Drug use vs. abuse with Dr. LaVonda Mickens

Hello, I'm Julianne Good and this is Psych One-on-One. Welcome. We're here to make psychology understandable, entertaining, and hopefully informative for you. So tonight we're going to be talking about drug use versus abuse. There's a lot of questions floating out there right now because of what's happening legislation-wise and society-wise with what is use versus abuse. And we have a lot of questions. So tonight we are going to be having Dr. LaVonda Mickens on as our guest. Hello. Hello. And I also want to remind you that if you would like to call in, we would love to have you at any moment. Ask questions and have your opinion. Our number is 800-893-9562. And again, it's 800-893-9562. And if you like this webcast, you can also download us at iTunes. Just type in Psych One-on-One. That's P-S-Y-C-H, the number one, the word on, O-N. Number one again. So just in case you don't have enough time to listen to us, you can download us at any time and join us. Well, Dr. Mickens, her background is she has a PhD in clinical psychology from the University of Detroit Mercy. And she is a trained clinician who has worked with individuals with psychiatric and substance use disorders in inpatient and outpatient settings. She practices with psychodynamic family systems. She has worked with youth, adults, and families to assess substance use, eating behaviors, and emotional well-being. Dr. Mickens has also spent several years providing treatment to urban-bound, low-income youth and families living with chronic diseases. She's also worked as an inpatient emergency room psychotherapist for victims of violent crime in Detroit receiving hospital in Detroit. And also she has done research on addiction and health behaviors. So Dr. Mickens, I would like to start with the first question I have for you, as I'm sure this is a lot on a lot of our minds right now is why does someone start using drugs in the first place? That's a great question, Julianne. Thanks for having me also. There are so many reasons that an individual starts using drugs in the first place. I think one of the primary reasons is because of their curiosity. You may know like teens in high school, even junior high, actually the average age of the patients that I've worked with that start using drugs, surprisingly it's not 15 or 18, it's 11. So you know, our brains are not fully developed. So we think we can just be invincible and use any amount of drugs. That's one reason. Another reason is if they grow up in a household, if the person grows up in a household, they're going to be really full of pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and pity and trauma, family difficulties, such as physical abuse, emotional abuse, sexual abuse. Those are really, really common risk factors for abuse. So there are so many reasons. That's the short of the long answer. Okay. And also, what about the neighborhoods that people grow up in and that kind of an impact, that influence on a young person? Yeah. So if it's normative for you, if you grow up walking outside and you see somebody putting money underneath the trash can, and then you see five minutes later, a person coming and picking up something underneath the trash can, and you see that cycle happening a hundred times within a day, that sets a tone for you that that's okay within your community and environment. And that's some of the things, those are the things that we're trying to do. And I think that's a really important thing. Those are some of the challenges of urban environments in particular. Right. It looks normal. Right. To a lot of people. Right. So now, what is your opinion on, is marijuana a gateway drug? That's huge out there. That's a good question. How long do we have to talk about that one? Okay. So I think yes and no, to be honest. So is it a gateway drug if you start using marijuana and you've decided, oh, or discovered this is a great escape and this is a way to have fun like no other. And then you just start seeing other drugs that become more and more and more and more fun. However, on the flip side of that, if you see some, if someone starts abusing marijuana and they don't like the effects of it and they don't have many reasons to escape their environment or they have parents who, like a child who has parents who are interested in doing, interested in doing tobacco and tobacco and tobacco and tobacco and doing, interested in learning about what they're doing, then it might not necessarily be a gateway drug. Or the kid, there are lots of people, surprisingly, I've met lots of people in clinical practice who say, I tried marijuana, weed, pot, whatever they call it once, and I just didn't like it. So for a lot of people, it is, but for a lot of people, it isn't. What I'm saying is, I think most people have one another factor other than they just feel curious about drugs. There's usually something else that could be driving the long-term abuse or dependence. What about the the ability to just be an addictive personality? I mean, that's also in that mix is people like, well, you know, I've got an addiction to this and I like to really overdo that. And so what would you say on that? Yeah, this is interesting. So I, I've known people who decided I'm no longer addicted to heroin, but now I'm addicted to shopping. And then when they're stopped, they're not addicted to shopping, then they're addicted to gambling. So like there, there is a such thing as someone just needing something in their life to become addicted to, to, to have a particular purpose. And would you say that most of us are addicted to something? Okay. So we didn't list, you know, on the criteria, we've got, you know, nicotine, caffeine. You may identify, you know, nicotine, caffeine, caffeine, caffeine, caffeine, caffeine, I can certainly identify with, hey, at certain periods of life, it's like, you know, the job is just not going to get done without caffeine. So there, there are many, some would say shopping, you know, other notorious