Why are opioids so addictive? What makes opioid drugs so lethal? Is rehab effective for opioid addiction? From the frontlines of the nation’s opioid epidemic, psychiatrist Marvin D. Seppala, MD, joins host William C. Moyers to discuss the role of science and compassion in responding to the opioid addiction crisis. As chief medical officer for the Hazelden Betty Ford Foundation, Dr. Seppala led the organization’s development of innovative protocols targeting opioid use disorders. Hospitals and treatment providers around the country are adopting the treatment protocols which address issues related to opioid detox, drug craving, treatment engagement and ongoing recovery support. Read the podcast transcript below, listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:16 William Moyers Hello and welcome to the Hazelden Betty Ford Foundation's Let's Talk series of podcasts. My name is William Moyers and I've been with the organization since 1996. However, before that, in 1989, I was a patient at Hazelden and so that makes me not only an alum, but a man in long-term recovery from addiction to alcohol and other drugs. Thanks for joining us and for listening in on our series of conversations with my colleagues about the important issues related to research, prevention, treatment and recovery support. 0:00:53 William Moyers Today we're talking about opioids. And my special guest is the Chief Medical Officer of the Hazelden Betty Ford Foundation, Dr. Marvin Seppala. Dr. Seppala joined Hazelden in 2002 as our Chief Medical Officer. He's a Mayo-trained Doctor of Psychiatry. But long before that, Marv, you had a personal connection to the organization. And so before we get to our topic of opioids today I would just ask if you’d share a little bit about that. 0:01:23 Dr. Marvin Seppala Glad to. And my involvement at Hazelden began at 17 as a high school dropout. And I'd never even heard of Hazelden. And in fact wondered what it was as we drove in and I saw that name I had no idea where my parents were bringing me or why. I knew there was something wrong, I had no clue it was addiction. And I learned that in treatment obviously. And completed treatment at Hazelden and went back to Stewartville, Minnesota and my family and I immediately relapsed because I didn't do any of the things that they suggested. But ultimately about a year and a half later, I finally did. And attending Twelve Step programs got sober and now I'm also in long-term recovery. 0:02:07 William Moyers How many years now? 0:02:07 Dr. Marvin Seppala Forty-two years. 0:02:10 William Moyers Wow. Did you ever—they always talk about living it a day at a time, did you ever think those days would add up to these decades? 0:02:17 Dr. Marvin Seppala No, not once. I—my sponsor, my first sponsor was sober five years when he became my sponsor and I thought that was in a lifetime, you know, that was an eternity. How would I ever accomplish that? 0:02:30 William Moyers And surely you didn’t ever have any notion that you would one day become a Mayo-trained doctor and a doctor of psychiatry as the Chief Medical Officer of the organization that you'd gotten treatment from. 0:02:44 Dr. Marvin Seppala Not at all. In fact, part of dropping out of high school was that I didn't think I was gonna live that long. And so why have a high school degree? And so I had no vocational plans of any kind. When I first got sober. It was—I really had no idea. No thoughts, no plans, nothing. Didn’t have a clue. 0:03:06 William Moyers Well you and I are shining examples that from adversity comes opportunity. 0:03:11 Dr. Marvin Seppala That's for sure. 0:03:12 William Moyers And the opportunities that we got when we started that journey at Hazelden have resulted in us being here, colleagues and friends and fellow travelers. So we're here though today to talk about a very serious subject: opioids and certainly the opioid epidemic. It is a epidemic that does not discriminate, it doesn't matter whether you are in the inner city of Minneapolis or in the bucolic suburbs of Wisconsin or Iowa or Kansas, opioids are everybody's problem. And we at the Hazelden Betty Ford Foundation certainly have seen this epidemic up close and personal. Dr. Seppala, tell us a little bit why opioids are an epidemic. 