Hello and welcome to Listen Up People, a podcast
of the USC Suzanne Dworak -Peck School of Social
Work. I'm Dr. Eric Rice, professor and associate
dean for research. This episode, we are focusing
on advancing addiction science. In 2024, 48 .4
million people aged 12 or older had a substance
use disorder in the past year, yet only one in
five people received treatment. My guests today
are part of the USC Institute for Addiction Science,
which aims to revolutionize the way substance
use is discussed and treated and prevented. I'd
like to welcome Dr. Jennifer Lewis, teaching
professor and director of the Master of Social
Work program, and Dr. Olivia Lee, associate professor
and director of the PhD. It's great to have you
both here with us. Hi, thank you for having us.
So I want to start off with something that I've
been enjoying doing for the past few episodes,
which is to ask people a personal question as
we get this started, which is why did you get
involved in this kind of work? So maybe I'll
turn to Jen, you first, but what got you interested
in addiction? Thank you again for having me.
And I'm happy to share a little bit about this
really exciting initiative with USC. You know,
as a clinician in practice, I think so many of
us worked with individuals who had co -occurring
disorders. And back in the day, not to show my
age, but anybody we were assessing, we were determining
whether or not they had addiction that preceded
their mental health issues or were a consequence
of potentially. And depending on what we found,
we would refer them to services either for addiction
or for mental health. health. And even at the
time, I just thought that this does not make
sense. This really, you know, so many of these
issues are intertwined. And so separating into
those, those different areas just didn't make
sense to me. And in during that time, the treatment
that we had available was really focused on,
you know, like peer led addiction treatment and
versus the mental health side, which had more
evidence based interventions and professional
care. And so it just, it seemed at the time that,
you know, they weren't great options and maybe
not the best for the, the clients that we were
working with. Yeah. Yeah. Olivia, how about you?
How did you get involved in addiction work? Uh,
so let me think. So like, so kind of similar
to what Janice is saying. So before me joining
in a PhD program and a whole kind of thing, I
was a practitioner. I was a social worker in
the field. And before that one, there's a practicum
and all of those. And you saw the intersection
between the poverty and then substance use a
lot. But back then, before me joining the PhD
program, My obsession was a poverty, so I did
not really see the substance use of science that
much, even if I was working with them and a whole
kind of thing. But my interest in the substance
use is really picked up and I clearly see the
intersection from the PhD program. I was a part
of. this research group and I was on the grant
and study, so really study about the kind of
social determinant of substance use and whole
kind of thing. So that was how my trajectory,
but like a beginning was like Jen was in the
field by working with people, see them one, it
was in me and then it blossomed in the PhD program.
Yeah, that's so interesting to hear both of you
talk about your experiences as practitioners
informing this. I think From my perspective,
at least, I don't know that a lot of people think
about social work and social workers as having
a lot to do with addiction. And yet for the two
of you, I know we have both a strong commitment
to both educational programs and research programs
driven by your social work and your passion.
So it's really great to see. I guess I want to
turn to talking about each of those. Things right
the educational programs as well as the research
programs and maybe we'll start a little bit with
the education part of things. Jen, I know you've
been. deeply involved with creating new programs
around addiction here at USC. Can you talk about
those programs? Yeah, you know, interestingly,
when we look at social work programs around the
country, we all have accreditation standards.
And so there's some uniformity with all of us.
We oftentimes differ in terms of our specializations,
but at least at the foundation level, it's all
sort of the same. And we have a lot of competencies
to cover. And addiction is not one of them. Interestingly,
so if we as programs in this country are going
to insert addiction knowledge, you know, we do
so in the form of electives or maybe a specialization,
but it really isn't uniform. And so in our program
specifically, we just didn't have a lot. And
while CSWE had provided some guidance around
addiction education, we had we had pieces of
it, but we weren't doing it comprehensively.
And so I became really interested in the Institute
for Addiction Science, which was an institute
where education was part of their mission across
transdisciplinary across the university. And
they were starting a master's in addiction science
as a transdisciplinary degree so that it was
bringing social work, public health, pharmacy
and medicine to the table to develop curriculum,
literally to sit down with each other, build
relationships and develop curriculum that would
serve all of our professions with the intent
that our students would not only receive the
education, but would learn at the same time in
classrooms with other professionals and so not
just learning with their own profession and then
going into the field and working with different
professions, but actually learning with different
professions. So I was not only interested in
increasing or enhancing the social work knowledge
within addiction, but really the idea of interprofessional
education or transdisciplinary education where
people were learning together at the same time.
