We're Out of Time

Dr Fong's Mind-Blowing Technique for Making Patients Feel Comfortable

38 min
β€’Aug 5, 20259 months ago
Listen to Episode
Summary

Dr. Timothy Fong, UCLA addiction psychiatry professor, discusses his patient-centered approach to treating addiction and co-occurring mental health disorders. He emphasizes the importance of genuine connection, holistic treatment addressing biological, psychological, social, and spiritual factors, and highlights the rising severity of addiction cases driven by social isolation, smartphone adoption, and high-potency substances.

Insights
  • Successful addiction treatment depends more on genuine therapeutic connection and patient honesty than on any single intervention; the therapeutic relationship is foundational to outcomes
  • Co-occurring disorders have increased dramatically from 25% to 85-90% of treatment-seeking patients in two decades, driven by social isolation, social media, and mental health crises rather than substance availability alone
  • Treatment centers remain structurally fragmented between addiction and mental health services due to historical stigma and regulatory separation, limiting integrated care despite clinical evidence of its necessity
  • Cannabis-induced psychotic illness is a distinct condition requiring psychiatric treatment even after cannabis cessation, representing a significant emerging clinical challenge in addiction medicine
  • Recovery domains of home, health, purpose, and community are more predictive of success than traditional metrics; purpose and community building should be primary resource allocation targets
Trends
Rising prevalence of cannabis-induced psychosis with high-THC dispensary products; psychotic symptoms persist 6-12 months post-cessationShift from sequential treatment (abstinence first, then mental health) to simultaneous treatment of co-occurring addiction and psychiatric symptomsIncreasing severity of addiction presentations with multiple co-occurring disorders, trauma, and medical complications among treatment-seeking populationsMobile sports betting, cryptocurrency trading, and fintech creating new behavioral addiction vectors alongside traditional substance use disordersRegulatory and structural barriers preventing integration of psychiatry into addiction treatment infrastructure despite clinical consensus on necessitySocial isolation and loneliness as primary drivers of mental health crises and addiction initiation, predating and exacerbated by COVID-19Smartphone adoption (2011) and social media economy as measurable inflection points in mental health decline among younger populationsCannabis withdrawal syndrome recognition as legitimate physical dependence despite lower severity than opioid/alcohol withdrawal
Topics
Addiction Psychiatry vs. Addiction MedicineCo-occurring Disorders TreatmentCannabis-Induced PsychosisTherapeutic Alliance and Patient ConnectionBorderline Personality Disorder vs. Bipolar Disorder DifferentiationSuicidal Ideation and Lethal Emotional Pain ManagementCannabis Withdrawal SyndromeGambling Disorder and Behavioral AddictionsMental Health Crisis in AmericaRegulatory Fragmentation in Addiction TreatmentPurpose and Community in RecoveryHolistic Treatment: Biological, Psychological, Social, SpiritualHigh-THC Cannabis Products and HarmSleep Hygiene and Mental HealthMedication-Assisted Treatment Approaches
Companies
UCLA
Dr. Fong is a professor of psychiatry at UCLA and runs the UCLA Gambling Studies Program and UCLA Center for Cannabis...
Northwestern University
Dr. Fong attended medical school at Northwestern in the mid-1990s where he first learned addiction is a brain disease
Betty Ford Center
Dr. Fong visited in July 1995 as an embedded observer, which became a formative experience driving his career in addi...
Clifside
Treatment center that Richard Tate sold before returning to the field two years prior to this interview
Carrera
Treatment organization Richard Tate is currently affiliated with after selling Clifside
Bet Tzedek
Long-standing recovery program (30-40 years) that partnered with UCLA psychiatry residents 12 years ago to address ri...
Department of Healthcare Services
California regulatory body overseeing 1,500+ licensed residential addiction treatment programs and managing fragmente...
American Academy of Addiction Psychiatry
Professional society of 1,500 addiction psychiatrists; Dr. Fong announced he will serve as president in 2025
American Society of Addiction Medicine (ASAM)
Partner organization to American Academy of Addiction Psychiatry representing addiction medicine professionals
People
Dr. Timothy Fong
Expert in addiction psychiatry, gambling disorder, and cannabis research; discusses patient-centered treatment approa...
Richard Tate
Podcast host and treatment center operator who conducts interview and shares clinical observations from his own treat...
