 Good evening everyone who's joining us now, we're just going to give everyone who's filing in a couple more minutes before we begin. So again, thank you to everyone who's joining us, we're just going to give it another minute while some more people file in before we begin. Okay, so we're going to get started. Thank you so much everyone for being here. Welcome to Shatter the Stigma. My name is Catherine Ferrara and I'm the program coordinator for the Bedford Lewis Borough Pound Ridge Drug Abuse Prevention Council. We're a group which aims to create a positive and safe community environment by raising awareness about substance use and mental health struggles and the different risk and protective factors associated with both. If you'd like to learn more about what we do and access some of the resources we have available to the community, please visit our website at the DAPC.org. We are proud to collaborate on tonight's program with the Bedford Playhouse and I just want to thank Dan Friedman from the Playhouse from all of this hard work and helping us to put these programs together. He could not be here with us tonight. But again, we say thank you Dan, we really appreciate all of your hard work. Before we begin, we wanted to remind the audience that the content of tonight's program is not intended to be a substitute for professional help, diagnosis or treatment. If you are a family member need assistance finding qualified health professional to address an issue with substance use or mental health, please contact your physician. You can also email the DAPC at gmail.com and we can provide a list of some local treatment providers. I also want to take a moment to recognize that September is National Recovery Month, which aims to raise awareness that mental health and substance use disorders affect all communities across the nation. With commitment and support, those affected can and do recover every day. Empowering yourself with information by attending events such as this evening is a great first step. To learn more about National Recovery Month and the resources available, please visit the DAPC.org. Now I'd like to introduce our presenters. We are pleased to have Dr. Jonathan Avery here with us this evening. He is the director of addiction psychiatry and an associate professor of clinical psychiatry at Wild Cornell Medical College and New York Presbyterian Hospital. We are also so happy to have Ron Kilner here with us tonight. She will be sharing her daughter Zoe's story with us. One more thing I wanted to add. If you have questions during the presentation, please type them into the Q&A box and they will be answered at the end of the evening. So without further ado, I will turn it over to our presenters for the evening. Thank you for the kind introduction and for all that you all are doing as a part of this and for everyone that's attending. We're always honored to share on substance use and the stigma of addiction and I'm always thrilled to do this with Robin, who's often my partner in crime in giving these talks. So our agenda for today is I'm going to review for a couple of minutes the stigma of addiction, describe how it exists in society and also in the places that should be the safest, including in the medical community. I'll then turn it over to Robin who will tell her story and Zoe's story. And then at the end I'll review the treatment landscape a little bit in terms of things that we can offer to folks struggling with substance use and co-occurring disorders. And then if we have time, I'll do a brief Narcan training, which will, if you stick around, it'll be a Narcan kit that will mail to your home afterwards. And so we have a packed agenda and we appreciate everyone joining. So, you know, I'm a director of addiction psychiatry here and, you know, I love the field of substance use and addiction. I think there's a lot of interesting meds and therapies and people can get better. And I learned early on that not a lot of people share my enthusiasm for this space and that the negative attitudes exist in the medical community and throughout our society. And I've done a lot of research to help understand why that is. And, you know, one of our conclusions and there are many and, you know, I noticed some people I recognize in the audience and happy to hear other people's thoughts. But a lot of the core of why we treat individuals with substance use different is the idea that it's a moral failing and not a disease model of addiction. That is, we know a lot about the neurobiology of addiction. We know how it hijacks the pathways in the brain, how it makes free will decisions very hard. Yet the general view of society and even in healthcare settings can be that it's a moral failing, you know, that it's bad people doing bad things that it's, you know, kids making bad choices and then follow people that should know better. And the consequences of that view that it's not a brain disease that it's bad choices bad people has been a whole society that punishes individuals with substance use disorder. And we see that from school to work to the way our prison system is set up if someone struggling with substance use we kick them out of school. We put them in jail if they're using, you know, we don't allow them to get promotions at work or even to speak about it. And the sum of that and even how we see it in the media portrayed as, as, you know, all the bad things that happen and we tend not to champion people on recovery. And the sum of all of that stigma that exists in all these different spaces is that it pushes addiction into the secrets where people feel like they can't talk about it. That it's something that should be associated with shame and and and other attitudes. And that part of that all is that the person struggling with addiction then takes on those thoughts themselves. They thought to they begin to believe what they see on TV what they hear from schools and families and even treatment providers. You know that they're a bad person and if only they could do better things would change. And that situates the person in the spot which makes change very hard. You know, you'll hear from Robin and from Zoe story about, you know, how stigma can can impact health timelines. And you know my wish is that doctors and healthcare professionals were better for this but I've studied a lot and how that's not the case that ER doctors, even psychiatrists sometimes even addiction psychiatrist hold similar views. And the sum of that is that people feel like there's nowhere to turn for help. And part of what we're doing here part of my mission in my job in my life is really to change the narrative on all this, you know, to create an environment where people can be open about their substance use disorders where it can be viewed as a disease model, where people know that there's hope and there are options. And then it's something we should be talking about, you know, as a, as individuals as families as societies as schools, especially because there's good treatments that exist. And that's actually when you view it in the disease model of addiction. And so that's a little bit about the background on stigma and why it's so important. But I'll turn it over now to Robin and to tell Zoe story to sort of further highlight, you know, the importance of paying attention to stigma and how it can impact one's health timeline. So Robin. First, I hope that you can see that's Zoe. This is my daughter Zoe. And on September 9 on a Sunday night in 2007, so