← Thriving with Addiction with Dr. Jonathan Avery
Thriving with Addiction with Dr. Jonathan Avery
Two Brothers, One Fight: Addiction and the Law
00:33:35
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A
Welcome to the Thriving With Addiction podcast where we explore how recovery is not just about surviving, but about truly living. Each week we'll dive into the science stories and strategies that help people and families heal from addiction and build healthier, more resilient lives. I'm your host, Dr. John Avery.
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B
Let's get started.
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C
Welcome back to the Thriving with Addiction podcast. I'm John Avery. Today I'm joined by Dr. Joseph Avery. Joe is an assistant professor at the Miami Herbert Business School. He has additional appointments in Miami's Department of Psychology and its Institute for Data Science and Computing. And he is affiliated fellow at Yale Law School's Information Society project. Dr. Avery's research interests are at the intersection of business, law and AI. His scholarship has been published in leading peer reviewed journals as well as top law reviews. Prior to joining Miami's faculty, Joe received a Ph.D. from Princeton University, a J.D. from Columbia Law School, and also completed a postdoctoral fellowship at Yale Law school. Beyond academia, Dr. Avrios practiced law and founded a National Science foundation supported legal technology company. And he's my brother. Welcome to the podcast, Joe.
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B
Yeah, thank you for having me.
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C
I have to admit, I was a little nervous to interview you. I think for other people that I don't know, it's almost easier. And that was. I was telling a colleague, a fellow psychiatrist in the. In the hallway that I was about to interview you and that I was nervous. And he asked if it was because we were competitive with each other, but I said no, that's not, that's not the case. It's that we root for each other so hard that the end, you know, are so close that to see each other in a. In a new context just. It feels. Feels strange. A little bit, right?
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B
You know it does. But I think definitely for like a family podcast, this is a little bit easier than doing one with mom.
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C
It would have been harder with mom. That's a good point. And in some ways this is for mom.
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B
This counts as a check in call.
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C
This counts as a week, a weekend call. That's right. But I think our relationship has helped in that obviously we were very close growing up. We were only two and a half years apart, but I left for college when you were in ninth grade. But then we got to live together in our 20s when you were an undergrad at NYU and I was at NYU Med School. And I think that helped solidify the relationship that is sort of the adult relationship between us. I think that was a good time.
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B
That's right. That was the first three years of medical school. For you, and that was nice. It was a time that we could live together when you were really starting your career. So I have felt kind of close to your medical career mainly because of that. I saw the work that went into it right from the beginning.
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C
The most competitive thing, though that did happen to us, I think happened then in that I was near the end of med school. I was sort of getting in shape again. And I remember I played in this med school flag football game where I felt fast. And we both played competitive basketball. We both played competitive basketball as kids, but you were always much faster than me, and I thought I might finally be faster than Joe. I mean, you were in the middle of preparing for law school, even working hard, and so I challenged you to a race and, And I don't know if. Do you remember what happened in that race?
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B
I do remember. I remember that entire time period. I think you. You had a personal trainer also around then.
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C
Things were escalating.
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B
Yeah, yeah, things were escalating. I also, I felt confident going into the race because I remember, and correct me if I'm wrong, but I think after your first session with that personal trainer, he had blown out your biceps to the extent where you could barely brush your teeth. And so I thought, well, in a race, I might have a chance. So we went over. Yeah. On the east side there. We went to that, that park. Right.
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C
We walked down to a track on the. On the Lower east side right by the east river there, and we raced. And you smoked me good. I think you were even, like, backpedaling towards the finish line, which is.
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B
I remember the intensity, though. I don't think we even spoke on the way down. I don't think we spoke during the race. I don't think we spoke after. It was just like something we had to take care of.
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C
Yeah. Yeah. All right.
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B
But.
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C
But outside of that moment where I thought I was faster, it's been. Been pretty smooth sailing and. And non competitive. I. I think. Right.
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B
Always. We. Yeah, we never competed. And also because you're so far ahead at this point, it's sort of. Somebody has to give up.
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C
That's not the case. That's not the case at all. I just read your. Your. Your whole resume. It's, it's, it's. Then your track was towards law. When we were living together, you were studying for law school and you got into Columbia. Remind me, why were you interested in law? It seems like so long ago now.
