Joseph Lee, MD, President and CEO of the Hazelden Betty Ford Foundation

Summary

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Episode Overview

In this episode of the Becker’s Healthcare Podcast, host Maryan Muhammad interviews Dr. Joseph Lee, President and CEO of the Hazelden Betty Ford Foundation. Dr. Lee draws on his background as a child psychiatrist and addiction medicine specialist to discuss the current youth mental health crisis, the intersection of trauma and substance use, the impact of cannabis legalization, the necessity for integrated treatment, and the critical importance of community and family engagement in adolescent recovery.

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Key Discussion Points & Insights

1. Youth Mental Health Crisis: Surface Symptoms and Deeper Causes

• Dr. Lee describes a national crisis among young people, characterized by rising anxiety, depression, trauma, and substance use.
• Key Insight: These presenting issues are surface-level symptoms; deeper causes include isolation, loss of community, and impaired social development—often exacerbated by social media.
• Quote:

  “Young people today are very isolated from each other and we've lost the kind of framework for how young people develop socially... They feel isolated from each other, and they're having a hard time being vulnerable, even in their friend groups.” (B, 02:17)

2. Cannabis Legalization & Shifting Perceptions of Risk (03:16)

• Increasing legality and commercialization of cannabis has led to youth perceiving it as less risky.
• Key Trends:
  • Substance use is declining among low-risk kids but rising/concentrating among high-risk, more isolated youth.
  • Potency and efficiency of cannabis products have increased, particularly with vaping.
  • Industry targeting of vulnerable populations parallels trends seen with alcohol and gambling.
• Quote:

  “When kids perceive a substance to be less harmful because it's legal, or people use it for different reasons, they're more likely to use it... So you see a lot of normalizing of cannabis use. You see parents and families who are confused or have lost some vigilance about cannabis use.” (B, 04:17)

3. The Importance of Integrated Treatment for Co-occurring Disorders (05:47)

• Dr. Lee advocates for a fully integrated, team-based approach to treating both mental health and substance use disorders—especially among youth.
• Practice at Hazelden Betty Ford:
  • Family-oriented care, skill-building for both youth and parents.
  • All disciplines—psychiatrists, psychologists, nurses, counselors—work together as a cohesive unit.
• Risks of Segregated Care:
  • Fragmented (“parallel play”) approaches—separate medical, addiction, and psychotherapy services—fail to address the core communal and emotional needs.
• Quote & Memorable Moment:

  “One of them said to me, ‘I lost many of my high school years because of the pandemic. And now that I've come to treatment, I realize this is the very first time in my life that I have experienced community.’ And I about fell out of my chair because that statement was both incredibly profound and incredibly sad.” (B, 07:35)

• Gentle Critique of Mental Health Field:
  • Treatment has become too “sterile”; patients receive meds and therapy but lack a sense of belonging.
  • Recovery in addiction treatment is deeply rooted in community, volunteerism, and purpose.

4. Current Substance Use Patterns and Challenges for Clinicians (09:09)

• Emerging Trends:
  • Rise of Kratom (specifically a lab-grown variant referred to as "7oh")—noted for stimulant and sedative effects, dependency, and withdrawal concerns.
  • Drug trends are transient, but the underlying issues of youth isolation, loneliness, and lack of community are persistent.
• Effect of Social Media:
  • Despite knowing the unreality of social content, youth continue to feel left out and lonely.
• Quote:

  “Drug trends come and go. I think what we see in this moment is again the isolation and the lack of community for young people to plug into anything… They feel like they're the odd ones out, and so they're very lonely.” (B, 10:08)

5. The Vital Role of Family Engagement in Recovery (10:41)

• Approach:
  • Whole-family involvement—teaching skills and facilitating joint healing—yields better engagement and outcomes.
  • Families suffer their own isolation and stress, intensifying the need for integrated support.
• Scientific Evidence:
  • Youth outcomes improve markedly when families participate in care versus youth-only interventions.
• Quote:

  “The science is very clear, that young people whose family members are involved in care have much better outcomes and engagement than young people whose families are not involved.” (B, 11:26)

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Notable Quotes & Memorable Moments

• Isolation as Root Cause:

  “They're aware of all the dangers and pitfalls of a technological age... but they're still very helpless to it... they've lost the framework for kind of organic development.” (B, 02:40)

• The Power of Community in Treatment:

  “Substance use treatment has always been wedded to this deep sense of community and volunteerism and belonging to something and having purpose.” (B, 08:02)

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Timestamps for Key Segments

• 00:22 – Dr. Joseph Lee’s background and experience
• 01:29 – Rising youth mental health emergencies: underlying causes and connections with substance use
• 03:16 – Cannabis legalization, youth perceptions, and trends in use
• 05:47 – What truly integrated treatment looks like; the necessity of community
• 07:35 – Story: Youth experiencing community for the first time during treatment
• 09:41 – Current drug trends: Kratom, loneliness, and the compounding effect of social media
• 10:41 – Family engagement: Why whole-family treatment models matter

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Episode Takeaways

• Today’s youth are facing pervasive isolation, which underpins a surge in mental health and substance use challenges.
• Cannabis legalization is shifting perceptions, with negative consequences for the most vulnerable.
• True integrated care—melding mental health, addiction care, and deep communal engagement—offers hope, especially when families are included in the recovery process.
• The essence of successful adolescent treatment: community, purpose, and family involvement.

