WEBVTT
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When we talk about the drug crisis in America, we usually picture the hardest moments.
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An overdose.
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A 911 call.
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What's come 911?
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What is the address of your emergency?
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An emergency room in the middle of the night.
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We're gonna be taking her straight to the operating room, OR9.
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But what if we don't just focus on the hardest, most dramatic moment?
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What if the most important moment happens long before?
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The second before the first drink.
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The first vape.
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The first pill.
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The juncture at which most teenagers make that life-altering decision.
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And when we do focus on that turning point, we're now seeing some pretty good news.
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In 2024, 42% of high school seniors said that they've never used any addictive substance at all.
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And two-thirds said that they've not used any substance in the past month.
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That quiet shift didn't happen by accident.
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It's the result of decades of prevention work.
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And this year, it was named a national priority.
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Good morning, and thank you for joining us today as we launched the 2026 National Drug Control Strategy.
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Boosting prevention, treatment, and recovery efforts nationwide.
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White Owl saying it wants to create a drug-free America as a social norm.
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For the first time, this year's National Drug Control Strategy put primary prevention, keeping drug use from ever starting, back at the center of the national conversation.
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Today, I'm joined by two people who've spent their careers on opposite ends of that journey and have somehow now ended up in the same place.
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Dr.
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Renit Lev is the chief medical officer for the White House Office of National Drug Control Policy.
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She's an emergency physician who's treated countless patients and who helped shape the strategy from the inside.
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And Dr.
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Carolyn DuPont is a psychiatrist and vice president of the Institute for Behavior and Health.
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She grew up in a family that has shaped the national conversation around prevention, treatment, and recovery for decades.
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She spent her life making the case that non-use can be the norm.
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One started with the individual and moved toward policy.
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The other started with policy and moved toward the individual.
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And here's what I love: they don't always agree.
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They'll happily debate the science right in front of you, but underneath, there is a deep, long-standing friendship.
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Years of mutual respect between two people who come at this from different perspectives and learn from each other every time they're in the same room.
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This is Empathy Affect, the Forsmarsh Media podcast that explores the human side of government.
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I'm Melissa Sasinski, and today we're talking about what it really means to prevent addiction before it starts, why a drug-free life is becoming the norm for a new generation, and how two doctors who see the world differently find common ground in the same hopeful truth.
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Doctors Lev and DuPont, welcome to Empathy Affect.
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It's an honor to have you both here today.
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Thank you so much for having us.
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Yeah, thank you.
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It's it's fun.
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We're gonna have a good time.
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Absolutely.
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So both of you have worked directly with patients facing substance use disorders in emergency rooms, clinics, and in communities.
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What does it feel like now to be working at the level of national policy and prevention strategy?
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What do you carry with you from those encounters you've had?
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Well, first of all, you know, you are the sum of your experiences, as our psychiatrist would tell us, right?
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So I have not stopped being a doctor.
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I've I've been an emergency physician for over 30 years.
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I think I've treated 120,000 patients, and I take all those experiences with me to my work here.
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Not just in the hospital, but you know, I had a podcast and I learned a lot.
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I was involved in medical politics.
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Even, you know, being a mom and having a family, you take all those experiences with you, and I'm giving all of that to my job here in government.
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And I'm finding that all those experiences, you know, help shape and I think they make me successful in my job, even though I don't have experience in government, those other experiences are are working to push our agenda and priorities forward.
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Absolutely.
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Dr.
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DuPont?
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Yeah, I love this question.
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Working in primary prevention is the best.
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I just want to say it is the most exciting work that I do.
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And I think one of the reasons is because it's not really often in medicine that we have the information we need to really make a difference in people's lives by preventing the initiation of a chronic lifelong and potentially fatal disease, the way we do with substance use disorders.
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And so I feel like as a physician, I see people who are much further along on their journey with difficulties with mental health and with substance use disorders, which often go together.
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And so having that opportunity to think, wait, what could we do different for future generations of people?
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That's so exciting.
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And so I just I feel so lucky to be working in this.
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I do want to say that I have a really long-term view on prevention.
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So a little bit of history for me is that my father was a second White House drug czar, that's what's now ONDCP, and the first director of NIDA, uh, the National Institute on Drug Abuse.
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And so I literally grew up around the dining room table talking about prevention, treatment, and recovery.
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And so this is like in my blood.
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But then when I became a psychiatrist, I kind of for a while put all that aside and I really focused on patient care, this patient in front of me.
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And so when I think about prevention, I always think about that individual.
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It it really we think about numbers when we're doing big, big work on strategies and policy.
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We're thinking about big numbers, communities, the country, but you always have to think about those individuals, the individuals that this is going to affect.
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And so this is the pleasure of my life to work in this field.
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Well, so uh, Carolyn, it seems like we have uh cross paths.
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So you started thinking about things broad and then went to patient care.
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And I did the opposite.
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I was always about the individual, and now I'm thinking broad.
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So it it both works.
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It both works.
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And we need all the all those perspectives at the table.
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Absolutely.
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And speaking of which, we're talking broadly, O and DCP released the 2026 National Drug Control Policy this month when we're talking in May.
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I'm wondering from both of you, what is the most important shift you see compared to previous strategies?
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And what does it signal to healthcare providers, prevention practitioners, and communities?
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All right, I'll take it from here, and then and then I can't wait to hear what Dr.
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DuPont has to say, because she's she'll be like the critic.
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But in general, strategies always talk about prevention, treatment, recovery.
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Uh, I think what makes this uh strategy different, it's it's very ambitious, it's robust, it's visionary.
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We start our strategy with emerging threats.
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We want to be ahead of the enemy, ahead of the of the threats, not behind.
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You know, and we create a vision, and the vision is that we want to be comprehensive in what the threats are from mortality data, morbidity data, drug seizures, what's on the ground of patients are experiencing.
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That's how we start.
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We talk about supply and being fierce, and we could see that in the government being fierce on the issues of supply.
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And when it comes to issues of demand, we're we're clearly defining prevention.
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And I know Dr.
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DuPont's gonna love this, that it's primary prevention, preventing drug use before it starts.
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Because what's happened in the past, there's primary prevention, secondary prevention, tertiary prevention, everybody was doing prevention.
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Everything was prevention, and that really robbed the whole focus of primary prevention.
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So we make that very clear that we want to bring primary prevention back into focus and bringing prevention science and evaluation, not just everybody does prevention, everybody has a program, but bringing uh the science and outcomes to that.
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And when it's treatment, we also have, you know, very visionary treatment.
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We want to make treatment easier than getting drugs.
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We want to bring addiction to the mainstream of healthcare.
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And then we want to go upstream.
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We don't want to wait to my experiences in the emergency department where people are in the worst of the worst of disease.
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Think about treating the pre-cancerous lesion rather than trying to get chemotherapy for stage four cancer.
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Think about treating pre-diabetes instead of being on an insulin pump forever.
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So that's kind of our vision with treatment.
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We always want to be there for everyone.
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We believe in rescue, second, not just second chances, but third, fourth, fifth, tenth chances.
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You always have to be there.
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Sadly, because of the threats of fentanyl and even worse opioids, uh, we need to strategically place naloxone.
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We we need to have it in the right places.
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And then we also, as always, want to promote and celebrate recovery.
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You know, there's 25 million Americans living in recovery.
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They're showing the example.
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We actually need to learn and study them because it's not one size fits all.
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I think that's where like research be like, how are you successful?
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And uh, we're very excited about it.
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Yeah, I mean, it's definitely holistic, covers the whole life cycle from primary prevention, as you were saying, through recovery, the supply, the demand.
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I want to turn to Dr.
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Deepont.
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Um, prevention, as Dr.
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Lev was mentioning, is really near and dear to your heart.
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So, from your perspective, as a prevention practitioner and someone who's connected to local coalitions across the country, where does the strategy meet communities where they actually are?
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It's just so important.
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So, most prevention is local.
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It's small, it's one community at a time.
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And it's so important for them to have the information and the support from policy at all levels of government.
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And so then this national strategy's emphasis on primary prevention is a really big deal to bolster the work of coalitions who are already there, boots on the ground, doing the work.
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Also, the support of the drug-free communities DFC program is essential.
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And so I want to just say that the people who are doing the work, they know how to best serve the people in their own communities.
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But having this shared vision of normalizing non-use for youth and recognizing that's in the best interest of public health, this is a public health message, and that that's again supported from the very top is really important because this work is hard.
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Like Dr.
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Leb said, primary prevention often gets kind of shoved to the side and kind of looked down on.
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People don't necessarily recognize how critical it is as a public health strategy.
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And so really highlighting it.
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So I love that whole spectrum.
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We often have our kind of colorful rainbow spectrum we show, where we show that kind of universal prevention messaging on this side, and it goes all the way through selected and indicated and treatment and recovery.
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All of those things are so important.
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And everybody does need to be at that table.
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Yeah, I mean, no surprise.
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I mean, Dr.
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DuPont and her father were both mentors to me, so that that definitely has an influence.
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But it's interesting, uh, Carolyn, you know, in the strategy, we explain the different population cohorts in order to understand what people need.
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Right?
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So we we have the cohort of people who don't use dubs, they never use drugs.
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You know, that cohort needs messaging.
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Good job.
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Continue.
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Most people are just like you.
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Then we have a cohort of people who misuse, they don't have a substance use disorder.
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They're they're making risky life choices and they need education.
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That's a different messaging.
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And then we have the people who have a substance use disorder from mild to severe, and they deserve compassion and treatment.
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Um, and then we have the people in recovery.
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So, you know, different cohorts um require different messaging and and resources.
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And I think when I see this infighting that you were talking about, I take them back to the cohorts.
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That makes a lot of sense too.
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I mean, uh, we've seen, say, in like the tobacco space, uh different kinds of messaging for like vaping prevention with young people versus more like combustible tobacco, you know, cessation for older folks.
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Um the messaging really needs to be, you know, targeted to the audience that makes sense.
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So definitely resonating there.
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Another thing about the strategy is that it makes creating a drug-free America as a social norm, as a central pillar.
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That framing is pretty bold in my mind.
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So, why does norming matter so much to behavior change?
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And what does it actually take to shift a culture around drugs, not just a message?
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So, Melissa, I don't think that messaging is bold.
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I think it the data shows that that's where we are right now.
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What we did is usually say, oh, we want to teach kids not to use drugs and don't do this.
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All we did, instead of saying, all these kids are using drugs, all we did is switch it from a negative to a positive.
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That's all we did.
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So we're now highlighting, not all the people who are using drugs, we're highlighting that 83% of people don't use drugs.
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That's just the data.
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So we're we are, and instead of, you know, saying, you know, what we see on TV or what we hear, or or even if our profession seems like drugs are all around us, the fact is most Americans are not using drugs.
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So we want to push that social norm and expand it.
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And what I've learned from the professionals in in prevention science is that pushing the social norm is what moves.
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Everybody, you know, there's peer pressure.
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So if we emphasize the fact, the fact that most people don't use drugs, we want to be healthy in order to achieve our life's dreams, whether, you know, it's athletics or music or writing or whatever, or family.
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In order to be your best, you do that better by being drug-free.
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And that's why the majority of Americans make that choice.
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And we want to expand upon that.
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So I want to clarify a few things with this that I think are really important.
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And one of the things is what do you mean when you say drug-free?
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And I love that term, drug-free.
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So I'm I'm very in support of it.
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I have a little bracelet that says drug-free.
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I love it.
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But you have to make sure that everybody's talking about the same thing.
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So, one of the things is I talk about primary prevention.
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I'm talking about youth.
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I'm talking about people under the age of 21.
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And that correlates with the law, but it also correlates with brain development.
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And for youth, when we're talking about drug-free, we're talking about all the drugs that super stimulate the brain's reward system: alcohol, nicotine, cannabis, and all illicit drugs are in that umbrella.
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And so I want to make sure that we're being really clear about that.
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And I love your data, and I absolutely agree that we don't have to create a social norm.
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There already is a social norm that's ready to be recognized.
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So we at the Institute for Behavior and Health looked at the monitoring the future, which is the big data that our nation collects to follow young people and their drug use.
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And it's usually used to look at what percentage of high school seniors are using X, Y, Z drug or whatever.
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But we did research where we looked at that data in a different way and we said, what percentage of high school seniors have not used any drugs?
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No alcohol, nicotine, marijuana, or any other drug.
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And we did it both by lifetime and by past month.
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And what we've seen is over the past 50 years, we have data from 50 years, because in fact, that second White House drug czar, who I again mention is my father, Robert DuPont, he started that monitoring the future with the University of Michigan.
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So, anyway, back in the 70s and 80s, it was something like 3 to 5% of high school seniors had not used any substance in their lifetime.
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So 95 to 97% of high school seniors had used something.
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Now that number is over 35% of high school seniors have never used anything in their lifetime.
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And that's a huge change that's been going on for 50 years.
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And the reason it's been happening is because of prevention.
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Prevention really works.
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The messaging really works.
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But the more important one to consider is past month non-use, because I never want to think about this as a purity test.
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This has to do with a health standard, like other health standards, like did you wear your seatbelt or not?
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When you get more information, you can change your behavior.
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You can start wearing your seatbelt, you can start wearing your bike helmet, you can stop using substances.
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So that past month non-use used to be like the 16 to 20% of high school seniors haven't used in the past month.
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Now it's over 60%.
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Over 60% of high school seniors haven't used in the past month.
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That's really different than what most adults think.
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And that's because it was different 30, 40 years ago when those adults were in school.
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And so they think that's normal, that that like it's normal for kids to use.
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But actually, the the normal is non-use.
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And I think that's really important.
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I also want to say that the American Academy of Pediatrics came out with a wonderfully strong statement.
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They said the non-use message should be reinforced by pediatricians through clear and consistent information presented to patients, parents, and other family members.
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And so we are not alone in promoting this non-use message.
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And so having it again appear in the strategy and with such strong language and supporting this change that's already there is really wonderful.
00:18:38.079 --> 00:18:38.720
Yeah.
00:18:38.960 --> 00:18:52.319
So, Carol, I like, I like your more precise, and you know, you you mentioned all the great data that that uh your dad started and agree with almost everything you said.
