Is It Addiction? Questions to Ask Yourself

0:00:22 William Moyers
Hello and welcome to Let's Talk, an award-winning series of podcasts produced and delivered by the Hazelden Betty Ford Foundation. Each podcast focuses on a topic related to addiction. From research and prevention to treatment, trends, current events, advocacy, and of course, recovery from a substance use disorder. I'm your host, William Moyers, and today, we're talking about the essentials of addiction. We know that addiction affects about one in seven Americans in this country. But of course as our guest Chris Yadron can tell us, addiction is everybody's problem. Chris, thanks for joining us today.

0:01:00 Dr. Chris Yadron
It's my pleasure William. Thank you.

0:01:01 William Moyers
We're here at the Betty Ford Center where you are the administrator. Running the show here. In Rancho Mirage, California. How has that been for you?

0:01:09 Dr. Chris Yadron
It's been an incredible honor and a wonderful experience. Obviously we're encountering people at a very painful intersection of their lives. But it's deeply rewarding because of what recovery offers in terms of people getting their lives back who are struggling with addiction. As you just said a moment ago, it's everyone's problem. It's hard these days to find someone who doesn't know another person impacted by this disease.

0:01:36 William Moyers
Talk more about that. Does addiction discriminate? 

0:01:40 Dr. Chris Yadron
Absolutely not. We know it affects people from all walks of life and we see it every day, right? It doesn't, you know, economics doesn't protect or financial backing doesn't protect someone from addiction. It's—it affects people irrespective of race or ethnicity or gender. The solutions often times have not always been equally offered to individuals and I think one of the wonderful legacies of the Betty Ford Center is early on, the recognition of the way this disease affects women as much as it does men. And so that's a wonderful part of the legacy. Because it does impact so many different people. And families and children. So, it doesn't discriminate at all unfortunately.

0:02:26 William Moyers
What are the signs that somebody might be struggling with a substance use disorder?

0:02:31 Dr. Chris Yadron
Yeah that's a great question. The most basic sign is loss of control. A substance use disorder or addiction isn't simply just the misuse of a substance that leads to harm. Addiction is really about compulsive use that leads to progressive brain changes. Addiction is actually a chronic but treatable medical disease that impacts the brain. It involves genetics. The environment, a person's life experiences. And the interactions between those areas that leads to compulsive use often also involving harmful consequences. That's the more technical—

0:03:14 William Moyers
Yeah.

0:03:15 Dr. Chris Yadron
—Definition from the American Society of Addiction Medicine. But its fundamental characteristic is a loss of control. On the part of the person.

0:03:22 William Moyers
And is it—is that true that a drug is a drug is a drug? And so if you've lost control over one drug you've lost control over all drugs?

0:03:30 Dr. Chris Yadron
I think that's true of addiction, right? The loss of control is true of addiction. But depending on the drugs or the type of substances you're using, it can have a different impact. On the individual. Based on their genetics and based on the drug itself.

0:03:44 William Moyers
Mmm-hmm. Yeah. If somebody's watching this right now and feeling a little bit squirrely because they feel like you're talking about them, what would be the signs, the symptoms, the evidence that you would recommend they look at to determine if they might have a substance use problem?

0:04:02 Dr. Chris Yadron
Mmm-hmm. So squirrely, did you say? [laughs]

0:04:05 William Moyers
Yeah. [grins]

0:04:06 Dr. Chris Yadron
Perhaps concerned?

0:04:07 William Moyers
Yeah! [chuckles]

0:04:09 Dr. Chris Yadron
Another great question. You first of all, you could begin to ask yourself or take a look at the harmful consequences—

0:04:18 William Moyers
Yes.

0:04:18 Dr. Chris Yadron
—Of your use. Have you attempted to control or stop your use? Another good sign is to think about the amount of time you spend thinking about the substance or using. You might say preoccupation. So to what degree do I spend a lot of time of my day either using or thinking about using or focusing my behavior on using? And that's also another simple way to begin to think about the potential of having an addiction or a concern here.

0:04:49 William Moyers
What about other consequences?

0:04:51 Dr. Chris Yadron
Well there's a whole variety of consequences. One of the older definitions of addiction as I mentioned a moment ago that's been updated recently to include the concept of it being treatable which is really important. But one of the older definitions broke it down in terms of biological, psychological, social, and spiritual manifestations of the condition or of the disease. And so, we can think about how it affects our body, right? Am I experiencing harmful consequences in terms of anxiety, the inability to sleep well? Other ways that it might be impacting me physiologically. Psychologically how is it impacting my perception, my emotions, my experience of the world psychologically. Socially. That's a real good, clear indication. Socially and behaviorally as well. How's it impacting my relationships?