Kevin Hines
Golden Gate Bridge suicide attempt survivor who coined term 'lethal emotional pain' to describe suicidal ideation; ci...
Robert Putnam
Sociologist who authored 'Bowling Alone,' cited by Dr. Fong as documenting rise of isolation and loneliness in Americ...
Nick Saban
Football coach whose quote on repetition and mastery ('do things until we can't get them wrong') is referenced in dis...
John Wooden
Basketball coach whose philosophy on activity vs. achievement is referenced in recovery discussion
Quotes
"You don't judge, you don't preach, you don't criticize, you're not our best friend, but you're someone we can relate to because you're talking to us in a genuine connected way."
Dr. Timothy Fong (describing patient feedback)β€’Opening segment
"No matter how bad you think you are, or how bad things are, we can make things better."
Dr. Timothy Fongβ€’Early in episode
"Structure and purpose are completely different. You can be sitting there all day, eight to eight and have structure, but that's meaningless. You need purpose."
Dr. Timothy Fongβ€’Mid-episode discussion on recovery domains
"We do things over and over and over again until we get them right. We do them over and over and over again until we can't get them wrong."
Coach Nick Saban (quoted by Dr. Fong)β€’Discussion of mastery and recovery
"Cannabis is addictive because it's an addictive substance. When you stop smoking it, you're sleeping in a puddle of sweat and you have to change your clothes four times a night."
Richard Tateβ€’Cannabis withdrawal discussion
Full Transcript
Dr. Timothy Fong, professor of psychiatry at UCLA, joins the We're Out of Time podcast. A lot of my patients and family tell me, they say you don't judge, you don't preach, you don't criticize, you're not our best friend, but you're somewhere we can relate to because you're talking to us in a genuine connected this way. A successful treatment, the first visit, no matter how bad you think you are, or how bad things are, we can make things better. Thank you for listening to the We're Out of Time podcast with Richard Tate. If you haven't already, please follow the podcast. Rate and review. And if you're getting value out of We're Out of Time, share it with someone else you know. If someone has a problem with substance use disorder, please call one call placement. That's 888-831-1581. And if we can't help you, we'll make a referral to someone who can. Please, We're Out of Time. Dr. Timothy Fong, thanks for showing up for us today. Thanks for having me. It's amazing to be here and the privilege is all mine. Trust me, it's mine. All right, I wanna get right into it. Just for the viewers, you're a real big shot in psychology in and you're with UCLA, right? Yes. Tell the viewers a little, not your CV, because you wanted to take me 25. Right, right, right. The 32nd to one. Yeah, it's amazing. So I'm actually from Chicago. I came to LA in 1998, so it's been 27 years. About half my life now is LA. I'm an Angelo now. I went to medical school at Northwestern where in the mid-90s, for the first time I heard addiction is a brain disease, 1995. I went to the Betty Ford Center July 1995, basically wanted to play golf for a week, but I was embedded with men and women with addiction, 1995. I remember the men and women today, like it was yesterday. It left such a footprint on me about this condition of addiction and the recovery stories and everything intertwined. After that, I said, I got to be an addiction psychiatrist. And that's what I did. Went to medical school there at Northwestern, came to UCLA, do addiction fellowship. I've been at UCLA since 2000, this is 1997, but I've been on faculty since 2002. I really do four main things in addiction psychiatry. I do research in gambling. I run the UCLA gambling studies program, as well as the UCLA Center for Cannabis and Canapnoids. I teach about addiction and mental health to anyone who listened to me. Medical students, undergrad, people with psychiatry, residents, people in recovery, families, whatever. I do clinical care, provide care for addiction. Again, as a psychiatrist, we do addiction psychiatry, which is a little bit different than addiction medicine. How so? Because we're focusing on the mental health aspects. We're focusing on the psychiatric part of the care, the body, the brain and the mind. Whereas addiction medicine tends to be more about, dealing with the impairments from cirrhosis or medications or the medical aspects of detox. Detox, right. And the last part I do is community engagement and stuff like this. We used to call it advocacy. I don't really like that anymore. I just like community engagement, where we learn from each other. We find out what people are doing in best practices. We spread the word about recovery, about hope, about the messages that families have to get. So that's the nutshell of what I do. It's a lot of work, but it's also a tremendous amount of fun. And it puts me in front of a lot of really interesting folks over the last 27 years in this field for sure. Are there psychological cases you've seen, where you just knew the person wouldn't make it and you were ever wrong? These are, that's a fascinating question. Yes and no. Number one, we absolutely, by the time people call us for help, the addictions of psychiatrists, things are bad. We're not the first call after the first DUI, right? We're the call when things are really falling apart. So by definition, the