00:18:52.640 --> 00:18:52.880
Uh-oh.
00:18:53.039 --> 00:18:53.359
Uh-oh.
00:18:53.519 --> 00:18:55.440
You said I was gonna be the contrarian.
00:18:55.519 --> 00:18:57.279
Look who's gonna be the contrarian.
00:18:58.240 --> 00:19:01.680
See, what what we are using, we're using the age of 25.
00:19:01.839 --> 00:19:05.039
You said 21, and I think Oh, I love 25, Ronet.
00:19:05.119 --> 00:19:06.799
I am so with you on 25.
00:19:07.279 --> 00:19:13.599
What I tell people is age 18 and 21 is for lawyers, but I'm a doctor, okay?
00:19:13.839 --> 00:19:16.880
And so as a doctor, the age is 25.
00:19:16.960 --> 00:19:24.079
I'm not gonna compromise on the medicine and the science of when the brain grows for your politics and for your laws.
00:19:24.319 --> 00:19:33.119
So um, you know, if you want to use, you know, 18 is legal to do a lot, and 21 is legal to do all sorts of things, but it's not a healthy choice.
00:19:33.359 --> 00:19:36.480
So we we have that 25 in our strategy.
00:19:36.640 --> 00:19:40.480
We're using 25 across government together.
00:19:40.559 --> 00:19:41.200
We're on that.
00:19:41.279 --> 00:19:45.680
So I'm giving you permission, Carolyn, to to move your 21 to 20.
00:19:45.920 --> 00:19:46.799
I mean, I love 25.
00:19:46.880 --> 00:19:49.599
And when I talk about brain development, I always talk about that.
00:19:49.680 --> 00:19:52.240
And actually, I think it's moving older than that.
00:19:52.400 --> 00:19:57.200
And here's the the actual secret: these substances aren't safe for anybody at any brain age.
00:19:57.440 --> 00:19:58.160
No meaning.
00:19:58.720 --> 00:19:59.599
That is really true.
00:19:59.759 --> 00:20:12.400
But what I have found when we're talking about prevention is it can be really helpful to talk about young people because you get much better traction than you get a lot of pushback from adults when you talk about everybody.
00:20:12.559 --> 00:20:14.720
So I'm always prepared to do that.
00:20:14.960 --> 00:20:27.839
And the reality is that people put off initiating use of any of those substances that hijack the brain's reward system until after the age of 21 or 25, they're very unlikely to start them.
00:20:28.079 --> 00:20:36.000
And so that's that's one of the things that it's not like where I have a gate there that I'm like, no, it's a you know, free-for-all, use anything you want.
00:20:36.240 --> 00:20:52.079
No, what we see is that in terms of behavior, that risk taking that's part of that adolescent period and part of that brain development part, that's the part we need to protect from that early exposure to substance use.
00:20:52.160 --> 00:20:52.960
And you're absolutely right.
00:20:53.039 --> 00:21:04.720
And that goes back to that point that I made at the beginning that not initiating use wildly decreases the risk of that chronic lifelong and potentially fatal illness of substance use disorder.
00:21:04.880 --> 00:21:17.920
But I also want to talk about the connection between mental health, other things, uh anxiety, depression, psychosis, all of these things can be made worse or more likely by adolescent substance use.
00:21:18.079 --> 00:21:25.920
And that is something that when I'm talking to youth, they're very open to that discussion because they're really concerned about their mental health.
00:21:26.079 --> 00:21:32.240
Young people today are more aware of mental health than I feel like any generation in the past.
00:21:32.400 --> 00:21:41.279
And so when I show them that data of the relationship between substance use and worsening mental health, the light bulb goes off and they're like, wow, I don't want to do that.
00:21:41.440 --> 00:21:42.640
That makes a lot of sense.
00:21:42.960 --> 00:21:45.200
I'm so glad you brought in mental health.
00:21:45.279 --> 00:21:48.960
Um, and and that is proudly in the strategy as well.
00:21:49.279 --> 00:21:58.000
It it appears several times, even in our emerging threats chapter, uh, we talk about all the psychiatric boarding in the emergency departments.
00:21:58.160 --> 00:21:59.759
I couldn't help myself as an emergency department.
00:22:00.160 --> 00:22:05.359
But a big percentage that we have not researched is because of substance use.
00:22:05.519 --> 00:22:11.119
And we and that correlation of substance use disorder, mental health disorder, that that's that's there.
00:22:11.279 --> 00:22:21.200
And and studying that, I think from the emergency department is really important because then we can make smarter drug policies and smarter resources.
00:22:21.359 --> 00:22:27.200
Like, because we always argue, oh, well, we need more mental health beds, or we need more long-term beds, or we need detoxes.
00:22:27.279 --> 00:22:35.519
It's like, well, why don't we stay that population and make educated, you know, policy and resource uh choices?
00:22:35.759 --> 00:22:41.359
And the other place mental health shows up is in the treatment substance use disorder.
00:22:41.599 --> 00:22:46.880
If you take everyone who has a substance use disorder, half of them have a mental health disorder.
00:22:47.119 --> 00:22:49.759
If we separate that, you're missing half the population.
00:22:49.839 --> 00:22:52.960
What's, you know, that's it, doesn't make sense to separate that.
00:22:53.119 --> 00:22:55.440
We need to handle that both together.
00:22:55.680 --> 00:23:02.000
And the other place it shows up is we really want to put a focus on early onset psychosis.
00:23:02.160 --> 00:23:08.640
And we see that kind of, again, I can't help my emergency physician analogy, but like a heart attack.
00:23:08.880 --> 00:23:17.039
You're having chest pain, you're having EKG changes, we get you the cath lab, we open up, you know, door to balloon time is critical.
00:23:17.200 --> 00:23:22.160
And it's critical because if you don't act upon it, you're gonna have permanent damage to your heart.
00:23:22.319 --> 00:23:24.319
And the same thing is with your brain.
00:23:24.480 --> 00:23:35.599
If you have early onset psychosis, first-time psychosis, if you don't do anything about it, you keep using drugs, then you will have permanent damage to your brain and have schizophrenia.
00:23:35.680 --> 00:23:43.039
We are creating in America more and more schizophrenia, bipolar disorder than needs to be because of drugs.
00:23:43.599 --> 00:23:54.880
Several drugs could do that, but out of all the drugs, the highest, the one with the highest conversion rate from one episode of psychosis to permanent mental illness is is cannabis, is marijuana.
00:23:55.039 --> 00:23:58.079
So we we want to um reverse that.
00:23:58.400 --> 00:24:02.960
If you take one thing away from this, that is the most important thing that what Dr.
00:24:03.119 --> 00:24:04.240
Just Love just said.
00:24:04.400 --> 00:24:06.160
That is so key.
00:24:06.319 --> 00:24:20.079
It's something that's happening right now, and it's gonna um have a huge negative effect on our individuals, our families, and our communities and our country for decades down the road if we don't do something about that.
00:24:20.319 --> 00:24:28.240
One of the things I was gonna bring in with that commercialization is there are a lot of people that are again trying to make money off of our young people.
00:24:28.640 --> 00:24:40.240
And one of the things that that means is that the drugs are different, they're stronger, there are different delivery methods, they're different packaging, there are different techniques of hooking people.
00:24:40.480 --> 00:24:50.400
And so our young people, you know, I have that good news I would say, and that really good news about the norm and how many people are making that active choice not to use.
00:24:51.039 --> 00:24:58.799
But the people who are using are at much higher risk because the substances are so different than what they were in the past.
00:24:59.039 --> 00:25:09.119
And if we don't pay attention to that, and if we are too substance specific, then we're gonna miss that there's a whole new threat that maybe we don't even know about today.
00:25:09.359 --> 00:25:16.079
And so really arming people with this concept of non-use for help is vital.
00:25:16.400 --> 00:25:24.000
And the analogy you made, um, you know, about your heart health, about, you know, tackling prediabetes, again, the primary prevention.
00:25:24.160 --> 00:25:36.960
I think that really resonates because once you sort of, you know, you could take a substance and be like, I'll feel fine later, but if you don't look at it with the long-term scope of what this is doing to your body, you know, I think that analogy really makes sense.
00:25:37.119 --> 00:25:40.400
Um, I don't want to bury the fact that um, you know, I think Dr.
00:25:40.559 --> 00:25:45.920
DuPont touched a little bit about it, but I really just want to put it plain out there in uh the spotlight.
00:25:46.240 --> 00:25:59.279
One choice prevention takes the position that youth should make no use of all substance together, so alcohol, nicotine, cannabis, any other drugs before the age of 21, or as you guys were just debating, maybe even 25.
00:25:59.359 --> 00:26:04.079
Uh, but officially um one choice prevention takes this, the um, the stance of 21.
00:26:04.400 --> 00:26:08.640
Why does that unified standard matter clinically and behaviorally?
00:26:08.880 --> 00:26:10.240
So, yeah, thank you so much.
00:26:10.319 --> 00:26:14.240
It really matters a tremendous amount because it's a health standard.
00:26:14.400 --> 00:26:22.400
So when we have a health standard, the reason we have it and the reason we feel confident about it is because it's backed by science and data and experience.
00:26:22.559 --> 00:26:24.559
And so it's like that seatbelts I mentioned.
00:26:24.640 --> 00:26:30.160
If you, if I tell someone wear your seatbelt, they know it's not just like I have a, I don't know, a thing about seatbelts.
00:26:30.240 --> 00:26:34.079
It's because that's really the data is very strong for seatbelt wearing.
00:26:34.160 --> 00:26:40.880
And it's not just in the front seat and it's not just at night, or it's not just if you're the passenger, it's everybody should have a seatbelt on every time.
00:26:40.960 --> 00:26:42.640
And then we have the data to back it up.
00:26:42.799 --> 00:26:44.319
And that's the way a health standard is.
00:26:44.480 --> 00:26:47.359
It needs to be very clear and it needs to be universal.
00:26:47.519 --> 00:26:50.319
And that's the way the non-use message is for health.
00:26:50.400 --> 00:26:51.119
It's universal.
00:26:51.200 --> 00:26:55.279
So the non-use for health message is universal across that spectrum.
00:26:55.440 --> 00:26:59.119
So if you have a young person who's never used, that's the right health message.
00:26:59.279 --> 00:27:04.640
But if you have one that is using but not having any trouble, it's still the health standard is non-use.
00:27:04.960 --> 00:27:10.960
If you have one that has a diagnosed substance use disorder as a young person, the health standard hasn't changed.
00:27:11.039 --> 00:27:16.640
And it doesn't have any kind of morality or purity test or, you know, good kids, bad kids kind of thing.
00:27:16.799 --> 00:27:19.599
It's just what the science and data supports.
00:27:19.839 --> 00:27:27.119
The two things that are really important to me to understand about this one is that science of the developing brain, which we have already talked about.
00:27:27.200 --> 00:27:29.599
And I, you know, again, I love 25.
00:27:29.680 --> 00:27:33.519
I always worried about college students and that early adulthood age too.
00:27:33.680 --> 00:27:36.000
So that developing brain is really, really important.
00:27:36.160 --> 00:27:47.359
Things that happen to our brain, and especially these things that hijack again, that dopamine pleasure center of the brain, retrain or literally change the trajectory of that brain for that person.
00:27:47.519 --> 00:27:53.119
And so it's very important to not expose the brain to those things during those years of development.
00:27:53.359 --> 00:28:03.519
But the other reason that we have this concept of one choice is what we say, is because we we did this research that showed that for youth, all substance use is connected.
00:28:03.759 --> 00:28:14.960
So when they make the choice to use one substance, for example, marijuana, their risk of using other substances, nicotine, alcohol, pills, any other substance goes way up.
00:28:15.279 --> 00:28:23.759
And so we did this study, what I call little bars, big bars, which shows if you would look at teens and say to them, did you use marijuana over the past month?
00:28:24.000 --> 00:28:29.920
You have one side of the graph has little bars, which is associated with they were very unlikely to use other substances.
00:28:30.000 --> 00:28:35.599
If they said no, if they said no marijuana in the past month, little bars, unlikely to use other substances.
00:28:35.759 --> 00:28:42.000
If they said yes the past month, marijuana used big bars, much more likely to be using other substances.
00:28:42.160 --> 00:28:48.880
And that's the case where whatever drug you look at it, look at alcohol, look at nicotine as your primary, primary drug you're comparing.
00:28:49.200 --> 00:29:07.359
When a teen has made that choice, oh, maybe I will try vaping, for example, it becomes a really slippery slope of, well, if I'm vaping nicotine, maybe I'll vape vape cannabis, or if I'm vaping, maybe I'll start smoking a cigarette, or if I'm smoking and vaping, maybe I'll drink some alcohol.
00:29:07.519 --> 00:29:13.200
It becomes a question of which substances, when to use it, with whom do you use it?
00:29:13.359 --> 00:29:14.799
So many questions.
00:29:15.039 --> 00:29:25.920
But if that person makes that initial decision, um, no thanks, not for me, to whatever that first thing that they were introduced to, then they're very unlikely to use other substances.
00:29:26.079 --> 00:29:30.240
So we see that it kind of boils down to that one choice that that person is making.
00:29:30.480 --> 00:29:34.240
Am I someone who uses substances or someone who doesn't use substances?
00:29:34.480 --> 00:29:39.279
It sounds really easy, but I always talk about this as being an active and continuing choice.
00:29:39.440 --> 00:29:41.359
Being a teenager is hard.
00:29:41.599 --> 00:29:44.160
So you can't just say to your kid, don't use.
00:29:44.480 --> 00:29:58.400
I mean, you can, and then you should, and that's great, but it has to have many more aspects to a conversation than this, because it is hard to navigate those social situations and you aren't going to be there with your kid, especially all the way till they're 25.
00:29:58.640 --> 00:30:04.240
So they need to have the data, the science, and understand the health message of non-use.
00:30:05.519 --> 00:30:09.920
Thank you so much for sharing a little bit more about uh, you know, why that matters.
00:30:10.240 --> 00:30:16.319
I love talking about, you know, the level of risk that increases because it is so important.
00:30:16.720 --> 00:30:22.400
And I think that your organization's mission is a really great one and the science really backs it.
