Highway to Heroin

Highway to Heroin


– HELLO, AND THANKS FOR TUNING
IN TO THIS CADCA TV SHOW, “EXPLORING THE LINK:
DRUG USE AND MENTAL HEALTH.” I’M MARY ELIZABETH ELLIOTT, VICE PRESIDENT
OF COMMUNICATIONS, MEMBERSHIP, AND I.T. AT CADCA: COMMUNITY ANTI-DRUG COALITIONS
OF AMERICA. RESEARCH HAS SHOWN PEOPLE OFTEN
STRUGGLE WITH SUBSTANCE USE AND MENTAL HEALTH ISSUES
AT THE SAME TIME. THEY CAN BE LINKED TOGETHER, YET AS FAR AS PREVENTION
AND TREATMENT ARE CONCERNED, THEY’RE OFTEN HANDLED
QUITE DIFFERENTLY. THREE EXPERTS ARE WITH ME TODAY TO HELP EXPLAIN IT ALL. PAMELA HYDE IS THE ADMINISTRATOR
FOR THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION KNOWN AS SAMHSA. SAMHSA IS PART
OF THE UNITED STATES DEPARTMENT OF HEALTH
AND HUMAN SERVICES, AND THE AGENCY’S MISSION
IS TO REDUCE THE IMPACT OF SUBSTANCE ABUSE
AND MENTAL ILLNESS ON AMERICA’S COMMUNITIES. WELCOME. DR. JOHN KNIGHT IS AN ASSOCIATE PROFESSOR
OF PEDIATRICS AT HARVARD MEDICAL SCHOOL AND FOUNDER OF THE CENTER FOR ADOLESCENT
SUBSTANCE ABUSE RESEARCH AT BOSTON CHILDREN’S HOSPITAL. AND ELLEN MOREHOUSE IS A
LICENSED CLINICAL SOCIAL WORKER WHO DIRECTS A COMMUNITY-BASED SUBSTANCE ABUSE
AND BULLYING PREVENTION AGENCY AND IS ACTIVELY INVOLVED IN SEVERAL SUBSTANCE ABUSE
PREVENTION COALITIONS. SO WELCOME, EVERYONE. THANK YOU FOR YOUR TIME TODAY. WE’RE GONNA START
WITH SOMETHING FOR ALL OF YOU, AND IT REALLY IS, BECAUSE YOU ALL HAVE
DIFFERENT PERSPECTIVES ON THIS. WHERE–IN YOUR WORLD, HOW DO YOU
SEE DRUG USE AND MENTAL HEALTH, AND HOW DO THEY COEXIST? I’M GONNA START WITH YOU, JOHN. – I THINK THEY’RE
FULLY INTERTWINED NOW. I SEE IT IN MY CLINICAL WORK
ALL THE TIME. IN OUR OUTPATIENT SUBSTANCE ABUSE TREATMENT
PROGRAM FOR ADOLESCENTS, CO-OCCURRING DISORDERS ARE
THE RULE, NOT THE EXCEPTION. ALMOST 90% OF THE YOUNG PEOPLE WHO ARE ADMITTED
TO OUR OUTPATIENT PROGRAM FOR AN ASSESSMENT HAVE AT LEAST
ONE CO-OCCURRING DISORDER– MAJOR DEPRESSION, P.T.S.D.,
A.D.H.D., ANXIETY DISORDERS– IT RUNS THE GAMUT. AND THEN WE HAVE
GREATER THAN 60% THAT HAVE TWO OR MORE
CO-OCCURRING DISORDERS. THE GOOD NEWS
IS THAT OUR RESEARCH SHOWS THAT IT DOESN’T INHIBIT
TREATMENT. IT’S NOT–IT DOESN’T MAKE YOU
AT HIGHER RISK. AS LONG AS BOTH ARE TREATED
SIMULTANEOUSLY, THE OUTCOMES ARE VERY GOOD. IN FACT, THE KIDS WHO HAVE
MULTIPLE DISORDERS DO A LITTLE BIT BETTER
IN OUR PROGRAM PROBABLY BECAUSE
THEY’RE IN MORE DISTRESS, AND THEY’RE HIGHLY MOTIVATED
TO GET INTO TREATMENT. – AND CO-OCCURRING DISORDERS
JUST MEANS THAT YOU’VE GOT TWO DISORDERS HAPPENING
AT THE SAME TIME SIMPLY. – CORRECT.
– OKAY. AND, ELLEN, IN YOUR WORLD, HOW DO YOU ADDRESS THESE TWO? – WELL, IT’S DIFFERENT THAN
JOHN’S WORLD. WHEREAS JOHN RUNS
A TREATMENT PROGRAM, I DIRECT A PREVENTION AGENCY THAT PROVIDES PREVENTION
SERVICES IN SECONDARY SCHOOLS– MIDDLE AND HIGH SCHOOLS– AND WE FIND THAT MOST OF
THE STUDENTS THAT USE SUBSTANCES DO NOT HAVE
MENTAL HEALTH ISSUES. WE DO SEE SOME
THAT ARE MEDICATING FOR MENTAL HEALTH ISSUES, AND WE SEE SOME STUDENTS
THAT HAVE MENTAL HEALTH ISSUES THAT WIND UP SELLING
OR TRADING THEIR DRUGS– THEIR PSYCHOTROPIC DRUGS– FOR STREET DRUGS. AND SOMETIMES STUDENTS
WHO HAVE MENTAL HEALTH ISSUES DRINK OR USE OTHER DRUGS
TO FIT IN. BUT MOST OF THE STUDENTS WE SEE
THAT HAVE SUBSTANCE ABUSE USE DO NOT HAVE
MENTAL HEALTH PROBLEMS. – MM-KAY. AND, PAM,
FROM SAMHSA’S PERSPECTIVE? – YEAH, WELL,
THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION IS THE FEDERAL AGENCY
THAT’S RESPONSIBLE FOR BOTH, BOTH SUBSTANCE ABUSE
AND MENTAL HEALTH, AND WE RUN THE GAMUT
OF PREVENTION, TREATMENT, AND RECOVERY SUPPORTS. WE DO A LOT
OF SURVEILLANCE WORK, SO WE LOOK AT WHERE THE
CO-OCCURRING DISORDERS OCCUR. WE DO TREATMENT RESPONSES, SO WE’RE WORKING NOT ONLY
WITH OUR PROGRAMS, BUT WITH OTHER PROGRAMS LIKE
MEDICAID AND PRIVATE INSURANCE AND OTHERS TO FIGURE OUT
HOW TO TREAT THESE DISORDERS. WE DO SOME
OF THE PRACTICE IMPROVEMENT, SO WE HAVE OPPORTUNITIES
FOR PEOPLE TO LEARN HOW TO DO CO-OCCURRING
DISORDER TREATMENT AT THE SAME TIME. SO WE RUN THE GAMUT
OF ALL OF THOSE ISSUES IN OUR WORLD. – AND THE TERM
“BEHAVIORAL HEALTH,” CAN YOU DEFINE IT FOR US AND SHARE A LITTLE BIT MORE
ABOUT THAT? – WELL, I CAN CERTAINLY TELL YOU
HOW WE USE IT. IT IS DEFINITELY A WORD THAT IS USED DIFFERENTLY
BY DIFFERENT PEOPLE. FOR SAMHSA,
IT BASICALLY MEANS BOTH SUBSTANCE ABUSE
AND MENTAL HEALTH. IT MEANS THE PREVENTION
OF EMOTIONAL DISORDERS OR BEHAVIORAL HEALTH PROBLEMS AS WELL AS TREATMENT
AND RECOVERY SUPPORT. IT’S SORT OF A SHORTHAND WORD
FOR A LOT OF THINGS. IT’S UNDERSTOOD
IN THE MEDICAL COMMUNITY, AND INCREASINGLY,
STATES ARE USING THAT WORD TO DESCRIBE AGENCIES
THAT HAVE BOTH MENTAL HEALTH AND SUBSTANCE ABUSE
ORGANIZED IN THEM. – SO, JOHN, PAM JUST SAID IT’S UNDERSTOOD
IN THE MEDICAL COMMUNITY. DO YOU ALL USE IT
ON A REGULAR BASIS, AND HOW WOULD YOU SEE IT– WOULD YOU SEE IT
ANY DIFFERENTLY? – WE DO. WHEN A LOT OF THIS KNOWLEDGE
CAME INTO THE FIELD, FOR A WHILE, PEOPLE REFERRED
TO DUAL DIAGNOSIS. BUT THAT DOESN’T QUITE COVER IT. CO-OCCURING DISORDERS– MANY CHILDREN THAT WE SEE
ALSO HAVE MEDICAL DISORDERS. CERTAIN CHILDREN
WHO HAVE OVERCOME CHRONIC MEDICAL CONDITIONS THAT MIGHT HAVE ENDED IN DEATH
50 YEARS AGO ARE SURVIVING TODAY. BUT THEY’RE AT MUCH HIGHER RISK. THEY HAVE
BEHAVIORAL HEALTH PROBLEMS INCLUDING SUBSTANCE USE, AND THEN THEY HAVE SPECIAL
ISSUES AND TREATMENT BECAUSE THEY MAY BE FATALISTIC
ABOUT THEIR USE. “WHY SHOULDN’T I GO OUT
AND HAVE A GOOD TIME? I COULD BE DEAD TOMORROW.” AND SO WE REALLY HAVE TO LOOK
AT EACH INDIVIDUAL AS HAVING MULTIPLE AXES
OF DIAGNOSES. SO THERE CAN BE
SUBSTANCE-RELATED. THERE CAN BE BEHAVIORAL HEALTH– THERE ARE SCHOOL PROBLEMS
THAT COME UP. WE HAVE TO LOOK AT
FAMILY ISSUES. AND THEN WE HAVE TO LOOK AT
PSYCHIATRIC DISORDERS AS WELL VERY CAREFULLY. – SO IS IT THE TERM
“BEHAVIORAL HEALTH,” IS IT REALLY UNDERSTOOD
BY PEOPLE, DO YOU THINK? PAM’S SHAKING HER HEAD NO. YEAH. – NO, I THINK THERE’S A LOT
OF CONTROVERSY ABOUT THE WORD. DEPENDING
ON WHO YOU’RE TALKING TO, THERE ARE SOME FOLKS WHO BELIEVE IT’S A BROADER WORD
OR A BROADER TERM THAT MEANS ALL
THE BEHAVIORS THAT ARE– SURROUND CONDITIONS,
HEALTH CONDITIONS, MENTAL AND SUBSTANCE ABUSE
CONDITIONS. SO THINGS LIKE HOW YOU EAT
MIGHT HAVE– OR HOW YOU EXERCISE MIGHT HAVE
AN IMPACT ON DIABETES. SO SOME PEOPLE USE IT THAT WAY. AND OTHER TIMES,
PEOPLE USE IT TO MEAN THINGS LIKE AUTISM SPECTRUM
DISORDERS WHICH ARE CLEARLY A PART
OF THE MENTAL HEALTH WORLD. BUT SOMETIMES PEOPLE USE THAT
A LITTLE DIFFERENTLY. SO I THINK IT IS NOT
WELL UNDERSTOOD, AND I THINK THAT’S PART
OF THE CONTROVERSY BEHIND THE WORD SOMETIMES. – AND HOW IS IT– IS IT BEING USED
IN THE AFFORDABLE CARE ACT? IS THIS TERMINOLOGY THERE, AND HOW IS IT BEING USED THERE? – IT IS. ALTHOUGH IT MAY BE
IN SOME WAYS CONFUSING, THE AFFORDABLE CARE ACT HAS THE TERM “MENTAL HEALTH”
THROUGHOUT. IT HAS THE TERM “SUBSTANCE USE,” IT HAS THE TERM
“BEHAVIORAL HEALTH,” AND ESPECIALLY IN
THE ESSENTIAL HEALTH BENEFITS, WHICH IS SO CRITICAL
TO OUR FIELD. IT’S ONE OF TEN
ESSENTIAL BENEFITS THAT INSURANCE COMPANIES
HAVE TO PROVIDE, AND THE WORDS
THEY USE FOR OURS ARE “MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES, INCLUDING BEHAVIORAL HEALTH
TREATMENT.” SO WHATEVER THAT MEANS. BUT IT CLEARLY–I THINK CONGRESS
WAS TRYING TO INCORPORATE ALL THOSE CONSTRUCTS
AND MAKE SURE– AND NOTHING WAS LEFT OUT. – RIGHT, AND SO, THEN,
NOW THE WORK IS TO DEFINE BEHAVIORAL HEALTH
TREATMENT A LITTLE DEEPER I’M SURE, RIGHT? – YES.
– THAT’S THE–YEAH. SO, NOW, BEHAVIORAL HEALTH
ENCOMPASSES PREVENTION AS WELL? OR IS IT MORE DOWN THE ROAD? – CERTAINLY FROM OUR POINT
OF VIEW AT SAMHSA, IT DOES, ‘CAUSE WE REALLY ARE TRYING
TO THINK ABOUT MENTAL HEALTH AND BEHAVIORAL HEALTH AND WAYS TO GET EMOTIONAL HEALTH
DEVELOPMENT, EARLY CHILDHOOD, DEALING WITH EARLY TRAUMA
EXPERIENCES, SO–AND RESILIENCE– SO EMOTIONAL HEALTH
AND BEHAVIORAL HEALTH IS A GOOD CONSTRUCT. SO WE ARE TRYING
TO USE THAT TERM TO ENCOMPASS
ALL OF THOSE ISSUES. – ELLEN, FOR WHERE YOU SIT, ARE YOU USING THE TERM
“BEHAVIORAL HEALTH” IN YOUR WORK? – NO, WE’RE STILL SEPARATING IT. WE’RE STILL TALKING ABOUT
SUBSTANCE USE, SUBSTANCE ABUSE, AND WE’RE TALKING ABOUT
SUBSTANCE USE DISORDERS. WE’RE TALKING ABOUT
MENTAL HEALTH ISSUES. WE SEPARATE THEM OUT STILL. – AND, JOHN, FOR SOME FOLKS
THAT THINK ABOUT ADDICTION, AND THEY THINK ABOUT THAT TERM– AND THAT’S A, YOU KNOW, A TERM
THAT SOME FOLKS ARE USING VERSUS A DISORDER– IS THERE A DIFFERENCE THERE
ON TERMINOLOGY? – ADDICTION
IS A TERM THAT’S FAVORED BY THE AMERICAN SOCIETY
ON ADDICTION MEDICINE. THAT’S A GROUP OF PHYSICIANS
FROM MANY DIFFERENT SPECIALTIES WHO ALL FOCUS
ON SUBSTANCE ABUSE TREATMENT, WHERE DISORDERS IS THE TERM
THAT’S USED BY WHAT SOME WOULD CALL THE BIBLE
OF MENTAL DISORDERS, “THE AMERICAN PSYCHIATRIC
ASSOCIATION DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS.” VERSION FIVE IS COMING OUT. IT’S QUITE A MOUTHFUL.
– [laughing] YES. – BUT THERE,
THERE ARE ONLY DISORDERS, AND THE DISORDERS
ARE ABUSE AND DEPENDENCE. – BUT NOW WE CAN ALL
LOOK AT THE PROBLEM. HOWEVER WE–
WHATEVER WE–TERM WE USE, WE CAN ALL LOOK AT THE PROBLEM
WITH SOME SORT OF SET OF UNDERSTOOD PARAMETERS, RIGHT? I MEAN, WE DON’T WANT TO GET