Are you developing any social work specific programs
or is it mostly a collaboration with the Institute?
Well, we did something really Well, I think there
was an opportunity for us. There was some funding
from the state of California to do workforce
development, because really, unfortunately, most
of the certification and addiction is tailored
towards laypeople, a lot of community colleges,
or for people to get a certification in addiction.
And it takes a long time in those settings. And
so the state of California was interested in
enhancing the workforce, making sure that we
could create more knowledgeable addiction people.
And so we actually were able to integrate our
certification for addiction into our social work
program. So individuals through the support,
with the support of the state of California and
funds that supplement their tuition, were able
to receive a certification in addiction at the
same time that they were receiving their masters
of social work. So that was a way of sort of
layering our masters in social work with additional
addiction training without diminishing their
their master of social work content that we're
required to provide. That's really cool. I think
one thing I'm excited about with today's podcast
is that we have both the director of the MSW
and the director of the PhD program on here.
And so Olivia, I want to ask you How is it that
you're engaging with our PhD students around
issues in addiction and addiction science? So
as you know, Eric, the PhD program is a little
different from the MSW program, because my PhD
program is driven by students' research interests.
So whenever I see other students are interested
in addiction, like PhD students are interested
in addiction, Essentially, one of them I'm trying
to do is engage them in activity, especially
the research side of activity is going. the IAS
Institute for Addiction Science. So for example,
there is going to be some mini retreat, we call
that one some mini retreat, by like a research
retreat, where we are going to get together and
kind of talking about the study, talking about
the papers, maybe writing a grant together, that
kind of thing is happening soon, like in October.
And myself and my colleague, Dr. Eric Peterson,
we're going to co -lead that conversation. So
I invited, I spotted some PhD students who are
interested in addiction or some of the data that
is going to be discussed there. Then I invite
them and they're engaged in the conversation.
And also, some of our faculty colleagues are
part of, like many of them, are actually part
of this institute for addiction science so that
they're going to be there as well. So I facilitate
that kind of idea of addiction is really complicated
problem. Social work alone cannot solve the problem.
We need help and thinking together so that we
can solve this addiction problem and provide
the space. and invited PhD students who are interested
in addiction, bring in the research space, and
then they can get exposed, and then hopefully
they can get some collaboration out of it. I'm
cognizant of the fact that you both have mentioned
this Institute for Addiction Science a couple
of times in the answers that you've been providing
for us this morning, and I'm wondering if maybe
we could... take a minute to talk a little bit
more about this institute and what it's all about
and and how it functions. So maybe I'll turn
to you, Olivia, first. So can you just give us
a little bit of an overview of what is this Institute
for Addiction Science and how and how have you
been involved with it? So the yeah, the Institute
for Addiction Science is actually mouthful because
I never say the full name in a conversation and
we call this one as IAS. affectionately and it's
really like kind of nations of first as far as
we know university wide like uh addiction science
space and like we can talk about that one so
what it is is like there are a lot of people
from a multiple discipline not just from social
work from the you know like medicine pharmacy
and we have nursing folks as well and political
science and really a wide range of disciplines
get together and really trying to solve this
like a complicated problem with addiction. Main
thing that we are doing in that IAS is substance
use and also other addiction problem like some
of us are interested in gambling and whole thing
and we have the research side, we have four different
research affinity groups. and each research affinity
group tackling on their front one. I'm going
to just mention the one dose of four. The first
one is called mechanism and treatment development.
So it's a really treatment -focused group and
a priority population and health equity. That
is a vulnerable population, the substance use
issue and addiction issues among the vulnerable
population and addiction policy and health economics.
As you can tell, it is a policy -oriented people.
like for example, legalization of recreational
cannabis, what is the impact of those on the
substance use, those kind of thing, or tax policy,
those kind of thing is happening in that group.
