April 30, 2025 • 60 mins
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
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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!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Lisa Carole Cude (00:02):
Understanding Addiction.
Know Science, which is K-N-O-W,and NO Stigma, which is N-O.
Let's end stigma surroundingaddiction in this country.
Stigma is our biggest killer.
I have today as my guest DrCharles Smith.
(00:26):
He and his colleague Dr JasonHunt are the authors of their
book Understanding Addiction ~Know Science, No Stigma.
They bring a unique andimportant perspective to the
subject of addiction.
An expert in this field, DrSmith, has a personal, firsthand
(00:49):
experience with the shame andhumiliation that accompanies
substance use disorder.
Addiction is a disease, no lessso than diabetes or heart
disease, and it needs to betreated as such.
Hi, Charles, Welcome.
I hope you don't mind mecalling you Charles, but first
(01:11):
let's clarify that statement forour audience.
Addiction is a disease.
Tell me what you know aboutthat and let's begin with the
science behind that statement.
Dr. Charles Smith (01:22):
Well, my interest in that particular
phrase happened when I went totreatment myself in 2009.
I had been a family practicephysician in West Virginia and
Kentucky for 26 years and in2009, due to a series of
interventions that I describe inthe book, I went to treatment
(01:45):
myself.
But when I got there and spokewith the addiction medicine
physician and the counselors andthe therapists, they told me
you have a disease.
And I said wait a minute, Idrank too much, okay, and you
know I got hooked on those pills, but that can happen to anyone,
(02:05):
because I had a sample cabinetfull of them and that was my
knowledge and my mindset at thatpoint.
And, of course, that was almost13 years ago now.
Since then, I have learned thatit is a disease just like
diabetes, just like heartdisease, just like hypertension,
(02:27):
and it can be identifiedthrough a particular area of the
brain and a particular systemof the brain the dopamine reward
system and the dopamine rewardsystem's effect on the
prefrontal cortex and ourdecision making.
And that's really what promptedme to write the book.
I check in patients at the twodetoxes that I work here in
(02:57):
South Florida daily and I goover this with them that
certainly they did have some badbehaviors, but I think those
bad behaviors can be explaineddue to the fact that he had a
vulnerable dopamine rewardsystem.
Lisa Carole Cude (03:10):
I read your book, by the way, thank you, and
I actually learned a lot fromit.
I wish I knew then what I knownow that I've learned more about
addiction.
Can you explain to our audienceabout what you mean about the
dopamine receptors, because alot of us parents or people who
(03:33):
have a loved one who has anaddiction, especially an opioid
addiction, we can neverunderstand why can't they just
stop, like you know?
Explain that to us.
I mean, I found it veryinteresting about that part of
the brain.
Dr. Charles Smith (03:50):
Well, you know, I always start out by
using that little example.
The newborn infant you have anewborn infant in the nursery
goes through the trauma ofchildbirth.
Then you know a couple of hourshe's going to be laying under
the incubator and he's going tostart crying.
So I always pull my audience.
(04:12):
Why does this baby start crying?
And people will say all sorts ofthings he's cold, he's wet, the
lights are too bright, hemisses his mother.
But the bottom line answer ishe's hungry.
So his dopamine reward systemsignals him that there's stress
(04:33):
and trauma and if he doesn't getsome carbohydrates he's going
to die, which is the fact.
So when that infant getscarbohydrates, his dopamine
reaches up to near top, what Icall top normal levels.
It goes up to almost 200 in themidbrain.
When that happens, the infant'scalm and serene, his restless,
(04:57):
irritable, discontent goes awayand he's comfortable.
That system continues to operateon through life, with dopamine
being released for eating whenyou're hungry, drinking fluids
when you're thirsty, escapingdanger.
Even sex gives normal dopaminereleases which start to modify
(05:20):
our behaviors because we havethat inherent desire to sustain
life.
Ben enters mind-alteringsubstances and that's anything
that releases dopamine higherthan 200, alcohol, opiates,
benzodiazepines, cannabis,amphetamines, and when those are
(05:42):
released at that much higherlevel, it's a little bit like
noise exposure hearing loss.
If you go to a rock concert,what can you hear the next day?
Not very much, just ringing inyour ears.
So those massive releases ofdopamine are what dysregulate
(06:02):
the system, and of particularimportance here is that about 9
out of 10 people cannot acceptthose massive releases of
dopamine the 1 in 10 people inthe general population that can
have a vulnerable dopaminereward system, and they're the
ones that are very much at riskfor the disease of addiction.
Lisa Carole Cude (06:28):
I find it so fascinating because we all know
people that can drink or dopills or whatever, and it
doesn't affect them.
They can easily walk away fromit.
And then we also have peoplethat can drink or do pills and
(06:49):
they become highly addicted tothem.
So I guess are you saying thatsome 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?
(07:09):
Is that right?
Dr. Charles Smith (07:10):
Yes, that's exactly what I had.
I had many of the risk factorsthat set me up to be able to
accept that reward when thatlarge rewards release, and
primarily that's due to dopaminesubtype receptors.
But there are also otherfactors involved.
As far as amounts of dopaminereleased, the ability to accept
(07:32):
that dopamine, it isn't quite assimple as that.
I can simply accept the reward.
But there's many other socialfactors involved.
But the bottom line I use thisas an example with patients many
times of what I call anaddiction stress test.
And if I go up to anyone at arestaurant maybe they're having
(07:54):
a margarita and I say well, youknow what, it's your lucky day.
You get five more margaritas onthe house.
Nine out of 10 people willdecline those and when you ask
them why, they're going to sayvery simply I don't like the way
five make me feel.
None of us at risk for thedisease of addiction are going
(08:15):
to say that Now we may declinethat extra five if we still have
the ability to make gooddecisions.
Maybe we know we're driving,Maybe we don't have to work the
next day, but for the most partwe want them.
So that's my stress test foraddiction.
Now it may not be that alcoholis the drug of choice.
(08:36):
Maybe it was opiates, Maybeit's cannabis, Maybe it's
cocaine, Maybe it's amphetamines, but the bottom line is nine
out of 10 people simply don'tenjoy or are able to receive
that reward from those massiveamounts of dopamine.
Lisa Carole Cude (08:54):
That makes sense when you explained it.
What are some of the riskfactors?
Dr. Charles Smith (09:02):
Well, the risk factors, the number one is
the genetic predisposition.
If you have a first or secondorder relative who has had
problems with alcohol or drugsor has the disease of addiction,
you have at least a 50% chanceof having that yourself simply
by being exposed to thosesubstances, and that makes it
(09:24):
very rare that you wouldn't bedisposed.
It's exposed, I mean.
It's somewhere around 87% ofpeople in the United States are
exposed to alcohol at some pointin their life.
There are a few religioussubsets that don't drink and
some very health-consciouspeople just never drink alcohol.
(09:44):
But that's very unusual.
So genetic predisposition isone.
Age of early use is another.
Many of the patients I admitstarted their substance use 9,
10, 11, very young.
This dopamine reward systemdoesn't mature until ages 24 or
(10:05):
25.
So it's a very vulnerable timeto have that massive release of
dopamine.
Another is adverse childhoodexperiences.
Someone who's experienced abuse, trauma physical, emotional,
sexual as a child also makesthem very predisposed to this
(10:29):
High tolerance to substance.
If you're one of the teenagerswho could drink 12, 16 cans of
beer or a whole bottle of wine,it simply exposes you to more
chemical and more milligrams ofthe substance.
Another would be dual diagnosisPatients who have anxiety,
(10:53):
depression, bipolar disorder,even schizoaffective disorder.
All these also give you muchhigher risk of having a
vulnerable dopamine rewardsystem.
Lisa Carole Cude (11:05):
Yes, sir, and from what I read in your book,
it's not like a person has tohave all of these risk factors.
They can have simply one ofthem, right?
Yes?
Dr. Charles Smith (11:18):
Is that true?
Yes, that's true, and you know.
Also, when patients tell me,you know I don't have any family
members, you know, I always saywell, you know, when I look at
your DNA, simply by your knownfamily history.
That's a little bit like askingyou what a Harrison Ford movie
(11:40):
is about.
Simply by showing a snapshot ofhim, you wouldn't know if it's
Star Wars, Indiana Jones or whatthe movie was about.
So I'm still a big proponent ofthe genetic predisposition
being the main risk factor.
Lisa Carole Cude (11:56):
Yes, I agree on that, and it's just like when
you go to the doctor and theygo well, what's your history of
diabetes or cancer or heartdisease in your family?
It's like they don't ask youabout addiction, but they ask
you about, like, what you'repredisposed to.
And it makes perfect sense ifwe're going to treat addiction
(12:17):
as a disease, because you knowit can be like a grandparent, it
can be uncles, it can be likesomewhere down your you know
generational lineage, so tospeak.
It doesn't necessarily have tobe first generation, we can all
go back somewhere down thebloodline.
Is that correct in saying that?
Dr. Charles Smith (12:46):
You say that physicians don't take that
history.
There's many reasons they don't.
One may have to have to be thatmaybe they don't have the
training to ask the question.
The other is maybe it'suncomfortable for them to ask
the question.
But University of Florida,where I did my addiction
medicine fellowship, was thefirst university to require a
mandatory rotation for medicalstudents in addiction.
(13:06):
So during my two years there werotated one or two medical
students through each month andreinforced to them the reason
they should ask the familyhistory pertinent to addiction.
Lisa Carole Cude (13:20):
That's awesome because I'm sure medical
schools in the past did nottrain doctors about addiction
and as prevalent as it is in oursociety now, I'm sure there's a
bigger and greater need forthat now.
(13:41):
So ,are you saying that they'restarting to do that?
Implement that into trainingfor our doctors and medical
personnel.
Dr. Charles Smith (13:51):
As far as I know now all medical schools do
include addiction.
It's very much to the forefrontin continuing education.
