"Setting the Stage for Addiction and Recovery" - Dr. Drew Pinsky | Recovery Reinvented 2020

[Music] but let's get get into our first keynote speaker we're so uh fortunate uh to have our this keynote speaker with us he's a familiar face in the world of addiction recovery dr drew pinsky nationally known simply as dr drew he's been a ubiquitous fixture both on television and radio for the entirety of his multifaceted career dr drew's vast experience with treating addiction led to hosting stints on celebrity rehab with dr drew the wildly popular vh1 series that chronicled celebrities struggle for sobriety and rehab with dr drew which followed the experiences of everyday people battling addiction beyond being a thought leader and an influencer on how we address the disease of addiction dr drew is a distinguished practicing md a diplomat of the american board of addiction medicine and the american board of internal medicine he has literally treated tens of thousands of people at the most difficult intersection of behavioral health and addiction dr drew's leadership to publicly eliminate the stigma of addiction and shed the spotlight on the hope and the power of recovery is making a difference to reinvent recovery across the entire country please help us give a warm north dakota welcome to dr drew thank you guys it is such a privilege to be back in north dakota so thank you and thank you for all you're doing to support recovery and mental health um everything working technically do i sound okay you look good you sound great and we look forward to your keynote and we look forward to a q a with you following your remarks thanks for joining us dr drew one quick thing don't go don't leave my screen yet two couple things a thank you to doug and catherine for sharing your stories thank you to the governor and first lady you're both those things guys uh for being leaders in the recovery process i'm going to talk about how well north dakota is doing as compared with the rest of the country and catherine um a couple of things about your recovery very little secret about about sustained recovery is you said how it took you about eight years of trying before you got recovery well that actually is the average but from this time somebody begins thinking about stopping drinking to the time they get a year is about eight years on average so you're right in there well done and then finally to both of you the idea of gratitude whenever i am working with people and i'm wondering how they're doing when they start to express gratitude i know they're doing okay and as representatives of north dakota the fact that gratitude is up front and center that tells me north dakota is doing okay and to the extent that people are not connection as catherine emphasized connection indeed is the way to improve and i'll talk a little bit about that and you're right i was a little worried about zoom meetings at the beginning too but now the mutual aid societies that are on zoom have proven to be quite good we still need the in-flesh meetings but the zoom meetings really surprised me so i thank you for bringing that up as well okay so here i go thank you guys uh let me just we've been talking about the disease of addiction so let me do something of this i'm going to run through a little bit about the addiction and some of the important topics in it then i'm going to talk about the intersection with mental health and then we're going to talk about what's going on in mental health and covid and hopefully i can cram that all into 20 or 25 minutes so here we go i think before anybody talks about whether something is or is not a disease you must define what a disease is one in three north dakotans still believe that addiction is some sort of moral failing or weakness here's what let's just first talk about what is a disease a disease is the genetics of the individual interacting with the environment resulting in an abnormal physiology that physiology is reflected in signs and symptoms those signs and symptoms follow a predictable pattern we call that a natural history so people like me can identify it and then we guys like me try to change the natural history with something called treatment that's disease genetics environment abnormal physiology reflected in signs and symptoms follow a pattern and have a predictable response to treatment well that fits addiction right that is the where people get a little weirded out is where is the disease process well it's in the brain and we actually know where in the brain it is it's in the what's called the medial forebrain bundle it's the ventral tegmental cells and their input onto the shell of the nucleus accumbens and the genetic changes that are are incurred in those cells that result in abnormal motivations literally the most primitive part of your brain the survival system is altered and usurped by a single priority which is used all the other priorities go to work love your children survive even shrink as this one priority emerges there's also something that goes on in the frontal part of the brain where we're doing our thinking and reasoning and impulse control that down regulates and the impulse the so-called one thing system of the brain see the brain has two systems there's a liking system and a wanting system and you kind of have to like drugs in order to do them you have to find the one you like and if you don't like it you're not going to use it so people definitely are genetically set up to like it they like it but then the wanting system kicks in and even when they don't like it anymore the wanting continues and that's the disease of addiction and addiction is really defined i've defined it simply as ongoing use in the face of consequence when it comes to any serious mental illness functionality interfering with function is the threshold that we say okay well that's an illness that needs to be treated it's an illness in fact and it needs professional help so functioning problems on work or school health finance relationships or legal status those areas of your life are affected you have a genetic history grandpa grandma had a history with alcoholism you have progressive use despite consequences and some degree of denial denial is part of the defining feature of the disease that's addiction and whether it's alcohol excuse me alcohol or cocaine or opiates whatever it is they all kind of fit under that umbrella of genetic heritage progressive use in the face of consequence and some degree of denial about it and that's it that that defines pretty much all addiction now uh there is a there is an environmental influence on the process of addiction the first lady brought this up a little bit uh which is trauma and particularly childhood trauma finally we're starting to have conversations about what are called adverse childhood experiences