Polio. She would encourage Franklin Roosevelt to continue with his political ambitions. Ladies from Martha Washington to Michelle Obama tonight at like 9 00 eastern, live on cspan. We will start the evening with a conversation from a story of new Richard Norton smith and the first ladies and their contributions to the nation live at 8 00. The next watch it in looks at Kevin Kuhlman how the Health Care Laws impacting small businesses. Then, samesex marriage and the goals of getting it legalized in more states. Then we talk about the currency known as the going which recently experienced problems from cyber attacks. Plus your phone calls and tweets all on washington journal, ive at 7 00 eastern on cspan. Next, former congressman Patrick Kennedy looks at societys role in fostering addition addiction and how the Health Care Laws might help. He spoke in an event moderated by dr. Travis stork who is an emergency room doctor and cohost of the tv show the doctors. It is 45 minutes. , please welcome to the stage Emergency Room Physician dr. Travis stork and the Mental Health and prescription abuse Prevention Panel members. [applause] i am dr. Travis stork for those of you who do not know me. A lot of people know me as the host of a Television Show and what a lot of dont people dont realize is that in my real life i am an er doctor. This is important because i truly believe that what we can do today is help save lives. Consider this and the next 19 minutes while we sit before you, someone will die from a Drug Overdose that is preventable. All of these deaths are mental. We call them accidental but in many ways they are not accidental at all. That is what we will be discussing today. I want to encourage anyone who is watching at home and streaming this, we would love you to become a part of this situation. You can tweak a question to us atter2014 and i would like to get you involved with an initial question. The question i have for all of you is, what is the most Common Source for people who abuse Prescription Drugs to obtain the medication . They got it from a drug dealer or a stranger, they bought it from a friend or , it was prescribed by one dr. , or obtained free from a relative or a friend . You can text or tweak your answers to us. We will give you the results. Ater and the correct answer without further ado, i would like to welcome my fellow panelists. We will go down the line starting with congressman after kennedy. Tell us why this matters to you individually. Thank you. Thank you to the Clinton Foundation and all of the sponsors. Ago, after leaving congress i went to get a new doctor where i was living in southeast jersey. Publicityten a lot of locally in the Atlantic City press because i married a jew married a jersey girl and they big deal i was in the area. I was recovering and doing all this work in Mental Health and addiction. I go to my new physician and im also asthmatic. A go to the doctor and he asked me, does my height, weight, blood pressure, asks me about my lung capacity and all the rest. Scandal withcent my colleague trey radel, i was that. Driving arrested for under the influence was splashed over the National Press for being an addict and i went to treatment and the like. I him pretty well recognized if you know anything about this as the face of someone in recovery. The shocking thing was, like most of my physicians in the past, i go and they dont ask me anxiety,ion about my my depression, or how my recovery is doing. Todayhave health care trying to figure out how to do health care and i message is, you need to include Mental Health care in health care. You need to include in your dr. s checkup, a check up from the neck up. Come a travis,s that you see as an emergency room doctor, those are all driven not by the back pain the person is saying they are in four or the your herbal bowel syndrome were the fact they have lacerations or broken bone. All of those are symptoms of an untreated depression, anxiety, or severe and persistent Mental Illness. Yet, your colleagues in medicine are not trained or culturally patientsto ask their about the most important organ in their body their brain. [applause] it is shocking. My story is that i try to tell the story. A couple turned the tragedy of their sons suicide entered into the largest best practice for preventing situations like that which had befallen them. My hat is off to them for what theyve been with the jet foundation. One of the goals of the panel today is to help explain to people what addiction really is, why it happens, and why it is occurring so frequently, especially amongst teenagers. Dr. Volkow . Thank you for having me here. I went to reiterate what congressman kennedy said about the issue of wellness but we should also address Mental Illness or disorder. Why are we attracted to drugs . System that has taken millions in millions of years of evolution to make sure that organisms, including humans, do behaviors that will and us forward for survival survival of the species. It does that by stimulating reward centers in the brain. Eat, to create, social interaction, that is why we moved. It is highly rewarding. Drugs can stimulate those same systems. That is why we are probing into very primitive mechanisms that can create trouble. Speaking about prescription medication, one of the things that people think when they take them or abuse them is that they cannot be very harmful because they are given by physicians. That certains types of medications like analgesics or stimulants with , they have the same