Announcer: The views and opinions expressed on the Advice Line are not necessarily those of the station, the sponsor, or your host. Advice is provided for informational purposes only. Advice Line appearances are paid for by the participant.

Bob Lewis (Host): And good afternoon. I'm Bob Lewis. Welcome once again to our continuing series of interviews with the doctors and experts from the Summa Health System. This program is sponsored by Summa Health.

April is going to be Alcohol Awareness Month once again, a time to raise awareness about alcohol and other substance abuse disorders and all the serious health consequences associated. And the program today, we're welcoming Dr. Aly Zewail, who's a psychiatrist specializing in addiction medicine at Summa Health, to tell us about what we should know about substance use disorder, including some of the signs, symptoms, the treatment options, and how to support someone who's struggling with this disorder. Dr. Zewail, thank you for joining us on the program.

Dr. Aly Zewail: Good afternoon. Thanks for having me, Bob.

Host: So first of all, tell us about how we define substance use disorder.

Dr. Aly Zewail: All right. Substance use disorder is a treatable mental condition. In plain terms, it's when someone keeps using alcohol or other drugs and other substances, even though it's causing a lot of problems at home, at work, in relationships, or with their own health. The repeated substance use can actually change how the brain works. Those changes don't just go away when you get high or get the pleasure, and after that it wears off. No, it continues, and it stick arounds and start building up tolerance. And you need more substance to get the same effect. And even if you try to stop them after that, you start experiencing withdrawal, and it's already did the changes in your brain.

So over time, basically, excessive consumption can lead to development of chronic diseases, not just like physical, but it also can be mental, and serious issues that can affect the quality of your life. And as I mentioned, like physical and mental health are affected tremendously with that.

Host: Now, what are some of the risks that make us liable for a substance use disorder?

Dr. Aly Zewail: There are a lot of risks, like, we can start with the age-related risks. Like in young adults, brain development is still in progress. Adult identities are forming. Transition, such as in college, exposed to these groups, causes increase of the risk for substance use. According to like 2022 national survey by Substance Abuse and Mental Health Services Administration, about 50% of young adults aged between 18 and 25 drank alcohol in the past month. And out of those 60% already had the binge drank in the past month.

Then, we come with the midlife adults. They start having stresses due to parenthood, employment, marriage. So, those factors can attribute to their increased drinking and substance use. And then we get to the older adults, you know, with changes in the body. They start getting, like, pain issues, arthritis, and they start using drugs or alcohol to self-medicate, and it becomes a vicious cycle. It can cause injuries and falls, memory problems. And also, there is one of the things that the people, they are not aware of that genetic risks. There are genetics that are involved in substance use, like genes influence risk by affecting various biological process in mental states and traits.

Example include psychological response to alcohol. Not everybody that drinks respond the same way to alcohol or substance. And there's also the mental health, which part of it is genetic, part of it is the way that people are brought up. So, it can increase the risk for substance use. Like, they also try to self-medicate for depression and anxiety, PTSD, and that will include exposure to trauma and other stresses.

Host: Is there such a thing as an addictive personality?

Dr. Aly Zewail: There is, definitely. As I said, like, people with addiction, they have a different makeup of their brain than other people. Like, I'll give you a baseline example. If a normal person sees a sunset and he says like, "Wow, it feels so good," because they have enough serotonin in their brain already, and that can cause happiness.

Well, somebody with addiction, they don't produce the same amount of chemical transmitters. So when they see the same sunset that the other person sees, they're not going to be as happy. So, they need that boost from the outside substances just to feel normal, not to feel high. So yes, there is a difference between somebody with addiction disease and somebody that's normal.

Host: Now, what are some of the signs? How can we tell if someone or ourselves has a substance addiction?

Dr. Aly Zewail: Well, there are some common signs and symptoms you can watch for, like failing to fulfill obligation at home, work, or school. It can be like sudden weird financial issues that were not there before, relationship problems, withdrawal from the loved ones. Remember, some people with addiction, their brain try to trick them that they want to be by themselves so they can keep using. So, withdrawal from loved ones is a big thing. Loss of interest in favorite activities, change in eating or sleeping habits or patterns, memory lapses, poor concentration, worsening depression and anxiety. Those are few things that you can look at to start suspecting someone has substance use disorder.

