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Wise Counsel Interview Transcript: An Interview with John C. Fleming, MD on Preventing Addiction

David Van Nuys, Ph.D.

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Dr. David Van Nuys: Welcome to "Wise Counsel," a podcast interview series sponsored by mentalhelp.net, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I am a clinical psychologist and your host.

On today's show, we will be talking with Dr. John C. Fleming who is author of the 2007 book, "Preventing Addiction: What Parents Must Know to Immunize their Kids Against Drug and Alcohol Addiction." A native of Mississippi, and a graduate of the University of Mississippi Medical School, John Fleming, MD, currently lives and practices medicine in Minden, Louisiana.

During his medical residency, he trained at the Drug and Alcohol Treatment Unit at Navy Regional Medical Center, Long Beach, California, which was then a pioneer in chemical dependency treatment. That program influenced his medical practice and also helped shape the way he and his wife Cindy raise their four addiction-free children. Now here's the interview.

Dr. John Fleming, welcome to the "Wise Counsel" podcast.

Dr. John Fleming: Thanks for having me today.

David: Yes, well I have been reading through your book, "Preventing Addiction: What Parents Must Know to Immunize their Kids Against Drug and Alcohol Addiction." I think there's a lot of useful information in there. We'll be going over that.

But before we get into it, let me ask you what experiences in your own life and background led you to write this book or form the backdrop for it.

John: OK David, my training as a physician is in family practice. I actually did my residency out in your direction, which was in Camp Pendleton, California, at the Naval Hospital there from 1967-9. During my training, we were required as residents, to spend two weeks at the Long Beach Naval Regional Medical Center, drug and alcohol rehab center. I'm sure that that name doesn't mean anything to you, but I think probably Betty Ford and Billy Carter mean something to you.

David: Yes.

John: That's where they went for treatment.

David: Oh!

John: And, of course, Betty Ford later started her own facility. This was a pioneering facility. There were very few drug and alcohol treatment centers in those days. The only thing available for people was really just AA, which is great, but there are some little benefits of in-patient treatment.

What it did for me is this. I had to go through the program almost as if I were a patient. I had to be involved in group therapy, I had to listen to lectures, I listened to the stories. One thing I was really impressed by and that is the fact that each and every alcoholic or drug addict began their drinking careers at a very young age.

And that really stayed with me for many years, even in raising our kids who are now full adults as we speak, four kids. My wife and I really utilized that thought, that consideration.

Then a couple of years ago, some major studies came out -- one that was done by the National Institute of Drug Abuse, the other came out in the "Archives of Pediatric and Adolescent Medicine." What it said was there is a direct correlation between the age at which kids first begin using alcohol and the ultimate risk for addiction.

I can summarize it by saying that we know that kids who begin drinking alcohol hard at age 15, have a five fold increased risk of addiction to all substances, greater than kids who begin drinking after age 15.

So, as you can see, that really spoke to me. As no one had really published that, put it in writing, I really felt the need to do that. Also sort of put together techniques that would work into this information that could be very useful.

David: Well that's a very interesting statistic and I must say it's a study that I hadn't heard of so, I'm really glad to hear that. Hopefully, it will lodge itself somewhere in my faulty memory because that sounds like a really important study.

One of the things that I like about your book is you do a lot of self-disclosure, both in terms of the problems of your family of origin, where I think you say that you saw some alcoholism, and then later some of the challenges you faced in raising your own teenagers. Maybe you can talk about those to us as additional backdrop to our conversation.

John: Well, my grandfather, and an uncle, and an aunt were alcoholics. I can recall -- really, I must have been three and a half, four at the most -- when I would watch my grandfather stagger to the refrigerator, open it up, pull out a bottle of whisky and then turn it up and drink it pretty much the way I sometimes will turn up a carton of milk.

Of course, as a child I found that very interesting. I had no idea why he did that, but my grandfather's wife told me that he did it for its effect, not because of its taste. And then I began to really learn about what alcoholism was. I noticed the kind of behaviors that were unpleasant and unwanted around the house.

As I became older, I came in contact with an uncle, who was his son, who was also a very terrible alcoholic. He was always giving me trouble, stirring up trouble. Then, of course, as I got older I had to consider whether or not to drink alcohol myself. And you see growing up in Mississippi back in the 60s -- and that was, by the way, a totally dry state; it was illegal to drink alcohol of any sort or to buy it -- in those days, much different from today, of course.

To me, the only people who would drink alcohol were alcoholics. I didn't know there was such a thing as drinking alcohol in a social way; that there was actually a responsible way to drink alcohol. So I, myself, never even considered drinking alcohol until I was a sophomore in college and it was introduced to me by my girlfriend. And, as you point out, I go into detail of what my first experience with alcohol was.