SO HUNG UP ON THE TERMINOLOGY. OR ARE THE TERMS VERY IMPORTANT? – AS A DEVELOPMENTAL
PEDIATRICIAN, I’D JUST LIKE TO ADD
THAT I THINK IT’S IMPORTANT TO TAKE
A DEVELOPMENTAL VIEW OF THIS. THERE ARE VERY IMPORTANT FACTORS
THAT PLAY INTO A FINAL BEHAVIOR. BEHAVIOR IS A SYMPTOM
THAT PEOPLE OBSERVE THAT CAN CAUSE
TERRIBLE PROBLEMS. BUT IT HAS COMPLICATED
UNDERPINNINGS. PART OF IT LIES IN OUR GENES. THE OTHER PART
LIES IN THE ENVIRONMENT. IT’S HOW THINGS AROUND US, THE FAMILY WE GROW UP IN, THE AGE AT WHICH WE START
TO DRINK OR USE A DRUG, ALL OF THOSE THINGS PLAY INTO
HOW THE GENES ARE EXPRESSED, AND THEN THE FINAL SYMPTOM
BECOMES THE BEHAVIOR. THE ONE THING WE KNOW
IS THAT FOR PREVENTION, WE NEED TO PREVENT KIDS FROM
STARTING TO USE AT YOUNGER AGES, BECAUSE SCIENTIFIC DATA
ARE VERY CLEAR THAT THEY ARE WIRING
THEIR BRAINS AT A YOUNG AGE FOR ADDICTION AND A HOST OF OTHER
MAJOR MENTAL DISORDERS. – THAT’S AN IMPORTANT STATEMENT.
PAM? – YEAH, I THINK
THERE’S TWO OTHER CONCEPTS THAT’D BE FAIR TO PUT
ON THE TABLE HERE. ONE IS COMORBIDITY. IT’S A DIFFERENT TERM THAT USUALLY
THE MEDICAL COMMUNITY USES, AND FREQUENTLY, IF YOU HAVE
A SUBSTANCE ABUSE OR A MENTAL HEALTH PROBLEM AND A PHYSICAL HEALTH PROBLEM, THAT WILL BE CALLED
A COMORBIDITY SOMETIMES. SO THE TERMS GET
UNCOMFORTABLY DIFFICULT. AND I THINK IT’S ALSO IMPORTANT TO JUST ACKNOWLEDGE THAT SOME
PEOPLE REALLY ARE CONCERNED ABOUT FOCUSING ON THE BEHAVIOR BECAUSE ESPECIALLY
FOR SUBSTANCE ABUSE, THERE’S BEEN A HISTORY OF
TREATING IT AS A MORAL PROBLEM, AS, “IF YOU WOULD JUST STOP
THAT BEHAVIOR, YOU WOULDN’T HAVE THIS ISSUE.” AND I THINK THAT’S WHY
SOME PEOPLE ARE UNCOMFORTABLE
WITH THAT TERM. – CAN YOU SHARE WITH US
THE DIFFERENCE BETWEEN HOW SAMHSA’S LOOKING AT MENTAL HEALTH
AND MENTAL ILLNESS? – THAT’S A GREAT QUESTION TOO. AGAIN, WE’RE REALLY TRYING
ON THE MENTAL HEALTH SIDE TO SEE THAT
AS A VERY POSITIVE THING, TO LOOK AT EMOTIONAL HEALTH, EMOTIONAL HEALTH DEVELOPMENT,
RESILIENCE, PREVENTION OF MENTAL ILLNESS. MENTAL ILLNESS, MENTAL DISORDER,
MENTAL HEALTH CONDITION, THERE ARE LOTS OF DIFFERENT
TERMS PEOPLE WILL USE FOR THE DISORDER PART
OF THE SPECTRUM. – AND, ELLEN, FOR YOU, WHAT ARE THE DIFFERENCES
BETWEEN SUBSTANCE USE– WHICH OF COURSE
WE WANT TO PREVENT, DELAY THE ONSET OF FIRST USE– SUBSTANCE USE, ABUSE,
AND ADDICTION? – WELL,
SUBSTANCE USE GENERALLY MEANS WHEN YOU’RE TALKING
ABOUT YOUNG PEOPLE, WHEN YOUNG PEOPLE DRINK
UNDER 21, WHEN SOMEONE USES
AN ILLICIT DRUG OR THEY USE A PRESCRIPTION
OR OVER-THE-COUNTER DRUG IN A WAY THAT WASN’T PRESCRIBED OR AN AMOUNT
THAT WASN’T PRESCRIBED OR FOR A CONDITION
IT WASN’T PRESCRIBED FOR. SUBSTANCE ABUSE GENERALLY MEANS
THAT THAT SUBSTANCE USE HAS REPEATEDLY INTERFERED
WITH SOMEONE’S FUNCTIONING OR THEY’VE LOST CONTROL
OVER THEIR BEHAVIOR OR THE AMOUNT THAT THEY CONSUME. ADDICTION ACTUALLY, IN “DSM-V” AND AS JOHN SAID, IT’S NOW SUBSTANCE USE DISORDER, AND IT’S RATED FROM MILD,
MODERATE, TO SEVERE. ADDICTION USED TO MEAN
THAT THERE WAS A PRESENCE OF PSYCHOLOGICAL
OR PHYSICAL WITHDRAWAL AND THAT THERE WAS
A COMPULSION ASPECT TO IT. NOW WITH THE NEW
DIAGNOSTIC TERMS, IT HAS TO DO
WITH A NUMBER OF CRITERIA. SO THOSE ARE DIFFERENCES. – WOW, WE’RE GETTING–WE’VE GOT
A LOT OF TERMS OUT THERE. DUE TO RECENT EFFORTS
BY SAMHSA AND OTHER ORGANIZATIONS, WE ARE HEARING A LOT MORE
ABOUT BEHAVIORAL HEALTH. HOWEVER, THE TERM ISN’T NEW
TO SOME ORGANIZATIONS. THE INDIAN HEALTH
SERVICES AGENCY HAS BEEN USING THE TERM
FOR YEARS, AND IT HAS TRICKLED DOWN
TO THE VARIOUS TRIBES. RECENTLY,
WE TRAVELED TO OKLAHOMA TO VISIT THE CHEROKEE NATION.   female narrator:
WHILE STEEPED IN HISTORY, CHEROKEE NATION IS PROGRESSIVE
IN ITS THINKING. THEY’VE BEEN LOOKING
AT THE WHOLE PICTURE OF WELLNESS FOR SOME TIME NOW. – BEHAVIORAL HEALTH IS THE TERM
THE INDIAN HEALTH SERVICE USES FOR BASICALLY BLENDING
SOCIAL WORK, MENTAL HEALTH, AND SUBSTANCE ABUSE SERVICES
INTO ONE DOMAIN. I LIKE THAT TITLE
BECAUSE I THINK IT– TRADITIONALLY,
THERE’S BEEN A HUGE SPLIT BETWEEN SUBSTANCE ABUSE
AND MENTAL HEALTH SERVICES, AND EVEN TO THE NOTION
THAT THEY’RE SO DIFFERENT THAT THEY DON’T DO
THE SAME THING. narrator: STAFF AT THE TRIBE’S
BEHAVIORAL HEALTH CENTER LOOK AT ROOT CAUSES AND
RISK FACTORS FOR EACH PATIENT. – IF YOU PREVENT ONE,
YOU’RE GONNA PREVENT THE OTHER. A LOT OF THE INTERVENTIONS
ANYMORE ARE VERY SIMILAR. YOU DON’T SEE THAT MANY PEOPLE
WHO ABUSE SUBSTANCES THAT DON’T HAVE
ANOTHER SORT OF MENTAL HEALTH OR BEHAVIORAL ISSUE. SO TREATING ADDICTION
IN A VACUUM LIKE IT’S NOT PART
OF A LARGER PHENOMENON IS NOT GETTING
THE WHOLE PICTURE.   narrator: TO REALLY GET
HOW IT ALL WORKS, WE FIRST MUST UNDERSTAND A BIT
ABOUT THE AREA AND ITS PEOPLE. – CHEROKEE NATION IS 14 COUNTIES
WITHIN NORTHEASTERN OKLAHOMA. IT’S RELATIVE IN SIZE
TO THE STATE OF NEW JERSEY. WE HAVE A VERY DIVERSE GROUP
THAT WE HAVE TO WORK WITH. WE HAVE CITIES.
WE HAVE SMALL TOWNS. AND THEN WE HAVE
VERY RURAL AREAS. narrator: IT’S NOT
AN INDIAN RESERVATION, BUT RATHER A SOVEREIGN
GOVERNMENT WITHIN A GOVERNMENT SERVING MORE THAN 315,000 PEOPLE FROM ITS CAPITAL
IN TAHLEQUAH, OKLAHOMA. – THE STATE, COUNTY,
AND MUNICIPAL GOVERNMENT STILL HOLD JURISDICTION
INDEPENDENT FROM TRIBES. SO WE ARE PART OF A LARGER,
MORE DIVERSE POPULATION. SO WE WORK AND GO TO SCHOOL
AND LIVE NEXT DOOR TO NON-NATIVES,
TO NON-CHEROKEES, TO MEMBERS OF OTHER TRIBES THAT
LIVE IN THIS PART OF THE STATE. narrator: AT ONE TIME, CHEROKEE PEOPLE
LIVED ON ABOUT 81 MILLION ACRES IN THE SOUTHEASTERN U.S. – THE CHEROKEE PEOPLE WERE THE
MOUNTAINEERS OF THE SOUTHEAST. ORIGINALLY, WE LIVED IN
EIGHT CURRENT-DAY STATES. OUR CULTURE WAS,
FOR THE MOST, PART AGRICULTURAL. narrator: HISTORICALLY,
SUBSTANCES WERE ONLY USED DURING TRADITIONAL CEREMONIES AND NOT FOR PLEASURE. THEN THE EUROPEAN COLONISTS
CAME ALONG. – OUR CULTURES HAD REALLY
NO TIME TO DEVELOP SOCIAL NORMS AROUND SOCIAL CONSUMPTION
OF ALCOHOL, CASUAL CONSUMPTION OF ALCOHOL, WHEN IT IS AND ISN’T APPROPRIATE
TO CONSUME ALCOHOL.   narrator: AS THE TRADITION
OF ONLY USING SUBSTANCES FOR CEREMONIAL PURPOSES
BEGAN TO ERODE, OTHER TRAGEDIES CAME– ONE AFTER ANOTHER. THE MOST WELL-KNOWN
IS THE CHEROKEE TRAIL OF TEARS WHICH FORCED THE TRIBE
TO MOVE FROM ITS ORIGINAL LAND TO WHAT IS NOW
THE STATE OF OKLAHOMA. THOUSANDS DIED DURING THAT MARCH
ACROSS THE COUNTRY, CONTINUING A CYCLE
OF HISTORICAL TRAUMA. – SO YOU HAVE GENERATIONS
OF PEOPLE WHO’VE BEEN DISPLACED, REMOVED FROM THEIR HOMELANDS, OR REMOVED FROM THEIR
TRADITIONAL WAYS OF LIFE AND NEVER REALLY GIVEN A BREAK TO SORT OF SETTLE DOWN
AND REESTABLISH THEMSELVES BEFORE THE NEXT THING HITS. – MANY OF THE CHEROKEE PEOPLE
LOOKED FOR WAYS TO COPE. – I THINK THAT INSTEAD
OF USING WHAT WE MIGHT FIND IN OUR ENVIRONMENT
TO HELP US WITH, WE BEGIN TO DEVELOP SOME
CRUTCHES OR SOME ADDICTIONS, MAYBE SUBSTANCE ABUSES
ALONG THE WAY. narrator: NOW THE RATE
OF SUBSTANCE USE FOR NATIVE AMERICANS IS HIGHER THAN
FOR OTHER DEMOGRAPHICS. – AND THEN SO JUST ONE THING
AFTER ANOTHER UNTIL YOU’VE GOT GENERATION
AFTER GENERATION AFTER GENERATION
WHO HAVE EXPERIENCED OR ARE GROWING UP ON THE HEELS
OF THEIR PARENTS EXPERIENCING A PRETTY TRAUMATIC
DISRUPTIVE EVENT THAT TEARS THE COMMUNITY APART. IT TEARS AT THE FABRIC
OF THE CULTURE. narrator:
THE CULTURE IS ALSO WHAT IS HELPING THE
CHEROKEE COMMUNITY HEAL ITSELF. – I PERSONALLY
AND PROFESSIONALLY BELIEVE THAT SUPPORTING
CULTURAL ACTIVITIES, ENSURING THAT CULTURE
IS AN ASPECT THAT WE UTILIZE IN EVERY SITUATION
THAT WE POSSIBLY CAN, BY USING CULTURE
AS A PROTECTIVE FACTOR, WE CAN BOTH ENCOURAGE
AND SUPPORT CHEROKEE CULTURE WHILE ALSO PREVENTING
SOME OF THESE ISSUES THAT ARE GOING ON
IN OUR COMMUNITIES. narrator: THE COALITIONS
WITHIN CHEROKEE NATION ARE PART OF THE SOLUTION. – WE HELP THE COALITIONS
BECOME BETTER AND TO ASSIST THEM
IN GETTING OUTCOMES, AND WHILE DOING SO, WE ENSURE THAT THERE’S
A CULTURAL COMPETENCE TO WHAT THEY DO. narrator:
ONE OF THOSE COALITIONS IS THE GRAND NATION CENTERED IN THE TOWN OF VINITA WHERE TWO MAJOR RAILROADS
INTERSECT, AND HISTORIC ROUTE 66
RUNS RIGHT THROUGH TOWN. – WE ARE THE FAR NORTHERN PART
OF CHEROKEE NATION. PEOPLE– THEIR FAMILIES HAVE BEEN HERE
SINCE BEFORE STATEHOOD. narrator: THE COALITION IS USING
CHEROKEE CULTURE TO PROTECT FUTURE GENERATIONS BY TAKING A GAME WITH HUGE
HISTORICAL SIGNIFICANCE AND BRINGING IT
INTO THE MODERN AGE. – STICKBALL IS MY ANTIDRUG. AT THE TURN OF THE CENTURY, THE ELDERS IN THE TRIBE
MADE STICKBALL COMMUNITY STYLE, AND THEY DID SO BECAUSE THE COMMUNITIES WERE LOSING
THAT CONNECTEDNESS TO THOSE TRADITIONAL BELIEFS, AND WHAT’S REALLY COOL
ABOUT THE CHEROKEE CULTURE IS, THEY IMPLEMENT
PREVENTION SCIENCE. SO WHEN THOSE ELDERS SAID, “WE’RE GONNA PLAY STICKBALL
COMMUNITY STYLE FROM NOW ON,” IT BROUGHT PEOPLE TOGETHER. narrator: CHEROKEE LANGUAGE
IMMERSION PROGRAMS ARE ALSO HELPING
REBUILD TRADITIONS. SO FUTURE GENERATIONS HOPEFULLY WON’T FACE
THE PROBLEMS OF THE PAST. – I THINK THAT WITHOUT
OUR CULTURAL IDENTITY, WE’LL JUST BE BROWN PEOPLE. IF WE DON’T HAVE OUR LANGUAGE
AND OUR ORAL TRADITION, WE WON’T KNOW THE DIFFERENCE BETWEEN A CHEROKEE PERSON
AND ANOTHER TRIBE. OUR CULTURE,
EVEN THOUGH IT’S SOMETHING THAT’S HARD