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B
Yeah. So for me, law, actually, it's kind of interesting because in undergrad at nyu I double majored in economics and philosophy. Philosophy was my primary major and economics I just picked up towards the end. Philosophy I took mainly because when you were an undergrad you took philosophy, which is interesting because you were philosophy and then also you had the hard sciences going into medical school. I was philosophy without the hard sciences. So for everybody else who was in the major with me at nyu, it was like, well, what do you do? You go and get a PhD in Philosophy or you go to law school? So it seemed like a very natural fit for me to go to law school.
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C
Just.
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B
And also because the skill set that needed for being an attorney was a skill set. I possessed a good reader and could read very large, large amounts of stuff and didn't bother me at all. And also liked your argumentation and liked working through sort of the foundational tools that you need for the lawyer's toolkit. So that was. But I also took a couple years off. I had like a two year break and did different things but knowing that I would, you know, eventually, you know, complete the jd.
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C
Right. And that's what I loved about your path in general is that you weren't afraid to take time off or change. That's what I've always so admired about you. But you did practice law for a few years before you, you decided to, to go back to school to get your PhD in psychology at Princeton. What finally pushed you away from the law and towards psychology?
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B
Yeah, so I practiced in Virginia and was doing mainly business law. A lot of stuff with startups, litigation involving acquisitions and that and that kind of thing. I could have stayed in the law. I, I liked it and I liked litigation. I was, I was mainly doing litigation. I liked going to court, but I also had other, other interests and at the time sort of blossoming interest in tech, like a lot of people. And this was back in 2015, so exactly 10 years ago. And so I thought, well, if, if I had an opportunity to go back and, and get a PhD and do something that was still in the law, but also included like a tech aspect, included AI, I thought, well, that would kind of be the dream for me to do that. I, what I wound up doing was I did a year of research at Columbia's Medical Center. I worked at a lab there and then from there jumped to Princeton and did a PhD. And the PhD was entirely focused on questions at the intersection of law and technology and also things I will discuss today, which is really perception of sort of different forces. Yeah.
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C
And let's jump into that now. And that was A great time for us. I loved. We had these times living together, but it was really our first academic time working together. We edited a book on the stigma of addiction and we published a number of studies together. You really took the lead with them at Princeton. But I think that was another chapter in our relationship that was really interesting and fun and. Yeah, and our work collided because you were interested in looking at, I mean, my work is on the stigma that doctors have towards patients with substance use disorder. The idea being that sometimes the people that are supposed to be on your team, like doctors and family members actually for complex reasons, aren't, or have these negative attitudes. And that sort of dovetailed what you were interested in. And you started to look at how lawyers perceive their clients with substance use. So tell us a little bit about, about that.
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B
Yeah, so that's exactly right. And you know, I, I didn't mention that in my last answer, but it is true that when I was practicing law then, you know, you have clients. And so I'm, I'm, I'm solely working on, on, on the work that they bring to me. But I saw you doing research and I found the research very interesting. I found it interesting also that you were looking at these, these like inversions, you know, where you might perceive something slightly differently than, than you would in the abstraction or if you were thinking clearly. And so all of those questions interest me. And then moving into the PhD, it was suddenly that that world opened up and I could do this research and look at these, these questions again. Yeah, so we had a couple of articles early on, actually a number of them. Do you want me to run through any of them?
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C
Yeah, let's highlight a couple of them. I think the ones on how lawyers attitudes related to the disease model and their attitudes to their clients, I think that's worth reviewing because I think people with substance use at times interact with doctors in my work, certainly family members, but at times lawyers. And it's important to recognize that bias exists in this setting, even when it seems like a safe place. So tell us what we found.
