“Exploring Different Treatment Options” Panel Discussion

“Exploring Different Treatment Options” Panel Discussion


SO
SO THIS FINAL SESSION THIS AFTERNOON IS GOING TO BE A
LITTLE BIT DIFFERENT THAN I THINK WHAT MOST PEOPLE HAVE EVER
EXPERIENCED AT A NOBEL CONFERENCE.
AS WE GOT FRAMING THIS TOPIC, IT WAS REALLY IMPORTANT TO US TO
TALK ABOUT, OKAY, IF WE CAN COME TO SOME KIND OF UNDERSTANDING
ABOUT PATTERNS OF USE AND MAYBE WHAT ADDICTION IS OR ISN’T, WHAT
ARE THE OPTIONS FOR WHAT DO WE DO, AND I THINK THAT THERE ARE
SOME CLEAR-CUT CASES WHERE ADDICTION MEANS SOMETHING, AND
THEN THERE’S SOME GRAY AREAS. I HOPE YOU ARE STARTING TO SEE
HOW COMPLEX THIS CAN KIND OF BE, SLICE AND DICE.
BUT THIS PANEL IS GOING TO TRY AND TALK A LITTLE BIT ABOUT WHAT
DO WE DO, WHAT ARE THE NEXT STEPS, WHAT ARE THE INSIGHTS
THAT WE’VE LEARNED AT THIS CONFERENCE THAT MIGHT HELP US
MOVE FORWARD, WHETHER IT’S ABOUT THE SPECIFIC USE PATTERNS, OR
IT’S ABOUT THE PERSON, THAT WILL COME OUT IN THE PANEL
DISCUSSION. ALSO AS A PART OF THIS, IT TURNS
OUT THAT SEVERAL OF OUR PANELISTS WRITE FOR “PRO TALK” A
BLOG ON REHABS.COM. REHABS.COM IS A FOR-PROFIT
COMPANY THAT SORT OF TRIES TO BE AN INTERNET CLEARINGHOUSE, AND
I’M OVERSIMPLIFYING, AN INTERNET CLEARINGHOUSE FOR TREATMENT
PROGRAMS. THEY DID US A HUGE FAVOR BY
SENDING OUT A LOT OF OUR PUBLICITY TO THEIR CLIENT BASE,
SO WE WANT TO ACKNOWLEDGE THAT THEY WERE INSTRUMENTAL IN
GETTING A LOT OF OUR PUB LIST ELT — PUBLICITY OUT TO AN
AUDIENCE WE DON’T AL — NORMALLY REACH.
WE THANK THEM EXPLICITLY FOR THAT.
[ APPLAUSE ] AND IT’S NOW MY PLEASURE TO
INTRODUCE TOM CRATEY, VICE PRESIDENT OF THE COLLEGE, AND
WHILE WE NORMALLY HAVE FACULTY WHO KNOW QUITE A BIT ABOUT THE
SPEAKER’S AREA INTRODUCE OUR GUEST, WE THOUGHT IT WAS VERY
FITTING THAT TOM WOULD INTRODUCE OUR PANEL, SINCE HIS
DISSERTATION WAS ON UNWRITTEN NORMATIVE DRINKING BEHAVIORS,
ALCOHOL USE, IN FRATERNITIES. SO HE KNOWS A LITTLE BIT ABOUT
THIS TOPIC. SO TOM?
[ APPLAUSE ]>>THANKS, SCOTT.
IT IS MY PLEASURE TO INTRODUCE OUR PANEL TODAY.
I WILL START WITH ANNE FLETCHER, M.S., RD, NATIONALLY KNOWN,
AWARD-WINNING, AND MEDICAL WRITER SPEAKER AND CONSULTANT ON
THE TOPIC OF WEIGHT MANAGEMENT AND LIFESTYLE CHANGE, AS WELL AS
THE TREATMENT AND RECOVERY OF ADDICTION.
SHE SPENT NEARLY FIVE YEARS WRITING A BOOK CALLED “INSIDE
REHAB,” THE SURPRISING TRUTH ABOUT ADDICTION AND TREATMENT
AND HOW TO GET HELP THAT WORKS,” PUBLISHED BY VIKING IN FEBRUARY
OF 2013. WITH AN ACCOMPANYING E-BOOK
TITLED “HOLISTIC REHAB THERAPIES, OR ALTERNATIVE
APPROACHES HELPFUL, HARMFUL OR HEAD GAMES?”
ALSO THE AUTHOR OF A “NEW YORK TIMES” BEST SELLER “SOBER FOR
GOOD.” ANNE CURRENTLY WORKS AS PEER
SUPPORT AND FAMILY SERVICES SPECIALIST AT MINNESOTA
ALTERNATIVES OUTPATIENT PROGRAM IN MINNEAPOLIS, AND IS ALSO THE
LEAD COLUMNIST FOR THE ONLINE FORUM PRO-TALK AND REHABS.COM.
DR. WILLENBRING IS DIRECTOR OF THE TREATMENT RECOVERY RESEARCH
DIVISION OF THE NATIONAL INSTITUTE OF ALCOHOL ABUSE AND
ALCOHOLISM NATIONAL INSTITUTES OF HEALTH, PRIOR TO HIS CURRENT
APPOINTMENT, HE WAS PROFESSOR OF PSYCHIATRY AT THE UNIVERSITY OF
MINNESOTA. HE IS A BOARD-CERTIFIED GENERAL
PSYCHIATRIST WITH ADDED QUALIFICATIONS IN ADDICTION AND
FORENSIC PSYCHIATRY, AND IN HIS RESEARCH HE HAS WORKED TO
DEVELOP TEST, INNOVATIVE MANAGEMENT STRATEGIES FOR
PATIENTS WITH COMPLEX ADDICTIVE PROBLEMS, SUCH AS COMBINED
MENTAL HEALTH AND ADDICTIVE DISORDERS, MEDICALLY ILL HEAVY
DRINKERS, AND HOMELESS PUBLIC INEBRIANTS, A ALSO A LEADING
ROLE IN THE EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES FOR
TREATING ADDICTIVE DISORDERS, AND CO-LED A NATIONAL INITIATIVE
TO DETERMINE THE UTILITY AND FEASIBILITY OF IMRECHLTING
PRACTICE — IMPLEMENTING PRACTICE GUIDELINES IN THE
TREATMENT OF ADDICTIVE DISORDERS WITHIN THE U.S. DEPARTMENT OF
VETERAN AFFAIRS. IN HIS CURRENT POSITION HE WORKS
TO STIMULATE NEW DIRECTIONS AND RESEARCH ON TREATMENT AND
RECOVERY, HEALTH SERVICES RESEARCH, AND TO DISSEMINATE NEW
RESEARCH FINDINGS AND TO FACILITATE THEIR ADOPTION.
DR. MICHAEL PANTALON IS A SENIOR RESEARCH SCIENTIST IN THE
DEPARTMENT OF EMERGENCY MEDICINE, ASSISTANT CLINICAL
PROFESSOR IN THE DEPARTMENT OF PSYCHIATRY, AND LECTURER AT YALE
UNIVERSITY PSYCHOLOGY DEPARTMENT.
HE IS ALSO CO-FOUNDER OF THE CENTER FOR PROGRESSIVE RECOVERY,
WHOSE PHILOSOPHY IS THAT RECOVERY COMES WITHIN THE
ADDICTED INDIVIDUAL VERSUS OUTSIDE PRESSURE.
THUS THE RESPONSIBILITY OF CHANGE IS PLACED IN THE HANDS OF
THE ADDICTED INDIVIDUAL BY ACKNOWLEDGING THAT HE OR SHE IS
FREE TO DECIDE WHETHER OR NOT TO CHANGE.
INTERNAL LOCUS OF CONTROL. FREE TO DECIDE WHY THEY MIGHT
WANT TO DECIDE, AND FREE TO CHOOSE HOW THEY WOULD LIKE TO
CHANGE. FINALLY, WE HAVE WILLIAM COPE
MOYERS, WHO IS THE VICE PRESIDENT OF PUBLIC AFFAIRS AND
COMMUNITY RELATIONS AT THE HAZELDEN BETTY FORD FOUNDATION.
HE HAS BEEN IN THE FOREFRONT OF THE NATIONAL RECOVERY ADVOCACY
EFFORTS FOR MORE THAN 20 YEARS. CARING THE — CARRYING THE
MESSAGE ABOUT ADDICTION, TREATMENT AND RECOVERY TO PUBLIC
POLICY, PHILANTHROPY, MOYERS BRINGS A WEALTH OF PROFESSIONAL
EXPERTISE AND AN INTIMATE PERSONAL UNDERSTANDING OF
COMMUNITIES ACROSS THE NATION. HE USES HIS OWN EXPERIENCES TO
HIGHLIGHT THE POWER OF BOTH ADDICTION AND RECOVERY.
MOYERS IS AN AUTHOR OF “BROKEN: MY STORY OF ADDICTION AND
REDEMPTION” IN 2006, BECAME A “NEW YORK TIMES” BEST SELLER.
NOW AN INSIDERS GUIDE TO ADDICTION AND DISYOFR I 2012.
MANY OF MOYERS’ SYNDICATED COLUMNS RECENTLY COMPILED IN A
NEW E-BOOK ENTITLED “BEYOND ADDICTION.”
VOLUME 1, HE HAS APPEARED ON LARRY KING LIVE, OPRAH, AND IS A
REGULAR CONTRIBUTOR TO “GOOD MORNING AMERICA,” AS A FORMER
JOURNALIST FOR CNN, HIS WORK HAS BEEN FEATURED IN THE “NEW YORK
TIMES,” “U.S. TODAY” AND NEWSWEEK.
AT THIS TIME I WILL TURN IT TO PEG O’CONNOR WHO WILL FACILITATE
THE PANEL. THANK YOU, PEG.
[ APPLAUSE ]>>THANK YOU, TOM. WHEN WE CONCEIVED THIS PANEL, WE
KNEW THAT THERE WOULD BE A SET OF QUESTIONS THAT WOULD CONTINUE
TO POP UP, AND WE’VE SEEN THE KINDS OF DISAGREEMENTS WE HAVE
ABOUT TRYING TO FIGURE OUT WHAT ADDICTION IS, OR WHEN SOMETHING
MOVES FROM THIS DRUG USE INTO SOMETHING SLIGHTLY MORE
PROBLEMATIC. WE KNEW IT WAS REALLY IMPORTANT
THAT WITHIN ALL OF THESE CONVERSATIONS THAT WE TALK ABOUT
SO WHAT DO WE DO? SO IN THIS PANEL WE’VE GOT FOUR
QUESTIONS THAT OUR PANELISTS WILL ADDRESS SOMEHOW, AND WITHIN
THIS CONSTELLATION OF QUESTIONS ARE THE FOLLOWING:
WHAT COUNTS AS EFFECTIVE TREATMENT, ALONG WITH THE
EMBEDDED QUESTION, WHAT IS OR WHAT ARE THE GOALS OF TREATMENT.
WHAT’S WORKING? WHAT’S NOT WORKING?
WHAT ARE THE WAYS WE TREAT, IF THAT’S EVEN THE RIGHT WORD,
PEOPLE WHO HAVE MILD TO MODERATE SUBSTANCE USE DISORDER.
AND THEN FOUR, WHAT INSIGHTS FROM THE CONFERENCE MIGHT
INFLUENCE CLINICAL PRACTICE. NOW, THEY WON’T TAKE THESE ONE
AT A TIME, BUT IN THEIR COMMENTS, THEY WILL ADDRESS
VARIOUS PARTS OF THAT. SO EACH WILL HAVE ABOUT FIVE TO
TEN MINUTES TO SPEAK, AND OUR ORDER IS ANNE FLETCHER, MIKE
PANTALON, MARK WILLENBRING, THEN WILLIAM MOYERS, THEN WE WILL
OPEN TO CONVERSATIONS BETWEEN THEM, BUT IF YOU ARE IN THE
AUDIENCE AND YOU WANT TO WRITE A QUESTION AND SEND IT UP, SO
WE’LL HAVE ABOUT AN HOUR FOR THAT, AND THEN FOR THAT LAST
HALF HOUR, WE’LL PUT THE REST OF THE BAND BACK TOGETHER, THE
OTHER CONFERENCE PARTICIPANTS WILL JOIN US FOR THAT FINAL HALF
HOUR. SO ANNE FLETCHER.
>>HI. I’M GOING TO ADDRESS THE
QUESTIONS, OR AT LEAST SOME OF THEM, IN THE CONTEXT OF SHARING
SOME OF THE FINDINGS FROM MY LATEST BOOK, “INSIDE REHAB” AND
THE RESEARCH I DID FOR THAT. AFTER ONE OF LINDSAY LOHAN’S
EARLY VISITS, IT WAS KIND OF THE EARLY PERIOD WHEN LINDSAY AND
BRITNEY SPEARS WERE IN AND OUT OF REHAB, A LEADING ADDICTION
RESEARCHER TOLD ME THAT WHEN A “PEOPLE” MAGAZINE REPORTER CAME
TO HIM AND SAID, HOW CAN WE FIND OUT WHAT GOES ON INSIDE THESE
PLACES, IN THESE REHABS? THE RESEARCHER, WHO HAPPENED TO
BE A FRIENDS OF MINE, SAID TO ME, “I HAVE NO CLUE.”
I THOUGHT, IF THESE RESEARCHERS HAVE NO CLUE, THE PEOPLE WHO ARE
WORKING IN THIS FIELD, NOBODY SEEMS TO KNOW WHAT GOES ON
INSIDE THESE PLACES. ANOTHER PROMINENT TREATMENT
RESEARCHER, THOMAS MCCLELLAN, REGULARLY FILLED ME IN ON HIS
RESEARCH ABOUT GROSS SHORTCOMINGS HE WAS FINDING IN
ADDICTION FACILITIES THAT HE WAS STUDYING ACROSS THE NATION.
SO IN 2008, I SET OUT ON MY OWN TO WHAT BECAME A FIVE-YEAR
JOURNEY TO STUDY OUR ADDICTION TREATMENT IN THE UNITED STATES.
COAST TO COAST I VISITED 15 FACILITIES.
EVERYTHING FROM CELEBRITY REHABS, FAMOUS 12-STEP
RESIDENTIAL FACILITIES, PROGRAMS, OUTPATIENT PROGRAMS
THAT TREAT INDIGENT PEOPLE, RURAL OUTPATIENT PROGRAMS AND
RESIDENTIAL PROGRAMS. I WANTED TO GET A WHOLE
SMATTERING OF DIFFERENT TYPES OF FACILITIES.
THE RESEARCH PROCESS INCLUDED INTERVIEWING HUNDREDS OF CLIENTS
AND THEIR FAMILIES WHO HAD BEEN THROUGH SOME KIND OF TREATMENT,
AS WELL AS MANY LEADING EXPERTS IN THE FIELD.
IN FACT, THAT’S HOW I GOT TO KNOW SOME OF THE PEOPLE ON THIS
PANEL. BEFORE ADDRESSING THE QUESTIONS
PROPOSED TO OUR — TO THE PANEL IN THE CONTEXT OF MY FINDINGS, I
WILL FIRST SHARE A FEW FACTS ABOUT TREATMENT OR REITERATE
SOME OF WHAT WE SAID EARLIER VERY BRIEFLY.
OF THE MORE THAN 21 PEOPLE IN THIS COUNTRY WITH DRUG AND
ALCOHOL USE DISORDERS, WHICH IS THE PROPER TERM THAT WE NOW USE,
WE TALKED ABOUT THE DSM EARLIER, HOW WE DIAGNOSE
SUBSTANCE PROBLEMS, OF THE 22 MILLION PEOPLE WHO HAVE ONE OF
THESE PROBLEMS, ONLY ABOUT ONE OUT OF TEN RECEIVES TREATMENT IN
THIS COUNTRY. MANY WHO NEED ADDICTION
TREATMENT DON’T RECEIVE IT, AS WE SAID EARLIER, THE TRUTH IS
THAT MANY DON’T NEED WHAT WE THINK OF AS TREATMENT.
TREATMENT, GOING TO A REHAB OR AN OUTPATIENT PROGRAM.
WE TALKED ABOUT HOW DRUG AND ALCOHOL USE PROBLEMS FALL ON A
WIDE CONTINUUM. THEY CAN BE MILD, MODERATE, OR
SEVERE. MOST PEOPLE WITH DRUG AND
ALCOHOL PROBLEMS, INCLUDING THOSE THAT ARE SEVERE, GET
BETTER ON THEIR OWN. THOSE THAT ARE SEVERE ARE THE
ONES MORE LIKELY TO NEED TREATMENT.
