Speaker 1: Everything I see ads, even just people talking to me,
Speaker 1: everything saying you need more right right right, from social
Speaker 1: media to working to consumption, whether it's buying or partaking.
Speaker 1: It feels like there's just no balance between things. Yeah,
Speaker 1: and when we stopped and looked, we realized there was
Speaker 1: a term that was being thrown around a lot without
Speaker 1: knowing about it, and that's addiction. Yeah. People are like, oh,
Speaker 1: I'm addicted to this new game. I'm addicted to the
Speaker 1: Pumpkins spice latte, to work to expresso Martiniz. But what
Speaker 1: is addiction really? I'm TT and I'm Zachiah, and this
Speaker 1: is Dope Labs. Welcome to Dope Labs, a weekly podcast
Speaker 1: that mixes hardcore science with pop culture and a healthy
Speaker 1: dose of friendship. Now, in this episode, we're going to
Speaker 1: talk about substance use and what's happening in the brain
Speaker 1: and the psychological, social, and cultural environments that nurture this
Speaker 1: type of chronic brain disorder and its symptoms. This episode
Speaker 1: is for informational and educational purposes only, and it is
Speaker 1: not intended to be medical advice. And so now that
Speaker 1: we have that out the way, let's dive into it. TT,
Speaker 1: what are our questions. Well, I think for me understanding
Speaker 1: what addiction is so like the term addiction because like
Speaker 1: we were saying, everybody's throwing it around. I want to
Speaker 1: know what addiction really is. Yeah, and like where's the line,
Speaker 1: Like where is it that you're I like something a
Speaker 1: lot and I want more of it versus I'm addicted.
Speaker 1: And if there is a line, what's happening in our
Speaker 1: brains that crosses that, you know? And it's interesting because
Speaker 1: we see the casual use of the word addiction, but
Speaker 1: also we see like the villainization of addiction to different
Speaker 1: types of things as well, Like there seems to be
Speaker 1: like a higher even in addiction. Right, there's like these
Speaker 1: respectability politics that are in play where it's like some things,
Speaker 1: it's like, okay, addicted to television is fine, but addiction
Speaker 1: to this other thing is awful.
Speaker 2: Yeah.
Speaker 1: Oh, addiction to TikTok is bad, but addiction to Instagram
Speaker 1: is okay. I don't know how some of these things
Speaker 1: work socially, and so I'm curious about the history of
Speaker 1: addiction a little bit. And we haven't even touched on drugs, right, right,
Speaker 1: I feel like there are so many questions I don't
Speaker 1: even know where to start, right, so we should probably
Speaker 1: bring in our expert. This is a perfect time because
Speaker 1: the questions are just going to keep pouring out.
Speaker 2: We need answers.
Speaker 1: Today we're talking to doctor Zinga Harrison.
Speaker 2: Oh doctor and Zena Harrison. I'm a physician.
Speaker 3: My specialties are psychiatry and addiction medicine. I have been
Speaker 3: practicing both for over the last twenty years. I'm co
Speaker 3: founder and chief medical officer of Eleanor Health, where we
Speaker 3: we care for people with addiction and a longitude a
Speaker 3: model and then also author of the book An Addiction,
Speaker 3: Six mind changing Conversations that Could Save a Life. The
Speaker 3: big issue I'm trying to tackle is just how scary
Speaker 3: it's been to talk about addiction, because the things we
Speaker 3: don't talk about kill us.
Speaker 1: I am a person who doesn't mind uncomfortable conversations, right,
Speaker 1: and that's the conversation I think is very taboo and
Speaker 1: makes people uncomfortable, which is interesting because the stats tell
Speaker 1: us that almost one in six people over twelve are
Speaker 1: diagnosis having a substance use disorder. I want to set
Speaker 1: the stage when we say addiction, and I really want
Speaker 1: people to understand what addiction is and what it isn't.
Speaker 2: I love the stat that you dropped.
Speaker 3: One in six people is diagnosed with a substance use disorder,
Speaker 3: So I would say substance use disorder is the medical
Speaker 3: diagnosis of a subset of the addictions, meaning the addiction
Speaker 3: is to a substance kind of a partner.
Speaker 2: Statistic to that is forty six.
Speaker 3: Percent of Americans, so one and two if you let
Speaker 3: me round up to fifty percent report themselves or someone
Speaker 3: close to them has struggled with the substance.
Speaker 2: So that's one out of two.
