 Hi, everyone. I'm Ed Baker. I'm your host producer at the Addiction Recovery Channel. Thank you so much for joining us today. I couldn't be happier than to have our guest join us today. Our guest today is Dr. John Kelly. Dr. Kelly, thank you so much for being with us today. My pleasure, Ed. Great to be here with you. Thanks for the invitation. Yes, thank you. First and foremost, Dr. Kelly is a licensed clinical psychologist, actively working with individuals and families with alcohol and other drug use disorders. He is the Elizabeth R. Spalin Professor of Psychiatry in the field of addiction medicine at Harvard Medical School. He enjoys the distinction of being the first and dad professor in addiction medicine at Harvard. Dr. Kelly is prolific. He's published more than 200 peer reviewed articles, reviews, and contributions to books focused in the field of addiction science. I could go on forever, but I'll just cite a few more of his impressive accomplishments. He's served as a consultant to the White House Office of National Drug Control Policy. He's served as a consultant to the Substance Use and Mental Health Services Administration and the National Institutes of Health. Again, Dr. Kelly, thank you so much for being on the show today. Thanks for having me. So we were chatting a little bit before we went on air and I was telling you that my introduction to you, my familiarity with your work basically revolves around your research into stigma and language. And I would like, I would like to begin there. I'd like you perhaps to review your work or summarize your work. I think our audience would benefit greatly from hearing about your work from you. Thank you. Yeah, you know, this is a topic, of course, that whenever we're talking about addiction and substance use disorders, we are talking also about stigma and discrimination because those unfortunately go together. And there are many reasons for that I can talk about some of those reasons why that is the case. I became interested particularly, I wasn't necessarily interested in stigma per se as a, as a, you know, scientific pursuit and studying stigma when I got into the field. I was more interested in, you know, helping people with addiction and the families and studying things like treatment and recovery support services and mechanisms of behavior change through which people recover. But I got into this area around about the early 2000s, where this term abuse in particular began to concern me. And I began to think, well, you know, if you call someone an abuser, it's kind of like like a child abuser. You're kind of implying that they're kind of engaging in willful misconduct. And I wonder what the implications of that are, you know, in DSM for some of viewers may remember DSM for or know about DSM for and the prior iterations of our diagnostic and statistical manual of mental disorders, which included the term abuse, because there were two categories of a substance problem, if you will, one was called substance abuse, the other one was called substance dependence. And the abuse therefore terminology was really perpetuating this idea, potentially that people that had these problems that suffered from these disorders were actually engaging in willful misconduct. So, so then I designed a study to test that out. And I randomly assigned, you know, a vignette to about 700 clinicians. These were doctoral level commissions to see if when they were exposed to someone with a drug problem, if they were described as being a substance abuser versus being described as having a substance use disorder. Otherwise, the description was the same. And you randomly assigned those two terms describing the same person. Would there be differential judgments placed on that person based on just on that terminology difference. And in fact, we found, yes, there were even among highly trained professionals. They were systematically biased by exposure to that abuse terminology. So that opened my eyes and I think many other people's eyes this back in 2010, we published that we did a follow up study similar study with the general public, found even bigger magnitude differences, whereby the abuse terminology team to induce these negative more punitive biases against people with drug and alcohol problems, relative to calling them as having this referring them as having a substance disorder. That's the fascinating the power of language. Both has negative effects and also positive effects but your paper of 2019 the real statement of substance use disorders. You summarize the effects nicely. It's there's basically five bullets. The person described as a substance abuser was perceived as less likely to benefit from treatment and more likely to benefit from punishment. How much more clear. Can it be the person described as a substance abuser was perceived as more likely to be socially threatening. So these are your findings and they're profound. The person perceived as a substance abuser was found to be more likely to be blamed for the symptoms associated with their disorder, and more likely to be perceived as being in control in other words. Well, you know, I can just stop doing this whenever I feel like it so that element of choice enters into the picture. I'll elaborate on that a little bit. The