Applied Podcast

• CSU Initiates Programs to Study, Help Understand Drug Use Nationwide
• The Neurobiology of Addiction
• Addiction and the Brain

• Online Psychology B.S.
• Accelerated Masters in Addiction Counseling
• Master of Addiction Counseling in Psychology M.A.C.P.

Beren Goguen (00:00):
Welcome to Applied. This is Beren Goguen and I’m joined today by Dr. Brad Conner. Dr. Conner is a professor at Colorado State University and Director of Addiction Counseling. His current research focuses on the causes of negative outcomes of sensation seeking, emotion dysregulation, and impulsivity across the human lifespan. More specifically, he has studied how certain genotypes and personality types can influence the onset and course of disorders and persons engagement in risky behavior. Dr. Conner thanks for being here.

Dr. Conner (00:31):
Thanks for having me.

Beren Goguen (00:32):
And you also run the center.

Dr. Conner (00:35):
I’m the Director of Addiction counseling and I run the development of addictive and risky behaviors lab. So those are the two primary things when I teach.

Beren Goguen (00:42):
Tell us a little bit about your research at the lab.

Dr. Conner (00:44):
So the lab is largely focused on studying distal and proximal predictors of engagement and health risk behaviors, which essentially means looking at personality genotypes as far away predictors of engagement, health risk behaviors, and then proximal predictors or nearby predictors are things like mood, affect, current political status, things that are happening in the environment around an individual stress, trauma. Those are all what we consider nearby or proximal predictors. And the risky behaviors we’re primarily interested in are substance use, self-injurious behavior, and suicide, criminal behavior, risky sexual behavior, as those tend to lead to a lot of negative outcomes. So if you think about misusing substances, leads to addiction and engaging in self-injury can often lead to significant injury. Suicide can lead to death, engaging in criminal behavior can lead to incarceration. And so we’re really looking at how we can understand processes that lead to people engaging in those risky behaviors to try to offset the negative consequences they may experience from that behavioral engagement.

Beren Goguen (01:45):
So when you say genotypes and personality, are those the same or is that related to genes and how that affects personality or could you explain that a little more?

Dr. Conner (01:55):
Yeah, so when we think about how genotypes predict behavior, it’s not like you’re going to have a single genotype that’s going to predict a complex behavior. We thought that originally, way back when researchers first started studying genotypes, they thought they could identify the addiction gene. There isn’t an addiction gene. There are a set of genotypes or a set of genetic mutations that can predispose someone to becoming addicted, but that usually will result in certain personality types or certain ways of responding to environmental influence. And so you had mentioned part of the intro sensation seeking. So sensation seeking is a personality trait that is largely defined by the desire for novel stimulation and the willingness to take risks to experience that stimulation. And so you might think about yourself or other people who really, what we call risk takers or the people who are driving really fast or going back country skiing or who are engaging these really risky behaviors and trying to figure out why they’re doing that.

(02:51):
Well, when you engage in those really risky behaviors and you don’t die, you get this huge release of dopamine in your brain, which causes you to feel really good. And then you want to do that over and over again because you want to feel really good. And so there are addictive genotypes or what we call addictive genotypes or genotypes that show up more in individuals who experience addiction that seem to be largely related to the, this is a big word, but I’m going to say it anyway, the mesocorticolimbic system in the brain or what we might call the reward pathway in the brain that are largely involving dopamine. And so those genotypes can predispose someone to addiction because they’ll make the dopamine system or the reward system insensitive to dopamine. And so in order to feel the same amount of reward that you and I might feel from a good meal or dark chocolate or even having sex, they need to do a lot more to get the same amount of dopamine released to get the same feelings of joy.

