April 30, 2025
Understanding Addiction as a Disease ~ Know Science, NO Stigma
Understanding Addiction - Know Science, No Stigma... Interview with Dr. Charles Smith, author of this most informative book ... a must-read for those struggling from the tragic effects of drugs and alcohol.. and for their families to understand the behaviors often associated with this disease of addiction.
Dr. Smith is an expert in this field with personal, firsthand experience with the humiliation and shame that accompanies substance use disorder. He points out that addiction is a disease .. no less so than diabetes, heart disease or hypertension... and needs to be treated as such.
Unlike most other illnesses, substance use disorder is characterized predominantly by behavior. Stigma is our biggest killer. It is a deterrent in combatting addiction and to get to the root of this disease. It hinders growth and progression.
Knowledge is POWER...
https://www.amazon.com/Understanding-Addiction-Know-Science-Stigma/dp/173723520X
The Fatal Facts of Fentanyl podcast is dedicated to raising Awareness to the illicit FENTANYL crisis hitting the USA.
The goal is to SAVE LIVES and families from this travesty.
Awareness and Education are the Key.
Knowledge is Power!
The Fatal Facts of Fentanyl podcast is dedicated to raising Awareness to the illicit FENTANYL crisis hitting the USA.
The goal is to SAVE LIVES and families from this travesty.
Awareness and Education are the Key.
Knowledge is Power!
00:00 - Understanding Addiction: Breaking Stigma
08:42 - The Dopamine Reward System Explained
14:30 - Personal Journey from Doctor to Patient
21:50 - Risk Factors for Addiction
30:11 - Treatment and Recovery Timeline
42:29 - Illicit Fentanyl: A National Crisis
51:57 - Remission and Living in Recovery
WEBVTT
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Understanding Addiction.
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Know Science, which is K-N-O-W, and NO Stigma, which is N-O.
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Let's end stigma surrounding addiction in this country.
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Stigma is our biggest killer.
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I have today as my guest Dr Charles Smith.
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He and his colleague Dr Jason Hunt are the authors of their book Understanding Addiction ~ Know Science, No Stigma.
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They bring a unique and important perspective to the subject of addiction.
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An expert in this field, Dr Smith, has a personal, firsthand experience with the shame and humiliation that accompanies substance use disorder.
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Addiction is a disease, no less so than diabetes or heart disease, and it needs to be treated as such.
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Hi, Charles, Welcome.
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I hope you don't mind me calling you Charles, but first let's clarify that statement for our audience.
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Addiction is a disease.
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Tell me what you know about that and let's begin with the science behind that statement.
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Well, my interest in that particular phrase happened when I went to treatment myself in 2009.
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I had been a family practice physician in West Virginia and Kentucky for 26 years and in 2009, due to a series of interventions that I describe in the book, I went to treatment myself.
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But when I got there and spoke with the addiction medicine physician and the counselors and the therapists, they told me you have a disease.
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And I said wait a minute, I drank too much, okay, and you know I got hooked on those pills, but that can happen to anyone, because I had a sample cabinet full of them and that was my knowledge and my mindset at that point.
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And, of course, that was almost 13 years ago now.
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Since then, I have learned that it is a disease just like diabetes, just like heart disease, just like hypertension, and it can be identified through a particular area of the brain and a particular system of the brain the dopamine reward system and the dopamine reward system's effect on the prefrontal cortex and our decision making.
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And that's really what prompted me to write the book.
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I check in patients at the two detoxes that I work here in South Florida daily and I go over this with them that certainly they did have some bad behaviors, but I think those bad behaviors can be explained due to the fact that he had a vulnerable dopamine reward system.
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I read your book, by the way, thank you, and I actually learned a lot from it.
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I wish I knew then what I know now that I've learned more about addiction.
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Can you explain to our audience about what you mean about the dopamine receptors, because a lot of us parents or people who have a loved one who has an addiction, especially an opioid addiction, we can never understand why can't they just stop, like you know?
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Explain that to us.