David: And then you also, I guess, faced some challenges with your teenagers around...

John: Yes.

David: ...some drinking behavior. Is that something you feel comfortable talking about?

John: Sure, yes, the outcomes were very positive. I'll just give you the example of my younger son. When he was 16, he got his license like most kids do. I bought him an inexpensive pick up truck and he went to events with his friends. But one night, he was not coming home at the appointed time; he wasn't meeting his curfew.

I spoke with him. I got some sort of deceptive answers. I was not comfortable with what I was hearing, so I actually got in my car and drove out to where I thought he was. Didn't find him, but on the way home I actually pulled in behind him not realizing it. I noticed that the truck was weaving a bit. I followed him home and we had a conversation when we got home. I smelled alcohol on his breath, I could see that his eyes were glazed over a bit, and I was very concerned about that because not only was he drinking at age 16, but he was also driving while he was drinking.

We had a long talk and he promised he wouldn't do it. But I took it another step. I actually purchased online an inexpensive home breathalyzer. We sat down, and I said, "Son, from now on, when you come in, you're going to blow into this breathalyzer. And of course, you're expected to be home on time. If there are any problems at all, then you will get further punishment until the privilege is loss, obviously, if you do it the first time. Eventually, I'll just take your truck away if we have any more problems."

He was a little bit reluctant and unhappy with it, but he really didn't have much to say because I caught him red-handed.

David: Yeah.

John: Well for two years after that, until he went off to college, every afternoon that he came home from seeing his friends, he very dutifully blew into the breathalyzer, and every time it gave me double zeros. He never had any problems, never had any DUIs, and never had any accidents.

And interesting enough, there were some byproducts to this that were unexpected. Not only did he come in on time for his curfew, he often came in early. And instead of hanging out with some of the kids we were not comfortable with, he actually took my advice and hung out with some other kids that we were comfortable with -- we knew who their parents were and we knew their values. As a result, we've been very blessed by the outcome of that.

He did what a normal kid does and, I think, had we not implemented some of the steps that we did, I think it could be a very different thing today. Some of his friends today have either dropped out of college, had several DUI arrests, have moved up to marijuana and cocaine. And so we just feel very blessed and very pleased that some of these techniques have worked very well.

David: Well I think it's good for my listeners to know that you're speaking from the experience of being a father of four, and that it's based on something other than what you've read in books. Because when some expert is giving people advice, they want to know that you've been there too. So it's sounds like you have been there.

John: I'm glad you say that, David, because believe it or not, the American Academy of Pediatrics and the American Psychological Association have come out against the use of home breathalyzer and drug testing. I'm a physician and I've been involved in the political structure of the American Academy of Family Physicians, and they have really taken no stand on this. Through my personal experience as a physician and a father, I can say without hesitation that these sorts of techniques were not only important and helpful; I think they're necessary in today's environment.

I think that some of these organizations are really coming from a policy-locked position, sort of an "ivory tower" type of attitude. And I think that those of us parents -- and I've spoken with many others -- who are in the trenches feel a whole lot different about how we need to use these technologies to protect our kids.

David: Well we can come back to this. I'm really glad you brought that up. I want to touch on some other points. I'll just say that I had a mixed reaction when I encountered some of the techniques that you describe in the book including the breathalyzer -- I was a bit on the fence. The professional associations were probably coming down on this because this sounds a little heavy-handed, maybe authoritarian, and maybe just a bit too intrusive. On the other hand, if you have a kid who is having problems, it is important to step in with some kind of intervention.

So let's put that on the shelf for now and we can come back to it. You've got an early chapter that says, "What You Don't Know Can Hurt Your Children". Now what are you referring to by that?

John: What I'm referring to is this: The average age that kids begin drinking and smoking in this country -- and that's all kids, not just those who become addicted -- is 13 for girls and 11 for boys. Every time I quote this statistic, I get very wide-opened eyes and jaws dropping.

This is something that the average parent just doesn't know, and even when you tell parents this, the first thing that comes to their mind is, "That's other kids. That's not my kid." Remember, that's the average age. So that means for every kid who's doing this at age 15, there's another doing it at age 8.

Where are these kids getting alcohol? Well they're getting it in our homes and we're just not aware of it. And if you don't have alcohol in your home or if it's locked up, they're getting it in your neighbor's home.

David: Yes.

John: My point is that we have to start at the end and work forward. Number one, addiction is an incurable disease; it really is a brain disease. It is treatable, although the remission rates are less than four percent, with the best of treatments. But you see it's a chronic terrible disease that you don't want to get if you could prevent it.

