tv Dr. Stuart Gitlow Remarks at Oxford House Convention CSPAN September 5, 2017 10:02am-10:41am EDT
considering a judicial nomination for the district of columbia and possibly working on defense policy for the next year. see the senate live on c-span 2. , the base c-span 3 realignment or closure between the department of defense and congress, which determines which military bases will be open for 2018 fiscal year. live coverage at 10:30 a.m. eastern. or listen with the free c-span radio app. rugged action was the subject of a presentation at a conference at washington, d.c. next, remarks from dr. stuart the americanaded society of addiction medicine. this 35 minute portion was part of the annual convention of oxford house. an organization that provides a
drug-free living situation for recovering addicts. an gitlow: we live in incredibly health-conscious country. how many of you have ever bought all the old water? [laughter] dr. gitlow: when you buy the bottled water, are you concerned there is bpa in the plastic? yes, you are. you are concerned to such an extent about health and that you decide to buy something that you can get for free out of your tap, then are further concerned about whether there is something called bpa in the plastic. if you go to the grocery store, there are aisles full of products, supplements, you can take, ranging from willow bark to l-carnitine.
all of which might be helpful, but sells tremendously well. we even passed laws that are a minority oflp people in the country in order to protect their health. what is one such law? a big one is the seatbelt law. we all put on our seatbelts because we have to and because we know that we don't want to go through windshield. the reason why the law is there is to make it so a minority of injured.n't get it wouldn't be a majority of us that it some point in our lives go through the windshield. it would be a minority. we all wear our seatbelts in order to protect the minority, who would otherwise get hurt. , motorcycle helmets. if you go anywhere near a ski
slope, everyone is wearing a helmet. most people did not end up with head injuries. here we are in a country that is focused on health to such an extent that we pass laws to .rotect the minority isn't it odd that we don't seem to mind the 500,000 people are year who died of cigarette smoking-related illness, and we don't mind the 80,000 people year that i've alcohol-related illness, and we don't find the 50,000 people a year that die from opioid-related illness, though that is coming out in the media. why are opiates coming out in the media and tobacco and alcohol are not. why are the drugs that kill 50,000 people year making headlines and the drugs that kill 580,000 people year is nowhere near the front page? why is that?
it is because the majority of people would like to continue to be able to use the two drugs that are responsible for killing 580,000 people year. [applause] thosetlow: even though same people are buying bottled water where they are watching out for the bpa that might hurt them. [laughter] dr. gitlow: we live in a country that is health-conscious but doesn't always seem to make sense. ?ow can we change the text how can we make it so this is clear to people that addiction, no matter what the drug is, is addiction. how can we clarify that it doesn't matter whether or not your favorite drug is methamphetamine, marijuana, tobacco, or heroin.
it all boils down to a disease state. you know what? disorder.ngenital a birth defect, if you will. we are not talking about substance use. we are talking about a disease that affects about 15% of the american public. how does it affect 15% of the american public? 85% of the public can drink, can can useopiate, marijuana, and can smoke from time to time and not end up with addictive disease. when i was 13 or 14 years old i needed a root canal. the night before the surgery was one of the most painful experiences i care to have and i got an injection of demirel, a morphine-like agent.
it essentially made me nauseated, gave me an uncomfortable feeling, and think god i fell asleep. there was no joy in it. i talked to my patients and they tell me about their first experience with a morphine-like agent and they say, "my god, it was better than sex." you say, why did they have that experience and i didn't? what is the difference other than there must have been something separating the two of us before either of us used the defect.nce birth this is a congenital disorder. let me give you another metaphor designed to separate that out. ishumans, we fall on what called a normal curve. i will walk over to the flipchart.
that is coming out on the screen? wonderful. curve. on a normal we are distributed normally. meaning that if i were to pull all of you out and measure your iqs, most of you would be in the middle. some of you would be a appear, some of you might be way down there. if i took an entire population we would find it is distributed like this. i could do with height, pulse rate, body temperature. there is another normal distribution that we find in humanity. are of the aware we world around us. how much does the world around us stimulate us? how loud is it? how irritating is it?
