Good Life Project - Nzinga A. Harrison, MD | Power, Recovery & Equity

Episode Date: August 3, 2020

As a physician with specialties in addiction medicine and psychiatry who has spent her career focusing on stigma reduction and health equity, Nzinga Harrison is uniquely positioned to help people navigate the stress of current events including from opioid crisis and COVID to racial violence and systemic injustice and move from thinking to action with the goal of improving health and society. Dr. Harrison is the Chief Medical Officer and Co-Founder of Eleanor Health, an innovative company who provides comprehensive outpatient care for individuals experiencing opioid and other substance use disorders. She also holds adjunct faculty appointments at the Morehouse School of Medicine Department of Psychiatry, is Co-Founder of Physicians for Criminal Justice Reform, Inc. and Campaign Psychiatrist for Let’s Get Mentally Fit, a public education and stigma-reduction campaign. As host of the In Recovery weekly podcast by Lemonada Media, she engages a large audience on all things addiction including drug addiction, but also other addictions, for example food, sex, gambling.You can find Dr. Harrison at:Website : https://www.eleanorhealth.com/In Recovery Podcast : https://www.lemonadamedia.com/show/in-recovery/-------------Have you discovered your Sparketype yet? Take the Sparketype Assessment™ now. IT’S FREE (https://sparketype.com/) and takes about 7-minutes to complete. At a minimum, it’ll open your eyes in a big way. It also just might change your life.If you enjoyed the show, please share it with a friend. Thank you to our super cool brand partners. If you like the show, please support them - they help make the podcast possible. Hosted on Acast. See acast.com/privacy for more information.

My guest today, Dr. Nzinga Harrison, was raised by parents who really instilled this profound sense of confidence, dignity, and service. And now as an adult, a physician with specialties in addiction medicine and psychiatry who has spent her career focusing on stigma reduction and health equity. And Zynga is really, she's uniquely positioned to help people navigate the stress of current events, including everything from the opioid crisis to COVID to racial violence and systemic injustice, and move from thinking to action with the goal of improving health and society. Dr. Harrison is the chief medical officer and co-founder of Eleanor Health, a really innovative company who provides comprehensive outpatient care for individuals

experiencing opioid and other substance use disorders. She also holds adjunct faculty appointments at the Morehouse School of Medicine Department of Psychiatry. She's the co-founder of Physicians for Criminal Justice Reform, Inc., and campaign psychiatrist for Let's Get Mentally Fit, a public education and stigma reduction campaign. And as the host of the In Recovery weekly podcast by Lemonada Media, she engages in all things addiction, as well as really the broader major psychological and social issues of the day. She even draws this really fascinating

parallel between racism and addiction, which I found incredibly eye-opening. I learned so much from this conversation that goes way beyond a core conversation about addiction and really talks about the state of society, her fascinating journey, what it was like really growing up and being raised by parents who championed not staying silent and having a voice and how that inspired her to go out into the world and do incredible things. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. We'll be right back. Don't shoot him, we need him. Y'all need a pilot? Flight Risk. The Apple Watch Series X is here. It has the biggest display ever.

It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you eight hours of charge in just 15 minutes. The Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required,

charge time and actual results will vary. Just really interested in you and in the work you're doing and in what inspired it. And also, there is a rumor floating around the internet that you were the student who actually loved organic chemistry in high school. It was my favorite course. But I need to know where is this rumor on the internet. I cannot reveal my sources. My deepest secrets are revealed. I just remember there was one person in high school who loved organic chem.

And I'm like, I found the person. That is incredible. And quite possibly everything that your listeners need to know about me. That's great and as equally as organic chemistry was my deep passionate love physics was my nemesis like really oh yeah and it totally makes sense i'm actually super clumsy which i think i can interpret as being like not just naturally visual, spatially gifted, which is physics. Our brains do a lot of physics just automatically. Yeah.

And so I think my brain like doesn't automatically do physics well either. It definitely doesn't do physics well in a classroom. What can you do? We're all suited for different things. Okay. So now we know you loved organic chem. You did not like physics and you were a cheerleader. Yes. You're good at this. You see, you thought you weren't following in your father's footsteps. I could tell by that soothing voice of yours when we first connected that indeed you were there we go um

yeah i mean that that's interesting that uh the physics thing is actually kind of interesting right because it's sort of you know like one is the study of the of you know like organic chemistry study of sort of like the deep molecular stuff that's happening in your body and the the chemical stuff that's happening inside and physics is all about the physical plane and then which is a little bit of foreshadowing, right? To a certain extent for you. So 100% foreshadowing. And I hadn't thought of it like that until you just said it. So that was some good insight oriented work. But I intended to be a surgeon. Oh, no kidding. Yeah. So I decided pretty young, I was six years old. I decided to be a doctor and a teacher.