and if you have three or more adverse childhood experiences your potential your probability of depression anxiety disorders substance use even suicide start to climb dramatically and if you get to five adverse childhood experiences it it it becomes asymptotic it goes up rather dramatically and what do we mean by average childhood experiences will you be surprised we we as a culture have minimized have sort of ignored what our pro experience that are profoundly impactful on children a parent not being available a parent being in prison a divorce fighting in the home domestic abuse and what the threshold is for that is different for different kids some things that we sort of go oh no kids are so resilient they'll get over that you add those things up and the probability of serious mental illness goes sky high and addiction is definitely one of those things now the stigma and shame around addiction to my mind is uh bizarre uh it's it's bizarre to me that we treat in any manner illnesses that develop in this system differently than we treat something that occurs in my wrist or my heart or my thyroid we have brains brains get ill that's just the way it is and we should not treat brain conditions any differently than we treat any other organ system it is it's it's just bizarre to me that people will uh well i kind of understand that people don't i have a flood of ideas because this one because this one means a lot to me here's the deal we stigmatize people with serious mental illness and we do it primarily because we're afraid and we've not had contact with people with serious mental illness and the best way to overcome stigma i've got a lot of study on stigma and that is contact very simple when somebody comes in your life that seems kind of maybe you're afraid or maybe you don't like it see if you can contact that person and hang in you don't have to do much else except be there you will be surprised at first of all how much benefit you do to the person who's suffering but secondly your own ability to understand these conditions will begin to immediately improve contact is so key now stigma is different than shame shame is something that the individual feels they feel like they're bad having had adverse childhood experiences and trauma sets you up for shame it's why as you heard first lady's story there was a lot of negative self-talk and something got going in childhood that set that all up that's shame that's shame but there is a certain amount of stigma coming in from the world that confirms shame and what people do is adopt that stigma as just it's called self-stigma you start literally turning the stigma in on yourself and i don't know but so far i've never seen anybody do that with a myocardial infarction or hyperthyroidism or a stomach ulcer and and why we do that to people with brain conditions is we must stop we must not treat the medical record any differently we must not treat the care any differently we must it's a medical problem with a medical treatment and you must simply deal with it as such that will go a long way to diminishing stigma now unfortunately and shame too by the way unfortunately we do a lot of uh special sort of laws and all kinds of considerations of people with serious mental illness most we've actually done a pretty good job with addiction the stigma on addiction is actually reducing i know families feel a lot of stigma addicts don't complain about it so much these days they complain about shame and that's you know a lot of trauma and then self stigma but we're doing a pretty good job but when it comes to other serious mental illness it's it's off the chain it's really bad let me circle back a little bit to uh trauma again so trauma essentially is an experience that ex exceeds the brain's capacity to regulate children's brains are rather delicate and they're building the capacity to regulate and they build that in the context of being present with another brain it's actually other brains that build our brains well when you've been traumatized by another person being close in that proximity for emotional regulation building becomes threatening and so kids that have been traumatized exit the frame of being able to build that system of emotional regulation so they hit their adolescence on young adulthood unregulated with feelings that are too prolonged too intense and too negative and as such they start looking for solutions to that and solutions that our culture gives us are things like drug and alcohol and as you heard again in uh first lady story it works and then you trigger a new problem which is addiction right so you have trauma and you have addiction they both need treatment there's a lot of debate about which treatment you know what order and what timing we go at in terms of treating those things general principles the addiction has to be treated first because your brain is in an altered state and there's no way to treat the trauma when you're in an altered state so we at least have to handle that addiction at least initially if not for a sustained period of time and oftentimes in the recovery process people do get involved in their trauma management and issues around trauma come up in recovery and they do learn to regulate those things now there are tons of professionally managed services out there but i want to emphasize that dr keith humphries at stanford and dr john kelly who's the lead arthur out of harvard these are leaders in my field have published what's called the cochrane analysis these are the highest level academic studies available unfortunately it got published right in the fog of war of last spring in the middle of the covet outbreak and no one noticed it but i'm here to champion it what they showed was without without question mutual aid societies meaning 12-step those sorts of things are as effective or more effective as any professionally managed service particularly when abstinence is your goal and it's free and it's available everywhere and oh did i say it it's free why are those of us that are concerned with the cost of health care would undermine the application and and encourage not encourage the use of a free service that is as effective or more than any other professionally managed service let me think about how silly that is that's that's that's not okay now i'm not saying that mutual aid is necessarily the only thing you will need in your recovery but it is a lot of what you need and there are you when you're in recovery you need a lot of support every day all day and there just aren't enough professionally managed services around to provide that and the recovering community is delighted to give you that because they've been there and they they know what that feels like and in fact them doing it for you keeps them sober i know that sounds sort of magical but that is some of the