addictions would be sex addiction. Sometimes even love addiction, people talk about. So as human being on the realm of, you know, possibilities of things to be interested in and tapped into. And when we all probably have addiction to something, I joke all the time that I haven't met a chocolate that I don't like. I haven't met a chocolate that I don't like. I just haven't. I'm sure a lot of people can attest to that one. No, is there something like in our brain that says, I really like that. And all of a sudden, you know, chemicals start firing off whenever that, you know, the drug of choice is in your, in your reach? Yeah. Yeah. So to make, to make it pretty straightforward, and simple, there is a reward pathway in all of our brains. So there's a neurotransmitter called dopamine, right? So when people are abusing cocaine, they've got tons of dopamine, just kind of like hanging out like, and they're like having a party in their brain. What's interesting about addiction and substance abuse is that that happens when people are playing video games, or when they're shopping and they're in a rush or whatever it is that taps into their drive of feeling good. We all have the reward pathway, and it doesn't have to be a substance for that to be activated. So I actually think that's pretty fascinating. It is. And it depends on what you get hooked to. Yeah. Honestly, it could be, you know, anything from, you know, chocolate to heroin. It's, what would you say are some of the components for a person to pick up a drug, use it once, and say never again, versus the person that uses it once, and then says, wow, this is really great. And then they use again, and again, and again, and then it starts slipping from use into abuse. Yeah. Some of the things I hear from clients, and even other professionals is a bad experience. I mean, you only need a bad trip once for a lot of people with hallucinogens, such as, you know, LSD, or even PCP. I had one bad trip, and that was it. So for a lot of people, that's it. But for others, that may not be it. Maybe they just decide, let me try again and see if it works out this time. So I would imagine with your experience in working in an emergency room, and dealing with a lot of people coming in with either, you know, they had the bad trip, or they try to overdose, or whatever. And they're coming in, and you're trying to work with them. You know, did you come up with any kind of thoughts or theories as to why a person would keep on doing that to themselves? That's a great question. So, you know, sometimes we talk about the person not hitting rock bottom, so to speak. So, you know, they need to have a certain level of, okay, this is the worst it's ever been. And I think that's a great question. And I think that's a great question, because, you know, there's so many things that have been forgotten for me, and I'm not going to abuse, because, like, I don't want to lose my friends, my family, I have no job, I have no money, my teeth are falling out, you know, I have no nasal cavity for those who inhale drugs. So this is, that's a big question. To tell you the truth, I actually think it's intrinsic, or what we call internal motivation, as much as I'd like to be able to walk in any clinic, or ER, or any environment. And as a clinician, be able to help the person. It does not matter until that person decides, I don't want to use this drug anymore. It's ruining my life or it's not fun anymore or I want to do something else. It doesn't matter until the person says, I'm done with this. And they make the change and they're saying, I want to quit. I want to get off of this. I want to change my life and that's it. Right. And we can't make that decision for anyone. We can only make it for ourselves. Which really frustrates friends and family around the addict. Yes. And you had said something before about kind of getting them motivated. And I know one of the techniques that you use for working with addicts is motivational interviewing. Can you explain that? Yes. Motivational. Thanks for bringing that up. Motivational interviewing is a technique that has a lot of research behind it, actually. You know, there are four principles in motivational interviewing. And just briefly, it's have empathy for the person. Be able to put your judgments aside about the substance abuse and just have some empathy for them for being a human being. So that's the first one. The other is rolling with resistance. Okay. So they may not want to quit. And okay. So you just go with where they are there, right then and there. Another is called supporting self-advocacy. So basically supporting them, their belief that they can actually make a change if they wanted to. And then the last is developing discrepancy. So helping the person see that the drug use or abuse might be affecting other areas of their life. So those are kind of the four core components of motivational interviewing. But I have to say that the spirit of it is remembering that it's always that person's choice. And all we really have to do is be there to guide them in whatever direction and really let it be okay if they want to continue to use. And I'm sure for a lot of family and friends, that's really difficult because they're like going, you got to go get help. You're going to kill yourself. You're going to kill somebody else. This has got to stop. You know, and they have a whole, you know, they've been in and out of hospitals, in and out of jail. They've been in and out of rehab or whatever. And they still aren't, the light bulbs is still not going off in their head that, you know, quit or die or back down on the use so that you can actually function in society. So working with the family, how would you deal with them? Yeah, that's, I have to say like, you know, that's, hmm. That's a lot of the equation for the families who still want to be involved. Sometimes people who are addicted to said substance or using it, the family is just tired and they're totally gone. But for families as a clinician, one of the