[Applause] Max was supposed to visit for Christmas it was my first Christmas as a mother our second Christmas without our mother I'd hung our childhood decorations presents were wrapped cookies were baked I was eagerly anticipating feeling his arms around me hearing his laughter creating new memories with my 10-month-old baby but it was a little Bittersweet it had only been 17 months since our mother had died so when his flight arrived and he wasn't on it it was December 23rd Christmas Eve Eve we called the police to do a safety check and after a few hours
I looked at my husband and I said max is dead Max my 24 year old younger brother my sweet younger brother i' later learned he died of a self-inflicted gunshot wound the consequence of his depression and his alcohol use disorder which should have been a Christmas celebration resulted in a haunting silence I'm an addiction medicine physician and I still ask myself questions how did we get here how did we go from Reading bedtime stories together to facing the unbearable reality of his absence was this the same boy who I cheered for in high school football
games who was in law school traumatic losses made us do this they make us ask questions they make us doubt reality they make us doubt everything even as an physician where I'm supposedly meant to know everything what I learned is that sometimes those answers come too late and we're forced to deal with the pain and the grief that comes after it and we have to learn to do something with that grief and so I'd like to tell you my story but in order to do that I have to tell the story of many and to
do that I'd like to start with you do me a favor close your eyes and think about one of the darkest moments in your life a time when you didn't have any hope how does that feel feel did you ever feel any guilt or shame for not being able to get over it did anyone around you contribute to those feelings or help you with those feelings now keep your eyes closed but instead of yourself imagine a loved one in that same amount of emotional pain what would you do how how would you approach them would
you blame them for having to drink after a particularly long night would you offer them a drink to help take the edge off and what would you do if that pain didn't go away and now they can't stop drinking how do you approach them now I want you to keep that notion with you we'll come back to this exercise as we keep talking according to the World Health Organization elicit substance use is the number one most stigmatized illness worldwide with alcohol use ranking at number four on the list in the United States the average age
of first use of alcohol is between 14 and 15 years old Max was 14 the first time he tried alcohol he'd later tell me that it was the first time that he felt normal and you see Max's story is not unique he is not alone and all too often these stories end in similar tragedy one in8 people in the United States has a substance use disorder and that number jumps to one in four if we include nicotin use now when you were picturing your loved one were you picturing someone with a substance used to disorder
and what does someone with a substance use disorder look like anyway that question is the root of where stigma lies so as an addiction medicine Professor one of the first things I try to do is teach my students that the opposite of stigma is empathy we have to first learn to untie ourselves from derogatory images and stereotypes eliminate things from our vernacular like the words addict junkie user and learn to replace it with empathy with the knowledge that that patient it could be any one of us at the wrong time under the wrong circumstances and
the right amount of pressure it could be any of us it could be you it could be your sibling your family member your friend your partner it could be any of us us and that's the thing about addiction is it could never be us until it is and then it's too late now it's not exactly difficult to point out that we have stigmatized ideas of one another and of people with substance use disorders in particular so the question became for me as a professor how do I inoculate my students against stigma how do I prevent
it from happening in in the first place now when you were thinking of your loved one what was your reason for giving them the benefit of the doubt around their substance use disorder and not someone else no matter what your reason is whether it's rational or irrational what you're doing is you're trying to explain something in our society that's taboo addiction and the root of addiction lies in pain and suffering at first substance use relieves that pain it relieves that suffering and then all too often it Cycles out of control with an end result that
can be as severe as death my young son recently told me that he thinks that the reason some people use drugs is to borrow happiness from tomorrow for today my brother felt as though though his tomorrows had no happiness left and you know what I have felt like that too I was in the final stages of my training an addiction fellow when my brother died despite all the knowledge I had I couldn't save Max his disease was too severe and I knew that at some point in my career I would meet a patient that would
in a way bring Max back to me and I'd want to save them and when this happened I did want to save them and I did all the right things I used the FDA approved medications countless hours of counseling care team meetings and it all left me wondering did Max have any of this did Max suffer and die because addiction treatment is hard to access did he die because Physicians aren't trained to treat addiction did he die because insurance coverage for addiction is spotty and what I realized was these questions aren't individual questions they're systems