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B
Yes, so that was fascinating. One of the things I was looking at there was obviously you're on the front line of treating substance use disorders, you have patients. But I was thinking, well, as the US has sort of closed and shuttered many sort of public facing treatment centers, a lot of drug offenders wind up getting moved into the criminal justice system. So it becomes more of something that's criminalized rather than as a disorder that can be treated. And so what we did that first Study, I remember, is a massive undertaking because we got close to 2,000 attorneys from around the country, defense attorneys, including a large sample, over a thousand, were, I believe, public defenders. And we were looking at, well, what are their attitudes towards their clients who are accused of drug offenses? And we had some good scales to pull from because you. You have done this work with physicians and their attitudes. So what we did there was, we had different mock clients. Somebody who's been arrested for a drug offense, or somebody who's been arrested for just a property offense, like theft. And we matched these up in severity. We also did extensive testing on who we were presenting as the client, as the defendant, to make sure they were paired in terms of attractiveness, in terms of socioeconomic status, to try to limit the impact of confounding variables on these attitudes. And then we asked these defense attorneys about their attitudes towards these clients and things like, you know, how likely did they think this person was to reoffend? You know, if they. If they were back on the streets, if they were let go? And so what we found was, as attitudes deteriorated for the attorneys that had worse attitudes, their predictions that these clients, these people they were representing would reoffend were. Went way up. In essence, it was a clear. A clear correlation. As attitudes got worse, they thought, well, this person is sort of a hobby, hopeless case. They're gonna get arrested again and again and again. So that I thought that was extremely interesting. Not because those attitudes are wrong necessarily, but because we were able to show, well, these attitudes actually have impacts on belief. They actually are correlated with beliefs you hold about this person and how they'll behave outside in the world.
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C
But it's really concerning. I mean, if. If we know that folks with substance use see bias in so many, you know, from. From the police, from in the jail setting, from prosecutors. And then if your own criminal defense attorney has negative attitudes, thinks you're going to commit more crimes or use again, you can imagine that they then don't defend that person as vigorously or, you know, you want, in theory, to like your client and to believe in them. And if you don't, that's a little scary.
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B
It is, especially for the attorney client relationship, because it is a true relationship. In criminal work, almost. Almost nothing goes to trial. So you're working with this person to really negotiate, you know, a plea bargain. You're negotiating what in civil law, we call settlement, but here it's a plea bargain. So you need a good relationship, and you need to be rooting for this person. You know, it also was interesting we found that public defenders, which were a subset of our sample, and public defenders often have somewhat. They've had a negative reputation over the years because they tend to be overworked and they're representing a lot of people. And people question whether the defense you get from a public defender is good. And what we found though is that these attorneys had greater familiarity with drug offenses. So a lot of people get picked up for drugs crimes just go through and are given a public defender. And for those who don't know, public defender is assigned to you by the state at very low cost or no cost. And what we found was they were more familiar with these clients, had greater experience representing these individuals, and their attitudes were actually better towards them. So you might expect the opposite. You might say, well, if this was something that's rooted in reality, then the more you interact with these people, the worse your attitudes will become if they really are such bad clients and likely to reaffect.
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C
They're sort of like the addiction psychiatrists of the law though. I mean, we have all these doctors that, you know, the ones that you think would be the ones that represent you well, maybe the ER doctor or your primary care doctor or the ob gyn. But those folks all have been shown to have worse attitudes. But the addiction people with some special interests who choose to really go into the field and take probably a lower public defenders that probably have a lower paycheck and they're doing the good work and even though they're over taxed, they're ready to be in it with you. That's a positive from that study that is interesting.
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B
And so in medicine you would say you find something very similar.
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C
Those with specialty training. And they're often those that, I mean, it's a bit of a sacrifice to do more and more training to go into addiction and to be in these frontline settings, they have more positive attitudes than towards other groups. And so maybe there's a parallel there a bit.
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B
Yeah. And I like how that you're also describing yourself. Right,
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we're the best. Yeah. A little bit self congratulatory there, but I think it's important to know. I mean, I think sometimes you think you pay for a private defense and you gotta be careful, you know, really pay attention to what this person thinks and feels. And I think our second study sort of underscored why people might have. Have negative attitudes as it relates to the. To the disease model of addiction.
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B
Yeah, yeah, that. That was a fascinating one. So this was one. And of course the disease model of addiction is Somewhat controversial in medicine, less so than in sort of wider society where people will hold it up and say, this is crazy. But, you know, basically we're looking clarify
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C
the pause on that for a second. I think we'll talk about in this podcast. You know, I think the disease model does have its, its limitations. You know, the disease model, addiction being the idea that a lot of or almost all of the behavior of a substance use disorder can be explained from a brain basis or neurobiologic basis. But I think increasingly we've maybe gone too hard on that and appreciate all the societal and socioeconomic and environment and familial and trauma and mental health. And I mean, there's so many factors that go into a substance use disorder or towards any medical condition. But I think what I found in my work and you're about to describe when you believe it's more of a disease model than not, it does improve your attitudes towards individuals who are struggling.