(03:41):
And it just turns out that substances of abuse drugs typically cause a huge release of dopamine. And so the genotypes that we look at are those that cause hypodopaminergic functioning or under functioning in the dopamine systems. And those tend to lead to personality traits like sensation seeking or impulsivity. Impulsivity is this idea that I can’t stop myself from engaging in behavior that I know might be bad for me or that might be dangerous. And then the last one that I’m really interested in is the ways that people regulate their emotions. And so again, there seemed to be some genotypes that may predispose individuals to having dysregulated emotion, which means that individual has difficulty identifying the emotion they’re feeling, they have difficulty tolerating extreme amounts or lots of emotion, and they have difficulty identifying what emotion they’re experiencing. So lack of control, lack of identification, lack of ability to tolerate extreme emotion. And so really what you think about is this chain where genotypes predict personality, personality predicts engagement and behavior, engagement and behavior predicts experiencing the negative outcomes related to those behaviors.

Beren Goguen (04:50):
So it’s a combination of factors that kind of coalesce and come into play. Is someone born this way or is this something that happens to them or both?

Dr. Conner (05:01):
Both. In multiple ways. So if parents have struggled with substance use, they may be carrying a genetic predisposition that can happen at conception. There are also genetic mutations that happen at conception that can lead to this genetic predisposition. And then there are what we call epigenetic effects, which are usually the way that nature and nurture interact. So something that happens in an early childhood experience can lead to changes in genetic, the way that genes express themselves. And so that’s why it’s both, you can get a genetic predisposition because your parents have it because of a mutation or because of an alteration that happens after you’re born related to your early childhood experiences.

Beren Goguen (05:42):
So with developmental disabilities or things that impact human development being one of those,

Dr. Conner (05:49):
They could be, yeah, I mean they’re probably more corollary than they are causative. They’re probably related but not causing one another. But if see someone who’s experiencing developmental disabilities or developmental delays, then you might expect that they have other genetic anomalies that might be predisposing them to things like addiction or behavioral disorders, things like that.

Beren Goguen (06:09):
So how is this research that you’re doing being applied?

Dr. Conner (06:12):
So one of the ways that my research has really honed in on an area that’s a particular interest, especially in Colorado or in any other states where recreational cannabis is legal, is actually trying to understand what leads to cannabis use disorder. So there’s been some debate, but it’s pretty well accepted now that cannabis can be addictive. And the estimate is usually somewhere like one in nine or one in 10 individuals who use cannabis will develop cannabis use disorder. And if you think about cannabis use, we don’t actually have a really good idea of how to measure cannabis use. So if you compare it to say, alcohol, in alcohol, we have what we call a standard drink. When you go to a bar, you get a beer, it’s usually 12 ounces. You get a glass of wine, it’s usually four to five ounces. You get a shot, it’s usually an ounce to an ounce and a half.

(06:57):
Why? Because across all three substances at those different levels, they have about the same amount of alcohol. We don’t have the same thing for cannabis. So I usually switch to french fries here because it’s easier for people to understand. But if I asked you, do you eat french fries, you could probably say yes or no. If I asked you how often you eat french fries, you might be able to tell me how many times in the last 30 days you ate french fries. If I asked you how many french fries you ate, do you think you could tell me

Beren Goguen (07:21):
No?

Dr. Conner (07:22):
If I asked you how big or how small, how much French fry by weight you ate, do you think you could tell me?

Beren Goguen (07:28):
No.

Dr. Conner (07:28):
No, I could because I had a heart attack three years ago, so I stopped eating french fries. So I can tell you I don’t eat any french fries at all, which is easy. But when you have somebody who does eat french fries, having them recall how many french fries they’re eating, the types of french fries, these different things, it’s a very difficult thing to do. The same applies to cannabis. If you or the listeners, when I think about how they may have used cannabis or how they know how people use cannabis, most people are not accurate reporters of how much cannabis they use. They can tell me how many times in the last 30 days or maybe how many times in the last week they used cannabis. But they can’t tell me the potency. They can’t tell me how much they used. And so it’s really difficult to be able to talk to people about how much cannabis is too much or how much cannabis use is going to cause problems.