Number two, it has a very prolonged latency period, which means that people are becoming addicted and people around them, even the patients themselves, are not aware of it. Often times, the actual symptoms of addiction don't manifest until kids are much older or even adults. But in fact, the process begins much younger -- when they're, of course, around 11, 12 and 13 years of age.

So the critical time that the most can be done to stop the transition to addiction, to in some way intervene or prevent it, is when it's actually occurring and you're unaware of it. And that goes back to the breathalyzer and drug testing. If you're waiting until you see these problems, you may be waiting too late. Once there's addiction, a lot of these techniques are not nearly as useful as they are when the child is not yet addicted. So that's really what I mean by that.

Just to take this a step further, studies also show -- and they've done very sophisticated imaging studies -- that the human brain does not mature until about age 25. Also, the use of addictive substances, alcohol, marijuana and all of those things, actually cause permanent changes to brains, particularly, immature brains.

So, in effect, kids who are drinking at age 11, 12 and 13 years of age, are actually causing changes in their brain. They're altering or reprogramming the chemistry and the circuitry of their brain to desire euphoria at a greater rate over time.

So all this is happening underneath the surface. When parents find out that their kids, at the age of 14, are getting drunk or using marijuana, they implement some punishment and think that's the end of it.

But, in fact, the addiction is already beginning its process. So then when they're 16 and they're getting into real trouble, DUIs and that sort of thing, they use some harsher punishment, but as soon as things calm down, they forget about it. And then by age 18, it's time to put them into some sort of rehab center and they're addicted already and it's incurable.

Now you're looking at a child who's going to have a future of very serious problems. They may be legal, family, business, personal, health and many other things. So it's all about being proactive and getting ahead of the curve.

David: Sure. You talk quite a bit about the brain mechanisms in your book, which I thought was very good and solid science. I recently attended a continuing education workshop on child development, and I've been amazed, in these sorts of workshops, to see how much more we understand about the brain during childhood development.

It's really clear that there are all sorts environmental toxins and so on that are leading to a lot of the problems that we see among kids today. Maybe you could a little bit more about how the brain processes these addictive substances.

John: Absolutely. Well, it's interesting, my youngest son, who was six-foot two when he was 16 years old...

David: Wow.

John: In every way, looked like an adult.

David: Sure.

John: But he was walking around with a brain that still had about nine years of maturity left. What we know--and I'm sure you, as a professional, know this, through the workshops--when children are born, they have very large brains relative to their body size. But the brains are at a low functional activity, of course. Children can't speak when they're born. They really have very little coordination.

And the reason is because, despite the fact that they have plenty of brain matter, they don't have the maturity of myelination, which is a covering that facilitates the signals along the nerve endings that are so important, so critical. Those are not yet in place.

And so, as they become older and more mature, the brain, of course, matures, and they become better physically able to do things, neurologically and so forth. But the brain remains very, very susceptible to toxic substances, just as you point out.

And the really cynical thing about addictive drugs, including alcohol, is their ability to affect the reward system of the brain, which is found in the mid-brain area, or the area we'd call the ventral tegmental area. And there's a mediation of reward and pleasure by a chemical called dopamine. It's a neurotransmitter. Many of us have heard about it.

We talk about it in relationship to depression and treatment of depression. We talk about the runner's high -- the marathoner who feels good after the first five miles -- when the dopamine is kicking in. But dopamine is used for day to day activities. For instance, watching a beautiful sunset, the pleasure of sexual activity. All that is mediated by dopamine.

Well, what happens with addicting substances--particularly the really harsh ones, like heroin and methamphetamine--is dopamine is pushed to unprecedented in the blood. And those who are addicted will tell you that there's no high like that first high, and they can spend the rest of their lives trying to reacquire that first experience of euphoria.

And so, what happens is, even when you use a mildly addictive substance like alcohol, with each episode of euphoria, that reward center is being trained to seek and look forward and forward to that next euphoric experience. And it sort of builds upon itself. But over time, the same substances give less euphoria, so they have to march up to something else. And usually, that's going to be marijuana, then powdered cocaine, then crack cocaine, heroin, etcetera.

So, in the career of an addict, there is that tendency to march up to stronger and stronger drugs, to achieve the same or greater levels of euphoria.

David: There seem to be fashions in drugs, I guess, in terms of both demand and availability and stylishness and so on. What are the problem drugs among kids these days? Have there been some changes in the pattern of drug preferences and availability?