importance of this element of people being perceived as willfully engaging in the behaviors associated with addiction. Yeah. Yeah, and this kind of pertains to why it is that substance use disorders are so stigmatized as I began to talk about right at the beginning of this show today. And it has to do these two two factors cause and controllability. And this pertains to choice because sometimes people. And I think, you know, even relative to other psychiatric illnesses, substance use disorder is more stigmatized, because people view it as people taking something outside of themselves, taking it into their body. That involves an initial choice to do that. So you can see why then people will say well, they're just engaging in selfish willful misconduct at the expense of other people. Now, the thing is with cause and controllability we know now from 50 years of studies on the etiology of addiction over the last 50 years. We've learned a ton about genetics and the genetic contribution to addiction. We know now for example, that roughly half the risk of addiction is conferred by genetics. And this pertains to cause one of the dimensions that underlies stigma. Because if we say if we say about a condition that somebody has the stigmatized that you know it's not their fault and they can't help it stigma tends to go down. If we say it is their fault and really they can help it then stigma tends to go up. And so we know with the genetic contribution that just like other complex illnesses to which we may be susceptible addiction is no different in that we have a genetic. Some of us have a genetic predisposition which places at higher elevated risk for contracting the disorder of addiction. And that manifests in different metabolism and different reward salience on the initial exposure. Take a drug like alcohol, 90% roughly the population exposed to alcohol, but only about 20% of people in their lifetime will encounter a problem with alcohol. Now that's just by virtue. Some of us are protected. Some of us are more vulnerable by virtue of our genetics related to controllability. So in other words, you know, we don't know people don't know they're getting into that high risk area because they don't know they're different from other people when they're exposed to the drug initially. Whether that be illicit drug like alcohol or illicit drug like opioids or heroin, people don't know that they're experiencing a more profound effect from this exposure, but they do know that they like it and they want to repeat it. But they don't realize that they don't realize nobody as they say ever plans on becoming addicted. That is something that you know nobody ever in a million years thinks it's going to happen to them. The other thing is this as you which you began to talk about it is the controllability aspect the choice aspect. And this is another dimension the second dimension that pertains to stigma, because this issue of controllability. It implies and again this is where the abuser term I think has more relevance is that people are choosing to engage in it therefore they can turn it on and turn it off. It's not a compulsion. It's not something that's beyond their control. They're just engaging in selfish behavior. We know now, again, from the last 30 years of neuroscience, that the neuro circuits in the brain are radically affected functionally and structural let me show you an image. Thank you. Thank you to share the screen here per second. And hopefully, you can all see this. One of the wonderful things that we've learned, thanks to the National Institute on Drug Abuse and National Institute of Alcohol Abuse and alcoholism, part of the National Institute of Health in the United States. Through the funded research that's emanated from these institutes in the last 30 years. We understand now these neuro circuits, which are implicated in addiction, which pertain to the subcortical areas of reward and memory. Right around here in subcortical deep areas in the brain, which are older areas the brain and reward motivation impulse control and judgment up here in the prefrontal cortex, which are associated with decision making and inhibitory control, regulating the impulse to engage in a certain behavior. Now what happens in addiction is that all these circuits, which are strongly related to reward and reinforcement are impaired. They're impaired. They become increasingly impaired over time, not just functionally, but also structurally. And you can see on the bottom right here here's someone with alcohol addiction. And if you compare that to the brain on the left someone who's a moderate drinker you can see a radical difference in not just a function but the structure of the brain is radically different. It has this ventricular enlargement and the cortical shrinkage associated typically associated with alcohol exposure. Now this produces toxic effects in the brain it kills brain cells and also structurally changes the brain. In radical ways now the good news is, here's the good news the bad news is is what you can see on the screen. The good news is is that a lot of that are damaged to the brain can be repaired. The mother nature can do a job when people abstain and get into recovery. There's a lot of brain recovery as well in the brain of a nature