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Addiction Research and Progress Around Stigmas

July 28th, 2021

Today’s guest, Dr. Mark Gold, is a pioneer in addiction research. Specializing in addiction-related diseases in the 1970s and long before it was considered a health factor by physicians and researchers, Dr. Gold has over 45 years of experience studying and destigmatizing addiction, from opioids and cocaine to food and other drugs. In this episode, Zach and Dr. Gold cover substance use disorders (SUDs), progress around the stigma of addiction, the epidemic of opioid overdoses, and the transition to post-pandemic life.


Welcome to Recovery Radio by Landmark Recovery with your host, Zach Crouch. In this program, we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields, and help navigate the road to recovery. Now, here’s the host of Recovery Radio, Zach Crouch.

Zach: Hey, guys. It’s Zach Crouch again. You’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can always find us online wherever you get your podcasts, and please hit that subscribe button and tune in each week to get new content. You will learn a lot about the information on addiction from the leading experts in the field. We have a great guest today. We have guests, Dr. Mark Gold, joining us on the show.

Dr. Gold is one of the addiction researches pioneers who became an expert on addiction-related diseases in the 1970s before it was on most physicians’ and researchers’ radar. He’s been awarded numerous accolades and awards for his novel work. Over the last 45 years of groundbreaking experience, destigmatizing addiction as a brain disease by showing the effects of opioids, tobacco, cocaine, as well as other drugs, and eating food, on the brain and behavior. Dr. Gold, really looking forward to this conversation. Thank you for coming to the show.

Dr. Gold: Thanks, Zach. It’s good to be here with you.

Zach: You have a lot of experience. You got a lot of knowledge on this and a long career in this field in addiction medicine and mental health. In 2021, where we are, especially in light of the pandemic that’s been going on, what progress have you made in terms of the stigma that surrounds substance use and seeking treatment?

Dr. Gold: Many people are having problems that most of the behavioral health stigma has been challenged. People are depressed. People are anxious for good reason, but they’re having sleep problems and calling for help, so the kind of mental health crisis for health has gone up. For substance use disorders, NYDA and others have shown pretty clearly that the pandemic has been especially stressful, especially difficult for people with addictive diseases.

The difficulties range from people who noticed that they’re drinking more than they did before, now smoking marijuana or using other drugs and didn’t have a substance use disorder before, to those people who are in stable recovery and the treatment programs, all of them have had special difficulties. Right now, would be the time in my career when I say that it was pretty evident to most everyone that substance use disorders are diseases of the brain. Substance use disorders can be treated a lot better than we could have done when I started in this field in the 1970s.

And that, we understand that treatment has a long way to go but we have evidence-based treatment that’s improved over time. So, if people are waiting to get help, they should get it. If they’re wondering if there is hope and treatment and recovery, sure, there is. There is progress going on in treatment research? I’m still doing that myself. We’re going to make treatment better. We have all along but it’s a slow and incremental process. We don’t have anything like the moon shot for the covid vaccine.

They invented a vaccine that could prevent you from getting COVID 19 and it was safe and effective with 90% efficacy in less than a year. We haven’t been able to do that. When I started Opioid use disorder, in the mid-70, we had a method on and we had therapeutic communities. That was the range of treatment options. It was difficult.

When I started in the Yale University School of Medicine, Young Haven Hospital Emergency Department, if somebody came in with an overdose, we did have no option. We could treat them but we would have to take them outside of the hospital to get the addiction treatment. AA meetings were outside of the hospital and church basement. We didn’t have addiction medicine or addiction psychiatry as part of major academic medical centers at that time.

It was so stigmatized. I even remember when people would say that they preferred to not have anyone know that they had an alcohol use disorder or that they were ashamed and embarrassed and that they’ve never even heard of treatment is available, we’ve made remarkable progress. We have a lot more to make and it will come but things don’t get better if you don’t engage in treatment.

Zach: I appreciate that. You bring up an interesting point to just around how much has occurred with understanding how the brain capacity to deal and cope. Heavily influences a person’s proclivity to begin using substances, especially when there’s high stress, called chronic stress, anxiety, especially with the pandemic. People who go to treatment are coming to a better understanding of how their brain works because I think any treatment center that’s worth its salt does a really good job explaining the neurobiology of addiction to the patient.

I’m a marriage and family therapist. There is family involvement in getting the families to understand how the brain works. It can be a completely different topic of the challenge. I’d call it that. Do you find in your research that families that get involved in the treatment process but also understand how the brain works do a better job maybe at conceptualizing their loved ones?