So my mom was a teacher. We didn't have any doctors in the family, but I was enamored by the human body anatomy physiology. Kind of at a young age, I had a doctor, a pediatrician. It's the only kind of doctor that I knew by six years old. So I said, I'll be a pediatrician. And then, but I didn't think my pediatrician was great. I was like, I don't feel like he's a great doctor. I was only six. So what do I know? But then in seventh grade, I got an orthopedic surgeon for scoliosis. Luckily, I didn't have to get surgery. But this surgeon was amazing. I was like, that is the kind of doctor I want to be. And I realized it was because he talked to me and it seemed like what I had to say was important to him. And he explained

like his medical decision-making to me, a 12 year old, like to make sure I understand it, understood it. And that's what my pediatrician had not done. Like I was invisible in that room. He talked to my mom. I feel like he never addressed me directly. He certainly didn't explain anything to me. And I was like, now I get it. That is the kind of doctor I want to be. One that like sees the human being that walks in the door. And that human being is important to them besides the list of questions on their paper. And so I

decided to be a pediatric surgeon. This is a long roundabout story for how physics and organic chemistry was definitely foreshadowing because, you know, in medical school, you have to do everything. And I was a pretty vocal opponent of psychiatry. I was like, that's not real medicine. I'm just talking to people. And I loved every rotation. But like surgery, it was evident to me like, oh, you are not visually, spatially gifted. And I could have been, I would have done just fine as a surgeon. Like, let it be clear. I would have done just fine. I would not have excelled. I would have been, I was a medical student, taught me the biology and the neurobiology and the neurophysiology and the neuroanatomy and how that intersected

with psychology and how that intersected with what was going on in people's lives and stress and how all of our experiences like turn into chemicals and electricals in the brain. And I was like, all of this time, it was like the organic chemistry of medicine. All of this time, I was like, so psychiatry is whack. And it was actually perfect for me. Oh, that's so interesting. So it was somebody who was able to effectively translate the science of the mind into the science of chemistry and electricity that made your brain say, oh, this is actually that even though it took being able to quantify it in a real way, like the expertise that I've developed that I feel like comes naturally to me

now is like the not quantifiable part, right? Like I tell people all the time as a psychiatrist, the concept is that as a psychiatrist, you talk, talk, talk, talk, talk. But in reality, you listen, listen, listen, listen. I'm listening as much for the things that people are not saying as I'm listening for the things that people are saying. And that actually brings a foreshadowing way back before organic chem. It was when you were six. I mean, because if you're thinking in your mind at six years old, a good doctor is the doctor who actually relates to me as a person, right? That's so interesting.

I didn't know that at six, right? I just knew at six. But something sensed it. I sensed it. I sensed like, this is not a good doctor-patient relationship. I didn't have the words or the concept to pull that together, but I just felt it. And because of that, I didn't trust him, right? And luckily I was healthy as a kid, but I just remember thinking, I don't want to do what this guy says. He doesn't even know what I think about this.

He doesn't even really know what's going on with me, right? Like, I remember having those kind of thoughts at six. And so I think that really turned into the kind of doctor that equally, if not more than I value my medical expertise. Like I recognize to make magic, we need my medical expertise. I also recognize there is no magic without that other person sharing themselves and their experiences with me. It's also making me curious if at six years old, you walk into a doctor's office and you have an expectation of being treated in a particular way and given respect and having

a voice and a point of view, what's happening in your upbringing that instills that in you? 100%. And so I know exactly what's happening. My father was an electrical engineer. He was a teacher and my mom was a teacher, but my dad, that was his day job. My dad's real life passion was and still is activism. And so he was the commander of the local Black Panther militia in Indianapolis, Indiana. In the 70s and early 80s. And so at home, what we were being taught. So your listeners may have heard of the Black American holiday Kwanzaa, and it has seven principles. And the second day is Kujichagulia, which is self-determination. To name yourself, define yourself, speak for yourself instead of being named, defined and spoken for by others. I feel like Kuji Chaglia was put in me from the day I was born.

Like you define yourself. Your voice matters. Speak up. Even as a toddler, like it is your responsibility to raise your voice. Speak up. It is your responsibility to be seen. And it's your responsibility to be heard. It's your responsibility to make a difference.

This is the activism that I was being raised in. And so I think that probably is the connection. That's amazing. But also, I mean, it goes beyond that. It's not just your responsibility to have a voice. It sounds like there was also an expectation that you will be seen and heard, which is a whole, I mean, which is, I feel like that's unusual. I do feel like that probably is unusual just in the way that we raise kids. Like the old adage that kids should be seen, not heard is like for a reason. And so I think that is different. And I would say special about the way we were all raised. The other thing is like being named Nzinga in Indiana in the 70s and 80s. And it was drilled into us. So I was Nzinga. My older brother was Modibo. My younger sister was Okosua. And our parents drilled into us like, and our last name is Ajabu. So I'm Harrison now because I'm married, but I grew up in Zinga, Ajabu. And it was like, you don't let anyone

mispronounce your name. Like ever period. You are four years old. And if somebody mispronounces your name, then you are to politely correct them and let them know how your name is pronounced because you are to be heard, you are to be seen, you are to define yourself, like from the very beginning. What a powerful foundation to start with. And then to see your dad out there in the world forcefully modeling the behavior rather than just saying,, you know, like these are the rules by which like we're supposed to live, but actually being a living example of that, modeling it too, so that you have the coherence to say, oh, this is real. This isn't just words. And this is actually the way to be in the world. Absolutely. And not just modeling it. I mean, I can remember very young, probably maybe like four or five years old being on picket lines, protesting injustice. What were your, I'm curious, what were, what, what are the memories

that come to you when you think of that? So we had, I, and I can't even like, I would say no justice, no peace, but I feel like probably that's more of an adult memory. But I just remember like being really little and having a sign that was like bigger than me and a big crowd of people. And there was a picket line and I don't know what the picket line was for, but what we were doing was keeping people from crossing the picket line. And so I don't even know what they were picketing, but I just remember very early on and my dad being like, you do not disrespect anybody's cause by crossing their picket line. And so that's what I remember we were doing, not necessarily picketing,

but keeping people from crossing the line for those people that were raising their voices. I have no idea what the issue was. Yeah. So fascinating how all these things play into the choices that you made when you sort of, you end up going to school. You end up in Howard for undergrad, Penn for med school, right?

