Addiction and Anxiety: What Works?

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00:06 - 00:53

Welcome to Women and Wealth. I'm Beata Kirr, co-head of investment strategies at Bernstein, and this podcast aims to educate and inspire women to make the right choices for their wealth. Well, hello, everybody. We're recording this episode in March, but with full intention of releasing it during Mental Health Awareness Month, which is in May, it is clear that the pandemic has taken a toll on our collective mental health and the news of the day, whether it is in March or May, only continues to do so. So we felt it was prudent to dedicate an episode to a professional who spends her time working with families, really helping them navigate the enormous complexities of the mental health provider system.

00:57 - 01:52

According to early CDC data, more than 87,000 Americans died from drug overdoses during the one year period ending September 21, and that exceeds the number from any year since the opioid epidemic began. We're also seeing alarm bells go off about mental health crisis amongst America's youth. I see this locally in our community as well. The U.S. Surgeon General's December 21 report noted that symptoms of anxiety have doubled during COVID, with 20% of youth now experiencing them. So today I'm honored to be joined by Arden O'Connor, who founded the O'Connor Professional Group, to help families with addiction and behavioral health concerns navigate their options. We're going to talk to her about her own journey and some best practices for families battling substance abuse and anxiety issues. Arden, thank you so much for making the time to join us today.

01:52 - 01:55

Thank you for having me. I'm really excited to be here.

01:55 - 02:28

I feel like we all know friends or family members who really have increased their alcohol intake during the pandemic, quote unquote. Zoom cocktails became a running joke at some point in time. And look, the CDC and the liquor stores actually have the receipts to back it up. I think it was in an August 2020 study from way back early in the pandemic. About 13% of adults admitted to having started or increased substance abuse to cope with the stress or emotions related to COVID 19.

02:28 - 02:55

Now, we're two years into the pandemic, not to mention the horrific experience of watching war unfold literally before our eyes in Ukraine. So lots of reasons for anxiety to continue to be high. So I want to pivot to your own experience and just in setting the stage, you really have this unique vantage point through consulting with families struggling with addiction. But it's also personal.

02:55 - 03:04

So before we dive in. Can you talk to us a little bit about how you came to found the O'Connor professional group? Absolutely.

03:04 - 04:04

And thank you again for tackling this important issue on your podcast. So I started O'Connor Professional Group almost ten years ago or actually over ten years ago now, based on a personal experience with my family member, Chris, I had a younger brother, seven years younger than me, that started drinking and using marijuana at very early ages. At 13, you're 12 or 13. And we know that at that age range, the chances of someone becoming addicted later in life are very, very high if you start using at very young ages. But he wound up getting addicted to multiple substances, including heroin, cocaine. He went through about 15 facilities. He spent some time in jail. He had 25 different physicians who were advising my family at various points about his diagnosis with conflicting advice about what his diagnosis was and which medications would be beneficial. Sometimes within the same two week span, they would have divergent diagnoses and different medication suggestions.

04:04 - 04:45

So during the period that my brother struggled with addiction very acutely, I unfortunately had a leukemia diagnosis. And I always draw the parallel because while addiction is a chronic disease, it's not really viewed that way and it's not treated that way by our medical system. So from a different standpoint, my brother was resistant to care when I got leukemia. I was very willing to do whatever the doctors told me to do. I had a very clear diagnosis and there were two treatment paths that were laid out in front of me in terms of what my long term survival rates would look like and what the trajectory of treatment would look like. In my brother's case, everybody had differing opinions. He should do outpatient. He should do inpatient. You should cut them off.

04:46 - 05:45

So the emotional dynamics for my family, trying to figure it out were much more complicated. And this wasn't the main concern for my family. We were blessed to have resources, but financially the picture was very different. My surgeries and various procedures related to leukemia cost of around $500,000 and that was paid for, I think up to maybe $1,000 of medication were off our insurance plan and paid for privately. In my brother's case, his experience cost about $500,000 as well, and all of it, if not the majority of it, was covered privately and wasn't billable to insurance. So very similar processes in terms of getting a diagnosis and families being scared, but very different trajectories in terms of how people access care and what clarity they have around how to find the right providers and how to manage their own feelings along the way and how to have better long term outcomes. And that was really the reason that I started OConnor Group is, you know, how do I make families like ours have better long term outcomes than what exists now?

05:46 - 05:59

While I'm still reeling in all of the stats you shared and in both your personal stories, I'm sorry for all that you've been through with your brother and on your own and for your family. That. That's a lot. So thank you for sharing that.

