New approaches to understanding drug addiction — interview with Sally Satel | VIEWPOINT

New approaches to understanding drug addiction — interview with Sally Satel | VIEWPOINT

Dr. Satel: People who use drugs to the point
where it’s sabotaging their lives for them in some way, there is a rationale to it and
it really is a trade-off because it makes their life so much more bearable. Aparna: Doctor Sally Satel, thank you for
being here. You’re a Resident Scholar at the American
Enterprise Institute and thank you so much for writing a chapter for my “American Family
Diaries” volume. Your chapter’s titled “Why do people use drugs?” And I have a bunch of questions about that,
but before I begin, would you like to tell us a little bit about your work at AEI? Dr. Satel: Well, sure. But I’ll first mention why I think I know
why people use drugs and that’s because I’m a psychiatrist and I specialize in addiction. So, I’ve been treating and talking to people
with drug problems for a long time. And so, at AEI in general, I work on issues
that are at the interface of medicine and culture. And I consider addiction, which has traditional
medical components but also social components and psychological components to be an area
that that fits well under my umbrella, especially because one of my interests is how science
and medicine can be politicized. And in some ways, I think the problem of drug
addiction is. Aparna: Right. And that was so fascinating because that was
a dominant theme sort of off your chapter with the volume. So, in the chapter, which I must say is beautifully
written, you know, you have all these stories and I’ll talk about that, but you talk about
a dominant narrative surrounding addiction, which seems to be the idea that, you know,
as outsiders, we view addicts as being sort of not in control. And you know, it’s like a brain disorder and
there’s no way that they could change their behaviors to get off the addiction, but at
the same time, you also say that neurobiology is not destiny. So, can you expand on that? Can you tell me a little bit about, you know,
where that comes from? Dr. Satel: Yeah. Well, so you mentioned the, I guess the prevailing
narrative these days is not merely that addiction is a disease and in many ways, you can think
of it that way. It’s certainly a pathological behavior that
no one who wants to have and it’s also a behavior for which professionals like psychiatrists
and psychologists can be helpful and we use medication. But now, it’s being referred to as a brain
disease. Actually, this is a label that’s been used
for over 20 years now. It originated with the National Institute
on Drug Abuse and I personally find it far too reductionist. Now, of course, the brain is involved in addiction,
why would people use drugs otherwise? But it’s rarely enough to explain this very
complicated phenomenon. Now, I should say I understand why the National
Institute on Drug Abuse and many of my colleagues want to medicalize addiction to the extent
that they have. And I think their motives are really benign
and I agree with them, which for example, it’s to get drugs and people who abused them
out of the criminal justice realm and into the therapeutic one. I understand that they want to get more funding
for treatment and research. Well, so do I. They think that it can reduce stigma associated
with addiction, the data show that it doesn’t, plus one has to think more subtly about what
it is you want to destigmatize. Certainly, an individual should always be
treated with respect, definitely in a medical setting, and hopefully, they elicit compassion
from others, but there still has to be accountability when people commit crimes. So, that particular aspect I think deserves
more thought. But again, all those motives are very noble
and I think we can achieve them in other ways that don’t involve perverting the really essence
of what it means to be addicted, which as I started to say, plays out on many different
explanatory levels. One is the level of the brain. It’s just that that one, the circuitry, and
neurotransmitters are not really the one that is most relevant when you’re a clinician and
a patient or a policymaker. In those cases, I find that the psychological
level, the social and behavioral levels are far more informative when it comes to treating
people and when it comes to making policy. Aparna: Perfect. So, this gets me to our volume, which has
focused on ethnographic research or qualitative surveys. And again, you mentioned in your chapter that
if we want to help sustain recovery then face-to-face engagement yields insights, how does that
work with addicts? You know, why do thing you know, ethnographic
research or qualitative surveys could play a role in helping us address opioid addiction? Dr. Satel: Well, because it goes to the core
of addiction which I think is underappreciated. And that’s the concept that people use drugs
for reasons, that drugs are not in and of themselves rapacious chemical that just takes
over the brain. And in fact, consistent with the brain disease
concept, the phrase the hijacked brain, you know, the drugs come in and they hijack the
neurocircuitry and of course, they exert some control and no one for a minute is saying
that it’s easy to just give up drugs. It’s very difficult both because the drugs
do certainly exert a neurochemical pull, I mean, people become…they crave intensely
and they go through withdrawal symptoms that they want to avoid and hence keep using often. But again, that’s not the whole picture. And for example, I worked in a methadone clinic
for many years. If the problem was simply that people couldn’t
tolerate the withdrawal from opioids, for example, then everyone should be fine with
a few doses of methadone, right? Because they’re not in withdrawal anymore. But we find that the patients will often continue
to use other drugs for you know, quite a while, even though they’re much more stable than
they were before but there’s continued use of other drugs. Why is that? And it’s because, again, people want to alter
their consciousness, but not because it’s fun, sure maybe, you know, some people certainly
do enjoy even hard drugs recreationally. And to be honest, we don’t see them because
we as clinicians don’t see them because frankly, they can control their drug use. Aparna: That’s right. Dr. Satel: But people who use drugs to the
