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Addiction: What is it? Signs, Causes & How to Overcome It (Part 1) · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_04: We know that 40 to 60 percent of addiction or addictive disorders are based in genetics.
• 0:20
  SPEAKER_00: Justly certified psychiatrist, addiction medicine physician, and certified physician executive.
• 0:26
  SPEAKER_04: So addiction really is a chronic relapsing and remitting disorder of the brain.
• 0:32
  SPEAKER_03: What are the biggest myths or misconceptions about addiction that you'd like to see people stop believing right now?
• 0:39
  SPEAKER_03: Wow.
• 0:40
  SPEAKER_03: Um Dr.
• 0:44
  SPEAKER_03: Jocelyne Chell, thank you so much for joining us.
• 0:46
  SPEAKER_03: Thank you for having me here, Terry.
• 0:48
  SPEAKER_03: And we're going to be asking the questions that are most searched on the internet when people try to learn about what addiction is.
• 0:55
  SPEAKER_03: The number one question, not surprisingly, that searched on the internet is the foundational one.
• 1:00
  SPEAKER_03: What is addiction?
• 1:01
  SPEAKER_04: So addiction really is considered a chronic relapsing and remitting disorder of the brain, which essentially means that reward circuitry in the brain gets hijacked by either substances or behaviors.
• 1:17
  SPEAKER_04: And it means that when a person is engaging in a behavior or using a substance, initially dopamine starts to surge.
• 1:26
  SPEAKER_04: So dopamine is a neurotransmitter that gives us sort of that feeling of a high that people think about when they think about addiction.
• 1:33
  SPEAKER_04: Initially, as the person starts using this, we have discovered that it's very often not to chase a high or, you know, feel high all the time.
• 1:46
  SPEAKER_04: But in the beginning, it's really becomes one of the ways that they're trying to self-medicate something that might not feel good inside.
• 1:53
  SPEAKER_04: So we notice individuals who've had trauma in their lives, early life trauma, they may just feel that other people's normal or what is normal outside in the world is not how they feel.
• 2:05
  SPEAKER_04: And so, in a way to match what the world expects them to look like or feel like, they might start to use substances to just feel like everybody else looks.
• 2:17
  SPEAKER_04: And then what happens is that with that reward system and that dopamine having taken over their brain or the brain's functioning, we start to see that then when they're not getting that dopamine hit, they start to feel worse.
• 2:33
  SPEAKER_04: And so the repeating action of using a substance or having that type of addictive behavior is to not feel terrible anymore.
• 2:42
  SPEAKER_04: And so with along with that reward circuit and, you know, then having that withdrawal of the reward, you're just then trying to repeat that behavior to feel at a more normative place than before.
• 2:56
  SPEAKER_04: And it just becomes a self-destructive or self-limiting type of cycle because once your dopamine system is functioning at a much higher or needs a much higher hit to feel normal, then suddenly you're just chasing that experience and no longer even feeling good at any point.
• 3:17
  SPEAKER_04: So addiction becomes something that can take over a person's life for that reason.
• 3:22
  SPEAKER_04: And so often when we think about addiction, we think about anything that a person ends up spending an inordinate amount of time or energy trying to meet or complete or engage in.
• 3:36
  SPEAKER_03: Based on that definition, it sounds like what is perceived from the outside as a problematic behavior when somebody is in addiction from the inside can feel like the solution to my problem.
• 3:46
  SPEAKER_04: That's definitely true.
• 3:48
  SPEAKER_04: Um, because in the world, we move around comparing our insides to other people's outsides, which means that we're often chasing what other people are projecting.
• 4:00
  SPEAKER_04: And that makes it very hard because we all feel terrible sometimes.
• 4:05
  SPEAKER_03: Yeah.
• 4:06
  SPEAKER_04: And what happens is that as we're trying to look normal for other people or believe what the normal is, we are, yes, trying to just self-medicate what doesn't feel good inside.
• 4:18
  SPEAKER_04: What others are seeing is just that external behavior.
• 4:22
  SPEAKER_04: And they might say, gosh, why are you doing that?
• 4:26
  SPEAKER_04: Right.
• 4:26
  SPEAKER_04: Can you not see that you're hurting yourself?
• 4:29
  SPEAKER_04: Can you not see the damage you're doing to your relationships, to your job, to your life?
• 4:34
  SPEAKER_04: Um, and really the person who is in the throes of that behavior is zeroed in and zoomed in to themselves and their experience.
• 4:43
  SPEAKER_04: They are not seeing it from a 10,000-foot view.
• 4:47
  SPEAKER_04: And so that I think is very important to consider that for the person who is in the throes of the addictive behavior, that for them really it is the solution to the problem they're experiencing right in there.
• 5:01
  SPEAKER_03: When I was interviewing people with addictions, I was often hearing like it's my friend.
• 5:05
  SPEAKER_03: Like I, it's not that I couldn't stop.
• 5:06
  SPEAKER_03: I will some at some point it may have been, but that I didn't want to.
• 5:09
  SPEAKER_04: Yeah.
• 5:10
  SPEAKER_04: And, you know, why would you stop something that makes you feel more normal and be able to be in the world?
• 5:17
  SPEAKER_04: I think often about people when they're young people and go to college.
• 5:21
  SPEAKER_04: You hear very frequently people will pre-game with having a couple of drinks or using marijuana or using some other substance as a way of being more social.
• 5:33
  SPEAKER_04: And folks will say, you know, see me when I've had two drinks, or I'll see you on the dance floor after I've had enough.
• 5:39
  SPEAKER_04: They believe that they can't really be fun or engaging or live their best life till they've done that.
• 5:48
  SPEAKER_04: You know, that is even for folks who may not have true blue addiction.
• 5:53
  SPEAKER_04: We make that a pretty normalized component in our culture.
• 5:59
  SPEAKER_04: So if on top of that, you don't feel good inside, because you either have developmental trauma, you're going through some pretty intense stress right now, you might have an anxiety disorder, you might be depressed, that then even more so one can rely on certain substances, forms of behavior as a way of looking more normal, feeling more normal, being out in the world doing the things they think they're expected to do.
• 6:28
  SPEAKER_03: How would that understanding, like my person, child partner, coworker, whomever, is engaging in this behavior because to them it's working?
• 6:39
  SPEAKER_03: How how would understanding that help us relate in a more constructive way to somebody in an addiction?
• 6:45
  SPEAKER_04: For family members, oftentimes there are other things that matter to them.
• 6:52
  SPEAKER_04: For me as a clinician, I may be able to separate that out and talk to my patient about it in a much easier way because I don't have other expectations of them.
• 7:03
  SPEAKER_04: As a family member, it becomes very important first to get clear on okay, why does this bug me so much?
• 7:11
  SPEAKER_04: Right.
• 7:12
  SPEAKER_04: It could be that as a parent, I had certain expectations of my child.
• 7:16
  SPEAKER_04: I thought they're the smartest child, they're going to be so successful, and now they're not graduating college.
• 7:22
  SPEAKER_04: So even becoming aware that I have this like additional layer of disappointment or sadness that I have to get through before I can approach the behavior my loved one has is important.
• 7:35
  SPEAKER_04: Because for me as a clinician, to get to that, I will ask people tell me the ways this thing helps you.