TO PUT OUR FINGER ON, IT’S THE VALUES, BEHAVIORS,
AND BELIEFS THAT ARE PASSED
FROM ONE GENERATION TO THE NEXT. A LOT OF TIMES,
IT’S ON ACCIDENT. BUT AS WE TAKE THIS
INTO OUR OWN HANDS AND WE TRY TO PERPETUATE
OUR OWN IDENTITY, WE’LL STRENGTHEN OURSELVES. AND I THINK THAT NOT ONLY
WILL WE BENEFIT FROM THAT– I THINK THAT OUR NEIGHBORS
AND OUR FRIENDS WILL AS WELL.   – WELL,
SO I JUST WANT TO ASK YOU ALL. WHAT REALLY STANDS OUT FOR YOU IN LOOKING AT WHAT’S HAPPENING
IN THE CHEROKEE NATION? ELLEN? – I LOVE THE FACT THAT THEY SAID THAT STICKBALL’S THE ANTIDRUG. IT’S SO IMPORTANT FOR YOUNG
PEOPLE TO DEVELOP SKILLS, ACTIVITIES, AND OTHER WAYS
OF HAVING FUN AND COPING SO THEY WON’T NEED CHEMICALS. – PAM? – YOU KNOW, I HAD TWO REACTIONS. ONE IS, WE WORK A LOT
WITH TRIBAL LEADERS ACROSS THE COUNTRY, AND THEY HAVE
VERY STRONG OPINIONS AND CONSISTENTLY TELL US THAT TRADITIONAL PRACTICES,
REESTABLISHING CULTURE, ELDERS WORKING WITH YOUNG PEOPLE
IS THE ANSWER. THEY–IT’S WHETHER
IT’S SUICIDE PREVENTION OR SUBSTANCE ABUSE PREVENTION, AND THEY OFTEN
PUT THOSE THINGS TOGETHER. THEY DON’T MAKE AS–
THE KIND OF DISTINCTIONS THAT NON-TRIBAL PEOPLES
TEND TO DO. SO I THINK THEY’RE TERRIFIC. I THINK WE DON’T SUPPORT THEM
ENOUGH UNFORTUNATELY. BUT I DO THINK THEY’VE GOT
THEIR HANDS ON SOMETHING THAT WOULD BE IMPORTANT–
WE COULD ALL LEARN FROM. THE SECOND THING IS THAT SAMHSA USES
THE CONCEPT OF RECOVERY, AND WE HAVE FOUR CONSTRUCTS
IN RECOVERY: HEALTH, HOME, COMMUNITY,
AND PURPOSE. SO IN SOME WAYS, WHILE THAT’S A RECOVERY CONCEPT, IT WRAPS BACK AROUND
TO PREVENTION AND SAYING THOSE ARE THE THINGS
THAT PEOPLE HAVE TO HAVE, AND THEY HAVE TO HAVE
COMMUNITY IN THEIR LIFE. THEY HAVE TO HAVE
SOCIAL CONNECTIONS AND THE ABILITY TO RECOGNIZE WHAT THEIR PURPOSE IS
IN THAT LARGER WHOLE. – THAT’S RIGHT. AND, JOHN,
WHAT STOOD OUT FOR YOU? – SO THIS IS THE MODEL
THAT I TALKED ABOUT ON A WHOLE POPULATION BASIS
WITH TRAGIC RESULTS. I THINK WE UNDERSTAND NOW THAT MANY
OF THE AMERICAN INDIAN TRIBES CARRY GENES THAT ARE
ASSOCIATED WITH ALCOHOLISM. THERE’S NOT ONE GENE. THERE ARE MANY WITH IMPUNITY FOR 1,000 YEARS
OR MANY THOUSANDS OF YEARS, AND THAT THOSE GENES LIKELY
HAD IMPORTANT SURVIVAL VALUE– THINGS THAT BROUGHT
PEOPLE TOGETHER, A LOVE OF MUSIC, SONGS,
SPIRITUALITY. WHEN THE EUROPEANS ARRIVED
AND THEY INTRODUCED ALCOHOL, ALL OF A SUDDEN, IT TRIGGERED THIS SAME PATHWAY
IN THE BRAIN THAT ENDS
WITH THE REWARD PATHWAY. IT’S VERY POWERFUL. AND WITHIN A SINGLE GENERATION–
AT MOST TWO– THROUGH A PROCESS OF FLIPPING
A GENETIC SWITCH, YOU CAN CHANGE THE
ENTIRE GENE POOL OF A PEOPLE, AND I THINK THAT’S WHAT WE’VE
SEEN HAPPEN WITH TRAGIC RESULTS. WHAT WAS INSPIRING ABOUT THIS IS WHAT THEY’RE DOING ABOUT IT, THAT THEY’RE USING
THE TRIBAL TOGETHERNESS AND THE SPIRITUALITY
OF THEIR NATIVE WAYS TO BRING ABOUT RECOVERY. – ELLEN, IN YOUR EXPERIENCE, CAN SOMEONE HAVE
A SUBSTANCE USE DISORDER OR A PROBLEM WITH DRUGS AND NOT HAVE
MENTAL HEALTH ISSUES? – YES. I’LL JUST GIVE YOU
A QUICK EXAMPLE. NOW, AGAIN, SUBSTANCE USE
DISORDERS, THAT NEW TERM– MILD, YOU KNOW,
MODERATE, AND SEVERE– BUT JUST FOR EXAMPLE, IT’S POSSIBLE FOR A 16-YEAR-OLD
SOPHOMORE IN HIGH SCHOOL TO GET INVITED TO HER FIRST
PARTY WITH JUNIOR AND SENIORS, AND SHE FEELS AWKWARD, AND MAYBE A SENIOR GIRL
WHO SHE’S ON A TEAM WITH SAYS, “WELL, YOU KNOW,
WHY DON’T YOU TAKE A DRINK “OR SMOKE, YOU KNOW,
SOME OF THIS BLUNT, “OR HAVE SOME ECSTASY? IT’LL HELP RELAX YOU.” AND SHE RELAXES,
AND SHE HAS A GREAT TIME. AND THIS IS A,
LET’S SAY A 16-YEAR-OLD WHO’S NEVER BEEN TRAUMATIZED. SHE HAS A HEALTHY FAMILY. SHE’S PERFECTLY ADJUSTED. AND SHE DOESN’T GO TO A PARTY
FOR TWO WEEKS, AND THEN TWO WEEKS LATER,
SHE GOES TO A PARTY, AND SHE REMEMBERED HOW
THAT CHEMICAL MADE HER RELAX. SO SHE DOES IT AGAIN,
AND AGAIN SHE HAS A GREAT TIME. THEORETICALLY, YOU KNOW, IT’S INTERFERING
WITH HER FUNCTIONING, BECAUSE SHE’S SUPPOSED
TO BE LEARNING HOW TO DEVELOP SOCIAL SKILLS AND HOW TO FLIRT
AND HOW TO RELAX. SO TECHNICALLY, SHE COULD HAVE
A MILD SUBSTANCE USE DISORDER. BUT THERE’S NO
MENTAL HEALTH ISSUE THERE. AND THAT’S JUST
A SIMPLISTIC EXAMPLE. – AND WHEN YOU’RE TRYING
TO RAISE AN ADOLESCENT AND DELAY THAT ONSET
OF FIRST USE, WHAT ARE SOME OF THE TACTICS
THAT YOU WOULD HAVE PARENTS USE? – WELL, THERE’S SEVERAL THINGS, AND WE KNOW THAT THERE ARE
SOME RISK FACTORS THAT ARE SPECIFICALLY
FOR PREVENTING SUBSTANCE USE THAT AREN’T NECESSARILY FOR PREVENTING
MENTAL HEALTH DISORDERS. SO FOR EXAMPLE, PARENT ATTITUDES
ARE REALLY IMPORTANT, LIMITING ACCESS, TEACHING YOUNG PEOPLE
SOCIAL SKILLS TO RESIST DRUGS, LEARNING HOW TO DEAL
WITH DRUG-USING FRIENDS OR STAYING AWAY
FROM DRUG-USING FRIENDS, AND ONE OF THE MOST IMPORTANT IS INCREASING PERCEPTION
OF RISK OF HARM. KIDS HAVE TO KNOW THE DANGERS
OF INDIVIDUAL DRUGS, AND THEN THEY WON’T USE THEM. I MEAN, SOMETIMES THEY USE THEM, BUT IF THEY BELIEVE SOMETHING’S REALLY GONNA BE HARMFUL
FOR THEM, THEY’RE LESS LIKELY TO USE. SO THOSE ARE REALLY IMPORTANT
THINGS WE ASK PARENTS TO DO. NOT TO GLORIFY
THEIR DRUG USE, AND IF THEY HAVE
A POSITIVE ATTITUDE, IT’S MORE LIKELY THEIR CHILD’S GONNA DEVELOP
A SUBSTANCE USE PROBLEM. – WE ALSO FIND THAT IT HAS
TO START WITH PARENTS MODELING APPROPRIATE BEHAVIOR. THEY HAVE TO DRINK
RESPONSIBLY, AND THEY CANNOT BE USING DRUGS. AND WHAT BOGGLES MY MIND IS INTERVIEWING FAMILIES
THAT ARE BRINGING A CHILD IN, YOU KNOW,
AS THE IDENTIFIED PATIENT AND FINDING OUT THAT, IN FACT, THE FATHER’S BEEN SMOKING
MARIJUANA AT HOME, AND, OF COURSE, HE THINKS
NO ONE IN THE FAMILY KNOWS, BUT KIDS ALWAYS KNOW
WHAT’S GOING ON. THEY NEED TO MODEL
POSITIVE BEHAVIOR. THEY NEED TO COMMUNICATE
WITH THEIR CHILDREN FREQUENTLY. HAVING ONE DRUG TALK
IS NOT ENOUGH. IT SHOULD BE ONCE A MONTH, AND IT SHOULD BE TAGGED
TO EVENTS THAT ARE IN THE NEWSPAPER, AND AT TIMES WHEN YOUR TEENAGER
HAS TO LISTEN, LIKE IN THE CAR, OR MY FAVORITE, PERSONALLY,
WAS ON A SKI LIFT, MY TEENAGE SON, BECAUSE HE HAD TO LISTEN
TO HIS DAD OR JUMP, AND HE NEVER JUMPED
OVER ALL THOSE YEARS, AND I’VE SEEN HIM SAFELY NOW
TO 30 YEARS OLD. – I NEED TO ADD ONE THING,
THOUGH, TO WHAT JOHN JUST SAID. LOOK,
MANY PARENTS AREN’T PERFECT, AND THERE ARE CERTAINLY
MANY PARENTS THAT HAVE SUBSTANCE USE
DISORDERS, AND THERE ARE PARENTS
WHO SMOKE MARIJUANA TOO MUCH AND DRINK TOO MUCH. I THINK, THOUGH,
THERE’S STILL A ROLE FOR THEM. I THINK IT’S OKAY FOR A PARENT
TO SAY TO THEIR SON OR DAUGHTER, YOU KNOW, “I WANT YOU
TO BE HEALTHIER THAN I AM. “I WANT YOU TO KNOW
HOW TO HAVE A GOOD TIME “WITHOUT USING CHEMICALS. “I DIDN’T LEARN THAT
FROM MY PARENTS. “I WANT YOU TO KNOW
HOW TO DO THAT. I WANT YOU TO KNOW
HOW TO COPE WITH STRESS.” I THINK IT’S OKAY EVEN IF YOU’RE
NOT THE PERFECT ROLE MODEL TO STILL HAVE THE KIND OF TALK
JOHN JUST TALKED ABOUT. BUT YOU HAVE TO NAME IT. YOU HAVE TO SAY,
“I HAVE A PROBLEM,” AND IF YOU HAVE A FAMILY HISTORY
OF SUBSTANCE ABUSE– AND JOHN TALKED ABOUT
THE GENETICS– THEN IT’S EVEN MORE IMPORTANT
TO SAY, “OUR FAMILY HAS A REACTION
TO ALCOHOL,” AND THEREFORE
IT’S EVEN MORE IMPORTANT THAT YOU DON’T USE OR YOU
DELAY USE AS LONG AS POSSIBLE. – AND WE’RE GONNA TALK A LITTLE
BIT MORE LATER ON ABOUT SOME OF THE, YOU KNOW, GREAT NEW CAMPAIGN
THAT SAMHSA’S GOT. BUT I WANT TO TALK A BIT MORE ABOUT HOW SUBSTANCES MIGHT AFFECT MENTAL HEALTH OR TRIGGER MENTAL HEALTH ISSUES. CAN YOU TALK A LITTLE BIT
ABOUT THAT, JOHN? – SO WE NOW KNOW FROM LARGE
LONGITUDINAL STUDIES– THESE ARE STUDIES THAT ARE DONE
ON NATIONAL DATABASES, LIKE THE ENTIRE COUNTRY
OF AUSTRALIA, NEW ZEALAND, OR SCANDINAVIAN COUNTRIES WHERE THEY KEEP SERIAL DATA
ON EVERY INDIVIDUAL AS PART OF THEIR NATIONAL
HEALTH SERVICE OVER MANY YEARS, AND THEY’VE LOOKED,
AND THEY’VE SEEN THAT IF YOU START USING
ALCOHOL OR MARIJUANA BEFORE THE AGE OF 14, YOU ARE GREATLY INCREASING
YOUR RISK OF DEVELOPING A SERIES OF VERY BAD
MENTAL HEALTH DISORDERS. ADDICTION RATES QUADRUPLE AMONG THOSE WHO START
BEFORE AGE 14. THE RATES OF MAJOR DEPRESSION
AND ANXIETY DISORDERS, THREE TO FOUR TIMES
WHAT THEY WOULD OTHERWISE BE, AND PSYCHOTIC THINKING,
TWO TO SIX TIMES MORE PREVALENT AMONG THOSE
WHO START USING EARLY. AND THE OPPOSITE RELATIONSHIP
DOES NOT PAN OUT. WHEN THEY LOOK AT THOSE
WHO DEVELOP AN ANXIETY DISORDER OR DEPRESSION AT YOUNG AGES, THAT DOES NOT PREDICT GREATER
SUBSTANCE USE LATER ON. – I THINK THAT’S IMPORTANT. PAM, FOR SAMHSA, HOW DO YOU USE DATA
TO SHOW THESE LINKS, OR WHAT SORT OF MECHANISMS ARE
YOU USING AT THE FEDERAL LEVEL TO TRACK ALL OF THIS? – WE DO SURVEILLANCE OURSELVES. SO WE’RE ONE OF THE LARGEST
SURVEILLANCE METHODS TO TRY TO TRACK THE USE
OF SUBSTANCES AS WELL AS MENTAL DISORDERS
IN THE COUNTRY. ABOUT–
TO JUST TO ADD SOME OTHER DATA, ABOUT 2/3 OF YOUNG PEOPLE
WHO START DRINKING BEFORE 14 WILL ALSO TAKE AN ILLICIT DRUG. AND THEN ABOUT 40% OF THOSE
WHO START DRINKING BEFORE 14 WILL ACTUALLY END UP
WITH A PROBLEM WITH ALCOHOL AS AN ADULT. THERE IS SOMETHING ABOUT
THE DEVELOPING BRAIN THAT WE REALLY NEED TO KEEP
YOUNG PEOPLE FROM DRINKING, AND THE I.O.M.– THE INSTITUTE OF MEDICINE– IN A REPORT PUT OUT IN 2009 THAT LOOKED AT MENTAL,
EMOTIONAL, AND BEHAVIORAL DISORDERS– THAT’S THE WAY
THEY TALKED ABOUT IT– INDICATED THAT ABOUT HALF
