Emerging from the Darkness: The End of the Drug War and the Rise of Recovery - April 2017

[Music] the next program and emerging from the dark temple the edge of the drug war and the rise recovery will be presented by dr. Kevin Collison the nationally recognized advocate in recovery kids book under and Institute addiction study any author may article to me including the pleasure of women would reduce sec I became more and more in my head and the people that without protect Express the science to please welcome thank you thank you very much it's wonderful to be back in this room this room has always been very good to me and by a room I mean you and so it's great to be about among friends again those of you who might have seen me in the past thank you for coming back those of you might have seen the one or two of the films that I've made I hope that those films are helpful to you either in understanding your own addiction or explaining it to a family member explaining it to patients this lecture is one I've been working on for a little while this is much more of a personal lecture something I feel a lot more strongly about opinionated you might say when I do the other when I did the other films when I do the other lectures that's really designed to get a job done you know to try to explain the basic neuroscience the people who are trying to understand addiction or trying to get sober themselves and then the other film is to try to lay out what good recovery management really looks like and so those are you know kind of check off the boxes the films and lectures and we'll talk about the neuroscience more tomorrow this is more something that's much much more about some conflicts that I have I think I think we all do we all those of us are in recovery we all have this similar experience and this is the thing that we all share whether we're young or old or whether we live now or a thousand years ago where we kind of come to this point where we ask ourselves you know why am I doing this you know why why why can't I stop this and I think that that's the kind of the common thing that binds us all together I think that something else happens those a person gets a little deeper into recovery you start asking you know did it really have to happen that way you know what kind of done differently and I think that that's something that that a lot of us are thinking about right now especially those of us who have been involved in in the criminal justice system I'm very grateful to the people that I met in the criminal justice system they were very kind to me I can increasingly and realize just how lucky I was to have met them but in the United States we tend to shoulder the entire burden of recovery on the individual and I think that that's wrong I think that there are there's there's almost a structural violence that occurs in the United States when it comes to the treatment of the mentally ill and especially to people with addiction and when I'm using the term violence I'm using the term to mean using more force than is necessary to get the job done and I think back on the way my own addiction played out I'm very grateful that I'm standing here and that I'm sober I asked myself you know what was it that I had that that allowed me to survive that was it really necessary for me to go to prison to get sober you know how should I work to make a world a better place so that people other people don't have to go through that I will always be plagued by the idea that what got me sober or what keeps me sober right now up to this point is not necessarily the fact that I that I worked hard and I and I you know cleaned house and I trusted God and I helped others all the things that we believe I worry that the reason I'm sober is that I'm white and I'm male and that really concerns me I would like to think that that there's more to sobriety my sobriety than that but I can't be sure and I'm plagued by that and it makes me wonder you know what is it that other people are faced with that I never was that will keep them from getting recovery you know what is it that I got that other people don't have access to that that really made it possible for me to get into recovery I believe that that if we want to solve this problem that we're facing right now and we are we're in the this moment in history we're in this terrible terrible epidemic of drug overdoses I think we have to want other people to have the things that we got and we have to work for that there is a social justice component to recovery that that exists outside I think of of 12-step recovery because it doesn't get you know it wisely does not get concerned in those things but I think that that's under more threat now than it has been in quite a while this was a much more positive lecture a year ago but now now I'm reading things in the paper that that the the gains that we've made even the ending aids we made very recently are going to be rolled back and I think that we should fight I think there's a part at which point at which we should say you know what I'm not going to let this happen anymore right and even though I my serenity what is it for so that I can just sit around and say well I'm glad I got sober and I'll help a few other people who are easy I think that's right that's serenity and meaning my sobriety is fuel to be burned and burned to fight to even lose that serenity so that other people might have a wider gate to be able to pass the room I said [Applause] I've said this before you know you addiction is an equal opportunity to disease but sadly the opportunity to get into recovery is not distributed equally in the society and so what I'd like to talk about tonight and even discuss with you because I'm still learning a lot about this is is how we got to where we are now and what is it that we're facing and and do we have any solutions as to how we're going to to try to tell that story and continue to tell that story that recovery is possible then it's a good thing and that it's worth investing in if you would like any of these slides or any of the journal articles that I'm going to be talking about any of the research that's my email and you can i'll get send you the slides you have any questions that come up in the future you know feel free to write me it's always my honor to be a sources of reference for people that I've lectured for in the past I tell this to family groups all the time if you do open up the New York Times and you read an article that says that heroin addicts you go back to moderately using heroin you might just write me because it's usually a little bit more complex than they're letting on right there's a lot of really terrible information out there I would be very careful about anything that you listen to the concerns addiction on Ted because this is this is not the kind of thing that lends itself to those those easy answers it's very very complex as you know so a lot of you know my story I won't necessarily go into it in great depth but there was a point that I was in the military and I was addicted and and if you use drugs especially when you're working for the Marine Corps some pretty basic things are going to happen and so I ended up here this is the Camp Pendleton brig I can't be entirely sure but I think that this is the window across from my cell it's a bit of a crisis of faith in the Marine Corps whenever an officer goes to the brig so they didn't want anyone to know that I was there in the general population so they cleaned out this entire cellblock and they put me in the last cell it looked almost exactly like that except no window and I spent the next 90 days in solitary confinement and you know there are people who have done a lot more time in solitary confinement than I have but this I think is an act of cruelty especially to anyone who who has a mental illness I did not come out of there the same person and this is what I mean by was that really necessary there's a very good program on frontline on PBS last night about solitary confinement the fact that most of the time that it's used it's not necessarily used to protect the individual or the staff or the other inmates it's used really for administrative purposes it's because they don't want an officer in the general population right and I think that that's we become so used to using that violent approach that we never think about other ways of doing things right and I would rather have not I'm very glad that I got sober and I'm very glad that the military paid for my treatment which they eventually did once they let me out of here but I don't think that it was necessary for me in this box for 90 days and to really have any commonality with the people that I saw on television last night we'll have lasting problems based on the fact that they spent so much time in isolation I think that's something that we should fight against so the solitary confinement is is is something that I hope you never go through I hope none of this makes any sense to you that you don't recognize any of it it really is quite the amazing thing to not be able to tell what time it is right and to constantly get the answer back when you ask hey what time is it it's time for you to be in jail that's one of the classic things that guards say what I was able to do was I was able to kind of look through the the feed tray slot in my door and see on the opposite wall here there was a clipboard and every time they one of the guards came by he and this is the Marine Corps so they were all keys at that time had to sign off on a little thing and so I was able to count it he had to come by every 15 minutes so I was able to count up all the little squares that I could barely see through the feed tray slot and get an idea of whether it was two o'clock or three o'clock in the afternoon and over time then I started to become aware of exactly where the Sun was but this is not something that I had ever had to do before and I've always been able to know what time it was I could always ask somebody and when these things are taken away from you it kind of screws with you a little bit and it did the fact that the lighting never goes out right and that it's never particularly quiet I find that I find that particularly annoying until they put me in another cell because my cell was being sprayed for bugs which there were plenty of and that cell I spent the night in that cell and that cell had no light whatsoever and so when they shut off the light the normal light that stays on overnight now it's a little dimmer wasn't working and I spent that entire night in an absolutely pitch-black environment so it's kind of interesting like like I was all angry about the light being on all the time and then all I really wanted was just little bit of license I think it's the unpredictability I think of this that that makes it so disturbing I was a naval officer I had never gone through basic training or anything like that I was a staff officer so since I was being overseen by Marines drawn from infantry units they took everything that I didn't understand as a sign of resistance when I first got there they they do pretty much what they always do they strip you naked take a shower and and