You know the whole prescribingof opioids has been revamped in
the last few years so thatphysicians take that history
(14:11):
that we just talked about familyhistory of addiction and also
that they monitor more closelythe supply of opiates they give.
You know, for example, say 30years ago you had your
gallbladder out.
You may have got sent home with30 Percocets.
Today, when you havelaparoscopic gallbladder surgery
, you get sent home with, say,five, five milligram oxycodone
(14:36):
and if you have more pain orrequire more, it's going to
involve another physicianinteraction to get more, going
to involve another physicianinteraction to get more.
So those sample cabinets allthrough the country at home that
may have 25 or 30 Percocetvenom simply not there anymore
due to the physicians beingeducated and simply not
overprescribing.
Lisa Carole Cude (14:58):
Right, it's more regulated.
Is that correct in saying that?
Yes, it is regulated?
Is that correct in saying?
Dr. Charles Smith (15:02):
that.
Lisa Carole Cude (15:09):
Yes, it is Dr Charles.
I'm going to ask you somepersonal questions, or I
probably don't even have to askyou, but I find your history
very, very interesting and Iread your book and I learned so
much about yourself and yourcolleague.
But do you mind telling ouraudience about your history and
(15:32):
what happened?
Dr. Charles Smith (15:34):
No, I don't mind at all.
I was born in West Virginia,went to medical school West
Virginia School of OsteopathicMedicine and had a pretty
inconsequential college careerand medical school career.
One thing was very important mygrandfather on my father's side
(15:55):
died of the town drunk in thisvery small town that I was
raised in in southern WestVirginia 5,000 people.
I only met the man twice and mymother would simply say that's
your dad's dad and he's a badman, he's an alcoholic.
So I only met the man twice andhe died a street alcoholic and
(16:16):
was never able to obtaintreatment.
So even with binge drinking incollege, it didn't continue for
me until my early 30s when I wasfaced with a lot of stress.
I had work stress, I hadfinancial stress, I had marital
stress and I already knew that Icould drink a pretty good lot.
(16:42):
I had a high tolerance, prettypretty good lot.
I had high tolerance and mydrinking picked up to the point
that by my mid-30s I was cominginto work with alcohol poisoning
, just so sick I couldn't putone foot in front of the other.
And that was late 80s and aboutthe time Vicodin and Lortab and
(17:03):
Xanax were being sampled toprimary care physicians.
So I went to my sample cabinet,looked at it and said I wonder
if a few of these would help.
And after that, the next 20years, it's somewhat of a blur.
I got my pills many differentmechanisms from ordering them
wholesale to finally writingfraudulent prescriptions which,
(17:28):
in 2009, resulted in myintervention by the DEA and got
me to treatment and subsequentlysaved my life.
Lisa Carole Cude (17:37):
Wow.
Well, you know the movie, youknow the series.
Dope Sick is very popular nowand it kind of is describing a
little bit what your experiencewas.
Just like Michael Keaton, youknow, the doctor in Dope Sick
went through with his patientsand then apparently he had a I
(18:03):
don't know.
He started on it because ofpain and it was in.
That's how easy what you justdescribed about yourself.
That's how easy and innocent itcan start.
Is that correct in saying it'slike no one is bored or no one,
I believe, says okay, I'm goingto be an addict when I grow up,
(18:26):
or I'm going to be an alcoholic,or I'm going to do this and
that, and then it just startsinnocently and it just continues
in this downward spiral.
Is that how you felt at times?
Dr. Charles Smith (18:42):
Yes, you know , you're exactly right.
At second in second grade, oncareer day, no one holds their
hands up and says you know, Iwant to be an alcoholic or I
want to be an opiate addict, soyou're exactly right.
But once that door was open andmy alcohol consumption
increased, it was really just apath of least resistance of what
(19:06):
I could do to stay functionaland what I could do to survive.
So I don't want to make itsound like I didn't have a
choice.
It was just that ease of accessI had to those pills made it
the easiest route of choice forme.
I had to.
Those pills made it the easiestroute of choice for me.
Lisa Carole Cude (19:25):
Right, which happens, you know, with a lot of
people that I've interviewedand people that I've known that
to have some sort of substanceuse disorder.
I call it substance usedisorder.
Let's talk about that.
How can we as a society breakthe stigma of this so people do
not feel ashamed or guilty andthere's a thin line behold,
(19:50):
holding someone accountable forthe behavior of the addiction.
But I feel like to understandthe addiction, like you said,
like the science behind it.
It will give people, or oursociety, a little bit more
compassion and not judge peopleso harshly.
(20:11):
But yet some of the behaviorthat is displayed, I feel like
people need to be accountable.
Do you kind of see where I'mgoing with this?
It's kind of like a catch-22situation.
How do you feel about some ofthose statements I just made?
How can we end the stigma first?
Dr. Charles Smith (20:29):
Well, I think by sticking with current and
even more progressive scientificliterature is exactly the way
to go.
You know, it would be real easyto put out stigma-related
statements for diabetes, foroverweight, for lung disease,
(20:50):
because many diseases patientsplay a part in that disease,
coming along by their behavior.
So with addiction, you know thewords alcoholic, the word
addict, junkie, abuser tend tohave a negative connotation.
Words are hurtful.
(21:12):
It's much better when wedescribe 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 yetcompassionately, is the best
(21:32):
word.
You know I was thinking.
One of the things is whenever wego to do interventions, or
whether I see a patient withintervention, I don't look at
this any different than if I sawa skin cancer or a suspicious
skin cancer on your face.
I approach it with that samevigor and intensity.
(21:56):
Person or the family has donethe screening tools that we can
talk about and they have it.
I tell them not to give up anymore than they would if they
said, oh, I think that's amalignant melanoma on his
shoulder.
Well, you wouldn't just sweepit under the rug and say, no,
maybe it's a freckle, you wouldget professional evaluation.
(22:18):
So this is no different.
We really advocate that peopleget professional evaluation.
Then maybe it turns out thatthey are just a light social
drinker and it was all a bighubbub.
But that's not very likely orthe family wouldn't have noticed
the changes.
Lisa Carole Cude (22:37):
Right.
What do you do when you want tocall in an interventionist and
you want to call in an addictionspecialist?
This is for someone that youlove very, very much and you see
the person struggling and yousee the daily fight, like moment
to moment, with an addiction,and I'm talking now an opioid
(23:01):
addiction, which I think is sostrongly, highly potent, whether
they're prescription or illicitdrugs.
But how can you encourage andlove that person through this
without enabling them?
And then also, how can you leada horse to water if they don't
(23:25):
want to drink, so to speak?
Dr. Charles Smith (23:27):
Well, I understand exactly what you're
saying.
In my years out of medicine Idid get trained in interventions
and did professionalinterventions for a few years.
It is difficult.
Once again, I take them back tothat same medical scenario.
If you had a patient who youwere suspicious, say you had a
(23:48):
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.
That's what you have to do with, say, the opioid-addicted
patient.
You can't give up on them.
Where most families would failis that ultimately it may mean
(24:08):
loving, detachment or, you know,used to be called tough love.
But you said, how do you do itwithout supporting them?
You may have to say, well, youknow, if you choose, for example
, to keep this cancer and notseek medical care, then we're
going to have a break in ourrelationship and most people
(24:30):
have difficulty with that.
Obviously they love them.
You know, one of thedefinitions of codependency is
love, because that's what is theroot of it.
Codependency is love becausethat's what, that's what is the
root of it.
Lisa Carole Cude (24:41):
Yeah, there's a there's a thin line between
codependency and interdependencyin all relationships actually,
and you do have to love andencourage him through it and not
be judgmental.
But then ultimately it seemsthat it's up to the person to
(25:02):
take that step and seek medicaldetox because I feel that's
what's needed and I'm sure youfeel that's what's needed, and
rehab and long term treatmentcenters, and let's talk about
that.
How long does it take if aperson who goes through all
(25:28):
those steps as far as to get outof active addiction into active
recovery, how long does it takefor the brain to heal if they
follow all those steps?
Is there a number of yearsattached to that or is there
like variables in there?
Dr. Charles Smith (25:46):
Well, there are some variables, but you can
find very consistent that it'sone to two years before this
dopamine reward system is goingto heal, and primarily the
prefrontal cortex or thedecision-making portion of our
brain one to two years.
So you know that old minnesotamodel of 30 days rehab is
(26:10):
basically archaic.
If you just go for 30 days andyou go home and you expect to be
recovered, that would be nodifferent than putting a cast on
a broken leg for two weeks andsay 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 thebone six to eight weeks to heal.
This is the same thing.
We need that sort of intensivetreatment for addiction for one
(26:35):
to two years.
Now that doesn't mean we keepthem out of their home, but once
they do return to their home,we still have cognitive
behavioral therapy, 12-stepmutual aid and possibly the most
important factor here is wehave random testing so that we
keep mind-altering substancesout of the body, and that's the
(26:56):
biggest failure we see withlaypeople treatment in the
United States.
We've figured that out when itcomes to doctors, nurses and
airline pilots, because that'sthe type of programs that we're
put in and we have 90% successrate.
But for the general publicthat's simply not in place yet.
Lisa Carole Cude (27:17):
Do you feel like I know through the years
that I watched my loved one?
I feel like each year it'sgetting better and better.
There's more education aboutthis.
There's more awareness aboutthis.
The programs are getting better.
I still think there's a major,big need in this country, but do
(27:42):
you have hope about this?
I know you work in a treatmentcenter yourself and medical
detox with your patients.
Do you see a growing awarenessof this in our country that
people are starting to open upand there's more our country
(28:04):
that people are starting to openup and there's more avenues for
people and their families toseek this?
Do you see that or am I naiveabout it?
Dr. Charles Smith (28:11):
No, I actually do see it and, to tell
you the truth, it mirrors almostany other disease that we've
seen progression in.
It mirrors almost any otherdisease that we've seen
progression in Since I graduatedmedical school in 1982, that
was right at the beginning ofthe HIV AIDS crisis, so I saw
all the stigma associated withthat.