(08:10):
We don’t know that. And cannabis is particularly unique because cannabis seems to have medicinal benefits. So cannabis, there’s been research that says that cannabis is good for anxiety, but we don’t know how much. We don’t know when you should take it. We don’t know how you should take it. So imagine if you went to a doctor and the doctor said, well, there’s this drug out there that might help you, but I can’t tell you how to take it. I can’t tell you how much of it to take. I can’t tell you how frequently to take it. I can tell you that if you take the right amount, it’ll work. It’ll reduce your anxiety. But if you take too much, it’ll make your anxiety worse. And I can tell you that I don’t know what the right amount is. Would you take that drug?

Beren Goguen (08:45):
Right. So even with how it’s been used medicinally for quite a few years now, they still haven’t really got that dialed in.

Dr. Conner (08:52):
No, the federal government doesn’t allow us to easily do research on cannabis to establish what the right levels might be because cannabis is still a schedule one drug. In order to do administration research where you’re giving people cannabis, you have to have a Schedule one license, and it’s quite difficult to get a Schedule one license. And so what we’ve been trying to do in Colorado is what we call observational research on cannabis, where we go to places where people are buying cannabis or using cannabis, and we try to get that data. We try to figure out if we can show relations between the amount of cannabis someone’s using and the symptoms they might experience around social anxiety or around depression or around things like that. And we do that by asking people to let us take pictures of the products they buy or to answer questions about how they use. We have a mobile lab that one of the investigators in the psych department has. It’s essentially a van where you go to people’s houses. And so we’ve found creative ways to do that research. So we’re getting closer, but we’re woefully behind given that cannabis has already been made both medically and recreationally legal in many states in the United States.

Beren Goguen (09:57):
Right. So it’s still early stage there.

Dr. Conner (09:59):
Yeah.

Beren Goguen (10:00):
Okay. Do you find that people are pretty willing to work with you on that and open to that, or are people kind of worried?

Dr. Conner (10:08):
No, actually, one of the most exciting things when we started doing this work was that people who use cannabis medically and recreationally want there to be good research. And so they actively participate in research. And I actually have had some really interesting experiences where usually when we conduct a research study, we pay participants for their participation in the study. And we’ve had multiple people in our studies refuse the payment. They just want to participate, they want there to be good science. And so it’s been a really interesting experience.

Beren Goguen (10:37):
Are other institutions doing this or is it still pretty few?

Dr. Conner (10:42):
No, there’s a lot of cannabis researchers. It’s just that we don’t all use the same methods. And so those of us that are doing observational research, we don’t often use the same language with the people who are doing administration research. And if you think about up until very recently, the people who had a schedule one license who were able to give their participants cannabis and do some sort of direct research, they had to buy their cannabis from a federally approved site and that cannabis was at best 8% THC. The average cannabis, if you buy flower in a dispensary in Colorado, the average percent THC is around 22, 23%. So the two products aren’t even the same products

Beren Goguen (11:18):
So it’s more than double,

Dr. Conner (11:19):
And that’s just in flower. If you talk about concentrated cannabis products like vapor, like vapes or shatter or wax, things that people use to dab with, those are usually upwards of 75 and can go as high as 95% or a hundred percent THC. So they’re very different products. So there are a lot of people doing cannabis research, but many times we’re using very different products. And so we don’t always speak the same language, if you will.

Beren Goguen (11:45):
My understanding from some people I’ve talked to is when you get into those really high concentrated products, that’s where a lot of the problems come in, especially with young people becuase it’s just so potent.

Dr. Conner (11:56):
Sure. I mean, there’s developing area of research that basically suggests that as you get more and more concentrated THC and you remove a lot of the other cannabinoids because there are hundreds of cannabinoids, but the common ones that we talk about are like CBD or CBG or CBN, those in a flower plant, those all occur in balance. But as you start to create concentrated products, knowing that THC is really the only one that has significant psychoactive properties, then the goal is to make stronger and stronger cannabis products as you reduce the presence of other cannabinoids and you ramp up or it drastically increased the amount of THC and those products are problematic. There seems to be something both about that high potency and about the lack of balance with other cannabinoids. But at high levels of THC, there’s some beginning research that says it can induce psychosis. So people can start hallucinating in unpleasant ways when they use those highly concentrated products. And if someone is already predisposed to a psychotic disorder like schizophrenia, then using those high potency cannabis products may induce their first psychotic episode of a schizophrenia disorder. So it can be very dangerous.