0:03:57 Dr. Marvin Seppala You know they're extremely powerful medications. They're necessary for pain relief of a moderate to severe nature. Especially like for a broken bone, for post-surgical pain, that sort of thing. Really severe pains that we need opioids for. And in the before the mid-90's, there was great care in the prescribing of these medications by physicians and other health care practitioners. And there was real concern about extended use of them and high dose use of these medications. So, there wasn’t much of a problem for decades actually. And then in the mid-90's a change occurred in which a particular medicine was developed by the pharmaceutical industry. And marketed not just to pain experts, which was going on up until this point in the mid-90's, but now they changed their marketing strategies to address primary care. And the suggestion was that they could treat people with chronic pain safely and wouldn't even have to worry about addiction 'cause this is, you know, this is new medicine, Oxycontin, was different and wouldn't cause addiction in this population. And they used some really bad science to publish a couple things that were used to convince physicians and others of these false truths, you know. 0:05:22 William Moyers The bad science being that it wasn’t addicting. 0:05:24 Dr. Marvin Seppala Yeah, exactly and that it wouldn't be problems for people. And so suddenly, guidelines in regard to the use of these medications started to change. And the prescribing went up dramatically. And—and whenever any population's been exposed to opioids, of course a certain percentage become addicted to it. So as the prescribing increased and the number of prescriptions increased in the country, so did the treatment admissions for opioid use disorders or addiction to these prescription painkillers. And coincidentally, the death rate from opioid overdose, which in most of our you know kind of historical look at addiction, when you think about the cocaine crisis, there certainly was a death rate associated with that. But nothing like what we’re seeing now. Or Methamphetamine, there's a death rate associated with you know high dose methamphetamine use. 0:06:21 William Moyers Or alcohol too. 0:06:22 Dr. Marvin Seppala Yeah, alcohol actually kills way more than any other illicit substance. Maybe even four times more than everything else combined. But it's primarily people at the end stage of their addiction to alcohol. They're certainly some young people that overdosed on alcohol but the major issue's end stage. And with the opioids, it's sudden overdose. And in general, it's a young population doing that. And an older population. Like in our age group, about 50 or so and above, and it's usually from combining pain medication that they're being prescribed with other medicines, or with high dose alcohol that—that also reduce respiratory rate or reduce the rate in which people take their breaths. And that's how opioids kill is that they—they alter the brain stem area where respiration is controlled. They—and opioids slow it down and if you take enough and overdose, it actually stops us from breathing. And so if you take enough to slow it down some, but you also drank a lot of alcohol that also slows it down or used something like Xanax, a Benzodiazepine, a sedative-hypnotic for anxiety or sleep, you suddenly could overdose just from that combination. 0:07:45 William Moyers So when we say epidemic and we—we really mean epidemic, we're not using that as a euphemism or to suggest something, what does it mean that we're actually in an opioid epidemic in the United States? 0:07:59 Dr. Marvin Seppala So the epidemic officially is defined by the Center for Disease Control in Atlanta. And they usually use it in regard to infectious disease. And you know there's enough people that end up with the disease, enough people die, then—then they call it an epidemic. And they decided for the first time actually in regard to addiction to describe this as an epidemic based on the high rate of overdose deaths that's been occurring here in the United States. And it was a great stance for them to take. To just you know kind of throw down the gauntlet and say this is truly a crisis. It's an epidemic and it got everyone's attention. 0:08:39 William Moyers And I think one of the statistics that you've cited I think coming from the CDC is that opioids are killing more people every year than in car crashes, for example, right, or overdoses are killing more people. And the preponderance of those overdose are opioid. 0:08:53 Dr. Marvin Seppala Absolutely. Yeah. And—and now there's more people dying from opioid overdoses than died from AIDS at the peak of HI—or the AIDS crisis, it was called AIDS crisis then, now we call it HIV. But at its peak, not as many people were dying as they're dying currently of these opioid overdoses. And you—if you remember just the incredible attention that that disease received, a stigmatized disease. 0:09:23 William Moyers Yes. 0:09:24 Dr. Marvin Seppala Received at that time and it resulted in tremendous change and I think of the response both you know civically and politically to this opioid crisis we're finally getting attention, but there's still controversy. Another stigmatized disease and if you use just response to crisis as a way of examining the two, I would say this is more stigmatized. 