things I tell them is, okay, so you judge them for 12 years while they were using and abusing. And where did that get all of us from just judging the behavior? The thing is, most people who are addicted to a drug or alcohol, they probably judge themselves worse than the family members do anyway. So in the family's thinking, okay, well, if I just tell them how horrible it is or that they could die or end up in the ER or something's going to happen or they can lose their kids. The thing is that person already knows all of those things. I think the family thinks that they can still bank on a shock value. But usually, what I think is that also the family doesn't understand that addiction's a disease, that it's a brain disease that activates our reward pathway. And it's not just a bad habit. I don't feel like putting my shoes on at the right spot. It's not like putting your shoes in the corner. It's actually much more complicated than that. It's very complicated. Yeah, yeah. Especially since, like you stated before, family could be a part of the reason why they're addicted to drugs. They're using consistently because they want to numb out some pain that was instilled a long, long time ago and they haven't quite gotten to the point of saying to their family, you're the problem. Or they do say you're the problem, but they don't quite know where that problem started from. Yes. So that could be tricky. Yeah. You know, there's another thing that I wanted to mention. You just jogged my memory about it. The family members often don't take ownership of the family members. So there's a lot of people in the family needing that person to be sick. So in family therapy, we call that, you know, an identified patient. So there's one patient in the family that comes to therapy, oh, well, let's say they're abusing heroin. They've been using heroin for five years. And the job of the therapist is to assess that individual, but also the family system. Like, is there a need for that person to be ill, for that person to be abusing heroin? And sometimes there is. And that, I think, is hard, for families to see, because it's painful. No one wants to believe that they're contributing to their child or their brother or their sister abusing a dangerous substance. But in fact, for many families, it's the reality. Sometimes it's distracting from other family pain. Or okay, like nobody wants to talk about divorce. So now I have a substance abuse problem. Or we don't wanna talk about physical, sexual, emotional trauma that's been long lasting. So let's focus on that person over there with the drug use problem. And scapegoat him or her. And scapegoating, right. Right. Yeah, they'll always say, okay, well, he or she's the crazy one. He or she can't stop using. Exactly, so instead of, you know, the family member taking ownership of what they're going through, let's go blame the addict for it. So I think that's really common, isn't it? Yeah, it's actually unfortunately very common. It's, well, think about, I mean, it's human nature is, it sounds strange, but who doesn't like to focus on somebody else rather than focusing on themselves? Because it's pretty painful to focus on our own issues. And I think that that's where families run into, okay, let's find one source to put all of our energy into. That can be problematic. I see that a lot with the people to counsel with. Yeah, the variety, definitely. So can you tell us what are some commonly abused, abused drugs? Oh, that's a good question. Okay, so we'll start with the, you know, the drugs that people know about. So alcohol, you know, the, one of the most common, if not most commonly abused legal drug, marijuana, depending on what state you're in is also legal. Heroin, cocaine, ecstasy, also called MDMA, ketamine, which may be on the street as special K, it's actually a horse tranquilizer. Interesting. PCP, LSD, steroids, inhalants, and then some commonly abused substances or commonly abused, let's call them, I don't know if I would call them substances or drugs of choice, but they are definitely things that people can become addicted to. Shopping, gambling, sex. And then I didn't mention nicotine, which is absolutely a dangerous substance and contributes to many, you know, health risk factors. That nicotine I think is the most commonly abused substance, even though it's legal, has all sorts of health risks associated. One in five Americans abuse nicotine. And I think it's interesting too, that the two drugs that are the most common in nicotine and alcohol are legal and they are the most dangerous to the body in a lot of circumstances. Yes. So I, you have to kind of wonder about that. You know, I, that just blows me away, but. Yeah, the two, yeah, those are the most legal, even the illicit drugs. Yeah. Yeah, so in your clinical expertise, what are the patients that you have seen the most? What types of drugs were they abusing? That is a fantastic question, Julianne. Okay. So it really, so now it's, you know, the truth is I think it's, often it's geographical. Often depending, so I've worked in Detroit, Michigan, New Orleans, Louisiana, and Southern California. So I've seen lots of people who have abused drugs in those three environments. So it depends, but the, you asked about the most common. Mm-hmm. So I'm gonna use teens as an example. I think it's usually marijuana for teens. Mm-hmm. Yeah. Yeah. Yeah. Yeah. And I think it's second to marijuana most recently for me, my clinical experience has been opiates. Heroin, Oxycontin, Vicodin, Morphine, Demerol, Percocet. And so the thing about opiates is that, you know, it's not just heroin that you have to go score and find on the street. It's somebody's medicine cabinet. You know, you could be walking in your grandma's medicine cabinet and, oh, there is a Vicodin left over, okay? And then you walk in and take that, and you're like, oh, I'm gonna take that. Or you could even be prescribed the medication for some oral surgery or purpose that way. But you know, you have to be very careful with