05:59 - 06:19

So before we talk about really the angle of families and engagement around these topics and both addiction and anxiety, I'm wondering if you could clarify for us. At O'Connor Professional Group, tell us what you do. How do you work with families to really navigate this maze of complexity and uncertainty?

06:19 - 07:17

So it depends on how a family comes to us. We get some families who come to us in absolute crisis. And really what we're trying to help them do is have a partner in thinking through on a more strategic versus an emotional level. What can be done in this situation. Many other families come to us earlier stages in the process. They just got a diagnosis or they've had a diagnosis present. And they're trying for they've been trying for years to get the right suite of services. And in that case, we offer sort of two ways that we can be supportive. One is to help people navigate the complex maze of providers that exist out there, both inpatient and outpatient. If you Google residential support for someone with a mental health issue, you're going to come up with thousands of results and all the websites are going to look a little similar. So figuring out which is the right choice for your family member? Similarly with the therapist, how do you make sure they're qualified? How do you make sure that they're the right match from a personality type to your loved one? So we support families in that process.

07:17 - 08:16

We also do a lot of coaching and case management in the home. One of my concerns with my brother's situation is when he came out of rehab, he sort of jumped off a cliff from very, very structured, 24 hour supervised care into a couple meetings a week with a psychiatrist. My brother showed up in those meetings as organized and put together as he could be. What we saw as family members if we dropped by his apartment on a random Saturday morning was very different than how he presented to his psychiatrist. And frankly, his needs went beyond just talking about his own feelings related to addiction he struggled with at 26, What is my life look like and long term sobriety? How do I even date? How do I have a social life? How do I get back into the job market without a college degree? A lot of very common challenges for someone with a behavioral health issue who didn't reach some of the adult milestones that their peers did and not always solvable by a once a week therapy appointment. So that's why we were created. And we have these coaches that are available internationally.

08:16 - 08:18

Very interesting. Thank you for that.

08:18 - 08:55

Well, so let's pivot to what your experience in this field has taught you in terms of the engagement and interaction with families as they're approaching these incredibly complex, difficult and deeply personal experiences. You know, let's tackle the question of addiction first. I suppose when we were preparing for this podcast, we recognized that there's too much to bite off in one episode. So it will be a very kind of 30,000 foot look at some of these lessons. But on the addiction front, in your experience, Arden, what are some of the complicating factors that you've seen with wealthy families when their loved ones are battling addiction?

08:56 - 09:38

So I think, you know, some of the dynamics we see our families with the best of intentions who do what we call protecting behaviors. You know, the term that most people have heard is enabling, and that can be rather shaming. But what we know is that families and this includes my own, they get nervous when somebody has a problem. They oftentimes are trying to either find the provider and hope that by paying a lot of money for a facility or a particular therapist or psychiatrist, that that's going to be the solution. Sometimes they're even hoping by, you know, I hate to say it, but bribing the individual, whether that's getting them their own apartment, getting them a car or promising some kind of financial incentive, that that's going to help somebody with a serious addiction issue or a serious even a mental health issue or both.

09:38 - 10:26

And what we know is that, in fact, money can offer choices in terms of treatment. It can get you best in class care, but it can't solve the problem of addiction. If anything, money can often allow somebody to have the experience of addiction get exacerbated. And what I mean by that is folks with unlimited financial resources can often pay for that person to go to multiple rehabs. They can often pay to replace an apartment. If the person gets kicked out of one place and needs to move, that person can remain isolated and isn't as required in the same way someone from a more moderate income background would be to find a sense of purpose defined sustainability. So we know that giving money directly to the person isn't the solution. We know that just picking a place because it's expensive isn't a solution.

10:27 - 11:08

We also know that, you know, wealthy families often worry about the blowback if somebody finds out about their loved one. And that can be for all sorts of reasons. It could be just because they have a name or a reputable name in their community. It could be because they're embarrassed that this happened to them when they seem to have all of the advantages that one would want. It could be that they're part of a family business. For many people, the idea that they could even be associated with some type of clinical service or need that type of services. Shaming enough that they choose not to access it and then it winds up. The family members are really trying to fix something down the road that could have been addressed when it was much less malignant and much more benign.

11:08 - 11:10

It's complicated. That would be an understatement.

11:11 - 11:28

I think every family situation, I'm sure you agree, is unique. But have you seen some common themes emerge where situations have worked, where families have looked at all that complexity and gotten it right and come out on the other side in a better place.

11:28 - 11:54

So in terms of what does work, well, we know that being honest and open about what is happening helps to reduce shame and stigma and ultimately helps a family to begin their journey to heal. And I would say that that is particularly true for families where there's a genetic predisposition. I'm sure it's not a shocker, given that my name is Arden O'Connor, that I come from an Irish Catholic background. And, you know, very early on in my life, my dad was very honest about our own familial genetic predisposition.

