Transcript I was surprised to hear all the drugs he did. I hadno idea that he was drinking that much, or that hewas high every day in school. I'd get up some mornings and I'd be like, man,today's gonna suck. If I had some prescriptionpills left over from the weekend, I'd pop a coupleof those. This is a disorder of young people. Very littleaddiction starts after the age of 30. It almostalways starts between the ages of 18 and 25. How can we comprehend the concept of a personthat wants to stop doing something and theycannot, despite catastrophic consequences?We're not speaking of little consequences. Theseare catastrophic. And yet they cannot controltheir behavior. There've been so many things that I haven'taccomplished because-- because of the problem, Ithink. My drinking's killing me. I desperately need help. The right medication with the right therapy reallycan give an individual a leg up in recovery. There are more treatments available. There'sbetter understanding. There's more acceptancethat this is a medical condition with real medicalsolutions than there ever has been. This whole addiction ruling your mind andthoughts-- even though I've lived through it, I stilldon't understand it. How can we comprehend the concept of a personthat wants to stop doing something and theycannot, despite catastrophic consequences?We're not speaking of little consequences. Theseare catastrophic. And yet, they cannot controltheir behavior. Drug addiction is a disease of the brain thattranslates-- that that disease translates intoabnormal behavior. Addiction is a result ofadaptations in the brain that leads to changes inbehavior that translate, among others, in theinability to control the intake of the drug. Theirbrains have been modified by the drug in such away that the drug makes a signal to their brainthat is equivalent to the signal-- if I have to comeup with a metaphor-- of when you are starving--the signal of seek the food and eat it when you arestarving. That's what the parent has tounderstand or the spouse has to understand, thatthere's been a change, an adaptation, from theuse of the drug that leads to the situation ofalmost as if the individual was in a state ofdeprivation, where taking the drug isindispensable for survival. It's as if their brainwere sensing that the drug is something that'snecessary for survival. It's as powerful as that. It's likely to be multiple factors. But one of theones that is likely to be very important is geneticdifferences. We're all born differently. And likewith any other disease, there are some peoplethat are more vulnerable, for example, fordepression. Or they may be more vulnerable forhypertension or for cancer. The same thing withaddictions. There are some people that becauseof hereditary reasons are more likely to becomeaddicted to drugs. This is one of the elements.Environment-- we know that there are someenvironments that are actually higher risk whilethere are other environments that are protective.For example,  ...

1. Transcript
I was surprised to hear all the drugs he did. I hadno idea that he
was drinking that much, or that hewas high every day in school.
I'd get up some mornings and I'd be
like, man,today's gonna suck. If I had some prescriptionpills left
over from the weekend, I'd pop a coupleof those.
This is a disorder of young people. Very littleaddiction starts af
ter the age of 30. It almostalways starts between the ages of 18
and 25.
How can we comprehend the concept of a personthat wants to st
op doing something and theycannot, despite catastrophic conseq
uences?We're not speaking of little consequences. Theseare cata
strophic. And yet they cannot controltheir behavior.
There've been so many things that I haven'taccomplished becaus
e-- because of the problem, Ithink.
My drinking's killing me. I desperately need help.
The right medication with the right therapy reallycan give an in
dividual a leg up in recovery.
There
are more treatments available. There'sbetter understanding. Ther
e's more acceptancethat this is a medical condition with real me
dicalsolutions than there ever has been.
This whole addiction ruling your mind andthoughts--
even though I've lived through it, I stilldon't understand it.
How can we comprehend the concept of a personthat wants to st
op doing something and theycannot, despite catastrophic conseq
uences?We're not speaking of little consequences. Theseare cata
strophic. And yet, they cannot controltheir behavior.
Drug addiction is a disease of the brain thattranslates--
that that disease translates intoabnormal behavior. Addiction is
a result ofadaptations in the brain that leads to changes inbehavi
or that translate, among others, in theinability to control the inta
ke of the drug. Theirbrains have been modified by the drug in su
ch away that the drug makes a signal to their brainthat is equiva

