S1 E49 Shit2TalkAbout Solving Addiction with Dr. Joseph Volpicelli
Transcript was AI generated, if there are mistakes, please let me know! Thank you in advance! Jenn Junod
Hello, beautiful human.
Jenn Junod
Thank you for joining. Shit. You don't want to talk about. We're stoked to have you be a part of the conversation changing shit. You don't want to talk about into shit to talk about. This show was created to have us open our minds and learn about new perspectives. Even when we don't agree with them, please be advised episodes can discuss content that is not suitable for all listeners and it can be triggering opinions of our guests expressed on the show are their own. They do not
necessarily represent the views of myself or the show. There are a few ways we could really use your support. Please share your favorite episode especially send them to someone that could really use the content we talked about, donate on paypal and Patreon, subscribe and rate the show itunes and Spotify and follow on social media and join the conversation. It's shit to talk about. That's shit. The number two talk about links are in the episode description.
Jenn Junod
Hey, Doctor Joseph Vol Pelli.
Dr. Joseph Volpicelli, Jenn Junod
I know I always but you hear me actually you got it right.
Dr. Joseph Volpicelli
It's for Pelli.
Jenn Junod
Yes, for one. Beautiful. Thank you for joining shit you don't want to talk about and please introduce yourself and the shit you want to talk about today.
Dr. Joseph Volpicelli
Well, thank you, Jen. Thank you for having me on the show. What I like to talk about is the opioid crisis right now in the United States, 100,000 people die from drug overdoses and most of them are related to opiate overdose and you know, 250 people die each day from drug overdose. And during the time of this podcast, 10 people will die.
So it's a serious problem and a problem that I think we're addressing very poorly. And the mission right now is to see if we can do something about it. All brain based treatments, clinical practice. So we can help people recover.
Jenn Junod
Awesome and the fact that you're wanting to help people recover not awesome that we're having to talk about this shit before we go into the addiction side of things. How did you get into psychiatry?
Dr. Joseph Volpicelli
Well, you know, I was number one, I think this is a great concept for a show talking about shit that you don't want to talk about. And, and as I was thinking about doing the show, I started thinking about some of my own stuff that I don't talk about or think about. And in my family, when I was in my early twenties, I learned of a grandmother, my father's mother who died in Norristown State Hospital and I never knew her that apparently when she came to the United States from Italy, after she
gave birth to my father, she had a nervous breakdown. And at the time they put her in a mental hospital and she was separated from her family and we never talked about her. I don't know if my father even visited her very much while she was in the hospital. And for me, you know, that was just a, a terrible shame about how people dealt with mental illness.
And I don't know how that affected me. But, that's something that sort of sticks with me a bit. And it's ironic that even though in my family, we have these, these secrets that my, during my daily job, I spend my time talking to people and encouraging them to talk about shit that they don't want to talk about. So that's what I do for a living. And so that got me involved in interesting, interested in behavior and how behavior interacts with biology.
And so I went to University of Pennsylvania where I was a medical scientist training program person. And, so I got an MD and a phd at Penn. Wow. And so one of the rotations I had was a rotation at the VA hospital and I had a patient who was in terrible alcohol withdrawal. So he was hallucinating and he was a Vietnam vet. And, you know, I felt pretty full of myself at the time I was in the MST P program and thought I knew what was going on.
And, and so we had rounds one day and so we had the attending doctors and other students and I was presenting the case of this patient who had trauma in Vietnam. And while he was in Vietnam, he started using heroin. But when he came back to the United States, he stopped using heroin and started drinking heavily. And I said, and so he's in, has Liam T Truman's DTs, we're gonna treat it.
Xy and Z. And as I was presenting the case, patient turned around and slapped me. Now, I don't know if he knew what he was doing because he was out of it. But I sort of needed that slap a little bit because while I was presenting the case, I failed to take notice that I was dealing with a person and not just the clinical case. And so I spent time talking to him after he detoxed and I found more about his story about all the trauma he suffered when he was in Vietnam, all the uncontrollable
stress he had and, and how he and many of his buddies would use heroin to cope with that. And then when they came back to United States, heroin wasn't as easily available and he found that he could use alcohol as a way of helping to cope. Now, at the time, in addition to working with patients in the medical school. I was always also doing research in the psychology department where I was looking at uncontrollable trauma and relationship to disease and this was in a rat model.
Dr. Joseph Volpicelli, Jenn Junod
So I was working with rats and, that's like a whole another conversation because I have so many curiosity questions there.
Dr. Joseph Volpicelli
Oh, well, sure, we have to get into it. But it was interesting that it was hard to get rats to, drink alcohol and I found it by giving them uncontrollable trauma that they were more likely to drink. Hm. And what I found was that it wasn't the trauma per se that led the rats to drink, but the ability to control it because when I did the studies, I had other rats who were exposed to the exact same trauma, but they could turn it off, they could shuttle back and forth or hit a lever and turn the
shock off. And so even though the physical stress was the same, psychologically, having had control over things had a profound effect in terms of how the rats coped and having controlled rats wound up being less depressed, less helpless. We, we call that learned helplessness and it even improved their physical ability to fight disease.