'Cause there's less—less, you know, action going on to really address this issue. 0:09:53 William Moyers And some of that has to do with the fact that addiction as an illness in general is misunderstood. So whether it's addicted to opioids or addicted to methamphetamine or addicted to cocaine or addicted to alcohol, people still look at it moralistically or think that it's a lack of—you're addicted because it's a lack of faith or a bad upbringing; that's not true. We know addiction doesn't discriminate, it's an equal opportunity illness. 0:10:19 Dr. Marvin Seppala It sure is. It's a brain disease, it's a chronic brain disease. It doesn't discriminate at all, the—we know that the primary risk factor is genetic. You know so it runs in families. And—and we also know the parts of the brain involved. It's been well-defined in the neuro-scientific research. 0:10:38 William Moyers And yet, opioids are unlike any other drug when it comes to the effects. As you talked about the overdoses, the fact that so many young people are dying. And we saw that. You, actually, saw that. Probably sooner than perhaps anybody else in our organization. Maybe the main line counselors, but even nationally, you were one of the first doctors to recognize that this group of patients that were coming to us had a certain set of dynamics that were unlike the addiction we were used to treating. Can you talk a little bit about that? When that was and what happened? 0:11:18 Dr. Marvin Seppala It'd be the late to— 0:11:21William Moyers Ten years ago. 0:11:22 Dr. Marvin Seppala So yeah, ten years ago, we started to see this increase in treatment admissions for people with opioid use disorders. In—in our residential settings. In our residential settings usually have groups of men or women of about 22, 24. That gather together with a positive peer culture that support each other and get into recovery and you know they do group therapy together and they become friends and it's a tremendous fellowship that occurs. And when there was one, two, three people in opioid use disorder, they'd fit right in and be in that positive you know sort of situation and things would go well. And they had as—we'd do outcome studies—they had just as good of outcomes as our alcoholics or anybody else under that circumstance. But then, when we started to have more and more people with opioid use disorders on those same units. So let's say they're six, eight, ten, they tended to bond together negatively. And uh— 0:12:20 William Moyers Why? 0:12:21 Dr. Marvin Seppala And I think it was because they were—they saw themselves as different than the other people with other addictions. And they saw a camaraderie with their peers with opioid use disorders. They'd had a similar experience. I don't think we were adequately addressing them. So I think that's a big part of the "why." But also, you know they—they have a long sort of detox period. It's kinda difficult. They have a lot of craving whether on medications or not for opioid use disorders. And they—they just started trying to figure out how to bring you know opioids onto campus, how to get outta treatment early. And they were leaving early. Twenty-five percent of our people with opioid use disorders were leaving treatment early. They were not completing treatment. 0:13:12 William Moyers Because of the craving dynamic? Wow. 0:13:14 Dr. Marvin Seppala Mostly. And going back to use just a horrible statistic and with that, we also had you know within those groups, we call it a treatment milieu you know what's going on among all those people. And there were statements like snitches get stitches. So the opioid use disorder rate, younger group in general, upset with like an older alcoholic who—who told a counselor that this guy wasn't doing so well. And—and he said that. You know and other things like that were occurring. And—and with that, we also saw the—the national data about the death rate. And we started to see some deaths of our own patients after treatment upon relapse to opioids. 0:13:58 William Moyers So they were—they were coming to treatment, they were successfully completing treatment as we would have defined it, and they were being discharged. 0:14:05 Dr. Marvin Seppala Yes. 0:14:07 William Moyers And then they were overdosing? 0:14:08 Dr. Marvin Seppala Relapsing and dying, yeah. And abstinence itself increases the risk of death upon release because they lose their tolerance while they're abstinent. So, so during the course of opioid use, they develop tolerance really rapidly and it grows and grows and grows. They need more and more— 0:14:26 William Moyers Of the substance. 