(28:32):
Then, basically, the opening upof that to get more funding for
research made it a moremainstream disease and
ultimately we're at where we aretoday, which there's excellent
treatment and it doesn't shortenlives.
Today, that same type vigor andenthusiasm is starting in
(28:56):
addiction.
It's not there yet but, as yousaid, there's many, many avenues
now that are pursuing moreintense education, early
education and also advocacy fortreatment.
It's more understood by mostmajor companies now that this is
a disease and that, onceproperly treated, they can have
(29:19):
a better employee than they hadbefore.
Lisa Carole Cude (29:23):
Yes, sir, as far as recovery treatment, what
do you feel like the componentsor the important components for
someone to have a high successrate?
Because, from what I understandand correct me if I'm wrong
there's a very high incidence ofrelapse and during recovery,
(29:45):
during active recovery.
So, with your experience, whatare the components that someone
has to follow through with inorder to have that high success
rate, and is this something thatthey live with every day of
their life?
Like you said, a lot of peopleI think falsely leave treatment
(30:08):
centers or recovery centers andthink, oh, I'm cured,
everything's going to be fine, Ican go back to that lifestyle,
or I can be doing this, and Ihave found personally in my
loved one's life that wasn't thecase.
So can you kind of elaborate onthat for my audience please?
Dr. Charles Smith (30:27):
Yes, and you know the perfect analogy that I
use with patients is thetreatment of high blood pressure
, treatment of hypertension.
I did family medicine for 26years.
It was not unusual at all forme to see a patient diagnose
them with hypertension, startthe medication, ask them to come
back in a month and see them.
(30:48):
They came back in a month.
Pressure's good.
I said okay, any questions?
Here's your six-month refillson your medication.
Come back and see me in sixmonths.
Patient comes back in sixmonths.
Blood pressure sky high, I go.
What happened?
He goes.
You know, I just didn't think Ineeded that.
(31:09):
Addiction is actually nodifferent.
It's very important thatinitially they get a good
professional evaluation so thatthey can see what level of care
they go in.
Maybe they don't need detox,maybe they don't have enough
comorbidities to requireresidential treatment, maybe
they don't need sober living,but the big thing is they've got
(31:31):
to have treatment for two years.
We've got to keep mind-alteringsubstances out of them and
that's the advantage tomonitoring when you're
monitoring one slip, even ifit's not their drug of choice.
Maybe they were opiate addictedand they smoked cannabis.
Maybe they were methamphetamineand they drank some beer.
(31:52):
We still need to know it,because then we can intervene at
a much less intense level ofcare.
So always with patients parallelto hypertension, because
hypertension, still in theUnited States today, is very
difficult to treat because itrequires so much patient
compliance.
(32:13):
That's what addiction treatmentrequires patient compliance.
But you know, most of the timewith this 30-day model of
treatment and then send you toyour local AA group is not
enough accountability.
Lisa Carole Cude (32:27):
No, I agree with that.
That's why I highly recommendyour book, so people can
understand the science behindthis.
I assume do you consider this abrain disease.
Dr. Charles Smith (32:41):
Oh, absolutely.
You know.
No different than the dopaminereward system is dysregulated.
No different than the glucoseinsulin system and diabetes, the
renin-angiotensin system andhypertension.
This is a bodily system thatbecomes dysregulated, results in
a disease.
However, with appropriatetreatment and management, the
(33:05):
disease can go into remission.
Now I never want patients toget confused.
Remission does that mean I cango over here and drink some beer
now?
No, it doesn't.
It means my brain's healedenough now that I actually make
good decisions and know that.
I'm one of the one in 10 peoplein the world it's not a good
idea to drink and drug.
I'm one of the one in 10 peoplein the world it's not a good
(33:28):
idea to drink and drug.
; --tw-#fff; It is impossible.
Lisa Carole Cude (34:30):
I'm thinking, oh my goodness, okay, he's in
the hospital now.
They're going to take care ofhim.
They're going to know that hehas a highly addictive you know
he's highly addicted to theseopioids and heroin at the time
and you know whatever else andso they left the decision up to
(34:52):
him.
They left this hardcoredecision up to him.
They did not offer himtreatment, they just talked to
him, where me, as a mother,thought, oh my goodness, they're
going to do something now orthey're going to help him or
offer something.
But they left this harddecision up to him and he walked
out of that emergency room.
(35:13):
He refused any sort of help andtreatment.
So I know that's because of theHIPAA laws, but is that
something that can that you feelneeds to be changed in this
country, because the loved oneshave their hands tied and
they're leaving this importantdecision up to somebody who
(35:34):
isn't capable of making thisdecision to save their life?
Do you understand what I'mtrying to convey?
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Dr. Charles Smith (35:40):
Yes, I do, and most states have some sort
of legal alternatives to follow.
Here In Florida it's called theMarchman Act, other states it
may be called something else,but anyway it's a substance use
disorder, involuntary treatment.
Now it results to start withjust an involuntary evaluation.
(36:03):
But see, that would be thestart of the treatment anyway.
So I always told family youknow, should I pursue that?
And I said of course you should.
You know, I still remember oneintervention I did back in
Alabama.
A gentleman was drinking.
His sisters actually called mein to do the intervention and he
(36:23):
was drinking significantly.
He had alcoholic cardiomyopathy, so severe drinking and his
life really depended on it.
He refused.
He refused to go.
After the family intervention,after the letters, after all the
loving pleading, he still toldthem no.
They asked me what our nextstep is and I said you need to
(36:45):
call law enforcement.
He just left here to drive homeand he's intoxicated and they
said oh no, we can't do that,he'll never speak to us again.
I told them pretty soon he'snot going to speak to you again
anyway.
Lisa Carole Cude (36:59):
Well, I want to let you know something.
I was going to do that and Iwas going to go to the county,
the sheriff's department, and Ispoke to them and they told me
about what needed to be done.
They had to go, arrest my sonand then take him to the
hospital and talk to apsychiatrist, an interventionist
(37:22):
, a medical doctor, be evaluated, and they would hold him for 72
hours.
But then I was told if he couldstill walk after 72 hours.
So actually, when I spoke tothe sheriff's department here
locally, they kind of talked meout of doing that to be quite
(37:42):
honest with you, out of doingthat to be quite honest with you
, because they said, well,they're going to let him go
anyway.
So do you understand what I'msaying?
That's what happened in mystate.
I don't know if they've changedit in the last four years, but
that's what happened.
Dr. Charles Smith (37:58):
It needs perfected in every state.
But even three years ago, inthe two years I spent at the
University of Florida, wemarksman acted many patients and
kept them for 90 days.
The judge had that ability oncewe showed evidence.
Now patients can have a show,cause hearing and go up in front
(38:18):
of the judge where both sidespresent their cases.
But we kept many patients for90 days, which in itself wasn't
still enough, but it was surebetter than 72 hours you're
talking about.
Yes, sir, and yes, and I knowwhat you're saying having them
arrested, go through that trauma, go through that embarrassment
(38:41):
of being involuntary andcommitted.
It does seem like a horriblething.
I understand that, but whenwe're talking about a deadly
illness, it's necessary.
Lisa Carole Cude (38:53):
Well, I would have done it in a heartbeat if I
knew that they would have kepthim and they still left the
decision up to him to walk.
You know what I mean.
Dr. Charles Smith (39:02):
Yeah, but see the true involuntary commitment
.
For substance use disorder isthe decision to leave not left
up to the patient, it's left upto the addiction professional.
Lisa Carole Cude (39:15):
Well, I hope they've changed that here in the
state that I live in Because,like I said, this was four years
ago and yes, sir, I knew allabout it.
I was ready to do it and theytalked me out of not doing it
because they said that he wouldwalk.
They couldn't keep him againsthis will.
That was what was told to me.
(39:35):
But anyway, let me ask yousomething.
You know my podcast deals withthe fatal facts of fentanyl.
So, in your experience as adoctor, tell me what you feel
about illicit fentanyl.
Are you seeing a rise in this?
Has illicit fentanyl beenaround?
From what I understand, it'sbeen around at least four years
(39:56):
and people are highly addictedto it.
Tell me your experience aboutillicit fentanyl and how you
think about this or what youthink about it.
Dr. Charles Smith (40:07):
It certainly was just a game changer For at
least the last couple of years.
Most of my opiate patients thatI've admitted to detox or to
residential rehab did not evenknow that it was fentanyl they
were getting.
They were buying these pressedpills that they thought were
oxycodone 30s or they thoughtthey were Xanax bars.
(40:29):
They did not even know theywere fentanyl.
The degree of strength of thatfentanyl just varies on how much
it was cut.
It may be thousands of timesstronger than morphine or heroin
, or it may not be.
Simply, there's no qualitycontrol among the illicit drug
world.
With the massive escalation inoverdose deaths that we've had
(40:54):
93,000 in the US, and that's alow number, because many died
that we don't know why and itprobably was opiate overdose
we're starting to get some moreattention to these illicit pills
.
The DEA sent out several emailsand newsletters focused on
(41:16):
these pressed pills, as theycall them that.
They look like the prescriptionpills, but they're not.
They're fentanyl.
So the fentanyl entering themarket has been a game changer
and we certainly saw a lot ofoverdose deaths with OxyContin,
with Oxycodone and Xanax, andthen mixtures with alcohol also,
(41:39):
but nothing like we're seeingnow.
Lisa Carole Cude (41:42):
Yes, sir, it seems like the illicit fentanyl
has changed the paradigm of druguse in this country.
The way I look at it, I'vetalked to several experts about
this and also people who havelost loved ones to this it seems
like there are three kind ofscenarios for this, and you can
correct me if I'm wrong or addanother scenario if you know of
(42:05):
one.
But it seems like we've got theseasoned.
