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Speaker 1: Everything I see ads, even just people talking to me,

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Speaker 1: everything saying you need more right right right, from social

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Speaker 1: media to working to consumption, whether it's buying or partaking.

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Speaker 1: It feels like there's just no balance between things. Yeah,

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Speaker 1: and when we stopped and looked, we realized there was

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Speaker 1: a term that was being thrown around a lot without

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Speaker 1: knowing about it, and that's addiction. Yeah. People are like, oh,

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Speaker 1: I'm addicted to this new game. I'm addicted to the

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Speaker 1: Pumpkins spice latte, to work to expresso Martiniz. But what

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Speaker 1: is addiction really? I'm TT and I'm Zachiah, and this

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Speaker 1: is Dope Labs. Welcome to Dope Labs, a weekly podcast

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Speaker 1: that mixes hardcore science with pop culture and a healthy

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Speaker 1: dose of friendship. Now, in this episode, we're going to

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Speaker 1: talk about substance use and what's happening in the brain

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Speaker 1: and the psychological, social, and cultural environments that nurture this

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Speaker 1: type of chronic brain disorder and its symptoms. This episode

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Speaker 1: is for informational and educational purposes only, and it is

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Speaker 1: not intended to be medical advice. And so now that

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Speaker 1: we have that out the way, let's dive into it. TT,

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Speaker 1: what are our questions. Well, I think for me understanding

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Speaker 1: what addiction is so like the term addiction because like

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Speaker 1: we were saying, everybody's throwing it around. I want to

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Speaker 1: know what addiction really is. Yeah, and like where's the line,

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Speaker 1: Like where is it that you're I like something a

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Speaker 1: lot and I want more of it versus I'm addicted.

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Speaker 1: And if there is a line, what's happening in our

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Speaker 1: brains that crosses that, you know? And it's interesting because

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Speaker 1: we see the casual use of the word addiction, but

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Speaker 1: also we see like the villainization of addiction to different

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Speaker 1: types of things as well, Like there seems to be

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Speaker 1: like a higher even in addiction. Right, there's like these

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Speaker 1: respectability politics that are in play where it's like some things,

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Speaker 1: it's like, okay, addicted to television is fine, but addiction

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Speaker 1: to this other thing is awful.

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Speaker 2: Yeah.

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Speaker 1: Oh, addiction to TikTok is bad, but addiction to Instagram

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Speaker 1: is okay. I don't know how some of these things

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Speaker 1: work socially, and so I'm curious about the history of

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Speaker 1: addiction a little bit. And we haven't even touched on drugs, right, right,

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Speaker 1: I feel like there are so many questions I don't

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Speaker 1: even know where to start, right, so we should probably

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Speaker 1: bring in our expert. This is a perfect time because

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Speaker 1: the questions are just going to keep pouring out.

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Speaker 2: We need answers.

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Speaker 1: Today we're talking to doctor Zinga Harrison.

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Speaker 2: Oh doctor and Zena Harrison. I'm a physician.

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Speaker 3: My specialties are psychiatry and addiction medicine. I have been

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Speaker 3: practicing both for over the last twenty years. I'm co

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Speaker 3: founder and chief medical officer of Eleanor Health, where we

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Speaker 3: we care for people with addiction and a longitude a

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Speaker 3: model and then also author of the book An Addiction,

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Speaker 3: Six mind changing Conversations that Could Save a Life. The

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Speaker 3: big issue I'm trying to tackle is just how scary

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Speaker 3: it's been to talk about addiction, because the things we

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Speaker 3: don't talk about kill us.

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Speaker 1: I am a person who doesn't mind uncomfortable conversations, right,

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Speaker 1: and that's the conversation I think is very taboo and

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Speaker 1: makes people uncomfortable, which is interesting because the stats tell

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Speaker 1: us that almost one in six people over twelve are

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Speaker 1: diagnosis having a substance use disorder. I want to set

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Speaker 1: the stage when we say addiction, and I really want

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Speaker 1: people to understand what addiction is and what it isn't.

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Speaker 2: I love the stat that you dropped.

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Speaker 3: One in six people is diagnosed with a substance use disorder,

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Speaker 3: So I would say substance use disorder is the medical

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Speaker 3: diagnosis of a subset of the addictions, meaning the addiction

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Speaker 3: is to a substance kind of a partner.

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Speaker 2: Statistic to that is forty six.

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Speaker 3: Percent of Americans, so one and two if you let

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Speaker 3: me round up to fifty percent report themselves or someone

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Speaker 3: close to them has struggled with the substance.

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Speaker 2: So that's one out of two.

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Speaker 3: So broad definition, you can think of addiction as continuing

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Speaker 3: to engage in a behavior despite negative consequences, outweighing positive

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Speaker 3: consequences or positive benefits, and so if you that's that's

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Speaker 3: kind of like the broad definition. The official definition, which

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Speaker 3: is given to us by ASAM American Society of Addiction Medicine,

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Speaker 3: defines addiction as a brain disorder that leads to compulsive

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Speaker 3: behavior that can be drugs, alcohol, which is a drug, vaping,

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Speaker 3: which is a drug, smoking which is a drug, sex, gambling, shopping,

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Speaker 3: social media, all of these different behaviors that run through

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Speaker 3: the same neuro biological pathway. But so a brain disorder

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Speaker 3: that leads to compulsive behavior that has negative physical, mental, social,

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Speaker 3: and emotional consequences. So that's kind of like, what's super

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Speaker 3: important about that medical definition is if I asked Yusekiah.

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Speaker 2: Stroke is a disorder of what organ in your body?

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Speaker 1: Brain?

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Speaker 2: Asthma is a disorder of what organ in your body.

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Speaker 1: I know the answer to this because I have asthma

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Speaker 1: and that's the lungs.

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Speaker 3: But you say, addiction is a disorder of what organ

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Speaker 3: in the body, and people don't even think of it

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Speaker 3: as a disorder of an organ in the body.