questions and systems questions require systems answers because there was no way that this many people were dying including Max in a system that worked in 2008 the mental health parody and addiction Equity Act was signed into Federal legislation and what this said was that it required insurers to cover addiction and mental health treatment in a way that was no more restrictive than their coverage for other physical health issues yet Michigan's Medicaid policy to cover seeing a prescriber for a person with a substance used to order went into full effect in 2024 that's 16 years later
how many more Maxes are there going to be before we see meaningful systemwide change you know my life has had its own grief and pain I saw my son's heartbeat for the first time after two years of fertility treatments the afternoon my mom died I was leading an end of life discussion when she died training other Physicians on how to talk to family members of dying patients when my mother died I was devastated people kept telling me it was the circle of life I hated that it wasn't the circle of life my mom wasn't supposed
to die when I was pregnant she was supposed to take care care of me when I had my baby so that I could take care of my baby it was unfair then when my brother died 10 months after my son was born it felt like my emotional world came crumbling down once again I'd experienced the lowest of the lows the death of my mother and brother and the highest of the highs the birth of my son and later my daughter remember that idea of the wrong place at the wrong time under the right amount of
stress it could be you why wasn't it me I had my husband I had my son but I remember sleepless nights of unbearable pain going into my son's room lifting my sleeping baby from his crib holding him rocking him the tears would flow and my husband would come in and gently lift our son from my arms Place him in his crib holding me until I cried myself to sleep the pain was so real I had to have a reason to get up every day I had to hope hope that for others things could be different
hope that other people didn't have to suffer the way I was and out of that I grew my practice of medicine because medicine is more than just a science it's also an art and and out of my suffering I found my route into patient care it involves being present it involves sitting with your patients it involves sharing in their pain because pain is not unique and while we are resilient we all sometimes need a little help too currently I exclusively treat pregnant people with a substance use disorder and my patients are some of the most
remarkable people I know their pain is immense but their strength that's beyond measure treatment is hard it's often riddled with cycles of using and the guilt and the shame that comes with it and then doing that again and again and so I try to be present for my patients as a person first and as a doctor second conquering addiction takes an incredible amount of inner strength it's the least I can do to sit with another suffering human because what can come of that is something beautiful healing can occur and so in addition to my mentoring
my teaching and my clinical work I also do advocacy working toward that systemwide change and after countless hours of advocacy conversations with legislature Congress people initially I'd come armed with all the evidencebased practice that math data and Science and the irrefutable evidence of what would happen if we did nothing Max's story and what I learned was that too often people didn't care doors Clos time and time again but eventually things started to change people started to listen because I think they realized that Max's story my story it's all of our story so I'm here to
tell you today that change is possible Michigan's Medicaid not only covers seeing an addiction prescriber for somebody with a substance use disorder but also counseling codes case management and collaborative care codes I was told that Medicaid internally referred to the policy as the Poland policy the Michigan cares program has trained over 1,000 addiction Specialty Physicians Nationwide we've also trained over 1,000 medical students and residents here in Michigan alone I chaired the American Society of addiction medicine's public policy writing committee writing and influencing policy across our country it sounds romantic but it wasn't always easy there
were moments when I wanted to give up when I didn't know if I had the strength to continue the resiliency the grit and in those moments I would remember my suffering my brother my children and my patients Max's memory lives on in every encounter I have a constant reminder of why I do this work to fight this devastating illness and prevent other people from suffering the way I do every day so that Max doesn't become a number so that my patience aren't numbers it's been a promising start but it's going to take so much more
work work that takes all of us in this room and Beyond Max's story my story it is the Story of All of Us and what we have to do is work together to find that passion that strength to have the hope and compassion and love of and for each other so we can create a healthier community and in my grief and in my pain I develop my purpose I do it for my family in my community and to all those who have lost their lives to addiction Max you will forever be in my heart [Applause]