folks we see at UCLA Psychiatric Hospital or the emergency room or in our UCLA addiction clinic, they're very severe men and women with addictive disorders. So they have multiple co-occurring, mental health problems, lots of medical problems, lots of damage. For instance, I saw a woman this week, first intake for gambling addiction, $600,000 in debt. That's a lot. From the medical world, we'll call it metastatic, right? That language that the condition has spread to so many parts of the body and organ that there's not a lot of quote you can do. But the vast majority of folks that we see, no matter what condition when they come into our office, we can provide some help. We can alleviate suffering. We can make their quality of life better. What I have seen though, are a lot of folks who come in who are not able to do the work of recovery or are not in a position to do it, either financially, emotionally or socially, or who've been impaired to the point where their insights are so lacking, right? That they can't engage in the basic first step of recovery. That's hard. I'll give you an example. I had a case last week, young man 33, college educated, methamphetamine use disorder, super smart guy. But the methamphetamine use disorder after 10 years has done what? It's ravaged his body, ravaged his mind, ravaged his family, ravaged his... He's hallucinating all the time. He doesn't know what's real. Exactly. He's not. And the family's bailing them out. They kicked them out. They've done the tough love. I'm seeing him with his family member. They're like, what should we do? I said, sir, you're 33. You don't have a job. You don't have an ID. You barely have a phone. This is not a dignified way of life. Give me a vision of how you want your life to be better. I'm not talking about any of my drugs or absence. I said, just give me a vision of how you want your life to be better. He says, I don't know. And then I said to his family member, he says, I don't know, not because he doesn't want to get clean, because his brain's impaired. Because he doesn't know how to get here. Doesn't know how to get here. Doesn't know how to say it. He's not processing basic information. And he's still using math three to four times a week. So... Nobody uses just so you know. Nobody uses math. He said, I love what you say. He says, he says. So when you say, you know, we knew the person, quote, wouldn't make it, that's the case. I know the recovery conditions by the time I, when I saw him are very, very poor. His prognosis is poor. But I don't like to pigeonhole and say people are never gonna make it. I'm proud to say that in my 27 years of doing this, I've had two deaths. Two deaths. Wow. Yeah. You know, and again, I don't see patients 40 hours a week. So I do maybe 10, 12 hours a week, but still two overdoses. And that's it. I'm really proud of that. That's magnificent. Really proud of that. And I mean, it's horrific, but if you guys knew what this was, that's amazing. Yeah. And partly it's, you know, medication we have out there, Narcan education, but a lot of it's just telling people straight up from the first visit, no matter how bad you think you are, or how bad things are, we can make things better. Now, this is my experience. Yes. When I first got into treatment in 20, in 2004, you had some straight alcoholics, right? Just straight alcoholics. Right. Not everyone had a co-occurring disorder. Maybe a quarter of the people have co-occurring. Today, I would, and it's just an estimate since I've been back, because I've been back for two years now with Carrera after selling Clifside. It seems to me like about 85 to 90% of the people now that come to seek treatment have co-occurring disorders. Sure. Severe, active. No, no, no, no, no. I'm not talking, I don't know. My lips won't move if it's not severe. Right, right. So I'm telling you, they are so much sicker today than they were when I started. And they were getting sicker, okay, from 2004 to 2018, I sold. But from 2018 till today, it's a new world. This, I've never seen anything like this. Is it COVID? What the hell is it? Here's how I think about it. I grew up in this world. I'm Gen X, right? And what we know is the following. We know there's a mental health crisis that was exacerbated by COVID, no problem. But on the run up to COVID, there were two things I noticed. Definitely the initiation of the smartphone made a huge impact on just people's mental health right around 2011. But even right around 2000, you go back to like Y2K, right on all that. And we started to see the spread of the internet. But you also started to see isolation and loneliness taking over modern day life, right? And I remember there's a book I read called Bowling Alone by a sociologist named Putnam. And he basically talked about right around the turn of the century, how as humans in America, we were starting to do more things by ourselves. And it wasn't for solitude, but it was out of loneliness, and isolation that certainly drove a lot of mental health issues. I think that's part of the trend for sure. So you combine all of that on top of, yeah, and all the other new substances that are out there that are way, way more toxic. But when it comes to straight, like alcohol use disorder, the alcohol is still the same as it was 30, 40 years ago. There are a lot more options, a lot more things out there. But we see this everywhere. In fact, one of the programs I work