they should be widely implement it. total integration of the services for substance abuse with corrective healthcare would improve quality of care. coordination and implantation should occur, research should be pursued. the next question, final question, what is oxford house doing. you can expand evidence-based intervention by working with trinity leaders and senior coalition prevention treatment and recovery programs and policies. use the surgeon general's report to document that position. you can use the surgeon general's report to inform your own members, your families, and the public and community leaders about the science behind your condition. it does not mean that you are brain damaged but it does mean that you have been exposed to substances that have affected your brain and you are recovering from. mobilize different segments of the community engaged with stakeholders and recovery,

policymakers, law enforcement, healthcare, education, businesses, the faith community to encourage change. you are in a position to do that. 1200 people here and you are a strong army. [cheering] you need to encourage parents to talk to their children. with her parents to the surgeon general's report. we need to continually assess the commitments, needs and of people and are covering community and stakeholders. you can adjust strategies. you can use your imagination and understanding of hope, and expands the strength of people seeking to recover from the effects of alcohol and drugs to envision a new reality. you are envisioning a new reality and you can use the surgeon general's report to

promote that. there is website where you can get collaborative all materials, there's a website addiction surgeon general .gov and you can download things and that will give you additional materials to address these issues. i hope you find this helpful. if you have any questions please give me a call, write me a note, i want you to be able to address these issues. it is important that you continue addressing the issue of recovery because it's a lifelong proposition. i have a disclaimer. i'm not an employee of the federal government and i'm just talking about the report because it needs to be discussed.

thank you. [applause] >> much obliged. thank you. i think that all of us should give doctor clark another hand. that was a big hand, but give him another hand. [applause] we are fortunate to not only have doctor clark here that we have doctor get low and i hope that you can all see his chart and i'm sure i'll figure out a way for us to see it and it may even show up on the big screen but after he speaks we will open

questions to both of these doctors. [applause] >> thank you. we live in an incredibly health-conscious country. how many of you have ever bought bottles of water? when you buy the bottled water are you concerned that maybe there is some bpa in the plastic? yes, some of you are. you are concerned to such an extent about health that you decide to buy something that you can get for free out of your tap and then you are further concerned about whether or not there is something called bpa in the plastic. if you go to the grocery store, there are isles full of products, supplements that you can take. they range from willow bark to.

[inaudible] and all of which might be helpful but sells tremendously well. we even passed laws that are designed to help a minority of people in the country in order to protect their health. what is one such law? a big one is the seatbelt law. we all put on our seatbelts because we have to and it's the law and because we know that we don't want to go through a windshield. but the reason why the law is there is to make it so that a minority of people don't get injured. it wouldn't be a majority of us that at some point in our lives go through a windshield. it would be a minority. we all wear our seatbelts in order to protect the minority

who would otherwise get hurt. similarly motorcycle helmets. if you go anywhere near a ski slope these days everyone is wearing a helmet. most people didn't end up with head injuries. all right. here we are in the country that is focused on health to such an extent that we passed laws to protect the minority. isn't it odd that we don't seem to mind the 500,000 people a year who die of cigarette smoking related illness and we don't seem to mind the 80000 people who die of alcohol-related illnesses and we don't really seem to mind the 50000 people a year die of opioid -related illnesses although that is coming out in the media. why is it that opiates are coming out in the media and tobacco and alcohol aren't? why is it that the drugs that kills 50000 people a year makes headlines and the drugs that

killed 580,000 people a year is nowhere near the front page. why is that? it is because the majority of people would like to continue to be able to use the two drugs that are responsible for killing 580,000 people a year. [applause] even though those same people are buying bottled water where they are watching out for the bpa that might hurt them. when you live in a country that is health-conscious but it doesn't always make sense. how can we change the text? how can we make it that this is clear to people and that addictions, no matter what the drug is is addiction. how can we clarify that it

doesn't matter whether or not your favorite drug is methamphetamine or marijuana or tobacco or heroin. it is all the same and it all boils down to a disease state. you know what? it is a congenital disorder. a birth defect, if you will. we are not talking about substance use but were talking about the disease that affects about 15% of the american publ public. how does it affect 15% of the american public? because 85% of the public can drink, can take an opiate, can use marijuana and can even smoke from time to time and not end up with addictive disease. when i was 13 or 14 years old i needed a root canal. the night before the surgery was