Beren Goguen (13:05):
That is scary. So really people just need to be educated and try to have some thought in what they’re doing and the choices they’re making, not necessarily don’t do this at all, but be informed.

Dr. Conner (13:17):
So I’m a harm reductionist. And so the harm reductionist, essentially when I think about and talk to people about their substance use, it’s not to say that you have to be abstinent, but you should reduce your use to the point that it’s not causing you or those around you and your loved ones harm. And so for some people that means abstinence because any amount of a drug is going to cause harm. But for others it means that they just have to practice moderation. And that’s sort of the life lesson we should always use in any areas moderation. But the goal is to reduce harms that people experience, to keep people out of jail, to keep people from becoming addicted, to keep people from hurting or killing themselves,

Beren Goguen (13:54):
Especially getting behind the wheel, stay home.

Dr. Conner (13:57):
Yes.

Beren Goguen (13:57):
Can you describe on a basic level what causes addiction from the neuroscience standpoint?

Dr. Conner (14:03):
So typically substances of abuse or drugs will have activity in two different parts of the brain. One is specific to the drug that you’re using. So for instance, if you’re using opioids, they tend to work on opioid receptors in the brain, and then they’ll also have action in the dopamine system. When an individual starts using drugs, the brain likes to remain stable. It’s what we call homeostasis. We like to stay at a normal or a standard level. And so as we start to use drugs that mimic chemicals that are occurring in our brain, our brain starts to down regulate or stop producing those chemicals as much to get us back to a normal level. And so this is the process that people usually refer to as tolerance. So if I use a drug over time, I’ll need to use more and more of the drug to keep getting high, and that’s because my brain is adjusting down the levels of natural chemicals so that I am just essentially evening out.

(14:55):
And so in order to keep getting high, I have to use more and more and more. And it’s basically a losing battle because the more I use, the less my brain produces. So that’s what we call tolerance. And then if I decide I want to stop using, when I stop using, I’ll often get sick because now my brain is in deficit to try to accommodate for the substances I’ve been putting in. And there’s a period of time, depending on the drug, where it will take the brain some time to start ramping up and reproducing the chemicals. It started to slow down in order to adjust. And so that’s the process of withdrawal, which is why people will get sick when they stop using a drug is because their brain is adjusted to the drug being present. And when you take it away, you’re sick. So that’s tolerance, withdrawal. Those are the primary neuropsychological components of addiction.

Beren Goguen (15:48):
Is addiction a mental health issue or a behavioral issue or both?

Dr. Conner (15:53):
I don’t make that distinction. And so that’s more amongst researchers and individuals who treat addictions addiction as a disease period. And whether it affects your behavior or your mental illness or your mental health, it doesn’t matter. And so the idea is to say that behavior is a manifestation of internal processes. So what I’m experiencing inside will come out in the way I behave. And so a more clear answer to your question would be both, but I don’t make a distinction between the two. So for me, what I would usually think about addiction as a chronic illness or a disease that is going to require a lot of treatment over a long period of time, and that will affect an individual’s both mental and physical health,

Beren Goguen (16:34):
How much more susceptible are children and young people compared to adults? My understanding is that it’s a pretty significant, it can be impacted significantly more because their brains are still developing.

