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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