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Understanding Substance Use: What is Addiction?

July 19, 2018

Host: Dr. Jennifer Hunter, Assistant Director for Family and Consumer Sciences Extension, University of Kentucky

Guest: Alex Elswick, Extension Associate for Family Resource Management

Episode 7

0:00  Welcome to Talking FACS - what you need to know about family, food, finance and fitness. Hosted by the University of Kentucky Family and Consumer Sciences Extension Program, our educators share research knowledge with individuals, families and communities to improve quality of life.

0:20  Dr. Jennifer Hunter: Hello and welcome to Talking FACS. This is your host, Dr. Jennifer Hunter, Assistant Director for Family and Consumer Sciences Extension at the University of Kentucky. Today, I'm pleased to have with me our guest, Alex Elswick, an Extension Associate in the Department of Family Sciences. So, within extension, Alex wears many hats and one of those hats is that he is our subject matter expert on substance use prevention and recovery. Thank you for joining us, Alex.

0:45  Alex Elswick: Thanks for having me.

0:46  Dr. Jennifer Hunter: So, in conversation with Alex and preparing for today's podcast, I asked him if he would visit with us and essentially create a series of podcasts over the next several weeks that focus on understanding substance use prevention, addiction, as well as what some families may face while they have a loved one that is suffering from addiction and what the recovery process looks like and how we can help individuals in recovery.

And so, today, we're going to start with just the very basic conversation of, “What is addiction?” I think that this is an issue that is so pressing in so many of our local communities. But potentially one that just us, as average consumers, may not be overly informed on. So, I'm excited with the information that you have to share with us today, Alex. And let's just start with that question. Can you just give us a basic overview about, “What is addiction?”

1:40  Alex Elswick: Yes. So, such an important question; given all the mischaracterizations of addiction that there are out there. But the National Institute of Drug Abuse defines addiction as a chronic relapsing brain disease, which is characterized by compulsive drug seeking and using, despite the harmful consequences.

And so, there are some important parts of that to break down. The first is that addiction is a chronic disease; which means you can't go to the hospital and get cured for it overnight. It doesn't work that way. You can think of it like other chronic diseases like diabetes that have to be managed over the long term.

It's a relapsing disorder; which means it's sort of characteristic of addiction for people to experience cycles of relapse and remission. Oftentimes, it takes people multiple episodes of treatment to successfully enter and maintain their recovery.

The part that says, “Characterized by compulsive seeking and using of drugs” is the behavioral expression of addiction that most of us are familiar with. It's the part of addiction that we see; that's visible. And then despite harmful consequences, this is kind of what defines an addiction of any kind; whether it's an addiction to food or to gambling, it sort of becomes an addiction at the point that a person is doing it to their own detriment – at the point that they're doing it despite the fact that it's harmful to them.

3:02  Dr. Jennifer Hunter: So, like you said, that's a lot packed into one definition. And I think it would probably be beneficial for our listeners to break that down just a little bit.

And one thing that I heard you say in talking about addiction as a chronic disease; which I think sometimes that we may not perceive that. That we might look at it as this person is choosing to do this or they're choosing to harm themselves or they're choosing to harm their family.

But you put it in the context very similar to diabetes or I think I've heard you've referred to it in the past of maybe heart disease and that we take a very medical approach to addressing those forms of chronic disease or chronic illness.

3:42  Alex Elswick: Yeah. So, another way of understanding addiction in the disease model is through what's called The Bio Psychosocial Model.

3:50  Dr. Jennifer Hunter: Oh, that sounds so technical.

3:52  Alex Elswick: I'm going to break it down for you.

3:53  Dr. Jennifer Hunter: Okay.

3:54  Alex Elswick: It's a fancy fancy word, but all that it means is there are biological factors, psychological factors and social factors.

So, by biological factors, we mostly mean there's a strong genetic component to addiction. We see genetic influence in all sorts of diseases. For instance, we say that breast cancer has a genetic component; it runs in families. But in reality, the research shows only like 3 percent of breast cancer is explained by genetics. Whereas in addiction, it's between 40 and 60 percent. So, a really strong genetic contribution.