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I mean, I found it very interesting about that part of the brain.
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Well, you know, I always start out by using that little example.
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The newborn infant you have a newborn infant in the nursery goes through the trauma of childbirth.
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Then you know a couple of hours he's going to be laying under the incubator and he's going to start crying.
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So I always pull my audience.
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Why does this baby start crying?
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And people will say all sorts of things he's cold, he's wet, the lights are too bright, he misses his mother.
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But the bottom line answer is he's hungry.
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So his dopamine reward system signals him that there's stress and trauma and if he doesn't get some carbohydrates he's going to die, which is the fact.
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So when that infant gets carbohydrates, his dopamine reaches up to near top, what I call top normal levels.
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It goes up to almost 200 in the midbrain.
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When that happens, the infant's calm and serene, his restless, irritable, discontent goes away and he's comfortable.
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That system continues to operate on through life, with dopamine being released for eating when you're hungry, drinking fluids when you're thirsty, escaping danger.
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Even sex gives normal dopamine releases which start to modify our behaviors because we have that inherent desire to sustain life.
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Ben enters mind-altering substances and that's anything that releases dopamine higher than 200, alcohol, opiates, benzodiazepines, cannabis, amphetamines, and when those are released at that much higher level, it's a little bit like noise exposure hearing loss.
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If you go to a rock concert, what can you hear the next day?
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Not very much, just ringing in your ears.
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So those massive releases of dopamine are what dysregulate the system, and of particular importance here is that about 9 out of 10 people cannot accept those massive releases of dopamine the 1 in 10 people in the general population that can have a vulnerable dopamine reward system, and they're the ones that are very much at risk for the disease of addiction.
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I find it so fascinating because we all know people that can drink or do pills or whatever, and it doesn't affect them.
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They can easily walk away from it.
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And then we also have people that can drink or do pills and they become highly addicted to them.
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So I guess are you saying that some people's dopamine levels, that's what happens to the brain, why they just can't stop that population that I'm describing, that actually, that you had you know that exactly?
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Is that right?
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Yes, that's exactly what I had.
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I had many of the risk factors that set me up to be able to accept that reward when that large rewards release, and primarily that's due to dopamine subtype receptors.
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But there are also other factors involved.
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As far as amounts of dopamine released, the ability to accept that dopamine, it isn't quite as simple as that.
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I can simply accept the reward.
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But there's many other social factors involved.
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But the bottom line I use this as an example with patients many times of what I call an addiction stress test.
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And if I go up to anyone at a restaurant maybe they're having a margarita and I say well, you know what, it's your lucky day.
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You get five more margaritas on the house.
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Nine out of 10 people will decline those and when you ask them why, they're going to say very simply I don't like the way five make me feel.
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None of us at risk for the disease of addiction are going to say that Now we may decline that extra five if we still have the ability to make good decisions.
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Maybe we know we're driving, Maybe we don't have to work the next day, but for the most part we want them.
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So that's my stress test for addiction.
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Now it may not be that alcohol is the drug of choice.
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Maybe it was opiates, Maybe it's cannabis, Maybe it's cocaine, Maybe it's amphetamines, but the bottom line is nine out of 10 people simply don't enjoy or are able to receive that reward from those massive amounts of dopamine.
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That makes sense when you explained it.
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What are some of the risk factors?
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Well, the risk factors, the number one is the genetic predisposition.
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If you have a first or second order relative who has had problems with alcohol or drugs or has the disease of addiction, you have at least a 50% chance of having that yourself simply by being exposed to those substances, and that makes it very rare that you wouldn't be disposed.
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It's exposed, I mean.
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It's somewhere around 87% of people in the United States are exposed to alcohol at some point in their life.
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There are a few religious subsets that don't drink and some very health-conscious people just never drink alcohol.
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But that's very unusual.
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So genetic predisposition is one.
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Age of early use is another.
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Many of the patients I admit started their substance use 9, 10, 11, very young.