BUT PEOPLE WHO EITHER GET BETTER ON THEIR OWN BY GOING TO A —
THIS IS MOST PEOPLE, GET BETTER ON THEIR OWN BY GOING TO A
PRIVATE THERAPIST, OR EXPERT, OR BY ATTENDING SUPPORT MEETINGS.
SUPPORT MEETINGS COULD BE AA, SMART RECOVERY, THEY COULD BE
SOME KIND OF A CHURCH GROUP. THERE ARE MANY, MANY, MANY
DIFFERENT WAYS TO RECOVER FROM A DRUG OR ALCOHOL PROBLEM.
AND BY THE WAY, AA IS NOT TREATMENT.
AA IS INFORMAL, IT IS AN INFORMAL SUPPORT GROUP.
IT IS NOT CONSIDERED TREATMENT. OF THOSE WHO DO GO TO ADDICTION
TREATMENT, FAR MORE DO IT — FAR, FAR MORE, I DON’T HAVE THE
NUMBERS IN FRONT OF ME, BUT FAR, FAR MORE DO IT IN OUTPATIENT
THAN INPATIENT SETTINGS, DESPITE THE FACT THAT THE KNEE JERK
REACTION OF MOST PEOPLE WHEN SOMEBODY HAS A PROBLEM IS, OH,
YOU GOT TO ACCEPTED THEM TO REHAB.
— SEND THEM TO REHAB. THIS IS PERPETUATED BY
TELEVISION SHOWS, THIS IS WHAT WE SEE ALL THE TIME WHEN
SOMEBODY HAS A DRUG OR ALCOHOL PROBLEM.
AND THE RESEARCH SUGGESTS THAT OVERALL, OUTCOMES ARE NOT BETTER
FOR RESIDENTIAL OR, OFTEN THE TWO TERMS USED SYNONYMOUSLY,
RESIDENTIAL INPATIENT TREATMENT, THAN THEY ARE FOR OUTPATIENT
TREATMENT. TURNING BACK NOW TO MIGHT HAVE
BOOK RESEARCH FINDINGS, WHICH UNCOVERED MANY THINGS THAT
AREN’T WORKING IN TREATMENT, INCLUDING BOTH RESIDENTIAL AND
OUTPATIENT SETTINGS, I AM GOING TO REFER TO THEM AS
SHORTCOMINGS, ALSO REVEAL AREAS FOR MORE EFFECTIVE TREATMENT
THAT COULD HELP MORE PEOPLE. I WILL ALSO SHARE, TOO, THAT
I’VE SEEN SOME SIGNS THAT THINGS ARE BEGINNING TO CHANGE SINCE
THE BOOK WAS PUBLISHED. THE FIRST SHORTCOMING, I AM JUST
GOING TO ADDRESS THREE MAJOR AREAS.
THE FIRST SHORTCOMING IS THAT ADDICTION TREATMENT IN THIS
COUNTRY TENDS TO BE ONE-SIZE-FITS-ALL.
THE MORE OPTIONS WE HAVE, THE MORE PEOPLE COULD BE HELPED.
REMEMBER I SAID THAT ABOUT ONE OUT OF TEN PEOPLE WITH A
SUBSTANCE USE DISORDER GETS HELP IN THIS COUNTRY.
SO WHAT ARE SOME EXAMPLES OF ONE-SIZE-FITS-ALL TREATMENT?
WE PREDOMINANTLY HAVE GROUP TREATMENT IN THIS COUNTRY.
DR. THOMAS MCCLELLAN, WHO WAS THE CO-FOUNDER OF A VERY
PROMINENT TREATMENT RESEARCH INSTITUTE, WHICH IS AFFILIATED
WITH PENN IN PHILADELPHIA, IS KNOWN FOR SAYING, IF YOU GO TO
JUST ABOUT ANY ADDICTION PROGRAM IN THIS COUNTRY, THE MAJOR
ACTIVITY IS GROUP. IF THAT DOESN’T WORK, THEY WILL
SAY TRY GROUP. AND WHEN ALL ELSE FAILS, THEY’LL
SUGGEST GROUP. [ LAUGHTER ]
AT RESIDENTIAL REHAB, THESE ARE FROM THE REHABS I VISITED, WHERE
SOME I STAYED FOR FIVE DAYS TO A WEEK, AND I HAVE TO GIVE
TREMENDOUS CREDIT FOR THESE PROGRAMS TO LET A STRANGER, A
WRITER, COME IN AND STAY AMONGST THEIR MIDST AND SIT IN ON
TREATMENT WITH THEIR CLIENTS. I GIVE THEM TREMENDOUS CREDIT
FOR ALLOWING ME TO DO THIS. AT RESIDENTIAL REHAB, THERE’S
SOME TYPE OF GROUP COUNSELING, EDUCATION, LECTURE OR OTHER
GROUP ACTIVITY ABOUT EIGHT HOURS A DAY AT MANY PLACES.
THIS DOESN’T INCLUDE MEALS. INDIVIDUAL COUNSELING CAN EASILY
BE FIVE HOURS A WEEK OR LESS. OUTPATIENT.
OUTPATIENT MODEL IN THIS COUNTRY IS TYPICALLY THREE HOURS OF
GROUP TREATMENT THREE TIMES A WEEK.
SOMETIMES WITH NO INDIVIDUAL COUNSELING AT ALL AT SOME
PLACES. DESPITE ITS WIDESPREAD USE, AND
THERE CAN BE GREAT VALUE IN GROUP THERAPY, BUT DESPITE ITS
WIDESPREAD USE, IT HAS NOT BEEN WELL RESEARCHED, AND WE KNOW
RELATIVELY LITTLE ABOUT ITS EFFECTIVENESS FOR TREATING
SUBSTANCE USE DISORDERS. THERE’S NO EVIDENCE THAT IT’S
CRITICAL TO THE RECOVERY PROCESS, DESPITE WHAT DR. DREW
HAS SAID ON TV. YOU HAVE TO HAVE GROUP TREATMENT
TO GET WELL FROM ADDICTION. THERE’S NO EVIDENCE OF THAT.
AND OF THE MANY PEOPLE I INTERVIEWED SOME OF THEM SAID “I
COULD NEVER SPEAK IN A GROUP. I COULD NEVER SPEAK UP IN AN AA
MEETING.” SOME OF THEM SAID I WASN’T ABLE
TO GET WELL UNTIL I FOUND AN INDIVIDUAL THERAPIST WHO WAS
WILLING TO WORK WITH ME ALONE. ANOTHER EXAMPLE OF
ONE-SIZE-FITS-ALL TREATMENT IS WHAT I CALL AA UBIQUITY.
THERE HAVE BEEN SOME VERY DISTORTED, IN A NEGATIVE WAY,
NEGATIVE TO AA FIGURES THAT HAVE BEEN GOING AROUND, BECAUSE OF
SOME POPULAR BOOKS IN THIS COUNTRY.
THIS IS THE BEST I COULD COME UP WITH.
7 TO 8 OUT OF 10 PROGRAMS IN THE U.S. ARE BASED — IT’S HARD TO
FIND DATA ON THIS. ABOUT 7 TO 8 OUT OF 10 PROGRAMS,
TREATMENT PROGRAMS IN THE U.S., INVOLVE THE 12 STEPS OF AA IN
SOME FASHION, BUT STUDIES SUGGEST THAT THE DROPOUT RATES
ARE QUITE HIGH. ONE REVIEW OF THE LITERATURE
SUGGESTED THAT BETWEEN 6 TO 8 OUT OF 10 PEOPLE WITH SEVERE
ALCOHOL PROBLEMS WHO ARE ENCOURAGED TO ATTEND AA WHILE IN
TREATMENT WILL STOP ATTENDING AA IN LESS THAN ONE YEAR.
NOW, THAT DOESN’T TELL US ANYTHING ABOUT THE PEOPLE WHO
WILL DROP OUT, AND THEY MAY COME BACK AGAIN.
BUT THE DROPOUT RATES ARE FAIRLY HIGH.
AGAIN, IF WE OFFERED MORE OPTIONS, AND WE TOLD THEM ABOUT
MORE OPTIONS IN TREATMENT, IT’S BELIEVED THAT MORE PEOPLE WOULD
BE HELPED. WHAT WOULD BOOST THE EFFICACY OF
TREATMENT? CHOICES AND FLEXIBILITY.
THIS IS A QUOTE FROM A MAJOR GOVERNMENT PUBLICATION,
MOTIVATION FOR PARTICIPATING IN TREATMENT IS HEIGHTENED BY
GIVING CLIENTS CHOICES REGARDING TREATMENT GOALS AND TYPES OF
SERVICES NEEDED. OFFERING A MENU OF OPTIONS
INCREASES TREATMENT EFFECTIVENESS.
CLIENTS OFTEN REALLY HAVE A GOOD SENSE OF WHAT HELPS THEM.
MANY PEOPLE HAVE BEEN THROUGH TREATMENT TIME AND TIME AGAIN,
AND THEY HAVE A PRETTY GOOD IDEA OF WHAT IS GOING TO BE
EFFECTIVE AND WHAT IS NOT FOR THEM.
BUT THEY ARE OFTEN TOLD THINGS LIKE, YOUR OWN BEST THINKING GOT
YOU HERE. WHEN IN FACT THEY HAVE A PRETTY
GOOD IDEA FROM THEIR PAST EXPERIENCES THAT THAT KIND OF
TREATMENT HURT ME IN THE PAST, AND THIS WOULD HELP ME A LOT
BETTER. MOST ADDICTION — THE SECOND
MAJOR AREA OF SHORTCOMINGS, I SAID I WOULD ADDRESS THREE, IS
THE SECOND ONE IS THAT THERE’S A HUGE GAP BETWEEN SCIENCE AND
PRACTICE. MOST — WE KNOW ABOUT
SCIENCE-BASED PRACTICES THAT HAVE BEEN SHOWN TO BE KSH — TO
INCREASE THE — TO PRODUCE BETTER OUTCOMES IN ADDICTION
TREATMENT, I BELIEVE DR. WILLENBRING WILL BE TALKING
ABOUT SOME OF THESE. MOST ADDICTION TREATMENT
PROGRAMS SAY THAT THEY ARE USING EFFECTIVE APPROACHES SHOWN TO
BE EFFECTIVE IN SCIENTIFIC STUDIES, AND THEY ARE, TO A
CERTAIN EXTENT, BUT THEY ARE OFTEN NOT USING THEM IN WAYS
THAT THEY WERE SHOWN TO BE EFFECTIVE IN SCIENTIFIC STUDIES.
ONE RESEARCHER WENT INTO PROGRAMS, TYPICAL TREATMENT
PROGRAMS, AND SHE FOUND THAT OFTEN WHAT WENT ON IN THOSE
PROGRAMS SHE DEFINED IT AS “CHAT.”
THERE WAS NOT A LOT OF EVIDENCE-BASED TREATMENT GOING
ON. SHE SAID THAT IT WAS SO RARE AS
TO BE ALMOST UNDETECTABLE. ANOTHER EXAMPLE OF THE GAP
BETWEEN SCIENCE AND PRACTICE, WE HAVE MEDICATIONS, NUMEROUS
MEDICATIONS, THAT CAN HELP PEOPLE WITH ALCOHOL PROBLEMS.
BUT ONLY ABOUT 25% OF FACILITIES, TREATMENT
FACILITIES, REPORTED THAT THEY OFFER ANY OF THEM IN THE LATEST
SURVEY OF TREATMENT PROGRAMS IN THE U.S.
ALTHOUGH WE KNOW THAT LONG-TERM USE OF MEDICATIONS, SUCH AS
METHADONE LOWERED DEATH AND RELAPSE RATES SUBSTANTIALLY FOR
PEOPLE ADDICTED TO PRESCRIPTION PILLS AND HEROIN, THEY ARE
GROSSLY UNDERUSED IN THIS COUNTRY.
THIRD MAJOR SHORTCOMING, THE THINGS THAT WE THINK SHOULD
PROTECT US IN THIS COUNTRY DON’T.
LICENSING AND CERTIFICATION OF PROGRAMS PROVIDE NO GUARANTEES.
THE MAIN ACCREDITING BODIES FOR REHABS DON’T ASSURE THAT
SCIENCE-BASED CARE IS OFFERED. BEING STATE LICENSED, SOME OF
THE MAJOR ACCREDITING BODIES FOR ADDICTION TREATMENT FREE —
PROGRAMS, MAINLY QUALITY CONTROL MEASURES, THEY DON’T ASSURE
THAT THEY ARE USING SCIENCE-BASED TREATMENT.
FINALLY, OFTEN PEOPLE IN THIS FIELD ARE INADEQUATELY TRAINED.
THERE WAS A MAJOR STUDY THAT WAS DONE BY A GROUP CALLED
CATHACOLUMBIA, SURVEYED THE SAFETY OF ADDICTION TREATMENT IN
MANY DIFFERENT AREAS A COUPLE YEARS AGO ALL ACROSS THE
COUNTRY, AND THEY LOOKED AT THE QUALIFICATIONS FOR BECOMING AN
ADDICTION COUNSELOR. ADDICTION COUNSELORS PROVIDE
MOST OF THE TREATMENT IN ADDICTION PROGRAMS.
THEY FOUND THAT SIX STATES HAVE NO DEGREE REQUIREMENTS FOR
BECOMING AN ADDICTION COUNSELOR. 24 REQUIRED ONLY A HIGH SCHOOL
EQUIVALENCY OR AN ASSOCIATE’S DEGREE.
THIS IS REALLY DISTURBING, GIVEN THE COMPLEXITY OF TREATING
SUBSTANCE ABUSE DISORDERS AND THE FACT THAT MORE THAN HALF THE
PEOPLE WITH A SUBSTANCE USE DISORDER HAVE ANOTHER
CO-OCCURRING MENTAL HEALTH PROBLEM.
ONE EXPERT SAID TO ME, IN TWO OTHER FIELDS DO WE PLAY SOME.
MOST DIFFICULT AND COMPLICATED PATIENTS IN THE HEALTHCARE
SYSTEM WITH SOME OF THE LEAST TRAINED FOLKS AMONG US.
WHAT WE NEED TO MAKE THIS BETTER IS TO REQUIRE BETTER AND MORE
TRAINING, AT LEAST A MASTER’S DEGREE FOR PEOPLE IN THE FIELD.
AS IT IS FOR ANY OTHER MENTAL HEALTH PROBLEM.
SO THE OTHER THING, TOO, IS THAT WE NEED THERAPISTS WITH EMPATHY
AND RESPECT. NOT TELLING PEOPLE THAT WE KNOW
WHAT’S BEST FOR YOU, BUT PEOPLE WHO WILL MEET YOU WHERE YOU ARE,
AND WHAT YOU ARE READY FOR IN TREATMENT.
THANK YOU. [ APPLAUSE ]>>MIKE PANTALON.
>>THANK YOU ALL — THANK YOU ALL FOR THANK YOU ALL
FOR BEING HERE. I APPRECIATE YOUR CONCERN ABOUT
THIS TOPIC. AND THANK YOU TO MY PANELISTS
FOR THEIR PASSION IN THE AREA, AND FOR ALL THE PRESENTERS.
I THINK IT’S FANTASTIC THAT WE HAVE THIS MANY PEOPLE HERE WHO
ARE CONCERNED ABOUT THE TOPIC OF ADDICTION, PROBLEMATIC
SUBSTANCE USE, WHATEVER YOU WANT TO CALL THE CONDITION.
AND I’M THRILLED TO BE HERE. I WANT TO THANK GUSTAVUS FOR
INVITING ME TO THIS VERY IMPORTANT AND, FRANKLY,
MAGNIFICENT CONFERENCE. IT’S BEEN WONDERFUL.
SO MY AIM TODAY IS TO TELL YOU THAT IN NO UNCERTAIN TERMS WE
HAVE A SCIENCE OF THE TREATMENT OF ADDICTION.
IT IS NOT A PERFECT SCIENCE, NOR IS ANY OTHER, BUT WE DO KNOW A
GOOD MANY THINGS ABOUT WHAT CONSTITUTES EFFECTIVE TREATMENT.
WE KNOW WHAT OUTCOMES WE GET FROM CERTAIN TREATMENTS, AND
EVEN IF THEY ARE NOT AS EFFECTIVE AS WE WOULD LIKE THEM
TO BE, WE KNOW WHAT THEIR EFFECTIVENESS IS.
AND AS A SCIENTIST, A THERAPIST, AN EDUCATOR, THAT IS CRITICALLY
IMPORTANT TO ME. AND I THINK IT IS PROBABLY VERY
IMPORTANT TO YOU. SO WHILE ANNE DID A FANTASTIC
JOB OF SETTING UP WHAT ISN’T WORKING, AND WHAT WE NEED IN
THERE, I AM NOT GOING TO REPEAT THAT.