John: Absolutely. Yeah. And you've heard me talk a lot about alcohol. Let me preface it by saying that alcohol, as I said, is the lowest addicting substance and the most accepted through our customs. We've been drinking alcohol for thousands of years, as humanity. And certainly, someone who has a mature brain and drinks alcohol responsibly can do so without becoming addicted.

The problem is that alcohol, in the young brain, usually triggers that addiction process. So it's a dangerous drug, mainly for children. And it is by far the most used drug and the most dangerous drug for kids, mainly because of its acceptance and its accessibility.

Now, of course, kids then have sort of a backup drug that's kind of important to them, and that is marijuana, because it's the next most accessible drug, fairly inexpensive. And many people seem to think that it's not an addictive substance. But I'll point out to you that, among kids today, 16 percent of admissions to drug and alcohol treatment centers is for marijuana alone, and that's up from three percent just a few years ago. So there is a growing trend there.

There is also a decreasing trend in using illicit or illegal drugs among children, but there is an increasing interest in using legal drugs, such as Lortab, Oxycontin; things that are prescribed by doctors. One of the reasons is they're getting it from their parents' shelves. But another one is--and this is really horrifying--they're buying it online, even without a physician.

David: Oh my goodness.

John: And that's a very difficult thing to control.

David: Yes. And what about methamphetamine? I'm aware that there are labs.

John: Methamphetamine, yeah, that has really taken the country by storm.

David: Right.

John: And it's sort of the "perfect storm" drug, if you will. Number one, it's highly intoxicating, it's highly addictive. But it's very inexpensive. It's easy to make. Cocaine has to be made in special labs, whereas methamphetamine, you can make it in your garage very simply, and the basic substrates are very easy to find, or have been. Mainly adults who sell it have been using Sudafed, which is easily found over the counter.

Today, there is a good bit of control in the purchase of buying Sudafed. You may find that you have to sign for it, or you're limited to how much you can buy. And the reason for that is that, if it's purchased in large quantified, it's also used to make methamphetamine.

So it's kind of the poor man's, or the rural man's addictive drug, the equivalent to heroin in rural areas. As opposed to what we used to see in the inner cities, where heroin was so important, and crack cocaine.

We moved to the city we live in today of 13, 000, Minden, Louisiana. We moved here to raise our kids, because we thought we could get away from the drug scene. But smaller communities than ours, around us, are just flush with methamphetamine.

David: That's amazing. There really is no place that you can get away from it these days, is there? At least, not in this country.

And we can talk about this, or we can ignore it, but I think I'm much softer on the question of marijuana than you are. And let me hasten to add that I don't think it's good for kids, and would totally agree with you about the developing brain and the dangers that it would pose for kids. But even with my softer stance on marijuana, I was brought up short to...

Here in California, we have a lot of national forests and we have heard about... that there are pot gardens, as they are referred to, in these various forests. The vision that that conjures up in most people's mind, certainly that it conjured up in mine, was small operation, and people who are trying to just grow a little bit for themselves or their friends, or even people who are into it for making some money.

But in fact, according to a couple of articles I've read recently, Mexican drug cartels have moved in big time and are occupying our national forests, are growing huge amounts of marijuana there, are causing environmental degradation with the chemicals, fertilizers, pesticides, etc. And they're armed to the teeth, so that the stray hikers now are running into some serious violence.

John: That's interesting, that's amazing. Of course, the problem the cartels have with marijuana is the bulkiness of it. It's a lot harder to smuggle marijuana, so it kind of makes sense that they would transplant their operation to the forests, and actually grow it there. That way they can distribute it directly rather than trying to push it across the border.

David: Yeah, exactly, that's exactly what these articles said. Now, you say addiction is incurable, and that seems so strong. It seems to me that I've met people who say that they were once addicted to cocaine or they once had a habit of one sort or another, and now they don't seem to be. They seem to be leading successful lives and so on. So, I am wondering if it's as hard and shut as you make it sound.

John: Well, it's hard to say what's out, maybe more studies. But here are some points to consider there, and I think it is a good issue to be raised. Firstly, the two men who started AA -- Alcoholics Anonymous -- one of the first things that they came to a conclusion of, is that there is no cure for addiction, certainly for alcohol addiction. Certainly a person can stop using substances completely, as hard as it is, and return to a normal existence and normal function.

But by incurable, for instance, let's take an alcoholic, who has gone 20 years of a very successful life, never had a drop of drink in that period of time. But he decides that he's going to have a social drink just to see how things go. Studies would tell us -- and I've heard a lot of anecdotal stories on this -- that within a few short weeks, that individual's alcoholism symptoms return to exactly where they were when he left off.