In one study. For example, we did way back in the day, we gave rats tumor cells after, after giving them exposure to uncontrollable trauma, no trauma or controllable trauma. And we found that if you had uncontrollable stress, your ability to fight cancer was suppressed. So more rats were likely to die from the tumors compared to rats who had no stress at all.
But the surprising thing was that if you had controllable trauma, you tended to be more resilient, you're able to fight the tumor better. So we call that learned mastery. So that was the sort of research I was doing. And I said, let me see if I can come up with a rat model of drinking and see if I can tie all these things together. And what I found was that exposure to uncontrollable trauma also increases rats, drinking.
And at the time, I was looking at the biology of uncontrollable trauma. And it turns out that the familiar fight or flight response is only part of the story that during the fight or flight response, your body also releases endorphins and do in the oia molecules which help kill the pain. And so now I had sort of a mechanism to explain how uncontrollable trauma, alcohol and opiates work.
They all work through the opiate receptor, they all stimulate opiate receptor activity in some way. And so I reasoned if I could block the opiate receptors, then I could block drinking in rats, drinking caused by the uncontrollable trauma. And so I did the experiment in rats and sure enough, it worked. And then I did the study in humans. So after I finished medical school, I did a residency in psychiatry.
Then I did a fellowship in n psychopharmacology and then did a study where I gave Naltrexone an opiate blocker to veterans who are recovering from alcohol problems. And I found that when they took Naltrexone, it blocked the high associated with drinking and it reduced relapse rates dramatically.
Dr. Joseph Volpicelli, Jenn Junod
Wow, that is, that is so cool.
Jenn Junod
And to the beautiful humans listening or watching one question that I asked because I don't know medication names at all. And I asked, oh, is this the pill that makes you throw up if you drink alcohol? And the answer was no, it is something totally different. But just to get that clarified, I, I do want to bring it back a bit about your grandmother because when was your father born?
Do you know 1918? Ok. So she was during the time that the anything that happened would put you into a psych psychiatric ward as well as po depression, all of those were not known? And was it that I'm trying to remember the research I was doing on that. There was like a blanket, a diagnosis that caused a lot of craniotomies to happen to.
Dr. Joseph Volpicelli, Jenn Junod
And so your mother or grandmother lived through that time and that, yeah, she did and, and she was diagnosed as having paranoid schizophrenia, but I'm not sure about that diagnosis.
Dr. Joseph Volpicelli
That's what they were doing.
Jenn Junod
That's what I was trying to think of.
Dr. Joseph Volpicelli
The poor woman was an immigrant did not know English at all. And I'm sure they were asking her questions and there are things lost in the translation. She died. She, she had her symptoms after giving birth. So it's more likely postpartum depression and they didn't have very effective treatments at the time except to isolate people from the rest of society.
Jenn Junod
Oh, my gosh. And audience. If you haven't done research there, it is heartbreaking yet It really did help modern medicine. So, for myself, I'm torn because I'm like, oh, my gosh, that's horrible. Yet glad we learned. But it's definitely something. It's, we see that show up and how we learn through it. And now, did you get any information about the time her time there or was it because your father may not have visited her much? You just knew she was there?
Dr. Joseph Volpicelli
Yeah. I just found out when I was in my early twenties that she died from, I believe, a stroke and I think she was in her seventies at the time and that's when I first learned about her.
Jenn Junod
Wow. Ok. And then you went to, you were getting your MD and your phd and I'm not sure if I've ever asked a psychiatrist this. Do you need both to be a psychiatrist?
Dr. Joseph Volpicelli
No, just the medical degree. Ok.
Jenn Junod
I thought so. I'm like, wait, I don't remember them ever. Anyone else I've talked to talking about getting both. That is a lot.
Dr. Joseph Volpicelli
Yeah, I it, it's funny people ask me, are you a psychiatrist or a psychologist? And I say yes because of both.
Jenn Junod
Awesome. OK. And then you started working with the VA do you still work with the va a lot?
Dr. Joseph Volpicelli
Not so much anymore?
Dr. Joseph Volpicelli, Jenn Junod
And I can tell you the story of how I left the VA in the University of Penn to set up the our clinical program, the Volpicelli Center and the Institute of Addiction Medicine that happened a few years later, but I spent many years at the VA I will ask that after let's break down addiction, you did kind of a little bit about, you know, us wanting that high with addiction and the medication you mentioned about blocking that high.
Jenn Junod
And I know I am by no means gonna be talking about this in a medical terms. I am gonna probably be dumbing it down quite a bit to make sure I can conceptualize it. Now, what could you define for us? What is addiction and if there's different types of addiction?
Dr. Joseph Volpicelli
Yeah, that's a great question. And I'm happy to talk about that because even in my field, the way it's defined by the DS M Diagnostic Statistical manual, it's defined more by its consequences that people have an obsessive desire to use a drug despite adverse consequences and the consequent can consequences can include problems with work, problems in relationships, problems with impaired control, over drinking and even physical consequences.
Like tolerance and withdrawal. So they define addiction by its consequences, but we normally don't define other diseases by their consequences. We look at what's the cardinal feature, what's the really defining aspect of addiction? And I think this gets lost. And for me, the defining characteristic is simple. It's when you do something, it increases the motivation or the need to do it more.