we took an accidental drug overdose and her life at just 22 years old was over. Just like that. I know now that overdose deaths are preventable, which makes this so much more impossible. Imagine losing someone you love more than life, and knowing that this didn't have to happen, that there was, and is so much that could have been done. All these years later, it's so hard to believe what happened and how it all unfolded. But first, let me tell you about Zoe. Zoe, love life. She was interested in everything. She could spend the day in Barnes and Noble reading about neuroscience religion fashion and then back to the brain again. She was brilliant and beautiful. And Zoe care deeply about others. She would have made a difference in today's world where humanity and empathy are often in short supply, but she lived with emotional pain. Childhood trauma was buried deep under her skin. Mostly she managed to deal with it, putting her best self forward, trying her best. She was in therapy on and off for many years. But that kind of pain doesn't resolve easily. And it's hard for a child to reach deep and look at the pain they're so fearful of. I think it's also hard for parents to deal with many mental health issues, including substance use disorder, which is often not recognized as a real health issue, but rather one. That's viewed with shame and stigma, a lack of moral fortitude, a general feeling of you did this to yourself. You're not the victim here. But I'm going to get back to that later. What I think changed Zoe's life course were few but very significant missed opportunities when we interacted with the medical community opportunities to provide us with information, and with clear treatment recommendations. Those missed moments cost us. There was so much negative judgment surrounding Zoe struggles and my parenting. It almost felt like her doctors had disdain, believing she somehow wasn't trying hard enough that she wasn't really sick. I can give you a good example. In high school, Zoe developed an eating disorder in her in her junior year. Her pediatrician identified it and recommended that she be admitted in patient at a hospital, and I agreed. So he was terrified having never been in a hospital except when she was born. Unfortunately, when we arrived that day, her doctor had not made the arrangements and there was no bed for Zoe. The nurse said that she could sleep in the corridor until the bed was available. That really didn't feel right. So I called her doctor to let her know. Zoe's doctor, her pediatrician said, you know what I think. I think what Zoe really needs is a good swift kick in the pants. Leave her there for now. I didn't understand it then, but I do now. It was stigma. It was punitive. How does a medical professional not realize that Zoe was ill, not manipulating us. She was behaving in a self destructive way, because she was suffering and lack the tools to do better. That was the first breakdown in the medical care that Zoe would receive over the next five years. And then her life would end. I just want to add that I learned later on my own that an eating disorder can be a predictor of substance misuse later. I learned that there's a correlation between eating disorders and substance misuse. That was important information, which we didn't have. When Zoe went off to college, she loved it. I learned not happily that she and her friends experimented with new freedoms feeling like adults, though emotionally not nearly there. Along with those new freedoms. So he experimented with alcohol and drugs. I first became concerned. It was her second year at college. I had a few phone conversations where she just didn't sound like herself. I flew down to visit a mother's instinct. And all seemed perfectly fine. And I thought, okay, I'd rather be a little paranoid than miss something. Sunday we planned to have brunch before I flew home, but she didn't show up. I thought she must have overslept, been with her friends after we had dinner. I got a call from a hospital. Zoli had overdosed found unconscious on her college campus. She was taken to the emergency room and stabilized by the time I got there they had charcoaled her, though she was still very incoherent. The doctors decided she needed to be observed for 36 hours. She was deemed at risk of hurting herself. She stayed in the ER in that cubicle. She on the gurney I had a plastic chair for the next day and a half. That's a lot of time. Time to evaluate Zoe time to provide information to both of us time to listen and understand this youngster understand what she did yes, but why she did it. We need to take care and provide what might have been life saving information. There was enough time to provide referrals and recommendations, time to inform both of us, just how serious and overdose is, and the risk of future fatal overdose. I learned years later that a non fatal drug overdose can be a predictor of a fatal drug overdose. That was such important information for us. It was a time to provide a Narcan kid, just in case, but also it's such a strong and powerful message. But that's not what happened. What did happen was the unexpected stigma, stigma interfered with good medical treatment. She was judged a spoiled reckless indulged kid time, taking time and space away from someone who's truly sick. Zoe almost died that day. How much sicker does one need to be to receive health care. That's also compassionate and humane. That was the second brush with stigma, but I still didn't understand it then I probably felt we deserve the treatment that we got feeling so ashamed and embarrassed because I knew so little about drug misuse and mental health mental health issues back then. And that began this chaotic and alarming period in our lives. Long story shorter. I ultimately took Zoe out of school and came back to New York with her. I was able to access some of the most well respected professionals in the field of mental health and substance use disorder. However, little did I know that stigma exists within this highly specialized medical community. Here I am. A mother frightened and frantic and desperate to help my child at the same time feeling so shamed. I had very little information about this health issue at the time, keeping all that in mind. Imagine getting advice like this. A doctor recommended I have Zoe arrested. Another suggested kidnap her to another state where she could be held against her will. Everything was punitive. I thought to myself, is this medical treatment. Are you kidding. All right, there was also a lot of let her hit rock bottom. That's like saying wait to treat a cancer patient until she stage four. I know that rock bottom is like playing Russian roulette with someone's life. She might survive. Then again, she might not. And what would she need to go through to finally get to a point where she accepted the idea of being treated. Would she have to be homeless. Her drug use having progressed to a life and death stage, more complex, more dangerous, and more embedded. I rejected those recommendations and I eventually got Zoe into a treatment with a psychiatrist who specialized in addiction and slowly over time. She seemed to come back to herself. But as can happen with this health issue. It ebbs and flows. And when it flowed back, it was terrifying. I started searching again for help. It shouldn't have to be this way. We should be able to talk to her primary care physicians or pediatricians and find the support and direction as we would with any other