Yep. And then heading out into the world. So you end up having this experience where all of a sudden psychiatry becomes real to you. It also ties into, okay, it's the science of the mind. It's the hard science that I love. And reaching all the way back, it's the ethics, you know, that brings it all into this one thing. So it all makes so much sense when you think about it. Yeah, exactly.

And I always say psychiatry is the redheaded stepchild of medicine. And addiction medicine is the redheaded stepchild of the redheaded stepchild. Right? Psychology, life, relationships, activism, marginalized, denigrated, undervalued people. I was like, activism, doctoring, teaching. Literally, there is no dress that fits better than this dress. So when you end up choosing to go down that path, I mean, especially addiction, right? Because from what I have a handful of friends and a handful of colleagues over the years that have chosen in some way, shape or form to dip into that world and a service level. And very often

it's because there's a fascination with it, but also there's either personal experience or family experience or community experience with it also. I'm curious whether any of those were part of what drew you to that specialization too. Yeah, definitely. So I would not say a fascination until I started having clinical experiences with addiction. So as a medical student, my second psychiatry rotation, once I decided, oh, I might want to be a psychiatrist, let me do an elective. My second elective was with liver transplant psychiatrists. And we did research and we did pre-liver psychiatry evaluations and post-liver ongoing psychiatric care. And it was just so many of those folks that

needed livers was because of alcohol use disorder or hepatitis C from IV drug use. I saw the way they got treated in the hospital and it just like set me on fire. Like people should not get treated this way for having an illness at their most vulnerable time when they are like literally at the sickest about to die unless they get this liver. Like I cannot believe that doctors and hospital systems are treating these people the way they are treating these people. And so that was kind of when I became passionate and got set on fire for addiction care. But to your point, tons of addiction runs in my family, as do other mental health disorders. And so I grew up with aunts, uncles, cousins with mental health disorders,

addictions. And our family dynamic is that that's our family, like period, right? And so I don't think anybody in my family probably even necessarily conceptualized the addiction for sure, probably not even the other mental health disorders as illnesses, but it was just like, this is our family relationship, period. Like people don't get kicked out of our family. We are a pack and we take care of our people. And so I think that laid down in me very early also. And then it is just, I mean, psychiatrically, you can look back and say it was destined to be that I would be an addiction psychiatrist, practicing like these are my people. This is my pack. I stand up for my people.

I do not kick my people out. I care about my people. Like all of that is my upbringing. Yeah. So again, there's the activist side of you, right? That's the advocacy side saying, okay, so it's not just a steep fascination. It's also this affects me in a personal way, and I'm standing up for those who I love most in my family. I mean, you also came out of med school at a really interesting time.

So you're out in 2002. That's right after 9-11 in the U.S. Isn't that also kind of right around the time when psychiatry is also going through a massive shift into psychopharmacology? So it's sort of like it's moving out of this much more therapeutic modality. And a lot of it, like everyone's starting to turn to, okay, so the role of psychiatry is largely, let me do one or two sessions so I can diagnose what the right cocktail is for a particular person.

And then I'll turn them over to a psychologist to handle the talk therapy. So you're coming out of school just after this mass, mass disruption in society from 9-11. And then this real shifting in the dynamic of what the field is. I'm curious what it was like for you to step into that? Yeah. So my overarching answer to that is that the pendulum was swung too far away from biology. And then that revolution swung the pendulum too far to biology, right? So initially, my concept of psychiatry when I was growing up was Freud, lay on my couch, talk to me, which is why I couldn't see the science in it, right? Because it was just talk, talk, talk. And that really underappreciated the biology that underlies our thinking, our feeling, our impulse control,

our decisions that we make. And so as more knowledge started to build around the biology and the neurobiology and the neurochemistry of thinking and feeling and behaving, then the classic human thing happened, which is like create a pill to cure it. And what's interesting is like at the same time, psychiatry was going on this biological revolution, like there's a pill for that, which no, there's not. There's a pill for some of that. But as psychiatry was going on this biological revolution, the rest of medicine, which had been, there's a pill for that, was starting to recognize, oh, there have to be other, like there has to be psychological support for diabetes. There has to be lifestyle changes for diabetes. There have to be political changes to support people with physical illnesses, right?