it gave you a whole bunch of things like soap and toothpaste and stuff like that and then they gave me the sack to put it in and so I put it in the sack and I put on a little uniform and then they chained me and changed my legs together and my hands to my waist and then they handed me the sack and I didn't know what to do a sack so I flipped it over my shoulder and then they frog-marched me to myself and I got about maybe 20 steps when this gunnery sergeant saw me and he walked right up to me and he said what the [ __ ] are you Santa Claus and I just I didn't really know what the same thing and I said I asked you a question are you [ __ ] Santa Claus and I'm like gosh what does the angry man want I said no I know gunnery sergeant I don't think I'm Santa Claus and he said then hold that sack at port arms well now those of you are Marines you know what port arms is I didn't being a navy doctor and so he just got you know louder and louder and louder and I said I just guy tried to appeal to his humanity and I looked into his eyes and I said gunnery sergeant I'm a navy doctor and when you say port arms I don't know what you're talking about but if you tell me what you want me to do I promise I will do it right away he goes you're an officer and you don't know how to carry a rifle I'm like nope never got that training I'm a doctor because sort of that in front of you like that like a rifle I'm like okay great no problem so I did that right so they bounced me back down to my cell and they they opened up the door and and they take off all the chains and I put my little sack on the little rack there who bent in the back and then they said okay it's time to strip-search you I'm like oh boy here we go the Karm of a thousand rectal exams has come home to you so this guy this young Lance Corporal stood in the doorway and he said okay take off your shirt check it out throw it on the ground take it off your pants take it shake it out throw it on the ground take off your socks take off your underwear throw it all on the ground all right turn around I only could turn around he goes squat and I squatted and said cough my coughed he said all right stand up and I'm like all right well that wasn't so bad writing stood up he said lift up your sack and I went over to my rack and he looked at me and he said what the [ __ ] are you do like you told me to lift up my sack he goes you nut sack you stupid son of a [ __ ] and like I'll go cut Lance Corporal you see I'm a navy doctor right and when you say sack I think you know sack write the word you mean is scrotum right so let me please accommodate you here and this this went on for 90 days and and it was that was one of the funnier ones most of them were you know me not knowing how to do things or what anyone was talking about so every time that door opened up and it opens up electronically it was a bit of a panic attack right and over over time I just was happy if the door never opened up at all and so over time I just kind of became least anxious when everybody just kind of left me alone and that kind of sucked me up a little bit for the long term and I've always been a little afraid of people ever after that and that was not the case before I went in there I just don't think that that was necessary I certainly had done bad things I realized I needed to be punished but that this is what I mean by using more force than is necessary to get the job done because you know I had the wherewithal to kind of put this into context I eventually got through all this went to treatment got sober but there are a lot of people who did not and in fact the guy at the very very end of the block was taken from MCRD which is the recruiting Depot he had only been in the Marine Corps about two weeks and they basically just screamed at him until finally he broke and then they brought him down to sell at the other end of the block which had nothing in it except the hole in the wall and the ground and they stripped him naked and put him in there and I had had listened to him essentially sob for the next two days and it turned out that the guy was was you know he was intellectually compromised right and they the recruiter because the recruiter just too much you go to the marine marine corps depo they just put him in there and and that's kind of thing that their leaves you changed after you hear you know other Marines essentially tortured this guy for the next two days so when they picked pictures of Abu Ghraib came out and I saw those people you know being put into stress positions and I heard people say how could they ever do that well let me tell you right now we do it to ourselves we do it Americans do it to Americans where you think they learned that right and so I think that this is sort of what the person who is poor or as a person of color or as a person who doesn't have you know a high school education or has a mental illness is faced with you and I get to go to treatment what this gave me was a was a very stark look into what other people have to go through to get sober and there's a story as to how we came to this form of thinking right so the effects of solitary confinement in short-term are that it has a strange and interesting not entirely unpleasant mild hallucinatory effect on the brain the things that you that you think about the memories that you call are particularly intense that's what they were for me but there are people who you know can go as far as psychotic symptoms be personalizing there's a lot of self-harm involved people do commit suicide in these cells I guess one gentleman who is fairly famous just did it the other day that that's an absolute indication of how well that prison is run if a person can commit suicide in that cell and so that that is a big hit that's malpractice in action right and of course there is this long lasting increase of suicide that goes you know beyond just the confinement this is what it did for me personally right my sense of smell or at least it felt like my sense of smell was particularly acute they only set us about 1,400 calories a day and so I was very very hungry and I learned to eat every single thing that was given to me including the little packet of equal that came with the coffee but the minute that that it was you know that the truck would arrive with the dinner with food I could smell that from you know two floors and to Sally ports away what I noticed is when I came out of the cell I couldn't focus on distance because everything that I had been looking at was you know no more than eight feet away from me in solitary confinement you become very aware of the very small and so very very small pieces of ground you know I you know would look at them ants you know they only had ants in myself so that actually they were all over the place they were all over me but it did at least gave me something to kind of you know focus on and do so there are these these things to kind of stay with you I had this very strange sense of impending doom and that that sort of was there all the time the long-term effects are the sort of residual social phobia and I would say and this is something that was mentioned on that show last night was that you just these bouts of incredible rage and anger just kind of come from nowhere and all of a sudden like I feel like acting out on this hostility and so I think a little more misanthrope ik than I was before I went into that and I don't like that I like people I like to be around people I also noticed this intense desire to hide to essentially be invisible I would kind of turn off all the lights and whatever dwelling I was in and just look outside and draw some comfort from the fact that nobody knew that I was mailed there so I mean this is this kind of stuff that that that people with addiction go through all the time and I don't think I think that the person who is able to get sober in spite of that is you know particularly to be admired so then after I was court-martialed they took me I had all these sort of grandiose fantasies that they would take me to the maximum-security prison in Fort Leavenworth Kansas that the military uses I thought that they would take me on some you know private jet the military the Navy actually has a couple Gulfstream Jets that they use or at least a c12 that's a little Beechcraft King Air nope we went commercial air and so it was me and my white uniform shackled with three chasers flying TWA and going through the st. Louis this is San Diego the st. Louis and the Kansas City Airport and I arrived here our maximum security prison for the military on the day before Thanksgiving in 1997 and Leavenworth is a very beautiful base I don't know if you've ever had a chance to go there it's a it's a showpiece base it there's a General Staff College there it's very historic base this is the actual compound here and this is what they call the castle General Custer was court-martialed in this building right this there's a bluff here you can't quite see it but it goes down to the Missouri River and on this hill right here which I have mowed many times there there are ruts that remain from people pushing up the Conestoga wagons this is actually the beginning of the the Oregon Trail so everywhere you turn there's there's a little piece of history and it's impossible to forget that they never let you forget that every single brick that created the thing was was was dug by prisoners killed by prisoners hauled and set by inmates so fortunately I made minimum custody pretty quickly because I had a fairly short sentence I I was given a year and I could go outside the walls every day and join the leaf raking grass mowing detail right and so I would you know basically blue grass clippings all over I wasn't you know quite fast enough with the mower so they handed me one of these things this is my trusty machine here the tour Ord 50 3-6 mod C you have to get the mod C because it has the tapered nozzle and that's very important so I was very good at this I was very quite excellent at this and it takes a physician to do this kind of work you give one of these things to a sex offender and they just blow a grass clippings all over the place they don't know what the hell they're doing that was very good at it I could do you have to get a little cyclonic action going and kind of list the grass clippings in so I don't want to say that I thrived by the time I got to a normal prison was outside solitary confinement but it was a very regimented day and I tried to spend as much time as I could learning about addiction so I was on the officers here and so they have a separate tier for officers so life actually got a lot better and that's kind of an important lesson that most people know the time that's hardest to do is in your local jail if you're in the you know whatever jail they use downtown town here that is very very hard time to do when you go to prison you have a library you can you know go outside more you can be with other people but County Jail is about the toughest time that you can you can do and it does start to wear you down this is actually a picture of Alcatraz but it looked almost exactly like that and I would just my cell door was open because