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Speaker 2: The answer to that is.

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Speaker 1: Brain addiction sounds like a cousin or maybe even a

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Speaker 1: sibling to obsessive compulsive disorder. Yes, So that was the

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Speaker 1: first thing that I thought, And the second is how

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Speaker 1: easy it is to miss things because of what part

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Speaker 1: of them we choose to look at. So if you

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Speaker 1: focus on the choice or what the thing is that's abused,

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Speaker 1: maybe you may say, oh, well, addiction to alcohol is

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Speaker 1: not the same as addiction to drugs or addiction to gambling,

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Speaker 1: or somebody who gambles a lot and puts themselves in

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Speaker 1: a precarious situation is not the same as someone who

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Speaker 1: does drugs and it's like, well, if you look at

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Speaker 1: the pathway, that's very different than if you just look

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Speaker 1: at the I don't even know what the term is

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Speaker 1: for it, the choice I don't need.

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Speaker 3: Yeah, the symptoms, the symptoms, And so I think to

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Speaker 3: kind of to just use a medical term love that

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Speaker 3: you said as a sibling or a cousin of OCD.

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Speaker 2: Absolutely right.

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Speaker 3: So OCD uses all of the same neurotransmitters as addiction.

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Speaker 2: Ah okay.

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Speaker 3: And so if you think of obsessions medically, obsessions, we

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Speaker 3: define them as thoughts, intrusive thoughts that keep coming back.

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Speaker 2: Compulsions are the behaviors.

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Speaker 3: That people do to decrease the impact of those thoughts

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Speaker 3: on them. And so if you think about addiction, you

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Speaker 3: could think about the obsession as being the craving. Although

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Speaker 3: cravings are not just cognitive, they're not just thoughts. Cravings

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Speaker 3: are actually a whole brain and body experience. But you

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Speaker 3: could think of cravings as the thought and using a substance, sex, drug,

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Speaker 3: social media, shopping, whatever, as the behavior that relieves the

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Speaker 3: distress from those intrusive thoughts. So nailed it, like a plus, Yeah,

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Speaker 3: that was amazing. So the second part of what you say,

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Speaker 3: which is like what we decide to focus on, and

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Speaker 3: I said symptoms. So what I really want people to

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Speaker 3: understand is addiction is a chronic condition that.

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Speaker 2: Starts in the brain.

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Speaker 3: Yes, anything that starts in the brain affects your entire

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Speaker 3: body physically. Our brain is responsible for our thoughts, so

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Speaker 3: it affects your thinking. Our brain is responsible for our emotions,

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Speaker 3: so it affects your emotions. Our brains are responsible for

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Speaker 3: our decisions, so it affects your behavior. Our brain is

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Speaker 3: responsible for our impulse control, so it affects your impulse

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Speaker 3: control and our thoughts. Feelings, decisions, and impulse control are

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Speaker 3: how we interact with the world, and so anything that

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Speaker 3: starts with the brain is going to impact the way

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Speaker 3: we interact with the world. And what you're saying is

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Speaker 3: when you look at addiction, just starting with the way

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Speaker 3: a person interacts with the world, you think they're a

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Speaker 3: bad person, they don't have good judgment, they are morally bankrupt,

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Speaker 3: when in reality, it's a series of neurobiological things that

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Speaker 3: are happening in the brain that turn into what we experience.

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Speaker 1: The brain is our experience of the world. Brain, it

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Speaker 1: is it constructs all We just did an episode with

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Speaker 1: a neuroscientist. She's a PhD student at PEN and she

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Speaker 1: talked to us about pain, and she talked to us

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Speaker 1: about like natural opioid release and the expectation of relief.

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Speaker 1: And immediately it made me think about if you have

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Speaker 1: these intrusive thoughts and then you have this compulsive behavior,

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Speaker 1: and that's probably reinforced by another neural network that says

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Speaker 1: you can expect relief, you can expect this thing, and

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Speaker 1: so you're reinforcing some of these pathways in the brain. Okay,

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Speaker 1: so let's talk about brain circuitry really quick. Okay, so

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Speaker 1: this is a chronic brain disorder. But for people who

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Speaker 1: are saying, okay, you keep saying brain disorder, what does

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Speaker 1: that mean? What's happening? Can you talk more about reward

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Speaker 1: and learning and impulse systems so that we can help

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Speaker 1: people understand why this isn't something that you just snap

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Speaker 1: your fingers and are done with it.

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Speaker 3: So, okay, I want you to think about your brain.

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Speaker 3: We're going to break it down into a number of

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Speaker 3: different parts. The first breakdown we're going to do is

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Speaker 3: your deep brain. So the deep brain is the part

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Speaker 3: of the brain that we share with all animals. That's

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Speaker 3: where our instincts are. That's where our impulses generate. That's

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Speaker 3: where our motivation for survival is. That's the dopamine pathway.

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Speaker 3: That's where our like breathing and heart rate and all

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Speaker 3: of this is controlled. Okay, okay, deep brain on top

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Speaker 3: of your deep brain. When humans think about the brain,

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Speaker 3: you think about that little picture that we see pointed

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Speaker 3: to the side that looks like a fist with all

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Speaker 3: of the folds in it, right right, that's your what

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Speaker 3: we call cerebral cortex. So your cortex is the part

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Speaker 3: of the brain and humans that has really developed hugely,

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Speaker 3: and that's where our higher order thinking is.

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Speaker 2: So that's where our impulse control is.

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Speaker 3: That's where what we call our executive decision making, so

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Speaker 3: like taking in information, deciding.

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Speaker 2: What it means, and then choosing to do something about it.

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Speaker 3: And then that command center sends back down through the

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Speaker 3: deep brain to the body to tell.

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Speaker 2: It everything to do.

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Speaker 3: And so I tell people, I want you to think

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Speaker 3: about three parts of the brain as it relates to addiction.