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Transcript

[A]

Welcome everyone, to the Becker's Healthcare podcast series. I'm Maryan Muhammad, writer and moderator with Becker's Healthcare. I'm thrilled to have with me today Dr. Joseph Lee, President and CEO of Hazelden Betty Ford Foundation. Dr. Lee, welcome to the podcast. We're very excited to have you join us today to get us started. Would you mind please introducing yourself and telling us a bit about your background?

[B]

Yeah. My name is Joseph Lee. All my friends and family call me Joe. I am a physician, an md, a child psychiatrist, and I'm also board certified in addiction medicine. I lived in different parts of the country. I grew up in Oklahoma. I did my medical training at Duke University and then at Johns Hopkins. And I've been at Hazelden Betty Ford, the nation's leading nonprofit substance use treatment provider, for 17 years. And I've been in my CEO spot for five years. But, you know, I've built my career seeing thousands of young people across the country. And I've really had the privilege and honor of being in the intersection of culture, substance use, mental health, and families. And really happy to share what I know and what I see from young people today.

[A]

Wonderful. Thank you so much for giving us that background. So with the youth mental health emergencies rising, what connections are you seeing between anxiety, depression, trauma, and the substances young people are turning to? Are there any particular warning signs providers and families to take more seriously?

[B]

I think the country's young people are in a continued crisis. And when you talk about anxiety, depression, trauma, we see all of those things, but those are the surface level symptoms of a larger root cause problem and connections between different problems. And so on the surface level, we do see a lot of anxiety, depression. We see many mental health conditions that come with substance use disorders or addiction, like ADHD as well. We're seeing an increasing focus on trauma. And many of the young people are more aware about how their life story and the things that have happened to them, either because of their substance use or things that happened before their substance use that cause them to use substances to, you know, modify symptoms, make themselves feel better. And so we're seeing a lot of that trauma as well. But when you get to some of the deeper connections, I think young people today are very isolated from each other and we've lost the kind of framework for how young people develop socially. We see a lot of young people who don't know how to be in groups. They don't know how to speak up for themselves. They don't like to make phone calls, they don't like to be vulnerable. With each other. And they're also in a time where, and I think some of this is due to social media. They're aware of all the dangers and pitfalls of a technological age, like with Internet and social media, but they're still very helpless to it. And so you have young people who have lost the framework for kind of organic development. They've lost a sense of community. They feel isolated from each other, and they're having a hard time being vulnerable, even in their friend groups. And so, of course, they're having a multitude of mental health and addiction issues.

[A]

Yeah, yeah. No, that definitely makes a lot of sense when you break it down like that. And specifically for one drug. As cannabis becomes widely legalized and commercialized, we're seeing it pretty much everywhere now. I live in New York City, and it's on literally every block that I turn. How is that reshaping youth perceptions of risk? From your perspective, what trends are emerging in cannabis use disorders among adolescents?

[B]

Yeah, interestingly, the use of substances and addiction for young people requires a bit of a social contagion, you know, so they. They hang around other kids who are using or risk taking. And. And I think in part because young people are so isolated, when you look across the bigger population, substance use for young people has actually dropped a little bit the past few years. But you got to go deeper than that, because in that population are high risk pools, kids who are really, you know, at high risk for getting in trouble, and then low risk kids. And what you're really seeing is that the low risk kids are using less, but the high risk kids are now even more isolated, and they tend to normalize cannabis use. And we've known this in the science forever, that when kids perceive a substance to be less harmful because it's legal, or people use it for different reasons, they're more likely to use it. So we see young people use it in many efficient ways. Vape cartridges are kind of the way to go now, and potency has gotten higher, so they are having more mental health issues. And you've seen in the adult population, even the number of adults who are starting to struggle with cannabis use. And then in a larger kind of national discussion, whenever you think about alcohol or cannabis or even gambling, it's a small minority of Americans that consume most of those goods. So for alcohol, you have about 10% of the population that consumes 50% of the alcohol in the country. And about the same ratio goes for cannabis and gambling and other things. And so you have this concentrated pool of people who are being advertised to by industry and they're at high risk. And so you see a lot of normalizing of cannabis use. You see parents and families who are confused or have lost some vigilance about cannabis use. And so the lower risk kids tend to be using less, but the higher risk kids are, I'd say, even more isolated and perhaps in greater trouble.

