Latest / Becker's Healthcare Behavioral Health / Joseph Lee, MD, President and CEO of the Hazelden Betty Ford Foundation

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Joseph Lee, MD, President and CEO of the Hazelden Betty Ford Foundation · Becker's Healthcare Behavioral Health

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  Welcome everyone to the Becker's Healthcare podcast series.
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  I'm Ryan Mohammed, writer and moderator with Becker's
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  Healthcare. I'm thrilled to have with with me
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  today doctor Joseph Lee, president and CEO of
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  Hazelden
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  Betty Ford Foundation.
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  Doctor Lee, welcome to the podcast. We're very
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  excited to have you join us today. To
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  get us started, would you mind please introducing
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  yourself and telling us a bit about your
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  background?
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  Yeah. My name is Joseph Lee.
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  All my friends and family call me Joe.
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  I am a physician, an MD,
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  a child psychiatrist,
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  and I'm also board certified in addiction medicine.
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  I lived in different parts of the country.
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  I grew up in Oklahoma.
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  I did my medical training at Duke University
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  and then at Johns Hopkins, and I've been
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  at Hazelden Betty Ford, the nation's leading nonprofit
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  substance use treatment provider for
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  seventeen years.
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  And, I've been in my CEO spot for
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  five years, but, you know, I've built my
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  career
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  seeing thousands of young people across the country.
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  And I've really had the privilege and honor
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  of being in the intersection of culture, substance
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  use, mental health, and families, and, really happy
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  to share what I know and what I
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  see from young people today.
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  Wonderful. Thank you so much for giving us
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  that background. So
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  with the youth mental health emergencies,
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  rising,
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  what connections are you seeing between anxiety, depression,
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  trauma, and the substances young people are turning
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  to? Are there any particular warning signs providers
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  and families should take more seriously?
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  I think the the country's young people are,
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  in a continued
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  crisis. And when you talk about anxiety, depression,
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  trauma,
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  we see all of those things, but those
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  are the surface level symptoms
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  of a larger root cause problem and connections
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  between different problems. And so on the surface
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  level, we do see a lot of anxiety,
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  depression.
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  We see many mental health conditions that come
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  with substance use disorders or addiction like ADHD
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  as well.
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  We're seeing an increasing focus on trauma,
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  and many of the young people are more
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  aware about how their life story and the
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  things that have happened to them,
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  either because of their substance use or things
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  that happened before their substance use that caused
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  them to use substances,
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  to, you know, modify symptoms, make themselves feel
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  better.
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  And so we're seeing a lot of that
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  trauma
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  as well. But when you get to some
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  of the deeper connections, I think young people
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  today are very isolated
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  from each other, and and we've lost the
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  kind of framework for how young people
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  develop socially.
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  We see a lot of young people who
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  don't know how to be in groups. They
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  don't know how to speak up for themselves.
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  They don't like to make phone calls.
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  They don't like to be vulnerable with each
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  other. And they're also in a time where
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  and I think some of this is due
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  to social media.
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  They're aware of all the dangers and pitfalls
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  of a technological age, like with Internet and
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  social media, but they're still very helpless to
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  it. And so you have young people who
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  have lost the framework for kinda organic development.
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  They've lost a sense of community.
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  They feel isolated from each other, and they're
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  having a hard time being vulnerable even in
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  their friend groups.
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  And so, of course, they're having a multitude
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  of mental health and addiction issues.
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  Yeah. Yeah. No. That definitely makes a lot
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  of sense when you, break it down like
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  that. And specifically,
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  for, one drug, as cannabis becomes widely
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  legalized and commercialized,
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  we're seeing it pretty much everywhere now. I
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  live in New York City,
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  and it's on literally every block that I
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  turn. How is that reshaping youth,
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  perceptions of risk? From your perspective, what trends
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  are emerging in cannabis use disorders,
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  among adolescents?
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  Yeah. Interestingly,
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  the the use of substances and addiction
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  for young people requires a bit of a
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  social contagion.
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  You know? So they they hang around other
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  kids who are using a risk taking. And
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  and I think in part because young people
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  are so isolated,
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  when you look across the bigger population,
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  substance use for young people has actually dropped
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  a little bit in the past few years.
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  But you gotta go deeper than that because
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  in that population
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  are high risk pools, kids who are really,
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  you know, know, at high risk for getting
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  in trouble, and then low risk kids. And
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  what you're really seeing is that the low
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  risk kids are using less,
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  but the high risk kids are now even
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  more isolated, and they tend to normalize cannabis
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  use. And we've known this in the science
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  forever that when kids perceive a substance to
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  be less harmful,
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  because it's legal,
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  or people use it for different reasons,
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  they're more likely to use it. So we
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  we see,
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  young people use it in many efficient ways.
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  Vape cartridges are are kind of the way
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  to go now. And, and potency has gotten
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  higher, so they are having more mental health
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  issues. And you've seen in the adult population
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  even, the number of adults who are starting
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  to struggle with cannabis use. And then in
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  a larger kind of national discussion, you know,
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  whenever you think about alcohol or cannabis or
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  even gambling,
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  it's a small minority of Americans that consume
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  most of those goods. So for alcohol, you
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  have about 10% of the population that consumes
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  50% of the alcohol in the country, and
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  And about the same ratio goes for cannabis
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  and and gambling and other things. And so
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  you have this concentrated
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  pool of,
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  people who are,
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  being advertised to by industry,
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  and they're at,
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  high risk. And so you see a lot
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  of normalizing in cannabis use. You see parents
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  and families who are confused
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  or have lost some vigilance about,
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  cannabis use. And so,
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  the lower risk kids tend to be using
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  less, but the higher risk kids are,
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  I'd say, even more isolated and, perhaps in
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  greater trouble.
