Substance Use Disorder is a medical... | Georgia Telehealth Therapy

I want you to just um try to imagine a stadium for a second. Okay. Like a football stadium. Yeah. Exactly. Yeah. But actually imagine a hundred of the biggest stadiums in the entire world and they are just packed to the absolute brim. That is a lot of people. Right. We're talking about 46 million people. Mhm. And um that is the approximate number of adults in the United States right now who are affected by substance use disorder. Wow. Yeah. When you put it like that, it's I mean it's massive. It really is. And when you hear a number that big, it, you know, it stops being this niche medical topic that's just happening to quote unquote

other people out there somewhere. Oh, absolutely. It's not a fringe issue at all. Right. It's a baseline reality of modern society. Yeah. Like you, the person listening to this deep dive right now, you almost certainly know someone or love someone or work with someone who was navigating this. Yeah. Statistically, it's almost impossible that you don't. Exactly. And yet the way we culturally talk about addiction, it's um it's often decades behind the actual science. Oh, it is entirely disconnected from the science. I mean, when a condition impacts 46 million adults, that is a structural public health crisis, right? It's not an individual character flaw, which is how a lot of people still view it. Unfortunately, they

do. Our cultural narrative is just stubbornly stuck in this idea of willpower. Like as if overcoming severe physiological dependence is the exact same thing as I don't know deciding to wake up early for a morning run, right? Just pull yourself up by your bootstraps. Yeah. Which brings us to the core mission of this deep dive. We are looking at a really comprehensive substance use disorder guide or SUD for short. Yeah. Published by Coping and Healing Counseling. Right. Exactly. Coping and Healing Counseling or CHC. They are this major teleaalth therapy practice operating across Georgia and um their clinical guide basically functions as a masterclass in how modern medicine actually treats addiction today. It's a fantastic resource.

It really is. Okay, let's unpack this because to even understand the treatment, we kind of have to completely redefine what the condition is. Yeah, we have to start from scratch right out of the gate. The source material draws a really hard line. It says substance use disorder is fundamentally a chronic treatable medical condition. Absolutely not a moral failing. And that framing is just everything. It is. The guide explains that it exists on a spectrum. So like mild, moderate or severe. And that's based entirely on DSM5 criteria. Things like um impaired control, tolerance, and withdrawal. Those specific words are so critical here because you know tolerance and withdrawal they are not behavioral choices, right? They're physical.

Exactly. They are measurable biological adaptations. When a person consumes a substance really heavily over time, the brain's neurochemistry physically alters itself to accommodate that substance. Wait, so the brain actually changes its own structure basically. Yeah. It downregulates its own natural neurotransmitter production. And that right there, that is tolerance. Wow. And then when the substance is removed, the brain is just left in this state of profound chemical deficit which triggers intense physical and psychological distress. And that is withdrawal. So it's literally just biology. Yes, we are talking about biology, not morality. Think about the last time you tried to break a simple habit, right? Like biting your nails or I don't know, cutting out sugar. Oh,

sugar is a tough one, right? Now imagine your actual brain chemistry actively punishing you with physical illness for trying to stop. It just completely changes the framework. It really does. I was actually thinking about this whole old moral failing argument and this different analogy came to mind based on what the guide reveals. Is viewing SUD as a moral failing kind of like getting mad at your car for having a bad transmission? Oh, I like that. Like you can yell at the car all you want. You can tell it to try harder, but it ultimately needs a mechanic, not a lecture. Right. That is spot on. But I do want to push you on something here.

The guide makes a huge point about language, specifically using the word disease. Why is the sheer act of changing our vocabulary an actual clinical tool and not just, you know, political correctness. What's fascinating here is how deeply that hijacked circuitry impacts behavior. Let's look at the dopamine pathways. Right. To the reward center. Exactly. Normally, dopamine rewards us for life sustaining activities like eating a good meal or socializing. But with SUD, those pathways are essentially taken hostage by the substance. So, the substance just overpowers everything else, right? It floods the brain with so much dopamine that normal everyday joys just cannot compete. The brain starts to demand the substance just to feel remotely functional. That's terrifying.