Speaker 3: So broad definition, you can think of addiction as continuing
Speaker 3: to engage in a behavior despite negative consequences, outweighing positive
Speaker 3: consequences or positive benefits, and so if you that's that's
Speaker 3: kind of like the broad definition. The official definition, which
Speaker 3: is given to us by ASAM American Society of Addiction Medicine,
Speaker 3: defines addiction as a brain disorder that leads to compulsive
Speaker 3: behavior that can be drugs, alcohol, which is a drug, vaping,
Speaker 3: which is a drug, smoking which is a drug, sex, gambling, shopping,
Speaker 3: social media, all of these different behaviors that run through
Speaker 3: the same neuro biological pathway. But so a brain disorder
Speaker 3: that leads to compulsive behavior that has negative physical, mental, social,
Speaker 3: and emotional consequences. So that's kind of like, what's super
Speaker 3: important about that medical definition is if I asked Yusekiah.
Speaker 2: Stroke is a disorder of what organ in your body?
Speaker 1: Brain?
Speaker 2: Asthma is a disorder of what organ in your body.
Speaker 1: I know the answer to this because I have asthma
Speaker 1: and that's the lungs.
Speaker 3: But you say, addiction is a disorder of what organ
Speaker 3: in the body, and people don't even think of it
Speaker 3: as a disorder of an organ in the body.
Speaker 2: The answer to that is.
Speaker 1: Brain addiction sounds like a cousin or maybe even a
Speaker 1: sibling to obsessive compulsive disorder. Yes, So that was the
Speaker 1: first thing that I thought, And the second is how
Speaker 1: easy it is to miss things because of what part
Speaker 1: of them we choose to look at. So if you
Speaker 1: focus on the choice or what the thing is that's abused,
Speaker 1: maybe you may say, oh, well, addiction to alcohol is
Speaker 1: not the same as addiction to drugs or addiction to gambling,
Speaker 1: or somebody who gambles a lot and puts themselves in
Speaker 1: a precarious situation is not the same as someone who
Speaker 1: does drugs and it's like, well, if you look at
Speaker 1: the pathway, that's very different than if you just look
Speaker 1: at the I don't even know what the term is
Speaker 1: for it, the choice I don't need.
Speaker 3: Yeah, the symptoms, the symptoms, And so I think to
Speaker 3: kind of to just use a medical term love that
Speaker 3: you said as a sibling or a cousin of OCD.
Speaker 2: Absolutely right.
Speaker 3: So OCD uses all of the same neurotransmitters as addiction.
Speaker 2: Ah okay.
Speaker 3: And so if you think of obsessions medically, obsessions, we
Speaker 3: define them as thoughts, intrusive thoughts that keep coming back.
Speaker 2: Compulsions are the behaviors.
Speaker 3: That people do to decrease the impact of those thoughts
Speaker 3: on them. And so if you think about addiction, you
Speaker 3: could think about the obsession as being the craving. Although
Speaker 3: cravings are not just cognitive, they're not just thoughts. Cravings
Speaker 3: are actually a whole brain and body experience. But you
Speaker 3: could think of cravings as the thought and using a substance, sex, drug,
Speaker 3: social media, shopping, whatever, as the behavior that relieves the
Speaker 3: distress from those intrusive thoughts. So nailed it, like a plus, Yeah,
Speaker 3: that was amazing. So the second part of what you say,
Speaker 3: which is like what we decide to focus on, and
Speaker 3: I said symptoms. So what I really want people to
Speaker 3: understand is addiction is a chronic condition that.
Speaker 2: Starts in the brain.
Speaker 3: Yes, anything that starts in the brain affects your entire
Speaker 3: body physically. Our brain is responsible for our thoughts, so
Speaker 3: it affects your thinking. Our brain is responsible for our emotions,
Speaker 3: so it affects your emotions. Our brains are responsible for
Speaker 3: our decisions, so it affects your behavior. Our brain is
Speaker 3: responsible for our impulse control, so it affects your impulse
Speaker 3: control and our thoughts. Feelings, decisions, and impulse control are
Speaker 3: how we interact with the world, and so anything that
Speaker 3: starts with the brain is going to impact the way
Speaker 3: we interact with the world. And what you're saying is
Speaker 3: when you look at addiction, just starting with the way
Speaker 3: a person interacts with the world, you think they're a
Speaker 3: bad person, they don't have good judgment, they are morally bankrupt,
Speaker 3: when in reality, it's a series of neurobiological things that
Speaker 3: are happening in the brain that turn into what we experience.
Speaker 1: The brain is our experience of the world. Brain, it
Speaker 1: is it constructs all We just did an episode with
Speaker 1: a neuroscientist. She's a PhD student at PEN and she
Speaker 1: talked to us about pain, and she talked to us
Speaker 1: about like natural opioid release and the expectation of relief.
