- Coming up on WTVP's "Docs on Call," Addiction.

We explore the reasons behind the disease, and how you can help yourself and others.

(bright upbeat music) (bright upbeat music continues) Good evening and thanks for joining us for WTVP'S "Docs on Call," I'm Mark Welp.

September is National Alcohol and Drug Addiction Recovery Awareness Month.

And to give you more information on addiction, we have Dr.

Robert Lizer.

He is board certified in Family Medicine and Addiction Medicine, and he is the medical director of the Addiction Recovery Center or ARC, at Carl Health Proctor Hospital.

Thanks for coming in, doctor.

- Thank you for having me.

- Great to see you.

So we talk about addiction, and some people say, Hey, I'm addicted to chocolate, I'm addicted to this TV show.

But it's a lot more serious than that for a lot of people.

How do you define addiction?

- Addiction is a term we toss around very loosely, I have a talk that I give, I'm addicted to chocolate cake, you know.

And so when you really get into addiction, we define it as a chronic brain disease with continued use despite negative consequences.

So you continue to use substances or have behaviors, and the negative consequences keep coming, but you continue to use.

And it's that chronicity in nature, which kind of begins to develop as the addiction is what it is.

- So if I'm understanding this right, there's behavioral addiction, and then there's also substance use disorder.

Can you kind of differentiate between those two things?

- Sure, when we talk about substances, we're talking about physical substances, we talk about alcohol, we talk about tobacco, cocaine, methamphetamine, opioids, as an opioid epidemic, heroin, those are the types of physical substances.

But then we have behavioral substances or behaviors that are more like gambling, pornography, gaming, internet, overeating, shopping disorders, compulsion disorders, is what those are.

- And how are they, how are those two categories similar, and how are they different?

- So whenever you have an addiction, I always use this analogy when I talk about addiction to patients, because they don't understand, and that's a big part, is about educating these patients.

When you think about addiction, you think about it as a chronic brain disease.

And so you have the middle of the brain, which is our reward center.

When someone says, "Hey, great job, you look great today."

You get a rise in this happy neurochemical called dopamine.

So dopamine makes us feel good with everything.

But when you use substances, or have a behavior, it also increases dopamine too, and the brain goes, oh my gosh, I love this, I want more of this.

Now, the front of the brain, which is our higher executive function, that tells us to take a left, take a right, yes, or no, is usually in control.

But what happens is that the substance and behaviors are so strong in this chemical reaction that you lose control, it's a loss of control because, you know you shouldn't drink because it causes cirrhosis, it causes all these negative problems, but the reward center says, "Hey, I want more of the substance."

And so we keep using it despite knowing that, and that's what happens with a lot of people, is that, Hey, we know we shouldn't do this, but we continue to do this.

So it comes down to that neurochemical response and euphoria within the brain is what it does.

- How much is that neuro response, and how much is, or maybe it's the same thing, your psyche convincing you that, Hey, I need a drink to get through the day, or I need another drug to get through the day.

- It's a little bit of both.

And we know that we always say this is not a moral failing, people don't choose to become an addict.

We always kind of define it as a biocycle social disease, a biological meaning, there's a genetic predisposition to it.

So if you have one parent that has an alcohol use problem, about 30% chance you're gonna have a possibility of developing.

And then you have the psychological, you know, is there some anxiety, depression, and other mental health issues that do it?

And then you have the social, what is else is going on, the peers, everything else that goes with it.

But as far as the question's concerned, you know, definitely it's more of that reward and the brain wanting that to have more substances, and in the fact that it does drive a lot of people to want to use substances throughout the day.

- What kind of addictions are you dealing with most?

And I mean, is there one or two addictions in our area, Central Illinois, that are really dangerous?

And, well, they're all dangerous, but really prevalent I should say?

- Well, I think if you look at, we treat all the addictions, definitely alcohol is a big one that a lot of people are focused on, and that we see in our facility and our patient facilities.

Definitely if you look in the Peoria community, the Peoria County has a higher alcohol use than the rest of the state.

And so alcohol's big.

Obviously the opioid epidemic over the past few years with the rights of fentanyl and other substances has been a big thing that we do treat also.

But then gambling, you know, we always forget about gambling.

Gambling is such a big behavior addiction.

There are so many casinos in Illinois, we have gaming cafes, we have all of these, that gaming, and that gambling is such a big thing.

And then we have cocaine addictions, we have the methamphetamines addiction.

And then obviously with marijuana being legalized, we still do see cannabinoid use disorders with that also.