0:05:48 William Moyers
Mmm-hmm.

0:05:48 Dr. Chris Yadron
And that's another key factor, so we could go on. But there's lots of different ways that addiction impacts people powerfully.

0:05:54 William Moyers
And then there's legal consequences—

0:05:56 Dr. Chris Yadron
Sure.

0:05:56 William Moyers
And there's financial consequences and familial consequences, as you talked about--

0:05:59 Dr. Chris Yadron
Absolutely. Absolutely. [nods]

0:06:01 William Moyers
And what about if you're a family member and you've tuned in and you're struggling with whether or not your loved one is actually, you know, addicted to something?

0:06:11 Dr. Chris Yadron
Mmm-hmm.

0:06:11 William Moyers
What would be your counsel to a family member who's in a household?

0:06:14 Dr. Chris Yadron
Wondering about that question?

0:06:15 William Moyers
Yes, exactly.

0:06:16 Dr. Chris Yadron
Well, just as the person who is developing or has an addiction becomes very preoccupied with the substance that they use—

0:06:24 William Moyers
Yes.

0:06:24 Dr. Chris Yadron
—Or the substances. The family member becomes very preoccupied with the person using.

0:06:29 William Moyers
Huh.

0:06:30 Dr. Chris Yadron
So, if you're the family member, I guess I would ask you the same question. To what degree are you spending your day preoccupied thinking about your loved one's use? How they might change on the basis of their use. The consequences of their use—you just mentioned legal and employment and financial consequences. To what degree is my life as a family member becoming oriented around this substance or the person using the substance as well?

0:06:57 William Moyers
What's your reaction as somebody who's worked in this field down in the trenches and the front lines and in the Executive Office, what's your reaction to the term or to the sort of popular notion that the—that the addicted person has to hit bottom first?

0:07:13 Dr. Chris Yadron
Yeah, when I first started a couple of decades back now actually, that was a common conception. That a person really needed to be ready in order to address their addiction. And had to hit bottom, as you say, right? It had to get bad enough. Hopefully they didn't get all the way to the point of death. But it had to get bad enough for a person to really face their addiction. And we just now—we know that that's just simply not true. The reality for most people dealing with addictions is that there's usually the presence of some ambivalence about change.

0:07:52 William Moyers
Hmm. [nods]

0:07:51 Dr. Chris Yadron
And what I mean by that is they certainly get some value or benefit from using. We often times don't create the space to talk about that with individuals—

0:08:01 William Moyers
Yeah.

0:08:02 Dr. Chris Yadron
—But there's some benefit or value at least perceived benefit or value from using. And then there's also reasons to change. And the more we can truly connect with a person's desires for change as defined by the person—

0:08:15 William Moyers
Mmm-hmm.

0:08:16 Dr. Chris Yadron
—Not by the expert. But by the person who's an expert of their own experience. We can build a relationship, we can build rapport, and find a way to begin to make some changes. Often times in a way that's meaningful—

0:08:29 William Moyers 
Mmm-hmm.

0:08:30 Dr. Chris Yadron
—To address the problem.

0:08:31 William Moyers
You noted that you've been working in this field for many decades now. What have you seen in terms of changes as it relates to addiction? And the impact that it's had?

0:08:43 Dr. Chris Yadron
There's been a number of changes that I've witnessed. One is for a long time, we seem to have an unhealthy or unneeded division between the use of medication and other forms of support or what I call psychosocial interventions or what we call psychosocial interventions. And there's really no need for that division. Because addiction affects us in so many different ways as I described earlier. And we need to use every tool and resource possible. And evidence-based tools and research. To try to help individuals. So the use of—the development and the use of medications over the last number of years has been really, really helpful. And then we've also begun to use more evidence-based psychosocial approaches. Motivational interviewing. It's actually been around since I believe the early 80s but that's begun to have a profound impact in the way that we relate to individuals in terms of their ambivalence as I just mentioned a few moments ago. So, the way we think about addiction and define addiction and the way that we offer solutions has continued to develop. All that being said, there's still the power and the wonder that happens in a Twelve Step community and environment for people. In terms of peer support. Knowing they're not alone, being able to form meaningful relationships with other people pursuing recovery.