one of the most painful experiences i care to have and i got in injection of demerol, a morphine like agent. the demerol essentially made me nauseated and it gave me an uncomfortable feeling and, thank god, i fell asleep. there was no joy in it. yet, i talked to my patients and they tell me about their first experience with a morphine like agent and they tell me, my god, it was better than sex. [laughter] you sit there and say, why do they have that experience and i didn't? what is the difference there other than there must have been something separating the two of us before either of us ever used the drug hence, birth defects. this is a congenital disorder. let me give you another metaphor designed to separate that out. as humans, we fall on what is

called the normal curve. i'm going to walk to the flipchart over here. let's see. that is coming out on the screen just wonderful. we live on a normal curve. were distributed normally. this means that if i were to pull all of you out in it measure your iqs most of you would be right here in the middle and some of you would be way up here and some of you might be way down here but if i take a whole population what we will find is that it is distributed like this. i could do this with height, i could do it with pulse rate, i could do it with body temperature. there is another normal distribution that we find in humanity. that of how aware we are of the world around us. how much does the world around

us stimulate us. how loud is it, how irritating is it. how annoying is it. how distressing is it. let's say all of us were to walk outside on a bright, sunny day. it is noon, the sun is shining down and we are in arizona. the sun is real bright. how many of you would put on a sun glasses when you walk outside? show of hands. how many of you would not put on a pair of sunglasses when you walk outside? how many of you are somewhere in the middle and you don't really care one way or the other? you always get a bunch. we saw a pretty good distribution there. a lot of you work i would put on the sunglasses. why is it that we would all walk out on an equally sunny day --

we are all seeing the same son and why is it that we perceive it so differently that some of us would use a drug in the form of sunglasses designed to make it more comfortable? and some of us wouldn't? those of you would put on the sunglasses, i'm going to call stimulus augmenter's, meaning that you are taking the stimulus of the sun and in your brain the volume knob is turned up a little too high. when you turn on the sunglasses you think to yourself that is more comfortable and that's the way it ought to be. stimulus augmenter's in general are individuals who find the world to loud, too noisy, too annoying, too irritating. you are the ones who don't like turbulence on airplanes.

the ones who don't want to go downhill real fast, if they go skiing. who don't go rock climbing or do exciting things like that because the world is already too much. you'd like to turn it down. you do so, if it is light by putting on his sunglasses but what's another way that you can turn the world down? >> heroin. [laughter] >> okay. heroin was offered. [laughter] what other possibility do we have? alcohol. alcohol does the same thing. over on the other side of the curve, those of you who don't even own a pair of sunglasses -- for you folks we are what we

call stimulus producers. the world is not vivid enough, not noisy enough and what you would like to do, if you could, is make the world noisier. you would go to a club where the music is loud and pumping or you would take a drug that makes the world more vivid, methamphetamines. there we go. [cheering] let me ask you. this is just a metaphor but i'm going to ask through a shouting of the voices whether i've properly identified use simply by whether you wear sunglasses or not, as to what drug you prefer. [cheering] okay. the bottom line is that since you likely thought that way

before you ever picked up a drug there was something wrong then, such that the very first time you ever used a psychoactive drug, your response was, oh my god, that's how it's supposed to be. and you know what? you are right. that is the way it is supposed to be. for 85% or so of the population -- this is a big part of the population, that is the way things are. the post with addictive diseases are outliers. you are the 15% and you're the ones we need to worry about before you ever get the drug because you are born with it and that is the difference between substance abuse and the problems that can arrive from substance

use and addictive disease or substance abuse disorder. a disorder or disease is something that is present without the context of an external drug or agent. it is a disease that comes before the drug. when we talk about addictive disease we're not talking about alcohol or heroin or methamphetamine we are talking about your brain and were talking about your brain in the absence of the drug. when patients come in and i'm talking to their insurance company on the phone as i often do in the interest of me says well, mr. smith, went through his treatment and he is all done now. [laughter] i say what you mean by that marquis was in the residential facility for 20 days. he's clean and sober. he doesn't have that addiction issue anymore.