That's, they were coming more towards the middle on the physical health side. And psychiatry was coming more towards the middle, but then just swung all the way to biological. And so that framework never fit me as a psychiatrist. And I feel like psychiatrists got marginalized. One of the most offensive things that I hear all day, every day is when I, one, I say I'm a psychiatrist and people don't know that's a physician. So I usually say I'm a physician, my specialties are psychiatry. And they say, oh, so you can write prescriptions, right? And I'm like, the practice of psychiatry is so much more. The practice of medicine is so much more than writing prescriptions or the new language in health specialty, than it does on a prescription that you can't just narrow it to prescribing. rotating in the emergency room in Philadelphia. I was in a patient's room and we watched the plane, the second plane hit the building. We watched it together with this person that was

in the ER for some reason that I can't remember. And it was like, what is happening? Sorry, we watched the first plane. And then I went back to the break room and medical students, residents, attending physicians, we were all in there. And we saw the second plane. And that was when the realization came that this was not an accident. And so it was a crazy time to be in psychiatry because the entire country was in panic. And somehow, though, by the time I finished in 2002, which was a year later, that panic had come down. Like I feel like people maybe thought we were getting our arms around it. I moved down to Atlanta. And despite so many people having been traumatized by that, there was still this

idea that just like prescribe an SSRI, like prescribe an antidepressant, just prescribe an antidepressant. And I was like, I will never practice medicine like that. And so even now, so I co-founded this company, I'm chief medical officer, it's called Eleanor Health. We take care of people with addictions. But even before I was at Eleanor Health, I was chief medical officer of a different company. And so part of that is recruiting your medical team and establishing the culture of your medical team. And the first question when I would be recruiting new psychiatrists, new psychiatric nurse practitioners was, how much time do I get to spend with a patient for the first visit? Because there's so, the entire system has just been like, you get 30 minutes for that first visit and you get 10 minutes for each

follow-up visit. And I was like, I will never, I will not do it. I will not do it. And so I've crafted, I guess it goes back to my childhood, what we were talking about. Like, I just don't accept that and just craft my own way. So I'm like, one, you can't figure it out in one visit. That's what I tell all of my patients. There's no way we can figure this out in one visit. I always believe that we should try for every health condition that's mild or moderate, non-medication options. For any health condition that is moderately severe to severe, we should be doing everything at once, medications plus non-medications. That will always include your support system. But more importantly, our relationship has to be that you can come back to me because we can't figure it all out today, period.

Yeah. So you really, it sounds like almost from the very beginning, you realize that you're going to have to, to a certain extent, either work outside the system or create your own system, which it sounds like is exactly what you did. That's exactly right. Cause I am a scholar, like that's code word for big old nerdo and proud of it. Right. And so I am always imagined that my career in medicine would be at an academic institution, but I very quickly learned through medical school and through residency training, both of which were amazing. I am not disparaging Penn Med. I am not disparaging Emory. They were amazing experiences. But I very quickly realized that I could not stay in academic medicine because it would be too constraining to have to perform within the system instead of being able to push the edge

of the system instead of being able to push the edge of the system towards better functioning. Yeah. Even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you 8 hours of charge in just 15 minutes. The Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required. Charge time and actual results will vary. Mayday, mayday. We've been compromised.

The pilot's a hitman. I knew you were gonna be fun on january 24th tell me how to fly this thing mark walberg you know what's the difference between me and you're gonna die don't shoot if we need them y'all need a pilot flight risk let's talk a bit about addiction because this has been your devotion for pretty much your entire professional life so far. And I'm kind of fascinated because I feel like there's so much confusion. I'm raising my hand in terms of the confusion around it. wide array of behaviors that range or domains of life that range from substances to sex, to technology, to relationships. So when, I guess maybe what I'm curious about is when, when we talk about addiction, what are we really talking about?

No, it's a great question. And so I think it's important here to make the distinction between when we use a term clinically and when we use a term kind of just like in general, we're talking about a concept or we're using it. So for example, in regular conversation, we'll say, oh, I'm so depressed. And we're really just talking about a feeling in that moment that is a feeling of depression. But in psychiatry, one, it wouldn't even be appropriate for me to say that person has depression because depression is not a diagnosis. Like there's a bucket that is depression and a lot of things fall under it. And so under that, there are clinical diagnoses that may be like a major depressive episode or a bipolar disorder currently depressed or a dysthymic disorder or a depression secondary

to another medical condition. And so, but we just use this broad term, which is depression to represent low mood, even though the input to that may be very different. And we talk about that specifically in medicine. The same is true for addiction. So my podcast is In Recovery. And on that podcast, the thesis that we use for addiction is this big bucket type of thesis, which is anything we keep doing, although the negative consequences outweigh the benefits.