on our tear we were minimum custody but it was basically in that cell that I that I you know did all the studying that turned into the two lectures than the two films so this is they have now sort of gotten rid of the prisoners here because this building was too unstable so these are all people who are basically tearing it down this is the castle inside we on this floor in this room right there they held a a meetings but what was interesting was is that they would not let the local H&I committee come into the hoppers in' the felt that that was too much of a security risk and so without the guidance of H and I and this is an important lesson which there was for me the meetings became extremely weird right not read how it works there was no you know recognizing the newcomer that would've been a little hard because the guard came by every five minutes and stuck his head angrily into the room to make sure that we weren't I guess digging out right he's trying to escape and people had kind of taken to saying some people like me said my name is Kevin I'm an alcoholic I heard people were saying things like my name is Joe and I'm in Discovery and I thought that was the strangest thing to say you're in discovery take a look around you man how much more proof do you need that you're an alcoholic a guy you know holds a shotgun over your head when you eat your Cheerios in the morning for crying out loud you know what more evidence do you need so that was kind of an important lesson that that you know that how important H&I meetings are is at the bottom of it there's a stairwell I went up every day to go to lunch and then they tore it down and I have to say there is a lot of mixed emotions when you see the object of your confinement torn down I mean there are very few things that you think of it's permanent as the walls that confine you and then all of a sudden they're gone it kind of you know kind of was kind of a weird mix of emotions and then of course they went and built down the hill they went and built the new military's prison and that's where a lot of famous people that you've heard of including a Chelsea Manning are now so this lecture is basically something that uh kind of trying to get at something that I was thinking in there you know I mean we all learned that addicts you know do bad things and they do and I don't mean to diminish that but this idea that that addicts have character defects that they the idea of an addict personality the idea that you know people didn't take personal responsibility for themselves and that's why they're here the idea of critical critical criminology is to ask maybe if that's not true maybe that's none of that is true and it really is the the things in our society that actually manufacture crime where it otherwise might not have occurred right so this is something that I think we all see we see money being taken from programs that are designed to help people get sober designed to prevent people from becoming addicted and they're put into the prison industrial complex right and you can't but wonder you know gosh are we actually you know sort of making crime to feed that system right and critical criminology really tries to take a look at that and say okay where is how is racism playing a part in this right how is sexism you know how is poverty what are these poverty health traps or poverty crime traps that people get into and that we just simply blame them when they don't get get better right so now we find ourselves in this time where we're all of a sudden the people that we know and care about and are familiar with are starting to become drug addicts it's not just happening to people on the fringes of society we are in the middle we're in this point in time 2017 where the leading cause of death now among young people is is not motor vehicle accidents which is traditionally always has been it's actually prescription and now moving into illicit drug poisoning right and so the the CDC just released in December the numbers for 2015 and everything is getting worse and it's not just getting worse it's getting worse faster so the problem is actually picking up speed so the worst year ever for drug overdose deaths was 2015 52,000 people died that's a thousand people more than died of hiv/aids in the worst year of that epidemic so already this is outstripp'd hiv/aids as a health epidemic right and now it's starting to migrate into into different drugs right the problem when it first began started as a problem with methadone mostly and there are reasons for that but we'll get into and then when people started seeing all these people die from methadone they kind of stopped using as much methadone for chronic pain and unfortunately those deaths were just replaced by oxycodone and that's really what we're really truly drove this now we're now we're assuming serious now we're starting to get a handle on that that's starting those deaths are starting to plateau plateau and even decrease a little bit but it's quickly being replaced by the next wave which is a transition to heroin and IV heroin and now we're starting to see the appearance of these super opiates drugs that are immensely potent drugs like fentanyl which is a hundred times the potency of morphine and even a drug called car fentanyl which is not traditionally used in human medicine it's used in veterinary medicine if you ever used to watch Mutual of Omaha when you're a kid and Marlin Perkins or whomever shot the Rhino and the Rhino you know fell over that's this drug car fentanyl 10,000 times the potency of morphine it's used in veterinary medicine as a large animal tranquilizer and this is starting to show up manufactured you know outside the country in places like China and Mexico it's starting to show up in samples of seized heroin and the DEA is trying its best to get the message out to local law enforcement be very very very careful of this stuff is dangerous merely to be in its presence right because it is just so potent so this is almost a chemical weapon of sorts I in fact the comparison is apt because several years ago the Russians weaponized Sentinel now if you remember that is Chechen separatists who took all those hostages at that movie theater well when they when the police attacked and when the Russian police raided them they used gaseous fentanyl and it killed half the the hostages right so we really are in a level of toxicity that that we have never seen before we have never seen people exposed to these drugs these drugs were really limited to the hospital setting and so Jay and I were talking about this you know they're they're people who are on Ted and other places saying you know it's not really the drugs that cause addiction it's the environment it's whether these people you know have a good environment or a bad environment no it's the drug trust oh right is the the environment is important I don't mean to discount that right but these are genuinely toxic drugs and they would be at any time for any person in any setting right because we really have entered just a new range where we're we're arguments about you know legalization just become meaningless right because this is not the kind of thing that you want people to have access to indiscriminate fashion because it will kill you within minutes right and so all of these deaths from from fentanyl are now starting to creep back up again and that's happening in you know their various states and so the worst states for drug overdose deaths the one that had the greatest increase in deaths and mortality rate in 2015 or these states right yes this is one of them we I live in Hawaii we don't see as much of this because traditionally Hawaii has been the sort of monopolized by crystal meth use but now slowly the problem is starting to make its way into why it's actually been there for a while on Maui and that's because Maui has a probably highest number of people we're actually coming from the mainland on a regular basis and so now we're starting to see people show up who are profoundly addicted to opioids when before we didn't really see that so we're not going to be able to escape it and now it's even showing up in New Zealand so I would have thought that I went to New Zealand about six months ago and they actually have the highest rate of increasing the highest rate increasing rate of opioid addiction in the world and so I would have thought that maybe it was our system of medicine that allowed us to develop this problem but nope it's actually attacking you know countries that have a very very different delivery system for health care so you know this is this is primarily the drug that caused most of the trouble yo yeah I always asked myself these questions you know do you ever wonder where this stuff comes from right and I mean I know it's made in a factory and stuff like that that's where the pills come from but was it the actual oxycodone originated in the world well all of the oxycodone that's you that's made in the world comes from a chemical called devein which comes from Tasmania Tasmania is the source of the world's supply of devein which is then turned into oxycodone right the little island down there famous words devil right and in the middle of this island and only run by a couple companies and a couple families really and very much a sort of local industry are these companies like Tasmanian alkaloids right and this is the company that has invented the Norman poppy they have specially bred this poppy that does not produce morphine or coding but it produces large amounts of this chemical feeding which is then extracted and turned into oxycodone right so these are people who more experts on opium poppies right and so they've they've learned how to breed these things and so they have it's kind of you know a little bit romantic you know you've got this sort of Ozzie farm farm culture and they're just these massive fields literally almost square miles of poppy fields right and they grow and they're of course surrounded by barbed wire but they're also geographically isolated so that that gives them some level of security there and they wait for the flowers to kind of the petals to fall off and the seed pods to dry out and then they harvest them like you would harvest just about any crop and they bring them to this giant warehouse which I'm sure is quite lethal to walk into but these are giant piles of essentially poppy straw concentrate and that has been packaged in one-ton bags and sent all over the world where it is turned from feeding with a fairly easy chemical reaction into oxycodone so these a lot of these bags show up at two labs in the United States ones in North Carolina the other is in downtown Wilmington Delaware you never know it's there it's only a few blocks from downtown and that is where they turn feeding into our nation's supply of oxycodone and so this company Tasmanian alkaloids is owned by Johnson & Johnson because they wanted to secure the supply of oxycodone make sure never fee Bain rather to make sure that nothing you know disrupted that right so the reason that we saw this epidemic the RET excuse me the epidemic that we have now is because of three things that kind of happened