Speaker 1: And immediately it made me think about if you have
Speaker 1: these intrusive thoughts and then you have this compulsive behavior,
Speaker 1: and that's probably reinforced by another neural network that says
Speaker 1: you can expect relief, you can expect this thing, and
Speaker 1: so you're reinforcing some of these pathways in the brain. Okay,
Speaker 1: so let's talk about brain circuitry really quick. Okay, so
Speaker 1: this is a chronic brain disorder. But for people who
Speaker 1: are saying, okay, you keep saying brain disorder, what does
Speaker 1: that mean? What's happening? Can you talk more about reward
Speaker 1: and learning and impulse systems so that we can help
Speaker 1: people understand why this isn't something that you just snap
Speaker 1: your fingers and are done with it.
Speaker 3: So, okay, I want you to think about your brain.
Speaker 3: We're going to break it down into a number of
Speaker 3: different parts. The first breakdown we're going to do is
Speaker 3: your deep brain. So the deep brain is the part
Speaker 3: of the brain that we share with all animals. That's
Speaker 3: where our instincts are. That's where our impulses generate. That's
Speaker 3: where our motivation for survival is. That's the dopamine pathway.
Speaker 3: That's where our like breathing and heart rate and all
Speaker 3: of this is controlled. Okay, okay, deep brain on top
Speaker 3: of your deep brain. When humans think about the brain,
Speaker 3: you think about that little picture that we see pointed
Speaker 3: to the side that looks like a fist with all
Speaker 3: of the folds in it, right right, that's your what
Speaker 3: we call cerebral cortex. So your cortex is the part
Speaker 3: of the brain and humans that has really developed hugely,
Speaker 3: and that's where our higher order thinking is.
Speaker 2: So that's where our impulse control is.
Speaker 3: That's where what we call our executive decision making, so
Speaker 3: like taking in information, deciding.
Speaker 2: What it means, and then choosing to do something about it.
Speaker 3: And then that command center sends back down through the
Speaker 3: deep brain to the body to tell.
Speaker 2: It everything to do.
Speaker 3: And so I tell people, I want you to think
Speaker 3: about three parts of the brain as it relates to addiction.
Speaker 3: First is in the deep brain. It's called the ventral
Speaker 3: tegmental area VTA. From the nerds out there, Okay, the
Speaker 3: VTA has a neuron in it and any external stimulus.
Speaker 3: So something outside of your body in the world triggers
Speaker 3: a dopamine signal, okay, that sends forward to another part
Speaker 3: that is still in your deep brain, your nucleus cucumbents.
Speaker 3: The nucleus cucumbents then packages that dopamine signal and sends
Speaker 3: it forward to your CEO of your brain and body,
Speaker 3: which is your prefernal cortex. Your CEO of your brain
Speaker 3: and body says, this is what the outside world is
Speaker 3: telling me, and then it takes information from your inside
Speaker 3: world and it decides what does that.
Speaker 2: Mean and what we are going to do about it.
Speaker 3: So what I just described to you is the three
Speaker 3: neuron or nerves that make up your dopamine pathway. Our
Speaker 3: dopamine pathway evolutionarily speaking, keeps us alive.
Speaker 1: Okay.
Speaker 3: So anything that generates a dopamine signal, your brain interprets
Speaker 3: as I need this to survive. The natural things that
Speaker 3: make a dopamine signal, our food need it to survive.
Speaker 3: M water, needed to survive mm hm, sex, needed for
Speaker 3: the species to survive mm hm.
Speaker 1: Because yes, to keep us humans, all species.
Speaker 2: The population.
Speaker 1: Right, the population alive, Yes, yes, yes, but there's another
Speaker 1: component of sex that's pleasure and connection. But we'll get
Speaker 1: back to the survival part.
Speaker 2: What else do we need nurturing?
Speaker 3: Because what happens the little human baby, what happens the
Speaker 3: little animal babies with no nurturing?
Speaker 2: They buy right, you're.
Speaker 1: Out of here.
Speaker 3: Those are the four natural determinants of dopamine. Here's what's crazy.
Speaker 3: You look at the drugs we have that people get
Speaker 3: addicted to. You look at the behaviors we have that
Speaker 3: people get addicted to. I'll talk about drugs right now.
Speaker 3: You can think of a dopamine signal from food as
Speaker 3: a light bulb starving.
Speaker 2: The ventral teg mental area says we need to eat. Pain.
Speaker 2: Light bulb.
Speaker 3: You see some food. The nuclear cucumbents is like, that's food.