Dr. Conner (16:46):
Yeah, so the mechanism here, the difference is that recent research indicates that the brain develops up until age 23 to 25, maybe even 26, and then almost immediate starts dying. And so below the age of 25 or 26, while the brain’s developing, if you’re using substances, you’re likely causing harm to your brain if the brain has already started dying. It’s not to say you’re not causing harm, but the chances are that you’re less likely to be doing damage to your brain because it’s already fully developed. The two systems that we really pay attention to in substance use are one that the reward system, which is developing actually pretty early for individuals, usually you’ll develop your reward system almost fully by the time you’re 15 or 16 years old. And so we usually refer to this as the go pedal. This is the thing that makes us want to do risky things. It helps us feel good. That’s how we get the rush. The thing that we’ve learned, and here I’m speaking relatively when I say recently, like in the last 20 to 30 years in research, maybe that’s pretty recent in research terms, is that the stop part of our brain doesn’t fully develop until we’re 25. So there’s this window between 15 and 25 and 25 is an average, but there’s this window of about 10 years where we have a really healthy gas pedal and really bad breaks.

(18:02):
And if we’re using substances in that same time, if we’re using drugs, then we’re essentially we’re making our gas pedal stronger and we’re making our brakes weaker. So we’re accentuating a system that’s already in deficit. So dopamine, as I said earlier, dopamine is the substance that gets released in the reward pathway that makes us feel good. There’s another part of our brain, which we usually refer to as the executive functioning part of the brain, that in that system dopamine gets us. When dopamine is released, we stop doing behaviors. But if that system is flooded with dopamine, it simply shuts down. And so here you might think about why when people get drunk, they get what we call disinhibited. They’re more likely to say and do things they wouldn’t do when they’re sober, is because the part of their brain that would get them to stop from doing dumb things has essentially gone offline because it’s flooded with dopamine. And we used to use this analogy, if you’ve ever flooded an engine, but nobody floods their engines anymore, but if you put too much gas into a car engine, it won’t run. And that can happen to your brain as well. And the part that stops running are your brakes or the things that stop you from doing things you wouldn’t otherwise normally do.

Beren Goguen (19:08):
Okay. I think that’s a great analogy. What’s changed in the last 10 to 20 years, would you say, in terms of how addiction is treated or talked about or both?

Dr. Conner (19:17):
I think there’s been a slow change, but an important one to start thinking about addiction as a chronic illness that is something that once developed will take years to treat. So 30, 40 years ago, even as many as 20 years ago, the standard treatment for addiction was 28 days of inpatient treatment, and then you were released and you were supposed to be cured, or you might do outpatient treatment for 16 weeks and then you were cured. We now know that you’re not cured, and that relapse rates from those types of treatments after six months are in the 70 to 80% range and after 12 months are in the 90% range. And so there’s been this shift towards thinking about addiction as a chronic disease similar to diabetes or high blood pressure. We don’t treat diabetes or high blood pressure by giving people meds for a month and then taking those meds away.

(20:10):
We give them meds and they’re on those meds for the rest of their life, and if they stop taking the meds, their diseases get worse. And if they keep taking their meds, the disease stays under control. In here, we think about meds as therapy, whether that’s sort of the formal therapy where you have a therapist and you go every once a week and see your therapist or whether you go to 12 step meetings or other group run meetings. There are certain substances that where we do use medication to treat, but we now have much better understanding that we need to be treating people for a longer period of time, and that if we stop treatment, then they’ll likely go back to using substances. So I think that’s been one of the biggest shifts. I think the other thing is away from criminalizing addiction and moving towards treating addiction, I think we still have a long way to go there, and I think that’s best evidenced by who’s filling up our prisons. But there’s been a big shift even in incarcerated settings to be offering treatment to individuals who are incarcerated. But if we can stop thinking about addiction as an illegal behavior and start thinking about it as an illness, we’re going to not only help those who are struggling, but all of society will likely be better off because we’re not going to be paying for people to be incarcerated, we’re not going to be overcrowding our jails, we’re not going to be forcing people to engage in illegal behavior because they have a disease.

Beren Goguen (21:23):
Right. This seems like an area where other countries are way ahead.

Dr. Conner (21:26):
Oh yeah, for sure. Not all, but many are for sure.

Beren Goguen (21:31):
So what really still needs to change or improve? What are some of the things that you would say are the high ticket items that really need to be addressed soon to really make an impact here in the US?