00:30:22.720 --> 00:30:36.319
We've talked really high level about what the science says, what the strategy says, but one of the persistent challenges in getting people help is that the formal healthcare system often isn't where people turn first.
00:30:36.480 --> 00:30:45.200
You know, they often turn to people and institutions they already trust, whether it's a faith community, a school counselor, a neighbor, or community organization.
00:30:45.599 --> 00:30:57.359
So, how do we build real bridges between those trusted networks and the providers and public health systems that can actually connect people to treatment and prevention resources?
00:30:57.599 --> 00:31:00.400
And where are those bridges missing right now?
00:31:00.720 --> 00:31:03.680
So, yeah, I'll start, I'll start with our strategy.
00:31:04.480 --> 00:31:15.359
When our our director, director Carter, you know, she built an amazing team and and uh she gave me the task of writing the first outline of the strategy.
00:31:15.519 --> 00:31:17.759
And she wanted it different and bold.
00:31:17.920 --> 00:31:20.079
So I was thinking about that all the time.
00:31:20.319 --> 00:31:24.480
And uh I was there in synagogue, you know, thinking about the strategy.
00:31:24.720 --> 00:31:28.640
And then I realized, hey, the answer is right in front of me, right in front of me.
00:31:28.799 --> 00:31:47.680
And you know, and the next day or Monday, uh I came in and wrote in God and faith into the strategy and put it in the front of the strategy and put it in scientific terms that 83% of the population believes in God or a higher power.
00:31:47.839 --> 00:31:50.400
And that is a powerful tool.
00:31:50.559 --> 00:31:52.960
It's a tool to be used, not to be hidden.
00:31:53.200 --> 00:32:03.599
And we have outcome measures, you know, for substance use disorder and probably for other medical problems of uh better outcomes for people who use this tool.
00:32:03.920 --> 00:32:07.599
And really proud that uh it was not edited out.
00:32:07.839 --> 00:32:13.599
You could say, imagine, you know, that the strategy goes through lots of vetting and lawyers and you know, separation for church and state.
00:32:13.680 --> 00:32:16.319
They'd want to, you know, advise us to get that out.
00:32:16.559 --> 00:32:22.960
And really, thanks to President Trump, who's made faith a huge focus of the administration.
00:32:23.119 --> 00:32:27.680
I said, okay, I dare anybody to edit God out of the strategy.
00:32:27.920 --> 00:32:30.720
Now, your question is like, how do we make those bridges?
00:32:30.799 --> 00:32:36.079
We've had lots of dis discussions on the integration of faith and medicine.
00:32:36.160 --> 00:32:40.079
And and we do that routinely at end-of-life care, right?
00:32:40.160 --> 00:32:42.160
That's we're very acknowledged about that.
00:32:42.240 --> 00:32:45.680
Um, and we're want to bring that into the mainstream.
00:32:46.000 --> 00:32:52.400
We now have faith leaders at every department of government, including our own here at ONDCP.
00:32:52.880 --> 00:32:58.559
And we are working ways, um, and we haven't, we don't have the solution yet.
00:32:58.640 --> 00:33:04.319
But we because, like just like you said, Melissa, sometimes people come to their faith leaders before they go to their doctor.
00:33:04.559 --> 00:33:12.319
So that means we need to educate the faith leaders to recognize some red flags when it comes to potentially addiction.
00:33:12.480 --> 00:33:29.119
Maybe maybe it'd be like, oh, you know, my son doesn't want to go to school or their grades are dropping, but maybe we need to dig deeper and have see if that is, you know, besides a mental health problem, a substance use disorder problem, and and teach the faith leaders how to get resources, uh, how to intervene.
00:33:29.200 --> 00:33:34.160
And so we need to build that structure for all faith communities.
00:33:34.400 --> 00:33:44.880
And we also, you know, if we are we just recently had a a summit on best practices for treatment in homelessness addiction.
00:33:45.440 --> 00:33:53.839
And a common denominator in best success rates are the rescue missions, the faith-based programs who bring that in.
00:33:54.079 --> 00:33:57.200
We don't want to force faith on anybody, you know.
00:33:57.599 --> 00:34:01.920
We, you know, and and we're there for you, whether you have faith or not.
00:34:02.079 --> 00:34:04.720
I mean, I as an emergency physician, I can tell that.
00:34:04.960 --> 00:34:09.440
But if you have this secret sauce, you need to unleash it.
00:34:09.519 --> 00:34:10.559
You need to use it.
00:34:10.880 --> 00:34:20.159
And we found that a common denominator for the best successful programs for recovery are the ones who use faith.
00:34:20.400 --> 00:34:24.320
And uh we want to continue to encourage that and foster that.
00:34:24.639 --> 00:34:25.199
Yeah.
00:34:25.440 --> 00:34:26.000
And Dr.
00:34:26.079 --> 00:34:36.960
DuPont, from um a prevention standpoint, we know that trusted messengers matter enormously, but you know, that messenger has to be able to reach everyone.
00:34:37.199 --> 00:34:48.559
How do you think about building those community bridges in a way that's inclusive and doesn't inadvertently create barriers for people who most need to hear that prevention messaging?
00:34:48.800 --> 00:34:50.639
Yeah, I think this is really important.
00:34:50.880 --> 00:34:56.000
Um, the thing is, I always think about who is responsible for prevention messaging.
00:34:56.239 --> 00:35:00.079
And I've given a lot of talks on prevention to a lot of different audiences.
00:35:00.159 --> 00:35:01.119
And some are really obvious.
00:35:01.199 --> 00:35:04.079
They're coalition leaders that like that's their bread and butter.
00:35:04.159 --> 00:35:05.199
That's what they do all day long.
00:35:05.360 --> 00:35:06.079
They're the experts.
00:35:06.159 --> 00:35:07.599
I learned from them all the time.
00:35:07.760 --> 00:35:08.880
It's wonderful.
00:35:09.199 --> 00:35:12.639
But it turns out that everybody has a role in prevention.
00:35:12.800 --> 00:35:22.079
And so I think about I can give a talk to literally any audience and tell the explain to them why they have a role in prevention.
00:35:22.239 --> 00:35:37.199
And it has to do with being educated and knowing what the resources is are and where to find them and how to connect people with them, and really being grounded in the science and data and being open-minded and non-judgmental.
00:35:37.280 --> 00:35:42.159
These are all the components of being available to the young people in your life life.
00:35:42.320 --> 00:35:57.199
So if you have young people in your life professionally, you're a doctor, a lawyer, an educator, a faith leader, whatever it is that your role is that you have in interactions with youth or with families, you should have a role in prevention.
00:35:57.360 --> 00:36:09.440
And I want to make sure that you have the information that you need to help people understand all of these topics that we're talking about, about why the non-use norm is brain protection.
00:36:09.840 --> 00:36:15.039
And also about if if you've got someone who's struggling, how do you get them help?
00:36:15.119 --> 00:36:16.559
And where is help available?
00:36:16.719 --> 00:36:19.679
And you want to use whatever tools you have available.
00:36:19.840 --> 00:36:22.239
So I want everybody at the table.
00:36:22.320 --> 00:36:23.039
That's my point.
00:36:23.119 --> 00:36:28.800
I've I want everybody at the table, but you do have to make sure that you're giving the right message to the right person.
00:36:28.960 --> 00:36:44.880
So if you're giving a general no-use message and you've got a parent in there who's got a kid that's really struggling with advanced substance use, it's not going to be a very effective message because you're going to miss that mark of what that person needs to hear and what they need to do.
00:36:45.039 --> 00:36:46.239
You need to understand, right?
00:36:46.480 --> 00:36:46.880
Exactly.
00:36:47.039 --> 00:36:48.480
Totally different cohort.
00:36:48.719 --> 00:36:49.360
Exactly.
00:36:49.599 --> 00:36:59.679
And so, but a lot of times when you're speaking or whatever, or you're teaching, or you're whatever caring for people, you might not know initially what cohort that someone is part of and what you need to bring.
00:36:59.840 --> 00:37:15.760
Um, and so I I I think it's really important to make sure that we're meeting people where they are, helping them with what what the they currently need help with, and then also using language that is inclusive and inviting to them.
00:37:16.000 --> 00:37:20.079
And so if someone is involved with a faith community, that is fantastic.
00:37:20.159 --> 00:37:22.559
And I am 100% in agreement with what Dr.
00:37:23.039 --> 00:37:28.320
Lev said, that that is a strength of theirs that they can can rely on.
00:37:28.559 --> 00:37:37.039
Um, and I see that all the time in my practice that people, when things going gets tough, you know, it's really nice to have a faith community if that's part of your life.
00:37:37.280 --> 00:37:50.880
The thing that I have to recognize also is for a lot of my patients, they may have have belong in that 80% that believe in a higher power or a spiritual something in, you know, but it's not a religion.
00:37:51.119 --> 00:37:56.320
And I have to be very careful to walk that line that doesn't sound like I'm alienating people.
00:37:56.480 --> 00:38:07.920
So one of the things I've noticed is even like AA sometimes, which has that um that belief in a higher power, can be alienating to people, even though AA is not at all affiliated with any religion.
00:38:08.159 --> 00:38:11.519
And so language matters, and we'll we'll talk about that some more.
00:38:11.599 --> 00:38:25.199
But here's a case of where language matters that you have to, you know, read the room of who you're speaking to and make sure that when you are giving messages, either of prevention or treatment or recovery, that you're addressing the needs of the person in front of you.
00:38:25.519 --> 00:38:25.840
Yeah.
00:38:26.079 --> 00:38:33.199
I think it also goes back to what we were talking about before about, you know, wanting to make a message right for someone.
00:38:33.360 --> 00:38:35.280
Everyone comes from a different place.
00:38:35.519 --> 00:38:49.519
We're maximizing the toolbox, so to speak, to make sure that there are the messages, resources, people, trust there so that wherever people are, wherever, whatever cohort they're in, they can have a seat at the tables, Dr.
00:38:49.599 --> 00:38:51.280
DuPont also mentioned.
00:38:51.599 --> 00:39:00.639
Since we are on the topic of language, we know that you know, stigma remains one of the most stubborn barriers for people who need help to seek help.
00:39:00.880 --> 00:39:07.679
How does national messaging and the language we use either reinforce or reduce stigma?
00:39:07.840 --> 00:39:13.199
And what does a culture where recovery is truly normalized actually look like?
00:39:13.920 --> 00:39:17.440
So you you will not find the word stigma in the strategy.
00:39:17.920 --> 00:39:28.800
And the reason is we don't want stigma on the human being, the person who has a medical illness and deserves empathy and compassion and the best care possible.
00:39:29.119 --> 00:39:31.280
But frankly, we do want stigma on the drugs.
00:39:31.440 --> 00:39:33.199
I don't want you to use fentanyl.
00:39:33.440 --> 00:39:35.360
I don't want you to use these drugs.
00:39:35.519 --> 00:39:36.320
There should be.
00:39:36.480 --> 00:39:40.400
And if you think about it in tobacco use, cigarettes, yeah, those are bad.
00:39:40.639 --> 00:39:42.800
Cigarettes have been stigmatized.
00:39:43.039 --> 00:39:48.480
And we found that universally that message can be mixed.
00:39:48.639 --> 00:40:00.400
So that's why we're we we have not used the word stigma in the strategy and instead really emphasize compassion, empathy, treating addiction like any other chronic disease.
00:40:00.800 --> 00:40:01.119
Dr.
00:40:01.280 --> 00:40:09.760
Deepont agrees here that empathy and compassion need to be at the forefront instead of language that emphasizes stigma around substance use.
00:40:10.079 --> 00:40:18.880
And from the clinical side, she's emphatic about two things too: that addiction is a real illness, and that recovery is just as real too.
00:40:19.280 --> 00:40:24.800
These illnesses are absolutely as real as any other illnesses.
00:40:24.880 --> 00:40:27.760
So these are real as cancer, real as diabetes.
00:40:28.079 --> 00:40:36.400
So we need to treat them patients, as patients, with unconditional respect, empathy, and compassion.
00:40:36.719 --> 00:40:49.920
And so I do think the way we need to do that as a society is by really making sure people understand the complexity of these illnesses and the pathways to recovery.
00:40:50.079 --> 00:40:55.360
So, kind of coming to that second part about kind of what does this mean in terms of recovery?
00:40:55.599 --> 00:41:08.480
I want to be really clear that recovery is absolutely possible and it's happening around us all the time, even from people with very, very significant substance use disorders.
00:41:08.719 --> 00:41:13.039
There is nobody that is too far gone unless they are dead.
00:41:13.199 --> 00:41:17.119
You can't treat dead as a very, you know, sad way of thinking about things.
00:41:17.199 --> 00:41:25.920
But otherwise, there is an opportunity for hope and for full recovery, um, sustained lifelong recovery.
00:41:26.079 --> 00:41:29.440
And so I think that is really important for us to see.
00:41:29.679 --> 00:41:38.639
And recovery from substance use disorders is the one disorder where I think the person is actually better than they were before they had the disorder.
00:41:38.880 --> 00:41:59.199
Because the process of recovery is a process of connecting with community and a process of finding meaning outside of yourself and getting the help you need for other things, mental health concerns or or social concerns, uh, housing or or family, whatever that is, getting those supports in place.
00:41:59.360 --> 00:42:03.199
And so recovery is a miracle.
00:42:03.360 --> 00:42:04.639
It's just fantastic.
00:42:04.880 --> 00:42:12.960
Yeah, I love how both of you are taking this with so much, I mean, like compassion, empathy, community, they're all so important.
00:42:13.119 --> 00:42:21.920
And just the way you're talking really resonates from what I've seen in people in my life who have struggled with substance use disorder, who have recovered or on journeys to recovery.
00:42:22.159 --> 00:42:30.239
And, you know, as we're wrapping up here, I know that both of you just across this conversation, getting to know you both, you lead through a deeply, deeply human lens.
00:42:30.480 --> 00:42:42.000
I'm wondering, is there a patient encounter, a family, or a moment from the front lines that still sits with you and still shapes how you think about this crisis today?
00:42:42.239 --> 00:42:47.679
And what do you most want people listening to this episode to carry with them?