Speaker 3: They package that information inside that make your stomach growl. Right,
Speaker 3: you feel hungry outside, you smell something. Your brain takes
Speaker 3: all that information. It says, I need to make a
Speaker 3: plan to eat so that we can stay alive. Yeah,
Speaker 3: that's the brightness of a light bulb pain. It's a
Speaker 3: great idea. Meth amphetamine. The size of that dopamine signal
Speaker 3: is ten to the ninth.
Speaker 1: Okay, so ten to the ninth. Ten to the sixth
Speaker 1: is a million times, and so ten to the ninth
Speaker 1: is a billion And so that means that your brain
Speaker 1: interprets dopamine signals way more than anything else.
Speaker 3: And your brain interprets a bigger dopamine signal as more important.
Speaker 2: Period.
Speaker 3: Yeah, So when people quote choose meth amphetamine over their family,
Speaker 3: it's because the myth amthetamine dopamine signal is ten to
Speaker 3: the ninth, the nurturing signal.
Speaker 2: One billion times one million times.
Speaker 3: Magnify it. And so the message that is sent forward
Speaker 3: with urgency to your CEO is we need this to survive,
Speaker 3: make a plan to never go without it. And as
Speaker 3: addiction kindles, like think about a fire, right, we go
Speaker 3: from that first ember, it gets.
Speaker 2: Bigger and bigger, and bigger and bigger.
Speaker 3: Your CEO becomes less and less able to refute that message.
Speaker 1: Now this, I am having a dopamine response here because
Speaker 1: I enjoy this type of stimulation. Okay, there's so much
Speaker 1: evolutionary biology, and there are so many things that our
Speaker 1: brain primes us for that are historical that no longer exists, right,
Speaker 1: and so I love the example to give us a
Speaker 1: range to understand magnitude between something really simple like hey,
Speaker 1: we need something to eat. You talked about vaping. Something
Speaker 1: that has incredible marketing for young people, fruity flavors. We
Speaker 1: see it all across social media. Packages beautiful packaging, cool yes,
Speaker 1: and so you know, so there's all of that going on.
Speaker 1: I think about marketing for food, and I'm also then
Speaker 1: thinking about what kind of signals do we see. I'm
Speaker 1: also thinking about social media. I don't know if you've
Speaker 1: seen it's on Netflix. It's a documentary. Oh unknown number.
Speaker 1: I thought that that was such a crazy documentary, like
Speaker 1: I could not believe it.
Speaker 3: Okay, no spoil or alerts for the listeners, but mind
Speaker 3: below now.
Speaker 1: And so I was thinking about what would make a
Speaker 1: person do this. I'm thinking about what we know about
Speaker 1: social media and the dopamine hits people get with the
Speaker 1: gamification of these different platforms. And I'm wondering because you know,
Speaker 1: you can't just override your biology.
Speaker 2: At least, I don't think you can write.
Speaker 1: And that's what I've learned from my friend, and so
Speaker 1: you would probably have to replace it with something else, right, Yeah,
Speaker 1: So when we think about things that are taking over
Speaker 1: our dopamine pathway, how do you get rid of them?
Speaker 2: You have to empower people with information.
Speaker 3: Right, So if we go back to our childhoods, just say.
Speaker 1: No baby, that black T shirt their yes, those good letters,
Speaker 1: it is etched into my memory.
Speaker 2: Okay, just say no.
Speaker 3: It doesn't work because it doesn't give people the information
Speaker 3: why they should say no, right, Like, empower people with
Speaker 3: information and then honor the choices that they make about it. So,
Speaker 3: for example, we can think about addiction. I describe to
Speaker 3: you the three neuron pathway. This is now like the
Speaker 3: three stages, right, One you have intoxication, Two you have withdrawal.
Speaker 2: Three you have craving.
Speaker 3: The combination of withdrawal and craving drive you back to
Speaker 3: use whatever. That behavior is intoxication. So when you think
Speaker 3: about social media actually brilliantly designed because your mind and
Speaker 3: your own business, and they trigger you with a notification, yeah,
Speaker 3: and then you know that notification is sitting there, and
Speaker 3: then you develop withdraw right, like those obsessive thoughts around
Speaker 3: what is that notification that.
Speaker 2: I didn't see?
Speaker 3: And then you go on social media and you scroll, scroll, scroll,
Speaker 3: and you get intoxicated because it is giving a dopamine
Speaker 3: and no, most likely through the connection pathway. Right, And
Speaker 3: so the way I think we help protect people against
Speaker 3: this is one not making it as if.
Speaker 2: Those people over there have addictive behaviors.
Speaker 3: All of us have some addictive behavior of some sort
Speaker 3: because we are all wired with the dopamine pathway. So
Speaker 3: my addictive behavior may be food, My addictive behavior may
Speaker 3: be shopping, My addictive behavior may be alcohol. My addictive
Speaker 3: behavior for some people may be exercise.