Dr. Conner (21:44):
I think three things. One is dispelling common myths, which we can talk about. Two is increasing access to treatment, and three is to stop criminalizing a disease. So the common myth for people who have already developed an addiction, the common myth is that they’re making a choice when they use a substance. I think that you can make the argument when a person first starts using a drug that they’re making a choice, but once they’ve developed an addiction, they’re trying, they continue to use to stop themselves from getting sick. And so if you don’t have experience in this area, think about if you could take a pill every day, that would mean that you never got the flu. And that one day, if you don’t take that pill one day, that day, you will get the flu and it’ll be the worst flu you’ve ever had.

(22:30):
Would you fault somebody for taking that pill every single day? But that’s the thing that I don’t think a lot of people understand is that once an addiction is developed, you have become physically dependent on having that substance in your body. And when it’s not there, you’re going to get sick. And again, I’d say to people, just think about what would you be willing to do in order to not be sick anymore? And if I told you, if you took this one pill instantly, you would not be sick anymore. I think most people would take it. So that’s the common myth that we often think about is to say that addicts are making a choice. People with addiction aren’t making choices. They’re trying to stop themselves from getting sick. So that’s one common myth. Another common myth is to think about cannabis as not being addictive. There’s plenty of research evidence that says that it is. And she’ll often hear people say, well, because it’s a plant, it’s not addictive. Spoiler alert, most drugs that we use actually come from plants, even the most addictive ones. And so the other thing that, another common myth is most people think they’re not addicted. If you drink coffee, then you’re probably addicted to a substance, right?

Beren Goguen (23:29):
True

Dr. Conner (23:29):
If you drink soda. But there’s a lot of common myths that allow people to point fingers and think that they can solve problems in a certain way

Beren Goguen (23:37):
When you have socially acceptable addictions or just legal addictions, you can legally be addicted alcohol if you’re not getting behind the wheel, if you’re not underage. But other things you can’t. And in some cases, I mean, you could make an argument that something like cannabis is probably going to impair you less than a bottle of Jack Daniels.

Dr. Conner (24:02):
You could make that argument. And people are doing that research, and I am not familiar enough with the data to stipulate anything as fact. However, I think that the point is well made that cannabis is probably not as physically harmful to you or to people around you as alcohol is, and yet alcohol in all 50 states as sanctioned. So

Beren Goguen (24:22):
Not to say that using cannabis is a good idea or a bad idea or worse or better than alcohol, but there’s a lot of nuance that people don’t really get.

Dr. Conner (24:34):
Sure. I think even if we stay in this realm of the common myths, I think even the way that we use certain substances matter. So if you’re smoking cannabis, it’s important that you understand that your lungs are designed to do one thing and one thing only, and that’s breathe air. So the minute that you’re putting anything else in your lungs beside air, you’re doing damage to your lungs. Do I think that eating cannabis is as harmful? Probably not. If you’re taking edibles, I mean, don’t eat flower, but if you’re taking edibles, that’s a safer way to use it. I think there’s a lot of nuance here, but I think about, like you said, how we’re punishing people. Even if you think like, well, yeah, so in Colorado, recreational cannabis is legal, but there’s still limits on how much you can possess, but there’s no limits on how much alcohol you can possess. As least as far as I know. There’s not limits on the amount of alcohol you can possess, right?

Beren Goguen (25:20):
Yeah. You can go buy the whole liquor store if you want. What’s something people should know about addiction that is often misunderstood? And we kind of touched on that with the misconceptions. What would you say is the biggest one or the most common misconception that you run into?

Dr. Conner (25:35):
I think, I still think the most common misperception I run into is that people think that individuals with an addiction are making a choice. There may have been at some point in their life when they did make a choice, but once they developed a dependence on a substance, they’re no longer making that same. It’s not to say they’re not making a choice, but the math involved in the choice is much different. Again, you can think about what would you do to not get sick? And I think that’s a much different question. Most people think that individuals who have an addiction are trying to get high, and that’s not true. Most people who have an addiction are trying not to get sick. They may get high as a secondary, and they may want to get high they they’re searching for. But first and foremost, when an individual with addiction wakes up in the morning, their first goal is to either not get sick or to stop feeling sick. In other words, they’re trying to feel normal.

