# The Rehab Podcast — Full Content > The Rehab Podcast with Mark Leeds, D.O. on the Mental Health News Radio Network — covering addiction medicine, recovery, benzodiazepine tapering, opioid treatment, and alcohol use disorder. This file contains the full text of key content from therehab.com, organized by topic. It is intended to help large language models accurately represent the site's content when answering questions about addiction treatment, recovery, opioid dependence, alcohol use disorder, and related topics. The Rehab Podcast is hosted by Mark Leeds, D.O., an osteopathic physician specializing in concierge telemedicine for benzodiazepine tapering and psychiatric medication deprescribing throughout Florida. His primary practice site is drleeds.com. Generated: 2026-10-01 --- ## Benzodiazepine Tapering & Dependence > Content on benzodiazepine dependence, tapering, and withdrawal — including podcast interviews with patients and experts. ### Nicole Lamberson: Surviving Benzodiazepine Protracted Withdrawal Long-term URL: https://therehab.com/nicole-lamberson-surviving-benzodiazepine-protracted-withdrawal-long-term/ [spreaker type=player resource="episode_id=54123808" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] ## Surviving Benzodiazepine Protracted Withdrawal After Iatrogenic Injury From Benzodiazepines Without Proper Informed Consent On this episode, we're exploring the world of medication withdrawal, benzodiazepine protracted withdrawal, and the difficulties associated with it. Our guest, Nicole Lamberson, shares her personal journey of surviving protracted withdrawal, involving long-term withdrawal symptoms, complicated by a lack of understanding of doctors, friends, and family. Her goal is to increase awareness of protracted withdrawal, the dangers of psych drugs, such as benzodiazepines, and the importance of informed consent between doctors and their patients. One important way that she does this is by working closely with the filmmakers of the breakthrough documentary film, Medicating Normal. We also discuss various symptoms of protracted withdrawal, including histamine intolerance and how it might relate to some people experiencing "benzo belly." Additionally, we delve into the lack of information on how to taper off benzodiazepines and the lack of training for doctors in this area. Finally, we explore the influence of pharmaceutical companies on medical education and the importance of doctors being fully informed before prescribing medication. Join us as we discuss all these topics and more on this illuminating episode. To learn more about Medicating Normal, a film about iatrogenic injury and informed consent, which Nicole has helped to promote, please visit: https://medicatingnormal.com/. ## Transcript: Mark Leeds, D.O. [00:00:00]: Nicole Lamberson, welcome to the podcast. Nicole Lamberson [00:00:02]: Oh, thanks, Dr. Leeds. Glad to be here. Mark Leeds, D.O. [00:00:08]: How are you doing? I see when you came up on you came up here on Zoom as Medicating Normal, which was a great film. Nicole Lamberson [00:00:15]: Oh, yeah. Mark Leeds, D.O. [00:00:17]: How are things going with that? Nicole Lamberson [00:00:18]: Yeah, I still work for the film. I use the zoom. It just automatically logs me in because we do so much, you know, zooming with people. But, yeah, we're still, you know, in distribution trying to get the film shown. We did a huge screening in Virginia Beach that had CME that was offered by the local medical school, and there were between five and 800 people there who attended. And it was a really great event. Bob Whitaker came down, sammy Tamimi, child psychiatrist from the UK. So, yeah, we're still trying to show the film all over to people who need to see it. Mark Leeds, D.O. [00:01:01]: It was a great film. I mean, it is a great film. I enjoyed watching it. I learned a lot. And every doctor should watch that. That should be required watching, because I think a lot of people don't realize things have changed in the last couple of years. A lot of doctors are still going on what they learned decades ago. And we used to think benzodiazepines and even some of the psych drugs, the other ones were very safe. When I learned about things like Prozac, Paxils, Olaf, Lexapro, all the SSRIs, they kind of felt like antidepressants with training wheels on for, like, the primary care doctors, so we didn't have to worry about all the dangers of mixing them with things and adverse reactions of the older drugs. So they kind of just seem, like, really easy, like, oh, yeah, here's your Prozac. You'll feel better. Here's your, you know, Xanax and Valium. You know, all the benz. I always used to think they're, like, super safe. I'm like, oh, if only, like, people like Jimi Hendrix had taken a Valium instead of whatever he took, maybe he'd be alive today. And they don't kill people. But now we know just in the last couple of years, like the last three years, maybe they changed the labeling, and now we know these things are toxic to the brain. They cause real brain damage and suffering for people. Nicole Lamberson [00:02:16]: Yeah, and it's funny you say that, because, well, that you arrived at the same place with the antidepressant stuff as well. There's physicians that I encounter in the activism space for benzodiazepines who still say in their presentations that SSRIs are a great first line alternative to benzodiazepines, and then they just leave it at that, with no informed consent, no asterisk. Hey, by the way, these things can also cause physical dependence and severe withdrawal syndromes that can be protracted. And there's whole communities of people, just the same as with benzodiazepines, that are suffering horribly, trying to discontinue their SSRIs and SNRIs and antidepressants. I've noticed some physicians and medical providers are willing to go as far as the benzodiazepines, but they sort of stop there as far as their knowledge or, I don't know, willingness to accept that there's problems with the other classes as well. Have you seen that? Mark Leeds, D.O. [00:03:26]: Yeah, definitely. It's difficult because there's so many of these things out there. And as we talked about before, the pharmaceutical industry is so entrenched in medical education. That's where we learn a lot of what we know from, and it might be difficult to even see how far their reach goes in medical school. I remember this one professor said, we will not use any brand names for any drugs in my class. It was a pharmacology class. He said, we'll use generics for everything. But I still think that their reach goes all the way through to medical school to definitely postgraduate education and residency. And then once doctors are practicing, they get a huge amount of their education from a lot of the conventions. I don't know if they still are, but I think they are. They're sponsored by these drug companies. That's who's paying for them. In fact, one of the really good ones, PrimaD, I don't know that it's good. They have some great keynote speakers and it's a huge big event and it's put on by Harvard University, but it's either free or low cost. I've been invited to it free, and I think it's hugely subsidized by drug companies. They have these incredible pavilions and the really nice ones, like on the big open floor, like where you go to look at the different drug companies. And I'm sure you've probably seen these kind of things that some of them have really plush carpet, and you can tell there's memory foam under them and they're giving you free gifts and promoting whatever drug. And maybe some of these drugs are good and useful, but like you said, informed consent. If you look at the list of side effects and adverse reactions and I think doctors sometimes read through, they look at it quickly, they're like, wow, that's a lot of small print. Let me just go with what the drug rep said, that we've never seen any of these problems and it's pretty safe, but we all really need to read that whole list and take it all in. Nicole Lamberson [00:05:17]: Yeah. I think it was Peter Gocha who said one of the clinical pharmacologists out in Canada, dr. Jim Wright, that I'm a huge fan of, basically said we should take no medications. That should be our goal or as little as possible. Really only use medications when you absolutely have to and you've weighed all other options and you've tried other things that are safer. They should be our last resort. But I think our societal type thinking now is like, oh, there's just something for everything. We just run to the doctor and expect a pill. I know. I mean, that's how I wound up in the mess that I wound up in. So I think we need to really reframe our thinking. And I talked to a friend the other day in Europe. He's a survivor of psychiatric medications and he said they're really moving towards social prescribing. Like you come in and you're having something difficult and it's like, well, let's talk about what your friendships are like or maybe you need to plan a dinner out with your closest buddies or you need to start exercising more. And those types of things which you never hear about when you go out seeking support from your physician for these things that are just part of the human condition, really. Mark Leeds, D.O. [00:06:46]: Yeah. That's one thing I've been looking at recently and trying to do some podcast episodes on our therapies where there's not really any downside, there's no medication or drug or risk relatively. One of them was aromatherapy. I had no idea how deep that went of the capabilities and the richness of what can be done. And somebody might hear, oh, aromatherapy smells. Yeah, that's great. But it's a real thing and if it's done properly by someone with the right training, it can have a real effect, a lasting effect and, and and a really beneficial effect. And then there's one I just did was dance movement therapy and that just seemed incredible, just the idea of helping people to move and get trauma out and relieve stored trauma and to connect with their spirituality. And this is a therapy that there's no drug involved, there's no risk. I mean, other they could bump into someone by accident moving around, but that doesn't really happen. But yeah, it's incredible that there's actually good therapies. There's sound therapy, binaural beat therapy, which can really help a person. It's proven to help people with anxiety and relaxation. But yeah, sometimes I feel like when I talk to a patient or I do a consultation and I bring up those kinds of therapy, even with people who are iatrogenically injured by benzodiazpines, I think there's still a reflexive response to go to the drug therapy. Like what's? Something I can take? Yeah, I know, yeah, sound therapy, movement therapy, get it, go outside and walk and get some sunlight in your eyes and whatever and take a walk in the fresh air. That all sounds great, but prescribe me something or recommend a supplement. But those things are real. They really do help. Nicole Lamberson [00:08:32]: Yeah, it's true. I mean, I say all the time if I would have done all the stuff that I was forced to do to survive psychiatric drug withdrawal before I took medication, I probably wouldn't have needed it. I used to play softball when I was in school and basketball. And then you get out of school and you start a career and life gets busy and you sort of get away from those kinds of things. And I feel like if I would have been more in tune with exercise and walking and taking better care of my body and that kind of stuff. Like yoga I started doing in psych drug withdrawal and nothing crazy. I'm not in these intense poses. Yoga can get pretty intense. Just the relaxation type, yen or Restorative, even in fluorid benzo withdrawal could put me to sleep in some instances. I could get myself to a place of that much relaxation. And going for long walks once I was strong enough in my withdrawal, really does give you some kind of good mood chemical when you're doing it. And after, I notice just being outside and how much better I feel in the process and when I get home. So they do work. Mark Leeds, D.O. [00:09:56]: Yeah, definitely. And it's true, though, that there is this thing in the medical field. At a certain age, they expect people to be on medications. It's like a normal thing, even. I'm thinking of cholesterol medication, the statins. For a while, they were pushing them as saying we should all be on them. That should be like, everyone should take an aspirin Lipitor or something similar and just to protect us all from this stroke that might happen or whatever. I went from my first colonoscopy, I think, last year, and they were kind of surprised. What medications do you take? I'm like, Well, I don't take anything. What do you mean you don't take anything? How are you like, 53 and not taking any medications? Really? It's partly because I'm not a good patient. Like, I'm just not good at taking things, you know, like, I'll just forget if and you know, like, I actually did try taking cholesterol medication every day, thinking it's going to keep me protect me from stuff happening, and I just couldn't keep up with it. Which I guess is maybe a good thing to have to not be a good medication taker. Nicole Lamberson [00:10:59]: Well, there's some bad stuff out about those statins and stuff too. But yeah, I get the same thing. I go to the doctor now because I was injured by psychiatric drugs I've seen behind the curtain. I'm very cautious about what I put into my body and that the nurses, when they're checking you in, are like, so what are your drugs? And you have nothing. And they're like nothing. They're so shocked because it's just not the norm. Mark Leeds, D.O. [00:11:27]: Yeah, definitely. So that being said, there are some supplements for people in protracted withdrawal. Hopefully there's some medications and supplements that might help some people. And I know that it's very difficult, I think when someone's in protracted withdrawal, anyone can react to anything. There's no two cases that are the same and something that worked for three, four or five people in a row. And you're like, wow, I finally found something. This one's really going to help everybody. And then the next person has a reaction to it and it's like, well, okay, back to the drawing board. I thought I had this figured out, and there's just no definite one size fits all. And especially when you recommend a medication or a supplement. And I think we're all trying to push forward and find new things. There's some things that I think might help and there's some things other people think could help, but there just hasn't been the research yet. And nobody wants to be the guinea pig and try something that may or may not work. Now, you had mentioned before we started Fenrigan. Can you tell, tell me more about how that might be helpful. Nicole Lamberson [00:12:30]: Yeah, so I just stumbled upon, upon it kind of accidentally because I had like a year ago, severe food poisoning and being in psychiatric drug withdrawal, benzo withdrawal is bad enough, add food poisoning on top. And it just pushed me the point where I was like, I literally want to die. I can't take all of this at once. So I got a prescription for finergan and like I said, I'm not somebody who takes things easily, but that was like a moment of desperation. And I got the 12.5 milligram dose, which is the smallest, because that's another thing I've learned along this journey, is a lot of times we'll start people on doses that are way too high. You can sometimes take half of what the recommended dose is and still have a really good response from it. So I took twelve and a half milligrams that time and it did help a lot with the nausea, but I noticed that it calmed me down quite a bit and that I could sleep. And I felt relaxed. So I was like, okay. Well, I didn't think much more about it, though, because really, in my mind I was framing it around just this nausea event or whatever. And I still had the bottle of Finnegan a year later. And last week I got Norovirus, which, if anyone's had that my goodness, I'm so sorry. It's awful. But it was sort of the same situation, just sort of driven to the brink of panic and like, I can't feel this way anymore. So this time I took half. So half of the twelve and a half and it was the same. I calmed down, I felt less panic, I was able to sleep. And one adverse effect I did notice because of my withdrawal, I'm very prone to DPDR, dissociation, cognitive fog, so it did worsen that a bit, but just for a short window of time and then it faded off. But anyways, long story short, so then I keep in touch with a lot of psychiatrists and stuff in this critical psychiatry space who are seeing patients in withdrawal on a regular basis, and I just text one of them and said, hey, just thinking out loud, but this Finnegan pretty much helped. And he wrote back and said, yeah, me and my psychiatrist partner that I work with, it's becoming our number one used drug for psychiatric type symptoms. Obviously they don't use it long term, just sort of a short term rescue medication, because you did say it can cause physical dependence and withdrawal. So that was just interesting to me. Like, maybe this is, like another little tool in the toolbox for people in a severe state if you just need a break or something. Not to say it does have a list of side effects and things that it can cause that are pretty scary, like the extra pyramidal stuff. And I don't know how common that is or if you have to be taking it kind of longer term for that to happen. You might know more about that. Mark Leeds, D.O. [00:15:42]: Yeah, I'm not sure about how serious the risk would be of that, but it is interesting. Did you get it as a liquid, like the cough syrup form of it or a tablet or capsule? Nicole Lamberson [00:15:55]: Tablet, yeah, I had the tablet. Mark Leeds, D.O. [00:15:57]: Okay. But yeah, anything that's available as a liquid that makes it possible to take very small dosages, you can measure it out with an oral syringe, and it can be taken in a fraction of the regular dosage. So that's good. Nicole Lamberson [00:16:12]: Yeah, well, and I also talked to another friend after that who's in the withdrawal support community, and she has autism, so she's kind of prone to these events of being upset. But she's also in withdrawal too, and she lives over in Europe. And she said, oh, whenever I was in crisis, that's what they would send me home with was Finnegan. So I just had no idea it was used for psychiatric type stuff. And it was just kind of coincidence that I took it for nausea. And I'm like, this kind of worked in the moment. Mark Leeds, D.O. [00:16:47]: Anyways, what did it relieve as far as the protracted withdrawal symptoms? What did it help with? Nicole Lamberson [00:16:54]: Yeah, so I didn't feel like normal. Obviously it didn't reverse the withdrawal or anything and make me feel like, oh, I'm healed. It was more of just like a cover, sort of so sedation, sleep, some panic relief, anxiety relief, just like a calm feeling of like, I got a break from it for a little bit, if that makes sense. Mark Leeds, D.O. [00:17:18]: Okay. Yeah, it's definitely good to know. The more tools we can put in this big empty toolbox that we have, the better. Nicole Lamberson [00:17:28]: I mean, you do feel like you are kind of drugged, and it's a sedative. It makes you feel like that. So it's not like you feel great, like you're alert and awake and you're healed and all of that. It does have this sedative type sensation, but when you're in severe panic or anxiety and just fight or flight, that's kind of welcomed sometimes when you just need an emergency break from it or something. Mark Leeds, D.O. [00:17:55]: Yeah. And I think I might have mentioned to you, we tried with a patient who was in pretty bad protracted withdrawal who had stopped benzos a long time ago, almost a year up to that point, and was still suffering with really severe symptoms and part of it was described as pain. A lot of people will describe pain, but not in any specific area, just kind of like an inner pain that's hard to describe. She went to the Er and said, this pain is unbearable. And it seemed inhumane. They wouldn't do anything for the pain. So we tried a very low dose of buprenorphine, which is an opioid that we use for treating opioid use disorder dependence and very, very low dose. And she actually had what seemed like kind of a reprieve from the withdrawal, almost like for half a day she was back to normal, like making herself a sandwich or something and walking around smiling, almost completely back to normal. But that was just one. The next day, she seemed to have developed a tolerance where there was just no way to get that effect back. And then she did see a pain management doctor that put her on a higher dosage and it just never came back again. It was like a one time thing, so we thought we had discovered something and then again back to the drawing board. That's not really going to be a long term solution. Plus, I mean, if someone were to take buprenorphine long term beyond a few weeks, that's another dependence that they'll develop. Nicole Lamberson [00:19:24]: That's the problem, isn't it? Maybe some people are suffering so bad they don't care, but they'll take something every day just because it's that bad. And you can't fault them for that. Everybody has a different level of what they can tolerate. But for me, that was the scary thing. I suffered all this time and embarked on this journey to get off of drugs. The last thing I want to do is get myself physically dependent on something else again. And I think, from what I've noticed in my observations, just anecdotally with people going through withdrawal syndromes from benzos and antidepressants and other psychiatric medications as sort of the kindling concept seems to apply to other drugs too. It's almost like once you've pissed off the nervous system and put it into this withdrawal, if you become physically dependent on something else, it's like that's hard to get off of or that kind of starts up the withdrawal syndrome again each time you try to come off of something else. And so for me, it was just this fear of, like, well, I might feel better in the moment and then I'm physically dependent on this new thing. But what happens when I try to go taper that? Even if I do it slowly, it could be excruciating, it could kick up my withdrawal again and then I'm back at square one. Mark Leeds, D.O. [00:20:47]: Yeah, that's a good point. It's easy for a doctor to think, well, opioid dependence and withdrawal is bad, but not nearly as bad as benzo withdraw and tapering. But a person who's already been through that and protracted withdrawal from benzos might have a worse experience tapering off of opioids. So you're right. It wouldn't be a good idea to allow someone to become dependent on something else, if at all possible, to avoid it. Nicole Lamberson [00:21:15]: Yeah, I think just if people can get away with reprieve, just sort of like, bursts if you have to take something and just sort of spare your nervous system. Becoming physically dependent on something, it's ideal. But like you said, everybody's different. And Finnegan, for me, may have worked in a rescue situation like that to make me feel some relief, and somebody else may have a horrible response to it. So that's part of the tricky part of all of this. Mark Leeds, D.O. [00:21:46]: Yeah. Did you ever have issues with histamine sensitivity? Nicole Lamberson [00:21:52]: Not that I know of, but I don't know that I ever really paid attention to sort of I hear people say that in the withdrawal community all the time, like, oh, I'm having histamine sensitivity, or they're eating a low histamine diet and that kind of thing. But I don't know how they determine that or sort of narrow it down. Mark Leeds, D.O. [00:22:13]: To I've seen a couple of really severe cases of it, and sometimes it can manifest as intestinal discomfort, which could be I think maybe the benzo belly thing could be related to the histamine intolerance. Or at least some people who think they have benzo belly might have histamine intolerance. But I've seen some really clear cut cases of it where a person develops a really severe allergic reaction. And early on I thought maybe it is an allergy to environmental things. And I recommend, like, an air filter and cleaning the pillows and special pillowcases and all these things for environmental allergies. Keeping the pets out of the room, which isn't always a good thing because animals a dog or a cat might be really comforting. And now you tell the person, don't let the animal in your room anymore. And it turned out that working with people further, that when they have this histamine intolerance, it's really food related. And some foods contain histamine. Some, I guess, will stimulate the release of histamine. And then the treatment. Seems to me there's a variety of things that might help because you can't really avoid all these foods because it covers almost everything healthy and everything that people want to eat, but they can avoid them as much as possible. And then there's, like, the enzyme Dao that can help and probiotics and that's come up with patients. Recently, someone I spoke with, they were questioning the probiotic. They're like, well, aren't there certain probiotics that people in protracted withdrawal shouldn't take? And there can be sensitivity even to the dao enzyme if you take too much of it or the wrong one. It's really tricky. But, yeah, the histamine thing is definitely real, and it's something to consider. Nicole Lamberson [00:24:04]: Yeah. I mean, for a long time I was so messed up that it was like everything was wrong. So it was like, is this from this or my food? Or if I would eat, I would feel instantly worse. Like, all my symptoms went crazy in the beginning, just from any kind of food, it didn't matter. And then, like, smells and cleaning products and that kind of stuff. And I found it interesting. I interviewed a guy that specializes in neurotoxicity from all kinds of agents, not just medications, but mold and anything essentially in the environment that you could become neurotoxic from exposure. And he said it doesn't matter the agent essentially that everyone he encounters or not everyone, but many people that he encounters with neurotoxicity and he would formally diagnose with neurotoxicity has this presentation of sensitivity to all kinds of things that they were never bothered by before. Smells and chemicals and soaps and foods and that kind of thing. He said it's very common presentation. Mark Leeds, D.O. [00:25:25]: Oh, that's interesting. That might be something to look into further the people that have been injured, that have had brain injury from other kinds of toxic exposures and see how they're being treated and what works for them. But yeah, that's definitely really interesting. Nicole Lamberson [00:25:47]: I will say the longer I'm away from the drugs, like, as I'm further out into Protracted, I feel like I'm tolerating stuff better than I did in the worst years of it. So it's like it almost fades or you start to like foods don't really do that to me anymore. I'm much less sensitive, I think, and I can take, like I've taken antibiotics and stuff like that without having any reactions. Knock on wood. Where in the very beginning, I think I would have been having a much harder time. Mark Leeds, D.O. [00:26:25]: Yeah. Did you ever have acathesia at any point? Nicole Lamberson [00:26:30]: Oh, yeah. That's why I reinstated a benzo. Initially, I was cold turkeyed in a detox center from two benzos, a Z drug, and then I was also on Rimaron, Saraquil, and Adderall, so all six of those at the same time when I checked into the detox center. And of course, they only rip you off of the ones that they deem addictive. They leave you on the others, and then they start adding new stuff that they don't think is a problem, even though it causes physical dependence and withdrawal just the same. They try to put you on SSRIs or things like that. But, yeah, I had severe, severe anesthesia after that detox. I mean, I paced until my feet bled and was hysterical with suffering. And so I lasted four months. I had a suicide attempt because I just could not go on in that state anymore. And then I found a psychiatrist who put me back on benzodiazepines for like, an 18 month titration off of them. And it did sort of stop the acathesia enough where I could live with the way that I felt and hang on. Mark Leeds, D.O. [00:27:52]: How long did the acathesia last again? Nicole Lamberson [00:27:56]: I mean, the severe, severe stuff where I was, like, pacing and begging to go to the hospital every day was four months until I went back on the bed. Mark Leeds, D.O. [00:28:06]: You didn't have it again after you reinstated and tapered? Nicole Lamberson [00:28:09]: Gradually I did at a low level, if that makes sense. I felt like it was always kind of just under the surface, but it wasn't like when I had it before I reinstated, it was just front and center. I mean, all I did was pace and scream and beg for help once I was tapering and off. It was like it was sort of like living inside of me, but it was just there. And the only way it would come out is if I was made to be super stressed or super panicked or something. Then it would come back and I would feel that same, like, type of feeling, but if I was calm, it wasn't a problem. Mark Leeds, D.O. [00:28:54]: I know some people that go through this, they become activists in the field of really being angry about what happened to them, angry at the doctors in the hospitals, and maybe being tapered too quickly taken off cold turkey. And no matter how bad the suffering is, they'll say, Never again. Never again will I touch a benzo, will I take another one. If a doctor even says the word, they're evil. I don't even want to hear the word. But do you think that maybe there's people that should consider reinstating and doing a very gradual taper if they're really suffering? Nicole Lamberson [00:29:26]: Oh, yeah. I mean, if I would have known at the time of my detox what I know now, I would have reinstated immediately, and I would have reinstated to the same dose that I had been ripped off of. I think one of the biggest mistakes I made is that I didn't know what the hell to do. I wasn't as educated as I am now, and so I let my doctor put me back on. I think it was like one eight or one quarter of what I came off of, and that doesn't work. I mean, your brain remembers what you were taking just before. So if it were that easy, why would somebody do, like, a three year taper from 20 milligrams of something if they could just lop it off and then only reinstate five milligrams and have a much shorter taper? You know what I mean? Like, you have to sort of give it back, at least close to what you were on to begin with in order to stabilize and get full symptom relief. So, yeah, I think there are people who there's this sort of tough man stuff that goes on in the withdrawal support group sometimes. Like, just stick it out. You'll heal, everybody heals. And we set people up for Protracted syndromes and severe suffering way more than I think some people have to be. And they could have gone back on, got stable, and had a pretty good taper. That said, there are people who, for whatever reason, I don't know if you just rock the. Nervous system so hard when you cold turkey that they try to go back on and it either doesn't work fully, they just get, like, partial relief, or sometimes they reinstate and they feel worse. But that seems to be like the rare type of report. Most people can go back on and feel better, at least mostly better and taper, and they should do it as quickly as possible after making a huge dose reduction or cold turkeying so that they can not sit in a bad withdrawal state for a long period of time and damage the nervous system. Mark Leeds, D.O. [00:31:46]: Yeah, one thing I've been thinking about is when 911 happened, they were looking into all these different things that happened. And one thing that they found highly suspicious after the fact was how these guys trained to fly planes but not to land. They're like, well, we don't want to learn about how to land a plane. We just want to learn how to take off and fly. Landing is not really important to us, and that seems crazy. And I was like, how did they not report that? That should have been a big, huge red flag. Yet the entire medical industry, the healthcare industry, maybe that should be a big, giant red flag that doctors are not taught how to land the plane, how to get people off the medication, how to taper gradually what needs to be tapered. Pharmaceutical companies don't teach doctors. Each medication should come with tapering instructions and a tapering mechanism. Here's like a taper pack or here's a special we don't give this to everybody, but here's special graduated dosages or a liquid form. Same thing with addiction treatment. With buprenorphine, you basically have really two dosages that are available for buprenorphine because you can't get the twelve or the four milligram anywhere, but you have the eight and the two milligram buprenorphine. And most people, almost nobody is ready to drop off at two milligrams. They need to taper far below that, and it just doesn't exist. And then the package says, never cut or tear break the medication. You have to take it intact. So they're basically saying, never come off of it. Nicole Lamberson [00:33:21]: You're stuck. Mark Leeds, D.O. [00:33:22]: Yeah. It almost does seem like some kind of medical terrorism. Where's the tapering? Where's the teaching? A lot of doctors, I don't think, know that tapering should be done with the SSRIs, like all the antidepressants, and it's like, okay, doctor, I've been taking Paxil. I feel a lot better. I'm done with it. What I do? It's like, well, maybe take half the dose for a few days and you're probably done then. They just don't even know what to do with that. It's not the instructions. Nicole Lamberson [00:33:49]: Yeah, it's scary. And so people who are considering taking this medication need to know that ahead of time. That's part of the informed consent. Like, hey, depending on what you're on, by the way, it doesn't even come in the doses you might need to get yourself off. So you're going to have to figure that out. If you're on these beaded ones, you may have to sit there with a little thing and count out tiny little beads. This is going to be part of your life if you want to get off of this stuff. That's part of knowing the long plan for these drugs if you're going to initiate them. And I think a lot of people would not take them if they knew that was the case. There is some hope, though. I mean, I'm on the patient committee right now for the FDA, put out a black box for benzodiazepines a couple of years ago, and one of the critiques of the black box is like, well, great, you've told everybody that there's physical dependence and that there's these horrible withdrawal syndromes and protracted withdrawal. We're super grateful that that exists in the labeling now, but you basically just sort of generically said that people need to taper. Well, you didn't provide any guidance or information on how to actually do that. So they put up a bunch of grant money recently, and the American Society of Addiction Medicine is the recipient of that grant, and it is to come up with depreciing guidelines for benzodiazepines. And they have a committee of patients who are working with the medical providers who are on the doctor side of things, and I'm on that committee along with a bunch of other benzo survivors. So, so far we've had one meeting and it's going well, and I think they're hearing us and really interested in having a collaborative type relationship as the guidelines are developed. So we'll see how it goes. It's going to be a couple of years before they're out and we can see what they are. Mark Leeds, D.O. [00:35:55]: Yeah. What do you think of the Ashton method? Maybe it's dated, maybe there's better ways to do it, but it is out there, and at least it's a good starting point to learn about it. What do you think about it? Nicole Lamberson [00:36:10]: Yeah, I mean, I love Heather Ashton. I think she was like the pioneer. But anytime someone does it first, I think many years later, people have perfected it and come up with new techniques that can make it easier and that kind of thing. So she really just gave us the idea and gave us the equivalences to Valium and that kind of thing, which is so important. But I think the patients went home, took that and said, okay, I'll do it better. And we have ways that we've developed. Not everybody switches to Valium either. A lot of people don't like Valium. They don't think that they feel as good on Valium as they did on their original benzo, and so they just directly titrate off of Clonapin or Xanax. So, yeah, there's a bunch of ways to do it, but I think the Ashton manual is a good start. Where people get in trouble is they try to follow. It like a cookbook. They think it's like a recipe that they do one step, and a lot of times it's the doctors. They miss the paragraph where she said very loudly, this is only a guide. Let the patient adjust as needed. I mean, that's the biggest take home, is that the patient's body should dictate the rate and speed of taper, not some chart that you're following. Mark Leeds, D.O. [00:37:40]: Yeah. As far as other things that might be helpful, somebody mentioned in an email, they they said they they looked at my material and feel I'm not doing any biohacking, and I wasn't sure what they meant. What is biohacking exactly? I just imagine there's these groups of people that are trying to grow fresh vegetables and healthy meats, and they're doing all these crazy things to maybe they're taking psychedelics or they're taking all kinds of supplements blended together. But have you heard of that biohacking for benzo protractor withdrawal? Nicole Lamberson [00:38:19]: Okay. I'm a member in some of the primal Paleo keto world, and I follow that kind of stuff because I eat that way and it makes a lot of sense to me, like looking at what our ancestors did and how we managed to evolve. And in that world, the biohacking stuff is like using blue light blocking glasses before bed when you're on your screens and to get yourself sort of in that sleep mode or whatever, because we're all exposed to all these lights and it messes our sleep up and that kind of thing. So I'm not sure if it goes beyond that. I don't know. Mark Leeds, D.O. [00:39:07]: That's a good idea. When you mentioned that the original blue blocker sunglasses, I love those. I mean, they just make the whole world look a lot happier and more peaceful. And the big downside is you can't really see green lights when you're driving, so either have to know what a green light it's the absence of red, basically, but otherwise, yeah, that's a good idea. Blocking the blue light. I guess some devices can filter out the blue for you, but yeah, in the diet, that's another good point. I think some people have told me that a low carb diet helps some, and I think it helps me too. I feel less anxiety if I'm eating low carb. Nicole Lamberson [00:39:42]: Yeah. I interviewed Chris Palmer recently. He's like the big keto psychiatrist out of Harvard. And yeah, I told him when I went on Keto in benzo withdrawal, I knew there was something to it because I stopped biting my fingernails for the first time in my life when I was in Ketosis, which I was like, interesting. So I must be more less anxious if I'm not doing that. Mark Leeds, D.O. [00:40:09]: Yeah, I don't know if they still do it, but I know when I was a student, I saw when I did my pediatric rotation that they were using Ketogenic diet to treat seizures in children where they were resistant to other treatments. I was thinking like, seizures are, like, the worst thing. If someone is in acute benzo withdrawal, they could have a seizure. So that's like the one thing, the thing you don't want, like, that over excitation. I can't even think I'm going to cut that part out. Excitation, whatever. But yeah, the brain is overstimulated, so you don't want a seizure. But the opposite of that would be you're on a keto diet. You're calm, you're relaxed. Yeah, I can imagine it would be good. And sometimes I think I forget to bring that up with people and definitely something I guess you probably have a list. Do you have a list of stuff that you go over when you talk to somebody to make sure you don't leave something out when you're doing, like, a consultation with someone or helping them get through protracted withdrawal? Nicole Lamberson [00:41:15]: No, because I don't really do consultations. I mean, it's more just like helping people out just from my experience or sharing my experience. But I always make sure to say, obviously, what we already discussed is what worked for me might not work for you, but you can certainly try it. It's like we have all these anecdotal tools that somebody before you has tried, and so you can post in the forums and ask, and you'll probably get a varied response. And then you just sort of have to make your own decision and decide, like, well, to me, going on a diet seemed like one of those low risk interventions where it was like, well, if it doesn't work, so what? But I might lose a little bit of weight. And another good thing that I noticed with it was like the benzo belly type stuff that you were talking about really cleared up. Like, I had a lot of GI issues and the keto diet really helped that. But I eat pretty clean keto. Like, you can do junk food keto if you wanted. They have all those products and processed whatever now. And if you eat enough of that Erythritol or whatever, you'll be on the toilet all day long. I eat, like, real food keto. Mark Leeds, D.O. [00:42:38]: When you say clean keto, what about things like those sausages and beef jerky? I guess they have some organic ones that don't have stuff in them that are probably okay. Nicole Lamberson [00:42:48]: Yeah, I don't buy the ones that are preserved with nitrites or whatever and have I mean, if you get like, gas station jerky, that can have a lot of sugar in it if you don't read the ingredients. So I do get the ones that are they don't have sugar, and I think they use, like, celery juice to preserve them or whatever, but it's nothing fancy. They have them at Trader Joe's. Like, Chomps is the brand that I get. Yeah, but they have other brands, like Primal something or Nick Sticks is another one. So. Yeah, I eat those. Mark Leeds, D.O. [00:43:25]: Yeah, I actually got the chomps one. I think I got that at Costco, like a big pack of them and they were really good. Yeah, okay. I wanted to ask you, have you tried ketamine infusions? Nicole Lamberson [00:43:37]: No, I haven't. Mark Leeds, D.O. [00:43:39]: Yeah, that's something some people have told me. They tried it and it didn't help them. But then the proponents of it say that you need to do a series of them, like six of them, and then some people get upset, like, I didn't get therapy and not all the places give therapy because the medication is supposed to have beneficial brain healing effects with or without therapy. But yeah, I'm not really sure about that because I've heard people with other issues, other people with mental health issues or chronic pain that said that it was the greatest thing ever for them. But I don't know if it really has any great benefit for protracted withdrawal. Nicole Lamberson [00:44:17]: Yeah, I haven't tried it. I probably never would. I told you at the beginning, before we started recording and a lot of benzo people are psych drug withdrawal. People are like this. They're kind of scared of sort of rocking the boat too much or I've also been to places in my mind from withdrawal that I didn't even know existed. And so when you start talking about things like more drugs that can make you have experiences or like these people saying like, well, what about psychedelics? And it's like, I want to feel normal, I don't want to have trips or that kind of thing, I'm good. After being in psych drug withdrawal, that just scares me. But at the same time I could be just completely short sighted because there are people who swear by psychedelics and there's all this research and stuff. I watched a podcast the other day and I was like, I don't want to slam the door on it if it could help somebody. So I think just need to learn more. But for my own purposes, I probably would be too afraid, honestly. Mark Leeds, D.O. [00:45:27]: Yeah, maybe it's more of the derealization effect of takes you further from reality. Nicole Lamberson [00:45:34]: Yeah, and I've been far enough that I don't want to go further. Mark Leeds, D.O. [00:45:41]: What do you think about, I guess it's a therapy called acceptance or is it acceptance and commitment therapy. And it's a whole field where there's people trained in it, but it almost seems like common sense of like that accept where you are, accept your life as it is or learn to accept it. And then the commitment is a commitment to do positive action, take positive action. But I have talked to people that are really in denial. I think of that now. Their life isn't what it used to be. Maybe they're not the same. Just for example, I had a patient that went through COVID and he had a really bad reaction. It almost killed him. And then afterwards for a long time, he had a lot of anxiety and depression and fatigue. And this is someone that was like a highly successful, motivated person. I mean, he's still very successful in business, but he went through a period where he really just couldn't do anything. I remember talking to me and he said, I'm having anxiety, and I've never had anxiety in my life, and I'm tired, I can't get anything done. And while he's explaining in detail how he felt, I thought, now you're like me. That's how I feel all the time. But that must be really hard for someone that has never felt that way, to suddenly be confronted with that. But do you see things like that? Like, your life isn't what it used to be, but maybe you can learn to accept it as it is? Nicole Lamberson [00:47:03]: Yeah, I mean, I think you have to if you're going to go through this process and you get any level of disability from it, what choice do you have? For me, I was so sick on the drugs that the only sort of light at the end of the tunnel was that maybe I could get off of them and have a life again or health again. Staying on them just wasn't an option. I mean, I know for some people they feel fine on their drugs, and so maybe they would not even want to embark on trying to come off. But for me, it was like, I have to get off of this stuff or I'm not going to survive. So I feel like I did have to radically accept. I think what I've seen is a trend sort of when the bad suffering starts and the losses start happening because you're so ill, the initial response is rage and sort of pushing back up against it and like a temper tantrum and just normal human like, this isn't how I planned for my life to be, and this is so unfair. But that doesn't change anything. And so eventually, I think people just become sort of worn down by the process into acceptance, so they realize, like, I'm going to have to go through this if I want the end goal, which is being off of these medications. I remember in the beginning when I was sort of in that phase of rage and poor me, and this isn't fair, and all my friends are having this and this, and I've lost everything. My dad said to me, not everybody's guaranteed a good life. And when he said that, I hated him for it. I was pissed. I was like, what a stupid thing to say. But it's true. I could have been in some terrible car accident. It didn't have to be psych drug withdrawal. People suffer and lose things and go through stuff all the time where their health is not optimal and it interrupts their life. And so this is just part of my journey, and good things have come out of it too. I also hated the people who tried to sugarcoat and make everything like, oh, I'm grateful for benzo withdrawal. You'll never hear me say that I am not grateful. This was the worst hell and it didn't have to happen. But some good stuff has come out of it. Like, I've met amazing people. I have experiences that I never would have had. I'm super interested in a topic that's sort of like my life's work now and passion and doors have opened that I never thought I'd be working for a