magic of recovery so you must keep that in mind and it's now available on zoom soon again in in flesh and meeting in person and uh i can't emphasize that strong enough so um i want to also talk about the crossover there's a lot to talk about it's like bringing a cardiologist in here and say please talk to me about the heart um the intersection with mental health is uh rather profound and getting more intense these days the drugs that people are using are triggering serious mental illness symptoms it becomes almost difficult these days to tell whether somebody has a primary serious mental illness or just addiction or both the drugs people are using are damaging the brain and so people are getting psychiatric symptoms from brain damage from the drugs people are highly traumatized and the trauma is causing other mental illnesses people with things like thought disorder schizophrenia bipolar disorder are prone to use drugs uh sometimes people will think of it as self-treating i don't know i'm not sure that's what it is so much as just struggling to manage uh and drugs become part of that and it obviously when people have serious mental illness and addiction it makes things just that much worse so there might be a common genetic heritage there might be the expression of the particular drugs being used there might be brain damage and there might just be plain old coexistence of medical disorders and we you know uh in in north dakota right now there's been a 68 increase 68 increase in mental illness one in five are reporting an increase in substance use the governor reported this to a minute a few moments ago and uh i'm here to tell you that's good news because when i review the national data you will be stunned how much better you're doing than the rest of the country and i humbly believe that the reason the country is doing so poorly is the way they are being treated they are being treated to live they're encouraged to live like a drug addict to isolate to disconnect to not work or to engage or connect they're being told to shelter in place i know of nothing more onerous for the mental health of a population than than a an outside first force coming in and rendering you helpless and hopeless and then this has gone on long enough that it's causing something something called crisis fatigue and now you start to have despair and loss because jobs and other things people enjoyed are literally being lost this is i i've been apoplectic about this for quite some time there has to be a better way for us to navigate this pandemic because what the consequence of what we are doing is going to absolutely rival what is happening with the covid the coven 19. of course i know in north dakota you've had you had uh you've been concerned about mental illness i listen there's a second time i'm visiting you all and i'm i'm privileged to be here you've heard the governor first lady commitment to this they've been at the forefront of mental health but of course in north dakota you guys have had you before covet hit you've had plenty of reason for concern about mental health there was economic stress farm stress global drop in demand for fuel i know you had a flood and a blizzard that was before covet 19 and then if you had had on top of that a shelter in place order trust me i've seen it in my own environments i've seen what that does to people i i just shudder to think what might have happened i understand we need to navigate so let me talk a little about the national data on cove but i know i'm almost out of time here guys so please bear with me one in three adults in the us reporting anxiety and depression not one in five like you guys one in three that's as compared to june of 2019 where it was one in ten kaiser family foundation is doing a poll they conducted in july 53 of adults reported the mental health has been negatively impacted by the pandemic uh much more higher than the 30 percent in march and of course research shows that job loss and poverty are going to have an adverse effect uh people with substance use disorder diagnosis have significantly higher risk of developing covid19 and finally among patients with a recent diagnosis of substance use disorder african americans had significantly higher risk of covenanting particularly those with opiate use disorder so i want to just briefly run through this notion of crisis fatigue that i was telling you about this is a model proposed by a colleague out of harvard medical school brad russell he put it into four stages one was a heroic stage the initial stage where we all get together and we have it's a crisis and we're determining how to survive then kind of a honeymoon stage stage two the success of the of the of the communal activity makes you all feel like we're in the same boat and we're all taking the same steps together and then disillusionment stage that kicks in as individuals feel physically and emotionally exhausted the what's called the allostatic overload literally the cortisol system the adrenaline flooding into our system over such a long period of time literally adversely affects our biology it is part of the contribution to the mental health problem and then the fatigue stage humans cannot survive or cannot sustain the survive levels of catecholamines and cortisol it just causes burnout people are easily triggered people reach for substances it's it is uh it's anathema to mental health and we are in absolutely in that stage of crisis fatigue now and when i read some of the literature out there about how we should be approaching this i actually get frustrated because what you'll see out there is a lot of platitudes about well people need support and they need to be able to go out and get some for sure we need to do those things we need to go out and get sunshine we need to exercise we need to watch our nutrition we need to sleep properly we need to engage in meaningful activity humans are meaning making machines and you have taken for the most part our country has taken that from us and we need to find ways to connect as the first lady said and to keep making meaning we must not become helpless when we when we um when we model depression uh in in laboratories one of the ways that was done was by creating what are called learn learned helpless dogs we would take dogs and put them on two grids one grid was electrified and the dog would learn that would jump to the other grid when the electricity came on they would the dog would have relief well then they would light up both grids so the dog was trying to get away from electricity but it was impossible so what does the dog do roll up and whimper and just take it the dog is helpless and that is a literally a model for depression that is us everybody that is the state we are in and we have to turn that rather than just the platitudes about well increasing