Dr. Sarah Wakeman

So I'm a medicine doctor by training. So I still do some general medicine like in the hospital, take care of pneumonia and heart failure and in the outpatient setting, take care of people's diabetes and depression. But I train especially in addiction medicine. So I'm board certified in addiction medicine. And that's been kind of my life's work.

So I'm a medicine doctor by training. So I still do some general medicine like in the hospital, take care of pneumonia and heart failure and in the outpatient setting, take care of people's diabetes and depression. But I train especially in addiction medicine. So I'm board certified in addiction medicine. And that's been kind of my life's work.

I work in a big academic medical center in Boston, Massachusetts, where I would say my kind of focus professionally has been thinking about how do we bring addiction care back into the medical system so that it's not this separate and unequal and often very poorly done sort of siloed system, but actually just a part of the health care that people get. And then I train people.

I work in a big academic medical center in Boston, Massachusetts, where I would say my kind of focus professionally has been thinking about how do we bring addiction care back into the medical system so that it's not this separate and unequal and often very poorly done sort of siloed system, but actually just a part of the health care that people get. And then I train people.

So I'm program director of our fellowship program. So I train doctors who want to be specialists in addiction medicine.

So I'm program director of our fellowship program. So I train doctors who want to be specialists in addiction medicine.

Oh, how much time do we have? Where do we begin? I mean, I think at its core, the biggest problem is that we've all been taught and sort of infused in this idea that addiction is an issue of behaving badly, that it's an issue of morality, that people really need to kind of knock it off and pull themselves up by their bootstraps.

Oh, how much time do we have? Where do we begin? I mean, I think at its core, the biggest problem is that we've all been taught and sort of infused in this idea that addiction is an issue of behaving badly, that it's an issue of morality, that people really need to kind of knock it off and pull themselves up by their bootstraps.

And that this is like a criminal legal issue, that it's an issue of willpower. And so if you believe those things, then why would you think that someone should get medical care? Or why would you treat them with compassion and kindness if you think that they're doing something wrong?

And that this is like a criminal legal issue, that it's an issue of willpower. And so if you believe those things, then why would you think that someone should get medical care? Or why would you treat them with compassion and kindness if you think that they're doing something wrong?

And so really reframing how we think about addiction based on all of the science we have and what effective treatment looks like, which often is very different than what people may have experienced if they were trying to access care for themselves or a loved one.

And so really reframing how we think about addiction based on all of the science we have and what effective treatment looks like, which often is very different than what people may have experienced if they were trying to access care for themselves or a loved one.

Yeah, it's a great question because we use that term colloquially a lot. You know, I'm addicted to Netflix or whatever. So addiction is really defined by use despite consequences. So continuing to do something in your life despite bad things happening to you because of it. So we talk of addiction, we talk of the four C's as a way to remember it.

Yeah, it's a great question because we use that term colloquially a lot. You know, I'm addicted to Netflix or whatever. So addiction is really defined by use despite consequences. So continuing to do something in your life despite bad things happening to you because of it. So we talk of addiction, we talk of the four C's as a way to remember it.

So one C is loss of control, meaning like you've tried to change and you haven't been able to. So you've tried to cut back or you've tried to stop and you couldn't. The other is compulsive use. So your use is like spiraling out of control that you're kind of using in a way that isn't really attached to your rational thinking. The next is consequence.

So one C is loss of control, meaning like you've tried to change and you haven't been able to. So you've tried to cut back or you've tried to stop and you couldn't. The other is compulsive use. So your use is like spiraling out of control that you're kind of using in a way that isn't really attached to your rational thinking. The next is consequence.

So continued use despite negative consequences either in your life, your job, your relationships, your health. And then the last C is craving, which is this sort of strong psychological urge to want to use. Like you can't get the idea of having a drink out of your mind. And so it's really those four Cs that we think about.

So continued use despite negative consequences either in your life, your job, your relationships, your health. And then the last C is craving, which is this sort of strong psychological urge to want to use. Like you can't get the idea of having a drink out of your mind. And so it's really those four Cs that we think about.

And then we make the definition based on how many criteria people meet out of this 11 list of different criteria. And then based on that, people can have a mild use disorder, moderate or severe. And so moderate severe is really what we think of as addiction. But it's that use despite bad things happening to you.

And then we make the definition based on how many criteria people meet out of this 11 list of different criteria. And then based on that, people can have a mild use disorder, moderate or severe. And so moderate severe is really what we think of as addiction. But it's that use despite bad things happening to you.