Dr. Sarah Wakeman
speaker
484 appearances
2 recordings
2 series
first heard Jan 2025
last heard May 2025
Dr. Sarah Wakeman’s voice in public audio — every appearance, attributed to the second.
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So most people think of like this is one fell swoop that you like decide to stop drinking and then success is that you never drink again. For most people, What we find is that's actually like a series of steps. So I always like to think of progress, not perfection and not have this kind of all or nothing mindset that for many people, they may early on have a month where they go without alcohol.
And then maybe next time it's three months and then maybe it's a year. And these recurrences happen, but ultimately they get to this place where they go into long-term recovery. After five years of recovery, a person's risk of subsequently developing addiction is no higher than the general public. So your brain actually does change. And we see this on functional imaging.
We see this in longitudinal studies that follow people over time. So you actually can overwhelm those things and get to a place where you don't have a higher risk than other people.
It's not so much about personality, but we do respond differently to substances. So, you know, take alcohol or opioids, anything. People feel differently the first time they ever use it. So often if you talk to someone who then develops addiction, they tell you that first time they used the substance, it was like this amazing feeling.
It felt like I've had people describe it as falling in love or, you know, a warm hug or like a relaxing bath, these like incredible comforting experiences. Other people, they get prescribed like an opioid for a tooth extraction. They feel nauseous and kind of like not like themselves and they don't like the feeling.
So how we respond to substances is definitely based on our neurobiology and is different for different people. So some people are, both from a genetic reason and their own brain, are just more wired to be at risk of addiction. And that's important to know about yourself because then you can make different choices.
You may decide, you know, never to keep alcohol in the house or not to drink because the risk is too great.
Food, sex, gambling. I think there are a lot of similarities. It's not my particular area of focus, but I think there are a lot of overlaps. I mean, I think many of the things you just listed, you could talk about, one, dopamine, obviously, but two, this idea of
needing to fill yourself with something else, either, you know, thinking about trauma, thinking about untreated mental illness, thinking about just kind of the deficit of connection and of meaning and reward and reaching to these external solutions.
Yeah, yeah. I can think of many patients, but one in particular who, you know, I knew that he'd experienced hard things in his life. He'd been in prison, for example, which is a traumatizing experience. He'd lost his parents, another thing. I never truly understood the depth of his trauma.
And he had struggled his whole life with substance use disorder and using lots of things, mostly opioids, but also alcohol and cocaine and just had had a really, really hard time. And After, I mean, years of knowing him, one day he broke down my office and shared that he'd actually been molested as a young kid.
And so sometimes there is that thing that people have never felt like they could share with anyone that really is at the root of so much of what they've been dealing with.
And like the person who whispered to you, I think the pain of keeping that inside, not only the trauma of experiencing that as a child, but then holding that secret and feeling like you somehow are damaged or that this thing inside you is there and not being able to heal it, talk about it, share it with people, I think, is just this well of pain that lives inside people.
He actually passed away.
From substance use, yeah.
Yeah, I mean, I think a couple things. One, there are so many stories of hope that I think counterbalance that for me. So I think the other stories in my mind I carry with me and still care for and are in touch with people who are living these amazing, vibrant lives in recovery. I mean, in the U.S. alone, there's 24 million people living in recovery.
So there are these stories of people who have overcome just trauma, tragedy, hardship, and are doing awesome. They're parenting. They're working. You probably don't even know they're around you. You know, they don't tell people necessarily that they're in recovery. And getting to be sort of a part of that process with someone and
watching you know there's nothing in medicine where I can actually see as dramatic of a change as with addiction where someone can be you know in a moment where they're dealing with all of these health consequences and relationship challenges and then they get better and it's just like the most beautiful thing to be a part of and so I think the hope from that the sort of
positivity of it is what keeps me going every day. Obviously finding ways to care for myself through that and family and connection, exercise, I run, I write, you know, you have to keep yourself whole through it all too. But I think I get tremendous purpose and mostly like a lot of hope from working with people and seeing them recover.
I think one thing is language. It's like this subtle thing. I sort of mentioned an example where you did it really well, where instead of saying someone failed treatment, you said the treatment failed them. But a lot of the language that we use with addiction actually subtly and not so subtly worsens stigma.
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