- Has there been any studies done, you know, since marijuana has become legal, to say, more people are addicted, less people are addicted, anything like that?

- There are studies in process, let's say, because now that it's legal, we have more opportunity to do the studies, and that was one of the positives about it being legalized, is we can now study it more and seeing, okay, what certain percentage of people do or develop a use disorder from the marijuana.

- So how do you, how does one know if they're an addict, or how can a family member spot someone who they think is an addict, what should they look for?

- And that's always kind of difficult, because there's so many different levels of substance use, whether they're a social user, if they're a heavy drinker or heavy user.

Yeah, I think we can split it into two areas; we can say physical, and then emotional.

So physical ways are there changes in their behavior.

Have they gained weight, have they lost weight?

Have they not taken care of their daily health?

Have they not showered for a while?

Are there bruises on their skins due to coordination of being intoxicated from the substances?

Or they have fractured ribs, other fractures within the body?

You know, is their nutrition poor?

Do they have more excitability at inappropriate times at 3, 5, 6 o'clock in the morning from using stimulants, whether it's cocaine, methamphetamines, things like that?

And so those are the physical type of things to look for as far as the changes.

And then emotional, you know, we see changes in people's personality.

Are they more irritable, more cranky?

Do you see more depression, are they more withdrawn, do they have more anxiety?

So all these things can definitely be clues to it.

And have they stopped doing social obligations, or family obligations?

Are they not showing up for family functions?

Are they not showing up for work?

Are they calling in to work?

You know, these are all the clues.

And do they have withdrawal symptoms as far as being more irritable from not having substance?

'Cause we talked about substances providing happiness, euphoria, and once we don't have the substances, we get cranky, we get irritable, we have those types of things, and so, is there a switch or something from people just unable to get the substance and have those emotional?

So those are kind of the ways that I, when I look at it, but still that doesn't, it's very hard to pick out somebody that can be, have a social alcohol use problem.

- When someone wants to get help for an addiction, is it typically after they've hit "rock bottom," and something awful has happened, and they finally realize they need help?

Or do some people just say, you know what, I'm sick and tired of being sick and tired.

- I see both is what I see.

Definitely, I see people that are brought in by a loved one, a spouse, I see people that are brought in by their work, because they showed up intoxicated at work, or they're hung over, and they still have alcohol in their system.

So it's always those loved ones, those close people.

You know, we talked about interventions you've heard of when someone has a use problem.

And so a lot of times people are brought in that way.

Other people are like, Hey, I'm just tired of this lifestyle, I'm tired of being tired, I'm tired of having to spend this ungodly amount of money for substances every week.

And when I'm not able or I'm unable to pay my house payment, my car payment, because I'm spending so much money.

And so that drives people in, and some people just say, Hey, I'm ready to be done.

And they show up on our doorstep for an assessment and evaluation.

- For people who haven't had an addiction, it's sometimes hard to understand why someone can't just stop cold turkey and all these other things.

If someone is hooked on meth, cocaine, something like that, is there such a thing as quitting cold turkey?

Does that happen?

- Well, that's, yes, it does happen.

But the risk of relapse is high.

We have people that come into our facility because they want to detox off substances, whether it's alcohol, meth, coke, or whatever, that's great.

But then they just want to detox and go home.

With what I see is that, if you don't do a recovery program after detox, probably that first 90 days you have a 60% to 90% chance of having a relapse.

And that's the biggest thing.

Yeah, you can quit cold turkey, but when we go back to that neurological process, the brain is still wired for that substance.

It still wants has substance.

And like for alcohol, I always say it takes about 12 to 18 months sometimes to stop that desire.

I mean, you always will want to that substance, just like, let's talk tobacco.

We have people that quit cold turkey, but years later they still say, Hey, I haven't smoked for 20 years, but I'd still like a cigarette right now.

It's 'cause the brain never forgets what it's like to have that euphoria on that substance.

And so you gotta, you have to really do the recovery after just the detox or you're you're going to relapse.

- And when you do the recovery, is that kind of rewiring the brain to... - It is, it's supporting it.

I always say you need accountability and support in recovery, and that's the biggest thing.

When people come to inpatient with us, we help them with their triggers, we help them with their medical issues, we emotionally support them.

Because during that first four weeks or so, you're craving that substance pretty much all the time.

And that's a big part, and that's where you need that solid recovery to say, okay, this is what I'm doing, I don't have access to the substance, which obviously helps.