health issue. Every day, while I searched for help, we lost time. I didn't know it, but we kept losing time. The doctor at McLean hospital provided a referral, a doctor who saw me without Zoe, because at that point she refused to come in. She felt she was fine. She was happy, and she didn't need help. This doctor explained that there was a way to lovingly encourage her to get into treatment so that she could get better, healthier, and move forward with her life. I thought it had to be Zoe at length, of course, the drugs, but also what was most important to her. I thought it had to be drugs, or maybe her friends. My husband pointed out, it was me. I was most important. So we love me and our relationship meant the most to her. So from that, we created a script. We narrowed our interactions down to just one focus. I announced to Zoe in an email and a letter and verbally that the only thing that I would talk to her about was going into treatment. She started to miss our interactions. She started to miss me and us. And one day when it seemed unlikely that anything would change, Zoe said, just tell me what you want, but please stop. I miss you. I want to talk to you. I want our relationship back. I miss you so much. When that happened, she did agree to a more intensive treatment and consented to include me so that I could participate. But we didn't know our time was running out. We did so much of it, searching for help, rejecting bad advice, feeling so ashamed and embarrassed with so many missteps. We lost so much time. And with this particular health issue, anything could happen at any time. And it did. It didn't have to be this way. Overdose deaths are preventable. That's just one reason, just one reason this is so tragic. This didn't have to happen. Do you know how there are things in life that are imprinted on your brain forever? Well, on Sunday night in April, Zoe came home in the evening and I was preparing dinner. And I asked her if she wanted something to eat and she said to me, Mom, I think I'm going to make myself a cup of tea and go to bed. And that's what she did. I didn't know that those were the last words I'd ever hear my daughter say. I don't think I hooked her that night. I probably didn't. I had narrowed everything down and was keeping to the script. I assumed I had tomorrow and the next day. After all, we had an appointment on a Thursday that same week. Zoe went into her room that night and with her tea she also took a combination of drugs that caused her respiration to slow and stop. She wanted to go to sleep, but not forever. We were told she died a few hours after she went into her room that night. She made a mistake and it cost her her life. I have so much respect for the medical community, especially Dr. Avery and all the terrific doctors at Wild Cornell. There still are some doctors who can look at someone maybe like Zoe or not and think she could do better. She needs to try harder, be better than this. They assume she is better than this. And all that's true, but not without the right treatment. And not if they keep blaming the patient. I think this health issue is still often misunderstood and terribly stigmatized. One day Zoe and I were arguing about her going into treatment. And it was another one of those I'll never forget moments. Do you really think I want to be like this? If I could do better, I would. Can you imagine my daughter needed to tell me what I should have realized. She was so right. No one wants to be that non-compliant person. No one wants their life to be so out of control. But at that time, Zoe didn't have the medicine, the tools, the support to do better. And that's on me. I didn't know enough, but I could have. I could have known more if I'd been more informed. It's on our community. When we look at someone struggling and think that could never be me, that could never be my child. I tell you something because now I know any one of us can be that person because anyone can get sick. And when we shame and embarrass rather than offer compassion and understanding children and loved ones die. And it's on our doctors to treat this health issue as they would and do any other health issue with cutting edge medications, therapy, support, and yes, compassion. Humanity, kindness, and intelligence is what makes great doctors. At least that's what we look for in ours. Thank you, Robin for for sharing Zoe's story. This reminds me to be a better doctor, a better community member. I always carry Zoe with me as I go about this. And I hope you all in the audience too. We heard how stigma really impacted things. And as I said at the outset, this idea that it's a moral failing, that people should just get better, is so pervasive, including in the medical community, and it can do so much harm. And the stakes are high these days. I mean, we're in an opiate epidemic, a youth vaping epidemic, an epidemic of substance use like we've never seen before. You know, during certainly exacerbated by COVID-19 and all the different stressors of these days, but we saw 90,000 plus people overdose in the last year and lose their life and we've seen so many young kids start with nicotine again after years of not using nicotine and and harder drugs and I think one of the most telling things of the last year is that substance use seems to impact everyone across the socio-economic spectrum across age, across gender. The first time we saw more women adolescents present to addiction care in the last year than men even and the biggest spike in opioid overdoses over the last year among adolescents was among women. And so all the data points to this is the most serious health crisis of our time. And yet we still as societies, as clinicians, as families can cannot give it the attention that it deserves. And so, you know, I'm certainly doing a lot of things to combat stigma where researching ways to educate doctors and communities. Part of this talk is sort of setting the space so that we can all think about stigma and how it impacts us and governs how we view different types of behaviors, especially as they relate to substance use. And so I appreciate all of you participating. And I also want to highlight that, despite this bad news and the surge in people using that increasingly good treatments do exist. And, you know, we don't have the time or space to review all of them now. But I'm going to discuss just some of the things that I think we should keep in mind as we, you know, see loved ones or how we should, you know, conduct ourselves as family members and community members as we see people struggling and I surely want to address all of it and happy to take more questions at the end. But just a quick review of some of the options that are available. To start, we are currently recommending that family members and pediatricians and schools start asking and talking about substance use as early as age nine. So as we think about preventing this epidemic, preventing overdoses, you know, we want early on people to start talking about their mental health, about trauma, about substance use in a way that encourages people to be open and honest about it, and to not have it be something that we have to hide. And similarly, for those that have struggled in, you know, as adults and parents to be honest and open about those struggles with with their children, you know, to the degree that they can understand them. Of course, this will advance as people make their way into adolescence and beyond, but the idea is to early on create