those things. But I would say, you know, Oxycontin is very, very common, has been very common in my experience amongst late teens, early twenties. I've seen a lot of people in treatment abuse opiates. And those are very addictive. Very, very. But I think a lot of people don't realize when they start taking pain pills, if they don't watch it, that all of a sudden it's like, especially if they're in a bunch of pain, and it's just like, I can't deal with pain, period. So I'm gonna just pop this pill. I'll feel better in an hour. And I can just go on with my life. But then, you know, then it starts becoming habitual after about two, three weeks, if you're using it on a daily basis. And some people don't even think twice about using medication on a daily basis, because especially, you know, working in an emergency room, I'm sure you saw it all the time. Those prescription pads come out and here you go. There you go. Yeah, go. You had this injury, here you go. And if they need a prescription, they call. And, you know, depending on the practitioner, they may or may not get another prescription. Opiates is dangerous. So like within the first year after, let's say the person decides to become sober and they're no longer using opiates, the first year relapse rate for opiates alone is 80%. Wow. 80%. So like, that means 20% of people who decide to stop using opiates right now in 2013, will be able to successfully say that they are no longer using opiates in 2014, if they stop today. It's pretty scary. The other one we didn't mention was benzodiazepines and you touched on it. The dangers of, oh, I wake up, I pop a pill. It's that simple. It isn't that simple when you decide to not use them anymore. Let's say you all of a sudden, you know, you have an awakening and don't wanna use them anymore. Okay, I'm not gonna use benzodiazepines. I'll give you an, so Valium is a common one or Xanax or it's a benzodiazepine that people would know about. You decide I'm not using anymore. And the risks are, there are many, many risks if you just decide to abruptly stop, including seizure and death. And I think people like, including death, if you decide to stop taking a pill that you've been taking for three weeks, and it's helped you, you know, you're not gonna use it, it's helped you. No one would equate that with, okay, if I stopped taking it, people tend to think it's like a headache medication. Okay, well then I might have a headache again. No, you actually could die or have a very, very severe seizure. And I wonder how many doctors really tell patients about that. Or, I mean, you look at the, you know, the writings and the medications that you get, and it is a ton of typing. How many people actually read through what are the side effects? What are the warnings? Yeah, well, you know, it's a great question. I do now, you know, I can't say that I read, you know, 10 or 20 years ago, I can't say that I read through all of those as thoroughly as I do today, because I know so much more about medication. So, you know, the doctors, you know, no doctor bashing here. I know a lot of doctors who really care a lot and do screen, but then I've also known of a lot of doctors who didn't, because the patients who came to us in treatment were like, oh yeah, my doctor just kept giving me more and more and more. Now that's their word. So I don't know those person, those people for sure. But you know, if thousands of people are saying the same thing, then you gotta wonder someone out there is being negligent with patient care. It's pretty scary. Yeah, and I think also as a society, we are intolerant to pain. We just wanna pop a pill, get rid of it. Pain is so, yeah, yeah. Oh, that's a long conversation. So yeah, so what makes us intolerant to pain? You know, wondering about that, you know. We're quick fix it, you know. There are lots of many messages around, you know, a microwave. Okay, we want it quick. So we heat up our food very quickly. Many people that come to me in therapy, not most, but many people, they really believe that a 30 day program is all it will take for them to be like, quote unquote, cured of addiction. So we want a quick fix. I don't want the pain. I just wanna come and get through the withdrawal. And then the pain of having to deal with why I started abusing drugs in the first place, that takes a lot of courage. It just takes a lot of work for most of us, or people in general. And a lot of patience and perseverance. Yeah. Definitely. Now you've worked in rehab centers before, correct? Yes, I have. Yeah, can you tell us a little bit about that? So I've worked in two rehab centers. One was a residential rehab, which meant that the person was there 24 hours, and most people detox there, which for the average person, the detoxing includes seven to 10 days of care, making sure that they don't have a problem, you know, that they don't have a seizure or die if they have been abusing alcohol or benzodiazepines per se. It includes like individual therapy, group therapy, art therapy, sometimes equine therapy, which is therapy with horses. So the person gets to be, you know, creative and live a life. We do have some scheduled outings. We do have, and that's important because people come into rehab, and we don't want them to think that they're not gonna have to face reality again. So even in small spurts, like, okay, two hours on a Saturday, you're gonna go outside, and you're gonna feel what it's like to go into a CVS or some grocery store and not go down the vodka aisle, which is something that you'd have to do in daily life. So I have to say the residential rehab is a very, very interesting place. It's great learning experience. It's great for any clinician, I think. You do see the level of manipulation and the bottoms that people will go to when they really wanna use. We've had people sneak in drugs of all, I mean, like, I knew a woman who drank Listerine because of the alcohol content in the Listerine bottle. Yeah, I've known one too. So we've known them. I hope it's not the