00:42:48.239 --> 00:42:55.199
Well, I guess my my first patient story is started in in my community.
00:42:55.440 --> 00:42:57.840
It was uh in Yom Kippur.
00:42:58.079 --> 00:43:08.239
We're all gathered in the synagogue, and one of the young boys was in the ICU, um, expected to die because of a drug overdose.
00:43:08.559 --> 00:43:20.960
And I remember uh, you know, being in the ICU, holding his hand and seeing his family and his dad in particular just broken up and and really saying goodbye to his son.
00:43:21.039 --> 00:43:23.039
And it was pretty gut-wrenching.
00:43:23.280 --> 00:43:28.559
And then months went by, and Aaron Rubin, he didn't, he did not die.
00:43:28.719 --> 00:43:34.880
He became um uh quadriplegic, and his mom, Sherry Rubin, became an activist.
00:43:35.360 --> 00:43:38.159
And the two of them went, you know, around the country.
00:43:38.559 --> 00:43:46.320
It was not hard easy with any, you know, electric wheelchair and everything, in in teaching on on the the dangers of prescription opiates.
00:43:46.480 --> 00:43:48.000
At that time, it was prescription opiates.
00:43:48.159 --> 00:43:50.880
And and Sherry brought me into the fold.
00:43:50.960 --> 00:43:54.639
Like, why are the doctors giving all these drugs to our children?
00:43:54.719 --> 00:43:57.840
And our children are are are are dying from that.
00:43:58.000 --> 00:44:03.280
And she brought me to meetings, like Like, okay, doctors, why are you guys giving too many drugs to patients?
00:44:03.440 --> 00:44:05.519
It's like, this is what I'm told to do.
00:44:05.760 --> 00:44:07.599
If I don't do that, I'm getting in trouble.
00:44:07.679 --> 00:44:13.199
I mean, we had patients in the emergency room yelling, like, I know my rights, I need to get my pain meds.
00:44:13.280 --> 00:44:20.400
We were told with the you know, fifth vital sign, that was what we were taught to do at the beginning of my profession.
00:44:20.480 --> 00:44:24.159
And I think about it, it's probably why I'm here today.
00:44:24.320 --> 00:44:25.760
I'm making amends.
00:44:26.000 --> 00:44:34.480
I am in recovery, my own professional mistakes that we did as a collectively as a profession to fix that.
00:44:34.719 --> 00:44:46.400
And from there, I went to really study the problem, looking at, I looked at, I teamed up with the medical examiner in our state pharmacy system and looked at every single person who died of a medication.
00:44:46.480 --> 00:44:55.360
I considered all of those, you know, potential deaths in in my hands, in my mind, I mean my profession, and really learned from that.
00:44:55.519 --> 00:45:02.239
I called those the death diaries because they were like I told a story of someone who died from prescriptions right before they died.
00:45:02.400 --> 00:45:04.960
And I applied that to my living patients when I saw them.
00:45:05.119 --> 00:45:10.559
It's like, oh my God, your medication record looks like someone I just saw from the morgue.
00:45:11.360 --> 00:45:15.599
And from that I learned to always listen to the parents.
00:45:15.840 --> 00:45:17.840
They've been my moral compass.
00:45:18.320 --> 00:45:24.000
We wrote guidelines in San Diego five years before the CDC ever wrote pain opioid guidelines.
00:45:24.079 --> 00:45:26.880
And it's because of my experience with those parent patients.
00:45:27.440 --> 00:45:32.400
And then I met the patients, um, the parents whose children died of fentanyl.
00:45:32.719 --> 00:45:34.320
You know, that was COVID.
00:45:34.559 --> 00:45:38.639
We were all about COVID, COVID, COVID, and I was fentanyl, fentanyl, fentanyl.
00:45:38.800 --> 00:45:40.079
Um, listening to the parents.
00:45:40.159 --> 00:45:47.039
And now there's a group of parents, they've children have passed away and died because of marijuana, and they're they're growing in their grief.
00:45:47.119 --> 00:45:58.400
And and so, you know, listening to those parents, they're ahead of the curve of what government is seeing, what data is is telling us.
00:45:58.559 --> 00:46:00.719
And they've they've been my moral compass.
00:46:00.800 --> 00:46:17.679
And to this day, in our office, if you if you look at my office and look at our TV screens outside, we have faces and pictures of of people who died from overdoses that remind me and the whole staff here at ONDCP of why we're here and and why we're doing what we're doing.
00:46:18.239 --> 00:46:27.199
Yeah, so I I feel a little bit the same that it it is the the pictures of loss that stay stick with me first.
00:46:27.440 --> 00:46:50.880
And so one of the things I often think about is how, you know, I told you how substance use among teenagers has changed and there's this growing number of substance-free teenagers um that the adults sometimes are like, oh, well, but I use when I was in high school and I was fine, and they kind of they want to normalize and kind of fondly remember their antics as teenagers.
00:46:51.119 --> 00:46:54.559
And I look at them and I'm like, I'm really glad you're okay.
00:46:54.639 --> 00:46:56.159
I'm thrilled that you're okay.
00:46:56.400 --> 00:46:57.840
But was everybody okay?
00:46:58.239 --> 00:47:04.320
If you think about your high school class, your college class, that young adulthood, was everybody all right?
00:47:04.480 --> 00:47:07.039
And and the answer is of course, no.
00:47:07.679 --> 00:47:09.599
Everybody knows someone at this point.
00:47:09.760 --> 00:47:15.760
Everybody, all of us have been touched by tragedies from substance use, a whole range of things.
00:47:15.840 --> 00:47:21.840
It could be an MVA or it could be a fentanyl overdose or it could be a mental health crisis.
00:47:22.159 --> 00:47:37.119
So it's those stories, those faces in my own life that often are are kind of my my why, my motivation to kind of stay in this and and keep fighting because I want not other people to not have to go through that.
00:47:37.360 --> 00:47:48.079
But one of the things that's interesting is that that motivates me as a physician and as a prevention person, but it actually isn't very motivating for young people.
00:47:48.320 --> 00:47:51.119
They don't actually see risk the same way.
00:47:51.360 --> 00:48:00.159
And so that now what I find extremely motivating because I see how much it motivates them is the stories of young people who have made that choice not to use.
00:48:00.320 --> 00:48:17.280
And so we can put the microphone in the hands of the young people who have have made the choice through high school, through college, not to use, and for them to explain their reasons why, very deeply personal reasons why they've made those that active choice not to use.
00:48:17.519 --> 00:48:21.119
That turns out to be extremely motivating to young people.
00:48:21.280 --> 00:48:30.079
And so when I think about stories now, I'm more likely to think about those young people and be like, oh yeah, those are my heroes.
00:48:30.159 --> 00:48:34.239
And I want to make sure that I keep getting them in front of those young audiences.
00:48:34.719 --> 00:48:41.679
I will say, when I was in college, some of my favorite people were the folks who didn't use, like they didn't go out drinking, partying.
00:48:41.920 --> 00:48:45.840
They found so many other fun ways to fill their cup, so to speak.
00:48:46.000 --> 00:48:51.119
So I really love that sentiment and it's a really positive way to sort of wrap up this conversation.
00:48:51.440 --> 00:49:09.280
Doctors Lev DuPont, this conversation has been so enlightening and so, so important for getting to understand where we are in this substance use landscape and how we can promote better prevention and policy and humanity, as you both really showed in this space.
00:49:09.360 --> 00:49:13.360
So I wanted to thank you both for the work you do and for sharing it with us today.
00:49:13.679 --> 00:49:14.559
Thank you so much.
00:49:14.800 --> 00:49:15.119
Thank you.
00:49:15.199 --> 00:49:16.639
And Carolyn, thank you.
00:49:16.719 --> 00:49:23.199
Because I always, every time we get together, and it doesn't matter where, whether it's for lunch or on a podcast, I always learn something.
00:49:23.360 --> 00:49:25.760
And Melissa, this has been a great experience.
00:49:25.920 --> 00:49:26.559
Thank you.
00:49:26.880 --> 00:49:29.119
Thank you so much for the work you're doing.
00:49:31.519 --> 00:49:35.679
Across this conversation, I'm reminded that prevention is powerful.
00:49:35.840 --> 00:49:42.480
It's about possibility, it's about protecting a young brain long enough for someone to become who they're meant to be.
00:49:42.719 --> 00:49:43.039
Dr.
00:49:43.280 --> 00:49:50.400
Lev keeps the faces of those we've lost to overdose on the screens in her office so no one on her team forgets why the work matters.
00:49:50.639 --> 00:49:51.039
And Dr.
00:49:51.199 --> 00:49:57.679
Deepont reminds us that the most powerful voices in prevention might not be from doctors or officials after all.
00:49:57.920 --> 00:50:01.519
They are the voices of the young people who quietly chose not to use.
00:50:01.679 --> 00:50:05.599
And who are, in her words, the real heroes of the story.
00:50:05.920 --> 00:50:12.800
My deepest thanks to these amazing women for their time, candor, and compassion they bring to this work every single day.
00:50:13.039 --> 00:50:19.519
Read the National Drug Control Policy and check out the Institute for Behavior in Health and One Choice Prevention in the show notes.
00:50:19.679 --> 00:50:23.440
If you enjoyed today's episode, share it with someone who needs to hear it.
00:50:23.679 --> 00:50:30.800
And if you're on a journey with substance use, know that recovery is real and it's happening all around us.
00:50:31.039 --> 00:50:34.960
Thank you for joining me on Empathy Effect, and I hope you'll tag along next month.
00:50:35.119 --> 00:50:36.320
Thanks, y'all.
00:50:38.559 --> 00:50:41.199
Empathy Effect is a product of Forest Marsh.
00:50:41.440 --> 00:50:48.159
You can reach us at Forrest Marsh Media at Forzmarsh.com with any feedback, questions, or inquiries.
00:50:48.400 --> 00:50:58.000
If you want to know more about today's guests, are interested in participating with Forest Marsh, or becoming part of our community, check out our show notes for more information.
00:00:03.040 --> 00:00:08.080
When we talk about the drug crisis in America, we usually picture the hardest moments.
00:00:08.320 --> 00:00:09.439
An overdose.
00:00:09.679 --> 00:00:10.720
A 911 call.
00:00:10.880 --> 00:00:12.080
What's come 911?
00:00:12.160 --> 00:00:13.759
What is the address of your emergency?
00:00:14.000 --> 00:00:15.839
An emergency room in the middle of the night.
00:00:16.079 --> 00:00:18.640
We're gonna be taking her straight to the operating room, OR9.
00:00:20.640 --> 00:00:25.359
But what if we don't just focus on the hardest, most dramatic moment?
00:00:25.760 --> 00:00:29.280
What if the most important moment happens long before?
00:00:29.519 --> 00:00:31.600
The second before the first drink.
00:00:31.760 --> 00:00:32.640
The first vape.
00:00:33.039 --> 00:00:34.079
The first pill.
00:00:34.320 --> 00:00:39.200
The juncture at which most teenagers make that life-altering decision.
00:00:39.600 --> 00:00:45.359
And when we do focus on that turning point, we're now seeing some pretty good news.
00:00:45.600 --> 00:00:52.640
In 2024, 42% of high school seniors said that they've never used any addictive substance at all.
00:00:52.880 --> 00:00:56.719
And two-thirds said that they've not used any substance in the past month.
00:00:56.960 --> 00:00:59.679
That quiet shift didn't happen by accident.
00:00:59.840 --> 00:01:02.159
It's the result of decades of prevention work.
00:01:02.320 --> 00:01:04.719
And this year, it was named a national priority.
00:01:04.959 --> 00:01:10.319
Good morning, and thank you for joining us today as we launched the 2026 National Drug Control Strategy.
00:01:10.799 --> 00:01:14.319
Boosting prevention, treatment, and recovery efforts nationwide.
00:01:14.560 --> 00:01:19.280
White Owl saying it wants to create a drug-free America as a social norm.
00:01:19.680 --> 00:01:29.840
For the first time, this year's National Drug Control Strategy put primary prevention, keeping drug use from ever starting, back at the center of the national conversation.
00:01:30.239 --> 00:01:38.159
Today, I'm joined by two people who've spent their careers on opposite ends of that journey and have somehow now ended up in the same place.
00:01:38.400 --> 00:01:38.719
Dr.
00:01:38.879 --> 00:01:44.640
Renit Lev is the chief medical officer for the White House Office of National Drug Control Policy.
00:01:44.879 --> 00:01:50.959
She's an emergency physician who's treated countless patients and who helped shape the strategy from the inside.
00:01:51.200 --> 00:01:51.680
And Dr.
00:01:51.760 --> 00:01:57.120
Carolyn DuPont is a psychiatrist and vice president of the Institute for Behavior and Health.
00:01:57.359 --> 00:02:04.560
She grew up in a family that has shaped the national conversation around prevention, treatment, and recovery for decades.
00:02:04.799 --> 00:02:08.479
She spent her life making the case that non-use can be the norm.
00:02:08.960 --> 00:02:12.080
One started with the individual and moved toward policy.
00:02:12.319 --> 00:02:15.439
The other started with policy and moved toward the individual.
00:02:15.599 --> 00:02:18.479
And here's what I love: they don't always agree.
00:02:18.639 --> 00:02:24.800
They'll happily debate the science right in front of you, but underneath, there is a deep, long-standing friendship.
00:02:25.039 --> 00:02:33.439
Years of mutual respect between two people who come at this from different perspectives and learn from each other every time they're in the same room.
00:02:36.400 --> 00:02:41.520
This is Empathy Affect, the Forsmarsh Media podcast that explores the human side of government.
00:02:41.759 --> 00:02:57.840
I'm Melissa Sasinski, and today we're talking about what it really means to prevent addiction before it starts, why a drug-free life is becoming the norm for a new generation, and how two doctors who see the world differently find common ground in the same hopeful truth.
00:02:59.439 --> 00:03:02.400
Doctors Lev and DuPont, welcome to Empathy Affect.
00:03:02.560 --> 00:03:04.400
It's an honor to have you both here today.
00:03:04.719 --> 00:03:06.240
Thank you so much for having us.