0:14:27 Dr. Marvin Seppala Of the substance. Yeah, whether it's heroin or Oxycodone or whatever, to—to get the same high. And they're always seeking more because they—they want that good feeling. 0:14:35 William Moyers Sure. 0:14:37 Dr. Marvin Seppala You know, they don't just want relief from withdrawal, they wanna feel good. And—and so when they stop using in treatment, that tolerance drops and drops and drops. And they don't really recognize that. And—and upon—if they leave early or they leave successfully and they relapse, they're not thinking to themselves I better be careful with how much I use. 0:15:00 William Moyers They just wanna get high. 0:15:00 Dr. Marvin Seppala Yeah, they just wanna get high. And at that point, if they use a similar amount to what they were before treatment, it could be enough to kill 'em. Because the tolerance to the intoxication goes way down but the tolerance to the respiratory effects of the drug don’t change in the same manner. And they really put themselves at risk. 0:15:22 William Moyers So you recognize this. You start to talk about it within our organization at Hazelden. At the time we were Hazelden, we merged with the Betty Ford Center and now we're the Hazelden Betty Ford Foundation. But you see this, and you implement a series of changes in how we approach or treat the opiate addicts. Describe that COR-12® Program for us. 0:15:44 Dr. Marvin Seppala So we—we called it COR-12 for Comprehensive Opioid Response with the Twelve Steps. And the with the Twelve Steps part was that we know the Twelve Steps are really beneficial, we wanna keep that solid. We know that a lot of the other types of psychotherapy we use are really beneficial. We wanted that to stay in place. But we also wanted to add some new things. And one—one thing we added was a group just for people with opioid use disorders. Because we—we kept everyone independent of the kind of addiction they had lumped together. 0:16:16 William Moyers Sure. Sure. We've always done that. 0:16:19 Dr. Marvin Seppala Yeah, and it's always worked. 0:16:20 William Moyers It worked, yeah. 0:16:20 Dr. Marvin Seppala But we'd—because of the issues on those units, we decided we need a separate group to give them the support they need with each other. And that has worked out tremendously. Now they bond in that group in that same sort of positive peer manner. And really support each other; it's tremendous to watch. It happens within a week or two. And it goes on for months and years. But we also added medications. Which was a really controversial decision for our organization. 0:16:49 William Moyers Because why? 0:16:50 Dr. Marvin Seppala Well, of the two medications: one extended release Naltrexone, very safe, doesn't cause any kind of intoxication, hardly even know it's in your system. That one was at least somewhat acceptable, but it's a medicine for the treatment of addiction and some people find that troubling. The other one was Buprenorphine. And Buprenorphine is a partial opioid agonist. Which means it partially stimulates opioid receptors. And for someone naïve to opioids, it acts just like the other opioid medicine. So it you could get pain relief, you could get intoxicated from it, just like Oxycodone or Hydrocodone or heroin. But it—but it's long-lasting and when we give that medicine to people with an opioid use disorder, they quickly develop tolerance to it. And what it does is relieves their craving, helps them engage in treatment, and helps 'em you know get on with their lives instead of undermining their lives in the way that regular opioid use would do. 0:17:55 William Moyers And we've had success with that. In fact, I believe the research that you and Dr. Audrey Klein and others in our organization have—have been focused on is showing that the use of COR-12 is a successful program. 0:18:10 Dr. Marvin Seppala It's very successful. In fact, I mentioned earlier we had 25 percent of people with opioid use disorder leaving treatment early, with COR-12 that dropped to about 6 percent so over 90 percent of our people with opioid use disorders complete treatment which is tremendous. And what we want now is people to stay engaged in outpatient care following residential treatment. Or just start in outpatient. But we want long-term involvement especially for opioid use disorders 'cause the craving lasts a long time. They need support for a long time. And we had over—about 73 percent, almost 75 percent of that group, transfer to one of our outpatient programs after residential. Which is also really tremendous. And we recently got our six-month data. And it shows really high recovery rates. Total abstinence for this population. And it shows we have three different groups: we have the group on the extended release Naltrexone, the group on Buprenorphine, and a group with no medication. And they all had very similar abstinence rates at six months. So, everything we're doing adds up to success for our patients. In that program. 