THAT’S OFTEN WHAT I SPEAK TO AUDIENCES ABOUT.
WHAT I WOULD LIKE TO DO IS TO PICK IT UP FROM THERE, SUCH A
GREAT SETUP FOR ME, AND TO GIVE YOU THE HIGHLIGHTS IN THREE
ARENAS OF WHAT I THINK ANYONE SHOULD KNOW IF THEY REALLY WANT
TO HELP A FRIEND OR FAMILY MEMBER WITH AN ADDICTION.
DOES THAT SOUND GOOD? HOW MANY OF YOU CARE ABOUT
SOMEONE WITH AN ADDICTION? [ APPLAUSE ]
>>THANK YOU. SO WHAT ARE THESE TREATMENTS
THAT ARE SCIENTIFICALLY SUPPORTED?
TWO GENERAL CATEGORIES, PSYCHO THERAPY AND MEDICATIONS.
I DON’T WANT TO GET TOO TECHNICAL, OR GET INTO THE
DESCRIPTIONS OF THE THERAPIES, BUT IT’S TOO RARE THAT GENERAL
AUDIENCES SUCH AS YOURSELVES, AND PROBABLY THERE ARE
PROFESSIONALS IN THE AUDIENCE AS WELL, KNOW WHAT THESE ACTUAL
THERAPIES ARE. SO FORGIVE ME, BUT I AM GOING TO
GIVE YOU THE TECHNICAL NAMES SO YOU CAN GOOGLE THEM, SEARCH
THEM, AND GRILL PROVIDERS ABOUT THEM UNTIL YOU ARE CERTAIN THAT
THEY ACTUALLY PROVIDE THESE, BECAUSE THIS IS YOUR BEST
FIGHTING CHANCE TO HELP YOUR LOVED ONE GET GOOD TREATMENT.
AND BY THE WAY, ANNE IS RIGHT, YOU DON’T NECESSARILY, OR
IMMEDIATELY, OR EVEN EVER NECESSARILY HAVE TO GO TO REHAB
IN ORDER TO GET WELL. IT DOES HELP A GREAT MANY PEOPLE
WHO ARE VERY MEDICALLY COMPROMISED, AND WHO CANNOT
STRING TOGETHER EVEN A FEW HOURS OF NOT USING TO HAVE A
CONVERSATION WITH SOMEONE. BUT BY AND LARGE INTENSIVE
OUTPATIENT TREATMENT WORKS JUST AS WELL, IF IT HAS
EVIDENCE-BASED TREATMENTS IN IT. AND IT’S ABOUT A 10TH OF THE
COST. SO THE PSYCHO THERAPIES ARE
COGNITIVE BEHAVIORAL THERAPY, WHERE WE TEACH PEOPLE HOW TO
REGULATE THEIR EMOTIONS, HOW TO CHANGE THEIR ENVIRONMENT SO IT
DOESN’T PRODUCE MORE CRAVINGS THAN WHAT THEIR BRAIN IS ALREADY
FEELING. COGNITIVE BEHAVIORAL THERAPY
HELPS PEOPLE UNDERSTAND THAT THEY ARE NOT POWERLESS, THAT
THEY HAVE POWER TO CONTROL THEIR SURROUNDINGS, THEIR THOUGHTS,
THEIR FEELINGS, AND THEIR BEHAVIORS, TO AN EXTENT, BUT
OFTEN THAT EXTENT ALLOWS THEM THE ABILITY TO EITHER CUT DOWN
OR STOP USING. MOTIVATIONAL ENHANCEMENTS
THERAPY IS THE OPPOSITE OF WHAT YOU TYPICALLY THINK OF WHEN YOU
THINK OF TALKING TO SOMEONE WITH AN ADDICTION.
YOU KNOW, ANYONE EVER HEARD OF TOUGH LOVE HERE?
RIGHT? TOUGH LOVE IS THE OPPOSITE OF
MOTIVATIONAL ENHANCEMENT THERAPY.
TOUGH LOVE IS SAYING, YOU BETTER, YOU OUGHT TO, YOU HAVE
TO, PLEASE DO IT FOR ME OR ELSE. WHEREAS MOTIVATIONAL ENHANCEMENT
THERAPY SAYS, LET’S MEET YOU WHERE YOU’RE AT.
WHAT ARE THE THINGS THAT ARE GOING WRONG FOR YOU?
IF SOMEONE IS A WILLING ADDICTED PERSON AND THEN PARTIALLY
UNWILLING, WHERE IS THE PIECE OF THIS THAT YOU DON’T LIKE.
LET’S START THERE. AND DOES NOT DEMAND ANYTHING.
IT SAYS TO THE PERSON, TELL ME WHAT UPSET YOU HAVE WITH YOUR
DRINKING OR YOUR DRUG USE. WHY MIGHT YOU WANT TO CHANGE?
NON-CONFRONTATIONAL. COGNITIVE BEHAVIOR THERAPY,
MOTIVATIONAL ENHANCEMENT THERAPY, AND TO BE FAIR, THERE
IS SOMETHING CALLED 12-STEP FACILITATION.
IT IS A PROFESSIONAL INDIVIDUAL ONE-ON-ONE PSYCHO THERAPY THAT A
FORMER U OF M GRAD DEVELOPED, WHO IS A COLLEAGUE OF MINE AT
YALE, THAT HAS BEEN SHOWN IN SOME STUDIES TO BE EFFECTIVE.
UNFORTUNATELY, VIRTUALLY NONE OF THE REHABS THAT PRACTICE A
12-STEP-BASED APPROACH USE 12-STEP FACILITATION.
BUT IF YOU FIND A THERAPIST IN YOUR COMMUNITY, OR A CLINIC THAT
DOES THAT, AND THEY ADHERE TO THAT MODEL, THAT CAN ALSO BE AN
EFFECTIVE OPTION. WE WILL TALK ABOUT HOW TO GET
PEOPLE INTO TREATMENT IN A SECOND POINT, BUT IN TERMS OF
MEDICATIONS, HOW MANY OF YOU HAVE HEARD OF THE MEDICATION
SUBOXONE? HOW ABOUT METHADONE?
HOW ABOUT NALTREXONE? ALL RIGHT.
ACAMPROSATE? TOPAMAX?
OKAY. THOSE ARE OUR MEDICATIONS TO
TREAT ADDICTION, AND I URGE YOU, WE ARE NOT GOING TO SPEND THE
TIME HERE, I URGE YOU TO GET OVER THE IDEA THAT YOU CANNOT,
OR SHOULD NOT TREAT ONE ADDICTION — AN ADDICTION WITH A
DRUG. IT JUST DOES NOT HOLD WATER.
THE EVIDENCE IS CLEAR, A COMBINATION OF SCIENTIFICALLY
SUPPORTED PSYCHO THERAPIES LIKE THE ONES I MENTIONED.
THERE ARE A FEW MORE, BUT THOSE ARE THE HIGHLIGHTS, AND A
MEDICATION CANNOT ONLY HELP SOMEONE RECOVER, BUT CAN SAVE
THEM FROM OVERDOSE DEATH. I MEAN, I’M SURE YOU HAVE HEARD
ABOUT OPIOID-RELATED OVERDOSE DEATHS, THE RATES HAVE
QUADRUPLED SINCE 2002 AND 2013. I THINK THAT’S WHAT’S BRINGING
US CLOSER TO EVIDENCE-BASED TREATMENT OF ADDICTION, BECAUSE
WE ARE GOING TO KEEP LOSING OUR CHILDREN IF WE DON’T GET THE
FACTS, IF WE DON’T PRESSURE OUR CLINICIANS, OUR COMMUNITY, OUR
POLITICIANS, OUR PAYERS, TO SUPPORT TRULY SCIENTIFICALLY
SUPPORTED TREATMENT. MY SECOND POINT IS THAT WHICH
MOST OF OUR SOCIETY THINKS WILL GET SOMEONE INTO TREATMENT
ACTUALLY DOES NOT WORK VERY WELL.
IN FAIRNESS, IT HASN’T BEEN STUDIED MUCH, BUT THE RESULTS WE
HAVE SO FAR ARE NOT VERY … NOT VERY POSITIVE.
AND THE ALTERNATIVES WORK A LOT BETTER.
NOT PERFECTLY, BUT HOW MANY OF YOU HAVE HEARD OF INTERVENTIONS,
OR SEEN IT ON TV, RIGHT? YOU SURPRISE AND CIRCLE YOUR
LOVED ONE AND YOU CONFRONT THEM WITH THE THINGS THAT THEY’VE
DONE WHEN THEY’VE BEEN DRINKING OR USING DRUGS IN ORDER TO
CAJOLE, FORCE, CONVINCE, COERCE THEM INTO TREATMENT, USUALLY
THERE IS A VAN WAITING OUTSIDE. OKAY?
THAT’S TRADITIONAL INTERVENTIONS.
THE SCIENCE SHOWS, VERY CLEARLY, THAT THOSE PEOPLE WHO GO
THROUGH THAT, GO AT A RATE OF 20%.
20% OF PEOPLE GET IN THE VAN. OKAY?
YOU MIGHT THINK, OKAY, I’LL TAKE MY CHANCES WITH THAT.
BUT KEEP IN MIND THAT 80% OF THOSE 20% LEAVE THE REHAB BEFORE
THE 28 DAYS ARE UP. NOW THE RATE IS SUBSTANTIALLY
REDUCED. IF YOU COMPARE IT TO SOMETHING
CALLED CRAFT, C-R-A-F-T, AN ACRONYM, COMMUNITY REINFORCEMENT
APPROACH AND FAMILY TRAINING, BUT JUST REMEMBER CRAFT, BECAUSE
IF THE PERSON YOU ARE TALKING TO DOESN’T KNOW WHAT IT STANDS
FOR, HANG UP, OKAY? CRAFT GETS PEOPLE INTO TREATMENT
AT RATE OF 64%. AGAIN, NOT PERFECT.
WE ARE STILL WORKING ON IT. BUT WHAT WE’RE LEARNING IS THAT
THE STRATEGIES THAT GIVE YOU THAT INCREASE OF ENGAGEMENT AND
TREATMENT RUN ALMOST COMPLETELY COUNTER, THE TOUGH LOVE
CONFRONTATIONAL APPROACH. I HAVE TO ADMIT THOSE ARE HIGHLY
SATISFYING APPROACHES, RIGHT? THINK OF SOMEONE YOU ARE UPSET
WITH, AND YOU UNLOAD ON THEM, RIGHT.
ISN’T THAT A LITTLE SATISFYING FOR THE MOMENT?
BUT HOW DOES THE RELATIONSHIP GO AFTER THAT?
OKAY. SO THERE IS A PULL TO IT.
BUT I LIKE TO SAY TOUGH LOVE MAKES LOVE TOUGH.
AND IF YOU DON’T GET THEM ON THAT TIME, IF THEY ARE NOT ONE
OF THAT RARE 20%, THEN YOU’RE OIT, AND YOU MAY NOT — YOU ARE
OUT, YOU MAY NOT BE ABLE TO SPEAK TO THAT PERSON ABOUT THEIR
ADDICTION AGAIN. THE MORE MOTIVATIONAL
APPROACHES, CRAFT, TALKING TO PEOPLE ABOUT WHAT DISSATISFIES
THEM ABOUT THEIR DRUG USE, ULTIMATELY DOES FAR BETTER TO
GET THEM INTO TREATMENT. I DO RESEARCH AND WORK IN THE
EMERGENCY ROOM AT YALE NEW HAVEN HOSPITAL, AND WE HAVE A
CLINICAL TEAM, AND WE HAVE RESEARCH TO SHOW THAT WHEN YOU
DO A FIVE TO TEN-MINUTE INTERVENTION, THAT COMPLETELY
TAKES OUT ANYTHING CONFRONTATIONAL, LECTURE-Y,
DIDACTIC, TELLING AND SELLING. ALL YOU NEED TO DO IS ASK A FEW
POIGNANT QUESTIONS ABOUT WHY THIS PERSON MIGHT SELF-ELECT TO
TRY SOME TREATMENT, OUTPATIENT TREATMENT.
WE GET THOSE FOLKS INTO TREATMENT AT A RATE OF 65% IN
THE EMERGENCY ROOM. MOST OF WHOM DIDN’T EVEN COME IN
BECAUSE OF AN ADDICTION OR SUBSTANCE-RELATED ISSUE.
THEY LOOK AT ME AND THEY SAY, I BROKE MY ARM, WHY AM I TALKING
TO THE SHRINK? WELL, THEY SCORED HIGH ON OUR
QUESTIONNAIRES. SO WE CAN GET PEOPLE INTO
TREATMENT WITH THAT APPROACH. SO THE LAST THING IS THAT
BECAUSE THE ONE-SIZE-FITS-ALL DOESN’T WORK IN TREATMENT, IT
ALSO DOESN’T WORK IN TERMS OF SOCIAL SUPPORT.
I HAVE NO ILLUSION THAT ONE SESSION A WEEK, OR EVEN THREE
HOURS A DAY FOR THREE DAYS A WEEK IN AN INTENSIVE OUTPATIENT
SETTING IS GOING TO BE ENOUGH FOR YOUR LOVED ONES.
THEY NEED YOUR INVOLVEMENT. AND IF THAT’S TOUGH, AS IT CAN
BE SOMETIMES, THEY NEED SOCIAL SUPPORT DAY-TO-DAY.
WE HAVE A FANTASTIC OPTION THAT IS AVAILABLE 24/7, AND THAT IS
AA AND NA. UNFORTUNATELY, MANY PEOPLE, AS
ANNE WAS SAYING, DON’T GO THERE. NOW, IN FAIR NGS — IN FAIRNESS,
THEY WERE THERE WHEN PSYCHOLOGISTS, PSYCHIATRISTS,
PHYSICIANS AND LOTS OF SOCIETY DIDN’T CARE TO DEAL WITH THE
SUBSTANCE-USING PERSON, AND FOR THAT I GIVE THEM GREAT CREDIT,
AND I’VE KNOWN PEOPLE WHO HAVE RECOVERED THAT WAY.
BUT WE NEED ANOTHER SOCIAL SUPPORT OPTION.
THAT’S WHY I TRAIN PEOPLE TO BE RECOVERY COACHES.
PEOPLE WHO ARE INFORMED ABOUT THE SCIENCE THAT I’M TELLING YOU
ABOUT, WHO CAN HELP YOU AND YOUR LOVED ONES FIND THE BEST
TREATMENT, AND MOTIVATE YOUR LOVED ONES TO STICK WITH IT AND
MAKE THE BEST USE OF IT. SO MY MISSION IS EFFECTIVE HELP
FOR ALL, AND I AM HOPING THAT WE CONVEYED SOME OF THAT
INFORMATION TO YOU TODAY. THANK YOU.
[ APPLAUSE ]>>MARK WILLENBRING.
>>THANK YOU. MY PLEASURE TO BE HERE.
IWILLENBRING. >>THANK YOU.
MY PLEASURE TO BE HERE. I FEEL A GREAT HONOR JUST TO BE
PART OF THIS, AND TO BE ABLE TO SEE IN PERSON ONE OF MY GREAT
HEROES, ERIC NECESSARY — I’M SORRY, ERIC KANDEL, CARL HART, AND IT’S A
GREAT PRIVILEGE. I WANT TO CONCENTRATE ON FUTURE
DIRECTIONS. AND BY THE WAY, SO ONE OF THE
THINGS I WANTED TO MENTION IS THAT THE INTRODUCTION WAS FROM
MY PREVIOUS JOB. SO I WAS AT THE NATIONAL
INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM BETWEEN 2004 AND
2010. BEFORE THAT I WAS A PROFESSOR OF
PSYCHIATRY AT THE UNIVERSITY OF MINNESOTA, DOING RESEARCH,
TEACHING, AND RUNNING AN ADDICTION TREATMENT PROGRAM AND
DEVELOPING PROGRAMS. I SPENT MOST OF MY CAREER IN AB
DEM YA — 5:00 DEM YA AND GOVERNMENT.
WHEN — ACADEMIA AND GOVERNMENT. WHEN I LEFT NIH, LET ME SAY FROM
THE VIEWPOINT OF NIH, WHEN I FIRST GOT THERE, I SAT BACK AND
SAID, WELL, WHAT’S THE MISSION? WHAT’S THE MISSION OF THE
NATIONAL INSTITUTES OF HEALTH? WELL, IT’S TO IMPROVE THE HEALTH
OF THE COUNTRY. SO I SAT AROUND WITH MY STAFF, I
SAID, WELL, AS A RESULT OF THE RESEARCH, WONDERFUL RESEARCH
THAT’S BEEN FUNDED HERE, COMMUNITY TREATMENT OUTCOMES ANY
BETTER THAN THEY WERE 50 YEARS AGO?