OF THE ADULT MENTAL HEALTH– AND IN THIS CONTEXT, THEY MEAN BOTH MENTAL HEALTH
AND SUBSTANCE ABUSE– ABOUT HALF OF THEM START
BEFORE THE AGE OF 24, AND ABOUT–EXCUSE ME–
BEFORE THE AGE OF 14. AND ABOUT HALF OF THEM– OR 3/4 OF THEM
BEFORE THE AGE OF 24. SO CLEARLY, HELPING YOUNG PEOPLE
NOT GET STARTED IS NOT ONLY A GOOD THING
FOR YOUNG PEOPLE. IT’S ALSO A GOOD THING
FOR OUR COUNTRY AND THE OVERALL ADULT RATES
OF ADDICTION AND MENTAL HEALTH ISSUES
AS WELL. – JUST ADD ONE QUICK THING. IT’S NOT ONLY ABOUT
DEVELOPMENT OF MENTAL DISORDERS AND ADDICTION LATER IN LIFE. WHAT BROUGHT ME INTO THIS FIELD IS THAT I’M OPPOSED TO DEATH, AND YOU DON’T HAVE TO HAVE
A SUBSTANCE ABUSE DISORDER OR A MENTAL HEALTH DISORDER
TO DIE FROM SUBSTANCE USE. SO TOO MANY TEENAGERS,
THEIR FIRST TIME DRINKING, OVERDOSE AND WIND UP
IN THE EMERGENCY ROOM. SOMETIMES THEY WANDER OFF
FROM A PARTY AND THEY’RE FOUND
DEAD IN A MARSH OR THEY’RE KILLED
IN A CAR CRASH OR THEY RIDE IN A CAR WITH
SOMEONE WHO HAD BEEN DRINKING AND THEY WIND UP DEAD. SO SUBSTANCE USE KILLS
DURING ADOLESCENCE. IT’S NOT JUST THE DISORDERS. – SO, PAM, SO WHAT COMES FIRST: THE MENTAL HEALTH ISSUE
AND THEN SUBSTANCE USE, OR IT’S, YOU KNOW– – OH, I THINK IT DEPENDS. SOMETIMES A SUBSTANCE USE CAN LEAD
TO MENTAL HEALTH ISSUES, AND SOMETIMES
MENTAL HEALTH ISSUES CAN LEAD TO SUBSTANCE ABUSE. THEY ALSO CAN JUST CO-OCCUR. SO I THINK TRYING TO SORT OF
PUT A LINEAR CONNECTION TO IT IS NOT ALWAYS THE MOST HELPFUL. WHAT THE MOST HELPFUL, AS
I THINK JOHN SAID EARLIER, IS, YOU GOT TO LOOK AT
THE YOUNG PERSON AND LOOK AT WHAT THEY’RE PRESENTING WITH,
WHAT THEIR TOTAL NEEDS ARE, AND WHAT’S GONNA HELP THEM
GET THROUGH THIS. – I THINK ALSO, THOUGH,
THEY CAN EXIST SEPARATELY, BECAUSE THERE ARE PEOPLE
WHO HAVE SUBSTANCE USE DISORDERS WHO DON’T HAVE
MENTAL HEALTH PROBLEMS. THERE ARE PEOPLE WHO HAVE
MENTAL HEALTH PROBLEMS WHO DON’T HAVE
SUBSTANCE USE PROBLEMS. – THE IMPORTANCE OF KNOWING
THAT THEY BOTH EXIST IS THAT YOU GET THE BEST RESULTS IF YOU TREAT THE DISORDERS
SIMULTANEOUSLY. IF YOU TREAT SUBSTANCE USE ONLY, IT WILL IMPROVE, BUT THE MENTAL HEALTH PROBLEMS
WON’T GET BETTER, AND THAT INDIVIDUAL WILL BE
MISERABLE IN THEIR SOBRIETY. AND VICE VERSA; IF YOU JUST TREAT
THE MENTAL DISORDER AND NOT THE SUBSTANCE USE, THE KIDS WILL KEEP USING, AND, YOU KNOW, THEY WON’T GET
BETTER WITH THEIR MENTAL HEALTH. – IMPORTANT–IMPORTANT COMMENT. WELL, NOW THAT WE HAVE
A BETTER UNDERSTANDING OF THE LINK BETWEEN
DRUG USE AND MENTAL HEALTH, WE’RE GONNA TAKE A SHORT BREAK. WHEN WE COME BACK, WE’LL TALK ABOUT
WHAT’S NEXT IN THE FIELD AND HOW COALITIONS
CAN PLAY AN IMPORTANT ROLE.   – OH, HEY, BUD. – OH. – WHERE, UH– WHERE YOU HEADED? – UH, JUST GONNA HANG OUT. – [thinking]
IT’S A SCHOOL NIGHT. [out loud]
WITH GARY AND TODD? – YEAH. – [thinking]
NOT SURE ABOUT THOSE TWO. [out loud]
I’VE BEEN MEANING TO ASK YOU… [thinking] THIS IS TOUGHER
THAN I THOUGHT. IS THERE ANY DRINKING
GOING ON IN THIS CROWD? – NO. – I HOPE NOT,
BECAUSE ALCOHOL CAN LEAD YOU TO SAY THINGS
AND DO THINGS THAT YOU REALLY
WISH YOU HADN’T. [thinking] ISN’T THIS WHAT
YOU’RE SUPPOSED TO SAY? – I KNOW. – SO IF ANY OF YOUR BUDDIES
EVER PRESSURE YOU TO TAKE A DRINK, JUST TELL THEM YOU PROMISED
YOUR DAD YOU WOULDN’T. [thinking] I’D DO ANYTHING
TO KEEP YOU SAFE. – OKAY, I WILL. – [thinking]
I HOPE THIS IS WORKING. – I PROMISE. [thinking]
LOVE YOU TOO, DAD. male announcer:
THEY REALLY DO HEAR YOU. – RYAN.
– YEAH? announcer:
SO START THE CONVERSATION EVEN BEFORE THEY’RE TEENAGERS. – GOOD IDEA. announcer:
FOR TIPS ON WHAT TO SAY, VISIT
UNDERAGEDRINKING.SAMHSA.GOV. A MESSAGE
FROM THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION.   – SO WE JUST SAW
A GREAT P.S.A., AND LET’S TALK A LITTLE BIT
ABOUT THE CAMPAIGN. PAM? – THIS CAMPAIGN IS CALLED:
“TALK. THEY HEAR YOU.” IT’S A FOCUS ON THE PREVENTION
OF UNDERAGE DRINKING. IT CAME FROM
A CONGRESSIONAL LAW CALLED S.T.O.P. ACT. IT STANDS FOR THE SOBER– OH, I ALWAYS FORGET THE ACRONYM. ANYWAY, IT’S ABOUT THE
PREVENTION OF UNDERAGE DRINKING. WE DID SOME RESEARCH AND UNDERSTOOD THAT PARENTS START TALKING TO THEIR KIDS
ABOUT DRINKING– IF THEY’RE GOING TO–
SOMEWHERE IN TEENAGE YEARS. THAT’S WAY TOO LATE. WHAT WE KNOW
ABOUT YOUNG PEOPLE IS, BEFORE ABOUT AGE NINE, THEY SEE ALCOHOL
AS SOMETHING FOR ADULTS. BUT SOMEWHERE AROUND AGE NINE, THEY START THINKING THAT
ALCOHOL’S A LITTLE INTERESTING. SO THE IDEA BEHIND
THIS CAMPAIGN IS TO DO TWO THINGS: TO GET PARENTS TO UNDERSTAND THAT THEIR KIDS
REALLY DO LISTEN TO THEM. THE FOCUS GROUPS
WITH YOUNG PEOPLE TELL US A VAST MAJORITY OF KIDS SAY THAT THEIR PARENTS,
WHAT THEY SAY MATTERS TO THEM. BUT A LOT OF PARENTS
DON’T KNOW WHAT TO SAY. THEY’RE AFRAID TO SAY SOMETHING. THEY DON’T KNOW
WHEN TO STOP OR START OR HOW OFTEN TO DO IT
OR WHEN TO DO IT. SO THIS IS SOME ADS
TO HELP THEM DO IT. THERE’S ANOTHER PIECE COMING. AND THAT IS–
WE’RE REALLY PROUD OF IT– IT’S GONNA COME AS AN AVATAR, WHICH WILL HELP PARENTS
PRACTICE WITH YOUNG PEOPLE AND GET SOME FEEDBACK BEFORE THEY DO IT
WITH THEIR CHILD ACTUALLY. – THAT’S COOL. I HAVE A FIVE-YEAR-OLD, AND I’LL START PRACTICING NOW. BECAUSE I KNOW I’M GONNA HAVE
THOSE CONVERSATIONS. SO, JOHN,
WE TALKED ABOUT AGE HERE, ABOUT THIS CAMPAIGN AND YOUNG PEOPLE’S
ATTITUDES CHANGING. AT WHAT AGE DO THESE BEHAVIORAL HEALTH ISSUES
OR MENTAL HEALTH ISSUES MANIFEST THEMSELVES? – WELL, I THINK AGE NINE
IS A VERY GOOD PLACE TO START. THE AMERICAN ACADEMY
OF PEDIATRICS SETS AGE NINE AT THE AGE TO START HAVING
CONVERSATIONS IN THE PEDIATRICIAN’S OFFICE ABOUT THE HARMFUL EFFECTS
OF ALCOHOL AND DRUGS. IT JUST NEEDS TO BE DONE IN A DEVELOPMENTALLY
APPROPRIATE WAY. AND JUST TO REINFORCE
WHAT WE JUST HEARD, IN SURVEYS OF CHILDREN
WHO DON’T USE DRUGS AND ALCOHOL, THEY WERE ASKED WHY. “WHY DON’T YOU USE?” AND THE NUMBER ONE REASON– NUMBER ONE REASON IS, “MY PARENTS WOULD KILL ME.” AND SO KIDS DO NOT WANT
TO DISAPPOINT PARENTS. IN FACT, WHEN I TALK
TO PARENT AUDIENCES, I’LL ALWAYS SAY,
“HOW MANY OF YOU HERE, YOU KNOW, “WHO HAVE PARENTS
WHO ARE STILL LIVING DON’T CARE AT ALL ABOUT WHAT
YOUR PARENTS THINK OF YOU?” AND NO HANDS GO UP. EVERYONE CARES
WHAT THEIR PARENTS THINK. YOU KNOW,
THEY MIGHT NOT ACKNOWLEDGE IT. MIGHT BE WHATEVER, YOU KNOW, BUT THEY DON’T LIKE
TO DISAPPOINT. AND SO I DON’T THINK
IT’S THE CONTENT SO MUCH OF WHAT
PARENTS HAVE TO SAY. IT’S LETTING YOUR CHILD KNOW, “I’M CONCERNED ABOUT THIS. “IT’S UNHEALTHY, AND I REALLY HOPE
THAT YOU WON’T DO IT.” – AND WHAT ABOUT
MENTAL HEALTH ISSUES? WHEN DO THEY
MANIFEST THEMSELVES? IS THAT–
FOR PARENTS WHO ARE CONCERNED, IS THAT–
IT DEPENDS ON THE ISSUE? – IT CAN START MUCH EARLIER. AN EXAMPLE WOULD BE
ATTENTION DEFICIT WITH HYPERACTIVITY DISORDER. THOSE SYMPTOMS CAN BE SEEN
STARTING AROUND AGE FIVE OR SIX, AND THAT DOES PLACE CHILDREN AT HIGHER RISK TO–
FOR IMPULSIVE ACTIONS INCLUDING USE OF SUBSTANCES. BUT DEPRESSION– ALSO THERE ARE
CHILDHOOD VARIETIES, BUT I THINK WE SEE MORE COMING DURING THE EARLY
ADOLESCENT YEARS THAT I WOULD DEFINE AS 10 TO 14. SUBSTANCE USE DISORDERS
ARISE THEN. WE ALSO SEE A BIG BUMP
IN CHILDHOOD PSYCHOSIS AT ABOUT THAT AGE. – OH, AND, ELLEN,
YOU COUNSEL SO MANY KIDS AND HAVE FOR SO MANY YEARS, SO WHAT ARE YOU SEEING IN TERMS
OF, ARE THEY SELF-MEDICATING, AND HOW WOULD YOU IDENTIFY THAT
WHEN THEY’RE USING SUBSTANCES? – SOME ABSOLUTELY ARE, AND I’D SAY THE TWO BIGGEST
REASONS FOR THE SELF-MEDICATION ARE THE ANXIETY DISORDERS
AND DEPRESSION. THOSE ARE
THE MOST COMMON REASONS. YOU KNOW, HOW DO WE DETERMINE? WE TRY TO SAY, “WHAT IS IT LIKE
WHEN YOU’RE NOT USING?” AND THAT’S WHEN THEY TELL US, YOU KNOW,
THAT THEY JUST FEEL LIKE, “HOW CAN I BE UP FOR THIS PARTY,
YOU KNOW, WHEN I JUST DON’T EVEN
WANT TO GET OUT OF BED?” OR THEY MIGHT SAY, YOU KNOW, “I’M JUST SO ALL OVER
THE PLACE AND SO NERVOUS, “AND I JUST FIND,
IF I TAKE SOMETHING, IT REALLY CALMS ME DOWN.” THAT’S ONE OF THE WAYS
WE PICK IT UP. – JOHN, ARE THERE ANY DRUGS OR DRUGS THAT ARE LINKED
MORE TO MENTAL HEALTH– SUBSTANCE THAT ARE LINKED
MORE TO MENTAL HEALTH ISSUES? LIKE, I THINK NIDA
HAS IDENTIFIED CANNABIS AND PSYCHOSIS
IN SOME LINKS. – YEAH, FROM MY REVIEW
OF THE MEDICAL LITERATURE, I’D SAY CANNABIS LEADS THE WAY. ONE OF THE THINGS
WE NOW UNDERSTAND IS THAT THE EFFECTS OF CANNABIS
ON THE HUMAN BRAIN ARE VERY WIDESPREAD, AND IT AFFECTS A SYSTEM KNOWN AS
THE ENDOCANNABINOID SYSTEM THAT’S VERY IMPORTANT
FOR MIGRATION OF BRAIN CELLS TO THEIR FINAL LOCATIONS, AND IN THE PROCESS
OF MYELINATION– WHICH IS REALLY CONNECTIONS
BETWEEN CENTERS OF THE BRAIN– WITHOUT RAPID CONNECTIONS
THAT FUNCTION WELL, YOU CAN’T PERFORM
HIGHER ORDER FUNCTIONS. YOU CAN’T DO COLLEGE WORK OR HAVE A HIGHLY TECHNICAL JOB, AND IT’S BEEN SHOWN MARIJUANA INTERFERES WITH
THE CONNECTIONS IN THE BRAIN. THOSE ARE ALSO THE UNDERPINNINGS THAT UNDERLIE DEVELOPMENTIVE
DISORDERS LIKE DEPRESSION, ANXIETY DISORDERS,
AND PSYCHOTIC THINKING. – I ALSO JUST WANT TO ADD,
AND I THINK YOU WOULD AGREE, THAT ALCOHOL AND OTHER DRUG USE WILL EXACERBATE
ANY MENTAL HEALTH PROBLEM. – ABSOLUTELY. YEP. – WHICH IS WHY YOUNG PEOPLE
WHO ARE IDENTIFIED AS HAVING MENTAL HEALTH ISSUES
EARLY ON, AS JOHN MENTIONED, HAVE A REALLY HIGH NEED FOR SPECIFIC SUBSTANCE ABUSE