self-care and watching nutrition which of course we have to do we must fight we must turn this around and we must fight to navigate in a healthy way we must connect we must engage and i there's got to be there has got to be alternatives to shelter in place because the impact i am seeing on that is so profound and so disturbing that they're just literally we have to think of something else in order to navigate in a way that's not heedless and not hysterical but is a proper fighting gives us a fighting chance to flatten the curb to prevent our hostile systems from being overwhelmed from saving lives and i know in north dakota you've gone to great lengths to take the at-risk population and keep them protected they're the ones we have to worry about by the way i would encourage you to talk to those populations some of them uh are are really upset in fact i deal with because i'm an international study with a lot of elderly patients and they they will tell me i don't i may have only five years left i don't want somebody taking a year a year away from me in terms of my enjoying my time with my grandkids i for a 10 risk of i'll take that 10 risk people that don't want to to to do that they you have to talk to the the people in your life that now if they want protection give them protection and we should categorically do we should do it systematically but it's not and it's not necessarily something that is a foregone conclusion for the individuals in that population i encourage you to talk to them it's also an opportunity for all of us to talk about end of life issues but that is a bigger topic maybe later in the q a we can get into that i have um exceeded my my time here um i i will just say that uh because we are being encouraged to uh live our lives like drug addicts in isolation the solutions are very similar too right we need a spiritual life whatever that means for each individual personally i believe a lot of that is interpersonal in the connection that the first lady wasn't mentioning we need meaning and we need to uh we need to take an inventory we need to take an inventory and and really start to evaluate our lives and share it with another person and then engage we have to and we have to do it in a way that gives us purpose again i we have to restore agency uh as the world health organization says the only thing that locks down to do is make poorer people poorer we have to find a way to give people work we have to find people to give them play and we have to have a connection with that i think we will go to the q a section thank you guys thank you dr drew uh fantastic uh i love your analogy that this is like uh asking a a cardiac uh expert to say you know can you talk you know half an hour about the heart the 20 minutes give me 20 minutes on the heart yeah okay but anyway but fantastic uh overview you covered a uh a lot of topics that were really relevant to what we're discussing today uh but uh let me just say at the beginning you and i are on the same page uh of course as you know north dakota no shelter in place no stay-at-home orders our health care system has remained open our schools are open right now we're working to get all the kids back in school five days a week because we know that social and emotional connection really matters our businesses are open uh and we're we're working through this thing and we have every single day at every one of our press conferences discussed behavioral health at the same time so we really appreciate your understanding and appreciating the approach we've taken here in north dakota well because i live with my feet in many different worlds i i see the consequences when governments take other approaches and it's it's not good it's just not good and and uh one of the things that you've spent more time on maybe than others is this intersection of addiction and uh and mental health and when you think about models that you've seen in terms of you know either community or health systems or state approaches or individuals maybe just give us more drill down a little bit more on what we could do in north dakota if we want to be on the front edge of how to address that intersection well the the biggest problem we have and this may seem maybe it's not fair to to frame it this way but the thing i run up against more than anything else is the law laws treat brain disorders differently than they treat other medical conditions and it's bizarre just think about the fact that if somebody is schizophrenic and psychotic and is saving their excrement in the state of california not only can i not get near that person try to treat them i can't treat i can't take care i can't clean up the excrement if the patient then says that that's my belongings just because i had in my psychotic delusion i identify that as my belongings i can't get near that individual as opposed to i have dementia and i'm psychotic and i'm wandering in the streets if i as a physician don't rush in and treat that patient i'm guilty of patient abuse think about how insane those laws are and the same is true with drug addiction we need to have a really for me really effective drug courts and that not all drug courts are effective so you have to have enlightened judges working with recovering community to really push people we have to when people's brain this is this is an important point when people have serious mental illness including addiction they suffer from something called antisegnosia antisignosia is literally i i called it denial in the definition of addiction and we think of it sort of in the colloquial sense denial but it's antisegnoja is something deeper it's something that happens in the brain i it was it was a a term coined by a guy named babinski at the turn of the 20th century in regard to right through right middle strokes when you had strokes up here on the right side of the brain the left side of the body goes out and the patient literally is unaware of it in fact the patient loses awareness of the left side of everything and that was coined antisegnosia well in serious mental illness people can't see what's happening to them they can't have insight into their illness they can't they can't make judgments about it's it's a literally a biological block in the ability to in the simplest sense make the connection between the disease and what's happening in their life now again in dementia we are charged to rush in and treat that but all other brain conditions don't go there we need to have rational laws that give us the potential to help sick people the way they do on ver in virtually every other country on earth by the way i completely agree and that's you know a really great description of of how important that is you know one of the things i say a lot is we will make progress when people that are being treated for addiction aren't