Speaker 2: Right, whatever, work.
Speaker 3: Let's not forget work, because I actually, I actually say
Speaker 3: it all the time.
Speaker 2: To people like I use work like a drug.
Speaker 3: I love work when I'm not working, I have withdrawal,
Speaker 3: I have cravings for work when I'm not working. When
Speaker 3: I am working, I binge yes. I work to my detriment.
Speaker 3: I work to negative consequences. I get lots of positive
Speaker 3: feedback for this, and it makes my addiction loop worse. Right, So,
Speaker 3: like all of us have something that is addicted to us,
Speaker 3: because that's just the neurobiology of have we built. So
Speaker 3: if we can accept that, that gives us compassion for
Speaker 3: the person whose addiction happens to be alcohol, for whose
Speaker 3: addiction happens to be opioid, for whose addiction happens to
Speaker 3: be cocaine, and then we empower yourself with the prefernal
Speaker 3: cortex can be trained to top down control that deep brain.
Speaker 3: It requires a supportive environment, It requires community and belonging,
Speaker 3: It requires education and knowledge and empowerment. And so how
Speaker 3: do we address environments, how do we address cultures?
Speaker 2: How do we address psychological needs?
Speaker 3: All of that allows us to create an environment that
Speaker 3: a prefernal cortex can be trained.
Speaker 1: This is also blowing my mind a little bit. So
Speaker 1: I was reading something about the genetic risk and they
Speaker 1: put it at about forty to sixty percent. What do
Speaker 1: we know about genetic risks as it relates to addiction?
Speaker 1: Is there a hereditary component to it? What's the state
Speaker 1: of things right now?
Speaker 2: Yeah, it's a multi gene an environment interaction.
Speaker 3: I lay out this framework that says every chronic condition
Speaker 3: has biological inputs, psychological inputs, and environmental inputs. And the
Speaker 3: environment is both cultural environment and physical environment. And so
Speaker 3: if you look at all three of those, This is
Speaker 3: how the book is laid out into six sections. The
Speaker 3: first three sections are inherited, So inherited biological, that's your DNA,
Speaker 3: inherited psychological, your childhood, inherited environmental, the culture and physical
Speaker 3: environment you were raised in.
Speaker 2: When we look at.
Speaker 3: Inherited biological forty to sixty percent of your risk for
Speaker 3: developing an addiction of any sort is coded in your
Speaker 3: DNA the day you.
Speaker 2: Are born, forty to sixty percent.
Speaker 3: If we look at the forty to sixty percent inherited
Speaker 3: risk through your DNA for any addictive disorder, that.
Speaker 2: Is higher than high blood pressure.
Speaker 3: Ooh, that is higher genetic loading than asthma, that is
Speaker 3: higher genetic loading than type two diabetes. So whereas we
Speaker 3: look at addictions so more realistically, like you just chose
Speaker 3: to have addiction. It's really because it's hard to separate feelings, behaviors,
Speaker 3: and thoughts from like who you are as a person.
Speaker 1: Doctor Harrison, How do you even go about talking about
Speaker 1: something like this, Like how do you prepare your kids
Speaker 1: to understand this type of risk at like a biological
Speaker 1: level when it comes to the genetics of it all.
Speaker 3: I have a very robust family history of addiction of
Speaker 3: all sorts and mental health conditions from both sides. Maternal
Speaker 3: side is loaded, paternal side is loaded. What that allows
Speaker 3: me to do is practice generational prevention with my kids. Right,
Speaker 3: so from four years old, I start training my kids
Speaker 3: into the understanding of addiction as a chronic medical condition
Speaker 3: that deserves and requires compassion for the people who are
Speaker 3: suffering from it. And then as they get older, I
Speaker 3: can say, listen, this is what Mom gave you in
Speaker 3: your DNA. Risk for high cholesterol, risk for alcohol use disorder,
Speaker 3: risk for cocaine use disorder ADHD, resilience, high IQG.
Speaker 2: Like these are all the things that come in my DNA.
Speaker 2: But because you know.
Speaker 3: You are most likely on the sixty percent end of
Speaker 3: that spectrum based on our family history, like sixty percent
Speaker 3: of your risk for development an addiction you were born
Speaker 3: with courtesy of mom. Right, then, when you go to
Speaker 3: a party in high school and the kids are on
Speaker 3: a line of cocaine, they might be able to do
Speaker 3: a lot of cocaine and have fun. Right, they might
Speaker 3: be able to binge drink. Let me tell you what
Speaker 3: happens in our family. They might be able to hit
Speaker 3: the bong for marijuana. Let me tell you about this
Speaker 3: schizophrenia risk in your DNA. And then that empowers people
Speaker 3: to choose maybe differently.