capacity to stimulate the reward centers and as a result they can be addictive. We are in a system where a medication that can have very beneficial effects when used inappropriately can result in trouble. Through research, we now understand how drugs start to change the brain in ways that actually make you much less sensitive to other types of reward. Imagine, you wake up in the morning and nothing motivates or excites you. The main drive becomes taking the drug. Your brain learns it. It is a learning that is automatic. You dont need to be conscious about it. It is like a reflex. You get exposed to that stimulus and you immediately desire it. The same is that at time, the frontal area of your brain which is the one that allows you to observe cognitive control, to make a decision and say i am not going to do it, is also harmed by the repeated administrations of these drugs. At the end, you have a brain that is functioning differently from a brain that is not addicted to drugs. Those changes are very longlasting. Highlights why we need to address the issue of Substance Abuse disorders and addiction and diseases of the brain that requires treatment. At the same time, recognizing that and addressing the importance of wellness, we need to address prevention is a key component for all of us as a society to improve the outcome of our citizens. I think it is important. Atiction can affect anyone anytime. There is not one person in this audience are watching at home that this cant potentially happen to and a lot of it is biological. And itre reward centers is not just drugs. There are a lot of things in this world igo the last time we try to live down a doughnut. Addiction is something that is rampant out there. Offer ff is an author. Glad to have you as part of the panel. Thank you. The first thing i want to say is to be Clinton HealthMatters Initiative that it is an extraordinary you are taking it on. The first time i met pastor kennedy i was on capitol hill and i came to talk about drugs and edition. Addiction. Said, if you mentioned drugs and health on capitol hill, people will flee. We dont have a lobby. Addicts are not in shape to lobby for themselves and families are in hiding because of the shame around the disease. Itfact, i would not he here at all had i not been dragged into this field, into this world when my son became addicted as a child. He first tried drugs when he was 12 years old. Time, a short amount of used every drug you could think of. He was on the streets, he stole from us. I got a call the middle of the night that parents dread. We have your son and we dont think is going to make it. But, he did. Reason he did is only because we are lucky. I realize now how lucky we are because i hear every single day from people who tell me stories about their own children, their sons and daughters, their beautiful boys and beautiful girls who were just like my son, just like nick, but they did not make it. A person dies every 19 minutes. Addiction is the number three killer in america, yet we dont talk about it. What im excited about now is that the conversation is changing. It is changing because the people on this panel. The Obama Administration has made some remarkable steps forward. We have so far to go and i think the thing that i feel will make the difference, the biggest difference, is that we are having the conversation. Second, when we understand that a symptom. Often we talk about drugs and tell kids to say no, we try to scare them. We really have to understand that the reason will speed we use drugs, the reason our children do there was a study where they asked parents all over the country why they think their kids use drugs. The answer was overwhelmingly, because it feels good. Big high. Peer pressure. But when they were asked teenagers, the answer that they gave an number one answer was stress. Wonder whyneed to our kids are so stressed out. What is happening in our world oneonone hand, we have this pressure on kids that by the time it there 12 years old they have not filled out called tremolite resumes they will fail in life, and on the other hand we have kids growing up without support, families, in broken neighborhoods. Do we do with the underlying reasons kids are using drugs, we will not solve this problem. The hopeful news is that it is solvable. John and noopur who you have already met, i want this to be a discussion. The first thing i would like to do is to further establish how. Evere of a problem this is we are living in a day and age where one in four teens has misused a prescription medicine. You mentioned stress. One in 4 so if you have a home with four kids, chances are, one of them have just used estrogen medicine. Misused prescription medicine. For small, Prescription Drugs are too easy for kids to get. Most of the time we think of drug dealers on the street. People dont understand. Prescribedre does by doctors and their parents take them, kids think they are safe. The other reason is that reason use drugs, theyre called painkillers because they kill pain. People suffer whatever it is. When you are a teenager, you are stressed out, youre heading off to college and youre away from home for the first time. You are dealing with the world that is overwhelming in many cases and somebody hands you a pill. You take it and figure out how to get a pill. Guess what . They work. The pain goes away, at least for a while. So often we go back for another. I i will just add that presented some of the statistics about College Students and the issue of stress