PREVENTION STRATEGIES. – AND I’LL JUST ADD THAT ALCOHOL IS RESPONSIBLE FOR MORE DEATHS THAN ALL OTHER DRUGS COMBINED AMONG OUR YOUNG PEOPLE. – THAT’S IMPORTANT. AND WE’VE LEARNED
SO MUCH ABOUT THE BRAIN, AND SO HOW IS OUR UNDERSTANDING, PAM, AT YOUR LEVEL, ABOUT THE BRAIN
AND HOW IT WORKS? THIS–
ALL THIS INCREDIBLE RESEARCH THAT WE’VE HAD
OVER THE PAST DECADE OR TWO, HOW ARE YOU APPLYING IT
WHEN YOU LOOK– WHEN WE’RE LOOKING
AT BEHAVIORAL HEALTH? – I THINK WE KNOW MUCH MORE ABOUT THE PLASTICITY
OF THE BRAIN AND HOW IT DEVELOPS, AND THE FACT THAT THINGS
THAT HAPPEN TO YOU, SUBSTANCES YOU USE, THE WAY YOU FEEL, THE WAY YOU EXPERIENCE
THE WORLD, HAS SOME IMPACT ON THE WAY
THE BRAIN DEVELOPS. AND I THINK IN THE PAST, WE JUST DIDN’T GET
THIS CONNECTION. YOUR QUESTION EARLIER ABOUT,
“WHY DON’T WE LOOK AT THE BRAIN THE SAME WAY WE LOOK AT OTHER
THING–OTHER PARTS OF THE BODY,” IS IMPORTANT, AND YOU MAY HAVE SEEN SOME OF THE FEDERAL EMPHASIS
RIGHT NOW ON BRAIN RESEARCH. SO NIDA, OR NATIONAL
INSTITUTE OF DRUG ABUSE, NATIONAL INSTITUTE
OF MENTAL HEALTH, THEY’RE BOTH REALLY
TAKING A LOOK AT HOW BRAIN DEVELOPMENT HAS
AN IMPACT ON AND IS IMPACTED BY BEHAVIORAL HEALTH ISSUES. SO WE TRY TO TAKE THAT
INTO OUR WORK– WITH OUR TRAUMA WORK, WITH THE WAY WE DO OUR
PREVENTION AND TREATMENT WORK, AND IN OUR RELATIONSHIPS
AND POLICY WITH PAYERS AND HELPING THEM UNDERSTAND THAT GETTING THESE ISSUES
DEALT WITH SOONER IS ACTUALLY GONNA BE
A GOOD VALUE IN COST ISSUE AS WELL AS A GOOD TREATMENT
AND OUTCOME ISSUE. – I JUST WANT
TO ADD SOMETHING ALSO. THERE’S RESEARCH NOW THAT SHOWS THAT BEING THE VICTIM
OF BULLYING AS A CHILD INCREASES YOUR RISK
FOR SOME CHRONIC DISEASES SUCH AS DIABETES
AND SOME OTHER ISSUES. – THAT’S AMAZING. SO, ELLEN, FOR COALITIONS, HOW ARE THEY USING
THIS NEW KNOWLEDGE OR WHAT WE KNOW ABOUT THE BRAIN? HOW ARE THEY TAKING THAT
OUT THERE IN THE COMMUNITY? – WELL,
COALITIONS ARE SO EFFECTIVE AT INCREASING AWARENESS
ABOUT WHAT THE ISSUES ARE, AND COALITIONS DO EVERYTHING
FROM PUBLISH– OR NOT PUBLISH–PRODUCE
PUBLIC SERVICE ANNOUNCEMENTS TO HOLDING YOUTH SPEAK-OUTS. ALL KINDS OF STRATEGIES
ARE BEING USED TO INCREASE AWARENESS
ABOUT THE HARMFULNESS OF YOUNG PEOPLE
INGESTING CHEMICALS. – AND, JOHN,
NOW THAT WE HAVE THE SOPHISTED– SOPHISTICATED BRAIN IMAGING–
I CAN’T EVEN SAY THAT– ARE WE SEEING FROM THAT THAT DRUG ISSUES
AND MENTAL HEALTH ISSUES ARE SHOWING UP
IN THE SAME PARTS OF THE BRAIN? – THEY’RE INVOLVED
WITH THE SAME NEURORECEPTORS AND THE SAME NEUROTRANSMITTERS. DOPAMINE IS AN EXAMPLE THAT CAN BE INVOLVED
IN DEPRESSION. LACK OF DOPAMINE
CAN CAUSE DEPRESSION, AND SO WE HAVE
A WHOLE CLASS OF DRUGS, YOU KNOW,
THAT WILL BOOST DOPAMINE. SEROTONIN IS ANOTHER PEOPLE ARE PROBABLY
FAMILIAR WITH, THE S.S.R.I. DRUGS– SELECTIVE SEROTONIN
REUPTAKE INHIBITORS. THESE SAME CHEMICALS
ARE BOOSTED BY THE EFFECTIVE
EXOGENOUS CHEMICALS THAT PEOPLE INGEST. SO THEY’RE VERY MUCH RELATED. THE BRAIN DOESN’T HAVE
SEPARATE SECTIONS, ONE INVOLVED WITH DRUGS,
ANOTHER, YOU KNOW– THERE ARE SECTIONS THAT HAVE
TO DO WITH MEMORY AND FEELINGS, AND THEY’RE BOTH INVOLVED
IN BOTH KINDS OF DISORDERS. – AND IS TREATMENT DIFFERENT? LET’S TALK A LITTLE BIT MORE
ABOUT TREATMENT. IS TREATMENT DIFFERENT FOR SOMEONE
WHO HAS CO-OCCURING DISORDERS? DO WE ADDRESS THAT PATIENT
DIFFERENTLY? – THE BEST OUTCOMES ARE FOUND WHEN YOU HAVE BOTH TREATMENTS AVAILABLE
FOR THE INDIVIDUAL AT THE SAME TIME
AND IN THE SAME LOCATION. WHEN YOU SEPARATE SERVICES, THEN YOU DECREASE THE OUTCOME
RATE BY A SUBSTANTIAL MARGIN. – AND IF–
THIS IS A QUESTION FOR ANYBODY. SO IF SOMEONE GETS DETOX
OR TREATMENT, IS THAT ADDRESSING THEIR– IF THEY HAD AN
UNDERLYING MENTAL HEALTH ISSUE, THAT’S NOT GETTING
TO WHERE THEY NEED TO GO, AS FAR AS TREATING THE PATIENT? – NOT NECESSARILY. IT CAN CERTAINLY HELP. BUT IT CAN ALSO SORT OF IDENTIFY WHAT THE UNDERLYING ISSUE
MAY BE. AND AS JOHN SAID,
WE HAVE A TOOL KIT ACTUALLY NOW. IT’S FOCUSED TOWARD ADULTS MORE, BUT IT IS ABOUT
HOW TO DO INTEGRATED TREATMENT OF BOTH MENTAL HEALTH
AND SUBSTANCE ABUSE. AGAIN, NOT EVERYBODY
HAS CO-OCCURING DISORDERS. BUT FOR THOSE THAT DO, THAT INTEGRATED TREATMENT IS, BY FAR, THE BEST
EVIDENCE-BASED APPROACH. – THE TRICKIEST PART
IS THAT IT TAKES A FEW DAYS FOR THE PERSONALITY,
THE BRAIN, THE BEHAVIOR TO CLEAR WHEN SOMEONE STOPS
DRINKING AND USING OTHER DRUGS. AND UNFORTUNATELY, MANY
INSURANCE COMPANIES WON’T PAY FOR THE NEEDED NUMBER OF VISITS TO ALLOW THE REAL PERSONALITY
OR THE REAL BEHAVIORAL ISSUES TO EMERGE. – AND THIS IS VERY TRUE. AGAIN WITH CANNABIS
OR MARIJUANA, BECAUSE THE EFFECTS
ARE SO LONG-LASTING, THIS IS A DRUG THAT
CAN BE DETECTED IN THE URINE SIX TO EIGHT WEEKS
AFTER SOMEONE STOPS USING, AND THE EFFECTS
ON CLOUDED THINKING CAN LAST SEVERAL MONTHS. AND SO WE OFTEN BELIEVE
SOME INDIVIDUALS NEED TO BE PULLED OUT OF THEIR
ENVIRONMENT FOR SEVERAL MONTHS BEFORE THEY CAN REALLY
PARTICIPATE IN THERAPY BECAUSE THEY’RE JUST NOT THERE. THEY’RE NOT THINKING NORMALLY
FOR THAT PERIOD OF TIME. – AND WHAT ABOUT PEDIATRICIANS? I MEAN, THAT’S YOUR LOVE
AND YOUR VOCATION, SO HOW ARE THEY TAUGHT TO ADDRESS SUBSTANCE ABUSE
AND MENTAL HEALTH ISSUES? – WELL, THE STANDARD OF MY
PROFESSION IS THAT PEDIATRICIANS SHOULD SCREEN EVERY ADOLESCENT
EVERY YEAR FOR SUBSTANCE USE– TOBACCO, ALCOHOL, CANNABIS,
OTHER DRUGS– AND OFFER BRIEF COUNSELING. AND MY ENTIRE RESEARCH LIFE HAS BEEN ABOUT TRYING TO EQUIP
PEDIATRICIANS SO THEY CAN DO IT. I’LL JUST MENTION
THAT THERE ARE TWO MESSAGES THAT WE FOUND IN 15 YEARS
OF QUALITATIVE RESEARCH THAT HAVE THE GREATEST IMPACT
ON A YOUNG PERSON’S BEHAVIOR IN TERMS
OF CHOOSING TO USE OR NOT. ONE IS SCIENCE. YOUNG PEOPLE SAY,
“GIVE US THE FACTS. “DON’T TELL US WHAT TO DO. “GIVE US INFORMATION. TRUST US TO MAKE
THE RIGHT DECISIONS.” AND THEN TRUE-LIFE STORIES. IT’S THE POWER OF THE NARRATIVE. YOU KNOW, PUT A HUMAN FACE ON IT
TO DRIVE THE MESSAGE HOME. SCIENCE AND STORIES: IT’S THE ONE-TWO PUNCH
THAT PRODUCES BEHAVIOR CHANGE. – AND WE ALSO FIND THAT PEERS–
IT’S THE STORY– IS SOME OF THE BEST ENGAGEMENT, WHETHER IT’S AT
THE PREVENTION LEVEL OR ENGAGEMENT
FOR YOUNG PEOPLE WHO NEED HELP. SO PEERS ARE SOME OF THE BEST
AT ENGAGING, AND THEY’RE ALSO
SOME OF THE BEST AT HELPING WITH RECOVERY SUPPORT FOR EXACTLY THE REASONS
JOHN SAID. – ELLEN,
DO YOU THINK KIDS UNDERSTAND THEIR OWN MENTAL HEALTH ISSUES? – IT DEPENDS ON THE AGE. I THINK THAT KIDS
BEGIN TO UNDERSTAND THAT THEY’RE MORE NERVOUS
THAN THEIR FRIENDS OR THAT THEY’RE MORE DEPRESSED
THAN THEIR FRIENDS OR THEY DON’T HAVE
THE SAME ENERGY LEVEL OR THAT THEY’RE “WEIRD”– KIDS’ WORDS, NOT MINE. I THINK THAT WHEN
THEY GET TO TEENAGERS, THEY SO BADLY WANT TO FIT IN, AND IF THEY’RE
NOT LIKE EVERYONE ELSE, THEY BEGIN TO THINK
MAYBE SOMETHING’S WRONG. AND THAT’S ONE OF THE REASONS THAT SOMETIMES
THEY USE SUBSTANCES, BECAUSE IF YOU’RE AT A PARTY, AND YOU ACT WEIRD,
AND YOU’RE DRUNK, YOU CAN SAY, “OH, IT’S BECAUSE
I WAS REALLY WASTED.” BUT IF YOU ACT WEIRD
AND YOU HAVEN’T BEEN USING, THEN THERE’S NO EXCUSE. – DO THEY UNDERSTAND
THAT THERE MIGHT BE A LINK WITH MENTAL HEALTH
AND SUBSTANCE ABUSE? DO THEY UNDERSTAND THOSE LINKS,
YOU THINK? – I THINK MOST YOUNG PEOPLE
DON’T UNDERSTAND THAT. IT TAKES A WHILE, AND IT TAKES USUALLY
A PROFESSIONAL TO HELP THEM UNDERSTAND THAT. SOME WILL ACTUALLY SAY, “I FEEL
BETTER WHEN I USE DRUGS,” SO THEY THINK DRUGS
ARE A MEDICINE. – AND WHAT ABOUT INTERVENTIONS? AND I WANT TO TALK
A LITTLE BIT ABOUT SCREENING AND INTERVENTIONS, AND I WANT TO HEAR FROM ELLEN
FIRST ON WHAT COALITIONS– ARE COALITIONS DOING SOME WORK
AROUND INTERVENTIONS AND REFERRALS TO TREATMENT? – ABSOLUTELY. COALITIONS ARE SO VISIBLE
IN MOST COMMUNITIES, SO MANY COMMUNITY MEMBERS
GO TO THE COALITION AND SAY, “I’M WORRIED ABOUT MY SON,” AND YOUTH ARE A VERY
IMPORTANT PART OF COALITIONS. SO MANY TIMES, THE YOUTH MEMBERS
ON A COALITION WANT TO KNOW
HOW TO HELP A FRIEND. BUT COALITIONS
HAVE ALSO BEEN RESPONSIBLE FOR TRAINING EMERGENCY
DEPARTMENT STAFF ON SCREENING,
BRIEF INTERVENTION, AND REFERRAL TO TREATMENT. COALITIONS HAVE BEEN REALLY
IN THE FOREFRONT AND REALLY PUSHING THE NEED FOR EARLY IDENTIFICATION
AND REFERRAL. MENTAL HEALTH
AND TREATMENT PROVIDERS ARE PARTS OF COALITIONS. – PAM, HOW DOES S.B.I.R.T., OR SCREENING
AND BRIEF INTERVENTION– SCREENING
AND REFERRAL TO TREATMENT– HOW DOES THAT–
I’M GONNA CALL IT S.B.I.R.T. JUST TO MAKE LIFE EASIER. HOW DOES THAT FIT INTO
BEHAVIORAL HEALTH, AND HOW ARE YOU WORKING ON IT? – WELL, S.B.I.R.T.
IS ACTUALLY A PROCESS. IT’S A PROCESS OF ASSESSING
OR SCREENING, AND THEN IF YOU FIND AN ISSUE,
DOING A BRIEF INTERVENTION, BUT IF THERE’S A MORE DIFFICULT
OR MORE IMPORTANT ISSUE THAT NEEDS MORE ATTENTION, THEN A REFERRAL
TO SPECIFIC TREATMENT. EACH OF THOSE PROCESSES
IS REALLY CRITICAL– DOING THE SCREENING,
DOING THE BRIEF INTERVENTION, AND THEN DOING THE REFERRAL
TO TREATMENT. FOR ALCOHOL USE,
IT’S VERY EFFECTIVE. S.B.I.R.T. IS MORE
OR LESS EFFECTIVE– THE RESEARCH IS MORE OR LESS– SHOWS MORE OR LESS VALUE
DEPENDING ON THE AGE, DEPENDING ON WHAT
YOU’RE SCREENING FOR, ET CETERA. SO THERE’S INCREASING
EVIDENCE THAT USE OF CERTAINLY SCREENING AND BRIEF
INTERVENTION FOR DEPRESSION AND CERTAINLY SCREENING,
BRIEF INTERVENTION, AND REFERRAL TO TREATMENT
