Latest / Life Lived Better / Episode 146: Addiction - More Than a Personality

Transcript

Episode 146: Addiction - More Than a Personality · Life Lived Better

0:03
Hi, this is Paula. And I'm Joseph and you're
0:05
listening to life lived Better. Welcome back everybody to Part
0:12
2, our series on addiction. If you have not listened to Part
0:16
1, we suggest you go back and take a listen.
0:19
Some good information. We pause our conversation after
0:22
an in depth look at many of the myths related to addiction, what
0:27
causes addiction, and whether or not addiction is a disease.
0:30
That was a very good conversation, I think.
0:33
I hope everyone will go back and listen to that.
0:35
And so now let's get back into the information, beginning with
0:39
a question that people ask me a lot.
0:42
I don't know about you, but people, especially my students,
0:45
ask me, is it true that some people just have addictive
0:49
personalities and do you can? Ask that I do.
0:54
And one of the resources that we use to create this episode,
0:58
there was a doctor, Daniel Hutchman, and he said something
1:01
that made an impact on me. He said addiction is a trained
1:06
pattern of seeking pleasure to escape intolerable, painful
1:10
emotions. Which that that right there is
1:12
addiction. I mean, at least it's the start
1:14
of addiction. I think so that that gives me a
1:18
lot of information about whether people might have an addictive
1:21
personality. Because his statement about
1:23
addiction tells me that if a person tends to seek pleasure as
1:27
an escape from painful emotions that they, they think they can't
1:31
tolerate, then they might have what looks like an addictive
1:35
personality. You know, that they they
1:38
probably escape pain in a lot of ways in their life.
1:41
So addiction to chemicals is just one of the kind of socially
1:45
unacceptable ways people use to avoid intolerable pain.
1:51
I think we all, I think many people do it in other ways, so.
1:56
I always tell people I think are, you know, when it comes to
1:59
addiction, I think the brain operates on pain or pleasure.
2:01
And I'm not feeling pain. How do I feel pleasure?
2:04
If I know there's like a quick way to do that, then that's
2:07
probably the route I'm going to go.
2:08
And so that's why a lot of people struggle with like,
2:11
relapse. And not.
2:12
But isn't it funny, like there aren't many of us, that when
2:15
we're feeling pleasure, wonder how we can escape that to feel
2:18
pain? Right.
2:20
I'm sure there are people who do.
2:21
Yeah, well, and I always think of like, you know, when you do
2:25
use something to escape the pain, it's, you know, when you
2:28
start getting recovered and you start feeling emotions, I feel
2:32
so overwhelming because you haven't built up like a
2:34
tolerance to just like pain medication.
2:37
If you've not taken pain medication and then suddenly you
2:39
take it, you know, it's it's your, you have no tolerance for
2:43
it. So it takes time to kind of
2:45
adjust. Absolutely.
2:46
So is addictive personality a thing professionally?
2:50
No. Addictive personality is not a
2:52
scientific term, so there's not one specific personality type
2:56
that guarantees addiction. But some traits do make people
3:00
more vulnerable, especially stress, trauma or access to
3:04
substances are also in the mix. So when you have access or you
3:08
grow up around it, that can be problematic.
3:11
So it's less you have the addictive personality and more
3:14
some traits can raise the odds. Makes sense.
3:17
I just did a lecture on emotional regulation and class,
3:20
and that makes a lot of sense to whether or not someone, I mean,
3:25
if you can tolerate your emotions, if you can feel your
3:28
emotions, there's less of a chance that you do something to
3:31
quash them. You know, right.
3:33
Well, we alluded to all those traits previously, but
3:37
researchers see some of the the trait patterns like impulsivity
3:42
when you just act quickly without thinking things through.
3:46
If you're a sensation seeker. So you like crave excitement or
3:50
intensity, intensity. Or you have difficulty
3:53
regulating your emotions like big motions, emotions that are
3:57
hard to soothe, high stress or anxiety.