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This dopamine reward system doesn't mature until ages 24 or 25.
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So it's a very vulnerable time to have that massive release of dopamine.
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Another is adverse childhood experiences.
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Someone who's experienced abuse, trauma physical, emotional, sexual as a child also makes them very predisposed to this High tolerance to substance.
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If you're one of the teenagers who could drink 12, 16 cans of beer or a whole bottle of wine, it simply exposes you to more chemical and more milligrams of the substance.
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Another would be dual diagnosis Patients who have anxiety, depression, bipolar disorder, even schizoaffective disorder.
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All these also give you much higher risk of having a vulnerable dopamine reward system.
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Yes, sir, and from what I read in your book, it's not like a person has to have all of these risk factors.
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They can have simply one of them, right?
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Yes?
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Is that true?
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Yes, that's true, and you know.
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Also, when patients tell me, you know I don't have any family members, you know, I always say well, you know, when I look at your DNA, simply by your known family history.
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That's a little bit like asking you what a Harrison Ford movie is about.
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Simply by showing a snapshot of him, you wouldn't know if it's Star Wars, Indiana Jones or what the movie was about.
00:11:48.831 --> 00:11:55.474
So I'm still a big proponent of the genetic predisposition being the main risk factor.
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Yes, I agree on that, and it's just like when you go to the doctor and they go well, what's your history of diabetes or cancer or heart disease in your family?
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It's like they don't ask you about addiction, but they ask you about, like, what you're predisposed to.
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And it makes perfect sense if we're going to treat addiction as a disease, because you know it can be like a grandparent, it can be uncles, it can be like somewhere down your you know generational lineage, so to speak.
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It doesn't necessarily have to be first generation, we can all go back somewhere down the bloodline.
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Is that correct in saying that?
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You say that physicians don't take that history.
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There's many reasons they don't.
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One may have to have to be that maybe they don't have the training to ask the question.
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The other is maybe it's uncomfortable for them to ask the question.
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But University of Florida, where I did my addiction medicine fellowship, was the first university to require a mandatory rotation for medical students in addiction.
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So during my two years there we rotated one or two medical students through each month and reinforced to them the reason they should ask the family history pertinent to addiction.
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That's awesome because I'm sure medical schools in the past did not train doctors about addiction and as prevalent as it is in our society now, I'm sure there's a bigger and greater need for that now.
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So ,are you saying that they're starting to do that?
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Implement that into training for our doctors and medical personnel.
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As far as I know now all medical schools do include addiction.
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It's very much to the forefront in continuing education.
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You know the whole prescribing of opioids has been revamped in the last few years so that physicians take that history that we just talked about family history of addiction and also that they monitor more closely the supply of opiates they give.
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You know, for example, say 30 years ago you had your gallbladder out.
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You may have got sent home with 30 Percocets.
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Today, when you have laparoscopic gallbladder surgery, you get sent home with, say, five, five milligram oxycodone and if you have more pain or require more, it's going to involve another physician interaction to get more, going to involve another physician interaction to get more.
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So those sample cabinets all through the country at home that may have 25 or 30 Percocet venom simply not there anymore due to the physicians being educated and simply not overprescribing.
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Right, it's more regulated.
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Is that correct in saying that?
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Yes, it is regulated?
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Is that correct in saying?
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that.
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Yes, it is Dr Charles.
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I'm going to ask you some personal questions, or I probably don't even have to ask you, but I find your history very, very interesting and I read your book and I learned so much about yourself and your colleague.
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But do you mind telling our audience about your history and what happened?
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No, I don't mind at all.
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I was born in West Virginia, went to medical school West Virginia School of Osteopathic Medicine and had a pretty inconsequential college career and medical school career.
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One thing was very important my grandfather on my father's side died of the town drunk in this very small town that I was raised in in southern West Virginia 5,000 people.
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I only met the man twice and my mother would simply say that's your dad's dad and he's a bad man, he's an alcoholic.
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So I only met the man twice and he died a street alcoholic and was never able to obtain treatment.