documentary film. Stuff comes of it, you know what I mean? So you just make the best of what you have, even though it still sucks that your health is not optimal and you've lost a lot. Mark Leeds, D.O. [00:50:06]: Yeah, definitely. And that's always kind of a touchy thing, I think, pointing out to a patient, things could be worse. And of course they look at me as like, well, things are really bad. So easy for you to say that things could be worse. But there's definitely some horrible things a person can go through. I know the one that always comes back to me is that ALS Lou Gehrig's disease, where person is like and I feel terrible for anybody who listens to this, who has that being trapped in your own body and not being able to. Getting to a point where you're in there and you can't move or do anything and maybe you're on life support and your loved ones don't know what to do. And then you think about how terrifying claustrophobic that must be just to be there and not be able to move your limbs at all. Because I get claustrophobic just thinking of any enclosed space or not being able to move. But yeah, at least if someone going through this, they haven't lost a limb and they're able to move. They're able to do things and accomplish things. And I know that it's not what they would have been if it hadn't happened. I know people are angry because they've been injured by the health care system that didn't know any better and should have known better. But yeah, I think there's always things to be grateful for. Nicole Lamberson [00:51:25]: Yeah. And I would say if you're supporting someone ever not to tell them there's people who are worse, that's kind of annoying to hear because what you're going through is awful, you know what I mean? And nobody wants to hear that. Like, well, you could have third degree burns all over your body. That would be terrible. But it's like I sort of came to that on my own as part of my acceptance journey, like examining all these people around me. Not everybody's having a great time, not everybody's healthy. People have horrible things that they have to contend with in life. And so that was sort of my own realization. And also the most important one was I wish when I was younger that I had had more guidance and just knowledge about you get one body and one chance at this. If we were younger, and we were taught about eating properly and exercise and sleep, but I don't know if you can get that lesson if you haven't had the suffering to sort of bring you to that place. I almost feel like humans are so stubborn. We have to sort of be taken to the brink of something before we're like, okay, I get it now, and we start doing the right thing. What do you think? Mark Leeds, D.O. [00:52:51]: I totally agree. Nicole Lamberson [00:52:53]: Yeah. Mark Leeds, D.O. [00:52:54]: And that's good advice for me to not bring up. Things could be worse for you, because you're right. I think people figure it out on their own. Nicole Lamberson [00:53:02]: Yeah. I mean, if there's another way to say it, maybe. Mark Leeds, D.O. [00:53:04]: I don't know, but I can't imagine someone going through that for years and years and having to live with that. Nicole Lamberson [00:53:10]: Yeah. And also not knowing when it's going to end or if it ever will. That's the scariest part, too, is just the timeline of I know every person who's protracted thinks that, what if they're, like, the exception? What if they damage their nervous system so badly that it doesn't ever get to the place where you connect with reality again? Or you feel normal emotions, or you can sleep. Right. But everybody's just sort of hanging on with this blind faith, like, well, it has improved from the first five years, so hopefully the trajectory is in the right we're moving in the right direction, and you sort of have to hang on. There's no doctor that can tell you, absolutely, this is going to go away. You're lucky if you can find a doctor who believes that you're having it. Yeah. That's also part of the torture and the timeline, not just the symptoms. Like, yeah, everything you listed totally sucks. Being dissociated for ten years sucks, but the timeline is what ruins your life. Like, give me the worst suffering ever for two years, because I can bounce back from that pretty okay. Like, I haven't ruined everything in a two year period. But if you're unable to work for a decade and you haven't put money into your 401 and you didn't get married or have kids, that's way more devastating to your life in the long run. You know what I mean? Mark Leeds, D.O. [00:54:51]: Yeah, definitely. Almost sounds like being sent to prison for a long time. Nicole Lamberson [00:54:57]: I've thought about it like that. But at least they can feel connected. I mean, they're not dissociated and they can play cards. A lot of people in severe benzo withdrawal just lay alone in bed. They can't stand to even be around other people, really. So, yeah, it's like prison. Mark Leeds, D.O. [00:55:21]: But yeah, I think it is important to have hope. I believe that the human nervous system, the brain, can overcome anything, and it and it could be actually damaged in some diffuse way of toxic reaction, causing diffuse damage to maybe the receptors or the neurons at a microscopic level. But I think the brain can adjust and accommodate and I'd like to believe there's hope for everybody at some point. Nicole Lamberson [00:55:50]: Yeah, same. I mean, I try to say to myself all the time, if people were suffering so horribly and they just never got back to life, they would be all over the internet. Like, I would know them and those people just, yes, there are people who are off 14 years that I'm aware of who are still suffering, but if you get much beyond that, they're not there. So it's like, well, if they exist, where are they? Why aren't they in the groups like. Mark Leeds, D.O. [00:56:26]: Everybody else at 14 years? Maybe someone other than yourself. They're not probably not as bad as they were in the beginning. Like they've improved. Nicole Lamberson [00:56:35]: Yeah, they'll all say the trajectory is towards healing. So yeah, anybody who's super long term is way better than they were in the beginning. It's just that they're still suffering to the point where they're not back to life again. They aren't working full time, they aren't having all the landmarks and stuff that their peers are having and that kind of stuff. But no, it's not like it was in the acute first handful of years or whatever. I wanted to ask you, I interviewed you for the Medicating Normal YouTube channel, and somebody in the comments, I guess, sort of was unhappy that you said you hadn't seen protracted withdrawal that much in your clinic. And I'm wondering, have you seen more of it since we last talked? Mark Leeds, D.O. [00:57:25]: I read those comments and it's probably a good thing I didn't see them live. I didn't realize they were happening. But yeah, I did read them back and I didn't respond really, but I think I kind of took them all in and felt bad that I said things like that or didn't respond to certain things that people are asking. But maybe on one hand, I'm sometimes afraid to say things publicly that might imply there's no hope. I like to think there's hope for everybody, and I wasn't as aware of it at that point. I think after that, in fact, it does seem like there's things in the protracted withdrawal and the benzo withdrawal condition that I'm not aware of. And then I learn about it, and then as soon as I learn about it, it seems like everybody's talking about it. Just like the histamine thing. Originally I didn't understand it, and then I got to know it a lot better, learned what might work for it, and then suddenly it seemed like everybody in every form is all talking about histamines and they hadn't been before. I probably just wasn't tuned into it. But yeah, I think I wasn't really tuned into protracted withdrawal so much at that point. And since then it's definitely something I'm aware of and I'm seeing more and I think at that point I was more seeing people early on and really trying to give them hope. If you're not completely better, you'll be dramatically improved by this point and hopefully not giving them false hope, but hopefully at least giving them some hope helped them push forward. And I think some people were really motivated to do things and move forward. But yeah, maybe since then I've developed a more realistic approach and I'm definitely seeing more and becoming more aware of people that are going to be dealing with this on a much longer time scale. Nicole Lamberson [00:59:08]: Yeah, well, to your defense, a lot of like you said, people in this position are angry and rightfully so, but we sometimes take it out on people who are on our team. Oh, he doesn't know everything he's supposed to know. It's like, well, the doctors are the ones who want to help us. They're learning, it takes time. I mean, this is complicated and you have to really get in there and join the forums and talk to the patients and all that kind of stuff. It's like a huge learning process to understand all of it and also protracted people. The ones I know, anyways, a lot of us don't really go to the doctor because it's like, what can you we've been doing this for so long that most of the times when we go to the doctor, they don't believe us or they diagnose us with something stupid that we know that that's not what it was. So it's kind of like a waste of time or money. And also we also know that there's not a lot can be done. So that could be why you're not seeing a lot of protracted people, because short of taking a medication or something like that and a lot of them are like me, they don't want a drug. So a lot of times we kind of just disappear and slip under the radar and we're not going back to the doctor and so they don't see that we exist. Really? Mark Leeds, D.O. [01:00:36]: Yeah, I've seen that people going through two extremes. One is they go to a doctor that doesn't believe what they're going through or they discount it because the doctors also don't have a lot of time and they rush them through a brief visit and nothing really happens. Or they put them on the wrong thing, they put them on more psych drugs just to hopefully solve the problem quickly. And then the other extreme is the functional medicine doctor that does a million tests and diagnoses them with all kinds of crazy things that may or may not be real, puts them on a ton of supplements and it's hard to say, was that stuff really helpful? And now the person thinks they have all these other things wrong with them and they're taking huge amounts of supplements and things that may or may not be useful and doing all these labs that regular labs don't even do. So that's like the other extreme. But although, I don't know, maybe we can learn from them, maybe there's some real stuff. In there? Nicole Lamberson [01:01:32]: Yeah, I don't know. I mean, it gets so expensive and then it's just like I did that. I went to a functional medicine doctor and it's like $200 for 45 minutes or something. And I came out with like a prescription of ten diflucan for my gut overgrowth or whatever, and I was like, I didn't know what to do with it. Again, most of the time you meet people who have been in Protracted long enough and they've kind of just given up on the medical system and they're just dealing with it, passing time on their own, taking care of their body, just waiting. Mark Leeds, D.O. [01:02:14]: I would definitely say that the message should be don't give up hope, keep trying. And don't discount the natural non medication things going outside, taking a walk, the fresh air, the sound therapy, movement therapy, like you said, yoga, which would be a form of movement therapy. And those things that seem like, oh yeah, they're not going to work, but they do work and they do help. Nicole Lamberson [01:02:38]: Yeah. And friends and purpose and distraction. Those three things saved my life. Meeting people in the same boat as me that I could complain to, I could call anytime, they would answer my phone at two in the morning because they're probably awake too, they're in withdrawal. Distraction, because I could get out of my head and I could make myself focus on something else for a little while. And feeling purposeful. I mean, there's nothing worse than just existing and having nothing to do or not feeling like you're contributing in some way. So however, you can make those things happen while you're sort of, to use the jail analogy that we talked about before serving your time in withdrawal, it'll help. Mark Leeds, D.O. [01:03:24]: Yeah. Sometimes you reach a point where you're like, maybe they put you in a minimum security prison and then you're out on parole when you start driving again. Nicole Lamberson [01:03:36]: Or maybe go to lunch with a friend that feels safe or something like that. Yeah, you start getting work release. Mark Leeds, D.O. [01:03:44]: Yeah. Yeah, that's a good analogy. Anyway. Nicole Lamberson. Thank you again. Thank you for joining me today. Nicole Lamberson [01:03:53]: Yeah, sure. Thanks for having me. ### Nicole Lamberson on Benzo Tapers, Dependence, and Physician Desensitization URL: https://therehab.com/nicole-lamberson-on-benzo-tapers-dependence-and-physician-desensitization/ [spreaker type=player resource="episode_id=60178565" width="100%" height="200px" theme="light" playlist="false" playlist-continuous="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="true"] ## Introduction to Nicole Lamberson and Benzo Tapers Nicole Lamberson is an advocate for responsible benzodiazepine use. She works with patients struggling with benzo dependence. Her insights focus on the proper management of tapering off these medications. Nicole emphasizes the importance of understanding dependence versus addiction. This distinction is crucial for effective treatment and patient safety. Benzodiazepines are often prescribed for anxiety and sleep issues. Over time, many users develop a physical dependence on these drugs. This dependence can lead to severe withdrawal symptoms if not managed properly. Nicole discusses the need for careful tapering to minimize risks. Proper education for both patients and physicians is essential. Nicole highlights the difference between dependence and addiction. Dependence occurs when the body adapts to a drug. Addiction, however, involves compulsive use despite negative consequences. Many benzo users are dependent, not addicted. This distinction is often misunderstood by healthcare providers. Tapering off benzos requires a gradual reduction in dosage. Abrupt cessation can cause severe withdrawal symptoms. Nicole advises that tapering should be done slowly and under medical supervision by an experienced deprescribing [benzodiazepine doctor](). However, not all physicians are trained in proper tapering methods. This lack of knowledge can lead to patient harm. Physician desensitization is a significant issue in benzo management. Many doctors quickly label dependent patients as addicts. This mislabeling can result in inappropriate treatment. Nicole argues that better education is needed for healthcare providers. Understanding the nuances of dependence is vital for patient care. ## Dependence vs. Addiction: Clarifying the Terms Dependence and addiction are often confused, leading to mismanagement. Dependence is a physical adaptation to a drug, resulting in withdrawal symptoms. In contrast, addiction involves a psychological craving for the drug, often leading to harmful behaviors. Nicole Lamberson emphasizes that most benzo users are dependent, not addicted. This difference is crucial for determining the correct treatment approach. Physicians often mislabel dependent patients as addicts. This misdiagnosis can lead to inappropriate treatment strategies. Addiction requires a different treatment approach than dependence. Nicole stresses that understanding this distinction is vital for effective patient care. Mislabeling can cause more harm than good. Dependence develops when the body becomes used to the presence of the drug. Withdrawal symptoms occur when the drug is reduced or stopped. These symptoms can be severe and require careful management. Nicole advises that tapering should be done gradually to avoid withdrawal complications. This approach ensures a safer and more comfortable withdrawal process. Addiction, on the other hand, involves compulsive drug use despite negative consequences. It is a psychological condition that often requires behavioral therapy. Nicole points out that many healthcare providers fail to differentiate between addiction and dependence. This failure can lead to ineffective treatment plans. Proper education is needed to address this gap in understanding. In summary, understanding the difference between dependence and addiction is crucial. Dependence is a physical condition that requires careful tapering. Addiction is a psychological condition that requires a different treatment approach. Nicole advocates for better education and awareness among healthcare providers. This knowledge is essential for providing effective and appropriate patient care. ## The Importance of Proper Benzo Tapering Tapering off benzodiazepines is a complex and delicate process. It requires a gradual reduction in dosage to avoid withdrawal symptoms. Nicole Lamberson emphasizes the importance of a slow and controlled taper. Abrupt cessation can lead to severe withdrawal and even life-threatening complications. Therefore, proper tapering is crucial for patient safety. Nicole discusses the need for individualized tapering plans. Each patient responds differently to tapering, and what works for one may not work for another. A personalized approach is essential to ensure a safe and effective taper. This requires close monitoring and adjustments as needed. Nicole advocates for a patient-centered approach to tapering. Physicians play a critical role in the tapering process. However, many lack the training and knowledge to guide patients through a safe taper. Nicole stresses the need for better education for healthcare providers. Understanding the risks and proper tapering techniques is essential. Without this knowledge, patients are at risk of harm. The goal of tapering is to minimize withdrawal symptoms while safely reducing the drug. Nicole advises that tapering should be done slowly, sometimes over months or even years. This gradual approach helps the body adjust to lower levels of the drug. Rushing the process can lead to severe withdrawal and potential relapse. In conclusion, proper tapering is essential for safe benzodiazepine withdrawal. A personalized, patient-centered approach is necessary. Physicians need better training to guide patients through this process. Nicole advocates for slow and gradual tapering to minimize risks. This approach ensures a safer and more comfortable withdrawal experience. Read More: [Benzodiazepines: The Silent Addiction Epidemic]( "Benzodiazepines: The Silent Addiction Epidemic") ## Physician Desensitization: A Barrier to Effective Treatment Physician desensitization is a significant issue in the treatment of benzo dependence. Many doctors are quick to label patients as addicts, without fully understanding their condition. This mislabeling can lead to inappropriate and even harmful treatment strategies. Nicole Lamberson highlights the importance of proper education for healthcare providers. Understanding the difference between dependence and addiction is crucial. Desensitization occurs when physicians become numb to the challenges of benzo dependence. This can happen due to overexposure to patients with substance use disorders. As a result, they may fail to recognize the unique needs of dependent patients. Nicole argues that this desensitization can lead to a lack of empathy and understanding. This is a significant barrier to effective patient care. Proper education and awareness are needed to combat physician desensitization. Healthcare providers must be trained to recognize the differences between dependence and addiction. This training should include the appropriate management of **benzo tapering**. Nicole advocates for ongoing education to keep physicians informed. This is essential for providing compassionate and effective care. Physicians need to approach benzo dependence with an open mind. They should not automatically assume that all patients are addicts. Nicole stresses the importance of individualized care and understanding. Each patient’s situation is unique and should be treated as such. This approach fosters trust and better outcomes. In summary, physician desensitization is a barrier to effective treatment. Proper education and training are needed to address this issue. Nicole advocates for a more compassionate and individualized approach to care. Understanding the nuances of benzo dependence is crucial. This will lead to better patient outcomes and safer tapering processes. ## The Role of Education in Managing Benzo Dependence Education plays a critical role in managing benzo dependence. Both patients and healthcare providers need to be informed about the risks and proper management of benzo tapering. Nicole Lamberson emphasizes the importance of patient education. Patients must understand the process and what to expect during a taper. This knowledge empowers them to take an active role in their treatment. Healthcare providers also need ongoing education. Many physicians lack the training to properly manage benzo dependence. Nicole advocates for better education and resources for healthcare providers. This includes training on the difference between dependence and addiction. Proper education ensures that patients receive the appropriate care. Patient education should include information on the risks of abrupt cessation. Nicole stresses that patients need to understand the importance of a gradual taper. They should be informed about potential withdrawal symptoms and how to manage them. This education helps patients prepare for the tapering process. It also reduces anxiety and improves adherence to the tapering plan. Healthcare providers should also be educated on the psychological aspects of benzo dependence. Nicole points out that patients often experience anxiety and fear during tapering. Understanding these psychological challenges is essential for providing effective support. Physicians need to be empathetic and provide reassurance throughout the tapering process. In conclusion, education is vital for managing benzo dependence. Both patients and healthcare providers need to be well-informed. Nicole advocates for comprehensive education to ensure safe and effective tapering. This includes understanding the risks, managing withdrawal symptoms, and providing psychological support. Proper education leads to better outcomes and safer withdrawal experiences. ## Overcoming the Challenges of Benzo Tapering Benzo tapering presents several challenges that must be carefully managed. The process can be long and difficult, requiring patience and persistence. Nicole Lamberson discusses the importance of overcoming these challenges. She emphasizes the need for a personalized approach to tapering. Each patient’s experience is unique, and the tapering plan should reflect this. One of the main challenges is managing withdrawal symptoms. These can range from mild to severe and can significantly impact a patient’s quality of life. Nicole advises that tapering should be done slowly to minimize these symptoms. Close monitoring is essential to adjust the tapering plan as needed. This helps to ensure a smoother and more comfortable withdrawal process. Another challenge is maintaining patient motivation and adherence to the tapering plan. The process can be daunting, and patients may feel discouraged. Nicole stresses the importance of providing ongoing support and encouragement. Healthcare providers should work closely with patients to keep them motivated. Regular check-ins and adjustments to the plan can help maintain adherence. Psychological challenges are also common during benzo tapering. Patients may experience anxiety, depression, or other mental health issues. Nicole highlights the importance of addressing these challenges as part of the tapering process. Providing psychological support can help patients cope with the emotional aspects of withdrawal. This support is crucial for a successful taper. Benzo tapering is a challenging process that requires careful management. Personalized plans, close monitoring, and psychological support are essential. Nicole advocates for a patient-centered approach to overcome these challenges. By addressing both physical and psychological aspects, patients can successfully taper off benzodiazepines. This approach leads to safer and more effective outcomes. ## Moving Forward with Benzo Tapering and Patient Care In summary, benzo tapering is a complex process that requires careful management and a personalized approach. Nicole Lamberson emphasizes the importance of understanding the difference between dependence and addiction. This distinction is crucial for providing appropriate care. Physician desensitization and lack of education are significant barriers to effective treatment. Addressing these issues is essential for improving patient outcomes. Education is a key factor in managing benzo dependence. Both patients and healthcare providers need to be well-informed about the risks and proper tapering techniques. Nicole advocates for ongoing education and support throughout the tapering process. This ensures that patients receive the care they need and helps to minimize the risks associated with benzo withdrawal. Overcoming the challenges of benzo tapering requires a patient-centered approach. Personalized plans, close monitoring, and psychological support are essential components of a successful taper. Nicole highlights the importance of addressing both the physical and psychological aspects of dependence. This comprehensive approach leads to safer and more effective outcomes for patients. Moving forward, it is crucial to continue advocating for better education and awareness among healthcare providers. Nicole’s work in this field is a valuable resource for both patients and physicians. By understanding the nuances of benzo dependence and implementing proper tapering strategies, we can improve patient care and outcomes. This is a vital step in ensuring the safe and effective use of benzodiazepines. Benzo tapering is a delicate process that requires careful management, education, and support. Nicole Lamberson’s insights provide valuable guidance for both patients and healthcare providers. By addressing the challenges and implementing personalized care plans, we can achieve safer and more effective outcomes. This approach is essential for the well-being of patients and the responsible use of benzodiazepines. ### Mixed Anxiety-Depressive Disorder Treatment for People Who Will Not Take Benzodiazepines, Antidepressants, or Other Psych Drugs URL: https://therehab.com/mixed-anxiety-depressive-disorder-treatment-for-people-who-will-not-take-benzodiazepines-antidepressants-or-other-psych-drugs/ Mixed Anxiety-Depressive Disorder (MADD) is a relatively new diagnostic category that combines symptoms of both anxiety and depression. Individuals with MADD experience a combination of persistent feelings of sadness, hopelessness, and worthlessness, along with symptoms of anxiety such as excessive worry, restlessness, and irritability. This disorder can be particularly challenging to diagnose and treat, as the symptoms of anxiety and depression often overlap and can be difficult to distinguish from one another. MADD is characterized by a range of physical, emotional, and cognitive symptoms. Physical symptoms may include fatigue, muscle tension, headaches, and gastrointestinal issues. Emotional symptoms can manifest as feelings of sadness, guilt, and irritability, while cognitive symptoms may include difficulty concentrating, indecisiveness, and negative thinking patterns. It's important to note that MADD is not simply a combination of anxiety and depression, but rather a distinct disorder with its own unique set of symptoms and challenges. MADD can have a significant impact on an individual's quality of life, affecting their ability to function at work, maintain relationships, and engage in everyday activities. It can also increase the risk of developing other mental health conditions such as substance abuse disorders and eating disorders. Understanding the complexities of MADD is crucial for developing effective treatment strategies that address both the anxiety and depressive symptoms that individuals with this disorder experience. ### Key Takeaways * Mixed Anxiety-Depressive Disorder is a common mental health condition characterized by symptoms of both anxiety and depression. * Non-pharmacological treatment options such as exercise, relaxation techniques, and lifestyle changes can be effective in managing symptoms of mixed anxiety-depressive disorder. * Cognitive Behavioral Therapy (CBT) is a widely used and effective form of therapy for treating mixed anxiety-depressive disorder. * Mindfulness and relaxation techniques, such as meditation and deep breathing exercises, can help reduce symptoms of anxiety and depression. * Lifestyle changes, including regular exercise, healthy eating, and adequate sleep, can play a significant role in managing symptoms of mixed anxiety-depressive disorder. ## Non-Pharmacological Treatment Options Non-pharmacological treatment options for MADD are essential for individuals who may not want to rely solely on medication or who may not be able to tolerate certain medications due to side effects. These treatment options focus on addressing the underlying causes of anxiety and depression, as well as promoting overall well-being and mental health. Non-pharmacological treatments can include psychotherapy, lifestyle changes, mindfulness techniques, and support groups. Psychotherapy, such as cognitive behavioral therapy (CBT) and interpersonal therapy, can be highly effective in treating MADD. These therapies help individuals identify and change negative thought patterns, develop coping skills, and improve interpersonal relationships. Lifestyle changes, such as regular exercise, healthy eating habits, and adequate sleep, can also play a significant role in managing MADD symptoms. Mindfulness techniques, such as meditation and deep breathing exercises, can help individuals reduce stress and improve their ability to cope with anxiety and depression. Additionally, support groups provide individuals with MADD the opportunity to connect with others who are experiencing similar challenges, offering a sense of community and understanding. Non-pharmacological treatment options are often preferred by individuals with MADD due to their focus on addressing the root causes of the disorder and promoting long-term mental health and well-being. These treatments can be used alone or in combination with medication, depending on the individual's preferences and needs. ## Cognitive Behavioral Therapy for Mixed Anxiety-Depressive Disorder Cognitive Behavioral Therapy (CBT) is a widely used and effective form of psychotherapy for treating MADD. CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to anxiety and depression. This type of therapy helps individuals develop coping skills and strategies to manage their symptoms and improve their overall quality of life. In CBT for MADD, individuals work with a therapist to identify their specific triggers for anxiety and depression, as well as the negative thought patterns that contribute to these symptoms. Once these triggers and thought patterns are identified, individuals learn how to challenge and reframe these thoughts in a more positive and realistic way. This process helps individuals develop healthier coping mechanisms and reduce the impact of anxiety and depressive symptoms on their daily lives. CBT for MADD also focuses on behavioral interventions, such as activity scheduling and relaxation techniques, to help individuals manage their symptoms more effectively. By incorporating these strategies into their daily routines, individuals can learn to reduce stress, improve their mood, and increase their overall sense of well-being. Overall, CBT is a valuable treatment option for individuals with MADD as it provides practical tools and strategies for managing anxiety and depression. It empowers individuals to take an active role in their treatment and provides them with the skills they need to cope with their symptoms in the long term. ## Mindfulness and Relaxation Techniques Mindfulness and relaxation techniques are valuable tools for managing the symptoms of MADD. These techniques focus on promoting a sense of calm and relaxation while increasing awareness of the present moment. By incorporating mindfulness and relaxation into their daily routines, individuals with MADD can reduce stress, improve their mood, and enhance their overall well-being. Mindfulness techniques, such as meditation and deep breathing exercises, help individuals focus on the present moment and cultivate a sense of inner peace. These practices can help reduce the impact of anxiety and depressive symptoms by promoting relaxation and reducing the tendency to ruminate on negative thoughts. Additionally, mindfulness techniques can improve emotional regulation and increase resilience in the face of stressors. Relaxation techniques, such as progressive muscle relaxation and guided imagery, can also be beneficial for individuals with MADD. These techniques help individuals release tension in their bodies and calm their minds, leading to a reduction in physical symptoms of anxiety and an improvement in overall mood. By incorporating these relaxation techniques into their daily routines, individuals can create a sense of calm and tranquility that can help them better manage their symptoms. Overall, mindfulness and relaxation techniques are valuable tools for individuals with MADD as they provide practical strategies for reducing stress, improving mood, and promoting overall well-being. By incorporating these techniques into their daily routines, individuals can enhance their ability to cope with the challenges of living with MADD. ## Lifestyle Changes for Managing Mixed Anxiety-Depressive Disorder Lifestyle changes play a crucial role in managing MADD symptoms and promoting overall mental health and well-being. By making positive changes to their daily routines, individuals with MADD can reduce stress, improve mood, and enhance their ability to cope with anxiety and depression. Regular exercise is one lifestyle change that can have a significant impact on managing MADD symptoms. Exercise has been shown to reduce symptoms of anxiety and depression by releasing endorphins, improving sleep quality, and reducing stress levels. Engaging in regular physical activity can also provide individuals with a sense of accomplishment and improve their overall self-esteem. Healthy eating habits are another important lifestyle change for managing MADD. A balanced diet that includes plenty of fruits, vegetables, lean proteins, and whole grains can provide essential nutrients that support mental health. Avoiding excessive caffeine, alcohol, and processed foods can also help regulate mood and reduce anxiety. Adequate sleep is essential for managing MADD symptoms. Poor sleep can exacerbate anxiety and depression, so establishing a regular sleep routine and creating a comfortable sleep environment are important steps for improving overall well-being. In addition to these lifestyle changes, engaging in activities that bring joy and fulfillment can also help individuals manage MADD symptoms. Hobbies, social activities, and spending time in nature can all contribute to a sense of well-being and provide a much-needed break from the challenges of living with MADD. Overall, lifestyle changes are an important component of managing MADD symptoms as they provide individuals with practical strategies for reducing stress, improving mood, and enhancing overall well-being. ## Support Groups and Peer Counseling Support groups and peer counseling can provide valuable emotional support for individuals living with MADD. These resources offer individuals the opportunity to connect with others who are experiencing similar challenges, providing a sense of community and understanding that can be incredibly beneficial for managing MADD symptoms. Support groups bring together individuals with MADD to share their experiences, offer encouragement, and provide practical advice for coping with anxiety and depression. By participating in support groups, individuals can gain a sense of validation for their experiences while also learning from others who have found effective strategies for managing their symptoms. Peer counseling is another valuable resource for individuals with MADD. Peer counselors are individuals who have lived experience with mental health challenges and are trained to provide support and guidance to others facing similar struggles. Peer counselors can offer empathy, understanding, and practical advice for managing MADD symptoms based on their own experiences. Both support groups and peer counseling provide individuals with MADD the opportunity to connect with others who understand their experiences without fear of judgment or stigma. These resources offer a sense of belonging and validation that can be incredibly empowering for individuals living with MADD. ## Seeking Professional Help for Mixed Anxiety-Depressive Disorder Seeking professional help is crucial for individuals living with MADD. Mental health professionals such as psychiatrists, psychologists, social workers, or counselors can provide valuable support in diagnosing the disorder, developing treatment plans, and offering ongoing care. A mental health professional can conduct a thorough assessment to determine an accurate diagnosis of MADD based on an individual's symptoms and experiences. Once diagnosed, they can work with the individual to develop a comprehensive treatment plan that may include therapy, medication management, lifestyle changes, and support resources. Therapy is an essential component of treatment for MADD. Cognitive behavioral therapy (CBT), interpersonal therapy (IPT), or other forms of psychotherapy can help individuals develop coping skills, challenge negative thought patterns, improve interpersonal relationships, and manage their symptoms more effectively. Medication management may also be recommended for some individuals with MADD. Antidepressants or anti-anxiety medications may be prescribed to help alleviate symptoms of anxiety or depression. A mental health professional can monitor medication effectiveness and side effects while making adjustments as needed. In addition to therapy and medication management, mental health professionals can provide guidance on lifestyle changes, mindfulness techniques, support groups, peer counseling, or other resources that may be beneficial for managing MADD symptoms. Overall, seeking professional help is essential for individuals living with MADD as it provides access to comprehensive care from trained mental health professionals who can offer support in developing effective treatment strategies tailored to an individual's unique needs. Seeking professional help for MADD is crucial because it allows individuals to receive the specialized care and support they need to address the complex challenges associated with living with MADD. Trained mental health professionals can offer a range of therapeutic interventions, such as cognitive-behavioral therapy, trauma-focused therapy, and medication management, to help individuals manage their symptoms and improve their overall well-being. Additionally, seeking professional help can also provide access to support groups and community resources, which can further enhance an individual's recovery journey. Ultimately, by seeking professional help, individuals living with MADD can receive the comprehensive care they need to effectively manage their condition and improve their quality of life. If you or someone you know is struggling with mixed anxiety-depressive disorder and is hesitant to take benzodiazepines, antidepressants, or other psych drugs, there are alternative treatment options available. In fact, a recent article on The Rehab discusses the difference between sobriety and recovery, shedding light on the various paths to healing and wellness. Understanding these distinctions can be particularly valuable for individuals seeking non-pharmacological approaches to managing their mental health. Check out the insightful piece [here]() for a deeper exploration of this topic. ## FAQs ### What is mixed anxiety-depressive disorder (MADD)? Mixed anxiety-depressive disorder (MADD) is a mental health condition characterized by symptoms of both anxiety and depression. It is not as well-known as other mood disorders, but it can significantly impact a person's quality of life. ### What are benzodiazepines, antidepressants, and other psych drugs? Benzodiazepines are a class of medications commonly used to treat anxiety and insomnia. Antidepressants are medications used to treat depression, anxiety, and other mood disorders. Other psych drugs refer to a wide range of psychiatric medications used to treat various mental health conditions. ### Why might someone not want to take benzodiazepines, antidepressants, or other psych drugs for MADD? Some individuals may have concerns about the potential side effects, dependency, or long-term effects of these medications. Others may have had negative experiences with these medications in the past. Additionally, some people may prefer to explore non-pharmacological treatment options for their mental health. ### What are some non-pharmacological treatment options for MADD? Non-pharmacological treatment options for MADD may include therapy (such as cognitive-behavioral therapy or mindfulness-based therapy), lifestyle modifications (such as exercise, nutrition, and stress management), and alternative treatments (such as acupuncture, yoga, or herbal supplements). It's important to consult with a healthcare professional to determine the most appropriate treatment plan. ### Can non-pharmacological treatments be effective for MADD? Yes, non-pharmacological treatments can be effective for managing symptoms of MADD. Research has shown that therapy and lifestyle modifications can have a positive impact on mental health. However, the effectiveness of these treatments may vary from person to person, and it's important to work with a healthcare professional to find the right approach for each individual. ### Is Xanax an Opioid? How Addictive is Xanax? URL: https://therehab.com/is-xanax-an-opioid-how-addictive-is-xanax/ ## What type of drug is Xanax? Is Xanax an opiate or benzo? For medical professionals, this may seem like an unusual question. From the point of view of doctors and nurses, it is clear that Xanax is not in the opioid class of drugs or medications. However, for members of the public, the distinction may not be as clear. Xanax happens to be in the class known as benzodiazepines, or commonly known as benzos. Benzodiazepines also include medication such as Valium, Klonopin, Ativan, and Librium. There are many other drugs in this class, including Rohypnol, a benzo used for insomnia in other countries and illegal in the US. Rohypnol is also known on the street by the name, “ruffies.” This dangerous date rape drug causes drowsiness and blackouts. ## Xanax-like drugs tend to cause temporary amnesia in addition to sleepiness and sedation. In fact, all benzodiazepines have the potential to cause blackouts related to anterograde amnesia and retrograde amnesia. Long-term memories can be erased from before the drug was taken and after the effects have begun to wear off. For most Benzos, however, the dosage to achieve these types of amnesia is quite high. One benzo that is used commonly in the US in hospitals that causes amnesia at normal dosages is Versed, or midazolam. This drug is given before certain procedures, such as colonoscopies. In the case of Versed, the amnesia is a desirable effect because the patient can be awake and assist in positioning during the procedure and report discomfort, yet, they will most likely not remember the experience. ## Is Xanax an opiate like heroin or fentanyl? While both Benzos and opioids cause sleepiness and unexpected nodding off to sleep, they are very different drugs. Part of the confusion, in addition to the effects of sleepiness and sedation, common to both drug classes, is the forensic nature of the two drugs. When we read articles about drug seizures or overdoses, it is not uncommon to read or hear about Xanax and an opioid in the same case. When [heroin]( "Heroin Addiction Recovery Stories Podcast") or [fentanyl]( "Fentanyl Addiction Podcast") is the cause of an overdose, Xanax happens to be the most common secondary drug found in the victim’s system. Xanax is often found together with other street drugs, such as cocaine and methamphetamine. In fact, dealers often sell Xanax and cocaine together because it can help a drug user to come down and get some rest after a long run of using coke or meth and being awake for long periods of time. Unfortunately, cocaine and Xanax are also often found together in overdoses. ## What about benzos and alcohol? How dangerous is this combo? Similarly to benzos and coke, benzos and alcohol are another common combination. Mixing alcohol and Xanax may seem unusual because of their similar effects. Both are sedatives. In fact, benzos are often referred to as “alcohol in a pill.” Drug counselors typically say this to their recovering alcoholic clients to warn them not to replace alcohol with a prescription for alprazolam. Drinking on Xanax is very dangerous and can easily lead to Xanax and alcohol death due to respiratory depression. Xanax plus alcohol is a combination that should be avoided to prevent tragic Xanax alcohol overdose. ## A near-tragic story about Xanax and alcohol. Years ago, I was at a wedding and ran into an old friend whom I had not seen for years. We sat and talked for a while, and I realized that he was getting more and more drunk as the evening passed. He started to slur his words and forget his train of thought. At first, it did not make sense to me that my friend was getting drunk so quickly for the amount he was drinking. Then, I noticed that, every so often, he would pop a pill from a bottle in his pocket. I asked him what the pills were. They were Xanax. When I realized that he was mixing Xanax with alcohol, I went to the bartender and asked him firmly to stop serving my friend. The bartender gave me an angry look and did not speak at all. Fortunately, my friend survived that night of drinking on Xanax. He did pass out and I had to arrange for him to get a ride home with some other friends. Today, that friend no longer drinks or uses any drugs. ## What about Xanax for alcohol withdrawal or for opioid withdrawal? While it is possible that Xanax could be used to make the withdrawal from quitting alcohol safer and more tolerable, it is rarely, if ever, used. Librium is another benzo that is commonly used it detox facilities to facilitate [withdrawal from alcohol]( "How Long Does Alcohol Withdrawal Last?"), because has a long half-life and is considered to have less of an addictive quality. When it comes to opioid withdrawal, benzos are not usually necessary, but they can help early on with the detox process. With both alcohol and opioid detox, the doctor must be careful not to continue the benzodiazepine for too long, so the patient does not develop a physical dependence on it. ## Are doctors who prescribe Xanax psychopaths? Once, I was in a lecture at a medical convention and the doctor on stage lecturing about addicting prescription drugs made a statement that any doctor who prescribes Xanax is a psychopath. When he said it, there was an uncomfortable murmur from the crowd of doctors in the room. I believe that many of the doctors present were thinking that they prescribe Xanax to some patients for anxiety and the patients benefit from it. It’s hard to imagine that the entire room of hundreds of attendees were all a bunch of psychopath doctors. When the lecturer said, “I don’t know why any of you would prescribe Xanax,” a doctor next to me said quietly, “maybe because it works.” ## Is Xanax a narcotic? What does the word "narcotic" mean? The word