I call them the seasoned users,the people that do knowingly
know that they are buyingfentanyl and they are ingesting
fentanyl, and there's differentways to ingest it, of course.
And then you've got the peopleyou said that feel like maybe
(42:25):
they're buying an oxy cotton, Iguess roxy's, is that what
they're called?
M30s, whatever, is that whatthey're called?
yeah, yeah okay, there's so much, so many terminologies, but, um
, or they might be thinkingthey're buying cocaine, or do it
buying a xanax or heroin, eveneven even though I've read and
(42:47):
heard that heroin is the mostobsolete now because of the
fentanyl.
But anyway, they kind of aredeceived.
All of a sudden they're dyingfrom ingesting straight fentanyl
instead of like thinkingthey're doing a line of cocaine.
(43:14):
And then you've got, like yousaid, the press counterfeit
pills, now this.
And then you've got, like yousaid, the press counterfeit
pills, now this.
All of it breaks my heart.
But the press counterfeit pillsthink they're buying Percocet
or Aroxi or something.
And they're almost beinggroomed by known dealers on
(43:36):
Snapchat let's just say Snapchatand they are sold or given
something and all of a suddenthey're dying.
I mean, it's crazy in thiscountry.
Do you know of any otherscenario that I'm forgetting or
not mentioning.
Dr. Charles Smith (44:00):
That's actually a very good synopsis
that you said.
We have the severely addictedsubstance use disorder patient
who intended on fentanyl, hashigh tolerance, injects fentanyl
, smokes it or snorts it.
They have a large physicaldependence.
They get very sick If theydon't take it.
That would be the first levelyou described.
And also heroin simply isn'tavailable anymore.
(44:20):
Most of the patients, I admit,here in South Florida don't test
positive for heroin or opiate,they test positive for fentanyl.
The second level would, as yousaid, maybe they just intended
to party some but they've usedenough opiates.
They may have withdrawal andthey thought they were getting a
(44:41):
Percocet or Xanax or some pillthat came from a pharmacy but
it's not.
And then, even as you said, thescariest level to me is the
bachelorette party or thebachelor party where maybe they
took a Xanax when they were incollege or something and
(45:01):
celebrating this weekend theythought they were going to do
some cocaine and take a Xanaxand you know they have no
tolerance for this very powerfulopiate and they die on the spot
.
Lisa Carole Cude (45:15):
So, with all that being said, do you feel
that these should be?
These deaths should bedescribed as overdoses or
poisoning.
Dr. Charles Smith (45:30):
You know that's excellent to even bring
it up in that light.
I had just read today that thisshould be looked at as a
national security issue.
You know, no different thansomeone were attacking our
country with chemical warfare.
Lisa Carole Cude (45:47):
Exactly, it does seem to be that way
chemical warfare, and it's likeyou said.
I think the numbers I believelast year, in 2020, were 94,000.
And I don't know how many ofthat is illicit fentanyl.
I've read so many differentthings 50, 60, 70, 80 percent
(46:08):
but I think the numbers are alot higher and I think in 2021,
they're going to be a lot higher.
I don't know how accurate theinformation is, but I just feel
like it's going to escalate andkeep escalating.
Is that how you think, or feel?
Dr. Charles Smith (46:21):
Yes, you know , I think it has to be
approached as any nationalsecurity problem.
When you think or feel, yes,you know, I think it has to be
approached as any nationalsecurity problem.
Would you know?
I think back on how we'veapproached terrorism.
So we both did more screeningat the sites.
We've done more screening atthe borders.
I think addiction hasparticularly the fentanyl
(46:43):
problem, the opioid crisis hasto be addressed.
The same way, we need toenhance our abilities so it
doesn't get into the country,but at the same time, don't
overlook its marketplace.
These patients who have avulnerable dopamine reward
system, no matter where they fitin that spectrum of people who
(47:04):
are going to use them we justdescribed all those three
scenarios need treatment andwe've got to make that treatment
available and offer you know, Iwon't say necessarily pay these
people to do it, but offer arewarding lifestyle that they
can see.
They need some incentive for it.
Lisa Carole Cude (47:24):
Yes, I see that, and the journey with
addiction and the stigmaattached to it.
A lot of people cannot get jobs.
So, yeah, they do need to berewarded, they need some
incentive to work towards tobetter their life, to better
themselves, not necessarily allthe punishment, or I think you
(47:50):
know what I'm saying, becauseyou live this yourself.
You live this yourself.
Dr. Charles Smith (47:54):
Yeah, and I advocate for a term called
contingency management.
It's that all of these fruitsof my recovery don't continue if
I don't have negative drugscreen tests.
So you know, instead of that ohmy God, you know what Mom's
driving me crazy?
She's making me give urinespecimens four times a year,
(48:18):
next year or something.
But those come with a rewardthat, yeah, not only that, but
your car insurance is cheaper,your college tuition is cheaper,
your college tuition is cheaper, but all of the fruits that go
with that mind-alteringsubstance free become more
readily apparent to them.
And that the testing is notlooked at as a penalty, which is
(48:40):
what it's looked at now.
Lisa Carole Cude (48:43):
Yes, it is Well, you have come a long way.
I just I don't want to give toomuch about your book because I
really want people to buy it.
I bought mine on Amazon I'mgoing to put plug in there about
Amazon but I really learned somuch from your book and it
really opened my eyes.
I loved reading about yourfirsthand experience with this
(49:06):
yourself and what was involved,and also your colleague, dr Hunt
.
Is that correct?
Yeah, that's Jason Hunt, andyou both were medical doctors
and you both suffered with thisfor years and it changed your
life and you had to do somereally soul searching and hard
(49:29):
work to get your life back.
You both lost your medicallicenses over this.
Is that correct?
Dr. Charles Smith (49:34):
Yes, it is.
Lisa Carole Cude (49:36):
And then you worked and did what you had to
do and got it back.
My goodness,god gbless Gblessbless you both.
I mean, I used to tell my sonyou're like the strongest person
I know Because I saw his battle.
You know every day with thisand this is something that you
live with the rest of your lifeand it is a battle.
(49:59):
Is that correct?
Dr. Charles Smith (50:01):
Well, additionally, yes, it is, but it
actually with appropriate andproper care and compliance of
the patient, most of us believethis day, the disease goes into
remission.
I look at it no different thanI use the example of a breast
cancer patient.
Quite often I have a breastcancer patient.
(50:22):
They have a lumpectomy, aradiation chemotherapy and 15
years later they're good.
Now that doesn't mean they stopdoing mammograms.
That doesn't mean they stopdoing breast exams.
That doesn't mean they startsmoking cigarettes.
That means they start drinkingalcohol, they start going to the
tan and bed anything that wouldbe increased risk factor for
(50:43):
cancer.
So the same now.
I'm sure my disease is inremission today, but I go to a
wedding, I make plans.
I don't drink champagne.
You know if I go to the sportsbar for Buffalo Wings, you know
I have Diet Coke.
I have a lemonade.
You know Mexican restaurant,you know it's frozen lemonade,
(51:10):
not a margarita.
And that doesn't happen byaccident.
That happened by goodscientific medical care and,
importantly, compliance withtreatment.
I have to have that frompatients.
So that's why I need thefamilies involved, because it's
not them nagging them, it's justhelping me ensure compliance.
Lisa Carole Cude (51:30):
Exactly Right.
Nagging doesn't help anything.
Dr. Charles Smith (51:36):
But help.
You know they call that theirsober support network.
Their sober support network,you know, would be involved.
And when you're going out withthese 10 guys that you went to
high school with and all you allever did was drink and smoke
pot, what do you think you'regoing to do with those guys
tonight?
What would you possibly have incommon with them?
And if you say, well, I do haveto meet them, et cetera, then
(52:00):
I'm going to take a sober friend, I'm going to have extra
accountability and even say youknow what?
You get a pee in this cup whenyou get home too.
Lisa Carole Cude (52:11):
And if they say no to that, that's a problem
.
So you're more aware,definitely, and more conscious
about all of this, and that'swhat it takes right.
Dr. Charles Smith (52:21):
Education is the pathway out of this one.
Lisa Carole Cude (52:24):
Yes, sir, I believe education is the pathway
out of this one.
Yes, sir, I believe educationis power.
Dr. Charles Smith (52:27):
What seems to be a voluntary disease is
actually not because of all thesocial pressures.
You know I had that phrase inmy book that in this country
alcohol is not just sociallyacceptable, it's socially
expected.
You're right, that has tochange.
Lisa Carole Cude (52:43):
You're right.
Yeah, it does has to change.
Dr. Charles Smith (52:46):
You're right.
Yeah, it does have to change.
Teens get peer pressure bulliedinto alcohol and cannabis.
Lisa Carole Cude (52:52):
Most definitely Peer pressure is a
major thing, and now nowadaysit's pill parties.
They're pressured into takingpills.
It's just not.
I mean, it used to be justsmoking cigarettes or drinking a
couple beers.
That has changed a long timeago.
Peer pressure has a lot to dowith it.
Yes, sir, well gosh, charles, Icould talk to you all night and
(53:15):
you're just a wealth ofinformation and I just want to
thank you for being sotransparent with your own story
about your journey and I wantyou to know that you are so
loved and appreciated in doingso and in also helping to make a
difference with others withtheir continued battle with this
.
And if you are my audience, ifyou or a loved one is struggling
(53:38):
with addiction, you'll findhelp in Dr Smith and Dr Hunt's
book, and it is called again,understanding Addiction, no
Science, which is K-N-O-W, andto no Stigma.
Let's end the stigma.
It's up to us as individuals toend the stigma in this country,
and when one understands thescience behind addiction, one
(54:00):
can begin to move forward,because beyond stigma, there's
always hope.
There still lies hope, andthank you, charles, I really do
appreciate it.
I hope we can possibly interviewsome time again in the future.
Okay, okay, it's been apleasure, thank you.
Dr. Charles Smith (54:20):
Take care.
Lisa Carole Cude (54:20):
Bye, thank you .