in some building on the edge of town somewhere they are in the hospital system you know this is a disease just like diabetes whatever it should be treated with all the other diseases in the hospital system why do you think that you know this is not happening now in our health care system well some of it is the history of psychiatry i mean there's an onerous history that you should study that that when i've really been looking at that a lot lately and i i sort of lived it because i started working in a psychiatric hospital in 1980s and i saw a lot of the medical misadventures from the 40s and 50s and uh psychiatry got a black eye for it's first of all it's over it was completely um captured by psychoanalysis which was not an evidence-based treatment and then it quickly switched over into these goofy conditions treatments and surgeries and insulin shock therapies and psychosurgeries and all kinds of horrible things and finally modern medicine kicked in in the 80s 90s and since now you got to remember that history was 70 years ago we're coming in on a hundred years since psychiatry has been out of line in terms of its aligned with with the rest of medicine and across that we started treating psychiatric patients in a special place with special uh people treating them and special uh uh confidentiality the confidentiality around mental health should be no different than around any other medical condition the medical record should not be treated any differently than any other medical condition and you're right catherine the environment of care should be exactly the same as anywhere else the only difference being that these are long these require long brain is a slow instrument to heal require a lot of treatment over a long period of time and we have to come up with a residential environment of care for the latter phases of treatment and that indeed should be away from the rest of the medical system that's a different issue in a way right so you bring up another question i have and that is i'm pretty sure although i can't quote a study that there's evidence-based data out there that 30 days of treatment does not work for the disease of addiction just like it doesn't necessarily work for diabetes you know insulin for you know 30 days so the the the 30 days uh treatment and i said that back in the days on celebrity rehab i don't know how much of it went on tv but i kept chanting it this is the enrollment process this is the beginning of the beginning the pride this is a chronic illness requires daily management much like diabetes or asthma and you this is about teaching you how to do that it's not about it's not a car wash that you go through and up your addiction's taken care of that's that brain diseases tend to be chronic and they require long-term regular management and they are marked by much like diabetes where blood sugar goes out of control once in a while they are marked by episodes of decompensation so dr drew when during your remarks today you you talked about uh the difference between guilt and shame and i think in the past you've said that uh you know guilt is i did something bad and shame is i am bad uh but maybe talk a little bit about how the differences the depth and how they get in the way of recovery both stigma and and right you know for me you know it's really hard to to convince people they shouldn't have guilt or shame right those are natural emotions guilt is when you're using drugs you do awful things that are not you and you feel bad about it and you learn in recovery to disconnect the disease and what it had you doing and who you in fact are and part of recovery is living a certain kind of life and part of the amends for whatever you're feeling guilty about is cleaning up your side of the street is making that all good again now that you are your fullest person not on drugs shame is a is a much more complicated process shame is again i'm bad it's it's a it's a hiding impulse it's it's something that many many different family systems and of course as we've said adverse childhood experiences and trauma induce shame see one of the things about children is when bad things happen they blame themselves i'm either not worthy of good care or it's because i did something that my parents are fighting whatever it is it's a grandiose posture that eight-year-olds have but it's normal and so everything bad that's happening in an eight-year-old or six-year-old or a four-year-old's life is because there must be something wrong with me and wrong with me something's wrong with me is the source of shame then you start doing things that the society stigmatizes you for or calls you weak or tells you you shouldn't be doing so even if you don't feel guilty about the things you've done you just feel as though those people that are telling me i should not be doing this must be right well it's of course because i'm bad so now you're taking social stigma and you're self-stigmatizing and you're adding to shame that make sense yes it does it totally does not you want to follow up on that i have something i want yeah please please okay so i'm changing this subject a little bit here and um the governor and i have worked really hard to create partnerships with the tribal nations that we share geography with in north dakota and all the research shows that you know native americans american indians indigenous people are the most adversely affected population related to the disease of addiction across the nation and um i just wonder in general if you have any thoughts on you know how we can help this poppy how better initiatives and better you know procedures and better you know whatever could could be created to help i i we know a lot about indian health and that's a very tough system but you know we as a state are trying to figure out you know initiatives outside of that system that make more services and resources available but what are your thoughts on that let me just start with what i consider to be how you motivate people this is pertinent to covid too we know what works in public health messaging and nationally we are doing the opposite everywhere i look of what we know works for proper health messaging here's how you we learned this from the aids epidemic and it's been highly studied here's how you you change people's health behavior you create a relatable source so somebody from each of the nations need to be representative in a narrative okay and a story that you share with them that narrative hopefully will have engaging and interesting and funny humor it turns out has a huge role in reducing stigma and all these things that keep people from accessing uh things like addiction treatment so relatable source narrative humor and uh uh and then delivering the messages within that so think about how that worked katherine in recovery what what do you