can and do her work to bring the bank the brain back to life now it might not be the same level of speed of processing that was there before. So, instead of, you know, using the I 95 to get from a to B you might have to use the side roads, but mother nature does a job in helping us all get there. When we get into recovery so the brain does change and does recalibrate and repair itself in different ways, but you can see quite clearly and this has been one of the advantages of the latest science. In the last 30 years that we understand now much more about this impaired control, and we understand it now in the neurosurgery and not can identify that that is why this is a psychiatric illness. If that was not the case. If it was just a matter of choice people just choosing to do it, then punishment would work. It would work to change behavior, and people would elicit control over the behavior and kind of get on get on the wagon as it were. But we know that punishment does not work to treat these conditions, whereas treatment does. Well, thank you. Thank you and thank you for that clear explanation of what happens in the human brain when it's been exposed to toxic chemicals over a period of time. People people have a, I think it's difficult for people to understand a choice because people who develop addiction do choose to self administer drugs, but they don't choose to self administer drugs with the intent of becoming addicted. It could be self administer drugs for many many reasons. It could be self esteem. It could be depression, it could be anxiety could be post traumatic stress it could be to fit in. It could be because of availability or social determinants, you know, poverty and isolation it could be anyone There are lots of reasons for choosing to self administer drugs, but what happens over the course of the process is under the surface, the brain is being affected and people are unaware of that. And I think that the American Society of Addiction Medicine in 2019 clarified this idea of addiction and when it occurs the word is kind of thrown around. I think a little bit inappropriately with someone with a mild substance use disorder is not addicted. The ASAM clarified that a little bit I think they located it around the end of moderate beginning of severe substance use disorder. By that time, the brain, as you so eloquently portrayed has adapted to the presence of drugs operates with the presence of drugs and they can operate without the presence of drugs. That's addiction proper, where as you have said there is no choice then is simply an incentive salience or a very powerful drive is that correct doctor. Yeah, yeah, I would say that, you know, in maybe very rare instances there is no choice, very rarely. Now, what there is is radically impaired decision making and inhibitory control. It doesn't mean that they can never make the decision to not use the drug and follow through with it. Oftentimes they can, but they cannot do it consistently or for very long. So they can't hold on for very long without extra support and help. So I would describe it as it's not impossible, but it's extremely difficult, extremely difficult for people to not use when the locomotive is like a locomotive of energy that is pushing all the time. In that direction towards drug use so that people are trying to put the brakes on the slow down that locomotive, but because the way the brain works and you said it you know the neuro adaptations and the automation that the brain does with powerful reinforces. I mean this is genetically modulated, don't forget, it's not just a function of neuro adaptation and neuro toxicity, but for certain people, there's a much deeper level, whereby they are much more susceptible at the same level of exposure than somebody who does not have that genetic predisposition. So there's all these forces kind of converging. Then if you add to that, as you pointed out, other kinds of developmental environmental stresses, including early exposure to the drugs during teenage years, these all amplify the risk. And so if you're coming from an impoverished environment, if you suffer abuse as a child and neglect as a child. That affects your brain neuropsychiatry and brain chemistry, which sets people up for that more positive relief that they get on exposure to these substances than other people do who have a more enriched environment. They don't experience that level of reward. Yes, thank you Dr Kelly and with that in mind, it couldn't be any more clear how how important supports are for people with substance use disorder. Recovery supports, environmental supports, financial supports, transportation, housing, education, the kinds of supports that that people need to establish safety while while the brain heals. I think you've alluded to that it's a healing process and it takes time. Now, people, I think Nora Volkov, the director of the National Institutes on drug use. I think Vivek Murthy, the Surgeon General under Obama, I think you worked with Surgeon General Murthy on his facing addiction in America. Is that true. Yes. People noted people and yourself included are are are speaking out about the way that stigma will militate against the development of effective supports. Now, I know you've been I think you were instrumental