same person. I hope not either. Minty, breath, and drunk. Yes, minty and drunk. So there are all kinds of things. The other environment was what we'd call a more intensive outpatient program where the person came for like several hours a day, like seven hours a day, like 11 to six, and they didn't necessarily live at the treatment center, but they came and participated in group therapy. We had three groups a day, individual therapy, art therapy, medication management, with the psychiatrist. So those things are important. I often, and I have to say that many, many people have another diagnosis on top of substance abuse. So it's not just that they only like cocaine and that's their only problem. Usually there's some other thing happening, like they may actually be dealing with a major depressive disorder and they may have been clinically depressed for many years and decided, all right, I need to self-medicate. And thinking about it in human nature, I can't blame a person for that, for wanting to feel better. They just decided in a way that could get them into more trouble. So. Right. And then in a case like that too, it's like the chicken and the egg thing. It's like, which started first? Where did you start? Did the substance use start first and it was fun, and then all of a sudden they slipped into depression? Or did the depression, the trauma happened first, and then they ended up using to self-medicate? Right, right. So I would imagine that would be a little tricky to have to, you know, weed through and try to figure out where it started from. And would that really make any difference in the long run just to see where the weed started? Right, right. It gets really complicated and it's exactly what you're saying, the chicken or the egg. So you're seeing a person, this is why detox is so important because one of the things you can't do when a person comes into your treatment facility and they're high or drunk is create a treatment plan and find out exactly what their diagnoses are. Because you actually don't know what you're looking at. They could be high as a kite. You kind of have to wait and figure out, okay, what is this person's actual baseline when they're not intoxicated? Yeah. Yeah, because I mean, you know, anybody that's under the use of anything, it's not gonna be thinking in their left mind, not the right one. The right one's going all over the place someplace. But you know, I wanted to ask you too, what for any of our listeners out there who might be questioning this, you know, where's the fine line between use versus abuse? That's a, that, so, okay. It always depends on the person, right? I'll tell you what our, you know, our book of diagnosis says. Like, so we have a book, psychologists, psychiatrists, mental health, practitioners, we have a book. It's called the DSM-4-TR. And the DSM says substance abuse includes, you know, some behavior within 12 months, including like leaving responsibilities for using or drinking, having trouble with relationships, using or drinking, going to jail or being arrested around drug use, drug possession, even distributing or selling drugs. So that's what abuse, it's interesting because I don't know that drug dealers would always abuse, but if you have that in your possession, it would kind of, it would go with a substance abuse category in terms of the DSM. So basically within 12 months, you've got to have one criteria for to meet substance abuse. For substance dependence, that includes the person's in, not intolerance, tolerance and withdrawal. So the person wakes up in the morning, at five o'clock and they cannot function without drinking a shot of vodka right away before starting their day. Or they are in hives or in almost a seizure, shaking or nauseous because they haven't drank yet, or even smoking. And you'll hear this from people who have nicotine dependence, that they have to smoke a cigarette within the first five minutes, otherwise they feel really ill. So use versus abuse, if you have a substance abuse. According to. So the average serving of wine is five ounces. So that's actually one serving of wine per person. So then we ask the question, what's too much wine? If we're told, okay, a glass of wine a day is okay for most people. Okay. So if you have two glasses of wine. Is that okay? Two glasses of wine a night. Okay. If you have three glasses of wine a night, is that okay? There really isn't like a number specifically that says, okay, if you're having this much, that is definitely abuse. It actually does depend on the person's physiological symptoms and their social consequences. So that's why when you hear terms like functional alcoholic, it gets confusing because maybe the person actually is functional during the day, but it doesn't mean that they're not abusing. It doesn't mean that they are not tolerant, that they have to have more in order to actually sustain a high or that they are withdrawing first thing in the morning if they don't drink. It's a dicey question. I think it really, I mean, I think we have to really, really understand the person. And ask specific questions about, okay, well, if you're drinking a bottle of vodka a week, how much were you drinking a year ago? And then what are the circumstances around the person actually drinking so much? Did something just happen in their life? Is it a particularly traumatic time? Did they grow up in a household where everybody drank vodka? I mean, it's, you know, we live in the United States, but many countries view wine with dinner as totally appropriate. It's totally appropriate for adolescents, adults. You know, we have a 21 drinking age, but not everybody feels that way. Yeah, not in Europe, but 12, 13 years old, exactly. I was actually thinking of some European countries, such as Italy, you know, that a 15-year-old has a glass of wine with dinner. And it's like, we're not thinking of that as abuse. But if, you know, our 15-year-old here were out on the corner drinking a glass of Chardonnay, we'd be like, where's their mother? Where's