Drunk on Your Dollars

[Jaunty Guitar Music]

Mike: Welcome, everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting and the Kenosha County Substance Use Disorder Coalition. I'm Mike McGowan.

Mike: A drug is a drug is a drug. Unless the drug is alcohol, in which case it is or is not considered a drug depending on where you live, how you grew up, and what part of the family you come from. You guys confused?

Mike: Well, join the club for those of us who have been working with alcohol use disorder and fighting to get the disease to receive more than just lip service. We're going to discuss all of that and then some today with our favorite returning guest, Guida Brown. Oh, I just probably insulted nine other people.

Guida: Yeah, right. (laugh)

Mike: That's my fault.

Guida: I feel good about myself. That's okay.

Mike: For all of you who I insulted, I apologize.

Mike: Guida is the principal for Guided by Guida and serves as a community relations consultant for the U. S. Drug Testing Laboratories in Des Plaines, Illinois. She's an adjunct faculty member for Carthage College, University of Wisconsin Parkside, Concordia University, and Gateway Technical College.

Mike: She's also certified by the state of Wisconsin as a substance abuse counselor, a fetal alcohol spectrum disorder trainer, and an intoxicated driver program assessor. She is also a relatively newly elected Kenosha, Wisconsin County Board supervisor. Welcome back Guida.

Guida: Thanks, Mike. Thanks for having me.

Mike: Can I call you Guida or do, or do I have to?

Guida: Oh, please do. If only if you want me to answer you. Okay. ,

Mike: (laugh) I don't know what the protocol is. Yeah.

Guida: It is Supervisor Brown. A lot of people, you know, in the county, I get a lot of Supervisor Browns.

Mike: Oh, I could never do that.

Guida: Yeah, and I'm forever saying, just call me Guida. Okay.

Mike: All right. Well, we'll go with that.

Mike: Guida, I want to start with a topic. You have a blog. I love your blog. People go to go to Guida by Guida, read the blog. Makes you think. You wrote a blog recently called They're Drunk on Your Dollars. Well, let's start here. First, what is alcohol use disorder? Give it a little definition.

Guida: I yeah, I don't know. I literally don't know it's... So addiction is when there's a compulsion to use a substance despite negative consequences, right. I mean, that's the shortcut answer to that. Alcohol use disorder could be addiction. It could be misuse. It could be significant misuse before addiction.

Guida: I don't know what that answer is. And quite honestly it pisses me off that you asked me that question. (laugh)

Mike: Well, good. That's a great way to start this thing. Well, you know, that's part of the dilemma here. And that's part of why I wanted to have you on talking about this. There's a lot of symptoms that are listed to diagnose it, right?

Mike: Let's go through a couple.

Guida: I'm trying to think. I'm going from the top down. So, lack of control.

Mike: Right.

Mike: Tolerance.

Guida: Yeah, inability to do your normal daily stuff. Missing work, missing school. Tolerance. Withdrawal. I know they took one off criminal, criminal, is that the one that got taken out?

Mike: Well anything that interferes with your life, education, you know, betting, gambling, you know, whatever. But here's the point of that. You only, said, you only need two of those symptoms at any one time to meet the criteria for AUD, right?

Guida: Right.

Mike: All right.

Guida: So, okay, so let me use myself as an example.

Mike: All right, go, that's where I was going.

Guida: When I was in college. I missed class because I had such a bad hangover, right? I drank too much. I'm from Wisconsin. I think we all drink too much during college or the good majority of us do because it's our first and I was legal at 18. And so it's our first time not being under our parents thumb and paying it, you know, not having to pay attention to what they told us for the first 18 years, hopefully told us for the first 18 years to stay away from substances. And so, yeah, did I have an alcohol use disorder? I did. Do I have one today? I do not. I don't drink, but that has nothing to do with having a problem with drinking. I don't have an alcohol use disorder.

