From audio interview transcript

    Dr. David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by mentalhelp.net, covering topics on mental health, wellness, and psychotherapy.

My name is Dr. David Van Nuys. I'm a clinical psychologist, and your host.

    On today's show, we will be talking with Laurence M. Westreich M.D. about his book, "Helping the Addict You Love: The New Effective Program for Getting the Addict into Treatment."

Dr. Westreich is a board certified psychiatrist who specializes in the treatment of patients dually diagnosed with addiction and mental disorders. He is board certified by the American Board of Psychiatry and Neurology in General Psychiatry and he holds a certificate of added qualifications on Addiction Psychiatry and is certified as an Addiction Specialist by the American Society of Addiction Medicine.

    Dr. Westreich is Associate Professor of Clinical Psychiatry at the New York University School of Medicine and serves as the consultant on drugs of abuse to Major League Baseball. Now, here's the interview.

    Dr. Laurence Westreich, welcome to the Wise Counsel podcast!

    Dr. Laurence Westreich: Well, thank you for having me.

    David: Now, before we get into your book, which I must say I'm really impressed by. It's a very practical, down-to-earth book for families who have loved ones who are struggling with addiction. But before we get into your book, let's start out a little broadly. Let's start off with what's your definition of addiction?

    Laurence: Well, my definition is when someone has compulsive use of a substance that's causing them problems in their life, like with their physical health or with their job or with education or with their relationships, then I think that's enough of a problem that we should call it an "addiction."

    David: OK. We hear of so many celebrities struggling with addiction -- people like Britney Spears, Lindsay Lohan, Keith Urban and the recently deceased Anna Nicole Smith. Is there something about being famous that makes them more likely to have drug problems or are they simply reflective of what's going on in the larger society?

    Laurence: Well, I think that's exactly right. They reflect what's happening all around us. I think people who are wealthy or who are celebrities are often protected from the consequences of their actions.

For instance, if you've got a bunch of people around you who are your entourage, people unlikely to confront you about your destructive behavior. Or you've got a lot of money, sometimes you can back off the consequences of addictive substance use, the point that you don't get help as quickly as the rest of us would.

    David: Right, and of course, the person in the news now is Paris Hilton, and I guess what you've just said applies to her as well.

    Laurence: Sure, and I think the main issue is that most people who have addictions are not wealthy or celebrities and most people get good treatment for their addictions, don't go to fancy mint-on-the-pillow treatment facilities. There's plenty of good treatment around for people who have medical insurance or have Medicaid or Medicare.

    David: OK. Now, what do you think of the war on drugs?

    Laurence: Well, I think if it means spending a lot of money on law enforcement, I think it's mostly a loss. I think that can even be a war on their own citizens. I think we need to focus our efforts and our money on treatment for this problem rather than trying to put every drug user in jail, which is simply silly.

    David: Yeah, I have to agree. What's your assessment of how the war on drugs is going?

    Laurence: Well, since we spend so much on law enforcement and so little on treatment, I think it's not going very well at all. I think that law enforcement attempts to stop drug use are essentially a waste of time and energy and money.

    David: Yeah. What's happening these days with teen addiction?

    Laurence: Well, the data show that teenagers are probably plateauing out on the use of drugs like marijuana and alcohol but there's been an increase over the last two or three years in the use of prescription drugs. Those are things that they can get from Mom and Dad's medicine shelves. That's where the concern in the field is right now, with that increase of prescription drug use.

    David: My goodness. That seems kind of bizarre, that things would evolve to that place.

    Laurence: Yeah, I agree.

    David: Well, you've spoken of this a little bit, I wanted to ask you if you're seeing any changes in the pattern of what drugs are being abused now as opposed to in the past.

    Laurence: Well, there is a change. Over the last seven or eight years, there's been an increase in the amount of heroin being used by people across the board, with the drug that would have been seen as very deviant by most people 20 years ago that's essentially flooded the market with very potent and inexpensive heroin.

    So you're seeing people who long ago would never have used heroin or have had any access to it, use it in the same context they use party drugs. They use marijuana, a little K, a little Ecstasy and then try snorting heroin with it. When they snort the heroin, obviously they don't have to inject it so it doesn't seem as scary. The scary part though is that you can get physically dependent on it very, very quickly, after three or four uses.

    David: Oh my goodness! Is heroin somehow perceived as chic now?

    Laurence: Yeah, there was a whole movement of heroin chic several years ago and there were, you know, talk about models looking like they were heroin users and that was seen as kind of cool. I think the spate of deaths that have occurred from heroin have cooled that off, but the issue is there's a lot of heroin around, and I see high school students, I see professionals, doctors and lawyers hooked on heroin in a way that we never would have seen 15 years ago.

It's something very scary and often hidden because it's seen as much more stigmatized and shameful to be addicted to heroin than having an alcohol problem.

    David: Interesting. Now, the subtitle of your book is "The New Effective Program for Getting the Addict into Treatment." That raises the question, what's new about your approach?

    Laurence: Well, I have concerns about families who use the "tough love" approach in the intervention approach. The reason being that sometimes, families focus on the "tough" part of it rather than the "love" part.

By just waiting till an addict hits bottom, it can be a very disastrous method because sometimes, the "bottom" for an addict is death.

I'd never advocate for just pushing the addict out and waiting for them to make the choice to get better. I advocate for raising the bottom.

    Rather than doing the tough love approach, I advocate for a series of staged and graded confrontations with the addict that take place over time and that press the addict and push the addict towards treatment rather than a big, final ultimatum that can sometimes be disastrous.

    David: Yeah, and one of the things that I really like about your books are these dialogues, these sample dialogues, that you provide plenty of when you talk about the graded confrontations. I think many of us would say, "Well geez, I don't know how to do a graded confrontation.

What the heck do you mean by that?" But in your book you really illustrate that by giving these sample dialogues, which really I think give the reader a very concrete idea of appropriate confrontations.

    Laurence: Right, thank you for noticing that. Because I think that is the most important piece that families often ask, "What do I say, if he says this?" Or, "What do I say, if he says that?" I've been doing this for a long time, so I have a pretty good idea of what people are going to say in different situations, although everyone is different. But there's some very, very common scenarios that arise, that I can give families advice on how to respond to.

    David: Yeah.

    Laurence: The response has to be a loving response. It has to be a true response. You have to say what your concerns are. But the idea is not to get into a battle with the addicted person, but to ally with the addicted person and say, "Look, we both think that you have a problem with alcohol. We're all concerned about it. I'm sure you see the problem also. Let's get on this, and try and get some help."

Rather than shouting at the addict or expressing your anger with the addicted person. ....

See The Wise Counsel Podcast to hear audio and read rest of transcript.

[Photo: Huston Clemons and his daughter - from article Researchers attribute many factors to sobriety.]