• 7:41
  SPEAKER_04: Tell me what are the things it helps you with, what are the things it makes better.
• 7:46
  SPEAKER_04: Because obviously it's filling some function in your life.
• 7:50
  SPEAKER_04: It's filling some role.
• 7:52
  SPEAKER_04: That's why you do it repeatedly.
• 7:54
  SPEAKER_04: Because cognitively, the person can often relate to me, well, you know, I had this, I got let go from my job.
• 8:01
  SPEAKER_04: I had this difficulty with my relationship, you know, no longer I'm talking to my parents.
• 8:06
  SPEAKER_04: Like they can cognitively often list out the problems that are happening, right?
• 8:12
  SPEAKER_04: Because of this addiction, substance use, behavioral engagement.
• 8:16
  SPEAKER_04: However, once you ask that question, you're getting more to what the pros are for that person.
• 8:23
  SPEAKER_04: Those are the cons, right?
• 8:25
  SPEAKER_04: And they kind of know that in their brain.
• 8:27
  SPEAKER_04: They might not emotionally fully connect with them, but they often can list them out.
• 8:32
  SPEAKER_04: However, when you actually get them to say the positives that are being associated with that, is when you finally can validate for them that they're not being unreasonable in continuing that behavior or using that substance.
• 8:48
  SPEAKER_04: And I think once you can validate what the positives are for them, recognizing those helps then have a discussion about the negatives.
• 8:56
  SPEAKER_04: Because if you say, no, no, no, let's just ignore all the functions it's having, let's just talk about the bad things.
• 9:01
  SPEAKER_04: It's like, yeah, you're splitting it up too.
• 9:04
  SPEAKER_04: And it's very likely that you as a loved one or a parent are focusing on the bad and they internally are focusing on the good.
• 9:12
  SPEAKER_04: And so the two of you will never have a reasonable or a unifying conversation till you can bring both into the mix.
• 9:20
  SPEAKER_04: And I think that extra layer for family members of what expectations of theirs have not been met with their loved one or why they're what roles they're not completing.
• 9:30
  SPEAKER_04: So if, say, we're co-parenting and the person I'm co-parenting with has an addiction, uh, it may be that I am also really stressed out and angry because they're not doing their bit in raising our children.
• 9:41
  SPEAKER_04: Raising children is very hard.
• 9:43
  SPEAKER_04: And so being able to recognize that, oh gosh, I'm also, I have this extra two, three, four layers of anger, stress, disappointment, because judgment, because they're not doing their bit is helpful.
• 9:58
  SPEAKER_04: So even before you approach a conversation with your loved one, taking some time to take stock of what else is layered on is really essential.
• 10:07
  SPEAKER_03: That is a really, really important point.
• 10:09
  SPEAKER_03: And I've actually never heard it, but I can see how what a difference it would make in the conversation because you're meeting them more than halfway and saying, I understand a bit and help me understand it more, which is very different than it's all damage to stop it.
• 10:22
  SPEAKER_03: Yeah, it's a it's affecting me and you.
• 10:25
  SPEAKER_04: And sometimes I'll tell families, right?
• 10:27
  SPEAKER_04: Like one person becomes the identified sick person.
• 10:31
  SPEAKER_04: So whether we're talking about substance use, depression, bipolar disorder, whatever condition, it's often that, you know, this one person in our family member is the sick one.
• 10:40
  SPEAKER_04: Restaurant all of us are healthy.
• 10:42
  SPEAKER_04: Yep.
• 10:43
  SPEAKER_04: And let me tell you what you need to do to fix your life.
• 10:46
  SPEAKER_04: Why are you not fixing your life?
• 10:48
  SPEAKER_04: However, that's rarely how it functions.
• 10:52
  SPEAKER_04: Because once one person does develop some illness, be it mental health, cancer, or substance use, suddenly other people in the family system take on different roles.
• 11:04
  SPEAKER_04: And so for this person to change their role, everybody else is also going to have to change their role.
• 11:11
  SPEAKER_04: Almost think of it like uh not to traumatize people, but like an organic chemistry setup where there's an atom in the middle and then there's, you know, other molecules attached.
• 11:22
  SPEAKER_04: If you move one of them out, the whole system's going to crumble.
• 11:27
  SPEAKER_04: Which is really where for a family to decide that their loved one, who's now the identified sick person, needs to get better, they all need to know that they're going to have to change and grow too.
• 11:38
  SPEAKER_04: Because the minute that person starts to change, whatever has been the dynamic between the family is going to have to change.
• 11:46
  SPEAKER_04: And are we talking about boundaries and enabling and those kinds of things?
• 11:50
  SPEAKER_04: Everything.
• 11:51
  SPEAKER_04: Right?
• 11:51
  SPEAKER_04: How you relate to that person, because now you no longer can be their caretaker and telling them what to do.
• 11:57
  SPEAKER_04: Because if they own their part and change and work towards recovery, they're going to have probably better boundaries than they did before.
• 12:09
  SPEAKER_04: So they may not really enjoy or welcome or be willing to have the type of comments you may have said to them before, the type of advice you try to give them before.
• 12:19
  SPEAKER_04: And so I think the entire family system needs to know that when one person starts to get well, they also need to then respond and change, which is why I think doing your self-reflection is very important to say, okay, this is the role I play in continuing whatever is going on.
• 12:39
  SPEAKER_04: Am I enabling that person?
• 12:41
  SPEAKER_04: Am I making it easier for them to obtain the substances?
• 12:46
  SPEAKER_04: Like often we see young people who come in where parents or family members continue to support them financially in ways that could be considered enabling.
• 12:56
  SPEAKER_04: So if they want the young person to get well, they do have to go through their own change.
• 13:01
  SPEAKER_03: What are the biggest myths or misconceptions about addiction that you'd like to see people stop believing right now?
• 13:08
  SPEAKER_04: First, addiction is a moral failure.
• 13:11
  SPEAKER_04: Right.
• 13:11
  SPEAKER_04: We know that 40 to 60% of addiction or addictive disorders are based in genetics.
• 13:19
  SPEAKER_04: So they're 40 to 60% of the genetic risk or the risk comes from genetics.
• 13:26
  SPEAKER_04: That doesn't mean that if we have a genetic loading towards addiction, that we have to go down that path.
• 13:33
  SPEAKER_04: It just means that it's going to pull you much harder.
• 13:36
  SPEAKER_04: Right.
• 13:36
  SPEAKER_04: And I always, always like to equate mental health and substance use disorders with cancer.
• 13:43
  SPEAKER_04: Because we are able to understand that for cancer a lot better.
• 13:47
  SPEAKER_04: I think maybe 50 years ago we didn't, but oncology and cancer-related stigma has reduced a lot since that time.
• 13:57
  SPEAKER_04: So you think about like if your parent had breast cancer, it means that you are at a higher risk.
• 14:03
  SPEAKER_04: But what we do for that is we screen earlier.
• 14:06
  SPEAKER_04: Right.
• 14:06
  SPEAKER_04: So we now blame the person.
• 14:08
  SPEAKER_04: Yeah.
• 14:08
  SPEAKER_04: Yeah.
• 14:09
  SPEAKER_04: We screen much earlier.