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Speaker 3: First is in the deep brain. It's called the ventral

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Speaker 3: tegmental area VTA. From the nerds out there, Okay, the

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Speaker 3: VTA has a neuron in it and any external stimulus.

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Speaker 3: So something outside of your body in the world triggers

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Speaker 3: a dopamine signal, okay, that sends forward to another part

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Speaker 3: that is still in your deep brain, your nucleus cucumbents.

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Speaker 3: The nucleus cucumbents then packages that dopamine signal and sends

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Speaker 3: it forward to your CEO of your brain and body,

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Speaker 3: which is your prefernal cortex. Your CEO of your brain

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Speaker 3: and body says, this is what the outside world is

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Speaker 3: telling me, and then it takes information from your inside

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Speaker 3: world and it decides what does that.

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Speaker 2: Mean and what we are going to do about it.

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Speaker 3: So what I just described to you is the three

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Speaker 3: neuron or nerves that make up your dopamine pathway. Our

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Speaker 3: dopamine pathway evolutionarily speaking, keeps us alive.

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Speaker 1: Okay.

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Speaker 3: So anything that generates a dopamine signal, your brain interprets

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Speaker 3: as I need this to survive. The natural things that

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Speaker 3: make a dopamine signal, our food need it to survive.

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Speaker 3: M water, needed to survive mm hm, sex, needed for

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Speaker 3: the species to survive mm hm.

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Speaker 1: Because yes, to keep us humans, all species.

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Speaker 2: The population.

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Speaker 1: Right, the population alive, Yes, yes, yes, but there's another

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Speaker 1: component of sex that's pleasure and connection. But we'll get

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Speaker 1: back to the survival part.

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Speaker 2: What else do we need nurturing?

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Speaker 3: Because what happens the little human baby, what happens the

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Speaker 3: little animal babies with no nurturing?

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Speaker 2: They buy right, you're.

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Speaker 1: Out of here.

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Speaker 3: Those are the four natural determinants of dopamine. Here's what's crazy.

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Speaker 3: You look at the drugs we have that people get

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Speaker 3: addicted to. You look at the behaviors we have that

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Speaker 3: people get addicted to. I'll talk about drugs right now.

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Speaker 3: You can think of a dopamine signal from food as

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Speaker 3: a light bulb starving.

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Speaker 2: The ventral teg mental area says we need to eat. Pain.

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Speaker 2: Light bulb.

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Speaker 3: You see some food. The nuclear cucumbents is like, that's food.

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Speaker 3: They package that information inside that make your stomach growl. Right,

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Speaker 3: you feel hungry outside, you smell something. Your brain takes

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Speaker 3: all that information. It says, I need to make a

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Speaker 3: plan to eat so that we can stay alive. Yeah,

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Speaker 3: that's the brightness of a light bulb pain. It's a

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Speaker 3: great idea. Meth amphetamine. The size of that dopamine signal

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Speaker 3: is ten to the ninth.

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Speaker 1: Okay, so ten to the ninth. Ten to the sixth

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Speaker 1: is a million times, and so ten to the ninth

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Speaker 1: is a billion And so that means that your brain

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Speaker 1: interprets dopamine signals way more than anything else.

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Speaker 3: And your brain interprets a bigger dopamine signal as more important.

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Speaker 2: Period.

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Speaker 3: Yeah, So when people quote choose meth amphetamine over their family,

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Speaker 3: it's because the myth amthetamine dopamine signal is ten to

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Speaker 3: the ninth, the nurturing signal.

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Speaker 2: One billion times one million times.

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Speaker 3: Magnify it. And so the message that is sent forward

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Speaker 3: with urgency to your CEO is we need this to survive,

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Speaker 3: make a plan to never go without it. And as

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Speaker 3: addiction kindles, like think about a fire, right, we go

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Speaker 3: from that first ember, it gets.

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Speaker 2: Bigger and bigger, and bigger and bigger.

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Speaker 3: Your CEO becomes less and less able to refute that message.

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Speaker 1: Now this, I am having a dopamine response here because

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Speaker 1: I enjoy this type of stimulation. Okay, there's so much

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Speaker 1: evolutionary biology, and there are so many things that our

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Speaker 1: brain primes us for that are historical that no longer exists, right,

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Speaker 1: and so I love the example to give us a

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Speaker 1: range to understand magnitude between something really simple like hey,

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Speaker 1: we need something to eat. You talked about vaping. Something

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Speaker 1: that has incredible marketing for young people, fruity flavors. We

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Speaker 1: see it all across social media. Packages beautiful packaging, cool yes,

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Speaker 1: and so you know, so there's all of that going on.

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Speaker 1: I think about marketing for food, and I'm also then

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Speaker 1: thinking about what kind of signals do we see. I'm

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Speaker 1: also thinking about social media. I don't know if you've

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Speaker 1: seen it's on Netflix. It's a documentary. Oh unknown number.

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Speaker 1: I thought that that was such a crazy documentary, like

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Speaker 1: I could not believe it.

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Speaker 3: Okay, no spoil or alerts for the listeners, but mind

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Speaker 3: below now.

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Speaker 1: And so I was thinking about what would make a

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Speaker 1: person do this. I'm thinking about what we know about

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Speaker 1: social media and the dopamine hits people get with the

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Speaker 1: gamification of these different platforms. And I'm wondering because you know,

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Speaker 1: you can't just override your biology.

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Speaker 2: At least, I don't think you can write.

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Speaker 1: And that's what I've learned from my friend, and so

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Speaker 1: you would probably have to replace it with something else, right, Yeah,

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Speaker 1: So when we think about things that are taking over

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Speaker 1: our dopamine pathway, how do you get rid of them?

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Speaker 2: You have to empower people with information.

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Speaker 3: Right, So if we go back to our childhoods, just say.

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Speaker 1: No baby, that black T shirt their yes, those good letters,

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Speaker 1: it is etched into my memory.

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Speaker 2: Okay, just say no.