do when you go to a meeting you hear people's narratives and you think to yourself oh man that that's i can relate to that i understand oh i could end up there oh wait that's not really me but maybe it could be those it's exactly the way the narratives work in recovery the sharing so you really need people from the nation who are representative of the success of recovery and then of course rather than telling people they're bad and they must do something you must lead with inspiration and positivity so this person and this is all stuff you've heard in recovery you see you you just you lead with the recovery you lead with the inspiration you lead with the gratitude and it's a it's a it's a phenomenon of attraction not of mandates you can't force people to do these things you can force them but it doesn't work it ends up in a bad place so relatable source narrative humor attraction in the positive outcomes and that will go a long way in that regard and then i want to refrain if this may help you guys uh understanding what this disease is for people like an indian nation and and mrs first lady i'm going to i'm going to refer to your viking heritage which you brought up which i found fascinating the viking heritage and the north american indian heritage here's what addicts share genetically i i did a lot of thinking early on in my career i was like why does this this genus the people with this genetic potential and again i could we could talk for hours about what that genetic mechanism is and what you know what we have different models for it but there there's clearly genetic heritage why didn't it burn out of the human population centuries ago it's had such deleterious effects on people's health it should there should not be a 10 incidence of diction in the population this gene has just been this gene has been um incredibly steady in its presence and i thought would must have some adaptive advantage there must be something about this genetics that is advantageous and uh i actually happened to be watching the movie braveheart is back in the 90s and in the movie they portrayed you know ten thousand scotsman's going to battle five guys survive the five guys that survives are alcoholic and i go not using alcoholics they just portray them as later alcoholics i thought oh yeah that's my patients these guys are survivors so i started going into my uh groups right lecture and i'd say hey how about if a bunch of huns came over the hill here what would you guys want to do and almost to a person they say well i pick up a chair and run right at them and i to as a normie hearing that is bizarre because i'm thinking i would turn and run now evidently in extreme circumstances being able to go in and fight increases your probability of survival and i started looking at who my patients were they were extreme athletes they were fighter pilots they were smart they were engaged in all these extraordinary activities short stops on baseball teams that for the average person is overwhelming but for the addict it's engaging it's when they don't feel anxiety it's when things slow down for them it's when they're at their best so it's actually and this i will frame it this way this gene is actually a more evolved version of the human being in extreme stress you're more likely to survive that's what genetic advocate that's what the natural selection is surviving in adversity but it carries this liability with it when you're not fighting to survive that thing is we call it alcoholism and addiction how about that yeah good doctor dr drew our next question we've got a lot of family members that are watching today uh supporting their loved ones uh and so we had a question about uh your uh you know what would you say to family members and also uh elizabeth uh one of our viewers today uh is sent in a question just now that says you know dr drew how do we help those suffering from addiction uh to get their self-esteem back and stop being ashamed of their addiction well uh look uh we've we've sort of talked all about how you should be just dealing with this like like your loved one had a cardiac condition you shouldn't be you've been dealing with it matter-of-factly with one caveat this disease is is extraordinary in the way it takes advantage of all the other brain mechanisms okay so reasoning and thought and emotionality and social interaction all serve the false god of addiction so naturally when one brain comes in contact with another brain the second brain is sort of brought into the disease of addiction i i think of you've ever saw the little shop of horror the plant a little shop of horror that eats people every time they come near them addiction that's a perfect model for addiction if you go near the plant alone you're going in the plant even me as a treating professional i'd always have to have another person with me to pull me back we call it ariana's cord you gotta have somebody there pulling you back because the way that is it's cunning in terms of how it gets into the interaction with other people and you end up being part of the pathology there is one solution and patients come into my office all the time and they say i love my son so much i'll do anything i'll do anything i say okay i'm not i'm gonna give you one it's an order it's not even a recommendation it's not a recommendation like hey man you know maybe uh take a few less carbohydrates or maybe a few more steps when you exercise in the afternoon this is not that this is an order that if you do not do you are actively contributing and i know david chef will talk about this a little later you're contributing to the problem one thing i order you to do this go to a program called al-anon it's available on zoom it's available right now it's free get a sponsor start working steps yourself go to meetings regularly and the response is almost always the same yeah but but what do i what else can i do what do you want me to do give me something else it's like there's one thing go to al-anon and i know it's not your deci it's not your disorder but you didn't ask for this but if you actually want to contribute to the process of recovery go to al-anon and you will help your loved one i am i you must trust me on this it is the one thing you can do that can change the course of your loved one's disorder good advice dr drew so during the pandemic you know i know you've talked a lot about how sheltering in place and those kinds of things can can be really you know challenging for mental health and behavioral health what are the things that you would recommend to people to stay healthy and maintain recovery and protect against covet 19. it's really hard uh i i would you know i i got depressed you know i had depression when i was 19 and so when if you've had depression you're more likely to get depressed and i found myself