← We're Out of Time
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- [00:00]
Dr. Timothy Fong
Doctor Timothy Fong, professor of psychiatry at ucla, joins the we're out of Time podcast. A lot of my patients and family tell me, they say you don't judge, you don't preach, you don't criticize. You're not our best friend, but you're someone we can relate to because you're talking to us in a genuine connectedness way. A successful treatment, the first visit, no matter how bad you think you are or how bad things are, we can make things better. Thank you for listening to the we're out of Time podcast with Richard Tate. If you haven't already, please follow the podcast rate and review. And if you're getting value out of we're out of Time, share it with someone else.
- [00:34]
Richard Tate
You know, if someone has a problem with substance use disorder, please call one call placement. That's 888-831-1581. And if we can't help you, we'll make a referral to someone who can. Please, we're out of time. Dr. Timothy Fong, thanks for showing up for us today.
- [00:53]
Dr. Timothy Fong
Thanks for having me. It's amazing to be here. And it's a privilege. The privilege is all mine.
- [00:58]
Richard Tate
Trust me, it's mine. All right. I want to get right into it, just for the viewers. You're a real big shot in psychology in. And you're with ucla.
- [01:11]
Dr. Timothy Fong
Yes.
- [01:11]
Richard Tate
Right.
- [01:12]
Dr. Timothy Fong
Yes.
- [01:12]
Richard Tate
Tell the viewers a little. Not your CV, because I want it to take me 25.
- [01:17]
Dr. Timothy Fong
Right, right, right. The. The.
- [01:19]
Richard Tate
The 32nd to one.
- [01:20]
Dr. Timothy Fong
Yeah. That's amazing. So I'm actually from Chicago. I came to LA 1998. So it's been 27 years. About half my life now is LA. I'm an ang now. I went to medical school at Northwestern, where in the mid-90s, for the first time I heard addiction is a brain disease. 1995. I went to the Betty Ford Center. July 1995. Basically wanted to play golf for a week. But I was embedded with men and women with addiction. 1995. I remember men and women today like it was yesterday. It left such a footprint on me about this condition of addiction and the recovery stories and everything intertwined after that. I said, I gotta be an addiction psychiatrist. And that's what I did. Went to medical school there at Northwestern, came to UCLA, do addiction fellowship. I've been at UCLA since 2000. This is 1997, but I've been on faculty since 2002. I really do four main things in addiction psychiatry. I do research and gambling. I run the UCLA gambling studies program as well as the UCLA center for cannabis and Cannabinoids. I teach about addiction and mental health to anyone who listen to me. Medical student, undergrad people, psychiatry residents, people in recovery, families, whatever. I do clinical care, provide care for addiction. Again, as a psychiatrist, we do addiction psychiatry, which is a little bit different than addiction medicine.
- [02:42]
Richard Tate
How so?
- [02:43]
Dr. Timothy Fong
Because we're focusing on the mental health aspects. We're focused on the psychiatric part of the care, the body, the brain and the mind. Whereas addiction medicine tend to be more about, you know, dealing with the impairments from cirrhosis or medications or the medical aspects of detox. Right. And the last part I do is community engagement and stuff like this. We used to call it advocacy. I don't really like that anymore. I just like community engagement where we learn from each other. We find out what people are doing in best practices. We spread the word about recovery, about hope, about the messages that families have to get. So that's a nutshell. What I do, um, it's a lot of work, but it's also a tremendous amount of fun and makes me, puts me in front of a lot of really interesting folks. You know, over the last 27 years in this field, for sure.
- [03:32]
Richard Tate
Are there psychological cases you've seen where you just knew the person wouldn't make it and you. And you were ever wrong?
- [03:43]
Dr. Timothy Fong
These are. That's a fascinating question. Yes and no. Number one, we absolutely, by the time people call us for help, the addiction psychiatrist, things are bad. We're not the first call after the first dui, right. We're the call when things are really falling apart. So by definition, the folks we see at UCLA Psychiatric Hospital or the emergency room or in our UCLA addiction clinic, they're very severe men and women with addictive disorders. So they have multiple co occurring mental health problems, lots of medical problems, lots of damage. For instance, I saw a woman this week, first intake for gambling addiction. $600 in debt. That's, that's a lot from the medical world. We'll call it metastatic. Right, that language that the condition has spread to so many parts of the body and organ that there's not a lot of quote you can do. But the vast majority of folks that we see, no matter what condition, when they come into our office, we can provide some help, we can alleviate suffering, we can make their quality of life better. What I have seen though are a lot of folks who come in who are not able to do the work of recovery or are not in a position to do it, either financially, emotionally or socially, or who's been impaired to the point where their insights are so lacking. Right. That they can't engage in the basic first step of recovery. That's hard. I'll give you an example. I had a case last week. Young man, 33, college educated, methamphetamine use disorder. Super smart guy. But the methamphetamine use disorder, after 10 years, has done what? It's ravaged his body, ravaged his mind, ravaged his family.