It is. And this is exactly why the guide places such an intense emphasis on language. Using the word disease isn't just a matter of clinical politeness. It is a strategic medical intervention. So calling it a disease actively does something for the patient. Exactly. The guide states that referring to SUD as a disease actively reduces stigma which directly increases the likelihood that people will actually seek care. Because if society labels you as morally bankrupt, the natural human response is shame. Yep. And shame makes you hide, right? But if you have a recognized medical condition, you go to a doctor. You seek treatment without carrying that burden of moral judgment. Exactly. Shame is a literal physical barrier

to healthcare. It keeps people out of clinics. When we shift the vocabulary to disease, we give the individual a medical framework. We legitimize what they're going through, right? We are telling them, "Hey, your hardware has adapted to an environment in a way that is now harming you." And we actually have evidence-based tools to stabilize that hardware. Here's where it gets really interesting, though, because once we accept that SUD is this complex physiological disease, it naturally follows that the treatments have to reflect that reality. They absolutely have to be rooted in science. And this is where the guy directly contradicts what we constantly see in pop culture. Oh, the pop culture narrative is so misleading. It

really is. like movies and TV shows tell us that the only way to treat addiction is hitting rock bottom and then going to a 12step meeting. But the source is explicit about this. What does it say? It says that while 12step programs, a mutual support group, so things like AA, NA or Smart Recovery, while they are incredibly useful adjuncts, they are not standalone medical treatments. And that makes perfect sense medically. They cannot be standalone treatments because you cannot just share your way out of severe neurochemical dysregulation. Right? Talking doesn't fix the dopamine deficit. Exactly. Mutual support groups are brilliant for providing community and accountability and shared experience. And those things are vital for long-term maintenance,

but they aren't the first step. I mean, wait, pop culture basically tells us that going to AA or NA is the treatment. I know. So, is a 12step program basically like physical therapy after a major surgery? like it's absolutely vital for your recovery, but you still actually need the medical intervention, the surgeon first. That is a perfect analogy. Yes. If a patient is experiencing acute withdrawal or their dopamine receptors are completely suppressed, relying solely on group support just completely ignores the medical emergency happening in their physical body. It's the difference between hardware and software basically. Oh, I love that. Yeah. Going to a mutual support group or even doing talk therapy, that's trying to reprogram

the software. But if the hardware, the physical brain chemistry is crashing, the new software just won't run. It literally can't. So the guide outlines the actual hardware fixes. It talks heavily about medicationass assisted treatment or MAT specifically for opioid and alcohol use disorders. Matt is truly the gold standard of care right now. Yeah. And it lists very specific medications, things like buprenorphine, methadone, nrexone, and amproate. Let's actually look at the mechanics of those medications because it illustrates exactly why Matt is so crucial. Take buprenorphine for opioid use disorder for example. Okay, how does that one work? It is what we call a partial agonist. That means it binds to the brain's opioid receptors basically tricking

the brain into thinking it has the substance which stops the withdrawal. Exactly. It completely stops the withdrawal symptoms and those agonizing cravings. But, and this is the key part, it doesn't trigger the massive dopamine flood. Oh, okay. So, it doesn't get the patient high, right? It simply turns off the biological alarm bills so the patient can actually function. Wow. And then Nrexone works differently, right? Or it's an antagonist. Correct. Nrexone essentially puts a lock on the receptor. So even if the person somehow introduces the substance to their body, it physically cannot bind to the receptor. Meaning there is no euphoric effect at all. Exactly. And then you know you have the physiological complexities of alcohol

withdrawal which is a whole different beast. Yeah. The guide mentioned that unlike opioid withdrawal, alcohol withdrawal can actually be clinically fatal. Yes. Due to GABA receptor downregulation. Let's expand on that for a second because I think the listener really needs to understand the gravity of this. Alcohol artificially boosts GABA, right? Which is the brain's primary calming chemical, right? And at the same time, it suppresses glutamate, which is the excitatory chemical. So over time, the brain just stops producing its own GABA to balance out the massive amounts of alcohol. So if a person just suddenly stops drinking cold turkey, they have zero calming chemicals left and their excitatory chemicals just go completely unchecked. Oh wow. Yeah.

And this leads to severe tremors, hallucinations, and potentially fatal seizures. You just cannot treat that with sheer willpower or a 12step meeting. You treat that with rigorous medical intervention. That makes total sense. And then once that hardware is stabilized with the medication, then the evidence-based behavioral therapies can actually take root. Exactly. Then we can work on the software. The guide highlights three main ones. Cognitive behavioral therapy or CBT, motivational interviewing, and contingency management. All highly evidence-based, right? And when you look at the mechanics of these therapies, they are incredibly targeted. Like CBT isn't just venting on a couch about your childhood. No, it is actively identifying the neurological triggers that lead to substance use and