0:19:24 William Moyers And yet it hasn't been without controversy. I know you were quoted in national media outlets weighing in and articulating our position on this because there are some who would argue that the use of medication such as Naltrexone or Suboxone would—is counter to an abstinence-based program. And yet it isn't. 0:19:47 Dr. Marvin Seppala No, in fact, your right people made statements like we were ruining AA in the Twin Cities because we were sending people there that were on Buprenorphine, this medication. And other treatment program providers and specialist in the addiction field who were solidly in a Twelve Step abstinence camp were saying that we were ruining the field, we were turning our back on our whole heritage as a Twelve Step organization, as an abstinence organization. And it was often focused at me because of my role in starting this. And that's—that was difficult but it was necessary to go through. 0:20:26 William Moyers Sure. 0:20:28 Dr. Marvin Seppala And it put us in a position to just say you know we're responding to a crisis. We're responding to this terrible death rate. We just wanna do whatever we can to help these people to keep 'em in treatment long enough and keep 'em engaged in recovery long enough that they start to get into good recovery as individuals. And—and then, whatever they do with the medicine is fine with me. But until then, anything we can do to help was necessary. Because of the nature of this crisis. 0:20:59 William Moyers And in fact, our program is designed to taper people off of the medication eventually and just to give them that full experience in a Twelve Step abstinence-based environment. 0:21:12 Dr. Marvin Seppala It is. It is. And we don't expect everybody to get off the medication. But we do describe that after they're in good recovery if they choose to get off, we're glad to work with them and help 'em to do that and stop the medicine. The extended release Naltrexone really easy to get off of. There's no withdrawal, they just—it's an injection once a month. You just don't get the next one, you don't even notice. But the Buprenorphine has a typical sort of classic opioid withdrawal associated with it. If you do it really slow and easy it goes smoothly but the—the last little bit that you have to stop can be really tough on people. And it—it's such a reminder of their addiction. When they withdrew from whatever. 0:21:55 William Moyers Sure. 0:21:56 Dr. Marvin Seppala Oxycodone, from heroin, and—and it's frightening to people. And it—it really is a—a risk for relapse at that point in time. Because it triggers it subconsciously what addiction was really like. And so we have to really support 'em through that if they choose to. There's—there's certainly some people that should stay on it long-term. And our research study shows that there's people that don't even need the medicine in the first place, 'cause—but we just don't know who they are yet. 0:22:27 William Moyers Right. 0:22:27 Dr. Marvin Seppala We have to take a stance that since we can't predict who's gonna stay sober without medicine, then our expectation is everybody gets recommended to go on a medicine when they come into our program. One of the two. And if they—if they choose not to we're still gonna do everything we can to help 'em. 0:22:44 William Moyers Sure. Yeah, right. Right. 0:22:46 Dr. Marvin Seppala Because in the end it's their decision whether to take the medicine or not. 0:22:48 William Moyers Well, the whole experience we've had shows that there are many pathways to recovery. Even among the—even along the Twelve Step pathway. Some people are gonna approach it using medication, some are gonna approach it with different perspectives on faith or on all those other components to it. There's not a one size shoe fits all when it comes to addiction treatment or recovery. 0:23:09 Dr. Marvin Seppala Not at all. And—and it's so important to recognize that and support people in whatever they really choose in that regard. 0:23:15 William Moyers Sure. 0:23:16 Dr. Marvin Seppala As long as it makes sense and it's successful, you know. 0:23:19 William Moyers Right. And it treats 'em with dignity and respect. 0:23:21 William Moyers Now, early in our conversation today, and by the way we're talking with Dr. Marvin Seppala, the Chief Medical Officer of the Hazelden Betty Ford Foundation. You—you talked about how this epidemic was born and became the crisis that it is. And what I heard you talking about was the fact that doctors had a role in that epidemic. But wait a minute, Dr. Seppala. Doctors are smart. Doctors get a lot of training. What is it that they were missing in their medical training that helped to foster this epidemic? 