But then as time goes on, it's stepping down in a stepwise to help with that recovery, like after inpatient, which is usually 30 to 90 days, depending on the facility, then we go to an outpatient program.

And those outpatient programs help you deal with recovery.

But also that daily function of life is what it does, because it's stressful in recovery.

You're busy with recovery, you have life, you still have all the stressors, you have the coping issues is what it is.

And so I always say you need that safe place to go after you go to inpatient because if not, I can give you the best education and treatment inpatient.

But if you don't do that follow up as an outpatient, or you go back to same situation, same using friends, same place that has the cocaine, everything, you're gonna relapse, is what it comes down to.

- Sure.

We talked about some signs earlier, now one of the hardest parts I guess, is getting to rehab.

If you're a family member and you suspect someone or you flat out know someone in your family has a problem, how do you navigate that?

- That's always the tough one.

And I think that if you really know that someone has a use problem, whether it's alcohol or hard substances, or as a gambling problem, I think just starting that conversation in a casual.

You know, don't say you need to go to recovery, you have to go to detox.

'Cause human nature is, when I tell you to do something, you don't want to do it.

And just like, we counsel people, quit smoking, quit smoking, but you have to have that buy-in for the patient.

And so as a family member, you definitely have to have those conversations.

And that first conversation might not even be about recovery.

It might be, Hey, do you think you're using too much of a substance?

And so you have to have those conversations, and you have to have it when the person is sober.

They can't be using it at that time.

You have to have it a neutral place, because if you have it at some place, they might really be defensive, and then you've lost them all together.

And if somebody is very resistant at first to, oh, how dare you bring that up, you don't keep pressuring them.

You back off and you come back another time.

And so you just kind of continue to have that ongoing conversation with them till they say, Hey, have you ever thought about coming in for an assessment?

Not, have you thought of going to rehab?

What about an assessment?

Come see the medical professionals who could say, Hey, you do have a problem, or you don't have a problem, is what it comes down to.

- Are interventions by family and friends something that's worthwhile, or should those people focus on getting the person they're worried about to a professional first, like you?

- I think it's both ways, I think one is getting, you can do the intervention, but I think that that needs to be followed up with getting them in for that assessment, a professional to say, yes you do have a problem.

Because most people, and certainly friends don't understand addiction, and that's not their fault, they just don't understand the repercussions and the disease process, and so getting them in for that evaluation with a professional is the next step.

- Can you give us an idea of what the inpatient program is like?

Because there may be people out there who are thinking, oh, that's scary, they're gonna take all my stuff, I won't be able to talk to my family, I can't afford it, kind of walk us through that.

- So, it depends on obviously if you need the detoxification or the detox phase.

You know, a detox is that medically managed withdrawal.

So we use medications to help support them during that.

Anywhere from three days to seven days as far as that's concerned.

At that time, the conversation with the family is kinda limited with the patient, because we're trying to get them more stable medically.

And then we look at just the inpatient portion is, yeah, everyone kind of says, oh this is like a prison in here.

But the thing about recovery is, you have to have boundaries.

'Cause if you don't have boundaries, a lot of times everything gets veered off.

But people come in, yes, we have phone times, we do allow people to do some work on the computers if they have a job, because not everybody can say, oh, I'm just gonna take 30 days off my life.

I mean that's the whole thing, that's my livelihood, pace of my house, my car, all these things.

And so we want to try to help people with that.

But as I always say is that if you continue using, you're gonna lose all those things anyway.

Whether it's a DUI, whether it's a relationship issue.

So in the recovery program we have meetings on the hour that talk about different behaviors.

We use cognitive behavioral therapy, which kinda identifies patterns for relapse, and triggers with that.

We do motivational interviewing, but we do some other really interesting things, we have music therapy, we have yoga, definitely physical exercise is one of my favorite things.

Like, well at the ARC we have a new state-of-the art gym that we use all the time because, you're cooped up in these groups, you wanna get out there and just to blow off some steam.

And so we have the walking track, we have the exercise, and definitely exercise increases that happy neurochemical, dopamine again.

And so that is a big part about it.

And so all these are peer-based programs, which are programs which I think are so important.

If you look at the research, peer-based programs I think are more beneficial than individual counseling.

We have many people, and don't get me wrong, individual counseling helps many people in their emotional needs, but peer-based programs are such an important part about it.

So we have all these groups, we have different topics we discuss, we talked about relapse prevention, we have trigger exercises, they have the groups, they have individual activities is what they have.

And this goes for all the facilities, not just the ARC, it goes for our women's unit, New Leaf, the men's unit, the Knolls, they do the same thing with everything is what it is.