um, no. now we will start treating the addictive disease. [cheering] when we talk about going into rehab and going through partial programs and going into inpatient detox and so forth we are not treating addiction. retreating intoxication. retreating withdrawal. those are easy and i can give anyone intoxication and withdrawals to the point that they require a hospital. that is not what is being treated there. it is only later, after the postacute withdrawal is out of the way, after you start thinking clearly again and at that point we can start getting to the core. the core is that you are uncomfortable and you're uncomfortable to begin with. that's discomfort is what needs to be treated, to get you to the point where you say, i am

alright in my own skin. that comes to part two. part two -- addictive disease is a three-part entity. we have the genetic part which we just went through, the part that you are born with and the part that you can't get away from and at the part that makes it seem like life is an extremely uncomfortable place without drugs. part two is an environmental issue because there are some folks out there born with the disease of addiction who don't end up with addictive disease. what differentiates them from those with the illness? there has to be a trigger like there are for many diseases. see, if i take a patient with juvenile dvds who happens to have a an identical twin and the identical twin doesn't always

have juvenile diabetes -- even though they have the same genetic structure and the genes are calling for the immune system to attack cells of the pancreas and to make it so that insulin isn't produced and they can't metabolize sugar the way they should. all of that is built in and yet, one identical twin has it in one does not. why? because the same thing is true and addictive disease. what is it that makes the difference that triggers these genes so that you end up having trouble. well, it all goes back to when we were about four or five or six years old. it always does. more often than not it involves appearance. almost always the parent of the same sex as you. the difficulty is a lack of ability to identify with that parents, to want to be like that parent, or the parent is not

properly representing themselves, they are irresponsible, inconsistent, abusive, hostile, absent -- whatever it is they are not making the connection. i apologize for those who for the story before and i told him before but it's the baseball story. little boy goes out in the very first time he will play baseball and he knows it's his first time and his friends know it's his first time playing baseball and where does he get put? right field. there is our seven -year-old, he standing in right field and nothing happens in right field if you're playing with a group of kids, balls never go out there and yet, the inevitable one ball does. it comes somewhere in the eighth or ninth inning and he's standing there and he's sunburned and hungry and needs to go to the bathroom. he's counted the four leaf clover's and is already decided with clouds look like, pay no attention whatsoever to the game because it's so bloodied far away and the ball lands behind him.

he hears a pop. everyone is yelling at him. what the heck do i do with this ball? i pick it up. it is too big for my hands and i have to throw it while everyone is yelling but i see some guy running. i throw it at the running guy. no, that is wrong and i don't hear the end of it for my friends. i go home and i say dad, i don't know how to play baseball and everyone made fun of me and i feel awful. dad looks at me and says you know what, i think that happens to every boy. it happened to me. let's go grab some ice cream and i'll take you out to the backyard and teach you how to play baseball. you will never have this happen to you again. or that says well, billy, you just suck it everything you do, don't you? how many of you had a dad like that? right. that is the dad who teaches you

something. what that dad teaches you is when i feel uncomfortable and when i need to share my emotions with other people so that i feel better i will end up feeling worse. if i learned that enough times at the hands of the only person in my life i should be able to trust at that age then i will grow up thinking when i am uncomfortable instead of being part of the herd because were herd animals but i won't have learned that. i will end up going to my life thinking to myself that when i am uncomfortable the last thing that i'm going to do is go up to someone and tell them about it. what i'm going to do instead is run from that's because that will make me feel worse.

which is why when i look at my patience and i say listen, i can make it so that you end up getting your life back and you'll be rehired at work and your family will love you again and you will have a home and you'll have a car that runs annual have money in your pocket and what i want you to do is go in front of the group of people all of whom have had the same experience and i want you to stand up and front of that room and i wanted to say hello, my name is on stuart and i'm an alcoholic and share wisdom and the feelings and the difficulties they are pad in the burdens that you carry and let them help you. if they jump up and they say thank you doc and i'll go to the next aa meeting and i made at the disc diagnosis. that's the scariest thing in the world.