And the final one is a community engagement and
the dissemination. The IAS has really wanted
to focus on and facilitate the collaboration
between the research space and the community.
and not just like isolated we are here and a
community that are out there is nothing like
that so so that we have like a constant interaction
and that we invite the community members and
we have like some workshop, we have a conversation,
we have the community advisory board and there's
ongoing conversation. There's a lot of cool things
that are going on. So that is a little bit of
kind of more research aside, but a general idea
of IAS, interdisciplinary, the global people
who are really obsessed with this substance is
a problem. We really dedicate themselves to solve
this problem. We all realize that this is really
complex a problem. One discipline cannot solve
it. So that's a nutshell for me. Jenna, how about
you? I think that the same concepts apply on
the curricular side in that we have, you know,
even within our own university, but certainly
nationally, there are so many Individuals doing
such great work. around this area, and that just
we don't oftentimes have an opportunity to really
get together and share sort of, you know, across
discipline, what kinds of things that people
are doing, and engaging professions across discipline.
And so in on the education side, the director
of IAS and I are co teaching a course in the
master addiction of addiction science. And it's
the introductory course where students from social
work and public health and undergrad and grad
students and alumni. And people are coming back
to take this course. We invite individuals across
different areas, policy, research, practice,
to speak about their experiences to a broad range
of students. And so the students are able to
really engage in the research or the practice
or policy. in really meaningful ways. We have
this one segment of our class that we do called
Ask the Expert. This past week we had Christian
Hendershott. coming and describing his research
on the use of GLP -1 receptors like Ozempic and
as a novel treatment for alcohol use disorder.
And so, you know, these are social work students
and public health students that would have probably
never read those articles that were, you know,
getting exposed to cutting edge research. So
it was such, you know, it's really cool. We do
one of those each week across different disciplines.
That's very cool. I imagine the students in these
settings have a lot of interesting conversations
with one another because of the variety of backgrounds
they come from. They really do. And I think,
you know, in in our in the profession, more and
more, there's opportunities for professionals
to engage in treatment in addiction. Whereas,
as I said earlier previously, it was more peer
driven. But I think as it's professionalizing
the different professional groups are working
together in practice. And so I think it's that
we have an opportunity to train them together
is incredibly valuable. I like the way that both
of you have described the complexity of working
on the addiction problem and the need for this
variety of intellectual perspectives, professional
orientations. I'm personally a big fan of this,
which I know the two of you know because I've
been doing work with. social workers and engineers
together for a while, but I really love this
notion of bringing a variety of different intellectual
perspectives together on research topics. And
Olivia, I want to turn back to you for a second,
pick up on a thread that you had started on where
you were talking about research retreats with
interdisciplinary groups of folks and involving
the PhD students. You know, what sorts of opportunities
Are there or have there been for you as a researcher
in addiction science as a result of this IAS?
Yeah, so the because of that the nature of IAS
in the interdisciplinary and also we are very
collegial like I was a part of the center grant.
And when I was a part of the center grant, it
was a lot of conversation. And I met a lot of
people whom I have never met before. And also,
like students in Jen and Adam's class, some of
them I have never thought about it. As a person
who was really focused on this poverty and socioeconomic
status aside for the substance use, I did not
think about like whatever other element. There's
so many different elements going on. and I have
not thought about it. Like there was a new collaboration
happened between me and some of our colleagues.
And I'm looking at the really policy aspect and
neighborhood tax policy that I have never thought
about it. What is the impact of those kind of
thing? It's just really cool from that perspective.
Because of a colleague who is so knowledgeable
about that, it just made me, inevitably made
me think about that. And then because of that
synergy, we created something new together. That
is really like magic about ISA for me. Absolutely.
People who are in there and that collegiality,
they're just willing to chime in with their ideas.
And we talk about that one. Oh, yeah, that's
awesome. Let's do it together. And then you make
it happen. Now, like at the paper level and our
PhD students, I'm hoping that they can be part
of some new paper that I have never been before.
So that is a productivity for our PhD student
colleague. And then by involving in that collaboration,
they're going to meet new people that intellectual
space. That's what is really cool about IAS for
me. No, I love that. And I want to give you an
opportunity to talk a little bit about your research,
Olivia, because, you know, you've just spent
some time giving a lot of accolades to your colleagues
who've been inspiring you, but you yourself are
really an expert in this space. I know recently
you got a big grant from the National Institute
of Drug Abuse, yes, and I'm wondering if you
can talk to our listeners a little bit about
the work that you're doing and what are the kinds
of questions that you're exploring in the space
of addiction. that I can talk about forever.
Whenever I can talk about like, can you talk
about what you're doing? I can talk about forever.