4:00
So you just want that relief real fast.
4:03
Or even when you have perfectionism, so you use
4:06
substances to escape any kind of major pressure and even
4:09
loneliness or low self esteem when you seek comfort or
4:13
belonging because you don't feel it elsewhere.
4:16
And here's an interesting twist though some risk traits can also
4:20
be strengths like creativity, energy, curiosity, passion.
4:26
They just need healthy outlet. It does.
4:29
And life experiences way into the outcome as well.
4:33
So although you know, traits alone don't cause addiction, the
4:37
risk increases when personality and environment combine.
4:41
Things like trauma, chaotic or stressful home life, a lack of
4:46
support, early exposure to substances, or even untreated
4:50
mental health issues. So two people with similar
4:53
traits can have a totally different outcome.
4:56
What the term addictive personality gets wrong is that
5:00
it really can oversimplify a pretty complex condition.
5:05
And again, it can blame the person instead of the situation
5:08
and their biology. And it can also make people feel
5:12
doomed. Like I'm just wired this way so
5:14
I can't stop being addicted. And that's not fair and it's not
5:18
really accurate. I think a more helpful way to
5:21
think about it is instead of do I have an addictive personality
5:25
is to ask like, what makes me vulnerable and how can I support
5:28
myself? You know, like ask yourself, do
5:31
I, do I use things to numb my feelings?
5:34
And do I struggle with stress or self-control?
5:37
And do I feel lonely and overwhelmed a lot?
5:39
And do I in chase, do I chase those intense feelings or want
5:44
to escape a lot? And, and if you said yes to
5:47
those, that that's not a flaw. It just means coping tools are
5:50
going to matter a lot. You know even more.
5:53
And the good news is that risk does not equal your destiny.
5:57
So people can build resilience through things like therapy,
6:00
developing a support system, having good consistent routines,
6:05
mindfulness and grounding, meaningful connection, having a
6:09
purpose, and even healthy outlets like exercise,
6:12
creativity and community. And we have to remember that the
6:16
brain is very capable of change. Like we can definitely, you
6:19
know, rewire things and and change pathways and, and it's
6:23
very much possibility. That is so hard.
6:25
Sometimes we think we're just doomed.
6:27
And that is so true. Now let's talk statistics, shall
6:31
we? Let's look at the number of
6:34
people who have an addiction, and that means they meet the
6:37
clinical criteria, if you will. First look at, let's look
6:41
globally at the number. So people who have drug use,
6:45
drug use disorders, that means we're not talking about alcohol,
6:48
just drugs. So according to the recent
6:51
United Nations data, it's estimated that about 64 million
6:55
people worldwide suffer from some kind of drug use disorder.
7:00
And in earlier world reports, they estimated that around 39.5
7:05
million people had drug use disorders in 2021.
7:08
So look at that rise to 60, 4 million just in, I mean that's
7:13
what's 5 years, that's that, that's so the numbers not really
7:17
improving there. I wonder how much of that how
7:21
much was impacted by COVID 2020? Because we know that it
7:25
increased so much. During drinking increase
7:29
considerably for people. So Speaking of, let's talk about
7:33
alcohol use disorders. So, and alcohol use disorder is
7:36
typically far more common globally than drug use
7:40
disorders. WHO, which is the World Health
7:42
Organization. Reports have noted that around
7:44
400 million people worldwide live with alcohol use disorders,
7:50
many with dependency to alcohol. That's wild.
7:54
That is, Yeah, there's a lot of people.
7:57
It really is a nice suppose that's because alcohol's
8:01
available in many countries. You know it's socially
8:04
acceptable in many countries. It is.
8:07
And it's so, like, it's so common to plan things around,
8:10
you know, alcohol, where you can drink, who has the best drinks,
8:13
who has the the best bartender. And like, we're going to
8:17
celebrate, let's pop a top, we're going to be sad, let's
8:21
have a bottle, you know something?