- [05:27]
Richard Tate
All the time. He doesn't know what's real. That's not.
- [05:30]
Dr. Timothy Fong
And the family's bailing him out. They kicked him out. They've done the tough love. I'm seeing him with his family member. They're like, what should we do? I said, sir, you're 33. You don't have a job. You don't have an ID. You barely have a phone. This is not a dignified way of life. Give me a vision of how you want your life to be better. I'm not talking about anything about drugs or absence. I said, just give me a vision of how you want your life to be better. He says, I don't know. And then I said to his family member, he says, I don't know. Not because he doesn't want to get clean, because his brain's impaired, because he.
- [06:06]
Richard Tate
Doesn'T know how to get here.
- [06:07]
Dr. Timothy Fong
Doesn't know how to get here, doesn't know how to say it. He's not processing basic information, and he's still using meth three to four times a week.
- [06:15]
Richard Tate
So nobody uses, just so you know, nobody uses methods.
- [06:17]
Dr. Timothy Fong
He said, I love what you say. He says. He says, so when you say, you know, we knew the person, quote, wouldn't make it, that's the case. I know the recovery conditions by the time I, when I saw him are very, very poor. His prognosis is poor. But I don't like to pigeonhole and say people are never going to make it. I'm proud to say that in my 27 years of doing this, I've had two deaths. Two deaths.
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Richard Tate
Wow.
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Dr. Timothy Fong
Yeah, I, I, you know, and again, I don't see patients 40 hours a week. So I do maybe 10, 12 hours a week, but still two overdoses. And that's it. I'm really proud of that.
- [06:54]
Richard Tate
That's magnificent.
- [06:55]
Dr. Timothy Fong
Really proud of that.
- [06:55]
Richard Tate
And I mean, it's horrific. But if you guys knew what this was, that's amazing. Yeah.
- [07:02]
Dr. Timothy Fong
And partly it's, you know, medication we have out there, Narcan education. But a lot of it's just telling people straight up from the first visit, no matter how bad you think you are or how bad things are. We can make things better.
- [07:19]
Richard Tate
Now. This is my experience.
- [07:22]
Dr. Timothy Fong
Yes.
- [07:23]
Richard Tate
When I first got into treatment in 20 in 2004, you had some straight alcoholics, right? Just straight alcohol. Not everyone had a co occurring disorder. Maybe a quarter of the people have co occur today. I would. And it's just an estimate since I've been back, because I've been back for two years now with Carrera after selling Cliffside. It seems to me like about 85 to 90% of the people now that come to seek treatment have co occurring disorders.
- [08:07]
Dr. Timothy Fong
Severe, active.
- [08:09]
Richard Tate
No, no, no, no. I'm not talking. My lips won't move if it's not severe.
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Dr. Timothy Fong
Right, right.
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Richard Tate
Okay. So I'm telling you, they are so much sicker today.
- [08:19]
Dr. Timothy Fong
Yeah.
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Richard Tate
Than they were when I started. And they were getting sicker. Okay. From 2004 to 2018, I sold. But from 2018 till today, it's a new world, right? This, I've never seen anything like this. Is it Covid? What the hell is it here?
- [08:40]
Dr. Timothy Fong
Here's how I think I grew up in this world. I'm gen. I'm Gen X. Right. And what we know is the following. We know there's a mental health crisis that was exacerbated and by Covid, no problem. But on the run up to Covid, there are two things I noticed. Definitely the initiation of the smartphone made a huge impact on just people's mental health right around 2011. But even right around 2000, you go back to like Y2K, right. And all that. And we started to see the spread of the Internet. But you also started to see isolation and loneliness taking over modern day life. Right. And I remember there's a book I read called Bowling Alone by a sociologist named Putnam. And he basically talked about right around the turn of the century how as humans in America, we were starting to do more things by ourselves. And it wasn't for solitude, but it was out of loneliness and isolation. That certainly drove a lot of mental health issues. I think that's part of the trend for. For sure. To combine all of that on top of. Yeah. All the other new substances that are out there that are way, way, way more toxic. But when it comes to straight, like alcohol use disorder, the alcohol is still the same as it was, you know, 30, 40 years ago. There are a lot more options, a lot more things out there, but we see this everywhere. In fact, one of the programs I work with closely bet Shuva, they weren't around for 30, 40 years.