how annoying is it? how distressing is it? of us were to all walk outside on a bright sunny day. it is noon, the sun is shining down, and we are in arizona where the sun is real bright. how many of you would put on a pair of sunglasses when you walk outside? a show of hands. how many of you would not put on when you sunglasses walk outside? how many of you are in the middle and don't care one way or the other? we saw a pretty good distribution. a lot of you were "i will put on the sunglasses." we would all walk out on an equally sunny day, all un.ing the same s
why do we perceive it so differently that some of us would use a drug in the form of sunglasses designed to make it more comfortable? and some of us would not? you who would put on the sunglasses, i'm going to augmentersus au . you are taking the stimulus of the sun, and in your brain the volume knob is turned up too high. so when you put on the sunglasses you're thinking to yourself "that is more comfortable. that is the way it should be." stimulus augmenters find the world too loud, noisy, irritating. you are the ones who do not like turbulence on airplanes. who do not want to go downhill real fast as they go skiing.
who do not go rock climbing or exciting things because the world is already too much. you would like to turn it down. , bydo so, if it is light putting on sunglasses. what is another way you can turn the world down? heroin. [laughter] dr. gitlow: ok. heroin was offered. what else do we have? alcohol. alcohol does the same thing. side of the curve, those of you who don't own sunglasses, for you, you are what we call stimulus reducers. vivid or is not
noisy enough. you would like to make the world noisier. where the music is loud and pumping. or, you take a drug that makes the world more vivid. methamphetamine. there we go. this is just a metaphor, but i will ask, through a shouting the voices, where there are properly identified you whether you wear sunglasses or not as to what drug you prefer. [applause] line isow: the bottom that since you likely thought that way before you ever picked up the drug, there is something wrong then.
such that the very first time you ever used a psychoactive drug your response was "oh my gosh, that is how it is supposed to be." [applause] dr. gitlow: you know what? you're right. that is of the way it is supposed to be. for 85% or so of the population, because this is a big part of the population, that is the way things are. those with addictive disease are outliers. , the ones we need to worry about before you get the drug. you are born with it. that is the difference between substance use and the problems that can arise from substance use and addictive disease, or substance use disorder.
a disorder or a disease is something that is present without the context of an external drug or agent. it is a disease that comes before the drug. the we are talking addictive disease we're are not talking about alcohol, heroin, or methamphetamine. we are talking about your brain in the absence of the drug. and i aments come in, to their insurance company on ,he phone as i often have to do and the insurance company says "history smith went through his troop -- mr. smith went through his treatment, he is done now." mean?""what do you they say, "he went through and is clean and sober. he doesn't have the addiction
disease anymore." i say no, now we going to start treating the addiction disease. [applause] dr. gitlow: when i talk about rehabthrough programs, we are treating withdraw. i can give anyone in toxic is an and withdraw to the point they need a hospital. that is not what is being treated. it is only after the withdraws out of the way and do start thinking clearly again that we can get to the core. the core is that you are uncomfortable to begin with. that discomfort is what needs to be treated to get you to the point where you say i am all right in my own skin. that comes to part 2. because addictive
disease is a 3-part entity. we have the genetic part, the part you are born with. the part you cannot get away from. the part that makes it so life is uncomfortable without drugs. is an environmental issue. there are some folks out there born with the disease of addiction who do not end up with addiction disease. what differentiates them from those with the illness? trigger,re has to be a like there are for many diseases. if i take a patient with juvenile diabetes with an identical twin, the identical twin doesn't always have juvenile diabetes even though they have the same genetic structure and the genes are
toling for the immune system attack the pancreas that they cannot metabolize sugar the way they should. that is built and, yet one identical twin has it and one doesn't. why? the same is true in addiction disease. what makes it trigger these genes so you end up having trouble? back to when you old., 5, or six years it almost always involves a parent, almost always the parent of the same sex that you are. the difference is a lack of ability to identify with that parent, want to be like that parent, or the parent representingly themselves.
they are inconsistent, abusive, hostile, absent -- whatever it is they are not making the connection. i've told this before. it is a baseball story. a little boy goes out for the first time to play baseball. he knows it is his first time. his friends know it is his first time playing baseball. where is he put? .ight field he is standing in right field? what happens in right field? nothing. the ball never gets out there. inevitably one does. somewhere in the eighth or ninth inning. he is sunburned, needs to go to the bathroom, counted the four leaf clover's, decided with th , paying nok like attention to the game because it is so far away. the ball lands behind him. he hears it plop.