their? Where's their father? What's going on with that kid? Depends. Or be drinking out of a bottle. Yeah, or out of the bottle. Yeah, that's another one. Be more like 44-ouncers, right? Yeah. Exactly. So, at what point would you recommend that a person start questioning themselves as to whether or not they have a problem with their... You know, addiction of choice, let's put it that way, because it could be anything. You know, if you put it under the whole addiction umbrella. Uh-huh. At what point are, you know, like, job loss, I would imagine, would be one of them. Are looking at a consistent pattern of losing people, losing income, you know, losing their, you know, attachments. Those are all... Those are all perfect examples of questions that I would ask a person. Another one would be, have you tried to cut down on using or drinking lately? Has anyone been annoyed with you? Even before, I mean, I think by the time a husband or a wife or some significant other is saying, I'm going to leave you if you don't stop, they get it. They know, all right, I got to do something. But usually it's, you see, this is like the gray area, like where it starts before the big action, all of the mini actions. If someone's annoyed with you and saying, why are you drinking so much? Or if you're missing, like, important events for people you love. You know, you start missing your kids' basketball or soccer games because you couldn't get up at nine o'clock in the morning. That's something to explore. And then if you have guilt about using. So the other one is, do you have to drink or smoke or do X behavior the second you wake up? Like, as soon as you open your eyes, if you're thinking about drinking, that would be, yeah, that would be indicative of... Yeah. Yeah. Yeah. That's a problem. Or before you go to sleep at night. Or before you go, or both. Right. Yeah. Yeah. Exactly. Okay. One of the things I wanted to hit up with you too, because we, there's so much media attention over the last few years to meth use and abuse in the labs and all the dangers around meth use. And can you give us a... You know, your perspective on why people are getting hooked into meth and kind of what the whole meth rage is about because a lot of people sort of understand it, but a lot of people are probably afraid of it or, you know, just don't understand. One reason is because you can cook it. You know, you can create a meth lab in your house. You can learn how to do it and do it. I mean, you could do that with other drugs, but you can cook it. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. I have to say meth is one of the most hurtful substances for me personally as a clinician because I've seen it really, really destruct someone's life within a short span of time. Not that other drugs cannot do the same, but you know, if somebody is using meth for six months and they have no teeth and their nasal cavity is missing where they lost their sense of smell or they're picking their skin off, like literally trying to pull their skin off. I've seen people do this in front of me, not just in the ER, but even in inpatient. It's a really, really tough, it's a tough drug. And I think I used to work in emergency rooms also, and I would see a lot of female addicts. And their reason for starting was I wanted to lose weight and this was a quick way to do it. Yes. And cheap. Right, right. So here's the thing. Here's what I hear from a lot of women in particular. They say, well, I don't want to use cocaine. You know, those are for the hardcore abusers who want to be anorexic. You know, I don't want to be model anorexic, skinny, you know. But they say, well, but I can get dexedrine over the counter. And if it's approved over the counter, then it's fine. Well, it still has an amphetamine quality and it still can be abused. You know, it's still like methamphetamine. So that's still part of that. That's a really good point you brought up. That I've heard from women all the time. Yeah. Or, you know, college kids, I want to stay awake. This is the thing about the Ritalin craze. Okay. So Ritalin is also a derivative. It's an amphetamine that I don't think Ritalin, Adderall, Focalin, Concerta, these are all drugs used for ADHD that are commonly abused among college campuses. And I don't think a lot of kids know that they're actually, it's actually meth. I don't think so. I was, when I was at USC, there, we were conducting a research studies and a research study on the effects of methamphetamine. And anyone who had been on any drugs such as Ritalin was excluded from the study. So that tells you that once it's been, once you've been exposed to it, your system has the possibility of changing. Yeah. And then what happens to your brain too. Yeah. That's that, that, that's one of the things. You have to question with a lot of these drugs is how is it going to change my brain? Because a lot of them, there's no, you get hooked on it. There's no turning back. There's brain damage involved and there's, there's a lot of times there's no healing. Right. That part of whatever the drug took out. So, I mean, that's something to take into consideration once you start having fun. Our brains, our brains is something. It's worth it. It's helpful. I think your, your point was really, really important. It really, it really stood out to me that the brain question is like, so it's so poignant because when I talk to adolescents, they, they are not thinking about their brain. They are there. They don't even realize that their frontal lobe, like that their brain isn't done developing. You know, the frontal lobe develops into the mid twenties. And so they're like, oh, it doesn't, it doesn't matter. So they're not even giving themselves an opportunity to have optimal brain functioning before introducing something potentially damaging. It's pretty scary. I mean, we, you know, without being like all, you know, afraid of every substance, that's not what we're advocating. We know that human beings, we like our coffee. We like