11:54 - 12:28

What my dad's gift of giving that information early in life meant is that when I was in college, I watched my drinking patterns. And even to this day, I think about social drinking differently than the average person because I know what my genes are. Even for families where there isn't a genetic predisposition, trying to hide this under the rug or claim that somebody is at a tennis camp for two years when they're actually in rehab usually increases the shame and stigma. So being honest and open and saying, we need to address this and we need to find you the best possible solutions and we're going to work with you to increase your health. And wellness is usually a better approach.

12:29 - 13:06

I also think on the flip side of that sort of loving engagement, there needs to be boundaries. There needs to be sort of a clear understanding from the parents or the individuals paying for services. You know, what are we going to support? What won't we support? And that's financial support, emotional support. What is our bottom line in terms of what we think is in your best interest and what we will allow? And that can be anything from we will support rehab, but we aren't going to put you back into an apartment to live independently and give you an allowance if you're not engaging in treatment. And if we have no accountability, no drug and alcohol testing in place, no verification that you've attended clinical appointments.

13:07 - 13:53

And then the last thing, which sounds like a very basic thing, is to just think through the use of financial resources. I always say for somebody with any type of behavioral health issue, paying directly to the providers that need help. So paying someone's apartment bill directly as opposed to giving them the cash to pay their landlord is always a better solution. I would also say thinking through long term estate planning ramifications, if somebody has a behavioral health issue and parents are aging thinking through, you know, who is the corporate trustee involved, how do we think about what type of monitoring we want in place just to make sure that any financial resources that are being passed on are used appropriately and ideally. How do we not engage siblings in that type of situation? Because that's a pretty emotionally complex position to be, put it.

13:53 - 14:26

Mm hmm. I'm processing. You've said so much. And I think one of the most interesting things you said is about this idea of, you know, your tennis camp example. I can think of examples in my own life where that was the case and your assertion that therefore that creates more shame for the individual, I think is really a powerful conclusion, art, and that it's better, to be honest up front and not think that you're protecting somebody by fabricating the whole situation. But it's obviously such a difficult and personal choice that really sticks with me.

14:26 - 15:10

So I guess we've covered some ground on addiction, but of course, not all of what you do and I share the stats at the outset that we've got a massive problem today in society with not just addiction, but with insight. And I'm a mother of a 11 and 14 year old, so I think the middle school years were always anxiety ridden, but now we've got anxiety ridden, quote unquote, normal middle school years with social media during a pandemic. And now we have a war that's being live through social media. So I can't imagine what combination of things could possibly be worse than that right now. So the anxiety issue is one that I know many of our listeners will be able to directly relate to.

15:11 - 15:39

So, I mean, what's the the recent data I'm sure you've seen the survey, the Kaiser Family Foundation and the US Census Bureau recently did a survey of 40% of adults are reporting experiencing symptoms of anxiety or depression at this time. And for a baseline in 2019, that number was 10%. So anyway, I'm asserting I think it's everywhere. But I guess I'll ask you, do you think it's everywhere? And are you are you seeing a big uptick in kids as well?

15:40 - 16:21

So I do believe it's everywhere. I think it's for all the reasons you've said, we've been isolated. And that takes out the many, many, many people across the world who have had jobs lost, who are living in much more uncertain times financially, who are still. The kids are in school, they're out of school, and they're trying to balance that with challenging careers. So I do think anxiety is there everywhere. I also think anxiety was one of the top mental health issues going into the pandemic. And kids mental health has been on the rise for years. I mean, there was a study in 2017 that talked about the suicide rates and the dramatic rise between ages of ten and 14. So I think the unfortunate answer is yes. We're seeing an uptick in kids level of anxiety.

16:21 - 17:13

Now, some of that is probably perceiving parental anxiety, which does have an impact on kids. To your point there, absolutely. You know, there are more social media outlets. There's more uncertainty with if you you do all the things your parents did, are you going to be able to afford the same lifestyle or is it going to be markedly worse from a financial perspective, given the level of competition that exists in this world? I think there's all sorts of reasons why I think we're we are seeing upticks that we hadn't seen before in age range or those younger kids. We already knew that the teenage years are a time of identity shifting and it's a time for substance use, experimentation, anxiety, depression. But at the younger years it was less common. And I think the other challenge has been accessing services. We just have a dearth of therapies overall. And so especially if you're a family trying to only use insurance benefits, you know, it's a long wait list and you're trying to navigate something that's very scary at home.