safe spaces in our families in our schools in our communities where we can all have permission to be open and honest about substance and that includes for doctors to encourage them to ask the questions early and often, and Robin often highlights the importance of involving families in the process so that we're all sort of, you know, aware of what's going on and can offer the best treatments. And, you know, increasing there are a range of treatments I think one of the key principles is to get good mental health treatment as early and often as possible. And to address it with therapy trauma-informed care, you know, certainly treating co-occurring psychiatric disorders as they pop up. You know, the leading hypothesis for substance use remains the self-medication hypothesis, the idea that, you know, people tolerate what substances do to them because of what they do for them. And it's to relieve really difficult states of trauma and distress and mood and, you know, for them, they use because they don't have other options. And then that's part of the disease model of addiction too that it's tied up in a lot of mental health processes that have also hijacked, you know, the brain and the neurotransmitters and everything. And so, you know, I think as we set that space early on, we're hopefully will increasingly get people into good therapy psychiatric care early on. And then with substances, you know, if you I was giving this talk, even like 20 years ago, the advice would be sort of just go to AA, go to 12-step meetings. But fortunately, the menu of options to address substance use has expanded over the years. And certainly AA is a good option for many folks. There's a strong adolescent group, you know, there's groups for however you identify. But it's not for everyone and there are increasingly wonderful AA alternatives. The biggest on the block right now is called smart recovery. It's sort of a CVT informed group therapy that's also free and peer based available online now during COVID so you can access it and sample it. You know, whenever you want that provides an AA alternative. And for those interested in and in seeking out peer support we often recommend they try three a groups one smart recovery group. And then if they're interested in moderation, there's moderation management groups that are free and even refuge recovery and other Buddhist or mindfulness informed groups that are available on the pure end. We also feel though that, you know, we increasingly have good therapies and meds that specifically target substance use that you can do with therapist and psychiatrist. And so there's a lot of increasingly trained professionals that can engage people in therapies such as motivational interviewing, cognitive behavioral therapy, dialectical behavioral therapy. These are treatments that have been shown to be effective for anxiety depression but they also help people learn how to cope and deal with the problematic thoughts and feelings and coping skills that come up when you're struggling with substance use. And then we have medications, you know, I think increasingly we have medications that help with craving for alcohol and alcohol accidents, nicotine replacement and meds for cigarette and you vaping is critical. And then for opiate use disorder medications are critical. And so in the world of addiction we separate all substances of abuse into one. And then we put opiate use disorder in another bucket. And the reason we separate them out is that it's opiate use that really is driving the epidemic and now fentanyl contaminating a lot of substances of abuse including cocaine toes marked as annexed. And if someone's struggling with opiates, you know, it raises, you know, our concern, and we feel like people can't recover, unless they really do have good medications and so all will tackle alcohol, marijuana use nicotine use with a combination of therapy meds plus or minus peer support. Once opiate use disorder gets involved and people are using, you know, prescription pain meds or, you know, fentanyl contaminated products or, you know, turning to heroin or other substances like that, we feel you need the medical treatments, such as meds like venorphine or suboxone, which is an opiate replacement treatment, methadone or a medication called nautrexone or vivitrol which blocks the opiate receptor. And these are needed because relapse rates from opiate use disorder are really high, especially in the first year of abstinence where, where rates can, relapse rates can be as high as 95% in some of the studies. And so we feel like when you're struggling with addiction, regardless of what it is, but especially for opiate use disorder, you need medical attention early on and access to these medications. Certainly if you're struggling to function out in the world and the community, you know, that's when you might go to an outpatient rehab or an inpatient rehab. But someone has to be motivated for that. There's certainly enough for everyone. There's also a huge variant in terms of the quality of such treatments and you can certainly get, get ones that are less desirable. And, you know, I would always start, you know, when you're concerned about someone with a with a good eval from the psychiatrist or addiction psychiatrist who can help tease apart. So that's what we need to address the co-occurring mental health issues and what meds one should be giving for the co-occurring substance use. And then, you know, we know people are going to experiment, we know people aren't always going to be motivated for a care. We want to make sure that people have harm reduction tools available to them. And the chief one these days in the setting of the opioid epidemic are the naloxone rescue kits, which I'm going to do a brief training on now. And so our current recommendation is that everyone carry an arcane kit. And especially those who had no loved ones who are, you know, struggling with substances, you know, even marijuana these days carries a risk, some say of fentanyl contamination, although it's controversial. But certainly we're seeing opiates turn up in pills marked as an ex and cocaine. And a lot of people accidentally overdosing when they didn't even realize they were using opiates or totally trying to avoid opiates all together. So, you know, for those of you that are interested, we can provide my email or email the organizers and I'm happy to mail you out in the locks and rescue kit at the end of the event. And what Narcan does is it allows you to save someone's life and so I'm going to go through the steps of the training real quick so that I can ship it to you and you can be equipped to have it at home to address someone you see wherever you are with the substance use. The steps of the training are that if you see someone who's overdosed or non responsive. We don't want you to play detective. It doesn't matter if you suspect opiates or don't suspect opiates. If there's any opiate involved, you know, this is something that can save their life and also because Narcan is a very safe intervention. Basically, if you spray it up someone's nose and they're not using opiates, it just will do no harm. The way it works is it goes into the brain knocks the opiates off the receptor and allow someone to breathe again if the overdose is related to opiates. And so the steps of the training are if that if you see someone down. You know, if you suspect opiate use or even if you don't to see if they're arousal and in each kit that I'm going to give