consciously building new neural pathways to bypass them. And then you have contingency management, which is fascinating. It uses positive reinforcement to encourage abstinence, which works well for a brain starving for dopamine, I'd imagine. Precisely. By providing tangible immediate rewards for things like negative drug screens, you are essentially hijacking the brain's reward system back in a healthy direction. That is so smart. And what about motivational interviewing? That works to resolve the patients internal ambivalence. It counters that deep-seated shame we talked about earlier. It's just a very deeply collaborative process between the therapist and the patient. But you know, treating the substance use is still only treating the surface if we ignore what caused the use in

the first place, right? That is the big catch. Which brings us to this truly staggering statistic from the coping and healing counseling guide. They note that approximately 50% of people with substance use disorder have a co-occurring mental health condition. half of the population we are talking about that is 23 million adults who are simultaneously navigating sud and a mood disorder an anxiety disorder or just profound trauma. So the substance use is often just a coping mechanism. Exactly. It's a deeply ingrained coping mechanism for a nervous system that is already completely overwhelmed. And the source makes it abundantly clear that treating these co-occurring disorders is the only way to meaningfully improve SUD outcomes. You have to

treat both. You absolutely have to. And doing that relies entirely on accurate professional diagnosis. The guide mentions that primary care settings often use quick validated screens, things like the ATC or the DAS 10. Very standard tools. Yeah. And they also use a public health approach called ESPERT, which stands for screening, brief intervention, and referral to treatment. Right. It's a great way for a general doctor to catch the red flags during just a routine five-minute visit before a patient reaches severe dependence. But the guide has a very firm rule here. It is adamant that an actual diagnosis must be made by a licensed clinician using DSM5 criteria, never by an online self test. This raises an

important question about our reliance on digital convenience, doesn't it? Seriously, I mean, I have to ask on behalf of the listener, if the DSM5 criteria are basically just a checklist that determines mild, moderate, or severe SED, why can't I just take a quiz online? We take online quizzes for literally everything else. I know we live in an era where we want an app or a quick online quiz to give us an immediate answer for everything. But let's look at the actual mechanics of co-occurrence, right? I mean, I used to think those online checklists were enough. You know, you check a box for cravings, a box for insomnia, and the algorithm tells you what's wrong, but

it's so much more complicated than that. Yeah. Looking at the sourc's data on co-occurrence, a checklist can't tell the difference between, say, alcohol withdrawal and a severe panic attack. Precisely. The symptoms are virtually identical. Elevated heart rate, sweating, agitation, severe insomnia. The physical manifestations overlap entirely. So, a quiz just sees the symptoms, not the cause. Exactly. When a patient presents with those symptoms, a licensed clinician isn't just tallying up a score like an online quiz. They are conducting a highly nuanced differential diagnosis. They have to untangle the whole web, right? They have to ask, "Is this patient drinking excessively because they have an underlying undiagnosed PTSD and alcohol is the only way they can numb

that hypervigilance or is the excessive alcohol use actually causing the neurological symptoms of anxiety as the brain constantly bounces in and out of many withdrawals?" Wow. An online test just gives you a label. A clinician gives you the actual causal relationship. Exactly. And the guide notes that the clinicians at Coping and Healing Counseling, and these are specialized licensed professionals, by the way, they focus heavily on areas like anxiety, depression, trauma, and grief, which makes sense given the co-occurrence rate, right? They have the clinical training to separate those overlapping symptoms and build a treatment plan that addresses the root cause and the substance use simultaneously. Because if you only treat the SUD and you just ignore

the underlying trauma, the patient has no coping mechanisms left, they are raw, exposed, and highly vulnerable to relapse. And conversely, if you only treat the trauma but ignore the physiological dependence, the brain's chemistry just remains completely unstable. Exactly. The integration of care is the only actual path forward. So, what does this all mean? We have this incredible evidence-based toolkit. We understand the neurobiology of Matt. We understand how CBT rewires the brain and we know that treating co-occurring trauma is absolutely essential. We have the knowledge. Yes. But here is the brutal reality. The absolute best medical science in the world is completely useless if the 46 million adults who desperately need it cannot actually access it.