17:14 - 17:41

This topic clearly merits hours of discussion. The more the more you comment on, the more it opens up a line of questioning that will go far beyond our scope in our so-called survey course on the on the high level of addiction and anxiety takeaways through your practice. So let's think about some useful advice for our listeners in the realm of anxiety and maybe take it step by step. What should parents be on the lookout for?

17:42 - 18:25

Well, in some circumstances, children are very vocal that they need help. And I would say take that seriously. I think not having any judgment or shame if somebody steps forward and says, guys are really struggling and that does happen. But not all kids are that open. But some some children will self-identify. I feel like I'm really sad. I think overall, parents should be looking for changes in mood like dramatic changes, not a daily change, because you didn't get ice cream after school, but for days on end, somebody seems to be less joyful than they were before if their friend, group or their interests suddenly change. You know, they used to be really into playing a certain instrument. And now it's not that they want to switch from guitar to drums, but they really are lacklustre about doing anything that brought them joy before. But for later.

18:25 - 19:09

Adolescence, if you see dramatic changes in their appearance, changes in their hygiene, certainly sleeping, you know, not sleeping enough or sleeping way too much or signs changes in appetite. Somebody has become very restrictive about their eating or not interested in eating at all. Or on the other extreme eating what seems to be, you know, copious amounts of food at odd hours of the day. Sometimes you have to see a couple of these symptoms in conjunction with one another. But I think those are some of the signs that we look at and tell parents and and certainly the duration for how long these symptoms have been going on is important to consider. If it's over a two, three, four week span and you're seeing the same changes and there's not you don't seem to see that person coming out of the, you know, the light at the end of the tunnel.

19:09 - 19:30

I think it's time to think about doing a consult. You know, lots of kids are going to absorb the opinions of their peers or of their parents or of others of seeing a therapist. You know, we I've heard even from friends who are, you know, my peers from Harvard Business School. If I've ever suggested to see a therapist, you know, the quick answer is I'm not crazy. And so sometimes kids picked up on that bias if they hear that.

19:30 - 20:23

But I think sometimes saying, hey, look, you know, we want to make sure you're as healthy as possible. Can you go in and talk to this person and we'll see where we go from there. So maybe not assuming you're going to need long term help unless it is a very acute situation. I think sometimes allowing particularly older children or something like, you know, 13, 14, 15 year olds, particularly mature ones, if they're very resistant to getting help, maybe saying to them, look, the answer can't be you're not going to see anybody, but I'm happy to have you involved in the process. Maybe you can interview a few people, maybe we can go together. But I think trying to make it as normalised as possible, I think to the extent parents can share stories either of themselves or of people that the children know who access to treatment and why it was helpful. I would also say just making sure that, you know, the therapist is matched in an appropriate manner. They have.

20:23 - 21:02

They're just going to ask about that. I was going to ask maybe if I could stop you for a minute. Again, I want to summarise all that you've said in the first question, right? There was a lot there in terms of keeping an eye out for multiple symptoms and the duration of a period of time and change in sleep and eating, even hygiene I thought was interesting. So then what? And then your your point is, wait a second. The field is still really complex. Based on what you said earlier, even on addiction, the same thing applies here, right? There's psychiatrists. There's therapists. There's different types of. RB How does anyone figure this out? You know what? What kind of baseline advice do you have on what's a first step?

21:03 - 21:44

So I think for many families it's figuring out if you have clarity on the diagnosis and that is really tricky. Before the age of 18, the brain isn't fully developed and people don't necessarily want to slap on a clinical diagnosis for fear that it follows the individual. I think if a family has a sense that she seems anxious or she seems like she's experiencing some depression, find a reputable therapist. You can do that in a number of ways. Ask your PCP for suggestions. You can look at there's websites like Zen Care that give you a vetted directory list of therapists, but find someone who's a specialist with young people. And that's the first question I would ask. And I often will say to our clients, Let's go in for a consultation.

21:44 - 22:32

It may be important to go to a psychiatrist and do a consulting around medication. I think there is a big fear about medication, and I think it's rightful for parents to be concerned. We are a medication culture. That said, it can be used absolutely appropriately and really help with the reduction in symptoms for adolescents and children. I think that's for cases where it's not, you know, all hands on deck. This is a complete crisis. It's still important to have a therapist in a crisis. But there are times where a family saying, I need to bring this person to the psych E.R., I need to bring them to a hospital setting. And that may be contacting your physician, contacting a group like ours, contacting a psychiatrist directly who could help you with the admission into a facility. So I don't mean to sound vague, but the question of where to start largely depends on what's the picture that.