all right. so, that is the bottom line as to the way the environment traditioners the disease. you're uncomfortable. you're growing up. you've learned not to share that discomfort with anybody, and then part three happens. part three is something that would never happen or would be highly unlikely to happen if we lived in a community that didn't promote drug use. we live in a culture that

promotes it. what do are you supposed to do the day you turn 21? what are you supposed to do when you good to a football game? what are you supposed to do when you go to a wedding? what do most people do at a funeral? okay. so, the bottom line is, our cultural events are all tied to activities in which people use psychoactive drugs. you can't possibly go through life and not be exposed to that. let's look at what psycho active drug does. i'll go with alcohol because it happens to be one of the more prevalent of the drugs. so, alcohol -- and by money alcohol "i don't just mean beer or wine or hard lick coaxer i'm also talking about the drugs that work the same way in the brain.

that includes valium, lib breean,ed a da -- expand next, find e find bosh tall. soma, which is the muscle relaxant you may have hey been prescribed. owl of these drugs, all of the solid ones are very dry martinis. they work the same way. they all do the same thing. the cause a two-hour period of sedation. now, on this curve, i have the horizontal line that is time, and here on the vertical line i have a line that represents where you start, mildly sedated or relaxed, very relaxed, asleep, dead. as we go -- i think it's the dry way i present that makes people laugh. as we good up, we see somebody

who is a little jittery and uncomfortable, extremely agitated. grand mal seizure. that the range we go from and to. when i drink alcohol i get what i call curve a. a two-hour long period of sedation or relaxation or sleep, depending on how much i've imbibed. if i drink too much, i fall asleep. that's not what i'm trying to do when guy to a party so i don't drink that much. so, if you're going to drink and experience a certain level of sedation for the duration of the party, you have to know how to drink. you don't start out at home by having an enormousment and go to the party and gradually let it ware off. that's not how it works. you have one drink per hour. when you have one drink per hour, or two drinks per hour as the case may be -- so, as you go through the evening, what you're trying to do is maintain a

certain level of sedation. so, about here, about when the first amount of alcohol peaks is when you start your second one and you go like this. so what you're actually experiencing over several hours of an extended football game is a ongoing level of sedation that doesn't change very much. however, what you don't know is what happens next. the brain works by setting things. it likes to set things in a particular way, so it sets, for instance, your heart rate and your boy temperature and so forth. when alcohol comes along and pushes on the brain like that, the brain says, no, no, no, i'm trying to go here. and when the brain does that, it overshoots. goes like that. so, as the brain overshoots, it

does so in what we call a damped manner. what i mean by damped? if i had a steel ball here and i drop it on the floor, it would just go bang on the floor. if i had a long tube full of motor oil and dropped the steel bearing into the tube of motor oil, it would slowly drop to the ground. a damped system. the brain works the same way. so, when i push on it with the alcohol, the brain pushes back but slowly, and over a longer period. as a result, i get curve b. curve b is barely noticeable. if you have had enough to drink so that you just notice the alcohol, you won't notice curve b. curve b is the agitation, the result of having used alcohol hours before. it lasts six to eight hours.

if i've had a certain amount of alcohol for times in a row, over an extended period of time, to maintain my level of sedation, you would think, oh, well, then i'll maintain the level of an addition tomorrow. no. because the brain is a damped system so there's that longer period of agitation. what ends up happening is each of these curves generates a curve b. here you are the next morning at 4:00 in the morning, when you should be sleeping and instead that is you. and you say, my god, why am i so hung over? i was never really drunk yesterday. true. but you were intoxicated to some degree over an extended period of time. long enough that you get an agitation that seems to far -- be far stronger than the

sedation you had initially. this happens with everybody. 100% of mammals get this kind of curve with any sedative drug, be it budweiser, xanax, or ambien. they all do the same thing. however, there's a difference in terms of how we all perceive this. take the normal curve that i shod you before. stimulus augmenters and stimulus reducers and we can draw that right here. acknowledge -- imagine that instead of strategy the average person starts, you start here. and this is your base line. i need another color. so, a person with addictive disease has a base line that is higher than everybody else. so that when you take alcohol or