Host: But are there people that can be in the throes of alcoholism, for example, or substance abuse that have no outward symptoms of it? I mean, they function normally, they do their jobs. You can't tell if they're, you know, high or drunk, but hey're drinking, you know, a fifth of gin a day or taking, you know, drugs of some sort. You know, is it something about those people that it makes it particularly hard to find out if they're really, you know, battling an addiction?

Dr. Aly Zewail: Well, I mean, even if they're like people—say functional alcoholic, I mean, with this amount of drinking, eventually, it's going to catch up with their health. And if they know that it's affecting their health and they're still drinking, that by itself is one of the criteria for substance use disorder. We see a lot of people in the hospital, they came in not for alcohol issues. They came up, for example, with atrial fibrillation. But one of the most common causes of atrial fibrillation, which is irregular heartbeat that can lead to strokes, is alcohol consumption, especially on weekends binge. Even if they don't drink during the week, but they all of a sudden, it's a weekend, let's relax and have fun. One of the causes of this irregular heart rate that can lead to strokes and a lot of health issues is this kind of drinking. So eventually, it's going to catch up with them.

Host: What are some of the other health issues that can come about from both alcohol abuse or other kinds of substance abuse?

Dr. Aly Zewail: Well, I mean, if you're going to talk about just alcohol by itself, alcohol basically, if you're drinking excessively, it stocks into each cell of the body. So if I'm going to go, like with the brain, it can cause memory issues. The heart, can cause irregular heartbeat, congestive heart failure. Liver, it can cause liver failure. It affects basically every bone in your body. it even affects the bones. One of the common side effects of alcohol for people above 60, is something called avascular necrosis of their hip bone. So, all of a sudden he thinks there's nothing wrong with him, but all of a sudden he cannot walk or he's limping.

He goes to get an MRI, and he finds that his hip joint is gone. So basically, it affects every cell in your body differently. Like the bone, you can have bone issue. The heart, you can have heart issue. The brain, you can have brain issue. And brain, mainly, it causes shrinking of the brain. So if you have memory issues, it's going to make it worse.

Of course, strokes, it's going to make it worse. And it affects your decision-making because it prevents your frontal lobe from controlling your brain to do the executive function it's supposed to be doing. So, you do bad decisions.

Host: Now again, we're talking a lot about alcohol awareness, because that's what April is. But there's a lot of controversy now, a lot of different studies coming out and different opinions about if there is any safe amount of alcohol that one could have, if at all. What is the current idea about whether alcohol is safe at all, even in modest quantities?

Dr. Aly Zewail: Well, if you're going to talk about alcohol, there is nothing safe about alcohol. As I said, there are people that can handle it, but there are also people with addiction disease disorder, that they don't know that they have addiction diseases disorder. So in this case, if you think it start affecting your life, then even one drink is not good for you. If it starts affecting your relationship with your spouse, your studying, your work, you need to know that one drink is not good for you. It's as bad as 10 drinks. So, some people, they can handle it, and some people, they can't.

Host: So let's talk about, again, how to help somebody who is suffering from alcohol or even other types of addiction. Again as a relative or a loved one or a friend of somebody who is an alcoholic or is addicted to a substance, what kind of support can we provide for them that can help them?

Dr. Aly Zewail: Well, you have to talk to them first. Like, finding a way to talk with a loved one about addiction is never easy. So, start by setting aside time to talk when you're both free with no interruptions or distractions. Some tips to help to start the conversation, exercise your concern about the person's health and wellbeing.

You can offer support without judgment, blaming, and arguing. You have to understand it's a disease, so don't just blame them. It's like you're blaming a diabetic, a diabetic person for having high sugar, you know? So, stick to the facts about how treatment can help, ensure them they don't have to do it alone. Ask open-ended question and then listen without interruption. Acknowledge their feelings. Show respect to their point of view. Focus on what loved one should do instead of not to do. And also, tell them there is professional help available right now without being judged. If a loved one is struggling with addiction, it may be difficult to know where to turn for help.