And I'll give you some examples of sort of mild addictions If you will. I have an addiction to these pretzels that have like a peanut butter inside that I can go all day without eating them. And I'm perfectly fine. But if I eat a couple, my craving to keep eating them increases the more I eat them. And so I have to hide, I literally, I have to hide them right now.
They're up in my bedroom. So I don't, reach down to start grabbing the, the pretzels now. And it's the same with people who are addicted to drugs and alcohol that for some people when they drink it produces a nice, pleasant sensation. But as that pleasant sensation wears off the craving to have the next drink increases. And that seems to be particularly true for people who have a strong family history for alcohol problems.
Now, there's another group of people that the addiction occurs more gradually in time. So there's some people who have one or two drinks at five o'clock at the end of the day to relax and I found during the pandemic that for some people es especially during the pandemic, the one or two turned into 23 or four drinks. And so you could see that the need for drinking increased more over time. And that's what differentiates addiction and addictive behaviors from other pleasant
behaviors. I for example, love raviolis. But after I have a couple of them, my motivation to keep eating raviolis goes down, I get full, I'm, I'm I get satiated. I'm done. And the same thing with other pleasant things to eat, usually I get full and I am no longer hungry.
But for addictive substances or addictive behaviors, you get more and more need to do it the more you do it. And so it creates a vicious addictive cycle. And that's the cardinal aspect of what addiction is interesting.
Jenn Junod
I'm kind of cringing over here since I have a sweets addiction. If there are sweets in the house, they will not be in the house for more than a day or two. And it is very relatable. And the fact that if I have my gluten free Oreos and I don't touch them, I'm fine. But if I have one, I will eat them until I'm full like and can't eat anymore. And it's like I wanna stop.
Dr. Joseph Volpicelli, Jenn Junod
But I just like, I'm craving more and perfect example of that addictive cycle.
Dr. Joseph Volpicelli
That's a really good example.
Jenn Junod
I guess in my mind when I hear addiction I think of people that are like could have gotten into addiction from peer pressure from, you know, from going and they wanted to do ecstasy, their buddies wanted to do ecstasy. They hear how good it is and then they just want to do it all the time. I don't know if ecstasy is actually addictive, but I was trying to think of something other than weed because most people I know could quit weed and it's not as addictive from what we So I was going for
another one. But you mentioned about with your research with the rats that it was trauma that you were really researching traumas. So even if people don't have addictive tendencies in their family, is it more likely for individuals to find addiction as a coping mechanism due to trauma?
Dr. Joseph Volpicelli
Yes. So trauma is clearly one of those factors that can lead to addiction that let's look at alcohol for example, that some people when they're anxious will drink alcohol and alcohol turns out not to be a very effective anxiolytic if you will, but that your body gets sedated when you drink, which is fine, it's a way of escaping. But then as the alcohol wears off, you go through a phase where you're even more anxious than before you started drinking.
So, yeah, I call it anxiety. The hangover is increases your anxiety and when people learn that they can take away that anxiety by redoing on alcohol, it sets in motion that addictive cycle where then they have to start drinking to deal with the effects of the previous agents. And that's, that's, that's when you cross that line from being, occasional user to becoming, having a problem with it.
Jenn Junod
Interesting. Ok. So there is definitely. And the way you talk about addiction, it makes me feel like I understand a bit more about gambling. I worked as a cocktail server for about a year on random jobs I've had and there were regulars that I just couldn't understand why. And to this day I hate gambling because I hate, it's the, I hate losing. And I'm like, I don't want to wait till I win because I know I'm just gonna lose all my money.
But I would watch people lose thousands of dollars through the time that I knew them. And, yeah, it makes sense why even in sales and I was in sales in sales leadership for 12 years that when you close a sale, when you get the winnings from gambling, it is definitely a high.
Dr. Joseph Volpicelli
Yeah. It's probably related to biochemical changes in the brain. There may be a little squirt of dopamine if you will. That gives you that pleasure. But then you're chasing the dragon all the time. You're trying to get that squirt back and, and you miss it. And the people who are, make money from gambling know the right payoff matrix to get that little squirt to, to get people addicted and, and even when it comes to food, there, some foods seem to be particularly addictive for me.
It's the, the pretzels with the peanut butter inside. For a lot of people. It's sweets and things like that. The high fructose corn syrup is probably a, a good example of something that could be addictive for people. What I've noticed for myself, at least that if I see a patient after eating some pretzels, after about an hour that craving wears off, so it has a time course. So that's why it usually doesn't turn into a terrible problem for me because I, I hide them and give myself some
space for that craving to wear off. But different drugs, different behaviors that craving lasts a while and when and it can create the condition that you're more likely to get addicted to the substance. And I think part of why pots not so addictive is that it wears off so slowly that you don't go through that withdrawal, that you have to redose to feel better. But you can design drugs that wear off quickly and then create the need to have to redose again.
Dr. Joseph Volpicelli, Jenn Junod
And then that's where, you know, drugs like heroin and fentaNYL come in that they're really designed to produce a quick high and then they wear off and then you feel lousy and you have to redose and those other, I'm just thinking from my own experience.