you it's going to come with gloves. I know some of you are sometimes worried about approaching people during coven but if you feel comfortable the ideas to first do a sternum rub which is to take your knuckles and rub them firmly into the sternum to see if they're arousal will shout at them. And if they're not the second step of the training is to call 911 and the use of the Narcan kit is protected by the good Samaritan law and 37 states around the country and they want people to feel confident that they can call 911 to get help, especially because Narcan only lasts for 60 to 90 minutes. And so if you spray it and someone knows and rescue them, they will go back down into an overdose and 60 to 90 minutes because the opiates hang around in the brain, even if Narcan knock them off. And so you'll do a sternum rub you'll call 911 to make sure medical attention is coming so they don't go back down to the overdose. And then it's very easy you'll take the naloxone spray this Narcan spray out of the kit. And then you'll tilt the head back and spray it all up in one nostril. There's no priming no pumping you can't give the half spray. And then in after about 10 seconds of the overdoses related to opiates, you'll see a characteristic sort of a breath and a return to breathing. Or at times people are just a little groggy and they're, they're you know able to communicate when they weren't before. If you know CPR and it's indicated you can begin it after the first step but it's not critical to know CPR for this. And then if they're still not responding after two minutes there's two of these in each, each kit, and you can spray it up the same nostril or the other nostril, and hopefully they're responding. But if they're not then you put them in their left side in the recovery position. Again, this is predicted by the Good Samaritan law, each kit that you'll receive in the mail also come with my card. So if you have questions about treatment or you want more Narcan kit, we're happy to provide that. And then they also will come with a blue card which is a certificate that you completed the training, which also has a link to different substance use resources. I will add just to make you aware that there's one more harm reduction effort that we're encouraged increasingly encouraging families to get access to. It was just finally received federal funding under the Biden administration when it what didn't receive federal funding prior. We have a program here at the hospital and the Department of Health in New York in the coming months is going to roll out their own program to make it more available. And we're also recommending if people are using substances to have access to fentanyl test strips. That is if you know someone who's using drugs cocaine opiates other substances, and they're sort of not motivated to stop yet they want to be safe. They can take these kits and take a little bit of the substance that they're using, put it in water and you dip the kid in the water and it lets you know the fentanyl's president, which allows you to take the need of precautions. You can have another drug supply to have an arcane available to make sure you're not don't use alone. And, and hopefully not end up with that outcome. A lot of talking I've done we've said a lot and we've covered a lot. But to review the key is that we've got to combat the stigma overall that we've you know we've all got to do what Robin's doing with all of you are doing by coming here which is to think about and talk about substance in our schools in our families, and then to know if you identify an issue, you know with mental health or with substance use that good care exists. And you know that can involve good mental health care, but also good substance use care and increasingly there are targeted therapies and medications, especially for opiate use disorder. You know that can really save lives and improve outcomes and I know a lot of stigma exists with medications for substances, but they really are a lifesaver and in fact the data for them shows there's almost no safer medication, and more effective medication and medicine, in terms of promoting life and preventing me laughs and accidental death. And then yet we all want you all to have these narkin kits and the pencil test strips. Robin did I forget anything as I reviewed the menu there. I'm not the famous. My husband's quote, and he's quoting his mother, who said, where there is life there's hope. And that is, that is such truth. So, every life, everybody is worth our love and care and support where there's life there's hope so let's just all know how to do this, just in because accidents happen and accidents like this, the result of an accident like this is the cost is just too great. That's right and and also because it is a chronic health condition these substance use and so sometimes we wish as we tackle it all that there were sort of quick fixes but it's a long struggle, and it's a long, it's a battle and relapses and, you know, by some estimates it takes six times to stop using and an ups and downs as as one makes their way into recovery. The good news is that many do there are 24 million people in recovery in the United States. The odds are for anyone struggling with substances and they're in their 20s or 30s if they can make it through that peak that they'll end up in recovery. And hopefully as a society will, it will stop punishing and making these treatments more available in the years to come. And I see Vanessa has joined us and with that we're happy to take any questions or thoughts that anyone has. That's great well I want to ask you a little bit more into that. If people make it through their 20s and 30s, can you talk a little bit more about that. And in terms of reduction of staying in this in this state or phase or whatever. There's the biggest peak the biggest number of people using substances are college age kids on until the late 20s and 30s. And then, you know, somewhat treatment some even on their own age out of the substance use. You know the data is that many age out without treatment, but that's mainly because we haven't had treatments, and we haven't had the data since we've had treatments and treatments are sort of a new thing in the last decade or so. Even if though we have treatments actually only one in 10 people access our treatments and part of that is cost, or that is availability. For example, there's only 1000 addiction psychiatrists in the whole country, a number that makes no sense because there's you know 93,000 people losing their lives and 22 million people struggling with substance use. And so treatments not so accessible but hopefully those numbers will change but people age out there's also a slight bump in substance use as people go around retirement age, but the but but overall there's, you know, the events and flows that being said for any individual who's struggling especially you know with opiates and alcohol. There's often a number of bumps in the road along the way, and then there's a subset that struggle, you know despite intervention just because of the severity of the disease for sure. That's why it's so great that you're doing what you're doing. We have a question. What are some ways to encourage someone. Sorry. How can parents talk to kids and Robin you you have such an amazing story I mean, and you and you tried and you did your best and you did it over and over and over again so what would you suggest to parents who are struggling with the way to communicate