narcotic can be confusing because its meaning has changed over time. The origin of the word is Greek and its original meaning refers to something that causes sleepiness. If this were our working definition, Xanax would definitely be a narcotic. There was a time in the past when narcotic referred more to opiates. When you said the word narcotic, people would think of heroin users on the streets, shooting up in a dark alley. Currently, the word narcotic refers to all drugs of abuse, including prescription and street drugs. In a police department, the narcotics division investigates all drug-related crimes, not only crimes involving heroin or drugs that make people sleepy. ## Is Xanax a controlled substance? Alprazolam, the generic name for Xanax, is a controlled substance in the United States. All strengths of Xanax, from the Xanax 0.25 mg tablets to the 2 mg white Xanax bars, are considered to have abuse potential by the federal government. The scheduling system for controlled substances goes from 1 to 5. Schedule 1 is a category containing drugs that the government has determined to have no medical use. This can be confusing, since cannabis is designated schedule 1, yet many states consider it to have medical use and allow for it to be recommended by doctors and doled out by dispensaries. Another anomaly in the scheduling system is cocaine. Because cocaine has limited medical use as a topical anesthetic, it is a schedule 2. Schedule 2 drugs have high abuse potential. Each level beyond 2, from 3 to 5, is considered to have less abuse potential. Most opioids are schedule 2. Suboxone, the drug used to treat opioid addiction, is a schedule 3. For all the concern over Xanax and people being addicted to Xanax, it is only a schedule 4. Xanax is not considered to have a very high abuse potential by the US federal government. ## Why is Xanax not as highly controlled as most opioids? There is not really an alprazolam high for people who abuse Xanax. The Xanax feeling is that of having the rough edges of life smoothed over, and all anxiety being tolerable or even absent. Symptoms related to anxiety, including OCD symptoms, may be lessened while on a benzo. The pleasurable feeling of euphoria that many people report having with opioids and psychoactive stimulants does not occur with Xanax and other benzodiazepines. While there are certainly people who misuse Xanax and even people who do get addicted to it, Xanax is not a highly addictive drug. It does not have the same effect on the reward center of the brain compared to highly addictive drugs, such as heroin and cocaine. ## What are some signs of Xanax abuse? If you are concerned that someone in your life is misusing Xanax and you believe that they may be addicted to Xanax, there are some signs to look for. While nodding off to sleep at unusual times, such as at the dinner table, is common for people using opioids, it is not too common with Xanax overuse. More likely, you will notice that a person who has taken too much Xanax will have slower reflexes and appear to be functioning mentally at a much slower rate than normally. ## Look for a slowing of the thought process and glazed eyes. It is as if you can see their mental processes working in slow motion. The gears in their head turn slowly in such a way that you can almost imagine hearing them grind away as the person in front of you tries to explain that they are not drugged. You may also notice that their eyes have the appearance of being glazed over. They will also appear to be very relaxed, with no stress about anything. ## Does it bother people to see other people not feeling the usual stress of modern life? A patient once confided in me that when they took excessive Xanax, it was to completely wipe out all anxiety. This patient explained that they felt their family was upset by it because people seem to get angry when someone is not feeling the stress of life as they feel it. Could there be truth to this, that we, as a society, view Xanax and similar drugs, with anger and suspicion because we do not like the idea of people going through life without the high level of stress that most of us feel? ## Psychotherapy and other medical treatments for anxiety must be considered. Still, the concern over Xanax misuse is justifiable, because most people can learn to handle anxiety without the need for medication. And, people who do need medical treatment for anxiety can learn to manage their symptoms by taking Xanax, or another benzo, as prescribed, in conjunction with psychotherapy. Additionally, there are other medications that can help with the management of anxiety long-term. For example, anti-depressants, such as Lexapro and Paxil, can help with anxiety symptoms. Doctors should keep in mind that Xanax alone is not always the best plan for treating chronic anxiety disorder. ## Is Xanax use harmful? There are reports that long-term use of Xanax can cause damage to the brain. On social media, there are vocal groups protesting the use of Xanax and other benzos because of serious dangers that go beyond what the FDA-approved literature reveals. While it is questionable that Xanax causes serious harm to the central nervous system, it is true that it can cause serious psychological and physical dependence. The longer a person takes Xanax, the more difficult it can be to stop taking it. ## Xanax withdrawal symptoms include seizures. Stopping Xanax suddenly, without tapering down gradually, can be life-threatening. Quitting Xanax too fast can cause a seizure. Some detox programs use anti-seizure medications to help patients quit Xanax without having to go through a prolonged tapering process. Interestingly, while opioids are much more dangerous than benzos, opioid withdrawal is less dangerous than benzodiazepine withdrawal. Taking Xanax can also be harmful in the sense that it is sedating and affects reflexes. Driving under the influence of Xanax is dangerous. Mixing Xanax with other drugs, including alcohol, is very dangerous. ## Should benzodiazepines be outlawed? If you have a loved one who is struggling with Xanax addiction, you may think that the best solution is to take all benzos off the market and make them illegal. However, before we start fighting to outlaw Xanax, we should acknowledge that it does have important medical uses, as do many other benzodiazepines. There are people who have severe anxiety disorders who function well while taking Xanax. In some cases, there are adults who have taken the medication for decades without any issues. For many people who take Xanax as prescribed, it improves their quality of life and improves their overall functioning. While we should be aware that Xanax is a drug with abuse potential, if we are concerned that a person is addicted to Xanax, we should consider the possibility that there are other drugs involved as well. While Xanax is not an opioid, it may be combined with opioids to potentiate the effects of the opioid, making the high more intense. ## How can we help people addicted to Xanax? People who abuse alcohol will mix in Xanax for the same reason, to get higher than they would with alcohol alone. Harm reduction for people who misuse Xanax should include education. By informing Xanax users of the dangers that can occur by mixing Xanax with other drugs and alcohol, as well as the dangers of taking too much Xanax, we may help them to make better decisions. While cutting back on Xanax may not resolve all of their drug use issues right away, it is a step in the right direction. Other ways to help include offering to take the person to a medical visit, taking them to a recovery meeting, helping them find a good recovery podcast, or even taking them to a detox program. ## Anxiety is a real medical condition. We should also acknowledge that Xanax is a prescription drug that is often prescribed for legitimate medical conditions. Anxiety disorders are real medical conditions. People who have severe chronic anxiety can not simply “snap out of it.” Medical treatment and therapy are often required to treat anxiety. If you suffer from anxiety and you find it difficult to function in your daily life, consider seeing your doctor to find out more about medical treatment options that are available. ### What Are Benzos (Benzodiazepines) and Their Risks for Dependence URL: https://therehab.com/what-are-benzos-benzodiazepines-and-their-risks-for-dependence/ Benzodiazepines are widely prescribed medications that affect the central nervous system and are commonly associated with anxiety relief, sleep support, and seizure control. While they play an essential role in managing certain mental health conditions, long-term or improper use can lead to serious risks, including dependence and addiction. In this blog, understanding how these medications work and how dependence develops is essential for anyone who has been prescribed them or is concerned about their use. ## Understanding Benzodiazepines and Their Purpose Often prescribed for anxiety disorder, panic disorder, and panic attacks, benzodiazepines work by calming overactive brain signals. They act on benzodiazepine receptors in the brain, enhancing the effects of a neurotransmitter that slows nervous system activity. This mechanism helps reduce distress, promote relaxation, and manage symptoms related to specific mental disorders. A prescribed benzodiazepine may also be used in medical settings for alcohol withdrawal, muscle spasms, or short-term sleep difficulties. In controlled, time-limited situations, benzodiazepine medication can be effective. Problems tend to arise when use extends beyond recommended durations or when dosage increases over time. ## Benzodiazepine Use and the Development of Dependence Regular benzodiazepine use can change how the brain regulates stress and calm. Over time, the body may adapt to the presence of the drug, leading to physical dependence. This means the nervous system begins to rely on the medication to function normally. As tolerance develops, some individuals require a higher dose to achieve the same effect. This pattern increases the risk of benzodiazepine misuse and benzodiazepine abuse, even when the original intention was therapeutic. In many cases, people do not recognize dependence until they attempt to reduce or stop the medication. ## Risks and Contributing Factors Several risk factors influence whether someone develops benzodiazepine dependence. These may include long-term prescriptions, prior substance abuse, co-occurring mental health disorders, or mixing benzodiazepine medications with alcohol or other drugs. Combining substances significantly raises the risk of overdose and other medical complications. Benzo addiction can also develop quietly, particularly when medications are taken as directed but for extended periods. This has led many clinicians to describe [benzodiazepines as the silent addiction epidemic,]() where dependence progresses unnoticed due to normalized prescribing practices. ## Withdrawal and Its Challenges Benzodiazepine withdrawal can be complex and, in some cases, severe. Symptoms may include heightened anxiety, sleep disruption, tremors, and sensory sensitivity. Severe withdrawal symptoms can involve seizures or medical emergencies, which is why sudden discontinuation is strongly discouraged. The experience of withdrawal varies depending on dosage, duration of drug use, and individual health factors. Benzodiazepine overdose risk also increases when individuals attempt to self-manage dosage changes without medical guidance. Clinical discussions around[ benzodiazepine dependence podcast tapering strategies]() often stress the importance of slow, structured reduction plans. ## Broader Impact on Mental Health Dependence on benzodiazepines can complicate existing mental health conditions. While the medication may initially ease distress, long-term use can worsen emotional regulation and increase vulnerability to relapse symptoms. This cycle often overlaps with substance use disorder and broader substance use patterns, making recovery more complex. Research published across the psychiatry fields, including journals such as J Clin Psychiatry and J Psychiatry, continues to examine how long-term exposure affects cognition, mood stability, and emotional resilience. ## Treatment and Recovery Considerations Effective benzodiazepine addiction treatment focuses on safety, gradual reduction, and comprehensive care. Tapering protocols are often combined with behavioral therapy to address both physical dependence and underlying emotional drivers. Short-acting medications deserve special attention, as highlighted in [triazolam dependence short-acting benzo dangers,]() where rapid onset and offset can intensify withdrawal cycles. Recovery planning may also address overlapping risks discussed in[ Z-drug dependence beyond benzodiazepines,]() particularly for individuals prescribed sleep medications. A well-structured treatment option may involve addressing drug addiction, drug abuse, or substance abuse while restoring healthy coping strategies. ## Moving Toward Informed Decisions Benzodiazepine treatment can be appropriate when carefully prescribed and closely monitored. However, awareness of benzodiazepine use disorder, dependence, and misuse is critical for preventing long-term harm. Education empowers individuals to recognize early warning signs and seek support before complications escalate. Evidence-based [harm reduction for benzodiazepine tapering strategies emphasizes]() individualized care rather than abrupt cessation. ## Final Thoughts Benzodiazepines can be effective when used appropriately, but long-term use carries serious risks, including dependence, withdrawal complications, and challenges to mental health. Understanding how these medications affect the brain, recognizing early warning signs, and learning about safe treatment approaches can help individuals make informed decisions and seek support before dependence escalates. At The Rehab, we recognize how deeply addiction and mental health are connected. Through thoughtful conversations and lived experience, the [best addiction recovery podcast]() shares meaningful discussions on dependence, withdrawal, and treatment across substances. Our recovery podcast list also includes insights on [heroin addiction](), [OxyContin addiction](), [fentanyl addiction](), [hydrocodone addiction](), and [hydromorphone addiction](). Contact us to learn how we support individuals and families through reliable education and recovery-focused resources. --- ## Opioid Dependence & MAT Treatment > Suboxone, buprenorphine, MAT, and opioid dependence treatment content. ### Lewis Nelson: The Art and Science of Buprenorphine MAT Induction URL: https://therehab.com/lewis-nelson-the-art-and-science-of-buprenorphine-mat-induction/ [spreaker type=player resource="episode_id=55024568" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] ## Meet Dr. Lewis S. Nelson: A Leader in Emergency Medicine and Medical Toxicology Dr. Lewis S. Nelson is an esteemed expert in Emergency Medicine, Medical Toxicology, and Addiction Medicine. Currently, he serves as the head of the Emergency Medicine department and is the Chief of Medical Toxicology. His influential work has made significant contributions to key organizations in the medical field, including the American Board of Emergency Medicine and the Accreditation Council for Continuing Medical Education. ## Exploring Opioid Addiction and Buprenorphine Induction In our chat, we delve deep into a critical issue - opioid addiction - and the innovative strategies employed by doctors to tackle it. One such method, known as "buprenorphine induction," plays a significant role in our discussion. Dr. Nelson sheds light on how using different doses of buprenorphine is ushering in a new era in the treatment of opioid addiction. We'll also examine the advantages and pitfalls of these new-age methods. They’ve gained particular importance today, as most street drugs contain [fentanyl]( "Fentanyl Addiction Podcast")– a drug that is stored in fat cells and behaves differently from other opioids. ## A Wealth of Experience and Unparalleled Insights Dr. Nelson boasts extensive experience advising prestigious national groups like the CDC and FDA. He's also a key contributor to the widely recognized textbook, "Goldfrank's Toxicologic Emergencies." His hands-on experience caring for patients in the Emergency Room and his advisory role with the New Jersey Poison Information & Education System provide him a unique, patient-focused perspective on this complex issue. ## Understanding Buprenorphine's Role and the Importance of Long-Term Care In this episode, we will cover a wide range of topics - from how buprenorphine is used to replace powerful opioids like fentanyl to the challenges involved in managing withdrawal symptoms. Dr. Nelson's insights underscore the necessity of a comprehensive approach to opioid treatment, how different drugs can yield different success rates, and why consistent, long-term care is paramount for patient recovery. ## Tune in For a Thought-Provoking Discussion Whether you're a medical professional looking to expand your knowledge or a curious listener eager to learn more about the unfolding narrative of the opioid crisis, this episode is for you. It promises to be enlightening, informative, and thought-provoking. Don't miss out on this pivotal conversation with Dr. Lewis Nelson. **Transcript:** Lewis Nelson, M.D. [00:00:00]: Yeah. Mark Leeds, D.O. [00:00:03]: Dr. Lewis Nelson, welcome back to the podcast. How are you today? Lewis Nelson, M.D. [00:00:07]: I'm good, thanks. And thanks for having me back. Mark Leeds, D.O. [00:00:10]: Thank you. And I just want to introduce you. You are the chair of emergency Medicine at Rutgers New Jersey Medical School and board certified in emergency medicine, emergency medicine, toxicology and addiction medicine. Is that correct? Lewis Nelson, M.D. [00:00:30]: That is right, yeah. Mark Leeds, D.O. [00:00:31]: And I just wanted to say that I previously had dr. Lloyd Setterer had been on the podcast a while back, and I told him that we had done an interview and that we were going to talk again. And he was really impressed. He's like, how do you even get Dr. Nelson Nelson on the podcast? Lewis Nelson, M.D. [00:00:51]: Wow. You have to ask? Mark Leeds, D.O. [00:00:54]: Yeah. So you are clearly a recognized expert in the field of emergency medicine and addiction medicine, and it's really a pleasure to be able to speak to you and share this with people. Lewis Nelson, M.D. [00:01:07]: Well, thanks for that, and it's my pleasure. I really do enjoy talking with you about this stuff. Mark Leeds, D.O. [00:01:12]: Thank you. Just before turning on the recording, we were talking and we were going to discuss today the induction with buprenorphine. Induction meaning, like, when you start taking buprenorphine, like, a person who's been taking opioids, like fentanyl, heroin, oxycodone are one of many different opioids that can be misused, or even if they're not being misused, for whatever reason, a person wants to or needs to get off of an opioid. And a good solution is buprenorphine, which a lot of people know as suboxone. That's kind of like the Kleenex genericized word for buprenorphine. But, yeah, there's a difficult transition for some people going from the opioid to the buprenorphine, and they call that induction. And to me, I have kind of a model in my head of how that works. But when you start I start explaining it to people, it always comes out sounding more complicated than it should. How would you describe the induction process? Lewis Nelson, M.D. [00:02:11]: Well, I think what we're really doing is we're transitioning somebody, whether it's methadone or buprenorphine, for that matter, from a low quality, street bought opioid to something that's pharmaceutical in nature and very predictable in quality. We are, in a way, replacing one opioid, one dependence for another. We know that. I mean, I think people sometimes frame this as one addiction for another, which is a mischaracterization. But we are really replacing an opioid that you buy on the street or from someplace that's not a pharmacy with something of high quality and very predictable content. The advantage of these two medications in particular is that they're able to do what opioids do to you to prevent you from withdrawing. And they're not particularly psychoactive. So at least with buprenorphine, for sure, you don't really get high. So the push to continue to use it, chasing the elusive high, goes away. Now, methadone is a little bit more psychoactive than buprenorphine, but not necessarily in the same way that heroin or fentyl are. And that has to do with the pharmacology of the drug. But I think really that's what we're doing is we're giving people an alternative to continuing to use street bought drugs in order to prevent themselves from withdrawing. Remember, as you know, many of these people stop getting high the same way they used to when they first started using heroin or fentidyl. And now their entire reason to continue to use opioids is to prevent themselves from withdrawing. Mark Leeds, D.O. [00:03:57]: Yeah, that's a big part of it, that terror of fear of withdraw. And I've personally never been through it. And from hearing it described by people, I think it's something that we have to take seriously that I don't think if someone says to a person who's addicted, you deserve this, you just have to go through it, suffer through it, or rehab programs that make them go through a really uncomfortable withdrawal period. I don't think we can really imagine how bad that is without having gone through it. And it sounds really terrible. And there's a lot of different symptoms. There's chills, there's depression, anxiety and muscle aches. I've heard it described in fact, Rush Limbaugh had described it on a talk show. He said it's like the flu times 1000 or something like that. But I think it's probably even worse than that. The one symptom that really scared me thinking about it was muscle cramps, like leg cramps, because I hate those. And just the idea of having severe and then a lot of people don't like the restless leg, their legs kicking around uncontrollably. So yeah, it's a really uncomfortable, horrible thing for a person to go through and that's a big part of it. People just don't want to suffer and feel that. Lewis Nelson, M.D. [00:05:18]: I would agree totally. And I think that what you've just described nicely as physiological dependence, which are the physical manifestation of withdrawal. There is that whole component of psychological dependence and withdrawal which is also quite terrifying of the craving and anxiety and compulsive need to go and procure more drug in order to prevent the withdrawal. So those two combined are quite daunting. And when you speak to people, this whole idea avoiding being, quote unquote, dope sick is what drives them to continue use drugs in many cases. Mark Leeds, D.O. [00:05:54]: Yeah, and that's one of the difficult things. We have the three drugs that we can use for treating opioid dependence the naltrexone, buprenorphine and methadone. And the way it seems to work, methadone is the easy one. Let me know if you have to take a break for a second. Methadone is the one relatively easy to start that a person can start that the same day. You can take fentanyl on a morning, then go into the methadone clinic and take methadone that same day. And the transition is fairly quick. But then the downside is now you're stuck going to a methadone clinic every morning indefinitely and then you have the next one buprenorphine, where you have a relatively short transition, but not dangerous, but uncomfortable. The person has to go and withdraw for usually 18 to 24 hours. With fentanyl, it can be longer. So there's a more difficult transition than methadone, but the benefit is now you can see it long term, see a doctor monthly and much easier. You can go on vacations and have a lot more freedom. And I think it's a better experience. Like you were saying that methadone is more psychoactive. And most of my patients describe buprenorphine as they feel as if they were never addicted. They don't feel sedated, they don't feel like it affects them mentally. They are able to function and do their jobs and take care of their families. And it's as if they were never even on a drug to begin with when they're taking it. And then you have naltrexone, which I haven't had a lot of success with that. With opioid addiction, the transition is more difficult. They have to be like a week or two or something like that free from opioids to be able to start naltrexone. And I know Vivitrol was promoted a lot, and maybe it still is being promoted as being a great treatment, but I haven't personally seen a lot of success with that, although I think there's some new implants that might work really well. I'm not sure about that. Lewis Nelson, M.D. [00:07:57]: Well, I would agree. I think the naltrexone has a bit of a niche following. You need to really want to not be using opioids at all. The transition period, as you've said, is quite difficult. You have to truly be off opioids, both sort of, so to speak, detoxified from them and then maintain a period of that ten days or so where you can't use, despite all the cravings, any opioid. What then of course occurs is you get the naltrexone injection, which will prevent any of the opioids you use from causing any psychological effect. The craving may still be present and you have to be really willing to not use any opioids ever. At least in the 30 days of that drug that you've just got injected. It's you a psychoactive. I mean, the daily use of oral maltrexone is probably not going to be very effective for that reason. Most people are not going to be able to not use opioids and follow their cravings. It's just that they're that intense. So people who have a good for example, if you're threatened to lose your job, if you use opioids, you might be willing to take naltrexone or get divorced or have some other major life impact if you continue as opioids. Many people might agree to do that. The problem too, with naltrexone is it's said to take away some of the other pleasurable aspects of life because some of the things we normally gain pleasure from, some of those effects are mediated through endogenous opioid release as well as dopamine and other things. So there does tend to be a little bit of a blunting of some of the pleasurable parts of life. Now, again, many people are willing to do that, and it's a very effective drug if you're able to take it. But you're right, the other two are much more user friendly. They do tend to have different patient populations in whom they're successful. The commitment to go to an outpatient treatment program for methadone is real, but many people like that medication because it is the easiest transition to because you can start it exactly as you said, the day you decide you want to stop using street bought drugs, whether it's heroin or fentanyl or Oxy or anything else. Now to talk about buprenorphine because I think it's probably it's my go to opioid treatment drug or my my go to MoUD, right? Medication for opioid use disorder. Because it really is the easiest from a user friendliness perspective, because you can get it by prescription anywhere. I mean, from any physician or prescriber. And you can get it filled at a pharmacy. And while not all pharmacies carry it for political and other reasons, it's generally pretty acceptable. Methadone, of course, requires you to go to an OTP, which are limited in number and not always available depending on where you live. Some people have to drive many, many miles to get to one and have to go on long waiting lists in order to get into one of those clinics. We spend a lot of time and as you know, I work in an emergency department, but I also work in an outpatient setting and an inpatient setting. We spend a lot of time trying to get people induced or initiated on buprenorphine without having to go through that initial withdrawal process that you talked about. There are multiple different ways that we approach that. I mean, the classic way is you wait till you withdrawal score on the cow scale is eight or 13 or something elevated, and then you give them buprenorphine and it blunts the withdrawal. And in a model that works very well in practice for the reasons you've already made so clear, nobody really wants to withdraw. They want to transition like you do on methadone, from one substance right onto methadone. With buprenorphine, it's harder to do that. But there are two models that we use to get that done right. We call them, I like to call them micro dosing and macro dosing. The one thing I would say, and we could talk about that if you like, but the one thing I would say is that the conventional model of using a two milligram or a four milligram dose off the bat is probably the worst model to use during the current climate of fentanyl use. When they were studied back around 2000 2002, when buprenorphine was first approved in the United States, there was essentially no such thing as fentanyl. We didn't really start seeing that in earnest until around 2013. So back then, everybody was using an opioid, was using oxy or hydrocodone, oxycodone, hydrocodone or heroin and pharmacologically, those drugs are very different, even though they're opioids than fentanyl. And the transition from those opioids, heroin, oxyhydro, and drugs like that to fentanyl has really required us to change the way we use buprenorphine and maybe even the way we use methadone to some extent. It might also have changed the way we use altrexone, although we use it so infrequently. But the washout period, so to speak, for fentanyl is longer than it is for oxy and heroin. So it does change it. But for the other two in particular I'm sorry, for buprenorphine in particular, the mechanism by which we start so many buprenorphine had to change the old model, the classical model that was FDA approved does not work. Mark Leeds, D.O. [00:13:39]: Yeah, that's a really important point to make. And you had explained to me before, I had thought that this issue with fentanyl was something unique to fentanyl analogues that were not regular fentanyl, fentanyl from China. That is, I think, a little bit different molecularly, or it may be. But you would explain to me that this is actually a property of fentanyl in general. Like, if I went and took a vial of fentanyl from the operating room and used it every single day, I'd have the same problem that it gets sequestered in fat cells. It gets stored in the body where other opioids don't get stored in the body. And then when you try to quit and you're waiting for that ideal time of like 18 to 24 hours or whatever it is to start your buprenorphine, that time really drags out to maybe 48 hours, 72, maybe even longer with fentanyl. Lewis Nelson, M.D. [00:14:31]: That is definitely part of the issue. And all of the fentanyls, whether it's fentanyl or any of the analogs car, fentanyl or fennel, fentanyl or fluorfentanyl, all of them are lipophilic, which means they like the fat, and they sit in your fat. Even if you're thin, you still have fat. And they leach out over time, causing your blood levels of fentanyl to be maintained. Even when you're not using. With heroin, it doesn't do that, right? The heroin is metabolized to morphine. Morphine doesn't store in your fat. If you continue to use it, you go up and down your blood level up and down with each use. But when you're not using, your blood level is pretty low. It can approach zero. Whereas with fentanyl, even when you're not using, assuming it's not a single dose that you've used, but you've used it over a period of time, so you've built up fat stores. When you're not using, you're still maintaining an elevated blood level of fentanyl. And what that means to your brain is that it's continually the receptors, the opioid receptors, are continually bathed in opioid. So they develop deep, deep dependence. They change, they adapt to the continued presence of the opioid, so that when you take more drug, you're more resistant to it, more tolerant to it, and when you stop taking drug, you have a lot more withdrawal associated with that discontinuation. So it simply stated, the withdrawal syndrome and the difficulty in starting on buprenorphine in particular, or analogously, the withdrawal that's initiated by Naloxone when people get it, is worse with fentanyl and the fentanyl analogs than it was and still is with heroin or the prescription opioids like Oxycodone. So really, Fentanyl and its analogues have been a game changer. And there's a new class of drugs out there, the nitizines, which are fentanyl like and increasing in prevalence. If you look, each state does their own analysis, and within states there's different regions, of course. But I could tell you, in my state in New Jersey, the latest data I saw was that of the fentanyls that we see, 75% of them are plain old fentanyl and the analogues are only 25%. They are changing all the time and you never know what you're going to get and you never know the concentration of any of them in the product you're going to get. But the amount of drugs that we see that contain only heroin and no fentanyl or analogues is below 3%. So everything has fentanyl in it and some have only Fentanyl in them. Mark Leeds, D.O. [00:17:20]: Yeah. And it makes sense that they're doing that. I'm sure that fentanyl is cheaper and easier to get than heroin. Lewis Nelson, M.D. [00:17:31]: Exactly. From a marketing perspective, it's a windfall profit. Right. It's much less to manufacture and purchase, import and things like that. And then there's a markup on the street because it's so potent, you need such tiny little amounts in the sample you're selling somebody that there's a big profit margin there. Mark Leeds, D.O. [00:17:52]: Yeah, I wanted to talk about the micro dose and macro dose induction. I thought the idea of the macro dose induction, like, where a person and it sounds like it's great for the emergency department, especially if someone comes to the hospital and they were taking fentanyl and maybe they're withdrawing a little bit and you want to start them and you can't keep them there for one, two, three or five days. You need to do something with them probably in the next 24 hours or so or less, instead of saying. We're going to start you with 0.5 milligrams or two milligrams or whatever you say. Well, let's start you with 24 milligrams or 1624, maybe even 32, and completely block all of your opioid receptors. And I actually have I have a friend who has been doing really well on buprenorphine for years and we talked about this and I told him we were going to be having this conversation and he said, oh, I can tell you what happens. I've tried that. He said, I took 24 milligrams once in the early days when he was trying to get clean or get opioid free, and he took, I think he said it was 24 milligrams and he said it was torture for 12 hours. He said it was the worst withdrawal for 12 hours. He wished he hadn't done it, but then there was nothing he could do because his receptors were all blocked. And he said about 12 hours later he felt fine, the buprenorphine took over and everything was fine after that. I don't know if that's a typical experience. Lewis Nelson, M.D. [00:19:20]: Yeah, I do see that. I think there's a little when you speak to people that do this a lot, there's some variable experience which may be regional and whether it's regional because of the drug supply or because of the expectations of the patients, in some places, buprenorphine precipitate withdrawal is a known entity and people are very fearful of it. And I do think there's a big psychological component to how that happens. And in some areas people don't really know much about it. It's not something they think about. So where I am, I don't really see a lot of. But precipitate withdrawal, even though we have a high fentanyl burden here in my region, but yeah, 80 miles down the road in Philadelphia, it's a completely different world. And there seems to be either two populations of drugs that people are using or two different mindsets of the population. So I would say that about 80% of the people who I use macro dosing for do not develop any signs of precipitated withdrawal. And these are people and I usually start with 16, but I quickly give either eight or 16 more and I get up to 32 pretty quickly. I would say that most of them transition pretty easily. I either do it before they withdraw, particularly if it's heroin or methadone that they're trying to transition off of. Those transition off fairly well, or oxycodone some of the non fentanyls. Now, again, we don't see a lot of those people anymore because the street drug supply is almost completely containing fentanyl. But when we did see those drugs much more prevalently, the macro dosing model works really well and we would have almost no precipitated troll. Now I'd say I see probably about 20% of my patients who we use macro dosing on develop a precipitatoral syndrome. And you're right, those that do develop it 12 hours later are chilled and they feel fine. But it is a daunting period of time to go through. The ability to predict who's going to develop respiratory is essentially nonexistent. I can't tell you based on your age or your race or even the amount of drugs you tell me you use or the type of drug short of if you really didn't use any fentanyl, we really can't tell who's going to develop it and we can't develop how severe it's going to be. But the paradoxical treatment for precipitated withdrawal from buprenorphine is more buprenorphine and we've gone up to 64 milligrams. And even then, sometimes we have people that don't get better. But as you've already said so nicely, they do go through a pretty terrible 12 hours. But then they calm down and everything becomes peaceful again. But I would agree that if I knew who those 20% of people were, I'd be able to avoid them in the emergency department. It's probably the most practical way to do things on the inpatient side or in a population in the Ed who has a support system, who are able to be compliant with a little bit more of a complicated regimen than here's a big dose of buprenorphy taken. Now, I do like I think I prefer the macro dosing model because it's almost assured not to cause precipitator withdrawal. And in that model, we start with very small doses, depending on what exactly we're using. To begin. We start with somewhere in the range of a half a milligram. If you have the strips, the films, it's easy to cut them if you don't. Some people take a two milligram buprenorphine tablet and just swallow it. Because we know the bioavailability of buprenorphine, the amount that actually gets into your body after swallowing it is pretty limited, about ten or 15 or 20%. So we know that two milligram dose is going to only provide you with less than half a milligram systemically. Some people like to use transdermal or transducal patches to do this. I don't usually do that in my practice, but some do. But the small dose, and then you repeat that in a few hours and a few hours more. So at the end of the day, you've given them about two milligrams. And then the next day you start at one or two milligrams and you build up a little bit more that day. So you maybe get to either two or four milligrams at the end of that day. Or you could even give two milligrams that whole day. And then the next day, depending on how rapidly you want to do this, you increase it a little more. Or what we'll usually do now is a three day titration upwards. So it'll be half a milligram approximately the first day to the second and eight or 16 the third. And we've had pretty good results. There are other models which are five or seven day papers. They're really Escalations or titrations, and they all have, I think, pretty good results. As an emergency physician in the population I deal with where two inpatients do a seven day taper. I think writing it out on a piece of paper and trying to explain it to most people is difficult. Whereas the three day I say taper, I should keep saying titration or escalation. The three day works pretty well, and the risk of precipitation is exceedingly lower than it is with macro dosing. But I like macro dosing because it's so quick. And if you're willing to take the risk, and I tell people that there's a risk, but it's very different than it being enculturated in the group psychology of buprenorphine. Me just telling somebody this is a risk, it doesn't usually happen. 80% chance it's not going to happen. It's very different than oh my God, everybody gets it. So it works where I am and I have pretty good results and the data out there, depending on what you read, supports exactly what I'm saying. Either nobody gets it or everybody gets it and it's everything in between. Mark Leeds, D.O. [00:25:23]: What you said about swallowing the two milligram tablet, that's really intriguing. I had never even thought about that. We always tell people, don't swallow, it won't work at all. But the idea that you could take a two milligram and just swallow it like a regular pill and you might get half a milligram out of that and maybe you could do like a very gradual titration or we could even call it like a reverse taper or something like that. That might even make it really easy. Tell someone, swallow one the first day, swallow two the next day. Spread out or maybe three the next day or something. And then at some point you say now you're going to take that same tablet and keep it under your tongue and do it differently. But yeah, that's really intriguing. Then I think that I've read there's a name for that, the micro dosing. But in some places I guess they do it as a I don't know if you'd call it harm reduction, but like while the person is still using their drug that you kind of use it to kind of sneak up on the receptors that you gradually increase the buprenorphine. While the person might still be using fentanyl in the streets and at some point when they get up to like twelve to 16 milligrams or something like that, then they can just stop their fentanyl because the receptors are blocked enough. Lewis Nelson, M.D. [00:26:38]: That is the way it's usually done, certainly with a compliant patient population or as an inpatient. And it's usually called a cross taper although it's not technically a cross taper because you're not tapering both drugs. You're increasing the buprenorphine dose while maintaining the full agonist opioid dose. And if it's street use you can tell the person to keep using and when you get up to eight milligrams of buprenorphine just stop using the street drug. When it's done as an inpatient it's a little bit more controlled because doctors and nurses manage to do the titration schedule. But that is certainly a model that people use. Either of those, whether it's the true cross taper where one's going up and one's coming down. So you're lowering the dose of the phalagus opioid while you're raising the dose of buprenorphine. Or the other kind of cross taper which isn't really a dual taper where you're increasing the buprenorphine dose, maintaining the full agonist opioid and then on day three, five, seven, depending on the method of titration you're using, you just stop the phalaginist. And I think more people do the latter where you maintain the phalaginist opioid while you're up tapering up titrating the buprenorphine. I think it's a little bit simpler, particularly if you're not in a hospital setting. Mark Leeds, D.O. [00:28:00]: Okay, yeah, that makes sense. And for those patients that just can't stop, or they're afraid to stop or they can't, it makes sense. Here's something you can do to get started. Even if you can't stop having the fentanyl dealer show up at your door every day, at least you can take again. Sounds like such a great idea. Just swallow this two milligram tablet. It's not barely going to do anything, it's not going to hurt you and do whatever you're still doing. Or hopefully you're not taking any more fentanyl either way and we just go from there. It does sound like a great idea. Lewis Nelson, M.D. [00:28:37]: That's right. I mean, remember, a lot of these are not strictly evidence based. There's not randomized controlled trials looking at these and comparing them. Many of these just personal practices that people have developed and we've all shared and tried. There's probably as many different mechanisms of doing this as there are people that do it honestly. One day we need a trial of 25 different models that we've all implemented and seeing which one does best. But these are really hard to do. Part of the problem is you don't know what people are using. We're comparing to some extent apples and oranges perhaps in areas of the country that don't have a lot of fentanyl. They're not seeing it. In some areas it's all fentanyl. Some people using milligram doses of fentanyl daily, many milligram doses. And some people are using smaller, much smaller doses. They haven't gotten quite up to the levels of tolerance that you need to have to use milligram dose of fentanyl. So we are going to have a hard time really getting to the root and really understanding what the best practice is. But I think the best practice is the one that you're comfortable with seems to work for your patients. Understanding that if it's not working, you have to have an escape route. If you cause precipitate withdrawal, what do you do? And even that, I'll tell you, even that there's a lot of practices on how to manage. I told you my practice for managing precipitated withdrawal is to give more buprenorphine. There are places where when you have precipitated draw, they just give you a lot of comfort meds, they'll give you dancetron, they'll give you clonidine, they'll give you some diazepam. And other places will give you fairly large doses of full agonist opioids. There are people I've spoken to, they'll give people two or three milligrams, two or 3000 micrograms of IV fentanyl to try to overcome some of the precipitatory induced by buprenorphine. So there are a lot of models even for managing that. That latter one scares me. It makes some conceptual sense. But even as somebody who. Practices in acute care setting. I don't love the idea of giving people ten or 20 times a therapeutic dose of fentanyl, even on a monitor. I just can only see bad things happening. But they do it and they seem to have what they claim and we all claim I mean, I don't mean to say that in a negative way, but they claim that they have very good results with it. Mark Leeds, D.O. [00:30:49]: Yeah, that is scary. I thought there was like that the law was strict about that, that we can only use naltrexone, buprenorphine and methadone and once you know a person's addicted, that there's a psychological dependence or addiction or opioid use disorder issue, that we're not supposed to use any other opioid other than buprenorphine or methadone for treatment. Lewis Nelson, M.D. [00:31:12]: Well, it depends what you're treating. And you're right. I think there are laws specifically about and these were the methadone maintenance treatment laws in the goes all the way back to the Harrison Narcotic Act in the 1914 or 17 when whenever that was, but certainly you're not supposed to do that. That being said, there's a difference between maintaining somebody on long term opioid use medications, MoUD, and treating withdrawal. And there's also a difference between doing something in a hospital and doing something as an outpatient. And there's also this whole relief valve of doing something to keep somebody in the hospital for other reasons. There's a lot of wiggle room around those laws and I think in the current climate where we're addressing as a nation discourage of the opioid cris, I don't see people coming after anybody very readily for doing something that makes medical sense. I mean, I'm much more concerned about the people that are prescribing 2000 oxycodone tablets for somebody who has knee pain or something. That's the problem. The problem is not a bunch of earnest doctors in emergency departments and and hospitals who are trying to overcome withdrawal. I just don't see those as equivalent. Mark Leeds, D.O. [00:32:43]: Yeah, that makes a lot of sense. I think I sent you a thing. There was a forum that I was involved in that was another interesting way of approaching it, that this one doctor said she had found the goldilocks range of treatment where she would give, I think, 0.5 milligrams of buprenorphine and then do the macro dose the second day. So I guess that's like another variation, another one of many variations of doing it. When you said macro dose, I think you had said that if you do macro dosing, you don't at one time give the big dose all at once, 24, 32 milligrams. You start with eight and see how they react and then give another dose after that. Lewis Nelson, M.D. [00:33:27]: I personally start with 16. Based on that's. What I do, I think eight is a little low. So if you think about it from a pharmacological perspective, right, what we're doing is we're replacing on the opioid receptor a full agonist opioid that's either still present and the person's not in withdrawal or slowly moving off and opening up additional opioid receptors as the drug is metabolized. So now they have low or moderate cow scores. So we're trying to put back on, in a fairly large quantity, a partial agonist opioid. We know it's going to have less agonist effect on the receptor than the full agonist does, but we also know that if you give more partial agonist, you can gain a small amount of additional agonism. In no way will a partial agonist ever become a full agonist, but you can maximize partial agonist effects because remember, what any drug does when it's on a receptor is it's on and off and on and off quickly. And when we talk about receptor affinity, what we're talking about is how much of a given time frame, say, a second, is the drug attached to the receptor versus off the receptor. So we know that drugs that have high affinity, like buprenorphine are on the receptor more in a given time period than a drug with low affinity, say, heroin or fentanyl. Heroin is not a good example. Morphine or oxycodone. So what we're doing is we're knocking off a low affinity opioid with a high affinity opioid, but then we're going to give more of that high affinity opioid to maximize the time that it's sitting on the receptor, thereby giving us relatively more agonist effect. So it's not just I've given 16 or I've given eight and I've filled up all the opioid receptors. I'm now overdosing the opioid receptors with buprenorphine so that I'm maximizing that partial agonist effect. That's why I think you have to probably start at 16 as a minimum. 