and anxiety and feeling overwhelmed and depressed. Is really progressive pervasive. It really raises the question about how we are supporting them. The earlier panel talked about loneliness as a disease and the feels aloneperson and isolated as opposed to connected and belonging to a community is a big part of this. What can we do, what can schools do to help you be connected and feel like they belong is a big part of this. For those struggling with Mental Health issues, how are we identifying them . How are we connecting with them to help . With the stigma of raising her hand and asking for help . This is part of this. That one of the Biggest Challenges come when you talk about prescription medicines, prescriptions do start in the doctors office, in the emergency department. The great irony is that these medicines are prescribed to treat pain. One of the central tenets of medical school is that you are taught very early on treat your patientss pain. When someone comes in is pain, you him as a physician, want to treat their pain. Treatingh this veil of pain, this massive epidemic of drug abuse has occurred. It was slowly simmering. Patrick, you at the nail on the head. There is a disconnect between a physician who is trying to treat pain but maybe not fully understanding that the pain that they now need to be treating is truly a Mental Health issue as well as a physical pain. I would like you to address that, but quickly, to keep everyone involved out there, we asked what is the Common Source for people who use restriction drug to obtain their medication. The results we have are 71 said that it was obtained free from a relative or a friend. That is absolutely collect correct. That leads discussion that people somehow think these are safe, which it is not. There readily available. About a culture the culture big picture and how we can change the healthcare system. Our culture needs to be reat reoriented to stop keeping quiet about this. The biggest enemy is silence. It is the pathology of not being able to talk about the elephant in the room. Mom had suffered from severe and persistent Mental Illness and ill call as him. Ill call as him alcoholism. We never talked about her. My family is liberal minded and never breathe a word about her. She disappeared to go to treatment. David writes about it. The biggest challenge is that we need a conversation. I love the idea that mtv is trying to break these barriers down. Olds the stigma that is our our most insidious enemy. This is not just about ascription drug abuse. I could have been addicted to anything. I was genetically predisposed, had an environment that encouraged it, and then it was oxycontin for me for a while. I was hospitalized for that but then i cannot and could not sleep, so i started abusing ambien. You could give me anything, and as an addict, i would abuse it. We need to get to the bigger picture. It is not the name of the drug, it is the underlying issue, as you said, about the Mental Health. As our culture goes forward, we tonot have the nomenclature talk about our emotional and psychic development, the Spiritual Development that is so crucial to us as human beings. We teach our kids but leave out this important piece that art of their development is being able to be a social being and not be stuck on their phone or their ipod. I love technology, but art of our problem is that we are more connected yet more disconnected. We dont have that Human Interaction that the Previous Panel talked about. That is going to be one of the big Outlook Health issues that we need to talk about and i salute resident clinton. He may have, unbeknownst to him when he did americorps, instilled part of the answer. Others,er is service to connectedness to your community, and serving your fellow human being, your brother and sister, who needs help. That is how my medication for my disease of selfcenteredness is trying to help someone else. I would just offer that as a broader topic. I know it eva from your issue of , how do we get doctors to change . Frank lee, everyone has to change. Frankly, everyone has to change. We were talking earlier. If you go back in time you mention abusing oxycontin which has become a very common word. A lot of may or may not know that it is a our cottage pain killer and there are a lot of different types, but they also really have the same effect. They are in the same family with morphine and heroin. Drug,ommonly known street but more people are drying from Prescription Drug abuse than heroin and cocaine combined. If you go back in time when you were abusing oxycontin, where was your headspace . What ispart is difficult to understand is if you have never abuse the drug, how do you communicate . Patrick, who was talking about the cancer personalized medicine. Theyre doing screenings. We need screenings for anxiety and depression. Where i come me from, what my family situation is, what i am dealing with, you are going to keep writing the whateverhat keep me the doctor was doing but after a wild, everyone had to have known. I had been in and out of rehab a dozen times and no one was still asking me. It is not on my medical record. I go to a new doctor and, guess what . If its not on my record they will give me what i want. We have both a cultural problem and then you ask about a system problem, as the first panelist talked about. We can correct that. Any otherat that like physical illness because this is not just a character flaw. Although, you have lots of character flaws when you are an addict. This is also