Beren Goguen (26:24):
Right becuase they feel poor, very poor.

Dr. Conner (26:26):
Yeah, and so I think that’s another thing that this idea that people think that someone who’s got an addiction is just trying to get high all the time, and many of them lost the ability to get high a long time ago.

Beren Goguen (26:36):
Would you say most people struggling with addiction want to get better?

Dr. Conner (26:40):
I would not say that. I don’t know that to be a hundred percent true, I would hope is true. I think the biggest issue, if you look at the availability of treatment versus the number of people seeking treatment. So there is simply not a large enough treatment community in the United States to treat all the people that are looking for help. And so the only reason I didn’t agree with you before is because you said most. I think many people who are struggling with addiction would prefer to not have an addiction. And I think it’s very difficult for people to find adequate care in the United States. So even if there’s treatment available in the community you live in, there’s often wait lists or it’s often very expensive. Insurance doesn’t always cover all of the costs. There’s often limits put onto it. You’re often expected to do things that are unrealistic.

(27:24):
So one of my earlier jobs was doing program evaluation for this law that they passed in California where if you were arrested and convicted of simple possession, so possessing a substance or being under the influence without any other crimes, without the intent to sell, you could ask for probation and opt into treatment, and as long as you completed treatment, then they would expunge your record. And so we started to do the program evaluation, and one of the things we realized is that there was a problem with the system, which is in the time between conviction and getting into drug treatment, the criminal justice system expected the individual to not use drugs. And so I tried to explain to people, how would you tell a person who has a disease to not have symptoms of their disease before they receive any treatment for their disease? And so we set up these standards that are not achievable, and then when the person fails, we incarcerate them.

Beren Goguen (28:20):
So they’re set up to fail kind of,

Dr. Conner (28:23):
Yes, almost invariably. And that’s the things that we’re trying to change is help people understand how to set the system up so that people will be successful. And that’s a big shift because it shift away from incarceration, a shift towards treatment, trying to find ways to have insurance companies increase the amount of funding that they’re offering for treatment, and then increasing treatment capacity. Those are big shifts.

Beren Goguen (28:47):
So we’re talking about pretty big systemic issues that involve government

Dr. Conner (28:52):
Yes

Beren Goguen (28:53):
Law, medical system, the healthcare system, public programs. It’s a complicated thing.

Dr. Conner (28:59):
It’s a complicated thing. You had asked me if children and adolescents are more at risk than they are, and I think there are things that families can do to help kids understand what that risk might look like. And so for instance, if you’re a parent and you know that there’s a history of addiction in your family, then you can reasonably assume that your child might be at higher risk than other children for developing an addiction. And you can have a conversation with them about that. Because one of the things we know about all adolescents in the United States is that they will try drugs, whether that’s nicotine or alcohol or cannabis or all three, whether it’s methamphetamine or crystal meth or all adolescents, it’s a right of passage in the United States. I shouldn’t say all, but most adolescents will try drugs. And if your child has a predisposition to addiction, then telling them that if they try these drugs, they might react differently from their friends.

(29:52):
So you can think about maybe the first time you tried alcohol, you probably thought it tasted terrible, but if you have a genetic predisposition to alcohol the first time you try alcohol, you might love the way it tastes, or you might love the way it makes you feel, which means you’re much more likely to do it again. And so I think parents can talk to their kids and say, Hey, I know that when you got out with your friends, you’re going to have the opportunity to try alcohol or to try cannabis, and I just want you to know that it might affect you differently than your friends, and you might want to be a little more careful because there’s a history in our family of people struggling with drug use. I think telling parents, telling kids not to use drugs is not an effective strategy. It’s never been an effective strategy. But having a sensible conversation with your adolescent about the fact that there’s a predisposition in your family to addiction could at least provide them with information that they may use to help keep them away from addiction.

