The dos and don’ts of helping a drug addict recover | Maia Szalavitz | Big Think

Summary

The transcript discusses the ineffectiveness of brain surgery for addiction compared to methadone, which is a safer and non-invasive treatment. It emphasizes the importance of methadone and buprenorphine in reducing death rates by 50% for opioid addiction. The speaker advocates for compassion and empathy in addressing addiction, rather than tough love, and stresses the need for evidence-based treatment. They also advise employers to support employees with addiction by advocating for them and ensuring treatment is evidence-based, not profit-driven.

Takeaways

• 🚫 Brain surgery for addiction is not more effective than methadone and is an invasive procedure.
• 💊 Methadone and buprenorphine are the best current treatments for opioid addiction, reducing the death rate by 50%.
• 🛑 These treatments allow users to lead normal lives without being high or impaired, contrary to the misconception of substituting one addiction for another.
• 🤝 Addiction is a learning disorder, not a moral failing, and should be approached with compassion and empathy, not tough love.
• 🏢 Employers should create a supportive environment for those with addiction, focusing on inclusion and safety rather than adversarial measures.
• 🚫 Firing an employee with addiction is not a helpful intervention; it can lead to homelessness and death rather than recovery.
• 🤔 It's crucial to approach potential addiction issues with respect and without assumptions to avoid damaging trust.
• 🧠 A thorough psychiatric evaluation is essential before seeking treatment to understand the underlying issues and appropriate services needed.
• ⚖️ The addiction treatment industry can be profit-driven and lacks standardization, so it's important to advocate for evidence-based care.
• 🏥 Employers can significantly influence the quality of care by demanding that treatment providers they work with follow evidence-based practices.

Q & A

What is the speaker's opinion on using brain surgery for addiction treatment?

The speaker believes that brain surgery for addiction treatment, specifically using electrical stimulation, is not more effective than methadone and is an invasive procedure.

According to the speaker, what are the two best treatments for opioid addiction?

The speaker states that methadone and buprenorphine, which are opioid agonists, are the best treatments for opioid addiction.

How do methadone and buprenorphine contribute to harm reduction in opioid addiction?

These treatments cut the death rate by 50 percent, regardless of whether the person continues using drugs or not, thus providing a significant harm reduction benefit.

What is the speaker's perspective on the concept of addiction being a learning disorder?

The speaker views addiction as a learning disorder rather than a sign of being a bad person, emphasizing the importance of understanding and compassion.

Why is it important to approach someone with addiction with compassion and empathy according to the speaker?

The speaker argues that compassion and empathy are crucial because research shows they are the best ways to help people with addiction, as opposed to tough love or adversarial approaches.

What is the speaker's advice on how employers should handle employees with addiction?

The speaker advises employers to approach employees with addiction as allies, not adversaries, and to help them realize that addiction is not a sin but a condition that can be managed with support.

What is the speaker's stance on the idea of 'tough love' in addiction treatment?

The speaker is against 'tough love' approaches, suggesting that they can lead to negative outcomes like homelessness and death, rather than helping the person with addiction.

Why is it important to not assume a problem is drug-related when approaching someone with potential addiction?

The speaker emphasizes that assuming a problem is drug-related can damage trust and that it's important to approach the person with respect and without preconceived notions, as there could be other underlying issues.

How does the speaker suggest approaching a conversation about potential addiction with someone?

The speaker suggests approaching the conversation from a place of concern and offering help, rather than accusation, and focusing on the individual's well-being.

What is the speaker's recommendation for the initial step in getting help for someone with addiction?

The speaker recommends a complete thorough psychiatric evaluation by an unbiased professional as the first step to understand the problems and the appropriate services needed.

Why is it challenging to find evidence-based addiction treatment according to the speaker?

The speaker points out that the addiction treatment industry is largely based on reputation and advertising, making it difficult to find programs that provide evidence-based care, unlike other areas of medicine.

Outlines

00:00

💉 Debunking Brain Surgery for Addiction

The speaker refutes the idea that brain surgery for addiction is more effective than methadone, emphasizing that methadone and buprenorphine are the best non-invasive treatments available. These treatments reduce the death rate by 50% and allow individuals to lead normal lives without being high or impaired. The speaker clarifies misconceptions about substituting one addiction for another, explaining that physical dependence is not as problematic as compulsive behavior and can be managed with a safe and legal supply. The paragraph concludes with the assertion that addiction is a learning disorder, not a moral failing, and that compassionate support is more effective than tough love in helping individuals with addiction.

05:04

🤝 Approaching Addiction with Empathy

The speaker discusses the importance of approaching addiction with empathy and understanding, rather than through confrontation or punishment. They argue that people often deny having a problem for valid psychological reasons, and that breaking through this denial should be done with care and respect. The speaker suggests that the first step in helping someone with addiction should be a thorough psychiatric evaluation to understand the underlying issues. They also warn against the 'buyer beware' nature of the addiction treatment industry, where not all providers offer evidence-based care. The speaker emphasizes the need for employers to advocate for their employees by demanding evidence-based treatment options and to approach the issue with compassion, not as a moral failing.