The good news, there are available programs all over the country that can offer help that they need. For example, Summa Health where I work, we can assist your loved ones from the very first step of recovery, keep maintaining understanding that every person's experience is unique. Summa treatment plans are tailored to your situation and your individual needs for the best outcomes.

We offer first step program in the ER. It's the emergency room. So, it's open 24/7. So if you're having the withdrawal issues, if you're having cravings, all you have to do is just go to one of the ERs for Summa Health, like in Akron, Barberton, Green or Wadsworth. The emergency room, as I said, is open 24/7.

At the very first visit, providers, we treat all the withdrawal symptoms, ease craving, and provide on-site care coordination to ensure patients don't leave our hospital without a plan. This program provides care and assistance for patient and needs for addiction and any addiction, like the new ones that came out like kratom. I'm sure you heard about kratom. It's a big thing now. And of course, the alcohol, benzodiazepines, methamphetamine, cocaine, even marijuana and smoking too.

Then after this evaluation, we have a full detox unit that has specialized psychiatrists, specialized social workers and, of course, specialized addiction medicine doctor, specialized nurse just for addiction medicine. And to know about how we are, like, very unique about this detox unit, we have been the first detox unit in the United States since 1939. We built this detox unit with Sister Ignatia and Dr. Bob, Bob Smith, who was a co-founder of Alcoholics Anonymous. So, we've been dealing with this problem for more than—I'm not very good at math—but 1939 till now, I would say at least close to 100.

Host: Yeah. Almost 90 years or more. Almost 90 years.

Dr. Aly Zewail: Oh, yeah. Yeah. So, we are very experienced about that. Our detox unit, as I said, we're so specialized. We approach the patient 360 degrees from all the angles. As I said, we have the social worker that's just specialized for that, nurses, and we have meetings inside of the unit.

And it's a very nice unit. Like private rooms, two large areas. We have a lot of activities. So, the patients, they don't feel that they're judged. They feel that they are part of this community. We let them get really involved in their treatment by offering them a lot of alternatives.

And before they leave, we got like a plan between them, their loved ones, the social worker, just to make sure that the treatment process stays on. And this includes offering them something called intensive outpatient therapy after they're done, which it explains itself. It's like three hours a day, three times a week for 15 to 20 sessions. It's basically cognitive therapy. So, plus that, we also have a unit for dual diagnosis. So, definition, they have dual diagnosis, like they have psych illnesses, and on top of that, they have addiction problem. So, we have a unit specialized for that. So, we cover all types of addictive disease, whether it's mainly caused by mental health or other issues. Summa Health program also supports abstinence in the form of either complete abstinence or something called harm reduction treatment program.

Like in the past, let's give an example of opioid use disorder. In the past, if the patient starts relapsing on other substances, we would consider that this is like a red line. We cannot cross that. You cannot use other substances while we're treating you for opioid use disorder.

However, recently, and when I say recently, it's the last few years, I would use something called harm reduction, which means, yes, I understand the patient keep relapsing on other substances, but I would still keep treating him in order to prevent a major catastrophe like overdose, that kind of stuff.

This is called harm reduction. So, we use for that something called medication-assisted treatment. So, Summa Health offers a broad spectrum of specialized addiction services, including this medication-assisted treatment, which is approved medications that helps with cravings, help with withdrawals so the patient does not need to keep using. So, we use this medication-assisted treatment including—I'm sure a lot of people heard about Suboxone, which is buprenorphine, and it comes in forms which is oral, sublingual, or injectable. And we also have the naltrexone, which also come in oral forms and injectable forms like Vivitrol to help them with cravings.

We don't stop only at that. We keep following up to make sure that giving this medication has taken care of the cravings. If not, we can add medication. We add the IOP, which I mentioned prior to that. And also, we try to dig deeper in the root of the problem. If it's a mental health problem, we get a psychiatrist that is specialized in dual diagnosis to make sure that the problem with their mental health is not going to continue to be a trigger for relapse. And yeah, basically, we offer the 360-degree care for those patients in our facilities.