Guida: Whereas people who have addiction, that's a lifelong progressive disease, right? And so again, Mike, I always use you as the person who has the best answer for this is, you know, when somebody says, Oh, you do an assessment and somebody says, So, so I'm gonna, am I an alcoholic? And you say, Well, no, you've got a alcohol use disorder.

Guida: And they go, Oh, cool. I'm not an alcoholic, right? They don't know what that means. We don't know what that means. We don't know what a substance use disorder is. The general population doesn't. And I have this issue with changing our language so much that we have become so unclear in what we're trying to convey that the people who need that conveyed to them don't know what that is.

Guida: So I liken it to other diseases. We don't tell somebody who has skin cancer, you have a skin disorder. Or somebody who has diabetes, type 1, type 2 diabetes, you have a pancreas disorder. But somehow we have given this ridiculous language to substances so as not to explain what is really going on. And part of that is the stigma, because we in the field have had such a hard time discerning between use, abuse, misuse, disorder.

Guida: And so we sort of took all of those other bad words off the table, but we took them off the table to the point where now we're not conveying a message. So one of my blogs I talk about. It might actually have been that one too. I talk about having a conversation with Dr. George Kube.

Guida: He was one of the first drug czars, alcohol czars, and now he runs NIAAA, the National Institute on Alcohol and Alcohol Abuse, I believe is what it, and again, so there's that word, abuse, right? And he, they, for two seconds, there was a movement in the field that said, let's talk about pre addiction, because we talked about pre diabetes and we talked about pre cancer and this will get people.

Guida: So maybe that step before alcohol use disorder or that mild alcohol use disorder like I had when I was in college that we could talk about pre addiction. You're not in addiction yet, but you could be if you continue down this path and it that conversation lasted for two seconds. They went out to the public and the public said, absolutely not!

Guida: We are never going to use pre addiction for this population! Again, because God forbid we would stigmatize them and say, you know, all you you are on this road to addiction. But so I was at a conference with him and that was the topic of the conversation that he was leading a panel discussion. But they had already taken it off the table.

Guida: So it ended up being more of a conversation about why we're never going to use pre addiction as a phrase to address substance use disorder, alcohol use disorder. And so afterwards, because I don't have the sense of who I shouldn't, (laugh) should not talk to afterwards, I went up to him and I said, hi, I have a question for you.

Guida: When do we get to use addiction? And he said, well, what do you, I'm not really that caught up in labels. I go, no, no, no. Here's the thing. Here's the thing. When we use pre diabetes, if you have pre diabetes. and you leave it untreated, you get diabetes. And when you have pre cancer and you leave it untreated, you get cancer.

Guida: But when you have pre addiction, if you leave it untreated, you don't get a substance use disorder. That doesn't make any sense, and people don't understand what that means. And seriously, he like looked at my nametag and went and walked away. Like that was the end of the conversation. And I'm like, okay.

Guida: So recently now our government looking out for us. Our government is trying to change the NIAAA and NIDA the National Institute on Drug Abuse and combine them underneath an umbrella of the N. I. S. U. The National Institute on Substance Use. So I have a humongous problem with that, and I let my friends at the government know. (laugh)

Guida: I told my husband there might be an FBI agent hanging outside because I'm pretty sure I typed it with both middle fingers, and that was all. To say please leave us alone. Please leave us alone. You have ruined our language so completely that we can't even understand what we're saying anymore. But now you want to take away alcohol and put it only under substance use.

Guida: And honestly, what the hell does substance use mean? Does that mean if I have a drink every occasional day, not even every day, because we know that one drink for a woman... Any more than one drink for a woman and two drinks for a man on any given day is unhealthy drinking. But I'm talking about, so now we're really going to address substance use?

Guida: Like, I don't think they need our help addressing substance use, right? We need to address substance use disorders, or God forbid, substance misuse, substance abuse, and addiction. We, again, we don't talk about diseases. Except in the pre state right there. We there's a billboard in Kenosha that says, one in a million people get struck by lightning and one in three people have pre diabetes.