a chemistry issue as director volkow can tell us. Our medical system is not trained for this. They dont know how to ask about it. Travis, that is the big issue that we need to change. You acknowledge that as a patient, you are physically going to the doctor and getting medicines from doctors. Lets briefly talk about the focus of the panel, which is colleges and teenagers. There are a lot of people that are getting these medicines through friends and acquaintances assuming they are safer because it was written as a prescription by a physician. Impact these kids that are going off to college away from from him in debt for the first time, and a friend says, hey. I have some of these. It is prescribed by a doctor. Try this. One of the ways is to help the students understand that the drugs are not safer. We had a student that we spoke with one were doing research for these videos who says that she was taking Energy Drinks to prepare for an exam and her friend said, i cant believe youre taking Energy Drinks. You should take adderall instead. Energy drinks are so bad for you. [laughter] i was caught off guard. I couldnt believe that was the thinking. True information about the reality of the consequences, that is one big way to move the needle. Panel,le sit on the getting to the underlying issues of why the students are so stressed. The third thing i wanted to point out any big focus of half of us over the past seven years has been speaking to the friends of those people who are thinking of taking the drug or her in the abusing them. Friends are often the first line of defense. Young people are more likely to turn to their friends more than any other source if they are dealing with an issue. If we equip friends with the knowledge and information and empower them to step in when they see a problem occurring, and i think that will help us get a lot of the way there. One of the things it is very important in college. The two drugs that are most frequently used are pain drugs and stimulants. These kidse that have in order to perform in their scholastic study, in order to be able to achieve the grades that they need. If they see another kid studying with stimulants, they feel the pressure that if they dont take them, they will be at a disadvantage. In a very interesting way, we are creating a system that is pushing them to take a medication that outside the context, can actually be very addictive. With respect to pain medications, the issue is compounded. Culture where we try to solve all the problems we have a paypal. To have an idea of how important these prescriptionfocuses in United States, in 2011 there were 230 million prescriptions for either hydrocodone or oxycontin own. 200 230 it million prescriptions. How Many Americans do we have . Countryally have such a in such a level of pain that we require this description medication . Address the cultural aspects we have as a society that may be promoting the use of substances as a way to resolve issues that make us feel uncomfortable, such as pain or inattention. We are in a society that is obsessed with taking pills and i say that as a physician. It is interesting that we have 5 of the worlds population and yet we use about 75 of the prescription medicines. Those can be lifesaving and they certainly are in many cases, or they can cut lives short. It is interesting when you talk about stimulants. It can be very effective who kids who need them. One in eight use them without a prescription and in some cases, you even have parents begging the doctor to get their kids on these medicines and that is another cultural problem because they are not meant to be taken without the guidance of a physician for a known medical problem. I think that gets back to the pill, itf it is a was prescribed for someone, lets just see if it works. Lets see if it helps me study better or makes a more relaxed. Is interesting because the data shows that College Students that you stimulants for academic reasons do not actually perform better than those who dont use them. That is part of the knowledge and awareness cap on this issue. Students dont appreciate that it is illegal. They dont think through whether or not its ethical or it is right. They can do this themselves. The safety risks, as you said. That is part of what needs to be filled in here. As families, as physicians, all of us can help students as they transition from high school to college by talking about the fact that this will come up, that they will be told about these drugs and how, and give them the skills and tools to say no and be ready for it when it happens. David has written publicly about your sons addiction. What kind of conversation should parents be having with their kids . We should start way earlier than we think. Every parentume i talk to is worried about drugs and yet, no one knows how to have a conversation. No one knows what to do about it. Since we know that so much drug use and escalated use and addiction is related to a whole list of risk factors, if you have addiction or metal illness and your family, if you have psychological disorders, if a child is experiencing a loss or a trauma once we understand these things, it we know that if parents are educated, we know that we can teach adults to look even closer at our children. A pediatrician told me that if you think your child is struggling, they are struggling. Rather than wait for something or the problem to as scully, intervene as soon as you can. You are not expected to be a doctor. Take your child to a doctor. Find out