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So even with binge drinking in college, it didn't continue for me until my early 30s when I was faced with a lot of stress.
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I had work stress, I had financial stress, I had marital stress and I already knew that I could drink a pretty good lot.
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I had a high tolerance, pretty pretty good lot.
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I had high tolerance and my drinking picked up to the point that by my mid-30s I was coming into work with alcohol poisoning, just so sick I couldn't put one foot in front of the other.
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And that was late 80s and about the time Vicodin and Lortab and Xanax were being sampled to primary care physicians.
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So I went to my sample cabinet, looked at it and said I wonder if a few of these would help.
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And after that, the next 20 years, it's somewhat of a blur.
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I got my pills many different mechanisms from ordering them wholesale to finally writing fraudulent prescriptions which, in 2009, resulted in my intervention by the DEA and got me to treatment and subsequently saved my life.
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Wow.
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Well, you know the movie, you know the series.
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Dope Sick is very popular now and it kind of is describing a little bit what your experience was.
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Just like Michael Keaton, you know, the doctor in Dope Sick went through with his patients and then apparently he had a I don't know.
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He started on it because of pain and it was in.
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That's how easy what you just described about yourself.
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That's how easy and innocent it can start.
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Is that correct in saying it's like no one is bored or no one, I believe, says okay, I'm going to be an addict when I grow up, or I'm going to be an alcoholic, or I'm going to do this and that, and then it just starts innocently and it just continues in this downward spiral.
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Is that how you felt at times?
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Yes, you know, you're exactly right.
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At second in second grade, on career day, no one holds their hands up and says you know, I want to be an alcoholic or I want to be an opiate addict, so you're exactly right.
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But once that door was open and my alcohol consumption increased, it was really just a path of least resistance of what I could do to stay functional and what I could do to survive.
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So I don't want to make it sound like I didn't have a choice.
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It was just that ease of access I had to those pills made it the easiest route of choice for me.
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I had to.
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Those pills made it the easiest route of choice for me.
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Right, which happens, you know, with a lot of people that I've interviewed and people that I've known that to have some sort of substance use disorder.
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I call it substance use disorder.
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Let's talk about that.
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How can we as a society break the stigma of this so people do not feel ashamed or guilty and there's a thin line behold, holding someone accountable for the behavior of the addiction.
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But I feel like to understand the addiction, like you said, like the science behind it.
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It will give people, or our society, a little bit more compassion and not judge people so harshly.
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But yet some of the behavior that is displayed, I feel like people need to be accountable.
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Do you kind of see where I'm going with this?
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It's kind of like a catch-22 situation.
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How do you feel about some of those statements I just made?
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How can we end the stigma first?
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Well, I think by sticking with current and even more progressive scientific literature is exactly the way to go.
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You know, it would be real easy to put out stigma-related statements for diabetes, for overweight, for lung disease, because many diseases patients play a part in that disease, coming along by their behavior.
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So with addiction, you know the words alcoholic, the word addict, junkie, abuser tend to have a negative connotation.
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Words are hurtful.
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It's much better when we describe them for just what they are Substance use disorder, habitual use, substance use disorder, habitual use, overtaking of substances I mean, if it's done thoroughly yet compassionately, is the best word.
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You know I was thinking.
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One of the things is whenever we go to do interventions, or whether I see a patient with intervention, I don't look at this any different than if I saw a skin cancer or a suspicious skin cancer on your face.
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I approach it with that same vigor and intensity.
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Person or the family has done the screening tools that we can talk about and they have it.
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I tell them not to give up any more than they would if they said, oh, I think that's a malignant melanoma on his shoulder.
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Well, you wouldn't just sweep it under the rug and say, no, maybe it's a freckle, you would get professional evaluation.
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So this is no different.
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We really advocate that people get professional evaluation.
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Then maybe it turns out that they are just a light social drinker and it was all a big hubbub.
00:22:31.950 --> 00:22:35.865
But that's not very likely or the family wouldn't have noticed the changes.