with closely, Betsh Uva, they've been around for 30, 40 years. Is your abye still driving his Jaguar? No, they left. They've retired. They have a new, a younger group there. But they brought our UCLA psychiatry residents to come onsite to provide mental health care about 12 years ago. The exact same reason you just said, which is that they were getting people coming in with very severe co-occurring disorder that unlike they had ever seen before. So it's just part of this natural rise we see in America, just mental health crises coming up over the last 20, 25 years. And we don't have a super simple explanation. I think there's lots of reasons, but it's undeniable that force of what we're seeing. I think it's COVID. I think it's social media. I think it's the social media economy. I think it's the fact that they don't have the right anymore. These kids today don't have the right to experiment with drugs. That was a right of passage. They don't have that anymore. Okay, I think that's upsetting. Yeah. Okay. I think it's a lot of things. And I think it's just, it's so hard. I mean, you know how we do it. Yeah. Okay, I mean, it's like if we're finding it hard, everyone else is finding it next to impossible. I think that's very well said. Very well said. Yeah. All right, let's move on. How much of successful treatment is psychology versus environment? So successful treatment, again, starts with this approach that we use, biological, psychological, social, and spiritual. When folks come into my office, when we see folks, we're using elements of all those four things equally. So I don't just give pills, that's wrong. I don't just say go to 12 step meetings and that's the only thing you need to do. That's wrong too. So psychology, they're all critical. The biological treatments, psychological treatments, the social treatments, and the spiritual treatments. And people say, well, what are biological treatments better than medication, sleep, nutrition, physical movement, those are biological treatments. And I think that's why things like sauna, things like cold plunges, these are biological treatments that we vastly underutilize in my world in medical field. That's right. Vastly. On the psychological side, we vastly underutilize them as well from therapy as well, because we forget it's the power of the connection. I think one of the things I, a lot of my patients and family tell me, they say you don't judge, you don't preach, you don't criticize, you're not our best friend, but you're someone we can relate to because you're talking to us in a genuine connected this way. So I found that the most successful outcomes have always been when there's a strong, positive connection between me and the client and the family. And it's an earnest, genuine connection, right? It's not based on power. Is it their power of the mind? Yeah, it's a strong thing. And you know it when you feel it, right? That's right. You look forward to seeing each other. You ride ups and down. There's a consistency there. The way I look at it is we're cheerleaders for them and we're showing them the way and we're supporting them every time we go. So I put that all of that into what will make for a successful outcome. But all the studies will tell you that things that matter is again, length of time in treatment. The more visits you have, the better people do. Also, they'll look at the capacity for honesty that the person in front of you has will also tell you how far you're gonna go. Which means for me as a therapist, I had to have my radar on too. Again, finding out the BS. But drug addicts do fly. Never. I mean, their lips never move, right? So, and therapists never lie either, right? Man, therapists are such well-meaning people. The problem is there's so few of them that actually have the ability to help anybody. But the ones that can and have the best souls are like gold. And I got them all. If you had unlimited resources, what psychological support system would you build for addicts in early recovery? That is an excellent question. That is an excellent question. So, I think the thing I see missing the most is the following. I think of domains of recovery. At any time I'm working with a client, I think about four areas. Home, health, purpose, and community. Because we all know when that clicks in, those four things click in. And the health is mental health and physical health, of course. But purpose and community. And if I had an unlimited amount of resources, I'd invest it into building ways that people can find purpose and community opportunities. If I had an unlimited amount of resources, I'd emphasize pouring funds and resources into building opportunities so that people can develop purpose and community for themselves and their families and whoever they've involved. Again, I'll give you a perfect example. And this is why we have the smart people on people. Go on. So, again, where I got that comes from years of just listening to people. No, it's common sense. But it's also where I thought works for me. You know? It works for everybody. It works for everybody. But in LA in particularly, I think that's where we struggle so much with. Loneliness, community, safety, opportunities, right? So, purpose is everything. Yeah, everything. And they used to call it structure, structure, structure, structure, right? Structure and purpose are completely different. Completely different. I said, well, you can be sitting