a sedating drug, you good like that. and you say, i feel normal. i feel the way i'm supposed to feel. i feel the way i think everybody else feels. and then you get the second curve. and if you thought you were uncomfortable to begin with, you ain't seen nothing yet. this becomes impossible to cope with. so now here you are at this point that is impossible to cope with, and your parents took away from you the normal coping mechanism, which is, oh, my god, feel terrible, let me talk to everybody and make sure they know that. and so they can offer me some support. because you know that if you talk to other people, you'll end up feeling worse. so you have no choice at that point but to turn back to the very drug that caused this to

happen in the first place, and when you do that, to counteract the effects of curve b, you will feel better temporarily. but then you'll feel worse again later. even worse than you did. that is what you're chasing. that is what everybody chases whether they have the disease or not. that's why patients come in to me and tell me that when they've been on vicodin for five years, for something they didn't need vicodin for in the first player, they have to take the vicodin because they have to feel better from this horrible feeling they have which is simply the withdrawal from the vicodin. if i can get them through the withdrawal comfortably, they'll good back to their original base line, which is much better then point they're at now. the same thing with the the people who have been taking valium or xanax for more than eight weeks. experiencing more side effects than desirable or beneficial.

so, when we're talking about this point, and you say to yourself, well, the average person out there is saying, well, these people do this to themselves. even if they feel that uncomfortable they don't have to pick up the bottle. well, imagine that i close the doors to this room. lock everybody in. and i put food up here and i say, do not eat the food, it's poisonous, it will kill you. but i lock you in. some time goes by. close to a day before the first person goes up and eats the food. he eats the food and instantly drops dead next to the food. and you'd say to yourself, the rest of you, you know you can see that it kills people. you're not going eat that food. but you're still here in the room. and i guarantee that more and more of you kill start go up and

eat the food, and you'll say things to yourself, well, it killed him but i'm stronger than he is. won't kill me. yeah, killed him because he ate it too fast. i'm going to go more slowly. he ate off that side. this side, i think, will be the good one. you'll all eat the food. i guarantee it. there will come a point where despite the fact that it's proven deadly to you, where you have seen people die from it, you'll eat the food. and darn if this doesn't sound exactly like what is going on with heroin and the fentanyl mixed. in right? where people go and they eat the food. it kills their best friend. say, all right, won't do it to me. because that's part of the disease. part of the process.

but it's not because of denial. it's because of human nature. this would happen to 100% of people if they were pushed hard enough in that direction. it's just that we have 15% of the american public that is pushed there, and what we have to realize, as a culture is that if we're going to protect our 15% the way we do with fluororide in the water, with bpa-free plastic in our water about., seatbelt laws, motorcycle helmets, is we have to move away from being a culture that embraces the use of psycho active drugs as a way of entertaining ourselves. and we can't do that when 90% of the country seems to be standing up and embracing marijuana as

the second coming and saying this should be used because, why not? which seems to be the best argument they've got. [applause] >> and i'll tell you something, y'all are why not? [laughter] so what we have got is a culture that embraces psychoactive drugs at the same time we have loads and loads of 747s going down with people every day, and you know would we do something about that. if there were indeed four 747s full of people crashing every day, it's something our society would not stand for. and yet we're losing that many people every day due to addictive disease and we're barely saying something about that. the fact we are starting to

about opioid addiction, great, wonderful, call our attention to it. c-span2 is here this year. that's fantastic. we're on the edge. [applause] and it is wonderful to think we're getting a wider audience than usual for this topic, which affects so many in our culture and our population, but we need to stop turning a blind eye to that population, and that means accepting that the 85% who can use from time to time without significant degradation of their life needs to say, you know what? it's not worth it. i'm not going to bother because it hurts too many people. [applause] so, i'm not a prohibitionist. wouldn't sit here and say it should be outlaud, thrown out,