- [10:01]
Richard Tate
Rabbi still driving his Jaguar?
- [10:02]
Dr. Timothy Fong
No, he. They left. They've retired. They have a new, a younger group there. But they brought our UCLA psychiatry residents to come on site to provide mental health care about 12 years ago. The exact same reason you just said, which is that they were getting people coming in with very severe co occurring disorder unlike they had ever seen before. So it's just part of this natural rise we see in America. Just mental health crises coming up over the last 20, 25 years. And we don't have a super simple explanation. I think there's lots of reasons, but it's undeniable. That force of what we're seeing.
- [10:40]
Richard Tate
I think it's Covid. I think it's social media. I think it's the social media economy. Yep. I think it's the fact that they don't have the. The right anymore. These kids today don't have the right to experiment with drugs.
- [11:01]
Dr. Timothy Fong
Right.
- [11:01]
Richard Tate
That was a rite of passage. They don't have that anymore. Okay. I think that's upsetting.
- [11:07]
Dr. Timothy Fong
Yeah.
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Richard Tate
Okay. I think it's a lot of things, and I think it's just, it's so hard. I mean, you know how we do it.
- [11:15]
Dr. Timothy Fong
Yeah.
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Richard Tate
Okay. I mean, it's like if we're finding it hard. Yeah. Everyone else is finding it next to impossible.
- [11:23]
Dr. Timothy Fong
I think that's very well said. Very well said.
- [11:25]
Richard Tate
Yeah. All right, let's move on. How much of successful treatment is psychology versus environment?
- [11:34]
Dr. Timothy Fong
So successful treatment, again starts with this approach that we use. Biological, psychological, social and spiritual. When folks come into my office, when we see folks, we're using elements of all those four things equally. So I don't just get pills. That's wrong. I don't just say, go to 12 step meetings and that's the only thing you need to do. That's wrong too. So psychology, they're all critical. The biological treatments, psychological treatments, the social treatments, and the spiritual treatments. And people say, well, what are biological treatments other than medication? Sleep, nutrition, physical movement, Those are biological treatments. And I think that's why things like sauna, things like cold plunges, these are biological treatments that we vastly underutilized in my world, in medical field.
- [12:25]
Richard Tate
That's right.
- [12:26]
Dr. Timothy Fong
Vastly. On the psychological side, we vastly underutilize them as well from therapy as well, because we forget it's the power of the connection. I think one of the things I, a lot of my patients and family tell me, they say, you don't judge, you don't preach, you don't criticize. You're not our best friend, but you're someone we can relate to because you're talking to us in a genuine connectedness way. So I found that the most successful outcomes have always been when there's a strong positive connection between me and the client and the family. And it's an earnest, genuine connection. Right. It's not based on their power. Yeah. Is it strong? And you know it when you feel it. Right? That's right. You look forward to seeing each other. You ride ups and down. There's a consistency there.
- [13:11]
Richard Tate
The way I look at it is we're cheerleaders for them and we're showing them the way and we're supporting them every single day.
- [13:18]
Dr. Timothy Fong
Exactly. They're all that. So I put that, all that into what will make for a successful outcome. But all the studies will tell you the things that matter is again, length of time and treatment. The more visits you have, the better people do. Also, they'll look at the capacity for honesty that the person in front of you has. Will also tell you how far you're going to go. Which means for me as a therapist, I. I had to have my radar on tune again for finding out the bs.
- [13:46]
Richard Tate
But. But drug addicts lie.
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Dr. Timothy Fong
Never. I mean their lips never move. Right. So. And therapists never lie either. Right.
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Richard Tate
Man, therapists are such well meaning people. The problem is is there's so few of them that actually have the ability to help anybody. But the ones that can and have the best souls are like gold. And I got them all. If you had unlimited resources, what psychological support system would you build for addicts in early recovery? That is an excellent question.
- [14:22]
Dr. Timothy Fong
That is an excellent question. So I think the thing I see missing the most is the following. I think of domains of recovery. Anytime I'm working with a client. I think about four areas. Home health, purpose and community. Because we all know when that clicks in. Those four things click in and the health is mental health and physical health, of course, but purpose and community. And if I had an unlimited amount of resources I invested into building ways that people can find purpose and community and opportunities. If I had an unlimited amount of resources. I emphasize pouring funds and resources into building opportunities so that people can develop purpose and community for themselves and their families and whoever they've involved. Again, I'll give you a perfect example.
- [15:10]
Richard Tate
This is why we have the smart people on people. Go on.
- [15:16]
Dr. Timothy Fong
So again with where I got that comes from years of just listening to people.