Jenn Junod
And mom, if you're listening, please just like skip through the next five minutes that I've tried ecstasy and it wore off so quickly, it made me so nauseous afterwards that the people around me had cocaine and I tried it. And in the way I work on understanding drugs is cocaine is a lot like cocaine Adderall and meth all have very similar reactions in the body.
And I'm a DH D. So when I was taking the cocaine, it just felt like I was taking my Adderall. And for listeners, that is not a suggestion that you should go do cocaine, please don't do be very like if you're gonna go explore, please be very cautious. Do your research? Just wanna say that I'm talking about my own experience.
Dr. Joseph Volpicelli
Yes. Well, which raises a really good point because I have patients who have AD D and they have addictions and, and so they would benefit from going on something like Adderall. But in the field, they would say, don't ever give someone with an addiction Adderall because they'll get addicted to it. But if you look at the I call pharmacokinetics of the drug for something like cocaine, it gets in your body very quickly.
So it stimulates dopamine quickly and produces a nice euphoria and then it leaves your body quickly. And so you go through a rebound phase in which you feel dysphoric, you feel uncomfortable and, and people with cocaine, it is really a perfect example where doing a little cocaine increases the need to do more of it. You get stuck in that addictive cycle.
You can even do studies with rats where rats will bar press for cocaine and give up other reinforcers. They, they're not interested in eating anymore, having sex anymore. Everything centers around getting the, the cocaine and so by wearing off quickly, you can learn that you can feel better by redoing on. It sets up the addictive cycle. But when you take something like Adderall that is slower and it's onset and particularly if it's a ss release Adderall, it wears off more slowly.
So you don't go through that rebound period where you feel awful. And so that tends to not be so addictive. Now, there are still people who use Adderall to do well in for studying and things like that. But it's, it's, again, it tends to be less addictive than something like cocaine and it has to do with how the drug works in your body.
Jenn Junod
Yeah. And with, with my Adderall, I can say that my one thing and I'm, I feel so fortunate that my primary care told me this when I first was diagnosed was take what she would call drug holidays. And for two reasons of when you're constantly taking a medication that like this, it can cause you to need more over time and up a dosage and also the addiction cycle of it, whether or not, I consciously go for, you know, want more Adderall is my body will go through withdrawals even without just
the constant wanting to get quote unquote high because I don't feel high when I'm on Adderall, but I'll feel more awake, I'll be able to get more done. I'll be able to pay more attention, which is what it's for. And so I've come off of that are all quite a few times for surgeries for experimenting to see with, of course, the help of my psychiatrist to see if I can handle it.
I, I mentioned these three because my father in law moved in with us a little over a year ago and he was a meth addict for over 30 years. And that's where I learned more about cocaine and Adderall. And that because there's different types of drugs and the different reactions and it does make sense that when you talk about medication or a drug that goes through our system quickly, we want to redose such as what you talked about with alcohols and anxiety.
And that makes so much more sense and also why we get addicted to possibly, at least in my, my father-in-law's example of not wanting to deal with demons as he would say. So we talked a lot about what addiction is and how addiction can start. There's so many different ways, many ways we didn't even talk about. Now, I'd love to hear more about how to treat addiction. And also after that, how to prevent addiction if we're noticing these type of things.
Dr. Joseph Volpicelli
Yes. No, that, that's great. The, so one of the things I found in my research is that medicines like Naltrexone can be helpful to help block that addictive cycle. And it turns out NALTREXONE, particularly the injectable version of Naltrexone, the extended release, NALTREXONE can help people with opiate addiction. There's other medicines to help pe treat people with opiate addiction, including buprenorphine or Suboxone and methadone.
I can talk a little bit more about the advantages of those medicines. But it's clear that medicine can have a profound effect in terms of reducing the problems associated with addiction that has a dramatic effects in terms of reducing overall overdose deaths, for example. But the problem is that the medicines are not routinely given to care and this is what sort of gets me upset is that we know from research that these medicines are helpful, but many people have addictions, even
those who wind up getting treatment for their addiction are not even offered the medicines. So for example, for opiate addiction, less than half the people who go into treatment receive any medication. None of the methadone buprenorphine or Naltrexone and that's terrible. That's just unacceptable. But the only thing I found is that the medicines by themselves are not the whole story.
When I did my research with Naltrexone, I found the medicine works great for a lot of people, but some people would stop taking their Naltrexone on Thursday so that they could get high on the weekends, you know, as the naltrexone wore off, they could still get the high from the alcohol. And so the medicine only works if people are willing to take it.
So people have to be on board with wanting to, to recover. And so I found that I needed to integrate psychosocial treatment into care to really get people to recover. So it's more than just a physiologic disease. You know, and you know, they, they say it's a brain disease, it's not a brain disease, it's a behavioral disease. And we need to change people's behavior. And so the psychosocial component is really important to integrate.
And so I just wrote a book and designed a a psychosocial treatment that could be easily conducted by physicians or physician assistants or nurse practitioners. And we found it were great in our research studies that help get people engaged in treatment and to stay in treatment. But what I found was that it wasn't being done in clinical practice.
Jenn Junod
And so a few things to impact there when we say clinical practice, that's more of if we talk about like systemically of it being used everywhere, right? OK. And then for when we talk about overdose, especially after someone has gone through addiction support from my knowledge there, that's from a lot of times you go into someone will overdose due to their time away from the drug, they try to take the same amount and their body can't handle it anymore.