depressed again during all this and i was in a state that was extremely onerous with the shelter in place orders and it was deep resting and i found that sunlight and exercise it went a long way i was rather surprised how much it helped me engagement with family proper sleep proper nutrition all those good things and if you do get sick if you have if you can't function get treatment treatment works you've got to bring we have good treatments for brain disorders now and do not you know again functioning is that threshold after which you've got to really think about seeing a doctor about things um but but i i again those to me they sound like empty recommendations in a situation where you're essentially imprisoned in your home we have to have other things we can do we have to find work we have to find engagement we have to find connection zoom meetings if that's all you've got you must get very active in in being being in the world whatever that means for you given the opportunities you have in your particular environment absolutely um so dr drew we have a question from john um he's wondering if you can speak to multiple pathways to recovery uh in i mean exactly different things that are available out there for treatment yeah like you know i think there's a lot of paths to recovery and sounds like this and the first lady in her speech you know things she was saying caught my ear things like meet patients where they are right which is i a thousand percent agree with that so you you i emphasize the free services because they work and they're free and they're available now uh and they're available constantly and that's what addicts need so there's that cognitive behavioral therapy has been shown as an evidence-based treatment and the practitioners that do cognitive valuable therapy have very good results with this sometimes interpersonal therapy emotional focused therapies can be useful motivational enhancement therapies can can be useful so there's there's many different ways and and i intentionally use the word mutual aid society i characterize it as 12-step because that's what people usually understand it as but there are many different kinds of mutual aid and peer support groups out there so it really is you know it's part of the problem is patients have to find their way in kind of a complex system but what i'm urging all of us as practitioners is not to impose a particular treatment on an individual there are medication assisted treatments there are pharmacological assistant some people get into trauma therapies earlier i would be careful with that because sometimes trauma therapies exacerbate the dysregulation and the desire to use if your addiction isn't first managed but it's really incumbent upon us as treating professionals to give the do what the patient is willing to do in that moment let's get on it lots of things work let's start where the patient is dr drew one one thing in north dakota we've had uh great success on uh initiating we've got a long way to go we've had we've had some really good initial success in criminal justice reform uh here in north dakota uh similar to other uh places in the country uh unfortunately our corrections budget far outweighs our behavioral health budget in corrections uh we find that in the male population almost 80 percent of the male population uh has a history of substance abuse disorder in the female population it's a hundred percent and so the so we are again as we take a look at that uh in in sort of when we think about from a policy what's wrong it'd be like again if we think that you can you know treat somebody for 28 days and then they're not fixed and if they aren't then they end up we're going to incarcerate them we incarcerate people in north dakota we have one of the lowest rates but it's one thousand dollars a year uh and and often if we're doing that i can do a lot with that we may not be addressing the underlying problem you know we're trying to figure out how can we spend less than forty one thousand dollars a year helping people get healthy as opposed to uh that kind of dollars to you know punish them for a consequence that was related to the disease but thoughts on what's working in other places i i it's it's it keeps me up at night this very issue uh and it's the source of homelessness i i wish we'd get rid of the term homeless because it suggests if you give somebody a home a problem solved this is a mental health crisis we have open air asylums in our country and and shooting galleries uh and so this issue preoccupies me all the time and this is back to having some sort of legal capacity not to take people to care as i said earlier forcing care on people doesn't work but we know how to motivate people into treatment a carrot and a stick we need laws that help us do that i don't have a you know i don't know enough about north dakota's legislative landscape to really give you specific recommendations except to say that physicians much the way they're empowered to treat dementia need to be able to treat addiction and other serious mental illness both by saying hey you can't do this here but come with me we have something for you it's as simple as that but you have to have some teeth in it and part of it has to be if you don't come with me you're gonna end up in prison and we don't want you there you don't want you there so come with me we have a long-term residential facility for you that will focus on vocational rehab recovery treatment dealing with your serious mental illness and instead of staying in prison for three years you'll be in a residential program for 12 months and let's see if we can get you back in the world and you get people earlier in the process before their disease has progressed to the point that they're committing crimes or that they're dealing drugs you've got to get it earlier so we we have a system that's really um uh developed really uh as a part of um this issue and you know the legislators in our state put a lot of money towards something called free through recovery which we'll talk about a little while but um but the whole goal is to you know not have people end up in in prison and it's also to create some you know to have this model that works with peer support specialists and care coordinators tell us what you think about this idea of peer support specialist that and these are people with lived experience right they have behavioral health experience with mental illness or addiction incarceration or all three what are your thoughts on peer support well this goes back to what i was saying about health messaging right relatable source with a narrative that's what these peer support specialists are and somebody who can say i understand you i know and for addicts they're very defensive and they're very ashamed and that you have to have somebody who indeed has