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B
Yes, that's the interesting thing. So for this one, we set it up just as you described. We have kind of a sliding scale and on one end, and we. Four categories and not a scale, but four categories. And one was sort of the full disease model of addiction where we, we identified addiction as a chronic relapsing brain disorder, a brain disease. And we also mentioned that addict, addicts or substance users have practically no choice about whether to seek and use. So it's a disease. And here we're sort of equating it with something else, you know, like, like a heart condition. It's, it's there and you're, you're subject to it. Second category was, we had it as this chronic relapsing brain disease. But then we, we, we entered into this definition some aspect of free will. We said addicts have genuine choice about whether to seek and to use. And then third, we had addiction that primarily reflects this failure of self control. We got rid of the disease language. And here it's, well, you have a choice. And then you, you failed here to make the correct choice. And then on the far end, we had what would be moral censure where we said, you know, addiction primarily reflects not just a failure of will, but a moral failing. It's a moral lapse. And so in some sense you can see it's sort of moving from full disease model to, to, to no disease model whatsoever. And in this article, we were not weighing in on which is the correct way of conceptualizing, which is one of the things I liked about it. We were saying there's a Debate about this. And so we're putting it out there just as. As you described. But we're going to look at how these beliefs about addiction, about substance use disorders, and where they fall into these categories, where your beliefs fall into these categories affect your attitudes. And what we found was the more that the participants and these were attorneys and also physicians, we had two different categories, but across the board, the more they believed that it was a failure of will or a moral failing, the worse attitudes became. And it was a pretty stark difference where those who believed in the disease model had relatively much better attitudes, which is interesting, showing that whatever you think of these categories, they actually affect how you see the world. It shades how you view your clients and your patients.
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C
And I think that aligns, I mean, with my experience. I mean, in society in general, if people view it as a moral failing, we kick these people out of school. We distance ourselves from them and our family and friends. We do put them in jail or think they should be put in jail. And for physicians, we've shown something similar, like if you believe it's a moral failing, you're less likely to want to take care of these folks, have negative attitudes, and it gets in the way of people's care. And so the same true for lawyers. And so when you're struggling and you're interviewing a criminal defense attorney or public defender, you almost have to ask them, like, what do you.
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B
What do you think?
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C
I mean, what can we take from this study? How can we sort of apply it, do you think?
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B
Absolutely. And for. For clients, it's. It's excellent advice if you were to tell them just when you meet an attorney initially, just probe some of these areas. And if somebody thinks this is a moral failing, even if they think that they can represent you fully, it's likely that their attitudes will sort of be. Will cut against best outcomes for you.
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C
The other thing that struck me about that study and our previous one is that lawyers are not a very diverse group. Huh. There's. For the doctor arm of the study, it was extremely diverse, but the lawyer group was older, white males, predominantly, which was striking. I didn't realize it was still so dramatic, the demographics of lawyers.
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B
Yeah, and we did that study, that was five years ago. That was 2020 or maybe a little less than five years ago. And that's true for attorneys. It tends to skew white and male and older. But that's especially true, of course, with defense attorneys. For those who go into that work and who are in that work, it does skew in that direction. But it was interesting. We found very similar results for the physicians and the attorneys. Right. Regardless.
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C
Yeah, the physicians weren't better than the lawyers. I think they were slightly worse than lawyers when we compared them.
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B
Yeah.
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C
So, I mean, that's the striking. That's a striking thing for physicians. We're not, I mean, a lot of, lot of rejection of the disease model, a lot of rejection of patients with substance use. And I think we actually did worse than lawyers. And no offense to lawyers, but if you're doing worse than lawyers, it's not a great look for doctors as it relates to attitudes around the health condition.
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B
No, you always want to. Lawyers should always be the baseline for.
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C
I know, we gotta, we gotta do better. What do you think we can do better, though, in general for helping our clients with substance use or what should the legal field do in light of some of these findings or what are they doing?