all at once the first one was we tried to get better at pain management this is what I was taught in medical school you know pain is the fifth vital sign if you're not asking your patients about pain then you're not doing your job doctor we can't leave patients in unnecessary pain so we had this little face of scale that we would ask to still use that in most hospitals the American Pain Society teamed up with the Joint Commission for the accreditation of healthcare organizations what's now called the Joint Commission today and they decided they were going to make this actually a quality of care issue so if you were a doctor and you left your patients in unnecessary pain you could actually get in trouble right and and what was the best indicator of a patient's pain asking them all right so that was that was believed you know beats of even the main way of assessing pain is to simply ask the patient if they had pain that they had pain that was enough to go ahead and use these drugs right and they're trying to get physicians over this this newly coined term opieop obeah that was you know essentially equated with malpractice right the second thing that happened after this big movement to try to get more aggressive with pain management was the appearance on the market of new formulations of drugs that had previously been very familiar to us right so drugs like oxycodone which at that time when I was in medical school came in a single tablet five milligrams not a whole lot combined with Tylenol basically and that was your generic or your brand name percocet right and so a person wanted the take oxycodone that hesitating pills one maybe two and they would have to keep taking it every four to six hours because they were fairly short acting right well now we had formulations that would take you know a day's supply of percocet and put it into one tablet right and so for any given tablet there was a much much larger amount of opioids so if you counted that as a bottle of tablet all of a sudden there was a very pure form of oxycodone right because they took the tylenol out tylenol and overdose is actually much more dangerous even than oxycodone right so they took the tylenol asked prevent tylenol toxicity and just put the oxycodone in this formulation speaking of the story and quickly people recognized that if you crushed it up we would break up the time-release preparation you could liberate all of the drugs in one setting right fentanyl which was a drug really only used in the o.r or in surgical day care centers and now Jane has a patch right and people could put that patch on and it would give them a very steady dose of fentanyl this is a drug that is ghosting millionths of a gram of micrograms because it's so potent but quickly people realize that if they cut the thing in half and squared about the the gel and then put that gel up their bottom if they could get themselves a pretty good dose of fentanyl in fact such a good dose that it would kill them it was famously how people would hop and die and even fentanyl even came in and kind of lollipops or the lozenge that could was designed to be used for breakthrough pain when the pastor before the controlled release tablet didn't work and of course this started to get out to people started through abuses all of a sudden these drug that you never heard of being used outside the hospital now they were out in the general public right the third thing that happened was that a particular manufacturer of oxycodone Purdue Pharma came up with a new marketing strategy to sell their drug this is right around the time that we were trying to get away from drug companies giving us pens or little putters with their you know drug named on it or or taking doctors to dinner or anything like that so what Purdue Pharma did is they would hire an expert an expert in say pain management and they would pay that doctor to go to a hospital and so it had the appearance of being delivered the message was being delivered by an impartial expert not connected with with with the manufacturer but it was right and eventually Purdue was was fine and now individual states are starting to go after Purdue Pharma but the damage really has been done right and so you had a number of things this is a sort of a traditional infectious disease triangle right you had a change in the environment right so the increased emphasis on pain management and more and more emphasis on on not leaving patients in unnecessary pain you had new formulations of these drugs much more potent formulations I you had a vector now healthcare providers the actual prescription pads that they used and there were certain things about the host that started to change for instance certain economic policies left individual communities much more vulnerable to the problem of addiction right and so there was a change in all these things and this is what led us to this problem by the way a highly recommend this lecture which is confined online by this gentleman dr. Kolodny he started this organization physicians for Responsible opioid prescribing if you go to this website it has some terrific videos one of which is done by one of these doctors who is this big advocate for pain man so I mean it's it's a it's a big day when one of the leading experts in pain management says you know what we were trying to create a narrative to help people become more comfortable with using these medications and patients who were genuinely in pain and if we had any idea what we were doing we never would have done that and so we were wrong I think it takes a lot of you know courage to do that right there's a very good book that that has just come out by an author by the name of San camiones it's called dreamland it is the best for written description of how all of this evolved and unfortunately dr. Portnoy figures rather prominently in that book so what dr. kowambe points out is that we really only had one part of addiction accelerate and accelerate very quickly so addiction did not necessarily get worse across the board it was specifically these synthetic opioid pain relievers right and so the number of treatment admissions and the number of opioid overdose deaths absolutely paralleled the sales of that medication regionally right so if that reason saw a lot more sales very quickly after that more people came to treatment and more people died right so it was absolutely related to the marketing of that product right what was interesting is that it attacked a particular group all right usually men at first now increasingly women - right who were in the middle of their life and an white right to be black was to actually little protected against this problem because doctors raided pain less severe in african-american patients they didn't take it seriously so to be an african-american was to actually have a little bit of a resilience factor against being exposed to these drugs right so this is you know this really put on its heels a lot of the prejudices that we believed about addiction only striking certain groups right because this was going right to the heart of this very vulnerable demographic right so the things that we used to believe like opioid therapy is safe for chronic pain right you're not really going to create addiction if it's truly pain okay there's good evidence to support this practice right it's better to use the longer acting drugs like oxycontin rather than a drug like percocet because percocet is either coming on or going off and you get this roller coastering you don't want that so if you have a nice steady state release that's actually better right there's really no toxicity to opioid so you go as high as you need to just keep on giving it until the pain gets managed and actually higher doses are better over the long run right it turned out that all of this was wrong right and a lot of it was based on not a study not a clinical trial but a letter an individual letter that was written to the New England Journal of Medicine where these two doctors essentially did a big chart reviews and looked at several thousand charts and noticed that people who were prescribed very few of them became reported any addiction right so the this is the sum total of the evidence that supported the use of these opioids for chronic pain right and so it quickly became apparent that that a lot of this damage was actually created by physicians themselves we weren't really being critical thinkers we weren't you know we were giving in too readily to what the manufacturer was telling us right so the first wave of this epidemic came with methadone more and more primary care providers took this stuff to heart and started putting their patients on longer acting medications things like methadone right and almost immediately state health department's started to see a spike of deaths from methadone all right methadone is almost a different drug when you use it for pain management then when you use it for its traditional use which is the management of opioid addiction right it has very complex pharmacokinetics right so it's broken down differently from patient to patient in high doses it can actually cause cardiac arrhythmias so a lot of these patients were taking the drugs and very quickly getting into trouble and they were usually dying in their sleep almost all of the patients in one study in Utah were found in their place of usual sleep you're in bed or in their lazy boy right and and in that one study in Utah almost all the people were dying within a week of the prescription being written right and most of those deaths had a legitimate prescription written so this is clearly a problem and we did manage to get a handle on it but unfortunately not before the damage was done and we started to see the rate of the risk of death from drug poisonings that's the term of art poisonings actually outstrip what traditionally killed young people which was motor vehicle accidents that's a big statement that's a huge thing because that's almost entirely iatrogenic entirely physician caused right the second wave was when people moved from these opioid pain relievers like methadone and oxycodone over to heroin so the minute they started to reformulate oxycontin people recognized that they could just move over to a much cheaper source and that was heroin which was increasingly cheaper and increasingly more pure alright so one of the things that I really liked about that book dreamland is that they go into why this happened right all of the sudden there was essentially a change not only in the product but in the way that it was distributed right so these these uh people in this particular province of Mexico all right essentially we're very very close to where they were growing we're the growers made heroin right and it was this different heroin than you found and say Southeast Asia so it was a different process which had a lot more impurities into it in it but it was very very pure and so these people from this particular province came to the United States and they didn't go to big cities like Detroit or New York they went to small cities they went to small cities and they essentially sold it in this pizza delivery sales model where they