 Hi everyone, I'm Ed Baker. Welcome to the Addiction Recovery Channel. This month's show will feature a talk that I gave at the LaMoyle Valley Fourth Annual Opioid Forum. The title of the talk is Understanding and Supporting People with Addiction. I try to address three questions. One, what is it that makes one person more vulnerable than another to develop substance use disorder or addiction? Two, what is this process, this progression of this disease? How do people engage in this process of ever worsening consequences over time, sometimes becoming incredibly grave, even resulting in death? And number three, what can we do about this? If you're not a doctor, you're not a therapist, you're not a legislator, you're just a regular vermonter who cares. What can you do? What can you do about this problem every day? How can you contribute to solutions? If you're interested in the answers to these questions, I think you'll benefit from watching this talk. I hope that you find merit in it. Thank you. I'd like to thank each and every one of you for listening to that little voice inside you. That little voice that said, go ahead, go to the opioid forum, see what it's about. Maybe you can learn something. Maybe you can get some help for yourself. Maybe you can understand what addiction is about. Maybe you can go home and help someone in your family or in your community. Thank you for listening to that little voice. It is entirely my honor to be here with you this evening, entirely my honor. I want to first recognize that we are many in this room, and this is as it should be. And although we are many in this room, we are of one heart. This is compassion, and compassion is at the core of my talk tonight. We are joined with you. We are joined with the Teatro family in your grief and in your hope and in your commitment. I would dare say that we may be a little behind you in our courage. Make no mistake about it. We face the most pressing healthcare emergency we have seen in our country since the great flu pandemic, following the First World War in the early 1900s, over 100 years ago. This is profound. We are up against something. Make no mistake about it. We are at our best when we are deeply challenged, and we are deeply challenged today. Vermonters do not leave each other behind. Vermonters do not quit. We do not give up. We band together, and we craft solutions in the face of adversity. We are part of a sea change that is occurring in our culture today, a groundswell of compassion for people with addiction, their treatments, and their recovery support services. My goal tonight is to explain people with addiction. I hope to explain it in accurate terms, in understandable terms, and terms that you will remember, terms that will help you. My goal, the driving force, my driving force is to help people to feel compassion for this particular population, to bust through stigma, to leave stigma behind, to feel hope and feel compassion, to approach this population with inclusiveness, support. Addiction profoundly affects the human brain. It affects the human brain in areas and in functions that are necessary to survival. Learning, memory, reward, motivation, decision making, the ability to inhibit impulses. In other words, the entire person, the entire person is affected by addiction. As I move along in my talk, I'd like you to keep three concepts, three ideas in mind. Complex, gradual, and innocent, and we'll go through all three of these. We'll begin with complex. The disease of addiction, the process of developing addiction in a person is complex. It's not simple, it's not unitary, it's different for each person. It's complex, like any other disease process. In order to understand it, we have to understand risk factors, genetic risk and environmental risk. I have a handout that you can pick up on the way out that has a bibliography that goes into this in a little more detail. But for our purposes, we've all wondered, why is it that one person is more prone to developing addiction than another? Risk factors are part of that answer. There are genetic influences that cause one person to be more vulnerable to the development of addiction than another. Similar to type 2 diabetes, similar to prostate cancer. People don't choose type 2 diabetes, people don't choose prostate cancer. People don't choose to be at risk for addiction. It is not a choice. The other area of risk factors is environmental risk and we know a lot about this. The adverse childhood experiences studied in the late 90s have shed a lot of light on the effects of what's called toxic stress on brain development in children. Children exposed to ACEs, adverse childhood experiences, multiple ACEs, are much more likely to develop addiction in life because they're prone to impulsive decision making. Tell me, does a child choose to be born into a family where there's family violence? Does a child choose to live in a neighborhood where there may be gunshots or violence? Does a child choose to be discriminated against? No. Adverse childhood experiences. Some people have both. Some people have genetic predisposition and environmental disposition. When this is combined with likely exposure to a psychoactive chemical, and we have to face it as a society, we have to face it as a culture, it's likely that a child is going to be exposed to a psychoactive chemical. We have nicotine, prevalent. We have alcohol, prevalent, and pretty soon we'll have marijuana, prevalent, prevalent. Three drugs with known addiction potential that a child is likely to be exposed to. And when you add tragically over the past 20 years, the way that the medical profession has been writing prescriptions for opioids, you have the likelihood of being exposed to an opioid. So when someone with pre-existing conditions is exposed to a psychoactive chemical, the result is an overvalued response to their drug effect. This is not everybody, this is people with addiction. When a person has an overvalued response to a drug effect, they tend