2. lent to the signal-- if I have to comeup with a metaphor--
of when you are starving--
the signal of seek the food and eat it when you arestarving. That
's what the parent has tounderstand or the spouse has to underst
and, thatthere's been a change, an adaptation, from theuse of the
drug that leads to the situation ofalmost as if the individual was
in a state ofdeprivation, where taking the drug isindispensable f
or survival. It's as
if their brainwere sensing that the drug is something that'sneces
sary for survival. It's as powerful as that.
It's likely to be multiple factors. But one of theones that is likel
y to be very important is geneticdifferences. We're all born diff
erently. And likewith any other disease, there are
some peoplethat are more vulnerable, for example, fordepressio
n. Or they may be more vulnerable forhypertension or for cance
r. The same thing withaddictions. There are some people that be
causeof hereditary reasons are more likely to becomeaddicted to
drugs. This is one of the elements.Environment--
we know that there are someenvironments that are actually high
er risk whilethere are other environments that are protective.For
example, which are high-risk environments?High-
risk environments are ones where you havekids, for example, w
here they are in a householdwhere no parent surveillance, high l
evels of stress,high levels of abuse, high levels of accessibility
ofdrugs. Well they have the drugs in front. Theyhave no constra
ins. They have little alternativebehaviors. They'll start to take it
. They areadolescents. And that's a vulnerability period.You're
more likely to become addicted if you startin adolescence or in
childhood. So those areelements that are likely to be playing a r
ole.
The answer is depends what drugs you've beentaking, depends h
ow long you've been taking it.And also there are differences bet
ween people.One of the messages that I do say is very clearly--
particularly young people--
our brain has atremendous capacity for recovery, much moretha
n what we thought in the past, even as adults.Our brain is what

3. we call plastic. So even though,yes, that repeated use of drugs l
eads to damageof certain areas of the brain--
It leads to changesin the way that we may perceive emotions. It
leads to changes on the way that we makedecisions. It leads to c
hanges in memory. It leadsto changes on your motor reflexes. S
o it makesyou slower. All of those things can recover to acertai
n extent.
They're going to have to take steps to minimizethe chances that
they relapse, to minimize thechances that they will hurt others.
That entails aseries of changes in their behavior that includesad
herence to treatment, that includesrecognitions of situations wh
ere they can actuallyget back into the drug
and relapse to avoid them,recognition of situations where there
actuallycould lead to dangerous behavior like drinkingand drivi
ng. The person that's addicted has totake responsibility that they
have a disease.
In diseases whether it's something like cancer orwhether
it's something like addiction, you want todo an aggressive interv
ention that increases thelikelihood of helping the person. If that
involves astrong behavioral intervention-- a 12-
stepprogram and medications, why not? Why limit itto this or th
at? If a person can benefit from amedication to help them engag
e on the 12-
stepprogram, why not explore it? Certainly medicationis not goi
ng to be by itself, in most instances,sufficient. You will require
more than medication.You will require behavioral intervention.
There are many reasons why people may not becompliant to trea
tment. One of them, let'saddress it--
the program is not a good program, sothe person cannot be com
pliant. It doesn't havethe elements that will engage the patient.A
nother one may
be that the treatment is verygood, but it's not actually fit the per
son. Andagain, we are in a situation that is not one-size-fits-
all. So you can take a kid and push them into aprogram that it's
predominantly of adults where itactually is not going to work pr
operly. Thenthere's the other element, are their individualsthat a

4. re more resistant to treatment, or in otherwords, are there indivi
duals that are moreaddicted for which it's much harder to stop t
hem?And evidently there
is. There are geneticdifferences that not just makes you, for exa
mple,more vulnerable to take drugs, but may make youmore vul
nerable to actually become moreseverely addicted. The longer y
ou have becomeaddicted to a
drug, the harder it is for you torespond to treatment. And that's
where theimportance of doing an early intervention is sokey. So
it's much harder to treat someone that hasbeen addicted to cocai
ne for 30 years than it issomeone that has been addicted to five
or six orseven or eight years. And the same thing pertainsfor oth
er drugs like alcohol or cocaine or nicotine.
One of the surprises when I took this position--
Ialways was under the notion that to be able totreat the drug-
addicted person, they have to bewilling to want to stop taking th
e drugs. One ofthe things that I rapidly learned was that I waswr
ong. But that was the prejudice of mine andmany of my colleagu
es. And I was--
and whatmade me realize was wrong was when I started toread
about the successes that are coming upwhere--
from treatments from the drug-
courtsystem or for programs that institute treatment inthe prison
will show that mandated treatment iseffective. The data is there
to prove
it. When youlook at the numbers, and you see them replicatedun
der very different conditions with differenttypes of drug
addicts, and it works, you start tocome to recognize that the noti
on of voluntarytreatment is not indispensable for success.Manda
tory treatment works. And that's why it's
an extraordinary opportunity in the criminaljustice system to int
ervene and start treatingpeople that are addictive.
Mental disorders and drug
addiction appears tobe almost more the rule than the exception.
Which are those mental disorders that make youmore vulnerable
to take drugs? You name it--