- [15:22]
Richard Tate
No, it's common sense.
- [15:24]
Dr. Timothy Fong
Common sense. But it's also where I thought works for me. You know, it's what works for everybody. It Works for everybody. But in la, in particularly, I think that's where we struggle so much with loneliness, community, safety, opportunities. Right. So purpose is everything.
- [15:42]
Richard Tate
Yeah, everything.
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Dr. Timothy Fong
And they used to call, oh, structure, structure, structure, structure. Right.
- [15:46]
Richard Tate
Structure and purpose are completely different.
- [15:49]
Dr. Timothy Fong
Completely different. I said, well, you can be sitting there all day eight to eight and have structure, but that's meaningless.
- [15:55]
Richard Tate
That's right.
- [15:56]
Dr. Timothy Fong
You need purpose.
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Richard Tate
Yeah, it sounds like, it sounds like what John Wooden said. Never confuse. What do you say? Never confuse activity with achievement.
- [16:05]
Dr. Timothy Fong
I love that. Yeah, yeah, yeah. Be quick, but don't hurry.
- [16:10]
Richard Tate
I wish I had another one. We could do the volley thing all day long and see how far we could go. But I just dropped. Yeah, well, you have to have another one. If you have another one, you win.
- [16:19]
Dr. Timothy Fong
Not the top of my head. I tried to memorize the pyramid of success years ago, but it was tough because it was.
- [16:26]
Richard Tate
The greatest thing I've ever heard is from Coach Saban. Okay. We don't do things over and over and over again until we get them right. We do them over and over and over again until we can't get them wrong.
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Dr. Timothy Fong
Who said that?
- [16:41]
Richard Tate
Coach Nick Saban.
- [16:43]
Dr. Timothy Fong
That's pretty good.
- [16:44]
Richard Tate
Yeah, yeah. All right, let's move on. Roll tide. All right. Do you think most treatment centers fully understand how to deal with co occurring disorders or are they just checking boxes?
- [17:00]
Dr. Timothy Fong
Here's my story on that. You know, California has what like 1500 residential programs that are licensed by Department of Healthcare Services. And why I'm going on this is important. Just the way California structured this, you know, for years you'd have substance use disorder treatment centers to the left, mental health to the right. And they're not supposed to be together.
- [17:20]
Richard Tate
That's right.
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Dr. Timothy Fong
And many people don't understand that history. And it's tell the history, tell the.
- [17:26]
Richard Tate
History because that's awesome because when I got here, my first license was drug and alcohol addiction with co occurring disorders.
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Dr. Timothy Fong
With co occurring disorders.
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Richard Tate
Right, right.
- [17:38]
Dr. Timothy Fong
Yeah. And so, I mean, it's a long standing pattern that goes. We'll start right in the 50s and 60s where they decided to institutionalize the hospitals and the asylums, break it up into quote, recovery homes. But then in my view, just based the pure stigma toward, quote, addiction. Oh, let's just keep it in a separate financial pot. Let's keep it from a separate legislative pot, creating two different offices. There's a California Office of Alcohol and drug programs, ADP, the 70s, the 80s and 90s, and then again the Department of Mental Health, all ultimately under Department of Health Care. Services and Department of Health and Human Services. Alcohol drug programs erase themselves and merge, you know, about 10 years ago, but DMH and mental health still remains kind of separate. So for years you're still living with this weird vestige that addiction is not a mental health condition. Addiction is an issue of willpower, morality, crimes, all this stuff, and should be treated way to the left and mental health way to the right. It's that weird split. Then again, just creates. Only in the last, I'd say 10 years are we starting to see more, get a little bit more narrower where some programs are saying, wait a minute, this makes no sense for us to do it and have a narrow way of treating. We need to really expand our services and abilities so we can treat the whole wide range. Addiction, by definition, is a mental health condition and should be folded in and when you treat the whole person. So the answer to your question is that unfortunately many programs have not kept up because it's difficult to keep up training and resources. And if you have someone there who's been doing this for 30 years and they only know one way and teaching them another way is very difficult from time to time. So some programs just don't have that. The other really strange part I've always never quite grasped is why when you try and bring a psychiatrist on board, right, you know, you got to put them in the little shed in the outside, right. And they can be medical director, but they really can. And you know, it's all these weird bells and whistles. So our field of psychiatry has often been kind of invited in, but not really part of the core part of its infrastructure. So the bottom line is, I think, unfortunately, most don't do it as well as we all like to see, right. But others really do a tremendous job from intake and, and moving forward because it can take, as you know, you see it all the time, weeks to figure out what's happening with somebody, or even months sometimes. Particularly with these folks coming in now with the substances they have, really, the.