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Speaker 3: It doesn't work because it doesn't give people the information

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Speaker 3: why they should say no, right, Like, empower people with

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Speaker 3: information and then honor the choices that they make about it. So,

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Speaker 3: for example, we can think about addiction. I describe to

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Speaker 3: you the three neuron pathway. This is now like the

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Speaker 3: three stages, right, One you have intoxication, Two you have withdrawal.

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Speaker 2: Three you have craving.

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Speaker 3: The combination of withdrawal and craving drive you back to

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Speaker 3: use whatever. That behavior is intoxication. So when you think

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Speaker 3: about social media actually brilliantly designed because your mind and

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Speaker 3: your own business, and they trigger you with a notification, yeah,

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Speaker 3: and then you know that notification is sitting there, and

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Speaker 3: then you develop withdraw right, like those obsessive thoughts around

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Speaker 3: what is that notification that.

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Speaker 2: I didn't see?

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Speaker 3: And then you go on social media and you scroll, scroll, scroll,

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Speaker 3: and you get intoxicated because it is giving a dopamine

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Speaker 3: and no, most likely through the connection pathway. Right, And

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Speaker 3: so the way I think we help protect people against

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Speaker 3: this is one not making it as if.

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Speaker 2: Those people over there have addictive behaviors.

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Speaker 3: All of us have some addictive behavior of some sort

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Speaker 3: because we are all wired with the dopamine pathway. So

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Speaker 3: my addictive behavior may be food, My addictive behavior may

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Speaker 3: be shopping, My addictive behavior may be alcohol. My addictive

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Speaker 3: behavior for some people may be exercise.

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Speaker 2: Right, whatever, work.

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Speaker 3: Let's not forget work, because I actually, I actually say

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Speaker 3: it all the time.

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Speaker 2: To people like I use work like a drug.

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Speaker 3: I love work when I'm not working, I have withdrawal,

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Speaker 3: I have cravings for work when I'm not working. When

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Speaker 3: I am working, I binge yes. I work to my detriment.

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Speaker 3: I work to negative consequences. I get lots of positive

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Speaker 3: feedback for this, and it makes my addiction loop worse. Right, So,

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Speaker 3: like all of us have something that is addicted to us,

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Speaker 3: because that's just the neurobiology of have we built. So

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Speaker 3: if we can accept that, that gives us compassion for

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Speaker 3: the person whose addiction happens to be alcohol, for whose

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Speaker 3: addiction happens to be opioid, for whose addiction happens to

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Speaker 3: be cocaine, and then we empower yourself with the prefernal

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Speaker 3: cortex can be trained to top down control that deep brain.

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Speaker 3: It requires a supportive environment, It requires community and belonging,

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Speaker 3: It requires education and knowledge and empowerment. And so how

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Speaker 3: do we address environments, how do we address cultures?

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Speaker 2: How do we address psychological needs?

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Speaker 3: All of that allows us to create an environment that

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Speaker 3: a prefernal cortex can be trained.

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Speaker 1: This is also blowing my mind a little bit. So

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Speaker 1: I was reading something about the genetic risk and they

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Speaker 1: put it at about forty to sixty percent. What do

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Speaker 1: we know about genetic risks as it relates to addiction?

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Speaker 1: Is there a hereditary component to it? What's the state

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Speaker 1: of things right now?

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Speaker 2: Yeah, it's a multi gene an environment interaction.

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Speaker 3: I lay out this framework that says every chronic condition

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Speaker 3: has biological inputs, psychological inputs, and environmental inputs. And the

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Speaker 3: environment is both cultural environment and physical environment. And so

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Speaker 3: if you look at all three of those, This is

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Speaker 3: how the book is laid out into six sections. The

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Speaker 3: first three sections are inherited, So inherited biological, that's your DNA,

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Speaker 3: inherited psychological, your childhood, inherited environmental, the culture and physical

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Speaker 3: environment you were raised in.

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Speaker 2: When we look at.

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Speaker 3: Inherited biological forty to sixty percent of your risk for

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Speaker 3: developing an addiction of any sort is coded in your

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Speaker 3: DNA the day you.

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Speaker 2: Are born, forty to sixty percent.

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Speaker 3: If we look at the forty to sixty percent inherited

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Speaker 3: risk through your DNA for any addictive disorder, that.

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Speaker 2: Is higher than high blood pressure.

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Speaker 3: Ooh, that is higher genetic loading than asthma, that is

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Speaker 3: higher genetic loading than type two diabetes. So whereas we

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Speaker 3: look at addictions so more realistically, like you just chose

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Speaker 3: to have addiction. It's really because it's hard to separate feelings, behaviors,

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Speaker 3: and thoughts from like who you are as a person.

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Speaker 1: Doctor Harrison, How do you even go about talking about

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Speaker 1: something like this, Like how do you prepare your kids

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Speaker 1: to understand this type of risk at like a biological

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Speaker 1: level when it comes to the genetics of it all.

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Speaker 3: I have a very robust family history of addiction of

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Speaker 3: all sorts and mental health conditions from both sides. Maternal

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Speaker 3: side is loaded, paternal side is loaded. What that allows

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Speaker 3: me to do is practice generational prevention with my kids. Right,

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Speaker 3: so from four years old, I start training my kids

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Speaker 3: into the understanding of addiction as a chronic medical condition

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Speaker 3: that deserves and requires compassion for the people who are

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Speaker 3: suffering from it. And then as they get older, I

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Speaker 3: can say, listen, this is what Mom gave you in

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Speaker 3: your DNA. Risk for high cholesterol, risk for alcohol use disorder,

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Speaker 3: risk for cocaine use disorder ADHD, resilience, high IQG.

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Speaker 2: Like these are all the things that come in my DNA.

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Speaker 2: But because you know.