there all day, eight to eight and have structure, but that's meaningless. You need purpose. Yeah, it sounds like it sounds like what John Wooden said. Never confuse, what are you saying? Never confuse activity with achievement. I love that. Yeah, yeah. Be quick, but don't hurry. I wish I had another one. We could do the volley thing all day long and see how far we could go, but I just dropped it all if you want. Well, you have to have another one. If you have another one, you win. No, I have to drop it on my head. I tried to memorize the Pyramid of Success years ago, but it was tough because it was the greatest thing I've ever heard is from Coach Saban. Okay. We don't do things over and over and over again until we get them right. We do them over and over and over again until we can't get them wrong. Who said that? Coach Nick Saban. That's pretty good. Yeah. Yeah. All right, let's move on. Roll tide. All right. Do you think most treatment centers fully understand how to deal with co-occurring disorders or are they just checking boxes? Here's my story on that. California has what, like 1500 residential programs that are licensed by Department of Healthcare Services. And why I'm going on this is important, just the way California structured this. For years, you'd have substance use disorder, treatment centers to the left, mental health to the right, and they're not supposed to be together. That's right. And many people don't understand that history. And it's... Tell the history. Tell the history, because that's awesome. Because when I got here, my first license was drug and alcohol addiction with co-occurring disorders. With co-occurring disorders. Right. Yeah. And so, I mean, it's a longstanding pattern that goes, we'll start writing it in the 50s and 60s where they decided to institutionalize the hospitals and the asylums, break it up into, quote, recovery homes. But then in my view, just based on the pure stigma toward, quote, addiction, oh, let's just keep it in a separate financial pot. Let's keep it from a separate legislative pot, creating two different offices. There's a California office of alcohol and drug programs ADP, the 70s, the 80s, and 90s. And then again, the Department of Mental Health, all ultimately under Department of Healthcare Services and Department of Health and Human Services. Alcohol and Drug Programs erased themselves and merged about 10 years ago, but DMH and mental health still remains kind of separate. So for years, you're still living with this weird vestige that addiction is not a mental health condition. Addiction is an issue of willpower, morality, crimes, all this stuff, and should be treated way to the left and mental health way to the right. Is that weird split then again, just crazy. Only in the last, I'd say 10 years, or we started to see more, you get a little bit more narrower, where some programs are saying, wait a minute, this makes no sense for us to do it, and have a narrow way of treating it. We need to really expand our services and abilities so we can treat the whole wide range. Addiction, by definition, is a mental health condition and should be folded in and when you treat the whole person. So the answer to your question is that, unfortunately, many programs have not kept up because it's difficult to keep up, training and resources. And if you have someone there who's been doing this for 30 years and they only know one way and teaching them another way is very difficult at some time to time. So some programs just don't have that. The other really strange part, I've always never quite grasped, is why when you try and bring a psychiatrist on board, you gotta put them in the little shed in the outside, and they think it can be a medical director, but they really can. And it's all these weird bells and whistles or our field of psychiatry has often been kind of invited in, but not really part of the core part of its infrastructure. So the bottom line is, I think, unfortunately, most don't do it as well as we all like to see, but others really do a tremendous job from intake and moving forward. Because it can take, as you know, you see it all the time, weeks to figure out what's happening with somebody or even months sometimes, particularly with these folks coming in now with the substance that they have. They're really sick ones. You gotta start ruling stuff out immediately. Right. In order to figure it out, you're right. A doctor, do me a favor, you can read it. Number five? Yeah, read me the last one. What do you do when a client doesn't want to live anymore but also won't stop using? That's the core thing of what we do. So number one, I'll break that into two parts. When they have what I call lethal emotional pain, we call it suicidal, right? I like the term lethal emotional pain. I like it too. Because it's exactly what it is. Exactly how you feel in that moment. And I got that term from... That's better branding than defund the police. I really like that. It's pretty good. And my source of that is from a guy named Kevin who jumped off the Golden Gate Bridge and he does, he's talked about that. And in his talk, he talks about that term lethal emotional pain. He said, that day I woke up in pain but then as the day wore on, it became lethal. And he was taking, he describes incredible detail of the taking the bus up to the bridge, walking up there, feeling completely numb but such a pain that was something like he'd