00:03:06.479 --> 00:03:07.280
Yeah, thank you.
00:03:07.439 --> 00:03:08.080
It's it's fun.
00:03:08.240 --> 00:03:09.599
We're gonna have a good time.
00:03:10.159 --> 00:03:11.120
Absolutely.
00:03:11.360 --> 00:03:19.439
So both of you have worked directly with patients facing substance use disorders in emergency rooms, clinics, and in communities.
00:03:19.680 --> 00:03:25.039
What does it feel like now to be working at the level of national policy and prevention strategy?
00:03:25.280 --> 00:03:28.800
What do you carry with you from those encounters you've had?
00:03:29.039 --> 00:03:36.000
Well, first of all, you know, you are the sum of your experiences, as our psychiatrist would tell us, right?
00:03:36.240 --> 00:03:38.879
So I have not stopped being a doctor.
00:03:38.960 --> 00:03:41.439
I've I've been an emergency physician for over 30 years.
00:03:41.520 --> 00:03:47.919
I think I've treated 120,000 patients, and I take all those experiences with me to my work here.
00:03:48.080 --> 00:03:53.599
Not just in the hospital, but you know, I had a podcast and I learned a lot.
00:03:53.759 --> 00:03:56.479
I was involved in medical politics.
00:03:56.719 --> 00:04:05.840
Even, you know, being a mom and having a family, you take all those experiences with you, and I'm giving all of that to my job here in government.
00:04:06.080 --> 00:04:24.480
And I'm finding that all those experiences, you know, help shape and I think they make me successful in my job, even though I don't have experience in government, those other experiences are are working to push our agenda and priorities forward.
00:04:24.879 --> 00:04:25.439
Absolutely.
00:04:25.600 --> 00:04:25.920
Dr.
00:04:26.000 --> 00:04:26.720
DuPont?
00:04:27.279 --> 00:04:28.800
Yeah, I love this question.
00:04:28.959 --> 00:04:31.600
Working in primary prevention is the best.
00:04:31.759 --> 00:04:35.120
I just want to say it is the most exciting work that I do.
00:04:35.360 --> 00:04:53.519
And I think one of the reasons is because it's not really often in medicine that we have the information we need to really make a difference in people's lives by preventing the initiation of a chronic lifelong and potentially fatal disease, the way we do with substance use disorders.
00:04:53.839 --> 00:05:06.560
And so I feel like as a physician, I see people who are much further along on their journey with difficulties with mental health and with substance use disorders, which often go together.
00:05:06.800 --> 00:05:14.160
And so having that opportunity to think, wait, what could we do different for future generations of people?
00:05:14.399 --> 00:05:15.839
That's so exciting.
00:05:16.000 --> 00:05:18.800
And so I just I feel so lucky to be working in this.
00:05:18.959 --> 00:05:24.240
I do want to say that I have a really long-term view on prevention.
00:05:24.480 --> 00:05:37.199
So a little bit of history for me is that my father was a second White House drug czar, that's what's now ONDCP, and the first director of NIDA, uh, the National Institute on Drug Abuse.
00:05:37.600 --> 00:05:43.920
And so I literally grew up around the dining room table talking about prevention, treatment, and recovery.
00:05:44.079 --> 00:05:46.319
And so this is like in my blood.
00:05:46.480 --> 00:05:55.360
But then when I became a psychiatrist, I kind of for a while put all that aside and I really focused on patient care, this patient in front of me.
00:05:55.519 --> 00:05:59.759
And so when I think about prevention, I always think about that individual.
00:06:00.000 --> 00:06:06.399
It it really we think about numbers when we're doing big, big work on strategies and policy.
00:06:06.480 --> 00:06:14.720
We're thinking about big numbers, communities, the country, but you always have to think about those individuals, the individuals that this is going to affect.
00:06:14.959 --> 00:06:19.040
And so this is the pleasure of my life to work in this field.
00:06:19.360 --> 00:06:23.600
Well, so uh, Carolyn, it seems like we have uh cross paths.
00:06:23.680 --> 00:06:28.720
So you started thinking about things broad and then went to patient care.
00:06:28.879 --> 00:06:30.079
And I did the opposite.
00:06:30.240 --> 00:06:33.839
I was always about the individual, and now I'm thinking broad.
00:06:34.000 --> 00:06:35.600
So it it both works.
00:06:35.839 --> 00:06:36.480
It both works.
00:06:36.639 --> 00:06:40.079
And we need all the all those perspectives at the table.
00:06:40.399 --> 00:06:41.279
Absolutely.
00:06:41.519 --> 00:06:50.800
And speaking of which, we're talking broadly, O and DCP released the 2026 National Drug Control Policy this month when we're talking in May.
00:06:51.040 --> 00:06:56.879
I'm wondering from both of you, what is the most important shift you see compared to previous strategies?
00:06:57.040 --> 00:07:01.600
And what does it signal to healthcare providers, prevention practitioners, and communities?
00:07:02.160 --> 00:07:07.120
All right, I'll take it from here, and then and then I can't wait to hear what Dr.
00:07:07.199 --> 00:07:10.319
DuPont has to say, because she's she'll be like the critic.
00:07:11.439 --> 00:07:17.839
But in general, strategies always talk about prevention, treatment, recovery.
00:07:18.079 --> 00:07:26.560
Uh, I think what makes this uh strategy different, it's it's very ambitious, it's robust, it's visionary.
00:07:27.120 --> 00:07:30.240
We start our strategy with emerging threats.
00:07:30.399 --> 00:07:35.920
We want to be ahead of the enemy, ahead of the of the threats, not behind.
00:07:36.079 --> 00:07:49.600
You know, and we create a vision, and the vision is that we want to be comprehensive in what the threats are from mortality data, morbidity data, drug seizures, what's on the ground of patients are experiencing.
00:07:49.920 --> 00:07:51.040
That's how we start.
00:07:51.199 --> 00:07:58.959
We talk about supply and being fierce, and we could see that in the government being fierce on the issues of supply.
00:07:59.279 --> 00:08:04.480
And when it comes to issues of demand, we're we're clearly defining prevention.
00:08:04.560 --> 00:08:05.199
And I know Dr.
00:08:05.279 --> 00:08:10.480
DuPont's gonna love this, that it's primary prevention, preventing drug use before it starts.
00:08:10.560 --> 00:08:17.279
Because what's happened in the past, there's primary prevention, secondary prevention, tertiary prevention, everybody was doing prevention.
00:08:17.439 --> 00:08:23.360
Everything was prevention, and that really robbed the whole focus of primary prevention.
00:08:23.519 --> 00:08:40.639
So we make that very clear that we want to bring primary prevention back into focus and bringing prevention science and evaluation, not just everybody does prevention, everybody has a program, but bringing uh the science and outcomes to that.
00:08:40.799 --> 00:08:45.039
And when it's treatment, we also have, you know, very visionary treatment.
00:08:45.200 --> 00:08:48.080
We want to make treatment easier than getting drugs.
00:08:48.240 --> 00:08:51.440
We want to bring addiction to the mainstream of healthcare.
00:08:51.600 --> 00:08:53.200
And then we want to go upstream.
00:08:53.279 --> 00:09:00.080
We don't want to wait to my experiences in the emergency department where people are in the worst of the worst of disease.
00:09:00.399 --> 00:09:06.559
Think about treating the pre-cancerous lesion rather than trying to get chemotherapy for stage four cancer.
00:09:06.720 --> 00:09:11.120
Think about treating pre-diabetes instead of being on an insulin pump forever.
00:09:11.279 --> 00:09:13.519
So that's kind of our vision with treatment.
00:09:13.600 --> 00:09:16.480
We always want to be there for everyone.
00:09:16.799 --> 00:09:22.240
We believe in rescue, second, not just second chances, but third, fourth, fifth, tenth chances.
00:09:22.320 --> 00:09:23.440
You always have to be there.
00:09:23.679 --> 00:09:32.720
Sadly, because of the threats of fentanyl and even worse opioids, uh, we need to strategically place naloxone.
00:09:32.879 --> 00:09:34.879
We we need to have it in the right places.
00:09:35.200 --> 00:09:40.960
And then we also, as always, want to promote and celebrate recovery.
00:09:41.360 --> 00:09:43.919
You know, there's 25 million Americans living in recovery.
00:09:44.000 --> 00:09:45.279
They're showing the example.
00:09:45.360 --> 00:09:49.120
We actually need to learn and study them because it's not one size fits all.
00:09:49.279 --> 00:09:52.399
I think that's where like research be like, how are you successful?
00:09:52.639 --> 00:09:54.720
And uh, we're very excited about it.
00:09:55.039 --> 00:10:03.039
Yeah, I mean, it's definitely holistic, covers the whole life cycle from primary prevention, as you were saying, through recovery, the supply, the demand.
00:10:03.279 --> 00:10:04.559
I want to turn to Dr.
00:10:04.639 --> 00:10:05.360
Deepont.
00:10:05.519 --> 00:10:06.879
Um, prevention, as Dr.
00:10:06.960 --> 00:10:10.000
Lev was mentioning, is really near and dear to your heart.
00:10:10.159 --> 00:10:20.720
So, from your perspective, as a prevention practitioner and someone who's connected to local coalitions across the country, where does the strategy meet communities where they actually are?
00:10:21.679 --> 00:10:23.200
It's just so important.
00:10:23.840 --> 00:10:26.320
So, most prevention is local.
00:10:26.399 --> 00:10:29.600
It's small, it's one community at a time.
00:10:29.919 --> 00:10:38.080
And it's so important for them to have the information and the support from policy at all levels of government.
00:10:38.240 --> 00:10:49.440
And so then this national strategy's emphasis on primary prevention is a really big deal to bolster the work of coalitions who are already there, boots on the ground, doing the work.
00:10:49.679 --> 00:10:54.320
Also, the support of the drug-free communities DFC program is essential.
00:10:54.559 --> 00:11:02.879
And so I want to just say that the people who are doing the work, they know how to best serve the people in their own communities.
00:11:03.200 --> 00:11:18.879
But having this shared vision of normalizing non-use for youth and recognizing that's in the best interest of public health, this is a public health message, and that that's again supported from the very top is really important because this work is hard.
00:11:19.120 --> 00:11:19.600
Like Dr.
00:11:19.759 --> 00:11:25.440
Leb said, primary prevention often gets kind of shoved to the side and kind of looked down on.
00:11:25.600 --> 00:11:32.559
People don't necessarily recognize how critical it is as a public health strategy.
00:11:32.720 --> 00:11:35.039
And so really highlighting it.
00:11:35.120 --> 00:11:36.720
So I love that whole spectrum.
00:11:36.799 --> 00:11:49.200
We often have our kind of colorful rainbow spectrum we show, where we show that kind of universal prevention messaging on this side, and it goes all the way through selected and indicated and treatment and recovery.
00:11:49.440 --> 00:11:51.120
All of those things are so important.
00:11:51.200 --> 00:11:53.840
And everybody does need to be at that table.
00:11:54.080 --> 00:11:55.840
Yeah, I mean, no surprise.
00:11:55.919 --> 00:11:56.559
I mean, Dr.
00:11:56.720 --> 00:12:01.840
DuPont and her father were both mentors to me, so that that definitely has an influence.
00:12:01.919 --> 00:12:12.080
But it's interesting, uh, Carolyn, you know, in the strategy, we explain the different population cohorts in order to understand what people need.
00:12:12.559 --> 00:12:12.799
Right?
00:12:12.960 --> 00:12:18.240
So we we have the cohort of people who don't use dubs, they never use drugs.
00:12:18.480 --> 00:12:21.519
You know, that cohort needs messaging.
00:12:21.679 --> 00:12:22.320
Good job.
00:12:22.480 --> 00:12:23.120
Continue.
00:12:23.279 --> 00:12:24.879
Most people are just like you.
00:12:25.200 --> 00:12:28.879
Then we have a cohort of people who misuse, they don't have a substance use disorder.
00:12:29.200 --> 00:12:33.519
They're they're making risky life choices and they need education.
00:12:33.840 --> 00:12:35.279
That's a different messaging.
00:12:35.519 --> 00:12:43.919
And then we have the people who have a substance use disorder from mild to severe, and they deserve compassion and treatment.
00:12:44.080 --> 00:12:46.159
Um, and then we have the people in recovery.
00:12:46.399 --> 00:12:52.639
So, you know, different cohorts um require different messaging and and resources.
00:12:52.720 --> 00:12:58.080
And I think when I see this infighting that you were talking about, I take them back to the cohorts.
00:12:59.519 --> 00:13:00.799
That makes a lot of sense too.
00:13:00.960 --> 00:13:13.679
I mean, uh, we've seen, say, in like the tobacco space, uh different kinds of messaging for like vaping prevention with young people versus more like combustible tobacco, you know, cessation for older folks.
00:13:13.840 --> 00:13:18.559
Um the messaging really needs to be, you know, targeted to the audience that makes sense.
00:13:18.720 --> 00:13:20.879
So definitely resonating there.
00:13:21.279 --> 00:13:29.279
Another thing about the strategy is that it makes creating a drug-free America as a social norm, as a central pillar.
00:13:29.600 --> 00:13:31.919
That framing is pretty bold in my mind.
00:13:32.080 --> 00:13:36.080
So, why does norming matter so much to behavior change?
00:13:36.240 --> 00:13:42.080
And what does it actually take to shift a culture around drugs, not just a message?
00:13:42.480 --> 00:13:46.240
So, Melissa, I don't think that messaging is bold.
00:13:46.399 --> 00:13:49.600
I think it the data shows that that's where we are right now.
00:13:49.919 --> 00:13:55.679
What we did is usually say, oh, we want to teach kids not to use drugs and don't do this.
00:13:55.840 --> 00:14:03.200
All we did, instead of saying, all these kids are using drugs, all we did is switch it from a negative to a positive.
00:14:03.440 --> 00:14:04.399
That's all we did.
00:14:04.559 --> 00:14:13.600
So we're now highlighting, not all the people who are using drugs, we're highlighting that 83% of people don't use drugs.
00:14:13.919 --> 00:14:15.360
That's just the data.