4:24  Dr. Jennifer Hunter: Very strong connection.

4:25  Alex Elswick: So, that's the biological part. The psychological part is things like co-occurring mental illness. And when we say mental illness, most often, people think of the more striking mental disorders like schizophrenia or bipolar disorder. But really, it can just be things like anxiety or depression that give people a sort of internal experience that's negative and makes it more likely that they're going to look for ways to cope with how they feel.

And then the social factors are really vast and varied, but one would be your peer influence. So, my mom used to say, “Show me your friends and I'll show you your future”. So, there's definitely some truth to this idea of sort of running with the wrong crowd, so to speak. There's family influences. So, certainly having a family member, a parent who is addicted, gives you a genetic contribution, but they may also be modeling substance use behavior in the home.

And then the impact of trauma. What's called adverse childhood experiences; which are basically just bad things that can happen to you as a child. So, things like having a parent who is incarcerated or a parent with a mental disorder or neglect and abuse; things like that greatly increase the risk that you'll develop a substance use disorder at some point in your life.

5:38  Dr. Jennifer Hunter: So, we mentioned at the beginning that substance use is really at the forefront of a lot of communities right now, especially in Kentucky, that we have some Kentucky communities or counties that have a very high prevalence of substance use. Can you share a little bit of just data or information about that in those communities?

6:00  Alex Elswick: There are a number of reasons why Kentucky has been especially hard hit by this opioid epidemic. Part of it has to do with the fact that as, particularly in Eastern Kentucky and Appalachian communities, we have places where industry has left, we have folks who did hard physical labor that may have led to injury for which they were prescribed pain medication. And what we know is that– I think research says for a person who's prescribed pain medication for 10 days, one in five will become addicted.

6:32  Dr. Jennifer Hunter: Wow!

6:33  Alex Elswick: So, extremely high. They're just very powerful narcotics. And most often, people don't realize that they may have a genetic risk.

6:40  Dr. Jennifer Hunter: Right.

6:41  Alex Elswick: So, they've never had a problem with any kind of substance before in their life, but they're exposed through legitimate means, via a prescription from a doctor and they become addicted.

6:51  Dr. Jennifer Hunter: Okay. So, just as a community, what are things that just the average consumer, the average citizen, can do or can support or can learn more about to help deal with this crisis?

7:06  Alex Elswick: The first thing that I suggest everyone do who I meet, who asked me about substance use is that they educate themselves. Addiction is so incredibly complex. And unfortunately, throughout history, it's been really stigmatized. There are a lot of stereotypes and a lot of misunderstanding around what addiction is. A lot of pushback against the fact that addiction is a disease for any number of reasons.

And so, I encourage people to read as much literature as they can, watch TED Talks or YouTube videos, come to understand how addiction is changing the brain.

And I think part of what it does is give people a little bit of compassion– a little bit of an understanding that what we're talking about is truly beyond a person's control and is truly a disease for which they need treatment.

7:51  Dr. Jennifer Hunter: I'm from a community in the state of Kentucky that was exactly how you describe. It was a heavy manufacturing community and the manufacturers moved out for a variety of reasons. And it is definitely an issue that they're grappling with at home now, because jobs are relatively low paying, the unemployment is relatively high compared to other aspects of the state. And so, it's definitely an issue that I think we can all learn more about. And I'm pleased that you've agreed to be with us and share with us additional information.

8:24  Alex Elswick: Thanks for having me and I'll look forward to coming back.

8:27  Dr. Jennifer Hunter: Thanks Alex.

8:29  Thank you for listening to Talking FACS. We deliver programs focusing on nutrition, health, resource management, family development and civic engagement. If you enjoy today's podcast, have a question or a show topic idea, leave a ‘Like’ and comment on Facebook @UKFCSEXT. Visit us online at fcs.uky.edu or contact your local extension agent for Family and Consumer Sciences. We build strong families. It starts with us.