0:23:56 Dr. Marvin Seppala On average, during medical school, as physi—you know physicians, we get a single day on addiction. 0:24:05 William Moyers One day? Of training. 0:24:05 Dr. Marvin Seppala One day. So and so that'd be 8 hours at most. It's terrible. So, when the Affordable Care Act was passed, there was a description that we had—that they chose to prioritize addiction as one of the primary illnesses to be addressed. And—and—and they forced that issue for the first time politically which was just remarkable and wonderful. But they did so because they—they described that 25 percent of the health care budget was in some way associated with addiction. 0:24:37 William Moyers Whoa. 0:24:37 Dr. Marvin Seppala So 25 percent of the health care budget is associated with this one disease and in medical school you get on average one day of training. So physicians don't know much about it at all. And in general as a physician, I wanna know what I'm doing. And I wanna know what I'm talking about and if you've come to me for help, I wanna be able to help you. And if I don't know a disease, I'm gonna steer clear of it. 0:25:01 William Moyers Sure. 0:25:01 Dr. Marvin Seppala Because I'll look like an idiot, right? I'm not gonna look competent. By addressing it. And—and that's been a real issue. There's lack of training. 0:25:10 William Moyers That's one reason why at the Hazelden Betty Ford Foundation we know we're known for being an addiction treatment provider, but we have a lot of other components to our mission. And one of them is our medical education for docs. Could you talk a little bit about that? 0:25:34 Dr. Marvin Seppala Yes, we have a program, Summer Institute for Medical Students, it started at Betty Ford Center, now is involved there and at our Center City campus in Minnesota. Where we train medical students for a full week. They get a immersion experience into addiction treatment and they get lectures about addiction and its treatment. And it changes their minds dramatically. At a point in their careers where they're open-minded. You know. [Both laugh] Later on that doesn't happen as well. But we also have opportunities for physicians to come in and do the same thing. It's not as frequent, but it is extremely helpful for those docs who really want a quick sort of look at addiction and how it's treated. 0:26:12 William Moyers Do you have any hope that this country will be able to get on top of the opioid epidemic, number one? And then number two, Dr. Seppala, do you have any hope that we as a country can get on top of addiction as the chronic illness it is? 0:26:28 Dr. Marvin Seppala Yeah I really have hope we can get on top of this opioid crisis, the prescribing of opioids has decreased about 20 percent from efforts within medicine to try and address the overprescribing. There's certainly a long way to go, 20 percent's not enough by any means. But it's a start. And President Trump's budget has 3.3 billion devoted to the opioid crisis. Which is remarkable. It's more than ever has been devoted to addiction. Which we—hopefully it stays there and it gets funded. 0:27:02 William Moyers Sure. Mmm-hmm. 0:27:05 Dr. Marvin Seppala And I also think it—this crisis has gotten national attention in a way that no other addiction problem has. And it's resulted in people not just supporting addressing opioid addiction, but also addressing addiction as a whole and starting to examine that differently. So that makes me optimistic about addiction as a whole as well. And how we'll be able to see it for the disease it is and treat it in that manner going into the future and be much more successful. 0:27:35 William Moyers Another part to it that's been very encouraging is how we've been able to take what you developed in COR-12 and apply it or take it to other cities and other hospitals and other doctor groups through training. 0:27:53 Dr. Marvin Seppala We have it's been really exciting to see what we developed in Center City, Minnesota— 0:27:59 William Moyers Yeah. 0:27:59 Dr. Marvin Seppala Go out to you know major hospital systems and other treatment providers— 0:28:03 William Moyers We have a curriculum, right? 