Dr. Joseph Volpicelli
Yeah. So there's several reasons why people are overdosing. It's such a high rate right now and a lot of it has to do with fentaNYL and how potent it is and easily accessible it is. So, for example, there are people who find their way into treatment. Maybe they go into a rehab center and they spend 28 days in the rehab center. And during that time, your body loses its tolerance to opiates.
So it might have taken six bags to get high before, but only take one bag now. But when they leave the rehab and they've lost their tolerance, they go out and they, they slip up, they get back in the old environment and they go back to using the same dose that they used to use and now they overdose and could potentially die. There are people who are in treatment with the Naltrexone or in treatment with buprenorphine who feel that well, they're cured now, they don't need it anymore.
So they stopped the medicine and you know, I have a couple of patients that a year 23 years later, something happens in their life and they relapse and they go back to using it as high rate as they used to use. And, and this time they overdose and die. And then right now there's another problem which is contributing to the overdose deaths. And that is that fentaNYL is being put in everything. So I have patients who abuse Xanax and they said, oh, I bought some Xanax on the street.
I said, are you sure it Xanax? And they swore up and down. Yeah, it's Xanax. Here's the, here's an example. Here's the pill looks exactly like the pills you buy over, you know, at the pharmacy. But when I checked the urine, all the person that was fentaNYL in their urine. So people are pressing pills to look like Xanax and it has fentaNYL in them.
Jenn Junod
Yes. And just really quick for our listeners, like if you are doing recreational drugs, our family does have a personal death from somebody buying cocaine and it being laced with fentaNYL and the dealer has been convicted of murder because this is something that is also a huge issue of fentaNYL being laced in so many things and not that I'm for or against
100% on like recreational drugs. We're talking about addiction itself. But for those who are not aware of that, please start thinking about that as repercussions as well.
Dr. Joseph Volpicelli
That's a great message. That's really a great message and, and yeah, many people have overdosed accidentally when they thought they were buying something else and it had fentaNYL in it. So they had to be very, very careful.
Jenn Junod
Now when we're talking about your like you started your center, you have the book you wrote. I know that when my father in law moved in with us, he was homeless at the time he lived in California. And there is such a homelessness in such high homelessness in California. We live in Colorado. So we moved him out here. You talked about previously that a lot of people go back and overdose because they're around the people that their community again and the community gives them access.
So we were able to help solve with that. But trying to find a paid rehab is like non-existent like, hey, how do we help addiction? I don't know, you can be like charged a gazillion dollars to be able to get help. You don't have money. And I feel like that is a very systemic issue because it means those in poverty which I'm guessing have a higher addiction
rate because like that's a way of making money of then we're not helping those type of communities that it's basically just like a privilege to be able to overcome addiction.
Dr. Joseph Volpicelli
Yeah, I it's, it's even worse than that. So clearly poor people have much less access to treatment and, and I think they get signaled out in the legal system at a higher rate. So they wind up going to jail and that's their for opiate addiction that seems to be a affect virtually all areas of society, urban areas, rural areas and the bad news there is that even people who can afford treatment are not getting very good treatment.
So people pay $60,000 or more to go into a rehab center. And the treatment is I should say, you know, petting the dolphins and the horses and some part and, and you know, and, and these programs advertise that they have five star chefs and you know, rooms, they have private rooms and that's where they're spending their money. But when they leave, they don't even go on medically proven medicines to help prevent relapse. They people are sent back in the old environment and they
relapse and some, some of these programs are proud of the fact that they have people who keep returning to treatment. So you look at all these people who love our programs so much that they keep coming back here as if they were hotel and they want to get return visits. I, I look at that and I say no, that's not a good. And you know, statistic to advertise if people didn't have to return, that would be a good statistic.
Jenn Junod
It's like you want to outgrow your therapist, you wanna outgrow rehab, you don't wanna, I mean, it's there if you need to go back. But yeah, that's not something really to be proud of.
Dr. Joseph Volpicelli
Yeah. And, and so right now, many of the inpatient rehab programs will have people who've been sort of a revolving door where they've been in there. I, I know talk to someone who's, you know, running a program in which people will come back 1213, 1516 times and they're doing something wrong, you know, and, and it just gets me upset when people in the addiction treatment community will say, well, that person hasn't hit rock bottom yet.
Maybe you haven't given the person the right treatment yet. So that's my issue is that we need to give the right treatment to the right person at the right time. And there are many options available to help people recover and people don't even know about the various options. And the treatment community is not offering the various options. And so there's really very small number of quality treatment programs that offer integrated care that combines the right medicine and the
right psychosocial support to help people recover. And, and that's, you know, one of the messages that I want to get across today that it is possible to get better, that people who struggle. It's not your fault that there are ways to get better. But you have to find the right kind of program that really addresses all your needs.
Jenn Junod
And if now, where are you located again? Since I get to do these all virtually, I start to forget where everyone is.
