Alison Stewart (3:04)

I do want to ask, ask you a question about marijuana, though. What is the line between a casual user and someone who's really become dependent on marijuana?

Dr. Lisa Borg (3:13)

Okay, I'll tell you. In one word or two phrases? Two words, two phrases. Compulsive use. In other words, using more than they want to, more than they think is even they think is good for them. They can't stop using. They can't stop. They're using all day. They're using five times a day. They're using three times a day. They're going to work under the influence. They're with their children under the influence. They're driving under the influence. Those would be indications that things are out of control. So that would be one thing, a very important thing. The second very important thing would be impairment. Do they have impairment? Are they using marijuana to the point where they have impairment in functioning, in their health, in their ability to think, in their ability to sleep, in their mood? Any kind of impairment? You would say, okay, this isn't just, you know, a couple of tokes on a joint at the end of the day, you know, or on the weekend. This is something that's a problem.

Alison Stewart (4:13)

Doctor Will bring. Let's bring you into the conversation. Alcohol can sometimes be harder to identify because drinking is more socially accepted. You might just think, oh, someone's a little tipsy this time of year. Could you tell us some signs that someone might be struggling with alcohol dependence?

Dr. Mark Willenbring (4:32)

Sure. Again, compulsive use is a really common thing. First of all, using more than you want to, more than you tend to. Secondly, using inappropriate situations or using more than you think is appropriate. And those are some of the early signs. The, you know, the, the late signs are really easy to identify. They're the typical drunk that you find that you see, but other than that, before that, people are. It affects their, you know, their interpersonal relationships more. And their first, their first one is usually their spouse. And the, and, you know, there are several other signs that we probe for. Yeah, but those are some of the common ones.

Alison Stewart (5:42)

Dr. Borg, you may suspect that someone in your family has an addiction to alcohol, might have an addiction to drugs, and you want to talk to them about it. What are some common pitfalls or mistakes people make when they want to confront someone about their addiction?

Dr. Lisa Borg (6:00)

Okay, well, you identified it in your question, but you said confront. I would not Use the word confront.

Alison Stewart (6:06)

Gotcha.

Dr. Lisa Borg (6:07)

If you're going to talk to a family member who you love and try to persuade them that you think that they have a problem, I would not be confrontational. I would go to them in a loving manner and say, I'm concerned. You come from a place of concern and love. I'm concerned. You don't seem like yourself. It seems like something's wrong. It seems like you're, and you could be specific. It seems like your, your mood is, is not your typical mood. You're irritable, you're depressed, you're sad, you're, you know, react reactive, whatever it is, you know, you're grooming, your grooming, your grooming is not what it normal is. You're having trouble at work, you're having trouble with your, you know, you know, with your children, you're having, you know, financial problem, whatever it is, you know, and you're concerned that there's, you know, what, you know, ask more open ended questions, you know, what's going on and then you could say, you know, especially if they have a history, you know, I'm worried that you might be using, you know, substances, you know, alcohol, cocaine, whatever it is, you know, is it possible that that's what's going on? If so, you know, what can we do?

Alison Stewart (7:22)

Yeah.

Dr. Lisa Borg (7:23)

So I would, I would try, I would not, I would not put them on the spot. And you know, there's something in psychiatry called motivation. Well, in treatment, addiction treatment called motivational interviewing, where you help the person to recognize that they have a problem and that they want to do something about it. And I'm not saying you should be a therapist, but I'm saying it kind of, it kind of speaks to that. You know, you try to lead, help them, help them realize that they need to do something about it without imposing, you know, a judge. Because you're going to feel that you're being judgmental and critical and trying to railroad them. And that's not what someone with a substance abuse problem wants to hear. They want to hear that you're concerned and you care about them, you love them and you want to help them.

Alison Stewart (8:08)

Dr. William Brang, that brings my next point. Someone might get defensive immediately as you start to have these conversations. As loving as you may try to be, what are some ways that you can deescalate the conversation?