Keywords

💡Brain surgery for addiction

This refers to the controversial practice of using invasive surgical procedures to treat addiction. In the script, it is mentioned that such methods do not show better efficacy than methadone, which is a less invasive treatment. This concept is significant as it underscores the video's theme of questioning extreme measures for addiction treatment and advocating for evidence-based approaches.

💡Methadone

Methadone is an opioid agonist medication used to treat opioid addiction. The script highlights its effectiveness in reducing the death rate by 50 percent, which is a critical aspect of harm reduction in addiction treatment. Methadone is used as an example of a more conventional and less invasive treatment option compared to brain surgery.

💡Buprenorphine

Buprenorphine is another opioid agonist mentioned alongside methadone as a first-line treatment for opioid addiction. It is noted for its ability to help stabilize the lives of those who are ready, allowing them to function normally without being high or impaired. This keyword is important as it represents a medical approach to addiction that is both effective and less stigmatizing.

💡Harm reduction

Harm reduction is a public health approach that aims to minimize the negative consequences of behaviors, such as drug use, without necessarily eliminating the behavior itself. In the context of the video, harm reduction is exemplified by the life-saving effects of methadone and buprenorphine, which reduce the death rate among opioid users.

💡Physical dependence

Physical dependence refers to the body's adaptation to a substance, leading to withdrawal symptoms upon cessation. The script differentiates between physical dependence and addiction, explaining that the former is not as problematic as long as there is a safe and legal supply of the substance. This concept is crucial for understanding the nuanced view of addiction presented in the video.

💡Compassion and empathy

These terms are central to the video's message about the importance of a supportive and understanding approach to addiction. The script argues against the 'tough love' approach, suggesting that compassion and empathy are more effective in helping individuals with addiction seek and sustain treatment.

💡Inclusion and safety

Inclusion and safety are emphasized as essential elements for creating an environment where individuals with addiction feel comfortable seeking help. The script suggests that a non-adversarial and supportive atmosphere is more conducive to recovery than a punitive one.

💡Evidence-based care

Evidence-based care refers to medical practices that are supported by scientific evidence. The video advocates for seeking treatment from providers who offer evidence-based care, rather than those who may be profit-driven and offer ineffective treatments. This keyword is significant as it underscores the need for quality and effectiveness in addiction treatment.

💡Denial

Denial is a psychological defense mechanism where individuals refuse to accept reality, often used in the context of addiction to describe the reluctance to acknowledge a substance abuse problem. The script suggests understanding denial as a natural response, rather than a barrier to be broken down, which reflects a more empathetic approach to addiction treatment.

💡Psychiatric evaluation

A psychiatric evaluation is a thorough assessment of an individual's mental health, which the script recommends as the first step for anyone seeking treatment for addiction. This evaluation helps to identify the underlying issues and appropriate treatment paths, emphasizing the importance of personalized and comprehensive care.

💡Maintenance treatment

Maintenance treatment refers to long-term use of medications like methadone or buprenorphine to manage opioid addiction. The script discusses the benefits of such treatment, including a reduced risk of death, and contrasts it with abstinence-only approaches, highlighting the video's theme of advocating for the most effective and evidence-based treatment options.

Highlights

Brain surgery for addiction is not more effective than methadone.

Methadone and buprenorphine are the best current treatments for opioid addiction.

These treatments cut the death rate by 50 percent, regardless of continued use.

Opioid agonists allow people to stabilize their lives without being high or impaired.

Physical dependence is not a real problem as long as there is a safe and legal supply.

Addiction is a learning disorder, not a sign of being a bad person.

Compassion, empathy, and support are the best ways to help someone with addiction.

Tough love is not effective in helping individuals with addiction.

Firing an employee with addiction should not be seen as a favor to help them hit bottom.

Creating extra-negative consequences is not guaranteed to help someone with addiction.

Approaching someone with addiction should be done with respect and without assumptions.

Confrontational approaches can destroy trust and are not recommended.

Denial is a defense mechanism and people have reasons for it.

Approaching someone with addiction should be from a stance of befriending, not attacking.

Reducing harm is a key goal in dealing with addiction.

A complete psychiatric evaluation is the first step in helping someone with addiction.

Treatment providers should be chosen based on evidence-based care, not just reputation or advertising.

Employers can advocate for evidence-based treatment for employees with addiction.

Employers should demand that treatment providers they work with offer evidence-based care.

Transcripts

There are people who are trying to promote brain surgery for addiction using electrical

stimulation of that area and it doesn't work any better than methadone.

And that's not to say that methadone isn't the most useful drug we currently have, but

it does not involve invasive surgery!

And I should say methadone and buprenorphine, the opioid agonists, are the best treatments

that we have for opioid addiction.