5. schizophrenia, depression, anxiety disorders,post-
traumatic stress disorder, conduct disorder,learning disabilities,
attention deficithyperactivity disorder. In many instances, thepe
rson may have started to take the drugs as amechanism to auto-
medicate. Despite this, wetreat these two things as if they weren
't co-
occurring together. You treat the addiction, butyou don't deal wi
th the depression, they'reactually going to, in fact, relapse in tha
t instance.They are so closely intertwined that it has been a
tremendous disservice for the field not torecognize the importan
ce of actually treating bothof them.
Family and friends can play a very important rolein helping som
eone to go to treatment and toencourage them and motivate the
m to stay intreatment. And so they play a role at both thosestage
s--
number one, making the personrecognize that they do have a pr
oblem withaddiction, that they do need help, which is notsometh
ing that occurs automatically. That is tosay it does require some
insights to understandthat there is a disease going on, and that i
t isunlikely to go away by itself.
The anger that has been built up in a family whenthere is one of
the individuals that's addictedleads to a confrontation. Either y
ou do that oryou're
out. And again, in some instances thatworks. But in others it
alienates because whathappens is the person leaves the house. If
it's anadolescent and it leaves the house they may bereally on th
eir own. And they may be pushed intoan environmental conditio
n of tremendous stress,that without a structure to support them c
an leadthem further into the drugs.
Once they go into the treatment, the family canplay an extremel
y important role to maintain themotivation to stay in the treatme
nt. Again, thefamily many times needs to be treated. The family
itself--
because there's so much these disruptionthat there are very abn
ormal patterns in
thecommunication of the family members thatdevelop as a result

6. of the
addiction. If not dealtwith, those abnormal patterns may contrib
ute torelapse.
In many ways not completely different of how youevaluate if a
physician that's recommended foryou for treatment is good or a
hospital, you relyon what the track record of that particularprog
ram is. And how do you rely on that trackrecord? There's in cert
ain instances, there isinformation about the particular center tha
t doesprovide their history. There's information frompeople that
have gone through those treatments.So you go about in many w
ays in a similar waythat you would go when you're seeking for a
surgeon to do these procedures. So there is thataspect to it.
12-
step programs are actually probably the mostfrequently utilized
treatment variety for drug
addiction and they are part of the recoveryprocess. And they are
based on programs, 12-
stepprograms, are based on taking advantage of thepeer influenc
e in helping the person that'saddicted to drugs stop taking the dr
ugs. So theyrely very much on a peer process.
Is it enough to have a 12-
step program and whatwe know from past experience is that in c
ertaininstances it is
enough. But in others it's not. Itbrings forth the concept there is
not onetreatment that fits all. And there is neither onetreatment
that fits a given person at all stagesduring the addiction process
. So while step-- 12-
step programs may be very helpful for anaddicted person during
the recovery phase, theymay not be sufficient to maintain them
during thedetoxification.
So again you have to evaluate and tailor theneeds of the
individual to where they are at todetermine at what stage, for ex
ample, a 12-
stepprogram would be beneficial for them or whetherit
could at all be beneficial. There are somepeople for whom the 1
2-