Guida: That's the only time we talk about a disease before it becomes a disease. We talk about the pre's. We talk about the pre cancer. We talk about the pre diabetes. We talk about heart disease from the perspective of what you can do to prevent it. But we're not preventing substance use, right? I mean, if we were, alcohol wouldn't even be legal.

Guida: We wouldn't be legalizing THC the way we are. So it's not, it's, it's complete misinformation, complete, complete misnomers and leading to a really bad system of trying to provide care to anybody.

Guida: Well, and I'm thinking of people who listen to this who are therapists who then have to write something in their notes to get paid.

Mike: Right.

Guida: Oh, absolutely, yup.

Mike: And they have to categorize it. And I think it's incredibly difficult to put this into a box, you know, back in the day. I watched, are you old enough to have watched Father Joseph Martin's Chalk Talks? Do you even know what I'm talking about?

Guida: Yeah, yeah, yeah. Yeah, I watched them at my first gig at the Hope Council.

Guida: Yeah.

Mike: Okay. Well, he used to say his definition of it was, if someone who loves you thinks you have a drinking problem, you do. I love that. I mean, it was that simple, but well, that kind of left it to the family (laugh) that led for some Thanksgiving. Right?

Guida: See my friend, you should see my dad. You should see. Yeah, exactly.

Mike: Well, so going back, if you had alcohol use disorder in college. That's what you said. How did you cure it?

Guida: Well, that, because I didn't have addiction, right? I believe that the disease of addiction is an incurable, manageable disease. Just like, my friend had cancer, and she was told she was going to be dead in five years, and she's not.

Guida: And she still talks about herself as, you know, having cancer and I'm like, you don't, you don't have cancer. You're in remission.

Mike: You're recovering from addiction. You're not recovered.

Guida: Right, right.

Guida: So I don't believe that you ever recover, which is a part of the problem too, for young people who get diagnosed with alcohol use disorder, addiction at an early age. You know, a lot of people in the rooms will say, I would rather believe I have addiction than use and remove all doubt. Right. If I got the label on me, that's great.

Mike: Right.

Guida: My definition of alcoholism is from Marty Mann, the first woman in the room, it's in the 12 step programs.

Guida: Marty Mann says drink two drinks a day for six months, no more, no less for six months. If you can't do that, you have alcoholism. And I just wish everybody would be like, yep, that is the gauge, right? Drug testing, the forensic drug testing from USDTL is that sort of gauge. It looks back three months in your nails for alcohol.

Guida: And we always worry about, well, yeah, but what if they're sneaking it? Or what if, you know, and it's like, but they're not managing it well, right? You can do two of those tests over the course of six months and somebody who actually has an addiction will have a positive test. Regardless of what they're doing because they can't manage that drinking to that degree, right?

Guida: So the Marty Mann test is just brilliant because people aren't able to continue to drink and not misuse the substance, not drink too much. So yeah, that's my absolute favorite because no, yeah. The family is not pointing out to anybody that they have an alcohol use disorder anymore.

Mike: You know, you're also making me think in what you're talking about that we do a really, and I spent my whole life doing this, so I don't like to admit this, we do a really crummy job educating people about the line that they may cross.

Mike: Like when you, you no longer have alcohol use disorder, you had to make some changes to do it. What changes did you make? Like, where should the education go, Guida?

Guida: Oh, yeah. I mean, that's it. We, I always say we can't treat and we can't incarcerate our way out of this problem, right?

Guida: So we have to prevent it. And we're doing a terrible job of prevention. Because we don't know what to say, you know, Oh, well, I drank when I was 18. So it's okay if my child does or always, it's not, it's absolutely not. We know that the brain is not done forming until you're at least 25. We know that when you drink at a younger age, you're much more inclined to have it.