8:24
So if we combine that alcohol and drug use disorders
8:27
statistics older, your World Health estimate suggests around
8:32
160 million people globally have some form of an addiction.
8:36
So that's like 2% of all people globally.
8:40
Well, OK, seeing it that way is a little different, I think in
8:43
my my view than the number. But new reporting methods and
8:47
updates are still emerging and the figures vary by source.
8:51
So roughly in global terms, 10s of millions of people worldwide
8:56
struggle with drug use disorders and hundreds of millions
9:00
struggle with alcohol use disorders.
9:02
So when you look at them together, hundreds of millions
9:05
of people globally meet some kind of criteria clinically for
9:09
significant substance use disorders.
9:11
And these conditions really do contribute heavily to
9:15
preventable death. Preventable disabilities every
9:18
single year, for example, like alcohol and drugs, together
9:21
account for like over 3,000,000 annual deaths.
9:25
Wow, that's a lot. That is.
9:27
Wow. Well, in case you're wondering
9:29
like I have, the reason these numbers vary so much is because
9:32
different reports use different definitions and data sources.
9:36
So some include only illegal drug use disorders.
9:40
Some include alcohol use disorders.
9:43
Most still underestimate the true burden because many cases
9:46
go undiagnosed or unreported worldwide.
9:49
Most people are not actively talking about, you know, having
9:51
an addiction or struggling with addiction, or they don't
9:54
recognize that they have a problem yet.
9:56
Yeah. So that's why you can see
9:58
numbers ranging from 35 million to 64,000,000 plus just for drug
10:03
use disorders and they become much higher when you add in
10:06
alcohol. There's some countries that you
10:09
just would never ever admit that because it would be just if some
10:13
countries it's illegal to to drink and or to have alcohol.
10:17
So you just wouldn't ever admit that anywhere.
10:20
Looking at the latest data in the United States, it's
10:24
estimated that 48 to 49 million people that are 12 years and
10:28
older in the United States have a substance use disorder in the
10:32
past year. So that's roughly 16.8 to 17.3
10:38
percent of the population in that age group that so we have a
10:41
lot of the issue here in the United States.
10:44
In plain terms in the United States that means that one in
10:48
six people that are over 12 years old meet the clinical
10:51
criteria for substance use disorder in whatever given year
10:55
that the stats are looking at. And remember, that's clinical
10:59
criteria, not just casual use. And that's a goal.
11:02
Yeah, it is. And that clinical criteria is
11:05
very specific. So we should definitely, I don't
11:08
know if we're gonna cover that at some point, but if not, put
11:10
it in the show notes cuz that's kind of interesting to me still
11:14
to look at the criteria. It is.
11:15
And a lot of people don't meet the full criteria, even people
11:18
that I would consider to have a problem.
11:21
Yeah, criteria. Exactly.
11:23
So what criteria are we looking at?
11:25
Is it a Sam criteria? Is it the DSM?
11:29
Is it the international criteria?
11:32
Right. So it's important to mention
11:33
that those rates we talked about are about the number of people
11:37
who have addictions and substances and not the number of
11:39
people who actually get treatment.
11:41
Unfortunately, only a small fraction of people worldwide
11:44
actually seek out treatment. According to the United National
11:48
Office on Drugs and Crime and the World Health Organization,
11:53
only about one in 11 people with drug use disorders receive drug
11:58
related treatment globally. That's crazy.
12:01
One in 11. That is unfortunate.
12:05
That's roughly like 9 to 9 to 10% coverage, meaning like
12:11
around 90% of people who need it don't get it.
12:15
So wow, let's talk about like, what's the reason for the
12:18
dramatic number and people who need it and people who actually
12:22
get the treatment? Yeah.
12:24
So coverage, it varies, you know, region by region.
12:27
So, for example, Europe and Oceana have a relatively high
12:31
treatment rates. You know, Africa and much of
12:34
Asia have some of the lowest global rates, often under 5%.