the way to stay involved and also once a I I told you before our talk started. I have a 22 year old. I totally feel what you are dealing with what you dealt with. How do, how do parents talk to kids, and what what happens in that communication when a when a child an adult turns 21, and that kind of steps on to a different platform. Well just in terms of talking to our children. I mean, I can I can really sort of narrow it down to talk often talk early. I mean I think that if we start this really early, it becomes a conversation like other conversations. You know, I would have conversations with Zoe about food and I'd have conversations about sex and I would have all of those conversations about being a good person and bullies etc. I just never thought that this was going to be an issue. And I really, I didn't really, I didn't know enough about it. It was embarrassing, I felt shamed, and I didn't make it enough of our conversation and I think, you know what what Dr. is saying about starting at nine. I think that's absolutely what we do we start talking about this at an age that seems too early, but it's really not. And it's hard because the. It is really hard to be it's impossible to be a parent I think and and you know, a lot of the substance uses is evolving and the mental health issues are evolving at the same time that an adolescent and young adult is trying to form their own identity out in the world. There's a lot of tension between trying to forge your own way and needing help from from your family and there's tension in the medical community about how much to involve family members in the treatment and and you know I do a lot of talks with pediatricians who you know starting at age, you know 1314 start having the moment where they asked mom and dad to leave the room to talk about substance use, and then they never bring mom and dad back in exactly and and we're sort of encouraging them to start to do that, you know, get their permission and but to let people know that you can't recover on your own. And I think that's the initial instinct that everyone from kids to adults has is that I'm struggling with addiction and because of how I've seen everyone respond to it. I'm going to try to tackle this by myself and and so we're, we're encouraging whoever gets that info that someone's struggling to, you know, to share it with with, you know, health professionals and everyone else. What about some success story. Go ahead. I think also just when we think about substance use disorder as a health issue. You know, we would discuss health issues with the pediatrician adolescent medicine doctors and we'd be a part of that. Each, this should feel the same. And if we start early enough addressing it like the health issue that it is, maybe it would feel the same to everybody. What are some success stories, what are you, what are some successful conversations and like what are the mediations or mediations that have happened between and families because this is all about family. And by the way, by the way, what does stigma mean when you were talking about stigma what do you think what can you tell our audience what stigma really means. What I think it means, I, sorry. Yeah, go Robin, I think it means I think it means judgment without the information. It's, it's you form an opinion based on no information. And that's how we get ourselves into trouble. Exactly. And it's so I mean addiction stigma is sort of its attitudes that relate to the fact that someone uses substances and in that way it boils the person down to their behavior a substance use and misses the whole person and all the things that go into making them. And, you know, you see it in our language, for example, we refer to someone as an addict, as if that's their entire identity or a heroin user and, and you know we sometimes even miss their names and the medical community is guilty of that you can watch, watch the you know heroin addict does, you know, it's just the way it's all portrayed is so negative and misses the people, you know, who are struggling with mental health issues and other issues and I said at the beginning I don't know if I said it clearly but our attitudes in society among young doctors worse towards substance folks that use substance use disorder, then towards any other medical or psychiatric condition, and the attitudes get worse over time and so it seems like our younger generation may have better attitudes but something happens as people age, as well that you know it's it seems like these attitudes may harden as well. So are there, I mean I was starting to ask about the conversations and families but is there a way to kind of talk about that. Is there a way to put that out into the into media into into the way we deal with therapy I mean what what are some, what are some solutions, some ideas about those things. I think from, from every angle, I think, and so you know I think like an example of a good family dynamic is sort of as we've described where we're talking about it early and often and always being there to provide support and that doesn't mean they're not going to use and then bad things might not happen and they might reject it but just really setting the stage that I'm there regardless and so, you know, for example, we started this Narcan program in 2015 and you know the first person we gave it to was a mom and son who came in with an acute overdose to the kids ICU and they were fighting and it wasn't going well and he refused treatment he went home against medical advice and he overdosed, and the mom saved him in Narcan he came back to the hospital. And it was like everyone was really you know motivating the kid and the family but he just wasn't there yet. A couple weeks later he overdosed again the mom rescued him in Narcan again the first two kits ever used back then and, now he's in recovery for, for six years and the idea is that you know we keep people alive where there's life there's hope as, as john Robin's husband says, and then with time and it was hard. As I still see him, you know they repaired the family dynamic and you know I think sometimes we, I understand the sort of like apologizing for past behavior. But I think what was most healing was sort of the everyone stepping back, and even him stepping back and saying I was in the middle of a terrible disease here. I was doing the best I could and I was lost and I was anxious and I was struggling. And for the parents to step back and recognize this guy, we came to a very difficult disease a life threatening and almost disease and. And then you don't need the sorry's and you know as if you did something wrong in the past but that you were struggling and that and I think that was really healing when we got you know the fighting got through the fighting and, and that it was a bad person doing that thing. Well I want to say to both of you I mean a medical professional and a parent. You are, you are doing amazing work but you're all also doing everything you can, you're doing the best you can, and we're all doing I think most people are trying to do the best they can, all the time. But sometimes with not these kinds of outcomes and this person, for example. You know, I mean I think that's amazing that he has come back after to to potential overdoses, and that he's all right right now or in recovery. That's great. That's great. What else would you like to say about this. I want to say in general about stigma, and I guess the addiction landscape and by the way man just ask a