never experienced in his life. He needed to do it. He was being pulled to it. It's compulsion to do it. There was this darkness over his soul. It was incredible to hear that. So when we have that obviously that's something we focus on emergency action plans. Since that's a hard thing. I think one of the biggest shifts that happened in our field is when I first came in... Hey, when something happens like that, what do you do? So one of the things that we talk about in our early sessions with all patients is in the event you develop lethal emotional pain, what's our plan to deal with it? Just like we always say, if you develop an allergic reaction to a bee sting or you have a stroke or you have a heart attack, what are you gonna do? Yeah, except for when you have a stroke or a heart attack, there's usually one protocol or a bee sting, one protocol. But here, since everybody's different, you have to have a plan to make certain that every, it's a different plan for every person. Exactly. And so that plan has to make sense to the person before it happens. But we also know that while it's happening, it's incredibly difficult to execute that plan to actually do it. So my work, thankfully, on the outpatient side, doesn't land in that area that often. On the inpatient side, absolutely, we get that all the time. But we see the folks that come in who are actively suicidal or in profound pain who made that decision to come to the hospital or were brought there because a family member or a therapist was so concerned about them or they were brought there because of the paramedics and the police found them in such a terrible state that that's what brings them in there. So that's how we handle that on that end. My, what we usually break through again, is I like people to have, again, those plans that make sense for them. For some people, it's having a couple of extra medications they know that will bring down their anxiety. For some, it's a chain of phone calls. For other, it's just a safe spot that they can go to. And 99% of them are, what drugs are you gonna give me if I have a problem? That's right, that's right. And that's what we don't want. We say, no, listen, there's a million things you can do. I have one patient and she came up with, I'm just gonna listen to a set list of five songs from the 80s. Oh, that's awesome. It was amazing, right? And it's, you know, exactly what you think about. Don't stop believing, taking on me. Like a virgin. Yeah, well, not only that one's in there, but... Like a virgin. It's not in there. I don't know exactly what was in there for her. But she put it... Wait a minute. You don't remember? I remember, of course. In the cake and the... No, of course, I remember. I don't think that was her song in there, but she created a set list and she put it in her phone for, and she labeled it for emergency purposes only if I get suicidal, you know, something like that. And we kind of laughed about it. She's sweet, it changed her state. It got her centered, made her comfortable. She felt she came up with that plan, not me. Okay. That was cute. Okay. That's really cool. Mm-hmm. Okay. That's Barry Manilow. Yeah. I swear to God. No, that's what he was. She intuitively knew to bring back the old songs... Right. That bring back the old times. That's right. Yeah. Isn't that amazing? Yeah, that's amazing. There's no... Real men. Real men like Barry Manilow. He's still alive. I think he's still performing. He's the best. I've not seen him, but... You've never seen Barry Manilow? I've not seen him. I know. Oh, my God. He's on the list. Oh, God. Okay. I'm just going to ask the question. How does treatment change when you're dealing with someone who's also got a borderline personality? Oh, we even love this one. I love you. I hate you. I love you. I hate you. You know, I think borderline personality is where it's gotten such a backwrap through the years. You know, people here, they immediately think, oh, my God, absolutely difficult, can't deal with them, hard to like, and that's absolutely not true. You know, number one, we know that when you die, you when you get a proper diagnosis, that's the first step, right? When people understand what they have that's affecting their mind, their body, and their behavior, that really, really helps. So... That's the first thing you think about. That's the first thing. So, again, the hottest treatment change when you're dealing with someone doesn't change much because you've identified what the reasons are, why their behaviors and their thinking patterns are creating so many problems for them. So, it changes when you actually make that diagnosis. On the flip side, too often, we see a couple of things. We see a lot of times folks come into the hospital and immediately they're called borderline within a matter of minutes. Why? Just the way they're acting and people just jump to a conclusion. So that's very dangerous in my mind. But the number two, I think when we take the time to actually diagnose it, it provides tremendous, tremendous relief for people. Well, how so? Well, because now they understand what they're dealing with. What's the difference in treating borderline personality disorder versus bipolar disorder? So, there's two different things. Bipolar disorder, by definition, is a mood disorder. Borderline personality disorder is a disorder that is hinged back to kind of your facets of your personality. Their presentations