Dr. Gold: It’s clear to experts in the field that the person with a substance use disorder has difficulty accessing treatment. Our group studied impaired health professionals, impaired doctors, doctors with opioid use disorders or not. We showed that coerced treatment, meaning their colleagues getting together, the hospital administration getting together and saying, “You can’t be a physician like that. We can’t trust you in taking care of patients like this. You need to go to treatment or you can’t work in this hospital anymore.”

People who have interventions like that just as well as impaired health professionals who came to the realization themselves that they needed treatment, waiting for somebody to hit bottom risk an overdose or other catastrophe. Involving family, understanding the nature of the disease, understanding the progressive, oftentimes, fatal is very important. I think what also is important is if a family, friends, doctor, colleagues, loved ones understand that is a brain disease, how hard it is to stop just anything like any or change a person.

So, if you were to change almost a reflex and acquired drive state like a substance use disorder, how could that change just by wishing? How could that change just by detox? Our research has shown that detox or treatment with medications is an important part of the treatment process but it doesn’t put the disease in our mission. It’s not like giving penicillin for strep throat. If a person were to be sent to the moon and they couldn’t use drugs and they were separated from drugs, when they came back with the moon, it would be logical to assume that the environment.

The cues would trigger some cravings and the potential for use, abuse, dependence, and substance use disorder. We’ve tried to encourage the families to understand these. When did their addiction start? When most people start the substance use disorder with teenage cannabis, alcohol, or tobacco use. The heavier the use and the earlier the use, the more the brain is trained and the more likely it is to form these pathological attachments to drugs of abuse.

If an addiction started seven years ago, how can any reasonable person think that the brain can change back in 28 days or three months? The idea of a comprehensive program with psychotherapy family therapy exercises some of the novel’s approaches, Nutraceutical approaches, Transcranial Magnetic Stimulation (TMS), an experimental approach being used. The more the treatment is intense and continues over a long enough period, the better. To give you an example, the impaired doctor programs are 5 years.

Zach: Five years commitment is a big thing with Physicians Health Foundations.

Dr. Gold: Yes, it is. It makes sense because of the brain changes that occur during a substance use disorder and the things that people learn, the drug solutions to everyday life. You have changed in the brain and changes in behavior and all those are very difficult to reverse. It can’t be reversed in 30 days, or 90 days, or even years. The outcome seems to pale in the face of the year after year of substance use and brain retraining with drugs on board.

Zach: I think one of the best, if there ever was, from my perspective. A model on how to go about being successful with a patient who has substance use disorder and the physician self-foundation. We’re talking about physicians. We’re talking about typically a highly paid professional who has plenty of resources. There’s the built-in accountability from the foundation and the support.

If you’re talking about your average Joe Guy, who is probably going to be using their insurance and they may get 28, 35, 45 days of detox and residential treatment followed by an outpatient program, 5 years seem like a mountain decline in terms of getting that sort of built-in wraparound support. I think you’re right that if you look at the rates of success of physicians’ health foundations compared to the general public, it’s just not even comparable.

Dr. Gold: I do think that is an important point. On the one hand, Physicians Health Program successes are now reported. Our group studied 37 States. Others have studied more for 5 years. What are the lessons? One lesson would be that being engaged in treatment matters. Some treatments are free, AANA Community Support. That’s an interval part of physician health program treatment.

Others mean having a sponsor-free. Others mean diet and exercise like that’s something that people can do. And when you talk about brain recovery, we don’t have regenerative medicine treatments that we can call on right now. People are studying Transcranial Magnetic Stimulation as a way to get the brain back to where it was before substance use. People have been studying exercise, Pete Thanos and Eminem.

There have been approaches with vigorous physical exercise as a way to get the brain back to the way it was before. I do think that the lesson in physician health programs is that treatment that exists is safe and effective can be very effective. 80% recovery rate is highly effective and would be much better than what we have in psychiatry. Many of the components of that treatment can be applied to everyone if they had a comprehensive treatment plan and followed it with their family support.

Zach: I appreciate that. We’re still in the middle of a very prominent opioid crisis in the Us. It’s only seemed to have gotten worse since COVID hit. From where you sit, what advice would you give to someone who’s struggling with addiction that’s maybe looking for support in a time that help and treatment are fairly limited right now?