in the Office of National Drug Control Policy Summit. I mean, whether Obama administration decided to end the inherited war on drugs and begin a public education campaign around addiction as a disease. So, I mean, you've been so instrumental in so many ways. How, how do you see priorities moving forward. How do we get to the, and believe me, Vermont, where I am is a great example. There's a lot of wonders in Vermont. We have recovery centers all over the place recovery coaches, low access buprenorphine, harm reduction. I mean, we're, we're, we're moving forward here. But but but Vermont I think it's a little bit of an exception. How do you how do you see priorities moving forward how do we push this forward. Well, it takes will and and, and, you know, kind of insight into the nature of these problems and what works and what doesn't and a willingness to admit when we've made wrong turns. And now nationally as you pointed out, that was done formally done back in 2013 on December 9, I was very fortunate to be there at that White House summit. It was the first ever national drug policy reform summit hell since the declaration of war and drugs and it marked a formal shift at the federal level away from the war on drugs as you pointed out towards a broader public health approach to these endemic problems. I felt and I think many people felt that was good news because it was an acknowledgement at the federal level at this shift towards this very important shift towards public health approaches to help people who suffer from these problems. Number one to prevent them ideally. Number two to intervene early. Number three to provide proper treatment and recovery supports for those who are severely addicted so that they can find recovery. I think, you know, what's happened now is a greater recognition of what we have learned about the nature of these disorders. And this of course pertains to the things that we've been talking about today. The cause and controllability factors involved with substance use disorder. We did not know this 50 years ago. We did not know about the genetic contribution and the degree of contribution of genetics to the onset of addiction, nor did we know about the nature we knew that people had impaired control. We don't understand didn't understand exactly why that was we understand much more clearly. Number one, what the nature of that damages in the brain and also the factors that you pointed out, which can help people recover. We think about, you know, the environmental conditions that we need to provide and create that really facilitates healing in the brain and recalibration re adaptation in the absence of the substances, so that people can get well and their brain and their central nervous system can can get well. Now what we're seeing now of course under the new administration, both with the Biden administration and now with the to some extent under the Trump administration but this has been really ramped up with a new Biden administration in terms of providing much more funding, particularly in light of the opioid crisis which has been an absolute necessity and, and obviously a horrible crisis that we're still dealing with. But the appropriation of funding, you know, it's been fantastic in the sense that now billions and billions of dollars now have been dedicated to providing access to harm reduction services to buprenorphine to needle exchanges to other kinds of harm reduction so that we can keep people alive long enough that we can help them into permission and recovery and a better quality of life. And, you know, there's a new bill now in Congress to provide for by law for additional recovery support services. And these are the kind of things that we don't normally think about when we think about treatment. These are things like housing jobs, the social support, the things that job training education, the traction the recovery capital as we call it, the things that can instill hope for people that they can lead a better life they can get back into into life and make a new start in life. Those things. Now NIDA recognizes as essential components of comprehensive drug treatment. Nice, 30 years that was not on the landscape that was not on the radar. So we've come a long way and recognizing not just to address clinical pathology, but the so called social determinants of health as well, which can augment healing. Beautiful. Yes, yes. And I couldn't be more encouraged. I've been in the field for a while. I am a person in recovery. So I've studied this from many, many different aspects. And then I couldn't agree more with you that there is something changing in America. It seems, I like to call it a sea change. But, but you could call it the beginning like or a tipping point. It seems that efforts like yours and many others throughout the decades have really taken hold in America is beginning to understand what's happening with people with addiction. And certainly in my state. I see it every day. You know, when you talk about cause and control ability. I think that it becomes most tragic and most clear when we look at overdose fatality in America that I believe at the 12 month period ending April 2021. The number now is 100,000. 