would essentially go to medical methadone clinics try to recruit people say here you ought to try our product here's my number call me anytime I'll come and deliver it to you right if you don't like the product let me know we'll give you a little bit more than the next time right and so it was all really very customer focused right these people didn't carry guns there was no violence involved and it was effective and so this is essentially how this gripped this these individual communities and one of the things that they talked about in that book dreamland is how important Walmart was to the local economy of drug use so people who were addicted to oxycodone or to heroin Lou later would actually get their money by stealing things from Walmart and so if there was a local Walmart that really helped you know opioids get a get a grip on that town me so their dealers would literally give him shopping list especially at Christmas and they would simply go to the Walmart and steal the stuff right and the managers and the workers in Walmart's are not paid very well they didn't really have a whole lot of vested interest in stopping shoplifting right so people would literally push you know flat-screen TVs out the back door and there was nothing to stop it right so this is kind of you know what gave us this giant problem now the third wave is coming along where this non-pharmaceutical fentanyl which is manufactured in places like China and Mexico is coming into the country and finding its way into samples of heroin all right then to know very potent very short acting right so this it's on and it's off within about 15 minutes and then you need more right so people find out about this super pure you know batch of heroin which really has fentanyl in it and they what they want that and they very quickly get themselves into trouble this is classically the drug that kills anesthesiologists who develop addiction right it's very hard to get the dose right two drops gets you high three drops kills you debt right so the traditional anesthesiologist is discovered when they overdose on fentanyl and if they overdose in the bathroom or in the o.r and they fall on the floor and everyone sees it they live but if they overdose in the call room and no one knows that they're in there they die right so this is even for experts this drug is extremely dangerous right it's a very very lethal drug okay and so now we're starting to see from 2013 on this big increase in fentanyl deaths right we had a case in Park City Utah where I used to live of two middle schoolers ordering fentanyl actually three methyl fentanyl through the mail right and and one of them was dead on a Monday and one of them was dead on a Wednesday and so that's that's the kind of thing that we're seeing is that these deaths are just sort of popping out of nowhere the other thing that's interesting is this study that was done by the sociology department at Penn State after the last election they noticed that in most of the counties that previously voted for Obama in the previous election that switched over to the other candidate all right in this election they they were also the counties where people died at the highest rates of drug overdoses and cirrhosis and suicide right and so these are sort of these these deaths of despairs they're defined is that income communities of high economic distress and a large working class that isn't employed those were particularly susceptible to this problem right and this is what started to reverse the longevity numbers for this particular demographic and everything else you know people are living longer living longer but for you know middle-aged young and middle-aged white men in the middle of the country their longevity numbers are actually decreasing worse right and that's the first time that that's ever happened if you look at that study that was done by the Department of Health of the state of Utah and some of the best epidemiology was done in Utah because Utah was seeing this problem ten years before the rest of the country for some very interesting cultural reasons right Utah was particularly susceptible to these two opioid addiction and opioid deaths right when they looked at these patients and they actually asked the families afterwards you know you know what can you tell me about them first of all they found that initially the dose were the deaths were from methadone later they were from oxycontin okay oxycodone right and in most of the cases of in a great deal of the cases of the deaths the people weren't actually buying it off the street they had a valid prescription right this was sort of started the clue people in that this wasn't coming from drug dealers this was coming from doctors themselves right and this is interesting and in the first study that they did in 2005 in the 44 deaths where a prescription was available to determine the onset of treatment death occurred within one week of that prescribed prescription being filled within 70% of these cases so what was happening in these cases again peculiar to Utah is that patients were being put on methadone for chronic pain and it's not really regular in Utah to ask patients about their alcohol use right it's just sort of assumed that they're not drinking alcohol so a lot of these patients were going home they were taking the medication exactly as directed they might have a beer or two on top of that and that was just enough to tip them over and and there are people who died from overdoses instantaneously but most people who die from overdoses it takes a few hours and they just breathe more and more shallow more or less and less frequently in a minute and and so it's actually a very slow death but it is absolutely assured to happen if the person isn't discovered right when they look at the actual characteristics in a later study they found that most of these people who died had kind of three things going on in their life one is they had had recent or yeah recent financial problems they were either employed or having difficulties or had lost their insurance okay they had a previous history of substance use disorders so these were patients who had previously been treated for addiction but yet their doctor did not take that into account when they wrote them the prescription for this you know prescribed opioid right and since one of the larger payers of treatment in Utah is the Church of Jesus Christ of latter-day saints this was important for them to know in fact I was the person who took it to them and said listen these people who are dying they've been treated and you paid for it right the problem is their leading treatment with no support they've got no long-term management and they're getting into trouble very quickly when they go to see a doctor right and a lot of them also had history of mental illnesses so this is where we start at the figures from this data that we started which is you know almost ten years old we started to kind of get a picture of these patients who were dying right okay so what Utah did to their credit was kind of you know engage in a campaign of information so if you drove on any of the interstates in Utah you would see big billboards that said don't share your medications keep it locked up or give it to the fire department something like that never share medications and with that campaign they act and then also a campaign of physician re-education they actually saw some they were actually able to turn this around so as the rest of the country is just starting to discover the problem and pick up Utah is actually going in the opposite direction then they cut off the funding and the problem started to get bad again right and actually for the more recent data it's actually starting to trend up again right so you can reverse it but it takes a constant effort right so we're did how did all these laws and how did these attitudes come about well the problem really became modern right in the 1970s those of you lived through the 1970s I barely remember them this was a time of great political and social upheaval right and with it came a rise in crime and so a lot of these things you know the death of Martin Luther King and Bobby Kennedy a lot of these things sort of motivated a fear in the United States that certain politicians were able to capitalize on right and so in 1971 Richard Nixon signed an executive order that essentially declared a war on drugs he said that it was a national emergency and there was going to be all kinds of money made available to fight the problem mostly he was worried about this sort of population of people coming back from Vietnam who had gotten addicted to heroin while they were in Vietnam and that was just a little bit too much for the Nixon administration to face a bunch of really pissed-off heroin addicted people of color coming back to the United States that really put the fear of God into them right and so they came up with this policy which interestingly involved a lot of effort for treatment Richard Nixon was not across the board a person who is necessarily bad for addiction he started essentially the first office to deal with this problem which later became the Office of National Drug Control Policy right there was a belief that that people should be treated a lot of those service members that were found to be addicted in Vietnam were treated and that before they were sent home and many of them never really continued on in their addiction right but this set up sort of a battle between other Republicans who were vying for the presidency to see who could get out in front of this and be perceived as more tough on crime and so Nelson Rockefeller who was a moderate Republican compared to Richard Nixon decided that this was going to be his issue and he was going to take this tough-on-crime stance and passed these incredibly draconian laws that involved you know like 10 years 20-year prison sentences for people who were busted with just a small amount of a drug right and this is what filled the prisons in New York and it's only been recently that some of these people have gotten out and they've tried to repair the problem that the Rockefeller laws gave us right there were also other theories that came along about crime that said well you know you really need to to to increase enforcement in communities of petty crime right so the idea is if you know I walked by a building and it's got a broken window and that window hasn't been repaired people just let it go that's just going to attract more crime and so this was a plea to to increase enforcement in communities that had traditionally been thought to have include more crime so that meant that there was a disproportionate enforcement of crime there were more cops in neighborhoods of poverty neighborhoods of color there weren't as many cops you know driving around Grosse Pointe Shores right trying to figure out what crimes might have been going on there right so you had people who were much much more likely to be exposed to this criminal justice policy and then this death occurred right the death of Len Bias it was a very prominent promising star who smoked crack cocaine and died and everyone was talking about this when