So, you see while you can certainly go into remission, you can't un-train the brain to be addicted -- or you can't retrain it to be un-addicted. There have been claims over the years that this could be done, but anytime a follow-up study is done to actually ensure that it's not, in some way, just an agenda that that person had, they have been able to see that that really was the case. There was one landmark case about 20 years ago, in a VA hospital, where they had 10 individuals who agreed to be "cured" of alcoholism.

Some other people did a follow-up on the 10 individuals, and within a few months they had had all sorts of problems, DUIs, hospitalization or alcohol intoxication, GI bleeding and that sort of thing. No one has ever been able to show or prove that there is a cure, and treatment centers certainly will never claim that they have a cure as well. What's also interesting is that, if you read the studies of The National Institute on Drug Abuse... to write my book, I wanted to actually see what are the recovery or remission rates.

David: Sure.

John: Not what are the cure rates, but what are these remission rates. What NIDA is showing is that they consider a success rate being the rate, not of a drug addict stopping using drugs, but just bringing it under control and making it a manageable rate.

That's really the state of the art today, is treating addicts, particularly the harsher drug addicts, the methamphetamine addicts. It's hopefully getting them to a point where they can manage their lives and get by on as little drugs as possible. One of the things that I have noticed over the years is, for instance, alcoholics who no longer drink alcohol still have to take Benzodiazepine tranquilizers to manage their cravings.

So, even people who claim they don't use cocaine anymore, they may actually be sustaining their recovery through some other drug.

David: OK, this is reminding me of another podcast interview that I did with a Dr. David Sinclair, who has developed something that's known as The Sinclair Method, in which he uses a substance called Naltrexone, I believe it is, that blocks the receptor for alcohol. I know he's got a big project that he's doing in, I believe it's Finland, he has relocated to Finland, and they've redesigned their whole alcohol treatment program around his approach. I understand that it hasn't been widely embraced in this country though, although some people are exploring it.

John: Well, there is a big problem with that. Theoretically, that should work, but I'll tell you about a couple of things that really send us the signals that there is no way that's going to work. You probably recall the drug Antabuse?

David: Yes.

John: It used to be used a lot. It's still used in some venues. Basically, it's a drug that people can take on a daily basis, and it won't block their craving for alcohol, but what it will do is make them very ill if they drink alcohol. So, that's been tried as a method to discourage alcoholics from drinking, but it's never worked, it has failed.

But here's another interesting thing. There are a certain percentage of people -- now that we have these lap-banding procedures and the stomach bypass procedures... They've become very popular, and they've really begun to study these people, and we know that a certain percentage of very obese people get that way as a result of their addiction to food. They are literally addicted to food, but, in many cases, nothing else. They are now seeing a big problem with these people who undergo the lap-banding procedure, and they lose tremendous weight. All of a sudden, many of them were becoming alcoholics and drug addicts.

So, what is happening is that they are exchanging one addiction for another. So, the problem is that if you block the addiction to one thing, the addiction is still firmly entrenched in that person. It will shift to something else, and that is something that we're not going to have an answer for just with drugs like Naltrexone.

David: Well, but the Naltrexone, instead of... I do understand your point of symptom substitution or substituting one addiction for another. Naltrexone of course doesn't create nausea, but if it works as Sinclair Report said, the reinforcement just goes away, and it's no longer reinforcing, and so the desire goes away as well.

John: Exactly, what it does is, if somebody takes it and they drink alcohol, they basically don't feel intoxicated. They don't get the euphoria from it. You see the problem is, the core problem with addiction is, that... Remember that I said that any addict will tell you that what they're really doing is pursuing the next euphoric experience. If that person drinks alcohol and he doesn't get a high from it, he's going to have to go to something else, because that's really what his addiction is all about.

It's not about the alcohol. Alcohol may be his drug of choice, but anything that will give him that euphoria he will march to in order to receive that. Unless you can somehow give that person a pill that will remove every possible euphoric experience, it's very difficult to see how that's going to work.

David: Yeah. Sinclair said that you actually have to be careful. Like, if the person's eating pizza around the time that they're taking the drug, they may actually lose the pleasure that pizza used to give them.

John: Yeah, that's a very good point, because you know, people will become suicidal if they lose all sense of pleasure. In fact, that's often times a problem that addicts have to deal with. They want so desperately to stop using, and yet their life can be so without pleasure as a result of it, because they can't experience the normal pleasures that a non-addict can. Many of them become suicidal for that reason.

David: Certainly, I agree with you on the broad sweep of what you're saying here. I think you might acknowledge that there are individual exceptions. I think it's pretty clear that there's no single, simple explanation for any of this. It's a combination of bio-chemistry, brain chemistry, genetic vulnerability, environmental -- what kind of environment they've grown up in, their belief system, so it's a very complex thing.