12:38
So globally, only 10% of those who need treatment actually get
12:42
treatment for their addiction because there are many barriers
12:45
to getting care. Let's look at some more stats in
12:48
the United States before we go into the depth about the
12:50
barriers to getting care. And I know stats, some people
12:54
can bore with stats, but to me they're kind of they, they just
12:58
speak volumes about what's happening in our world.
13:02
So about 10.2 million people again aged 12 or older received
13:08
substance use treatment in this past year.
13:11
So that includes outpatient, you know, residential programs,
13:14
telehealth, medication assisted treatment and other programs,
13:18
just whatever it was treatment for substance use disorder.
13:22
So that's about 3.5% of all people that are 12 or older in
13:27
the United States. That's a lot of people getting
13:30
some kind of treatment, even though it's not how many people
13:34
need it. Well, and in the United States
13:36
in 2024, about 52.6 million people were estimated to need
13:41
some kind of substance use treatment.
13:43
And of those who needed it, only about 19.3%, which is about 10.2
13:49
million, actually received treatment.
13:52
Wow, I really want to dig into why so many people do do not
13:58
receive the treatment they obviously qualify for.
14:02
That's unreal. I mean, I guess the first item
14:05
on the list little too familiar to all of us and that's the cost
14:09
or lack of insurance because treatment can be expensive.
14:14
And so the common barrier there is you don't have insurance or
14:19
even if you have insurance, you can't afford the co-pay.
14:22
And like, if you have Medicaid in the United States, the
14:25
coverage is limited. And then if you can't afford it
14:29
or you have the insurance, you can't take the time off of work
14:32
because maybe it would be unpaid.
14:34
And some people just choose, you know, between their survival
14:39
needs and going to treatment, to which I understand.
14:42
Yeah. And something I see a lot with
14:44
the insurance is that a lot of insurance companies don't have
14:48
mental health coverage and they don't have substance abuse
14:51
coverage. It's like it's excluded from the
14:53
plans. Even when someone wants help,
14:56
they might run into some other things like long waiting lists.
15:01
Rural areas may not have any nearby providers, so difficulty
15:05
finding some care. Most programs don't offer
15:09
childcare, which is a big issue. Some clinics reject people
15:13
without paperwork or ID's. I know that's something that the
15:18
clinic that I help out at, they require a valid driver's license
15:23
or identification card. You can have an expired one, but
15:26
you can't get treatment unless it's valid.
15:28
So that's a barrier. And a lot of people that you
15:32
know don't have valid ID's because they have outstanding
15:35
legal issues or things that they don't want to go to the DMV
15:38
because they're worried they're gonna get arrested Exact.
15:40
So also transportation might be an issue, and housing
15:45
instability can make outpatient treatment really difficult for
15:48
some people. And in some countries treatment
15:51
barely exists at all. So that's that's a problem.
15:55
I know during COVID when there's restrictions on like the
15:58
medication, medication assisted treatment were lifted.
16:02
A lot of people with these issues were helped because they
16:07
could do telehealth for the first time ever.
16:11
That's got to help when you live in a rural area or maybe you're
16:15
unhoused. You know, lots of people have a
16:18
phone at least, or even childcare could be helped with
16:21
that. That's amazing.
16:23
And you know, another issue we have to think about is the fear
16:26
of withdrawal. I mean, obviously if you go into
16:29
treatment, you're going to have to stop using.
16:31
And so for substances especially like opioids and alcohol,
16:35
withdrawal can be painful and it can be terrifying and it can be
16:40
medically dangerous. So many people don't know that
16:44
there are medications that can make it easier and safer to
16:47
withdraw, or they can't access them.
16:50
Yeah, it's, I mean, they have some really, really great
16:54
assistance with medications and things that that make a big
16:58
difference. Yeah, it where it used to just
17:00
be so incredibly physically painful.
17:02
Yeah. And now it's just doable.
17:04
Right. Well, we also have to talk about
17:07
this barrier, which is criminalization and legal risk.
17:10
So in many places, substance use is tied to punishment.