Understanding Addiction.
Know Science, which is K-N-O-W,and NO Stigma, which is N-O.
Let's end stigma surroundingaddiction in this country.
Stigma is our biggest killer.
I have today as my guest DrCharles Smith.
(00:26):
He and his colleague Dr JasonHunt are the authors of their
book Understanding Addiction ~Know Science, No Stigma.
They bring a unique andimportant perspective to the
subject of addiction.
An expert in this field, DrSmith, has a personal, firsthand
(00:49):
experience with the shame andhumiliation that accompanies
substance use disorder.
Addiction is a disease, no lessso than diabetes or heart
disease, and it needs to betreated as such.
Hi, Charles, Welcome.
I hope you don't mind mecalling you Charles, but first
(01:11):
let's clarify that statement forour audience.
Addiction is a disease.
Tell me what you know aboutthat and let's begin with the
science behind that statement.
Dr. Charles Smith (01:22):
Well, my interest in that particular
phrase happened when I went totreatment myself in 2009.
I had been a family practicephysician in West Virginia and
Kentucky for 26 years and in2009, due to a series of
interventions that I describe inthe book, I went to treatment
(01:45):
myself.
But when I got there and spokewith the addiction medicine
physician and the counselors andthe therapists, they told me
you have a disease.
And I said wait a minute, Idrank too much, okay, and you
know I got hooked on those pills, but that can happen to anyone,
(02:05):
because I had a sample cabinetfull of them and that was my
knowledge and my mindset at thatpoint.
And, of course, that was almost13 years ago now.
Since then, I have learned thatit is a disease just like
diabetes, just like heartdisease, just like hypertension,
(02:27):
and it can be identifiedthrough a particular area of the
brain and a particular systemof the brain the dopamine reward
system and the dopamine rewardsystem's effect on the
prefrontal cortex and ourdecision making.
And that's really what promptedme to write the book.
I check in patients at the twodetoxes that I work here in
(02:57):
South Florida daily and I goover this with them that
certainly they did have some badbehaviors, but I think those
bad behaviors can be explaineddue to the fact that he had a
vulnerable dopamine rewardsystem.
Lisa Carole Cude (03:10):
I read your book, by the way, thank you, and
I actually learned a lot fromit.
I wish I knew then what I knownow that I've learned more about
addiction.
Can you explain to our audienceabout what you mean about the
dopamine receptors, because alot of us parents or people who
(03:33):
have a loved one who has anaddiction, especially an opioid
addiction, we can neverunderstand why can't they just
stop, like you know?
Explain that to us.
I mean, I found it veryinteresting about that part of
the brain.
Dr. Charles Smith (03:50):
Well, you know, I always start out by
using that little example.
The newborn infant you have anewborn infant in the nursery
goes through the trauma ofchildbirth.
Then you know a couple of hourshe's going to be laying under
the incubator and he's going tostart crying.
So I always pull my audience.
(04:12):
Why does this baby start crying?
And people will say all sorts ofthings he's cold, he's wet, the
lights are too bright, hemisses his mother.
But the bottom line answer ishe's hungry.
So his dopamine reward systemsignals him that there's stress
(04:33):
and trauma and if he doesn't getsome carbohydrates he's going
to die, which is the fact.
So when that infant getscarbohydrates, his dopamine
reaches up to near top, what Icall top normal levels.
It goes up to almost 200 in themidbrain.
When that happens, the infant'scalm and serene, his restless,
(04:57):
irritable, discontent goes awayand he's comfortable.
That system continues to operateon through life, with dopamine
being released for eating whenyou're hungry, drinking fluids
when you're thirsty, escapingdanger.
Even sex gives normal dopaminereleases which start to modify
(05:20):
our behaviors because we havethat inherent desire to sustain
life.
Ben enters mind-alteringsubstances and that's anything
that releases dopamine higherthan 200, alcohol, opiates,
benzodiazepines, cannabis,amphetamines, and when those are
(05:42):
released at that much higherlevel, it's a little bit like
noise exposure hearing loss.
If you go to a rock concert,what can you hear the next day?
Not very much, just ringing inyour ears.
So those massive releases ofdopamine are what dysregulate
(06:02):
the system, and of particularimportance here is that about 9
out of 10 people cannot acceptthose massive releases of
dopamine the 1 in 10 people inthe general population that can
have a vulnerable dopaminereward system, and they're the
ones that are very much at riskfor the disease of addiction.
Lisa Carole Cude (06:28):
I find it so fascinating because we all know
people that can drink or dopills or whatever, and it
doesn't affect them.
They can easily walk away fromit.
And then we also have peoplethat can drink or do pills and
(06:49):
they become highly addicted tothem.
So I guess are you saying thatsome 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?
(07:09):
Is that right?
Dr. Charles Smith (07:10):
Yes, that's exactly what I had.
I had many of the risk factorsthat set me up to be able to
accept that reward when thatlarge rewards release, and
primarily that's due to dopaminesubtype receptors.
But there are also otherfactors involved.
As far as amounts of dopaminereleased, the ability to accept
(07:32):
that dopamine, it isn't quite assimple as that.
I can simply accept the reward.
But there's many other socialfactors involved.
But the bottom line I use thisas an example with patients many
times of what I call anaddiction stress test.
And if I go up to anyone at arestaurant maybe they're having
(07:54):
a margarita and I say well, youknow what, it's your lucky day.
You get five more margaritas onthe house.
Nine out of 10 people willdecline those and when you ask
them why, they're going to sayvery simply I don't like the way
five make me feel.
None of us at risk for thedisease of addiction are going
(08:15):
to say that Now we may declinethat extra five if we still have
the ability to make gooddecisions.
Maybe we know we're driving,Maybe we don't have to work the
next day, but for the most partwe want them.
So that's my stress test foraddiction.
Now it may not be that alcoholis the drug of choice.
(08:36):
Maybe it was opiates, Maybeit's cannabis, Maybe it's
cocaine, Maybe it's amphetamines, but the bottom line is nine
out of 10 people simply don'tenjoy or are able to receive
that reward from those massiveamounts of dopamine.
Lisa Carole Cude (08:54):
That makes sense when you explained it.
What are some of the riskfactors?
Dr. Charles Smith (09:02):
Well, the risk factors, the number one is
the genetic predisposition.
If you have a first or secondorder relative who has had
problems with alcohol or drugsor has the disease of addiction,
you have at least a 50% chanceof having that yourself simply
by being exposed to thosesubstances, and that makes it
(09:24):
very rare that you wouldn't bedisposed.
It's exposed, I mean.
It's somewhere around 87% ofpeople in the United States are
exposed to alcohol at some pointin their life.
There are a few religioussubsets that don't drink and
some very health-consciouspeople just never drink alcohol.
(09:44):
But that's very unusual.
So genetic predisposition isone.
Age of early use is another.
Many of the patients I admitstarted their substance use 9,
10, 11, very young.
This dopamine reward systemdoesn't mature until ages 24 or
(10:05):
25.
So it's a very vulnerable timeto have that massive release of
dopamine.
Another is adverse childhoodexperiences.
Someone who's experienced abuse, trauma physical, emotional,
sexual as a child also makesthem very predisposed to this
(10:29):
High tolerance to substance.
If you're one of the teenagerswho could drink 12, 16 cans of
beer or a whole bottle of wine,it simply exposes you to more
chemical and more milligrams ofthe substance.
Another would be dual diagnosisPatients who have anxiety,
(10:53):
depression, bipolar disorder,even schizoaffective disorder.
All these also give you muchhigher risk of having a
vulnerable dopamine rewardsystem.
Lisa Carole Cude (11:05):
Yes, sir, and from what I read in your book,
it's not like a person has tohave all of these risk factors.
They can have simply one ofthem, right?
Yes?
Dr. Charles Smith (11:18):
Is that true?
Yes, that's true, and you know.
Also, when patients tell me,you know I don't have any family
members, you know, I always saywell, you know, when I look at
your DNA, simply by your knownfamily history.
That's a little bit like askingyou what a Harrison Ford movie
(11:40):
is about.
Simply by showing a snapshot ofhim, you wouldn't know if it's
Star Wars, Indiana Jones or whatthe movie was about.
So I'm still a big proponent ofthe genetic predisposition
being the main risk factor.
Lisa Carole Cude (11:56):
Yes, I agree on that, and it's just like when
you go to the doctor and theygo well, what's your history of
diabetes or cancer or heartdisease in your family?
It's like they don't ask youabout addiction, but they ask
you about, like, what you'repredisposed to.
And it makes perfect sense ifwe're going to treat addiction
(12:17):
as a disease, because you knowit can be like a grandparent, it
can be uncles, it can be likesomewhere down your you know
generational lineage, so tospeak.
It doesn't necessarily have tobe first generation, we can all
go back somewhere down thebloodline.
Is that correct in saying that?
Dr. Charles Smith (12:46):
You say that physicians don't take that
history.
There's many reasons they don't.
One may have to have to be thatmaybe they don't have the
training to ask the question.
The other is maybe it'suncomfortable for them to ask
the question.
But University of Florida,where I did my addiction
medicine fellowship, was thefirst university to require a
mandatory rotation for medicalstudents in addiction.
(13:06):
So during my two years there werotated one or two medical
students through each month andreinforced to them the reason
they should ask the familyhistory pertinent to addiction.
Lisa Carole Cude (13:20):
That's awesome because I'm sure medical
schools in the past did nottrain doctors about addiction
and as prevalent as it is in oursociety now, I'm sure there's a
bigger and greater need forthat now.
(13:41):
So ,are you saying that they'restarting to do that?
Implement that into trainingfor our doctors and medical
personnel.
Dr. Charles Smith (13:51):
As far as I know now all medical schools do
include addiction.
It's very much to the forefrontin continuing education.
You know the whole prescribingof opioids has been revamped in
the last few years so thatphysicians take that history
(14:11):
that we just talked about familyhistory of addiction and also
that they monitor more closelythe supply of opiates they give.