That's the thesis of addiction on the show. And so we talk about drugs, of course, alcohol, cigarettes, other drugs, sex, gambling, food, technology, relationships. Like you really can nest anything under continuing to do that despite negative consequences. And so part of my strategy on the show, although when we talk about addiction clinically or from the perspective of medicine, then I always make sure on the show, I will say today we're talking about work addiction, which we recently did. Today, we're talking about work addiction. This is not a clinical diagnosis. This is the concept of when we continue working, even when it's bringing us negative consequences. And the reason I use that as a thesis, because so

much of what we've done with addiction in this country is to stigmatize it by making it those people who are addicted to things and the rest of us who are not. And the rest of us who are not are somehow innately better at being human beings than those people who are addicted to something. And so when I take this very broad view of addiction, I know for sure there is something you are doing that's causing you negative consequences. I know for something, there are things that I'm doing that are causing me negative consequences. Maybe it's not drugs, but we're still doing it. And brain chemistry is driving that. And so then I developed that empathy because, oh yeah, I can relate to trying to change a behavior and changing it and relapsing and changing it and relapsing and changing it and relapsing. I can relate to that. So then if I take

a person who has the illness of drug addiction, a clinical diagnosis of a substance use disorder, and I add in the additional neurochemical pressure that comes from that medical diagnosis, then I can understand if it's this hard for me to put my cell phone down and it's not even altering my brain chemistry the way cocaine is altering my brain chemistry. Now I can have more empathy for how difficult it must be to have a cocaine addiction. You made a really interesting linguistic distinction too, which I'm curious about. When you're talking about both depression and addiction, which was that you didn't say, I am depressed or I am an addict.

What you said was, I have depression or I have the illness of addiction, which seems like it's very intentional, your way of doing it. It almost seems like you're trying to strip it away from an identity level experience to something which maybe is more behavioral or in some way malleable. I mean, I'm curious about that. You put your finger exactly on it. So I am militant in a lot of ways. And one of the ways I'm like out loud militant is like, as every opportunity I get,

I say, I am language militant. And I put that identity out there because I'm always trying to not send connotations with my words that I don't mean. And also because it is an open invitation to every person I'm talking to to call me out when I unintentionally do that because I'm human. And so, yes, I always say, would we say that person is cancerous because they have cancer? No, because cancer is not the identity of that person. That person has the illness, which is cancer. And so I started this kind of language militants for myself very, very, very early on because I used to hear the disdain that people had in their tone when they said that person is schizophrenic. And it was an accusation and it

was denigrating. And it basically, the message that was being sent was there's nothing you can do for that person. So don't waste your time trying because they're schizophrenic. And I refused, I refused to send that message from my own words. And so I started saying that person has schizophrenia. And then I said, same thing with diabetic. That person is not diabetic. That's not their identity. They're a person with diabetes.

And I was like, you're not an addict. That's not your identity. You're a person with addiction. And so I just always try to lead with the human to remind ourselves, this is a human. And that illness is separate from that human. I think the other part of that that is so important is like cancer is an awful disease. We hate it. It ravishes our loved ones. It steals people from us.

It ruins lives. We hate it. But we don't hate the people who have cancer. And I think where we've gone wrong with addiction, although I can say all the exact same things, it is awful. We hate it. It steals our loved ones. It ravishes people. It destroys families. But the mistake we've made is that we hate the people who

have the illness instead of hating the illness. And so I intentionally try to separate those two so that the work that I'm doing with the support system and even the person with the addiction, because they hate themselves because they think the addiction is who they are. And it's like, no, we have to create that space. We hate the addiction. We don't hate you. I think such an important distinction to make because it brings, it inserts hope into the conversation, right? Because if it's an identity level thing, then we're effectively saying there's no hope of ever experiencing life differently.

But if we say, you know, like, no, you're a person who has this thing, then maybe we can't guarantee that you're ever going to be rid of it. But at least maybe we open the door to hope that there may be something that we can live differently in some way, shape or form, you know, with different things. And I feel like that's part of where the stigma comes from to a certain extent also, right,

is that there's this public perception, and I'm so curious about your lens on this, that so many approaches to addiction just don't really do anything. They don't work, which makes it easier, again, to go down that road of, well, this is just the person,, and it's, that's the person for life. Whereas, and it sounds like you've actually sort of what you're doing, your approach to it is, is designed to really a change the way that people are actually treated, but also again, reverse that whole set of assumptions that start this negative spiral. Yeah, that's exactly right. So it unfortunately is true. A lot of the things that we traditionally do for addiction are not effective.

They do not work. But that is not an indictment on the people who have addiction. That's not even an indictment on the illness of addiction itself. That's an indictment on the systems that we have built that are not evidence-based that we then wonder why they don't work. And so I talk about this from a couple of different ways. One, the research studies studies show us one of these is my favorite that compares asthma, type two diabetes, and type one or essential hypertension, which is just like the general high blood pressure that people know about. And it had people that came into the hospital for treatment for addiction or diabetes or hypertension or asthma. And it said at one year, because all four of those are chronic medical illnesses,

at one year, what percentage of those people had had a relapse in their illness? And it was the same across all four. The other thing it said was, what percentage of people were following the medication recommendations and the lifestyle recommendations one year later. So the relapse rate for all four of those illnesses was right at 60% at one year. And so relapse for high blood pressure meant your blood pressure was controlled and then the symptoms came back. That's how we define relapse in medicine. Asthma, your

symptoms were controlled and your asthma attacks came back. Diabetes, your blood sugar was controlled and then your blood sugar went up. Addiction, you were not using and then you started using. That's how relapse was defined. 60% across the board, all of them. The percent following medication recommendations? 40%. 30% across all of them. Across all of them. Right? The percent, oh, I'm sorry. Sorry. Sorry. The percent following medication recommendations was 50 to 60 percent. The percent following lifestyle recommendations was 30 percent across the board. It was equal for all of them. But if I ask the crowd of 100 people right now, does treatment for asthma work? They would say yes. Does treatment for diabetes work? They would say yes. Does treatment for high blood pressure work? They would say yes.