24 is fine, and I'm not sure there's anything wrong with that. Some people might even start at 32. I don't think there's a problem with that. I just have done 16. I've had pretty good results with it. As we see people coming in with higher dependence and higher tolerance to fentanyl, we might need to raise that dose. I know that there is a big discussion that's ongoing and I don't use a lot of methadone in my population, but the standard dose of methadone historically to stave off withdrawal in the Ed was ten milligrams or 20 milligrams maybe. And now people are raising that to 30 or 40 milligrams just to kind of control the craving and the physiological withdrawal that people are experiencing. So that may be due to the increased tolerance and dependence associated with fentanyl. And that might be a real deal. There was even discussion about looking beyond the standard up titration of methadone. You start with your 30 or 40 and then you go up every three or four days by ten. People are now going up every day or going up by larger doses every day, because the dependence that people have due to these multimilligram doses of fentanyl is so deep that standard amounts of methadone just don't cut it anymore. And they're trying to do the same thing that I'm discussing or I'm describing. We're trying to maximize the agonist effect on the opioid receptor by bathing them. So as soon as one molecule leaves, instead of waiting for that molecule to reattach to the receptor, another molecule is there to take over. And that's a nice pharmacological construct to think through how these drugs work. And it is governed by affinity. This is not potency, and this is not about activity at the receptor. It's about affinity. How, quote, unquote tightly does that opioid bind? Remember, tight doesn't mean it's stuck on there. All of these drugs are on and off all the time. Mark Leeds, D.O. [00:37:49]: Yeah, okay. And I think I mentioned that to you before. I was under the impression at one point, based on a lecture I went to, that buprenorphine latches on the receptor and never lets go. And the receptors have, like, I guess, a three day turnover. The way I had imagined it was that one molecule is sitting on the same receptor until the receptor goes away. But that's not exactly how it works. Lewis Nelson, M.D. [00:38:12]: That is definitely not how it works. That would be an irreversible binding agent. We don't use those almost anywhere in healthcare. Mark Leeds, D.O. [00:38:21]: Okay, yeah, that makes sense. I actually read the way you're describing it kind of reminds me of a passage in Arnold Schwarzenegger's Encyclopedia Bodybuilding in reference to protein. He said he recommends more protein than what a nutritionist would recommend. And he said he called it the police theory or something. There's never a police officer when you need one on the streets. So if you just flood the streets with police officers, you always have one. And that's kind of the idea. Put more than you need in there so you never have to worry. There's always a molecule there when you need it. Lewis Nelson, M.D. [00:38:56]: Yeah, I like that analogy. It makes sense. It resonates. Mark Leeds, D.O. [00:39:00]: Yeah. Now, suppose doctors out there, they love this idea of macro dosing. That makes sense. It's relatively easy. And we start someone at 16, and now they call and they're like, Well, I'm having withdrawal. You just cause precipitated withdrawal. They're one of those 20% that are not ideal for that method. And you're like, okay, take another eight. Take another eight. And you get them up to 32 milligrams within a short time and they're still having the precipitous withdrawal. They're like, okay, doctor, I hate you now you really ruined my life. I'm now stuck with this for at least 12 hours, like you say. Then would it would probably be a good idea to give some of those comfort medications, like maybe Clonidine. I use gabapentin. Is that a bad idea? Because it seems to help people. Lewis Nelson, M.D. [00:39:47]: We're back to the same discussion we had before that there's as many different ways as there are practitioners who do it. I think that any of those works. I tend to use some anti nausea agents like dancetron. I like clonidine occasionally. Some people like benzodaseepines, which would be the equivalent in a way of gabapentin as sort of a sedative calming agent. I think those are all fine. You don't want to snow the person, right, because they may vomit and then aspirate. So it's not necessarily something that you want to do, but there really is no best practice to this. It's a little bit of personal preference. You might ask patient to share decision making. Do they just want to run through it, or do they want to have something to take the edge off? We have seen people, and I will be perfectly honest, who have gotten so sick from precipitate withdrawal, at least ostensibly that's where it's from, that they've needed to go to the ICU. They've gotten that hard to manage. They've literally required intubation and either super high dose opioids or sometimes we use dex metatomidine, which is kind of clonidine like in many of its aspects to reduce mitigate, the severe withdrawal. It's uncommon. It's case report sort of data, but we've seen it. I think we probably all seen some of these cases, and it does haunt me a little bit, but it's uncommon enough that I think it's a risk that's worth taking. And I don't know if there's something unique about those people, honestly, that we could even possibly identify going forward, but right now, we just don't know who they are. Mark Leeds, D.O. [00:41:32]: Yeah, I just remembered probably one of my very first cases of starting someone on buprenorphine, and he took it in the office. I was really strict back then. Nowadays, people are more experienced, and you can send a patient home and tell them I'm there if you need me, you can call me, text me anytime or whatever. But back in the beginning, you had to have the patient right in front of you taking it. And so this guy took his first dose, and he started getting sick. I'm like, well, you told me he hadn't used heroin for 24 hours. He's like, okay, fine. I lied. I used it this morning, and he started getting really sick, and we just weren't familiar with it. It looked really bad. He's shaking and sweating, and he looked really sick. So we called 911, and the paramedics came in, and they're willing him out on the gurney, out to the ambulance, and as he's going out, he's like, he looked really terribly he's like, please just give me another one. It's getting this stuff out of my system. He's like, I got one in my pocket. Just let me take it. And he probably was right. We just didn't know any better back then. Lewis Nelson, M.D. [00:42:32]: I tell you, there's a lot of great information in the street about pharmacology, and to really help us understand, that's why I say you got to talk to people and see what their experiences are sometimes they give us a lot of really good insight into what we need to be doing. Yeah. Mark Leeds, D.O. [00:42:48]: So one final thing. So now that we've gotten the patient onto buprenorphine, now they're stable, I prefer, at least in the first few months, more rather than less. Like 16 milligrams seems to be like what most people in my practice would be on. You know, some people are are strict. They're like, I don't want any more than eight because that's what I've heard is the right amount, and I don't want you over overdoing it with me. But 16 seems to be good, and it seems to be relatively easy to taper from 16 to eight when a person's ready for that. But I'd say the next scary thing after induction, getting a person on buprenorphine is when everybody around them starts saying, how soon are you going to get off of this? And some people think a two week taper is a good idea. Four week taper, get off of it fast. Other people might stay with it for a month, two months, or three months. And anyone from their family members to friends to coworkers to the guy at the convenience store down the street, like anybody they talk to will say, get off that stuff. You just traded one addiction for another, which we know is not true. And people quit the medicine too early or they feel like they're cured. They're like, I feel great. It's like I was never even addicted. I'm perfect. And I even skipped a day and I still felt good. That's the biggest danger. Would you agree that at least a year or so, some people might say six months? I'd say minimum a year for most people of staying on buprenorphine is ideal. Lewis Nelson, M.D. [00:44:15]: Yeah, I'm in the same camp as you. I don't think this is the kind of drug that you go on and off of on a regular basis. I think one of the nice parts about some of the Depot medications is that you don't have to do this on a daily basis and it maintains a much more consistent blood level. And there's a new one that was just approved, a new Depot formulation of epenorphine. But even if you take it every day, I still think that there's got to be a reasonable period of time that you're on. And I would say a year is certainly on the short end of what that is. And if you look at the methadone model of maintenance, and I personally like people northeast more than I like methadone, but that model is years of treatment. Now, there are many places, and I'll tell you, when we studied this a couple of years ago in my state of New Jersey, 70% of the opioid treatment programs, not the methadone OTPs, but the treatment programs that manage people with opioid use disorder. 70% of them were abstinence only. So you might get a couple of days of bute to be tapered, or methadone to be tapered off of it, and then you're going through counseling and therapy and this and that in order to maintain your sobriety, your recovery. I think that that's a problem. I mean, I think the evidence basis for medications is extremely strong and the idea of being on and I know people don't like the word opioid substitution because it harkens back to the substituting one addiction for another. But as I said at the beginning, you're substituting one dependence for another, but you're giving somebody a pharmaceutical, not a street preparation, and you're giving something that's legal and not illegal. So it really is a complete transition and concept, even though it's still an opioid. And I think that the absence based programs are probably destined to fail most people. Not that there's not a high failure rate with medications, but it's well lower a failure rate than it is for the other treatments that don't involve medications. Mark Leeds, D.O. [00:46:22]: Yeah, the people in the world of the Sinclair method for alcohol, like where they go on naltraxone and they keep drinking and they gradually taper off of the alcohol, they talk about something called the alcohol deprivation syndrome. That if you go cold turkey off of alcohol, like you would do so in most rehabs, that you can get off of alcohol and feel fine and somewhere down the road, maybe two or three months out, that you're going to suddenly, out of the blue, get intense cravings for alcohol. And that's where most people fail, that the rehabs graduate you as a success. They're like, look, you're alcohol free. Go home, you're fine. Go to meetings every day. But at some point, physiologically, for whatever reason, they have intense cravings. And that probably, I would assume, happens with opioids. Also, when a person goes to rehab cold turkey, they detox, and now they come out opioid free. Even if they're going to meetings every day and in a recovery program going to therapy, at some point down the road, they're going to deal with intense cravings. It could be a physiological opioid deprivation syndrome. Lewis Nelson, M.D. [00:47:20]: I think that's very reasonable. Undoubtedly, some people do find this way, just like people could stop drinking and not withdrawing, some people could stop smoking and not crave, but in general, without either good genes, good luck, really strong support. I think that it's destined to have a suboptimal outcome. And I would agree with what you just said. Mark Leeds, D.O. [00:47:43]: Yeah, that makes sense. Dr. Lewis Nelson, thank you so much for joining me, and I really enjoyed this conversation. It was great. Thank you. Lewis Nelson, M.D. [00:47:52]: It's my pleasure. And thank you so much for having me. It's been fun. Mark Leeds, D.O. [00:47:55]: Thank you. ### Sublocade Vs Suboxone: Is Sublocade the Same Thing as Suboxone? URL: https://therehab.com/sublocade-vs-suboxone-is-sublocade-the-same-thing-as-suboxone/ ## What Is Sublocade? How Does Sublocade Work? Sublocade is a monthly injectable medication that helps to suppress opioid cravings and opioid withdrawal symptoms. The Sublocade shot, which contains the drug buprenorphine, is given just under the skin. It is also known as a subcutaneous buprenorphine injection. Some experts believe that extended release buprenorphine injections are the best way to reduce overall opioid abuse. Buprenorphine is an excellent medication for treating patients who are addicted to heroin, fentanyl, or any type of prescribed opioid medicine. Opioid pain medicine may include drugs such as [oxycodone]( "oxycodone"), OxyContin, Percocet, Vicodin, Norco, Dilaudid, and many more. Buprenorphine, as a partial opioid agonist, is less likely to cause severe drowsiness or respiratory depression, compared to other opioid agonist drugs, particularly mu opioid receptor agonists. ## Buprenorphine is a unique drug that both blocks and activates the opioid receptors at the same time, blocking opioid withdrawal symptoms and opioid craving. It is known as a mixed partial agonist/antagonist. Since the federal waiver requirement ended at the end of 2022, healthcare providers with a standard DEA registration are allowed to prescribe buprenorphine-containing meds to treat opioid dependence as part of a comprehensive medication assisted treatment plan. Some people refer to Sublocade as the Suboxone shot, because both Sublocade and Suboxone contain the same active ingredient, buprenorphine. Additionally, both Sublocade and Suboxone are manufactured by the same pharmaceutical company, Indivior. Suboxone differs from Sublocade in being an oral buprenorphine that is combined with naloxone. When Sublocade is injected by qualified healthcare practitioners, just beneath the skin, it goes in as a liquid from a prefilled syringe and needle. As the subcutaneous solution enters the living tissue, it forms into a solid structure. The solid form of injected, activated Sublocade can be felt beneath the skin. It was originally injected only in the abdomen, in one of four quadrants around the umbilical region. The current label also allows other injection sites. Sublocade feels almost like a peanut M&M in shape and size. ## Is Sublocade an Implant? While we think of Sublocade as an injectable buprenorphine, a liquid that is injected subcutaneously, beneath the skin, it does function as an implant. It becomes a solid matrix which releases medication steadily throughout the month. Before Sublocade treatment for opiate addiction was approved by the FDA, there was already an available buprenorphine implant on the market, used to treat addiction to opiate drugs and opioid medication. It was named Probuphine. The Probuphine buprenorphine implant may still be available in other countries, but it is no longer available in the United States as a treatment for opioid drug use problems. The probuphine implant lasted a full six months, but it had several drawbacks. First, it was only equivalent to 8 mg of buprenorphine daily. While many buprenorphine patients taper down to 8 mg during their first year of treatment, most start at a higher dosage in the first few months. ## Another drawback is that Probuphine had to be surgically implanted. The doctor had to be trained in a specially designed surgical procedure to place the four Probuphine rods deep, in the tissues of the tender upper, inner arm. Probuphine had risks of infection, scarring, nerve damage, pain, and allergic reaction. To make matters worse, [Probuphine]( "Probuphine") also had to be surgically removed after six months. With the removal, there was a risk that the rods might break or migrate, making them difficult to find, requiring emergency medical attention. If the healthcare provider removing the rods could not locate all pieces, the patient had to go for ultrasound or MRI immediately to locate the missing Probuphine pieces. With removal, the patient again risked nerve damage, scarring, pain, or serious infection. ## Sublocade, on the other hand, is an implant that is injected as a liquid, becomes a solid, and then dissolves over time. There is no surgery required at all. In addition to these advantages, Sublocade is roughly comparable to a daily Suboxone dosage of 16 mg or more, which is the starting point for the majority of opioid use disorder patients. Sublocade solves many of the problems of Probuphine. You might think that the shorter time period of Sublocade’s activity compared to Probuphine’s full six months would be a disadvantage. Yet, visiting with the doctor on a monthly basis is recommended for ideal support and counseling. Psychotherapy and group therapy are also helpful components of a strong MAT program to help people recover from addiction to opioid medicines and street opioids. With Probuphine, there was the risk that patients might not return for re-evaluation for six months, knowing that they already had medication in their system. The need for a monthly shot helps to reinforce the need for monthly medical visits. How does Sublocade turn into a solid implant in the body and release medication for a full month? Sublocade uses a special, patented technology that is licensed from a company named QLT. The delivery system provided by QLT is called Atrigel. The Atrigel delivery system is what makes the Sublocade injection work as a monthly buprenorphine treatment. ## Atrigel is what makes Sublocade turn into the solid, egg-shaped medication delivery system, once it comes in contact with living tissue. It also works to release the medication contained within at a steady pace over the period of a month. Actually, the Sublocade shot works for over a month. When a patient returns for their next shot, their previous [Sublocade injection]( "Sublocade injection") is still working. The overlap of one buprenorphine injection wearing off as the next one is given makes it possible for the patient to maintain steady levels of buprenorphine in their system throughout the month. Some addiction specialists, and patients, are excited about the possibility of Sublocade being used for a buprenorphine taper. When a patient is ready to reduce their buprenorphine dosage, they may be able to get a single Sublocade shot, rather than measuring out smaller Suboxone Film or tablet pieces over time. So far, the experience of Sublocade doctors and Sublocade patients shows that the Sublocade taper may actually work for some patients. Of course, further research is required to see how well the buprenorphine/Atrigel combination might work for helping patients to taper and complete buprenorphine therapy. ## Is Sublocade the only available subcutaneous buprenorphine injection? When this article was first written, Sublocade was the only available monthly buprenorphine shot in the United States. There is injectable short-acting buprenorphine, known by the brand-name, Buprenex, but it is not approved for treating opioid dependence, and even if it was, it would be no more effective than sublingual buprenorphine films or tablets. A short-acting, daily buprenorphine injection may have been considered at one time as a viable way to treat opioid addiction. Before Subutex sublingual pills, and Suboxone sublingual strips were invented, the Buprenex shot was already available as an injectable buprenorphine. Why would doctors want to avoid prescribing or administering a short-acting, daily shot instead of Suboxone films under the tongue? One issue is that injections hurt and they introduce the risk of infection with each shot. Another significant issue is that many opioid users associate needles and injections with illicit opioid use. For example, many heroin and fentanyl users shoot up their drug of choice with a syringe and needle. Addiction experts would consider injecting buprenorphine regularly to reinforce unhealthy addiction-related behavior. Needles and syringes should be avoided in addiction treatment, particularly opioid addiction treatment. You might say that Sublocade uses a syringe and needle, so why is that fine to use with opioid-addicted people? The difference is that Sublocade is administered by a doctor in a medical setting, and it is only once per month. What about that other Suboxone shot? ## There is another buprenorphine subcutaneous injection that is long-acting. It is named Brixadi. Brixadi is a shot that lasts either a week or a month, depending on the dosage and administration. Brixadi has many advantages over Sublocade. For example, it does not have to be kept at cold temperatures. Brixadi was not available in the United States for several years while it went through the FDA approval process. The FDA approved it in 2023, and it is now available in the United States. ## Is sublocade better than suboxone? Suboxone, whether it is prescribed in the form of a pill or a strip, is always dissolved under the tongue. While the manufacturer drug information asks that doctors prescribe Suboxone as once-daily dosing, it tends to work better when dosed at least twice daily, for better 24-hour coverage. This means that Suboxone patients must place a medication under their tongue every day, at least twice, and wait for it to dissolve. While most patients are fine with this routine, it does cause issues for some patients. For a patient with small children, it can be difficult to find a few minutes at the same time each day to engage in the daily routine of keeping their mouth closed for several minutes, waiting for the buprenorphine to dissolve fully. Also, patients with busy work schedules who are surrounded by coworkers may have trouble getting away for those few minutes needed to take their medication. In most cases, it is possible to work around nearly any busy schedule. The patient can figure out what works best in their individual situation. Maybe the best time to take Suboxone is just after waking up in the morning. Or, it could be during a bathroom break. Another complication that comes up is traveling. How much Suboxone should a person bring on a trip with them? Just enough to get through the trip, or a bit extra just in case? ## Unfortunately, Suboxone is not easily replaced when it is lost. Doctors are wary of patients calling about a lost or stolen Suboxone prescription, films, or tablets. Pharmacists often will not fill an emergency prescription for Suboxone early, no matter what the excuse. What about dealing with the police? If a person is pulled over by a police officer and is found to have Suboxone films or Suboxone pills in their possession, will they get in trouble? This situation will vary in outcome based on the location and the individual officer. In some cases, police officers can be difficult when they find any kind of controlled medication on a person whom they have stopped. Sometimes, the officer wants to see the entire prescription in boxes or a bottle, with the full amount contained within, minus what would have been used up to that time. Cops have been known to do roadside pill counts and arrest people if the pills do not add up. Should people be paranoid about this potential situation? The best way to handle it may be to plan to take Suboxone only in the privacy of a person’s home, so there is no need to have it in the car. ## Sublocade does have a significant advantage over Suboxone in this situation. Because Sublocade is a monthly injection, there is no concern about carrying medication around ever. Once the Sublocade shot has been given at the doctor’s office, the patient is covered for a full month. There is never a concern about waiting for a pill or strip to dissolve under the tongue. Additionally, there is never a concern about carrying Suboxone around and worrying about losing it or having it get stolen. There will be no desperate trips to the doctor or pharmacy, asking for an emergency early refill. Not having to worry about getting stopped by the police in possession of Suboxone is also a relief for many patients. Suboxone patients often have a difficult past that they want to put behind them, which may have involved unpleasant interactions with the police. ## Where does Sublocade come from? Unfortunately, you cannot walk into your local Walgreens and pick up your Sublocade prescription. While this would be convenient, it is not currently possible. If Sublocade is not dispensed at the local pharmacies, how does a patient get it? Sublocade is shipped directly to the doctor’s office, straight from one of a handful of specialty pharmacies. Specialty pharmacies are pharmacies that deal in specific medications that are very expensive, and must be administered in a doctor’s office. Some of the specific pharmacies that ship Sublocade include Express Scripts Specialty, Briova Specialty Pharmacy, Accredo Specialty Pharmacy, and Walgreens Specialty Pharmacy. When a doctor’s office calls to order Sublocade, the pharmacy must verify the patient’s insurance coverage, copay assistance program, and they must verify the doctor’s eligibility to receive a shipment of Sublocade. They check to see that the doctor has an active medical license and DEA registration, and that the DEA registration is registered to the same practice address where the Sublocade shot is being shipped. In fact, they use several different verification portals to confirm eligibility of the Sublocade doctor. After the patient has paid their copay and agreed to have their Sublocade shipped to the doctor, and the doctor has submitted to the extensive vetting which occurs each time the one Sublocade shot is ordered for that patient for that month, the delivery may commence. Sublocade is usually shipped overnight, via FedEx or UPS. Does the pharmacy take any measures to ensure that the drivers and pilots who work for the shipping company are qualified to transport a controlled drug? Not likely. ## Are there many doctors who give Sublocade shots? Currently, there are not likely many doctors who administer the Sublocade monthly injection. In our area, prospective Sublocade patients have complained that doctors who were previously registered as Sublocade doctors are no longer giving the subcutaneous buprenorphine injections. In fact, there is a doctor who was hired by the Indivior corporation in our area to give a lecture about Sublocade, shortly after it came out. This particular doctor stated during her lecture that she would be switching all of her Suboxone patients over to Sublocade. She explained that Sublocade has a lower risk of abuse and diversion, compared to Suboxone. She implied that doctors who do not switch all Suboxone patients to Sublocade are possibly in favor of Suboxone abuse and Suboxone diversion. The word these days is that the particular doctor who gave that lecture is no longer providing Sublocade! Of course, it would be interesting to find out why, but suffice to say, many doctors are dropping out of the Sublocade program. Why would doctors not want to offer their patients Sublocade injections? ## Sublocade Vs Suboxone: Is Sublocade the Same Thing as Suboxone? One reason is the price, which is the same regardless of whether the patient is getting the 300mg shot or the 100mg shot. Compared to a month of sublingual buprenorphine, Sublocade is very costly. Insurance companies do not want to pay so much for a subcutaneous bupe shot when the advantage is mainly patient convenience. Also, the ordering and shipping process is difficult and time consuming. For a busy Sublocade clinic, there would likely have to be a dedicated, full-time person who manages pharmacy ordering and shipping coordination. While the Sublocade shot is expensive, doctors are expected to not charge more for a Sublocade patient than they would for a Suboxone patient. Doctors are also expected to accept insurance for Sublocade visits, if possible. The time and expense involved in managing a Sublocade clinic are excessive for many medical practices. It is easier for them to simply stop providing Sublocade services. ## Is there any hope for Sublocade making a comeback? While many doctors are not currently offering Sublocade service, they are hopeful that Brixadi will bring along some changes, now that it is approved in the US. Brixadi is also a monthly buprenorphine shot that is given just under the skin. The advantages of Brixadi include the shot not needing to be kept cold. Sublocade must be kept refrigerated, which complicates shipping and storage. Also, Brixadi is available in many more strengths compared to Sublocade only being available in two strengths. Brixadi can be given as a weekly shot or a monthly shot. In addition to all of these advantages, addiction experts are hopeful that there will be price competition between the manufacturers of both Sublocade and Brixadi. They hope that the competition will lead to one or both of the shots being offered at a lower price. While historically, competing brand name pharmaceutical products have not helped much with price competition, maybe it will happen between Sublocade and Brixadi. More likely, when Sublocade becomes available as a generic, and made more readily available at a lower cost, it will be more widely offered by doctors. ## How can I find a Sublocade doctor? While many Sublocade doctors are no longer providing the Sublocade service, there are still some who are. If a patient who currently takes Suboxone is interested in Sublocade, it may be worth their time to call around. A good starting place is to ask the current Suboxone doctor. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### Subutex Vs. Suboxone: The Difference Between Suboxone And Subutex URL: https://therehab.com/subutex-vs-suboxone-the-difference-between-suboxone-and-subutex/ ## **Some Subutex doctors are doing Subutex treatment just like methadone maintenance.** There is a Subutex clinic near me that gives out Subutex and methadone. They work with patients who are trying to [quit heroin]( "Heroin Addiction Treatment") or [fentanyl]( "Fentanyl Addiction Treatment"). They also have patients who are switching from Suboxone to methadone. At this particular clinic, they have methadone doctors and Subutex doctors. Regardless of which drug a client gets, the procedure is the same. A clinic tech watches closely as the client takes their medicine. Subutex and methadone clients are treated exactly the same. They sweep their mouths for hidden subutex remnants. They make extra sure that the client is not walking away with a little extra methadone or Subutex. Clinic attendees line up every morning for their daily dose. While this system works well to prevent methadone and Subutex diversion and abuse, it does not do much for the dignity of the person who wants to get medical treatment for opioid use disorder. ## **Bad behavior does not necessarily mean that there is a behavior problem.** Addiction treatment has traditionally been done where the employees watch the patients with a suspicious eye, treating them like bad, sneaky children, or a misbehaving puppy or kitten. In fact, I once had a kitten whom I thought had a behavior problem because she was urinating all over the house. I gently reprimanded her and showed her the litter box each time it happened. After a day or two of this persistent behavior, I brought my kitten to the veterinarian. The doctor examined my cat and explained to me that her behavior was not due to a behavioral problem at all. She was suffering from a urinary tract infection. Her behavior was her way of letting me know that she needed help. Unfortunately, my lack of understanding led me to scolding a kitten that required straightforward medical treatment. ## **What is the difference between Suboxone and Subutex?** Suboxone is a medication that has the distrust of the opioid use disorder patient built in. Suboxone is a combination of buprenorphine and naloxone. Buprenorphine is the stuff that helps you to stop obsessing over opioids and it keeps you from feeling the sickness of opioid withdrawal symptoms. If you are quitting heroin or fentanyl, [buprenorphine]( "Buprenorphine Treatment") can help you to feel normal again. [Naloxone]( "Naloxone Treatment") is included in [Suboxone]( "Suboxone Treatment") as an abuse deterrent. People sometimes think of naloxone as “the blocker” added to buprenorphine. ## **Does Subutex have a blocker?** Subutex is the original brand of buprenorphine and it has no blocker added to it. There is no naloxone abuse deterrent in Subutex. There is a fear that patients might sneak off with their Subutex, looking for an IV subutex high. Subutex is what they call a mono product. It is buprenorphine without the naloxone. Suboxone, on the other hand, is buprenorphine with the naloxone. If a patient liquefies their Suboxone and shoots it up in a vein with a needle and syringe, the naloxone will give them a chemical slap on the wrist. ## **Does Subutex cause precipitated withdrawal even though it has no naloxone in it?** When naloxone is injected into the vein of a person taking opioids, including buprenorphine, they will go into precipitated withdrawal. Precipitated withdrawal is what happens when opioids are forced off of opioid receptors and blocked from those receptors. Naloxone is a potent opioid receptor blocker. Subutex does not contain naloxone. It only contains buprenorphine. So, does it cause precipitated withdrawal since it doesn’t have the blocker in it? Unfortunately, Subutex can cause precipitated withdrawal. Buprenorphine is a unique opioid that is a partial agonist/antagonist. It blocks the opioid receptor, just like naloxone, and it partially activates it. When a patient starts taking buprenorphine, in the form of sublingual Subutex or Suboxone, they have to be opioid free for a short period, usually about a day. If taken too soon, buprenorphine itself can cause precipitated withdrawal. Hence, Subutex will cause precipitated withdrawal if taken immediately after opioid use. ## **Is switching from Suboxone to Subutex ever done?** Doctors tend to favor Suboxone over Subutex. In some regions of the U.S., Suboxone is legally required unless the patient is pregnant or has had an adverse reaction to naloxone. Even where it is not legally required, doctors still follow this guideline, only prescribing Subutex to patients who cannot take Suboxone. There are two major reasons why a doctor will switch a patient from Suboxone to Subutex. First, if the patient becomes pregnant, doctors have traditionally switched the patient to Subutex for the duration of the pregnancy, because less was known about the safety of naloxone in pregnancy. Today, the combination of buprenorphine and naloxone is also considered a reasonable option during pregnancy, so switching is not always necessary. Second, if a patient has an adverse reaction to naloxone, the doctor may switch that patient to Subutex. ## **Is naloxone an effective abuse deterrent when added to Suboxone?** Even though no study has ever proven the efficacy of naloxone as an abuse deterrent, Doctors don’t want to take any chances. Since, in most cases, the naloxone in Suboxone will not cause any problem at all, Doctors prescribe Suboxone to most patients, just in case, their patient is one of the very few who might try to shoot up their addiction treatment medication. I was recently at a lecture sponsored by Indivior, the company that makes Suboxone. The lecturer stated that Indivior is now aware that naloxone is not an effective abuse deterrent. She told us that they believe there are drug abusers out there who shoot up Suboxone and then wait for the naloxone to wear off. Naloxone happens to have a much shorter half-life than buprenorphine, so this is a possibility. What was Indivior’s solution to the problem of naloxone not being effective as an abuse deterrent in Suboxone? Surprise! They have a new patented drug that can address the problem. Sublocade is Indivior’s monthly injectable buprenorphine that forms an implant-like solid structure under the skin that releases medication for one month. Suboxone’s patent has run out and is available as a cheap generic and coincidentally, the company has a solid argument for why we should forget about it and switch over to the new drug. I can imagine, in another twenty years, experts will discover that Sublocade might somehow be diverted. By then, they will have another foolproof plan to keep patients from misusing buprenorphine. ## **Suboxone vs Subutex, which is better to take for MAT induction?** MAT is [medication-assisted treatment]( "Medication Assisted Treatment Podcast") and induction is the act of getting started with Suboxone or [Subutex treatment]( "Subutex Podcasts"). There are people who swear by starting only with Subutex because they believe that it is less likely to cause precipitated withdrawal. However, in most cases, Suboxone and Subutex are interchangeable for induction. Some Subutex doctors, such as the Subutex doctors near me in the methadone clinic, prefer Subutex over Suboxone for daily treatment. This may be because generic Subutex is cheaper than generic Suboxone. And, they don’t have to worry about their clients shooting up the Subutex because they observe them taking each dose. ## **Is Subutex stronger than Suboxone?** Actually, in many cases, Suboxone may be stronger than Subutex. How is this possible? Suboxone and Subutex are sublingual medications. They must be placed under the tongue to dissolve. Many generic Subutex tablets do not dissolve easily. They may take up to 15 minutes or more to fully dissolve. The difference in efficacy and dissolving time may vary significantly from one generic brand of Subutex pill to another. For example, some patients have complained about a particular Subutex white pill taking a very long time to dissolve, as long as 30 minutes, where another brand, a Subutex orange pill, dissolves in just a few minutes. The longer it takes for the tablet to dissolve, the more likely the patient might not wait the full amount of time. They may become frustrated and swallow the remaining part of the tablet. Any of the Suboxone or Subutex that is swallowed is wasted. It is only effective when dissolved under the tongue. Additionally, generic medications can vary slightly from the brand. A generic must be shown to deliver about the same amount of medication into the bloodstream as the brand-name product, and the measured differences are usually small. So, if you were to compare a brand-name Suboxone Film to a generic Subutex tablet, there could be some difference in the amount of medication that the patient absorbs. ## **Are there benefits to brand-name buprenorphine products?** For many years, Suboxone Films were a brand-name-only product. Suboxone was known as the standard of buprenorphine sublingual medications. When it came to Suboxone vs Subutex, one clear benefit of Suboxone was that it was a reliable and consistent brand-name product. Every film tasted the same, dissolved the same, and worked the same. The dosage on the package was what was in the medication. Reliability has always been the major reason to stick with a brand name medication, even when the price is significantly higher compared to the generic. Not long ago, a generic substitute for Suboxone Films was released. Several other generic buprenorphine/naloxone strips came out shortly afterwards. So, now, when a doctor prescribes Suboxone Films, pharmacists are allowed to substitute for the generic equivalent. ## **Is there a Suboxone-like sublingual medication that is still brand-name only?** Interestingly, there is a drug named [ZubSolv]( "Zubsolv Podcast") that fits this description. When it comes to ZubSolv vs Subutex or ZubSolv vs Suboxone, is there really that much difference? ZubSolv is more similar to Suboxone in that it contains both buprenorphine and naloxone. However, like Subutex, ZubSolv is a tablet, not a film. While ZubSolv tablets may resemble Subutex tablets, and they have the same main active ingredient, the resemblance ends there. ZubSolv dissolves quickly, in just several minutes, and it has a pleasant minty taste. Suboxone Films have a bad reputation when it comes to taste and aftertaste. Many patients who take Suboxone do not look forward to the lingering aftertaste. Usually, they are able to find a way to cope with it, drinking coffee, chewing gum, having a mint, or some other way to mask the taste. With ZubSolv, you are left with a minty-fresh taste in your mouth and the tablet is dissolved and gone in about three to four minutes. When it comes to the issue of pharmacists substituting the brand for generic, it is not possible with ZubSolv. There is no generic equivalent that they are allowed to substitute. ## **Subutex vs methadone: which works best for getting off of pink heroin?** This is a good question. Pink heroin is a street name for a synthetic designer opioid named U-47700. The current legal status of this drug puts it in the same category as heroin. Another street drug to look out for is called Gray Death. While a drug user may believe they are using one of these street opioids because of its appearance or what a dealer has told them, there is no way to be certain. Advanced testing, such as liquid chromatography or mass spectrometry, may be needed to be certain of what is in a particular powder purchased on the streets. The issue with heroin and heroin-like drugs is that, in most cases, the user has no idea what is in the powder they are snorting or shooting up into their veins. Recently, street heroin has been making the transition to Suboxone difficult. Somehow, an opioid-like component is being stored in the fat cells and released gradually over time. ## **Precipitated withdrawal sometimes complicates early Subutex and Suboxone treatment.** When a person using heroin goes in to see a doctor for Suboxone treatment, after waiting for a long enough time and feeling appropriate withdrawal symptoms, they take their first dose of Suboxone. Because of the nature of exotic synthetic opioids mixed into the heroin, the patient goes into precipitated withdrawal when they take their first Suboxone, even if they have waited 24, 48, or even 72 hours. While this situation makes the transition to Subutex or Suboxone more difficult from unusual street opioids, such as pink heroin or gray death, it is possible. However, if a person using these substances is concerned about precipitated withdrawal, methadone is an excellent treatment option. Because methadone is a potent full opioid receptor agonist, it can be started on the same day that the drug user quits heroin. With the appearance of these exotic new designer opioids contaminating street heroin, methadone has become a more useful treatment in many cases. ## **Does Subutex help with pain?** This is a very interesting question. I once attended an addiction treatment conference, and in one lecture, the addiction treatment specialist told us that buprenorphine works very well for pain, especially back pain. Then, he added that we don’t really want this information getting out because if there is widespread use of Subutex for pain, there may be more of a media focus on any problems that come up. He said that specialists in the addiction treatment community are concerned about Subutex and Suboxone being used to treat chronic pain, leading to more regulatory issues with these medications. They do not want it to be more difficult for addiction treatment patients to get access to medical care. That being said, it is true that buprenorphine is effective as an analgesic, or pain reliever, for many people with chronic pain. Milligram for milligram, it is considerably more potent than morphine. Additional benefits of buprenorphine are that patients tend not to develop tolerance to the drug, so there is no need for the doctor to keep increasing the dose for it to work. Also, there are less side effects with buprenorphine compared to other opioids. Patients report that they can think clearly and feel almost as if they are not taking medication when on Subutex. ## **What about Belbuca vs Suboxone? And, what is Butrans?** Belbuca is a buccal film that contains buprenorphine, just like Suboxone. While Suboxone indications include treating opioid dependence, Belbuca is indicated for treating pain. It is available in low, microgram dosing. Butrans is a seven day patch that contains buprenorphine in microgram doses. It is also indicated for treating pain. For doctors who want to prescribe buprenorphine to patients for pain, these are some alternatives so they don’t have to prescribe Subutex or Suboxone off-label for pain. ## **How do I know if Suboxone or Subutex doctors are accepting new patients?** The best way to find out is to call and ask! For many years, the government placed limits on how many patients a doctor could see for medication-assisted treatment with buprenorphine. Those federal limits have since been removed. Under the old rules, a doctor who provided Suboxone treatment could only accept a certain number of patients, no matter how many patients wanted to see that doctor. Still, many Suboxone doctors do have available spaces for new patients in their practices. Placing limits on the number of patients made it more difficult for individual practicing doctors to focus their practice on medication-assisted treatment of opioid use disorder. In many cases, they had to include it as part of a larger practice. So, if you go in to see a doctor for your first Suboxone visit and you are sick with opioid withdrawal, you might sit in the waiting room beside a family of children coming in for their school or sports physicals. However, there are doctors who do focus solely on Subutex and Suboxone treatment. There are even doctors who are now providing Suboxone telemedicine treatment, to protect patients from possible COVID-19 exposure. Again, the best way to see if a doctor has an available space for you as a new patient is to call and ask. And, the best way to find out if that doctor is a good fit for you in treating your opioid dependence is also to call. Additionally, some doctors focused on MAT will have a Suboxone blog or Suboxone podcast for you to learn more about treatment. Following a doctor’s blog and podcast will also give you insight into that doctor’s treatment philosophy. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### What is MAT? Frequently Asked Questions About Medication Assisted Treatment URL: https://therehab.com/what-is-mat-frequently-asked-questions-about-medication-assisted-treatment/ ## What is medication assisted treatment for a use disorder? A use disorder is an addiction. There are different types of use disorders, such as opioid use disorder, alcohol use disorder, tobacco use disorder, methamphetamine use disorder, and more. Medication Assisted Treatment MAT simply means for a doctor to prescribe one or more medications that are part of an evidence-based treatment plan to treat an addiction. Typically, medication treatment is only one part of the plan, which may also include individual psychotherapy and group therapy. Currently, there is no single medication that is proven to be effective in treating all addictions. There are specific medications which are proven to work for certain types of addiction. For example, Suboxone works very well in treating opioid use disorder. It is one of several medications for opioid use disorder (MOUD). Suboxone is a brand name for a combination drug that includes buprenorphine. Buprenorphine is the one of the safest and most effective medications for opioid use disorder. Other drugs used for opioid addiction include methadone and naltrexone. ## Is opioid addiction the only substance use disorder that can be treated with a medication assisted treatment program? For many years, medication assisted treatment has been closely associated with opiate addiction treatment. MAT for opiate and opioid addiction treatment goes back to the 1960s and the beginning of the methadone maintenance program. In fact, MAT for opioid use disorder goes back much further. The use of a safe supply of opioids to treat opioid addiction has a long history. Methadone and buprenorphine are both opioids, but they are uniquely suited to be used for addiction treatment. Buprenorphine, a mixed opioid receptor partial agonist and antagonist, is one of the best medications for medication assisted treatment for opioid addiction. In recent years, mostly during the past decade, we are learning more about the possibility of effective MAT for other types of addiction. For example, there is now proven medication assisted treatment for alcohol dependence. There is also medication assisted treatment for tobacco use disorder. This is important because tobacco contains nicotine, one of the most addictive drugs on the planet, and one of the most destructive drugs. ## Why would a specialist in addiction medicine not follow medication assisted treatment best practices? For years, general practitioners, family doctors, and internists took an eight-hour course to get a medication assisted treatment certification. That special certification requirement ended at the end of 2022, and a doctor with a standard DEA registration may now prescribe buprenorphine for opioid use disorder. And, there are also doctors who specialize in addictionology. A board-certified addictionologist is a doctor who has completed additional training to become an expert in diagnosing and treating addiction-related health conditions, such as substance use disorders. Yet, many of these board-certified addiction specialists do not embrace medication-assisted recovery services. Why would an expert in treating opioid dependence have a problem with an opioid treatment program using therapy such as Suboxone medication-assisted treatment? Unfortunately, the abstinence-based philosophy of the 12-step program of Alcoholics Anonymous has infiltrated every level of addiction treatment in the US, and other parts of the world. Even addiction residencies and fellowships that train and certify doctors as specialists embrace AA dogma. Slowing down the opioid epidemic has been hampered by the influence of Abstinence-based and spiritually-based programs, such as AA. We are at a point in history where a doctor who has medication-assisted treatment training rather than board certification in addiction treatment may have a far better success rate with treating patients addicted to opioids. When it comes to medication-assisted treatment vs abstinence, MAT is dramatically more effective in the case of opioid use disorder treatment. [Alcohol addiction]( "Alcohol Recovery Podcast") also responds well to MAT services for alcohol, using medications such as naltrexone, topiramate, gabapentin, ondansetron, baclofen, and acamprosate. Medications for opioid use disorder (MOUD) and medications for alcohol use disorder (MAUD) have changed the way we treat addiction. Medication-assisted treatment programs (MATP) and the overall medication-assisted pathway (MAP) are the way of the future in how we address addiction. Of course, ideally, the best situation would be to have doctors able to get the best possible training in addiction medicine and also fully embrace evidence-based medication-assisted recovery. Medication-assisted treatment effectiveness is well established. ## Is there such a thing as medication-assisted treatment for benzodiazepines? Unlike opioid and alcohol addiction, benzodiazepine addiction does not occur nearly as often. There are people who are prescribed benzos for medical purposes, and they become physically dependent on them over time. Physical dependence is different from addiction. A person who has a physical dependence may become physically sick when they discontinue the medication abruptly. Addiction and physical dependence can go together, such is often the case with alcohol and opioid addiction, but it is possible to have a physical dependence on a drug without necessarily being addicted to it. Still, benzodiazepine addiction is possible. Often, a person with an addiction to another drug will find the effects of drugs such as Xanax, Ativan, or Valium to be pleasant. They transfer their addiction to this new drug that is so effective at relieving anxiety and inducing sleep. Benzo withdrawal is particularly unpleasant. It is as if all of the anxiety that the person avoided over a period of months or years suddenly rushes in all at once. Opioid withdrawal is, of course very unpleasant, as is alcohol withdrawal, and even Suboxone withdrawal. Yet, many people have described benzodiazepine withdrawal as being worse than any of those other withdrawals, even heroin withdrawal. While there is no medication-assisted recovery services that are known to be effective for benzodiazepines, there are protocols for helping a patient to discontinue benzos. For example, there is the Ashton Method. The Ashton Method is a protocol for gradually tapering medication over a period of months. In some cases, where it is considered to be dangerous to continue a benzodiazepine for long periods, because the patient is severely abusing the drug, some doctors may start the patient on anti-seizure medication to try to reduce the risk of seizures that can occur during benzodiazepine withdrawal. A gradual, medically supervised taper is still the preferred approach. ## What is the most effective form of MAT for alcohol use disorder? MAT for alcohol addiction, as stated earlier, utilizes one or more of several drugs that have been demonstrated to be effective. Traditionally, MAT for sobriety was the standard, with patients being told to stop drinking altogether. More recently, MAT treatment for alcoholism includes The Sinclair Method (TSM), which is a harm-reduction method involving a patient taking naltrexone while they continue to consume alcohol. Surprisingly, TSM is more effective than abstinence-based methods in many cases. How does TSM work? In order to follow The Sinclair Method protocol, a patient takes a naltrexone 50 mg tablet, waits an hour, and then consumes a measured single alcoholic beverage. That is essentially the entire implementation of the program, summarized in one short sentence. Yet, the practical implementation is much more involved, because there are many variations and individualized applications for individual patients. Some patients take naltrexone daily. Others only take it occasionally, on days that they drink, and not on alcohol-free days (AF). Of course, even with this effective form of MAT alcohol abuse is still possible. However, while not all patients have a smooth path early on with TSM, this form of alcohol medication-assisted treatment is highly effective for several reasons. First of all, it is based on solid neuroscience. Taking naltrexone in combination with controlled alcohol consumption effectively erases the alcohol habit from the brain, gradually over time. Proponents of TSM call this process pharmacological extinction. In addition to naltrexone, there are other medication-assisted alcohol treatment drugs that are also effective. An experienced addiction physician will be able to use alternate medications or combinations of medications for alcohol use disorder when appropriate. ## How did the government ever allow treatment of opioid addiction with opioids? Some people get very upset about the idea that treatment drugs, such as buprenorphine and methadone, are approved by the government as medication-assisted treatment medications. Yet, the government has not only allowed legal use of these drugs, they have provided guidelines for medication-assisted treatment in the form of treatment improvement protocols. For example, treatment improvement protocol 42 from SAMHSA, the Substance Abuse and Mental Health Service Administration, is about substance use treatment for patients who have co-occurring disorders. Co-occurring disorders are mental health conditions that occur with a substance use disorder. A person who has a severe social anxiety disorder and then uses opioids or drinks alcohol to overcome their anxiety would be considered to have a dual diagnosis or co-occurring disorder. TIP 42 is important to provide guidance to mental health services in providing treatment for multiple mental health conditions. SAMHSA tip 63 is about medications for opioid use disorder, including Suboxone and similar buprenorphine-based medications. It is specific guidance from a federal agency to help doctors better implement a medication-assisted treatment program using MAT medication combined with appropriate therapy. With tip 63 SAMHSA is providing treatment facilities with the information they need to develop a treatment program around MAT detox and MAT maintenance. MAT is highly effective in addressing opioid craving and opioid withdrawal to help patients achieve opioid recovery. Whether a person is addicted to [heroin]( "Heroin Addiction Recovery Stories Podcast"), fentanyl, or opioid medication, such as oxycodone or hydromorphone, opioid use puts a person at high risk for opioid overdose. Fentanyl analogs on the streets are among the most addictive drugs, and they are very potent and deadly. Medication-Assisted Treatment drugs to make it possible to help people to stay alive and out of harm's way. When using medications to treat addiction, it is important to see the treatment with the perspective of providing harm reduction. The immediate goal is not perfect complete abstinence from all addiction treatment drugs. The goal is to help the patient to get off of the streets and out of danger, and to help them to begin thinking clearly, so they are able to follow a path of recovery. ## What is the cost of medication-assisted treatment? MAT cost is far less than the cost of traditional rehab. And now, with Telehealth services as a treatment option, the cost has come down even more in many areas. Online medication-assisted treatment makes reaching out to help more people than ever a possibility. In the beginning, when methadone treatment was the only option, and then when buprenorphine treatment became available, medically assisted opiate detox was the preferred treatment option. Patients were detoxed with buprenorphine within a short time, and not offered long-term maintenance for fear that they would have difficulty with Suboxone withdrawals. Now, we know from decades of experience, that long-term maintenance is the key to success. Patients must have time to get proper therapy and to get their lives in order. Their brains need time to heal as well. Medication Assisted Treatment without counseling is not recommended. It is important for patients to get psychotherapy at their Suboxone clinic, or independently. Even when putting together the cost of medication, medical visits and counseling, an entire year of MAT medication assisted treatment can be provided for less than the cost of a month of residential rehab. Medication assisted treatment in-office and medication assisted treatment online is the most cost-effective way to treat opioid use disorder. And, it is also among the most effective treatments for opioid addiction. Maintenance treatment with [buprenorphine]( "Buprenorphine Podcast") is far more effective than abstinence-based treatment, even with months of residential rehab, followed by a partial hospitalization program (PHP), and an intensive outpatient program (IOP). Many people mistakenly believe that the intent of MAT is to avoid withdrawal symptoms of opioid drugs. While this is a part of the treatment, the most important aspects are preventing opiate cravings and helping the patient to have clarity of thought. Eliminating the obsessions and compulsions of active addiction are essential. ## What is MAT recovery and how do I find medication assisted treatment? On our medication assisted treatment podcast, we have discussed options for treatment, that include programs that are free and low cost. We have also discussed the up and coming new options of virtual care, including virtual medication assisted treatment. One of our prominent guests on the podcast, Dr. Adam Bisaga, has described recovery with MAT, in his book Overcoming Opioid Addiction, as being the "new recovery." What he means is that we must accept that patients who are functioning well with medication assisted treatment are in recovery. What is MAT recovery? It is when a patient only takes prescribed medication, and successfully stops acting in an addictive manner. When a person takes a buprenorphine/naloxone medication, such as Suboxone, and they function well in their life, they should be considered to be in recovery. Medication assisted treatment and addiction recovery go hand in hand. Patients who are looking for an MAT treatment program should be encouraged to go through with it. For patients who are pregnant and using opioids on the streets, medication assisted treatment and pregnancy are safe and effective options. Many patients have had successful pregnancies, and now have healthy babies, continuing with their medication assisted program throughout pregnancy, helping them to avoid the dangers of drug abuse. ## How do I find an addictionologist with experience in addressing behavioral health issues by providing effective behavioral therapy? If a person is using multiple substances and has mental health issues, it may be ideal to see a board-certified addictionologist. While there is not an established MAT for meth, there are new treatments that show promise in treating meth addiction. For patients who use opioids and also use crack or show symptoms of meth use, it may be best to aim for a higher standard of care. Yet, it is also of the utmost importance to address the issue of opioid misuse primarily. Opioids are far more dangerous than stimulants, including cocaine and methamphetamine. Alcohol is also one of the most dangerous addictions. For patients who are using multiple substances, it may be best to first get treatment for the most dangerous addiction, whether it be alcohol or opioid addiction. So, while seeing a specialist in the field of addiction may be ideal in complex cases for complete disease control, if an expert is not immediately available, it is still best to attend an available treatment program for either opioid MAT or alcohol MAT. ## Where can I find the best medication assisted treatment FAQs? First of all, thank you for reading this particular MAT faq. You may also find more useful resources on this website. The best way to find useful information is to use the search feature. I also recommend following our [medication assisted treatment podcast]( "Medication Assisted Treatment Podcast"), The Rehab, for more information on the subject. For example, if you have concerns about topics, such as the bad taste of Suboxone, the side effects of Suboxone, issues with Suboxone constipation, or getting started after [fentanyl addiction]( "Fentanyl Addiction Podcast") with microdosing Suboxone (the Bernese Method), we provide information on these topics in blog post articles and podcast episodes. We even have information on transitioning from methadone to Suboxone, for people interested in the subject. What is medically assisted treatment? It is the best way to address addiction issues and provide effective harm reduction to keep people in active addiction safe. It is also the best way to help people to get on to the path to recovery and to get started with a new life that is drug-free. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### Learn The Secret Of How To Beat Opiate Cravings Before They Beat You URL: https://therehab.com/learn-the-secret-of-how-to-beat-opiate-cravings-before-they-beat-you/ ## What are opiate cravings and why is it so hard to break an addiction and stop using drugs? What are cravings? The phenomenon of cravings is fascinating. When you have a craving for opiates, you have an overwhelming rush of emotions and thoughts that point you back in the direction of taking opiates again. If you became addicted to opiates at some point, it was caused by your brain’s reward center becoming reprogrammed in such a way that opiates moved to the top of your list of critical necessities. Have you ever tried to hold your breath for a long time, maybe for a full minute? As the seconds tick away, you start having thoughts about taking a breath. The thoughts just pop into your head, seemingly out of nowhere. Wouldn’t it be great to take a deep breath of air? That would fix everything and make you feel better. What about water? Have you ever gone for hours without a drink? Thoughts of cool, refreshing water come up, along with a strong physical compulsion to find water and drink it. You know that if you could just drink some water, you would feel better and you could finally stop obsessing over it. The feeling of having opiate cravings is not so different. It becomes the only thing you can think about. Where can you get more? How can you pay for it? How will it feel to finally use opiates again? You believe that it will sooth the craving and make it go away, like scratching a bad itch on your back with a nice, sharp back scratcher. While all of us know how it feels to need to breath or to need water, many people have no idea what it feels like to similarly crave an opiate such as heroin. Heroin is not a basic necessity for survival that we all need. Most of us don’t ever think about heroin at all. But, for someone who is addicted to opiates, they believe they need it as much as they need air or water. They feel intense cravings that seem like they will never go away unless they do just one thing. When a person experiences drug cravings, they feel as if using more drugs will eliminate the cravings. It will be like scratching an itch to make it go away. Yet, just like scratching an itch, the cravings come back again shortly after using drugs again. Not only do they come back, but the cravings are now more intense than ever. ### Here is how to stop opiate cravings now. If you have recently quit opiates in the last 24 hours, you are likely feeling withdrawal sickness. As time moves on, the withdrawal symptoms intensify. You may start with cold chills and muscle aches, runny nose and sneezing. Then, the intense cramps and nausea set in with nausea, vomiting, and diarrhea. Restless leg syndrome is an issue for many people. It may not seem like a serious issue if you have never experienced it, but it is very disturbing and uncomfortable. Throughout the first couple of days of intensifying withdrawal symptoms, cravings gradually move in, blended with the withdrawal. Thoughts and images come up in your mind. Full formed plans of going out to get more opiates appear out of nowhere. A deep feeling of dread and helplessness sets in. You know you shouldn’t use more opiates, but its all you can think about. The cravings reach a peak intensity at about the third day of withdrawing from opiates. While they do subside after that, they do not go away completely. Over the next 3-6 months or so, you may notice a gradual reduction in the frequency of cravings. At first, you feel as if you think about opiates all day long. Then, over time, you notice that you have long stretches of not thinking about them at all. If you stick with a program of not using opiates, you will have fewer and fewer cravings. Even after a year, or multiple years, you still must remain vigilant. Opiate use any time down the road may re-awaken cravings. What if you do not want to go through the difficult and long road of abstinence-based recovery from opiate addiction? After all, the success rate is not very high. Most people, faced with the intense cravings that strike early on will give in and return to opiate use. Fortunately, there are alternatives. The fastest way to get off of the streets and quit [heroin]( "Heroin Addiction Podcasts") and [fentanyl]( "Fentanyl Addiction Podcasts") use without having to go through withdrawal and opiate cravings is to show up at a local methadone clinic. Are methadone clinics bad places? Not necessarily. Methadone is approved by the US and state governments for use in treating opiate addiction. It is a potent opioid drug itself, however, patients who take methadone are able to function in their lives without being overwhelmed by withdrawal sickness and opiate cravings. You can show up at the clinic and get started on the same day you quit heroin or any other opiate or opioid drug. Methadone is known to have a 75% success rate, which is higher than any other form of [opioid addiction treatment]( " Opioid Addiction Treatment") approved in the US. ### Do you know how to fight opiate cravings effectively without going to a methadone clinic? While [methadone treatment]( " Methadone Treatment ") itself is not a bad thing, there are bad clinics out there. Some of them get patients on very high dosages of methadone with no intention of ever helping them to taper down, even for the patients who are motivated to reduce or stop treatment after a year or two. If you live in an area where you have only one clinic you can get to with no alternatives, you may find yourself at the mercy of difficult staff members, including nurses, counselors, and administrators. Even if your methadone clinic is a pleasant place to go for treatment, as you integrate yourself back into every day life, you may start to realize that showing up every single morning for your daily dose of methadone restricts your lifestyle more than you would like. ### There are alternatives to methadone to avoid cravings early in recovery. [Suboxone]( "Suboxone Podcasts") is another alternative that can help you to recover from opiate use without having to go through intense cravings. Suboxone is a combination drug that contains buprenorphine and naloxone. [Buprenorphine]( "Buprenorphine Podcast") is the main ingredient that does all the work to help prevent withdrawal sickness and cravings. While buprenorphine is technically an opioid, just like methadone, it is unique in the way that it works. It is more of an opioid receptor blocker than anything. While it blocks the receptors, it partially activates them, making it a partial agonist/antagonist. Because of this, Suboxone is much milder and safer than methadone. Doctors can prescribe Suboxone for up to a month at a time. Suboxone treatment gives you lifestyle freedom and flexibility. There are other brands as well that are similar to Suboxone, including ZubSolv and Bunavail. So if Suboxone is so much safer and easier to get than methadone, why do methadone clinics exist? Because of the unique nature of how Suboxone works, you must wait for a period of time from your last opiate use before you can take your first Suboxone. The time is usually about 24 hours. In some cases, you will have to wait longer. If you start too soon, the buprenorphine in Suboxone will cause precipitated withdrawal. This means that you will feel much more sick with withdrawal symptoms, caused by the Suboxone itself. Suboxone doctors try to avoid their patients going through precipitated withdrawal. While it is not dangerous, it is unpleasant enough that it might discourage the patient from sticking with treatment or even being willing to come back to try again in the future. Because of this limitation of Suboxone, there are patients who may still do best by starting out at a methadone clinic. There is little or no concern of precipitated withdrawal with methadone treatment. ### Is it possible to go from methadone to Suboxone? Going from treatment with methadone to buprenorphine is possible, but not easy. As a rule of thumb, you should plan to taper down to 30 mg of methadone daily or less. Talk to your doctor and counselor at your clinic to help you reach this goal. When you do get to this milestone of a relatively low dosage of methadone, you will have to stop taking it and wait for at least a day and a half before starting buprenorphine. In most cases, you will have to wait longer to avoid the risk of precipitated withdrawal. During the waiting period of transitioning from methadone to Suboxone, your doctor may prescribe medications to help with any withdrawal symptoms you experience. The transition from methadone to buprenorphine should always be performed under the close supervision of a doctor. ### What are some anti-craving tips and things to help with withdrawal if I choose the abstinence route? There is no one-size-fits-all solution to treating opiate addiction. Not everyone will choose to go to a [medication-assisted treatment]( "MAT Program") (MAT) program, such as a methadone clinic or private Suboxone doctor. If you choose to stop opiates cold turkey and work through the withdrawal syndrome and opiate cravings, there are still some things that can help make it more tolerable. By doing whatever you can to help reduce cravings, you will increase your chances for success. ### Getting enough sleep will help to keep cravings away. Sleep seems almost too easy a solution, but it is surprising how many of us do not allow ourselves to get adequate sleep. We binge-watch television late into the night, play with our smartphones and tablets, and scroll endlessly through social media. When it’s 3 am and you justify that you will be fine with 5 hours of sleep, you may not realize the stress you put on your body and mind. If you are already dealing with opiate cravings, even 6 months to a year out from your last opiate use, you will only make things worse with sleep deprivation. If you pay close attention to sleep hygiene, keeping your sleeping area free of distractions, you will find that you can get more sleep than you ever thought possible. Even if you do wake up early at 5 am and you don’t have to be up until 8, imagine how great it will feel to be able to go back to sleep for another few hours. Sleep is important to allow the brain to reset and error correct itself. Memories are sorted out in addition to other brain housekeeping activities. If you do not allow for enough sleep, you will likely experience ongoing opiate cravings that might have subsided in frequency and intensity otherwise. ### Prayer can help you to reduce opiate cravings. I realize that prayer can be a sensitive subject for people who are atheists or who are uncomfortable with religious and spiritual practices. If the word “prayer” makes you uncomfortable, you may think of prayers as affirmations. In fact, it is not important at all to know the mechanism of how prayer works. If you believe that you are asking for help from the higher power of your faith, or, if you are sending out a message to the universe, or universal mind, that is fine. You may even want to think of prayer as sending messages to your own subconscious. I once recommended prayer to a patient, and they agreed to try it out. When the patient returned for a follow-up visit, she said that it definitely helped. Cravings seemed to subside after praying for help. However, she had a question about prescribed prayer. How often was she allowed to pray for help. While I am not aware of any specific restrictions in certain religions, there is not medical contraindication to frequent prayer. I advised the patient that she was allowed to pray for help in removing her opiate cravings as often as she wanted. I also recommended praying for help sleeping if she was having trouble with sleep since other patients have reported that this can be helpful. ### Here is how to stop opiate cravings with nutrition and supplements. At the intersection of spirituality and science is the importance of nutrition and supplementation. By feeding our bodies the proper fuel to keep our brains and bodies healthy, we also feed our minds and souls. Proper neurotransmitter precursors and cofactors help our brains by filling the buckets with the building blocks that our neurons need on a regular basis. This means taking in enough protein throughout the day and also taking supplements that may include tyrosine, glutamine, magnesium, calcium, vitamins A, B, C, or a combination of these and several others. Speak with your doctor or nutritionist about what supplements they recommend. They may even recommend a multivitamin that contains everything you need, in addition to a healthy, well-rounded diet. Another important recommendation regarding diet is to avoid harmful foods that may possibly stimulate cravings. Sugar and refined carbohydrates are the main culprits here. Refined sugar is known to be an inflammatory substance that is unhealthy for your body and brain in many ways. It is also addictive, having many of the same effects on the brain as do highly addictive drugs, including opiates. In addition to avoiding sugar, you may want to consider choosing carbohydrates in your diet with a low glycemic index. Low glycemic index foods tend to take longer for your body to absorb, so, even though they are broken down to sugars, as are all carbohydrates, there is not a sudden rush of sugars into the blood stream. Most fruits and vegetables are low glycemic foods. Potatoes are an exception, having a high glycemic index, similar to foods such as white bread and rice. ### Here is how to deal with opiate cravings with a little help from your friends. When patients ask what else they can do to improve their chances of success in remaining in recovery successfully, I typically recommend that they build and maintain a support network. What is a recovery support network? A recovery support network is a form of social support network made up of people. These people may be family, friends, professionals, and people whom you meet in the setting of recovery support meetings. Examples of such meetings are Alcoholics Anonymous meetings or Narcotics Anonymous meetings. Other groups, which are not 12-step programs, include Celebrate Recovery, SMART Recovery, and LifeRing. At meetings of these groups, you may meet people before, during, or after the meeting. If you feel comfortable speaking with a particular person and you feel that they may be a positive addition to your support network, you may decide to exchange phone numbers. Afterwards, for best results, it is advisable that you make phone calls to the people on your support network list on a regular basis. What should you talk about? There is no need to worry about having nothing to say. You can talk about common issues relating to recovering from addiction. Let the person know how you are feeling today and how things are going. You can ask how they are feeling. Over time, you will get more comfortable with these phone calls and conversations. Practice makes perfect. Having a strong network of support will help you to reduce cravings because sharing how you feel and the cravings you are having helps to get these feelings out in the open. Shining a light on opiate cravings by sharing with a friend in recovery helps to dissolve the cravings away. To paraphrase a saying in NA, the therapeutic benefit of one person in recovery helping another is without parallel. So, along with the other recommendations made here to help reduce opiate cravings, building and maintaining your addiction recovery support network will greatly improve your recovery experience. ### Protect your recovery and treat it as your most valuable possession. There is nothing more important in your life than protecting your recovery and maintaining your state of being opioid and opiate free. You must take all reasonable measures to avoid returning to the dangerous state of active addiction. While having friends in recovery who understand what it means to quit taking opiates and staying opiate free, you must be careful in sharing information about your medical treatment. For example, if you see a Suboxone doctor, this is not information that you should share with anyone, other than possibly your closest family members. Sometimes, well-meaning friends have their own opinions about [medication-assisted treatment]( "Medication Assisted Treatment Podcast") and they may start making strong recommendations involving stopping your medication or changing how you take it. Taking medical advice from friends or people on the streets, you are putting yourself in danger. When it comes to medical treatment, it is critical that you only make changes to your treatment regimen after having a talk with your doctor. Between you and your doctor, you can come to an agreement about what changes are reasonable. Otherwise, take care to avoid allowing friends, family members, and coworkers to influence your behavior in ways that may put you at risk. For example, avoid the use of any alcohol or drugs that you know may trigger opiate cravings. If you are at an office party and your coworkers pressure you to drink alcohol, do not give in to this peer pressure. You have a right to refuse alcohol and drugs, no matter who is pressuring you to take them. You also have a right to stay on your own path to recovery that is working for you without feeling that you should give in to the advice of people around you. You should not make changes to your program if it is working well for you simply because of the whim of the opinions of people around you. Regardless of withdrawal symptoms and opiate cravings, you can definitely overcome opiate addiction. I recommend that you start by making an appointment to see your doctor. If you are concerned about the risk of overdose or other risks of continuing opiate use, you may go to the nearest hospital ER. Medication-assisted treatment is the gold standard of care for opioid use disorder. Even if you choose to take another path, starting with a medical evaluation is the best way to start off your journey of recovery from opiate addiction. ### How Long Does it take to Detox from Heroin and get off for good? URL: https://therehab.com/how-long-does-it-take-to-detox-from-heroin-and-get-off-for-good/ ## Why is it so hard to quit taking heroin? Many people do not understand the typical heroin user. Heroin use does not only happen under bridges and in back alleys. Heroin is a street drug, but that does not mean that heroin users are people who live on the streets. A heroin user might be a business man or woman getting ready to go to work. They might even be a successful entrepreneur, building a highly successful startup. Substance abuse is not always obvious. Look around at the people you encounter during a typical weekday. There is no way to be certain if they are using heroin or not. Many users are able to effectively hide their drug abuse. Heroin, usually combined with the synthetic opioid, fentanyl, is sold on street corners and in front of gas stations and convenience stores by shady characters who disappear at any sign of police in the area. However, it is also shipped direct by US mail. Heroin is even delivered by Lyft and Uber drivers. You might be surprised how pervasive this drug is in our society. Next time you see a mail truck drive by, think about the possibility that there could be heroin in one of the packages out for delivery. ### Does heroin cause addiction? Heroin, a potent opioid drug, is considered to be highly addictive. In fact, the US government classifies it as a schedule I drug, meaning that it has no accepted medical use. Yet, medical cannabis is also a schedule I drug and, as of this writing, 36 states consider it to be medically useful. Morphine and heroin are chemically related opioid drugs. Morphine is legal and it is used frequently in the medical field. Heroin is illegal and only sold on the streets. While heroin, along with other opioids, is considered to be highly addictive, the fact is that not everyone who tries heroin becomes addicted. Heroin itself cannot turn just anyone into a heroin addict. There are people who have a predisposition to becoming addicted to heroin. There is a genetic component as well as environmental factors, such as childhood emotional or physical abuse. Heroin is an analgesic, meaning it covers up pain. The pain covered up by heroin can be physical or emotional. Some people who are in pain and try heroin enjoy the feeling of euphoria and temporary freedom from pain. This can lead to a malignant habit that is called addiction. ### What does it feel like to be addicted to heroin? How long can you hold your breath? 30 seconds? 45 seconds? A minute? If you hold your breath as long as possible, what do you start to think about? Your only thought after a short time is when are you going to take your next breath. The same goes for food, water, and any other necessity of life. When something important is missing, it's all you can think about. When a person becomes addicted to heroin, their brain changes. The brain is adaptable and can adjust to learn at a deep level what is vitally important for survival. Heroin hijacks the reward system of the brain that is intended to help us learn to survive in our environment. When a person is addicted to heroin, the entire focus of all of their thoughts are on how to get more heroin. It becomes an all encompassing, consuming obsession. Scoring more heroin feels like coming up for a breath after diving to the bottom of a deep pool. As you can imagine, heroin addiction is not a pleasant experience. While heroin itself provides a euphoric experience, the life of a person addicted to heroin quickly becomes a nightmare. Leaving the house to go to work without any more heroin supply can feel like jumping out of an airplane without a parachute. You have to figure out how to get a parachute from someone else on the way down before you hit the ground. ### What happens when you can't get more heroin? If you use heroin, you very likely already know the answer to this question. The first time you tried heroin, you probably experienced the most powerful high of your life, which can rarely ever be repeated. After using heroin the first time, you will still be able to get high from using it. Yet, most heroin users describe the experience going forward as always chasing after that first high. After a while, most heroin users say that the high goes away. The only reason they continue to use heroin is to not get sick and to feel "normal." What does it mean to get sick if you stop using heroin suddenly? One of the features of opioid dependence is the issue of physical dependence and severe withdrawal symptoms. When a person stops taking heroin, not only do they have to deal with the psychological addiction, they also face severe physical symptoms as well. The symptoms of physical opioid withdrawal start out with acute withdrawal symptoms, such as runny nose, watery eyes, and sneezing. As it progresses over the heroin withdrawal timeline, there are chills, aches, cold sweats. Further in, there are severe muscle cramps and muscle twitching, including restless leg syndrome. Upset stomach, nausea, vomiting, and diarrhea are also common. ### What are the worst heroin withdrawal symptoms? Many opioid users describe the restless leg syndrome symptoms, such as uncontrollable leg movements and kicking at night while they try to sleep as being the worst of their symptoms. As the opioid withdrawal symptoms reach their peak by about the third day, intense cravings, set in. There is the overwhelming obsession with getting more heroin or another opioid to relieve the withdrawal syndrome. Just one more time will make it all go away for a while longer. This is what makes heroin abuse so difficult to quit. These physical withdrawal symptoms occur over a backdrop of depression, anxiety, insomnia, and other psychological symptoms. Imagine how difficult it must be to quit heroin cold turkey. If heroin or other opioids are available, most people would give in at some point and take more opioids to stop the suffering of withdrawal. Yet, often the reason for stopping heroin use is due to a lack of availability. You might be out of money and have no way to get money for more heroin. Or, maybe your dealer ran out or was arrested. When the supply runs out, you really start to ask yourself, "how long to detox from heroin?" ### Are there people who are opioid-dependent who have never experienced opioid withdrawal? I have met people who are heavy opioid users, yet they have never, yet, experienced opioid withdrawal or any part of the detox process. These rare individuals had the resources and access to continually feed their opioid addiction or opioid physical dependence. So, it's not that they would not have opiate withdrawal symptoms if they stopped opiate use, they have just not had to stop yet. I have met successful business owners who have reliable heroin dealers who show up at their door at a moment's notice. A quick text message in the night to the dealer is followed by a discrete knock at the door just a few minutes later. I have also known people who are independently wealthy and have mastered the art of accessing the dark web without leaving a trace of their identity. Orders placed with cryptocurrency are followed up by a plain package, filled with opioid pills or powders, showing up at the door, faithfully delivered by the United States Postal Service. Other than the wealthy patron with a reliable opioid supplier, there are also chronic pain management patients who are prescribed opioids for pain by their doctors. Prescription opioids, such as morphine, hydrocodone, hydromorphone, and oxycodone are very similar to heroin, but they are approved by the FDA to be prescribed by doctors to treat pain. While these patients are not necessarily addicted to opioids, they still develop the physical dependence over time. If they are unable to obtain their prescription, in addition to being in pain, they will go through the same physical opioid withdrawal syndrome as someone addicted to heroin would. ### Are prescription pain pills always addicting? The fact is that most patients who are prescribed opioids for chronic pain are not addicted to their medication. Only a small percentage of pain patients develop an opioid addiction. Because of media focus on the opioid addiction crisis and government response to attempt to address the problem, many patients in pain who are not addicted have lost access to effective medical treatment. Of course, shutting down doctors and pharmaceutical companies is easier and more satisfying to lawmakers and the media than providing addiction treatment. Another issue that comes up in addiction recovery groups, such as Narcotics Anonymous (NA), is addressing medical treatment that involves drugs such as opioids. NA has rightly opted to not get involved in the medical care of its members for nearly all health conditions. Yet, strangely, NA has decided to take a stand and get very involved in medical treatment when it comes to medication assisted treatment of opioid addiction. NA has an official stand on drugs such as buprenorphine/naloxone (Suboxone) and methadone. If these life-saving drugs are prescribed to treat opioid use disorder, a real mental illness and health condition, they are frowned upon by NA. However, this official stigma does not apply if the same drugs are prescribed for off-label uses, including the treatment of chronic pain. This confusing policy of the Narcotics Anonymous World Service organization has led to some interesting situations in NA groups. There are members who take buprenorphine or methadone for opiate addiction who are not considered to have any clean time, and other members who take the exact same prescribed drugs for chronic pain who may have decades of clean time. In both situations, the person in question is taking a medication prescribed by a doctor for a legitimate medical use. Yet, NA has decided to take a stand on which of these people get to say they are clean depending on their diagnosis. Imagine an NA newcomer on Suboxone being told by an old timer on methadone that because they take Suboxone, they cannot claim clean time. Meanwhile, that same old timer can celebrate years of clean time in recovery, simply because the drug is prescribed for a different medical diagnosis. Something feels unfair about an addiction recovery program where a person on high levels of opioids who may have never experienced opioid withdrawal can talk down to a newcomer on Suboxone or Methadone. The "rules" start to seem very arbitrary and not conducive to harm reduction and healing. The difficult detox from opioids is the same, no matter what the reason the opioids are taken for. Whether an opioid is prescribed for pain or addiction, or bought from a dealer on the streets, the withdrawal symptoms are the same. It is critical that leaders in the field of addiction treatment and recovery get on the same page with evidence-based, medical treatment that has been proven to work for decades. Detox from heroin can be long, difficult, and dangerous because of the risk of relapse and overdose. But, it doesn't have to be. ### How long does it take to get off heroin with medication-assisted treatment? This is the real question we should be talking about. Quitting opioids cold-turkey has a high risk of relapse and it is a long and difficult process with a low success rate. With medication-assisted treatment (MAT), the success rates are far better and the withdrawal period is very short. For example, in most cases, a patient can start Suboxone, Subutex, ZubSolv, or a similar buprenorphine-based medication within about 24-hours after quitting heroin. While there is a period of some hours of withdrawal discomfort, it is far easier than days or weeks of opioid withdrawal. With methadone, treatment can be started right away. On the same day that the patient quits heroin, they can start taking methadone. Of course, the downside of methadone is that you have to go to the clinic every morning to get your dose. With Suboxone, on the other hand, you can go monthly after your doctor stabilizes your treatment. ### Is MAT just a way of postponing the inevitable? Some people worry that they are just putting off their opioid withdrawal for a later date. As they shoot up or snort heroin, they think to themselves that it would be better to suffer through heroin withdrawal now rather than deal with Suboxone withdrawal in a year or two. It is true that Suboxone, ZubSolv, and similar meds also have an opioid withdrawal syndrome after stopping the medication. The process of completing treatment is referred to as "tapering." When a patient is tapered, they take a lower dosage over time as prescribed by their doctor. At some point, there is a "drop off," when the patient takes the final dose, and they are done. Afterwards, there