00:14:15.600 --> 00:14:27.840
So we're we are, and instead of, you know, saying, you know, what we see on TV or what we hear, or or even if our profession seems like drugs are all around us, the fact is most Americans are not using drugs.
00:14:28.000 --> 00:14:32.240
So we want to push that social norm and expand it.
00:14:32.399 --> 00:14:41.840
And what I've learned from the professionals in in prevention science is that pushing the social norm is what moves.
00:14:42.000 --> 00:14:43.679
Everybody, you know, there's peer pressure.
00:14:43.840 --> 00:14:56.960
So if we emphasize the fact, the fact that most people don't use drugs, we want to be healthy in order to achieve our life's dreams, whether, you know, it's athletics or music or writing or whatever, or family.
00:14:57.200 --> 00:15:00.879
In order to be your best, you do that better by being drug-free.
00:15:00.960 --> 00:15:04.080
And that's why the majority of Americans make that choice.
00:15:04.159 --> 00:15:06.639
And we want to expand upon that.
00:15:06.960 --> 00:15:11.600
So I want to clarify a few things with this that I think are really important.
00:15:11.919 --> 00:15:14.879
And one of the things is what do you mean when you say drug-free?
00:15:15.200 --> 00:15:17.200
And I love that term, drug-free.
00:15:17.360 --> 00:15:19.200
So I'm I'm very in support of it.
00:15:19.279 --> 00:15:21.200
I have a little bracelet that says drug-free.
00:15:21.279 --> 00:15:21.919
I love it.
00:15:22.159 --> 00:15:24.799
But you have to make sure that everybody's talking about the same thing.
00:15:24.960 --> 00:15:28.000
So, one of the things is I talk about primary prevention.
00:15:28.080 --> 00:15:28.960
I'm talking about youth.
00:15:29.039 --> 00:15:31.360
I'm talking about people under the age of 21.
00:15:31.600 --> 00:15:35.679
And that correlates with the law, but it also correlates with brain development.
00:15:36.000 --> 00:15:49.600
And for youth, when we're talking about drug-free, we're talking about all the drugs that super stimulate the brain's reward system: alcohol, nicotine, cannabis, and all illicit drugs are in that umbrella.
00:15:49.840 --> 00:15:53.120
And so I want to make sure that we're being really clear about that.
00:15:53.360 --> 00:15:58.399
And I love your data, and I absolutely agree that we don't have to create a social norm.
00:15:58.480 --> 00:16:01.360
There already is a social norm that's ready to be recognized.
00:16:01.600 --> 00:16:12.639
So we at the Institute for Behavior and Health looked at the monitoring the future, which is the big data that our nation collects to follow young people and their drug use.
00:16:12.960 --> 00:16:19.039
And it's usually used to look at what percentage of high school seniors are using X, Y, Z drug or whatever.
00:16:19.360 --> 00:16:28.879
But we did research where we looked at that data in a different way and we said, what percentage of high school seniors have not used any drugs?
00:16:29.039 --> 00:16:32.240
No alcohol, nicotine, marijuana, or any other drug.
00:16:32.720 --> 00:16:35.600
And we did it both by lifetime and by past month.
00:16:35.840 --> 00:16:48.799
And what we've seen is over the past 50 years, we have data from 50 years, because in fact, that second White House drug czar, who I again mention is my father, Robert DuPont, he started that monitoring the future with the University of Michigan.
00:16:48.960 --> 00:16:57.840
So, anyway, back in the 70s and 80s, it was something like 3 to 5% of high school seniors had not used any substance in their lifetime.
00:16:58.000 --> 00:17:03.039
So 95 to 97% of high school seniors had used something.
00:17:03.360 --> 00:17:09.359
Now that number is over 35% of high school seniors have never used anything in their lifetime.
00:17:09.599 --> 00:17:13.759
And that's a huge change that's been going on for 50 years.
00:17:13.920 --> 00:17:17.359
And the reason it's been happening is because of prevention.
00:17:17.599 --> 00:17:18.960
Prevention really works.
00:17:19.200 --> 00:17:20.720
The messaging really works.
00:17:20.880 --> 00:17:26.880
But the more important one to consider is past month non-use, because I never want to think about this as a purity test.
00:17:27.119 --> 00:17:32.160
This has to do with a health standard, like other health standards, like did you wear your seatbelt or not?
00:17:32.319 --> 00:17:34.480
When you get more information, you can change your behavior.
00:17:34.559 --> 00:17:39.200
You can start wearing your seatbelt, you can start wearing your bike helmet, you can stop using substances.
00:17:39.440 --> 00:17:46.640
So that past month non-use used to be like the 16 to 20% of high school seniors haven't used in the past month.
00:17:46.799 --> 00:17:48.079
Now it's over 60%.
00:17:48.720 --> 00:17:52.079
Over 60% of high school seniors haven't used in the past month.
00:17:52.319 --> 00:17:55.039
That's really different than what most adults think.
00:17:55.119 --> 00:18:00.319
And that's because it was different 30, 40 years ago when those adults were in school.
00:18:00.400 --> 00:18:04.640
And so they think that's normal, that that like it's normal for kids to use.
00:18:04.880 --> 00:18:07.839
But actually, the the normal is non-use.
00:18:08.079 --> 00:18:09.519
And I think that's really important.
00:18:09.680 --> 00:18:14.880
I also want to say that the American Academy of Pediatrics came out with a wonderfully strong statement.
00:18:15.039 --> 00:18:24.000
They said the non-use message should be reinforced by pediatricians through clear and consistent information presented to patients, parents, and other family members.
00:18:24.240 --> 00:18:28.720
And so we are not alone in promoting this non-use message.
00:18:28.880 --> 00:18:37.839
And so having it again appear in the strategy and with such strong language and supporting this change that's already there is really wonderful.
00:18:38.079 --> 00:18:38.720
Yeah.
00:18:38.960 --> 00:18:52.319
So, Carol, I like, I like your more precise, and you know, you you mentioned all the great data that that uh your dad started and agree with almost everything you said.
00:18:52.640 --> 00:18:52.880
Uh-oh.
00:18:53.039 --> 00:18:53.359
Uh-oh.
00:18:53.519 --> 00:18:55.440
You said I was gonna be the contrarian.
00:18:55.519 --> 00:18:57.279
Look who's gonna be the contrarian.
00:18:58.240 --> 00:19:01.680
See, what what we are using, we're using the age of 25.
00:19:01.839 --> 00:19:05.039
You said 21, and I think Oh, I love 25, Ronet.
00:19:05.119 --> 00:19:06.799
I am so with you on 25.
00:19:07.279 --> 00:19:13.599
What I tell people is age 18 and 21 is for lawyers, but I'm a doctor, okay?
00:19:13.839 --> 00:19:16.880
And so as a doctor, the age is 25.
00:19:16.960 --> 00:19:24.079
I'm not gonna compromise on the medicine and the science of when the brain grows for your politics and for your laws.
00:19:24.319 --> 00:19:33.119
So um, you know, if you want to use, you know, 18 is legal to do a lot, and 21 is legal to do all sorts of things, but it's not a healthy choice.
00:19:33.359 --> 00:19:36.480
So we we have that 25 in our strategy.
00:19:36.640 --> 00:19:40.480
We're using 25 across government together.
00:19:40.559 --> 00:19:41.200
We're on that.
00:19:41.279 --> 00:19:45.680
So I'm giving you permission, Carolyn, to to move your 21 to 20.
00:19:45.920 --> 00:19:46.799
I mean, I love 25.
00:19:46.880 --> 00:19:49.599
And when I talk about brain development, I always talk about that.
00:19:49.680 --> 00:19:52.240
And actually, I think it's moving older than that.
00:19:52.400 --> 00:19:57.200
And here's the the actual secret: these substances aren't safe for anybody at any brain age.
00:19:57.440 --> 00:19:58.160
No meaning.
00:19:58.720 --> 00:19:59.599
That is really true.
00:19:59.759 --> 00:20:12.400
But what I have found when we're talking about prevention is it can be really helpful to talk about young people because you get much better traction than you get a lot of pushback from adults when you talk about everybody.
00:20:12.559 --> 00:20:14.720
So I'm always prepared to do that.
00:20:14.960 --> 00:20:27.839
And the reality is that people put off initiating use of any of those substances that hijack the brain's reward system until after the age of 21 or 25, they're very unlikely to start them.
00:20:28.079 --> 00:20:36.000
And so that's that's one of the things that it's not like where I have a gate there that I'm like, no, it's a you know, free-for-all, use anything you want.
00:20:36.240 --> 00:20:52.079
No, what we see is that in terms of behavior, that risk taking that's part of that adolescent period and part of that brain development part, that's the part we need to protect from that early exposure to substance use.
00:20:52.160 --> 00:20:52.960
And you're absolutely right.
00:20:53.039 --> 00:21:04.720
And that goes back to that point that I made at the beginning that not initiating use wildly decreases the risk of that chronic lifelong and potentially fatal illness of substance use disorder.
00:21:04.880 --> 00:21:17.920
But I also want to talk about the connection between mental health, other things, uh anxiety, depression, psychosis, all of these things can be made worse or more likely by adolescent substance use.
00:21:18.079 --> 00:21:25.920
And that is something that when I'm talking to youth, they're very open to that discussion because they're really concerned about their mental health.
00:21:26.079 --> 00:21:32.240
Young people today are more aware of mental health than I feel like any generation in the past.
00:21:32.400 --> 00:21:41.279
And so when I show them that data of the relationship between substance use and worsening mental health, the light bulb goes off and they're like, wow, I don't want to do that.
00:21:41.440 --> 00:21:42.640
That makes a lot of sense.
00:21:42.960 --> 00:21:45.200
I'm so glad you brought in mental health.
00:21:45.279 --> 00:21:48.960
Um, and and that is proudly in the strategy as well.
00:21:49.279 --> 00:21:58.000
It it appears several times, even in our emerging threats chapter, uh, we talk about all the psychiatric boarding in the emergency departments.
00:21:58.160 --> 00:21:59.759
I couldn't help myself as an emergency department.
00:22:00.160 --> 00:22:05.359
But a big percentage that we have not researched is because of substance use.
00:22:05.519 --> 00:22:11.119
And we and that correlation of substance use disorder, mental health disorder, that that's that's there.
00:22:11.279 --> 00:22:21.200
And and studying that, I think from the emergency department is really important because then we can make smarter drug policies and smarter resources.
00:22:21.359 --> 00:22:27.200
Like, because we always argue, oh, well, we need more mental health beds, or we need more long-term beds, or we need detoxes.
00:22:27.279 --> 00:22:35.519
It's like, well, why don't we stay that population and make educated, you know, policy and resource uh choices?
00:22:35.759 --> 00:22:41.359
And the other place mental health shows up is in the treatment substance use disorder.
00:22:41.599 --> 00:22:46.880
If you take everyone who has a substance use disorder, half of them have a mental health disorder.
00:22:47.119 --> 00:22:49.759
If we separate that, you're missing half the population.
00:22:49.839 --> 00:22:52.960
What's, you know, that's it, doesn't make sense to separate that.
00:22:53.119 --> 00:22:55.440
We need to handle that both together.
00:22:55.680 --> 00:23:02.000
And the other place it shows up is we really want to put a focus on early onset psychosis.
00:23:02.160 --> 00:23:08.640
And we see that kind of, again, I can't help my emergency physician analogy, but like a heart attack.
00:23:08.880 --> 00:23:17.039
You're having chest pain, you're having EKG changes, we get you the cath lab, we open up, you know, door to balloon time is critical.
00:23:17.200 --> 00:23:22.160
And it's critical because if you don't act upon it, you're gonna have permanent damage to your heart.
00:23:22.319 --> 00:23:24.319
And the same thing is with your brain.
00:23:24.480 --> 00:23:35.599
If you have early onset psychosis, first-time psychosis, if you don't do anything about it, you keep using drugs, then you will have permanent damage to your brain and have schizophrenia.
00:23:35.680 --> 00:23:43.039
We are creating in America more and more schizophrenia, bipolar disorder than needs to be because of drugs.
00:23:43.599 --> 00:23:54.880
Several drugs could do that, but out of all the drugs, the highest, the one with the highest conversion rate from one episode of psychosis to permanent mental illness is is cannabis, is marijuana.
00:23:55.039 --> 00:23:58.079
So we we want to um reverse that.
00:23:58.400 --> 00:24:02.960
If you take one thing away from this, that is the most important thing that what Dr.
00:24:03.119 --> 00:24:04.240
Just Love just said.
00:24:04.400 --> 00:24:06.160
That is so key.
00:24:06.319 --> 00:24:20.079
It's something that's happening right now, and it's gonna um have a huge negative effect on our individuals, our families, and our communities and our country for decades down the road if we don't do something about that.
00:24:20.319 --> 00:24:28.240
One of the things I was gonna bring in with that commercialization is there are a lot of people that are again trying to make money off of our young people.
00:24:28.640 --> 00:24:40.240
And one of the things that that means is that the drugs are different, they're stronger, there are different delivery methods, they're different packaging, there are different techniques of hooking people.
00:24:40.480 --> 00:24:50.400
And so our young people, you know, I have that good news I would say, and that really good news about the norm and how many people are making that active choice not to use.
00:24:51.039 --> 00:24:58.799
But the people who are using are at much higher risk because the substances are so different than what they were in the past.
00:24:59.039 --> 00:25:09.119
And if we don't pay attention to that, and if we are too substance specific, then we're gonna miss that there's a whole new threat that maybe we don't even know about today.
00:25:09.359 --> 00:25:16.079
And so really arming people with this concept of non-use for help is vital.
00:25:16.400 --> 00:25:24.000
And the analogy you made, um, you know, about your heart health, about, you know, tackling prediabetes, again, the primary prevention.
00:25:24.160 --> 00:25:36.960
I think that really resonates because once you sort of, you know, you could take a substance and be like, I'll feel fine later, but if you don't look at it with the long-term scope of what this is doing to your body, you know, I think that analogy really makes sense.
00:25:37.119 --> 00:25:40.400
Um, I don't want to bury the fact that um, you know, I think Dr.
00:25:40.559 --> 00:25:45.920
DuPont touched a little bit about it, but I really just want to put it plain out there in uh the spotlight.