Dr. Joseph Volpicelli
Yeah. So my, my program is outside Philadelphia and Plymouth Meeting. OK. And it's interesting, I set that up like in 2009 and I left Penn because I was frustrated that the addiction treatment community wasn't really applying what we learned from research studies. And so I went to my bosses at Penn and I said we need to do a better job of educating the general public and, and helping these research centers provide quality treatment. And pen said that they're more interested in
doing research studies and writing grants than providing quality treatment. So I said, OK, oh, let me see what I can do. So I said, let me design a program based on what we find in research that works and see if we can, if it can work in actual clinical practice. So I set up a Well Pelli Center and, you know, for the past 12 years or so, we've been doing addiction treatment based on research studies based on evidence and we've had pretty good luck getting people better.
Jenn Junod
Congratulations on that. And I then how would by, you know, some random person? And I'll name some states that I've lived in? So we got Arizona, Idaho, Colorado and Indiana. Very random states live in and I'm addicted and I need help or I'm a family member of that person that's addicted and can see that they need help. Where do you turn?
Dr. Joseph Volpicelli
Yeah. No, that's, that's a great question. First, I would turn to understand addiction. You know, people say, just say no to drugs. I say no know you have to understand what addiction is and there are plenty of resources that you can look for. You can look at the N A website and other websites. You can go to our website but learn what addiction really is and learn about the various treatment options.
I even wrote a book called Recovery Options that outlines some of the, the options in terms of getting better. So know what's available. And then when you search for programs many times on their website, they will say things like we offer biopsychosocial spiritual care, we offer the full range of treatments. But what's important if you wanna help your loved one or you're interested in treatment yourself is ask them questions like when people leave your program, what percent
of them leave on Vivitrol, what percent of them leave on medicines? How many people have to come back into treatment? Do people get follow up? Because treatment is a lot more than just going in for 28 days and coming out cured? It's a, it's a, a disorder that you need to deal with over a period of time to learn to cope with things. And, and then some programs will say they offer C BT therapy and you find that the people giving the C BT therapy are people who maybe graduated college and
their whole learning is that they read a book by David Burns or whatever and that's their, their formal training. And so find out what their background is. Do they have a master's degree or a phd degree. Most likely they don't have a phd degree and, and I understand because they run a program, the financial complications of providing quality care because our insurance doesn't really pay for it.
Right now. The insurance companies often dictate the level of care that people get. And it's mostly based on what's the least expensive rather than what's the most effective. So, we need to change society's idea about addiction that it's not a moral issue. It's we need to reduce the stigma that it's a, it's a medical issue like other medical diso disorders.
And we need to pay for the right kind of treatment to get people better. I one example is in our community when people overdose, the police will pick them up, bring them to the emergency room. Well, they'll reverse the overdose with Narcan or naloxone, which is a sort of a cousin of Naltrexone. So it binds to the opiate receptor. So it knocks off the opiates and wakes people up who have overdosed.
Oh, wow. So that's great. And that's saving more lives than any intervention we've had over the past decade or so. Great. But then what does the, what does the emergency room do after that? They send people home? Sometimes they'll give them a card and say, call the center and they'll put you in rehab and people don't, of course, and they're back, you know, the next week where they've overdosed again.
Now, 11 thing that some emergency rooms are doing is they're beginning to, medication right there in the emergency room and, and give people a, a few days supply of something like buprenorphine to help them bridge the gap so that they don't go through bad withdrawal, they have to redose again. And so the, the study show that that can be a helpful intervention, but we need better handoffs from emergency rooms to treatment programs.
And, you know, it's, it's a shame that if you had a heart attack and you went to emergency room, you know, they can stop the pain of the heart attack, but they don't send people home right away. They send you up to the IC U or a monitored bed to make sure you recover and you get good healthy care when you leave the hospital and we need to do the same sort of thing when it comes to treating people with addictions.
Jenn Junod
Agreed. Agreed. And thank you for talking through some options for reaching out for recovery. Now, before we get a start closing out, what do you have any tips or i things that we can identify if we think we might be addicted or ways to prevent addiction.
Dr. Joseph Volpicelli
Sure. Yeah. So actually I did a study one time where I looked at claims data and to see if we could identify people who were having problems with, maybe getting addicted. And so this was at a time when physicians were writing for a lot of opiate prescriptions. And what we found is that contrary to the assumption that people who don't have addictions never get addicted when you give them opiates.
What we found is that about a third of the people who are getting prescriptions for opiates, for pain, for chronic pain are showing evidence of addiction. And we could see that in the claims data because they would begin to doctor shop, they'd see different doctors to get their opiates. Their dose would gradually inc and, and so you could begin to see that if someone starts to hide their drug use, if someone begins to use more than they were using before, if someone begins to be
preoccupied with just the drug and they begin to ignore other areas of their life, that's a very dangerous sign. So someone maybe who's addicted to opiates, you know, you can see that they sneak around and, you know, they go into the medic and cabinets and start using other people's opiates that they might have symptoms of withdrawal when they can't get the opiates where they're more irritable.
They're mo more emotionally labi these are some warning signs and, and for yourself, ask yourself the question. Does my need for the drug for the behavior increase, the more I do it. And if that's the case, you might be at risk for developing addiction in terms of prevent it's, you know, now that we understand more about the biology of addiction.
We can understand what are the conditions that cause it. And it's mostly when you get a big high, followed by where you feel uncomfortable where you have either physical withdrawal or emotional withdrawal and then you need to redose those are the conditions. And once a person learns that, that you can feel better by redosing that's, they're well on their way through that addictive cycle and addiction.
