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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Yeah, lots of things. I mean, I focus mostly on alcohol and drugs. So alcohol, obviously, probably most common. I think we'll talk about that a lot today, which I'm excited about. And certainly when we look worldwide, 400 million people have an alcohol use disorder, meaning addiction to alcohol. That's a lot of people. The other are drugs.
So that can be opioids like heroin or pain pills or fentanyl. It can be cocaine or stimulants like methamphetamine or prescription stimulants. sedatives that people may take for anxiety, like benzodiazepines, cannabis. And so there's a whole sort of range of substances that can be addictive. And how addictive a substance is, is really related to sort of how much dopamine is released in the brain.
I know you've had a wonderful episode with Dr. Lemke about dopamine. So you've talked about that a bit. And there are different sort of addictive indices of different substances. So cannabis is less addictive than methamphetamine, for example. But all of those substances can cause addiction in people.
Yeah, well, there's, you know, a couple important pieces there. Is your coffee drinking causing harm in your life in any way?
It may be helping you, right?
Yeah, so it's not addiction. So there's a difference between physiologic dependence, meaning, like, if you don't drink your cup of coffee, you're going to get a headache. And addiction, meaning that you're spending all your day and all your money buying more and more coffee.
We don't really see this, but buying more and more coffee despite, you know, your girlfriend nagging you about it and you're late to work because you're purchasing coffee. We don't really see that so much with coffee, but that would be sort of addiction.
Well, I guarantee that many people listening have been touched by addiction, either personally or in their lives. Because of stigma, we tend not to talk about that. But the scale is huge. So globally, 2.6 million people every year die from alcohol-related causes. So that's 7,000 people today will die from an alcohol-related death. Another 600,000 people die from drug-related deaths annually.
So that's like 1,600 deaths today from drug-related causes. And then when we look at the criteria of sort of meeting criteria for a substance use disorder or addiction, it's about 400 million people worldwide for alcohol and 80 million people for drug use. So it's incredibly common.
If you think about alcohol, some studies estimate that the lifetime prevalence, meaning over the course of your life, how likely are you to at some point develop alcohol addiction, is somewhere between 15% and 30% in some studies. So one in three people may have a problem with alcohol at some point in their life. So this touches all of us.
We just don't talk about it because of stigma and because of these mental images of kind of othering that it's only those people who are injecting heroin who have addiction or that person who has the shakes every morning and is drinking as soon as they wake up who has a problem with alcohol.
Yeah, great question. The pandemic was not kind to addiction, so we saw rates of alcohol and drug use and deaths related to those increase significantly after the onset of the COVID pandemic. That has started to level out. So for drug use related deaths, we're now back at the pre-pandemic levels. But there was a very significant increase during the time of the pandemic.
And that's really not surprising when we think about what are the things that drive people to use alcohol or drugs in a problematic way.
Yeah, so obviously COVID was one driver. One of the main other drivers was substance-related deaths. So actually immediately following the onset of the pandemic, so beginning March, April of 2020, we saw a 23% increase in alcohol-related mortality, and we saw the highest rates ever we've seen of drug-related overdose deaths. And that actually impacted U.S. life expectancy up until this year.
This is the first year that we've seen that change.
Yeah. So that's a really great question. What drives people to use substances? It's actually probably the most important question, even in my work. If you don't understand what someone's substance use is about or related to, how are you ever going to address it or help them address it? So trauma is probably the single biggest driver. So you often hear things like cannabis is a gateway drug.
I would say trauma is the gateway drug. If we look at many, many studies, they're kind of Two different things that drive someone's risk of addiction. One is genetics. It's about 40 to 60% genetics, similar to diabetes in terms of someone's risk. That's not a done deal, obviously. There are people with strong genetic risks who never develop addiction and people without that who do.
The other half of the equation is based on kind of your exposures and your experiences. And one of the number one drivers is what we call adverse childhood experiences. So there's this famous study called the ACES study, which stands for Adverse Childhood Experience, and it's been replicated.
There's a recent one done actually in Europe as well that looks at the number of adverse childhood experiences you have, and it's a linear track increase in terms of your risk of substance use disorder. So if you think about what's happening in the brain with substances, you know, when we use alcohol or drugs, all sorts of feel-good hormones are released, right?
Dopamine, your endogenous opioid system, which is literally your natural pain reliever. And if you take someone who's experienced trauma, there's great relief that people can find in substance use. And so we saw that in the pandemic, like what was going on in the pandemic. People were scared. They were bored. They were lonely. They were stuck at home. They didn't have their usual routine.
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