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Right.
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What do you do when you want to call in an interventionist and you want to call in an addiction specialist?
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This is for someone that you love very, very much and you see the person struggling and you see the daily fight, like moment to moment, with an addiction, and I'm talking now an opioid addiction, which I think is so strongly, highly potent, whether they're prescription or illicit drugs.
00:23:09.698 --> 00:23:20.675
But how can you encourage and love that person through this without enabling them?
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And then also, how can you lead a horse to water if they don't want to drink, so to speak?
00:23:27.704 --> 00:23:31.065
Well, I understand exactly what you're saying.
00:23:31.065 --> 00:23:38.394
In my years out of medicine I did get trained in interventions and did professional interventions for a few years.
00:23:38.394 --> 00:23:40.131
It is difficult.
00:23:40.131 --> 00:23:43.907
Once again, I take them back to that same medical scenario.
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If you had a patient who you were suspicious, say you had a sister who had a breast lump, you're suspicious of breast cancer, but she just simply says, well, I'm not going, you wouldn't give up on her.
00:23:56.148 --> 00:24:01.700
That's what you have to do with, say, the opioid-addicted patient.
00:24:01.700 --> 00:24:03.211
You can't give up on them.
00:24:03.746 --> 00:24:12.233
Where most families would fail is that ultimately it may mean loving, detachment or, you know, used to be called tough love.
00:24:12.233 --> 00:24:15.454
But you said, how do you do it without supporting them?
00:24:15.454 --> 00:24:31.355
You may have to say, well, you know, if you choose, for example, to keep this cancer and not seek medical care, then we're going to have a break in our relationship and most people have difficulty with that.
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Obviously they love them.
00:24:32.711 --> 00:24:39.352
You know, one of the definitions of codependency is love, because that's what is the root of it.
00:24:39.352 --> 00:24:41.815
Codependency is love because that's what, that's what is the root of it.
00:24:41.894 --> 00:24:54.478
Yeah, there's a there's a thin line between codependency and interdependency in all relationships actually, and you do have to love and encourage him through it and not be judgmental.
00:24:54.478 --> 00:25:21.574
But then ultimately it seems that it's up to the person to take that step and seek medical detox because I feel that's what's needed and I'm sure you feel that's what's needed, and rehab and long term treatment centers, and let's talk about that.
00:25:21.574 --> 00:25:41.115
How long does it take if a person who goes through all those steps as far as to get out of active addiction into active recovery, how long does it take for the brain to heal if they follow all those steps?
00:25:41.115 --> 00:25:46.128
Is there a number of years attached to that or is there like variables in there?
00:25:46.710 --> 00:26:05.547
Well, there are some variables, but you can find very consistent that it's one to two years before this dopamine reward system is going to heal, and primarily the prefrontal cortex or the decision-making portion of our brain one to two years.
00:26:05.607 --> 00:26:11.919
So you know that old minnesota model of 30 days rehab is basically archaic.
00:26:11.979 --> 00:26:28.288
If you just go for 30 days and you go home and you expect to be recovered, that would be no different than putting a cast on a broken leg for two weeks and say you know what, we're going to take this off and you go well, that won't work, doctor, because it's going to take the bone six to eight weeks to heal.
00:26:28.288 --> 00:26:30.313
This is the same thing.
00:26:30.313 --> 00:26:36.028
We need that sort of intensive treatment for addiction for one to two years.
00:26:36.028 --> 00:27:00.055
Now that doesn't mean we keep them out of their home, but once they do return to their home, we still have cognitive behavioral therapy, 12-step mutual aid and possibly the most important factor here is we have random testing so that we keep mind-altering substances out of the body, and that's the biggest failure we see with laypeople treatment in the United States.
00:27:00.055 --> 00:27:09.694
We've figured that out when it comes to doctors, nurses and airline pilots, because that's the type of programs that we're put in and we have 90% success rate.
00:27:09.694 --> 00:27:15.193
But for the general public that's simply not in place yet.