Dr. Mark Willenbring (8:21)

Well, first thing of all is you want to catch them being good. So you want to catch them at a good, when they're, when they're, when they're good, when they're not when they're not using to decrease the defensiveness. You also want to lose your anger. You don't want to come across in any kind of an angry or critical way. You also want to, but just at the same time, it's okay to have boundaries and to say things like, well, I just don't like being with you when you're using. Or I don't like being, you know, when you, when you behave in such a way as where the substance is more important than me. I'm not really interested. But, you know, so it's okay to protect yourself and your property. But you, but you want to be specific and clear as much as you can.

Alison Stewart (9:16)

Let's take a call. Oh, yes.

Dr. Mark Willenbring (9:18)

Well, there's a. There's a great place in New York actually called the center for Motivation and Change. And they have written, the authors have written a book that's called Beyond Addiction. And I would highly recommend it for anyone who is struggling with this problem of someone who has a substance use problem and doesn't recognize it. But this and it. And basically those are the principles you use. You catch them being good.

Alison Stewart (9:50)

Let's take a call. This is Martin calling in from Whitestone, New York. Martin, thank you so much for calling wnyc.

Martin (9:58)

Hi, my name is Martin, I'm an alcoholic. And I just want to say that, you know, I forced my family to watch me kill myself a little bit at a time on the installment plan. And I finally got beaten down to that point of surrender, a state of reasonableness. And I went into Flushing Detox. They brought into meetings naca, they all brought the meetings. And then they brought a message in to show me that there was a way out. I didn't know there was any way out. Before that I was literally drinking myself to death. But today, nowadays, this is called the hurricane season for alcoholics. And the Queens Intergroup Local. The local Queens Intergroup, queensa.org has a 24 hour AA live AA meetings from Christmas Eve to New Year's Day. And if anybody wants information, they're all open meetings. So anyone is welcome. It's on queensa.org It's a website. It's. You know, when I joined, they never asked me for money or anything. They asked me to do stupid things like my sponsor asked me to come there early and make coffee. And I couldn't figure out why I should make coffee for other people. But what happened was I learned how to show up.

Alison Stewart (11:17)

Yeah.

Martin (11:18)

And I was able to show up with my mother who had watched me drink myself to death for 35 years. I was able to show up for her when she was in the hospital dying and read to her every day after work.

Alison Stewart (11:28)

So thank you, Martin. You know what? I'm going to dive in real quick. Thank you so much. I really appreciate your call. This note says my mother, my retired mother was drinking a little more heavily than was good for her. Incorporating non alcoholic spirit replacements let her keep the ritual, but with less alcohol overall, she could make a cocktail that would slow alcohol or slip completely without feeling like she was being deprived. We have a question for you, doctor. The question is, how can. Dr. Borg, how can you tell if it's compulsive if I only see this person once a year?

Dr. Lisa Borg (12:03)

Oh, well, that's a very good question. That's not. Well, if the person, when you say once a year, let's say they show up for, you know, the Christmas dinner or whatever it is, that's the once a year and you see them. I would say if somebody is intoxicated at a Christmas dinner with the family, when they know that they're only seeing everybody once a year and they want to put their best foot forward and they can't restrain themselves under those conditions, I would say they probably have a problem because normally somebody would not would be careful, you know, in that kind of a setting. So if somebody is so is so compulsive about their use that they can't even restrain themselves for the family holiday, I would say, you know, it's a pretty safe bet that they have a problem.

Alison Stewart (12:52)

This text says Dr. Willenbring, you can take this one. It says, thank you for having this conversation. How can a family member encourage someone who is dealing with addiction but has started their treatment to stay within their recovery during the holidays when there can be so much alcohol built into celebration with family?

Dr. Mark Willenbring (13:10)

Well, the main thing is to have non alcoholic beverages be the norm. So you've got water with ice cubes, you've got sparkling water sodas and so forth. And you can also make mocktails. If you Google mocktails, then you can come up with a whole string of recipes on the web free of charge for non alcoholic cocktails. Maybe you can even sponsor a particular evening or for that around the holidays, you know, a mocktail. Go ahead. Yeah.