64% or 64,000 of those 100 are opioid and the rest, I think are stimulant. So there means, there's, there's, there's tragic things happening in the country today. Now, I, I mean, I feel the World Health Organization did a study where they ranked the severity of stigma and what they termed addicts were were were most stigmatized against alcoholics with the term they used, I think we're number four. And that's been my observation. When when when the word addict is used. It's associated with a person who injects drugs. And I think that people who inject drugs doctor. If there were a totem of stigma they would be the lowest on the totem. And I think I see that reflected in movement in our country toward what's called overdose prevention sites. This is today, this morning, New York Times has an article, there have been two overdose prevention sites open now in in New York, one in East Harlem, one in Washington Heights. There are two I think pilot programs slated to begin in Rhode Island in March of 2022 so there's a big, there's now there's a real beginning in America. I have no other opinion on that. You know, do you do you think that stigma is playing a role in in America's hesitancy to implement something that's proven worldwide to be effective with this particular population, the population that's dying. And it's stigma and what what what I think the stigma does is that it prevents a proper analysis of the data and what these things can do for people who suffer from these disorders and conditions. So it prevents people the stigma discrimination, it means people look the other way, they don't even take a look at the data and why these things are effective and why they're helpful for people. So I think that's the effective stigma is that it leads, you know, policymakers away from looking at how these can help because at first glance, just the same with needle exchanges. People thought well that's just going to increase drug use it's going to attract people to drug use if you provide needle exchanges or reduce harm. If you decrease young people's involvement with drugs if you decrease harm or have a safe place where people can go and inject drugs and prevent overdose. In fact, the opposite is true. It's, it's contrary to what one might think off the bat without taking stock of the nature of these problems and how these things can help. That's where stigma I think blocks people. And these things are absolutely crucial. This whole, you know, cadre of harm reduction services are critical from overdose prevention sites as you said at which are emerging and growing. And that can prevent overdose and spread of infectious disease and expose people to other people where they can get information about treatment and treatment services, if they want to take advantage of those. It ages people more when you have a compassionate stance towards people who suffer from these conditions. Again, not can needle exchanges, all these things have been shown to reduce overdose deaths. Imagine if it was your dad, or your mom, your sister, or your wife or your husband or your kid who was suffering from this, and they died. If you could, you would do anything to bring them back. And if that meant a safe place that they could go and under supervision inject drugs but stay alive, live, live, live to another day where they can actually have a chance and recovery a chance at remission. Anybody would take that. Yes, yes, so well put so eloquently and compassionately put and that really is the case it is, you know, my mother and my father and my sister and my brother and my son my uncle my boss, you know it's hitting everybody now and that's I think why you know we're beginning to tip in the because there is no one you could you could say let me see a show of hands how many people have been affected by the opioid overdose crisis and there'll be many many hands that will go up I was at a school in Burlington where a group of parents who had lost children to overdose fatality had they had pictures lining the entire park, lining the entire park and as you as you walked around the park seeing these kids, mostly young people who are under the age some older but mostly between 20 and 35 years old that you as you saw their pictures, your heart, you couldn't help but but feel empathy for them and for their parents and I think that's one of the things that's, you know, growing considerably in our country is empathy for this particular population. I think that's right. And, you know, sadly, that's, that's the case that so many families and have been touched by the crisis, and not just the opioid crisis, but the alcohol crisis, which of course is all has been with us and remains with us. And which is also, as you pointed out, heavily stigmatized and under reported. Now, we have reports of 100,000 deaths per year from alcohol but it's more like, actually 600,000 estimates place it more like at 600,000 because it's radically under reported people family members don't want alcoholism on the death certificate. Yeah, yeah, and often and I've seen this done myself. Where the clear cause of death has been alcohol addiction, but nobody wants to put that on the anywhere on the record. And so it's not documented and again, it's because of stigma and fear of discrimination. One of the things that's really changed in Vermont, we've had a