what is going on. If there is need for an intervention, that is the time to intervene. I think everyone has stressed the connection between Mental Health and in many cases that leading to Prescription Drug abuse or misuse. I want to get to a question that we got from allison will send says what can be used to increase awareness on Mental Health on when and where to access care . I have to imagine there is a lot of fear in taking that first step to access the system is Mental Health people are very afraid to admit when Mental Health issues arise. Im kind of like that old hair club for men died. Not only my head the founder of the company, i am also a client. Not only am i the founder of the country, i am also a client. We worked on enact that was meant to it 11 eight the insurance disparities in accessing care for Mental Health and addiction. There were higher treatment limitations when it comes to bring illness like brain illness like addiction or depression than it was for asthma, for example. We have to implement the law. George w. Bush signed into law. President obama is implement a new Mental Health parity. You can have Mental Health be something separate, although there are separate issues for people with severe and persistent Mental Health illnesses. You cannot treat a person with cardiovascular disease or diabetes. You hear that often. We heard about this grommet chronic illnesses. You cant leave out Mental Health. It cannot be a purview of psychiatrists and the like. It has to be the purview of all of those treating Health Conditions because those of you who were interested in outcomes, arerevor is, the outcomes going to be better if you are treating the cardiovascular cardiovascular patient who has depression, therefore ties were likely to have a heart attack. If they have diabetes and tricking alcohol, forget about. Sure really about making that it is seamless and if i dont have to go down the hall is, im the psych ward not going to be obsessed about whether i have a Mental Health issue or not because it is going to be a routine part of my checkup and will not be so unusual when the doctor says, what is your anxiety level . How many drinks have you had this week . Questions that we do not get asked in the health care system. [applause] important that anyone out there that is needing or wanting access to Mental Health care number one, you are public about your own struggles. Mental health and seeking help can and is a private matter. There are so many resources out there. One of the reasons we are doing the panel is because hand in hand, you see the Mental Health issues often time, saturday night in the emergency department, everyone would think that the majority of people are there for car accidents, gunshot wounds. Are, but there are other nights where the majority of people are there for Mental Health issues which lead to drug abuse which do, and set cases, the two unfortunate and untimely deaths. Anwhen you are writing up insurance claim, do you put contusion, laceration, in order to be reimbursed by our insurance friends, or do you start by saying if you treat alcoholism they will not be falling down the stairs . If you say they are in the yard because they drank, you might jeopardize the reimbursement by the insurance company. That is the facts of life. I dont want to get into health how health care is changing, but we are headed to the point of how to we prevent all this from happening in the first place . That was the focus in the most important part of the panel. You mentioned the importance of access to Mental Health. Moving back a little bit in time to teenagers and younger kids, because i cant help but believe that of all the people out there that are trying and experimenting, that is the age where we can prevent experimentation, we can prevent some of these unfortunate deaths. To add to that, i think what we have seen to the campaign over the years is that several of the reasons young people dont goal and seek that care, access is one issue but they dont want to see it because one, they feel like they are the only one that feels this way, and nobody is going else through this is going through this so no one could possibly understand and help them. You heard patrick on in the video, say that. He said he felt like that was someone something that other people did not go through. Second, they feel like it is embarrassing and shameful and do not want to be labeled as someone with a Mental Health issue. Thirdly, some of them might feel, is treatment really going to work . That is where authentic storytelling comes in and that is what we have done in our partnership with the foundation is to use real, authentic stories of students to show that you are not alone. There are people just like you going through the same thing. From celebrities like macklemore, who was the biggest artist for our audience right now, showing that it is not shameful. It is ok to open up and say you have an issue. We show Success Stories of people went to rehab or got treatment and that worked and that it a good experience for them. With those real stories, we can get them through that first barrier, which is going and looking for the help. I want to emphasize the chronic nature of these illnesses so that they dont just go to rehab and poof, the issue goes away. The chronic care model that is applied to diabetes and asthma, cardiovascular disease, incorporated Mental Health. All these folks on mtv telling their stories are going to need to continue to stay in recovery and that