question. When did addiction. When did the word addiction kind of come into popular usage. I mean, it wasn't like 1920. When did this all, when did this all kind of change so we're judging people in this way. Was this the 70s, the 80s, the 90s. I think it's still now but the, I think it's, I mean, when did it start that's why I think I mean like even in the 1700s there was always like I think Benjamin Rush one of the first doctors and he had a, you know, he was he argued that he was like the only guy way, you know, two centuries ago arguing that it was by his professional opinion more of a disease model, and people have ed and flowed in terms of accepting it over time. It's been politicized over the centuries to justify discrimination and racial practices and political factors. And, you know, because of some of that the most recent term is that we, we tend to call someone struggling with substance use, we use the term a substance use disorder. And we're sort of, I think the turn from because it just been to the connotations that become so negative and political and polarized over time that these days we've and this is really in the last, you know, 510 years we're now calling it an individual with a substance use disorder that is separating out that there's a person who's struggling with a medical condition as you would say he's an individual with, you know, heart disease or whatever. Who's also, you know, all these other identities that's just one of the many, many, many things and using a term that emphasizes the disease model and so that's been the sort of latest shift and even when people are struggling we've got rid of the abuse, for example, and we use terms like substance misuse. And we've gotten rid of terms like clean and dirty and, and, and all these other things that again are sort of blaming and so we've paid a lot of attention to, to the language over time just to emphasize that key point that it's, it's more of a disease model. Go ahead. I'd like to Robin wanted to add that I really think that when we can realize, and this is probably for other health issues as well that non compliance that there is a reason why people have trouble complying. That doesn't make them a bad person. It doesn't give us the right to blame them. It just means that their mental health issues are that much more complicated. So I think when we realize that non compliance is a health issue in itself, that we might find ourselves a little bit we might feel more compassionately towards someone. We might sort of view it the same way we would. If you gave someone a medication for cancer or chemotherapy for cancer that wasn't working, we wouldn't get angry we would say we need to try this, but we need to try that. We just have to have to rewire the way we view this and just do it all over again start again with, this is a patient, and they're doing the best that they can until they can be better. Right, beautifully put beautifully put. We just had a question come in it's from someone in the audience I can appreciate the early and often statement as a family member it becomes exhausting over time, even if you do not come from a mindset of stigma and try to distinguish things in a supportive manner. Healing doesn't happen in a straight line and sometimes never. How can family members find support. Right, and early and often to clarify and we've talked a lot about this with you faping it's it's not. Sometimes we think that means like crisis intervention conversations but but rather it is, we actually encourage will not when someone's in a crisis to not sort of you just to let people know you're there for support it's sort of a call it's the frame is just like setting the stage that you're always there to an interested and thinking about it. So that people can can get help, especially because it is going to be not linear and things are going to have been flow and so you know I think support for family as they go through it as we provide support for family members for individuals going through cancer or through other, you know a lot of chronic health conditions have support built in for family members just because it is, it is challenging to navigate the ups and downs of chronic disease process and so, you know, just as they're increasingly a menu of options to help address treatment for folks are a menu of options for families as well there's you know I think one thing I've noticed is treating a individual with substance use you want to make sure you're addressing your own substance use your own mental health issues and then getting the carry you might need on an individual level with meds and the evidence based therapy. There are a lot of their sort of a alternative a moot groups or family called Alan on, and then increasingly there's a therapy called craft, which is sort of teaches family members motivational interviewing teaches them. I think that Robin was was mentioning in terms of narrowing the dialogue and avoiding conflict. And I think there are a number of good books on that, including beyond addiction. That is basically it's a family guide for family members who don't want to change and how to, you know, basically how to lower the temperature and and understand the disease model and then how to hang in there and get your own supports. There's a number of family support groups that if you search craft that exists, you know, in different parts of the city and country. That's great. Just to add, I think it is exhausting. I think it's exhausting being a parent. I think it's exhausting getting your kid through high school and then worrying about college and getting them through college. It is exhausting. It's, it's everything. It's so worth it. It's so, you know, it's the good work. Yeah. And even despite all this best effort, you know, things happen, and we do the best we can, as parents as providers, you know, but you know this is a tough disease and mental illness is a tough disease and it's a lot of hanging in there for dear life which is exhausting and hard and it can create a lot of uncertainty and a lot of wish to, you know, make things better quickly but it's, it's, it is a hard chronic condition like cancer like like any of these other chronic medical conditions. Absolutely. Absolutely. Let me ask a question. Where can people how can people get the Narcan kit. Where can people get all this because I know everybody in our audience is going to know how to do that but where can people in the, all over the country get this. Yeah, our audience can email me I'll send it in the mail. Each state has their own program and each and sometimes it's it's on the city level so New York City has their own program New York State has their own program. The, you know, Connecticut, New Jersey all have their own sort of programs all the all the bordering states in New York. It's still a Narcan kit. It's still Narcan kit money around the country are available by just going to a pharmacy without a prescription. And you can if you look at the local Department of Health websites they often have links and how to acquire them in the setting of COVID there's also national organizations that ship them out as we're doing now. I think the biggest one is called next to Narcan if I believe. And maybe we can send it out afterwards but there are ways to get it shipped during COVID and some of those some of those rules might change postcode or they don't allow you to ship them anymore but but right now you pretty much can get it shipped to you if you find