Alcohol and Drug Recovery: Insights from 40 Years of Care (Podcast)

The 2023 National Survey on Drug Use and Health estimates that 48.5 million Americans above age 12 have a substance use disorder (SUD). Unfortunately, social factors like stigma, lack of access to care and unstable living environments can hinder recovery efforts, as can neurochemical changes to brain chemistry that affect the patient’s judgment and decision-making abilities. Despite these challenges, addiction specialists are helping an increasing number of patients achieve sobriety through targeted interventions designed to address the biological and psychological underpinnings of the disease.

“There’s no question that SUDs diminish the average lifespan of any population, but there is cause for great hope,” says psychiatrist David Streem, MD, Medical Director of Cleveland Clinic’s Alcohol and Drug Recovery Center. “By studying the long-term health and safety of individuals in recovery, we’ve learned that appropriate monitoring and care can significantly reduce the incidence of relapse. Research and experience show that, if we can give a patient five years of sobriety by supporting their growth and healing during that critical period, they’re very likely to remain sober for the rest of their lives.”

In the latest episode of the Neuro Pathways podcast, Dr. Streem shares insights gained through 40 years of caring for patients with SUDs. He addresses:

• The neurobiology of addiction, including genetic risk factors
• Improving outcomes with effective screening
• Evidence-based addiction treatments, including 12-step recovery resources
• Addressing addiction with multidisciplinary outpatient and inpatient care
• Ongoing, collaborative clinical research efforts

Click the podcast player above to listen to the 20-minute episode now, or read on for a short, edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

This activity has been approved for AMA PRA Category 1 Credit™ and ANCC contact hours. After listening to the podcast, you can claim your credit here.

Podcast excerpt

Podcast host Glen Stevens, DO, PhD: Addiction…is a chronic condition characterized by a compulsive need to engage in a behavior or substance despite its potentially harmful consequences. What happens to the brain with substance abuse? Why has it become a problem?

Dr. Streem: Well, one of the fascinating things is that the brain structures that are primarily involved and become dysfunctional in cases of addiction are subconscious. They're primitive parts of the brain – parts that are present in lower mammals and even lizards. They don't generate conscious thought, but they connect through those connections to the frontal lobe and other areas of the brain that do. They insidiously corrupt the thinking that sounds like our own.

The little voice in your head that directs you, [facilitates] judgment and leads other people to rely on your wisdom gets corrupted by addiction. So, helping people understand what parts of their mind they can trust and what parts they can't is an enriching and interesting part of my work.

Dr. Stevens: I imagine psychiatric comorbidities are pretty high with substance use disorders. Can you comment on that?

Dr. Streem: This underscores the importance of universal screening. When people enter our program, they are screened for a variety of psychiatric conditions, especially depression, bipolar disorder, social anxiety and – the number one comorbidity – trauma and post-traumatic stress disorder. It's my firm belief that if we don't adequately identify people with these disorders and effectively treat them – not just with medications, but with the best evidence-based psychotherapy out there – we're setting ourselves and our patients up for failure. It’s really important that we address all of that right from the start.