Apr 13, 2015

Interview Transcript

Interviewer: Addiction, it is a failure of morals and will power? A disease? It's an important distinction to make if you really want to help your loved one with an addiction. We'll examine that next on The Scope.

Announcer: Medical news and research from University of Utah, physicians and specialist you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: To really help your loved one with an addiction, it's important to understand that it is a disease. Dr. Katie Carlson is a psychiatrist who specializes in the treatment of addiction. Why is framing addiction as a disease and not a weakness important?

Dr. Carlson: I think it's important because it helps that person find the help that they need. If they're seeking help in correcting a moral feeling, they are missing some of the needed treatment for the disease.

Interviewer: For a long time, has addiction been considered a failure of morals and will power enlarged by society?

Dr. Carlson: I think for a long time that was the view. If you simply would stop using, everything would be better.

Interviewer: Yeah, sure.

Dr. Carlson: Why can't you, because it's ruining your life.

Interviewer: I think you still see that today when celebrities die of addictions. It's like, why would you throw all of that away? Why would you do that? Like, if the have some sort of control.

Dr. Carlson: Exactly, and we have seen a lot of that, and I think it's very unfortunate but it's helping to bring some awareness to this condition that is a disease of the brain.

Interviewer: Yeah, so explain exactly how it works in the brain then.

Dr. Carlson: The definition of addiction is a brain disease that's chronic. It relapses and remits, meaning there are times when it's active and times when it's in remission, and the person is not using. It manifest in problems with memory and attention. It's characterized by very strong cravings for the substance.

Interviewer: So just like any other disease, sometimes the pain is more or less. Sometimes your symptoms are more or less, this is the same way it's sounds like.

Dr. Carlson: Exactly. Just like any disease, there are times when you need more support because the disease is worse. You're not able to refrain from using, or the use is causing more severe problems either physically or emotionally.

Interviewer: So, in those moments where somebody is doing well, and then they don't do so well. People probably have a hard time understanding that. It's like, "You're doing so well, what happened?"

Dr. Carlson: Exactly.

Interviewer: Then what's going on is something completely beyond their control in their brain.

Dr. Carlson: Yeah. Sometimes that is when people enter treatment because they realize it's simply stopping, didn't address the underlined cause of the disease. So those people who don't get help with the underlined causes tend to be at high risk for going back to using.

Interviewer: So just like if I was having heart failure or a skin rash, you have to treat it. You can't just will it away or hope it'll go away.

Dr. Carlson: Exactly. When we look at this condition as a disease, like I said a disease that affects memory and learning, it also affects how we view rewards. As long as we are looking at it in that way, we know that there are medications that are available that can help with those aspects of the disease that need to be combined with the therapy and building skills to stay sober and stay away from relapsing.

Interviewer: So just like managing the heart condition. You might take some medication and then you might be told you need to exercise a little bit more.

Dr. Carlson: Exactly. We often use the analogy of diabetes. It's a chronic disease that you need to attend to even when your blood sugars are perfectly fine. You need to watch what you're eating. You need to watch how you're spending your time. You need to exercise, and that is really a matter of adopting healthy lifestyle as oppose to unhealthy lifestyle.

Interviewer: So in that respect, addiction can be a choice. You get the medication... maybe I'm not saying this right. You get the medication to help medicate it but then you have to make these lifestyle choices consistently.

Dr. Carlson: Yes, exactly.

Interviewer: Just knowing that if you don't, like if you don't take your medication then you're going to find yourself back in the same place.

Dr. Carlson: Yeah, and by calling this a disease which is what it is, we're not saying that choice is not part of it, and the individual's behavior is not part of it. It's a central part of this disease. The longer that person can abstain from the substance, the better the brain responds to managing this disease. So getting sober and staying abstinent is an important first step.

Interviewer: All right. So I'm imagining, if somebody is listening to this podcast right now and they do have somebody that has an addiction and they made it this far, they are open to the thought that it's not a moral weakness or will power weakness but maybe they're still on the fence. How can you help a person change their point of view completely from that weakness, to the "yes, it is a disease."

Dr. Carlson: Well, sometimes, it's challenging and it takes some time and it take some education of that loved one because they have seen what they've seen and they have a perspective that is based in reality. So to change that sometimes it takes time. We spend a lot of time educating family members about this disease.

Interviewer: Yeah.

Dr. Carlson: Eventually they see success in treatment that is based on a brain disease. So they start to understand that, "Well, the last time my loved one got sober, they simply stayed away from their friends and stopped drinking and went to bed early." This time around, they're using some medications. They're going to therapy. They're finding friends and outlets for connecting with others that are different, and they start to see this is a more holistic problem.

Interviewer: Yeah. So it appears that looking at addiction as a disease can drastically change the chances of a successful recovery. Is there some research that supports that?

Dr. Carlson: If we put components in the treatment that address the chronic brain disease as well as the behaviors, and as well as the choices that that individual has, do we see success compared with simply altering the choices that they make.

Interviewer: Yeah.

Dr. Carlson: Absolutely, the term in the addiction world is medication assisted treatment. It's the new standard of care. It is based on the fact that addiction is a brain disease. It includes medications to manage cravings and some of the other problems that go along with addiction. It also includes the behavioral, cognitive and emotional therapy.

Interviewer: Dr. Carlson, do you have any recommendations or resources that you found helps people that don't have the addiction better understand those that do have it?

Dr. Carlson: Family physicians, trusted friend or a counselor can be great resources for learning about this. There are websites and I don't know if you want me to recommend, there are two that I have in mind that I often refer patients to, DrugAbuse.gov. It is sponsored by the National Institute on Drug Abuse. The other is the National Center on Alcoholism and Drug Dependent, NCADD.org

Interviewer: I guess, at the end of the day if you have somebody that you really care about that has an addiction and you're still on the fence and you know, what is it. Is it a failure of morals and willpower? Is it a disease? Maybe just take that leap of faith and go, it's a disease and see where that path takes you.

Dr. Carlson: Yes, I would say that's a good approach. The more we have learned about this disease, and the more we have the technology and tools to understand how our brain functions, the better the treatments get.

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