number of families three or four families that have publicized their children's death being a result of drug overdose. And it's really caused so much of a, and in live in support to become, you know, present in the community we have entire communities rallying around these families, but let's take alcohol. So let's switch gears here and thank you so much for your views on overdose prevention sites it's controversial. And I was, I was looking forward to hearing, you know, you know what, where your present thinking was so thank you doctor. I want to move now. So look at the Cochrane studying. I'm going to read you your quote from an interview in Alcoholics Anonymous box 459, the AA, a periodical this is from the fall edition. You say quote. What it shows is that when you subject AA to the same scientific standards as any other type of intervention is at least as good as or often better and certainly cheaper than anything else. When you're talking about a disease that kills 3.3 million people around the world. This is something you have to pay attention to. So let's talk about that a little bit. Let's talk about this study. What did you find. I think it's fascinating. Yeah, well this was this was what what's called, you know, is a systematic review of all of the science, the rigorous science conducted on Alcoholics Anonymous and 12 step so called 12 step treatment or 12 step facilitation treatments, which are clinically clinical treatment treatments, which link patients who have a severe alcohol use disorder with AA so they're kind of a strategy a clinical linkage strategy, or some kind of psychotherapy that is 12 step based that links patients to these free ubiquitous indigenous community resources. So we found when we looked at all the most rigorous studies that have been done in the last 35 years. There were 27 of them that were included 27, these were mostly randomized studies. So true experiments where patients were randomized either to receive a linkage to Alcoholics Anonymous, or receive some kind of other treatment like cognitive behavioral therapy, for example, most of that was the case. And then they were followed up for varying lengths of time up to three years after the intervention. And as you alluded to what we found, which was quite surprising was that a simple linkage to AA produced as good. For instance is or better, when it came to long term remission. Better rates of recovery for those patients who were randomly assigned to the 12 step condition and the linkage to AA at a reduced healthcare costs of about $10,000 per patient a year. So that's good news. When we think about a very high volume high burden disease like alcohol addiction alcohol use disorder. That we can link to this free ubiquitous community support service, in this case Alcoholics Anonymous, and produce as good or better outcomes at a lower cost. That's what we're looking for all across healthcare. And that's what we found in that study. So that's just that's just beautiful. And I would like to help to publicize that. And that's why I'm bringing it up on the show and I'm so happy that I have you here to elaborate a little on it. You know, I'd like you to let's dig into that a little bit because, you know, and in my view, as an observer. In any place in the world that is close to stigma free. It's Alcoholics Anonymous. In fact, in Alcoholics Anonymous, part of the preamble and the AA tradition is the only requirement for membership is a desire to stop drinking. So not only does the person is the person not stigmatized against for having an alcohol use disorder, but it's required to be a member. So there's a value, which is kind of the opposite of a stigma placed on people with alcohol use disorder. You know, of a fellowship being paramount. You know, unity being paramount. People are there for each other. It just seems to me. Although they do use, you know, they will say alcoholic. They don't say I'm a person with an alcohol use disorder. But it seems to me, you know, on the deepest level where stigma resides, that Alcoholics Anonymous is very close to being stigma free. What are your thoughts on that? Well, it's interesting. I've never heard quite put like that and it's an interesting take on it. I agree with you in the sense that yes, what it does it provides a destigmatization because when people are suffering from these very various conditions, when they find themselves in a situation with other people in the same boat, literally the same, they've suffered the same kinds of problems. Then that is immense relief and liberation that sense of commonality and common suffering. What they've got Yalem calls, Yalem is a group therapy theorist, he calls universality, the idea that you've got this universal, you know, problem that you've had, and also the installation of hope that you can see other people. You've got visible role models right in front of you where you can see that recovery is possible and they can show you how to do it. And there's multiple pathways within a course to recovery that people have walked. And so there's a variety of different recovery experiences that people can pick up on and follow. And that is immensely liberating. The flip side though I would say that it's anonymous. So there's a reason why it's alcoholics