Maggie McKay (Host): Addiction is a tricky thing, and a lot of people misunderstand all the complexities of it. So today, we'll talk with Dr. Robert Lizer, Addiction Medicine, Carle Health Proctor Hospital, about understanding addiction and reducing misconceptions.

Welcome to Let's Talk with Carle Health, a podcast featuring Carle doctors, partners, and other experts, bringing you topics important to your health and wellness. I'm Maggie McKay. Great to have you here today, Dr. Lizer. Thank you for making the time.

Dr Robert Lizer: Thank you for being here also and giving me the time to talk about addiction.

Host: Absolutely. So in simple terms, just to start off, what is addiction?

Dr Robert Lizer: When I talk to patients or to people out in the public, I always talk about addiction. I use this definition. Basically, it's a chronic brain disease with continued use despite negative consequences. So if you break that down, it's long-term using of a substance. And with the continued use, despite negative consequences, which would a legal problem, a relationship problem, a cost, a health reason, and we would continue to use despite all these negative consequences, is what it would be.

Host: And what are some examples of different types of addiction? Like what's the difference between a substance or chemical addiction and a behavioral addiction?

Dr Robert Lizer: Well, I think we kind of break it down into substances and also process addictions. And when we talk about substances, it's the things that we think about all the time. We talk about alcohol. We talk about tobacco. We talk about opioids, which are chronic pain medications like hydrocodone, which also include heroin and fentanyl with this opioid epidemic. We also talk about cocaine, methamphetamines. We talk about marijuana, steroid use and also hallucinogens and a few others. So, those are basically the majority of the substances that we deal with when we treat addiction.

And then, if you break it down even farther, it's more of a process or behavioral addiction, it's more of a gambling addiction, it's overeating addictions, it's spending addictions, it's sex addictions. And so, those are the more of the process behavioral addictions when you break down into that category.

Host: So, you basically have substance, chemical, or behavioral.

Dr Robert Lizer: Correct.

Host: Okay. Are there some forms of addiction that are more common?

Dr Robert Lizer: I would say the most common addiction that we see and everyone sees is tobacco. That's the biggest one in our country, followed by what I see with alcohol, followed by cocaine, and methamphetamines, and the opioids. So, alcohol and cocaine and opioids are usually the top three, along with the tobacco. And then, here in Peoria, we see a lot of gambling with a lot of the casinos and also the cafes with the slot machines popping up, we see those.

Host: Why do some people develop a problem and others don't?

Dr Robert Lizer: I get this question all the time when people come in. They always wonder why when they sit down, let's take alcohol for an example, they sit down at a bar and they say, "Hey, why is it I drink six to 10 beers when the person next to me only drinks one beer? Why do I drink more?" And I always break it down into what we call a biopsychosocial disease. When I talk about that, I talk about the biological portion and that's more of the genetic predisposition to having a use disorder. And then, we talk about the psychological factors. This is people's physical health, people's mental health, people's coping skills, just what's going on from a psychological component with it.

And then, sociological or social is when we talk about family influences, what's going on with peers, any disruption of those relationships, any death within that family. So, it's like we have this biopsychosocial model. It's like all three are triggered, and the switch is flipped in some individuals, and they're more prone to develop a use disorder versus other people.

Host: Because sometimes you see someone who maybe their parents were alcoholics, and people say that's hereditary, although they don't have that problem. So, do some individuals have a higher risk for developing an addiction?

Dr Robert Lizer: Right. And when we talked about those genetic influences, if you look at the statistics, anybody in our population, for men, men have about a 10% chance of developing a use disorder, 5% for women. But if you have a first degree relative, which is like a parent, a mother, father, a sister, brother, or even a child that has a use disorder, that actually doubles. So, that increases to 20% for men and also to 10%.

But then, what's interesting, if you have a second degree, which is like a grandparent or an aunt and uncle, this increases even more to a 30% for a male and a 15% for female, the chances of having a use disorder. So, that genetic predisposition is also a very, very strong factor with those.

Host: So, do you advise people who have like a family history of addiction to just not even start whatever it is, alcohol, tobacco, whatever?

Dr Robert Lizer: Most definitely. I think that's a discussion with the individual and to let them know they are at a higher risk than the average individual. It's like people who have a family history of coronary artery disease and they have high cholesterol. And so, we want them to have better food habits so they don't develop coronary disease.

And so, if you look at it from an addiction standpoint, if you have a family member who had alcohol or some other type of use disorder, you'd say, "Hey, you are at higher risk. I recommend not drinking or really moderating and watching your use potential and being aware of those things." And that's the biggest thing, it's providing education to those individuals that are at a higher risk, because a lot of this can be prevented as far as having that education so people do not develop use disorders if they're aware of it.

Host: Dr. Lizer, how can you tell if someone's struggling with an addiction?

Dr Robert Lizer: That's a complicated question. But the first part is that, you know, it's obvious if someone's very intoxicated from a substance, whether it's alcohol, whether it's cocaine, whether it's an opioid. They don't act right. They're showing up to work or school or their home or at a birthday party, they're just not acting correctly. You know, they have different smells on them. And so, that intoxication state is kind of easy to see.

And then, what gets really more difficult, is that certain individuals, if you look at them, they have more what we call risk-taking. That means driving while they're intoxicated on a substance, going to work under the influence, doing other acts under the influence as far as that, and also neglecting responsibilities at school, home, work, those are big things. And also, changes in personality, a lot of people who develop use disorders sometimes neglect things that they usually like to do. And so, they've lost interest in things that they normally did. And so, you can see those change. Was there a change in their personality? Are they more anxious? Are they more paranoid? And there's no reason for that. And the other thing is, are there change in friends or their favorite hangouts? Are they changing their whole behavior?