22:33 - 23:08

The level of crisis. And then I think another important takeaway I don't I don't know that you've said this yet, but there's not an overnight fix. This isn't like, oh, you have a sinus infection, here's an antibiotic and it's complicated. You could be going to many providers. You could be trying many medications. One type of therapy may not be successful. Do you feel like in most cases, let's say they're not crisis cases, but cases of anxiety or depression diagnoses? It's really a multi-year engagement, if you will. Or do you have a different take on that?

23:08 - 24:00

No, I think it absolutely is. And I think that's part of the challenge. You know, unlike a medical diagnosis, where if you get, for instance, diabetes, people know they are signing up for long term care. And there's going to be a protocol and a plan and they're going to have to monitor this for the rest of their lives. I mean, my brother went through a number of facilities and some of it was his own personal emotional readiness. So I think that this is in many ways the most frustrating part for families is they feel like they're investing lots of time, lots of emotional and financial capital into what feels like a black hole of a lack of solutions. And that really is for many families. And frankly, it's why it's tricky unless you have a fair amount of resources because you you wind up trying a bunch of things that may not work. And it may be because you chose the wrong provider. It also could be.

24:00 - 24:10

The wrong process or match. Well, this is not an uplifting way to end our episode. That said, it's a multi-year process and lots of complexity.

24:10 - 24:24

Before I close out with my final question around investing with intention, can you leave us with some hope, perhaps around, you know, some direction for families facing this really challenging environment? Absolutely.

24:24 - 25:18

So my new hope is going to be an area that I never thought I would feel hopeful about. And it's in sort of the upcoming generation of millennials. I feel like in the workplace environment, all we hear is sort of slight eye rolls when it comes to millennials and what they want and what they don't want in terms of balance at work. But I have to say, I think this new generation of folks, they're much more open about accessing therapy. They're asking for it when they're going to employers. What are your mental health benefits? They're much more concerned about that in general of what we're seeing in data than they are about whether there's a ping pong table in the downstairs lobby. So I think just that in of itself, if attitudinally, we can change as a society. So it's not an embarrassment that a family has to hide behind a corner and say, we're here, we're going to see a therapist. If it becomes more like a cancer diagnosis where people are like, Oh, you're struggling, I'm bringing you some soup. As opposed to I'm not going to admit this to anybody and I'm going to try and hide it. I think that's progress.

25:18 - 25:53

I also think we're seeing with that same generation, we're seeing younger people, you know, start to look at alcohol consumption differently. We have very clear data on what's normal, how much is good, how much is not good. And if you look at the outpouring of different companies that have started nonalcoholic but feels like alcohol drinks, there's like, you know, all these different ones that are coming out with beverages you can enjoy in a glass that are much less that are not just about having a cocktail. And it's not I'm by no means the alcohol police. I'm a social drinker myself. But I think bottom line, it's pointing to we may be developing other ways to cope with our emotions that are that are healthier.

25:53 - 26:32

I like it. I like the. Hope that you've left us with and I'm picturing Simone Biles having just seen the recent commercials that she's affiliated with, with the tagline Pause is power. The pause is power. And I think that was really well done by them, really highlighting her and clearly her honesty and pause from incredibly competitive pressure she was under. So I like that. Thank you, Arden, for leaving us with some hope. Well, let me ask you the last question that I always ask all of our listeners, which is this question around investing with intention. Can you tell us what you make of that phrase? What does that mean to you?

26:32 - 27:00

The great question, you know, for me, honestly, investing with intention means finding causes and people that you believe in. And I'm probably a bigger proponent of the latter. I was blessed enough in starting my company to have a woman who was my mentor for years, invested in the nonprofit I created and then is an investor in my current business. I feel like if there were a legacy to leave, I think it's finding people that you can support and passing on. For me, at least, the gifts I was given.

27:00 - 27:26

Mm hmm. Well, thank you so much for that. Obviously, we're releasing this episode on Mental Health Awareness Month, so it's a good time to be talking about it, but it's always a good time. I think based on the stats around us and the reality that you've laid out, and I think it's important to recognize the thoughtfulness and care and time that it takes to address these issues. So I really appreciate your perspective. MARTIN And laying out the truths for us.

27:26 - 27:30

Thank you for having me. Really appreciate the time and enjoyed the conversation.

27:31 - 27:46

If you enjoyed the podcast and haven't subscribed to our show, please go to Apple Podcasts, Google Play, Spotify or wherever you listen to subscribe and write us. You can also find us on Twitter at Bernstein or find me Beata Kirr on LinkedIn.