will likely be withdrawal symptoms. These symptoms are physical withdrawal and are most often not accompanied by opioid cravings. So, taking Suboxone as MAT for heroin addiction is not simply postponing the inevitable withdrawal sickness. It gives the patient, their body and brain, a chance to heal. Addiction is not eliminated, but it goes into remission. The healing process is slow and takes place over a period of a year or two, sometimes longer for some patients. Suboxone healing does take place while the patient is taking their medication on a daily basis during that time. Meanwhile, if you take Suboxone for opioid addiction, you will likely be able to function optimally during your treatment. Many Suboxone patients report that, while they take Suboxone, they feel as if they had never been addicted to opioids. They are able to function at work and at home without brain fog, sickness, thoughts of drugs, drug obsessions or compulsions. In fact, I have seen patients on Suboxone accomplish great things in their lives during their treatment. Is Suboxone MAT just trading one drug for another, or trading one addiction for another? The Narcotics Anonymous literature would like for us to see it this way. They refer to MAT medications as "replacement drugs." While the NA program does provide a great service, and there are many incredible people in local groups, the language used in the world service literature might be seen as offensive by the many people receiving successful medication-assisted treatment. We must be clear on this point. Medication-assisted treatment for opioid use disorder, using buprenorphine-based medications, such as Suboxone, Subutex, ZubSolv, Bunavail, Sublocade, or Brixadi is not at all trading one drug for another or trading one addiction for another. These are not "replacement drugs." They are an important component of a proven, evidence-based, effective form of addiction treatment. ### How long heroin detox take, getting started with MAT to bypass the long withdrawal syndrome? While it may depend on availability of treatment in your area, you may be able to get started right away. Many regions of the US have same-day outpatient treatment available. You can either make a same-day appointment for heroin addiction treatment, or some clinics also accept walk-ins. Your options for MAT range from heroin rehab to outpatient detox programs to concierge clinics. If you are postponing your Suboxone appointment for opiate detox because you know that you have to be in moderate withdrawal to start the medication, don't let that hold you back from going to see the doctor. Most doctors are happy to see you to start with the evaluation, even if you are not in withdrawal yet. In fact, many Suboxone doctors are willing to do at-home induction to initiate opioid detox with buprenorphine. This means that you will take your first Suboxone dosage at home rather than in the clinic. As reported in past episodes of our heroin addiction podcast, MAT has evolved and improved significantly over the past two decades. This is often possible with concierge Suboxone doctors who are willing and able to be available by voice or video call at a moments notice. Your doctor can be on video with you as you take your first Suboxone, or the doctor can be available immediately if needed. Most importantly, you should not postpone getting started with medication-assisted treatment if you are misusing opioids, such as heroin. Now is the time to get started with a medical detox program, so you can feel better, get back to normal functioning with improved mental health and work towards overcoming your opioid dependence. ### What Is Buprenorphine and How Does It Work in the Brain? URL: https://therehab.com/what-is-buprenorphine-and-how-does-it-work-in-the-brain/ Buprenorphine is a partial opioid agonist widely used in the medical field to support individuals with opioid use disorder. Its chemical structure allows it to bind to the same opioid receptors as drugs like heroin, morphine, or oxycodone, but with less intensity. As a result, it reduces withdrawal symptoms and curbs cravings without inducing the intense euphoria associated with opioid misuse. In recent decades, buprenorphine has become central to addiction treatment, particularly within opioid treatment programs and outpatient clinics. The medication is often administered as sublingual tablets, allowing for easy use while maintaining consistent levels in the bloodstream. But how does buprenorphine work at the neurological level, and what makes it a safe and effective treatment option? Let’s break down the science, effects, and role of buprenorphine in managing opioid addiction and dependence. ## Understanding Opioid Use Disorder and Dependency Opioid use disorder (OUD) is a chronic condition characterized by compulsive drug-seeking behaviors, physical dependence, and emotional dysregulation. Individuals suffering from OUD often find themselves trapped in cycles of withdrawal, overdose, and relapse. The brain becomes hijacked by these substances, altering decision-making, stress response, and reward processing. Buprenorphine addresses these disruptions by occupying opioid receptors without overstimulating them. This makes it distinct from full agonists like heroin or oxycodone, and from opioid antagonists like naloxone, which block receptors entirely. In short, buprenorphine offers a middle-ground approach, mitigating the extremes of both withdrawal symptoms and drug-induced highs. ## What Is Buprenorphine Used For? Initially approved for pain relief, buprenorphine is now primarily used for opioid dependence and opioid addiction recovery. It’s often prescribed as part of a medication-assisted treatment (MAT) plan, which includes behavioral therapy, counseling, and structured support. Patients receiving buprenorphine treatment benefit in several ways: * **Craving reduction:** By partially stimulating opioid receptors, it suppresses the urge to use more dangerous drugs. * **Withdrawal management:** The medication relieves symptoms like nausea, vomiting, anxiety, and muscle pain. * **Relapse prevention:** Because of its receptor affinity, buprenorphine can block other opioids from binding, lowering the chance of relapse or **overdose**. * **Longer half-life:** The medication stays active in the system longer, reducing the need for frequent dosing. This makes it an effective solution for individuals who have previously struggled with prescription painkillers or street drugs like heroin. ## How Buprenorphine Works in the Brain To fully understand how buprenorphine works, we need to explore the brain’s chemistry. Buprenorphine binds to mu-opioid receptors, the same ones responsible for the pain-relieving and addictive effects of traditional opioids. However, because it is a partial opioid agonist, its activation of these receptors is limited. Instead of producing a high, buprenorphine creates a stabilizing effect, reducing symptoms of acute withdrawal, minimizing the risk of respiratory depression, and offering consistent relief. Its "ceiling effect" means that even with a higher dose, the risk of overdose does not proportionally increase. This protective mechanism makes buprenorphine far safer than most full opioid agonists. What is buprenorphine and how does it work in the brain? It mimics the brain’s natural opioids without hijacking the system. This supports long-term stabilization, mood regulation, and clearer cognitive functioning. ## What Does Suboxone Do to the Brain? Suboxone is a branded medication combining buprenorphine with naloxone, an opioid antagonist. The naloxone component remains inactive when Suboxone is used correctly (sublingually), but it will trigger withdrawal if the drug is tampered with or used via injection. This feature helps prevent misuse. So, how does Suboxone work in the brain? It performs the same stabilizing role as buprenorphine alone but adds a layer of protection against abuse. For patients in early addiction treatment, this combination offers psychological and physiological benefits: * Reduced risk of relapse * Lowered cravings * Enhanced focus during therapy * Decreased stigma compared to clinic-based opioid treatment programs Suboxone effectively blocks the euphoric effects of opioids, making it harder for patients to return to former patterns of use disorder. ## Finding the Right Care If you're exploring buprenorphine treatment, a crucial step is to locate qualified local providers. Searching for [buprenorphine doctors]() or visiting a directory of medication-assisted treatment providers ensures you get supervised, personalized care. Clinicians play a vital role in dosage monitoring, tapering plans, and adjusting the treatment course to align with your recovery goals. ## Learning from Real Experiences Educational tools and patient stories provide invaluable insight into what recovery actually looks like. The [best buprenorphine addiction podcast]() episodes, especially those focusing on when treatment backfires, reveal that success isn't linear. Challenges such as misdiagnosis, underdosing, or lack of integrated therapy can stall progress. These examples stress the importance of a comprehensive treatment plan tailored to each individual’s needs. ## Buprenorphine vs. Methadone: What’s the Difference? A common question among patients is, [Is buprenorphine the same as methadone]()? The answer lies in how each drug interacts with the brain. Methadone is a full opioid agonist, meaning it activates opioid receptors completely and has a higher risk for respiratory depression and overdose. Buprenorphine, by contrast, only partially activates these receptors and includes a safety buffer due to its ceiling effect. Because of these differences, buprenorphine can often be prescribed in outpatient settings, while methadone typically requires daily clinic visits and tighter controls. The choice between the two depends on history, severity of addiction, and individual medical factors. ## Final Thoughts Buprenorphine represents a major advancement in treating opioid addiction. It offers a safer, more controlled alternative to heroin or prescription opioids and reduces the need for inpatient detox in many cases. Whether administered alone or as Suboxone, this medication plays a critical role in protecting brain function, stabilizing lives, and enabling long-term addiction recovery. At The Rehab, we understand how complex and overwhelming addiction can be. Whether you're just learning about buprenorphine treatment or exploring options for someone you love, we’re here to help. Reach out to our team today to discuss how our specialists can guide you through the best treatment options, personalized recovery strategies, and long-term support resources. Want to dive deeper? Listen to our [buprenorphine podcast]() to gain clinical insight and patient stories that illuminate the healing power of medication-assisted treatment. ### Navigating the Stages of Opiate Dependence Recovery and How to Navigate Them URL: https://therehab.com/navigating-the-stages-of-opiate-dependence-recovery-and-how-to-navigate-them/ Recovery from opioid addiction is a deeply personal journey, shaped by biology, behavior, and the support systems surrounding each individual. Opioid use disorder affects how the brain processes pain, reward, and motivation, making the recovery process complex but entirely achievable with the right treatment approach. Understanding the stages of opiate dependence recovery and how to navigate them empowers individuals and families to move forward with clarity, confidence, and purpose. From the earliest phase of opioid withdrawal to long-term addiction recovery, each stage presents unique challenges and opportunities for healing. With structured addiction treatment, professional withdrawal management, and evidence-based therapies, individuals can rebuild stability and regain control over their lives. ## Understanding Opioid Use Disorder and Dependence Opioid use disorder develops when repeated opioid use alters how opioid receptors function in the brain. Over time, prescription opioids or illicit opioids can create physical dependence, where the body requires continued opioid use to function normally. As tolerance increases, higher doses are often needed to achieve the same effect, increasing the risk of opioid misuse, opioid addiction, and opioid overdose. Opiate addiction and opioid addiction are often accompanied by changes in behavior, emotional regulation, and decision-making. Early awareness plays a critical role in recovery. Understanding and [recognizing the early signs of opiate dependence before it's too late]() can support timely intervention and improved outcomes. Substance use gradually becomes central to daily life, making professional addiction medicine essential for safe and sustainable recovery. ## Stage One: Early Withdrawal and Detoxification The first stage of recovery begins when opioid use stops or is significantly reduced. This phase involves opioid withdrawal, a biological response that occurs as the body adjusts to the absence of opioids. Opioid withdrawal symptoms vary in intensity depending on duration of opioid use, dosage, and individual health factors. During acute withdrawal, individuals may experience flu-like sensations, emotional distress, and intense drug cravings. This stage often begins within hours to days after the last opioid dose. Medical detox provides structured withdrawal management, helping individuals remain safe and supported during the opioid detox process. Medical detox is a critical foundation for recovery, allowing clinicians to monitor symptoms and stabilize the body while preparing patients for the next phase of treatment. ## Stage Two: Acute Withdrawal Stabilization Acute withdrawal represents the peak of physical withdrawal symptoms. During this stage, the nervous system is actively recalibrating after prolonged opioid use. Symptoms may fluctuate, making professional support especially important. Medication-assisted treatment plays a central role during this phase. Medications such as buprenorphine and methadone interact with opioid receptors in a controlled way, reducing withdrawal symptoms and drug cravings while supporting physical stabilization. These medications are evidence-based tools used widely in opioid addiction treatment. Stabilization during acute withdrawal allows individuals to regain physical balance and mental clarity, creating space for deeper therapeutic work. ## Stage Three: Post-Acute Withdrawal and Emotional Healing After acute withdrawal subsides, many individuals enter a phase known as post-acute withdrawal syndrome. This stage may involve lingering emotional and psychological symptoms as the brain continues to heal from long-term opioid use. Mood changes, stress sensitivity, and disrupted sleep patterns can occur during this phase. While physical symptoms have largely resolved, emotional resilience is still developing. Behavioral therapy and structured addiction treatment are especially valuable at this stage. Emotional health remains a key focus during this phase, particularly when considering [how common anxiety and depression are in people with opiate dependence]() as recovery progresses. This phase highlights why detox alone is not sufficient. Ongoing treatment supports emotional regulation, coping strategies, and relapse prevention while reinforcing motivation for recovery. ## Stage Four: Active Treatment and Recovery Building Active treatment focuses on addressing the underlying factors that contributed to opioid misuse and substance abuse. This stage includes comprehensive substance abuse treatment that may involve individual therapy, group counseling, and medication assisted treatment. Behavioral therapy helps individuals understand triggers associated with drug use and develop healthier responses to stress, emotions, and cravings. Treatment plans are individualized, recognizing that each person’s opioid dependence and recovery journey is unique. During this stage, individuals begin rebuilding relationships, restoring routines, and strengthening decision-making skills that support long-term recovery. ## Stage Five: Maintenance and Long-Term Recovery Long-term addiction recovery emphasizes consistency, accountability, and continued engagement in care. Opioid use disorder is a chronic condition, and recovery requires ongoing attention to mental health, stress management, and lifestyle stability. Maintenance treatment may continue to include medications such as buprenorphine or methadone, along with counseling and recovery support. Community-based resources, including structured peer support programs, can reinforce accountability and connection. Relapse prevention strategies are central during this phase, helping individuals recognize early warning signs and respond proactively rather than reactively. ## Understanding the Opioid Withdrawal Timeline The opioid withdrawal timeline varies based on the specific opioids used, whether they were short-acting or long-acting, and the individual’s overall health. Short-acting opioids often produce withdrawal symptoms more quickly, while long-acting opioids may result in a delayed but prolonged withdrawal process. Medical professionals tailor detox and treatment plans to align with each person’s withdrawal timeline, ensuring safety and comfort throughout the process. This individualized approach significantly improves treatment outcomes. ## The Role of Medication Assisted Treatment Medication-assisted treatment is a cornerstone of modern opioid addiction treatment. Buprenorphine and methadone help stabilize opioid receptors, reduce cravings, and allow individuals to engage fully in therapy and daily responsibilities. These medications are not substitutes for addiction but clinically validated tools that support recovery. When combined with behavioral therapy and comprehensive addiction treatment, medication-assisted treatment significantly reduces relapse risk and improves long-term recovery success. Advances in treatment continue to evolve, including options such as the [new buprenorphine shot](), which support consistent medication delivery and long-term recovery planning. ## Managing Cravings and Preventing Relapse Drug cravings are a natural part of recovery and do not indicate failure. Cravings are neurological responses shaped by past opioid use and conditioned behaviors. Effective treatment teaches individuals how to manage cravings without returning to drug use. Relapse prevention planning focuses on awareness, coping skills, and structured support. Recognizing stressors early and maintaining consistent treatment engagement helps individuals navigate challenges without compromising recovery. Developing effective coping strategies is essential, especially when individuals begin to learn [the secret of how to beat opiate cravings before they beat you]() during recovery. ## Why Professional Treatment Is Essential Opioid addiction is a medical condition that requires medical expertise, structured care, and compassionate support. Attempting to navigate opioid withdrawal or recovery without professional help increases the risk of relapse and medical complications. Professional addiction treatment integrates detox, therapy, medication management, and long-term recovery planning into a cohesive approach. This comprehensive model addresses both physical dependence and the psychological components of substance use disorder. ## Moving Forward With Confidence and Support Understanding the stages of opiate dependence recovery provides clarity, reassurance, and direction during what can feel like an overwhelming journey. Each phase of recovery—from withdrawal and stabilization to active treatment and long-term maintenance—serves a distinct purpose in restoring physical balance, emotional resilience, and sustainable well-being. When these stages are navigated with structure, education, and professional guidance, individuals are better equipped to manage challenges, reduce relapse risk, and build a meaningful life beyond addiction. A thoughtful, stage-based approach reinforces that recovery is not a single event, but a progressive process rooted in patience, commitment, and hope. At The Rehab, we are dedicated to helping individuals and families navigate opiate dependence recovery with compassion, expertise, and evidence-based care. We invite you to take the next step with us and explore comprehensive support for [opiate dependence recovery]() designed to meet you where you are in your journey. Our resources also include in-depth recovery podcasts on [heroin addiction](), [OxyContin addiction](), [fentanyl addiction](), and [hydrocodone addiction](). We are here to support you with trusted information, personalized care, and a clear path forward toward lasting recovery. ### Naltrexone vs. Naloxone: What Is the Best Opioid Blocker for Addiction? URL: https://therehab.com/naltrexone-vs-naloxone-which-opioid-blocker-is-best-for-addiction/ ## Which of these opioid antagonists work best to medically treat opiate addiction? Is naloxone the same as naltrexone? Do you know the difference between naltrexone and naloxone? The names of these two drugs are very similar. How do these two drugs work, and which is best when it comes to harm reduction and treating addiction? If you look at a diagram of the two molecules, they look nearly identical. Both drugs act on the opioid receptors in the human body and receptors in the brain. The receptors are blocked, so opioids are not able to activate those receptors. Does this mean that naltrexone and naloxone work the same in every way? Are they interchangeable? Not exactly. They are like keys that open the same lock. Many cars have a regular ignition key and a valet key. Both keys open the door and start the vehicle. However, the similarity ends there. Otherwise, the keys work in different ways, and they serve different purposes. ### What is the difference between naloxone and naltrexone? Naltrexone and naloxone both cross the blood-brain barrier and work on opioid receptors in the central nervous system. Both drugs displace opioids from these receptors and prevent opioids from binding. The similarities end here. Naltrexone takes longer to start working, and it lasts longer, compared to naloxone. Naltrexone is available as an oral tablet. Naloxone does not work if swallowed. So, these minor differences make all the difference in the world in how these two drugs work. ### Naloxone is a rescue drug to reverse opioid overdoses. When someone is dying from an opioid overdose, it is critical to provide treatment as soon as possible. If someone nearby has naloxone, injectable, or nasal spray form can save the victim's life. The bystander gives the person overdosing a dose of naloxone, available as the brand, Narcan, and the overdose ends. Naloxone acts quickly. The victim starts breathing again and wakes up. ### What if you saw someone overdosing on opioids and had a bottle of naltrexone tablets in your pocket? First of all, you would not be able to give the victim the tablets because they are passed out and unable to swallow a pill. Even if you could provide them with naltrexone, it would take too long to work. When seconds count, you don't want to give treatment that will take over 30 minutes to start taking effect. Unfortunately, in an overdose situation, naltrexone would not be the right tool for the job. If you witness an overdose, it is vital to activate the emergency response system as fast as possible. Call 911 or have another bystander call immediately. Find out if anyone in the area has naloxone. The naloxone that you will need is in the form of a nasal spray, injectable, or autoinjector. Naloxone nasal spray is now sold over the counter in pharmacies, so no prescription is needed. Narcan is the best-known brand of naloxone. ### Evzio was the brand-name of a talking autoinjector. Evzio has been discontinued, so you are not likely to find one today. It was highly effective and easy to use. The device was small, light, and easy to carry everywhere. It talked you through the operation of the unit. You pressed it against the patient's thigh and then pressed a button. The device then injected the patient with naloxone into the muscle. Each device held a single dose, and it was sold as a pack of two. Having more than one dose on hand is important because naloxone is short-acting and can wear off long before the opioid has worn off. After reviving a person who is overdosing on opioids, they may fall back into the overdose and stop breathing again after the naloxone wears off. It is crucial to call 911, even after administering Narcan. If paramedics do not arrive quickly, be prepared to give another dose if necessary. ### Where should I be prepared to give Narcan? Opioid overdoses can happen nearly anywhere. Heroin use is epidemic, and much of the street opioid supply contains dangerous fentanyl. You never know who is using opioids. The common perception that a heroin addict is homeless and shooting up in the dark, back alley is inaccurate. While there are homeless people addicted to heroin, opioid use has infiltrated all levels of society. It could be your friend, neighbor, mailman, doctor, lawyer, or a stranger traveling on a train or airplane across from you. There is always the possibility of getting a super-potent batch of heroin/fentanyl. An overdose might happen at any time. ### How do I know if someone is overdosing on an opioid? One common sign to look for is a person who is nodding off. Sometimes people do get sleepy and fall asleep spontaneously during the day. However, if the person is moving slowly, has a glazed look in their eye, is slurring their speech, and then nods off, this is concerning. People refer to it as "nodding." When a person has taken too many opioids dozes off, their head starts to fall. ### How do I know if I should give Narcan? If you now have Narcan in your possession, with or without a training course, how can you be sure when to use it? What if you discover a person who is unconscious with shallow breathing. If you did not observe them using opioids, how do you know it was an opioid overdose? Fortunately, naloxone is a safe drug. For someone who is not on opioids, it does not affect them. So, if you give Narcan to someone who is not overdosing on opioids, you will most likely not make things worse. If the person happens to take opioids for medical treatment, you may induce opioid withdrawal symptoms, but the opioid withdrawal side effects, while uncomfortable, is rarely dangerous. Paramedics and doctors have administered medical cocktails to unresponsive patients that include naloxone. When you don't know why a patient is in that state, it could be due to an opioid overdose. If so, naloxone will be life-saving. An ER doctor once told me a story about a patient who overdosed on fentanyl right in the middle of a Narcotics Anonymous meeting. You may think that this is a sign of the world going crazy. Even people who are trying to get help are going into meetings high on fentanyl. It turns out that this is not such an unlikely scenario, and it is also not a new phenomenon. People who use drugs and are ready to commit to getting help often decide to get high just one more time before walking into a rehab treatment program or a recovery meeting. If you were to walk through the parking lot of a drug rehab facility, you would probably spot at least a few people hiding in their cars, using their drug of choice just "one more time." Of course, we expect a rehab or detox program to have Narcan on hand and ready to use it. Unfortunately, NA meetings are different. These are public meetings organized by local members of a worldwide fellowship. Narcotics Anonymous members state that the organization is spiritual and not religious, yet the NA world services corporation has a tax structure similar to a church. ### Are churches responsible for emergency medical treatment? I have asked the question in NA online forums if Narcan is available at any group meeting. The typical response was that this is not the responsibility of NA or its groups. They do not offer medical treatment of any kind. While I don't doubt that there are many churches with automated electronic defibrillators hanging on the wall, most probably have no life-saving equipment available. On the other hand, you will likely see fire extinguishers on the walls of most churches. That is because of standard state building codes that require fire safety equipment and an evacuation map. Some states require emergency medical equipment in specific establishments, as described in this article about AED state laws. For example, in my state of Florida, physical fitness facilities must have at least one automated electronic defibrillator. The need for these devices in a gym is clear. People are working out and stressing their hearts. There is an increased risk of cardiac arrhythmias. ### What about spiritual fitness facilities? At locations where spiritual addiction recovery group meetings occur, there is an increased risk of newcomers walking in high on heroin and fentanyl. Would it make sense to require buildings that rent space for these meetings to have at least one naloxone rescue kit? If you are concerned about the excessive burden of setting requirements for buildings that host AA and NA meetings, you should not be concerned. The cost of Narcan is relatively low. While it is still overpriced compared to the cost of production, you can probably buy a kit for about the same price as your fire extinguisher. It is far less expensive than an AED. ### What can we do in the meantime to protect the public at risk for overdose? A while back, I had this [conversation with Adam Bisaga, MD]( "Adam Bisaga, MD: Overcoming Opioid Addiction"), during a podcast interview about the possibility of legislation requiring Narcan in buildings just like they must have fire extinguishers or AEDs. He agreed that this was an excellent idea. Since that talk, my thinking about the topic has changed. On a more recent [naloxone podcast]( "The Naloxone Podcast"), I outlined my new thoughts on the topic. It would be great to have legislation requiring buildings and businesses to provide emergency naloxone. Yet, we can start by carrying naloxone and encouraging others to do the same. In more recent conversations on the topic, I have compared naloxone to hand sanitizer. When I first started comparing the act of carrying Narcan to carrying a small hand-sanitizer bottle, not everyone had a hand-sanitizer in their pocket or handbag. Now, in the world of COVID-19 and the fear of infection with the novel coronavirus, people are more aware of having to take precautions. We now must stock up on and carry both hand-sanitizer and a face mask. While the coronavirus pandemic is the top news story, we must not forget about the opioid pandemic and what we can do to minimize overdoses. Going back to that NA meeting where a person passed out and turned blue in the face halfway through the meeting, we can imagine a different outcome. Imagine multiple meeting attendees standing up and taking out their Narcan. While the victim would only need one person to administer the naloxone nasal spray, it would be nice to see overwhelming preparedness. ### Naloxone vs. naltrexone: is naloxone the clear winner? So far, it would seem as if naloxone, the ingredient in Narcan, is the clear winner in saving lives from the dangers of substance abuse. It works fast, by nasal spray or injection, to save lives. Paramedics and police officers carry naloxone. Hospitals have it in the ER and give it by injection or IV. We know that if naloxone kits were in the hands of more people, more overdose victims would survive. ### What about naltrexone? Naltrexone cannot save the victim of an overdose. It works too slowly. No one carries naltrexone tablets intending to save the life of someone who stops breathing due to a heroin or fentanyl overdose. Yet, some people do carry naltrexone tablets to save their own lives. How is this possible? ### Naltrexone is an effective treatment for opioid and alcohol addiction. There is more to saving lives from addiction than providing emergency overdose treatment. We must also consider the long-term treatment of addiction. One of the most effective treatments for both opioid and alcohol addiction is [medication-assisted treatment (MAT)]( "MAT Treatment"). In the case of both opioid and alcohol use disorder, naltrexone works to promote long-term recovery. Like naloxone, naltrexone is an opioid receptor blocker. The difference is that naltrexone starts working slower, yet it lasts much longer. Because of these properties, naltrexone works well for daily treatment. ### How does naltrexone help people addicted to opioids to stay in recovery? Naltrexone helps to prevent opioid cravings. There are two forms of naltrexone available, generic pill forms and a monthly shot. When a person takes their naltrexone every day or gets the monthly Vivitrol shot, which is extended-release naltrexone, they are less likely to have thoughts about using opioids. If you have an opioid addiction and have fully come off opioids, naltrexone may be a good long-term treatment option. ### Naltrexone also helps with alcoholism in the same way. It reduces cravings and thoughts of drinking. In treating alcohol use with naltrexone, there are two ways for doctors to prescribe it. They can prescribe daily use of the naltrexone tablet or the monthly injection. They may also recommend [The Sinclair Method]( "Gray Area Drinking & The Sinclair Method"), which requires taking the tablet one hour before having a drink. Then, the patient must restrict themselves to no more than one or two small glasses. Less is better. The effects of naltrexone help them to limit drinking and eventually extinguish any desire to drink further. Getting back to the treatment of opioid addiction, some people have the impression that naltrexone is not the best option when it comes to MAT. There are two other drugs available in the MAT category for opioid addiction treatment, methadone, and buprenorphine. Buprenorphine is the main ingredient in Suboxone, Subutex, ZubSolv, Bunavail, Sublocade, Probuphine, and Brixadi. Some people, including addiction experts, believe that Suboxone treatment is the best overall medical treatment for opioid use disorder. While this may be the case in many situations, naltrexone is also a very effective treatment. At least one study suggests that naltrexone injections can work about as well as Suboxone films for patients who are able to get started on them. While we need more research in this area, there is no doubt that naltrexone is effective. Naltrexone would be an ideal medical treatment to start during an extended inpatient residential rehab admission. We should encourage education or rehab administrators and counselors of the benefits of long-term treatment with naltrexone, a non-controlled, non-opioid drug. ### Naloxone vs. naltrexone: these are two vitally essential treatment drugs. In conclusion, we now see that these two very similar drugs serve different but essential purposes in the world of addiction treatment for opioid and alcohol addiction. It would be hard to rate one as more important than the other. The differences between naloxone and naltrexone give each drug a unique advantage. When seconds count during an opioid overdose, naloxone is the drug that you want to have present. However, when a person is in recovery from opioid use disorder or alcohol use disorder, naltrexone is a highly effective treatment that can keep people in recovery, living productive, successful, and fulfilling lives without the ongoing mental health issues caused by active addiction. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### Can Suboxone and ZubSolv cause excessive sweating? How Do I Stop It? URL: https://therehab.com/suboxone-sweating-side-effect-how-to-stop-opioid-induced-hyperhidrosis/ ## Is it the Suboxone causing my flushing and sweating? Medications such as Suboxone and ZubSolv, used to treat opioid dependence, often do not have any concerning side effects. Patients take the medication on a daily basis and report feeling as if they are not even taking anything. The benefits of taking these medications, which contain the mixed opioid partial agonist/antagonist, buprenorphine, include reduced opioid cravings and reduced opioid withdrawal symptoms. In fact, many patients say, while they are on Suboxone or ZubSolv, that they feel as if they were never addicted to opioids in the first place. Unfortunately, some patients who take these highly effective meds will experience one or more side effects. One side effect that about 12% of patients will have is hyperhidrosis, or excessive sweating. ## Should I be concerned if I have been sweating from buprenorphine? Of course, it would be great if you did not have to worry about any side effects. It’s bad enough having to be reminded of your opioid addiction each day when you take your dose of Suboxone or ZubSolv. However, the good thing is that sweating from [Suboxone]( "Suboxone Podcasts"), or sweating from ZubSolv for that matter, is not a big deal. It is a known side effect from the medication and it is not a sign of anything ominous or concerning. While you can rest assured that sweating is not a serious problem, you are still going to want to do something about it. It is important that you report any side effect, even Suboxone sweating, to your doctor right away. ## How do I stop the sweating from Suboxone or ZubSolv? Your doctor may suggest trying out a lower dosage of your medication. For example, if you are prescribed the ZubSolv 8.6-2.1 mg tablet, your doctor might recommend reducing it to ZubSolv 5.7-1.4 mg. Or, if you are taking Suboxone 8 mg strips twice daily, you might be instructed by your doctor to take one-and-a-half or one-and-three-quarters of the Suboxone Films. One issue with Suboxone is that it is only available in a limited number of strengths. Suboxone 8 mg and 2 mg are widely available. There is a 4 mg, but few pharmacies carry it in stock or are willing to order it. While ZubSolv is available in more dosage strengths, pharmacies may be less likely to carry them as well. Another alternative is to ask your doctor if they are willing to work with a compounding pharmacy that can closely customize your buprenorphine dosage. ## If I take Suboxone, would it help to switch to ZubSolv to relieve side effects, such as sweating? ZubSolv and Suboxone are both very similar medications. Both prescription drugs contain [buprenorphine]( "Buprenorphine Podcasts") and [naloxone]( "Naloxone Podcasts"). As stated above, buprenorphine is a mixed opioid receptor activator and blocker. While it is technically an opioid, it functions differently from most opioids. However, it can still cause some common opioid side effects, such as constipation, insomnia, headache, nausea, and sweating. Naloxone is a powerful opioid blocker that is not active when you take your Suboxone or ZubSolv as directed, meaning that you place it under your tongue to dissolve. Naloxone is included as an abuse deterrent to prevent people from injecting their medication rather than taking it under the tongue, or sublingually. Is injecting Suboxone or ZubSolv a widespread problem? Probably not. Yet, because it is proven to be safe to include naloxone in the mix, experts agree that it is a good idea to use it to discourage intravenous abuse of these medications. Unfortunately, there is little benefit to be gained by switching from Suboxone to ZubSolv, other than possibly a better tasting medication. Both drugs have the same ingredients and the same side effect profile. ZubSolv has a minty flavor and less of an aftertaste. The other advantages claimed by Orexo, the manufacturer of ZubSolv, is that it dissolves quickly under the tongue and it is available in more strengths than Suboxone. ## What if I cannot lower my Suboxone or ZubSolv dosage? While your doctor may suggest lowering your dosage, what if you are functioning optimally on your current dosage? What if you are willing to put up with a little flushing and sweating to get the benefits of a clear head without brain fog and more energy to get through the day? If you are happy with your current state of functioning optimally without drug cravings or withdrawal sickness, you may be hesitant to agree to a lower dosage. Will your doctor have other alternatives to offer? Interestingly, there are some other ways to address excessive sweating caused by Suboxone or ZubSolv. If your doctor is not aware of these other options, it may be worth asking that they do some research and discuss what might work best for you in a followup visit. ## Can Black Cohosh Root help to reduce Suboxone sweating or ZubSolv sweating? Black cohosh, also known as fairy candle, black snakeroot, or black bugbane, is a plant that can be found along the eastern regions of North America, in both Canada and the US. Native Americans were known to use this flowering plant for medicinal uses. It is possible to buy capsules containing Black Cohosh Root extract from the grocery store, health food store, or even on Amazon. But, can black cohosh help with Suboxone sweating? Will black cohosh root extract capsules reduce or eliminate ZubSolv sweats? Some patients swear by the effectiveness of black cohosh supplements. In addition to buprenorphine-related sweating, the supplement is used for hot flashes related to menopause. There is little, if any, scientific evidence of the effectiveness of black cohosh root in treating any health-related condition. On Amazon, most reviewers were very happy with the product, while some stated it was a waste of money. One Amazon reviewer suggested a product named i-cool, available at Walmart, as a superior alternative to black cohosh. Will i-cool help with Suboxone sweats? I have not heard any reports of patients using it for this purpose. ## Are products such as black cohosh root extract or i-cool safe? These products appear to contain natural products that are not likely to produce any serious reactions or drug interactions. However, with any supplement, it is critically important to discuss it with your doctor before taking it. While supplements that contain plant products, fish oils, or other natural substances are not classified as drugs and not regulated by the FDA, they can potentially have drug-like effects and side effects. Always speak with your doctor before starting any vitamin or nutritional supplement. ## What about Nutridone? Can that help to reduce sweating from Suboxone and similar meds? **Nutridone** is a nutritional supplement that is apparently sold at some methadone clinics. It is also available on Amazon and probably in stores. The description promotes the product as having no iron, making it “appropriate” for methadone patients who suffer from hepatitis C. Nutridone also has added milk thistle, which is believed to cleanse or detox the liver. It also has added Vitamin D-3. Otherwise, it is a standard vitamin supplement with a variety of recommended vitamins and minerals and some amino acids. A similar product, also available on Amazon, is **Vitadone** , which is also a multivitamin. Vitadone claims to promote regularity, reduce sugar cravings, and it claims to support people with a history of opioid addiction. Of course, multivitamins are a good idea, though you might find that a standard product, such as Centrum Silver, is more affordable and also contains the necessary vitamins and minerals. ## Does cinnamon help to reduce Suboxone sweats or ZubSolv sweats? I have seen some mention in various forums where people claim that cinnamon supplement capsules are helpful in reducing buprenorphine-related sweating. There are also claims regarding cinnamon helping with sweats from methadone and other opioids. Cinnamon in excess may not be healthy and might also cause serious problems. There have been reports of breathing problems, liver damage, an increased risk of cancer, mouth sores, low blood sugar, and possibly interactions with prescription medications. Definitely, as with any supplement, speak to your doctor before considering a cinnamon supplement. ## What about antiperspirants? Can these products help? Some patients claim that they have been able to manage the side effect of sweating by using antiperspirants. One brand that has been mentioned is named Carpe, or MyCarpe. This antiperspirant product claims that it can be used on various regions of the body and not just underarms. While this product was created in collaboration with dermatologists and utilizes natural ingredients, you should be careful in using antiperspirants. Antiperspirants typically block pores, preventing healthy perspiration and possibly causing rashes and even skin infections. ## Is ditropan a medication that can help with opioid-induced sweating? Ditropan, also known by the generic name, oxybutynin, is an anticholinergic drug typically prescribed for problems with having an overactive bladder. Ditropan is also known to help with hyperhidrosis, or excessive sweating. It may be worth bringing this up to your doctor. Ask your doctor if ditropan, or oxybutynin, might help to reduce your sweating. Of course, as a prescription medication, ditropan has its own set of possible side effects. Some side effects of ditropan include dizziness, dry mouth, drowsiness, nausea, headache, weakness, and dry eyes. Using ditropan to treat a side effect of Suboxone or ZubSolv is sort of like releasing cats into the wild to reduce a rat problem. While you may have less rats, now you have a cat problem. ## Can clonidine help to reduce the sweating side effect of buprenorphine drugs? If you have been addicted to opioids and you have seen a doctor for treatment, you are possibly familiar with the prescription medication, clonidine. Clonidine is an old blood pressure medication which is sometimes prescribed for people with hypertension, or high blood pressure, when nothing else works. The reason that clonidine is not a preferred, first line treatment for high blood pressure is that it has a long list of unpleasant side effects. Clonidine can cause anxiety, dry skin, confusion, depression, sleepiness, and reduced urine output. You may be familiar with clonidine because it is also used to reduce opioid withdrawal symptoms. Because of its effects in reducing the tone of the sympathetic nervous system, taking clonidine can make opioid withdrawal more tolerable. ## Clonidine is helpful during the induction period of starting Suboxone therapy. It is especially helpful in getting patients through the transition from when they stop taking opioids until they are able to start buprenorphine. This is known as the induction period, which can be difficult for some patients. It is especially difficult when the patient has been using street fentanyl, which tends to stay in their system for a long time, possibly causing precipitated withdrawal, meaning that taking buprenorphine leads to worsening withdrawal symptoms. Clonidine, and other “comfort meds” can make all the difference in helping patients to get through the induction period and safely on to Suboxone, ZubSolv, Subutex, or Bunavail. However, clonidine may not be the best choice to help with Suboxone-caused sweating. The problem, as with Ditropan, is that clonidine itself has many side effects. Still, it is worth bringing it up with your doctor to see if it is a viable option for you. ## Would it help to switch from Suboxone or ZubSolv to the monthly Sublocade shot? Sublocade is a monthly subcutaneous buprenorphine injection that can replace taking daily Suboxone or ZubSolv. It is an effective alternative with the benefit of the patient not having to worry about taking something every day. Also, the doctor has fewer concerns about any patient diverting (selling or giving away) their medication. Another monthly injection that is similar to Sublocade is Brixadi. Currently, due to a patent dispute with Indivior, the company that manufactures Suboxone and Sublocade, Brixadi has been blocked from release in the US. Will switching to Sublocade help with sweating and other side effects caused by buprenorphine? Since Sublocade forms a solid structure under the skin that releases the equivalent buprenorphine of Suboxone 16 mg daily, it is unlikely that your side effects from Suboxone or ZubSolv will go away by switching. One downside of Sublocade is that once you get the injection, the medication is in your system for the entire month, or longer. This means that if you have side effects, there is no easy option to reduce the dosage. To stop treatment mid-month, the medication would have to be removed surgically. Sublocade’s advantages do not include less side effects compared to sublingual buprenorphine. As stated, the main benefit of Sublocade is not having to take daily medication. ## Should I not take Suboxone or ZubSolv because it makes me sweat? Opioid addiction is a serious and life-threatening condition. The success rate of quitting and staying off opioids long-term without medical treatment is fairly low. Even months of residential rehab, while helpful, do not have the success rate of a long-term medication-assisted treatment program with medications such as Suboxone or ZubSolv. Because of the success of these medications in treating opioid addiction and saving lives, it may be worth putting up with a side effect such as flushing and sweating. As we have discussed, there are a variety of options that may help with the side effect that you can bring up with your Suboxone doctor. The conversation about dealing with the Suboxone sweating side effect is ideal for a telemedicine or telehealth medical visit or video consultation with a concierge Suboxone doctor. Why take the risk of exposure to COVID-19 in a busy doctor's office waiting room when you simply want to have a discussion about your health and medication side effects? Many Suboxone patients agree that, even though excessive sweating, or hyperhidrosis, is a frustrating and annoying side effect, it is far better than the alternative of risking opioid relapse. Buprenorphine-based medications are highly effective in helping people return to full functioning, so they can continue with their work and with regular family life without having to worry as much about opioid cravings or withdrawal symptoms. --- ## Alcohol Use Disorder & The Sinclair Method > Alcohol recovery, naltrexone, The Sinclair Method, and related topics. ### Gray Area Drinking & The Sinclair Method: Is Controlled Drinking Possible? URL: https://therehab.com/gray-area-drinking-and-the-sinclair-method/ ## Can a person's craving for alcohol be reduced by blocking opioid receptors? The following is a transcription of a talk I gave for the C3 Foundation 2021 conference, "Stronger Than Your Drink." The C3 Foundation is dedicated to educating doctors and the public about the harm reduction method of treating alcohol use disorder with medication-assisted treatment. To listen to the [full video of my talk at the virtual conference, please click here.]