- [20:17]
Richard Tate
Really sick ones, you got to start ruling stuff out immediately, right? In order to figure it out. You're right. A doctor. Do me a favor, you can read it number five. Yeah, read me the last one.
- [20:27]
Dr. Timothy Fong
What do you do when a client doesn't want to live anymore, but also won't stop using? That's the core thing of what we do. So number one, I'll break down into two parts. When they have what I call lethal emotional pain, we call it suicide out, right? But I like the term lethal emotional pain.
- [20:44]
Richard Tate
I Like it too, because it's. Because it's ex. It's exactly what it is. Exactly how you feel right in that moment.
- [20:53]
Dr. Timothy Fong
And I got that term from.
- [20:54]
Richard Tate
That's better branding than defund the police. I really like that.
- [20:58]
Dr. Timothy Fong
It's pretty good. And my source of that is from a guy named Kevin who jumped off the Golden Gate Bridge. And he does these. Talks about that. And in his talk, he talks about that term lethal emotional pain. He's like, that day I woke up in pain. But then as the day wore on, it became lethal. And he was taking. He describes in incredible detail, they're taking the bus up to the. The. The bridge. Walking up there feeling completely numb, but such a pain that was something like he never experienced in his life.
- [21:33]
Richard Tate
Needed to do it. He was being pulled to it.
- [21:35]
Dr. Timothy Fong
Compulsion to do it. There was this darkness over his soul. It was incredible to hear that. So when we have that, obviously that's something we focus on emergency action plans, since that's. That's a hard thing. I think one of the biggest shifts that happened in our field is when.
- [21:54]
Richard Tate
I first came into thinking, something happens like that, what do you do?
- [21:58]
Dr. Timothy Fong
So one of the things that we talk about in our early sessions with all patients is in the event you develop lethal emotional pain, what's our plan to deal with it? Just like we always say, if you develop an allergic reaction to a bee sting or you have a stroke or you have a heart attack, what are you going to do?
- [22:16]
Richard Tate
Yeah, except for when you have a stroke or a heart attack, there's usually one protocol or a bee sting. One protocol. But here, since everybody's different, you have to have a plan to make certain that every. A different plan for everybody.
- [22:27]
Dr. Timothy Fong
Exactly. And so that plan has to make sense to the person before it happens. But we also know that while it's happening, it's incredibly difficult to execute that plan to actually do it. So my work, thankfully, on the outpatient side doesn't land in that area that often. On the inpatient side. Absolutely. We get that all the time. But we see the folks that come in who are actively suicidal or in profound pain, who made that decision to come to the hospital or who are brought there because a family member or a therapist was so concerned about them, or they were brought there because of the paramedics and the police found them in such a terrible state that that's what brings them in there. So that's how we handle that. On that end. My. What we usually break through again is I like people to have again, those Plans that make sense for them. For some people, it's having a couple extra medications they know that bring down their anxiety. For some, it's a chain of phone calls. For other, it's just a safe spot that they can go to.
- [23:32]
Richard Tate
And 99% of them are, what drugs are you going to give me if I have a problem?
- [23:36]
Dr. Timothy Fong
That's right. That's right. And that's what we don't want. We say, no, listen, there's a million things you can do. I have one patient, and she came up with, I'm just going to listen to a set list of five songs from the 80s.
- [23:48]
Richard Tate
Oh, that's awesome.
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Dr. Timothy Fong
It's amazing, right? And it's, you know, exactly what you'd think about. Don't Stop Believing. Take On Me.
- [23:53]
Richard Tate
Like a Virgin.
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Dr. Timothy Fong
Yeah, I don't think that one's in there, but Like a Virgin. It's not in there. I don't. I don't know exactly what's in there for her, but she put it.
- [24:00]
Richard Tate
Wait a minute. You don't remember?
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Dr. Timothy Fong
No, I remember. Of course. I don't think.
- [24:03]
Richard Tate
In the cake.
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Dr. Timothy Fong
In the. No, of course I remember. I don't think that was her song in there, but she created a set list and she put it in her phone for. And she labeled it for emergency purposes only if I get suicidal. You know, something like that. And we kind of laughed about it.
- [24:21]
Richard Tate
And, sweetie, it changed her state. It got her centered, made her comfortable.
- [24:26]
Dr. Timothy Fong
But she came up with that plan, not me.
- [24:29]
Richard Tate
Okay?
- [24:29]
Dr. Timothy Fong
That was key, okay? That's what I do.
- [24:31]
Richard Tate
Do you want to know what's really cool? Okay. That's Barry Manilow.
- [24:36]
Dr. Timothy Fong
Yeah.