everyone is yelling for him. what do i do with this ball? he picks it up, it is too big for his hand, but everyone is yelling to throw it. i throw it at the running guy. that is wrong, i don't hear the end of it from my friends. , go home to my dad and i say "i don't know how to play baseball, everyone made fun of awful."i feel and the dad says i think that happens to everyone, it happens to me. let's go get ice cream, i will teach you how to play baseball, and you'll never have this embarrassment again. or, the dad says, "billy, you just suck at everything you do." ist that dad teaches you
when i feel uncomfortable and i need to share my emotions with other people so that i feel better, i will end up feeling worse. if i learn that enough times at the hands of the only person in my life who i'm supposed to be able to trust at that age, i will grow up thinking that when i am uncomfortable instead of being part of the herd, because don't herd animals and stand by ourselves we stand in groups, i will end up going through my life thinking when i am uncomfortable the last thing i'm going to do is go up to someone and tell them about it. what i'm going to do instead is at, because that will make me feel worse. that is why when i look at my patients, and i say i can make it so you get your life back. you will be rehired at work,
your family will love you again, your kids will talk to you, you will have a home, you will have a car that runs, you will have money in your pocket. go in want you to do is front of a group of people who all have had the same experience as you. i want you to stand up in front of that room and say "my name is sue, and i am an alcoholic." share with them the burden to carry and let them help you. wait, i am i can't going to go to the next aa meeting, i've made the wrong diagnosis. that is the scariest thing in the world to this particular group of people. doing what you do, to come here imagines, can you yourself doing what you're doing now when you are using?
this is scary as heck. congratulations to you guys for overcoming the hurdle your parents put there. [applause] so, that is the bottom line as to the way the environment triggers the disease. you are uncomfortable. .ou are growing up you have learned not to share that discomfort with anybody. 3 happens.rt it is something that would be highly unlikely to happen if we lived in a community that did not promote drug use. we live in a culture that promotes it. what are you supposed to do the day you turn 21? what are you
supposed to do when you go to a football game? what are you supposed to do when you go to a wedding? what do most people do at a funeral? the bottom line is that our cultural events are all tied to activities in which people use psychoactive drugs. you cannot possibly go through life and not be exposed to that. let's look at what psychoactive drug use does. i will go with alcohol because it is one of the more prevalent of the drugs. , and by alcohol i do not only just mean beer, wine, or hard liquor. i am talking about all the drugs that work the same way in the brain. 'sat includes valium,
index, chloral hydrates, and soma -- the muscle relaxant that some of you may have been prescribed. all of these are very dry martinis. they work the same way. they all do the same thing. ofy cause a 2-hour period sai sedation. on the vertical line i have a line that represents where you start. relaxed, very or asleep, dead. i think it is the dry way that i present that that makes them laugh at "dead."
here we have someone here that is extremely agitated, grand mal seizure. that is the range. when i drink alcohol i get curve a. iod of relaxation, sedation, or sleep. depending on how much i aimbibe. if you are going to experience a certain level of sedation for the duration of the party, you have to know how much to drink. you don't drink and enormous amount before the party, then go to the party and wait for to wear off. that isn't how it works. you have one drink per hour, or 2 drinks per hour as the case may be. you are trying to maintain a .ertain level of sedation
about here when the first amount of alcohol peaks is when you start your second. .nd you go like this what you are experiencing over several hours of an extended football game is an ongoing level of sedation that doesn't change very much. isever, what you don't know what happens next. settingn works by things. it likes to set things in a particular way. for instance, your heart rate, your temperature, and so forth. when alcohol pushes on the brain like that, the brain says no, i'm trying to go here. when the brain does that, it overshoots. as the brain overshoots, it does manner.damp
and had a steel ball dropped it on the floor it would go bang. but if i had a tube of motor oil and i dropped the ball into the tube it would slowly drop to the ground. the brain works the same way. the brain pushes back, but slowly and over a longer period. as a result, i get curve b. is barely noticeable. if you had enough to drink so you barely notice the alcohol, you won't notice curve b. that is the agitation, the result of having used alcohol hours before. hours.ts 6-8 if i have had a certain amount of alcohol four times in a row
over an extended time to maintain my sedation you think i will maintain the level of agitation tomorrow. no because the brain is a damped system. each of these curve generates a curve b. here you are the next morning at about 4:00 in the morning when you should be sleeping. you.ad, that is , why am i sood hung over. i was never really drunk yesterday?" true, but you were intoxicated to some degree over and extended time. long enough that you get an agitation that seems to be far stronger than the sedation you had initially. this happens with everybody.
of mammals get this kind of curve with any sedative drug. orit xanax, budweiser, ambien. in how we difference all perceive this. take the normal curve that i showed you before. stimulus augmenters, and stimulus reducers. we can imagine that instead of starting where the average person starts, you start here. this is your baseline. so, a person with addictive disease has a baseline that is higher than everyone else. when you take alcohol or a sedating drug you go like that. normal."i feel
i feel the way i think everyone else feels." then you get the second curve. if you thought you were uncomfortable to begin with, you ain't seen nothing yet. this becomes impossible to cope with. you are at this point that is impossible to cope with. away thents took normal coping mechanism, which i feel terrible, let me talk to everyone to make sure they know that so they can offer me some support." you know that if you talk to other people you will end up feeling worse. you have no choice, at that to thebut to turn back very drunk that caused this to happen in the first place.