• 14:10
  SPEAKER_04: So similarly, that's what we need to do for substance use disorders is that we need to start educating our young people, maybe even when they're teenagers, to say, hey, you know, this is a condition that runs in our family.
• 14:24
  SPEAKER_04: And so we want to educate you.
• 14:26
  SPEAKER_04: So you can take them to a counselor, you can have the primary care doctor or even a psychiatrist step in and help educate the person to say these are all behaviors that will, you know, put you at risk.
• 14:40
  SPEAKER_04: And also I think that type of education can help it that if the person then has the young person has a desire to drink, they hopefully can be more cognizant that for them the risk is much higher.
• 14:53
  SPEAKER_04: Um, so something like marijuana, which is considered a gateway drug, has become so prevalent with the legalization of marijuana that a lot of people think that it's an organic substance.
• 15:04
  SPEAKER_04: It has no harm.
• 15:06
  SPEAKER_04: For a lot of people, they may be able to use it a few times and stop.
• 15:10
  SPEAKER_04: However, if you have a genetic predisposition, then that is a slippery slope that you will get on.
• 15:17
  SPEAKER_04: And so again, those are really the types of things that we can do to change it from being a moral failure to starting to look at the biologic bases and that it's a health condition like any other.
• 15:30
  SPEAKER_04: We talk so openly about heart disease risk, cancer risk.
• 15:34
  SPEAKER_04: So I'm hopeful that with podcasts like these and all the work that recovery.com is doing and others in this space, that people in coming generations will talk openly about mental health and mental health and substance use genetic loading and say, okay, well, you know, there's this risk in our family, and how am I going to change my health behaviors to ensure that I don't get that condition or get a severe form of that condition, I may be predisposed to it.
• 16:05
  SPEAKER_03: How big is the gap between the stereotype of a person with addiction and the reality of people with addictions?
• 16:11
  SPEAKER_04: Ah, that is a gap as wide as the Grand Canyon.
• 16:16
  SPEAKER_04: Right.
• 16:17
  SPEAKER_04: Because for all types of depiction of people with addiction, it's extremely stigmatized.
• 16:24
  SPEAKER_04: It's the person who's unhoused on the street, who is not able to keep relationships, doesn't care about anybody, has given up their job.
• 16:33
  SPEAKER_04: Like it's just all those really extreme things.
• 16:38
  SPEAKER_04: Can people have that outcome?
• 16:40
  SPEAKER_04: Yes.
• 16:41
  SPEAKER_04: And is that only because of addiction?
• 16:44
  SPEAKER_04: No.
• 16:44
  SPEAKER_04: Because often there's all these other social determinants of health and mental health that are at play for a person to get to that point.
• 16:51
  SPEAKER_04: There's issues like access to care.
• 16:54
  SPEAKER_04: There's issues like trauma, which really is not only a personal and a family thing, but a systemic issue.
• 17:03
  SPEAKER_04: There's poverty, there's all of those different things.
• 17:07
  SPEAKER_04: And so the gap becomes very, very wide where even when we see patients who come to us for care, they'll say, I'm not like those people.
• 17:17
  SPEAKER_04: Right.
• 17:17
  SPEAKER_04: I don't really have an addiction because I still have a job.
• 17:21
  SPEAKER_04: I'm married.
• 17:22
  SPEAKER_04: What are you talking about?
• 17:24
  SPEAKER_04: Right.
• 17:24
  SPEAKER_04: And it is that addiction or substance use disorders don't discriminate.
• 17:30
  SPEAKER_04: We see people who are highly successful CEOs have substance use disorders, and we have people who are fresh, freshmen, fresh women, fresh persons in school who have substance use.
• 17:42
  SPEAKER_04: So the gap can be very wide.
• 17:44
  SPEAKER_04: I worked in community mental health before I worked in a residential treatment center.
• 17:48
  SPEAKER_04: And we did see people who were unhoused in that setting and maybe had that like more classic presentation that people believe is what an addict or addicted person looks like, versus, you know, you see moms who are driving their kids to soccer who have substance use disorders, who are drinking a few glasses of wine every day and feel like they can't really stop.
• 18:12
  SPEAKER_04: And it may be one of those things where they say, Oh, I I just I just drink it to relax.
• 18:16
  SPEAKER_04: I love wine.
• 18:17
  SPEAKER_04: And then over time it becomes that instead of them controlling the wine, the wine controls them.
• 18:23
  SPEAKER_03: Is the very my very asking that question part of the stigma?
• 18:27
  SPEAKER_03: Because I would never say, like, what kind of people get breast cancer?
• 18:31
  SPEAKER_04: You're asking the question because that is a commonly asked question.
• 18:35
  SPEAKER_04: I mean, with breast cancer, people think men don't get breast cancer, but men do.
• 18:39
  SPEAKER_04: It's rarer and it happens.
• 18:42
  SPEAKER_04: Um, but we all have bias.
• 18:44
  SPEAKER_04: I think that's just part of human nature.
• 18:47
  SPEAKER_04: Bias is not a negative thing, right?
• 18:50
  SPEAKER_04: So, again, one of those um the reason I want to even destigmatize bias is because bias is something your brain does to just make it easier to be in the world.
• 19:01
  SPEAKER_04: True.
• 19:02
  SPEAKER_04: You can't think through every situation all the time.
• 19:05
  SPEAKER_04: So you develop these like shortcuts of making judgments, making decisions.
• 19:10
  SPEAKER_04: And that's where bias comes from.
• 19:12
  SPEAKER_04: It's your brain trying to be more efficient.
• 19:14
  SPEAKER_04: Okay.
• 19:15
  SPEAKER_03: Thank you.
• 19:16
  SPEAKER_03: Yeah.
• 19:16
  SPEAKER_03: Um, other than genetics, which is a big other if it's the primary reason, what are other risk factors for addiction?
• 19:24
  SPEAKER_04: Trauma is a big one.
• 19:25
  SPEAKER_04: Yeah.
• 19:26
  SPEAKER_04: I think, you know, if anybody's heard me talk ever before, I talk about trauma a lot.
• 19:31
  SPEAKER_04: Because trauma impacts the development of your brain.
• 19:34
  SPEAKER_04: The earlier in your developmental trajectory that happens, the greater impact it can have over all areas of your brain.
• 19:43
  SPEAKER_04: So your emotion centers, um, how you process fear, joy, pain.
• 19:51
  SPEAKER_04: Also, your prefrontal cortex, which is right here in the front of our brain, develops essentially, we say, you know, till the age of 25 and beyond.
• 20:00
  SPEAKER_04: That's what helps you have executive control, like think through things, be able to make decisions.
• 20:06
  SPEAKER_04: That is also impacted by trauma.
• 20:09
  SPEAKER_04: And so it does become that trauma is a brain disorder that then fuels addiction because the person is not feeling good and may start using substances a lot earlier or start engaging in behaviors which are considered addictive, like things like even, you know, food can become a thing they use to self-soothe.
• 20:30
  SPEAKER_04: And so trauma really aligns with people using substances or addictive behaviors to self-soothe and self-regulate.
• 20:37
  SPEAKER_03: Let's talk about the concept of rock bottom because there are a lot of searches on the internet about this.