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B
Yeah, it is a very difficult question. I think you have more insight into it than I do. One of the nice things about being a researcher in my training, isn't it experimental psychology is I can often run studies and find results and say, well, it's very complex. You know, it's multiply determined is a word we often use and then kind of back away. You know, it leaves a policy for somebody else. Yeah, but, you know, for, for this one just sort of as a personal level and not going into sort of the empirical evidence for this, but, you know, prison for substance users is definitely a dead end. You lock somebody up and for. On the moral failing scale, and we say, well, that's it. This person has made some mistakes and they've done something that's immoral here. And so we're going to, we're going to, in essence, you know, the state is going to inflict some punishment on them. It's going to, you know, restrict their liberty for a period of time. And it just seems counterintuitive that, you know, something like this would happen. And, you know, there's a debate about, you know, how much control they have over this and, and all the different forces at play and causing it. And so you say, okay, we're just going to lock you up with other people who have done similar things. And then after a certain period of time, we're going to put you back into the same environment in which this happened. Now how we can fix that and how we can, how we can channel these individuals into treatment, you know, that's, that's a tough question. And what.
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C
Yeah, but that would be the goal, I think, to get out of this punishing mindset that dominates society to one in which we're offering treatment, understanding it as more of a medical condition, and connecting people with the resources they need to succeed, to be successful. I mean, we spent a lot of money trying to punish substance use out of people and I don't think it's got us very far. And so maybe our work can highlight a little bit about the need for moving away from legally solving this problem.
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B
I think that's right. I know even in your own work, some of the stuff that I was not involved in, but you've told me about, even when you go over to Italy and work with different clinics, I like that in a lot of those models there are individuals who have committed drug offenses or had substance use disorders and then they've overcome it and they become sort of a valuable resource for others who are going through it. And that's something where I think, well, if that could be the path where you're working with people as you're still sort of recovering yourself in terms of long term recovery, that could be a way forward, show them what life could look like without these disorders.
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C
Right. And in medicine we are lucky we can incorporate folks with substance use disorders who are in recovery into our treatments. You know, they can run with us in the hospitals, be a specialist, be there in the emergency room. It'd be hard to know what that might look like for the legal system, but there's definitely a lot to do. But from these studies, tell us what else you did in Princeton and how you ended up eventually making your way to the business school from there.
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B
Yeah. So this work, it intersected with my other work because I was doing different things, looking at attorneys perceptions. I'm still kind of in that space. But the bulk of the work in the PhD was really looking at technology. And as tech comes in, sort of the traditional maneuver with technology is you study well. Are these tools biased in some way? Is there a problem with the training data? Are there sort of very difficult trade offs in terms of fairness and ones that we're having difficulty solving? Are there questions with privacy? And I kind of view those as like frontline issues. You had issues with the tech and, and there are solutions that we can solve. But I was more interested in what I view as kind of like bigger issues, second line issues, which is when these tools are in play, how does it actually change how the humans behave? So I've done a lot of work looking at when AI commits arguably legally actionable behavior. So in essence, if AI steals A trade secret combs through a website and steals a trade secret versus a human combing through a website and stealing a trade secret. How does that change how jurors and judges actually view the behavior if the behavior is held constant? So in some sense it fits with our initial designs where you have a property offender and a substance use defender. These are primes of the same magnitude. And then how do we view these differently? So that was a lot of the work sort of looking at these attitudes towards tech. And so that, that work, of course, touches different fields. Very important for business. There are a number of different psychological factors involved. So it's important for psychology departments and then there's also legal core. So it's very important for the law. So I wound up here now at the University of Miami, where my primary placement is in the department of Business Law and secondary is in the department of Psychology. And then I'm in Miami's Institute for Data Science and Computing. So it's kind of all three kind of nested together.
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C
Wow. It's an incredible intersection and so timely. And can you give us a little bit of a practical application of how your work applies to something going on?