to seek the drug. Some people are born with a deficiency in the way that they process reward. Life is kind of blah to them. If they're exposed to a psychoactive chemical and that chemical gives them the type of reward that people seek, the brain will remember that and they will seek that chemical. Some people have inner worlds that are characterized by suffering, depression, anxiety, low self-esteem, isolation, post-traumatic stress. It's not uncommon. When a person with an inner world characterized by suffering is exposed to a psychoactive chemical, that drug effect is overvalued and the brain remembers it and they will seek it. This causes continued use and eventually brain adaptation on the cellular level. This is what the Tetralists were referring to when they referred to hijacking. On the cellular level, neuro pathways are established involving memory, learning, motivation, the ability to inhibit impulses. This is no longer a choice. The person has no choice but to follow the addiction. It's a matter of survival. At this point, external cues can set off a recurrence of use. You can have someone who's struggling with recovery, going to AA or NA or the Recovery Center or therapy or what have you, but their brain isn't healed yet. This is the point. It's a brain disease. On the cellular level, there hasn't been a restructuring of the brain. An external cue can set off a motivation, can set off memory, can set off compulsion. And then the front part of the brain that makes decisions that inhibits impulses is not healed. And the person has an impulse to use a drug and cannot stop themselves. I was a therapist for 30 years. I can't even tell you the number of stories I've heard from people with addiction who went out and sought and self-administered a drug against their own will. Caught in that tractor bin, like a robot, against their own will, a victim of their own impulses. This is the power of addiction. The second concept I ask you to remember is gradual. That the process of addiction is gradual. It may seem sudden. It may surface suddenly because it's been under the surface, but it's gradual in its progression. I struggled for a long time trying to come up with a visual explanation, a visual description of this gradual sense of addiction. And I think this captures it. My fourth grade teacher used to describe it as Roy G. Biff, the color spectrum. Red, orange, yellow, blue, indigo, violet. I'll always remember that. When you look at a rainbow, this is what you see. You see these colors, and they bleed into each other. They bleed into each other so gradually. Where does red become orange? Where does orange become yellow? Very, very gradual. It's like the process of addiction. It begins very subtly, very innocently. The progress of addiction corresponds to the text on top of the spectrum. It starts with abstinence. Children are abstinent. It moves into what we call early use, which is kind of a random use. From random use, it becomes intentional. Now there's a reason. The person is seeking one drug or another or in a factor to be part of a group, to look cool, to be older, to relieve pain, whatever. It moves from intentional to pattern. And then from pattern, if it's a pattern of use, it becomes problematic, then it's problematic use. Now, we'll take alcohol, for example. Alcohol is safe to talk about. Most people will hover around this point. A lot of people drink and it's not a problem. They use alcohol in a patterned intentional way. It's Friday, I'm going to drink. I'm going to a party, I'm going to a bar, I'm going to socialize, I'm going to drink. It's not a problem at all. Many people do it. Some people will move from patterned use to problematic use. It's a very subtle move, just like the change in the colors on the spectrum. Very subtle move. At this point, the majority of people, what will they do? They'll move backward to intentional use. They'll get some feedback, maybe from a boss. You've been late six Mondays in a row. What's that about? Uh-oh, I better stop drinking on Sunday. It's a problem. Maybe it's from a loved one. I can't believe what you said the other night. You embarrassed us. Uh-oh, I better get a grip on this. Maybe it's a self-observation. Oh my God, I can't believe I did that. I'm not going to do that again. This is a healthy brain evaluating behavior and taking steps to modify behavior. That person moves back into intentional use. This is not addiction. This is addiction. When a person moves through that process to problematic use, they get feedback from the environment, there are consequences, and they move forward into a deeper addiction and more serious consequences. And then they move forward again into even deeper addiction and more serious consequences. This is the definition of addiction. Continued use despite consequences. People forget how to take care of themselves. They lose the ability to differentiate between safety and danger. This is just an example of the subtle changes between mild, moderate, and severe. I've heard people in therapy tell me, I drew a line in the sand and I told myself, I'll never cross that line. People with addiction. When I got to that line, what did I do? I drew another line in the sand and I said, I'll never cross that line. And then what did I do? I drew yet another line in the sand. Innocent. Innocent. I can't even tell you how many people with addiction I have spoken to. I am a person in 34 years recovery from addiction. I have never, ever met a person who has consciously chosen to live a life characterized by the symptoms associated with addiction. It has always been innocent. Addiction wears a cloak. Addiction wears a disguise. Addiction tells you something it's not. And then when it's got you, it says I am addiction. It's extremely powerful. People with substance use disorder, people with addiction need us to understand what's going on with them. They need us because they don't understand what's going on with them. They need us to craft solutions. They need