• 20:43
  SPEAKER_03: Is it common for a person to have to hit rock bottom before they are willing to successfully get into recovery?
• 20:51
  SPEAKER_04: Rock bottom is a strong term, right?
• 20:56
  SPEAKER_04: Yeah.
• 20:56
  SPEAKER_04: And rock bottom differs for everybody.
• 21:00
  SPEAKER_04: So it's hard to say.
• 21:02
  SPEAKER_04: What I often will think is that what are the positive impacts of the substance and what are the negative impacts of a substance?
• 21:10
  SPEAKER_04: Often it's that balance.
• 21:13
  SPEAKER_04: So that when the negative starts to outweigh the positive, um, and it could be just because of the severity of the negative consequences, or it could be that the positive is no longer feeling positive enough.
• 21:27
  SPEAKER_04: And so the negative starts coming into focus.
• 21:30
  SPEAKER_04: And so it is that pros and cons balance working through an addiction is a very hard thing to do.
• 21:38
  SPEAKER_04: Right.
• 21:39
  SPEAKER_04: And to work that hard, you have to know that either there's going to be something you're going to get out of it, something will get better in your life.
• 21:47
  SPEAKER_04: And so there is that balance that does need to change often.
• 21:51
  SPEAKER_04: A person realizing that I'm going to lose access to my children.
• 21:54
  SPEAKER_04: They may realize I love my job, I'm going to lose my job.
• 21:57
  SPEAKER_04: So there has to be often that little bit of motivation, whether it is rock bottom for that person or not, it's hard to say.
• 22:06
  SPEAKER_04: There are some people where we do see that they'll go to treatment multiple times or attempt sobriety.
• 22:13
  SPEAKER_04: On their own many times and relapse.
• 22:16
  SPEAKER_04: In my book and in the literature, that's really not a failure.
• 22:21
  SPEAKER_04: Each iteration of attempting to achieve sobriety or leave the substance, reduce its impact on you, you're hopefully learning something.
• 22:30
  SPEAKER_04: So I think the concept of rock bottom comes because people may think that, okay, that's at least one time somebody will wake up.
• 22:38
  SPEAKER_04: There are some people who, even after they might hit what is called rock bottom or considered rock bottom by those around them, may not be able to move towards sobriety.
• 22:47
  SPEAKER_04: And I think again, it's that same balance of like, what is the positive impact they're feeling of the substance they're using and what is the negative may not really outweigh.
• 22:58
  SPEAKER_04: Or it could be that they feel just so hopeless that there's that motivation, the drive to be able to change it is not there.
• 23:06
  SPEAKER_04: And for those folks, often, you know, you do need that level of support, something to bolster you up to help you achieve it, which is where withdrawing support is not the answer.
• 23:18
  SPEAKER_04: I think sometimes people think like, oh, let me let them just hit rock bottom.
• 23:21
  SPEAKER_04: And maybe then they'll see the light of the day and want to work towards it.
• 23:27
  SPEAKER_04: I think thinking about this as an illness and saying, you know, I'm not going to participate in enabling this illness or making it worse for you.
• 23:36
  SPEAKER_04: And know that I'm here for you whenever you're ready to change or whenever you're ready to engage in treatment, whenever you're ready.
• 23:43
  SPEAKER_04: That is a tricky line to walk.
• 23:46
  SPEAKER_04: It is.
• 23:46
  SPEAKER_04: Yeah.
• 23:47
  SPEAKER_04: Nobody said it was going to be easy.
• 23:49
  SPEAKER_03: There are three or four, depending on what source you look at, Cs the letter C of addiction.
• 23:55
  SPEAKER_03: And I'd love to step through them just because they seem to be important.
• 23:58
  SPEAKER_03: Okay.
• 23:59
  SPEAKER_03: Have compulsive behavior.
• 24:01
  SPEAKER_03: So compulsion.
• 24:02
  SPEAKER_03: What is that?
• 24:03
  SPEAKER_04: Compulsion really means that you are no longer in the driver's seat.
• 24:08
  SPEAKER_04: You're not making the intentional decision to do something.
• 24:12
  SPEAKER_04: It's almost like you're driven by a motor.
• 24:15
  SPEAKER_04: And so whether that's compulsive drinking, compulsive substance use, compulsive eating, compulsive gambling, that really your brain has sort of short-circuited and you just do the behavior or you know, use a substance without thinking.
• 24:31
  SPEAKER_03: And the second C is cravings.
• 24:33
  SPEAKER_03: What are cravings and addiction?
• 24:35
  SPEAKER_04: Cravings is the deep desire to use something.
• 24:39
  SPEAKER_04: And it's often a physiological need.
• 24:43
  SPEAKER_04: And so when we were talking about the reward pathway before, craving really comes from your dopamine um receptors being hungry.
• 24:51
  SPEAKER_04: They're saying, give me more, give me more.
• 24:53
  SPEAKER_04: And so whatever the behavior is or the substance is, your brain is telling you, I need more of it to feel normal, to get like enough receptors covered.
• 25:02
  SPEAKER_04: And so that's often what is feeding the sensation of craving.
• 25:08
  SPEAKER_03: Uh continue in spite of negative consequences.
• 25:12
  SPEAKER_04: That is again the component that you cannot separate out the negative impact of it.
• 25:20
  SPEAKER_04: And even if you can recognize it cognitively, it's not enough to change the behavior or not engage in that behavior.
• 25:29
  SPEAKER_04: Because of that balance we talked about.
• 25:31
  SPEAKER_04: Because the drive or what's pulling you to continue that behavior is so strong.
• 25:36
  SPEAKER_03: The last of the four C's of addiction is loss of control and being then unable to cut back or stop using similar.
• 25:44
  SPEAKER_04: Yeah.
• 25:44
  SPEAKER_04: And I think that's that same the compulsiveness of it, the need for to fill your dopamine receptors, but that's really what then continues that cycle.
• 25:55
  SPEAKER_04: And you just have difficulty stopping and you're no longer in the driver's seat, right?
• 26:00
  SPEAKER_04: We're not in the driver's seat in many situations in our life.
• 26:03
  SPEAKER_04: And this is definitely one of those where your brain's just on this very strong pathway where your reward pathway is just saying, fill me up, fill me up, fill me up, fill me up.
• 26:14
  SPEAKER_04: And that's what the person's trying to do.
• 26:17
  SPEAKER_04: Um, and I was talking about the prefrontal cortex um a little while back.
• 26:21
  SPEAKER_04: And it's essentially like your prefrontal cortex says, Yep, this is, you know, I'm I'm going a little offline.
• 26:28
  SPEAKER_04: And so your reward circuit and your emotional centers are in the driver's seat.
• 26:32
  SPEAKER_04: And so you're just doing the thing compulsively without thinking.
• 26:37
  SPEAKER_03: What are the first signs of addiction that I should look for in a family member?
• 26:42
  SPEAKER_04: The first signs of addiction can differ for different people.
• 26:46
  SPEAKER_04: You know, that's not a satisfying answer.
• 26:48
  SPEAKER_04: Uh, and it recognizes that each person is unique.
• 26:52
  SPEAKER_04: Um, often, like we have been talking before, addiction can be fueled by something that's going on either acutely or something that's chronically been evolving in a person's life.