point where it’s sabotaging their lives, for them, in some way, there is a rationale to
it and it really is a trade-off that to them, for a while is worth it because it makes their
life so much more bearable. Aparna: That’s right. Dr. Satel: And they’re in a lot of psychic
pain for various reasons and you can talk about that at the individual level. And I did write about some people in the chapter,
you can talk about that on a communal level where sometimes entire communities are in
anguish and that’s where epidemics come from. So, without understanding that, it’s very
hard to, you know, scale-up. And it’s also very hard as a clinician, I’m
not scaling up, I’m as individualized as you can get. And so, that has to direct me. Aparna: Yeah. And so, you write about the stories that you
hear of the people who are coming into your clinics. I think one story you talk about that two
men, Zachary S. you call one, and Zack R. And then also the Vietnam veterans story. And I think those stories are really enlightening
because you realize that people get into addiction for a reason and then they can also in some
of these cases pull themselves off the addiction. So, I would love to hear about that because
I think listening to those stories could be, you know, very informative about how we help
people sort of more forward and find a way out of this abuse. Dr. Satel: We’ll start with the Vietnam vets
because that’s kind of a group and then I’ll talk about those two individuals. You know, the Vietnam veterans’ stories is
really fascinating and most of the research been conducted by Lee Robins from Washington
University, I think her papers came out in the ’70s. So, problem arose, or at least we became,
Americans became aware of a problem that was going on in Vietnam in about 1971 which was
extensive use of heroin and opium by the GIs. And the Army itself came up with estimates
that range between 15% and 25% of soldiers were actually addicted, not just used drugs,
but were addicted. And clearly, that’s an area, I mean, Southeast
Asia where you get the best stuff and but why were they using it? I mean, you can have the best stuff and not
use it. So, what made that appealing to the men? And those are the two main reasons were believe
it or not…and this is probably not the primary one, but intense boredom. I mean, you’re at the base most of the time,
it’s boring as heck, but this is the kind of boredom that’s interspersed with terror
because then you’re out in the jungle, and I’m sure some men were suffering post-traumatic
stress disorder. And there was, I think at that time also a
bigger problem, just intense demoralization. People including the soldiers were very much
questioning what they were doing there. And you know, war is hell and you can’t think
of a better way and they missed their family and I mean, you could just imagine all the
stresses on them. And there was all these high-quality drugs,
that was denormalized, I mean, that’s the other thing. I mean, it’d be different for me to go pick
up some heroin, but if everybody at AEI were doing it wouldn’t be such a big deal. So, it was pretty much accepted. It was widespread and it served the function
of helping these guys cope. And of course, I say guys because there weren’t
many women in the war then. And so, when President Nixon became aware
that there was so much drug use, he was very nervous that these men would export it with
them when they came home. And there was already significant heroin use,
especially in big urban settings. And so, they came up with this fairly ingenious
plan, or at least it had an ingenious name called Operation Golden Flow, where they would
not allow anyone to come back to the States when their tour of duty was up until they
could prove through a urine sample that they weren’t using drugs. And if they were, they had a week to detox
or some time and then they would return. And so, when that news got out, the vast majority
of people just stopped using drugs and were able to come home and stayed drug-free or
at least opioid-free, heroin-free. That was what they would use for the three
years that Lee Robins followed them. Now, if the term, there was a classic term,
once an addict, always an addict, if that were really true, then they would just start
using drugs when they came back. Aparna: Absolutely. Dr. Satel: But then the question is, well,
we know why they use drugs while they were there, and why did they stop using drugs when
they came back? Well, the whole context changed and context
is so key for understanding drug use. It wasn’t available easily and in order to
get it, you’d have to travel to some pretty bad neighborhoods. It was bad quality anyway. But they had lives, they had wives, they had
kids, they resumed their old identity, they had work to do and also, what behaviors would
say, the cues weren’t around anymore. The environment changed. Not only does the psychological need change
and maybe even the social need, but the actual triggers for craving were really not there
anymore. If your buddies weren’t there I mean, there’s
the classic people, places, and things you’re supposed to avoid when you’re in recovery
because those triggers will on a totally unconscious level start to generate craving. And you have to learn how to resist that craving. But some people are better than others and
you don’t want to put yourself in a position that makes you vulnerable. So, they basically really no longer needed
it. Aparna: For themselves. Dr. Satel: And the minority, about 12%, she
found over the course of three years resumed in addiction. And the majority of those actually had a heroin
problem before they went to Vietnam. So, they already had some sort of habit of
medicating themselves with opioids even before they went. Aparna: Nice. So, that’s interesting. And you know, for people who want to follow
up on the other stories, which are really key to this narrative of understanding what’s
going on with people who abuse drugs you know, I would encourage them to read your chapter. But, Sally, thank you so much for writing
that chapter for a volume titled “American Family Diaries.” Thank you so much for being here. Dr. Satel: No, thank you. Aparna: Hey everyone. That’s the end of our discussion with Dr.
Sally Satel. Thanks for watching. If you enjoyed what you saw, remember to like
the video or leave us a comment and be sure to check out the rest of our videos and research
from AEI.