0:10:12 William Moyers
Mmm-hmm.

0:10:13 Dr. Chris Yadron
And so, based on the Twelve Steps, and the principles that have worked for so many years, adding all of these evidence-based therapies over the last several decades and years has just I think been really important for addressing this disease. Another thing that's changed in my opinion is stigma. And the role that stigma plays. And people's willingness, family members' willingness, to talk about the problem to address this. [Moyers nods] And I feel like there's a lot of work to do, but we're definitely making progress and beginning to win that war.

0:10:44 William Moyers
I agree. I agree. At the same time, though, there's all a lot of conflicting mixed messages out there particularly as it relates to the legalization of marijuana.

0:10:53 Dr. Chris Yadron
Mmm-hmm.

0:10:54 William Moyers
What do you see in the patient population here at the Betty Ford Center in terms of people who might have a dependency on marijuana?

0:11:01 Dr. Chris Yadron
Yeah. That's always an interesting conversation [Moyers laughs] depending on the how the person is approaching that. I think it's important to not confuse a specific substance with the problem of addiction, right?

0:11:13 William Moyers
Interesting. Yeah.

0:11:14 Dr. Chris Yadron
So I typically at least in my clinical experience and history would attempt to shift the conversation to how has the use of this substance impacted you personally? Make it less about the substance or even especially the legalization of the substance. Or those type of issues. And more about the person and how the use is affecting the person. And how that's moved perhaps from misuse and harmful consequences into compulsive use. I've tried to stop, I'm unable to stop, despite negative consequences. I mean that's a hallmark of addiction. In spite of all these negative consequences, you know, a DUI or I lose my job, my spouse or partner is deeply upset or hurt. I continue to use in spite of these things. Then we're getting closer to the definition of addiction. And it's a little less about legalization. Those are distractions in my opinion.

0:12:11 William Moyers
Interesting.

0:12:12 Dr. Chris Yadron
And less about the person.

0:12:13 William Moyers
You and I did a podcast last year and I think we did it here on methamphetamine—

0:12:16 Dr. Chris Yadron
Mmm-hmm.

0:12:17 William Moyers
—Because you've got a lot of expertise in there. And you talked last year about the—what looks like a re-emergence of methamphetamine as a problem drug?

0:12:24 Dr. Chris Yadron
Mmm-hmm.

0:12:26 William Moyers
Not that it hasn't ever not been a problem, but it's come back. And of course the opioid epidemic is the opioid epidemic. What are you seeing in terms of some of those trends around their drug use?

0:12:35 Dr. Chris Yadron
Yeah. The opioid epidemic has continued to be an issue and people continue to lose their lives or develop an addiction. We've seen that shift away from some of or less around some of the prescription medications or heroin and into these much more potent and dangerous substances such as Fentanyl.

0:12:53 William Moyers
Mmm-hmm.

0:12:54 Dr. Chris Yadron
So a lot of the deaths that we continue to see most recently are related to the use of Fentanyl or that type of potent substance being added in with other substances that people are using in a way that's—where they're unaware. In terms of stimulant use disorder, we've continued to see that climb here at the Betty Ford Center. Stimulant use often times will follow a wave or an epidemic of a narcotic—narcotic use or an opiate use epidemic—

0:13:24 William Moyers
Mmm-hmm.

0:13:26 Dr. Chris Yadron
—Like what we've been in recently. So we continue to see the use of stimulants go up and methamphetamine continue to go up. There were some laws passed earlier in the 2000s—

0:13:36 William Moyers
Yes.

0:13:36 Dr. Chris Yadron
—That diminished that temporarily, but production just tends to shift [Moyers chuckles]. Trends shift for a variety of reasons. Perception of harm, access, cost. Are usually primary factors. And so we've seen a resurgence of stimulant uses as a result.

0:13:54 William Moyers
And of course we always talk about drugs and we reel off marijuana and methamphetamines and cocaine and all those other ones but then there's alcohol.

0:14:02 Dr. Chris Yadron
Yeah.

0:14:03 William Moyers
And what do you—what do you experience here as an Administrator of the Betty Ford Center in terms of patients who come to use with an alcohol use disorder?

0:14:11 Dr. Chris Yadron
Alcohol use disorder continues to be the primary—

0:14:14 William Moyers
Really? [nods] Fascinating.