Dr. Gold: I think we’ve had treatment accessible by digital means if somebody has digital access and if someone has the kind of employment that allows them to do virtual meetings and so forth. Our own experience with that is that that may not be very effective for people amid a substance use disorder like in-person meetings are preferable, in person groups are preferable. The sad part is people with substance use disorders haven’t been getting vaccinated.

They’re not likely to be able to avail themselves of treatments like that. All I say is that you have to try to get access to treatment whether it’s calling for help on the phone, availing yourself of digital treatment that is available, getting an MAT if you have an opioid use disorder, carrying naloxone, having friends and family carrying naloxone, everyone associated with everybody that’s affiliated with someone who has or has had an opioid use disorder and getting a treatment plan and sticking to it.

Zach: I think that’s critical because you recently wrote in that narrow DM article that the CDC stated that there have been about 81,000 plus overdose cases in the past year. I’m just curious what are some of the ways to address that issue and begin to decrease the numbers? As you said, some of these folks have sort of just not coming forward.

Dr. Gold: It’s pretty clear that if someone has an opioid use disorder and they’re taking medication, assisted treatment such as methods on Suboxone, Buprenorphine, or Naltrexone, or long-acting injectable Naltrexone, their chances of overdose death are greatly diminished. They only resurface after they discontinue treatment. Initiating treatment is safe and a way to preserve life. Naloxone, which I gave it in the Yale Emergency Department in the 1970s, was only available IV.

We had a pop open a vial, draw it up in a syringe, inject it into an addict, and rescue them. Now, it’s available. An auto-injector can be given intranasally, but expecting an overdosing paddock to rescue themselves with naloxone is a challenge. I was trying to make that point in the article. I’m so glad you refer to it. Naloxone or Narcan may be the ultimate harm reduction. Meaning, that’s an antidote to opioid overdose. The person is comatose.

They have no respiration, no pulse. They look dead and you give them Naloxone and they wake up. It’s a miracle. On the other hand, how can we expect the person to do harm reduction on themselves and reverse their overdose? Because by definition, they’ve overdosed. It falls on their loved ones, their spouses, their friends, their family. It has to be available on their person or in their bathroom.

It has to be available so it can be used. By the way, as we’ve seen from some of the celebrity overdoses, sometimes a person thinks they’re taking cocaine and there was Fentanyl in it. Keep in mind that there’s nothing lost if a person is overdosed on, supposedly they took methamphetamine, or supposedly they took cocaine, or supposedly they took X, Y, or Z. There’s nothing lost and giving Naloxone because if a person got any trace of fentanyl, you reverse that.

Zach: You brought this up earlier, Doctor Gold, underlying mental health conditions that are typically associated with substance use problems and substance use disorder and depression and anxiety being the two most prominent typically with this population. Does that explain this acceleration in the crisis and they’ll be used to sort of crisis that we’ve seen?

Dr. Gold: There’s a part of it. Anytime you have a substance use disorder since we don’t have a cure and we have no way of reversing the brain effects to the way they were before a person started using it, it’s a persistent vulnerability. So, just like a person under any stress, duress, or sleep disorder, they may feel an intense craving come back and they do slip or relapse. In AA, we used to tell people never to get too hungry, angry, lonely, tired.

That was the way to prevent relapse. Honestly, in the pandemic, we have all those things, anxiety and depression. Another thing that has been found is that for people who have untreated opioid use disorder who are using that, some of the overdoses are accidental. Some are averted. Meaning, because of the dose changing, or Fentanyl concentrations or dealer is changing. In the pandemic, drug supplies change.

More of the drug is Fentanyl and less of the drug is heroin. That by itself causes more overdoses. And then you do have this interaction with despair, deaths of despair. Some of the scientists, even the head of the National Institute on Drug Abuse, Nora Volkow, have said some overdoses are suicide attempts or wishing to be dead. If somebody had an overdose, it’s worth trying to understand their frame of mind at the time of use.

Zach: I’m glad you brought something up in your comments there because the Louisville area here in Kentucky lost one of the most said prominent entrepreneurs. If you’ve ever heard of Texas Roadhouse, the steak chain, the CEO and founder that ended up taking his own life. I think it was about a week or two. His name is Kent Taylor. Anyway, during this pandemic, have you seen a rise in suicides? What’s the demographic of that? Is there any significant statistical correlation with a particular demographic?

Dr. Gold: I don’t know that it’s a demographic but I think you’re right to say that people with substance use disorders are particularly vulnerable to just give up hope. Drugs of abuse by targeting the brain, pleasure systems and causing euphoria to have this particular effect in long-term use. They no longer produce euphoria because just breaking even and the brain kind of wears out.