- [24:37]
Richard Tate
I swear to God. No, that's what it was. She intuitively knew to bring back the old song, right?
- [24:47]
Dr. Timothy Fong
That.
- [24:47]
Richard Tate
Bring back the old times.
- [24:49]
Dr. Timothy Fong
That's right. Yeah.
- [24:50]
Richard Tate
Isn't that amazing?
- [24:51]
Dr. Timothy Fong
That's amazing. There's real men.
- [24:53]
Richard Tate
Real men like Barry Manilov.
- [24:55]
Dr. Timothy Fong
He's still. He's still alive. I think he's still performing.
- [24:58]
Richard Tate
He's the best.
- [24:59]
Dr. Timothy Fong
I've not seen him. But you've never seen. I've not seen him. I know he's on the list.
- [25:06]
Richard Tate
Oh, God. Okay, I'm just gonna ask the question. How does treatment change when you're dealing with someone who's also got a borderline personality?
- [25:16]
Dr. Timothy Fong
Oh, you love this one. So.
- [25:18]
Richard Tate
I love you. I hate you. I love you. I hate you.
- [25:20]
Dr. Timothy Fong
You know, I think borderline personality disorder has gotten such a bad rap through the years. You know, people here, they immediately think, oh, my God, Absolutely difficult. Can't deal with them hard to like. And that's absolutely not true. You know, number one, we know that when you die, when you get a proper diagnosis, that's the first step, right? When people understand what they have that's affecting their mind, their body, and their behavior, that really, really helps. So what's the first thing?
- [25:45]
Richard Tate
That's the first thing.
- [25:46]
Dr. Timothy Fong
So first thing again, the. How does treatment change when you're dealing with someone? Doesn't change much because you've identified what the reasons are why their behaviors and their thinking patterns are creating so many problems for them. So it changes when you actually make that diagnosis. On the flip side, too often, we see a couple of things. We see a lot of times folks coming to the hospital, and immediately they're called borderline within a matter of minutes.
- [26:13]
Richard Tate
Why?
- [26:14]
Dr. Timothy Fong
Just the way they're acting. And people just jump to a conclusion. So that's very dangerous in my mind. But the number two, I think when we take the time to actually diagnose it, it provides tremendous, tremendous relief for people.
- [26:29]
Richard Tate
How so?
- [26:29]
Dr. Timothy Fong
Well, because now they understand what they're dealing with.
- [26:32]
Richard Tate
What's the difference in treating borderline personality disorder versus bipolar disorder?
- [26:39]
Dr. Timothy Fong
So the two different things. Bipolar disorder, by definition, is a mood disorder. Borderline personality disorder is a disorder that is hinged back to kind of your facets of your personality. Their presentations can look similar. Impulsivity, rage, anger, mood, liability, things like that. Well, we know with the borderline personality disorder that these were things that had been set in stone from toddler years and all the way up, and that even though they're personality traits, that they can be modified, they can be helped. I'll give you an example. So a few times I explained this to patients, I'll say, you know what? Based on my read, you do not have a mood disorder that fluctuates and goes up and down like the seasons or puts you into a zone of two weeks straight. No. You have a brain that's incredibly sensitive to the world, and it reacts bang, like that. And unfortunately, your reactions, your thoughts, your feelings, your behavior create problems for you. But that, in another world, is a super strength or a super skill.
- [27:43]
Richard Tate
How so?
- [27:44]
Dr. Timothy Fong
Because you can react and think quickly on your feet. You can tolerate ups and downs. You can think in ways I can't even think. You see things I can't see. So.
- [27:55]
Richard Tate
So? So everything that's got a yang has a yang.
- [27:59]
Dr. Timothy Fong
That's right.
- [28:00]
Richard Tate
Okay.
- [28:01]
Dr. Timothy Fong
Any weakness can become a strength. Any strength can become a weakness. So you're not a bad person just because you get emotional and cry when you, when your friend doesn't text you. You know you're not a bad person when you have thoughts of wanting to hurt yourself after breaking up with a boyfriend. So you pile that all together and that's where we start to see those differences. And I think mood disorders, again, they have a rhythm on their own. They're not based on who you are, they're just based on what's happening to your body and your brain. And they're more consistent. You're depressed consistently every day, no matter what happens, good or bad. Or you have mania for seven days or 14 days straight. You're not sleeping, you're spending money. Things that are not part of your normal personality or your normal moral code. You're doing things outside the realm. That's how we start to differentiate a mood disorder versus a personality disorder.
- [28:53]
Richard Tate
Right? Ah, this is a great one. If someone's mood disorder is untreated, is there any point in trying to treat the addiction first?