requires what is known as cognitive behavioral therapy. You change the way you act and think. Oft is being paid for by all our competitors in countries around the world. The United States was the one that came up with cognitive behavioral therapy, but we have exported it and we have not used it in our own country. Tore is so much we could do improve the Mental Health and wellbeing of our own people and yet, as weird and Previous Panels, it has not been paid for. It is not reimbursed. They spokel before, about the notion of loneliness. This woman being lonely. Loneliness is going to put her at great risk for Substance Abuse disorder. Teenager, what puts them at greater risk is the lack of paternity. Cannotronment where they excel at their particular task. Therefore it is not surprising that we see another representation of kids that come from the lower socionow going socioeconomic class have higher rates of in addressing wellness, teaching kids behaviors that are not just going to be good for their body, their owing to be helping them overcome and prevent Substance Abuse disorder and Mental Illness. Integrate mental abuse Mental Illnesses and Substance Abuse with our own that whole bodies. Never got the tools and i was already in crisis. The key is early on, show people if you do this you will feel better. If you get socially connected, you will feel better. There are certain things that we know work and they are only given to us after we implode and we end up in rehab and we go to 12 step recovery, do we get to know. How do we live . We did not know before how to live. Can start to incorporate some of those best practices. You can triage. I know my kids are going to have a genetic predisposition and if you add a stressful event in their lives, we ought to be able to see where we put our resources. This is not a onesizefitsall. You can find out based on a personal interview with someone what their family background is and just like you would do in the original story about cancer, they checked my family. Everyone of my family has had cancer so i get all sorts of cancer screenings. Dont ever bothers to ask me about the history of Mental Illness and addiction in my family. Why not . Isnt it the same . Doesnt it create equal morbidity and mortality is cancer . You bet. No one is talking about it and we need to change that fundamentally so it is not just a separate, oh, just to do with Mental Health and addiction over here. It comes about how to address it. Later abouta panel Healthy Lifestyles. Ironically, a lot of people would not associate it with a Healthy Lifestyle but we will talk about how simple Lifestyle Changes and greatly reduced the risk of depression. We are running out of time but i do want to ask one of our panelists to help answer this one last question from sean on twitter. This is part of the discussion. When should we discuss the culture of pressure and unhealthy competition that drives kids to Prescription Drug abuse . I talk to kids all the time. They think drugs are cool. The fact that mtv is doing this who is going to connect with kids more powerfully than what you are doing . We have to change the conversation. Well so have a culture that glorifies also has a culture that glorifies drug use and we rarely talk about the joys of recovery. We have the schism, this idea that 80 of our kids before 18 are going to try something they are not supposed to. A prescription medication, drink, smoke pot, try harder drugs. It is like good and bad. Good kids dont use drugs, bad kids use drugs. The truth is they are our kids. Theyre not good or bad kids. They are our kids and we have to help them grow up as safely as we can. It is going to take media, programs like the jet foundation , it is going to take the research that is happening in the National Institute on drug abuse. It is a big, complicated problem but i think the fact we are sitting here together suggests that we can solve this. Says zero which means we are out of time. I want to thank each and every one of you personally for being here and sharing this passion and certainly, for all of you in the audience, if you are watching at home, streaming this and you are dealing with any of these issues, i think one of the thing we have tried to highlight is that there is help out there and also as a parent, dont be afraid to have the conversation with your kids before it is too late. Thank you all very much. [applause] cspan. We bring Public Affairs events from washington directly to you, wishing you in the room at congressional hearings, white house events, briefings, and conferences, and offering complete gaveltogavel coverage of the u. S. House all as a Public Service of private industry. We are cspan. Tvated by the cable and industry 35 years ago and funded by your local cable or satellite provider. Follow us on twitter. Next, we will take you live to the Dole Institute at the university of kansas for a conversation with historian Richard Norton smith about first ladies and the contributions to the nation. That is followed by the twohour conclusion of our series first ladies with a look at how the role has evolved and we will be looking for your comments via phone, twitter, and facebook. And were here at the institute of politics for a conversation with historian Richard Norton smith about to shart shortly start shortly. Good evening. My name is quinn reid and i am the coordinator of the Dole Institute student advisory board. Welcome to the Dole Institute of politics and thank you for attending tonights presentation