Alison Stewart (13:58)

Dr. Borg, you know, we're talking about people in recovery. Setbacks often happen.

Dr. Lisa Borg (14:06)

Yes.

Alison Stewart (14:07)

How can loved ones help someone navigate a relapse without that person losing hope or momentum?

Dr. Lisa Borg (14:15)

Well, the nature of addiction is by definition, it's a chronic disorder. You never can. You always have to be vigilant. If you have an addiction or you have a loved one with an addiction that they could relapse. It's the nature of the problem that it's chronic. It's a chronic psychiatric disorder. So at any time someone can relapse. It's always a possibility and especially around the holidays. So they should be in treatment. They should, you know, it's a lifelong problem and they should be, you know, just like you have diabetes, you have to be in treatment for your whole life. We have hypertension, you have addiction, you have alcohol, you have cannabis, whatever it is, you have to be in treatment your whole life. And you have to have a therapist who you talk to weekly to discuss stressors and what's going on and how you're feeling. You have to have a psychiatrist to monitor you in case you need medication. And I agree with the caller. Some kind of a program, whether it's AA or another type of outpatient program where you check in or go regularly, whatever it is, you have to be very involved in treatment. Not just when there's a crisis and not just when there's a relapse, but as maintenance. You have to be in maintenance treatment to make sure that you don't relapse. And that's a lifelong commitment if you have an addiction. Because it's never going to go away. The propensity is never going to go away.

Alison Stewart (15:41)

Got two more texts here to echo the person who called. There are 12 step support lines, meetings and special events during the holidays. In nyc. There's an overdose prevention center called On Point. Another text says keep naloxone in the house and be familiar with 988. That's a suicide and crisis lifeline. Dr. William Brang, I did want to ask you though. You have said that people for whom a works, it works, but there's a group that it doesn't work with.

Dr. Mark Willenbring (16:06)

Yes, yeah, that's right. It doesn't work for most people, actually. First of all, most people don't end up going to treatment of any kind. They end up talking to a regular therapist or a family member or a friend and they resolve it that way. It's about 60% of people who never even consider going to treatment or they wouldn't. So the people who are in treatment are the worst of the worst of the worst. They are the most severely disordered people. So that is the single most powerful predictor of AA affiliation is the severity of addiction. And so, and the other thing is that it's oftentimes not a they say it's not religious, but if you look at the program, if you talked, you know, it really is. And so now the way it's got a couple of real advantages. One is it's free. Secondly, it's like everywhere. So I mean, a lot of my patients in fact go. They go for what they call the fellowship. Not they don't really work the steps, but they go for the fellowship. And if you look at the steps, only the first couple actually have anything to do with drinking. Most of it is character building. And it's particularly good for sociopaths who. Yeah, I mean, basically the people who founded AA were sociopaths and. Well.

Alison Stewart (17:53)

But your point is, your point is that for people that it works for, it really, really works for. And it works for a great deal of people. Dr. Board, we've only got about a minute left. Would you like. Is there anything we should think about that we should think about as we go to holiday gatherings?

Dr. Lisa Borg (18:06)

Yeah, I would say one thing with these holiday gatherings, try to enjoy the gathering. Even if someone's there who's impaired. That wouldn't be the time to really get into a big head to head with anyone. You know, I would wait until after the holiday dinner and say, by the way, unless you think they're a danger to themselves in some way, you know, if they really seem very agitated or very intoxicated and they need to go to the emergency room, God forbid. But other than that, I would wait till after the holiday to have the conversation with the person if it's possible. If they're not, if they're not at danger, I would wait till after the holiday to have the conversation.

Alison Stewart (18:45)

Dr. Mark Willingbrang and Dr. Lisa Borg. They thank you to both of you for joining us on how to support loved ones facing addiction during the holidays. Thank you so much.

Dr. Mark Willenbring (18:55)

You're welcome. Take care. Bye bye.

Alison Stewart (18:58)

And that is all of it. I appreciate you listening and I appreciate you. Tomorrow, actor Michael Fassbender will be here to talk about his new role in the thriller the Agency. I'll meet you back here tomorrow.

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