You know, for example, say 30years ago you had your
gallbladder out.
You may have got sent home with30 Percocets.
Today, when you havelaparoscopic gallbladder surgery
, you get sent home with, say,five, five milligram oxycodone
(14:36):
and if you have more pain orrequire more, it's going to
involve another physicianinteraction to get more, going
to involve another physicianinteraction to get more.
So those sample cabinets allthrough the country at home that
may have 25 or 30 Percocetvenom simply not there anymore
due to the physicians beingeducated and simply not
overprescribing.
Lisa Carole Cude (14:58):
Right, it's more regulated.
Is that correct in saying that?
Yes, it is regulated?
Is that correct in saying?
Dr. Charles Smith (15:02):
that.
Lisa Carole Cude (15:09):
Yes, it is Dr Charles.
I'm going to ask you somepersonal questions, or I
probably don't even have to askyou, but I find your history
very, very interesting and Iread your book and I learned so
much about yourself and yourcolleague.
But do you mind telling ouraudience about your history and
(15:32):
what happened?
Dr. Charles Smith (15:34):
No, I don't mind at all.
I was born in West Virginia,went to medical school West
Virginia School of OsteopathicMedicine and had a pretty
inconsequential college careerand medical school career.
One thing was very important mygrandfather on my father's side
(15:55):
died of the town drunk in thisvery small town that I was
raised in in southern WestVirginia 5,000 people.
I only met the man twice and mymother would simply say that's
your dad's dad and he's a badman, he's an alcoholic.
So I only met the man twice andhe died a street alcoholic and
(16:16):
was never able to obtaintreatment.
So even with binge drinking incollege, it didn't continue for
me until my early 30s when I wasfaced with a lot of stress.
I had work stress, I hadfinancial stress, I had marital
stress and I already knew that Icould drink a pretty good lot.
(16:42):
I had a high tolerance, prettypretty good lot.
I had high tolerance and mydrinking picked up to the point
that by my mid-30s I was cominginto work with alcohol poisoning
, just so sick I couldn't putone foot in front of the other.
And that was late 80s and aboutthe time Vicodin and Lortab and
(17:03):
Xanax were being sampled toprimary care physicians.
So I went to my sample cabinet,looked at it and said I wonder
if a few of these would help.
And after that, the next 20years, it's somewhat of a blur.
I got my pills many differentmechanisms from ordering them
wholesale to finally writingfraudulent prescriptions which,
(17:28):
in 2009, resulted in myintervention by the DEA and got
me to treatment and subsequentlysaved my life.
Lisa Carole Cude (17:37):
Wow.
Well, you know the movie, youknow the series.
Dope Sick is very popular nowand it kind of is describing a
little bit what your experiencewas.
Just like Michael Keaton, youknow, the doctor in Dope Sick
went through with his patientsand then apparently he had a I
(18:03):
don't know.
He started on it because ofpain and it was in.
That's how easy what you justdescribed about yourself.
That's how easy and innocent itcan start.
Is that correct in saying it'slike no one is bored or no one,
I believe, says okay, I'm goingto be an addict when I grow up,
(18:26):
or I'm going to be an alcoholic,or I'm going to do this and
that, and then it just startsinnocently and it just continues
in this downward spiral.
Is that how you felt at times?
Dr. Charles Smith (18:42):
Yes, you know , you're exactly right.
At second in second grade, oncareer day, no one holds their
hands up and says you know, Iwant to be an alcoholic or I
want to be an opiate addict, soyou're exactly right.
But once that door was open andmy alcohol consumption
increased, it was really just apath of least resistance of what
(19:06):
I could do to stay functionaland what I could do to survive.
So I don't want to make itsound like I didn't have a
choice.
It was just that ease of accessI had to those pills made it
the easiest route of choice forme.
I had to.
Those pills made it the easiestroute of choice for me.
Lisa Carole Cude (19:25):
Right, which happens, you know, with a lot of
people that I've interviewedand people that I've known that
to have some sort of substanceuse disorder.
I call it substance usedisorder.
Let's talk about that.
How can we as a society breakthe stigma of this so people do
not feel ashamed or guilty andthere's a thin line behold,
(19:50):
holding someone accountable forthe behavior of the addiction.
But I feel like to understandthe addiction, like you said,
like the science behind it.
It will give people, or oursociety, a little bit more
compassion and not judge peopleso harshly.
(20:11):
But yet some of the behaviorthat is displayed, I feel like
people need to be accountable.
Do you kind of see where I'mgoing with this?
It's kind of like a catch-22situation.
How do you feel about some ofthose statements I just made?
How can we end the stigma first?
Dr. Charles Smith (20:29):
Well, I think by sticking with current and
even more progressive scientificliterature is exactly the way
to go.
You know, it would be real easyto put out stigma-related
statements for diabetes, foroverweight, for lung disease,
(20:50):
because many diseases patientsplay a part in that disease,
coming along by their behavior.
So with addiction, you know thewords alcoholic, the word
addict, junkie, abuser tend tohave a negative connotation.
Words are hurtful.
(21:12):
It's much better when wedescribe 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 yetcompassionately, is the best
(21:32):
word.
You know I was thinking.
One of the things is whenever wego to do interventions, or
whether I see a patient withintervention, I don't look at
this any different than if I sawa skin cancer or a suspicious
skin cancer on your face.
I approach it with that samevigor and intensity.
(21:56):
Person or the family has donethe screening tools that we can
talk about and they have it.
I tell them not to give up anymore than they would if they
said, oh, I think that's amalignant melanoma on his
shoulder.
Well, you wouldn't just sweepit under the rug and say, no,
maybe it's a freckle, you wouldget professional evaluation.
(22:18):
So this is no different.
We really advocate that peopleget professional evaluation.
Then maybe it turns out thatthey are just a light social
drinker and it was all a bighubbub.
But that's not very likely orthe family wouldn't have noticed
the changes.
Lisa Carole Cude (22:37):
Right.
What do you do when you want tocall in an interventionist and
you want to call in an addictionspecialist?
This is for someone that youlove very, very much and you see
the person struggling and yousee the daily fight, like moment
to moment, with an addiction,and I'm talking now an opioid
(23:01):
addiction, which I think is sostrongly, highly potent, whether
they're prescription or illicitdrugs.
But how can you encourage andlove that person through this
without enabling them?
And then also, how can you leada horse to water if they don't
(23:25):
want to drink, so to speak?
Dr. Charles Smith (23:27):
Well, I understand exactly what you're
saying.
In my years out of medicine Idid get trained in interventions
and did professionalinterventions for a few years.
It is difficult.
Once again, I take them back tothat same medical scenario.
If you had a patient who youwere suspicious, say you had a
(23:48):
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.
That's what you have to do with, say, the opioid-addicted
patient.
You can't give up on them.
Where most families would failis that ultimately it may mean
(24:08):
loving, detachment or, you know,used to be called tough love.
But you said, how do you do itwithout supporting them?
You may have to say, well, youknow, if you choose, for example
, to keep this cancer and notseek medical care, then we're
going to have a break in ourrelationship and most people
(24:30):
have difficulty with that.
Obviously they love them.
You know, one of thedefinitions of codependency is
love, because that's what is theroot of it.
Codependency is love becausethat's what, that's what is the
root of it.
Lisa Carole Cude (24:41):
Yeah, there's a there's a thin line between
codependency and interdependencyin all relationships actually,
and you do have to love andencourage him through it and not
be judgmental.
But then ultimately it seemsthat it's up to the person to
(25:02):
take that step and seek medicaldetox because I feel that's
what's needed and I'm sure youfeel that's what's needed, and
rehab and long term treatmentcenters, and let's talk about
that.
How long does it take if aperson who goes through all
(25:28):
those steps as far as to get outof active addiction into active
recovery, how long does it takefor the brain to heal if they
follow all those steps?
Is there a number of yearsattached to that or is there
like variables in there?
Dr. Charles Smith (25:46):
Well, there are some variables, but you can
find very consistent that it'sone to two years before this
dopamine reward system is goingto heal, and primarily the
prefrontal cortex or thedecision-making portion of our
brain one to two years.
So you know that old minnesotamodel of 30 days rehab is
(26:10):
basically archaic.
If you just go for 30 days andyou go home and you expect to be
recovered, that would be nodifferent than putting a cast on
a broken leg for two weeks andsay 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 thebone six to eight weeks to heal.
This is the same thing.
We need that sort of intensivetreatment for addiction for one
(26:35):
to two years.
Now that doesn't mean we keepthem out of their home, but once
they do return to their home,we still have cognitive
behavioral therapy, 12-stepmutual aid and possibly the most
important factor here is wehave random testing so that we
keep mind-altering substancesout of the body, and that's the
(26:56):
biggest failure we see withlaypeople treatment in the
United States.
We've figured that out when itcomes to doctors, nurses and
airline pilots, because that'sthe type of programs that we're
put in and we have 90% successrate.
But for the general publicthat's simply not in place yet.
Lisa Carole Cude (27:17):
Do you feel like I know through the years
that I watched my loved one?
I feel like each year it'sgetting better and better.
There's more education aboutthis.
There's more awareness aboutthis.
The programs are getting better.
I still think there's a major,big need in this country, but do
(27:42):
you have hope about this?
I know you work in a treatmentcenter yourself and medical
detox with your patients.
Do you see a growing awarenessof this in our country that
people are starting to open upand there's more our country
(28:04):
that people are starting to openup and there's more avenues for
people and their families toseek this?
Do you see that or am I naiveabout it?
Dr. Charles Smith (28:11):
No, I actually do see it and, to tell
you the truth, it mirrors almostany other disease that we've
seen progression in.
It mirrors almost any otherdisease that we've seen
progression in Since I graduatedmedical school in 1982, that
was right at the beginning ofthe HIV AIDS crisis, so I saw
all the stigma associated withthat.