Congress went into its break and Tip O'Neill in in Massachusetts was thinking this is the issue this is the issue that I can push back on against the Republicans in the executive branch and again it was another attempt to try to get out in front of this to see who could get tougher on this problem right and so a number of laws that were passed that were essentially and you know one of the people who was big on this was the Senate Judiciary Chairman Orrin Hatch from Utah who really believed that you know this was about you had to frame this problem in terms of killing youth and that essentially meant that you could do whatever you wanted you could turn up the link three sentences no problem so there were a number of these laws that were passed in fairly rapid succession right that did things like abolish parole in the federal system there is no more parole in the federal system that doesn't exist anymore right I did a federal year which is 85% of my sentence because I was you know I didn't get into any trouble or anything like that but no lower than that right so you had to do you know vast majority of the sentence right when the anti drug abuse came along okay it established mandatory minimum sentences they were trying to take discretion for sentencing out of the hands of judges right and so more power was transferred to the prosecutor and in the federal system where hearsay is admissible right so you could have an informant come in and say yep I saw him you know sell drugs that's all the evidence that you needed in that system and so the federal federal prosecutors were having like 95 percent success rates in their convictions and so they used as leverage to try to get people to to plea to sentences to crimes that still had very very high senses attached to them right and then of course there was the racial bias in certain drug crimes versus others right when the anti-drug Abuse Act was the one that actually a little bit of good by establishing the Office of National Drug Control Policy but usually this this drug czar was someone who was coming from law enforcement or from the military not necessarily a person who understood the public health implications of drug policy right and so is the series of events that occurred that caused for the first time in history this massive increase in the number of people who were incarcerated right this has occurred never before in history and in no other country right to the point that now we have somewhere between 2.1 and 2.2 million people still incarcerated right so you know I think back like you know we're now we're thinking about repealing marijuana laws right we're going to make marijuana you know not a crime anymore you can use it recreationally the only other time that's happened was when Prohibition was repealed and so I started asking myself well whatever happened to all those people that we remember from TV shows that were arrested for bootlegging right I mean when when Prohibition was repealed what did they think about that right I mean one day the thing that you did can get you prison and on the next day it can't well what happened was is that a lot of these people people like like George Remus it was one of the more famous bootleggers who was arrested and sent to prison their sentences were very short George Remus went to prison and he was like I said one of the biggest bootleggers that they prosecuted he only went to prison for two years so by the time prohibition was repealed most of these people were already out so that was the difference between then and now when people are in prison and they still have a long time more on their sentence and I think it says something about our country and I don't think that's something is good when a person in Boulder Colorado can do the same thing that a black man did and make a million dollars when that black man still has ten more years on his sentence so what does it say what would is the psychological reaction going to be when a person who still has much much more time to do when really their entire life has been taken away and all of a sudden the crime that they did is not a crime anymore right I don't really know what's going to happen but I don't think nothing will happen I think that that may be a very very socially disruptive phenomenon right so really what propelled a lot of these this this mass incarceration boom was the fact that more and more prosecutors were having more and more power more and more success in plea bargaining or convicting and the sentences were becoming more than much much longer all right and this is what really contributed to a lot of this right interestingly as we tried to get tough on crime and as the incarceration rate went up crime was actually going down so there was no link necessarily between crime rate and and and the the need to increase prison sentences now a lot of people what conservatives would say well the reason the crime went down is because all of those people were off the street they were they were incapacitated right difficult to make an argument against that there's I think some of that that is true but our desire to become more punitive is completely disconnected from the actual threat that's out there in terms of crime right but a lot of these policies were very popular you know Rudolph Giuliani you know it's hard to argue that he didn't clean up Times Square right but a lot of the policies again affected some people more than others and very negatively I would say right and so you started to see the mass incarceration problem particularly it groups that were already quite vulnerable right so the racial disparity disparities in sentencing were obvious almost immediately and a lot of those disparities were found in states with more conservative laws like in the south right just for marijuana possessions alone the disparities between the black arrest rate and the white arrest rate was you know very obvious most people started talking about the school-to-prison pipeline that because of underfunding of schools and over funding of prisons essentially a movement of that money that you were really just creating a system that just took people directly from prison and put them directly from school and put them into prison more and more cops were showing up in schools themselves I know if you saw that arrest of that young boy with autism the other day and he's arrested you know being taken out of the school in front of his friends his mother is saying what are you doing what are you doing apparently had a warrant from like you know months ago and the poor kid is saying I don't understand what's happening to me why is this happening I mean that is violence all right that is completely unnecessary but you know people were sort of in the they had the appetite for it right now where State of the Union was Louisiana right that was like over off the charts in terms of its incarceration rates right so it stood out okay and I think that we can start to say things like this is the now the third wave of racial violence that has gripped our country the first being slavery the second being Jim Crow and now this right where you know it was Michelle Alexander who said that more black men are in prison today there were enslaved in 1850 ten years before the Civil War right so this is I think something that really has to be called out for what it is right and I don't think that that that that that shame is off the table quite frankly and I don't think that the tactics that were used previously on the Edmund Pettus Bridge shouldn't be brought to bear against this problem right and of course we're completely out of proportion compared to the rest of the world and it's not like they don't have drug problems to they just found different solutions right so the National Research Council which is sort of main research body for issues of criminal justice took a look at this and said okay what is what is causing this rise of incarcerated Americans and they said that it really has not had any impact on crime rates of recidivism right and and and it does have it to do with increased prison time and time served right but it also has to do with the fact that drug use occurs in a certain context right in neighborhoods of disadvantage right in neighborhoods of housing segregation right so this is really what's good this concentrated disadvantage this what causes these communities not necessarily to have higher rates of drug use but to be particularly susceptible to the negative aspects of drug addiction which include differential enforcement right and not only that in many states people once they have a felony conviction right and so what previously was a misdemeanor was ratcheted up to a felony okay and once you are convicted of a felony in many states you are out of the political process you cannot vote anymore now there are states that are trying to change that Virginia has changed it right but it says something about you know the fact that these people are not able to bring their experience to bear and the political process they do not get to have a say and say hey you know I think maybe you know things could have been done differently or I could have done something differently so this is essentially a means of taking people who are in recovery to and making sure that they do not have a political voice all right the other thing I think that that history is really going to remember very very unfavorably is the fact that you can now be paid a dividend off the incarceration of another human being right so the increasing use of for-profit prisons to cope with the overcrowding problem when the Supreme Court says you know have as many people incarcerated in an institution they can quickly go to these organizations and very often these these for-profit companies have just sort of staked out a town made a deal with the local government to get taxes down right and for them to actually put sewage and electric lines into it and they just went ahead and built the prison without any real demand without anyone saying hey we really need this right but by the time the last nail goes in right and the keys are turned over the demand is there and so the prison can so the for-profit prison company can sell those beds for whatever they want to right and so again we're seeing an increasing number of people who are in that incarcerated group being housed in institutions that have no real vested interest in providing treatment or have any incentive whatsoever and making that environment of rehabilitation right and these tend to CDs a lot more in southern states the geo group and correctional Corporation of America which recently changed its name they tend to exist you know in these states that that are more you know pro prism and more tough on crime a lot of them are in Texas most people don't know this but almost all of a good chunk of the majority of the inmates in the state of Hawaii actually you see did I put that in there yeah they go to Arizona all right it's too expensive to house them in Hawaii so the Correctional Corporation of America has a Hawaii Department of Public Safety facility in this little town and about at any one point forty percent of the inmates