• 27:05
  SPEAKER_04: In terms of thinking about signs of addiction, it can be a change in behavior.
• 27:10
  SPEAKER_04: Like they're no longer behaving the way they were.
• 27:14
  SPEAKER_04: It can also be a person trying to hide or be more secretive in some way.
• 27:21
  SPEAKER_04: Um, and we do know that people who are using substances often know that there's, you know, something that's not, it's it's not the best way to do the thing.
• 27:30
  SPEAKER_04: And so there can be an overlapping shame component.
• 27:33
  SPEAKER_04: And so they are, they may be actively trying to hide that, even if they're not thinking about it.
• 27:38
  SPEAKER_04: It's just the behavior that's acting or that's showing up.
• 27:42
  SPEAKER_04: And then based on the substance that they're using, the behavior or what the projected outcome will be will be changed too.
• 27:50
  SPEAKER_04: It can be very hard to recognize that there may be an addictive component without actually talking to the person.
• 27:59
  SPEAKER_04: And at least at a very basic level, if you see any person engaging in a behavior or using a substance sort of compulsively or repeatedly, that might be a time to just ask the question, to, you know, say say it in a more fact-based way.
• 28:17
  SPEAKER_04: I see, you know, you using this, or in the last four days I've been with you, I've seen you use this six or eight times.
• 28:25
  SPEAKER_04: Um, help me understand what role it's playing for you.
• 28:28
  SPEAKER_04: Help me understand what it helps you with.
• 28:31
  SPEAKER_04: Um, and so I think opening the conversation in that way, which is a low judgment, more fact-based observational way, can be more helpful because the minute we say, Oh, I see you have a problem with this, you're doing blah, blah, blah.
• 28:45
  SPEAKER_04: The person hears your judgment and will just shut down.
• 28:49
  SPEAKER_04: And then it's very hard, or they may also get inflamed and say, Well, and you eat these things 16 times.
• 28:56
  SPEAKER_04: Right.
• 28:56
  SPEAKER_04: So then it just becomes a comparison.
• 28:58
  SPEAKER_04: Yeah.
• 28:59
  SPEAKER_04: And so coming at it with more of that observational focus can be one of the ways to open up the conversation.
• 29:07
  SPEAKER_03: And it to our earlier discussion, it's putting the attention where it should be, which is on what's the problem that you're trying to address with this?
• 29:14
  SPEAKER_03: What are you trying to solve for?
• 29:15
  SPEAKER_03: Yeah.
• 29:16
  SPEAKER_03: So related specifically to children, one of the top questions is my kids acting weird.
• 29:22
  SPEAKER_03: Is it drugs?
• 29:23
  SPEAKER_04: Kids act weird for many reasons.
• 29:26
  SPEAKER_04: Yes, they do.
• 29:26
  SPEAKER_04: And what is weird?
• 29:29
  SPEAKER_04: Um, I live in Tucson, and so we often say keep Tucson weird.
• 29:32
  SPEAKER_04: I think there's a few different cities in the US that do that.
• 29:36
  SPEAKER_04: But really, I think, you know, figuring out what weird means to you, what is the behavioral change?
• 29:41
  SPEAKER_04: And again, like we were saying, having a conversation that's more observational, fact-based, can be more helpful.
• 29:49
  SPEAKER_04: There can be many, many reasons that a young person may be acting differently.
• 29:54
  SPEAKER_04: Um, there's also other mental health disorders that show up around that same age, that addiction will rear its head.
• 30:02
  SPEAKER_04: Um, and so we often see co-occurring presentations.
• 30:06
  SPEAKER_04: Um, so a condition like schizophrenia, a person may be developing schizophrenia in that prodromal period.
• 30:13
  SPEAKER_04: They start to have these unexpected experiences, right?
• 30:17
  SPEAKER_04: Like they might be hearing something or seeing what are called visions or we call them visual hallucinations.
• 30:23
  SPEAKER_04: They might start to have some of those odd experiences.
• 30:26
  SPEAKER_04: They might be having increasing anxiety or having depression.
• 30:29
  SPEAKER_04: And that could be a reason they might use.
• 30:31
  SPEAKER_04: It may be that they're not really using something, but they're looking weird to a loved one because they're having these different experiences.
• 30:38
  SPEAKER_04: And then being a teenager is hard in the world.
• 30:41
  SPEAKER_04: It is.
• 30:41
  SPEAKER_04: So you could just be weird because you're a teenager who's trying to develop your self-identity.
• 30:47
  SPEAKER_04: I think that's where for family members, instead of jumping to the conclusion of like, this is substances or this is, you know, a different condition, or these are your bad friends, right, uh, to really just point out the behaviors you're seeing and say, I'm noticing X, Y, and Z.
• 31:03
  SPEAKER_04: Help me understand what's going on.
• 31:05
  SPEAKER_04: I really want to try and understand.
• 31:07
  SPEAKER_04: Um, and approaching it with that curiosity and understanding is just an easier way in.
• 31:15
  SPEAKER_04: And then you'll get the answer if they're using or not.
• 31:18
  SPEAKER_03: I'm hoping you say this like 10 more times during this podcast because every time I hear it, I'm thinking, oh yeah, oh yeah.
• 31:24
  SPEAKER_03: Because if you're not taught that, it's not the first thing.
• 31:27
  SPEAKER_03: It's like, what the hell's wrong with you?
• 31:28
  SPEAKER_03: What are you doing?
• 31:29
  SPEAKER_03: Well, you know, we know where that's gonna lead.
• 31:31
  SPEAKER_03: So what'd you learn in school today?
• 31:33
  SPEAKER_03: Nothing.
• 31:34
  SPEAKER_04: Yeah.
• 31:34
  SPEAKER_04: And I think that's the part that I feel very, very strongly about that as much as there's clinicians like myself out in the world doing this work, that we do need to bring mental health recovery into our communities.
• 31:49
  SPEAKER_04: It has to happen at the community level with our families, how we raise our children, really starting to educate them in the emotion words, understanding their feelings, because then they might be able to come up to you and say, I feel really frustrated, right?
• 32:08
  SPEAKER_04: I feel angry, I feel sad, I feel disappointed rather than not having those words and saying, what I feel doesn't seem normal, and then wanting to self-medicate.
• 32:22
  SPEAKER_03: And that everything that isn't positive, you know, happy on the happy side of the spectrum is bad because we have the full spectrum of feelings.
• 32:32
  SPEAKER_04: Yeah.
• 32:32
  SPEAKER_04: I mean, the pursuit of happiness is great in some ways, but you know, really talking more about contentment and that life is full spectrum.
• 32:41
  SPEAKER_04: Frustration is part of life.
• 32:43
  SPEAKER_04: Let me say it's essential to life.
• 32:46
  SPEAKER_04: Because if you don't face a level of hardship, frustration, difficulty as you're growing up, you're actually not going to know how to overcome it when you're an adult.
• 32:56
  SPEAKER_04: Yes.
• 32:57
  SPEAKER_04: So it really feeds into resilience.
• 32:59
  SPEAKER_04: And negative experiences for children are important because when they have a negative experience, and I don't mean to say big T trauma, but just a challenging experience is normal so that they can have their parent, their caregiver around to show them how to navigate it.