anonymous of course is because now there is a kind of a spirituality kind of humility aspect of that but also it's also because of the stigma. There's a reason why that was anonymous back in the day we started and still right with us, you know, because we're having this conversation now we've made a lot of progress as you said. We've made a lot of progress we have made progress and it's good to take note of that, look to see where we've made progress, and then what we need to do to continue to keep our foot on the gas here but there's a reason also why still today. There's that need for anonymity and confidentiality, because there is whether we like it or not. There can be negative ramifications for having one of these disorders now we are of course having this conversation with the aim of trying to change that. But that that is a fact. Absolutely I couldn't agree with you more. You know I've been in this field for a long time, and everyone who knows me knows I'm in recovery. But up until up until this year. I've allowed people to think whatever they want to think about what I'm in recovery from. But I see purpose now when revealing that I am in recovery from injection drug use, and I was unaware of it up until very recently. But what has made me reluctant to be explicit about that has been stigma. I find purpose real purpose in revealing it so I will reveal it. And because I think it can help push forward a little bit for people to see who I am, and what I'm in recovery from. But it can be very frightening. You know you can you feel you have a secret and you're going to be punished about it. There's no reason to reveal it. I mean I want to. I just in closing I know we have to close now. There's been talk about, you know, educating people about stigma educating people about language educating people about the dynamics of brand disease. And I think it's absolutely crucial. But there's been talk of the real test being exposing people to people. You know who use drugs exposing people to people who are in recovery from using drugs and having those personal relationships this is really the way forward really the way to change the nature of what's happening in America. How do we have faces and voices of recovery. We have like a lot of publicity what you're feeling about about that that next step where we're not only do we kind of intellectually understand but we kind of feel inside a relative comfort with someone who is in recovery or someone who has a substance use disorder. And I think we've focused on it beautifully, in my mind, you know, the, the, the stereotypes, and this is right. This is true right across prejudice and stereotype research, which affects many aspects of society of course, but exposure to people who have the condition disabuses people dismantles those stereotypes that people have. And this is a known thing in prejudice research is is exceptionalism where people will say well and yeah it's in recovery but he's an exception. It's a smart articulate gentleman. He was once addicted an IV drug user, but look at him now, but he's an exception. This is where the bias the cognitive stereotype and the bias, people get around it by saying, they're still, they're still hold the prejudice because that's an exception. Now, here's the difference though, when enough people begin to talk about it come out and start to talk about it. Then you can it further dismantles the stereotype where people can't just say well that's an exception. Well, can all these people be exceptions. And so, more and more people now, and I'm pleased to see at the federal level, the support for employing people in the federal government, who are in recovery. Yeah, what a great thing that is. You can see it with Marty Walsh who's now become the Secretary for Labor. And openly in recovery for many decades. And many people the Biden administration is actually making a point of employing people because they're in recovery almost because they want to, they want to send the message that we value people in recovery. And that people in recovery are valuable people as well. And so that's been, I think, a very important and nice step this administration. And it's things like that isn't it that they can make a difference and help the nation to change their mind. Oh, it really is that that's so thank you for sharing that that's so encouraging, encouraging to me. What a what a great time to be alive to be in this field. You know, there's so much energy. We I think we all feel more energized than ever before. People asked me at, you know, when are you going to retire. It's impossible to retire how could you possibly retire now time to retire. Let me let me just express my my my heartfelt thanks again Dr Kelly. Thank you so much. Oh yeah. Well, Ed, no, thank you. I'm just delighted to be here. Hopefully this was helpful. And, you know, if anybody has any questions or wants further information about or any any of the articles that I've talked about, they can always email email me at at MGH. If you just look up my name, John Kelly Harvard you'll find my page and you can, you can find my email there. We'll we'll we'll we'll make a page and we'll okay at the end of the show for sure. Thank you so much for being available. Thank you. Sure Ed. Okay, take care.