when you do that to counteract the effects of curve b, you will feel better temporarily. but you will feel worse again later. even worse than you did. that is what you are chasing. ,hat is what everyone chases whether they have the disease are not. patients tell me when they have years forcodin for 12 something they didn't need it in the first place for, they have to take the vicodin because they have to feel better from this horrible feeling which is the withdrawal from the vicodin. when i get them through that they will get to their normal baseline which is better than what they have now. same for people that have been or culloden for eight weeks. none of which are desirable or
beneficial. if you're are talking about this point and you say, the average person is saying you people do this to yourself, even if they feel this uncomfortable they don't have to pick up the bottle . imagine that i closed the doors to this room. locke everyone -- lock everyone in. i put food of peer and i say "don't eat the food. it is poisonous. it will kill you." everyone in.veryon it takes about a day before someone shows up and eats the food. he drops dead right next to the food. some of you will say it kills people. i'm not going to eat that food. but you are still the room. i will guarantee that some of you will eat the food.
you will say things like, it killed him, but i'm a lot stronger. it killed him because he ate it too fast. i will go more slowly. he ate off that side. this side will be the good one. you all eat the food, i guarantee it. there will come a point that despite the fact that it has been proven deadly to you, you have seen people die from it, you will eat the food. darned if it doesn't sound exactly like what is going on with heroin with the fentanyl mixed in. food.at the it killed their best friend. it won't do it to me. that is part of the disease, part of the process. it is not because of denial. it is because of human nature.
ofs would happen to 100% people if they were pushed hard enough in that direction. it is just that we have 15% of the american public pushed there. but we have to realize as a if we are going doprotect our 15% the way we with fluoride in the water, with in our watertic bottles, seatbelt laws, and motorcycle helmets, is we have to move away from a culture that embraces psychoactive drugs as a way to entertain ourselves. 90% ofot do that when the culture is embracing marijuana as the second coming and saying this should be used because why not?
which seems to be the best argument they've got. [applause] dr. gitlow: i will tell you y'all are why not. [laughter] [applause] what we've got is a culture that embraces psychoactive drugs at the same time as we have loads of 747's going down with people every day. we would do something about that if there were indeed 4 747's full of people crashing every day. yet, we are losing that many people every day to addictive disease and we are barely saying something about it. the fact that we are about opioid addiction, wonderful. call more attention to it.
c-span 2 is here. that is fantastic. we are on the air. [applause] and, it is wonderful to think we are getting a wider audience than usual for this topic, which affects so many in our population, but we need to stop turning a blind eye to that population. that means accepting that the 85% that can use from time to time without significant degradation of their life will have to say "it is not worth it. i'm not going to bother, because it hurts too many people." [applause] not atlow: i am prohibitionist. i will not say that it should be outlawed, thrown out, taken away. i will remind us of something.
if we look back at the prohibition of alcohol, which is what we have now for marijuana, if we go back to the alcohol days the use of alcohol per capita dropped almost 50% as a result of prohibition. the prevalence of alcohol-related disease dropped prohibition. in it may have been a political failure, but it was an enormous .ublic health success what we have with marijuana is the public health success. and get ridh that of prohibition, as we did with alcohol, we will see the same saw with alcohol. increased per capita use of marijuana, followed by increased problems of addiction related to
marijuana. let me ask this group something because we are on air, i will ask you to raise your hands, how many of you ever used opioids as a recreational drug? keep your hands up. how many of you started out with a drug other than an opiate, like marijuana. the hands are still up. you didn't go the other direction? opiates first, then marijuana? you started with marijuana then moved to opiates. i would not make the argument that everybody who uses marijuana will move on to opiates. did you knowu, that when you first used marijuana that you were going to end up using heroin? >> no. dr. gitlow: that didn't occur to
you. you said that will never be me. for those of you watching on tv saying "that will never be me." you just don't know. [applause] dr. gitlow: it has been an absolute pleasure speaking with you. this is still the favorite place i come to each year. thank you so much. my hat is off to you for all that you do. [cheers and applause] announcer: attorney general jeff sessions will talk about the deferred action for childhood arrivals program today. he is scheduled to