59
school record, your school record, my said talked about
34:01
that all the time. Like since he was in 6th grade,
34:04
they talked about your permanent record.
34:06
And so connection protects people and isolation and chaos
34:11
do the opposite. And one of the most viewed Ted
34:14
talks was about addiction. It was by a man named Johann
34:17
Hari. And one of the things that
34:19
Johann shared was about a study about addiction and community
34:23
with rats. And the ultimate discovery was
34:26
that community isn't the key component to assure a person
34:29
doesn't begin an addiction or have an addiction, and
34:32
connection with community is one of the key markers of recovery
34:38
and happiness. Like that.
34:40
So the properties and the substances of themselves.
34:43
So some substances are just extremely addictive.
34:47
So we're talking about things like nicotine, opioids,
34:50
methamphetamine, cocaine and alcohol.
34:54
Alcohol can be a very addictive substance and if you think about
34:58
it, I'm, I want to say it's probably one of the most, I
35:00
don't know what the statistics are, but everything we do so
35:05
often revolves around, you know, going and getting a drink or
35:08
having a drink with a meal or, you know, it's very socially
35:11
acceptable. So I think that definitely plays
35:13
a role as well. Well, we call it the social
35:16
lubricant. Yeah, you know.
35:18
But all of these hit the brain really, really fast and really,
35:21
really hard, and that causes the addiction process to really
35:24
speed up quickly. Frequency plus the speed of the
35:28
reward equals a higher addiction or overall.
35:31
I'd say sugar should be in that list.
35:33
Oh yeah. And we know that repetition
35:37
builds habit loops, You know, we, I heard in treatment a lot
35:40
when I first started in the field as repetition strengthens
35:43
and confirms that's true of, of everything.
35:46
So no matter what the issue that we're debating, whether it's
35:50
behavior and reward leading to craving, repetitiveness is just
35:56
the big key here. Because over time, the brain
35:59
learns to anticipate the reward and triggers from stress or
36:04
people or places or emotions causes you to want to, you know,
36:09
stop the, the feeling or increase the feeling, whichever.
36:12
So the behavior comes out becomes automatic.
36:14
That's exactly what we learn about how a habit forms, you
36:18
know, And when we learn to anticipate a feeling and we want
36:22
to avoid that feeling, it just becomes repetitious.
36:26
So it becomes kind of a constant after a while.
36:29
And we cannot forget about the social and cultural factors.
36:33
So things that normalize or encourage use increase our risk.
36:37
So things like party culture, work stress, culture, that 1:00
36:41
kind of thinking, peer pressure, media messaging, availability
36:47
and legality. So and, and stigma makes
36:50
recovery harder because people feel ashamed to ask for help.
36:53
And this is something that's not just true for teens, it's true
36:56
for many adults. Especially once they are in a
36:59
role. I'm a parent, I can't this I'm a
37:02
CEOI can't have an addiction. And then we have to look at
37:07
each, each of us have personal factors that play a role and
37:10
risk will increase with with personal factors like
37:14
impulsivity, people who are sensation seeking, have low self
37:18
esteem or have difficulty regulating their emotions, or
37:22
just a overall lack of coping skills, lack of healthy coping
37:27
skills. But none of those are moral
37:29
failings. Those are just human traits.
37:31
So you might be wondering after we've discussed all these valid
37:35
possibilities or causes for addiction, OK, then what causes
37:39
addiction on That's rarely one thing.
37:43
It's usually a combination, like you're vulnerable and then you
37:46
have stress. You have access to the substance
37:49
so you use it and over time you do that repeatedly and there's
37:52
an addiction. Or maybe you have pain and you
37:55
also have isolation, so you use it as a coping behavior.
37:59
Then it changes brain chemistry and then that can equal
38:02
addiction. And which is why addiction is
38:04
widely viewed as a chronic brain based condition, why it's
38:09
influenced by psychological and social factors, but also why
38:12
it's treatable. It's not always a simple fix,
38:15
but it's definitely treatable. Absolutely.
38:18
And I think it's really important to to reiterate again
38:20
that addiction is not a character.
38:22
You know, people with addiction are not broken.
38:24
They're not weak, they're not hopeless.
38:26
Most of the time, they're just trying to cope.
38:28
They're doing the best with what they know.
38:30
And they're carrying pain that most others don't see and may
38:33
never see. You know, we don't ever really
38:35
know what's going on with folks. And, and some people have some
38:38
serious trauma and pain that is unresolved or, you know, we just
38:43
don't know. And recovery is absolutely a
38:46
possibility. There is hope and people do it
38:48
every single day, so I think this is a great stopping place
38:52
for this episode. We still have a lot of
38:54
information remaining on this topic.
38:56
Addiction is definitely a big conversation.
38:58
Let's wrap it up here for today. I think a simple way to
39:02
summarize what we discussed is just to say addiction is complex
39:06
and it's very human, and it's absolutely worth unpacking with
39:10
compassion. But we really have only just
39:13
started this conversation. It's compassion, so, so
39:16
important. Well, don't forget that you can
39:18
reach us on all the social media platforms.
39:20
You can visit ourwebsite@lifelivebetter.net.
39:23
You can e-mail us directly. We are grateful that you guys
39:26
took the time to join us today and we look forward to
39:29
continuing this discussion. And as always, don't forget that
39:32
knowledge leads to a life. Live better.
39:39
Thank you for listening to Life Live Better with Paula and
39:41
Joseph. Yay, thank you for listening to
39:47
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39:58
This episode was written by Paula Garland, edited by Joseph
40:01
Massey, and recorded on Spotify. Information used in this episode
40:05
and other content data can be found in our show notes.
40:07
We look forward to seeing you again in two weeks.