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B
Yeah. So we've done a number of things and some were very obvious studies and then some were sort of more subtle. Some were with real property, and then we move into intellectual property. But to give one example, we, we ran a study with. It's a car accident, but a single car accident where a car hits a stop sign. So there's damage to the stop sign, there's damage to the vehicle, but no harm to any humans. And in one condition, it was a human driving that car, and the other, it was an autonomous vehicle with a human at the wheel, but the human was not at fault. So it was, it was, it was a mistake by the autonomous vehicle. And we asked participants, we tried to held everything else constant, but we were saying just. And we would show them pictures. Just looking at the damage to the stop sign and the damage to the vehicle, what would you estimate the repairs would cost? We tried to hold it constant. So they didn't think the autonomous vehicle was inherently more expensive or anything like that. And what we found was huge differences in the estimates of damage. We found differences just looking at the stop sign. Don't even look at the vehicle. How much damage has been done to the stop sign. When, when it was an autonomous vehicle that caused the damage to the stop sign, they said it, it's. The damage was much worse. And this wasn't because they, they thought well, there are deeper pockets that they, they could get money from. It was just when AI was involved in harm, they sort of were viewing the world as if, whoa, something much worse has happened here.
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C
Right.
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B
So we've taken that and moved that into other areas with intellectual property. I mentioned stealing trade secrets. But we also have done it with patent, patent law, creating patents. Have you infringed on a patent? We've done it with copyrights. And now I'm beginning to do some of this work and thinking it through in terms of legal standards. If you have the same standards, you know, we have standards of review applied to human versus, you know, a human that is responsible for an AI. Is the standard applied slightly differently. So the results. I find it interesting and I love running these studies and I'm always curious to see what happens, what comes out.
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C
But is the summary that there's a lot of fear towards AI or people are really worried about this? Should we be worried? I mean, I feel a little worried. Yeah.
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B
So it's Julian DeFreitas, who's, who's up at Harvard. He, he has a paper, I don't think it's out yet, but they've posted it. And, and he talks about speciesism. Yeah. Where he, he feels that in certain tasks we're now kind of doubling down on humans and saying, well, these non human things pose a threat. Something goes wrong, we're going to over penalize them. But there are studies going back years and years with people looking at them. Some of these came out of the military, but human factors research, looking at how we rely upon machines and AI machines or just more rudimentary prediction machines and when they make mistakes, how do we respond to it? And generally we find that there are fears and we'll over penalize machines and AI in different circumstances, but the circumstances matter. So it tends to be, if things are more, if it's a subjective task or it tends to be an, a task that has like an ethical component, then we tend to over penalize AI. But if it's something that's more quantitative or less subjective, then it might be on par with how we view humans. But at this point there are so many factors and so many different scenarios. It's hard for me and to really draw a conclusion. It's hard for me to design new studies where I can isolate these things. It's something we're thinking through.
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C
Well, it's really cool. You're at the cutting edge and I'm excited to see what comes next. It must be really, it's Very exciting field to work in right now.
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B
It is. I'm curious too, because you mentioned some fear of AI. Do you find in medicine that physicians feel threatened by AI or they're overly punitive towards AI if it makes a mistake.
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C
And I think a lot of us love it. I mean, it really helps us with patient care, with academics. I don't get the fear that I see in other places among medicine. I don't even get the fear that it's going to replace us, although it might in certain domains, but it's a real assist. Medicine is so complicated. There's so much to know that if you can have something reliable, synthesize the information and data and be a good partner, help you with your notes, there's so many ways that it can make the doctor's life easier. And so I've been excited by it in terms of its role in medicine, but scared about it in maybe outside of medicine, maybe because I just don't know exactly everything that's going on. I just trust you to be there to make sure things stay safe.
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B
And that's an interesting one too, because it is extremely useful and you're using it a lot. And. But. But also the like. One of the things that I'm interested in is how these attitudes will change over time because we're at a period here where AI now we see increasing adoption just because so many people are. Are using, you know, these LLMs like ChatGPT. And so I'm curious, like, if studies I ran a year ago, if I ran them, you know, six months from now, would we have the same results or will we see attitudes start to shift? So I like running these studies just to get points in time so we can sort of track how these attitudes are changing. Because maybe as people move more towards where you are with consistent use and use, that seems helpful. Maybe the attitudes will move in the other direction. You say, I'd rather have an AI assistant than some human who needs a lunch break and who gets things wrong and that kind of thing.
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C
Exactly. Well, that's cool. I'm really excited for what comes next for you, and I appreciate you taking the time today to talk to me. How'd it go?
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B
Fantastic. Yeah, thanks for having me. I really enjoyed it.
- [33:06]
C
Yeah, thanks, Joe. I love you. Thanks for coming.
- [33:08]
A
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