lived in their shoes before they'll start to let down and connect with them um but you know this also brings up the issue of of the warm hand-off or the warm handshake which is something that has been sort of universalized but the original study was on addiction essentially what they did is they went into emergency rooms and they studied two two phenomena doctors when patients would come in with addiction the er doctors would counsel the patient and give them literature and descri and give them an appointment at a particular 12-step meeting that night and send them on their way versus a second population where a peer support specialist somebody from the program came in shook the patient's hand and said i'll see in the meeting tonight i'll meet you there the attendance in the counseled group with the literature about recovery the attendance at the meeting that night in that group was zero and the attendance with the warm handshake was 100 so that tells you the power of having the relatable source of meeting somebody of decreasing the barriers and the other thing i wanted to say though is these i'm not suggesting that we uh strictly speaking it's going to sound to people like we're being warm and fuzzy i i i'm not saying that there must we have to be firm there must be teeth in the consequences when people do not do what they need to do otherwise they will not do what they need to do so there has to be a real sword of damocles that that motivates people to do what they need to do to get well and guess what they do well that's fantastic because it's uh encouraging we now have over 450 peer support specialists in north dakota and with lived experience many of them themselves have had interaction with our criminal justice system uh and again uh you've dealt with a number of patients uh that have had interactions with the criminal justice system and one of the things we're seeing here is even as we get people to overcome the shame and stigma of the the disease of addiction there still is stigma around being a felon in our country and we have laws uh that prevent employment they prevent housing they can prevent getting a driver's license and so we're trying to deconstruct all of those legal barriers uh so that someone that ran afoul of the criminal justice system because of their disease and had a non-violent property climb related to getting resources to fuel their disease that we can get them out of that system because if we get them they can get trapped by another layer of stigma around the the felony uh which creates an issue so this is a multi-layered problem but again credit to uh and and i know many of our peer support specialists uh that are doing this now many of them are supporting anywhere from two to six other individuals they're getting paid to do it it's one of the only pay for performance programs in the country if they help if they help the people they're counseling to get a get their driver's license get a place to live get a job they get paid more for their work than if they don't and so we're we're actually paying for the results that we're looking for and again so uh thank you for for your thought leadership and supporting uh complete rethinking of how we think about the disease of addiction and mental and behavioral health and thank you for joining us today uh and challenge and we have we have a challenge too but yeah we we have go ahead we have we have one thing we want to ask you go ahead i i'm again in terms of reducing stigma my hair goes up a little bit in the back of my neck when i hear behavioral disorders because the it's like saying fever disorders the behaviors are the symptoms of the brain diseases i i everyone uses that term but i feel like that term is anachronistic we need to get rid of the behavioral disturbance behavioral disorder that just adds stigma that's like again that's just the symptoms the disease is the brain we're gonna we're gonna mental illness and brain serious mental illness and brain disorders period and guess what their behavioral disturbance is associated with that but the disorders are not behavioral uh that's great that's really helpful thank you i completely agree because i really don't like to be referred to as someone as who has a substance use disorder you know when this is a brain disease it's a disease like you know diabetes etc so i don't know we don't call diabetes a disorder you know it's a disease so anyway okay that's my i'll get off that soapbox now but we have one final thing to ask you today dr drew and it is what kind of challenge would you leave our audience with today well i i'm very simple i mean i guess it would be a two-edged uh uh challenge make contact with somebody with serious mental illness uh i i think people fall into something i associate with the uncanny valley this is something out of the tech world with robots where when robots uh look more and more and more human we like them more and more and more until they become really nearly human and then we hate them and we're disgusted and i think that feeling of oh i don't underst this is not really human going on here whatever this is that is some primitive that goes back with being scared of snakes and you know what i mean to some primitive reaction that is anathema to the reality don't be afraid don't be don't worry you have no idea how much people with serious mental illness appreciate contact even if it's offering something a cigarette or something just some sort of but it's there's got to be contact involved and then by the same token the the other thing is uh what the first lady uh pushed out well two things i guess on and that the the governor the first lady already emphasized was live with gratitude find gratitude that is the healthiest thing you can possibly do but make connection great well we love the gratitude challenge we uh we want to be a state of gratitude uh and and we're grateful for you dr drew for being with us today thanks for sharing your wisdom your insights your experiences and thanks for thanks for challenging all of us uh as we go forward really appreciate it thank you for this event and thank you for your continued support of mental health you guys are at the leading edge it is a privilege to stand with you guys and support your your efforts thank you so much dr drew we hope you have a fantastic rest of your day and and stay safe and well the virtual crowd of 2500 is going crazy right now let's give it up for drew dr drew

Channel: Recovery Reinvented

Views: 1,743

Rating: 4.8571429 out of 5

Keywords: Dr. Drew, Dr. Drew Pinsky, Celebrity Rehab, Loveline, Addiction, Recovery, Addiction Specialist, Celebrity, North Dakota, Recovery Reinvented, Governor, First Lady, Doug Burgum, Kathryn Burgum, Alcohol, Opioids

Id: A8jOE8kmDc4

Length: 55min 17sec (3317 seconds)

Published: Tue Dec 08 2020