IN NO. WAS THE PREVALENCE OF ALCOHOL
DEPENDENCE ANY LOWER THAN IT WAS 20, 30, 40, 50 YEARS AGO?
NO. HAVE WE IMPROVED, HAS THIS
RESEARCH IMPROVED THE HEALTH AND WELFARE OF THE PEOPLE OF THE
COUNTRY? NO.
NOT ONLY THAT, BUT IT BECAME VERY CLEAR TO ME ONE OF THE MAIN
REASONS FOR THAT. BECAUSE THE RESEARCH THAT’S BEEN
FUNDED BY THE NATIONAL INSTITUTES OF ALCOHOL ABUSE AND
ALCOHOLISM AND ON DRUG ABUSE HAS PRODUCED SOME OF THE MOST
PRISTINE NEUROSCIENCE EP DEEM LOGICAL DATA — EPIDEMIOLOGICAL
DATA, TREATMENT RESEARCH, BUT I REALIZED, ESPECIALLY FROM THAT
VANTAGE POINT THAT IN THE SUBSTANCE USE TREATMENT FIELD,
WE DID NOT HAVE A VEHICLE FOR GETTING THOSE NEW TREATMENTS,
NEW IDEAS, TO THE PEOPLE WHO PAID FOR THE RESEARCH.
THAT OUR TREATMENT SYSTEM IS NOT BASED ON SCIENCE.
IT WAS FOUNDED AND FORMED IN ABOUT 1950 TO ’55, AND NO MATTER
WHAT THE MARKETING — THE ONLY THING THAT’S CHANGED FROM WHAT I
CAN TELL IS THE MARKETING. BUT THE SUBSTANCE OF THE
TREATMENT HASN’T CHANGED. AND IT’S NOT REALLY TREATMENT.
REHAB IS A KIND OF TREATMENT YOU DO WHEN YOU DON’T HAVE A REAL
TREATMENT. AND SO — WE USED TO TREAT
BREAST CANCER WITH PRAYER, TOO, BUT WE DON’T DO THAT ANYMORE,
AND WE SHOULDN’T BE DOING THAT WITH ADDICTION ANYMORE, EITHER.
NOT THAT I HAVE ANYTHING AGAINST PRAYER, BUT IT IS NOT A MEDICAL
TREATMENT OR A PSYCHOLOGICAL OR BEHAVIORAL TREATMENT.
ANYWAY, IN CONTRAST TO MY COLLEGE IN THE HEART, LUNG AND
BLOOD INSTITUTE, WHEN THEY PUBLISH A BIG STUDY ABOUT A NEW
APPROACH TO TREATING HIGH BLOOD PRESSURE, CARDIOLOGISTS AND
OTHER PHYSICIANS READ THOSE ARTICLES.
THEY GO TO PROFESSIONAL MEETINGS AND THEY HEAR ABOUT THE NEW
RESEARCH AND THEY CHANGE THEIR PRACTICE.
BERTRAM RUSSEL ONCE SAID IN A FAMOUS DEBATE, WHEN THE FACTS
CHANGE, I CHANGE MY MIND. WHAT DO YOU DO, SIR?
AND IN THE REHAB FIELD WHEN THE FACTS CHANGE AND THEY HAVE
CHANGED A LOT, THE MINDS HAVE NOT CHANGED.
SO WHEN WE PUBLISH STUDIES IN OUR FIELD, NOBODY WHO IS RUNNING
THE CENTERS READS THEM. AND IF IT COUNTERS WHAT THEY
ALREADY KNOW, THEY DISCOUNT THEM.
SO WHEN I LEFT NIH, I THOUGHT, WELL, I COULD GO BACK TO SOME
OTHER ACADEMIC INSTITUTION AND DO MORE RESEARCH AND WATCH THAT
SIT ON THE SHELF AND COLLECT DUST ALONG WITH ALL THE LAST 40,
50 YEARS OF RESEARCH, OR I COULD TRY TO CHANGE THE SYSTEM.
AND SO THAT’S WHAT I HAVE BEEN DOING NOW FOR THE LAST FIVE
YEARS. I FORMED A COMPANY CALLED
ALLTYR, WITH A CLINIC, A DEMONSTRATION PROJECT, TO SHOW
HOW TO DO 21ST CENTURY ADDICTION TREATMENT.
IT IS LOCATED IN ST. PAUL. AND FOR THE LAST THREE YEARS
WE’VE BEEN BASICALLY INVENTING THE MODEL.
NO ONE HAS DONE THIS BEFORE. AND IT TAKES ABOUT THREE YEARS
TO DO IT. YOU CAN’T COMPRESS IT.
I’VE DONE THIS A NUMBER OF TIMES, AND WE’VE PRETTY MUCH
DONE WITH THAT NOW. AND WE’VE GOT PROOF OF CONCEPT
FOR A NUMBER OF THINGS. AND I’LL TELL YOU A LITTLE BIT
MORE ABOUT THAT IN A MINUTE, IN TERMS OF WHAT WE’RE FINDING .
LET ME GO TO THE BEGINNING HERE. SO I’M JUST GOING TO VERY
BRIEFLY COVER HOW WELL DOES THE CURRENT SYSTEM WORK, WHAT DOES
WORK, AND DR. PANTALON HAS PRETTY MUCH GONE OVER THAT, AS
HAS ANNE FLETCHER, SO I WON’T SPEND A LOT OF TIME ON THAT.
HOW WELL DOES IT WORK, DO PEOPLE HAVE ACCESS TO UP-TO-DATE
TREATMENT, HOW DO WE GET 21ST CENTURY TREATMENT TO MORE
PEOPLE, AND HOW WILL RESEARCH HELP US IMPROVE TREATMENT.
ONE OF THE THINGS I WAS REALLY STRUCK WITH, WITH THIS RECENT
BIG RALLY IN WASHINGTON ABOUT ADDICTION, AND THE EMPHASIS WAS
ON SORT OF COMING OUT, OKAY. I AM A RECOVERING ADDICT, AND
WE’RE STRONG AND WE, YOU KNOW, SO FORTH.
I THINK THAT’S FINE. WHAT REALLY BOTHERED ME, THOUGH,
WAS THAT THERE WASN’T ANY EMPHASIS ON THE NEED TO FUND
MORE RESEARCH. IT’S JUST ABOUT HAVING MORE
REHAB. THAT’S REALLY A PROBLEM IN OUR
FIELD. WE DON’T HAVE AN ADVOCACY
ORGANIZATION THAT ADVOCATES FOR RESEARCH FUNDS.
SO THE ADVOCACY ORGANIZATIONS FOR HEART DISEASE, BREAST
CANCER, ALTZHEIMER’S DISEASE, AUTISM, WHAT ARE THEY ALWAYS
CLAMORING FOR? MORE FUNDING BY NIH TO DO MORE
RESEARCH. NOBODY IN OUR FIELD SPEAKS UP
FOR THAT: THEY SAY WE ALREADY KNOW WHAT TO
DO, WE DON’T NEED MORE RESEARCH TO SHOW THAT.
BUT WE DON’T KNOW THAT. SO THE CURRENT SYSTEM HAS ABOUT
A 10% MARKET PENETRATION. 10% OF PEOPLE WITH SUBSTANCE USE
DISORDERS WILL ACCESS THAT TREATMENT SYSTEM REHAB,
BASICALLY, AND MOST PEOPLE WHO GO TO REHAB ALMOST ALL OF THEM
ARE FORCED TO GO. REHAB, REHAB INDUSTRY IS
DEPENDENT ON THE CRIMINAL JUSTICE SYSTEM FOR THE MAJORITY
OF THE REFERRALS. THE SECOND MOST COMMON, AN
EMPLOYER MANDATE. THE THIRD IS WHAT I CALL A
FAMILY MANDATE. BUT NOBODY GOES TO REHAB BECAUSE
THEY CAN’T — WANT TO. BECAUSE IT IS AN OBNOXIOUS
TREATMENT. IT’S EXPENSIVE, DISRUPTIVE,
STIGMATIZING AND OLD-FASHIONED. IT IS AN AN AKRON — AN 5:00
CHRONNISM. IT DOESN’T WORK ANY BETTER THAN
SEEING A COUNSELOR FOR 12 BEEKS — WEEKS.
THERE’S NO CHOICE. PEOPLE DON’T HAVE A CHOICE.
ONE WOMAN A FEW MONTHS AGO, THERE WAS AN ARTICLE IN THE
ATLANTIC MONTHLY, IN WHICH ALLTYR CLINIC WAS FEATURED, AND
SINCE THEN THE CALL, YOU KNOW, PHONE HAS BEEN RINGING OFF THE
HOOK. HALF THE CALLS FROM OUT OF
STATE, BUT ONE WOMAN CAME TO ME, AND HERE’S THE INTERESTING
THING. 85% OF THEM HAVE BEEN PEOPLE ON
THE VERY MILD, TO AT MOST MODERATE END OF ALCOHOL USE
DISORDERS. THESE ARE PEOPLE WHO ARE
FUNCTIONAL, BUT THEY ARE DISTRESSED.
THESE ARE PEOPLE WHO GET UP AND GO TO WORK IN THE MORNING, THEY
ARE FINE. THEIR COLLEAGUES, YOU KNOW,
DON’T KNOW ANYTHING ABOUT THEIR STRUGGLE WITH DRINKING.
THEY PICK UP THE KIDS AFTER SCHOOL, THEY TAKE THEM HOME,
THEY HELP THEM WITH THEIR HOMEWORK, GIVE THEM DINNER, PUT
THEM TO BED, AND THEN THEY GO AND THEY DRINK THEIR TWO BOTTLES
OF WINE, OR THEIR PINT OF WHISKEY.
AND THEY DO THAT EVERY NIGHT, EVEN THOUGH THEY DON’T REALLY
WANT TO, AND THEY DON’T LIKE IT, AND THEY ARE DISTRESSED.
THEY ARE NOT — THEY ARE NOT SEEKING TREATMENT BECAUSE THEY
DON’T WANT IT, THEY ARE NOT SEEKING TREATMENT BECAUSE IT’S
NOT AVAILABLE TO THEM IN A FORM THAT’S ACCEPTABLE TO THEM.
SO 85% OF THE PEOPLE WHO HAVE COME AS A RESULT OF THIS ARTICLE
HAVE BEEN PEOPLE LIKE THAT. EARLY INTERVENTION.
SO WE’RE GETTING MUCH DEEPER PENETRATION INTO THE AFFECTED
POPULATION, JUST THE SAME AS WITH — AND EVENTUALLY TREATMENT
WILL ALL BE — I MEAN, ALCOHOL AND OPIATE TREATMENT WILL BE
PRIMARILY DONE IN PRIMARY CARE, JUST LIKE IT IS NOW WITH
DEPRESSION. BUT ONE WOMAN SAID TO ME, I’VE
BEEN LOOKING FOR HELP SINCE THE 1960S, AND ALL I COULD FIND WAS
12-STEP REHAB UNTIL THIS CLINIC OPENED.
IT’S NOT THAT PEOPLE DON’T WANT HELPHELP.
SO PEOPLE NEED A CHOICE. THERE’S INADEQUATE INFORMED
CONSENT. IT’S THE ONLY PLACE IN
HEALTHCARE WHERE YOU CAN ROUTINELY LIE TO PATIENTS, WHERE
YOU CAN ROUTINELY FAIL TO DISCLOSE WHAT THE SKYPE TIFK
EVIDENCE IS — SCIENTIFIC EVIDENCE IS FOR THE
EFFECTIVENESS OF DIFFERENT TYPES OF TREATMENTS AND WHAT THE
ALTERNATIVE TREATMENTS ARE AND GET BY WITH IT.
ANY PHYSICIAN WHO PRACTICED LIKE THAT WOULD BE OUT OF BUSINESS
IN ABOUT THREE MONTHS. SO PEOPLE WHO ARE HEROIN ADDICTS
GO TO ABSTINENCE-BASED REHAB. THEY ARE TAKEN OFF THE — THEY
ARE WITHDRAWN FROM THE OPIATES, THEY LOSE THEIR TOLERANCE, THEY
ARE TOLD IF THEY WORK A PROGRAM, AN ABSTINENCE-BASED PROGRAM IT
WILL WORK. THERE’S NOT ONE STUDY IN THE
WORLD THAT SHOWS THAT. WHILE THERE’S MASSIVE AMOUNTS OF
RESEARCH DEMONSTRATING THAT MAINTENANCE ON A DRUG CALLED
SUBOXONE OR METHADONE IS VERY EFFECTIVE AND COST-EFFECTIVE,
BUT PEOPLE AREN’T TOLD THAT. AND THESE MOSTLY YOUNG PEOPLE
NOW GO OUT AND THEY’VE LOST THEIR TOLERANCE, AND THE FIRST
TIME THAT THEY USE, THEY USE THE SAME AMOUNT THEY WERE USING
BEFORE, AND THEY DIE OF AN OVERDOSE.
THIS HAS HAPPENED OVER AND OVER AND OVER, BECAUSE THEY WERE LIED
TO IN REHAB. THE EXPECTATIONS ARE
UNREALISTIC. IF YOU COME TO ME AND YOU GOT
ASTHMA, AND I PR HE DESCRIBE SOME INHALERS — PRESCRIBE
INHALERS, WOULD EITHER ONE OF US EXPECT YOU WOULD NEVER, EVER
HAVE ANOTHER ASTHMA ATTACK THE REST OF YOUR LIFE, AND IF YOU
DID, IT WOULD BE A TOTAL FAILURE?
THAT’S THE EXPECTATION. NOW, HERE’S THE WORST THING OF
ALL. THE ONLY INDUSTRY I KNOW THAT
HAS BEEN SO SUCCESSFUL AT BLAMING THEIR CUSTOMERS FOR THE
FAILURE OF THEIR TREATMENT. [ APPLAUSE ] AND THAT PUTS A HORRIBLE STIGMA,
BECAUSE — IT TAKES THE AVERAGE ALCOHOL-DEPENDENT PERSON 5 TO
10 YEARS TO STOP IN THIS COUNTRY.
AND THEY DO IT THROUGH MULTIPLE QUIT ATTEMPTS AND MULTIPLE
RECURRENCES. THAT’S WHY ULTIMATELY SAY WE
DON’T JUST CALL ADDICTION A DISEASE, WE TREAT IT LIKE ONE.
REHAB IS LIKE SENDING A DIABETIC PERSON TO A SPA TEACHING THEM
DIET AND EXERCISE, AND THEN SAYING GO TO SUPPORT GROUPS.
WHATEVER YOU DO, DON’T TAKE INSULIN. NOW, THE ONE FINAL THING, ONE
FINAL THING I AM GOING TO SAY, IS THAT IN TERMS OF THE FUTURE,
I JUST WANTED TO MENTION, WHAT NEEDS TO HAPPEN, AND IS GOING TO
HAPPEN EVENTUALLY, IS THAT SUBSTANCE USE TREATMENT NEEDS TO
BE MAINSTREAMED INTO HEALTHCARE ACROSS HEALTHCARE COMPLETELY,
MOST OF IT CAN BE DONE IN PRIMARY CARE —
[ APPLAUSE ] — WE NEED A ROBUST,
MEDICALLY-BASED OR MEDICALLY ANCHORED SPECIALTY TREATMENT, I
MEAN, A COUNSELOR WITH A GED PREACHING AA FOR FOUR WEEKS IS
NOT A BACKUP FOR A PHYSICIAN. AND SO WE REALLY NEED TO
REORGANIZE CARE. WE REALLY NEED TO RETHINK WHO
PROVIDES CARE AND WHEN, AND HOW, MEDICATIONS ARE GOING TO BECOME
INCREASINGLY IMPORTANT. THAT’S WHY THE NEUROSCIENCE
RESEARCH IS SO IMPORTANT. THERE ARE NEW BEHAVIORAL
TREATMENTS THAT ARE GOING TO GO DIRECTLY TO IMPLICIT COGNITION
THAT ARE GOING TO BE MUCH MORE POWERFUL THAN WHAT WE ARE USING
NOW. MOST THERAPY WILL BE PROVIDED,
PSYCHO THERAPY, ON THE WEB. AND SO THOSE ARE SOME OF THE
FUTURE DIRECTIONS, AND I THINK THERE’S A LOT FOR THE USE OF
TECHNOLOGY AS WELL. BUT I THINK THE FUTURE IS
BRIGHT, BUT WE NEED TO — THE IMPORTANT THING IS WE HAVE TO
MAKE TREATMENT AVAILABLE, ACCESSIBLE, AFFORDABLE, AND
ATTRACTIVE. [ APPLAUSE ] THANK YOU.>>THANKS, MARK. LAST.