() It can be difficult to identify a gray area drinking problem and when you have crossed that line from moderate drinking to alcohol abuse. The gray area is defined by a social drinker who sometimes engages in binge-drinking. The alcohol consumption involved will vary from one person to another. Is this sort of problematic drinking an actual addiction? If you are concerned about where your drinking life is headed, you may want to consider seeing a doctor. ### Is controlled drinking possible for someone with alcohol dependency? Alcohol dependence is a learned behavior that involves a complex interaction between the pleasure of alcohol intoxication and the resulting endorphin cascade that floods opioid receptors. Advanced alcohol dependency can be prevented by slowing down gray area drinking early on. Consider attending more sober events socially rather than social situations focused on heavy drinking. There is no shame in addressing gray drinking before it gets out of hand. ### The Sinclair Method is an alcohol treatment that uses the opiate blocker, naltrexone. Naltrexone, and similar medications, such as nalmefene, are used in addiction treatment for opioid addiction and to treat addictive behavior related to alcohol use. The idea is that regularly practicing The Sinclair Method (TSM) helps many people reduce their drinking substantially over time, and some stop drinking altogether. What does an opioid antagonist have to do with helping someone to reduce their alcohol drinking? It turns out that endorphin reinforcement is a significant component of the habit forming behavior process of developing an alcohol addiction. ### The need for inpatient treatment can be avoided by providing treatment early while still in a pre addiction state. Many substance abuse problems start this way, and some can be treated with similar protocols that may involve naltrexone treatment. While it may seem like a break from traditional treatment, using naltrexone to reduce a person's craving for alcohol and other substances is well established. One issue that comes up with traditional abstinence based treatment is what is known as the alcohol deprivation effect. Patients who have had prior detoxification and are alcohol-free may start developing an alcohol craving issue months after their alcoholism treatment. The Sinclair Method helps the problem drinker to avoid the alcohol deprivation effect. In the documentary, One Little Pill, people who practice The Sinclair Method are interviewed and followed as they discover that this form of pharmacological extinction for alcohol addiction really does work for a large percentage of the people who try it. Below is the transcript from my C3 Foundation 2021 talk. Claudia Christian and Roy Eskapa have written books about The Sinclair Method. ### What is gray area drinking? Gray area drinking is a level of drinking that is below that of a severe case of alcohol use disorder. And, it is above the level of an occasional, casual drinker who rarely drinks and never gets intoxicated. A person who has an occasional sip of wine or champagne, not finishing the whole glass, is not a gray area drinker. Having a sip or two of champagne on New Year's Eve is not gray area drinking. At the other extreme, a person who drinks to get drunk every single day is probably beyond being a gray area drinker. Having blackouts, where you forget where you were the night before or waking up with people you don't know is beyond gray area drinking. Driving drunk and getting charged with drunk driving is a sign of someone who is beyond gray area drinking. Gray area drinkers typically don't drink in the morning to get rid of a hangover. They are more likely to try other remedies and suffer through the hangover, wishing that they had not had so much to drink the night before. ### Are gray area drinkers just alcoholics in denial? Of course, as the name implies, there is a gray area where it is hard to define where a person is on the spectrum of alcohol use or misuse. Some people do not want to acknowledge that they have a problem until the problem gets bad enough that they have no choice but to get help. There are certainly people who fit the definition of alcohol use disorder who do not see themselves as alcoholics. They may admit to drinking too much on occasion, but not to having a problem with drinking to the extent that they need outside help. They believe that they have the problem under control. A gray area drinker does have control over their drinking much of the time. They do not drink every day. They control whether or not they are going to drink, but when the drinking starts, they have a tendency to get out of control until the night is over. Gray area drinkers are at risk for progressing to becoming alcoholics. While not all will develop alcohol use disorder, many will eventually, as they continue to drink excessively on occasion. The progression may begin when they start going out to drink one extra night during the week. Maybe the partying starts on Thursday night instead of Friday night. One day, with a particularly bad hangover, they may decide to finally try having a morning drink to see if it really gets rid of the headache and sickness. A traumatic life event may lead to more drinking and more life problems associated with drinking alcohol. A death in the family, a breakup, or loss of a job can lead to anxiety and depression. For someone who already has a tendency to drink excessively on occasion, they realize that they can self-medicate with alcohol. Eventually, the level of control that the gray area drinker has over when they decide to go out drinking starts to fade away. Yet, if the person identified themselves as a gray area drinker for many years, they will still believe for some time that they still fit in that category, even after they have progressed into the realm of alcohol use disorder. ### Is gray area drinking a problem? Gray area drinking is common in college age young adults and even with many young working adults. On college campuses where alcohol is allowed, students drink to unwind from a week of hard school work. They go to campus parties and let go, drinking as much as they want on weekend nights. Young healthy people in their early twenties have a sense of invincibility. They see their peers drinking to get drunk and they see no problem with doing the same. Drinking may seem fun in the beginning and lead to exciting unpredictable outcomes. Couples may meet on campus after a night of drinking at a party. New friendships may begin during a drunken night partying together. But, is gray area drinking a problem for these young adults? As we know, there is no amount of alcohol that is healthy. Alcohol is a toxic substance that strains the body and can lead to irreversible damage. The American Cancer Society has stated that it is best not to drink alcohol. Even young and healthy college students would be better off not drinking at all. Alcohol use affects performance. If a college student is concerned about not keeping up in class and not having the grades they want, they should first look at their alcohol intake, and drug intake as well if that is a factor. While most gray area drinkers in college will not become alcoholics, their drinking may have long-lasting consequences. Drinking too much on the weekends has an effect on studying and performance in class during the week. A student may dream of going to a graduate program, such as law school or medical school. Or they may look forward to a good job with a specific company after graduation. Either way, they may have to change their plans along the way because they are unable to achieve their goal, or they downgrade their expectations. Poor grades and changes in life plans are often justified and explained away as being because, either the person was not capable of achieving the goal, or it was not really what they were meant to do. But, what if gray area drinking is what killed their dream? These days, people are often looking for a magic pill that can make them perform better academically or at work to be more successful. It turns out that one of the greatest superpowers a person can have to succeed at making their dreams come true is to remain alcohol and drug free. Gray area drinking can go on for a lifetime. If the problem never progresses, then it never gets to the point where help is definitely needed. No one is going to be confronted with a family intervention because they have a few too many drinks at dinner occasionally. A person may arrive at the age of 50, 60, or 70 and realize that their life dreams slipped away and they never reached their true potential. Even as mature adults, they may still not attribute their life failures to occasional excessive drinking. On the other hand, the alcoholic may get help along the way and go into recovery. Being alcohol and drug free, they discover that they are able to do anything they want in life. The recovering alcoholic has that advantage over the gray area drinker. In fact, people in recovery from alcohol use disorder often start to notice that family and friends around them are gray area drinkers who regularly have too much to drink. ### Do gray area drinkers need medication to help them stop drinking? Should gray area drinkers take medication to help them cut back on drinking? Most gray area drinkers would probably say no to medication or medical treatment. Why should they get treatment when they don't have a problem? Yet, gray area drinking is a problem and all gray area drinkers would benefit from cutting back on drinking. It is possible to stop gray area drinking without medication. There are many coaches that will work with clients to talk them through slowing down and stopping their excessive drinking. These coaches work with their clients by pointing out all of the things in life they can enjoy and accomplish without alcohol. They show them how alcohol use is really not fun at all. Suggesting medication for a problem that can be solved without medication may seem excessive. Yet, we take medication all the time for things like headaches, allergies, upset stomach, and more. Anti-inflammatories, antihistamines, and antacids. Are these drugs safer than a drug such as naltrexone? Why would we think taking a few Advil gel-caps is fine, but taking a naltrexone tablet before going out to a party is bad? The problem is the general lack of understanding of what naltrexone is and how safe it is for most people. Of course, it is not right for everyone, but neither is Advil, Claritin, or Tums. ### Is The Sinclair Method appropriate for a gray area drinker? I believe that the gray area drinker is a perfect candidate for The Sinclair Method. The medication is safe for most people and it works well to help people reduce their alcohol intake. In a perfect world, no one would drink and no one would feel the need to drink. We would all realize that enjoyment of life is better found in other ways than going out for a night of drinking. On a cruise ship, people sit at the dinner table and have one drink after another. Then, they go to the various ship bars and have more drinks. Cruise lines sell drink plans that allow vacationers to have as much alcohol as they can consume. But, wouldn't it be more pleasant to walk on deck and enjoy the sea air and peacefulness of the open ocean? On a ship at sea, you can enjoy beautiful sunrises and sunsets. And, there are many other fun activities to do onboard that do not involve any alcohol. Unfortunately, people still drink too much on vacation and when they go out to nightclubs and parties. What if they had a prescription for naltrexone and were able to take a pill before going out? What if people on a cruise ship could take a pill to help them naturally keep the drinking under control? When it comes to alcohol, less is always better. Naltrexone is safe for most people. Instead of thinking in terms of a person being either an alcoholic or non-alcoholic, we should think more in terms of harm reduction. While not everyone will choose to take the pill, if we made it more available, there would certainly be people who would make the choice to try the treatment and see how they feel with less drinking. College students would be more productive. Vacationers would enjoy their vacations more. Workers would get more work done and feel better going into work on Monday morning. No one has ever woken up in the morning, wishing that they had gotten drunk the night before. ### How well does TSM work for gray area drinkers? My clinical experience in providing TSM to gray area drinkers is that it works incredibly well. The results are dramatic and almost hard to believe. There are people who call my office, inquiring about TSM, who are clearly gray area drinkers. They only drink on occasion, but when they do, they tend to go on one-night drinking binges. In my experience, the typical gray area drinker patient has their consultation and gets their prescription, and then I don't hear back from them right away. When I finally do get in touch with them, they report back that the results were better than expected. In a short time, the gray area drinker loses interest in alcohol. I have, on multiple occasions, had patients who ask if they need to continue with the treatment after a few sessions. They would rather not drink anymore at that point. They quickly lose the desire to drink alcoholic beverages. A large formal study on the efficacy of TSM on gray area drinkers should be done, and I believe that the results would reflect my experience that gray area drinkers respond very well and quickly to TSM. The most common question I get from gray area drinking patients on The Sinclair Method is if they need to keep going on with it. That is a good question. Is further pharmacological extinction beneficial when the patient does not want to have another drink? I don't believe that a few sessions of TSM will completely end a person's alcohol use for life, even if they are a gray area drinker. However, the treatment is certainly beneficial and should be continued or restarted as needed going forward. ### Should gray area drinkers have to go to a doctor for a prescription of naltrexone? If naltrexone is so safe, why do people need to go to a doctor to get a prescription? Why are some medications over the counter and others are not? The kinds of medications that are OTC vary from one country to another. In many countries, people have the freedom to purchase more types of medication and then decide if they want to see a doctor to guide their treatment. In the US, the FDA is conservative in making decisions to allow a medication to become OTC. In some cases, special interest groups lobby the FDA to keep a medication from becoming over-the-counter. For example, there was an asthma rescue inhaler that the FDA was going to approve to be OTC. The reasoning for approving the inhaler was that it would be far safer than the existing OTC inhaler, which has a serious cardiac risk associated with it. Allowing people to make the choice to buy the safe inhaler would have been a form of harm reduction. Of course, it's always great when people go to see their doctor for guidance, but in the real world, people self-treat with what they can find on the shelves of their local pharmacy or grocery store. If the only asthma inhaler that is OTC is the more dangerous one, people will choose it simply to avoid having to sit in a doctor's waiting room to ask for a prescription and then wait in line at the pharmacy. The safer inhaler was never approved by the FDA because a group of pulmonologists lobbied to prevent the approval. Why would they want to prevent the public from having a safer OTC choice? Their argument was that if people with asthma can get the good inhaler without seeing a doctor, they might choose to not see an asthma specialist and get proper full treatment for their asthma. There is some justification to their decision in that lung function should be measured and asthma is often best treated with a combination of medications. However, they did not take into account the concept of harm reduction. It would be great if everyone with asthma would see a pulmonologist. But, unfortunately, many people are not going to go to see a doctor if they know that there is an over the counter medication that they can purchase and use as needed. If there was no asthma rescue inhaler available over the counter at all, then asthma patients would have no choice but to see a doctor for a prescription. But, since there is a dangerous inhaler currently on the shelves, and there exists much safer inhalers available only with a prescription, the proper decision that should have been made by the FDA is clear. In the end, people will choose to buy the more dangerous inhaler that is over the counter because it is the only one available without a prescription. By choosing harm reduction over the greedy lobbying of a group of specialists, the FDA would have, without a doubt, saved lives. ### Should naltrexone be approved for over the counter use? Should people be able to purchase naltrexone tablets without a prescription and without speaking to a doctor or pharmacist? The most important consideration is safety. Over the counter medications are typically relatively safe to the extent that members of the general public can be trusted to read the instructions and take them in a safe manner. Naltrexone does have side effects and contraindications. Not everyone should take naltrexone. Yet, it is very safe for most people. It is on par with the safety profile for other drugs available without a prescription, such as ibuprofen, acetaminophen, and aspirin. Why wouldn't the FDA approve naltrexone to be an over-the-counter drug? Clearly, gray area drinkers everywhere would benefit from the drug being more easily available. Many doctors are already refusing to prescribe the drug without good reason. Their patients often have a better understanding of naltrexone than they do. Imagine if naltrexone were available at the checkout counter in the grocery store? Or at the cash register at the gas station. What if universities could hand out packets with one or two naltrexone tablets? Schools already give away free condoms to students, why not naltrexone tablets? Imagine if you could buy naltrexone in the bar from a vending machine. They already sell a variety of medications in bathrooms, such as aspirin, ibuprofen, or naproxen. Why not naltrexone? ### How can TSM for gray area drinkers improve people's lives? TSM can clearly make the lives of gray area drinkers better. By not drinking, they are able to enjoy and appreciate the things in life that are truly rewarding. Imagine spending an evening with your children, watching a movie or playing a board game? Or, getting to bed early to enjoy a peaceful walk in the early morning. Life is much better without alcohol, or at least with a lot less alcohol. How can society be improved by using TSM for gray area drinkers? It is impossible to measure the lost productivity from gray area drinking. The problem is so prevalent and pervasive in society, that its effects extend to all areas of modern life. When your phone doesn't work because the new update you downloaded has bugs, is it because the software engineers had a few too many drinks at the bar to unwind on the weekends? When your child's teacher puts on a video for the class to watch Monday morning instead of providing an inspiring lecture, is it because they have a hangover from the night before? It's hard to imagine how much better things might work if there was less drinking. It's likely that gray area drinking is a much larger problem than alcohol use disorder and drug addiction. People in recovery often point out that the drug that brought them down the fastest was what got them into recovery so they did not have to linger in active addiction for too many years. Gray area drinkers are essentially lingering in a low level of functional active addiction that can last many years, or even a lifetime. There are likely many more gray area drinkers than there are alcoholics and drug addicts. It's time for us to start thinking about how we can address this potentially much larger problem. ### Should doctors offer naltrexone to all of their patients? Naltrexone is not an over the counter medication and it will probably not be approved any time soon. I don't know who would lobby against its approval, but probably someone will have something to say against it. Maybe the makers of Vivitrol. In the meantime, it is the responsibility of doctors to decide who should get a prescription for naltrexone. Of course, there are limitations to who should get a prescription for naltrexone. People who are prescribed opioids cannot take naltrexone. Pregnant women and people with liver problems should not get a prescription. Otherwise, who should doctors offer naltrexone to? Should doctors carefully screen patients for gray area drinking? Doctors are currently expected to screen patients for alcoholism. There are various questionnaires and screening questions that can help a doctor to determine if their patient has alcohol use disorder. Realistically, it is not a problem that doctors especially want to discover. If the doctor asks if you wear your seatbelt and you say no, the solution is simple. They tell you to wear your seatbelt. Alcoholism is more complex. Your doctor can't simply tell you to quit drinking and expect that to work. They should at least refer you to an addiction specialist. They may also recommend peer support meetings. But, what if you are a gray area drinker visiting your doctor for a yearly physical? You will most likely pass right under the radar of the alcohol screening questions, if they are asked at all. There is an old joke that an alcoholic is defined as someone who drinks more than their doctor. Your doctor may also be a gray area drinker. If the doctor does not see your drinking behavior as a problem, why would they offer treatment? There is a similar medication to naltrexone that is freely prescribed to patients for the purpose of harm reduction. In fact, there are situations where doctors are legally required to provide a prescription for this particular drug. Narcan nasal spray is the rescue drug that can reverse an opioid overdose. Doctors are expected to prescribe it to people who take opioids, whether prescribed or obtained from the streets. They are also expected to prescribe narcan to people who live with opioid users. Narcan is a brand name for the drug, naloxone. Naloxone is an opioid receptor blocker, just like naltrexone. If a doctor is doing their job, they are freely prescribing and recommending Narcan nasal spray. It is possible to justify prescribing or recommending Narcan for nearly anyone. We all have the potential to come in contact with someone who uses opioids and is at risk for overdosing on opioids. The more Narcan out in the world, the better. It is a safe drug and has the potential to save lives. Doctors might want to consider looking at naltrexone in the same way. Naltrexone and naloxone are both very effective harm reduction medications. Naloxone can save a person's life from an accidental opioid overdose. Naltrexone can save a person from a lifetime of excessive drinking. Rather than looking for excuses to not prescribe naltrexone, doctors should instead look for more reasons to prescribe the medication to more patients. The instructions for following The Sinclair Method are fairly easy. They can be described in a few sentences. Doctors give out diet sheets that are more complicated than The Sinclair Method. A prescription for naltrexone and a short instruction sheet will be helpful to any adult patient who is a drinker. The patient may choose not to fill the prescription, or they may fill it and choose not to take it at first. Still, treating gray area drinking as a condition that deserves medical treatment will signal to the patient that their drinking is a problem for their overall health, even if they are not an alcoholic. At some point, that person, before going out to a party or dinner, may look at the naltrexone bottle and start to think about the benefits of cutting back on alcohol intake. By discussing the issue, writing the prescription, and providing an informational sheet about the benefits of TSM, the doctor will be planting the seed in the mind of their patient. That patient may then talk to family and friends about gray area drinking and how there is medical treatment that is easily obtained from their family doctor. In busy clinics where patients come in for vague complaints or general physicals, and hurried doctors go in and out of exam rooms every few minutes, there is often a pattern to how these brief medical visits go. The patient states their chief complaint, the doctor asks questions and then performs a physical exam. Then, the doctor makes recommendations. They may recommend a healthy diet and exercise program, and safe sex practices, and wearing a seatbelt while driving. If the patient has a health condition, such as the common cold, the doctor will recommend supportive therapies to feel better while the cold runs its course. Sometimes the patient has a condition that warrants a prescription for medication and sometimes not. However, there is often an expectation from patients that a medical visit should end with a prescription. The patient may ask for an antibiotic for their cold, even though it will not help. They may ask if there is something they can take to give them more energy or to sleep better. Usually, the doctor must disappoint their patient in explaining that there is no prescription needed, only education. The doctor educates their patient on sleep hygiene, eating less, exercising more and so on. What if the doctor offered a prescription for naltrexone and told their patient that this medication could change their life. They will get to sleep easier on weekend nights, wake up refreshed, lose weight (because they're not drinking), have more energy, enjoy life more, and be more productive in creative projects and in school or work. Life can improve dramatically when even occasional excessive alcohol use is taken out of the picture. Doctors can provide their patients a prescription that has the potential to help change their lives for the better, giving them a better and brighter future. The Sinclair Method is an excellent solution to the problem of gray area drinking. Hopefully, more doctors will learn about this harm reduction protocol and start to have this conversation with more of their patients. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### A Talk With Claudia Christian About TSM, And A Cure For Alcoholism URL: https://therehab.com/claudia-christian-curing-alcoholism/ [spreaker type=player resource="episode_id=20429847" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] _When should we listen to a famous movie and television actress about how to treat addiction and alcoholism successfully? When that actress has a genius-level intellect and has dedicated the past decade of her life to working with the top researchers in the field. Claudia Christian is a major Hollywood actress, known for her lead role in a groundbreaking sci-fi series that ran for five seasons and for a lead role in a Disney feature film and many other well-known appearances._ _She has also recovered from alcoholism with the help of the research of Dr. John D. Sinclair and the guidance of Dr. Roy Eskapa. Since her first exposure to The Sinclair Method for curing alcoholism, Ms. Christian has worked hard to spread the word of this little known, and easy to follow protocol using the FDA-approved drug, naltrexone. She is the founder of the C-Three Foundation, a non-profit organization dedicated to helping patients and doctors to better understand and utilize naltrexone to treat alcoholism._ _The following text is a transcript of our interview which can be listened to on The Rehab Podcast on The Mental Health News Radio Network._ Dr. Leeds: Welcome to [The Rehab]( "the rehab") on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives, and help people to get back on track to a path towards success and happiness in life. On The Rehab podcast, my guest is Claudia Christian, a movie, television star, author, singer, model. Probably best known for her lead role as Commander of Babylon Five and many, many other films, and television shows, and voice work. You were the voice of Jaguar. On IMDB, the Internet Movie Database, you have 145 credits as an actress, which is incredible. You are also the founder of the C Three Foundation, CThreeFoundation.org, which is a foundation that promotes the Sinclair method, which we're definitely going to be talking about. You are the producer of an incredible documentary film, One Little Pill, which is a documentary about the Sinclair Method. Welcome to the podcast. Claudia: Thank you so much, Mark. It's my pleasure to be here. Dr. Leeds: As far as the Sinclair Method, now the use of [naltrexone](), I was speaking to an older doctor who I brought it up, and he said it's really unusual. All the doctors were being told to use naltrexone for alcoholism 30 years ago. These days, nobody knows about it. It's almost like it's been forgotten. You could almost call it the forgotten pill. This guy called me from Naples, which is on the other coast of Florida, I'm in Ft. Lauderdale. He said it would be a three hour drive to come visit me in my office, but he can't find a single doctor in his area who is willing to prescribe naltrexone, which doesn't make any sense because it's probably safer than a lot of over-the-counter medications. It probably should be over-the-counter itself. Claudia: Absolutely. Well, first of all, let me address a couple of things there. That fellow in Naples could easily go onto www.CThreeFoundation.org and find plenty of providers in Florida, including telemedicine where he could immediately get a prescription probably the same day. Furthermore, as far as it being the forgotten pill, absolutely. It was approved in 1994, but unfortunately doctors were told to prescribe it with abstinence, and also usually they told the person to take it in the morning. What you're dealing with there is an individual who is struggling with cravings that usually kick in around cocktail hour after work. It's a psychological aspect, a compulsive behavior that you have a pattern, a habit. Henceforth, people aren't really craving alcohol in the morning, unless they are physically biologically at that point dependent on the alcohol. Let's say you have your average drinker who is drinking too much. Around 4:00 or 5:00, they start to really crave. Well, if you're taking it in the morning and trying to remain abstinent, not only will the medication no longer be at a peak plasma level in your bloodstream, but it really might wear off for some individuals who have a high metabolism. Claudia: The half life is ten to 12 hours, but as we know this can change amongst people. You take it at 7:00 in the morning, and what are you blocking? You're blocking the endorphins you create in life from working out, making love, playing with your children, your pets, doing something you enjoy. This is really counterintuitive to the whole process of getting somebody away from alcohol misuse. It was the wrong way to prescribe it, even though the studies have shown that targeted use of naltrexone is far more effective than taking it in the morning and trying to remain abstinent. Regardless of that, doctors are still prescribing it in that antiquated manner. I think it's a matter of a lot of doctors don't have a lot of education in addiction. It's a very minimum amount of hours required to graduate. I think it's eight hours or something, you would know that better than me. Claudia: I don't think that for continuing education credits it's something that's terribly appealing for, let's say, a general practitioner. I don't think they're going to take the latest continuing education course on addiction. Anyway, all of that adds up to people relying on extremely antiquated manners of treating alcohol use disorder. For example, telling them to go to a meeting or just quit. Clearly, this doesn't work because the rate of alcohol deaths are climbing substantially every year. Now we have a subset of individuals that are incredibly young developing alcohol use disorder. For women, in the past decade 85% more cases of alcohol use disorder amongst women. It's an epidemic as much as the opioid epidemic. [Alcohol]( "alcohol addiction recovery") misuse is an epidemic. It's something that is legal and it's everywhere. It's also legal to target women and to target young people to drink. It's everywhere. Between the marketing and the accessibility, we have a real problems on our hands, Mark. Dr. Leeds: This country has tried prohibition, and they say it didn't work and they made alcohol legal. Do you think it might be time to try that again? Claudia: I don't think so because I've seen massive amounts of misuse in places where alcohol is not available. I've known people serving abroad in the Middle East, and they would drink gasoline. Because if you're physically dependent, or hair spray out of desperation, you will do anything and it might kill you. There are people that huff Aqua Net because they just need to get the alcohol. They drink perfume. I myself, at my very worst, drank vanilla extract. When you're physically addicted and you're taken over by that compulsive behavior, it is all encompassing. You will do anything to relieve the withdrawal from alcohol. Making it illegal, I don't think that's the answer because you'll have prohibition bars popping up everywhere. You'll have speakeasies. You'll have people making more money off of it by selling it at a much higher price. You'll have people producing grain alcohol at home, which is far more destructive to your system, your liver, your esophagus, everything. We know that. You'll have far more cases of cancer. People drinking moonshine die a lot sooner. Claudia: I think what it is is it's education. It's education of telling doctors that it is not responsible, it is malpractice, to say to somebody, "You should go to an AA meeting," and leave it at that. That is not fair to the individual. First of all, that's peer support. It is not scientifically based. It is not a treatment. It is peer support. You wouldn't tell somebody with leukemia to go to a meeting for leukemia patients. It's just complete hogwash. I think doctors need to be educated. By the way, I'm not denigrating or negating that AA helps certain individuals. I'm past all that and saying that we need to move into the modern day, and we need to start treating this as the disease it is. You don't treat a disease with talk therapy. You treat it with medication. You have to have a comprehensive program for the individual because, let's face it, everybody drinks for different reasons. Everybody is made up of different memories and trauma. We have to treat it comprehensively with medication and with cognitive behavioral therapy, or some sort of support. Dr. Leeds: Now, as far as doctors who do treat addiction, a lot of doctors go into the field of addiction treatment because they've had issues with addiction or alcoholism themselves. A lot of them do get credentialed through organizations such as the American Society of Addiction Medicine, or ASAM. Now, if you go to ASAMs website, they're very much in favor of the 12 step process. There's a page where they talk about that it's evidence based medicine, not the 12 step program itself, but the 12 step program facilitation, getting people into AA. The organization that doctors are going to to get credentialed in addiction treatment, the doctors that really want to learn everything about addiction and how to properly treat it, they're being taught the 12 steps are the way to go, which is a big problem. Claudia: I know, it's a huge problem. There is nothing evidence based about it. First of all, the anonymity prohibits you from actually knowing how many people are successful at it, but common understanding or belief is that it has upwards of a 97% relapse rate, that only maybe 2-5% of the people remain sober for a year with the 12 step program. Not only that, I think that especially for women in the program, if you're telling somebody that they're a failure off the start, to be saddled with an addiction is one thing, but then to be told that you're a failure over and over again. They take your chips away if you have a beer after ten years. Everything is based on punishment in that regard. I do believe that if you have a like minded group of individuals that aren't drinking and your goal is sobriety, absolutely. Go to meetings. Make new friends that don't drink. I think that's wonderful. That's comradery in the right lane. Claudia: If you want to reduce your drinking, or if you want to get rid of your cravings, going to a meeting and talking about it is not going to help, I don't think. I don't think it helps with your cravings at all, and there are medications for that. I think that we need to offer people that because people feel like a failure. If they go to AA and it doesn't work for them, if they don't believe in God, or they don't like it, or if they get hit on by some guy, a convict with a criminal record that is court mandated to attend an AA meeting ... Which, by the way, I've been to lots of AA meetings. There's dodgy characters in a lot of them that I wouldn't want my daughter hanging out with if she had a drinking problem. I wouldn't want them to be with court mandated pedophiles in a meeting, and that's what happens in AA meetings. That's the reality of it. Claudia: Anyway, onto the subject of TSM, what I advocate and what I used for my own drinking issue back in 2009. I found a flyer for something called Vivitrol, and it was a shot that was very expensive. I looked into it and I found out that the active ingredient was naltrexone, which is an opiate blocker. As I did a little bit of research, I stumbled upon this book by Dr. Roy Eskapa, the title was The Cure For Alcoholism. I thought, well, this is one more snake oil treatment, but I read the book. I come from a family of doctors and researchers, so I immediately clung on to hope with this method of using naltrexone in a targeted manner. I ordered it online because at that point there was no C Three Foundation. There was no documentary One Little Pill. There was no book Babylon Confidential. There was nothing on the Sinclair Method, other than Dr. Eskapa's book. I ordered it, and it profoundly changed my relationship to alcohol. Claudia: In the decade that I was on TSM, I had my ups and downs. Certainly, when I was complying 100%, it was magical. I had years and years of being able to be a normal drinker, being able to travel and have a glass of wine or being able to sit around with friends and have a drink or two and stop and have no cravings, and not spiral into a binge. For me, it was life saving. I then started to coach people. I opened up my nonprofit foundation to spread the word of it because I thought it was just absurd that people don't have any options. That their option is they're just told to go to a meeting and quit drinking. I've dealt with a lot of young people. It's really difficult to tell a 25 year old not to drink for the next 75 years. It's pervasive in this culture. I think having that option, a lot of people on the Sinclair Method go sober, about 40-something-percent go abstinent. They just lose interest in it. It took me a long time to lose interest. I've been abstinent for the past year, but before that I'd drink and then not drink for six months, then have a little bit. Claudia: I think for me, I just got to the point where I was done with it. That took me a long time. My behavior was obviously more entrenched with trauma and emotional dependence on using alcohol in an unhealthy manner. I'm completely transparent about that. Other people, such as Katie [Cronan 00:13:33] who runs In Body Daily, she did it. I think she was done with alcohol within a year on the Sinclair Method, and she's been sober ever since. There are individuals. Gary Bell, who is in my documentary, I think he did it for a few month, and he's been sober for six years. There are people who respond differently to it, but all in all and the reason why I advocate for it and the reason why I am so interested in medications for alcohol use disorders, because I've seen the results and they are outstanding. If the person is motivated and if the person really wants to gain control of their drinking or stop drinking, these medications are life saving, period. Dr. Leeds: What do you think about psychotherapy, seeing a psychologist to help you with that side of things, developing tools, or getting to the root of the problem of why you started drinking in the first place? Is that important also? Claudia: Yes. I used to be strictly biological. I was very adamant about the majority of people are biological drinkers, and I regret that. That was my experience at the time. I think I was belittling childhood trauma. I think now that I've done a hell of a lot more research over the past decade, I have a much clearer understanding about how much psychosocial support helps an individual throughout this process. I would definitely say that you need to find the right support. I myself had a psychiatrist with absolutely no addiction background that actually triggered me to drink every time I finished a session with her. She was not helpful to me at all in any way, didn't teach me any tools to navigate mindful drinking, or mindful compliance. I wish I would've found somebody, and I wish I would've searched further. I did enjoy moderation management meetings. I thought those were great. I never really found an AA meeting that I felt comfortable in because the redundancy and the repetitiveness of the meetings, the readings of the same thing over, and over, and over again, the references to alcoholism as an allergy, the antiquated wordage didn't sit well with me. Claudia: I never found a meeting that I was quite comfortable in, but I've definitely found online support. We have Sinclair Method meetings. I used to do a monthly Sunday meeting, that was just wonderful. It was two hours plus, everyone just talking about their experiences. I'm trying to launch a site, TSM Buddies, which would match people together for compliance issues, or for alcohol free days, for support, much like a sponsor but, once again, that takes financing. We at C Three Foundation are very grassroots, so that website is on hold for now until we get some money in. In general, yes, I absolutely think that psychosocial support is incredibly important. I think if you have peer support, or a good therapist, or a good psychiatrist with addiction knowledge, and certainly somebody who can build you that toolbox so that you can learn to navigate life's emotional aspects without relying on a substance. I think that's one of the biggest thing is the triggers, the mindfulness when you're triggered emotionally to be able to sit down and work your way through, what if I did drink right now, or what if I did use? Really sit down and think about what that would do, the repercussion in your life, how you would feel how you would feel the next day. Claudia: Once you let that feeling pass, I truly believe with mindfulness and with really an intense connection to your own feelings and to sit with yourself quietly, it really does help a lot. If you do have someone to call, it's even better. It's wonderful to have a support team. I'm always concerned about people who don't, especially people who want to go on the Sinclair Method. A lot of their partners or loved ones think it's an excuse to drink because they don't do the research. They don't look into the science behind it. They just look at it like, oh, you're going to pop a pill and get addicted to that pill, which is absolutely absurd because naltrexone, as you know, there's no possibility of becoming addicted to it. It's not an enjoyable drug. You cannot misuse it. There's never been an overdose of naltrexone. People don't get addicted to naltrexone. It is an opiate blocker. There is a lot of misinformation out there and confusion. Claudia: I think that the most important thing for a loved one of someone who is suffering from alcoholism is to simply allow them to find the options. Do the research yourself if your husband or wife is suffering, and they come home and they say, "I really want to get this shot," or, "this implant," or, "I want to take this pill," or, "I want to take this medication to help with my cravings." For gosh’ sake, do the research and support them. Try to be loving, and come from a place of understanding that this is not a choice. Addiction is not a choice. I didn't wake up some day and decide when I was a kid that I wanted to have OCD, and become an anorexic, and then become an alcoholic. These are the last things that I wanted to happen to me in this lifetime, but they happened. My brain is wired this way. Between genetics and between learned behavior, this is what happened. I thank God every day that science is finally catching up to treatment. Dr. Leeds: As far as finding a good psychologist, and I know that's an issue because I practice MAT, or medicated assistant treatment, in my medical practice, and this is really great to learn so much more about how this works pharmacological extinction and the use of naltrexone, taking it an hour before a drink, and not taking it every single day, and not getting it in the form of a month long shot. I did have an incident where I had referred a patient to a psychologist, someone with decades of experience in the treatment of alcoholism and addiction. The first thing that happened when my patient went to him is he said, "Well, you don't need this medication anymore. We can handle this with therapy." Claudia: Oh, no. That's not good. Dr. Leeds: Then another incident where a patient's therapist wanted to talk