Does treatment for addiction work? Even though it's performing exactly the same way as other chronic medical conditions perform. And so part of that is just our stigma, our beliefs that treatment doesn't work or that somehow addiction is different from other chronic medical illnesses. The other part of that is because part of the reason we believe treatment for asthma works is because when you have an asthma attack so bad that you have to go to the ER and get hospitalized, they don't send you out with no inhaler and say, good luck keeping your asthma in control. They send you out with a daily inhaler and as needed inhaler. They give you resources to stop smoking.

They talk to you about exercising. They link you with the primary care doctor who makes sure you check in every one to two months, even if you're not having symptoms. Diabetes. If you go in, your blood sugar is so high, you have to go to the ER and get admitted to the hospital. They don't send you out without insulin and give you a donut and say good luck. They give you insulin. They give you an oral medication. They give you nutrition education while you're in the hospital.

They link you with the nutritionist. They link you with a primary care doctor. You have ongoing care forever for your diabetes. Addiction. You go in, you get detoxed, which is the equivalent of needing an ER in hospital for substance use disorder. You finish your five-day detox. Even though we have FDA approved medications, you get sent out with no medication. You don't get connected to ongoing care. You get connected to a 30 day rehab for a lifetime chronic medical condition. And so of course, addiction outcomes look terrible. It's not because treatment doesn't work. It's because we haven't held the industry to the standard of

care that we know can work for addictions. I mean, I would have to imagine also that you send people back out into the world and there's also got to be a huge social construct to all of this, to what both on the one side leads to addiction, and then also what leads somebody to then engage in all the things that would allow for effective treatment. So it's not just happening in a vacuum. And I mean, I guess we see this across a population of like all the people that are living with addiction

and the prevalence is across all different groups. And so it's got, you you're not in your head. I'm like, there's got to be a much bigger part of this conversation, too. Yeah, it's a huge part. And so I always say humans are pack animals. And what happens when an animal gets kicked out of the pack? It slinks off and it dies, right? Like it literally withers and dies. And so, especially

an animal that is already hurt or injured, they're definitely slinking off to die. And so our people with addiction are hurt and injured and suffering. And what do we do? We kick them out of the pack and we kick them out of the pack. And when they're at their most vulnerable and their most hurting, we present them with a disjointed judgmental medical health system and say, good luck navigating your way around to trying to get better. Like, can you imagine, I always say, think about if we treated people with cancer the way we treat people with addiction. A hard intervention to make you go away to some program where none of your support system is. We don't let you talk to anybody for the first 10 days. And then we barrage you with all of the negative parts of your character and the terrible decisions you made that led you to having cancer.

And then we ask you, are you really ready for treatment? Like we wouldn't stand for it. We would not stand for it. What we do instead is, oh my God, you have cancer. We will bend over backwards and do absolutely everything we can do to try to help you beat this. And if we could take that same stance as a society for addiction, we would have much better outcomes. We would have a lot more people alive. We would have a lot more people whose illness could get in remission. I mean, I would imagine also that socioeconomically, depending, you look at who can invest, you know, who is society going to support in the efforts versus who's got a bank account that allows them access to a certain level of treatment. And that's got to be changing things also in a really big way. If you're at a point in life when you're ready to lead with purpose, we can get you there.

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charge time and actual results will vary. Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were going to be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg.

You know what the difference between me and you is? You're going to die. Don't shoot him, we need him. Y'all need a pilot? Flight risk. I mean, I'm curious also, you know, we're having this conversation in the middle of an interesting time in this country, right? You know, we've got a global pandemic. We've got police violence and killings and protests and massive uncertainty, along with at the same time some really amazing hope that I think hasn't been there in a long, long time also, but also like a feeling of just utter groundlessness and fear. And I have to imagine that if you already have a propensity or a history, that this is not the best environment for you. No, you're exactly right. And even

I will take that up a level. If you already have a history, this is not the best environment is exactly right. But even if you take people who didn't necessarily meet diagnostic criteria for a substance use disorder or a substance addiction, but they had high levels of stress, maybe lower levels of coping, maybe lower levels of social support. And then, like you said, COVID came and created an environment of complete and utter uncertainty, which our brains interpret as danger. It took away a lot of the access we had to the healthy coping behaviors that we engage in. So it put us in a dangerous emotional place, took away our healthy coping, severed our in-person support system. Even people who were not risky using alcohol or cigarettes or other drugs, or were prescribed a pain pill that they

only took every now and then, or prescribed an anxiety benzodiazepine medication that they only took every now and then, all of those folks are also at risk right now too, because of this chasm of just perpetual uncertainty. We don't even know when we will get our routines back. All of the negative emotion and devastation from the police violence, the hope helps to mitigate those, but it's still exhausting. And so it really is the perfect storm of risk, especially for people who already had a substance use disorder. So if I had to put the risk groups in order, let's say the highest risk are people with active drug use disorders. We know alcohol sales are up 55%. Yeah. We know the survey show

that three out of five people who are working at home are drinking on the job. I told you that I'm co-founder and chief medical officer of Eleanor Health. What has risen to the number one search term that is bringing people to our website is do I have a problem? Am I drinking too much? That is since COVID. So we know those folks with active drug use disorders are at highest risk, but below that are people with high stress, that's all of us, lower coping skills, who were already drinking, already smoking, already using a medication that puts them at risk.