I’M HONORED AND — I’M HONORED TO BE HERE, AND I HAVE TO ADMIT
TO YOU I AM A BIT PERPLEXED, TOO.
I’M HONORED BY THE INVITATION TO TAKE PART IN THIS PRESTIGIOUS
CONFERENCE AT THIS IMPORTANT INSTITUTE OF HIGHER LEARNING,
WITH A ROOM AND AN AGENDA FILLED WITH EXPERTS WITH LOTS OF
CREDENTIALS AFTER THEIR NAMES, AND IN SOME CASES BEFORE THEIR
NAMES. SO I’M HONORED, BUT I’M ALSO A
LITTLE BIT PERPLEXED, TOO, I HAVE TO BE HONEST WITH YOU,
BECAUSE I’M NOT REALLY SURE WHAT I CAN ADD TO WHAT YOU’VE
ALREADY BEEN TALKING ABOUT FOR THE TWO DAYS, OR REALLY ADD MUCH
MORE, OR DETRACT FROM WHAT OUR OTHER EXPERTS HERE IN THIS PANEL
WITH ME HAVE ALREADY TALKED TO YOU ABOUT.
THE TOPIC OF OUR PANEL IS, WHAT? EXPLORING DIFFERENT TREATMENT
OPTIONS. AND TO THAT TOPIC ALL I CAN SAY
IS, YES! OR ABSOLUTELY.
OR IF I REALLY WANT TO GET INTO IT.
OF COURSE! AND IF I REALLY WANT TO
EXTRAPOLATE AND GET INTO THE DETAIL OF WHAT IT MEANS TO
EXPLORE DIFFERENT TREATMENT OPTIONS, I COULD INCLUDE THIS:
WHEN IT COMES TO SUBSTANCE USE DISORDERS, A CHRONIC ILLNESS, WE
ALL KNOW THAT THERE IS NO CURE FOR THIS ILLNESS, AT LEAST NOT
YET. AND DESPITE THE RESEARCH OF MANY
PEOPLE TRYING TO FIND THAT CURE.
WE KNOW THERE IS NO CURE FOR THIS CHRONIC DISEASE.
BUT THERE IS A SOLUTION, WHICH MEANS, WHAT?
THAT TREATMENT CAN AND DOES WORK.
THERE ARE MANY PATHWAYS TO RECOVERY, AND THERE ARE MILLIONS
OF PEOPLE WHO ARE IN RECOVERY FROM ADDICTION RIGHT NOW, EVEN
THOUGH AMONG THOSE MILLIONS OF PEOPLE, THEIR DEFINITION OF
THEIR OWN RECOVERY MAY DIFFER OR BE SIMILAR TO MINE AND OTHERS.
THERE ARE MILLIONS OF PEOPLE IN RECOVERY FROM THAT SEEMINGLY
HOPELESS CONDITION, INCLUDING SOME IN THIS ROOM TODAY LIKE ME.
I CAN CONFIDENTLY STATE THESE POINTS THAT I JUST TALKED TO YOU
ABOUT, EVEN THOUGH I’M NOT A DOCTOR, I’M NOT A RESEARCHER,
I’M NOT A SCIENTIST, I’M NOT AN MSW, I’M NOT AN LADC, I AM NOT A
PhD. ALL I GOT IS A BA IN JOURNALISM
FROM WASHINGTON LEE UNIVERSITY, CLASS OF 1981.
BUT I CAN SPEAK TO YOU CONFIDENTLY — I CAN SPEAK TO
YOU CONFIDENTLY AND IN CONJUNCTION WITH THIS ESTEEMED
PANEL AND THE OTHERS THAT YOU HAVE HEARD FROM BECAUSE I
BENEFITED FROM TREATMENT. I AM A PRIME EXAMPLE OF THE
POWER OF ADDICTION, THE EFFECTIVENESS OF TREATMENT, AND
THE PROMISE AND THE POSSIBILITY OF RECOVERY, BECAUSE IN 1994, I
GOT WELL. AFTER FOUR TREATMENTS IN FIVE
YEARS BETWEEN 1989, AND 1994. YES, THIS IS WHAT A CHRONIC
ALCOHOLIC AND A DRUG ADDICT LOOKS LIKE.
THESE FOUR TREATMENTS AT THE TIME BETWEEN ’89 AND ’94 WERE
GROUNDED IN WHAT WE NOW WOULD SAY IS THE TRADITIONAL
ABSTINENCE-BASED MODEL THAT INCLUDED, YES, IT INCLUDED THE
12-STEP APPROACH TO NOT TREATMENT, BUT THE 12-STEP
APPROACH TO RECOVERY. I EVEN HAD TWO TREATMENTS ADD
HAZELDEN WHERE I WORK, FOLLOWED BY THREE YEARS OF ABSTINENCE
BETWEEN 1991 AND 1994. NOTE, I SAID AB STIN EN —
ABSTINENCE, BECAUSE I THINK IT IS IMPORTANT TO THE CONVERSATION
WE ARE HAVING HERE, AND TO THE CONVERSATION WE’LL TAKE BACK TO
OUR COMMUNITIES THAT WE TALK ABOUT THE FACT THAT ABSTINENCE,
AT LEAST AS IT RELATES TO MY BIASED PERSPECTIVE, IS NOT
RECOVERY, AS I WOULD COME TO UNDERSTAND IT.
BUT AT LEAST DURING THOSE THREE YEARS BETWEEN ’91 AND ’94, I
DIDN’T USE MOOD OR MIND-ALTERING SUBSTANCES, SO DURING THOSE
THREE YEARS IN THE EARLY 90s, I FUNCTIONED PRETTY WELL.
I BECAME A HUSBAND, A FATHER OF TWO BOYS, I WORKED AS A
JOURNALIST AT CNN, I BOUGHT A HOUSE, HE PAID MY — I PAID MY
TAXES AND GENERALLY I BEHAVED. BUT I DIDN’T RECOVER.
I DIDN’T RECOVER BETWEEN 1989 — THE — 1991 AND 94, EVEN THOUGH
I DID NOT USE SUBSTANCES, WHICH MEANS THAT I DIDN’T TAKE CARE OF
MYSELF BY TAKING CARE OF MICRON IK DISEASE — MY CHRONIC
DISEASE, WHICH MEANS THEN I HAD TWO MORE TREATMENTS
AT A FACILITY IN THEN I HAD TWO MORE TREATMENTS AT A FACILITY IN
ATLANTA, MUCH LIKE THE APPROACH THAT HAZELDEN IS TAKING.
IT WAS THE FOURTH ONE THAT IRONICALLY STARTED OCTOBER 12TH,
1994, A COUPLE DAYS FROM NOW, IT WAS THAT FOURTH TREATMENT
WHERE I FINALLY LEARNED TO TAKE PERSONAL RESPONSIBILITY BY
PICKING UP THE TOOLS THAT I HAD BEEN GIVEN BY THE COUNSELORS,
THE DOCS, MY THERAPIST, MY RECOVERY GROUP, AND OTHER
THINGS, PICKING UP THOSE TOOLS, AND BEGINNING TO WORK MY OWN
PROGRAM OF RECOVERY BY MANAGING MICRON IK ILLNESS.
— MY CHRONIC ILLNESS. KEEPING IT IN REMISSION, AND
DOING SO FOR A LONG TIME NOW. A LOT, AS WE’VE HEARD TODAY, AND
AS ANNE TALKS ABOUT IN HER BOOK, AS YOU’VE HEARD FROM THE
OTHER PANELISTS TODAY, A LOT HAS CHANGED IN 21 YEARS.
FOR ONE THING, I AM A LOT OLDER. BUT SERIOUSLY, WHAT’S CHANGED IS
HOW WE AS A FIELD, AND I USE THAT TERM IN THE BROADEST OF
SENSES, HOW WE AS A FIELD HAVE COME TO UNDERSTAND ADDICTION FOR
THE ILLNESS THAT IT IS, AND TO COME TO UNDERSTAND IT FOR THE
ILLNESS THAT IT ISN’T. HOW WE TREAT IT, BRINGING TO
BEAR THE BEST OF WHAT WAS, THE BEST OF WHAT IS, THE BEST OF
THOSE THINGS IN MEDICINE, IN PHARMACOLOGY, RESEARCH INTO THE
BRAIN, THE DYNAMICS OF GENETICS, AND, YES, I WILL ARGUE THAT
GENETICS DOES PLAY A FACTOR, THE ROLE OF MENTAL ILLNESS, AND
MAYBE MOST OF ALL, RECOGNIZING ALL THESE DECADES AFTER I LAST
WENT TO TREATMENT, RECOGNIZING THAT TREATMENT ISN’T THE END OF
ADDICTION, OR IT MAY BE THE END OF ADDICTION, BUT IT’S MERELY
THE BEGINNING, IT’S THE BEGINNING OF A PROCESS CALLED
RECOVERY. AND INTERESTINGLY AND NOTABLY
ENOUGH, RECOVERY THAT HAS COME TO EMBRACE A TERM THAT DIDN’T
EVEN EXIST WHEN I WENT TO TREATMENT IN ’89 OR ’91, OR TWO
TIMES IN ’94, AND THAT’S THE TERM RECOVERY MANAGEMENT.
THAT IS WHAT REALLY MATTERS. ALL OF THOSE FACTORS COMING
TOGETHER TO HELP US IMPROVE ON WHAT HAS WORKED TO GET RID OF
WHAT HASN’T WORKED, AND TO GIVE OUR PATIENTS AND OUR CLIENTS A
BETTER CHANCE. BY THE WAY, I HAVE TO ECHO
SOMETHING THAT DR. WILLENBRING SAID, WHICH I THINK IS SO
CRITICAL, WHICH IS THAT WE HAVE GOT TO MAINSTREAM ADDICTION
TREATMENT AND RECOVERY INTO THE HEALTHCARE CONTINUUM.
AND I THINK ONE OF THE MOST — [ APPLAUSE ]
I THINK ONE OF THE MOST IMPORTANT WAYS WE HAVE TO DO
THAT FOR THE BENEFIT OF OUR PATIENTS AND OUR CLIENTS AND
THEIR FAMILIES IS TO TAKE IT BACK DOWN TO THE COMMUNITY
LEVEL, WHERE MOST PEOPLE HAVE TO RETURN TO AFTER THEY GO TO
TREATMENT. THEY HAVE TO RETURN TO THEIR
COMMUNITIES. I CAN THINK OF NOBODY WHO’S GOT
THAT MODEL DOWN BETTER THAN A FRIEND OF MINE IN THE AUDIENCE
TODAY, I THINK HE’S STILL HERE. IS KEVIN KIRBY HERE?
KEVIN? THERE YOUR BACK THERE.
KEVIN KIRBY, YOU FOUNDED A FACE IT TOGETHER, A NATIONAL
ORGANIZATION IN SIOUX FALLS, SOUTH DAKOTA, THAT IS TAKING
THIS PARADIGM THAT WE TALK ABOUT AS IT RELATES TO ADDICTION
TREATMENT AND MAINSTREAMING IT NOT JUST INTO HEALTHCARE AND INTO THE
COMMUNITY. I THINK THAT IS THE FUTURE OF
TREATMENT, HOWEVER WE PRACTICE TREATMENT IN THIS COUNTRY.
THANK YOU, KEVIN KIRBY, FOR WHAT YOU ARE DOING. YOU ARE DOING.
[ APPLAUSE ] THAT’S ALL THAT REALLY MATTERS, IS THAT WE
TAKE ALL THE THINGS THAT WE KNOW, AND BRING THEM TO BEAR IN
A SYSTEM, IF YOU WILL, THAT WORKS BEST AND MEETS THE NEEDS
OF THE PATIENTS AND THE CLIENTS AS ANNE AND OTHERS HAVE SAID
WHERE THEY ARE IN THAT MOMENT. IT MATTERS THAT WE KEEP OUR
PERSPECTIVE — IT DOESN’T MATTER WHAT OUR PERSPECTIVE OR OUR
EXPERTISE OR BIAS IS, ALL THAT REALLY MATTERS IS THAT WE STRIVE
TO GET BETTER AT WHAT WE DO BY IDENTIFYING THE COMPLEXITIES OF
THIS ILLNESS, AND I WOULD ARGUE THAT THEY PERHAPS ARE MORE
COMPLEX THAN THEY EVER HAVE BEEN, AND THAT WE APPLY PROVEN,
SOME WOULD SAY EVIDENCE-BASED, APPROACHES TO THE TREATMENT OF
IT, AND THAT MOST OF ALL, WE DO THIS WITH THE DIGNITY AND THE
RESPECT THAT IS DESERVED OF OUR PATIENTS AND OUR CLIENTS.
THAT IS ALL THAT REALLY MATTERS, ISN’T IT?
[ APPLAUSE ] I DIDN’T COME HERE THIS
AFTERNOON, AND I’M GRATEFUL FOR THE OPPORTUNITY TO BE HERE, I
DIDN’T COME HERE TODAY TO DEBATE OR DEFEND OR ATTACK ONE PATHWAY
OF TREATMENT OVER ANOTHER. I’M HERE TODAY TO BE PART OF THE
BETTER UNDERSTANDING AND TO SOLVE THIS.
SUBSTANCE USE DISORDERS, ADDICTION, WHATEVER YOU WANT TO
CALL IT, IT IS AN ILLNESS THAT WE LIKE TO THINK OF AT LEAST I
LIKED TO THINK OF AS A RUBIK’S CUBE.
AND YESTERDAY WHEN I WAS THINKING ABOUT BEING HERE TODAY,
WITH ALL THESE EXPERTS WHO KNOW A LOT MORE ABOUT THIS THAN I
DO, I THOUGHT ABOUT THIS DISEASE AS A RUBIK’S CUBE, AND I PUT
RUBIK’S CUBE INTO GOOGLE SEARCH TO TRY TO FIND OUT WHAT THE
SOLUTION TO THIS PUZZLE WAS. I DON’T TRY TO DO THIS PUZZLE
BECAUSE IT FRUSTRATES ME. WHEN I PUT IT INTO GOOGLE, UP
POPPED THE OFFICIAL RUBIK’S CUBE PAGE.
IT SAID THIS, I QUOTE: IT TOOK ERNAL RUBIK, THE
INVENTOR OF THE RUBIK’S CUBE, ONE MONTH TO LEARN HOW TO DO A
RUBIK’S CUBE. SOME PEOPLE STARTED THINKING
ABOUT HOW TO COMPLETE THE RUBIK’S CUBE BACK IN THE 1980S,
AND IN 40 YEARS HAVE GOT BE LITTLE FURTHER THAN ONE SIDE.
IF YOU WANT TO LEARN HOW TO SOLVE THE RUBIK’S CUBE, LOOK NO
FURTHER — THIS RED PAGE PROMISED — GETTING HELP WITH
SOLVING THE RUBIK’S CUBE IS NOT CHEATING.
THERE ARE 42 QUINNTILLION POSSIBILITIES, BUT ONLY ONE
CORRECT SOLUTION. WELL, FORTUNATELY FOR ALL OF US
HERE TODAY, AND FOR THOSE WHO SUFFER WITH THIS ILLNESS, THERE
ARE NOT 42 QINTILLION POSSIBILITIES FOR GETTING HELP.
AND FORTUNATELY FOR US, AND FOR THEM, THERE ISN’T ONE CORRECT
SOLUTION. THERE ARE MANY.
I WAS REMINDED OF THIS THREE DAYS AGO RIGHT NOW WHEN I WAS ON
THE NATIONAL MALL IN WASHINGTON, DC, WHEN THOISS OF
PEOPLE — THOUSANDS OF PEOPLE TURNED OUT
TO THE UNITE TO FACE ADDICTION, IT WAS A RALLY AND A CONCERT
FEATURING, AMONG OTHERS, STEVEN TYLER OF AEROSMITH, JOEL WALSH
OF THE EAGLES, SHERYL CROW, AND EVEN I GOT TO SPEAK FROM THE
STAGE, AND I DIDN’T HAVE TO SING.
LOOKING OUT OVER THE SEA OF THOUSANDS OF PEOPLE, AND DR.
WILLENBRING MENTIONED THE RECOVERY ADD VO SI GOING ON IN
THIS — ADVOCACY IN THE FIELD. LOOKING OUT AT THE SEA OF
RECOVERING PEOPLE ON SUNDAY, I WAS REMINDED THAT WHILE WE ALL
HAVE THE SAME ILLNESS, WE HAVE FOUND MANY DIFFERENT WAYS,
PATHWAYS, TO THE SOLUTION. BY THE WAY, DR. WILLENBRING, ON
THAT STAGE THAT DAY WERE MEMBERS OF ALL THE NATIONAL GOVERNMENT
REPRESENTING THEIR CAUSES AND THEIR INTERESTS, AND THE ONLY
POINT I WILL DISAGREE WITH YOU ON IN YOUR PRESENTATION TODAY IS
THAT WHEN WE WERE ALL UP ON THAT STAGE AMONG THE MANY THINGS
WE ADVOCATED FOR WAS THE FACT THAT WE NEED MORE RESEARCH FOR
PREVENTION, TREATMENT, AND RECOVERY MANAGEMENT.