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Speaker 3: You are most likely on the sixty percent end of

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Speaker 3: that spectrum based on our family history, like sixty percent

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Speaker 3: of your risk for development an addiction you were born

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Speaker 3: with courtesy of mom. Right, then, when you go to

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Speaker 3: a party in high school and the kids are on

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Speaker 3: a line of cocaine, they might be able to do

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Speaker 3: a lot of cocaine and have fun. Right, they might

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Speaker 3: be able to binge drink. Let me tell you what

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Speaker 3: happens in our family. They might be able to hit

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Speaker 3: the bong for marijuana. Let me tell you about this

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Speaker 3: schizophrenia risk in your DNA. And then that empowers people

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Speaker 3: to choose maybe differently.

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Speaker 1: I love that because what it really highlights is this, huh,

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Speaker 1: this lack of compassion that is actually artificially creating, because

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Speaker 1: I think if we were to say, oh, this person

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Speaker 1: has breast cancer and they inherited this from their family,

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Speaker 1: we wouldn't say, well, why did they smoke cigarettes? If

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Speaker 1: they knew that their mom or grandma had breast cancer.

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Speaker 1: We wouldn't say why did they live in this neighborhood

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Speaker 1: where they would be exposed to carcinogens or whatever. We

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Speaker 1: wouldn't do those things. Yeah, we would not villainize people

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Speaker 1: for working with the cards that they were dealt, you

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Speaker 1: know what I mean mean, But if you're dealting that

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Speaker 1: hand of cards and you have the exposures and are

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Speaker 1: facing substance abuse, what's the path for it? If you're

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Speaker 1: trying to recover and someone's making this about morals and choices.

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Speaker 3: I think the answer to your question is one teach

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Speaker 3: people how to have the conversation to undermine the moral

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Speaker 3: high ground, because the true moral high ground as humans

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Speaker 3: is when we see someone suffering, we meet them with

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Speaker 3: compassion and support, not judgment.

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Speaker 1: I'm curious about relapsing and how we should be, how

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Speaker 1: we should understand it or think about it, like you

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Speaker 1: know you've already said we should be meet we should

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Speaker 1: meet people with compassion, Like what is what should you

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Speaker 1: expect based on what we know is happening biologically?

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Speaker 3: Yeah, so I'll come back to this foundational idea for

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Speaker 3: our conversation that I want people to understand. Addiction is

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Speaker 3: a chronic condition. In medicine, When we say something is

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Speaker 3: a chronic condition, that means you have periods of relapse

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Speaker 3: and periods of remission possibly right, Okay, So in medicine,

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Speaker 3: when we say in illnesses and remission, this means a

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Speaker 3: period of time where you either don't have symptoms at

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Speaker 3: all or your symptoms don't rise to diagnostic threshold.

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Speaker 2: Okay, when we.

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Speaker 3: Say you're in a period of relapse. First of all,

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Speaker 3: illnesses relapse, not people. So this is what I should

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Speaker 3: have said earlier is the key. And when you said

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Speaker 3: what can we do? Like, we accidentally send so much

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Speaker 3: stigma in our language.

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Speaker 2: So he's in even saying.

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Speaker 3: Drug abuse because like abuse is a crime, right, substance

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Speaker 3: use disorder is a diagnosis.

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Speaker 2: Addiction is a condition. But like abuse is a crime,

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Speaker 2: it automatically conjures up a bunch of stuff for us.

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Speaker 3: Yes, and so when we say you relapsed, use your

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Speaker 3: cancer example again, when a person has breast cancer, they

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Speaker 3: do chemo and radiation and the breast cancer goes in remission.

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Speaker 3: If the breast cancer comes back, we don't say that

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Speaker 3: woman relapsed.

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Speaker 1: We say the cancer returned.

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Speaker 3: The cancer returned, right, the cancer relapsed. And so the

441
00:27:24,520 --> 00:27:27,439
Speaker 3: same thing with substantute disorders. So to answer your question,

442
00:27:27,520 --> 00:27:30,199
Speaker 3: there was this foundational study done in twenty ten, one

443
00:27:30,240 --> 00:27:34,400
Speaker 3: of my favorites by McClellans, and he looked at individuals

444
00:27:34,400 --> 00:27:37,399
Speaker 3: with substance Hue disorders whose symptoms were severe enough that

445
00:27:37,520 --> 00:27:38,320
Speaker 3: they needed.

446
00:27:38,040 --> 00:27:39,680
Speaker 2: An impatient hospitalization.

447
00:27:39,960 --> 00:27:43,280
Speaker 3: Okay, okay, and then he also looked at people with asthma,

448
00:27:43,440 --> 00:27:46,600
Speaker 3: people with high blood pressure, people with diabetes, same thing,

449
00:27:46,760 --> 00:27:50,240
Speaker 3: symptoms severe enough that they needed a hospitalization. And then

450
00:27:50,280 --> 00:27:54,120
Speaker 3: he looked one year later, what percent of people were

451
00:27:54,160 --> 00:27:57,560
Speaker 3: following medication recommendations and what percent of people were following

452
00:27:57,600 --> 00:28:02,320
Speaker 3: psychosocial recommendations. When we look at addiction, we didn't have

453
00:28:02,400 --> 00:28:06,280
Speaker 3: any medications except methodone for addiction back in twenty ten,

454
00:28:06,440 --> 00:28:09,119
Speaker 3: so this study didn't wasn't a methodone study, so it

455
00:28:09,160 --> 00:28:15,000
Speaker 3: only had were they following psychosocial recommendations at one year?

456
00:28:15,920 --> 00:28:22,200
Speaker 3: Pretty much evenly across addiction asthma, diabetes, hypertension, seventy percent

457
00:28:22,240 --> 00:28:29,200
Speaker 3: of people were not following medication recommendations or psychosocial recommendations. Right,

458
00:28:29,720 --> 00:28:32,240
Speaker 3: And then when they looked at what percent of people

459
00:28:33,119 --> 00:28:37,040
Speaker 3: experienced a relapse of their illness within one year of

460
00:28:37,080 --> 00:28:40,920
Speaker 3: that impatient's day for addiction, high blood pressure, diabetes, asthma,

461
00:28:41,440 --> 00:28:45,120
Speaker 3: it was about fifty five percent across.