chocolate. Um, people have experimented without, um, dying, but know that it's a risk. Know that it's always there. Like you're not, you're not necessarily going to come away with a full escape. That's a good way of putting that. Yeah. Can you talk about some of the newer drugs that are out there and now the designer drugs? Yeah. Yeah. Yeah. Yeah. Oh, all of our favorites. So one of the favorites, one of the things I like to say is if you want to know what new drugs are out, uh, go ask a 13 year old because the 13 year old has access to all of their, you know, middle school friends and maybe some high school age friends. And they have access to information that adults might not necessarily. I mean, I think I knew a lot more about drugs in, uh, middle school and high school. This is the introduction of like the DARE programs. So then we start learning about drugs. Um, so bath salts, you heard about that one? No. Can you explain that? Okay. Okay. So bath salts is, um, it's an amphetamine like stimulant found in a cot plant that's spelled K H A T. So basically it acts on us as an amphetamine. Spice is synthetic marijuana commonly used. So you can find that in a tobacco store or something like that. I don't know. If you can find it in a grocery store and it would be interesting. Um, salvia is an herb in the mint family that's used for its hallucinogenic properties. And, um, another one that you may or may not have heard of is cough syrup. It's like a cough syrup, uh, combination. Sometimes it's called scissor. Hmm. Never heard of that one. Watch it. You know, check out MTV. You'll probably be, you'll probably see some of it there in some way. So basically you put cough syrup in a cup. And add, uh, sometimes Sprite is added to it. Cough syrup with codeine because codeine, um, people don't know it, but it's also an opiate. Um, cough syrup, codeine, opiate, and then Sprite. You've got all this sugar and a heavy level of opiate that you're sipping on all day. Why wouldn't you be high? Right. And they're just like, in the cup. Exactly. Let's just, let's take a little, uh, break here. Yeah. Yeah. Yeah. Yeah. That's interesting. Um, now we only have a few minutes left and I'd like to put out to our listeners again to call up and ask Dr. Dr. Mickens some questions or make your comments. The number is 800-893-9562. Again, that's 800-893-9562. Now, as we're wrapping up, um, what kind of treatment would you, um, you know, if you're going to treat addiction or if you're going to treat addiction or if you're going to treat if you're going to treat addiction or if you're going to treat addiction or if you're going to treat addiction or if you're going to treat addiction or if you're going to treat addiction or if you're going to treat addiction or if you're going to treat addiction or if you're especially you know um of course there's different treatments for every type of addiction but what do you think is one of the most successful ways of treating addiction thank you for asking that question because this for me is one of the most important things to be able to talk about to the public okay um i i'm for health and safety safe living but i do not think that the scared straight model works for the masses that if you just decide to put a poster and say drugs kill that people will respond to that because i think people are pretty smart and they actually already know that i do think that something called a harm reduction model is helpful which means that while you're not advocating the person to use drugs you know that they are going to go through the worst withdrawal so they're basically going to keep using to avoid getting sick happens with opiate abusers all the time so we have things like needle exchange programs to at least if they're going to use minimize the risk of contracting hiv hepatitis c or other diseases and just provide a clean opportunity for them in that way also suboxone and methadone clinics methadone is used as a replacement for opiate so is suboxone so the person they don't get high off of methadone or suboxone but they can basically continue to live their life but still still struggling to get off the drug but at this moment they may not be able to sustain that the the challenge with things like methadone and suboxone is that when you really want to be completely off the drugs you have to detox from those two and i do want to say that and make sure people do know that but i do think it provides an interesting and important alternative for people who you know like if they have seven things going on in their life right now they need a hand you know like if they're homeless and they're looking for a job and they're an opiate abuser um tell them to do all three at once and see what happens do you know what i mean that would not happen right see what happens right exactly that would be asking too much of a person to do right so with the harm reduction would you would there also be a recommendation to cut down versus stopping altogether depending on the person of course yes for a lot of people that's the goal that's the goal to go from however many milligrams you're starting off at methadone and reduce it over time um for some people i've seen people who enter treatment and decide that they're going to go through the bad withdrawal they're going to be in a safe place for 30 60 or 90 days and so they might as well go through and get get through um the opiate withdrawal while they're under the care of psychiatrists psychologists other medical and health professionals so that is an option for other people um i do think it's challenging i do think it's really hard um i'm i'm i'm not remembering the other part of your question but i did want to make sure i addressed it you basically addressed it yeah you did and um i i was also thinking about you know like alcohol pot smoking you know what tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco tobacco it's the, this is my other relationship. Oh, sometimes it's the primary relationship. It's, you know, it's about me