Speaker 1: I love that because what it really highlights is this, huh,
Speaker 1: this lack of compassion that is actually artificially creating, because
Speaker 1: I think if we were to say, oh, this person
Speaker 1: has breast cancer and they inherited this from their family,
Speaker 1: we wouldn't say, well, why did they smoke cigarettes? If
Speaker 1: they knew that their mom or grandma had breast cancer.
Speaker 1: We wouldn't say why did they live in this neighborhood
Speaker 1: where they would be exposed to carcinogens or whatever. We
Speaker 1: wouldn't do those things. Yeah, we would not villainize people
Speaker 1: for working with the cards that they were dealt, you
Speaker 1: know what I mean mean, But if you're dealting that
Speaker 1: hand of cards and you have the exposures and are
Speaker 1: facing substance abuse, what's the path for it? If you're
Speaker 1: trying to recover and someone's making this about morals and choices.
Speaker 3: I think the answer to your question is one teach
Speaker 3: people how to have the conversation to undermine the moral
Speaker 3: high ground, because the true moral high ground as humans
Speaker 3: is when we see someone suffering, we meet them with
Speaker 3: compassion and support, not judgment.
Speaker 1: I'm curious about relapsing and how we should be, how
Speaker 1: we should understand it or think about it, like you
Speaker 1: know you've already said we should be meet we should
Speaker 1: meet people with compassion, Like what is what should you
Speaker 1: expect based on what we know is happening biologically?
Speaker 3: Yeah, so I'll come back to this foundational idea for
Speaker 3: our conversation that I want people to understand. Addiction is
Speaker 3: a chronic condition. In medicine, When we say something is
Speaker 3: a chronic condition, that means you have periods of relapse
Speaker 3: and periods of remission possibly right, Okay, So in medicine,
Speaker 3: when we say in illnesses and remission, this means a
Speaker 3: period of time where you either don't have symptoms at
Speaker 3: all or your symptoms don't rise to diagnostic threshold.
Speaker 2: Okay, when we.
Speaker 3: Say you're in a period of relapse. First of all,
Speaker 3: illnesses relapse, not people. So this is what I should
Speaker 3: have said earlier is the key. And when you said
Speaker 3: what can we do? Like, we accidentally send so much
Speaker 3: stigma in our language.
Speaker 2: So he's in even saying.
Speaker 3: Drug abuse because like abuse is a crime, right, substance
Speaker 3: use disorder is a diagnosis.
Speaker 2: Addiction is a condition. But like abuse is a crime,
Speaker 2: it automatically conjures up a bunch of stuff for us.
Speaker 3: Yes, and so when we say you relapsed, use your
Speaker 3: cancer example again, when a person has breast cancer, they
Speaker 3: do chemo and radiation and the breast cancer goes in remission.
Speaker 3: If the breast cancer comes back, we don't say that
Speaker 3: woman relapsed.
Speaker 1: We say the cancer returned.
Speaker 3: The cancer returned, right, the cancer relapsed. And so the
Speaker 3: same thing with substantute disorders. So to answer your question,
Speaker 3: there was this foundational study done in twenty ten, one
Speaker 3: of my favorites by McClellans, and he looked at individuals
Speaker 3: with substance Hue disorders whose symptoms were severe enough that
Speaker 3: they needed.
Speaker 2: An impatient hospitalization.
Speaker 3: Okay, okay, and then he also looked at people with asthma,
Speaker 3: people with high blood pressure, people with diabetes, same thing,
Speaker 3: symptoms severe enough that they needed a hospitalization. And then
Speaker 3: he looked one year later, what percent of people were
Speaker 3: following medication recommendations and what percent of people were following
Speaker 3: psychosocial recommendations. When we look at addiction, we didn't have
Speaker 3: any medications except methodone for addiction back in twenty ten,
Speaker 3: so this study didn't wasn't a methodone study, so it
Speaker 3: only had were they following psychosocial recommendations at one year?
Speaker 3: Pretty much evenly across addiction asthma, diabetes, hypertension, seventy percent
Speaker 3: of people were not following medication recommendations or psychosocial recommendations. Right,
Speaker 3: And then when they looked at what percent of people
Speaker 3: experienced a relapse of their illness within one year of
Speaker 3: that impatient's day for addiction, high blood pressure, diabetes, asthma,
Speaker 3: it was about fifty five percent across.
Speaker 2: All of them. Wow, the symptoms of their illness had returned.