FOR ADOLESCENT SUBSTANCE USE. SO THERE’S DIFFERENT KINDS
OF S.B.I.R.T. BUT IT IS CLEARLY
THE RIGHT KIND OF PROCESS. I THINK THE PROBLEM IS, IS THAT A LOT OF PRACTITIONERS JUST DON’T HAVE ENOUGH TIME TO DO EVERYTHING
THAT THEY FEEL THEY NEED. SOME OF THE NEW WAYS THAT THEY’RE PUTTING
TREATMENT SYSTEMS TOGETHER SO THAT THE BRIEF INTERVENTIONS CAN BE DONE BY NURSE EDUCATORS
OR OTHER INDIVIDUALS, SO IT RELIEVES
THE INITIAL PRACTITIONER FROM HAVING TO DO SOME OF THAT. OR THERE ARE NEW WAYS TO USE ELECTRONIC APPROACHES
TO DOING SOME OF THE SCREENING. SO THERE’S LOTS OF WAYS THAT PEOPLE ARE TRYING TO USE
THIS TRIED AND TRUE METHOD AND THE EVIDENCE
THAT’S BEHIND IT– TO DO THE BEST THING. THERE’S NEW SETTINGS: EMERGENCY ROOMS,
E.A.P. PROGRAMS, SCHOOLS– OTHER PEOPLE ARE STARTING TO USE THE S.B.I.R.T. PROCESS
AND STRUCTURE IN ORDER TO BE HELPFUL
FOR YOUNG PEOPLE AS WELL. – AND, JOHN, HOW IMPORTANT IS IT
TO MEDICAL DOCTORS AND PEDIATRICIANS
THAT THEY USE THIS PROCESS? – SO IT’S REALLY– IT’S A MANDATED BEHAVIOR
FOR PEDIATRICIANS TO SCREEN. HOWEVER,
BY THEIR OWN SELF-REPORT, FEWER THAN 50%
SCREEN EVERY ADOLESCENT PATIENT WHO COMES IN, AND THE CONCERN IS TIME. THEY DON’T HAVE ENOUGH TIME. THEY GET 20 MINUTES
FOR A COMPLETE VISIT, AND THERE ARE PROBABLY 30 TO 40 DIFFERENT
BEHAVIORAL HEALTH ISSUES THAT THEY SHOULD SCREEN FOR INCLUDING TOO MUCH
TELEVISION WATCHING, YOU KNOW, UNHEALTHY EATING, AND THE LIST GOES ON AND ON. AND SO WHEN THEY GET A
POSITIVE SCREEN, THEY FEEL LIKE, “I DON’T HAVE ENOUGH TIME
TO MAKE THE REFERRAL.” THIS IS A TIME FOR PEDIATRICIANS TO WORK TOGETHER WITH COALITIONS SO THAT KIDS WHO NEED
MORE HEALTH INFORMATION OR BRIEF COUNSELING
JUST ABOUT HEALTH EFFECTS CAN GET THAT. BUT IT DOESN’T HAVE
TO ALL BE DONE IN ONE VISIT IN THE PEDIATRICIAN’S OFFICE. WE’VE BEEN WORKING
ON COMPUTER SYSTEMS THAT ADOLESCENTS CAN COMPLETE
THE SCREENING ON BEFORE THEY SEE THE DOCTOR. THE DOCTOR GETS THE RESULT, AND, YOU KNOW, THEN GIVES
SOME BRIEF COUNSELING, AND WE FOUND THAT
HIGHLY EFFECTIVE. THREE MONTHS
AFTER THE DOCTOR VISIT, 50% FEWER YOUTH WERE DRINKING. – THAT’S A GREAT USE
OF TECHNOLOGY. I THINK WE’LL BE MOVING
TO MORE OF THAT. LET ME ASK YOU, ELLEN, FROM WHAT YOU’RE SEEING AS OUT ON THE STREETS
IN THE COMMUNITIES, ARE THERE MORE BEHAVIORAL HEALTH
PROBLEMS IN OUR COMMUNITIES, OR ARE WE JUST
MORE AWARE OF THEM NOW? – UM, I THINK
WE’RE MORE AWARE OF THEM. THAT’S FOR SURE. JOHN DOES THE RESEARCH, SO
I DON’T KNOW IF THERE’S MORE. I UNDERSTAND THAT THERE’S MORE ATTENTION DEFICIT DISORDER
BEING PICKED UP. THERE’S MORE AUTISM
BEING PICKED UP. I DON’T KNOW ABOUT IF THERE’S AN INCREASED
INCIDENCE OF THE OTHER, BUT CERTAINLY PEOPLE
ARE MORE AWARE OF THEM. – THE RATES RISE AND FALL
OVER TIME. BUT THE GENERAL TREND RIGHT NOW
IS CLIMBING UPWARD, AND IT’S UNMISTAKABLE
THE PAST TEN YEARS HAS BEEN A TIME
OF INCREASED USAGE. SOME OF THIS HAS TO DO
WITH PUBLIC POLICY AND LAWS. IN MY OWN STATE, THEY JUST LEGALIZED
SO-CALLED MEDICINAL MARIJUANA, AND THAT WILL HAVE AN EFFECT. USAGE RATES ARE STARTING
TO CLIMB IN MASSACHUSETTS AS A RESULT
OF DECRIMINALIZATION, AND THEY’RE GONNA CLIMB
EVEN FURTHER. – AND, PAM, WHAT ARE YOU SEEING IN YOUR RESEARCH AROUND
BEHAVIORAL HEALTH ISSUES? ARE THEY INCREASING? – UM, I THINK THAT IT DEPENDS ON WHETHER YOU’RE TALKING ABOUT
USE OR DISORDERS. THE DISORDER RATES ARE NOT
INCREASING SIGNIFICANTLY. IT’S STILL ABOUT 20%
OF OUR YOUNG PEOPLE HAVE– ABOUT ONE IN FIVE
WILL HAVE THESE ISSUES. BUT WHETHER IT’S
THE DIFFERENT TYPE OF DISORDER OR THE SEVERITY OF THE DISORDER, WHETHER IT ACTUALLY RISES
TO THE LEVEL OF A DISORDER, THAT, I THINK, MAY VARY. AND I AGREE WITH JOHN. I THINK THE USE AROUND MARIJUANA IS THE SINGLE HIGHEST
INCREASING USE. PRESCRIPTION DRUGS
ARE ALSO SOMETHING THAT IS A DIFFICULT ISSUE AND IS GROWING
AMONG OUR YOUNG PEOPLE. – THERE’S ONE PIECE
OF GOOD NEWS, THOUGH. I UNDERSTAND THAT THERE
IS A DECREASE IN ALCOHOL USE, WHICH IS GOOD,
AND THAT’S BEEN GOING DOWN STEADILY NOW FOR A WHILE. – AND A DECREASE
IN TOBACCO AS WELL. – YES.
– ABSOLUTELY. YEAH. AND THAT VARIES BY AGE GROUP,
THOUGH, UNFORTUNATELY. IT IS DEFINITELY GOING DOWN,
ALCOHOL USE, UNDER AGE 18. THE 18 TO 25 YEAR GROUP,
THEY’RE STILL KIND OF STEADY. IT’S NOT COMING DOWN AS MUCH. THAT’S THAT COLLEGE AGE GROUP. THERE’S A LOT OF BINGE DRINKING
IN THAT AGE GROUP. SO AGAIN,
THESE THINGS VARY BY AGE. THEY VARY BY, FRANKLY, DIFFERENT
PARTS OF THE COUNTRY AS WELL. – HOW CAN WE MAKE PARENTS BETTER
UNDERSTAND THE LINK BETWEEN SUBSTANCE ABUSE
AND MENTAL HEALTH? – WE HAVE AN EDUCATIONAL WEBSITE
FOR PARENTS CALLED TEEN SAFE, AND THERE’S–IT OPENS
WITH A VERY POWERFUL VIGNETTE FROM A FAMILY
THAT HAD A TRAGIC EXPERIENCE WITH A SON WHO WENT DRINKING, AND THEN THERE’S
A 15-MINUTE SLIDE SHOW THAT PRESENTS THE SCIENCE
IN VERY SIMPLE TERMS FOLLOWED BY SOME QUESTIONS
AND ANSWERS ABOUT HOW TO HANDLE PRACTICAL
SITUATIONS IN YOUR HOME. AND THAT WILL EQUIP THEM. IT WILL GIVE THEM INFORMATION ABOUT WHAT THEY CAN DO
IN THEIR OWN HOMES. REALLY,
PARENTS SHOULD LOOK AT THIS AS– IT’S LIKE AN INFECTIOUS DISEASE, AND WE HAVE EPIDEMICS. IT RISES AND FALLS
WITH SPECIFIC KINDS OF DRUGS, YOU KNOW,
LIKE PRESCRIPTION DRUGS HAS BEEN A NEW EPIDEMIC
OVER THE PAST TEN YEARS. AND THEY CAN REALLY
IMMUNIZE THEIR CHILDREN. HAVING THESE FREQUENT TALKS AND DOING
SOME OTHER SIMPLE THINGS IS LIKE VACCINATING YOUR CHILD AGAINST AN ALCOHOL-
OR A DRUG-RELATED TRAGEDY. – I WANT TO ASK ONE QUESTION
ABOUT STIGMA BECAUSE I THINK IT’S IMPORTANT. HOW ARE WE ADDRESSING STIGMA– AND I’M GONNA START WITH YOU,
PAM– RELATED TO SUBSTANCE ABUSE
AND MENTAL HEALTH? – WELL, I HAVE TO TELL YOU
THE FIRST THING WE’RE DOING IS TRYING NOT TO USE THAT WORD. – YEAH. – WE BELIEVE
THAT THE WORD “STIGMA” ACTUALLY STIGMATIZES
IN AND OF ITSELF. WE TRY TO TALK ABOUT
NEGATIVE ATTITUDES BECAUSE WHEN
YOU’RE TALKING ABOUT STIGMA, IT SORT OF PUTS SOMETHING
ON THE MENTAL DISORDER OR THE MENTAL HEALTH ISSUE
OR THE SUBSTANCE DISORDER, THE ADDICTION. IT’S REALLY THE NEGATIVE
ATTITUDES ABOUT THOSE THINGS THAT ARE THE PROBLEM AND THAT SOMETIMES
PREVENT PEOPLE FROM WANTING TO SEEK TREATMENT. A LOT OF TIMES,
PARENTS ARE WORRIED THAT THEIR KID’S
GONNA GET IDENTIFIED AS HAVING A MENTAL DISORDER
OR EVEN AN ADDICTION. THEY’RE UNCOMFORTABLE
WITH THOSE THINGS. SO WE’RE TRYING TO DO
A LOT OF WORK AROUND EDUCATING. WE JUST BROUGHT UP A NEW
MENTALHEALTH.GOV WEBSITE THAT CAME OUT OF THE PRESIDENT’S
MENTAL HEALTH CONFERENCE THAT HAPPENED ON JUNE 3RD. SO WE’RE TRYING
TO HELP PEOPLE SEE THAT IT’S OKAY TO TALK ABOUT IT, THAT PEOPLE NEED TO RECOGNIZE
THE SIGNS AND SYMPTOMS, HAVE LITERACY AROUND MENTAL
HEALTH AND SUBSTANCE USE ISSUES, AND BE MORE WILLING
TO JUST SEEK TREATMENT WHEN THEY NEED THAT HELP AND TO GET INVOLVED
IN THINGS LIKE COALITIONS AND OTHER THINGS THAT
ARE GONNA HELP THEIR COMMUNITY. – I WANT TO JUST UNDERSCORE
WHAT PAM SAID, HOW IT’S SO IMPORTANT
IF PARENTS GET HELP EARLY, ESPECIALLY FOR A SERIOUS–
LIKE, THE FIRST PSYCHOTIC BREAK. THERE’S GOOD RESEARCH THAT SHOWS
THAT EARLY INTERVENTION, PROPER MEDICATION, TEACHING
THAT YOUNG PERSON SKILLS, AND FAMILY MONITORING
REALLY CAN REDUCE THE INCIDENTS OF FUTURE PSYCHOTIC BREAKS. SAME THING WITH NOT DRINKING
OR USING OTHER DRUGS CAN MANY TIMES PREVENT
A REHOSPITALIZATION. SO THE EARLY EDUCATION
IS SO CRITICAL. – PAM, CAN MENTAL HEALTH ISSUES
BE PREVENTED? – UM, SOME CAN, AND CERTAINLY
THE DISABLING EFFECTS OF MENTAL HEALTH CONDITIONS
CAN BE PREVENTED. EARLY CHILDHOOD
DEVELOPMENT ISSUES– THE INSTITUTE
OF MEDICINE AGAIN– THE REPORTS MAKES IT VERY CLEAR. THE RISK AND RESILIENCY FACTORS AND WORKING ON THAT, COALITIONS ARE A CLEAR PART
OF THAT SORT OF EFFORT, ‘CAUSE IT HAS TO BE MULTI-SECTOR
AND MULTI-APPROACH AND CONSTANT. BUT YES, MANY OF THOSE DISORDERS
CAN BE PREVENTED, AND CERTAINLY SUBSTANCE ABUSE
CAN BE PREVENTED AS A PUBLIC HEALTH ISSUE. SO THERE’S LOTS OF HOPE THERE, AND WE NEED TO DO MUCH MORE
ABOUT THOSE ISSUES. – THAT’S GREAT. JOHN, WHAT ARE YOU
SEEING IN YOUR PRACTICE, THAT PREVENTION
REALLY DOES WORK, DOESN’T IT? – IT DOES. IT CAN HAVE AN ENORMOUS EFFECT, AND ESSENTIALLY, ADDICTION WE NOW KNOW
IS A PEDIATRIC DISEASE. IT HAS ITS ONSET DURING
THE EARLY ADOLESCENT YEARS, AND IF WE CAN MAKE
A DIFFERENCE THERE, THE IMPROVEMENT IN PUBLIC HEALTH
WILL BE REMARKABLE. NORA VOLKOW,
WHO’S THE DIRECTOR OF NIDA, SAID IT BEST, THAT SUBSTANCE USE AND ABUSE
IS A PREVENTABLE BEHAVIOR. ADDICTION
IS A TREATABLE BRAIN DISEASE. – PERFECT.
– YEP. – JOHN, I’M GONNA LET THAT BE
YOUR FINAL THOUGHT AS WE’RE WRAPPING UP. – ELLEN, FINAL THOUGHT FROM YOU? – THAT COALITIONS HAVE BEEN A CRITICAL PART OF THE
PREVENTION INFRASTRUCTURE, AND IF WE WANT TO PREVENT
OTHER BEHAVIORAL ISSUES, THAT WE NEED TO BUILD
ON THAT INFRASTRUCTURE. – PERFECT. PAM? – WE HAVE FOUR MESSAGES. BEHAVIORAL HEALTH’S
ESSENTIAL TO HEALTH, PREVENTION WORKS,
TREATMENT’S EFFECTIVE, AND PEOPLE RECOVER. THAT’S MY FINAL COMMENT. – AWESOME. THANK YOU, ALL. WELL, THAT’S ALL THE TIME
WE HAVE FOR TODAY. WE’LL LEAVE YOU
WITH SOME INTERNET RESOURCES YOU MAY FIND HELPFUL. ON BEHALF OF PAM HYDE,
JOHN KNIGHT, AND ELLEN MOREHOUSE, I’M MARY ELIZABETH ELLIOTT. THANKS FOR WATCHING
“EXPLORING THE LINK: DRUGS AND MENTAL HEALTH.”  