462
00:28:44,760 --> 00:28:48,640
Speaker 2: All of them. Wow, the symptoms of their illness had returned.

463
00:28:49,160 --> 00:28:52,240
Speaker 3: And so to ask your question, what can you expect

464
00:28:52,800 --> 00:28:57,360
Speaker 3: in the first year of remission from a substance use disorder,

465
00:28:57,640 --> 00:29:02,120
Speaker 3: approximately fifty five piece percent and people will experience or relapse.

466
00:29:02,520 --> 00:29:06,480
Speaker 3: That is a dramatically high number that is reflective of

467
00:29:06,600 --> 00:29:12,600
Speaker 3: our system's inability to address the biological, psychological, and environmental

468
00:29:12,640 --> 00:29:14,600
Speaker 3: triggers of the illness.

469
00:29:15,080 --> 00:29:16,680
Speaker 2: Right as you get to.

470
00:29:16,640 --> 00:29:19,440
Speaker 3: The second year, that number only falls a smidge is

471
00:29:19,520 --> 00:29:22,520
Speaker 3: probably still about fifty to fifty five percent. As you

472
00:29:22,560 --> 00:29:24,800
Speaker 3: get to the third year, it falls a smidge is

473
00:29:24,840 --> 00:29:29,360
Speaker 3: about forty five to fifty percent. The risk of relapse

474
00:29:29,400 --> 00:29:32,000
Speaker 3: of a substance use disorder falls back to that of

475
00:29:32,040 --> 00:29:35,160
Speaker 3: the general public that never had an addiction at the

476
00:29:35,240 --> 00:29:38,440
Speaker 3: five year mark. And so when we think about a

477
00:29:38,440 --> 00:29:39,960
Speaker 3: thirty day rehab, y'all.

478
00:29:39,960 --> 00:29:42,360
Speaker 2: That ain't it When you think about a five day

479
00:29:42,400 --> 00:29:43,720
Speaker 2: detox y'all? That ain't it?

480
00:29:43,840 --> 00:29:46,320
Speaker 3: When you think about a ninety day residential stay, y'all,

481
00:29:46,680 --> 00:29:47,800
Speaker 3: that ain't it?

482
00:29:48,240 --> 00:29:48,440
Speaker 2: Right?

483
00:29:48,560 --> 00:29:51,320
Speaker 3: So when you say, is it something like eleanor health, Yes,

484
00:29:52,040 --> 00:29:55,320
Speaker 3: because we're trying to stay engaged with people for that

485
00:29:55,760 --> 00:30:00,240
Speaker 3: entire five year period of remission to practic This is

486
00:30:00,280 --> 00:30:04,280
Speaker 3: what we call in public health secondary prevention. So try

487
00:30:04,360 --> 00:30:07,840
Speaker 3: to prevent the symptoms from returning, just like you do

488
00:30:07,920 --> 00:30:08,800
Speaker 3: with breast cancer.

489
00:30:09,040 --> 00:30:11,200
Speaker 1: Wow. I really like how you explained that, and I

490
00:30:11,240 --> 00:30:14,080
Speaker 1: appreciate you correcting me because I want to learn and

491
00:30:14,280 --> 00:30:15,520
Speaker 1: I want to get it right. I don't want to

492
00:30:15,520 --> 00:30:16,440
Speaker 1: be out here saying the wrong thing.

493
00:30:16,520 --> 00:30:16,840
Speaker 2: Yeah.

494
00:30:16,920 --> 00:30:21,160
Speaker 1: Yeah. And for folks that want to do something little

495
00:30:21,520 --> 00:30:24,520
Speaker 1: like even as small as just shifting your language. Is

496
00:30:24,560 --> 00:30:28,520
Speaker 1: there any language that everyone should switch to? Is there

497
00:30:28,520 --> 00:30:31,400
Speaker 1: an activity or exercise you think that people can do

498
00:30:32,080 --> 00:30:36,120
Speaker 1: to reorient their minds in order to be more tolerant.

499
00:30:36,640 --> 00:30:38,480
Speaker 2: Yeah, the very first thing.

500
00:30:39,160 --> 00:30:41,640
Speaker 3: I just want to train people into two kind of

501
00:30:41,680 --> 00:30:44,040
Speaker 3: like ways of thinking and two ways of talking.

502
00:30:44,560 --> 00:30:44,920
Speaker 2: First.

503
00:30:45,040 --> 00:30:49,800
Speaker 3: This is for any illness, any chronic condition, addiction, included

504
00:30:50,480 --> 00:30:53,719
Speaker 3: that person is not a diabetic, that person is not

505
00:30:53,800 --> 00:30:56,680
Speaker 3: a schizophrenic, that person is not an addict.

506
00:30:57,280 --> 00:30:58,600
Speaker 2: Because what you're.

507
00:30:58,480 --> 00:31:00,920
Speaker 3: Doing when you say that is like making it as

508
00:31:00,960 --> 00:31:03,600
Speaker 3: if there is nothing else you need to know about

509
00:31:03,640 --> 00:31:06,880
Speaker 3: that person, and nothing else about that person that matters,

510
00:31:07,200 --> 00:31:11,960
Speaker 3: or that they and the illness they have are equivalent, right,

511
00:31:12,320 --> 00:31:16,720
Speaker 3: And so instead, that's a person with diabetes, that's a

512
00:31:16,760 --> 00:31:20,280
Speaker 3: person with schizophrenia, that's a person with addiction.

513
00:31:21,200 --> 00:31:21,400
Speaker 2: Right.

514
00:31:21,440 --> 00:31:25,000
Speaker 3: And so if you just lead with the person in

515
00:31:25,040 --> 00:31:28,360
Speaker 3: your words, then you also start to lead with the

516
00:31:28,400 --> 00:31:30,800
Speaker 3: person in your thinking, and then you also start to

517
00:31:30,920 --> 00:31:34,840
Speaker 3: lead with the person in your behaviors. So strike the

518
00:31:34,880 --> 00:31:39,040
Speaker 3: word addict. Yes, that's a person they have an addiction to.