But then, you know, 40% of your risk of developing addiction is coded in your DNA, born with it. And so even people who may be teetotaling, right, like 100%, never in my life am I ever going to try it because I've seen what it can do. The amount of stress that we're under right now for a person with a family history of addiction is increasing their risk right now. Yeah, I would imagine. People have different ways of dealing with it. And it is fascinating the way that the genetic element plays into it, where it's almost like there's a threshold, right? It's like histamine in your body. You can have all sorts of different things that add to it, but you're like, oh, I'm not allergic, I'm not allergic,

but this one little thing gets added to your system and it puts you over the threshold, and then all of a sudden you're busting out in an allergic response, and then you maybe even credit to that last thing, not realizing it was the nine other things that had been just piling into your system the whole time. You have a really interesting lens also. You did a podcast.

One of your recent conversations was a really interesting lens on addiction and racism, which can we talk about that? Because I thought it was really fascinating. Tell me, walk me through this a little bit, because I think it'd be really interesting for our listeners. So this is the same thing kind of that we talked about earlier, the concept of addiction as something we keep doing despite the negative consequences. But the other thing that I always say on the podcast in recovery is that as human beings, we don't continue to do things that have zero benefit. So even at the height of an addiction where the negative consequences are so palpable and so evident,

there is some benefit that is driving that behavior. And so what I did on the recent episode was conceptualize racism as America's addiction. And so what I said there was, because I'm super particular about my language, and I almost said this when you mentioned it earlier, is that I try not to call people racist. I try to say people have done something racist or are having racist behaviors. Like I try to say not that person is racist the same way I try to say not that person is an addict, quote unquote, or that person is a diabetic because I want to divorce racism from that person's identity. Because if that person is racist, like you said, there goes the hope. There goes being

able to change the way that person is thinking and feeling, behaving. And we know that humans are malleable and resilient. So there's almost always an opportunity for change. And so what I did on that show was say, can we agree that we continue to treat black and brown people differently in this country based on systemic racism and that there are negative consequences attached to that? Like, even though there are negative consequences, these behaviors persist. The ultimate negative consequence being killed. But other negative consequences being the school to prison pipeline. Disproportionate poverty.

Disproportionate lack of home ownership. Disproportionate mass incarceration. Right? Like I can go through every major system in this country and you can see the disparate racial treatment. So I think we can agree, negative consequences, and yet the behaviors persist. But the provocative question is, and so who is benefiting? Because we don't continue to do things when there's no benefit. And I think what has been painful for a lot of my white friends over the last three or four weeks, as we've been going through the protests in response to George Floyd's killing by the police, is really being able to see that they have been benefiting.

And so the conversation that I tried to have was like, one, the brain works in categories, like just period. So I don't want us to hold ourselves to never having a negative, never having a racist thought. Like that's impossible. All of us, Black people included, raised in the United States of America, we have been programmed from the time we came out of the womb with media images and it is everywhere. There's no way your brain didn't pick it up. But being anti-racist is being able to recognize when those thoughts come or when those feelings come or when we do something that is just maybe isn't racist or it's straight up like that was racist. And just

being able to have that conversation and say, I saw that in you. I saw that in me. We don't accept that. Like we don't accept being racist. We accept learning. We accept doing better. We accept changing. We accept finding what the benefits are and getting those benefits from something else that doesn't come with the negative consequences of racism. And so that was the discussion that we were having on the show. It's like, if we conceptualize it like an addiction, what power does that give us to change it? Yeah. I mean, it's really interesting, right? Because if we do accept that as sort of like, okay, so this is a model which actually sort of like can overlay,

then if we also then look at sort of like your more whole body approach to, well, what do we do if this is what's going on? You know, like rather than trying to band-aid things or somehow just get past it, but just, you know, like continue the pain, continue the pain, continue. And the cycle just never ends because we're never doing anything effective to actually zoom the lens out and say, okay, so let's understand what's really happening here.

Like if we even accept that, okay, so there's a possibility that I have just behaved in a racist way. And then we say, okay, so what's actually happening here? Can I examine the context? Can I examine my behavior? Can I examine the interaction and better understand, is it, isn't it?

What was actually going on here? And how do we, like, how can I be different? How could we be different? How can the context be created differently? So even outside of my own individual behavior, contextually, systemically, you know, like the triggers, the prompts, the scaffolding that supports that behavior ceases to exist. I thought it was such a fascinating lens on it. It really had me thinking.

Oh, good. I'm glad. Can I tell you a story? Yeah, please. So my 13-year-old, I have two boys, 13 and 14. They're both amazing, if I say so with my unobjective motherly lens. But so my 13-year-old's best friend for the last 10 years, they actually met when they were three, is a little girl.