[A]

Yeah, yeah, that definitely makes a lot of sense. And you've emphasized that co occurring mental health and substance use disorders need integrated treatment for you. What does integrated look like in practice? And what are the risk on when systems treat these issues separately, especially for adolescents?

[B]

Gosh, you know, I think this is such an important question. On the surface level, again, when you integrate mental health care with addiction treatment, you're fusing language skills that you're teaching people, work with families and bringing it into the young person's treatment plan. And so we really believe in a family style kind of version of care where we're teaching parents skills about their own well being and, and what behaviors to reinforce and not reinforce and how to communicate. And we're teaching many life skills to young people. So on the surface level, there's a lot of skills between mental health and substance use that you're delivering together. And the teams, the, the, the triple boarded psychiatrists we have, and the psychologists and the counselors and the nurses, they're all working together as one unit. And that makes a tremendous difference compared to more of a parallel play version where you're going to one clinic for meds and going to another clinic for addiction care and going to another clinic for family therapy. And we can all do it in one place. But I'll tell you what's more important than this. I'll tell you a little story, and I think it speaks to some of the isolation I mentioned earlier. I was eating lunch and I frequently round with young people and adult patients at many of our campuses across the country. And I was sitting down with a couple of young people at our youth and young adult campus in Plymouth, Minnesota and we were just talking about things and one of them said to me, you know, I lost many of my high school years because of the pandemic. And now that I've come to treatment, I realize this is the very first time in my life that I have experienced community. And I about fell out of my chair because that statement was both incredibly profound and incredibly sad. And so when you think about integrated treatment, it's not just about the melding of terminology or the skills. I think what's really unique about the kind of care we deliver is that substance use treatment has always been wedded to this deep sense of community and volunteerism and belonging to something and having purpose. And we've been able to meld that with the evidence based skills and the science and the skills that people need to overcome trauma and depression and anxiety and those skills. And I think that's very unique. I would actually say as a gentle critique of the mental health field, which I grew up in, I grew up more in the psychiatric setting. The care I find these days is very sterile. People get their meds, they do individual therapy, their symptoms may get better, 30%, 40%, but they don't belong to anything, they don't volunteer anywhere, there's no group for them to go to. And so much of what we do in recovery for substance use care is about community and belonging to something and being a part of the larger recovery community and being able to fuse that. When you have so many kids who are just craving for community and you're able to fuse that with the evidence based skills of mental health and the family therapy, I think there's something very special going on in our treatment. And I think young people who are just so desperate for that need it more than ever.

[A]

Absolutely. I completely agree with you on your last statement. And Dr. Lee, before I let you go, the last thing I wanted to ask you is on the ground, what substance use patterns are clinicians seeing most often right now among teens? And what makes this moment uniquely challenging? And also more importantly, I think how do family engagement and specialized children's programs change recovery trajectory compared with youth only approaches?

[B]

Yeah, we see a lot of different drug trends come around. The latest is a version of Kratom and it's called 7oh for short. And that's coming around. Young people are using Kratom. Kratom is a substance derived from a plant and it more or less makes people feel like they're under a mild stimulant at low dosages, and at higher dosages it's more of a sedative. But there are now versions of this that are lab grown that have major withdrawal symptoms and some major medical implications. And so we've been concerned about that, that trend. But drug trends come and go. I think what we see in this moment is again the isolation and the lack of community for young people to plug into anything. And you see this across the data. I mean, kids aren't even dating. They don't share things with their friends. I think, you know, they go on social media feeds and they know that what they see in the social media feeds aren't real, but it still kind of influences them. And I think they feel like they're the odd ones out, and so they're very lonely. And. And I think that's a real challenge right now is to build a system that encourages community and volunteerism and all the things that we know lead to great organic health benefits. And families are also under siege. They're also isolated, and they're also struggling with mental health issues and inflation in the economy. And so I think one of the challenges that we try to overcome is to really engage the entire family in care so that they can all learn the skills and they can all learn to heal together instead of suffering in isolation. So that's what our approach is. And the science is very clear, that young people whose family members are involved in care have much better outcomes and engagement than young people whose families are not involved.

[A]

Yeah, I can definitely see that. And, well, thank you so much for those final thoughts. It's definitely been a very informative discussion. So, again, I want to thank you so much for coming on Becker's Healthcare, Dr. Lee, and I look forward to connecting with you again soon.

[B]

Yeah, absolutely. It's been a lot of fun. Thanks for having me on.

[A]

Thank you.