• 33:19
  SPEAKER_04: Nobody is given a blueprint of how to live life.
• 33:23
  SPEAKER_04: If we teach our kids how to say they're ABCs, we also need to teach them how to deal with frustration, name frustration so that they understand how it feels in the body.
• 33:34
  SPEAKER_04: Which is why kids, when they're growing up, will say have a tummy ache.
• 33:38
  SPEAKER_04: Right.
• 33:38
  SPEAKER_04: They know that they're not feeling okay.
• 33:41
  SPEAKER_04: They'll tell you it's a tummy ache.
• 33:43
  SPEAKER_04: That's the most basic level of emotional awareness.
• 33:47
  SPEAKER_04: And then developing words for it, being able to conceptualize it, have layers of emotions in oneself, having layers of emotions in other people.
• 33:56
  SPEAKER_04: Those are the various levels of emotional awareness that we ideally want to develop so we can talk about these things rather than just act them out.
• 34:05
  SPEAKER_03: And emotional awareness can be addiction prevention.
• 34:09
  SPEAKER_03: It's an antidote for sure.
• 34:12
  SPEAKER_03: So this is not a very gently worded question, but it's verbatim how it was searched repeatedly.
• 34:17
  SPEAKER_03: Why do people with addictions lie so much?
• 34:21
  SPEAKER_04: The short answer may be that they may not feel safe in the world.
• 34:27
  SPEAKER_04: They may not feel that their experience will be understood or that anybody would want to understand it.
• 34:35
  SPEAKER_03: And it's interesting because from the non-clinical and and maybe not even as kind of a perspective.
• 34:41
  SPEAKER_03: I'm thinking it's so they can keep doing it, right?
• 34:43
  SPEAKER_03: So they don't have to stop that they don't get caught.
• 34:45
  SPEAKER_04: Yeah, I mean, but but often I would also say that people are not just lying to you, right?
• 34:53
  SPEAKER_04: They're also not being able to see the truth for themselves.
• 34:58
  SPEAKER_04: Like when we say lying, it m makes it seem like it's a very active deception.
• 35:04
  SPEAKER_04: And there is, it does get to that point.
• 35:07
  SPEAKER_04: However, it starts with not often recognizing it for oneself.
• 35:13
  SPEAKER_04: And then when you don't know the truth for yourself, then we do get into that confabulation space.
• 35:20
  SPEAKER_04: And confabulation just means that even in your brain, biologically, it'll fill in the blanks or it'll make up the story because you either don't know, don't remember.
• 35:33
  SPEAKER_04: And it's very hard for human beings to be able to say, I don't know, or I don't understand.
• 35:40
  SPEAKER_04: And we see that in all realms of life, especially like not being able to understand yourself.
• 35:45
  SPEAKER_04: That's a lot.
• 35:46
  SPEAKER_04: Right.
• 35:46
  SPEAKER_04: And so that's really where that confabulation comes up, where you start filling in the blanks with what you think seems reasonable.
• 35:54
  SPEAKER_04: And then gradually the disconnect between where you are, what your values you know are, and who you're being in the world starts to get wider and wider.
• 36:07
  SPEAKER_04: Further apart, yes.
• 36:08
  SPEAKER_04: And then it can become that you don't even remember the person you were because you've been building this external structure for the world to see.
• 36:19
  SPEAKER_04: And obviously, you know, people are very intuitive in being able to understand that this is not quite the real you, which is why in today's culture we talk a lot about authenticity.
• 36:29
  SPEAKER_04: Like be authentic.
• 36:30
  SPEAKER_04: If you're being real, people will see you and understand and like you more.
• 36:35
  SPEAKER_04: Because we know that intuitively people see that you're authentic, you're being yourself.
• 36:40
  SPEAKER_04: And so I think the person who's in the throes of this substance use disorder starts to believe their own confabulation.
• 36:49
  SPEAKER_04: And so then it can be so far out, and they're like, oh, you know, everybody believes this, but nobody else is believing that.
• 36:57
  SPEAKER_04: And so that's I think what is perceived as lying because it's just gone so far out.
• 37:03
  SPEAKER_04: And intuitively, family members, loved ones, professional colleagues can often see that there are some people who are better at keeping the facade than others.
• 37:13
  SPEAKER_04: But you know, at some point, the facade like it gets so far out, it's just it collapses.
• 37:19
  SPEAKER_03: Another one of those um kind of judgmental questions that searched is why can't people with addictions just quit?
• 37:24
  SPEAKER_03: Or why is it so hard for an addict to stop?
• 37:28
  SPEAKER_04: Because your brain has been taken over.
• 37:31
  SPEAKER_04: The reward circuit is something we all have.
• 37:35
  SPEAKER_04: And for most of us, day-to-day experiences are sufficient to stimulate it and feel good enough and walk about.
• 37:45
  SPEAKER_04: Um, so a nice conversation, a delightful cup of coffee.
• 37:50
  SPEAKER_04: Um, it could be a brisk walk with, you know, the wind in your face when you're in Madison uh in the winter.
• 37:57
  SPEAKER_04: Those are all things that can feel enlivening and stimulate your reward circuit.
• 38:02
  SPEAKER_04: However, for somebody who either has a genetic predisposition or is currently in the midst of an addictive disorder, what can happen is that the amount of stimulation you need is so much that you basically get disconnected from the ability to stop.
• 38:21
  SPEAKER_04: So those cravings, the compulsivity is driving you.
• 38:25
  SPEAKER_04: And we talk about, you know, the lizard brain and more the human brain, where the human brain has the prefrontal cortex to control, and the lizard brain or the animal brain, often they're, you know, just responding to things in their environment.
• 38:40
  SPEAKER_04: And really, in addiction, you can sort of move into that area where your prefrontal cortex doesn't quite play as much of a role.
• 38:47
  SPEAKER_04: You're just responding to the innate needs your body and your brain have in the moment.
• 38:52
  SPEAKER_04: And so that's really where it's hard to just stop because your brain's running the show, you know, that that addictive, the reward circuit hijack is running the show instead.
• 39:05
  SPEAKER_04: Can you get control of your brain back?
• 39:08
  SPEAKER_04: You can.
• 39:09
  SPEAKER_04: And I think that's really where treatment comes in, being able to, you know, step away from the substance, often again, in a supportive environment.
• 39:20
  SPEAKER_04: Uh, some people are able to gradually cut back use.
• 39:25
  SPEAKER_04: Um, it's not all the people.
• 39:27
  SPEAKER_04: So I think, you know, in other podcasts that you do, you might hear stories of people who say, I was able to do this on an outpatient basis.
• 39:35
  SPEAKER_04: I was able to do it without treatment, also.
• 39:37
  SPEAKER_04: You know, there'll also be people who say, I smoked cigarettes for these many years, and one day I just quit cold turkey.
• 39:42
  SPEAKER_04: Um, so it can happen.
• 39:44
  SPEAKER_04: There can be different reasons for that motivation to come up.
• 39:47
  SPEAKER_04: Um, different individuals may have different times in their life.
• 39:52
  SPEAKER_04: It could be that you're no longer in as unsafe of an environment as you were before.
• 39:56
  SPEAKER_04: And so suddenly you are able to step away.