(28:32):
Then, basically, the opening upof that to get more funding for
research made it a moremainstream disease and
ultimately we're at where we aretoday, which there's excellent
treatment and it doesn't shortenlives.
Today, that same type vigor andenthusiasm is starting in
(28:56):
addiction.
It's not there yet but, as yousaid, there's many, many avenues
now that are pursuing moreintense education, early
education and also advocacy fortreatment.
It's more understood by mostmajor companies now that this is
a disease and that, onceproperly treated, they can have
(29:19):
a better employee than they hadbefore.
Lisa Carole Cude (29:23):
Yes, sir, as far as recovery treatment, what
do you feel like the componentsor the important components for
someone to have a high successrate?
Because, from what I understandand correct me if I'm wrong
there's a very high incidence ofrelapse and during recovery,
(29:45):
during active recovery.
So, with your experience, whatare the components that someone
has to follow through with inorder to have that high success
rate, and is this something thatthey live with every day of
their life?
Like you said, a lot of peopleI think falsely leave treatment
(30:08):
centers or recovery centers andthink, oh, I'm cured,
everything's going to be fine, Ican go back to that lifestyle,
or I can be doing this, and Ihave found personally in my
loved one's life that wasn't thecase.
So can you kind of elaborate onthat for my audience please?
Dr. Charles Smith (30:27):
Yes, and you know the perfect analogy that I
use with patients is thetreatment of high blood pressure
, treatment of hypertension.
I did family medicine for 26years.
It was not unusual at all forme to see a patient diagnose
them with hypertension, startthe medication, ask them to come
back in a month and see them.
(30:48):
They came back in a month.
Pressure's good.
I said okay, any questions?
Here's your six-month refillson your medication.
Come back and see me in sixmonths.
Patient comes back in sixmonths.
Blood pressure sky high, I go.
What happened?
He goes.
You know, I just didn't think Ineeded that.
(31:09):
Addiction is actually nodifferent.
It's very important thatinitially they get a good
professional evaluation so thatthey can see what level of care
they go in.
Maybe they don't need detox,maybe they don't have enough
comorbidities to requireresidential treatment, maybe
they don't need sober living,but the big thing is they've got
(31:31):
to have treatment for two years.
We've got to keep mind-alteringsubstances out of them and
that's the advantage tomonitoring when you're
monitoring one slip, even ifit's not their drug of choice.
Maybe they were opiate addictedand they smoked cannabis.
Maybe they were methamphetamineand they drank some beer.
(31:52):
We still need to know it,because then we can intervene at
a much less intense level ofcare.
So always with patients parallelto hypertension, because
hypertension, still in theUnited States today, is very
difficult to treat because itrequires so much patient
compliance.
(32:13):
That's what addiction treatmentrequires patient compliance.
But you know, most of the timewith this 30-day model of
treatment and then send you toyour local AA group is not
enough accountability.
Lisa Carole Cude (32:27):
No, I agree with that.
That's why I highly recommendyour book, so people can
understand the science behindthis.
I assume do you consider this abrain disease.
Dr. Charles Smith (32:41):
Oh, absolutely.
You know.
No different than the dopaminereward system is dysregulated.
No different than the glucoseinsulin system and diabetes, the
renin-angiotensin system andhypertension.
This is a bodily system thatbecomes dysregulated, results in
a disease.
However, with appropriatetreatment and management, the
(33:05):
disease can go into remission.
Now I never want patients toget confused.
Remission does that mean I cango over here and drink some beer
now?
No, it doesn't.
It means my brain's healedenough now that I actually make
good decisions and know that.
I'm one of the one in 10 peoplein the world it's not a good
idea to drink and drug.
I'm one of the one in 10 peoplein the world it's not a good
(33:28):
idea to drink and drug.
; --tw-#fff; It is impossible.
Lisa Carole Cude (34:30):
I'm thinking, oh my goodness, okay, he's in
the hospital now.
They're going to take care ofhim.
They're going to know that hehas a highly addictive you know
he's highly addicted to theseopioids and heroin at the time
and you know whatever else andso they left the decision up to
(34:52):
him.
They left this hardcoredecision up to him.
They did not offer himtreatment, they just talked to
him, where me, as a mother,thought, oh my goodness, they're
going to do something now orthey're going to help him or
offer something.
But they left this harddecision up to him and he walked
out of that emergency room.
(35:13):
He refused any sort of help andtreatment.
So I know that's because of theHIPAA laws, but is that
something that can that you feelneeds to be changed in this
country, because the loved oneshave their hands tied and
they're leaving this importantdecision up to somebody who
(35:34):
isn't capable of making thisdecision to save their life?
Do you understand what I'mtrying to convey?
-snap-strictness (35:40):
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Dr. Charles Smith (35:40):
Yes, I do, and most states have some sort
of legal alternatives to follow.
Here In Florida it's called theMarchman Act, other states it
may be called something else,but anyway it's a substance use
disorder, involuntary treatment.
Now it results to start withjust an involuntary evaluation.
(36:03):
But see, that would be thestart of the treatment anyway.
So I always told family youknow, should I pursue that?
And I said of course you should.
You know, I still remember oneintervention I did back in
Alabama.
A gentleman was drinking.
His sisters actually called mein to do the intervention and he
(36:23):
was drinking significantly.
He had alcoholic cardiomyopathy, so severe drinking and his
life really depended on it.
He refused.
He refused to go.
After the family intervention,after the letters, after all the
loving pleading, he still toldthem no.
They asked me what our nextstep is and I said you need to
(36:45):
call law enforcement.
He just left here to drive homeand he's intoxicated and they
said oh no, we can't do that,he'll never speak to us again.
I told them pretty soon he'snot going to speak to you again
anyway.
Lisa Carole Cude (36:59):
Well, I want to let you know something.
I was going to do that and Iwas going to go to the county,
the sheriff's department, and Ispoke to them and they told me
about what needed to be done.
They had to go, arrest my sonand then take him to the
hospital and talk to apsychiatrist, an interventionist
(37:22):
, a medical doctor, be evaluated, and they would hold him for 72
hours.
But then I was told if he couldstill walk after 72 hours.
So actually, when I spoke tothe sheriff's department here
locally, they kind of talked meout of doing that to be quite
(37:42):
honest with you, out of doingthat to be quite honest with you
, because they said, well,they're going to let him go
anyway.
So do you understand what I'msaying?
That's what happened in mystate.
I don't know if they've changedit in the last four years, but
that's what happened.
Dr. Charles Smith (37:58):
It needs perfected in every state.
But even three years ago, inthe two years I spent at the
University of Florida, wemarksman acted many patients and
kept them for 90 days.
The judge had that ability oncewe showed evidence.
Now patients can have a show,cause hearing and go up in front
(38:18):
of the judge where both sidespresent their cases.
But we kept many patients for90 days, which in itself wasn't
still enough, but it was surebetter than 72 hours you're
talking about.
Yes, sir, and yes, and I knowwhat you're saying having them
arrested, go through that trauma, go through that embarrassment
(38:41):
of being involuntary andcommitted.
It does seem like a horriblething.
I understand that, but whenwe're talking about a deadly
illness, it's necessary.
Lisa Carole Cude (38:53):
Well, I would have done it in a heartbeat if I
knew that they would have kepthim and they still left the
decision up to him to walk.
You know what I mean.
Dr. Charles Smith (39:02):
Yeah, but see the true involuntary commitment
.
For substance use disorder isthe decision to leave not left
up to the patient, it's left upto the addiction professional.
Lisa Carole Cude (39:15):
Well, I hope they've changed that here in the
state that I live in Because,like I said, this was four years
ago and yes, sir, I knew allabout it.
I was ready to do it and theytalked me out of not doing it
because they said that he wouldwalk.
They couldn't keep him againsthis will.
That was what was told to me.
(39:35):
But anyway, let me ask yousomething.
You know my podcast deals withthe fatal facts of fentanyl.
So, in your experience as adoctor, tell me what you feel
about illicit fentanyl.
Are you seeing a rise in this?
Has illicit fentanyl beenaround?
From what I understand, it'sbeen around at least four years
(39:56):
and people are highly addictedto it.
Tell me your experience aboutillicit fentanyl and how you
think about this or what youthink about it.
Dr. Charles Smith (40:07):
It certainly was just a game changer For at
least the last couple of years.
Most of my opiate patients thatI've admitted to detox or to
residential rehab did not evenknow that it was fentanyl they
were getting.
They were buying these pressedpills that they thought were
oxycodone 30s or they thoughtthey were Xanax bars.
(40:29):
They did not even know theywere fentanyl.
The degree of strength of thatfentanyl just varies on how much
it was cut.
It may be thousands of timesstronger than morphine or heroin
, or it may not be.
Simply, there's no qualitycontrol among the illicit drug
world.
With the massive escalation inoverdose deaths that we've had
(40:54):
93,000 in the US, and that's alow number, because many died
that we don't know why and itprobably was opiate overdose
we're starting to get some moreattention to these illicit pills
.
The DEA sent out several emailsand newsletters focused on
(41:16):
these pressed pills, as theycall them that.
They look like the prescriptionpills, but they're not.
They're fentanyl.
So the fentanyl entering themarket has been a game changer
and we certainly saw a lot ofoverdose deaths with OxyContin,
with Oxycodone and Xanax, andthen mixtures with alcohol also,
(41:39):
but nothing like we're seeingnow.
Lisa Carole Cude (41:42):
Yes, sir, it seems like the illicit fentanyl
has changed the paradigm of druguse in this country.
The way I look at it, I'vetalked to several experts about
this and also people who havelost loved ones to this it seems
like there are three kind ofscenarios for this, and you can
correct me if I'm wrong or addanother scenario if you know of
(42:05):
one.
But it seems like we've got theseasoned.
I call them the seasoned users,the people that do knowingly
know that they are buyingfentanyl and they are ingesting
fentanyl, and there's differentways to ingest it, of course.