[ APPLAUSE ] AT THE END OF THE MALL EVENT,
AND AT THE END OF THIS DAY, THIS IS ALL THAT — THIS IS ALL THAT
MATTERS AT THIS NOBEL CONFERENCE.
WE, WE ARE THE LUCKY ONES. WE ARE THE ONES WHO HELP PEOPLE
GET WELL. WE ARE THE ONES WHO GOT WELL,
AND IT IS OUR RESPONSIBILITY TO CHANGE THE TERMS OF THE DEBATE
FOR THE SAKE OF THOSE WHO STILL SUFFER.
FOR THE SAKE OF THOSE WHO ARE NOT HERE TODAY.
[ APPLAUSE ]>>THANK YOU, PANELISTS.
THANK YOU ALL. SO WE’VE GOT, PROBABLY ABOUT 10
MINUTES BEFORE WE’LL ASK OUR OTHER CONFERENCE PARTICIPANTS TO
COME UP AND JOIN US. SO THIS TIME IS JUST FOR US, AND
I OPEN IT UP TO YOU TO RESPOND TO ONE ANOTHER, HOWEVER YOU
WOULD LIKE. THERE’S NO ORDER HERE.
SO IF SOMEONE IS READY TO GO?>>I WOULD LIKE TO JUST SAY THAT
— AND I JUST HAD THE LAST WORD THERE, SO TO SPEAK, BUT WHERE I
THINK WE REALLY NEED TO MOVE THE CONVERSATION, AND IT’S GOING
TO TAKE THE OTHER EXPERTS ON THE PANEL AND ALL OF YOU OUT
THERE, IS WHILE WE ARE PAYING ATTENTION TO THE IMPORTANCE OF
TREATMENT, WE’VE GOT TO FIGURE OUT HOW WE MEASURE THE
IMPORTANCE OF TREATMENT IN THE EFFECTIVENESS.
WHAT IS GOOD RECOVERY? I MEAN, BILL WILSON, WHO WAS A
CO-FOUNDER OF ALCOHOLICS ANONYMOUS MAY HAVE BEEN CLEAN
FROM ALCOHOL FOR 35 YEARS, BUT HE SMOKED HIMSELF TO DEATH.
SO HE WAS UNDER THE INFLUENCE OF A SUBSTANCE, EVEN THOUGH HE WAS
IN RECOVERY, AND HAD FOUNDED A MOVEMENT THAT HAS BENEFITED LOTS
OF PEOPLE. SO I GUESS THE QUESTION I HAVE
FOR THE REST OF THE PANELISTS, WHEN ARE WE GOING TO START TO
PAY ATTENTION TO HOW WE MEASURE THE OUTCOMES THAT ARE AS
IMPORTANT TO EFFECTIVE TREATMENT AS ANYTHING ELSE.
>>YOU KNOW, I THINK, IF I MAY, I THINK THERE’S ACTUALLY
EXCELLENT CONSENSUS NOW ABOUT HOW TO MEASURE OUTCOMES.
I MEAN, WE PRIMELY MEASURE SUBSTANCE — PRIMARILY MEASURE
SUBSTANCE ABUSE OUTCOMES. THE KIND OF MORE SUBTLE
QUALITIES OF LIFE, FOR EXAMPLE, ARE EXTREMELY DIFFICULT TO
MEASURE. AND WHETHER SOMEONE IS SATISFIED
WITH THEIR LIFE, OR WHETHER THEY FIND MEANING, OR THAT KIND
OF A THING. WE CAN MEASURE THAT IS KIND OF A
PROXY FOR THAT IS FUNCTION. SO EMPLOYMENT, ARE THEY MARRIED,
ABLE TO HAVE A RELATIONSHIP, YOU KNOW, ARE THEY FUNCTIONING
AT A GOOD LEVEL, YOU KNOW. THOSE ARE THE — SO IT IS A
COMBINATION OF SUBSTANCE USE AND HOW MUCH AND HOW OFTEN, AND IF
THEY STILL MEET CRITERIA FOR A DISORDER.
IN OTHER WORDS, IF SUBSTANCE USE IS STILL CAUSING IMPAIRMENT OR
DISTRESS, AND THEN FINALLY, THESE MEASURES OF FUNCTION, SUCH
AS, WELL, FREUD SAID, YOU KNOW, THE PURPOSE OF LIFE WAS TO LOVE
AND TO WORK. AND THAT’S KIND OF WHAT WE ARE
TALKING ABOUT HERE. >>I WOULD ADD THAT
CLIENT-CENTERED OUTCOMES I THINK SHOULD BE PARAMOUNT.
YOU DECIDED WHEN ABSTINENCE WAS NOT ENOUGH, AND YOU NEEDED TO
FOCUS ON RECOVERY. >>MM-HMM.
>>THAT WAS A PERSONAL DEFINITION.
I THINK WE OWE OUR CLIENTS, OUR PATIENTS, WHATEVER YOU CALL
THEM, THE RESPECT OF HAVING THEM TELL YOU WHAT IS A GOOD OUTCOME
FOR THEM, AND SIMILARLY, JUST AS YOU HAVE SAID, ABSTINENCE
DOES NOT NECESSARILY CONFER RECOVERY, YOU DON’T NECESSARILY
NEED TO STOP USING EVERYTHING AND ALL OF IT IN ORDER TO
IMPROVE YOUR LIFE. SOME PEOPLE WOULD HAVE BEEN
THRILLED WITH GETTING MARRIED, HAVING A HOUSE, HAVING A KID,
AND I THINK THAT NEEDS TO BE PART OF THE DISCUSSION HERE.
WE CAN’T WAIT UNTIL SOMEBODY ACHIEVES COMPLETE ABSTINENCE,
OUR DEFINITION OF A GOOD TREATMENT OUTCOME UNTIL WE ALLOW
THEM TO START WORKING ON THEIR LIVES.
I THINK THAT IS A VERY IMPORTANT POINT.
>>WELL, ANSWERED YOU MENTIONING BILL WILSON WAS ALSO A
MISERABLY UNHAPPY PERSON, AND A LOT OF THAT WAS PROBABLY
BIOLOGICAL. FROM WHAT I KNOW, HE SUFFERED
FROM HORRIBLE DEPRESSION. EE — WE DIDN’T HAVE MEDICATIONS
THAT WE HAVE NOW TO DEAL WITH THAT.
AND HE WAS — YOU KNOW, APPARENTLY MUCH OF THE TIME HE
WAS WRITING THE BIG BOOK, HE WAS SOBBING HIS WAY THROUGH IT, HIS
SECRETARY WOULD WALK IN AND FIND HIM WITH HIS HEAD DOWN ON
HIS DESK. AND IT EMPHASIZED TO ME, AND I
THINK YOU ALLUDED TO IT ONCE IN YOUR TALK, BUT THE INCREDIBLE
IMPORTANCE OF TREATING CO-OCCURRING MENTAL HEALTH
DISORDERS AT THE SAME TIME, THE THINKING FOR A LONG TIME, AND
STILL IS THAT MANY TREATMENT FACILITIES, WE HAVE TO DEAL WITH
THE SUBSTANCE USE DISORDER AS THE PRIMARY DISORDER, THEN WE’LL
DEAL WITH THE CO-OCCURRING DISORDER.
I MEAN, OBVIOUSLY YOU CAN’T WORK WITH SOMEBODY WHO’S DRUNK,
COMING INTO YOUR OFFICE EVERY WEEK, BUT, YOU KNOW, YOU CAN
TREAT BOTH DISORDERS AT THE SAME TIME, WHICHEVER ONE TAKES
PRECEDENCE AT THE TIME GENERALLY IS THE ONE THAT — IT SWITCHES,
THE ONE THAT YOU DEAL WITH FIRST.
BUT THEY CAN BE DEALT WITH CONCURRENTLY, AND THAT’S CALLED
INTEGRATED TREATMENT. AND THAT’S THE CURRENT APPROACH
THAT IS CONSIDERED TO BE PROGRESSIVE.
BUT WE’VE GOT TO DEAL WITH BOTH AT THE SAME TIME.
>>AND ON THAT POINT, WHEN I WENT TO TREATMENT AT HAZELDEN IN
1989, I CAME OUT TO MINNESOTA FROM NEW YORK, BECAUSE I HAD
OBVIOUSLY CAUSED A LOT OF PROBLEMS BACK THERE, AND I
NEEDED TO GO TO A GOOD PLACE, AND WE FOUND THIS PLACE CALLED
HAZELDEN. AT THE TIME, ALTHOUGH I DIDN’T
KNOW IT, ABOUT 10% OF THE PATIENTS WHO CAME TO WHAT WE
THEN CALLED RESIDENTIAL TREATMENT OR JISH PAIN —
INPATIENT TREATMENT PRESENTED WITH MENTAL HEALTH ISSUES OR
MENTAL ILLNESS. TODAY IT’S ABOUT 85%.
SOME OF THAT HAS TO DO WITH THE FACT THAT WE ARE BETTER AT
DIAGNOSING IT, BUT A LOT OF IT ALSO HAS TO DO WITH THE FACT
THAT PEOPLE ARE COMING TO TREATMENT WHO ARE A LOT SICKER
THAN THEY MIGHT HAVE BEEN IN THE OLD DAYS WHEN AA MIGHT HAVE
BEEN A WAY THAT PEOPLE COULD GET INTO A RECOVERY PROCESS WITHOUT
BEING TREATED FOR IT. IT’S NOT LIKE THAT ANYMORE.
>>ONE THING, I MEAN, YOU ARE RIGHT ABOUT WHO GOES TO REHAB,
BUT THAT’S TRUE FOR EVERY DISORDER.
SO THE PEOPLE WHO ARE IN — PEOPLE WHO HAVE ASTHMA WHO ARE,
YOU KNOW — SOME PEOPLE HAVE A LITTLE BIT OF ASTHMA, THEY GO TO
THE DRUG STORE AND GET SOME PRIMATEEN MIST, THEY ARE FINE.
THE NEXT GROUP GETS PRESCRIPTION INHALERS AT THE DOCTOR.
THEY DO FINE. THEN THERE IS THE GROUP THAT HAS
TO TAKE PRESENTED ANY SEWN, STEROIDS, THEY GET STEROID
DEPENDENT AND GET SICK. THEN THE GROUP THAT’S
HOSPITALIZED. THEN THE GROUP IN THE ICU ON A
VENTILATOR. SO PEOPLE IN REHAB, IN MANY
WAYS, ARE LIKE SOMEONE WITH ASTHMA IN THE ICU ON A
VENTILATOR, AND WHEREAS MOST PEOPLE IN THE COMMUNITY DON’T
HAVE ANYWHERE NEAR THE SAME SEVERITY OF DISORDER, OR ALL THE
CO-EXISTING DISORDERS. SO THERE IS A BIT OF WHAT WE
CALL THE CLINICIAN’S ILLUSION HERE, IT HAS TO DO WITH — AND
RESEARCH HAS BEEN — THE RESEARCHERS HAVE MADE THE SAME
MISTAKE, BY FOCUSING ON WHAT WE CALL CONVENIENCE SAMPLES, PEOPLE
IN REHAB, RIGHT, OR IN HOSPITALS, THEY ARE FOCUSING ON
THE SICKEST 5 OR 10%, AND IT IS ONLY UNTIL — ONLY MORE RECENTLY
THAT WE REALLY UNDERSTOOD THE EXTENT OF IT.
FOR EXAMPLE, 75% — IT’S 72%, BUT ABOUT THREE QUARTERS OF
PEOPLE WHO HAVE AN EPISODE OF ALCOHOL DEPENDENCE IN THIS
COUNTRY HAVE A SINGLE EPISODE THAT LASTS THREE OR FOUR YEARS
ON AVERAGE, AND THEN IT GOES AWAY AND IT NEVER COMES BACK.
THE MOST COMMON TREATMENT — THE MOST COMMON OUTCOME, RATHER, 20
YEARS AFTER TREATMENT, IS WHAT WE NOW CALL NON-ABSTINENT
RECOVERY. IT’S ABOUT 40% OF PEOPLE WHO ARE
DRINKING NOT VERY MUCH, NOT VERY OFTEN, THEY HAVE NO
ALCOHOL-RELATED PROBLEMS. THEN THE NEXT MOST COMMON
CATEGORY IS ABSTINENT RECOVERY, ABOUT A THIRD.
THERE IS ABOUT A QUARTER WHO ARE MUCH BETTER, BUT STILL HAVE
EPISODES OF DRINKING. AND THEN FEWER THAN 10% STILL
HAVE ACTIVE ALCOHOL DEPENDENCE. SO THE LONG-TERM — FOR EVERY —
THE ONLY THING — THE ONLY SUBSTANCE USE DISORDER WITH THE
LONG-TERM OUTCOME IS NOT GOOD, IS HEROIN ADDICTION.
I MEAN, HEROIN ADDICTION HAS A 50% MORTALITY RATE BETWEEN 25
AND 55 IF UOU — IF IT’S NOT TREATED APPROPRIATELY.
>>RIGHT.>>WITH ALL DUE RESPECT, I THINK
AS IMPORTANT AS IT IS TO DEFINE THE OUTCOMES, OUR GROUP HERE,
OUR AUDIENCE IS HERE TO FIGURE OUT WHAT KIND OF TREATMENT.
WHAT CONSTITUTES GOOD TREATMENT. AND I THINK, YOU KNOW, WE HAVE A
LITTLE BIT OF A DIVISION ABOUT EVIDENCE-BASED TREATMENT VERSUS
TREATMENT THAT IS NOT STUDIED. WHERE THERE IS NO KNOWN
EFFECTIVENESS. AND WHILE I RESPECT THE FACT
THAT MANY HAVE COME 0 — TO PLACES LIKE HAZELDEN AND DONE
WELL, THAT’S ONE METRIC, ONE WAY OF LOOKING AT IT.
YOUR ASTHMA EXAMPLE, EVERY LEVEL OF CARE HAS FDA APPROVAL.
HAS KNOWLEDGE BASES, HAS PHYSICIANS WHO KNOW THIS IS WHAT
THE EVIDENCE SAYS. DO PEOPLE TREAT OFF-LABEL, DO
THEY DO THEIR OWN THING? YES.
BUT WE HAVE IN EVERY OTHER MEDICAL CONDITION A KNOWLEDGE
BASE THAT IS BASED ON I AM PEER CAL EVIDENCE.
— EMPIRICAL EVIDENCE. IT DOESN’T MEAN THAT THE ONLY
THINGS WE STUDY ARE THE ONLY THINGS THAT WORK, BUT HOW ABOUT
MOVING ON AND THROWING AWAY THE OLD, TO USE YOUR TERM, OR THE
UNSTUDIED?>>YOU KNOW, WHEN I WAS WORKING
IN THE VA FOR A WHILE, I WAS THE FIRST CO-EDITOR OF THE VA AND
DEPARTMENT OF DEFENSE PRACTICE — EVIDENCE-BASED PRACTICE
GUIDELINE FOR THE MANAGEMENT OF SUBSTANCE USE DISORDERS.
WHAT WAS REALLY INTERESTING ABOUT THAT, THEY USE A VERY
RIGOROUS PROCESS ACROSS ALL DISORDERS, AND WHAT EMERGED FROM
THAT THAT WAS REALLY INTERESTING IS THAT THE EVIDENCE
BASE ACROSS THE CONTINUUM IN SUBSTANCE USE DISORDERS IS FAR
STONGER THAN IN MOST AREAS OF MEDICINE.
AND PEOPLE DON’T BELIEVE THAT. >>NO.
>>PEOPLE DON’T UNDERSTAND THAT.>>I DON’T THINK THIS AUDIENCE
WOULD BELIEVE THAT THE KOUT OUTCOMES FOR SUBSTANCE ABUSE
TREATMENT ARE ON PAR WITH ASTHMA, DIABETES, AND
HYPERTENSION. >>IT IS ACTUALLY BETTER.
>>AND BETTER. IRONICALLY, THE COMPLIANCE RATES
ARE BETTER. THE ONLY REASON WE HAVE SUCH
POOR OUTCOMES WITH OPIOID DEPENDENT PEOPLE, AND AGAIN THIS
SPEAKS TO THE ISSUE WITH OPIOID OVERDOSE DEATHS, IS THAT THERE
IS THE POOREST ACCESS TO THE MEDICATIONS THAT WORK FOR THAT
PROBLEM IN THAT AREA, BECAUSE PEOPLE HAVE VERY HEATED BELIEFS.