So it's a busy time for them.

I mean they're up at seven, eight, and they're going until 10 o'clock at nighttime.

- And does insurance typically pay for at least a portion of this?

- They do.

It depends all obviously on the insurance, as you know, insurance is always the rate limiting problem with anything in the medical field.

And so many times they'll dictate how many days they'll pay for.

Some insurances are better, depends on what type of plan you have.

But we have all different levels of care for the insurances between all the facilities with Trillium, which is nice.

And so heaven forbid they don't pay for the ARC, maybe they'll pay for the Knolls or New Leaf as another facility, depending on that insurance.

And so definitely it's a big, big issue, because, insurance unfortunately is, yeah, it limits people on the recovery.

- Sure.

I wanted to ask you too, when you deal with addicts and people having these issues, is there a certain type of person that you see more than others in terms of sex, race, religion, or is it just pretty widespread?

- It's pretty widespread.

I think if you got into the nitty gritty, and drill down to it, you could probably get some specifics out there, but what I see, it's pretty much spread across the board.

But the thing about addiction, it doesn't matter if you're homeless, or you make $500,000 a year, you're still at risk of developing an addiction.

And so we see people from all walks of life.

And when people are in there, it's just about the individual.

So it's a lot of different mix, is what it is with everything we see.

- What about young people, and young adults?

Are you seeing more of them as you've gone on your years of doing this?

Is it gone up down as far as younger people becoming addicts?

- I think it is.

You know, we treat 18 years or older, or at this point in time we don't, we used to have a facility that did the teenagers but currently don't, hopefully in the future we will.

But definitely we see that 18 to 25 range.

We see a lot of designer drugs, we see a lot of drugs that are used in clubs.

We see a lot of drugs that are sold at gas stations, like one called Kratom, which looks like and acts like an opioid.

You know, you get euphoria out of it, you get energy, and that's what all these smoke shops push, and they don't, people don't realize it.

But I see that usually with the younger population, just like nitrous oxide, or the old whippets with everything.

Definitely that is used out there too.

So we know that the younger you start to use a substance, the higher risk of developing a use disorder you have.

And so usually about between ages 18 to 25, we see a lot of those individuals start to come our way, is what we do - Well as far as those young people, what can we as adults, family members, community members do to try and prevent our kids from getting hooked on these substances?

- That's always a tough question.

I don't think we can ever guarantee it someone won't develop an addiction.

We can't, we can't say, oh do these things, and they'll never have a problem.

We can reduce the likelihood of having a problem.

And I think that starts when they're young teenagers, is what it is.

It's having that open, honest conversation with them.

You know, we don't use scare tactics, or anything with teenagers, 'cause they just don't respond to it.

You gotta use concrete statistics, everything.

Use, you know, what's happening in the world, news reports, studies with the opioids, things that are in the news, and given the concrete stuff.

But I think having that open relationship, that two-way conversation where, they can come to you with any problem, and you're not gonna say, oh, how dare you've been drinking, or how dare you use cocaine or anything like that.

You can't be that that accusation person, because you want them to come with you, and that's any type of problem with it.

Then also just be present in their life, and also model your behavior too.

Because our kids pick up what we do as parents.

You know, if you have a parent that's stricken a six pack, 12 pack a night, they're like, Hey, dad does it, it must be okay.

Or if they're smoking marijuana on time, hey, it's legal, it must be okay, let's do it.

Or however your do these substances.

So you have to really be careful of your behavior around your kids because as we know, our kids pick up our behaviors all the time is what they do.

So it's a combination of all things, it's just being present for their life, and having that open conversations, and if there's any questions, you know, you can always have them talk to their pediatrician, their family practice physician, or you know, or see a counselor with that.

And the other big things with teenagers these days is coping skills.

You know, with our modern technology, we're behind our phones, we can say whatever we want.

But we need to develop better coping skills, we need to help our kids develop coping skills.

'Cause many of the people I see as adults have poor coping skills.

They can't handle a stressful situation.

They can't handle stress at a job or a relationship.

And so what do they do?

They turn to substances.

And the same thing with gambling.

People gamble because, many people have anxiety of other issues, is what they have, and they're like, oh, this relaxes me, this makes me feel better.

And this is where a lot of that comes through.

- Doctor, a lot of good information, we appreciate your time, and keep up the good work.

- All right, thank you for having me.

- Thank you Dr.

Robert Lizer with Carl Health, our guest tonight.

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