Navigating Addiction and the Complexity of Change with Daryl Shorter, MD Pt. 2
In this continuation from last week's episode, part two of Health Gig sees hosts Doro and Tricia delve further into the realm of addiction, treatment, and healing. They are joined by special guest, Dr. Daryl Shorter, the Medical Director of Addiction Services at the Menninger Clinic in Houston, Texas.
Over the course of their conversation, they cover a wide range of topics, from the use of medications to treat addiction to the complexities of substance use disorders, including alcohol and cannabis. Dr. Shorter's insights shed light on the multifaceted nature of addiction, the impact of genetics and environment, and the importance of individualized, value-based approaches to healing. Join the discussion as they explore the intricate layers of addiction and the path to recovery.
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Website: https://www.menningerclinic.org/staff/daryl-shorter
LinkedIn: https://www.linkedin.com/in/daryl-shorter-798a276/
Quotes:
Everything in the life of a person who struggles with addiction might be telling them the substance is not doing them any good, yet they continue to engage in the source of their addiction. - Daryl Shorter, MD
The natural trajectory for some people can include a spontaneous recovery, and they may not even necessarily have identified themselves as or been identified as having an alcohol use disorder. - Daryl Shorter, MD
When we live in a manner that is consistent with our values, and we're accomplishing our goals, that's how we ultimately can create meaning in our lives. - Daryl Shorter, MD
Show Notes:
DARYL SHORTER: The DSM stands for the Diagnostic and Statistical Manual. It is the way that mental health clinicians go about diagnosing and classifying psychiatric and psychological conditions. We can prescribe medications for addictive disorders, not only medications that are FDA approved, but also non FDA approved medications can be prescribed to treat addictions as well both behavioral and substance use disorders.
DARYL SHORTER: We need to develop that same fluency and health care literacy where people might come in and say, all right, well, I'm struggling with alcohol. I'm struggling with nicotine. What are the medications that you can prescribe for me?
DARYL SHORTER: Great medication should absolutely be prescribed to people that have opioid use disorder. There are I think, questions and there's a conflict in the field about for how long someone should be prescribed that medication.
DARYL SHORTER: There can be lots of complicated reasons around why it is that someone may or may not feel comfortable taking that medication. And it's not because, quote unquote, they're not motivated. Right? It's not just that part of the work that we have to do is really helping people to understand, like, the complexity of their relationship to a substance. And that can also include why they may be more or less likely on a particular day to feel comfortable taking a medication for an addictive disorder.
DARYL SHORTER: What you're trying to do is you're trying to reduce some of the withdrawal symptoms that people are experiencing, to reduce some of the anxiety that they might be experiencing.
DARYL SHORTER: Smoking e-cigarettes, vaping has become a huge public health issue, especially among adolescents and young adults recently. I remember when nicotine replacement came out, the patch and the gum, and all of a sudden you saw people using the gum instead of smoking, not because they were trying to quit smoking, but rather because they were trying to continue to get the nicotine and slip in places where they might not have otherwise, which I think is still maybe, perhaps still a positive exchange.
DARYL SHORTER: I kind of think we have to maybe complicate our understanding of sort of how and why it is that people use substances and the circumstances that might contribute to why it is that someone might use those types of things. But, you know, we've been watching this unfold over the last couple of decades with prescription pain relievers and the impact that that has had on people.
DARYL SHORTER: What we know about the development of addictions is that it is a multifaceted, multifactorial, complicated condition. And there are a number of risk factors that are present on the biological side of things. So we can look to things like the genetics. We can look to things like family history. We can look to temperament and personality, which are biologically based.
DARYL SHORTER: Now I think parents are really having a much more challenging conversation around substance use.
DARYL SHORTER: Not all substance use like is born of this, like horrible trauma. Of course, for some people it is, but that's not necessarily a universal experience. And so we really have to think about kind of the complexity of why it is that someone is even perhaps vulnerable to going on to initiate substance use and then progress from use to use disorder.
DARYL SHORTER: I think it's important for us to sort of acknowledge that the natural trajectory for some people can include a kind of spontaneous recovery, and they may not even necessarily have identified themselves as or been identified as having an alcohol use disorder during that phase.
DARYL SHORTER: In the community, people are saying kind of anecdotally it seems or it feels like more and more people are presenting with cannabis induced anxiety disorders, cannabis withdrawal, cannabis use disorder, like the cannabis, is having maybe more negative impact on adolescents and young adults than we might, might hope.
DARYL SHORTER: That's true for really anyone with psychotic disorder like who rarely can you pinpoint the thing or the factor. It's probably a combination or confluence of factors, both psychological as well as genetic. And when I talk genetic, I'm not talking about even a single gene. I'm talking about probably multiple genes that contribute to this interaction between the genes and the environment.
DARYL SHORTER: It becomes important to have conversations with people about what their values and goals are for themselves. So I can have a really sort of lofty idea about what healing looks like for the person, but really think it begins with like, well, what do you want for yourself? What do you see for yourself? And can we help you to work toward that particular goal? And in what ways are these goals consistent with your values?
DARYL SHORTER: There are people who have meaning in their lives who also engage in substance use. Your life does not necessarily have to be devoid of meaning or connection.
DARYL SHORTER: When we talk about people who use substances, we allow people to self-identify as alcoholic or addict, but we really try to refer to folks as people in the same way that we kind of gotten away from calling people schizophrenic or calling people diabetic.
DARYL SHORTER: We're trying to change that language. And we talk about people. If they have had a reoccurrence or recurrence of their substance use, we just find that that is much more, I think, medically accurate and hopefully reduces a lot of that stigma and bias that people can experience as well. So language is like another thing that I love talking about, because I think it does so much to help bust stigma.
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