Speaker 3: And so to ask your question, what can you expect
Speaker 3: in the first year of remission from a substance use disorder,
Speaker 3: approximately fifty five piece percent and people will experience or relapse.
Speaker 3: That is a dramatically high number that is reflective of
Speaker 3: our system's inability to address the biological, psychological, and environmental
Speaker 3: triggers of the illness.
Speaker 2: Right as you get to.
Speaker 3: The second year, that number only falls a smidge is
Speaker 3: probably still about fifty to fifty five percent. As you
Speaker 3: get to the third year, it falls a smidge is
Speaker 3: about forty five to fifty percent. The risk of relapse
Speaker 3: of a substance use disorder falls back to that of
Speaker 3: the general public that never had an addiction at the
Speaker 3: five year mark. And so when we think about a
Speaker 3: thirty day rehab, y'all.
Speaker 2: That ain't it When you think about a five day
Speaker 2: detox y'all? That ain't it?
Speaker 3: When you think about a ninety day residential stay, y'all,
Speaker 3: that ain't it?
Speaker 2: Right?
Speaker 3: So when you say, is it something like eleanor health, Yes,
Speaker 3: because we're trying to stay engaged with people for that
Speaker 3: entire five year period of remission to practic This is
Speaker 3: what we call in public health secondary prevention. So try
Speaker 3: to prevent the symptoms from returning, just like you do
Speaker 3: with breast cancer.
Speaker 1: Wow. I really like how you explained that, and I
Speaker 1: appreciate you correcting me because I want to learn and
Speaker 1: I want to get it right. I don't want to
Speaker 1: be out here saying the wrong thing.
Speaker 2: Yeah.
Speaker 1: Yeah. And for folks that want to do something little
Speaker 1: like even as small as just shifting your language. Is
Speaker 1: there any language that everyone should switch to? Is there
Speaker 1: an activity or exercise you think that people can do
Speaker 1: to reorient their minds in order to be more tolerant.
Speaker 2: Yeah, the very first thing.
Speaker 3: I just want to train people into two kind of
Speaker 3: like ways of thinking and two ways of talking.
Speaker 2: First.
Speaker 3: This is for any illness, any chronic condition, addiction, included
Speaker 3: that person is not a diabetic, that person is not
Speaker 3: a schizophrenic, that person is not an addict.
Speaker 2: Because what you're.
Speaker 3: Doing when you say that is like making it as
Speaker 3: if there is nothing else you need to know about
Speaker 3: that person, and nothing else about that person that matters,
Speaker 3: or that they and the illness they have are equivalent, right,
Speaker 3: And so instead, that's a person with diabetes, that's a
Speaker 3: person with schizophrenia, that's a person with addiction.
Speaker 2: Right.
Speaker 3: And so if you just lead with the person in
Speaker 3: your words, then you also start to lead with the
Speaker 3: person in your thinking, and then you also start to
Speaker 3: lead with the person in your behaviors. So strike the
Speaker 3: word addict. Yes, that's a person they have an addiction to.
Speaker 2: Right.
Speaker 3: The second thing I would say to to try to
Speaker 3: strike and we use it. I'm gonna say three things
Speaker 3: you just talked about it relapse, right, Illnesses relapse not people. Yes,
Speaker 3: you can say that person's alcoholism relapse, or that person's
Speaker 3: opioid addiction relapse, or that person had a return of
Speaker 3: their symptoms. It's an extension of the first, which is
Speaker 3: leading with the person, and the third.
Speaker 2: Clean and dirty.
Speaker 3: So I think this language and kind of these depictions
Speaker 3: probably started with good intentions. Addiction is devastating and scary,
Speaker 3: and it steals the people we love from us. Opioids
Speaker 3: steal them kind of fast, like you can die right now.
Speaker 3: Alcohol cigarettes steal them slow, long and painful, right, methamphetamine, cocaine,
Speaker 3: et cetera. And so it was like, make this so
Speaker 3: scary so nobody will ever want to try it, and
Speaker 3: make it so awful, so that nobody will ever want
Speaker 3: to quote be one of the people. But unfortunately, it's
Speaker 3: just not how it works. And then once you do
Speaker 3: it so much, even if it starts with good intention
Speaker 3: and it has negative impact, it starts to just get
Speaker 3: ingrained in us, and we're like kind.
Speaker 2: Of thoughtless about it.
Speaker 3: And so that's what I would say to people who
Speaker 3: are listening. If you want to be part of the solution,
Speaker 3: be thoughtful. Be thoughtful that is a person periods. Start
Speaker 3: from there, and be thoughtful about that person as you
Speaker 3: would be thoughtful about any other person, as you would
Speaker 3: want someone to be thoughtful about you.