Sometimes there are some real exceptions. There's somebody I know quite well who smoked for years and one day quit. Without even deciding to quit! He just quit!

John: And you're talking about tobacco?

David: Yes, tobacco. Suffered no withdrawal, no nothing.

John: Right. Tobacco is interesting. You may recall from my book that I talk about it in a little different way. Tobacco is highly addictive; it's as addictive as heroin.

David: I know that because I used to try to treat tobacco addiction with hypnosis. I found it was a lot harder than...

John: The interesting thing about tobacco is that it's the only addictive substance that doesn't cause euphoria. That is why, I think, people who smoke are oftentimes able to stop smoking and stop permanently. In a sense, they are cured, because -- remember, the core problem is the incessant attempt to experience that euphoria again, and since smokers don't ever get euphoria, they get more relaxation than they get euphoria, I think, in some ways, it's a different drug.

Here's another point I would make about the so-called "cures." I do think that a certain number of people stop using substances during a transition phase of their addiction. I think that's why it's important, that if you see trends in your kids with drugs or alcohol, the sooner you get them into treatment, the sooner you get things really moving, and not to wait. Because if you wait just another few months, it may be too late.

The sooner you step in, the more likely you may catch them in a transition phase before they have full-blown addiction. I think the transition phase can vary anywhere from a few weeks to, in the case of alcohol, maybe even many years. So to some degree you may be talking about glass half-full or half-empty about that.

David: That's an interesting point that you're making, because I had wanted to mention to you a book by someone else that I interviewed recently, also an MD, a psychiatrist, in this case, Lawrence Westreich. He's written a book called "Helping the Addict You Love: The New Effective Program for Getting the Addict into Treatment." Something that he has beneath that subtitle -- he says: Tough love and intervention aren't the answer.

He gives lots of scripts for dialoging with the addict, making the intervention that you're talking about, not being passive and not ignoring it, but -- I forget what the word was -- almost a coercive persuasion. He give lots of sample ideas about how you would approach that. He seemed fairly optimistic.

He teaches both at NYU and also was head of Bellevue Hospital's detox unit and dual diagnosis unit, and he said he really likes that work. I said, "How can you like that work? I understood that it's kind of hopeless." His feeling was that, "No, no. It's not hopeless at all."

John: I think there are a lot in that industry that are very optimistic. I know this book that came out recently by the National Drug Abuse called "Addiction: Why Can't They Just Stop?" They really try to move away from the very pessimistic feelings that we have; they feel that addiction has a stigma to it that we need to remove.

But I'll be honest with you. I've dealt with a lot of addicts and alcoholics over many years, and I really don't share their optimism. I really feel, particularly when people get to the point where they have serious problems and we know they've fully transitioned into full-blown addiction, that the best you can hope for is that they will -- through family support and a lot of reasons to keep their life together, a lot of motivation -- that they will go into, hopefully, a remission or semi-remission state where maybe they take a supportive drug.

That's the best you can hope. I've never seen an addict, someone who clearly is an addict, to return to a fully functional, normal lifestyle -- with the exception, of course, of a smoker; I don't consider a tobacco user in this category.

So I honestly don't share that level of optimism, but I am very optimistic about the ability to prevent because I think that for so long we've thought of addiction in terms of a fatalistic thing -- either you've inherited it and there's no way to avoid it; you're going to be addicted no matter what, or there's something about your childhood that happened that's going to make you an addict. We know that, predictably, ten percent of the population or more is going to be addicted to a substance.

But I really think that there's a lot of optimism that we can really drive that number way down, to seven, five percent, maybe to three percent over time, but it's going to take following some of the science on this, and that is delaying the experimentation with addicting substances to as old an age group as possible and let that brain mature and be more resistant to the addictive capacity of drugs.

David: Well, I think that's a strong argument. That's the hallmark of your approach, to emphasize prevention over treatment, and I really can't argue against that.

It reminds me of that old story, if you notice babies floating down the river, drowning babies, are you going to pull babies out, or are you going to go upstream and figure out who's throwing the babies in and stop them from throwing the babies in? [laughs]

John: Exactly.

David: And that's the kind of approach that you've taken and you're advocating here. We're running a little long here but I wanted to give you more of a chance to talk about your treatment approach in terms of your advice to parents. I can refer them to the book because you actually have a sort of age graded approach where such and such an intervention or education is appropriate at this age and then at a later age it escalates. Do you want to say a little about that?

John: I would. I'm often asked at what age should techniques be implemented and my answer to that is that they should be implemented before birth. What I mean by that is that a couple who is anticipating starting a family or even a single parent should think about what the customs and attitudes about drugs and alcohol are going to be in the home and carefully evaluate how that will impact the child.