And what they do is two things: the first thing is they cut the death rate by 50 percent,

which is this happens whether you continue using on top or not.

So that's like pure harm reduction and that's wonderful.

If we can keep you alive long enough that you stabilize your life, that is a lot better

than having you die.

The other thing that they do is they allow people (who are ready) to stabilize their

lives.

So you couldn't tell right now if I was on a maintenance treatment or not because basically

once you get a tolerance to these drugs you are not high or impaired, and you can drive

and you can work and you can love and you can do all of these things, but we don't understand,

we think “oh you've just substituted one addiction for another.”

No, what you've done is you've substituted compulsive behavior despite negative consequences,

and now you just have a physical dependence.

And that's not a real problem as long as you have a safe and legal supply.

Well, I think the most important place to start is that addiction is a learning disorder;

it's not a sign that you're a bad person.

And if you want to have a safe and addiction free, or at least lower level addiction workplace

or school, you want people to feel included and comfortable and safe and you don't want

this to be an adversarial thing.

The research shows that the best way to get people help is through compassion and empathy

and support, and absolutely NOT tough love.

There may be situations in which an employer has to fire somebody because their performance

has just degraded so much that there's no other option, but they shouldn't think “I’m

doing them a favor by firing them, because that will make them hit bottom and it will

help them.”

Sometimes that happens, but sometimes they just go on to a life of homelessness and then

die.

So you can't assume that creating extra-negative consequences is actually going to help a person

with addiction.

What you want to do is ally yourself with them, and presuming this is an employee that

you want to keep, help them realize that this is not a sin.

“I am not trying to control you.

What I want to do is for you to be at your best; at work, at home.

And you're not being at your best right now, so what can we do to help?”

Well, I think the important way to start that conversation is to first not assume that a

problem that you think might be drugs is drugs.

The person could be having any number of mental illnesses, the person could be having, you

know, there's a million things that could look like oh you think they have a drug problem

and there's something else going on.

So if you approach the person with respect and not assuming that you're going to find

a drug thing, obviously in some situations it's completely obvious, but in most situations

it isn't.

And so the best way I think is to say “I’ve noticed XYZ.

I'm worried about you.

I'm concerned about you.

I want to make sure that I can help you.”

So it comes from a place of not like “I caught you!” you know, because there's so

much advice that is just like “well, threaten to fire them if they don't change, and drug

test them immediately” and all of this kind of stuff, which destroys trust.

So, that's not to say that if somebody is doing something dangerous or clearly inappropriate

that that behavior doesn't need to be addressed, but it is to say that you can approach somebody

in a confrontational degrading and sort of high-powered manner or you can approach them

as an equal human being deserving of respect.

And if you do the latter you will have much better results.

And I have to say it's almost and never going to be easy because people, whether they have

addiction or mental illness or anything else going on with them, often don't want to admit

to themselves that there's a problem.

In the addiction's field there's been this whole thing we've got to break through denial

and everything like that, well people have denial for good reasons.

If we didn't have denial everybody would be sitting around obsessing about death, or at

least I would be.

It's a defense mechanism because we need defending.

So recognizing that can allow you to sort of approach somebody not from an attacking

stance, approach somebody from a befriending sort of stance.

And that is hard to do and some people are going to get very defensive no matter what

you do and it's not going to be a pleasant conversation most of the time.

But you can minimize harm.

I mean this whole thing always comes down to like reducing harm, making things less

unpleasant if you can't make them non-unpleasant (or actually pleasant).

But the main thing is like see them as a full human being.

And I think really important in getting people into any kind of treatment is that, and I

always say this to parents or anybody who has an addictive loved one, the first step

should always be a complete thorough psychiatric evaluation by somebody who is not affiliated

with any treatment organization so that you can know going in what the problems may be

and what kind of services you should be seeking.

There are some absolutely wonderful treatment providers who if somebody shows up who is

not appropriate for their services they will send them away.

There are also unfortunately many people who will just take that person to make a profit

off of them and they will not help that person and they will not inform them of that, for

example, if they stayed on maintenance they would have a 50 percent reduction in their

death risk.

They would just say “we do abstinence; that's good for you.”

Blah.

And so I think, again, this is a sort of “buyer beware” industry.

In the rest of the medicine it's pretty easy to say, “Okay, here is PubMed, this is the

treatment for this particular cancer that has the most evidence behind it, and here's

the guy who designed the best treatment.

Let's go find this person.”

In addiction it's like virtually all based on like reputation and advertising, and it

is very difficult to actually find programs that provide evidence-based care.

This is also a problem in mental health more generally.

But anyway, the point here is that in order to get care that is good for you you need

to advocate for yourself, and if you have an employer that's willing to advocate for

you that's even better.

The way I think that employers could do an enormous amount of good by demanding that

the treatment providers they work with, the treatment that they cover is evidence- based,

and is not restricted because of money but is restricted because stuff that doesn't work

shouldn't be paid for.