in Hawaii are actually housed on the mainland which means they have no connection to their family they can have no visitation and one of the things I found particularly disgusting from my time in prison was the fact that AT&T exploited these prisoners you cannot believe the phone bills that I would get hundreds of dollars for just 15 minutes a few times a week right they realize they have a captive audience these people do not have the ability to pay that kind of money I think that that's particularly predatory right so going back here to look actually listen you know to looking at the worsening overall of the incarceration that experienced that the removal of rehabilitation and educational programs I was something that actually was done at Leavenworth they removed they had like a little mini college there they took that out so even in prisons that were I thought pretty thoroughly run pretty well and and I thought you know Leavenworth was run well they still were removing some of the things that would help people get back into their community and live a life without crime right so the health consequences of this stay in prison could be worsening of your substance use disorder right now I was a short-termer no one was going to take the chance of selling me any drugs I didn't want them necessarily you really had to be kind of someone to use drugs at 11:00 worth the average sentence there is 28 years so you really have to be part of the community to use drugs but in other prisons that's not so much the case and a lot of these people are simply the X population of people in mental hospitals that have just now moved over into the prison system the increased risk of tuberculosis and STDs so really to be sentenced to a prison sentence is not just to be sentenced to time but also to a disease that may actually kill you in the long run increasingly these patients have worsened chronic health conditions prisons are required to pay for medical care but there isn't a lot of incentive to pay for chronic care so acute problems get dealt with but chronic problems tend to be pushed under the rug right and more and more prisoners are becoming older and having an experiencing disability so there really is no mechanism to help these patients slash prisoners right okay and there are other laws that actually try to keep people from having any kind of say in this process or filing Appeals okay so generally this is the legacy of being in a prison so we have you know things that are going to exist in that person's life long after their sentence and it's not just the prisoners that have these effects there are also effects on their family members their romantic partners and their children so when you incarcerate to someone you actually do a great deal of damage not just to them but also to their family and then also to their community and this mass incarceration boom has literally dead stated it's decimated an entire generation of african-american men who are poor without a high school education and we are going to be paying for this problem for a long long time because one of the things that we know about stress and trauma is that it is her edible and that these early adversities gay they have a big impact on the health of that individual right so now we have an increasing number of children who have incarcerated parents right there aren't a lot of mechanisms to help these children they're growing up you know alone or raised by one parent now Sesame Street even has materials to reach out to these children that's an amazing statement quite frankly when when you know you actually have to come up with special materials to be able to meet the needs of this growing number of vulnerable children right who are already vulnerable in the first place now we know that there are actual mechanisms there are physical mechanisms that exist that can transmit this problem from one generation to another so this is where the field of epigenetics comes in I probably talked to you about this before we know that that things like trauma things like stresses in the environment they don't change DNA itself but they attach things to DNA like little methyl groups and what that does is it just kind of puts a kink in the DNA that's not a big deal but unfortunately when the DNA is wrapped it doesn't wrap as tightly and what that means is that those genes are a little bit more accessible and they might be turned into proteins faster whereas if the kink wasn't there you wouldn't have that so with that stress or you have an actual physical change that you can measure right and that will lead to a difference in creating proteins and that can lead to a difference in disease right so one of the things I was reading not too long ago is that a single instance of child mistreatment can create a methylation on a very very specific part of a particular chromosome and that is associated with a tripling of the risk of bipolar disorder as an adult right so we're getting to the point now that we can actually take the individual stressful event and linked it to the change in a DNA on the DNA on the chromosome and that is the linked to the disease itself the good news about epigenetics is that it is reversible there are things that you can do to erase these changes and one of them I think is is being in recovery right okay so I'm kind of looking at the clock here I don't want to spend too much time I could kind of kind of be bit beaten stew a dead horse we've talked a lot about the prison to school to Prison Pipeline more and more prisoners are becoming older and the mechanisms really don't exist to ensure their health right now this is actually becoming part of popular culture right and I found it very founded very kind of disturbing that when I watched this show there were certain things that they did on that show that are just kind of done in prison like I you don't learn them you just know to do them like for instance we never sleep under the covers I don't know why we just make our bed and sleep on top of that I know none of you have ever you know gone to prison you don't know what I'm talking about but when I saw that and I saw us a few other things when I watch this show I'm like holy cow how is it that that is just sort of something that people do when they go to prison I don't have any explanation for that right increasingly incarcerated women are an at-risk group a lot of these women are pregnant and they have special needs which aren't being met of course we talked a little bit about adverse childhood experiences so having an incarcerated household member is known to be one of the particularly powerful things that can affect an individual's health down the road again incarcerated household members of this was a study done in Minnesota and this is a study done in California and they were both looking at the prevalence of having an incarcerated family member and then they were able to link that to increased risk of disease down the road so childhood trauma and repeated stressors can affect all stages of addiction they increase the risk that a person will use drugs earlier in their life they increase the shift from just Craig experimental used to regular use they increase the escalation to actual dependence they can diminish motivation to quit and even increase relapse right so when a person is in a court-ordered program and they're being told hey if you relapse you're in big trouble a person who has been exposed to childhood trauma is more likely to relapse than a person who hasn't and so if you don't take that into account that's not really a fair comparison of how the person has worked to try to stay sober because they were already set up to have more relapses right and so we talked a little bit about epigenetics and how these changes can be handed down via this mechanism of methylation right the LA County Jail - in towers is the largest mental health facility in the world right and so increasingly this is where people with mental illnesses who are poor are being housed correctional facilities are required to provide medical care if they don't that's a violation of cruel and unusual punishment right but very often these services are minimal at best right okay so I think I've kind of you know come to this point you know what what's going to happen next alright now the thing things are kind of going in a positive direction maybe they will continue to go in a positive direction but you know now we've got essentially you know one person leading the team to investigate chronic opioid addiction we've got a person who is a famous drug warrior who's now in charge of the Department of Justice and so you're going to see a difference in how different states deal with this so things are kind of getting better and one group of states and things are getting a little worse or not getting any better in another group of states and so again that's going to increase the the disparity in access to to treatment and to programs that can get a person out of this mess where things will get really interesting and this is kind of an experiment that our entire country is going through is as we start to legalize things like cannabis right we're going to see if this really you know is is the scourge that we thought it was right I think what's going to happen though is that most people who use marijuana recreationally they're not going to have a problem but again the harm of this is going to fall upon communities of color and communities of disenfranchisement and communities of poverty right I don't care about that that undergraduate at the University of Colorado who smokes pot right I care about the person who lives in a bad section of Denver who already had a lot of disadvantage going into this and now they're being exposed to this essentially because people can you know have a recreational time right we also have to look at the number the total number of people who are actually under some kind of correctional control that's not just people in prisons but people on parole and probation and that's now rise risen to seven million people there are seven million people in the United States who are under some kind of control right let's not forget this more and more in jails the people that are in it have not actually been convicted yet they can't afford bail and so they're just sitting in there waiting to be convicted they haven't been convicted of anything but they're still receiving all of the harms of incarceration right and I have very little patience for the statement well sometimes you have to incarcerate them because you know that's what's good for them yes there is some there are some studies that show that especially for certain groups of people like black men when they become incarcerated their mortality rate goes down that's true but when they leave their risk of mental illness goes way up and kind of erases whatever the gain that is right so I think you know you have to think about what happens to a person when you when you strip them naked shower them with other people that they don't know you put them in an orange jumpsuit there is a real psychological impact to that even if the person isn't guilty of anything and that