Speaker 1: Yes, being thoughtful. I mean, it's so simple, but it's
Speaker 1: absolutely something that is missing, like culturally, like at the
Speaker 1: very foundation of how we interact with folks. But at
Speaker 1: a system level, how does our system treat substance abuse disorder?
Speaker 3: Yeah, just a quick look back at history. Before eighteen
Speaker 3: sixty five, there were no illegal drugs. There were drugs,
Speaker 3: but there were no illegal drugs. And then the series
Speaker 3: of laws that started to be developed. The first set
Speaker 3: of laws were targeting Chinese immigrants, made opioids illegal. The
Speaker 3: next set of drugs targeted Mexican immigrants and made cannabis
Speaker 3: illegal and even changed the name cannabis and start calling
Speaker 3: it marijuana so it will be associated with Mexican people
Speaker 3: and conjure up kind of like negative. When we look
Speaker 3: at the percent of people who are in prison and jail,
Speaker 3: the overwhelming majority are associated with substance use disorders. When
Speaker 3: you look at who is disproportionately jailed rather than offered treatment,
Speaker 3: that is black people, people of color, LGBTQ people, people
Speaker 3: with physical and other mental health disabilities, immigrants, people whose
Speaker 3: first language is not English, that's here in this country.
Speaker 3: And so it follows the exact same because those are
Speaker 3: all cultural constructs that are pulling into every single facet
Speaker 3: of our life. For example, suboxone is a medication that
Speaker 3: we had to treat opioid use disorder. Really well done
Speaker 3: study out of an er showed that a black person
Speaker 3: with opioid use disorder who exp sperienced and overdose significant
Speaker 3: enough to take them to the er, it's thirty five
Speaker 3: times less likely to receive a prescription for suboxone than
Speaker 3: the white counterpart.
Speaker 2: Thirty five times.
Speaker 1: And that's the prescription.
Speaker 3: That's not even the prescription, that's not even the psycho
Speaker 3: social support, that's.
Speaker 2: Not going to none of it.
Speaker 3: That is just purely in the biological realm, like not
Speaker 3: even a prescription. If you look at who has access
Speaker 3: to suboxone, it is higher socioeconomic White populations. Disproportionately lower
Speaker 3: socioeconomic populations have more access to methadone, which is extremely
Speaker 3: difficult to use because you have to go to the
Speaker 3: clinic every day at five am and all this kind
Speaker 3: of stuff, right, and so those cultural inequities are pervasive
Speaker 3: in every facet of our life, and substance use disorder
Speaker 3: has not been spare.
Speaker 1: H doctor Harrison, I have learned so much today, even
Speaker 1: down to my language. I now understand just how much
Speaker 1: I've learned from television and movies. And it was wrong,
Speaker 1: and I'm wondering why Dare didn't teach me a lot
Speaker 1: of the things. Honestly they were saying they were teaching us,
Speaker 1: teaching they weren't teaching us, and like, this is something
Speaker 1: that we always talk about Zee. Unlearning is sometimes so
Speaker 1: much harder than learning. So going back and like changing
Speaker 1: the way that you think about things and how you
Speaker 1: approach certain situations and the word your word choice, it's
Speaker 1: so important. And doing the work of unlearning and then relearning.
Speaker 2: Is so.
Speaker 1: It is it is a sign of compassion, like to
Speaker 1: understand that there is a different way of living in
Speaker 1: this world that can make folks feel more included, more considered,
Speaker 1: more thought about in choosing that I think is one
Speaker 1: of the greatest things about humanity. It's one of the
Speaker 1: most important things that we can do while we're here
Speaker 1: on this earth. That's right, t T. That's beautifully said.
Speaker 1: You can find us on X and Instagram at Dope
Speaker 1: Labs podcast TT is on X and Instagram at dr
Speaker 1: Underscore t Sho, and you can find Zakiya at z
Speaker 1: said So. Dope Labs is a production of Leimanada Media.
Speaker 1: Our supervising producer is Keegan Zimma and our producer is
Speaker 1: Issara a Sevez. Dope Labs is sound designed, edited and
Speaker 1: mixed by James farber Limanada Media's Vice President of Partnerships
Speaker 1: and Production is Jackie dan Singer. Executive producer from iHeart
Speaker 1: Podcast is Katrina Norvil. Marketing lead is Alison Canter. Original
Speaker 1: music composed and produced by Taka Yasuzawa and Ali suji Ura,
Speaker 1: with additional music by Elijah Harvey. Dope Labs is executive
Speaker 1: produced by us T T Show Dia and Zakiah Watki