can look similar. Impulsivity, rage, angers, mood liability, things like that. Well, we know with the borderline personality disorder that these are things that had been set in stone from toddler years and all the way up. And that even though they're personality traits that they can be modified, they can be helped. I'll give you an example. So, a few times I explained this to patients. Now, you know what? Based on my read, you do not have a mood disorder that fluctuates and goes ups and downs like this season or puts you into a zone of two weeks straight. No, you have a brain that's incredibly sensitive to the world and it reacts bang like that. And unfortunately, your reactions, your thoughts, your feelings, your behavior create problems for you. But that in another world is a super strength or a super skill. How so? Because you can react and think quickly on your feet. You can tolerate ups and downs. You can think in ways I can't even think. You see things I can't see. So, So, everything that's got a yang has a yang. It's right. Any weakness can become a strength. Any strength can become a weakness. So, you're not a bad person just because you get emotional and cry when your friend doesn't text you. No, you're not a bad person when you have thoughts that want you to hurt yourself after breaking up with a boyfriend. So, you pile that all together and that's where we start to see those differences. And they think mood disorders again, they have a rhythm on their own. They're not based on who you are. They're just based on what's happening to your body and your brain and they're consistent. You're depressed consistently every day no matter what happens, good or bad. Or you have mania for seven days or 14 days straight. You're not sleeping, you're spending money. Things that are not part of your normal personality or your normal moral code. You're doing things outside the realm. That's how we started to differentiate a mood disorder versus a personality disorder. Right. Ah, this is a great one. If someone's mood disorder is untreated, is there any point in trying to treat the addiction first? No, that is a good one. So, back in the 90s and 2000 when I went to medical school, the prevailing thought was what? You can't treat someone's mood symptoms until the substances are gone, right? Or in so... Because you don't know how bad they are? You don't know how bad they are. Or you don't do anything. Somewhere right around 2005, the fields started to say, you know what, it doesn't matter what's causing what. You treat the symptoms of giving people problems or pain. Now you fast forward on our 15, 20 years. It's a little bit more nuanced than that now. Now we're seeing that, yeah, of course you have to treat the symptoms right away. And you have to treat, quote, both at the same time. Because sometimes you don't know what leads one to one. I'll give you a perfect example. Cannabis is a great thing now, a great story. I don't know this. For years, we weren't seeing a lot of cannabis induced psychosis. Now we are. We're seeing tremendous amounts of it. And really deep psychosis, I'm sure you are as well. From the point where when people stop using cannabis six months later, a year later, they're still really psychotic. Oh, we're seeing a ton of that in the hospital. We're seeing a lot of that in other community-based settings and things like that. So then people will say, well, what is that? Are they psychotic or are they just cannabis use disorder? We're now moving toward to say, if you have cannabis induced psychotic illness, that that is a psychotic illness. Meaning had you never taken cannabis in at all, you would never have gotten. So therefore what you have is a psychotic illness. I swear, I have a treatment center. I've never experienced. No kidding. Well, mostly because when they call and they tell me they want to stop smoking pot, I mean, I'm here to help people. Right, right. With real problems. Yeah. November 2016, State of California legalizes cannabis adult use of marijuana act. First dispensary opened in 2018. You fast forward now to 2025. There's no doubt that the cannabis out available in dispensaries, regulated and unregulated, has a much higher concentration of THC than ever before. Number two, perceptions of harm or cannabis have gone down tremendously so that more and more people are using young, middle-aged, older adults. Basic things, there's a lot of myths out there. But number one, we know cannabis is addictive. Number two, we know cannabis makes the vast majority of mental health problems worse. Why is cannabis addictive? It's addictive because it's an addictive substance. And inside. Is it addictive physically? Are you physically addicted to it? Oh yeah, absolutely. How do you know for sure? Cannabis withdrawal, we see this. What is it? What is cannabis withdrawal? We see a syndrome of folks when they stop using or reduce using, they'll have things like difficulty with sleep, difficulty eating. Why do they have difficulty with sleep? Why do they have difficulty with sleep? Well, the presumption is that when they're canabinoid receptors now are altered by different blood levels that they previously used to, the body, you know, in a compensatory, like just like alcohol. The reason is, is because when you stop smoking hot, it is addictive and most people don't know that. But you do, and I do, but we know it for different reasons. You know it for, and