taken away. i would sit here and remind us of something, which is if we look back at prohibition of alcohol, which is what we have now for the most part for marijuana, if we go back the alcohol days, the use of alcohol per capita dropped almost 50% as a result of prohibition, and the amount of disease, the prevalence of alcohol-related disease dropped by almost two-thirds during prohibition. so prohibition may have been a political failure but it wag an enormous public health success. what we have right now with marijuana, on a federal level, anyway, is the public health success. if we abolish that and get rid of prohibition, as we did with alcohol, we'll see the exact same thing happen as happened with alcohol, increased per capita use of marijuana followed

by increased problems of addiction related to marijuana. now, let me ask this group something just because we're on the air and broadcast and i apologize i'll ask you all to raise your hands. home of you ever used opioids as a recreational drug? all right. keep your hands up. how many of you started out with a drug other than an opiate, like marijuana? see all the hands are still up. you don't go in the other direction? opiates first and then marijuana? snow. you started with marijuana, and then moved to opiates. now, i wouldn't make the argument -- you can put your hand down. i wouldn't make the argument that everybody who uses marijuana will move on to opiates. but let me ask you this. did you know, when you first used marijuana, that you were going to end up using heroin? >> no.

>> that didn't didn't occur to you you. said, no, that will never be me. right. so, for all you out there watching on tv, saying, that will never be me, you just don't know. [applause] it's been an absolute pleasure speaking with you. this is still the favorite place i come to each year. thank you so much. my hat is off to you for all that you do and keep doing it. [cheers and applause] >> thank you, thank you,

dr. gitlow. now, i suspect we can prevail on them for a couple of questions if anybody has a couple of questions out there. anyone have a question? i guess no questions because this group is a group of experts when it comes to drugs. >> okay. we'll take a little break and then we'll be back to do two important things. one -- okay. we'll do two important things when we come back. first of all, we're going to hear the campaign speeches for those who are running for world council. i will police that with vinegar -- vigor so a they only each have three minutes, and

then after that, gary con lan, our board director, is going to give out the 100 year awards. and then you're free, but first let's take a 15-minute break. [inaudible conversations]

[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> wrapping up the conference now on opioid addiction and drug abuse, presentations this afternoon about acute care and long-term recovery and training programs for medical students working with drug abuse patients. those along with the morning session including a speech by the acting director of the white house office on national drug control policy, all available later today on our web site, c-span.org. >> booktv recently visited capitol hill to ask members of congress what they're reading this summer. >> congress woman sanchez what are you reading this summer. >> i have got thereon awe fuel novels and have a couple on my list. so, one of the book is recently read was the nightengale a storm about women resisting nazi rule

in world war ii and their efforts to try to help the resistance, really excellent book. i highly recommend it. so much of history is written by men, and the stories of women are not told and so that was a very interesting book. book that i'm in the middle of now is "option b" how to build resiliencely and deal with loss and enjoy life, by sheryl sandberg, she lost her husband a year ago and this is a great way to give some helpful lessons and suggestions for how people can learn to cope with loss and learn to live again, and that's been a very eye-opening book. one of the book ipse currently red reading with my eight-year-old son are the novels "march" but john lewis which talks about the civil rights movement, and my son is transfixed by the stories in

book and the images in the book, talking about how people fought for civil rights and equality in this country. one of the books on my to-read list is "theft by finding" by david sed. >> and a history book "churchill and orwell and the fight for freedom." >> book dtv wants to know what you're reading. >> when you think about a one-day festival, that national book festival, and you have over

100 authors, from children's authors, illustrators, graphic novelists, all of these different authors there all day, over 100,000 people come in and celebrate books and reading. you can't have a better time, i think. i'm a little prejudiced because i'm a librarian, but i have to tell you, any reader or anybody that wants to get inspired this, book festival is the perfect place. >> booktv's live all-day coverage begins saturday at 10:00 a.m. with features authors including pulitzer prize-winning authors david mccullough and thomas freedman, former secretary of state condoleezza rice and best-selling authors michael lewis and j.d. vance. the national book festival, saturday at 10:00 a.m. eastern on booktv. >> now a hearing on military caregivers with former senate

elizabeth dole on her foundation work that advocates for those who care for wounded veterans weapon also hear from actor and director ryan phillipe, an ambassador for the foundation's hidden heroes initiative, and testimony from women who care for their injured husbands. >> this hearing will come to order. good afternoon.