My wife and I had small amounts of alcohol for social purposes before our kids came along but we made the decision that we were going to remove alcohol from our home and be role models for non-drinking and certain non-drug using people regardless of the fact that one would think that alcohol use by a responsible adults is an acceptable thing. And it is an acceptable thing. But we wanted to be sure we didn't send any mixed signals at all to our kids. We didn't want them to see me pulling a beer out of the refrigerator the way I saw my grandfather pull out his bottle of whisky.

Beyond that as kids get into the age range of three and four it's important to indoctrinate them to an anti-drug message. Don't wait until they're in the 7th grade to teach them about drugs and drug education. Indoctrinate them just as you would indoctrinate them to not talk to strangers or to not run out into the street where there's traffic. You want to indoctrinate them to things that are going to be harmful to them. Even point out how members of the family or people in the news have unfortunately succumbed to addiction. I think it's very important to convey that information at a young age.

Then there's the time in elementary school perhaps in 5th and 6th grade, you need to be careful about unsupervised time, home alone after school or when parents are at work, what they're doing at home. Is there alcohol in the cabinet? There is something called farming with kids in that age group. They love to gather up beer and alcohol and medication and have a little party.

David: What did you call that -- farming?

John: Farming -- F A R M I N G. No, I'm sorry, it's P H A R M I N G, which is you go into the medicine cabinet.

David: Oh, as in pharmacology. I get it.

John: Yeah, you're getting the pharmaceuticals out of the cabinet. That's become a real rage with preteens today. You need to lock up your lower cab and oxycontin and whatever your physician has prescribed. Kids know a lot about this stuff because of the Internet.

David: That's scary.

John: Then also preteen kids like to spend the night together and camp out. Very often nowadays these have become another way for beer draws. They usually have a substance there, it's usually alcohol, it's usually beer and more often than not that's the real purpose behind coming together. They usually go to the house that's least supervised or where parents are most accepting of that sort of thing. Then when they get to driving age, that real critical time, it's important to consider other techniques such as the breathalyzer.

We used that with our son. Also drug testing. We actually drug tested two of our kids on separate occasions and not for serious reasons. In one case we smelled something odd on the clothing of one of our daughters and another -- I don't even remember what the reason was -- but we took a urine sample and they tested negative. They weren't happy about it but to be honest with you it did not negatively affect our relationship. They knew because we made it clear in the context of our relationships overall that we loved them and it was our intention to protect them. It didn't create trust issues.

People often ask me, "Well does it hurt trust?" And, of course, you can't have trust. I answer that you can't have trust without honesty. How do you know your kids are being honest unless you verify it with some mechanism? Unfortunately far too many parents are nave to what their kids are doing and if they expect their kids to be honest with them about the things they're doing that they don't approve of, they're just fooling themselves. Kids are not going to be honest about underage drinking or using drugs.

This works the other direction, too. I've seen young adults who are now in desperate situations of addiction and are looking forward to a life of addiction. They are angry at their parents because they let them con them into getting away with a lot of stuff.

My message to parents is if you want your kids to truly appreciate you do the right thing now because later on they're going to be very upset with you when they have a problem like addition.

David: Now did none of your four kids end up rebelling against what are fairly strong -- what could be perceived as Draconian measures? Did any of them rebel?

John: Nope. I did not have rebellion among any of them. None of them developed addiction problems. My oldest is 27 and she has a graduate degree as a school teacher. She's married to a gentleman who is a graduate student at Duke today. She's expecting her first child. The second child had some problems in early childhood with depression and ADD so she didn't come to the table with everything in her favor and yet she had no problem at all with us forbidding underage drinking or use of drugs.

My two sons, of course being boys, they liked to do things like experiment with alcohol and they understand well what our attitudes were and today my oldest son is a senior in college and he's started a program at the University of Mississippi called "Cheers" where the local restaurants offer free sodas to the designated drivers who aren't drinking. So he's actually doing things to promote and he received a grant from the Department of Transportation on that behalf.

My other son is a freshman in college and he may be binge drinking as we speak but certainly I've done everything to prevent him from becoming addicted. But we know that when kids reach that age of independence, age 18 or so, they're going to go through rumspringa, which is a term that the Amish use where kids go off and they live in a hedonistic world until they finally return and live the quiet simple plain life that Amish do.

Probably my younger son is going through his rumspringa right now. But that's OK. I did my job as a parent to age 18 and hopefully you have faith that he's not addicted.