0:14:14 Dr. Chris Yadron
—Diagnosis. For individuals that we treat. So in spite of the opioid use epidemic—the opioid epidemic—gets a lot of press and rightfully so 'cause people are dying.

0:14:26 William Moyers
Sure. Dying, right. [nods]

0:14:27 Dr. Chris Yadron
But they're dying more acutely.

0:14:29 William Moyers
Mmm-hmm.

0:14:29 Dr. Chris Yadron
And quickly, right? With alcohol, it might be a more prolonged process. But it's still the most common. You brought up marijuana or cannabis a few moments ago. Often times people confuse or conflate issues around legalization. But legal doesn't equal safe, right?

0:14:47 William Moyers
Mmm-hmm.

0:14:48 Dr. Chris Yadron
And the issues of addiction are really issues that are irrespective of legality, right? I can become addicted, I can lose control, through progressive brain changes that impact with my genetics and my—my personal experience regardless of the substance, right?

0:15:07 William Moyers
Mmm-hmm.

0:15:07 Dr. Chris Yadron
All different substances can have that impact. It's really still about addiction.

0:15:11 William Moyers
Right.

0:15:12 Dr. Chris Yadron
And how do we help people suffering from this chronic and you know terrible medical condition, but a condition that is treatable.

0:15:21 William Moyers
And I wanna end on that note because I think you've really sort of hit it, that at the end of the day it is about addiction—

0:15:26 Dr. Chris Yadron
Mmm-hmm.

0:15:27 William Moyers
—And it is about how we help people who are struggling with addiction. So we know from these podcasts and talking to experts like you and Dr. Seppala and Jerry Moe and lots of other people who are associated with this organization. We know through these podcasts that people tune in because they themselves want help—

0:15:48 Dr. Chris Yadron
Mmm-hmm.

0:15:48 William Moyers
—Or they know somebody who needs help.

0:15:49 Dr. Chris Yadron
Mmm-hmm.

0:15:50 William Moyers
So in wrapping it up here today, Chris, what would be your message for somebody who's listening to this podcast today and doesn't know what to do about the problem? 

0:16:00 Dr. Chris Yadron
Mmm-hmm. Yeah. My message is usually and consistently one of hope. In that case. I mean, what does a person need? I mean, if you ask the question what is addiction, you know, I can provide technical definitions—

0:16:14 William Moyers
Yes.

0:16:14 Dr. Chris Yadron
—But I also think about the stories of people who are hurting. Early on in my career I remember this young girl in front of me she was probably 17 years old at the time. She had started experimenting with cannabis. Or marijuana as a freshman in high school. Moved to pills and a variety of medications. And then developed an opiate use disorder, was using heroin by her junior or senior year in high school. And it was—I was living in Chicago at the time.

0:16:43 William Moyers
Hmm.

0:16:44 Dr. Chris Yadron
And I remember her story. She OD'ed in the car with a friend and law enforcement came or somehow came onto the scene. And her friend pushed her out of the car and drove away. 'Cause she was afraid of being caught and being punished for the situation. And I—that young woman lived—

0:17:03 William Moyers
Mmm.

0:17:04 Dr. Chris Yadron
—She received the help that she needed. But I just think of the stories over the years, I think of a mom in front of me who had a 36-year-old son who was coming saying give me the money I need to get the substance that I feel I have to have in order to survive, or I'm gonna end my life. And was threatening suicide. And the pain that that mom felt and how powerless she felt, you know, in that situation. I mean ultimately, this question about addiction intersects deeply and profoundly with the pain that people feel. So when you ask me that question of you know what is important for people to hear it's to hear that hope and healing are available. And we see that every day in the lives of the people that we help. Practically, you know, reach out, come—use our website, go to hazeldenbettyford.org, ask for help. If it's not Hazelden Betty Ford, to another reputable treatment provider. Whatever it is that you need. But, hope and healing are available.

0:18:06 William Moyers
Amen. Chris Yadron, thank you very much for bringing your expertise, your knowledge, your leadership, and your passion for this cause. We really appreciate you being with us today.

0:18:17 Dr. Chris Yadron
Mmm-hmm.

0:18:18 William Moyers
And thanks you all for tuning in on another edition of Let's Talk. We hope that you will share your experience here with your colleagues, your family, your friends, and your neighbors. Let them know that there is hope available and you can find it right here at the Hazelden Betty Ford Foundation. We'll see ya again, thank you.