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Dr. Joseph Lee: Addiction is About People

Dr. Joseph Lee: Addiction is About People


When people ask me how I got to the great state of Minnesota because I trained here at Johns Hopkins, I say that one day I was driving
in a snowstorm, and I kept driving and got lost, and that the people in Minnesota took
me in and it’s been my home ever since. Before I get started I want to thank all the people in the room and out side of it who have propelled the cause and got us to this cusp and now
finally Comprehensive Addiction Reform is within grasp. And thank you all. I don’t count
myself in that number, because I am six and half years out of residency, but I am happy and honored to share in the championing of this cause. Feel free to throw up my slide
at any time and I’ll get to it. One of the reasons that we’re here, though, let’s face
it, is because of the prescription drug crisis which then bore the heroin crisis which we’re still facing today. The numbers are staggering, the the deaths are heart breaking. But there are
other facts. There have been disenfranchised communities that have been struggling with heroin use for decades, and they didn’t get the attention from our country until the numbers got bigger, and there is something more: We didn’t start paying attention as a country
to these people until the kids who were passing away started to more closely resemble my kids,
and your kids, and our kids. And that’s a tragic fact. But we can move on from that
and it is not too late. So, we must act swiftly and decisely to honor the lives of those who did not get the help they deserved. And we need to move swiftly because These problems are now in our homes, in our living rooms, on our streets, in our neighborhoods. At Hazelden,
we’ve had a 300 percent increase in the number of young people coming in for opioid addiction just in the past five or six years. At any one time now, you’ll see 40-50% of the clientele addicted to heroin. and all the other collateral damage. Teen pregnancies. Neonatal Intensive Care units for babies who were born Hepatitis C, sex trafficking. and I can go on and on. We been humbled , and rightfully so. and it was an easy decision
to make in changing our treatment philosophy. it’s well said that sometimes the only criteria for going to an AA meeting, is a desire to be sober, but We had to evolve that philosophy. we had to look people in the eye and say, “we will meet you where you are, you don’t
have to have a desire to be sober, but if you’re willing to have a conversation we will
meet you, and we will win you over with our compassion and our values, and our commitment
to your life. In order to do this, we had to do a number things: We found that shockingly,
young people who had opiate addictions had to choose between clinics that gave them medication
and no therapy, or therapeutic communities that gave them the therapy they needed and
no medications. And we vowed to give them both. Because they deserve both. they deserve
the best of all worlds. That meant that we used medications that are life-saving and kept
young people engaged, and we have the results to prove that it’s working. But it also meant
that we had to adopt evidence-based modalities like motivational interviewing which believes
in the humanism and potential of these individuals, to pursue their values if they see things
on a level playing field. And we have done that and we currently train our people. But
there’s more that needs to be done. It is true that when you say “evidence-based practice,”
we’re all assuming that it is more effective than it actually is but the results really
aren’t as good as we want. The solution though isn’t just coming up with a new medication
or a new different therapy manual, the solution is making a different kind of investment.
so my one treatment recommendation is one of orientation and perspective because that
is the most important. and that’s what i’m talking about in this graph. In this graph,
you see that most people get addicted between their mid teens and early adulthood. Imagine
this was a social problem of any other magnitude that affected America,and was a health crisis,
if you knew that this was the age group that got affected, where would you deploy your
resources? Now contrast that with what we do with addiction. So I say, scientifically
that addiction is a developmental disorder first. That is not to say that other people,
other age groups do not get addicted, or don’t need help. It is simply a matter of fact.
Addiction is a developmental disorder. Let’s consider what this means. Our infrastructure,
everything from our payment models, to how we allocate resources, is contingent upon
tertiary care. We wait for kids to cross over a trip wire, a line in the sand, and then
we divvy them up into how much they’ve used, and what symptoms they have, and we say, “mild,”
“medium,” or “spicy” substance use disorder, and then we treat them. And then the second
the parents can breathe and take a deep breath, we cut off all resources. We don’t treat any
other chronic illness in this manner. If you saw a teenager who was morbidly obese, you
would be concerned about the metabolic issues they would have maybe decades later, but you
would act imperatively now. But we don’t have an infrastructure. Everything from the payment
system to how we treat the kids, it’s a major problem for us. That’s what a developmental
model means. So on the front end, we must recognize that there are risk factors, and
trajectories that people have. Genetic individual environmental, and we need to address these
and early intervention- that is best kind of treatment — but risks also apply on the
back end. Sober colleges, sober schools, communities, ways to get the people plugged in that people
have talked about today. If you treat somebody for a heart attack and they get out of the
hospital, they’re not going to exercise automatically. It doesn’t mean that they’re all of a sudden
going to take care of themselves. So, risks stay with people even after they are temporarily
sober and that’s the dilemma we have. So on the front end there’s an issue, and on the
back end there’s an issue. you might be shocked by this, but we have a lot of data on risk
factors. My colleagues at the University of Pittsburgh have developed a tool called the
transmission liability index. And this tool, while not perfect, and they’re tinkering with
it, can predict starting at the age of ten, which kids are at high risk for addiction.
At the age of ten. By asking less than fifty questions, usually no more than fifteen. And
guess what? None of the questions are about drugs. We have that ability. We have that
science to intervene in that different way, now. the back end is also important, and I’ll
conclude with this. If we look at de-institutionalization as a model, and the reason I love the comprehensive
Addiction and Recovery Act is because of the holistic lifespan approach. if we look at
Deinstitutionalization as a failed model, good intent, good promise, but front loaded
myopic, short sighted . And there wasn’t enough on the back end and people with health issues — families still suffer
because there isn’t the support. Well, CARA is doing things differently. And we need to
invest in that. Fundamentally, drugs that kids get addicted to will change over time,
and policies we make around it will also change. and those are important discussions to have.
But what I am telling you is that addiction from a developmental perspective is not about
drugs. Addiction is about people. Addiction is about families. Addiction is about communities.
And if we work hard together, we can make addiction about redemption. Thank you. (applause)

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