Host: Once again, we're talking to Dr. Aly Zewail, who is a specialist in addiction medicine at Summa Health, a psychiatrist there, about substance abuse and, again, especially alcohol abuse. This is Alcohol Awareness Month coming up in April, and alcohol is probably the most commonly abused type of a drug out there. Although we have, again, many other drugs that are vying for second place, like marijuana, even cocaine and prescription drugs too. Would you still say, Doctor, that alcohol is still the main drug of abuse in this country?

Dr. Aly Zewail: Yes. Alcohol is basically due to the availability. You can, like, order it online and it is brought to your house. So, the availability is the issue. Plus, people look at alcohol use disorder different than other substance use disorder. So in some communities, it's acceptable to have alcohol use disorder, but it's not acceptable to have other substance use disorder, which we try to explain to people that alcohol is a drug. It is. It affects the brain exactly the same way that other drugs affect the brain. But you're right, alcohol is still number one abused substance in the United States. Aside from cigarettes, of course. Cigarettes too, nicotine. but we're talking about the one that has massive effect on people's lives.

Host: Let's talk about, again, when someone is becoming—before they can make that decision to enter some kind of treatment, you often hear people say, "Well, sometimes the alcoholic has to hit rock bottom before they might turn around." And again, I've known a friend of mine that he one day woke up in a jail cell in Massachusetts, had no idea how he got there. He had, you know, blanked out for the last two weeks. And this finally got him to seek treatment. Does it have to be that way? Does it have to be some kind of terrible crisis before an alcoholic seeks treatment? Could we intervene somehow and get them to treatment before that ultimate tragedy has to happen?

Dr. Aly Zewail: Well, the issue, Bob, is that the rock bottom is different from one person to another. So, some people, the rock bottom is if they get into accident or hurt someone else during an accident. Some of them, the rock bottom is if they use intravenous drugs and they will end up with an amputated limb. But other people, the rock bottom is basically if they go late to work. So, we cannot judge the rock bottom from one person to one person because people are different. That's why alcohol or like all substance use disorder, the recovery is basically 20% in some categories. But when we do the exact same study to see for, like, professionals, the recovery is 80%. Because if you think about the rock bottom, it's different. So, why wait till they hit the rock bottom and the damage is really hard to fix? If you feel or your loved ones feel that there is an issue with your substance use alcohol intake, try to get into the, the core of the problem before it becomes worse. But again, the person with substance use disorder, unless they are ready, there's nothing you can do to convince them that it's time to start treatment.

Host: Now, a recovery from abuse, it is a journey. It's an ongoing journey. Again, you talk to many, many alcoholics and they will tell you it's a day by day, literally. And, of course, it is not uncommon for someone to have a relapse, to have a slide back from time to time. And there's a lot of stigma around that when that happens to someone. Can you tell us about that and how people can, again, recover from those relapses and get the support that they need?

Dr. Aly Zewail: Yeah. I mean, but first thing to remember, that recovery is a journey, okay? Like, people do not become addicts overnight. It happens over the course of many years. And so, does the recovery process. Relapse is often part of the recovery journey for patients. People usually mentally relapse days prior to physical relapse. So, they should be aware of that problem.

To explain this in an easy way, you're still abstinent, but your brain starts playing a trick on you. That's why you shouldn't be alone. So, it will say, like, "Well, I mean, my loved one will be outside of the house on a trip in the next three days. I can start planning like a small, small party for myself, drink a little bit." This is mental relapse. You haven't relapsed, you haven't taken alcohol or substance yet, but your brain already relapsed. So, you have to be aware of those kind of tricks your brain playing. That's why you have to get an addictionologist and a specialized person to help you throughout that journey, or at least the first year, year and a half till your brain chemical neurotransmitters get back to the normal levels and the neurotransmitter and your brain is rewired to think logic like you used to do before.

Host: Now, once somebody is in recovery, they've completed treatment, they're now on that recovery journey, as loved ones or, again, as friends, what are some tips on how we can best support them in their recovery? You know, some things that we should do and maybe some things that we shouldn't do to help that person.

Dr. Aly Zewail: Okay. You have to continue followup with a medical professional. It's meetings as often as needed. We recommend, like, at least monthly visit with a specialist or if the patient becomes stable, we can make it every three months. But at least for the first two years, that's when your brain rewires and you can start thinking logic.