all the smart, you just said. And I know it because you can't stop sweating and you're sleeping in a pool of sweat and you have to change your clothes the four times of the night. Okay, well, it's, you're not suffering. It ain't a withdrawal like cocaine where you want to light yourself on fire or heroin where you're going to grab a brick and hit an old lady over the head and take her purse because you are violently sick. You're sleeping it off, but you can tell that you are physically addicted to it because if you stop smoking it for the next week, you're sleeping in a puddle. Yeah. Okay, so I love that. And I'm trying to explain it. Yeah, no, I love that. And the other thing people forget, sometimes it could take a week from the time you stop until you start feeling those withdrawal symptoms. Oh, no, you can't. Yeah, that's what we've seen. And you know, people go stop on a Monday and it's not until like the following Monday they start feeling those symptoms. Oh, okay. In part because of these really high points. Don't worry. I get what you're saying. So the addiction parts of cannabis is for real. Number two, I wish we could say with confidence that medical cannabis works really, really well. And fortunately it's not there yet. We know it works for pain. We know it works for certain types of nausea, certain types of muscle spasticity and things like that. But it makes essentially every mental health condition worse and it doesn't make it better. Do you know why that is? I have a whole thing, but I'd love to hear your quick and dirty answer. Because everything is delayed. Anything you push, you kick the can down the road. Yeah, it's a band aid. And you're not dealing with it. It's nothing you're procrastinating on dealing with gets scarier and scarier and scarier. The best way I can say is when patients say, it's the best thing for my sleep. I say, but what's the reason your sleep is so poor in the first place? Well, I'm not quite sure. Only you know, you're just not working that core issue. So all you're doing is covering up your sleep problems with a sedative like cannabis. And eventually that's going to stop working. What are the biggest reasons why people can't sleep in our sphere? Trauma, poor sleep hygiene, phones. Poor sleep hygiene, meaning the blue light. Blue light, the phone and the hand, the TV on, you know, caffeine, keeping the temperature too hot. Right, anything. Yeah, yeah, sleep hygiene. All right. Anything you want to plug, anything you want to, any question you want me to ask, anything you want to get out? Well, a couple of things I'll plug. So we have a UCLA Gambling Studies program that looks at examines, gambling behavior on all aspects, including gambling disorder. We have a California Gambling Treatment Program for no cost, 1-800-GAMBLER. Our website, UCLA Gambling Program, the ORG has a lot of great information on gambling. And of course in 2025, this is the rage, you know, mobile sports betting. That's what everyone's talking about. Cryptocurrency, financial tech trading, these are all the things that we're seeing and trying to address and minimize the harm from those behaviors. The second one, again, is our cannabis program, UCLA Center for Cannabis and Cannabinoids, available at cannabis.semmel.ucla.edu. And we're doing all sorts of studies in the lab looking at how cannabis impacts body, brain and mind. So if people are in an LA and they want to volunteer to sign up and be one of our research participants, take a look at our website when we take volunteers in and give them cannabis and understand what happens. That's kind of cool. And then lastly, I'm actually going to be president, fancy fancy, of the American Academy of Addiction Psychiatry. And we're a professional society of about 1,500 addiction psychiatrists across America that provide care related to addiction and mental health. We're friends and partners with our friends in ASAM, American Society of Addiction Medicine. But the message out there is that help is there. And I think so often families and people and folks who are unsure of what to do, they don't call anyone or they don't know who to call. They don't know to call. And I love it when patients or families come in there and they're just like, we're not sure we need to see you, but we've, someone told us we should. Or I just have questions about my cannabis or my gambling or about my, you know, cocaine use and I want to know more. That's the thing, people should go in and get help as soon as they can. But lastly, I think nowadays, the biggest thing that I see again is that there's so much information out there about addiction and mental health and substances. But there's a lot of noise, right? There's a lot of like misinformation and disinformation. And I think for folks to get proper information, it's really just to do the homework and research themselves and then verify it with trusted people to say, hey, does this make sense that I do this or I do that? Is it true that, you know, this can cause me to grow a third testicle, that sort of thing. So it's really about educating themselves through proper channels. Dr. Timothy Fong, thank you for coming here. You've done a lot of good today. That's what this podcast is about. It's about increasing awareness around the drug issue today and mental health issues today. And we're all better for it. Thank you for having me, absolute. Take care. All right, see you next Tuesday.