17:15
People fear that if they seek treatment they are a risk of
17:18
things like getting arrested, incarceration, losing their job,
17:22
sometime even losing custody of their children.
17:25
So seeking help can feel very scary and even risky at times.
17:29
Yeah, I mean, if I get honest about what's going on and I'm
17:32
divorced or going through a divorce, my ex will take my kids
17:36
and it's scary, scary. I mean, it'd be so much better
17:40
if the person went into treatment and cared for their
17:42
kids rather than stayed under the influence and cared for
17:45
their kids. And many people with addiction
17:49
have a Co occurring mental health issue and that can be a
17:52
barrier to seeking treatment because many people with
17:56
addiction also struggle with things that are pretty complex
17:59
like PTSD, anxiety, depression, bipolar disorder.
18:04
And unfortunately mental health care can ignore addiction and
18:08
addiction treatment can ignore mental health.
18:10
So there are a lot of people that just fall through the
18:13
cracks even if they got treatment for one of them.
18:16
So question, do you think that someone that has an untreated
18:19
mental health issue can successfully recover?
18:22
It's. A great not untreated, untreated
18:25
and I don't think untreated. I think you've got to treat both
18:28
of them because some people use because it regulates their
18:32
mental health condition and vice versa.
18:35
So I think they've got to get both of them treated.
18:37
And it's too bad. It, it, it's, it's fortunate
18:40
there are some places that can treat both at the same time.
18:43
It's unfortunate that this far down the line, what working in
18:46
the field 30 years, I don't see a great improvement with us not
18:51
separating those things, right? What do you think?
18:54
I'm the same. I think that if you have an
18:56
untreated mental health issue, that the, the likelihood of
18:59
getting, you know, clean and sober is much, much smaller than
19:04
if you're treating the whole person.
19:07
Because I just, I just like you said, I believe that some people
19:10
use because it helps regulate them.
19:12
They find something that helps make them feel normal or, you
19:15
know, not not anxious, not depressed, whatever.
19:19
And it becomes an addiction or it feeds that addiction.
19:23
And so I do think you have to treat the entire person as a
19:26
whole and not just one or the other.
19:28
Yeah. That's why so many people use
19:30
substances. You know, just I hear a lot of
19:33
people talk about marijuana use because of ADHD, because of
19:37
bipolar disorder, because of depression, because of anxiety,
19:41
and just so many people to have those issues and it just some
19:46
substances makes it feel regulated.
19:49
Yeah. Well, and then there's the issue
19:51
that people are having, which can be a bad experience with a
19:56
previous treatment episode. So some people may have gone to
19:59
treatment and felt judged or shamed, were forced into
20:03
treatment that didn't really fit them, return to use after they
20:07
after a stay in treatment. And so they feel like they were
20:10
just failures or it didn't work. Or they experience harsh or non
20:14
evidence based programs so they don't want to try again.
20:18
I I hear that a lot like treatment didn't work for me.
20:21
It was a bad experience and so you know, it's not for me.
20:25
Yeah, like all treatments the same, right?
20:27
It's important that we say it's not right.
20:30
There's also like a treatment that provides evidence based
20:33
care. And evidence based care simply
20:36
means that the treatment is grounded in scientific research
20:39
showing that it works. And it's supposed to be, you
20:43
know, our treatment programs should be.
20:45
And especially for opioid use disorder medications like
20:49
buprenorphine or methadone, they can save lives.
20:52
But some providers don't offer them.
20:55
Some programs banned them. Some countries restrict them.
20:59
And people may think like if treatment is is going to be so
21:03
much misery than why I go. Well and then there are issues
21:08
like social and cultural factors.
21:10
So things like the family disapproves of of treatment,
21:15
cultural beliefs about addiction, gender stigma, and
21:19
this is especially for women, faith-based misunderstandings,
21:24
mistrust in the healthcare system, and all of these can
21:27
really shape whether someone feels safe seeking help.