us to craft solutions that make them comfortable seeking help. What do we do? Does anybody feel like that? Because I feel like that. What do we do? We can't really do much about genetics. Genetics are genetics. We can educate people about risk factors. We can educate ourselves about risk factors. But I would submit this idea to you that we can shape the environment. We are the environment. It's our business. It's our duty. It's our responsibility to shape the environment in ways that welcome people with addiction, with compassion, that assure them that they're not being discriminated against, that we're not seeing them through a lens of stigma. This community here, this community in the Lamoille Valley, is quickly and very powerfully working its way toward becoming a recovery supportive community. There are people in the room. I saw Susan Bartlett a little bit early. There are people in the room who've been doing this literally for decades, my friend Michelle, others in the room. We're working toward becoming a recovery supportive community. And this is what we have to do. This is what it goes, put it perfectly. Our future depends on it. This last piece is on something every one of you can do every day. When you think of an advocate, you usually think of someone standing on a soapbox with a megaphone, you know, making a big fuss. This is the way of being what I like to call a softly spoken advocate. By the conscious choice of language, we can all use language that sends the message that we care about people with substance use disorder. We care about people with addiction. We have compassion. We want to use language based in science, not in stigma. Words can dismiss. Words can demean. Words can discourage. Words can perpetuate stigma. There's no blame here. You learn what you're taught and we've been taught the wrong language. Public information hasn't kept pace with science. Words like this we need to strike from our vocabulary. Drug abuser, dirty drug test, addict, recreational use, doctor shopping, user. These words don't get it. They don't sound compassionate. They don't reflect science. There's been research done on the word drug abuser. It elicits what's called implicit bias because the word abuser is housed unconsciously with other types of abuse. When you hear someone as a drug abuser, your response is punitive. I will punish you because you're an abuser. People who use drugs don't need to be punished. We've seen that with the war on drugs. It doesn't work. They need to be included in a compassionate way. We need to be all in, all hands on deck, exhausting resources. In the handout that we have, it's a paper I wrote called Softly Spoken Advocacy. Please pick one up. There's an additional reading. There's a bibliography included with that. This is something you can do every day. What I envision is that we will become a force in the community. We will educate our families. We will educate our neighbors. Words can affirm. They can empower. Words can motivate. They can eliminate stigma. And when stigma is eliminated, compassion takes its place. We know this. What are the two most powerful instincts a human is born with? Preservation of self and preservation of the species. Compassion is natural. We want to feel compassion for each other. We learn to feel stigma. We need to unlearn stigma and unleash compassion. These are some words that we can use. Simply put, person-first language. So-and-so is an addict. How does that sound? So limiting. No, so-and-so is a person with addiction. Much more compassionate. Ed is a person with substance use disorder. How does that sound? Compare it to Ed as a substance abuser. It's a whole different connotation. We want to use neutral, non-judgmental language. Drug use, not drug abuse. Non-medical use, I like to use instead of recreational use. The non-medical use of marijuana. It's not recreational. Drug misuse is a word that's gaining in popularity. Another safe, neutral word. People in recovery. Recovery needs to be celebrated. I surround myself with people in recovery. I am a person in recovery. People in recovery can contribute so much to society and so much to this cause. We don't want to characterize them as on the wagon or a clean addict. It doesn't get to the truth of what's going on. People in recovery, she's a person in long-term recovery. We need to struggle with this. We need to struggle with this as a community. This is the ultimate goal of Softly Spoken Advocacy. This is our ultimate goal as a recovery support of community. That we will change the language. That we will use language based in science and it will reflect what we know inside. We need to educate ourselves about the disease of addiction, the disease of substance use disorder. It's not space science. Vivek Murthy's 2016 Surgeon General's report Facing Addiction in America is written for people to read, not doctors, not psychiatrists. Written for regular people like you and I to read. It's in my bibliography. I've read it a number of times. We need to educate ourselves. At the barbecue, we need to educate whoever's standing next to the grill, getting a hamburger. We need to be out there. We need to be advocates for change. We need to step up. This causes an accurate perception of people with addiction. It's not a choice. It's not a moral failing. It's not a criminal behavior. It's a disease, a chronic disease of the brain that it needs to be responded to with compassion. And when we as a community respond to people with addiction with compassion, they feel included. They feel important. They feel included. They don't feel shame anymore. They're more likely to say, I have a substance use this order. I need help. Where can I go for help? And instead of languishing in the shadows, they get better. The legislature or leaders abandon stigma. They begin to spend resources on making programs easily accessible with low barriers. More people get help. We save lives. It begins with us. We are a recovery supportive community. Thank you.