24 thoughts on “Highway to Heroin”

  1.  cant help but notice that they last time there was a heroin epidenic in the states in the 1970's the world biggest producer was in the so called golden triangle, and where were america fighting a war ? Vietnam. Now the worlds biggest producer is Afghanistan and you have american troops kicking the northern alliance out of the region, where they'd erradicated the poppy harvest. Its the dark alliance all over again (cia funding nicaraguan contras by importing cocaine) 

  2. Omg seriously! I'm going to just throw this out there and some can agree and others may not. Just food for thought… But the harder they crack down on prescribed medications that otherwise compliant patients may NEED and the easier it is to find heroin….. the more deaths they will see period! For one you know what's in a script. Heroin down the street…not so much. Too many war vets, ppl in accidents with long term pain, PATIENTS don't want to feel like they are on PAROLE peeing in cups and going in for pill counts at pain management clinics because 9 out of 10 of them are NOT the problem BUT they do it so they probably don't leave their meds just laying in the bathroom when signing a contract saying they'll lock them up js. They educate the patient. Then, heaven forbid they took a toke of reefer on a holiday and got kicked out of their pain clinic OMG!!! NOW their physically dependant body needs something anything! MOST wouldn't turn to heroin, but look at the few too many that would ESPECIALLY if it's readily available unlike prescriptions and WAY cheaper on the streets since they cracked down SO hard on patients and most are eating not selling them since they need them…. fyi…. this war has just began and really THINK ABOUT where all this heroin popped up from over recent years hmmmm…….research that!! Whack a mole huh? EXACTLY!! There will always be opiates on the market btw making BIG bucks for big pharma, then all these programs need money right? What's worse, kid MAYBE getting a hold of medication which as controlled as it is now ALLOT less prevalent with all the hoops one must jump through to obtain a script and contracts to sign with education in place now…good job thumbs up…. OR make it SO hard that the kids ONLY get enough to possibly become DEPENDANT (Doc on here talks of addiction but not of the physical dependency that EVERY person on opioid analgesics will get and fairly quickly I might add) then they can't get more from ol gpa who locks his up now since they stole his but the heroin is just right around the corner. They don't know if that tiny bit of heroin is enough to put them in the ground or just "get them off sick" but if it was a pill they WOULD know potency so LESS likely to od. Catch 22, but I believe there are better ways to go about this war and more understanding about the people who are diverting and who are NOT. Too many times patients are labeled as drug seekers due to lack of pain relief and pushed out the door when actually SOME are missing a part in their dna and are high metabolizers of certain medications but never got the DNA screening. We've come SO far in science now let the docs take care of PATIENTS and law take care of criminals and figure out where all this heroin is coming from! Can't be that hard. They know where the pills come from. Supply and demand ppl. The more the supply the cheaper it becomes. The less the supply (pills) the more expensive it becomes to find. Of course making heroin cheap and readily available! I've seen TOO much of this in my own suburban community!! Years ago if you heard of heroin you'd think of St. Louis and never down the street! Make examples out of the few that DO sell their medication!! But don't make doctors scared to help the REAL patients in need of some quality of life with pain! Thank you!