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  Yeah. Yeah. That definitely makes a lot of
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  sense. And you've
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  emphasized that co occurring mental health
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  and substance use disorders need integrated
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  treatment.
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  For you, what does integrated,
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  look like in practice, and what are the
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  risk or when systems treat these issues separately,
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  especially for adolescents?
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  Gosh. You know, I think this is such
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  an important question.
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  On the surface level, again, when you integrate
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  mental health care with addiction treatment,
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  you're using language
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  skills that you're teaching people,
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  work with families and bringing it into,
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  the young person's treatment plan. And so we
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  really believe in a family style kind of
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  version of care where we're teaching parents
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  skills, about their own well-being and and what
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  behaviors to reinforce and not reinforce and how
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  to communicate.
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  And we're teaching many life skills to young
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  people. So on the surface level, there's a
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  lot of skills between mental health and substance
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  use that you're delivering together.
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  And the teams, the the the triple boarded,
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  psychiatrist we have and the psychologists and the
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  counselors and the nurses, they're all working together
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  as one unit. And that makes a tremendous
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  difference compared to more of a parallel play
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  version where you're going to one clinic for
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  meds, going to another clinic for addiction care,
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  care, and going to another clinic for family
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  therapy, and we can all do it in
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  one place.
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  But I'll tell you what's more important than
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  this. I'll tell you a little story, and
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  I think it speaks to some of the
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  isolation I mentioned earlier.
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  I was eating lunch, and I I frequently
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  round with
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  young people and and adult patients at many
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  of our campuses,
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  across the country.
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  And I was sitting down with a couple
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  of young people at our youth and young
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  adult campus in in Plymouth, Minnesota,
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  and we were just talking about things. And
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  and one of them said to me, you
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  know, I lost many of my high school
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  years because of the pandemic.
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  And
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  now that I've come to treatment, I realize
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  this is the very first time in my
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  life that I have experienced community.
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  And I about fell off my chair because
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  that statement was both incredibly profound
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  and incredibly sad. And so when you think
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  about integrated treatment, it's not just about the
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  melding of terminology or the skills.
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  I think what's really unique about the kind
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  of care we deliver is that,
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  substance use treatment has always been wedded to
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  this deep sense of community and volunteerism
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  and belonging to something and having purpose.
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  And we've been able to meld that with
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  the evidence based skills and the science and
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  the skills that people need to overcome trauma
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  and depression and anxiety and those skills. And
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  I think that's very unique. I I would
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  actually say as a gentle critique of the
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  mental health field, which I grew up in.
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  I grew up more in the psychiatric setting.
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  The care I find these days is very
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  sterile. People get their meds. They do individual
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  therapy. Their symptoms may get better thirty percent,
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  forty percent, but they don't belong to anything.
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  They don't volunteer anywhere. There's no group for
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  them to go to. And and so much
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  of what we do in recovery
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  for substance use care is about community and
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  belonging to something and being a part of
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  the larger recovery community. And being able to
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  to fuse that when you have so many
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  kids who are just craving for community and
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  you're able to fuse that with the evidence
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  based skills of mental health and the family
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  therapy,
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  I think there's something very special going on
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  in our treatment. And I think young people
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  who are just so desperate for that,
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  need it more than ever.
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  Absolutely. I completely agree with you on on
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  your last statement.
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  And, doctor Lee, before I let you go,
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  the last thing I wanted
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  to ask you is, on the ground, what
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  substance use patterns are, clinicians seeing most often
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  right now among teens, and what makes this
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  moment uniquely
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  challenging?
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  And, also, more importantly, I think,
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  how do family engagement
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  and specialized children's programs change,
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  recovery
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  trajectory
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  compared with youth only approaches?
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  Yeah. We see a lot of different drug
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  trends come around. The the latest is a
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  version of kratom,
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  and, it's called seven o h for short.
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  And and, and that's coming around. Young people
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  are using kratom. Kratom is a is a,
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  substance derived from a plant,
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  and it it and more or less,
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  makes people feel like they're under a mild
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  stimulant at low dosages, and at higher dosages,
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  it's more of a sedative.
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  But there are now,
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  you know, versions of this that are lab
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  grown,
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  that have major withdrawal symptoms and and and
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  some major medical implications. And so we've been
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  concerned about that trend.
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  But drug trends come and go. I think
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  what we see in this moment is, again,
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  the isolation and the lack of community for
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  young people to plug into anything.
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  And you see this across the data. I
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  mean, kids aren't even dating. They don't share,
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  things with their friends. I think, you know,
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  they go on social media feeds, and they
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  know that what they see in the social
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  media feeds aren't real, but it still kinda
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  influences them. And and I think they feel
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  like they're the odd ones out, and so
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  they're very lonely. And and and I think
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  that's a real challenge right now is to
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  build a system that encourages community and volunteerism
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  and all the things that we know lead
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  to great organic
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  health, benefits.
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  And families are un also under siege. You
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  know? They are also isolated, and they're also
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  struggling with mental health issues and, inflation in
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  the economy. And so I think one of
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  the challenges
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  that we try to overcome is to really
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  engage the entire family in care so that
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  they can all learn the skills and they
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  can all learn to heal together instead of
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  suffering in isolation.
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  So that's what our approach is, and the
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  science is very clear that,
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  young people whose family members are involved in
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  care have much better outcomes and engagement than
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  than young people whose families are not involved.
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  Yeah. I can definitely see that. And, well,
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  thank you so much for those, final thoughts.
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  It's definitely been a very informative discussion.
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  So, again, I wanna thank you so much
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  for coming on Veterans Health Care, doctor Lee,
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  and, I look forward to connecting with you
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  again soon. Yeah. Absolutely. It's been a lot
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  of fun. Thanks for having me on. Thank
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  you.