Accessibility is the ultimate bottleneck in public health. I mean, you can design a perfect integrated treatment protocol, but if it is locked behind geographic or financial walls, it completely fails the population. And this is where the coping and healing counseling guide kind of shifts from just being a clinical manual to basically a blueprint for healthcare democratization. They really do model how to systematically remove these barriers. First, let's talk about geography. They operate 100% via secure IPA compliant tellahalth and they serve all 159 counties in Georgia. The macrolevel impact of that simply cannot be overstated because you know in the traditional health care model, highly specialized addiction psychiatrists and dual diagnosis therapists, they are almost always

clustered in major urban centers, right? It's the whole idea of geography as a barrier to health. Imagine living in a rural county. Your brain chemistry is entirely destabilized. You are navigating severe underlying trauma and the nearest specialist is a three-hour drive away. It's an impossible situation. It is. If you don't have a reliable car or you work a wage job where you can't just take a random Tuesday off, geography has effectively denied you your right to healthcare. But by moving this comprehensive care entirely to a teaalth model, that barrier is instantly vaporized. It really changes the game. A teenager in a rural farming community now has the exact same access to a culturally competent, specialized

therapist as someone living in downtown Atlanta. It adapts the delivery mechanism to the reality of the patient's actual life. And the guide mentions they have a really large and diverse team. Right. Yeah. 15 plus licensed therapists. So, LCSSWS, LPC's, LMFTs, offering individual, couples, family, and teen therapy for anyone 13 and up. That's incredible. But geographic access is only half the battle. The financial barrier is often the final really insurmountable wall for patients seeking SUD treatment. And the guide addresses this problem beautifully by showing how integration with major insurance networks actually works. They accept the major commercial providers like Etna, Sigma, Blue Cross, Blue Shield, United Healthcare, Humanana, which keeps session costs relatively low, usually around

$10 to $40 a session, right? But the true game changer, the thing that really proves this model is about actual public health, is that they accept Medicaid for a 0 co-ay. When you look at the intersection of poverty and substance use disorder, that $0 co-pay is quite literally life-saving. I can imagine the chronic stress of financial instability is a massive driver for substance use. And simultaneously, severe substance use frequently leads to financial ruin. So charging exorbitant out-of-pocket fees for recovery just feeds the cycle. They are essentially taking this gold standard highly complex medical intervention and delivering it straight through a smartphone into a patient's living room potentially for free. It is a masterclass in modern

public health infrastructure and they actively coordinate with medical providers to manage the M too, right? They are stabilizing the hardware through coordinated MAT, reprogramming the software through specialized behavioral therapy, untangling the co-occurring trauma and delivering all of it without asking the patient to overcome massive logistical hurdles. It just proves that recovery from SUD is entirely possible at any level of severity as long as the health care system is actually designed to reach the patient. Precisely. We started this deep dive looking at a stadium of 46 million people and um I know it's easy to feel overwhelmed by the sheer scale of this condition but unpacking this guide provides a very clear scientifically rigorous path forward.

It gives us a real road map. It does. Let's synthesize the absolute essentials for you the listener from the CHD clinical guide. First we have to fundamentally retire the concept of willpower in addiction. Yes. Medicine over morals. Exactly. SUD is a treatable physiological disease that hijacks the brain's survival instinct. It requires medical intervention, not moral judgment. Second, the treatment must match the science. Stabilizing the hardware with Matt, like buprenorphine or nrexone, and rewriting the software with therapies like CBT while using 12step mutual support groups as powerful ongoing adjuncts. Third, accurate diagnosis by a licensed professional is non-negotiable, right? Because treating SUD without addressing the 50% co-occurrence of trauma and anxiety is basically just treating a

symptom while ignoring the disease. And finally, the future of public health relies on models like CHC, utilizing telealth to completely dismantle the geographic and financial barriers that keep people from the care they deserve. The science is clear, the tools exist, and the delivery systems are evolving. But I do want to leave you with a final provocative thought to maybe mull over on your own. Okay. What is it? It returns to the very beginning of our conversation about the immense power of language. We established that using clinical accurate language like the word disease actively saves lives by dismantling the shame that keeps people from seeking treatment. Right. But think about how casually, almost recklessly, we use

addiction language in our everyday lives. Oh man, you hear it constantly. People saying, "Oh, I'm totally addicted to this new Netflix series." Or, "I have a major sugar addiction just because they like really enjoy donuts." Exactly. We use the vocabulary of a devastating physiological crisis as a casual punchline for our minor everyday habits. But if clinical language is a crucial tool for public health, we really have to ask ourselves what our casual language is doing. That's a great point. When we dilute the severity of the word addiction by applying it to our streaming habits or our hobbies, are we inadvertently minimizing the reality of those 46 million adults whose neurochemistry is actively fighting against them?

Are we subtly keeping the stigma alive? Right? By implying that their chronic medical condition is basically no different than our lack of discipline around a TV show. The words we choose shape the reality we live in. And in the context of substance use disorder, those words dictate who feels safe enough to ask for help. Wow. Language shapes our healthcare. That is definitely something I'm going to be thinking about every single time I catch myself reaching for those words. Thank you so much for joining us on this deep dive. Keep questioning the narratives around you. Stay curious and we will catch you next time.