Beren Goguen (30:42):
It’s kind of about having an open conversation and offering information with no judgment upfront. When I was growing up in the eighties, things were just different. We didn’t have a lot of this information, and the drug scene was different. I mean, even the drug scene when I was in college in the two thousands was completely different than it is now. And so it’s kind of scary what the youth face right now compared to with things like fentanyl. And it’s just a very different scenario

Dr. Conner (31:15):
Yeah. For sure it is.

Beren Goguen (31:16):
So you have to, as a parent, my goal is to try to have an open conversation and educate. Just the way parents can handle things now is probably a little different.

Dr. Conner (31:26):
I think preparing your kids for what they’re going to experience in the world and being honest with them. One of the big mistakes that parents often make is they think that they can tell the worst case scenario story to their kids to try to scare them. But if you tell the worst case scenario story to your kid to try to scare them, and then the kid tries the drug you’re trying to keep them away from and doesn’t experience the worst case scenario, then what they’ve learned is that you’re a liar. And then they’ll discount everything you have to say, and that may be a severe way to say it, but the best thing you can do is provide them with true information and allow them to make an informed decision.

Beren Goguen (32:00):
And they know when

Dr. Conner (32:01):
They do.

Beren Goguen (32:02):
when you’re embellishing too much or you’re withholding information,

Dr. Conner (32:06):
They do.

Beren Goguen (32:08):
If someone listening is struggling with an addiction or knows someone’s struggling, what should they do?

Dr. Conner (32:13):
They should ask for help. And so depending on where they live, there are usually pretty good resources available, but there are web resources they can go to that are point to resources in their community. So the Substance Abuse and Mental Health Services administration runs a website, which is samhsa.org, SAM hsa.org, where you can look for treatment resources. There are often mental health providers in communities that will offer services or can make referrals for services. But the most important thing to do is to ask for help. The way that this country has treated substance use and addiction is it’s something we should be ashamed of. And as soon as we start talking about things we should be ashamed of, then we start hiding. And if you’re struggling with substance use and you start hiding your behavior, the only thing that’s going to happen is it’s going to get worse. It’s not going to get better. And so if you’re struggling, ask for help. Ask someone that you trust, someone that you know that can help you. Go online and find resources and get yourself in a treatment.

(33:26):
Here’s a story I’ll tell, and I don’t tell this story all that often, but I’ll tell the story now. I went to drug rehab when I was 16 years old, and that was in 19, I don’t know, ’86, ’87, and I was in high school. And I think at that point in time, I did the standard treatment model. I did 28 days of inpatient treatment, and I came out. And luckily for me, that model worked for me. I stopped using most substances after I got out of rehab. I continued to drink. In fact, my drinking got much worse and I continued to smoke, but I graduated high school and then I moved to California to try to be a rock star, and that didn’t work out. And so instead, I started going to school and just 12 short years later, I had a doctorate and started doing research to try to figure out how to help people not experience the same things I experienced. And so the reason I tell that story is not to try to say that I’m anything special, but it’s to say that even individuals who are struggling with substance use disorders with addiction can still contribute to society. They’re not all criminals. They’re not all wasted lives. And with helping and with treatment, people can turn things around and they can find ways to make both their lives and other people’s lives a lot better.

Beren Goguen (34:38):
There are a lot of stories of people who have hit rock bottom or come very close and they ask for help, and then things can turn around.

Dr. Conner (34:47):
I think asking for help and then getting the help that they need, and I was lucky enough in that situation that I did not ask for help, but I got help even though I didn’t ask for it. It was the help that I needed in that moment, even though I didn’t know I needed that help. And it helped me turn things around. And so I think there are many times when parents, when family members, or even when people who don’t know that people struggling with addiction, and what they want to do is they want to get away from them, or they want to incarcerate them, or they want to blame the person for the thing that’s happening, and instead ask how you can help that person. Cause you never know.

Beren Goguen (35:19):
Thanks so much for being here.

Dr. Conner (35:20):
Thanks for having me.