And I always tell the patients that you're going to start thinking clear and clearer for at least, like, after six months, you're going to be like, "Wow, I'm thinking so clear. I didn't know I can think that clear." I tell them, "Wait for another three months." And after three months they say, like, "Wow, yeah. I mean, we didn't think that we can think clearer than that."

And I always tell them, like, "You will get a little bit embarrassed of the things that you used to do in the past. Don't take this as a negative sign. This is a positive sign because now you're thinking logic." So, I tell them, "If you think embarrassed of behavior in the past, this is a very good sign that your brain is rewiring and you start thinking right."

You can join support groups, such as AA. Do not neglect your mental health because, as I said, in the past, medical people try to treat their depression and anxiety by using substances. So, do not self-medicate. If you have a trigger in the form of mental health, get this treated. And remember, you cannot beat this alone. You have a lot of support in the community nowadays. So, always try to take advantage of the support.

Host: And is it also possibly wise to find or avoid certain friends or ertain situations that you were in before that lend itself to the alcohol abuse that maybe you should avoid as you're recovering and, again, not hanging out with that particular set of friends who are still probably drinking or doing what they were doing? Should you find, like, new acquaintances or again, avoid those situations or those people?

Dr. Aly Zewail: Oh, yeah. I mean, like we always says, like, you have to avoid all that, the triggers that can can cause relapse. A lot of those triggers are friends that drink because you are still early in recovery and you cannot handle cravings on your own or this kind of triggers. That's why we give those medications to help with craving. But with certain substances, I tell them, "It doesn't matter how much medication I'm giving you. If you see substances or drugs in early recovery, you cannot resist because your brain is still trying to rewire." So, we tell them to avoid that.

We have meetings and we even, like the Al-Anon counsel their loved ones how to be supportive, not to drink around them. Situations, we try to tell them to avoid any kind of situations that can cause the relapse. But yeah, in the beginning, that's why we keep a very close follow-up with them till they realize that they can handle those kind of stressors or triggers on their own.

Host: Dr. Zewail, if somebody's listening right now, and again, whether they themselves are possibly in the throes of addiction or alcohol abuse or a loved one is, what could you say to them to get them to seek treatment and tell them what, that there's hope out there for them?

Dr. Aly Zewail: Well, I just want to let them know they are not alone. Help is readily available. know the signs of your substance use disorder and understand its harmful impact on your health and on your emotions. And it's not going to just affect you, it's going to affect your loved one. But know that the treatment is available 24/7. Just go to the emergency department at Summa Health. We'll offer help right away. We'll put a plan for you. We have addiction care coordinator 24/7. You know, like 4:00 in the morning, and they consult with us, whoever the addiction medicine physician on call. We do not let you go into this trip alone. So, seek help, seek help, seek help.

Host: Again, to find out more about the Summa Health Addiction Medicine Program, you can call them toll-free at 866-506-4917, 866-506-4917, or go to the website summahealth.org/addiction, summahealth.org/addiction. Again, Summa Health, you know, Akron has been with a leader in the country in alcohol awareness and alcohol abuse treatment. and Summa Health was there with the beginning, as they say, with Dr.Bob and the like back in 1939 when they founded Alcoholics Anonymous right here in downtown Akron. So, they've been around for a long time. They have a lot of experience in this area. And again, it's something that every single generation that comes by has to deal with because it's something that's always in our society and is always going to be a problem.

So whether it's alcohol or other substance abuse, if it's you or somebody else that needs the help, turn to Summa Health. Call them at 866-506-4917 or summahealth.org/addiction for over 90 years of experience in dealing with these situations as, again, we enter April, Alcohol Awareness Month.

Again, Dr. Aly Zewail, thank you for being with us here. He's, again, a psychiatrist specializing in addiction medicine at Summa Health. So, we thank you so much for being on the program today, sir. And we wish you a lot of luck and blessings in the work that you're doing.

Dr. Aly Zewail: Thanks, Bob. Thanks for having me again.

Host: I'm Bob Lewis.

announcer 2: The Talk of Akron, WNIR.