00:25:46.240 --> 00:25:59.279
One choice prevention takes the position that youth should make no use of all substance together, so alcohol, nicotine, cannabis, any other drugs before the age of 21, or as you guys were just debating, maybe even 25.
00:25:59.359 --> 00:26:04.079
Uh, but officially um one choice prevention takes this, the um, the stance of 21.
00:26:04.400 --> 00:26:08.640
Why does that unified standard matter clinically and behaviorally?
00:26:08.880 --> 00:26:10.240
So, yeah, thank you so much.
00:26:10.319 --> 00:26:14.240
It really matters a tremendous amount because it's a health standard.
00:26:14.400 --> 00:26:22.400
So when we have a health standard, the reason we have it and the reason we feel confident about it is because it's backed by science and data and experience.
00:26:22.559 --> 00:26:24.559
And so it's like that seatbelts I mentioned.
00:26:24.640 --> 00:26:30.160
If you, if I tell someone wear your seatbelt, they know it's not just like I have a, I don't know, a thing about seatbelts.
00:26:30.240 --> 00:26:34.079
It's because that's really the data is very strong for seatbelt wearing.
00:26:34.160 --> 00:26:40.880
And it's not just in the front seat and it's not just at night, or it's not just if you're the passenger, it's everybody should have a seatbelt on every time.
00:26:40.960 --> 00:26:42.640
And then we have the data to back it up.
00:26:42.799 --> 00:26:44.319
And that's the way a health standard is.
00:26:44.480 --> 00:26:47.359
It needs to be very clear and it needs to be universal.
00:26:47.519 --> 00:26:50.319
And that's the way the non-use message is for health.
00:26:50.400 --> 00:26:51.119
It's universal.
00:26:51.200 --> 00:26:55.279
So the non-use for health message is universal across that spectrum.
00:26:55.440 --> 00:26:59.119
So if you have a young person who's never used, that's the right health message.
00:26:59.279 --> 00:27:04.640
But if you have one that is using but not having any trouble, it's still the health standard is non-use.
00:27:04.960 --> 00:27:10.960
If you have one that has a diagnosed substance use disorder as a young person, the health standard hasn't changed.
00:27:11.039 --> 00:27:16.640
And it doesn't have any kind of morality or purity test or, you know, good kids, bad kids kind of thing.
00:27:16.799 --> 00:27:19.599
It's just what the science and data supports.
00:27:19.839 --> 00:27:27.119
The two things that are really important to me to understand about this one is that science of the developing brain, which we have already talked about.
00:27:27.200 --> 00:27:29.599
And I, you know, again, I love 25.
00:27:29.680 --> 00:27:33.519
I always worried about college students and that early adulthood age too.
00:27:33.680 --> 00:27:36.000
So that developing brain is really, really important.
00:27:36.160 --> 00:27:47.359
Things that happen to our brain, and especially these things that hijack again, that dopamine pleasure center of the brain, retrain or literally change the trajectory of that brain for that person.
00:27:47.519 --> 00:27:53.119
And so it's very important to not expose the brain to those things during those years of development.
00:27:53.359 --> 00:28:03.519
But the other reason that we have this concept of one choice is what we say, is because we we did this research that showed that for youth, all substance use is connected.
00:28:03.759 --> 00:28:14.960
So when they make the choice to use one substance, for example, marijuana, their risk of using other substances, nicotine, alcohol, pills, any other substance goes way up.
00:28:15.279 --> 00:28:23.759
And so we did this study, what I call little bars, big bars, which shows if you would look at teens and say to them, did you use marijuana over the past month?
00:28:24.000 --> 00:28:29.920
You have one side of the graph has little bars, which is associated with they were very unlikely to use other substances.
00:28:30.000 --> 00:28:35.599
If they said no, if they said no marijuana in the past month, little bars, unlikely to use other substances.
00:28:35.759 --> 00:28:42.000
If they said yes the past month, marijuana used big bars, much more likely to be using other substances.
00:28:42.160 --> 00:28:48.880
And that's the case where whatever drug you look at it, look at alcohol, look at nicotine as your primary, primary drug you're comparing.
00:28:49.200 --> 00:29:07.359
When a teen has made that choice, oh, maybe I will try vaping, for example, it becomes a really slippery slope of, well, if I'm vaping nicotine, maybe I'll vape vape cannabis, or if I'm vaping, maybe I'll start smoking a cigarette, or if I'm smoking and vaping, maybe I'll drink some alcohol.
00:29:07.519 --> 00:29:13.200
It becomes a question of which substances, when to use it, with whom do you use it?
00:29:13.359 --> 00:29:14.799
So many questions.
00:29:15.039 --> 00:29:25.920
But if that person makes that initial decision, um, no thanks, not for me, to whatever that first thing that they were introduced to, then they're very unlikely to use other substances.
00:29:26.079 --> 00:29:30.240
So we see that it kind of boils down to that one choice that that person is making.
00:29:30.480 --> 00:29:34.240
Am I someone who uses substances or someone who doesn't use substances?
00:29:34.480 --> 00:29:39.279
It sounds really easy, but I always talk about this as being an active and continuing choice.
00:29:39.440 --> 00:29:41.359
Being a teenager is hard.
00:29:41.599 --> 00:29:44.160
So you can't just say to your kid, don't use.
00:29:44.480 --> 00:29:58.400
I mean, you can, and then you should, and that's great, but it has to have many more aspects to a conversation than this, because it is hard to navigate those social situations and you aren't going to be there with your kid, especially all the way till they're 25.
00:29:58.640 --> 00:30:04.240
So they need to have the data, the science, and understand the health message of non-use.
00:30:05.519 --> 00:30:09.920
Thank you so much for sharing a little bit more about uh, you know, why that matters.
00:30:10.240 --> 00:30:16.319
I love talking about, you know, the level of risk that increases because it is so important.
00:30:16.720 --> 00:30:22.400
And I think that your organization's mission is a really great one and the science really backs it.
00:30:22.720 --> 00:30:36.319
We've talked really high level about what the science says, what the strategy says, but one of the persistent challenges in getting people help is that the formal healthcare system often isn't where people turn first.
00:30:36.480 --> 00:30:45.200
You know, they often turn to people and institutions they already trust, whether it's a faith community, a school counselor, a neighbor, or community organization.
00:30:45.599 --> 00:30:57.359
So, how do we build real bridges between those trusted networks and the providers and public health systems that can actually connect people to treatment and prevention resources?
00:30:57.599 --> 00:31:00.400
And where are those bridges missing right now?
00:31:00.720 --> 00:31:03.680
So, yeah, I'll start, I'll start with our strategy.
00:31:04.480 --> 00:31:15.359
When our our director, director Carter, you know, she built an amazing team and and uh she gave me the task of writing the first outline of the strategy.
00:31:15.519 --> 00:31:17.759
And she wanted it different and bold.
00:31:17.920 --> 00:31:20.079
So I was thinking about that all the time.
00:31:20.319 --> 00:31:24.480
And uh I was there in synagogue, you know, thinking about the strategy.
00:31:24.720 --> 00:31:28.640
And then I realized, hey, the answer is right in front of me, right in front of me.
00:31:28.799 --> 00:31:47.680
And you know, and the next day or Monday, uh I came in and wrote in God and faith into the strategy and put it in the front of the strategy and put it in scientific terms that 83% of the population believes in God or a higher power.
00:31:47.839 --> 00:31:50.400
And that is a powerful tool.
00:31:50.559 --> 00:31:52.960
It's a tool to be used, not to be hidden.
00:31:53.200 --> 00:32:03.599
And we have outcome measures, you know, for substance use disorder and probably for other medical problems of uh better outcomes for people who use this tool.
00:32:03.920 --> 00:32:07.599
And really proud that uh it was not edited out.
00:32:07.839 --> 00:32:13.599
You could say, imagine, you know, that the strategy goes through lots of vetting and lawyers and you know, separation for church and state.
00:32:13.680 --> 00:32:16.319
They'd want to, you know, advise us to get that out.
00:32:16.559 --> 00:32:22.960
And really, thanks to President Trump, who's made faith a huge focus of the administration.
00:32:23.119 --> 00:32:27.680
I said, okay, I dare anybody to edit God out of the strategy.
00:32:27.920 --> 00:32:30.720
Now, your question is like, how do we make those bridges?
00:32:30.799 --> 00:32:36.079
We've had lots of dis discussions on the integration of faith and medicine.
00:32:36.160 --> 00:32:40.079
And and we do that routinely at end-of-life care, right?
00:32:40.160 --> 00:32:42.160
That's we're very acknowledged about that.
00:32:42.240 --> 00:32:45.680
Um, and we're want to bring that into the mainstream.
00:32:46.000 --> 00:32:52.400
We now have faith leaders at every department of government, including our own here at ONDCP.
00:32:52.880 --> 00:32:58.559
And we are working ways, um, and we haven't, we don't have the solution yet.
00:32:58.640 --> 00:33:04.319
But we because, like just like you said, Melissa, sometimes people come to their faith leaders before they go to their doctor.
00:33:04.559 --> 00:33:12.319
So that means we need to educate the faith leaders to recognize some red flags when it comes to potentially addiction.
00:33:12.480 --> 00:33:29.119
Maybe maybe it'd be like, oh, you know, my son doesn't want to go to school or their grades are dropping, but maybe we need to dig deeper and have see if that is, you know, besides a mental health problem, a substance use disorder problem, and and teach the faith leaders how to get resources, uh, how to intervene.
00:33:29.200 --> 00:33:34.160
And so we need to build that structure for all faith communities.
00:33:34.400 --> 00:33:44.880
And we also, you know, if we are we just recently had a a summit on best practices for treatment in homelessness addiction.
00:33:45.440 --> 00:33:53.839
And a common denominator in best success rates are the rescue missions, the faith-based programs who bring that in.
00:33:54.079 --> 00:33:57.200
We don't want to force faith on anybody, you know.
00:33:57.599 --> 00:34:01.920
We, you know, and and we're there for you, whether you have faith or not.
00:34:02.079 --> 00:34:04.720
I mean, I as an emergency physician, I can tell that.
00:34:04.960 --> 00:34:09.440
But if you have this secret sauce, you need to unleash it.
00:34:09.519 --> 00:34:10.559
You need to use it.
00:34:10.880 --> 00:34:20.159
And we found that a common denominator for the best successful programs for recovery are the ones who use faith.
00:34:20.400 --> 00:34:24.320
And uh we want to continue to encourage that and foster that.
00:34:24.639 --> 00:34:25.199
Yeah.
00:34:25.440 --> 00:34:26.000
And Dr.
00:34:26.079 --> 00:34:36.960
DuPont, from um a prevention standpoint, we know that trusted messengers matter enormously, but you know, that messenger has to be able to reach everyone.
00:34:37.199 --> 00:34:48.559
How do you think about building those community bridges in a way that's inclusive and doesn't inadvertently create barriers for people who most need to hear that prevention messaging?
00:34:48.800 --> 00:34:50.639
Yeah, I think this is really important.
00:34:50.880 --> 00:34:56.000
Um, the thing is, I always think about who is responsible for prevention messaging.
00:34:56.239 --> 00:35:00.079
And I've given a lot of talks on prevention to a lot of different audiences.
00:35:00.159 --> 00:35:01.119
And some are really obvious.
00:35:01.199 --> 00:35:04.079
They're coalition leaders that like that's their bread and butter.
00:35:04.159 --> 00:35:05.199
That's what they do all day long.
00:35:05.360 --> 00:35:06.079
They're the experts.
00:35:06.159 --> 00:35:07.599
I learned from them all the time.
00:35:07.760 --> 00:35:08.880
It's wonderful.
00:35:09.199 --> 00:35:12.639
But it turns out that everybody has a role in prevention.
00:35:12.800 --> 00:35:22.079
And so I think about I can give a talk to literally any audience and tell the explain to them why they have a role in prevention.
00:35:22.239 --> 00:35:37.199
And it has to do with being educated and knowing what the resources is are and where to find them and how to connect people with them, and really being grounded in the science and data and being open-minded and non-judgmental.
00:35:37.280 --> 00:35:42.159
These are all the components of being available to the young people in your life life.
00:35:42.320 --> 00:35:57.199
So if you have young people in your life professionally, you're a doctor, a lawyer, an educator, a faith leader, whatever it is that your role is that you have in interactions with youth or with families, you should have a role in prevention.
00:35:57.360 --> 00:36:09.440
And I want to make sure that you have the information that you need to help people understand all of these topics that we're talking about, about why the non-use norm is brain protection.
00:36:09.840 --> 00:36:15.039
And also about if if you've got someone who's struggling, how do you get them help?
00:36:15.119 --> 00:36:16.559
And where is help available?
00:36:16.719 --> 00:36:19.679
And you want to use whatever tools you have available.
00:36:19.840 --> 00:36:22.239
So I want everybody at the table.
00:36:22.320 --> 00:36:23.039
That's my point.
00:36:23.119 --> 00:36:28.800
I've I want everybody at the table, but you do have to make sure that you're giving the right message to the right person.
00:36:28.960 --> 00:36:44.880
So if you're giving a general no-use message and you've got a parent in there who's got a kid that's really struggling with advanced substance use, it's not going to be a very effective message because you're going to miss that mark of what that person needs to hear and what they need to do.
00:36:45.039 --> 00:36:46.239
You need to understand, right?
00:36:46.480 --> 00:36:46.880
Exactly.
00:36:47.039 --> 00:36:48.480
Totally different cohort.
00:36:48.719 --> 00:36:49.360
Exactly.
00:36:49.599 --> 00:36:59.679
And so, but a lot of times when you're speaking or whatever, or you're teaching, or you're whatever caring for people, you might not know initially what cohort that someone is part of and what you need to bring.
00:36:59.840 --> 00:37:15.760
Um, and so I I I think it's really important to make sure that we're meeting people where they are, helping them with what what the they currently need help with, and then also using language that is inclusive and inviting to them.
00:37:16.000 --> 00:37:20.079
And so if someone is involved with a faith community, that is fantastic.
00:37:20.159 --> 00:37:22.559
And I am 100% in agreement with what Dr.