  3. I strongly doubt the claim of heroin as addictive stuff. During the WW2 at least 200 000 and perhaps even 400 000 Finnish soldiers used heroin/morphine as medicine, pills for pain and injection for wounded soldiers. It was wildly used for toothache, headache, sabdominal pain, diarrhea, cough, pneumonia etc. More than 250 million doses of heroin and morphine was used in 3 years and after the war there were less than 500 drug addicts in whole Finland and all were heroin addicts. Lesson number one about heroin is: it is excellent painkiller, one of the best ever produced.

  4. First day away from the prescription med….. back on subs ready to live life to its fullest once again. … good times and sober months here we cum deep and hard lol… but seriously a toast to the good sobriety life ladies a gentleman. …

  5. opium is in heroin…opium is in oxycontin….who produces the opium??….Afghanistan….where are our troops? Who is the main importer?? 1+1=2…… Yes mexico makes black tar heroin but its not as popular as the down town bobby brown or the china white where both are directly imported from the golden triangle. This is propaganda at its finest! Stay in your bubble people….let the government weed us out!

  6. @ dj ceaser…..your moms still an addict to….shes addicted to the meat pipe…….and man i cant get er off…..of it……

  7. Give the people that really need pain pills their pills !! Don't just take the pills after they have taken them for 10 or more years . Cut their dose down & ween them off of the meds .

  8. And I never said I was better than anyone else I just said I was happy to be away from it I don't care of being subs is not being on subs totally clean I understand that and that doesn't bother me I would much rather beyond them then dope and I feel everyone else has a chance to actually get clean with the use of subs which most of us don't being an addict that's all I meant in my life has been so much better the last few months on subs and not on junk so whatever helps should help in benefit you get clean anyway possible do it it will save your life that's all I'm saying thank you very much and sorry for getting the attitude with DJ Cesar but he seemed to be an a****

  9. This documentary was infuriating to watch. Such ignorance coming from the idiot coalition leader and the stupid ass cop. Almost nothing the cop said was accurate so you can pretty much hit mute when he starts moving his mouth. The prescription opiate coalition leader has led and caused the increase in heroin addiction in Ohio and she actually states exactly that. Nice job guys! Way to start a heroin epidimic you ignorant fucks. What do you think legit pain patients are going to do if you make the medicine they need, impossible to get? They will find pain relief. Either through a physician and pharmacy or through the local heroin dealer. Want to see the heroin epidimic get even worse? Keep cracking down on legal / legit pain relief!

  10. what good show on addiction .They did manage to keep the law out pretty well .IFit has nothing to do with the selling of herion then the police should keep out if you have a you ng person in trouble with herion then thats enough troubleto be in you get him thru the rehab then all he or she needs is a jail sentence for personal use or possession. Alot of times when someone is overdosing no one will call 911 because they don't want to lose their drugs and or get arrested. so when 911 is called for an overdose 5-oh should stay at the station till maybe later if at all

  11. THE POINT IM GONNA MAKE IS GONNA BE A BIT FUCKING HARSH OK.IF YOUR NOT AN HEROIN ADDICT OR USER YOU REALLY DONT NED TO SPEAK ABOUT THIS CAUSE YOUR FUCKING RETARDS THAT DONT KNOW SHIT ABOUT THE LIFE OF AN ADDICT OR WHAT ITS LIKE TO BE STRUNG OUT.WHEN YOUR GETTING AND USING NOTHING AT ALL WILL STOP US OR TRY TO.YOU GUYS NEXT TIME YOU TRY TO AIR A PROGRAM ABOUT ADDICTION I RECCOMEND THAT U HAVE A COUPLE ADDICTS ON HAND THAT KNOW AND UNDERSTAND.I CURRENTLY AM ON METHADONE AND FOR ONE IM THOUROUGHLY GRATEFUL FOR IT.PLUS ITS ALLOWED ME TO HAVE MY LIFE BACK AT THAT.AS FAR AS IM CONCERNED I AM CLEAN AS OPPOSEWD TO THE LIFE I WAS LIVING BEFORE.BYE.

  12. Who invited the IGNORANT BLACK DETECTIVE? He added nothing. (He subtracted.) Couldn't tell us where different forms of heroin originated, nor where they landed in the US. Can't pronounce FENTANYL (he said "fettanol."). Kick his black ass off.

  13. In America the only answer is jail,they don't give a fuck prisons and war is profit for Wall St. and corporations.

  14. people got to take some personal responsibility for themselves and stop blaming other people for their addiction. it is time to grow up.

  15. haha its just like when your growing up anything that your parents are completly against you find a way to get done so if BIG BROTHER tells us every day that drugs are bad then they sell more of their heron

  16. I have never abused anything… but this week I was involved in a major car accident.  My Doctor prescribed me some muscle relaxers and an anti inflammatory.  Well, fuck him and fuck the system.  I am going out first thing in the morning and buying as much heroin as needed to get rid of this pain.  And why interview a Psychiatrist for pain medications… I feel like saw an idiot like the ones on your panel.  Psychiatrist don't prescribe OPIATES…and Nurses don't prescribe Opiates… FUCK THIS PANEL and FUCK YOU.

  17. These people have no clue what they are talking about. If they want answers, why not ask the Users and dealers . The black guy talking about how the one dealer making it stronger and stronger is bullshit. Fact is the users go to whoever they can find

  18. these people touch on the truth mixed with a bunch of bs if you want to know about addiction they need to go to the streets these guys are a group of school rats that know very little

  19. Since everyone is in denial I will take the initiative a would like to thank President Obama and Hillary Clinton for the legalization of marijuana the gateway to the other hardcore drugs.

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