It’s like we’ve overused the pleasure system and what you’re left with is despair and the feeling that you can never get back to normal. In psychiatry, we talk about the loss of the ability to experience a real pleasure. We call that anhedonia. That’s the most common mood of people in the throes of a substance use disorder, anhedonia.

You mix that with food insecurity in the pandemic, access to health care, their home group, their group therapy, their medications, all sorts of financial disruption, loss of the routine and the job, being forced to stay indoors, not exercising, eating poorly. You add it all together and it’s a recipe for disaster. You see that in all of the psychiatric emergencies, the psychological crisis, and the substance use disorders.

Zach: I just want to go back because I want to be really clear, at least on the show. Kent Taylor, the founder of Texas Roadhouse. It was publicly stated that he had a long-standing issue with Tinnitus, the ringing in the ear. The press said that was a primary reason for him taking his life.

Dr. Gold: I don’t know him. I never really even heard that but I know that it’s been hard to find help. Think about it in the height for the regular person, in the height of the pandemic. If a person overdosed, they couldn’t even get the same response times out of their emergency vehicles. They could try to go to the hospital and they find that the emergency doors were not in the same place, or the entrance of the hospital had changed, or they were just afraid that they could catch COVID 19.

They stay at home. People weren’t going for follow-up treatment of cancer. They weren’t going for psychiatric problems or addictions. I just think, rather than a specific, it’s a fact of our current life that we’re in the midst of a terrible time economically, socially, and in the pandemic, all of those things adding up to make people anxious, sleepless, exercise less, eat more poorly, being more socially isolated, having more despair, and not seeing an end in sight. All that accelerates depression and substance use disorders.

Zach: Do you feel hopeful? I don’t know what the percentage of the population now that have received the vaccine but it seems to be getting better. This idea of transitioning back to sort of someone of a normal life without restrictions, what do you think things are going to look like? Do you think they look a lot different or something kind of like what we had before?

Dr. Gold: Luckily, you can be called a visionary when it comes to the brain and behavior but I can’t tell you. There have been some people on the one hand that warn that the post-pandemic could be roaring twenties and there could be a whole bunch of excess related problems. I just think that we might come out of this and realize that psychiatric, psychological, and substance use disorders are part and parcel of the human condition.

They are just other problems and diseases and should be treated like that. We should improve access to treatment, reduce stigma, and consider these longer-term problems rather than shorter-term problems that require long-term attention and treatment. If we did that, we would come out of this pandemic a lot better than when we went in.

Zach: That’s such a good point. If anything, I hope that this pandemic has brought to light that there is no shame at all in asking for help. I hope that’s something that carries over strongly into 2022 and beyond. What would you ever ask or feel ashamed about asking for help with your cancer, diabetes, whatever that kind of condition you have exactly? It’s a real pleasure to talk to one of the pioneers in our field, Dr. Gold. Keep up the good work. I appreciate having guests like you want because you’ve seen and done just about everything in this field at this point.

Dr. Gold: Well, I appreciate it. If you look back on my 45 years, I can tell you that it used to be the kind of disease that no one ever talked about, no doctor has ever worked on, no researchers ever studied. And that’s really all changed and changed well. So, thanks. We wouldn’t have had your shows back in the 70s because I don’t know any radio would have put it on.

Zach: I always end this show, let’s say, if you do know someone who’s struggling with an addiction and you’re searching for answers, you can always visit us at Landmark Recovery. It’s landmarkrecovery.com. There, you can learn more about substance abuse programs that are saving lives and empowering families. Until next week. Zach Crouch is here with Landmark Recovery. Wishing everybody well.

Thank you for tuning in to Recovery Radio. New content for this program is available every Tuesday at 12 noon Eastern Time and 9 A.M. Pacific Time, with all episodes available on-demand on The Voice America Health and Wellness Channel and through our content partners, iTunes, Stitcher, Tune In, and Google Play Podcasts. Please remember to subscribe, rate, and review so we can continue to create quality content to help save 1 million lives in the next 100 years. You don’t need to struggle through addiction alone. Live the life you’ve dreamed on the road to recovery.

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Landmark Recovery was founded with a determination to make addiction treatment accessible for all. Through our integrated treatment programs, we've helped thousands of people choose recovery over addiction and get back to life on their own terms. We're on a mission to save one million lives over the next century. We encourage all those struggling with substance use to seek professional help.

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