And so if you look at those types of things, it's a wide variety of symptoms that could present that way. And then, unfortunately, you have the people who do function, who do go to work, who do go to school, who are at home, and they're able to function, but they still have a use disorder despite being able to function, binge drinkers. And so, those are the other things that we apparently have to be very careful when we diagnose and look at people and when people are thinking, "Oh, do they have a problem or not?"

Host: I always find it surprising when you know somebody for a long time, like years, and you had no idea that they had an addiction because they could, you know, wait until they were home alone or compartmentalize it and not show it when they're with other people. I think that is so surprising. So, what are some of the misconceptions or misunderstandings about addiction?

Dr Robert Lizer: I think the biggest one that I see is that this is not a moral failing. This does not make you a bad person. This is a chronic brain disease. And so, a lot of people think that, "Oh, he chooses to drink. He chooses to use substances," when we know that the brain is driving that use. Maybe they chose to use initially, but then the chronicity of it is that the brain takes over and drives everything.

The smart part of the brain says, "Hey, we don't want to use," but the reward system says, "Hey, let's have more of the substance because it gives that euphoria." And so when people just say, "Oh, just quit," that really is not the correct way to approach it, because it's a chronic use of this. And so, I think that's the education that I try to present to the public, because they always think that individuals who have a use disorder, it's a choice they make to drink or to use a substance. And that is totally incorrect at that point in time.

Host: So if somebody is concerned about maybe they think they have an addiction, how can they get help?

Dr Robert Lizer: A lot of times, friends and families are the first people to notice, they notice that their behavior at certain individuals, at certain parties, they are acting differently, they're intoxicated, if they show up intoxicated at work, or they're under the influence. And so, the friends and family really need to have that conversation with the individual, and it's such a delicate conversation to have.

First of all, you never want to bring up the topic of substance use when the person is actually intoxicated at that point in time. The next thing is, if you're going to bring it up, make sure it's in a quiet environment. Don't do it at a restaurant. Don't do it where there's a lot of people around. Just make sure that it's in a quiet environment. And be open. It's a two-way street. And definitely, you want to be nonjudgmental. You want to be open. As I said before, it's a two-way conversation to have with them. And maybe the individual will be very rewarding and say, "Yes, I need to go treatment." But a lot of times, it doesn't happen that way. But you never know that individual might call the next day and say, "Hey, yeah, you were right," but it could be months down the road after other things have happened, they reach back out to the individual.

Then, I think the next conversation would be to talk to your primary care provider to get their opinion. Obviously, here at Trillium Place and Carle, we have options to come in for, assessments to see if that individual actually has a use disorder. And is it mild, is it severe, or do they not have one, or are they just displaying risky behavior?

So, I think talking to family, friends, then getting involved with the medical field with primary care, and then also here at Carle to help us help these people kind of walk the line, because it's uncharted territory. And they're scared, they don't know what it's about. Obviously, if the individual is very intoxicated, having trouble breathing, definitely calling 911, getting them to the emergency room is the appropriate thing. And another discussion for a future podcast will be a discussion on opioids and also Narcan, which we really encourage a lot of people with family members who use opioids like heroin and fentanyl.

Host: So for the person who knows they have an addiction, they can get help by maybe first just trying to get an appointment with someone, like with you, for instance. What message of encouragement would you like to share for those in recovery or those looking to take the first step to get help? Because that's got to be tough.

Dr Robert Lizer: The first step, and what I tell people is take care of yourself. Recovery can be mentally, physically, emotionally draining for these individuals. It can be that way for the people around them. So, I think taking take care of yourself, continue to be engaged, to seek treatment, to be open for positives, for negatives. I think the biggest thing is be hopeful. Don't give up. And that's a big thing, because so many people going through treatment get discouraged when they finally sober up and they realize what relationships they have broken and all these other maybe legal and other negative consequences.

And the biggest thing is seek out help and support, but just taking care of yourself and don't give up and seeking professional help is what I could say to any individual. Because you got one day at a time, and that's something we say to a lot of our people in recovery. Because looking for that one positive during the day is such an important thing, because a lot of these people who use substances have so much negativity, they don't see positives in that day. And so, we start with that one day at a time. Look at that positive. And that's what I would say to these individuals. And there can definitely be setbacks, but keep moving forward, keep being engaged. Because it's when people aren't engaged, that's when I see relapse, that's when I see people struggle even more at that point.

Host: And stay engaged if you're somebody who is watching somebody struggling, right? Don't give up on them and stay connected.

Dr Robert Lizer: Correct. And that's where we said keep that open line of communication. Don't badger them, but just know that, "Hey, you can come to talk to me anytime you want." And that two-way communication goes so far in helping people in recovery.

Host: Right. So, to be supportive, basically. Well, thank you so much for being here today, Dr. Lizer, and sharing your expertise. It's been very helpful and useful information.

Dr Robert Lizer: Oh, you're very welcome. And I'm always happy to share education on addiction with everybody that would want to listen.

Host: Great. Well, maybe we'll do another one on opioids. You never know.

Dr Robert Lizer: That would be great. Thank you so much.

Host: Thank you. Again, that's Dr. Robert Lizer. This information featured in this podcast is for educational purposes and is not intended to be used for a diagnosis or treatment. Take the first step and reach out to your doctor or visit carle.org or trilliumplacehealth.org for more information on addiction recovery services at Carle Health. For emergencies, dial 911. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening. Count on Carle to be your partner in health and wellness, and join us next time on Let's Talk with Carle Health.