• 40:01
  SPEAKER_04: Um, we talked about trauma earlier.
• 40:03
  SPEAKER_04: If, say, you, you know, start working through trauma, either with a clinician or even through more reparative relationships in your life, you could get to a place where you can stop.
• 40:16
  SPEAKER_04: But often it does take some level of environmental and situational change to be able to do that.
• 40:23
  SPEAKER_04: We've heard of people who come to us for treatment who then say, you know what, I'm not going back to my prior city because there's just such strong associations.
• 40:32
  SPEAKER_04: So often it takes for something in life to change to be able to get there.
• 40:38
  SPEAKER_03: Can you be addicted to things that aren't drugs?
• 40:41
  SPEAKER_04: Yes.
• 40:42
  SPEAKER_03: Yes.
• 40:43
  SPEAKER_03: Yeah.
• 40:43
  SPEAKER_04: Let me say it again.
• 40:45
  SPEAKER_04: Yes.
• 40:46
  SPEAKER_04: It can be things that the world rewards you for.
• 40:49
  SPEAKER_04: Workaholism.
• 40:51
  SPEAKER_03: Wow.
• 40:52
  SPEAKER_04: I had to take a survey myself a few years ago to say, am I a workaholic?
• 40:56
  SPEAKER_04: And then, you know, found an evidence-based questionnaire that I did.
• 41:01
  SPEAKER_04: Because we all cope with stresses in a different way.
• 41:04
  SPEAKER_04: And gosh, if you find something that helps you cope with stress, why would you not keep on doing it?
• 41:11
  SPEAKER_03: Let's talk about some of them and the concept of behavioral addictions.
• 41:15
  SPEAKER_03: So gaming, porn, you know, the let's let's list some of them and talk about how that they play out.
• 41:22
  SPEAKER_04: I think again, when you look at those process addictions as they're called clinically, uh, you really think about things that the world considers adaptive and that may be considered maladaptive.
• 41:36
  SPEAKER_04: So, say porn, most people in the world would think it's not adaptive, right?
• 41:42
  SPEAKER_04: So it does become a thing that we then say, well, you got to treat this.
• 41:47
  SPEAKER_04: But then you also have things like gaming, which especially now in the world of, you know, internet gaming and you can game for hours and hours, can become problematic.
• 41:59
  SPEAKER_04: But all of these process addictions also have the same structure as substance use addictions, is that they're filling that same sort of need.
• 42:10
  SPEAKER_04: Somebody may start doing them as a way of self-medicating away from something that did not feel good.
• 42:17
  SPEAKER_04: So if you, you know, have some difficulty with like your self-concept and have some difficulty with intimacy, then using porn as the way to have some sort of sexual stimulation or stimulation of your reward circuit starts.
• 42:33
  SPEAKER_04: And then suddenly you get deeper and deeper and deeper because you need a more intense experience to feel the same amount of stimulation of your dopamine circuits.
• 42:44
  SPEAKER_04: And so it really has a very, very similar biologic component.
• 42:51
  SPEAKER_04: The difference sometimes can be that in the addition of a substance, you also have the physiologic impact of the substance, like what it's doing to your biology when you take it.
• 43:03
  SPEAKER_04: Um, and so that can be the slightly significantly different component.
• 43:08
  SPEAKER_04: But process addictions very much are driven by that same compulsive motor, needing to fulfill that craving, needing to sort of continue on that behavior because you've lost control of it.
• 43:20
  SPEAKER_04: So that loss of control is very much similar in both places.
• 43:26
  SPEAKER_03: Where's the line between somebody does something a lot and someone has an addictive behavior about it?
• 43:32
  SPEAKER_03: Whether that's scrolling on their phones, whether that's substances?
• 43:38
  SPEAKER_04: Um, most conditions, when we think about disorders or clinically we define them as disorders, we talk about functional impairment.
• 43:45
  SPEAKER_04: So if it impairs your ability to work, be with your family, fulfill your role obligations.
• 43:54
  SPEAKER_04: So whatever your role obligations are, if you're unable to fulfill them because of engaging in that behavior, you're spending an inordinate amount of time, effort, energy in it.
• 44:04
  SPEAKER_04: Um, but really more so that like loss of functionality and other elements of your life can be the defining component.
• 44:13
  SPEAKER_04: Uh for some people, there's also just this very intense distress that they would feel.
• 44:18
  SPEAKER_04: And that distress can also be a signal that it's now gone into the realm of a disorder.
• 44:25
  SPEAKER_04: Um that if you don't do the behavior, you're feeling it can be both things, right?
• 44:30
  SPEAKER_04: That you're feeling distress when you're unable to do the behavior.
• 44:34
  SPEAKER_04: Okay.
• 44:34
  SPEAKER_04: But you're also feeling distress by engaging in it.
• 44:38
  SPEAKER_04: Because you likely could have a lot of shame judgment.
• 44:42
  SPEAKER_04: Um, think about somebody, you know, who maybe considers themselves a really moral upstanding citizen, has a family that they really love, children, and then they're engaging in a porn addiction.
• 44:54
  SPEAKER_04: It just doesn't align often with the values the person believes they have.
• 45:00
  SPEAKER_04: And so that same disconnect in who you think you are and the behavior you're engaging in can then cause distress.
• 45:07
  SPEAKER_04: And so once the person engages in the behavior, then there's the moral distress of like, why did I do that?
• 45:13
  SPEAKER_04: I'm not the kind of person who engages in this.
• 45:16
  SPEAKER_04: Um, so there can be that dual distress that whether you do it or you don't, you're in a terrible place.
• 45:23
  SPEAKER_04: That sounds awful.
• 45:24
  SPEAKER_04: It definitely is.
• 45:26
  SPEAKER_04: And I think that's maybe one way to develop a level of empathy for people who are struggling with this is that they're often not enjoying it either.
• 45:36
  SPEAKER_04: It's not an enjoyable experience to have your brain hijacked like that.
• 45:40
  SPEAKER_03: And how would that understanding help somebody help somebody?
• 45:44
  SPEAKER_04: Um, I think for family members, loved ones, colleagues, you know, community members, understanding that what a person does as in the throes of that behavior is not something they're doing to you.
• 45:59
  SPEAKER_04: They're not enjoying what they're doing.
• 46:02
  SPEAKER_04: And so coming more uh with a level of compassion and that same curiosity, wanting to understand the experience can be very helpful.
• 46:13
  SPEAKER_04: There is definitely a role for setting a boundary, right?
• 46:18
  SPEAKER_04: So we we're not saying don't set a boundary, don't you're not going to keep on welcoming bad behavior.
• 46:26
  SPEAKER_04: However, being able to separate the bad behavior and not making it a bad person is important.
• 46:32
  SPEAKER_04: So you can say, I will not be able to have you in my house when you have used alcohol.
• 46:38
  SPEAKER_04: That's not welcome in this house.
• 46:41
  SPEAKER_04: I still love you and I'll I'll support you whenever you're ready to take a different path.
• 46:47
  SPEAKER_04: And so being able to set a boundary, so it is that dialectic as we call it.
• 46:51
  SPEAKER_04: You're providing support and you're holding accountability at the same time.