- [29:05]
Dr. Timothy Fong
Oh, that is a good one. So back in the 90s and 2000 when I went to medical school, the prevailing thought was what? You can't treat someone's mood symptoms until the substances are gone. Right. Or because you don't know how bad, you don't know how bad, or you don't, don't do anything. Somewhere right around 2005, the field started to say, you know what, it doesn't matter what's causing what. You treat the symptoms that's giving people problems or pain. Now you Fast forward another 15, 20 years, it's a little bit more nuanced than that now. Now we're seeing that. Yeah, of course you have to treat the symptoms right away and you have to treat, quote, both at the same time. Because sometimes you don't know what leads one to what. I'll give you a perfect example. Cannabis is a great thing now, a great story on all this. For years, you know, we weren't seeing a lot of cannabis induced psychosis. Now we are, we're seeing tremendous amounts of it and, and really deep psychosis. I'm sure you are as well. From the point where when people stop using cannabis six months later, a year later, they're still really psychotic. Oh, we're seeing a ton of that in the hospital. We're seeing a lot of that in other community based settings and things like that. So then people say, well, what is that? Are they psychotic or are they just cannabis use disorder? We're now moving toward to say if you have cannabis induced psychotic illness, that that is a psychotic illness. Meaning had you never taken cannabis in at all, you would never have gotten. So therefore what you have is a psychotic.
- [30:39]
Richard Tate
I've never. I swear I have a treatment center.
- [30:43]
Dr. Timothy Fong
Yeah.
- [30:43]
Richard Tate
Never experience.
- [30:45]
Dr. Timothy Fong
No kidding.
- [30:46]
Richard Tate
Well, mostly because when they call and tell me they want to stop smoking pot, I mean, I'm here to help people.
- [30:52]
Dr. Timothy Fong
Right, right.
- [30:52]
Richard Tate
With real problems. Yeah.
- [30:54]
Dr. Timothy Fong
November 2016, state of California legalizes cannabis. Adult Use of Marijuana Act. First dispensary opened in 2018. You fast forward now to 2025. There's no doubt that the cannabis out available in dispensaries, regulated and unregulated, has a much higher concentration of THC than ever before. Number two, perceptions of harm with cannabis have gone down tremendously so that more and more people are using it. Young, middle aged, older adults, basic things. There's a lot of myths out there, but number one, we know cannabis is addictive. Number two, we know cannabis makes the vast majority of mental health problems worse.
- [31:32]
Richard Tate
Why is cannabis addictive?
- [31:33]
Dr. Timothy Fong
It's addictive because it's an addictive substance. And you decide, is it addictive physically?
- [31:38]
Richard Tate
Are you physically addicted?
- [31:39]
Dr. Timothy Fong
Oh, yeah, absolutely.
- [31:40]
Richard Tate
How do you know for sure?
- [31:41]
Dr. Timothy Fong
Cannabis withdrawal, we see this.
- [31:43]
Richard Tate
What is it? What is cannabis withdrawal?
- [31:45]
Dr. Timothy Fong
We see a syndrome of folks when they stop using or reduce using. They'll have things like difficulty with sleep, difficulty eating. Why do they have nausea, why do.
- [31:52]
Richard Tate
They have difficulty with sleep?
- [31:54]
Dr. Timothy Fong
Well, the presumption is that when they're cannon, cannabinoid receptors now are altered by different blood levels that they previously used to the body, you know, in a compensatory mechanism just like alcohol.
- [32:05]
Richard Tate
The reason is, is because when you stop smoking pot, it is addictive. And most people don't know that.
- [32:10]
Dr. Timothy Fong
Right.
- [32:11]
Richard Tate
But you do and I do. But we know it for different reasons. You know it for. And all the smart you just said. And I know it because you can't stop sweating and you're sleeping in a pool of sweat and you have to change your clothes three, four times.
- [32:26]
Dr. Timothy Fong
Feel like crap.
- [32:27]
Richard Tate
Okay, well, it's. You're not suffering. It ain't a withdrawal like cocaine, where you want to light yourself on fire, or heroin, where you're going to grab a brick and hit an old lady over the head and take her purse because you are violently sick. You're sleeping it off, but you can tell that you are physically addicted to it because if you stop smoking it for the next week, you're sleeping in a puddle.
- [32:56]
Dr. Timothy Fong
Yeah.
- [32:56]
Richard Tate
Okay, so I love that and I'm trying to explain it. Yeah.
- [33:00]
Dr. Timothy Fong
No, I love that. And the other thing people forget sometimes it could take a week from the time you stop until you start feeling those withdrawal symptoms.