  1. You have to understand people use mushrooms and we'd probably for punters a thousands of years
    Peyote herbs
    But the drugs are out there today like meth are synthetic
    How is lsd
    The Native Americans use peyote but they didn't abused it
    Drug abuse began when for example Columbus came to the Americas
    There's a difference between using it between rituals and Escape
    And then you also have culture that makes it popular
    So I can sell more
    Everything from cough syrup
    With liquor
    Lacing your weed with Coke
    And more
    When people use cocaine but it was different it didn't have all of this cut in it
    It was pure coca leaf
    Could be for pain
    People with chew on the leaves
    It wasn't processed
    People didn't snort it
    Didn't injected with a syringe
    There's a difference between use and abuse
    I don't think you can overdose on weed but I know liquor has negative side effects and it causes accidents
    Causes violence or at least it contributes to violence
    And they'd rather have people be violent off of liquor then people to smoke weed and that are relaxed and calm
    Because the system needs problems
    4 Profits
    The goal of the medical industry is not to find a cure but to sell you a treatment a pill for the rest of your life so it can make billions of dollars
    That's not scientific innovation that's exploitations of people's problems
    Which exacerbates the problem
    I mean if I gave you a killer that's a one-time quick fee
    But if I can sell you a lifetime of pills
    That steady income
    That's several yachts and an airplane
    That's a few mansions
    Why change that model when you can just become a billionaire off of people's problems
    The value system disorder
    It's not a life value system economy
    It's let's see how many people we can make sick and then give him a pill
    Let's see how many desperate people we can create so they take shity paying job so a few people can become rich
    Let's starve them into submission or lock them up when they commit a crime
    Lady you don't even understand the term evil
    All in the name of the good Lord
    Money has become God
    And in that country that hates dictators money sure does dictate everything
    It also has to do with social inclusion
    Psychosocial stress
    When we were kids were taught to share and to respect other kids and to get along
    Then we grow up or talk to f**** kill each other to make a profit
    The irony

    I know many things

  2. You talk about accountability on people that commit crimes but you don't even know what you talkin about
    What's the true cost lady
    You don't know
    You are Criminal
    Take accountability lady and go to prison
    Go to jail for faking being stupid with all that college f**** education you got you're still dumb
    I'll s*** on dumb feminist and hypergamy b**
    This is the manosphere

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