has long lasting consequences right okay so I think I won't go into that we'll just talk you know that that we seem to be doing pretty well Botticelli was the the drug czar and we were trying to find kind of a middle way between just full legalization and I retreat into more of the drug war I don't know if we'll be able to continue with this but if we do a large part of what sustains that is going to be you is going to be the recovery movement itself and that's why in many ways we have to become more vocal than we've ever been before because I think that this is something that we're going to have to continue to teach the world over and over again that people do get sober that they go on to great lives when they get sober and that they can be a benefit to their society but but that's something that we will have to constantly work for right so it's not exactly the happiest of lectures but I'm willing to take any questions I think yes ma'am right and I am wondering if you United seems to be a distance Walton friends food and clothes I just every for a lot everything right yeah yeah it's a it's a holdover from psychoanalysis what you have to remember really was all of psychiatry at the time that the big book was written and really all the way into the 70s right and this is this idea that that really what's the core of a person's mental health issues or even their health issues is a certain kind of personality this is what I learned in medical school that addicts are addicts because they have an addict personality and what we mean by that is that personality right they're they're more dishonest they're more antisocial they're more likely to use word you know immature ego defense mechanisms like projection and denial and things like that and this is a very powerful idea that really you know sinks in to people's thinking and we have to get out of that there is research to show that certain character traits can predict not addiction but earlier drug use right in life the age of first use is very predictive of lifetime risk of addiction right and that is associated with addiction it's kind of a you know sort of a half connection right but I don't think that those character traits which would be increased novelty seeking increased stress reactivity increase risk taking I don't think that they rarely rise to the level of personality so this would be one of the things that critical criminology would ask is it all [ __ ] and I think on a large to a large extent slight the psychoanalytic view of addiction is just that and I'm rejecting all of it and saying there is no addict personality you cannot lump these people into a certain group right you will find just as many people who are who are you know very very empathic who are addicts as people who are not as empathic right what I think we do is we actually kind of create the problem in the way that we treat the patient right I mean if we spoke to a diabetic the way we often speak to addicts hey mister addict have you relapsed are using drugs you know we can test you we can find out what you're you know with what your what your drug test is right and if we find out that you're positive we're going to put you in jail how do you do that to a diabetic hey mister diabetic you know you've got a diabetic personality right have you had a piece of chocolate cake today I think you have you know we can test your blood sugar we can find out right we don't do that and so it's in the way that we treat these people that we elicit the behaviors that we're calling a personality disorder and so this is what I would call flight surgeon psychiatry it's not I don't actually have a psychiatry asked me in five years because I'm going to try to get one right but the fact the matter is I'm still going to you know carry that that torch I think it's all a bunch of crap there is no attic personality it is not family a lot of the people that we find in their addiction started to be researched and write and work their head the immune exhibits really realize compromise audition for some right Perry Humpty yes and then all 3637 elevators we used to see many differences right I completely agree with you so my initial exposure to addicts was fighter jet pilots with alcoholism and these people were not sociopaths they were heroes I wanted to be more like them right so I got exposure to this interesting cohort who get very severe alcoholism but then get better and go back to doing the job that really I'd like to do which is flying planes and so it just completely disabused me of that idea that addicts have these fundamental character problems going into it now do I have character defects that I need to look at yes I do it's part of my sobriety but everybody does everybody has those I don't think that addicts have character defects out of proportion necessarily to the general population so I think that that's something that we really have to look at no one has been able to every time I hear in a psychiatrist talk about addiction there's some point in the lecture where they sort of descend into the language of cluster B access to personality disorders they can't help themselves right but nobody has been excited to explain to me how could you tell the difference between a person who meets those personality disorder criteria and a person who is in a creating brain state which is a temporary state this is permanent it ain't going to change right but this person can get sober and they can they come out of that brain state and so this is what Tim and Cermak who's the head of the California Society of addiction medicine calls the acquired narcissism of drug addiction and it's kind of a tongue-in-cheek term right because narcissism isn't really acquired it's its genetic it's constitutional right so here are people who are actually kind of you know moving into a frame of narcissism right they look like they have a narcissistic personality disorder but then when they get sober it goes away and that to me undermines the entire concept the entire psychoanalytic concept of addiction it has nothing to do with personality but yes when people are in the midst of their disease they sure look like a sociopath and that's something I probably need to hear any other questions yes ma'am right yes I have seen that medication completely changed the conveyor meant the treatment environment in our treatment center in Utah most of our patients in Utah are younger heroin addicted people and we just had a policy where if you wanted to go from the inpatient unit to the residential units of the extended care unit you had to be on extended release naltrexone you had to be on blockade brand name is vivitrol I have no financial connection to that manufacturer it changed everything they completely changed in their in their prognosis Janis is craving for 20 years it could it could here's the problem with naltrexone it's racist it's racist it doesn't work as well on people of Mediterranean and African descent and so there are certain genomic differences that make that drug a little less likely to work in that patient now not so much I haven't heard anything about that but this is something that we have to take into account because if I compare this patients relapse with that patients non relapse and I don't realize that there was a difference from the beginning then it's not a fair comparison and that information I think needs to be part of you know the discussion now something about the long term yeah it doesn't see what we thought that the drug might be have had a toxic turns out it's not and so people can take it kind of as long as they need it now it's expensive and it's not easy to take and it's never going to be the same thing as real recovery but if it gives that patient just a little bit of an edge I would want them to have that and it turns out the FDA approvals are for for alcohol use disorder and opioid use disorder right but there are studies not FDA approval proved use that it decreases gambling cravings and people who gamble on naltrexone gamble less money before stopping and people who are on now trek zone they don't binge eat as much so don't think I'm not thinking about it for myself yes that's the sweetest something that has become much bigger so what we did it our very home wasn't what everybody had just a low glycemic diet yes sir like South Beach Diet ranking that definitely healthy presence and really try to eliminate as much added sugar responsible so I thank you for coming I'll say one more thing I'll just leave you with this you know one of the things that people could have their family has a very specific measurement it couldn't be more than a certain place right and people would get these perspectives you have to and listeners people we're going to be there to the rest of their class I guarantee you a lot of people at scripture are still there right now and think of your sister don't you this commuter together the cookie batter Geronimo and hi and your whole County attacked the old better life right no I arrived another word I've heard pretty much will be all the people in prison are complete dirtbags a fire scene from this could be a matter of time before someone beating down and works right so when I get my Christmas package I figure out that he's gonna steal a froggie of India I figured my sister find things tweeted right what the crumpled packet of hot chocolate as elusive but if you highly prominent just a couple of this thing but that would be something of the victory in the evil just thinking this Criss Angel designer to welcome and so actually fact my cell like it and then Christmas table Christopher specifically and right at midnight something really strange how everybody kind of stopped watching TV trying to cover headphone they packed up the chess set and everyone came out of their selves and they had a part of it on the one table that we had on that tier guess what they wait out their Christmas backs and they came down at myself and said Kate you got fish what have you try these cookies is tired from my hometown be that was the moment I knew that every precise every state thought about business was no hard but you people if you show the kindness really kind if there was recession they would be returned proud of a lot of things I'm proud of my medical to drill now that my waves open I think I'm proudest it expects obese 2759 cleaner because I never learned I never would've been able to look at a person changes you mean artisanal in charity I don't think I trade happen anymore that is a story of image on time because whatever political she does come that to recovery as possible and people to our done terrible things can become your best neighbors friends Alison and I think there's a light after weaning retired even in the darkest of bread I think so thank you [Applause] [Music]

Channel: Dawn Farm

Views: 19,135

Rating: 4.7005348 out of 5

Keywords: edseries, Dawn Farm, Dawn Farm Education Series, addiction, alcoholism, recovery, substance abuse, drug abuse, treatment, substance use disorder, chemical dependency, Kevin McCauley, recovery advocacy, recovery movement

Id: je8HowJgTo0

Length: 96min 13sec (5773 seconds)

Published: Sun Jun 04 2017