- [33:10]
Richard Tate
Oh, no, you can't.
- [33:11]
Dr. Timothy Fong
You know, that's what we've seen. And you know, people go stop on a Monday and it's not until like the following Monday they start feeling those symptoms in part because of these really high points. I get what you're saying. Right. So the addiction parts of cannabis is for real. Number two, I wish we could say with confidence that medical cannabis works really, really well. Unfortunately, it's not there yet. We know it works for pain. We know it works for certain types of nausea, certain types of, you know, muscle spasticity and things like that, but it makes essentially every mental health condition worse, and it doesn't make it better.
- [33:44]
Richard Tate
Do you know why that is?
- [33:46]
Dr. Timothy Fong
I have a whole thing. But I'd love to hear your quick.
- [33:49]
Richard Tate
And dirty answer because everything is delayed. Anything you push, you kick the can down the road.
- [33:55]
Dr. Timothy Fong
Yeah. It's a band aid.
- [33:57]
Richard Tate
And you just, you're not, you're not dealing with it. That's right thing you're procrastinating on, dealing with gets. Gets scarier and scary and scarier.
- [34:05]
Dr. Timothy Fong
The best way I can say is when patients say it's the best thing for my sleep, I say, but what's the reason your sleep is so poor in the first place? Well, I'm not quite sure. You know, we have. You're just not working that core issue. So all you're doing is covering up your sleep problems with a sedative like cannabis, and eventually that's going to stop working.
- [34:23]
Richard Tate
What are the, the biggest reasons why people can't sleep in our sphere?
- [34:30]
Dr. Timothy Fong
Trauma. Poor sleep hygiene. Bones.
- [34:34]
Richard Tate
Poor sleep hygiene, meaning the blue light.
- [34:36]
Dr. Timothy Fong
Blue light, the phone and the hand, the TV on, you know, caffeine, keeping the temperature too hot.
- [34:46]
Richard Tate
Right. Anything?
- [34:48]
Dr. Timothy Fong
Yeah, yeah. Sleep hygiene.
- [34:49]
Richard Tate
Yeah. All right. Anything you want to plug. Anything you want to. Any, any, any. Any question you want me to ask. Anything you want to get out?
- [35:00]
Dr. Timothy Fong
Well, a couple things I'll plug. So we have at ucla, UCLA Gambling studies program that looks at an under looks and examines gambling behavior on all aspects, including gambling disorder. We have a California gambling treatment program for no cost 1-800- gambler. Our website, UCLA gamblingprogram.org has a lot of great information on gambling. And of course, in 2025, this is the rage. You know, mobile sports betting. That's what everyone's talking about. Cryptocurrency, financial tech trading. These are all the things that we're seeing and trying to address and minimize the harm from those behaviors. The second one, again, is our cannabis program, UCLA center for Cannabis and Cannabinoids, available at cannabis. Semel, ucla. Edu. And we're doing all sorts of studies in the lab looking at how cannabis impacts body, brain, and mind. So if people are in LA and they want to volunteer to sign up and be one of our research participants, take a look at our website where we take volunteers in and give them cannabis and understand what happens. That's kind of cool. Then lastly, I'm actually going to be President Fancy Fancy, of the American Academy of Addiction Psychiatry. And we're a professional society of about 1500 addiction psychiatrists across America that provide care related to addiction and mental health. We're friends and partners with our friends in asam, American Society of Addiction Medicine. But the message out there is that help is there. I think so often families and people and folks who are unsure what to do, they don't call anyone or they don't know who to call. They don't know to call. And I love it when patients or families come in. They're just like, we're about not talking. Sure, we need to see you, but we. Someone told us we should, or I just have questions about my cannabis or my gambling or about my cocaine use, and I want to know more. That's the thing. People should go in and get help as soon as they can. But lastly, I think nowadays the biggest thing that I see, again, is that there's so much information out there about addiction and mental health and substances. But there's a lot of. Lot of noise, right? There's a lot of, like, misinformation and disinformation. And I think for folks to get proper information, it's really just to do the homework and research themselves and then verify it with trusted people to say, hey, does this make sense that I do this or I do that? Is it true that, you know, this can cause me to grow a third testicle, that sort of thing? So it's really about educating themselves through proper channels.
- [37:31]
Richard Tate
Dr. Timothy Fong, thank you for coming here. You've done a lot of good today. That's what this podcast is about. It's about increasing awareness around the drug issue today and mental health issues today, and we're all better for it. So thanks.
- [37:52]
Dr. Timothy Fong
Thank you for having me. Absolutely. Take care.
- [37:55]
Richard Tate
All right, see you next Tuesday.