And so don't create conditions like that. If you use a pain medicine, use the smallest dose for the shortest period of time, don't use it over a month, two months or three months, your body's going to adapt to the drug. And then when you stop, you're gonna go through withdrawal. And if you learn that you can take away the withdrawal by redoing, you're gonna be in trouble.
We didn't talk very much about alcohol, but that's also a significant problem. And that's also associated with about 100,000 deaths per year. And there's a large percent of people who dichotomies that an alcoholic is someone who has lost their job, their relationships. This sort of the stereotype of what an alcohol addiction is. But it's more of a continuum than a dichotomy that people can start creeping up with their drinking a little bit before it, you develop all those
consequences that if you find that you're drinking a little bit more than you did earlier. If you find that when it's five o'clock and you don't have something to drink. You miss it. You, you spend your time looking around for a place to get the alcohol. If you start picking restaurants based on which one serves the, as the best wine list. Instead of the food list, you wanna be concerned about that.
Jenn Junod
And I, I mean, I go for wine list just because I want some good wine, but maybe the heaviest pour. If we're going for drinks, I'll go with that.
Dr. Joseph Volpicelli
So fair enough. So if you're going for the good expensive wines, that's different than someone who says they pour a lot of the good cheap wines. Then, then you're right. I stand corrected. I stand corrected. But yeah, when, when it starts becoming too important, has too important role in your life.
That's the point when, when that's more important than your relationships and that's more important than your job. Those are the danger signals and you don't have to have all the terrible consequences to recognize that it could be a problem for you and you need to address it.
Jenn Junod
And thank you for that. That is, is definitely something that I think we all need to look for. And definitely even talking about the, the your pretzels or my, the sugar that I also love. That is definitely something to keep an eye on. And I have more questions even more questions yet. I definitely want to go do some research on this Now, is there anything that we didn't cover today that you wanted to cover?
Dr. Joseph Volpicelli
Yeah. Well, let me bring you up to date on what I'm doing for research now. So, so I'm still doing research and, you know, I've been frustrated that even though I've tried to teach healthcare providers how to add the psychosocial component to treatment, still many people are given medicines and not the psychosocial treatment. And I think people may be doing ok where we're reducing their harm, but people are not flourishing.
And so one of the things that we've been experimenting with is to add technology to that. So if we can't train the clinicians, maybe we can use technology to help people get the psychosocial component. And so one of the new things in medicine now is the idea of digital therapeutics and these are programs that are located in the on the web and the internet and the cloud that people can access any time that help teach people skills and their digital therapeutics to help with insomnia,
to help with diabetes. But now there's new digital therapeutics to help with mental disorders, including anxiety and depression. And most recently that we're developing medical digital therapeutics to help with addictions. So with alcohol, with alcohol and opiates. And so we're doing a study right now in which we're doing a using a digital therapeutic called medea to help people have opiate addiction.
And so people get randomized, they get the digital therapeutic or not treatment. As usual, we're going to compare the differences between the, the two groups and the digital therapeutics help teach people C BT techniques, meditation techniques and, and other sorts of things to, to help them in their recovery.
Dr. Joseph Volpicelli, Jenn Junod
And, and some of the folks who use that, think it's a really helpful aid to their recovery and that a that's just like so phenomenal.
Jenn Junod
And I love like, yes, there's so many cons to the digital age yet there are so many pros like this one thing that I do want to break down as psychosocial. When, when I hear that in my head, I'm putting it together that if we're not taking care of the psychosocial psychosocial being like therapy, like actual like mental therapy, not physical therapy.
And also like as an overall human, do they, are they going to be in a safe space? Are they going back to the original crowd that they became addicted in? Are they going to have the same, like to circumstances, I guess is the best word or triggers around them that are going to cause another relapse?
Dr. Joseph Volpicelli
Yeah, exactly. Right. That, that all these issues need to be addressed. And, and for me, I look like to look at each person individually and so people have different needs for some people. The needs are that they don't have any friends and they feel isolated and they would use drugs as a way of connecting with people. And so if you take away the drugs, we're still left that they feel socially isolated, some even have social anxiety.
So that issue needs to be addressed if they're going to have a sustained recovery. So we help people with social anxiety and there's medicines that can help and other behavioral therapies to help people connect with people and, and you know, a a has for some people, they tend to be not so much pro medicines and I don't like them for that, but they do have some things that they do get right.
And that is by providing connections to other human beings, that's really helpful for people in recovery and, and to be able to share their story, helps people feel less shame and guilty. So they get that right. I think that's a really useful benefit and, and if you don't do a a there's other peer support groups that can be very helpful for people.
So therapy is helpful to learn to cope with stress without using drugs. We need to teach people appropriate coping mechanisms. So if someone uses alcohol to reduce anxiety, if we can give you other tools to reduce anxiety, then you won't need the drugs, you won't need to drink the alcohol to help people with depression. Some people just have nothing going on in their life, then you take away the drugs and they're really lost.