And then you've got the peopleyou said that feel like maybe
(42:25):
they're buying an oxy cotton, Iguess roxy's, is that what
they're called?
M30s, whatever, is that whatthey're called?
yeah, yeah okay, there's so much, so many terminologies, but, um
, or they might be thinkingthey're buying cocaine, or do it
buying a xanax or heroin, eveneven even though I've read and
(42:47):
heard that heroin is the mostobsolete now because of the
fentanyl.
But anyway, they kind of aredeceived.
All of a sudden they're dyingfrom ingesting straight fentanyl
instead of like thinkingthey're doing a line of cocaine.
(43:14):
And then you've got, like yousaid, the press counterfeit
pills, now this.
And then you've got, like yousaid, the press counterfeit
pills, now this.
All of it breaks my heart.
But the press counterfeit pillsthink they're buying Percocet
or Aroxi or something.
And they're almost beinggroomed by known dealers on
(43:36):
Snapchat let's just say Snapchatand they are sold or given
something and all of a suddenthey're dying.
I mean, it's crazy in thiscountry.
Do you know of any otherscenario that I'm forgetting or
not mentioning.
Dr. Charles Smith (44:00):
That's actually a very good synopsis
that you said.
We have the severely addictedsubstance use disorder patient
who intended on fentanyl, hashigh tolerance, injects fentanyl
, smokes it or snorts it.
They have a large physicaldependence.
They get very sick If theydon't take it.
That would be the first levelyou described.
And also heroin simply isn'tavailable anymore.
(44:20):
Most of the patients, I admit,here in South Florida don't test
positive for heroin or opiate,they test positive for fentanyl.
The second level would, as yousaid, maybe they just intended
to party some but they've usedenough opiates.
They may have withdrawal andthey thought they were getting a
(44:41):
Percocet or Xanax or some pillthat came from a pharmacy but
it's not.
And then, even as you said, thescariest level to me is the
bachelorette party or thebachelor party where maybe they
took a Xanax when they were incollege or something and
(45:01):
celebrating this weekend theythought they were going to do
some cocaine and take a Xanaxand you know they have no
tolerance for this very powerfulopiate and they die on the spot
.
Lisa Carole Cude (45:15):
So, with all that being said, do you feel
that these should be?
These deaths should bedescribed as overdoses or
poisoning.
Dr. Charles Smith (45:30):
You know that's excellent to even bring
it up in that light.
I had just read today that thisshould be looked at as a
national security issue.
You know, no different thansomeone were attacking our
country with chemical warfare.
Lisa Carole Cude (45:47):
Exactly, it does seem to be that way
chemical warfare, and it's likeyou said.
I think the numbers I believelast year, in 2020, were 94,000.
And I don't know how many ofthat is illicit fentanyl.
I've read so many differentthings 50, 60, 70, 80 percent
(46:08):
but I think the numbers are alot higher and I think in 2021,
they're going to be a lot higher.
I don't know how accurate theinformation is, but I just feel
like it's going to escalate andkeep escalating.
Is that how you think, or feel?
Dr. Charles Smith (46:21):
Yes, you know , I think it has to be
approached as any nationalsecurity problem.
When you think or feel, yes,you know, I think it has to be
approached as any nationalsecurity problem.
Would you know?
I think back on how we'veapproached terrorism.
So we both did more screeningat the sites.
We've done more screening atthe borders.
I think addiction hasparticularly the fentanyl
(46:43):
problem, the opioid crisis hasto be addressed.
The same way, we need toenhance our abilities so it
doesn't get into the country,but at the same time, don't
overlook its marketplace.
These patients who have avulnerable dopamine reward
system, no matter where they fitin that spectrum of people who
(47:04):
are going to use them we justdescribed all those three
scenarios need treatment andwe've got to make that treatment
available and offer you know, Iwon't say necessarily pay these
people to do it, but offer arewarding lifestyle that they
can see.
They need some incentive for it.
Lisa Carole Cude (47:24):
Yes, I see that, and the journey with
addiction and the stigmaattached to it.
A lot of people cannot get jobs.
So, yeah, they do need to berewarded, they need some
incentive to work towards tobetter their life, to better
themselves, not necessarily allthe punishment, or I think you
(47:50):
know what I'm saying, becauseyou live this yourself.
You live this yourself.
Dr. Charles Smith (47:54):
Yeah, and I advocate for a term called
contingency management.
It's that all of these fruitsof my recovery don't continue if
I don't have negative drugscreen tests.
So you know, instead of that ohmy God, you know what Mom's
driving me crazy?
She's making me give urinespecimens four times a year,
(48:18):
next year or something.
But those come with a rewardthat, yeah, not only that, but
your car insurance is cheaper,your college tuition is cheaper,
your college tuition is cheaper, but all of the fruits that go
with that mind-alteringsubstance free become more
readily apparent to them.
And that the testing is notlooked at as a penalty, which is
(48:40):
what it's looked at now.
Lisa Carole Cude (48:43):
Yes, it is Well, you have come a long way.
I just I don't want to give toomuch about your book because I
really want people to buy it.
I bought mine on Amazon I'mgoing to put plug in there about
Amazon but I really learned somuch from your book and it
really opened my eyes.
I loved reading about yourfirsthand experience with this
(49:06):
yourself and what was involved,and also your colleague, dr Hunt
.
Is that correct?
Yeah, that's Jason Hunt, andyou both were medical doctors
and you both suffered with thisfor years and it changed your
life and you had to do somereally soul searching and hard
(49:29):
work to get your life back.
You both lost your medicallicenses over this.
Is that correct?
Dr. Charles Smith (49:34):
Yes, it is.
Lisa Carole Cude (49:36):
And then you worked and did what you had to
do and got it back.
My goodness,god gbless Gblessbless you both.
I mean, I used to tell my sonyou're like the strongest person
I know Because I saw his battle.
You know every day with thisand this is something that you
live with the rest of your lifeand it is a battle.
(49:59):
Is that correct?
Dr. Charles Smith (50:01):
Well, additionally, yes, it is, but it
actually with appropriate andproper care and compliance of
the patient, most of us believethis day, the disease goes into
remission.
I look at it no different thanI use the example of a breast
cancer patient.
Quite often I have a breastcancer patient.
(50:22):
They have a lumpectomy, aradiation chemotherapy and 15
years later they're good.
Now that doesn't mean they stopdoing mammograms.
That doesn't mean they stopdoing breast exams.
That doesn't mean they startsmoking cigarettes.
That means they start drinkingalcohol, they start going to the
tan and bed anything that wouldbe increased risk factor for
(50:43):
cancer.
So the same now.
I'm sure my disease is inremission today, but I go to a
wedding, I make plans.
I don't drink champagne.
You know if I go to the sportsbar for Buffalo Wings, you know
I have Diet Coke.
I have a lemonade.
You know Mexican restaurant,you know it's frozen lemonade,
(51:10):
not a margarita.
And that doesn't happen byaccident.
That happened by goodscientific medical care and,
importantly, compliance withtreatment.
I have to have that frompatients.
So that's why I need thefamilies involved, because it's
not them nagging them, it's justhelping me ensure compliance.
Lisa Carole Cude (51:30):
Exactly Right.
Nagging doesn't help anything.
Dr. Charles Smith (51:36):
But help.
You know they call that theirsober support network.
Their sober support network,you know, would be involved.
And when you're going out withthese 10 guys that you went to
high school with and all you allever did was drink and smoke
pot, what do you think you'regoing to do with those guys
tonight?
What would you possibly have incommon with them?
And if you say, well, I do haveto meet them, et cetera, then
(52:00):
I'm going to take a sober friend, I'm going to have extra
accountability and even say youknow what?
You get a pee in this cup whenyou get home too.
Lisa Carole Cude (52:11):
And if they say no to that, that's a problem
.
So you're more aware,definitely, and more conscious
about all of this, and that'swhat it takes right.
Dr. Charles Smith (52:21):
Education is the pathway out of this one.
Lisa Carole Cude (52:24):
Yes, sir, I believe education is the pathway
out of this one.
Yes, sir, I believe educationis power.
Dr. Charles Smith (52:27):
What seems to be a voluntary disease is
actually not because of all thesocial pressures.
You know I had that phrase inmy book that in this country
alcohol is not just sociallyacceptable, it's socially
expected.
You're right, that has tochange.
Lisa Carole Cude (52:43):
You're right.
Yeah, it does has to change.
Dr. Charles Smith (52:46):
You're right.
Yeah, it does have to change.
Teens get peer pressure bulliedinto alcohol and cannabis.
Lisa Carole Cude (52:52):
Most definitely Peer pressure is a
major thing, and now nowadaysit's pill parties.
They're pressured into takingpills.
It's just not.
I mean, it used to be justsmoking cigarettes or drinking a
couple beers.
That has changed a long timeago.
Peer pressure has a lot to dowith it.
Yes, sir, well gosh, charles, Icould talk to you all night and
(53:15):
you're just a wealth ofinformation and I just want to
thank you for being sotransparent with your own story
about your journey and I wantyou to know that you are so
loved and appreciated in doingso and in also helping to make a
difference with others withtheir continued battle with this
.
And if you are my audience, ifyou or a loved one is struggling
(53:38):
with addiction, you'll findhelp in Dr Smith and Dr Hunt's
book, and it is called again,understanding Addiction, no
Science, which is K-N-O-W, andto no Stigma.
Let's end the stigma.
It's up to us as individuals toend the stigma in this country,
and when one understands thescience behind addiction, one
(54:00):
can begin to move forward,because beyond stigma, there's
always hope.
There still lies hope, andthank you, charles, I really do
appreciate it.
I hope we can possibly interviewsome time again in the future.
Okay, okay, it's been apleasure, thank you.
Dr. Charles Smith (54:20):
Take care.
Lisa Carole Cude (54:20):
Bye, thank you .
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