0:28:05 Dr. Marvin Seppala We do, yeah. And describing how to put COR-12 into play in your own treatment program. And the advantage of it is that it uses existing practices, you know, evidence-based practices that you know Twelve Step facilitation therapy, cognitive behavioral therapies, uses group therapies, things that most treatment programs already have. And it just adds a few other components that they can just kinda add on. And—and they're doing it. And it's—we've found that we've gotten reports that it's really been successful for them. And one of the successes is that people are attracted to it. I mean the staff is because it makes sense to 'em. 0:28:47 William Moyers Sure. 0:28:47 Dr. Marvin Seppala It's using things they already know it's adding some other things that make sense. It's evidence-based in that regard where we're just—you know, if you had a cancer that was rare, often they would say well we we're not so sure that this medicine is gonna work, this—for your cancer. So we're gonna add this medicine too. And in an experimental way to be—to give you everything we possibly can, we're just gonna add a few things that work for other cancers together in hopes that something kills these cells. And—and in a way that's what we did with COR-12. We said okay this works, this works, this works, let's just put it all together. And—and see what happens. See if we get better outcomes from that combination than trying to do things independent of one another. 0:29:32 William Moyers So you're—you're hopeful, overall? 0:29:34 Dr. Marvin Seppala I am really hopeful. Yeah. I know opioid addiction is long-standing. So, you know, we've had cocaine crisis, methamphetamine crisis, now we've got an opioid crisis. I think it will be harder to address, it'll be longer than those other issues because of the nature of this addiction once people are really caught up in it. It—it's—it's got a high relapse rate. It's—it's got high craving for a long period so it's hard for people to get into recovery. But I'm absolutely optimistic that it's being addressed and that it's getting the attention it deserves. 0:30:13 William Moyers Well thank you for your clinical and medical optimism. For your innovation in that way. Before we wrap it up I've just gotta ask you one more question. Because you have been walking this walk for forty-some odd years now. And we hear from a lot of young people who say they can't imagine the rest of their lives without a drink or a drug. They've run into a problem they've been diagnosed as being dependent. They need to go to treatment. But a lot of times young people say I can't fathom not having a drink or being able to use substances casually. What's your—based on your own experience having done this as a young person and now all these decades later, what's your counsel to those people? 0:30:59 Dr. Marvin Seppala You know it start—I had the same impression this just makes no sense, I would never be able to—and I've never used anything legally, all my drinking was before I was of age and I used illicit drugs. So, so—uh you know even alcohol I—I didn't get to have whatever kind of experience people have at 21 when they first drink and—and do so legally, whatever. And I went to college abstinent from alcohol and drugs. I mean how many people do that? [Both laugh] And—and I still have friends from my first year, the freshman year at St. Olaf College I get together with. And—and they helped me out in spite of having no clue about addiction. They—I told 'em my story about my use and dropping out of high school and they just pragmatically said well you shouldn’t do that. [Both laugh heartily] 0:31:55 Dr. Marvin Seppala And they—they—they stopped you know they stopped me from going to the punch bowel at the Christmas party in our dorm, you know, things like that. And what I found—a lot of people actually don’t drink. Or use drugs. And—and I don't explain it to everybody, I just you know will refuse a drink at a party, and now that marijuana's legal I haven't been faced with that question yet— 0:32:18 William Moyers Yeah. Yeah. 032:19 Dr. Marvin Seppala In a sit—party situation, but it's probably bound to happen at some point. And—and yet, it hasn't diminished my life experience. In fact, my life experience is so enhanced by being in recovery that I can't even imagine you know the—the same sort of thought pattern I had as a kid that—that somehow my life won't be whole without using drugs or alcohol. And it's so remarkably different and so much better. 0:32:47 William Moyers Well thanks for your innovation, your expertise, and your passion both professionally and personally for all you've done to impact the lives of thousands of people. Including me [points]. Thanks, Marv. 0:33:03 Dr. Marvin Seppala Thanks, William. 0:33:04 William Moyers And thanks to all of our viewers and our listeners who've tuned in today for the Hazelden Betty Ford Let's Talk Podcast. Make sure you join us again for more engaging conversation with experts and colleagues in the field of addiction prevention, research, treatment and recovery. I’m William Moyers. Thank you.