Guida: We know that you have a predisposition if you have somebody in your family who has alcohol use disorder. So what I did, honestly, like I said, I was legal at 18. When I turned 21... And I don't remember my 21st birthday with some, you know, glamorous anything. I don't think I went out and got smashed like so many people do, but when I turned 21, I said, this isn't even fun anymore.

Guida: Waking up with hangovers isn't fun, and I stopped drinking to excess, and I think I've been drunk twice since then. Both accidents. Once was having a couple glasses of wine with a friend at a bar, and they overpoured the wine. And I didn't realize it, I had two drinks, got up to go to the bathroom, and was like, oh shoot, I need to start drinking water.

Guida: And then the second one was in 2008, I went on a wine tour in Italy. And the last thing they gave us was grappa. Which tastes like turpentine and my husband doesn't drink at all. And so, yeah, you know, when you are already have been drinking Cabernet, I don't, I don't know what wine they have there.

Guida: Which I don't even like I was always a terrible drinker anyway. So that really helped me. But I drank the grappa and I had two shots of it because my husband wasn't drinking his. And I woke up in the middle of the night with a hangover, puking. And I was like, yeah, never again. So I, I didn't, that's not what's made me stop drinking.

Guida: I actually stopped drinking. I try to track it by the birth date of the person who the, my a family member was pregnant and when the baby was born and now the baby is about eight years old, I think that I just I said never again, never again, I can be a better example as a person who doesn't drink than I am for the people who can drink socially.

Guida: From from 18 to 21, 21, it just stopped being fun. I was babysitting my coworkers to make sure they weren't getting up and going to work because we would all go out after work and they would get smashed. And I would literally, I was a server. I was a waitress and I would get up and go and help them open the restaurant, regardless of whether or not I was even on the shift.

Guida: And I just, yeah, this isn't fun anymore. I'm not having fun. This, you know...

Mike: Kind of reminds me of in a way of skin cancer. By the time we start using sunscreen the horse is already out of the barn. So many people that I know, almost everybody I know, by 21, is slowing down their drinking. By the time it's legal.

Mike: They're already on the downside. Now, that's not everybody, but it's a lot of people. Which means that they're starting at an incredibly early age, and so the damage that you talk about is intense. So, that leads me to my next question. I hear the NIH is studying alcohol, so they must be, all this brain stuff, right?

Mike: What are they studying?

Guida: Yeah, no, no. They're studying the social aspects of drinking. So I was at a conference and they got up and talked about... We found people who were diagnosed with alcohol use disorder. And then we put them into a controlled setting and gave them alcohol for 32 minutes and got them drunk to see how they interacted with people they didn't know.

Guida: And after I, you know, scraped my head from the ceiling, I was like, you. Got to be kidding me. You've got to be kidding me. And a woman actually stood up and said, how did you get this passed? How is this ethical? And then the woman was, oh yeah, it was hard. I was like, yeah, it was hard. So I, I left, I went for a walk and called or texted David Galbis-Reig who's our local addictionologist, genius addictionologist.

Guida: I texted him and I said, am I wrong to think that this is really not acceptable? Like, how is this different than giving somebody who has diabetes a bunch of carbs and then sticking them in a social setting to see how they react? Or how is this different than, you know, we know somebody has lung cancer because of their cigarette smoking, and then we give them a bunch of cigarettes and stick them in a social setting to see how they react.

Guida: And he's like, yeah, you're not wrong. You're not wrong. (laugh) You've got to be kidding me. You've got to be kidding me. Who thought this was a good idea? Who cares anymore to study social aspects of drinking? I mean, I used to have a colleague, we would send each other these ridiculous research studies and say, Next up, Dog Bites Man, like, are you serious?

Guida: We don't know that alcohol reduces, gives you Dutch courage, right? How long has that phrase been around? It is just mind boggling to me. And so I always talk about the silos, right? We have this research silo where they don't talk to anybody. And then we have this treatment silo where they don't talk to anybody.