00:37:23.039 --> 00:37:28.320
Lev said, that that is a strength of theirs that they can can rely on.
00:37:28.559 --> 00:37:37.039
Um, and I see that all the time in my practice that people, when things going gets tough, you know, it's really nice to have a faith community if that's part of your life.
00:37:37.280 --> 00:37:50.880
The thing that I have to recognize also is for a lot of my patients, they may have have belong in that 80% that believe in a higher power or a spiritual something in, you know, but it's not a religion.
00:37:51.119 --> 00:37:56.320
And I have to be very careful to walk that line that doesn't sound like I'm alienating people.
00:37:56.480 --> 00:38:07.920
So one of the things I've noticed is even like AA sometimes, which has that um that belief in a higher power, can be alienating to people, even though AA is not at all affiliated with any religion.
00:38:08.159 --> 00:38:11.519
And so language matters, and we'll we'll talk about that some more.
00:38:11.599 --> 00:38:25.199
But here's a case of where language matters that you have to, you know, read the room of who you're speaking to and make sure that when you are giving messages, either of prevention or treatment or recovery, that you're addressing the needs of the person in front of you.
00:38:25.519 --> 00:38:25.840
Yeah.
00:38:26.079 --> 00:38:33.199
I think it also goes back to what we were talking about before about, you know, wanting to make a message right for someone.
00:38:33.360 --> 00:38:35.280
Everyone comes from a different place.
00:38:35.519 --> 00:38:49.519
We're maximizing the toolbox, so to speak, to make sure that there are the messages, resources, people, trust there so that wherever people are, wherever, whatever cohort they're in, they can have a seat at the tables, Dr.
00:38:49.599 --> 00:38:51.280
DuPont also mentioned.
00:38:51.599 --> 00:39:00.639
Since we are on the topic of language, we know that you know, stigma remains one of the most stubborn barriers for people who need help to seek help.
00:39:00.880 --> 00:39:07.679
How does national messaging and the language we use either reinforce or reduce stigma?
00:39:07.840 --> 00:39:13.199
And what does a culture where recovery is truly normalized actually look like?
00:39:13.920 --> 00:39:17.440
So you you will not find the word stigma in the strategy.
00:39:17.920 --> 00:39:28.800
And the reason is we don't want stigma on the human being, the person who has a medical illness and deserves empathy and compassion and the best care possible.
00:39:29.119 --> 00:39:31.280
But frankly, we do want stigma on the drugs.
00:39:31.440 --> 00:39:33.199
I don't want you to use fentanyl.
00:39:33.440 --> 00:39:35.360
I don't want you to use these drugs.
00:39:35.519 --> 00:39:36.320
There should be.
00:39:36.480 --> 00:39:40.400
And if you think about it in tobacco use, cigarettes, yeah, those are bad.
00:39:40.639 --> 00:39:42.800
Cigarettes have been stigmatized.
00:39:43.039 --> 00:39:48.480
And we found that universally that message can be mixed.
00:39:48.639 --> 00:40:00.400
So that's why we're we we have not used the word stigma in the strategy and instead really emphasize compassion, empathy, treating addiction like any other chronic disease.
00:40:00.800 --> 00:40:01.119
Dr.
00:40:01.280 --> 00:40:09.760
Deepont agrees here that empathy and compassion need to be at the forefront instead of language that emphasizes stigma around substance use.
00:40:10.079 --> 00:40:18.880
And from the clinical side, she's emphatic about two things too: that addiction is a real illness, and that recovery is just as real too.
00:40:19.280 --> 00:40:24.800
These illnesses are absolutely as real as any other illnesses.
00:40:24.880 --> 00:40:27.760
So these are real as cancer, real as diabetes.
00:40:28.079 --> 00:40:36.400
So we need to treat them patients, as patients, with unconditional respect, empathy, and compassion.
00:40:36.719 --> 00:40:49.920
And so I do think the way we need to do that as a society is by really making sure people understand the complexity of these illnesses and the pathways to recovery.
00:40:50.079 --> 00:40:55.360
So, kind of coming to that second part about kind of what does this mean in terms of recovery?
00:40:55.599 --> 00:41:08.480
I want to be really clear that recovery is absolutely possible and it's happening around us all the time, even from people with very, very significant substance use disorders.
00:41:08.719 --> 00:41:13.039
There is nobody that is too far gone unless they are dead.
00:41:13.199 --> 00:41:17.119
You can't treat dead as a very, you know, sad way of thinking about things.
00:41:17.199 --> 00:41:25.920
But otherwise, there is an opportunity for hope and for full recovery, um, sustained lifelong recovery.
00:41:26.079 --> 00:41:29.440
And so I think that is really important for us to see.
00:41:29.679 --> 00:41:38.639
And recovery from substance use disorders is the one disorder where I think the person is actually better than they were before they had the disorder.
00:41:38.880 --> 00:41:59.199
Because the process of recovery is a process of connecting with community and a process of finding meaning outside of yourself and getting the help you need for other things, mental health concerns or or social concerns, uh, housing or or family, whatever that is, getting those supports in place.
00:41:59.360 --> 00:42:03.199
And so recovery is a miracle.
00:42:03.360 --> 00:42:04.639
It's just fantastic.
00:42:04.880 --> 00:42:12.960
Yeah, I love how both of you are taking this with so much, I mean, like compassion, empathy, community, they're all so important.
00:42:13.119 --> 00:42:21.920
And just the way you're talking really resonates from what I've seen in people in my life who have struggled with substance use disorder, who have recovered or on journeys to recovery.
00:42:22.159 --> 00:42:30.239
And, you know, as we're wrapping up here, I know that both of you just across this conversation, getting to know you both, you lead through a deeply, deeply human lens.
00:42:30.480 --> 00:42:42.000
I'm wondering, is there a patient encounter, a family, or a moment from the front lines that still sits with you and still shapes how you think about this crisis today?
00:42:42.239 --> 00:42:47.679
And what do you most want people listening to this episode to carry with them?
00:42:48.239 --> 00:42:55.199
Well, I guess my my first patient story is started in in my community.
00:42:55.440 --> 00:42:57.840
It was uh in Yom Kippur.
00:42:58.079 --> 00:43:08.239
We're all gathered in the synagogue, and one of the young boys was in the ICU, um, expected to die because of a drug overdose.
00:43:08.559 --> 00:43:20.960
And I remember uh, you know, being in the ICU, holding his hand and seeing his family and his dad in particular just broken up and and really saying goodbye to his son.
00:43:21.039 --> 00:43:23.039
And it was pretty gut-wrenching.
00:43:23.280 --> 00:43:28.559
And then months went by, and Aaron Rubin, he didn't, he did not die.
00:43:28.719 --> 00:43:34.880
He became um uh quadriplegic, and his mom, Sherry Rubin, became an activist.
00:43:35.360 --> 00:43:38.159
And the two of them went, you know, around the country.
00:43:38.559 --> 00:43:46.320
It was not hard easy with any, you know, electric wheelchair and everything, in in teaching on on the the dangers of prescription opiates.
00:43:46.480 --> 00:43:48.000
At that time, it was prescription opiates.
00:43:48.159 --> 00:43:50.880
And and Sherry brought me into the fold.
00:43:50.960 --> 00:43:54.639
Like, why are the doctors giving all these drugs to our children?
00:43:54.719 --> 00:43:57.840
And our children are are are are dying from that.
00:43:58.000 --> 00:44:03.280
And she brought me to meetings, like Like, okay, doctors, why are you guys giving too many drugs to patients?
00:44:03.440 --> 00:44:05.519
It's like, this is what I'm told to do.
00:44:05.760 --> 00:44:07.599
If I don't do that, I'm getting in trouble.
00:44:07.679 --> 00:44:13.199
I mean, we had patients in the emergency room yelling, like, I know my rights, I need to get my pain meds.
00:44:13.280 --> 00:44:20.400
We were told with the you know, fifth vital sign, that was what we were taught to do at the beginning of my profession.
00:44:20.480 --> 00:44:24.159
And I think about it, it's probably why I'm here today.
00:44:24.320 --> 00:44:25.760
I'm making amends.
00:44:26.000 --> 00:44:34.480
I am in recovery, my own professional mistakes that we did as a collectively as a profession to fix that.
00:44:34.719 --> 00:44:46.400
And from there, I went to really study the problem, looking at, I looked at, I teamed up with the medical examiner in our state pharmacy system and looked at every single person who died of a medication.
00:44:46.480 --> 00:44:55.360
I considered all of those, you know, potential deaths in in my hands, in my mind, I mean my profession, and really learned from that.
00:44:55.519 --> 00:45:02.239
I called those the death diaries because they were like I told a story of someone who died from prescriptions right before they died.
00:45:02.400 --> 00:45:04.960
And I applied that to my living patients when I saw them.
00:45:05.119 --> 00:45:10.559
It's like, oh my God, your medication record looks like someone I just saw from the morgue.
00:45:11.360 --> 00:45:15.599
And from that I learned to always listen to the parents.
00:45:15.840 --> 00:45:17.840
They've been my moral compass.
00:45:18.320 --> 00:45:24.000
We wrote guidelines in San Diego five years before the CDC ever wrote pain opioid guidelines.
00:45:24.079 --> 00:45:26.880
And it's because of my experience with those parent patients.
00:45:27.440 --> 00:45:32.400
And then I met the patients, um, the parents whose children died of fentanyl.
00:45:32.719 --> 00:45:34.320
You know, that was COVID.
00:45:34.559 --> 00:45:38.639
We were all about COVID, COVID, COVID, and I was fentanyl, fentanyl, fentanyl.
00:45:38.800 --> 00:45:40.079
Um, listening to the parents.
00:45:40.159 --> 00:45:47.039
And now there's a group of parents, they've children have passed away and died because of marijuana, and they're they're growing in their grief.
00:45:47.119 --> 00:45:58.400
And and so, you know, listening to those parents, they're ahead of the curve of what government is seeing, what data is is telling us.
00:45:58.559 --> 00:46:00.719
And they've they've been my moral compass.
00:46:00.800 --> 00:46:17.679
And to this day, in our office, if you if you look at my office and look at our TV screens outside, we have faces and pictures of of people who died from overdoses that remind me and the whole staff here at ONDCP of why we're here and and why we're doing what we're doing.
00:46:18.239 --> 00:46:27.199
Yeah, so I I feel a little bit the same that it it is the the pictures of loss that stay stick with me first.
00:46:27.440 --> 00:46:50.880
And so one of the things I often think about is how, you know, I told you how substance use among teenagers has changed and there's this growing number of substance-free teenagers um that the adults sometimes are like, oh, well, but I use when I was in high school and I was fine, and they kind of they want to normalize and kind of fondly remember their antics as teenagers.
00:46:51.119 --> 00:46:54.559
And I look at them and I'm like, I'm really glad you're okay.
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I'm thrilled that you're okay.
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But was everybody okay?
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If you think about your high school class, your college class, that young adulthood, was everybody all right?
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And and the answer is of course, no.
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Everybody knows someone at this point.
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Everybody, all of us have been touched by tragedies from substance use, a whole range of things.
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It could be an MVA or it could be a fentanyl overdose or it could be a mental health crisis.
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So it's those stories, those faces in my own life that often are are kind of my my why, my motivation to kind of stay in this and and keep fighting because I want not other people to not have to go through that.
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But one of the things that's interesting is that that motivates me as a physician and as a prevention person, but it actually isn't very motivating for young people.
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They don't actually see risk the same way.
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And so that now what I find extremely motivating because I see how much it motivates them is the stories of young people who have made that choice not to use.
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And so we can put the microphone in the hands of the young people who have have made the choice through high school, through college, not to use, and for them to explain their reasons why, very deeply personal reasons why they've made those that active choice not to use.
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That turns out to be extremely motivating to young people.
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And so when I think about stories now, I'm more likely to think about those young people and be like, oh yeah, those are my heroes.
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And I want to make sure that I keep getting them in front of those young audiences.
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I will say, when I was in college, some of my favorite people were the folks who didn't use, like they didn't go out drinking, partying.
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They found so many other fun ways to fill their cup, so to speak.
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So I really love that sentiment and it's a really positive way to sort of wrap up this conversation.
00:48:51.440 --> 00:49:09.280
Doctors Lev DuPont, this conversation has been so enlightening and so, so important for getting to understand where we are in this substance use landscape and how we can promote better prevention and policy and humanity, as you both really showed in this space.
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So I wanted to thank you both for the work you do and for sharing it with us today.
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Thank you so much.
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Thank you.
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And Carolyn, thank you.
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Because I always, every time we get together, and it doesn't matter where, whether it's for lunch or on a podcast, I always learn something.
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And Melissa, this has been a great experience.
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Thank you.
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Thank you so much for the work you're doing.
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Across this conversation, I'm reminded that prevention is powerful.
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It's about possibility, it's about protecting a young brain long enough for someone to become who they're meant to be.
00:49:42.719 --> 00:49:43.039
Dr.
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Lev keeps the faces of those we've lost to overdose on the screens in her office so no one on her team forgets why the work matters.
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And Dr.
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Deepont reminds us that the most powerful voices in prevention might not be from doctors or officials after all.
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They are the voices of the young people who quietly chose not to use.
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And who are, in her words, the real heroes of the story.
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My deepest thanks to these amazing women for their time, candor, and compassion they bring to this work every single day.
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Read the National Drug Control Policy and check out the Institute for Behavior in Health and One Choice Prevention in the show notes.
00:50:19.679 --> 00:50:23.440
If you enjoyed today's episode, share it with someone who needs to hear it.
00:50:23.679 --> 00:50:30.800
And if you're on a journey with substance use, know that recovery is real and it's happening all around us.
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Thank you for joining me on Empathy Effect, and I hope you'll tag along next month.
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Thanks, y'all.
00:50:38.559 --> 00:50:41.199
Empathy Effect is a product of Forest Marsh.
00:50:41.440 --> 00:50:48.159
You can reach us at Forrest Marsh Media at Forzmarsh.com with any feedback, questions, or inquiries.
00:50:48.400 --> 00:50:58.000
If you want to know more about today's guests, are interested in participating with Forest Marsh, or becoming part of our community, check out our show notes for more information.