But I'm going to be trying to concise and one
of the main thing, the essence of that grant
is SES, social economic status. As you know,
social economic status includes various things
like education and income and wealth and job.
And in this grant, we specifically focus on the
role of job in the shaping substance use problem.
So that's the main thing. And also we look at
the neighborhood, the influence in that context,
in the relationship between job and a substance
use, what neighborhood or like role of a neighborhood,
like we have. neighborhood level of density of
outlet and whole kind of thing. And there's a
whole whole list of steps. I'm not going to go
there. And that is by my colleague Rosalind Pakula,
Dr. Rosalind Pakula comes in. But anyhow, that
is what this grant is about. And right now, the
paper that we are working on is that we're looking
at this employment status. Typically, including
my own previous work, what we are doing is with
employment, we split them up. Like in a way,
you don't have a job, you have a job. Those are
the one and see to compare those two, whether
or not you lost your job that has negative impact
on the substance use. That is a typical thing.
That's what I did before too. But there are a
lot of actually, if you think about In the today's
job situation, it is not simple like that. There's
a lot of more like a gray area. One of them is
under employment. So you have a job, but you
have a bad job. And then whether or not having
a bad job has an influence on your substance
use. So that that kind of thing. The other one
is we are focusing on transition, not just at
a given point, whether or not you have a job.
but you have a bad job, or you don't have a job,
or you're not working. Instead of just looking
at those four categories at a single point, we're
trying to understand their history, where they're
coming from. Then right now they have a bad job,
but it doesn't mean that they had a bad job before,
or they actually had a good job and now they
have a bad job. Versus, they did not have a job
before, but now they have a job, even if that
is not an ideal job. Does that trajectory has
different influence on the substance use? That's
what we are doing. The one interesting thing,
at least really interesting to me, is that the
trajectory wise, one other thing that we find
is that downward movement, the meaning is you
have a secure good job and move to the underemployed,
so not a good job, while losing a job has negative
impact on substance use. So specifically in this
paper that I'm thinking, is binge drinking, problematic
alcohol use. So that one is kind of expected.
You had a secure job, you moved to the unfavorable
employment status, so it has negative impact
on substance use. That is one. But one of the
really interesting thing, at least again to us,
is that upward movement. So meaning is, you did
not have a job, and not having a job, you're
moving to a bad job situation. Now you have a
job, but the job is bad. or you moving to the
secure job and whether or not that has impact
in terms of substance use, in terms of alcohol
problem. What we see is if people move from the
unemployed status to the secure job, the risk
is the same to you staying in the secure job.
So there is no difference. It does not have any
importance. However, if you move not having a
job to bad job, the risk actually increase. So
that upward movement in the employment status,
depending on your destination, your binge drinking
risk differ. So these kind of thing that nuance
understanding and then the policy implication,
if we use any job is better, that means we may
put the people in. not a good situation in terms
of like alcohol problem. It's fascinating stuff.
And I think you bring up a couple of things that
I just can't help but comment on. I mean, one
is that it's complex, right? Both of you have
said over and over, this is complex. And even
this one set of findings that you're sharing
with us, there's complexity to it. The other
thing that I think is really interesting is that
it reflects also the stresses of transitions,
right? That not necessarily, even if transitions
might on some level seem like good transitions
from the outside, you know, people don't necessarily
always respond in the ways that we would think
people would respond to those sorts of situations.
And that's actually what I wanted to go with
as a parting serve ideas. for us to talk about,
which is that I think in a lot of social work
domains, there's misunderstandings, right? People
have preconceived notions about whole sorts of
issues around mental health. And I'm sure that
people have preconceived notions about substance
use and addiction. And I'm wondering from your
perspectives both, and maybe I'll turn first
to you, Jen, and then to Olivia, if you had the
opportunity to help our listeners understand
better something about... addiction. Is there
some some myth that you would like to myth bust?