Guida: And then we have the affected individuals silo. Where they sort of beg to talk to people, but depends on who the affected individual is that we're talking about is a family member, or is it the person who actually has a substance use disorder. And so these three silos that never talked to each other and I thought a researcher thought it was a good idea, not only a reason like, so a research team came up with this nobody said squat about it. And then they wrote to NIH and said, Hey, we have an idea for a grant. And our National Institute of Health said, What a great idea. We just don't know enough about the social aspects of drinking. And then they funded it. And then we go to a conference, and the people let them talk about it.

Guida: And say, this was what we found, and I'm like, oh my gosh, so, so again, back to the DSM, what is alcohol use disorder, Mike? Who knows? Because somehow the researchers thought it's okay to find people with an alcohol use disorder, the person who only has maybe a mild alcohol use disorder, so only two of those aspects, that's okay.

Guida: We can continue them on their path to addiction, or their path to further disorder. But if they had a moderate, we wouldn't use them or if they had a severe. Oh, no, no, no. Can you make sense of that? Because I literally cannot make sense of that. But I will tell you that I also heard at a conference, they were talking about some, some, this, this, when we test for this, this happens.

Guida: And I went up to the researcher and said, did you test for alcohol? No, we only tested for drugs. So what you're telling me is all of your research could be wrong because alcohol really could be causing X, Y, and Z. That could really have been the only drug on board, but because you didn't even test for it, you don't know that.

Guida: That goes back to the 1990s when we were having a crack baby epidemic, right? Remember that? Oh my gosh, the whole world's going to end. And then we found out that, oh gosh, it wasn't the the cocaine. It was the alcohol these moms were using to come off of the cocaine that caused the fetal alcohol spectrum disorders and the lifelong problems for these children.

Guida: We can't keep spinning our wheels. It's just, it's, mind boggling and horrifying. And I don't know what to do anymore. And I just keep standing on my soap box, screaming about it. And I feel like you're the only person listening to me. (laugh)

Mike: (laugh) Well, and anyone who's bright enough to be listening to the podcast, you know, we had a friend of yours on recently Dr. Torralva. And for those of you who didn't think I could actually pronounce his name.

Guida: I actually listened to it today. So yeah, well done. (hands clapping)

Mike: Well, he was... It was fascinating. If you haven't listened to it, those of you listen to it. He was an anesthesiologist. He used fentanyl. So I think when sometimes people get on their soapbox, they assume your last statement is gonna be ban alcohol!

Mike: And I've never heard you say that.

Guida: No. And again, that's my, so that's my problem with, oh, we're gonna talk about substance use. Why? (laugh) Why? Why are we going to talk about substance use? Because that guy who has a beer a day, we don't need to help him. We don't need to fix him. We don't need to fix even the guy who smokes a joint at night.

Guida: We don't need to fix them. That's not the woman who smokes a joint. That's not our issue, right? That's not what's ruining the thread of our society. That's not what's killing people. We have to do a better job addressing the problem. And my issue with that, again, is our language is so poorly developed because we keep changing it, we keep changing it so fast, and we don't really have the right words for it.

Guida: And so when I say substance abuse, and people are like, Oh, how dare you use that stigmatizing phrase. What are you talking about? Are you really talking about substance use? Because you're not. You're not. Again, do we want to prevent substance use for kids up until the age of 21? And all, yeah, we do. We do.

Guida: Are we doing that in our society? Not very well. We're really not. So really what we are trying to prevent is substance abuse. Substance use disorders means nothing to anybody except the DSM, the American Psychological Association that we have to use in order to get paid. I, it, yeah, sorry.

Mike: Have you found... You're a newly elected board supervisor, and I, this, it's not like you're new to government, you're all weaving through there in your career. But are there things that local and municipalities can do on the education prevention front that they're not doing?