David: Yeah, that's a good attitude, I think. I think the reason probably why this has worked so well for you is that your values, your attitudes, and your communications probably have been very consistent down through the years. So it wasn't a big surprise as you began to toughen up in the teenage years.

If somebody were to just suddenly start slapping some of these measures on their kids, out of the blue, it might be a different reaction.

John: Yeah, our kids were not surprised when we did these things. Because they knew the context of our parental attitude and the parental authority, and it was instinct to everything that we had done, it was always done with a loving experience.

David: Yeah.

John: We didn't yell at our kids, we didn't get mad at them, and we didn't do some of the things that my adult friends have done -- punch their kids, and push them against the wall, and tell them never to drink again. We never did those things.

We just simply said, "Look, son, I love you, I don't want anything bad to happen to you. The worst nightmare that a parent could go through is finding out that their child died in a car accident and was all drinking alcohol. These are the kind of pains that we don't want to go through and we don't want you to go through." Kids are intelligent, and they know when it's the real McCoy. They really care about it.

David: OK, well, you know, I guess there's just one more point I want to raise. I feel a little funny about it, but in your book, both by the choice of the publisher and your forward and the acknowledgements, it really comes across that you're a fundamentalist Christian. Yet in this conversation here, and as I read the book, it seemed like your intention was to reach a very broad audience.

The information all seems solid, and yet when I saw that context, I couldn't help but have the reaction, "Well, some of this is going to be shaped by that religious commitment." I felt like, boy, putting that in the book, I don't know, on the one hand I loved the amount of self disclosure which I've already acknowledged, and then I thought, "Well, you know, that could be off-putting to some people."

John: Yes, and I really had debates about that within myself and also my content editor about that, because there's nothing that we've talked about today that wouldn't be good advice to anybody, whether atheist, or Muslim, or Jewish, whatever.

And so, yes, of course, I do bring fundamentalist Christian values to the table. We're always a product of our lives and our experiences. So rather than trying to ignore them, I think we should embrace and also try to be somewhat unbiased in the way we bring it to the table.

I really think every message here is consistent with Christian thought and Christian morality. It's also consistent -- and I make this point in the book -- it's also consistent with just common, everyday decency and morality, whether or not that you have a belief in Jesus Christ, or Buddha, or whoever.

But I will say this, and this is I think, a very important point that I try to make. Whatever religious belief that you have, if you have one, there's lots of reasons to believe that living a church lifestyle, and I use that word 'church' in a generic sense, which certainly applies to a synagogue, in which you have common values with people that are for the health and wellbeing of children.

I think there's a whole lot towards advancing the safety and protection from addiction of kids. And by that I mean there are a lot of people who claim to Christians, for instance. And yet, their lifestyle and their values are not consistent with what you may see with people who are frequent church attendees, or synagogue attendees.

And so I do try to make that distinction, that whether or not you really are Christian, or you even have a belief in God, that you really need to pull together with other people who have like-mindedness when it comes to the morality part of these issues.

David: Yeah. You really need some support if you are going to take a stand against drugs. You do need the support of some community.

Well, I want to thank you for dealing with that question so forthrightly, and I really can't disagree with anything that you've said about it. So, Dr. Fleming, I really want to thank you for being candid and for being my guest today on "Wise Counsel."

John: Great. Thank you, Dave. And if it's OK, I'd like to mention that my book, "Preventing Addiction." You can read more about it and even purchase it through my website at JohnCFleming.com, or just Google my name, "John C. Fleming," or you can buy it at Amazon.com or BarnesandNoble.com. It's pretty widely available.

David: OK. That's great. And I will put a link to that in the show notes as well.

[music]

David: I hope you enjoyed this interview with my guest, Dr. John C. Fleming. Dr. Fleming and I had a nice chat offline, after the interview. I discovered that he is just won recognition as "Outstanding Louisiana Family Doctor of the Year." Beyond this, I was further impressed to learn that he plays classical piano and also holds a 3rd degree black-belt in Karate.

You can find out more by visiting his website at www.johncflemingmd.com.

You've been listening to "Wise Counsel," a podcast interview series sponsored by mentalhelp.net. If you found today's show interesting, we encourage you to visit mentalhelp.net, where you can add a comment or question to this show's web page, view other shows in this series, or simply page through the site, which is full of interesting mental health and wellness content.

Access the show's page and show archive information via the podcast box on the mentalhelp.net home page. If you like "Wise Counsel," you might also like "Shrink Rap Radio," my other interview podcast series, which is available online at www.shrinkrapradio.com, and 'rap' is spelled, R-A-P.

Until next time, this is Dr. David Van Nuys, and you've been listening to "Wise Counsel."