in the vodka bottle that I hide in, um, whatever in the refrigerator or whatever. Okay. What would you recommend for, for steps to cutting down or stopping an addiction? Um, I would definitely say, see a licensed, um, medical professional. Um, if you're talking about something like illicit drugs and you know that you're dependent on it, if you're talking about alcohol, if you're only using alcohol, um, I think, you know, it's like, be very careful. A lot of times people are using alcohol in combination with something else, and they still need to see a medical professional. I'm, I'm very, um, I'm very concerned about that, that as human beings, we don't even, we don't always know what is happening inside of our body. And so then we say, well, I'm going to stop drinking and just cut it off. I would say, see a professional. Um, but if you want to do like a moderation management and then cut down, um, see a professional first and find, find out their advice on, what to do for your per, for your particular body composition. Um, because it would, I could recommend something for like a 200 pound person that would be different for a hundred pound person. Um, but I think seeing your doctor is probably the best way to go or starting a treatment program. I mean, if you know, if you have the time and you're, you can do it, it doesn't have to be inpatient, but if you can do inpatient, that is a great way to start. If you could do outpatient, that would be helpful also. And with mild to moderate addiction, um, what about a person just doing it on their own? Maybe going to like some kind of 12 step meeting or some kind of support group or, you know, finding, finding ways to sit there and, and, and, and work for themselves and say, Hey, you know what? I want to be healthier here. So I'm, I'm going to do this for myself. Um, it's the, the self-care self-love. Yeah. That's, that's so 12 step models are helpful. It's things like smart recovery, which, which, um, stands for self-management recovery training. Those are helpful. Those are good. Yeah. And those are definitely doable. And the information is out there on the internet too. So just Google smart recovery, 12 step meeting. You can find anywhere, anywhere you, I have an aunt, um, who told me this story. She, you know, you could travel across the country anywhere and find a 12 step meeting in the middle of the night in any place. Um, you could do it anywhere. Right. Which is wonderful. And it's free. So yeah, but that's, yeah, the recommendation for mild to moderate addiction too. So we, we just want to emphasize that part of it. What, what do you do if you suspect a loved one is using drugs or has a problem with it? Good question. Really important. So, um, the substance abuse and mental health services administration, it's a government, um, administration that has a substance abuse treatment locator. For all of us. So anyone in the U S it's really great. So, um, the website is fine treatment.s a M H S a.gov. Um, and basically you can click on a state or enter your zip code and it will tell you all of the substance abuse treatment centers around you. Um, I did it as an example, a couple of nights ago, just to see what was new, what was out there to check on it, to see if it's helpful. And many of the treatment centers in the local, Los Angeles County area were there, um, you know, numbers checked out. So it's really helpful. Um, if you live in the middle of the country on one of the edges of the country, uh, I would, I would advocate for the person starting there and, and checking them out. So you could use SAMHSA.gov or you could use Google, but no matter what you want to make sure you ask them some specific questions about what kind of techniques they use. Do they do individual therapy? Do they group do group therapy? Um, is it a harm reduction? Is it a reduction model? Is it an abstinence only model? Those things are important in a treatment program. And I have to say, you'd want to know that before you go into it. Right. And again, like you mentioned at the beginning of the program, empathy. Right. And understanding that this is a disease process. Right. Once you start using over a certain point, it changes your brain chemicals and it's your brain is, is sitting there and screaming at you at the most inopportune times. That's right. Help. Or I want some more of that. Cause it made me feel good. So just to have that understanding instead of doing the shame and blame and yelling and everything else that I've seen so many families go through and addicted families, especially they often do. And sometimes it's out of their own guilt. You know, sometimes the family members don't realize that they're yelling out of the family about their, the family member and it's their own guilt that they couldn't save that person or that it means that they're a bad sister or a bad mother that it touches on their own, um, insecurity or whatever. Right. And that's, that's the kind of feeling they may have about someone close to them using drugs. Right. So be supportive and patient, whichever, in whichever shoes you're standing in, whether you're addicted or whether you love somebody that's addicted, just be patient and understanding. So if you would like to contact Dr. Lavonda Mickens, her email address is L M I C K E N S at thechicagoschool.edu. Thank you. Thank you. And that's T H E C H I C A G O S C H O O L dot E D U. And I would really, uh, like to thank Dr. Mickens for her expertise and I hope that you were enlightened by it. And I definitely was. I learned a lot tonight, so we definitely think Dr. Mickens. Thank you, Julianne. My pleasure. Yeah. If you'd like to contact me, my email's J G O O D E 11 11 at hotmail.com or give us a call at 800-893-9562. We can leave a message anytime. And thank you so much for your listening. And I hope you learned a lot and the Qumran report is on next. So keep on tuned for that. And we would love to hear from you. Thank you. I really do. I really do. We'll be right back. We'll be right back.