NOT SCIENCE, BUT BELIEFS ABOUT THE MEDICATIONS THAT ARE
PRESCRIBED FOR THOSE. IF WE HAD MORE ACCESS, WE WOULD
HAVE FEWER DEATHS. >>ON THAT NOTE, WE AT HAZELDEN
BETTY FORD HAVE HAD TO CHANGE OUR TREATMENT PROTOCOLS AS IT
RELATES TO OPIATES, AND WE SORT OF ARE DAMNED IF WE DO, DAMNED
IF WE DON’T, BECAUSE AS A TRADITIONAL ABSTINENCE-BASED
PROGRAM, WE REALIZE THAT OUR OPIATE PATIENTS, PARTICULARLY
THEY WERE DOING WELL IN TREATMENT, BUT THE MOMENT THEY
WERE DISCHARGED, THEY WERE DYING.
THEY WERE RELAPSING AND DYING. AND SO WE HAVE CHANGED THOSE
PROTOCOLS TO INCLUDE THE USE OF MEDICATION WHILE THEY ARE IN
TREATMENT, AND THEN DISCHARGING THEM ON THOSE MEDICATIONS IN A
GROUP SETTING, AMONG OTHER THINGS, NOT JUST LETTING THEM GO
AND SAYING HERE’S YOUR PRESCRIPTION, GOOD LUCK.
BUT WHEN WE STARTED IT DO THAT — TO DO THAT AND WORD OF THAT
BECAME PUBLIC, AN OLD-TIMER FRIEND OF MINE, I WHO I ACTUALLY
OWE PART OF MY LIFE TO, SAVING ME IN THE EARLY 90s, A
TRADITIONALIST IN THE RECOVERY PROGRAM THAT HE WORKS, ASKED ME
TO HAVE COFFEE WITH HIM IN ST. PAUL AFTER HE HAD READ THIS
PIECE ABOUT THE FACT THAT HAZELDEN BETTY FORD WAS USING
MEDICATION. AND I SAT DOWN WITH HIM AND HE
SAID, WILLIAM, YOU’RE RUINING AA!
I SAID, WELL, I COULDN’T DO THAT EVEN IF I WANTED TO, BUT I SAID
WHAT DO YOU MEAN? HE SAID YOU’RE DISCHARGING
PEOPLE INTO RECOVERY MEETINGS THAT ARE UNDER THE INFLUENCE.
SO I MEAN, YOU KNOW, LOOK, I KNOW HOW THE 12 STEPS WORK, AND
THEY WORK FOR A LOT OF PEOPLE, BUT AT THE SAME TIME THEY HAVE
BEEN — I DON’T WANT TO SAY A HINDRANCE, BUT THEY’VE BEEN A
CHALLENGE TO MOVE BEYOND EVEN AS WE UNDERSTAND MORE ABOUT THE
NATURE OF THIS ILLNESS AND HOW TO TREAT IT.
>>YOU KNOW, CARL JUNK — >>CAN I TIME US OUT?
I WANT TO INVITE OUR OTHER CONFERENCE PARTICIPANTS TO JOIN
THIS CONVERSATION. I REALLY DON’T WANT TO STOP IT,
SO IF I COULD JUST ASK YOU TO COME UP QUIETLY, YOU WILL GET
MIC’D UP, AND WE WILL JUST CONTINUE.
SO AUDIENCE, PLEASE BE QUIET AND RESPECTFUL.
BACK TO MARK WILLENBRING.>>CARL JUNG SAID SAVE ME FROM THE JUNGIANS.
SO IT’S VERY — IT’S ALMOST UNIVERSAL WHEN YOU HAVE
CHARISMATIC LEADERS WHO FORM AN ORGANIZATION, WHETHER THAT’S
JESUS OR MOHAMMED, OR THE BUDDHA OR CARL JUNG OR DR. BOB, YOU
KNOW, THE FOLLOWERS FREQUENTLY START TO DISTORT AND GET RIGID,
OVERLY RIGID, YOU KNOW, THINK OF HOW MANY PEOPLE HAVE BEEN
KILLED IN THE NAME OF CHRISTIANITY OR ISLAM.
>>RIGHT.>>IT SHOULD BE KNOWN THAT AA
TAKES NO OFFICIAL POSITION ON MEDICATIONS.
SO THAT’S NOT AA’s POSITION. >>ACTUALLY, THE BIG BOOK SAYS
TALK TO YOUR DOCTOR AND WE SHOULD NOT INTERFERE.
>>RIGHT.>>IF YOU FOLLOW THE ACTUAL BIG
BOOK. >>I THINK IT SHOULD ALSO BE
SAID, TOO, THAT, AND IT’S ONE OF THE REASONS I SUGGESTED
MICHAEL, DR. PANTALON FOR THE PANEL, I —
IT WAS INTERESTING, AND IT ACTUALLY IS A WAY I GOT HELP FOR
AN ALCOHOL PROBLEM MANY YEARS AGO, I WAS TALKING WITH DR.
MCCLELLAN ABOUT, YOU KNOW, THE MANY DIFFERENT ROUTES TO
RECOVERY, AND HE SAID — AGAIN, THE CO-FOUNDER OF TREATMENT
RESEARCH INSTITUTE IN PHILADELPHIA, AND HE SAID WE
HAVE NO IDEA HOW MUCH ALCOHOL TREATMENT, OR SUBSTANCE USE
TREATMENT GOES ON BEHIND THE CLOSED DOORS OF AN INDIVIDUAL
THERAPIST. AND IN FACT, IT’S PROBABLY MORE
THAN OTHER ROUTES. BUT I DON’T KNOW THAT THERE ARE
ANY DATA TO SUPPORT THAT. I DON’T KNOW IF WE KNOW.
I THINK THERE HAVE BEEN A FEW STUDIES THAT HAVE LOOKED AT
THAT. BUT WHEN PEOPLE COME TO ME, I
KNOW WHEN I WAS INTERVIEWED BY JANE BODEY FOR THE “NEW YORK
TIMES” BEFORE I WAS READY FOR INTERVIEWS, THE BOOK WASN’T EVEN
DONE, AND SHE SAID TO ME, OKAY, I HAVE SOMEBODY RIGHT HERE,
RIGHT NOW, SHE WAS JUST MAKING UP A CASE, AND THEY COME TO YOU
AND THEY SAY “I GOT A KID, A YOUNG ADULT KID, AND HE NEEDS
HELP, AND WHAT SHOULD I DO.” I’M LIKE, OH, MY GOD, I AM NOT
READY FOR INTERVIEWS. AND I SAID, WELL, ASSUMING IT’S
NOT A REAL SEVERE CASE, WHERE THE PERSON NEEDS TO GO INTO
DETOX, MY FIRST BIT OF ADVICE WOULD BE TO GET AN INDEPENDENT
ASSESSMENT, TRY TO FIND SOMEBODY IN YOUR TOWN WHO HAS EXPERTISE
WITH DRUG AND ALCOHOL PROBLEMS, WHO’S NOT AFFILIATED WITH A
SPECIFIC TREATMENT PROGRAM SO THAT YOU GET AN UNBIASED
ASSESSMENT OF HOW BAD THAT PROBLEM IS, AND GET THEIR
OPINION ABOUT WHETHER OR NOT THEY NEED TO GO TO A TREATMENT
FACILITY. YEAH, GRANTED THEY MAY HAVE SOME
INVESTMENT ABOUT ADMITTING THAT PERSON TO THEIR PRIVATE
PRACTICE, BUT USUALLY EVERYBODY THAT I KNOW OF IS ALREADY FULL
AND YOU HAVE TO WAIT TWO MONTHS TO GET AN APPOINTMENT ANYWAY.
ANYWAY, GET AN INDEPENDENT ASSESSMENT, AND THERE ARE, I
MEAN, I CAN THINK OF MULTIPLE PEOPLE IN MANKATO WHO ARE IN
PRIVATE PRACTICE WHO HAVE EXPERTISE WITH SUBSTANCE USE
DISORDERS AND CO-OCCURRING MENTAL HEALTH PROBLEMS AT THE
SAME TIME. SO THERE’S LOTS OF TREATMENT
GOES ON THAT WAY. >>TO ADD TO THAT, ASK THEM WHAT
PSYCHOTHERAPIES THEY PRACTICE. USE ANNE’S BOOK.
GO TO THE BACK, THERE ARE A LIST OF QUESTIONS.
GRILL THEM ABOUT WHAT APPROACHES THEY USE AND FIND AN ADDICTION
PSYCHIATRIST WHO PRE DESCRIBES THOSE MEDICATIONS.
>>WILLIAM WANTED TO JUMP IN HERE.
>>JUST WANT TO SAY SOMETHING, THEN I WILL BE QUIET THE REST OF
THE HOUR, I PROMISE. >>PLEASE DON’T.
>>HERE’S THE THING. TO ANNE’S POINT, AND THIS IS THE
GREAT MYSTERY OF IT ALL, TO ME, WHO IS MORE OF A LAYMAN THAN
ANYBODY ELSE HERE, BECAUSE I DON’T HAVE THE PROFESSIONAL
EXPERTISE LIKE ALL OF YOU DO, BUT I THINK THE MALL EXPERIENCE
THREE DAYS AGO WAS A MICROCOSM OF THIS BIGGER, GREAT MYSTERY
THAT I LOVE TO DELVE INTO, WHICH IS THE FEDERAL GOVERNMENT A FEW
YEARS AGO DID SOME SORT OF SURVEY WHICH FOUND THAT ROUGHLY
23 TO 25 MILLION PEOPLE IN THIS COUNTRY CONSIDERED THEMSELVES TO
BE IN RECOVERY FROM SOME KIND OF SUBSTANCE USE PROBLEM.
WELL, THE 12-STEP MOVEMENT SAID THAT THEY HAVE ROUGHLY ONE TO
TWO TO THREE MILLION ACTIVE MEMBERS IN THEIR MEETINGS ON A
REGULAR BASIS, SO THE QUESTION IS, WHERE ARE THE REST OF US?
HOW ARE WE — HOW DID WE GET INTO THIS THING, AND HOW ARE WE
CONTINUING TO DO IT. I THINK THAT’S THE GREAT
MYSTERY. IF WE CAN TAP THOSE OTHER 22
MILLION PEOPLE, WE’LL HAVE ALL THE ANSWERS WE NEED TO TREATMENT
AND RECOVERY. >>THEY ARE NOT IN TREATMENT.
VERY FEW PEOPLE ARE IN TREATMENT.
FEWER STILL EVIDENCE-BASED TREATMENT.
SO I THINK THAT TELLS US SOMETHING ABOUT WHAT TREATMENT
IS AVAILABLE TO THEM THAT THEY PERCEIVE IS AVAILABLE TO THEM,
AND WHAT TREATMENT IS NOT. >>YOU KNOW, I THINK IT IS
REALLY IMPORTANT TO REALIZE THAT THE SYSTEM WILL DEFINE WHO THE
TREATMENT-SEEKERS ARE. SO IF YOU HAVE A SYSTEM LIKE WE
DO NOW WHERE THE VAST MAJORITY OF FACILITIES ARE FOCUSED ON
VERY ILL, YOU KNOW, VERY COMPLICATED AND KIND OF
INTRACTABLE CASES, THAT’S WHO YOU ARE GOING TO SEE.
AND — BUT IT’S SORT OF LIKE WE SAW WITH THE INTRODUCTION OF
PROZAC IN 1988, WITH DEPRESSION. WHERE BEFORE THAT, I MEAN, IF
YOU HAD DEPRESSION, YOU COULD GO TO THE STATE HOSPITAL, YOU
WOULD GET COMMITTED FOR 6 TO 12 MONTHS, YOU GET ELECTROSHOCK
THERAPY AND THORAZINE AND NOT MANY WENT.
SPENT SIX MONTHS IN BED BEING DID DEPRESSED RATHER THAN DO
THAT. WHEN PROZAC CAME ALONG AND THERE
WAS A WHOLE CONSTELLATION, I THINK, OF FACTORS THAT CREATED
WHAT I CALL THE PROZAC MOMENT, ALL OF A SUDDEN PEOPLE COULD GO
TO THEIR PRIMARY CARE DOCTOR, AND I THINK THE PENETRATION, AND
THE CHARACTERISTICS OF THE PEOPLE SEEKING TREATMENT CHANGED
DRASTICALLY. AND I’M SEEING THAT NOW IN MY
PRACTICE, BECAUSE IT’S ATTRACTING ALL THESE MORE
FUNCTIONAL FOLKS, WHO ARE COMPLETELY DIFFERENT.
NONE OF THEM, YOU KNOW, MOST OF THEM HAVE NEVER BEEN TO REHAB,
WOULDN’T GO. >>EXACTLY.
>>IT WOULDN’T FIT. THEY WOULDN’T FIT.
>>WOULDN’T NEED IT NECESSARILY.>>OWEN, DID YOU AND I GIVE EACH
OTHER A LOOK THAT SAID I HAVE GOT A QUESTION?
>>YES. SO YEAH, THAT WAS VERY, VERY
INFORMATIVE FROM THE AUDIENCE, THANK YOU ALL SO MUCH.
I HAVE JUST A QUESTION TO SEEK YOUR WISDOM ON, THERE’S BEEN A
LOT OF MENTION ABOUT THE SORT OF CO-OCCURRING CONDITIONS, AND
THE INCREASE IN THE LARGE NUMBER OF PEOPLE WHO NOW COME IN.
SO BUT THIS IS RELATED TO SORT OF A SEPARATE DEBATE THAT’S
GOING ON ABOUT THE PROLIFERATION OF MENTAL HEALTH — MENTAL
ILLNESS DIAGNOSIS IN GENERAL. SOME PEOPLE SAY WITH DSM4, BUT
ESPECIALLY DSM5, IT IS GUARANTEED THAT YOU ARE IN
THERE. [ LAUGHTER ]
AND I WAS THERE, IN FACT, MY SON WAS ONE OF THE VERY FIRST
PEOPLE TO BE DIAGNOSED WITH ADHD, AND THEN THE FLOODGATES
OPENED, AND THERE WAS A BIG DISCUSSION ABOUT THE MALL ADDY
CALLED BOYHOOD, OR WHETHER IT IS A REAL THING.
AND WE KNOW — SO I GUESS I JUST HAVE A QUESTION ABOUT, I MEAN,
THERE IS ANOTHER ISSUE ABOUT INFLATION OF DIAGNOSES OF
NEGATIVE MENTAL STATES OR ILLNESSES, OR PROBLEMS ON THE
ONE HAND. SO I WORRY ABOUT A CONFIRMATION
KIND OF BIAS THAT WE ARE JUST LOOKING FOR THAT ALWAYS, AND WE
OF COURSE WILL SEE THAT IF WE LOOK FOR IT.
I WONDER HOW YOU FEEL ABOUT THAT.
>>YOU KNOW, THE MAJOR MENTAL ILLNESSES HAVEN’T CHANGED.
DEPRESSION IS ON THE RISE WORLDWIDE.
THE PREVALENCE OF DEPRESSION. >>IS IT THE PREVALENCE OF
DEPRESSION OR THE DIAGNOSIS CRITERIA?
>>I THINK IT’S TRUE PREVALENCE. THE DIAGNOSTIC CRITERIA REALLY
HAVEN’T CHANGED SUBSTANTIALLY. DIFFERENT STUDIES USING
DIFFERENT, YOU KNOW, DIFFERENT APPROACHES HAVE FOUND THE SAME
THING. BUT THE MAJOR MENTAL ILLNESSES,
LIKE SCHIZOPHRENIA AND BIPOLAR DISORDER, HAVE PRETTY MUCH THE
SAME PREVALENCE AROUND THE WORLD.
SO, YOU KNOW, WHICH I THINK WHERE IT GETS FUZZIER IS WITH
ANXIETY DISORDERS, WITH ADHD, WITH SOME OF THE — ON THE
MILDER END, THE MORE FUNCTIONAL END OF THE SPECTRUM, BUT THE —
AND CERTAINLY THE CHANGE BETWEEN DSM4 AND DSM25 IN SUBSTANCE USE
DISORDER DIAGNOSES, INCREASED THE PROPORTION OF PEOPLE WHO MET
CRITERIA QUITE DRAMATICALLY, AND THEY DID SO PRIMARILY BY
PICKING UP WHAT USED TO BE CALLED DIAGNOSTIC ORPHANS, WHERE
THEY WOULD MEET ONE OR TWO CRITERIA FOR ALCOHOL DEPENDENCE,
BUT NOT — AND YOU NEEDED THREE.
SO NOW THEY ARE PICKING THOSE UP.
SO AND SO YOU HAVE TO TAKE THOSE THINGS INTO CONSIDERATION.