21:30
And those are reality. I mean, you want to think why
21:34
mistrust the healthcare system? We'll look at our history, look
21:38
at what we've done to certain cultures, certain races, certain
21:41
ethnicity, just there's so much just each of those.
21:45
We could break them apart and talk about the why for them.
21:49
And then there's simply just chaos of life.
21:52
You know, addiction rarely happens in a vacuum.
21:55
People might be juggling being unhoused, unemployed, in unsafe
21:59
relationships, having some unstable family situations, or
22:03
the court involvement, not wanting to admit to an addiction
22:07
because then the punishment that court could bring down on.
22:10
And it's also just hard to schedule therapy when you're
22:14
living in this survival mode. Yeah.
22:16
And a lot of people, I think, really get stuck on the word
22:19
treatment. And so they might be a little
22:21
bit more open to accepting things like counseling or peer
22:25
support, medical help, compassionate conversations, you
22:29
know, that makes a huge difference.
22:32
But they don't really connect with the word treatment.
22:34
So, you know, it can, it can sound really clinical.
22:37
It can sound scary and even extreme to some people.
22:40
I agree it does sound like a process, a long process of
22:43
something very scary to me on it to be honest.
22:49
Most people who won't go to treatment aren't refusing help,
22:53
they're just scale scared or overwhelmed or unsure or
22:57
unsupported or just trying to cope in the only way they know
23:00
how. Maybe they just don't know what
23:02
is available to them and systems don't always meet them where
23:06
they are. That's so true.
23:08
And I think it's, it's overwhelming for people when you
23:12
do decide that you want to get help, like it can be difficult
23:16
to find help and then, you know, most people that decide they
23:20
want help, they want they, you need to get them help
23:22
immediately and not wait. I've found that folks that, you
23:26
know, call and are looking for treatment, if you can't get them
23:29
in really, really quickly, then you lose them, you know, So it's
23:32
kind of like a fleeting thought. Today I want to be, you know,
23:35
clean and sober. And tomorrow I've, you know, my
23:38
brain has shifted and now I'm back to just my normal patterns
23:41
of using. You kind of got to get them on
23:43
the end of some big consequence or something that they're just
23:47
feeling really ready. Right well, as we wrap up this
23:50
part of our series on addiction, let's consider this key take
23:53
away. Most people who don't receive
23:55
treatment are not refusing help. They're just scared,
23:58
overwhelmed, unsupported, or stuck in survival mode.
24:03
O addiction is very complex, human, and deeply tied to both
24:07
emotional pain and systematic barriers.
24:10
And it's important to note it's not due to flawed personalities
24:14
like this is not just a weakness.
24:15
Well, thank you so much for joining us for this episode in
24:19
our series. If you believe that this or any
24:21
other episode might benefit someone that you know, please
24:23
share our podcast and you can participate in the discussions
24:27
that we have about each episode or communicate with us on most
24:30
of our social media platforms. You can even reach out to us on
24:33
our website at lifelivebetter.net.
24:36
And we look forward to continuing this conversation.
24:39
In our next episode, we'll be talking about what treating
24:41
addiction looks like and address types of treatment.
24:45
One of the most important things we will talk about is what kind
24:48
of questions you should be asking if you're seeking
24:50
treatment. We hope that this has been
24:52
useful information and look forward to continuing this
24:55
discussion in our next episode. Until then, don't forget that
24:58
knowledge leads to a Life Live Better.
25:05
Thank you for listening to Life Live Better with Paula and
25:07
Joseph. Thank you for listening to the
25:12
Life Live Better Podcast. Please subscribe, rate, review
25:16
and share our show with others you think will enjoy our
25:18
content. You can also find us on most
25:20
social media platforms and our website lifelivebetter.net.
25:24
This episode was written by Paula Garland, edited by Joseph
25:26
Massey and recorded on Spotify. Information used in this episode
25:30
and other content data can be found in our show notes.
25:33
We look forward to seeing you again in two weeks.