Well, they're not little anymore. They're teenagers. But a young lady who was Muslim and she covers. So when they first met, she was a little kid. And then we like learned about Muslim faith. She started covering when they were about eight or nine. And so he is also an archer. And so he was at his archery club and his teacher is Indian from India. And his coach came up to us one day. Nasir was just putting his bow together. That's my son. But the coach came up to me because we have a good relationship. And he said, one of these parents called me racist. Do you think I'm racist? And I said, well, what did you say or do? Because I can't just blanket, I don't know what happened. I can't say whatever you said or did

wasn't racist. And so the story was that there was a little Muslim girl at archery who covers and her mother accused him of being racist because he was treating her differently from the other kids. And so as he was telling us the story, he was really upset that he had been accused of being racist. And he had said, you can never come back here. And she had said, we're never coming back here anyway. Like it had turned into a whole ugly situation. As he's telling us the story, he tells us the little girl's name and it just so happened serendipitously to be my son's best friend's little sister. So we didn't even, we like knew peripherally that she went there, but she's a little kid. He's a big kid, different nights. We don't see them, whatever. So we weren't even considering

the idea that this is who he would be talking about, but he said her name and my son perked up. And then we got in the car. He said, that's his best friend's little sister. And I was like, yeah. And he was like, so you have to call her mom and tell her that my coach is not racist. And I was like, I don't know that I want to take this on, but I've obviously set the standard in our home that I should take this on. And so he didn't wait for me to take it on because what the coach had told us was that the little girl covers head to toe and archery coaching is very physical. Turn your torso, like touching the kids, turn your torso, touching their hips, turn your hips, grabbing their arms,

putting their arms where they should be. And he felt like it would be disrespectful to touch her. And he didn't want to disrespect her. And so, yes, he was treating her differently because she was Muslim. Her mom, who has experienced racism all day, every day, especially following 9-11 in this country as a covered Muslim woman, interpreted that through the lens of her experiences, like you're racist and that's why you're treating my daughter differently. And she leveled the accusation and no conversation could be had because emotions were high. My son at that time,

12 years old, wrote his best friend's mother a letter. And he wrote her a letter and he said, oh, because she wrote a Google review. She said, we're never coming back here. She wrote a Google review and said, this place is racist. Nobody brown ever go there. And my son wrote her a letter and he said, I hope this isn't overstepping because I'm just a kid, but I wanted to let you know what my experience with this coach has been. And I understand, you know, you've been through a lot of things that I know that Muslim people get treated badly in this country. I think this might have been different because he told me he didn't want to touch her because he didn't want to be disrespectful. And he said, I'm hoping if it's just a misunderstanding because I know she loves archery and these coaches are really important to

me. I would hate for her not to be able to come back. And I would hate for him to get a bad reputation when that's not been the experience I've had with him. 12 years old. 12 years old. And so it is possible because that story had the happiest ending, which is like, mom was like, wow. She took the Google review down. We went the next time and coach was like to Nzinga, did you have something to do with that Google review coming down? And I was like, not me. I was like, that was Nasir. Mom and coach talked. Daughter is back in archery. Mom and coach have a relationship now. Like none of that could have happened were it not for a brave 12 year old who was willing to take on the conversation about racism. And so that's the entire point of the story is that if at 12 years old, he can be brave enough, surely all of us adults can be brave enough to take on the conversation of racism

because it is worth the risk to take on that conversation. Yeah, it's so powerful. What a kid. What a kid. I told you, unobjectively amazing. the actions and behaviors from the identity. And because maybe in that moment, he did do, he behaved in a way which would have been considered racist. He did.

But maybe he, you know, or maybe he didn't, but you can't, you know, if you just say, well, this person has the identity of being A, rather than, I wonder if that was behavior that was or was not. The conversation doesn't even begin because neither side gives the other side at least enough space to hear each other.

Not that, I mean, you know, look, I would never belittle the harm that has been done to so many people for so long that it is not the easiest or even the right thing always to do to just say, well, let's have an open dialogue. But, but I think it is really fascinating to, to sort of, um, to really develop the skill of meta awareness that lets you kind of zoom the lens out a little bit. And before the immediate reaction, just ask the question, what's really happening here? That's right. I love that. And I say, so as a physician, I believe really as a person, but I'll put it in the physician context. I believe that the relationship creates

all opportunity. And when you sever the relationship, you lose the opportunity for whatever that is. Fill in the blank, whatever that opportunity that is lost. And so to your point that it's not always the time to openly have that conversation. I think it is the time to try to keep the relationship because the opportunity for that conversation will present itself. And in the context of a relationship that can bear one or both of those people taking that risk to open the conversation, the opportunity exists. This feels like a good place for us to come full circle as well. So as we're hanging out in this container of the Good Life Project, if I offer up the phrase to live a good life,

what comes up? Oh, to live a good life, I think, is to accept yourself and others around you unconditionally based on the innate value that we are all born with. That's a good life. We don't have to judge each other. We don't have to judge ourselves. We can just appreciate the inherent value in all of us. Thank you. Thank you so much for listening. And thanks also to our fantastic sponsors who help make this show possible.

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getting you eight hours of charge in just 15 minutes. The Apple Watch Series 10. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required. Charge time and actual results will vary. Mayday, mayday. We've been compromised. The pilot's

a hitman. I knew you were gonna be fun. January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're gonna die. Don't shoot him, we need him! Y'all need a pilot? Flight Risk.