BUT I THINK WE ARE TALKING MOSTLY ABOUT PEOPLE THAT HAVE
PRETTY SEVERE MENTAL DISORDERS. >>WHAT WAS THE STATISTIC YOU
GAVE? 85%?
>>IN 1989, IT WAS ABOUT 1 IN 10 OF THE PATIENTS WHO CAME TO THE
FRONT DOOR PRESENTED, AND TODAY IT’S 75 TO 80%.
I WILL TELL YOU, TOO, THAT I AM NOT A PSYCHOLOGIST OR
PSYCHIATRIST, SO I REALLY DON’T KNOW IF IT’S BETTER OR WORSE,
BUT WITH THE WARS IN AFGHANISTAN AND IRAQ OF THE LAST 10, 12
YEARS, WE’RE SEEING A LOT OF VETERANS COMING BACK WITH PTSD.
THERE’S NO DOUBT THEY GOT PTSD AND THEY ARE MEDICATING IT
BEFORE THEY GET HELP WITH ALCOHOL OR OTHER DRUGS.
>>MARK?>>THIS IS FOR DR. WILLENBRING.
I DON’T THINK I HAVE EVER HEARD A TALK THAT I AGREED WITH AS
MUCH AND DISAGREED WITH AS MUCH BOTH.
A LOT OF THE STUFF YOU SAY REALLY RESONATES FOR ME, AND
SOME REALLY DOESN’T. SO YOU SAY THINGS ABOUT THE
REHAB INDUSTRY, ABOUT HOW INEFFECTIVE IT IS, HOW IT SUCKS,
IT LIES TO PATIENTS. ALL THAT STUFF I AGREE.
BUT YOU WANT MORE MONEY FOR RESEARCH, AND WE KNOW THAT MOST
OF THE RESEARCH MONEY IS SPENT BY NIDA, BY THE NATIONAL
INSTITUTE ON DRUG ABUSE. AND 90% OF THE RESEARCH IN THE
WORLD IS IN DRUG ABUSE, IS CONDUCTED BY NIDA AND THEY
ENDORSE THE DISEASE MODEL OF ADDICTION.
SO YOU WANT MORE MONEY TO SUPPORT RESEARCH WHICH IS —
SUPPORTS THE DISEASE MODEL WHICH IS THAT ENDORSED BY THE REHAB
INDUSTRY, WHICH DOESN’T WORK AT ALL.
>>THEY ENDORSE A DIFFERENT DISEASE MODEL.
THE REHAB DISEASE MODEL, WHICH IS MORE THE 12-STEP DISEASE
MODEL, IS SIGNIFICANTLY DIFFERENT THAN THE BIOLOGICAL,
PSYCHOLOGICAL, SOCIAL DISORDER THAT WE ARE TALKING ABOUT IN THE
DSM. SO WHILE I KNOW THAT YOU HAVE —
YOU WOULD TAKE CONTENTION WITH BOTH TYPES, IT IS NOT A
CONTRADICTION, AS I SEE IT. >>I THINK YOU ARE RIGHT, AND
THAT MIGHT HELP SOLVE. SO OBVIOUSLY THE KIND OF DISEASE
MODEL THAT WILLIAM IS DESCRIBING IS NOT THE SAME AS
THE KIND THAT YOU ARE DESCRIBING.
BUT LET ME JUST GO ONE MORE POINT, AND THEN YOU CAN ANSWER
AS LONG AS YOU WANT. THAT IS THAT YOU FORESEE A
TREATMENT APPROACH BASED ON COMMUNITY SUPPORT AND EVENTUALLY
INTERNET-BASED CONNECTION BETWEEN PEOPLE, AND YET YOU ALSO
WANT IT TO BE DISPENSED BY PRIMARY CARE PHYSICIANS, WHO,
FROM WHAT I UNDERSTAND ABOUT THE MEDICAL PRACTICE IN THE U.S.,
ARE CHARGING HUGE AMOUNTS OF MONEY THAT HAS TO THEN BE
APPROVED BY AN INSURANCE INDUSTRY, WHICH DOESN’T SOUND
ANYTHING LIKE THE COMMUNITY. >>OKAY.
SO THAT WAS A COMPLEXION — A
COMPLEX OF IDEAS THAT YOU ADDRESSED.
FIRST OF ALL, I WOULD COMPLETELY AGREE WITH DR. PANTALON IN
TERMS OF THE DIFFERENCE IN DISEASE MODEL.
I CALL THE OLD SORT OF AA 12-STEP DISEASE MODEL THE
PNEUMONIA MODEL. YOU HAVE SOMETHING HIGHLY
SPECIFIC, YOU GO INTO THE HOSPITAL, YOU GET HIGHLY
SPECIFIC TREATMENT, YOU ARE CURED.
>>YES. >>AND WHAT WE ARE REALLY
TALKING ABOUT IS, YOU NO HE, THE WHOLE ISSUE OF — YOU KNOW, THE
WHOLE ISSUE OF BRAIN-BASED BEHAVIORAL ILLNESS, AND I KNOW
YOU WOULD OBJECT TO BRAIN-BASED, BUT BEHAVIORAL ILLNESSES, LET’S
SAY. AND THE — AND THOSE CAN BE —
ONE OF THE THINGS I DIDN’T HAVE A CHANCE TO TALK ABOUT IS WE ARE
UNDERUSING PUBLIC HEALTH APPROACHES THAT COULD PROBABLY
HELP MANY, MANY MORE PEOPLE THAN ANY KIND OF TREATMENT.
>>YOU BET. YEAH.
>>AND IN FACT, MORE — IN FACT, MOST OF THE MORTALITY AND
PREMATURE MORBIDITY IN THIS COUNTRY COMES FROM PEOPLE WHO
DRINK IN A BINGE FASHION, BUT DON’T MEET CRITERIA FOR A
DISORDER. >>YEAH.
>>SO WE HAVE THIS HUGE PUBLIC HEALTH PROBLEM THAT WOULD BE
BEST ADDRESSED WITH PUBLIC HEALTH, MAINLY LIKE RAISING
TAXES ON ALCOHOLIC BEVERAGES. SO WE ARE REALLY IGNORING THOSE
AND SO, BUT I’M JUST TALKING ABOUT THE — IN TERMS OF THE
MEDICAL ASPECT, YOU KNOW, WHEN I WAS A RESIDENT, THERE WAS AN
ARGUMENT GOING ON BETWEEN PSYCHO ANALYSTS —
>>MARK, COULD I ASK YOU TO SPEAK CLEARLY?
I AM HAVING A HARD TIME. >>SURE.
IS THAT BETTER?>>YES, THANK YOU.
>>THIS POSITION. SO WHEN I WAS A RESIDENT MANY
YEARS AGO, THERE WAS AN ARGUMENT GOING ON AT THE TIME BETWEEN
PSYCHOANALYSTS AND PSYCHOFARM KOL GISTS.
— PSYCHOPHARMACOLOGISTS ABOUT THE TREATMENT OF DEPRESSION.
PSYCHOANALYSTS ARGUE, NO YOU SHOULD NOT GIVE THEM MEDICATION,
BECAUSE IT WILL DESTROY THEIR MOTIVATION FOR EXAMINING AND
RESOLVING THEIR CONFLICTS IN PSYCHOANALYSIS.
WHICH ACTUALLY TURNS OUT NOT TO BE EFFECTIVE FOR DEPRESSION.
BUT — IT REMINDS ME VERY MUCH OF THIS DICHOTIMIIZATION WE ARE
EXPERIENCING HERE. MEDICATIONS ARE SIMPLY TOOLS
THAT ADDRESS SOME ASPECT OF THE PHENOMENONOLOGY.
>>MEDICATION IS REALLY ONLY ACCURATE FOR OPIATE ADDICTS, AND
MAYBE FOR A WEEK OR SO FOR EXTREME ALCOHOLICS.
>>NO, NO, NO. >>I MEAN, NO —
>>WHAT KIND OF MEDICATION ARE YOU GOING TO GIVE COKE ADDICTS,
SEX ADDICTS, METHAMPHETAMINE ADDICTS, YOU KNOW.
>>WHERE WE HAVE GOOD MEDICATIONS, WHERE WE HAVE GOOD
MEDICATIONS ARE FOR ALCOHOL AND OPIOID USE DISORDERS AND FOR
SMOKING. WE DON’T HAVE GOOD MEDICATIONS
NOW FOR STIMULANTS OF ANY TYPE. AND WE, FOR THE MOST PART, DON’T
HAVE MEDICATIONS FOR WHAT YOU CALL, YOU KNOW, BEHAVIORAL
COMPULSIONS THAT DON’T INVOLVE SUBSTANCES.
>>I WOULD LIKE TO BRING OUR FOCUS SO THAT WE MAY ADDRESS
SOME OF THE DEPARTING COLLEGE STUDENTS AND HIGH SCHOOL
STUDENTS. THE BINGE DRINKERS, OKAY.
SO WE’RE HERE TO TALK ABOUT TREATMENT, BUT YOU DON’T JUST
TREAT PEOPLE WHO ARE AT THE FAR END OF THE SEVERITY SPECTRUM.
YOU TREAT PEOPLE ALONG THE WAY. YOU MAY CALL IT PREVENTION, BUT
I CALL IT TREATMENT. IF YOU HAVE MILD ASTHMA, OR IF
YOU ARE MOVING TOWARDS IT, THERE ARE THINGS YOU CAN DO.
BINGE DRINKERS ARE MOVING TOWARDS AN ALCOHOL-USE DISORDER.
SO FOR THE BINGE DRINKERS, WE ARE NOT HERE TO SEND THEM TO
REHAB, DO AN INTERVENTION OR SAY THAT THEY HAVE TO COMPLETELY
STOP DRINKING. LET’S MEET THEM WHERE THEY ARE
AND HELP THEM TO REDUCE. TEACH YOUR CHILDREN, TEACH THE
STUDENTS HERE, THAT YOU KNOW, NO MORE THAN SEVEN DRINKS A WEEK,
OR MORE THAN FOUR ON OCCASION FOR A WOMAN, NO MORE THAN 14
DRINKS A WEEK, AND NO MORE THAN FOUR ON AN OCCASION FOR A MAN IS
WHAT IS CONSIDERED LOW-RISK DRINKING.
HOW MANY PEOPLE KNOW THAT? WHEN PEOPLE EXCEED THOSE LIMITS,
THERE ARE EVIDENCE-BASED STUDIED TREATMENTS TO BRING
THOSE LEVELS TO LOW RISK AMOUNTS, WHICH THEN MAKES IT
LESS LIKELY THAT THEY WILL END UP BECOMING AN ALCOHOLIC DOWN
THE ROAD. SO THERE ARE A RANGE OF
TREATMENTS ALONG THIS ENTIRE SPECTRUM.
>>FOR EXAMPLE, THE MEDICATION NALTREXONE, WHICH BLUNTS THE
EFFECT OF ALCOHOL, HAS BEEN SHOWN IN RELATIVELY LOW DOSE TO
REDUCE BINGE DRINKING AMONG COLLEGE STUDENTS.
IT MAKES IT EASIER TO DO. >>SO NALTREXONE HAS BEEN AROUND
FOR 40 YEARS, AND NAL OBJECTION OWN — NALOXONE, 40, 50 YEARS.
YOU ARE BASICALLY TALKING ABOUT THE PROBLEMS THAT HAVE TO DO
WITH — YOU ARE, THESE MEDICATIONS, THERE IS A
PSYCHOLOGICAL OVERLAY, HANG ON. THERE IS A PSYCHOLOGICAL
OVERLAY, IF YOU CAN HELP TO RELIEVE PHYSICAL SUFFERING, OF
COURSE THAT’S GOING TO ASSIST THE PROCESS OF PSYCHOLOGICAL
ADJUSTMENT, BUT I MEAN, WHAT OTHER SORTS OF MEDICATIONS ARE
YOU LOOKING FOR, GIVEN THAT ADDICTION IS PRIMELY A
PSYCHOLOGICAL — PRIMARILY A PSYCHOLOGICAL PROBLEM?
>>IT IS MUCH MORE COMPLEX. I THINK IF WE’VE SHOWN ANYTHING
OVER THE LAST TWO DAYS, WE CAN SAY — WE CAN’T SAY IT IS THIS
ONE SINGLE THING. ITS A LOT OF DIFFERENT THINGS
THAT NEEDS A LOT OF HELP FROM MULTIPLE ANGLES.
I THINK, TELL ME HOW YOU ALL FEEL ABOUT IT, THAT THE NUMBER
ONE PROBLEM IN TERMS OF ADDICTION IS THE LACK OF
KNOWLEDGE AND ACCESS TO EVIDENCE-BASED TREATMENT.
>>HEAR, HEAR.>>THAT IS THE NUMBER ONE THING.
IF WE — IF YOU LEAVE HERE WITH ONLY ONE THING, FROM MY
PERSPECTIVE, SO WITH ALL DUE RESPECT, IS THAT THERE IS MUCH
MORE SCIENCE ON WHAT WORKS OUT THERE, AND THAT YOU — YOU GOT
TO GRILL PEOPLE IN YOUR COMMUNITY TO EITHER GIVE IT TO
YOU, OR FIGURE IT OUT, OR FIND AN EXPERT AND BRING THEM IN.
YOUR PRIMARY CARE DOCTOR SHOULD BE ABLE TO HELP YOU WITH YOUR
KIDS IN TERMS OF SUBSTANCE USE PROBLEMS, OR ADDICTION.
>>AND THERE ARE GOOD BEHAVIORAL THERAPIES.
>>YES.>>AND THEY ARE BEST COMBINED,
OR SOMETIMES THAT’S ALL PEOPLE NEED.
AND I REALLY THINK THE FUTURE IS IN MUCH MORE DIRECT
INTERVENTION WITH IMPLICIT COGNITION.
>>YES. I LIKE THAT.
I AGREE WITH THAT A LOT. >>SO I’M NOT A REDUCTIONIST.
THAT WAY. BUT WHY SHOULD — IF THERE WAS A
MEDICATION AVAILABLE THAT MAKES IT EASIER FOR PEOPLE TO ACHIEVE
THEIR GOALS, PSYCHOLOGICAL GOALS AND SOCIAL GOALS, WHY
SHOULD THEY NOT HAVE ACCESS TO THAT?
>>I AM JUST SAYING, MINDFULNESS, WHICH IS BACK, BY
THE WAY, ONE OF THE MOST EFFECTIVE TREATMENTS, HAS BEEN
AROUND FOR 2500 YEARS, SO I’M NOT — YOU KNOW, THIS IS NOT
LIKE WE DON’T NEED — I JUST DON’T THINK WE NEED NEW RESEARCH
INTO THE SORTS OF THINGS YOU’RE TALKING ABOUT AS MUCH AS WE
NEED A REAL SHIFT, A MAJOR, MAJOR 180 DEGREE SHIFT IN THE
WAY WE THINK ABOUT ADDICTION, THE WAY WE DEFINE IT.
>>AND I AM GOING TO TAKE A LITTLE MODERATOR DISCRETION AND
SAY THANK YOU TO EVERYONE WHO HAS PARTICIPATED IN THIS
CONFERENCE, FROM THE ORGANIZERS ORGANIZERS —
[ APPLAUSE ]>>OUR DINING SERVICE, OUR
PHYSICAL PLANT, WHO HAS MADE THIS ROOM IMMACULATE, TO ALL THE
MULTI-MEDIA, TO ALL THE STUDENTS WHO HAVE ACTED AS
HOSTS. YOU’RE THE BEST!
[ APPLAUSE ] AND TO SPEAK AND SAY THANK YOU
FROM MANY OF MY FRIENDS WHO ARE ADDICTED, AND I MYSELF AM
ADDICTED, TO SAY IT HAS BEEN INCREDIBLY EMPOWERING TO SEE
THIS ROOM FILLED WITH PEOPLE WHO CARE.
SO THANK YOU. [ APPLAUSE ]>>AND I REMIND YOU THAT IF YOU
HAVE A TICKET FOR THE BABB — BANQUET THAT BEGINS AT 6:30,
MARK LEWIS IS OUR BANQUET SPEAKER.
HIS TALK WILL BE AT 7:30. IT WILL BE STREAMED, SO IF YOU
DON’T HAVE A TICKET, YOU MAY WATCH IT IN ALUMNI HALL IN THE
OJ JOHNSON — I ALMOST SAID OJ SIMPSON, OJJOHNSON —
[ LAUGHTER ]>>STUDENT UNION.
AND MAY THIS CONFERENCE HAVE PLANTED SOME SEEDS AS PRESIDENT
BERGMAN SAID IN HER OPENING COMMENTS, ABOUT WHAT WE CAN DO.
SO STAY WELL.

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