7. step program does notwork, whereas in others they are very valu
ableand has been able to help them stay clean foryears.
Addiction can happen to any kid, to any kid.There's no one reall
y that is protected. There
areprotected environments. But nobody'scompletely protected. S
o I think that the alertnessthat kids are at greater danger of drug
s issomething that parents should be alerted about,not become p
aranoid, but be aware of this as areality.
There's nothing that I have seen that disruptsmore a family than
having a kid who's addicted. Itcan be drugs or actually it could
be alcohol. It canreally disrupt the family, so the parents becom
every angry at the kid. And the kid then reacts out.And then you
start to create the dynamic that'svery negative. That's not going
to help theadolescent. Nor is it going to help the parent,because
the adolescent will rebel against thesenegative attitudes.
The family has to understand when they get veryfrustrated about
-- well, my child is
stealing fromme. He's lying to me left and right. I've got it. Ican
not deal with that child anymore. First, theyhave to stand back a
nd say, first of all their brainhas been affected by the drug. So a
lot of thesebehaviors that are so unacceptable, in
fact, areconsequences of the exposure to the drug.
Drug
addiction is a disease that, in mostinstances, lasts for a very lon
g period of time.There are many chronic diseases. We know, for
example, asthma. And you have asthma for many,many years. A
nd that means-- what does it meanif
you have a chronic disease? It means you needtreatment for a lo
ng, long period of time. So thesame thing happens with drug
addiction. Youneed treatment for a long period of time.
So initially during the early detoxification phasesand the early s
tages of the recovery, you need amore intensive type of treatme
nt. And as you startto restructure your life, the frequency at whi
chyou have to seek the treatment becomes less so.But still it im
proves the outcomes to maintainsome continuity in care, whethe
r it's through agroup therapy to an individual therapy, whicheve

8. rmechanisms have worked work for that person.
Clearly what studies have shown is that forprograms to really ha
ve effectiveness, they haveto be 90 days or longer. So in general
, a 30-dayperiod does not appear to be sufficient for a
treatment of a person that has a severe addictionproblem. Based
on what studies looking at thelengths of intervention and outco
mes haveshown-- that really it's
at 90 days that you start toreally significantly improve the outco
mes ofpeople that undergo treatment.
What does it mean when you have a chronicdisease, that while y
ou may be doing very well, allof a
sudden you may relapse? And see that, forexample classically w
ith cancer where it also is achronic disease. Someone is being tr
eated, andthen there is a relapse. Does that mean thattreatment d
oes not work? No, it does not meanthat treatment does not work.
We should beunderstood as a chronic nature of that disease.An
d what we're trying to achieve is rather thansaying, OK, treatme
nt--
we will only considertreatment works if the person can stay cle
an forall of their life. No, let's be more realistic like we
are more realistic with any of the diseases--
hypertension, asthma cancer. We'll call itsuccessful if we can ke
ep the person as clean aslong as possible. So if there is one or t
wo relapses,we shouldn't give up on the fact that
thattreatment is being effective most of the time.
We don't want to speak about drug
addiction. Andwe don't want to speak about drug
addiction ingeneral, because there's such a horrible stigma.So p
eople say to me, Nora, don't speak aboutcomparing these diseas
es with
drug addiction,because you're going to offend people that have
medical diseases. And I said, well, it's sad to see it.The person d
oesn't choose it. We need to startbringing down that stigma, bec
ause by notaddressing it, it's not going to go away. And it'slike
at one point we had the stigma of leprosy.Nobody spoke about l
eprosy, right? We had astigma of cancer at one point. We had a

9. stigma ofschizophrenia. There's still a significant stigmawith so
me of the mental diseases, but much lessso. The one that's laggi
ng behind is addiction.
One of the elements that we need to recognizethat favors the sti
gmatization of addiction is thatbecause it's a disease that affects
behavior, andwhere the main drive is procuring the drug, incert
ain instances it can lead to behaviors thataffect others. Stealing,
robbing, when someone issmoking marijuana and driving while
intoxicated,and they have an accident--
well, of course, that'svery enraging. And so that's where an ele
mentthat does not help the field at all--
that someindividuals, because of the disease process andwhat h
appens, engage on behaviors that directlyaffect others. In many
cases, most of the cases,these people that are addicted really ha
ve notharmed someone else. Others have, but most ofthem have
n't. And yet there's no empathy, there'sno recognition of the eno
rmous amounts of
suffering that goes with the disease of addiction.It's much harde
r to recognize it.
Detoxification is that initial stage that allows aperson to stay cl
ean. But that's just the beginningof the road. And then the rest i
s what is we'regoing to call recovery, that process by which the
person who has been addicted is re-
integratedinto society without the need of drugs. And therecover
y is when the person is able to do that. Soit's a long-
lasting process. Recovery is notsomething that occurs over two
or three months.It's a process that goes on for years, and it'salm
ost like a continuous aspect of the person whohas been addicted
for a continuous aspect of hisor her life.
Ultimately there is the power of healing. There isthe power of
healing. And we can recover. But it'snot in many instances happ
ening automatically. Itdoes require intervention in most instanc
es.