00:27:17.346 --> 00:27:23.490
Do you feel like I know through the years that I watched my loved one?
00:27:23.490 --> 00:27:28.980
I feel like each year it's getting better and better.
00:27:28.980 --> 00:27:31.573
There's more education about this.
00:27:31.573 --> 00:27:33.372
There's more awareness about this.
00:27:33.372 --> 00:27:35.652
The programs are getting better.
00:27:35.652 --> 00:27:44.343
I still think there's a major, big need in this country, but do you have hope about this?
00:27:44.343 --> 00:27:49.354
I know you work in a treatment center yourself and medical detox with your patients.
00:27:49.354 --> 00:28:07.970
Do you see a growing awareness of this in our country that people are starting to open up and there's more our country that people are starting to open up and there's more avenues for people and their families to seek this?
00:28:07.970 --> 00:28:10.433
Do you see that or am I naive about it?
00:28:11.214 --> 00:28:20.798
No, I actually do see it and, to tell you the truth, it mirrors almost any other disease that we've seen progression in.
00:28:20.798 --> 00:28:32.846
It mirrors almost any other disease that we've seen progression in Since I graduated medical school in 1982, that was right at the beginning of the HIV AIDS crisis, so I saw all the stigma associated with that.
00:28:32.846 --> 00:28:49.916
Then, basically, the opening up of that to get more funding for research made it a more mainstream disease and ultimately we're at where we are today, which there's excellent treatment and it doesn't shorten lives.
00:28:49.916 --> 00:28:56.876
Today, that same type vigor and enthusiasm is starting in addiction.
00:28:56.876 --> 00:29:10.217
It's not there yet but, as you said, there's many, many avenues now that are pursuing more intense education, early education and also advocacy for treatment.
00:29:10.217 --> 00:29:21.619
It's more understood by most major companies now that this is a disease and that, once properly treated, they can have a better employee than they had before.
00:29:23.286 --> 00:29:33.356
Yes, sir, as far as recovery treatment, what do you feel like the components or the important components for someone to have a high success rate?
00:29:33.356 --> 00:29:46.300
Because, from what I understand and correct me if I'm wrong there's a very high incidence of relapse and during recovery, during active recovery.
00:29:46.300 --> 00:30:01.358
So, with your experience, what are the components that someone has to follow through with in order to have that high success rate, and is this something that they live with every day of their life?
00:30:01.358 --> 00:30:22.936
Like you said, a lot of people I think falsely leave treatment centers or recovery centers and think, oh, I'm cured, everything's going to be fine, I can go back to that lifestyle, or I can be doing this, and I have found personally in my loved one's life that wasn't the case.
00:30:22.936 --> 00:30:26.630
So can you kind of elaborate on that for my audience please?
00:30:27.211 --> 00:30:34.721
Yes, and you know the perfect analogy that I use with patients is the treatment of high blood pressure, treatment of hypertension.
00:30:34.721 --> 00:30:37.105
I did family medicine for 26 years.
00:30:37.105 --> 00:30:48.535
It was not unusual at all for me to see a patient diagnose them with hypertension, start the medication, ask them to come back in a month and see them.
00:30:48.535 --> 00:30:49.875
They came back in a month.
00:30:49.875 --> 00:30:50.977
Pressure's good.
00:30:50.977 --> 00:30:53.558
I said okay, any questions?
00:30:53.558 --> 00:30:56.701
Here's your six-month refills on your medication.
00:30:56.701 --> 00:30:58.241
Come back and see me in six months.
00:30:58.241 --> 00:31:03.409
Patient comes back in six months.
00:31:03.409 --> 00:31:04.310
Blood pressure sky high, I go.
00:31:04.310 --> 00:31:04.932
What happened?
00:31:04.932 --> 00:31:05.613
He goes.
00:31:05.613 --> 00:31:08.699
You know, I just didn't think I needed that.
00:31:09.944 --> 00:31:11.989
Addiction is actually no different.
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