You know, let people know kind of what the reality
of working with clients is really like. I appreciate
that question, Erica, because I think that previous
models, while effective for some, really looked
at sort of the moral failings of individuals
related to addiction. And a lot of the treatment
was based on that. And so that may be helpful
for some people, but not all. And I think the
reason that social work is positioned very well
to be at the table, because what we know is that
addiction often develops from the context of
stress and trauma and social disadvantage. and
that those struggles have a ripple effect outward
and put strain onto families and communities,
healthcare systems, justice systems, and they're
expensive. Addiction's tied to so many layers
of human experience. And so prevention and treatment
has to be holistic for it to be effective. And
so I think that what I appreciate about our opportunities
to engage in this educationally is that if we
could just provide somebody a pill or you know
address one factor. with addiction and be successful
in that way, we would do it. But it's not effective,
unfortunately, for enough people. And so really,
we have to really look at the systemic factors
that are impacting recovery. Olivia, what's something
that you feel like you would like to help people
understand better that you think is a misunderstanding?
I think my take on is I really appreciate this
question as well. And I think my thought is similar
to Jen. one on earth was born with a glass of
beer in their hand. It's all addiction problem
and everything. No one really, literally is born
that way. that all the addiction issues and struggles
that we see among the people, that happens because
something happened, like something, some other
external factor, not because they're morally
wrong. So having that perception that it's not
like individual problem, they can fix it and
you got to like, you know, like tough it up.
It's not like that. It's really complicated.
The social determinants side of an addiction
problem, we've got to pay attention to that one
a lot. The other one is that prevention. Like
addiction problem, we talk about today, like
Jen and I and Eric, all three of us talk about
specifically addiction problem. But before substance
use problem happening, there is other precursors.
So we can intervene. though, like for example,
exercise and behavior issue, which is happening
a lot before the substance is a problem. That
one is happening a lot earlier. And we had I
had some studies looking at the children's exercise
and behavior problem from age 2 .5. So that like
that kind of prevention idea, we got to have
that one in our mind as well. So balance between
prevention and treatment. And the other is the
social determinants. of addiction problem, not
putting all the blame to an individual who are
currently struggling and need help. Right. No,
that's great. This is such a complex issue and
one that covers a huge span of disciplines. We
haven't, as you just said, Olivia, we haven't
even really gotten into talking about prevention.
It's mostly been about treatment so far. So I
hope that you will come back, tons more for us
to dive into. But before we go, I just wanna
give you each a chance if there's any parting
thoughts that you have that you haven't had a
chance to share that you'd like to share about
your work. Jen, maybe you can go first and then
Olivia, you can close us out. Is there anything
that you'd like to share, Jen? for the opportunity
that I've had to participate in some of this.
I think certainly I wasn't, I didn't start out
as a addiction curriculum developer by any means,
but I think or in any way, you know, I'm a social
worker as well and have been doing direct practice.
And I think it's been really exciting to address
areas in innovative ways that sometimes academics
don't get to do. And so it's just been really
fun. And I'm very grateful for the opportunity
and the students who have been able to participate
and be engaged and learn something new as well.
So I'm hoping that we'll be able to continue
this type of work and really start to measure
the impact that we're having. And other universities
will be able to replicate the model. Very cool.
Very cool. Olivia, some parting thoughts for
our listeners? They usually start not really
and have something to say. Perfect. That's what
we're looking for. I really appreciate this opportunity
to talk about and it actually helps me to think
about my own work and my collaboration with the
folks and everything. I guess I got to come back
to the main point that I was trying to come across
throughout the whole hour conversation today
is that Addiction is a really, really complicated
problem. We need everyone's help and everyone's
intellectual capacity so that we can solve this
problem. And it will be really incredible someday.
we can say I can say that I contributed at least
a point or one percent of that additional problem
down the road and we can talk about that one
at some point without without my colleagues and
whole kind of thing at the end we can say we
did something together to solve problem even
if It was not a 90%, but we did something together.
That's beautiful. And I think there's probably
no doubt in at least my mind that the work that
you are both doing will be more than a 0 .0001
% contribution to this massive problem. And it
is such a big problem. And it's great to see
people from our school being so heavily involved
in the education and research aspects of trying
to help. Our society deal with such a major problem
that addiction is. So thank you both to Jen and
Olivia for joining us today. If you, the listener,
want to learn more about the USC Institute for
Addiction Science or the Master of Addiction
Science program, you can visit our school's website
at dwarracpeck .usc .edu. And if you have questions
for our guests on the show or you want to support
our transformative research and education programs,
you can email us at listenup .edu. people at
usc .edu. And Jen, Olivia, thank you both again
for joining me today. And thanks again for doing
such wonderful work in the world. Thank you for
having me. Thank you, Eric. Appreciate it.