And so they need something that gives them joy you know, when I, when people come in to visit, I always ask them, you know, what are you doing for fun? What, what are your interest for me? That's what recovery is all about is to be able to participate in a whole smorgasbord of what life has to offer. Not just restricted to just one food group, but there's a whole lot of food groups out there that can give you joy and fun.
And for me, that's what recovery is about, that they can have good social relationships that people can have purpose in their life, that they get purpose in their work or maybe set up their own podcast to help people that it gives you a sense of purpose. And, and that's what recovery is all about. It's not just a clean urine, a urine that's free of illicit drugs, but it's, it's about having a full, complete life and, and, and that's, that's the approach I would take in recovery.
You know, I, I say that, you know, maybe different modalities are more effective at different parts of your journey that maybe in the initial stages, the medicines are especially helpful to get through the, the detox, the, the withdrawal phase. But maybe later in life, it's more dealing with issues of connectedness with people or purpose in life.
And some more, the psychosocial is really important. And so you have a program that just offers one modality, you're not going to get the full blast treatment. That's, that's the point that I want to make that people can get better. It's, we've come a long way. I think since, you know, in the mental health, at least from, you know, just locking people in asylums that now people can feel comfortable talking about that they take PROzac and they get therapy and they can share their
story and people like you have helped relieve the, the stigma associated with with that and, but we need to do the same thing for addiction. But you know, it's right now, it shouldn't just be an anonymous thing that people should be proud that they've had an addiction and they're recovering from it. And here are the steps that they took and, and share their story with that with everyone.
Jenn Junod
Thank you for that. And I know that with shit you don't want to talk about. We are one story at a time changing these conversations and into shit to talk about and it's difficult and it takes time, but we are slowly being a part of the change to change these stigmas. Now, do you have any words of wisdom for our audience?
Dr. Joseph Volpicelli
Well, the way I like to approach addictions and, and life in general is to approach it with curiosity, not with judgment. I think I'm paraphrasing Ted Lasso. But that's always been my philosophy to, to try to understand rather than to judge and when the people come in for treatment I'm really interested in hearing their story, not telling them what they should do, but really understanding what they want to do with their goals for treatment are and, and what I find is that the
people feel comfortable sharing their story and sharing their lives with me. And I'm so grateful that that they're willing to do that. And when you do that, I think people have a better chance for getting better for recovery. And it's possible that even if you haven't had success, it's not necessarily your fault that, that you can get better.
It's, you know, the the phrase I like that. Do I try to give comfort to people who are challenged? But then I also try to challenge people who are comfortable that we can do better, we can do better.
Jenn Junod
We can. I love that. I love that and definitely getting rid of the shame. And eight seeing ourselves with curiosity is one of the, the hardest things I've learned for myself because I've always been curious about everything else. But then just observing something I was feeling and not having the shame. So I love that you talk about the curiosity.
Yes. And for all your beautiful humans listening or watching, you know the drill, please reach out to us on social media or on our website. It's shit. The number two talk about and please share like donate and we could definitely use your help. And Joe, how do you does our audience reach out to you?
Dr. Joseph Volpicelli
Sure. Well, you can go to the website, I have a website Vic center.com and if people want to send me an email, they can send it to Volpicelli dot J at gmail.com. So you can always send an email. And I think I'm in linkedin and various other social media and I'm not necessarily an expert at those things, but you can get a hold of me and I'd be happy to reach out and talk to you. It's something I feel very strongly about.
Jenn Junod
Thank you. And last, but not least, what is something that you're grateful for?
Dr. Joseph Volpicelli
I'm grateful for my patients. I, you know, I've done a lot of schooling and residency fellowships, all that kind of stuff. But I think the most I've learned is from talking with people, talking with my patients that they've shared their lives with me. And I, you know, I've, I've learned an awful lot from them and that shaped my thinking.
Jenn Junod
I think more than anything else that really makes me think back to the guy that slapped you that, that it's people are and patients are more than just what did you call a, a client or a clinical?
Dr. Joseph Volpicelli
Yeah.
Dr. Joseph Volpicelli, Jenn Junod
Well, they, they're more than just, yeah, a statistic.
Jenn Junod
I'm not.
Dr. Joseph Volpicelli
Yeah, I know. Whatever I said with the right, someone to present in grand rounds. They're human beings.
Jenn Junod
Yeah. And I love that and I am grateful for having these conversations that we're starting to change the stigmas. And for each of us sharing our story can be scary. And by no means, do we need to share on a national worldwide platform yet sharing our story even with ourselves and learning from ourselves and reflecting? And I'm so grateful for being a part of that change.
Dr. Joseph Volpicelli
Well, and I'm grateful that you and other people like you do it as well. It's, it's very important to keep up the good work.
Jenn Junod
Thanks Joe and talk soon.
Dr. Joseph Volpicelli
Thank you. Bye bye bye.
Jenn Junod
Hello again, beautiful human. What did you get out of today's episode? We'd love to hear what was most impactful to you. We all know someone that could have really used this episode so please send it their way. Remind them that they're not alone. Stay tuned for new episodes every Wednesday. Here's a few ways that we could really use your support to keep shit.
You don't want to talk about going share an episode. Let's get the message out there, donate on paypal or Patreon. Subscribe and rate the show on itunes or Spotify and follow us on social media shit to talk about shit. The number two talk about. Bye.