Guida: Oh gosh, yeah I actually sat in a meeting where we were looking at our overdose deaths. And a couple of people were saying, Oh my gosh, look at all the fentanyl. Yeah. Yeah. That's bad. Look at all the opioids. (looking around and pointing a finger downward)

Guida: You know, that's the same thing, right?

Mike: Yeah.

Guida: Like the lack of education, the lack of... You know what, one of the things I heard in, in your interview with Randy Torralva even the words opiates and opioids. Remember when we tried to make a distinction between opiates and opioids? Opiates were natural and so methadone was an opiate, but everything else was an opioid.

Guida: And then it got to be like, this is a lunacy. They're all opioids. They're all opioids, but I will tell you, I hear opiate used interchangeably all the time and again, we don't know what we're saying. And so when the person on the street knows more about it than we do, or when we're talking about fentanyl, you know, killing people, yeah, but so do opioids.

Guida: What? So we're doing a terrible job. And, and so I would say, you know what, in your community, having a good dashboard, explaining to people just sort of the basics of these are the deaths, this is what's happening. But I don't think that, you know, you have to care, you have to care. And, and now we know that like one in three people is affected by somebody's substance use.

Guida: More people care, but they still, like you said, we're not addressing it, you know.

Mike: Well, and talking about what we're talking about today. I defy, well, I defy, that's the wrong word. How many people don't know somebody who has a problem with alcohol? How many people grew up walking on eggshells because of somebody they knew in their neighborhood, in their family, in their extended family, who had a problem with alcohol?

Mike: And you would think with such a humongous, that's, that's almost all of us. And, and yet it's like we study how people react in a social setting in a bar, right?

Guida: Yeah. Right. Like that was, that's important. That's what's important. Knowing how people become more social when they drink. That's the important part.

Guida: I don't get it. I really don't get it. I don't get how 50 years after identifying fetal alcohol spectrum disorders, we still don't do any screening for fetal alcohol spectrum disorders. I was on a webinar earlier and. Wherever the state was, they've changed child abuse when a baby is affected by drugs in utero.

Guida: It used to be if the baby tested positive for drugs, that was child abuse. They've changed it to the baby has to test positive and be negatively affected by those drugs. And you would know that how, particularly with alcohol. How would you see that? And so again, I appreciate that we shouldn't be stigmatizing people and that we should be helping people more and that we shouldn't be figuring out ways to end up in the child protective services and take their babies away.

Guida: But we have to address the problem, not ignore the problem and I think that's what's happening with our language we're just backing it up and pretending it's not a problem. I fully believe that the reason we have had such a robust response to our opioid crisis is because we have a pharmaceutical response to address it.

Guida: We have Narcan, we have the Suboxone, we have Vivitrol. And we don't have that for alcohol use disorder to the same degree. We do, we can use Vivitrol. We have had Anabuse forever, Camprol forever. But we're not using it to the same degree. And it's not new, it's not sexy with the exception of the Vivitrol.

Guida: And people don't realize you can even use Vivitrol for alcohol use disorder. So, while I appreciate it's addiction. A drug is a drug is a drug, and that umbrella should overhang over all of those drugs, including alcohol. We have to do a better job explaining that alcohol is a drug, and people don't see it that way.

Guida: And alcohol kills more people than opioids ever has. And again, because opioids kill you fast? And, you know, of course, the fentanyl kills you fast. We had a much better response to that than we have had to alcohol.

Mike: Wow. Well, when you figure it out, I'll have you back.

Mike: All right. So when, when you get a clue.

Guida: We'll both be [inaudible].

Mike: You know, Guida's blogs and her website are terrific and there are links to Guided by Guida and her resources attached to the podcast. I love having you on Guida. I love talking to you.

Mike: For those of you don't know Guida and I have these talks sometimes not on these things. (laugh)

Guida: Yeah.

Mike: We should just roll it.

Mike: They're actually interesting

Mike: For those of you who can join us again next time if you're able to until next time stay safe and stay informed.