• 46:56
  SPEAKER_04: Um, and that is a very challenging thing to do.
• 46:58
  SPEAKER_04: I mean, as clinicians, we have to practice that repeatedly to get there.
• 47:02
  SPEAKER_04: So expecting that family members will know how to do it is unreasonable, which is why, you know, keep on going back to that.
• 47:09
  SPEAKER_04: At the end of the day, it is a community-based solution to have communities that are welcoming and supportive, and that we have enough knowledge and psychoeducation, understanding of emotions to then also be able to hold accountability, that we have to be very healthy communities and families to be able to do that.
• 47:30
  SPEAKER_04: Yeah.
• 47:30
  SPEAKER_04: Um, and so anything we can do to help ourselves get to that place as we're trying to support a loved one, uh, we often will recommend that family members themselves seek some support.
• 47:43
  SPEAKER_04: So whether that's, you know, by going to a counselor yourself, um, being able to go to support groups that are for family members, really doing that as a way of bolstering your own social support because it's just a very hard journey to be navigating.
• 48:03
  SPEAKER_03: And isolation can be as problematic for family members as it is for the person in addiction.
• 48:08
  SPEAKER_03: Yeah.
• 48:09
  SPEAKER_03: Because we're trying to fix something we don't fully understand because you can't, and because it's really hard to understand.
• 48:15
  SPEAKER_04: And it's hard to fix anybody.
• 48:18
  SPEAKER_04: Right.
• 48:18
  SPEAKER_04: Right.
• 48:19
  SPEAKER_04: Like we also there's a component of like, what's my task here?
• 48:22
  SPEAKER_04: And so my task is to support, my task is to love.
• 48:28
  SPEAKER_04: It's not my task to fix the person.
• 48:30
  SPEAKER_04: Right.
• 48:32
  SPEAKER_04: It's hard.
• 48:33
  SPEAKER_04: It's it's very, very hard.
• 48:35
  SPEAKER_04: Yeah.
• 48:35
  SPEAKER_04: You know, but it's also for every other condition.
• 48:37
  SPEAKER_04: Yes.
• 48:38
  SPEAKER_04: Again, if your loved one has cancer, you're not fixing the cancer.
• 48:42
  SPEAKER_04: No.
• 48:42
  SPEAKER_04: What are you doing?
• 48:43
  SPEAKER_04: You're supporting, right?
• 48:45
  SPEAKER_04: And you're loving.
• 48:46
  SPEAKER_04: Tends to affect us less.
• 48:48
  SPEAKER_04: Right?
• 48:49
  SPEAKER_04: Yes and no.
• 48:50
  SPEAKER_04: Okay.
• 48:50
  SPEAKER_04: Right?
• 48:50
  SPEAKER_04: People also have a lot of grief and anger.
• 48:53
  SPEAKER_04: So especially if I think in cancer care, we also notice that sometimes the individual who has cancer may have had behaviors that people might consider causative.
• 49:04
  SPEAKER_04: That can be hard to well, you smoked for 30 years.
• 49:07
  SPEAKER_03: Yeah.
• 49:08
  SPEAKER_04: And sometimes it's like even if you don't have that, you can feel betrayed that this person is no longer going to be there for you.
• 49:15
  SPEAKER_04: Um, so it is different, but it may not be as different as we believe it is.
• 49:20
  SPEAKER_04: Because at the end of the day, we're all thinking about our experience.
• 49:23
  SPEAKER_04: We're like, you know, how does this affect me?
• 49:26
  SPEAKER_04: And we may not openly say that out loud.
• 49:29
  SPEAKER_04: Yeah.
• 49:29
  SPEAKER_04: But internally, that's really what's happening.
• 49:31
  SPEAKER_04: It's like, how does this affect me?
• 49:32
  SPEAKER_04: How does this affect my security, my safety, my life?
• 49:36
  SPEAKER_04: Um, and anything that's going on with a person we care deeply about or we love or we consider a family member is going to impact us.
• 49:44
  SPEAKER_03: Touched on this earlier, but it's a separate question that is often searched on the internet.
• 49:48
  SPEAKER_03: So I just want to return to it.
• 49:50
  SPEAKER_03: Is it possible to manage alcohol use without complete sobriety?
• 49:54
  SPEAKER_04: I think the short answer from a clinician standpoint would be it's best not to consider that option.
• 50:02
  SPEAKER_04: I think, you know, complete sobriety definitely is more the gold standard, so to say.
• 50:09
  SPEAKER_04: However, each person is unique.
• 50:12
  SPEAKER_04: And based on each person's circumstance, it really would be something you should discuss with your clinician, assess the risks and benefits.
• 50:20
  SPEAKER_04: At the end of the day, every decision you make about your health is a balance of risks and benefits.
• 50:25
  SPEAKER_04: You're the one in the driver's seat, you make the decision.
• 50:29
  SPEAKER_04: We're here to collaborate and support and provide our expertise.
• 50:34
  SPEAKER_04: But at the end of the day, we would work with the person given what their goals are.
• 50:41
  SPEAKER_04: I do believe very, very strongly in the concept of harm reduction.
• 50:45
  SPEAKER_04: And so if that's the best, you know, a person can do or is willing to do or is willing to achieve, we'd work with that.
• 50:53
  SPEAKER_04: Let's define harm reduction.
• 50:55
  SPEAKER_04: Harm reduction is anything that helps make it that the impact of, in this case, you know, substance use disorders or the addictive behavior is minimized.
• 51:08
  SPEAKER_04: So harm reduction can be things like needle exchanges.
• 51:11
  SPEAKER_04: So if somebody's using intravenous drugs, injecting themselves, um, harm reduction can be supplying clean needles so that they're not getting infection, which can lead to heart disease, HIV, other conditions, so sepsis.
• 51:24
  SPEAKER_04: So we're trying to make it that it's less harmful.
• 51:28
  SPEAKER_04: It may be creating things called wet houses, where when people are intoxicated or have used, they can come and sleep.
• 51:35
  SPEAKER_04: So they're not unhoused and at risk from the weather conditions outside.
• 51:41
  SPEAKER_04: Harm reduction can be working with somebody to create a plan where they don't get fully sober or stop using the substance entirely and use lesser amounts.
• 51:52
  SPEAKER_03: And to the people watching or listening saying, that's not getting better.
• 51:58
  SPEAKER_03: What the hell?
• 51:58
  SPEAKER_03: They're not stopping.
• 51:59
  SPEAKER_03: How do you respond to that?
• 52:01
  SPEAKER_04: Harm reduction is important because it helps us meet the person where they're at today.
• 52:07
  SPEAKER_04: It keeps them engaged.
• 52:08
  SPEAKER_04: You're still having the dialogue.
• 52:10
  SPEAKER_04: And as long as we're still talking, there's hope.
• 52:13
  SPEAKER_04: And anytime you are able to keep the door open, keep the conversation going, there's greater hope.
• 52:22
  SPEAKER_03: That is the best answer I've heard to that question.
• 52:24
  SPEAKER_03: Thank you very much.
• 52:24
  SPEAKER_03: And it's also the perfect place to wrap up this first half of our discussion.
• 52:28
  SPEAKER_03: We will be back next week with more answers to more of your questions about what addiction is and isn't.