519
00:31:40,800 --> 00:31:41,000
Speaker 2: Right.

520
00:31:43,400 --> 00:31:46,720
Speaker 3: The second thing I would say to to try to

521
00:31:46,760 --> 00:31:51,280
Speaker 3: strike and we use it. I'm gonna say three things

522
00:31:52,760 --> 00:31:58,680
Speaker 3: you just talked about it relapse, right, Illnesses relapse not people. Yes,

523
00:31:59,840 --> 00:32:04,320
Speaker 3: you can say that person's alcoholism relapse, or that person's

524
00:32:04,360 --> 00:32:07,160
Speaker 3: opioid addiction relapse, or that person had a return of

525
00:32:07,200 --> 00:32:10,280
Speaker 3: their symptoms. It's an extension of the first, which is

526
00:32:10,360 --> 00:32:12,080
Speaker 3: leading with the person, and the third.

527
00:32:11,880 --> 00:32:12,600
Speaker 2: Clean and dirty.

528
00:32:13,160 --> 00:32:17,200
Speaker 3: So I think this language and kind of these depictions

529
00:32:17,240 --> 00:32:22,240
Speaker 3: probably started with good intentions. Addiction is devastating and scary,

530
00:32:22,400 --> 00:32:25,440
Speaker 3: and it steals the people we love from us. Opioids

531
00:32:25,480 --> 00:32:27,960
Speaker 3: steal them kind of fast, like you can die right now.

532
00:32:28,400 --> 00:32:33,520
Speaker 3: Alcohol cigarettes steal them slow, long and painful, right, methamphetamine, cocaine,

533
00:32:33,520 --> 00:32:36,080
Speaker 3: et cetera. And so it was like, make this so

534
00:32:36,240 --> 00:32:39,800
Speaker 3: scary so nobody will ever want to try it, and

535
00:32:39,880 --> 00:32:42,480
Speaker 3: make it so awful, so that nobody will ever want

536
00:32:42,520 --> 00:32:45,080
Speaker 3: to quote be one of the people. But unfortunately, it's

537
00:32:45,200 --> 00:32:47,720
Speaker 3: just not how it works. And then once you do

538
00:32:47,800 --> 00:32:50,160
Speaker 3: it so much, even if it starts with good intention

539
00:32:50,400 --> 00:32:53,840
Speaker 3: and it has negative impact, it starts to just get

540
00:32:54,040 --> 00:32:55,640
Speaker 3: ingrained in us, and we're like kind.

541
00:32:55,440 --> 00:32:56,560
Speaker 2: Of thoughtless about it.

542
00:32:57,040 --> 00:32:59,240
Speaker 3: And so that's what I would say to people who

543
00:32:59,240 --> 00:33:01,600
Speaker 3: are listening. If you want to be part of the solution,

544
00:33:02,320 --> 00:33:08,400
Speaker 3: be thoughtful. Be thoughtful that is a person periods. Start

545
00:33:08,440 --> 00:33:12,120
Speaker 3: from there, and be thoughtful about that person as you

546
00:33:12,280 --> 00:33:15,200
Speaker 3: would be thoughtful about any other person, as you would

547
00:33:15,240 --> 00:33:17,600
Speaker 3: want someone to be thoughtful about you.

548
00:33:18,200 --> 00:33:22,000
Speaker 1: Yes, being thoughtful. I mean, it's so simple, but it's

549
00:33:22,120 --> 00:33:27,160
Speaker 1: absolutely something that is missing, like culturally, like at the

550
00:33:27,320 --> 00:33:30,880
Speaker 1: very foundation of how we interact with folks. But at

551
00:33:30,880 --> 00:33:35,080
Speaker 1: a system level, how does our system treat substance abuse disorder?

552
00:33:36,000 --> 00:33:40,280
Speaker 3: Yeah, just a quick look back at history. Before eighteen

553
00:33:40,360 --> 00:33:43,880
Speaker 3: sixty five, there were no illegal drugs. There were drugs,

554
00:33:45,120 --> 00:33:48,160
Speaker 3: but there were no illegal drugs. And then the series

555
00:33:48,200 --> 00:33:50,560
Speaker 3: of laws that started to be developed. The first set

556
00:33:50,600 --> 00:33:56,400
Speaker 3: of laws were targeting Chinese immigrants, made opioids illegal. The

557
00:33:56,440 --> 00:34:01,200
Speaker 3: next set of drugs targeted Mexican immigrants and made cannabis

558
00:34:01,400 --> 00:34:04,440
Speaker 3: illegal and even changed the name cannabis and start calling

559
00:34:04,520 --> 00:34:07,880
Speaker 3: it marijuana so it will be associated with Mexican people

560
00:34:07,920 --> 00:34:11,480
Speaker 3: and conjure up kind of like negative. When we look

561
00:34:11,600 --> 00:34:14,880
Speaker 3: at the percent of people who are in prison and jail,

562
00:34:16,360 --> 00:34:21,640
Speaker 3: the overwhelming majority are associated with substance use disorders. When

563
00:34:21,680 --> 00:34:26,280
Speaker 3: you look at who is disproportionately jailed rather than offered treatment,

564
00:34:26,800 --> 00:34:32,200
Speaker 3: that is black people, people of color, LGBTQ people, people

565
00:34:32,280 --> 00:34:36,280
Speaker 3: with physical and other mental health disabilities, immigrants, people whose

566
00:34:36,320 --> 00:34:39,040
Speaker 3: first language is not English, that's here in this country.