the right local or national organization. That's great by the way I want to go ahead, Robin. I was just going to say the CVS believe it or not CVS is now all across the country different CVS is are now making Narcan available without a prescription so we wrote a opinion piece and Slater or one of the magazines me and a couple students here at Cornell arguing that should be over the counter as well I mean I my hope is with time it's not. We put up all these barriers to addiction care this one is so safe it does basically no harm if you're not it does no harm no matter what it just reverses an open overdose and so you know you can feel very comfortable having you can't be allergic to it can't do anything. It's in and out of the system 60 minutes 90 minutes if you're down for a heart attack any other medical reason any other drug overdose, no matter what medication you take. It does no harm. That's great. That's fantastic. That's fantastic. I just want to say by the way I think I was incorrect my someone emailed me just now. It's not 21 years old at 18 years old you cannot have access to your son or daughters medical information. Correct. It's not 21. Yeah. And I want to ask you I just want to ask you this has been fantastic but what would you like to say to to wrap up for our audience, I mean, oh, sorry, we just sorry, another. Can I ask another question. Okay, this is from this. This is from the same person who asked a question before Lisa, I asked the question I'm a sibling, it has long lasting impacts on siblings as well thank you for your input appreciate it. So what would you say to what would you say to families, how to deal with, for example someone someone struggling someone. Having a rough rough time. I mean it because it is we are having when you think about the world, we are all family, all of us. So, I'm just going to quickly say because, johnny, you can you'll speak on it but you know something what I would say is, just is, if, if someone in a family was diagnosed with a very serious illness, the whole family would be involved. And I would recommend Dr every what do you think that the whole family get into family therapy, because why wouldn't you everybody needs support, everyone's going to be involved. So this is that. And that's what we need to start. That's how we need to start thinking that this is a serious health issue, but one that you can recover from, and one that you can have a great life. But you need to do just what you would, if God forbid a child had a cancer diagnosis which would impact everyone. Right. And if they're not interested in the most plain for having cancer, you don't play some. Sorry, go ahead. Right. And if they're not interested in, in sort of the, the ideal care that we want for them including involving family. And we don't kick them to the curb or let them hit rock bottom we let them know that we're here for them, you know, no matter what they were on this journey with them we know they're struggling. And if possible to avoid, you know, it's easy to get into these yelling matches around it but I think the most effective thing is to just let them know, you know that that you're there and and that you're ready to support them no matter if they can't handy. You know that certainly be prepared. It's probably it probably goes without saying but a lot of a lot of what we're dealing with is love. I mean it really is about love. It's about care it's about compassion. It's about being aware of other people it's about all those things. It's about looking at people and not judging them, just because of what you're see, and that's goes back that's that that's the definition of stigma, where we make a judgment but we don't have the information so it is a hollow judgment based on nothing but your feelings. Yeah. So what would you what would you like to say and in conclude, I'm just gonna see if there's another another question come came in now and what would you like to say and in wrapping up in concluding or what have we missed what haven't we gone over asked. What do you think Robin. Well, what I'd like to say is that. So we could be anyone's child. And I could be you. And I think once we realize and once we admit that I could be you and she could be yours. Then I think we start to look at this as though. Yeah, you know, this could happen to anyone. And I think anything cat now that I've been through this I know that anything can happen to anyone it's just a matter of sort of the perfect storm of things that all of a sudden you find yourself in a situation that you think would never happen to you. And I don't think it's arrogance I just think it's that. I mean I don't think I thought this could never be me because I'm an arrogant person. I think I never thought this could meet be me because nobody was talking about it. I didn't have enough information. And I just didn't understand it the way I do today. Today I understand it for what it is which is a health issue. Anybody can have a health issue. And that's I think that's what I would love people to come away with realizing because there's, there are doctors like Don Avery, they're terrific doctors there's great treatment, and you can get through this. You know, a question just came in on my, I've got people emailing me and texting me, how can we help. How can we help help the next person facing us. For example, somebody comes in tomorrow. Somebody comes to you tomorrow. What do we do. How do we lay people I mean we've got experts like johnson Avery fantastic. How do we help each other as just friends, and, and people in families, how do we, what do we do. We have all of Zoe's friends I can tell you that every year we have a holiday party for like all of Zoe's friends and all of our friends and Dr Avery and all the folks that have helped us. We have an arc and training. I mean, we spread all the information, all the health benefits that we know we want everybody else to know. I think it's just being in there, recognizing people are doing the best they can. We're all in this together and you know through the abs and flows the good and bad that you know no matter professional or not that, yeah, we're all in it, in it together. As we would for any anything that that you know couldn't happen to any of us and so. And life is so short and it's so hard sometimes and and and you know it's what else can we do but but but be kind and hang on to each other as we make our way through. Well you all are so remarkable I can't thank you enough for being here tonight for imparting this telling your story, being here and participating in you know what I think is a very very important conversation and here I know here's Catherine. I'm going to say from the Bedford Playhouse because our Dan Freeman is here, not here tonight. We really appreciate this through let's talk at the Bedford Playhouse and through DAPC and Catherine is going to take it away but thank you. Thank you. Thank you. I just wanted to, I just wanted to echo Vanessa sentiments. Thank you so much for being here tonight and delivering this really important message. I can tell you how much we appreciate you taking the time to be here for our community, and thank you to everyone who took the time to attend this evening. As I stated in the beginning, making time to really get this information is really the first step in helping stop the stigma which we spoke a lot about tonight. So again thank you to everyone involved in this evening and I wish everyone a wonderful night. Thank you. Thank you.