567
00:34:39,280 --> 00:34:42,279
Speaker 3: And so it follows the exact same because those are

568
00:34:42,320 --> 00:34:45,640
Speaker 3: all cultural constructs that are pulling into every single facet

569
00:34:45,680 --> 00:34:50,000
Speaker 3: of our life. For example, suboxone is a medication that

570
00:34:50,080 --> 00:34:53,479
Speaker 3: we had to treat opioid use disorder. Really well done

571
00:34:53,520 --> 00:34:57,920
Speaker 3: study out of an er showed that a black person

572
00:34:58,080 --> 00:35:02,080
Speaker 3: with opioid use disorder who exp sperienced and overdose significant

573
00:35:02,160 --> 00:35:05,640
Speaker 3: enough to take them to the er, it's thirty five

574
00:35:05,800 --> 00:35:10,359
Speaker 3: times less likely to receive a prescription for suboxone than

575
00:35:10,360 --> 00:35:11,239
Speaker 3: the white counterpart.

576
00:35:12,400 --> 00:35:13,400
Speaker 2: Thirty five times.

577
00:35:13,560 --> 00:35:15,200
Speaker 1: And that's the prescription.

578
00:35:15,440 --> 00:35:18,920
Speaker 3: That's not even the prescription, that's not even the psycho

579
00:35:19,040 --> 00:35:21,080
Speaker 3: social support, that's.

580
00:35:20,880 --> 00:35:23,360
Speaker 2: Not going to none of it.

581
00:35:23,440 --> 00:35:28,080
Speaker 3: That is just purely in the biological realm, like not

582
00:35:28,520 --> 00:35:31,480
Speaker 3: even a prescription. If you look at who has access

583
00:35:31,520 --> 00:35:38,080
Speaker 3: to suboxone, it is higher socioeconomic White populations. Disproportionately lower

584
00:35:38,120 --> 00:35:43,160
Speaker 3: socioeconomic populations have more access to methadone, which is extremely

585
00:35:43,200 --> 00:35:45,040
Speaker 3: difficult to use because you have to go to the

586
00:35:45,040 --> 00:35:47,200
Speaker 3: clinic every day at five am and all this kind

587
00:35:47,200 --> 00:35:52,840
Speaker 3: of stuff, right, and so those cultural inequities are pervasive

588
00:35:53,200 --> 00:35:56,680
Speaker 3: in every facet of our life, and substance use disorder

589
00:35:56,719 --> 00:36:01,080
Speaker 3: has not been spare.

590
00:36:04,040 --> 00:36:07,919
Speaker 1: H doctor Harrison, I have learned so much today, even

591
00:36:08,000 --> 00:36:13,080
Speaker 1: down to my language. I now understand just how much

592
00:36:14,040 --> 00:36:17,480
Speaker 1: I've learned from television and movies. And it was wrong,

593
00:36:18,640 --> 00:36:20,480
Speaker 1: and I'm wondering why Dare didn't teach me a lot

594
00:36:20,520 --> 00:36:23,960
Speaker 1: of the things. Honestly they were saying they were teaching us,

595
00:36:24,000 --> 00:36:26,919
Speaker 1: teaching they weren't teaching us, and like, this is something

596
00:36:26,960 --> 00:36:31,480
Speaker 1: that we always talk about Zee. Unlearning is sometimes so

597
00:36:31,760 --> 00:36:35,480
Speaker 1: much harder than learning. So going back and like changing

598
00:36:35,520 --> 00:36:37,719
Speaker 1: the way that you think about things and how you

599
00:36:37,760 --> 00:36:41,359
Speaker 1: approach certain situations and the word your word choice, it's

600
00:36:41,440 --> 00:36:46,719
Speaker 1: so important. And doing the work of unlearning and then relearning.

601
00:36:46,440 --> 00:36:46,959
Speaker 2: Is so.

602
00:36:48,880 --> 00:36:51,759
Speaker 1: It is it is a sign of compassion, like to

603
00:36:52,040 --> 00:36:55,520
Speaker 1: understand that there is a different way of living in

604
00:36:55,520 --> 00:36:59,240
Speaker 1: this world that can make folks feel more included, more considered,

605
00:36:59,280 --> 00:37:03,480
Speaker 1: more thought about in choosing that I think is one

606
00:37:03,520 --> 00:37:05,719
Speaker 1: of the greatest things about humanity. It's one of the

607
00:37:06,239 --> 00:37:09,160
Speaker 1: most important things that we can do while we're here

608
00:37:09,400 --> 00:37:12,319
Speaker 1: on this earth. That's right, t T. That's beautifully said.

609
00:37:21,320 --> 00:37:24,160
Speaker 1: You can find us on X and Instagram at Dope

610
00:37:24,239 --> 00:37:27,760
Speaker 1: Labs podcast TT is on X and Instagram at dr

611
00:37:27,960 --> 00:37:31,400
Speaker 1: Underscore t Sho, and you can find Zakiya at z

612
00:37:31,719 --> 00:37:34,840
Speaker 1: said So. Dope Labs is a production of Leimanada Media.

613
00:37:35,000 --> 00:37:38,800
Speaker 1: Our supervising producer is Keegan Zimma and our producer is

614
00:37:38,800 --> 00:37:42,759
Speaker 1: Issara a Sevez. Dope Labs is sound designed, edited and

615
00:37:42,920 --> 00:37:47,319
Speaker 1: mixed by James farber Limanada Media's Vice President of Partnerships

616
00:37:47,320 --> 00:37:51,280
Speaker 1: and Production is Jackie dan Singer. Executive producer from iHeart

617
00:37:51,360 --> 00:37:56,240
Speaker 1: Podcast is Katrina Norvil. Marketing lead is Alison Canter. Original

618
00:37:56,320 --> 00:38:01,000
Speaker 1: music composed and produced by Taka Yasuzawa and Ali suji Ura,

619
00:38:01,160 --> 00:38:05,840
Speaker 1: with additional music by Elijah Harvey. Dope Labs is executive

620
00:38:05,920 --> 00:38:09,440
Speaker 1: produced by us T T Show Dia and Zakiah Watki