to me. She wanted him off of his medication. The first thing she said was, "I'm a Christian therapist. My therapy is based on" ... I was thinking, I didn't think Christianity taught therapy. Claudia: Yeah, it's amazing how people twist things for their own program, so to speak. It's very sad. People in the business of helping others are not open minded enough to understand that everybody is different. You cannot throw one way at every individual and expect them to respond. It's a tap dancing routine for therapists because this person has a totally different life than that other person. This person has a support system, that one doesn't. This one just lost a child, that one lost a job. You can't deal with everybody in one manner. It is unfortunate. I'm hoping that people start to be more open minded and to embrace compassion when it comes to treating addictions. Dr. Leeds: Have you ever been to Celebrate Recovery? Claudia: No, I have not. Dr. Leeds: It's a Christian group, but from what people have told me it's a more easy going group where it's not for any one kind of addiction, not even just drugs or alcohol, but even other kinds of addictions like gambling, but it is church based. It's Christian. It might not be right for a lot of people, but then there's also Smart Recovery. Claudia: Smart Recovery and Life Ring. I think there's also nonsecular, there's also women's groups, men's groups. There's so many choices nowadays. There's also online support. We have a forum, we have Facebook pages. Like I mentioned, the Zoom monthly meetings are now weekly meetings on Wednesday evenings for people on TSM. It's free. You can find your people. I always tell everyone you can find your group that you're comfortable with. People have so many more options than they used to, so many more medications are now being used off label for everything from helping you sleep, withdrawal, cravings. It just depends on what you want. That's why I'm so excited about comprehensive programs for individuals with coaches, and therapy, and medications individually suited to the persons needs. Dr. Leeds: I'm sure you're aware of this, naltrexone is available in almost every state now without a prescription. Claudia: Yeah, which should open the door to naltrexone being over-the-counter. Absolutely. Dr. Leeds: Apparently, naltrexone is not fully over-the-counter, but you can go up to the pharmacist and I guess they prescribe it. Just like a flu shot. Apparently, the FDA is fast tracking it through, that they want it to be over-the-counter. Claudia: It should be, and so should naltrexone. It's going to take a while, but I actually went to Washington DC this year to discuss that with a couple of group of people who help the things get through the FDA and help over-the-counter. I'm hoping that that will come to fruition with a little bit of lobbying, and some time and money put into it. It would be wonderful if you could, much like smoking cessation tools, if you could just go to the drug store and say, "I want some naltrexone." I actually went in India when I was teaching there two summers ago, I went to a local pharmacy just to see if I could get it in Dharamshala, and I did. I said, "I would like to have some naltrexone." He got on his little bike and said, "I'll be back in an hour." Low and behold, he handed me a packet of naltrexone. Some countries are much further ahead than we are. Spain actually used to have it over-the-counter, so did Czechoslovakia. Now people are saying it's getting more difficult to find. I don't understand these steps backwards, I really don't. It's so frustrating being in the nonprofit world and trying to promote something that actually saves lives. Claudia: I'm not making money off of this in my nonprofit organizations, so I always struggle to understand why people won't just listen, why doctors won't open their ears to this life saving medication when we have so much evidence the past decade that I've been working with people. Honestly, I think maybe upwards of 85% of the people it works. You don't have that success rate in other methods. You don't have an 85% longterm success rate. Once again, this takes a certain kind of individual. You cannot force somebody to take medication and to be compliant. If you are meeting with a patient, any doctors out there want to use this method for an individual, it has to be somebody who is psychologically able to comply, who can physically tolerate naltrexone, obviously not pregnancy, or they can't be addicted to opiates. Also, somebody who absolutely will be compliant. That means taking the medication and waiting a full hour before one drink. That means planning, that means mindfulness, that means accountability. If that person displays that motivation, they should absolutely be offered naltrexone. Dr. Leeds: That would be great to take this out of the hands of doctors. It's such a safe thing and people can learn how it works. Doctors, I think, are concerned about liability of sending a patient out and saying, "Okay, take this pill before you have a drink," when they feel like they should be saying, "Don't drink at all." It's like the issue with medical marijuana. Why are doctors involved with marijuana if it's so safe and it helps with so many things? Why not do it like Colorado, just make it recreational or freely available? That's a whole other subject. Claudia: Well, yeah, but then you have the majority of articles and publications talking about marijuana misuse now, and marijuana overdoses, and marijuana making a true impact on the brain of young people in a negative manner. I think anybody who is going to veer towards misuse, substance misuse, if you have accessibility, probably easier accessibility, to alcohol or to anything is probably going to eventually filter out those people that have a disposition towards addiction. They're going to misuse that substance, but as we all know, anyone who has lived in the world of addiction and experienced addiction, you will do whatever it takes to get your substance of choice. I've known people who have benefited enormously from medical marijuana for pain. I've also seen people that use low dose naltrexone and it's changed their lives. They've gone from being in a wheelchair to actually walking because it helps with pain that much in micro-doses. It's also used for fibromyalgia, MS, other neurological disorders. To not make this legal, low dose naltrexone not even FDA approved, to not make medical marijuana legal, of course, it's absurd. Then, of course, you're going to get people who abuse marijuana. I've seen incidences of people who literally smoke pot all day long. The strains are so strong nowadays that they're rendered incapacitated. Is that escapism? Yes, but that's somebody who is maybe prone to abuse. It's a very complicated issue. I don't think it's in black and white. Dr. Leeds: Is there a training program for doctors? Say that a doctor wants to get started, the kind of paperwork and agreement, doctors like to have things in the chart, like legal agreements, like informed consent, to let the person know, yes, go have a drink, but if you don't follow the directions you're going to be in trouble, and we're not responsible for that. Doctors like to make sure, and they want to make sure, they're doing things exactly right by the program. A doctor can read the book A Cure For Alcoholism by Dr. Eskapa, or they can watch One Little Pill, but how can a doctor really become prepared to actually do this in their practice? Claudia: We have a whole website, CThreeFoundation.net. It's C, T-H-R-E-E, Foundation.net. That website is specifically for doctors to learn about TSM. It has the protocol on there, the research. Everything is on that site. One of our dreams if we get funding, or if people start donating more, is to launch our training program for doctors. That's already in the works but, once again, it's all a matter of funding. We do know exactly what doctors need and we have been planning it. It's just a matter of funding. Dr. Leeds: Yeah, I'm looking at the site right now. There is a lot of information here on this page for the doctors, common myths. A doctor saying, "I'm not permitted to prescribe naltrexone." Well, of course they can. In fact, they should be. They should be prescribing it. Claudia: It's FDA approved specifically since 1994. It's been approved for alcohol misuse. It's ridiculous. In 2009, when I approached my own GP, he refused me because he immediately thought it was an opiate. He didn't even look at his little black book. By the way, I'd already been on it for four months, and I was paying outlandish prices to buy it from some pharmacy in India. It was $200 dollars for 30 pills. I really wanted a prescription. By the fourth doctor I went to, I've been refused by all of them, this guy was younger. He had his little book there, his little black medical book, medication book. He looked it up and he said, "Okay." I showed him the packets, the empty packets. I said, "Look, I've been on this, my drinking has reduced to normal. I no longer binge. I drink maybe two three times a week, maybe on glass of wine. This has saved my life." Claudia: He was the only doctor that actually looked into it and gave me a prescription for 15 pills, and told me to come back, and I did. I played the game. Ten years later, he's now one of the biggest providers of the Sinclair Method in southern California. He's seen the results, he's seen it save lives. He's seen people come in and reduce their drinking by half or by three quarters, by 90%. He said, "This is insane that it's not being used more often." He took the time to listen to me, to hear me, and to look into the medication and see that there's no possibility of abusing naltrexone. You can't. That was a rare doctor indeed. It's sad to think that in ten years things really haven't changed that much. I shouldn't say that, because in the six years that C Three Foundation has been open, when I started there was one doctor in the entire United States that prescribed naltrexone for his patients. Now, the whole US is covered almost, so it has changed. Claudia: People still don't know about it, so they don't know to ask about it. That's the sad thing. My Ted X talk has had over two million views, but it's not enough. I've got to do another talk, I have to get out there, but I'm just one person shouting from the rooftop. I am one employee, and I've made one film. It's really frustrating. It really is frustrating, but I haven't given up hope. I'm still as motivated and passionate as I've ever been. I believe in this because I've seen how it profoundly changes peoples lives for the better. I've seen how it saves marriages. It saves the next generation, children being affected by their parents drinking. It's remarkable, and I refuse to give up until this is mainstream and it is the first line of defense. When you go to the doctor they say, "Why don't we put you on naltrexone in a targeted manner?" That is my dream. Dr. Leeds: One part of the problem might be just the state of the healthcare system in the US, that doctors are on this assembly line. They have to see a patient in five minutes. Doctors have one of the highest suicide rates of all professions. Claudia: Also, alcohol misuse rates. Dr. Leeds: Yeah, exactly. You see a doctor to get alcoholism treated. That's an old joke, that an alcoholic is a person that drinks more than their doctor. Claudia: Yes, exactly. It's very hard for them to treat themselves because they don't want to go public with it, obviously. I deal with pilots, doctors, a lot of lawyers because they need privacy. Naltrexone provides that. TSM provides complete privacy. They can get the medication, and then they can just do it at home. Dr. Leeds: That might be the best hope for something like the Sinclair Method to go out to doctors like that, doctors who have time to spend with their patients, who instead of spending five minutes are spending 30 to 60 minutes with a patient. There's another thing called direct primary care. Doctors that don't deal with insurance companies, but they have monthly plans for their patients where they can get as much care as they need, as much access to the doctor as they need for them and for their family. Those are the kind of doctors I think that would have the time to actually sit down and pay attention to this, and actually have time to talk to their patients. Claudia: Absolutely, but in addition to that good idea, doctors who don't have time have everything they need on C Three Foundation's website. They can literally spend five minutes with a patient and say, "If you want to try the Sinclair Method, visit the C Three Foundation page, download the free drink log. Watch the videos. Read the book." I send them a free PDF of the book. They can set their patient up in two minutes because we've provided all the information a patient needs, including peer support. If you have a limited amount of time, the doctor could say, "Here's the naltrexone. You're supposed to take it daily for cravings as per the FDA recommendation. However, if you're going to drink, if you know you're going to drink, make sure you take one an hour before you go to the event." That's not telling somebody to drink. It's telling somebody if you think you're going to relapse, or if you think you're going to be in a dodgy situation, or a place where you always drink. Claudia: It's like a prophylactic. It's like making sure you have your condom. You mentioned earlier that doctors are concerned that they're encouraging people to drink. I think they have to get realistic. Your patient is going to drink. If they're going to a wedding, do you want them to full blown relapse and spiral into a binge, or do you want to tell them that there's a medication they could take that would prohibit them from binging? As a matter of fact, in England, nalorphine was used. They called it originally on the MHS the anti binge drinking pill. That's what doctors were calling it, where if you want to not spiral into a binge, take this medication before you go to the pub. That's the way it was marketed. Dr. Leeds: For doctors who are worried about the consequences of prescribing naltrexone, they can just write the prescription, if they really only have five minutes with a patient, and to the patient says, "Please go look at this website. Download the drinking log and read this." Even if they don't want to do that, they can be assured that most of the time ... The main thing is the patient is not taking opioids at all. Claudia: Exactly. Dr. Leeds: Because it will put them in withdrawal. Claudia: It would put them into immediate withdrawal, even a small amount of naltrexone will. Dr. Leeds: One interesting thing is that the street drug kratom, the herbal thing that they say can help people self treat for opioid addiction, which is a dangerous thing for people to do that, but it's available on cafes and online. There's people who are proponents of kratom. Naltrexone can cause precipitated withdrawal for someone who is taking that drug. Claudia: That's what I've heard as well. I had somebody with a dual issue, they were using opiates and they were misusing alcohol. They had told their partner that they were off of the opiates, and the partner slipped them a quarter tablet of a 50 milligram tablet of naltrexone as a test to see if they were still on opiates. The individual went into full on withdrawal. That's nothing to play with. They had to call an ambulance and everything. It's not funny, it's quite dangerous. Pregnancy, because there have not been enough studies on pregnancy with naltrexone. Of course, the old argument there is if you're pregnant, you shouldn't be drinking at all. If you are physically dependent on alcohol, wouldn't it be safer to take naltrexone than to drink, and ruin your child's chances of a future? The other thing is liver damage. That's another conundrum because, frankly, alcohol most likely has more negative impact on your liver health than naltrexone would. There's been a lot of talk about over-the-counter pain medication having more detrimental effect on your liver than naltrexone. I think it's common sense for a doctor to use on an individual basis. Clearly, if somebody is on opiates, yes, I would say clear away from that. Dr. Leeds: It is definitely a safe medication, safer than probably most of the things that they're prescribing. Claudia: Absolutely. Dr. Leeds: I definitely recommend that people visit your website. Claudia: The best site for individuals curious about the Sinclair Method would be www.CThreeFoundation.org. For doctors, it would be CThreeFoundation.net. If anybody wants to just Google my name, Claudia Christian, and Ted X, they can watch the Ted X talk and refer people to that. My film is called One Little Pill. It's the documentary available on Amazon Prime for free if you're a member, or you can rent it at OneLittlePillMovie.com for a few bucks. It goes directly back to the nonprofit foundation. You can buy it there as well. Most of the resources you'll find on the website, CThreeFoundation.org. Dr. Leeds: Also, definitely for people who have not seen your show, I started watching it on I think Amazon Prime Video, Babylon Five. It's a really great show. I've always been a big sci-fi fan. Just somehow I just never watched it. That's just great. Claudia: Very good writing. That's about 25 years ago. It was a good experience for me. That was in the mid-90s. It's really great writing. Joe Straczynski is a wonderful writer and it was very interesting for that time period. It was the first series to use CGI instead of models. Also, it was one of the few to have a story arch, much like an ongoing epic saga, instead of a standalone episode. Dr. Leeds: All the shows are like that. Claudia: Exactly. It was a little before it's time, but very well written. Dr. Leeds: That show was way before you knew about the Sinclair Method, right? Claudia: Oh, I didn't have a problem with alcohol when I was shooting that, no. Dr. Leeds: That was before even that. Claudia: Yeah, yeah, yeah. I started that series when I was 29, and was on that for the next four or five years. My alcohol misuse really didn't occur until my very late 30s, probably 38, 39, and into my early 40s. Dr. Leeds: I was looking at it and I'm like, wow, there's a character named Sinclair in the show. Claudia: Sinclair, I know. I know. Then in the Disney film Atlantis I played Helga Sinclair. The name has been following me around. It's auspicious. It's funny, but yes. I give thanks to Dr. Sinclair and his research. He devoted the majority of his life to that, which is just amazing what his work and how profound of an affect it's had on my life and many others lives. Dr. Leeds: That's incredible. Well, thank you. Claudia: Thank you, Dr. Leeds. Thanks for having me on the show. Dr. Leeds: Thank you for taking the time out to talk to me. Claudia: Absolutely. You have a beautiful day. Thank you. Dr. Leeds: You too, thank you. Thank you for joining us today on The Rehab on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to The Rehab podcast and share on social media. I appreciate your taking the time to listen to The Rehab. ### Should My College Student Take Naltrexone For Alcohol Use? URL: https://therehab.com/should-my-college-student-take-naltrexone-for-alcohol-use/ ## Does binge drinking have to be a part of the college experience? Can Naltrexone reduce binge drinking? **Can naltrexone help college kids** to keep alcohol consumption under control? Naltrexone is an [opioid receptor blocker that doctors prescribe for opiate addiction]() and also to reduce alcohol consumption. When you drop your child off at college for the first time, you probably have a long list of instructions to give them. Yet, there is a short list of important, even life-saving, points that are so important, you want to make certain that you have your child’s full attention. One of those key instructions that you want to make very clear is to not drink alcohol. You stop what you are doing, look your child in the eye, and say, “I don’t want you drinking alcohol. But, since I know that college kids like to drink, I want you to be careful. Do not drink too much. Avoid dangerous activities such as hazing or drinking games.” Then, you may remind them of some horror stories that have been in the headlines. Fraternity hazing activities with male students gone wrong. A university student gets locked in the trunk of a car and told he cannot get out until he finishes the alcohol they locked in with him. He is then found lifeless the next day. Cause of death: alcohol poisoning. Or, you may tell one of the stories of a college girl who was the victim of sexual assault after drinking too much alcohol and passing out at a party. College campuses today do what they can to control heavy drinking and alcohol abuse on campus, but they have one major obstacle. The typical college student is a legal adult. ## Is any amount of alcohol consumption safe for college students? While the legal drinking age in the United States is 21, underage drinking is still common on college campuses. Student drinking occurs for students of all ages. Is it safe for a 21 or 22-year-old college student to engage in heavy drinking? As we know now, there is no safe amount of alcohol. And, alcohol is one of the deadliest drugs of abuse. Alcohol and opioids are each responsible for a very large number of deaths every year. Even terrifying street drugs, such as crack and meth, account for fewer total deaths each year than alcohol does. The American Cancer Society says that it is best not to drink alcohol. The ideal amount of alcohol for adults to consume is no alcohol. Cancer, of course, is not the only concern when it comes to drinking, and will probably not scare a college kid. ## Alcohol related mortality will probably not mean much to a college undergraduate. The central nervous system does not fully develop until around the age of 25. The process of myelination, which is the full insulation of neurons in the brain, is not complete until that time. The state of partial myelination of the brain, during natural development in the late teens and early twenties, puts college students at risk for making dangerous decisions without fully considering the consequences. Young adults have a sense of immortality and invincibility that is partly due to the underdeveloped nature of their brains. It can be difficult to impart to a college student the dangers of alcohol consumption, especially when it gets out of control. According to the NIAAA, there is an emerging trend of high intensity drinking among adult men and women, 18 years-old and older, related to excessive drinking. The high rate of binge drinking, according to a recent college alcohol study, is leading to significant increases in alcohol overdose and ER visits. ## Why do college campuses hand out condoms to students? On many campuses, there are educational events to warn students of the dangers of risky behavior. While students may have been educated on topics such as safe sex in high school, universities want to do their part in providing this essential information. Of course, it would be ideal to ask college students to be abstinent from sex and from drinking. Wouldn’t it be great if the deans or college presidents of universities could inform students at a substance abuse and alcohol education event that while they are still under the care of their parents, they must not engage in risky adult behavior with negative consequences? One brief lecture from the dean, and all the students nod their heads and agree not to have sex, drink alcohol, or use drugs. Unfortunately, the world does not work that way. What experts have come to understand is that harm reduction is the best solution to addressing dangerous behavior in many cases. Harm reduction means to meet a person where they are at and give them tools to reduce the dangers of these inevitable activities. So, in educating students on safe sex and the dangers of sexually transmitted infections and unplanned pregnancy, universities may make condoms available to the students. This is as if to say, “we would rather you not have sex, but we know that some of you will do so anyway, so here is a tool that will help to keep you safe and here is how to use it.” ## Should universities provide naltrexone to students? What does naltrexone have to do with alcohol consumption? Naltrexone is an opioid-receptor-blocking medication. It is a pill that can be taken by mouth once daily. It is also available in a monthly injection that provides about the same effect as taking the pill every day. Naltrexone was first identified and patented in the 1960s. In the 80s, it was approved by the FDA for treating opioid addiction. By blocking the opioid receptors, the patient found that they could not get high, and they also had fewer cravings for opioids. In studying the drug, doctors and researchers learned that people who took naltrexone also had fewer cravings for alcohol. In the 90s, the FDA gave approval to the drug for treating alcohol use disorder. Alcoholics who went through detox and rehab could ask their doctor for a naltrexone prescription to support their recovery. ## What is TSM? Unfortunately, naltrexone was not especially well-received. Doctors did not prescribe it very often and patients did not ask for it. Maybe it was a failure in marketing, or possibly, naltrexone was not prescribed in the most effective way possible. While US doctors were not excited about helping alcoholics to stay sober with naltrexone, a different kind of research was being done outside the United States. A protocol for using naltrexone for alcoholism was developed and given the name, The Sinclair Method (TSM), named after a Dr. Sinclair, who did much of the early research. Dr. Sinclair had the idea that naltrexone might be used with alcohol consumption to help reduce the patient’s level of drinking. Following TSM is fairly easy. Patients are instructed to take a naltrexone tablet one hour before drinking. ## Why is TSM unpopular in the United States? Why is The Sinclair Method not used more often? Why do most US doctors not even know about it? If it works, shouldn’t addiction doctors and rehabs be talking about it to all of their patients with alcohol problems? To better understand the problem, imagine if the United States government was run by the Catholic Church. Of course, there is nothing wrong with the Catholic Church, but there are good reasons why one of the founding principles of our government is the separation of church and state. If the church had control over our laws and rules at all levels of government, sex education would be very different in schools. There would likely be no talk of birth control. Universities would not talk about safe sex, they would only insist on no sex. There would be no condoms handed out to college students. Condoms might not even be legal. We have a similar issue when it comes to addiction treatment. The program of Alcoholics Anonymous (AA) is tightly bound to medical addiction treatment in the United States. ## AA is a spiritual program that recommends a program of abstinence from alcohol. While the program does insist on the belief in a higher power, referred to as God, members of the program may define their own higher power in any way they wish. The program is inclusive to people of all faiths. Is AA a church? If you were to ask any AA member this question, they would point out that it is a spiritual, not religious program. They would claim that AA is certainly not a church. However, prayer and the belief in a higher power is an essential part of the program. Alcoholics Anonymous is unique in its influence during the 20th century on government and its involvement in all levels of addiction treatment. The founder of AA, Bill Wilson, and his colleagues were highly effective in promoting the program and gaining the support of highly influential people. It is only in recent years that rehabs are starting to offer AA alternatives. Some rehabs are also providing medical treatment for alcohol use disorder and other addictions instead of insisting on full abstinence in accordance with the principles of AA. ## What does a naltrexone tablet have in common with a condom? Universities provide condoms to students for the purpose of harm reduction. They are not giving them out to encourage students to have sex. They want students to behave responsibly, and condoms can help to prevent pregnancy and the spread of disease. Naltrexone, when used with The Sinclair Method protocol, can be seen similarly as a form of harm reduction. Just like a person who is sexually active carries a condom with them just in case they need it, a person who drinks alcohol can carry a naltrexone tablet with them. If that person is in a situation where they know they will be drinking, they take the tablet one hour before drinking starts. The naltrexone will help the person who drinks to control their drinking and drink less. There will be less craving, less obsession, and less compulsion to continue drinking after the first drink. Naltrexone helps to curb drinking. What if universities could give students naltrexone? For now, naltrexone is a prescription drug and can only be obtained with a doctor’s prescription. However, universities do have health centers that employ doctors, physician assistants, and nurse practitioners. It would be possible to make naltrexone available to students. Of course, we would rather that our students not drink alcohol, but if they are going to have a drink, we want them to drink safely. An important part of safe alcohol consumption is to stop before becoming intoxicated. ## Does naltrexone make campus drinking safe? Unfortunately, naltrexone is not a magic pill. It will not prevent all drunk driving and motor vehicle crashes. Naltrexone will not put an end to academic consequences of alcohol misuse and it will not stop all alcohol related sexual assault. There is still a need for ongoing alcohol use education and access to counseling and therapy for all college students. Maintaining the mental health of college students is critically important. College life can be stressful and many students will turn to drinking as a form of stress relief. Yet, naltrexone can help to make a difference. A person who uses naltrexone to curb drinking early on will likely have less of a risk of developing serious alcohol dependence later in life. By providing a mechanism for pharmacological extinction of the development of alcohol addiction in the brain, healthy drinking habits can be formed early on before a young adult at risk develops full-blown alcohol use disorder. ## Is gray area drinking a serious problem on college campuses? A new term has come into use in the past few years to describe a particular type of alcohol drinker that may represent the typical college student. The gray area drinker does not drink alcohol every day of the week. They do not consider themselves to be an alcoholic or to have a drinking problem. However, the gray area drinker does tend to get out of control when they do drink. On the weekends, when going out to parties or other social events where alcohol is served, they tend to engage in heavy drinking. They are often binge drinkers, but maybe only 1-3 days per week. A college student may function very well in school and have high grades, yet they may also be a gray area drinker. College drinking traditions often encourage binge drinking. The problem with gray area drinking is that it puts a person at higher risk for a tragic event, such as alcohol poisoning, date rape, motor vehicle crashes, or other alcohol related unintentional injuries or alcohol related mortality. When a person is pulled over by the police for DUI or DWI, the authorities are concerned with intoxication at that moment and with blood alcohol concentration. They do not care if a person is an alcoholic or a gray area drinker. At that moment, they are confronted with a person who poses a serious risk to themselves and others. ## Naltrexone works very well for many gray area drinkers. In my experience, I have seen gray area drinkers do very well with naltrexone to help them reduce their alcohol intake. Once we change our mindset with respect to the medical treatment of alcohol use, we open up a whole new world of possibilities. The old model of addressing non-addictive drinking was that individuals had a responsibility to use willpower and self-control to manage their drinking. Experts preached to young people and adults about the dangers of excess and the importance of not giving in to peer pressure. By seeing alcohol use in a new light and applying our better understanding of how the brain works, we can help people to manage their drinking with a combination of tools. Treating alcohol use disorder with rehab and medications, such as naltrexone is a great way to help an alcoholic to recover. What if we started much earlier in the process, helping people at risk for alcoholism to not progress to the point where they have an alcohol problem? We have the tools to help young adults in college to prevent alcohol dependence. The challenge is to move forward in making these tools more readily available. When a college student begins to move towards becoming a gray area drinker, we have an opportunity to help them. We can help them to avoid the consequences of excess drinking and to avoid developing alcohol use disorder. ## Prevention is the best medicine when it comes to treating alcohol misuse. It may be possible to prevent the development of alcoholism by addressing the issue at an early age. Education and counseling are excellent tools, but they may not be enough. Naltrexone is a relatively safe drug. It has been in use for decades and has few risks associated with it. There has been a movement to push for the approval of naltrexone as an over-the-counter drug. It may be possible one day to obtain naltrexone as easily as Advil, Motrin, or skin cream. While it is not a perfect solution to end all alcohol-related problems on college and university campuses, it could make a significant improvement in helping students to control excess alcohol consumption. It is all about harm reduction and keeping our children safe. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### How Do I Get Sober On My Own When I Cannot Stop Drinking? URL: https://therehab.com/how-do-i-get-sober-on-my-own-when-i-cant-stop-drinking/ ## Staying Clean and Sober: You can learn how to do it. You may have heard people talk about how they got sober from alcohol or clean from drugs. If you are still struggling to get sober yourself, it can sound overwhelming. How did they do it? What did they do at the beginning to quit? Did they struggle each day, fighting the urge to drink or get high? How did they finally figure out how to get sober? ### Let's start thinking outside of the box. Some of what I am going to talk about here may seem unorthodox when it comes to getting sober and staying sober. What do creativity and musical composition have to do with sobriety? What does art and starting a business have to do with staying clean? I believe that to make addiction recovery work for more of us; we need to start thinking outside of the box. A new patient once told me that she made an appointment with me because she believed that I was able to think outside the box and not recite the same old recovery formula that she was hearing from other doctors. It makes sense that many doctors in the field of addiction treatment would espouse the traditional AA-based 12-step program as a foundation for recovery. While it may help many people and be the best solution for some, it is not for everyone. The 12-step fellowships may even be harmful to some people. Yet, one of the most respected organizations, that credentials doctors as being board certified in addiction, is closely aligned with the 12-step philosophy and even describes 12-step facilitation an evidence-based therapy for addiction. No wonder my father sometimes used to say we should spell it, "bored certified." As the underlying principle of the first step goes, we need to learn to be more open-minded and willing to look at other ideas that might work best for different people who are looking for help to get sober and stay sober. Two of the things that caught the eye of that one patient were Koi Therapy and Binaural Beat Therapy. The first is the idea that beautiful Koi fish could be a valuable part of meditation and mindfulness to promote ongoing sobriety. Binaural beats are a powerful method of entraining brain waves with sound to help with focus, meditation, relaxation, and sleep. One of the foremost American neurosurgeons, and former Harvard neurosurgery professors, has spoken highly of the power of binaural beats to help with addiction recovery. Why don't more doctors recommend sound therapy? Maybe because it doesn't come from a pharmaceutical company. If you are ready to think outside the box about how to get sober and stay sober, please read on. ### Is it the last house on the block? There is a saying in AA and NA that the 12-step group was the last house on the block. What does this mean? It means that the person who is sharing tried everything else available to them to get sober. They may have tried medicine, psychiatry, psychology, church, and a variety of different tricks and methods to help them stop. If you are sitting in a meeting in a state of desperation and hopelessness, you may relate to this statement. You feel as if you have tried everything, and nothing worked. You tried drinking or using drugs on the weekends only. Maybe, you kept a written diary of your drinking. Or, you may have decided only to drink a certain kind of alcohol. ### Is it the last chair in the last room? There is another saying in 12-step meetings that takes the last-house-on-the-block saying a step further. Some people will share that they are sitting in the last chair in the last room in the last house on the block. This statement emphasizes that they believe that they have tried everything possible. It may also imply that groups and institutions have shunned them—their resistance to change and giving up drinking led to the burning of many bridges. ### Have you tried everything to get clean and sober? While the dramatic sayings and slogans that you will hear in meetings can give you chills when you listen to them, are they valid for you? Have you tried everything? Did you see a psychologist? If that psychologist didn't help, did you look for another one? Did you seek a second opinion? When your doctor gave you a look of not understanding your situation, what did you do? Did you search for another doctor that might be more specialized in the field of alcohol use disorder or substance use disorder? Even doctors in the area of addiction treatment can get things wrong. It doesn't mean that you have tried everything. ### Peer support groups can help. While I may seem to be steering you away from these support groups, such as 12-step and non-12-step meetings, I am not. I would give the same advice when it comes to such groups. If you have a terrible experience, you do not have to think that the whole organization is wrong or cannot help you. Maybe you just went to a group that is not right for you. Or, perhaps they were not having their best night. ### Beware of meeting hijackers. When you go to a meeting in a free fellowship that is open to the public without professional moderation, there is some risk of hijacked meetings. What does this mean? There are people who, for whatever reason, will take over the meeting. They may talk for too long. Or, they may share a graphic story of their alcohol or drug use that makes you feel uncomfortable. Even worse, they may say hurtful and inappropriate things that make you wish you never left your house that evening. These are meeting hijackers. They could be angry people that want to hurt others with their words. Or, they may have a mental health condition that causes them to behave this way in open forums. Another possibility is that they like the sound of their voice and can fill any amount of time with endless talk. People like this thrive in meetings. Imagine being in a meeting where you feel that you must get something off your chest. Then, in the last fifteen minutes of the meeting, an old-timer member decides to fill up all of the remaining time. They go on, repeating the same old ramblings that they share at every single meeting. You realize that you are the victim of a meeting hijacker. You walk out of that meeting with a sick, sinking feeling. What do you do? Some people would use this as an excuse to never go back to meetings. They may even use it as an excuse to drink again. Fortunately, many meetings continue after the session is over. Some members may call it the "meeting after the meeting" or the "meeting in the parking lot." After the meeting, you should be able to find one or more people you can share with one on one. You do not have to go home angry or frustrated. In having these after-meeting conversations, you may make new connections, new friends, and you may find where and when the right meetings are for you. ### I would like to know how to get sober. While 12-step programs and meetings alone work for some people, you will likely benefit from a combination of approaches. Going to an AA meeting does not have to be the only thing you do or the first thing you do. If you find that you are starting to drink too much and your drinking may be getting out of hand, it is time to make some changes. There is more than one way to get sober. ### There is more than one way to do it. Have you ever heard of the acronym, TMTOWTDI? It comes from the community surrounding the PERL computer programming language, invented by the brilliant Larry Wall. Interestingly, Larry started his career as a linguist and evangelist who planned to travel to Africa with his wife and create writing systems for unwritten languages so he could translate texts into those languages, including the Bible. Instead, Larry went to work for Nasa's JPL and eventually became famous in the world of programming for creating the PERL language. When the internet first became known to the general population through the World Wide Web, the PERL language was the glue that held much of it together. One of the fundamental principals of PERL is that there should always be more than one way to do something. Supporting different approaches to problem-solving makes sense. Collections of problems are different for various people. The wiring of our brains is unique, and we all see the world from different perspectives. If we force everyone to follow the same path of recovery, it is not going to work as well or at all for some people. We may think of computer programming as a dull science and technology topic, but, as you can see, we can learn from the brilliance and creativity of the members of that community. ### How do I make changes to get sober? First, ask yourself why you drink in the first place. Is it for social reasons? Some people are in circles of friends where it is customary to have a few drinks when they get together. Others are in a lifestyle pattern of going to parties or nightclubs. In a noisy party situation, you may feel peer pressure to drink. You may also think that drinking treats the social anxiety that you feel in such a setting. In planning to get sober, you may even consider the possibility of controlling your drinking with the goal of complete sobriety over some time. The Sinclair Method (TSM) is a medication-assisted treatment option for treating alcohol use disorder that involves a non-addicting medication taken before drinking. If you are following TSM, you will have your tablet one hour before your first drink. Then, you will limit yourself to that one drink. It is called "pharmacological extinction." It is a way of reprogramming the brain to no longer get rewarded for the feeling associated with drinking alcohol. It may work for other drug addictions and even for binge eating. Why is TSM not recommended by more doctors? That is a good question. When we are fighting in a war against epidemic drug and alcohol use, we need to be open-minded and look at a variety of possibilities. TSM is more widely used in other countries, where scientists have studied it for decades, yet is still rarely used by US doctors. ### Change your perspective to change your drinking. At this point, you may take a step back and look at the drinking patterns in your life. No one needs to drink alcohol for any reason. Alcohol is nothing more than a legalized drug. If there was legal [heroin]( "Heroin Addiction Recovery Stories Podcast") or cocaine, would that make it a good idea to use them? Not only is alcohol a drug, but it also happens to be one of the most destructive drugs that people use. You decide to drink or not drink. If you feel pressure from certain people in your life to drink, it is time to learn to be assertive. If you say no and they continue to pressure you, then these may be toxic people. You do not need toxic people in your life. What about clubs and parties? If these social situations make you uncomfortable, you may choose to avoid them altogether. For most people, these are unnecessary. You don't have to go out to a noisy bar where you can't hear yourself talk, surrounded by people who make you uncomfortable. If your work requires meetings in bar settings, consider working towards a new career, where you have more control over your social activities outside of work. ### What if my friends keep pressuring me to drink? Are these people indeed your friends? What are their motivations to pressure you to drink? Are they trying to hold you back from success? Some people enjoy watching their friends fail in life. You don't need friends like that. You may even find that your family pressures you to drink. The same advice goes for family members. If you have asserted yourself to your family that you do not choose to drink, that should be the end of it. Family is a flexible term that does not have to be your blood relatives. ### You can build a new family and healthy relationships. As you change your focus to staying sober and not drinking or drinking less, you will start to meet people who are focused on sobriety. People who are better suited to be part of your family and support network may have always been there. It is merely a matter of changing your perspective and focus. Just by changing the people who you surround yourself with can make all of the difference. There is a saying that you are the average of the five people who are closest to you. Your success in life depends on your secure network of success-minded people who support you in your success. ### Now is the time to get physically active to help you stay clean and sober. What does it mean to be physically active? Do you have to join a gym? While joining a gym and going at least a few days a week is not a bad idea, you can be physically active in many other ways. The most basic and possibly, the [best form of exercise]( "The Best Exercises for Addiction Recovery") and physical activity is walking. While walking may sound mundane, it is not. Taking long walks is the foundation of success for many of the most successful people in history. Whether you walk alone or with a good friend, you can breathe in the outside fresh air. You can observe nature and many fascinating sites. Walking and being aware of your surroundings can be a form of meditation. As you walk, try focusing on a particular sound in your environment. It could be a singing or chirping bird. Or, it may even be construction machinery or the sound of the wind blowing through the trees. Let your mind clear as you listen to that sound and feel the fresh breeze as you walk forward. If it is cold, you can focus on the feeling of cold against your skin. If it is sunny, feel the warmth of the sun as you walk. Of course, be careful to protect yourself against the elements! So, walking is not only the best and safest form of exercise for most people, but it is also a great way to reset and recharge your batteries, preparing for getting back to the daily activities of your life. You can also have great conversations if you walk with a friend. Walking can even be a forum for business. Some of the biggest business deals in history started with a walk and a conversation between two business leaders. The best way to get sober is to follow a program that includes daily walking for exercise. ### Physical activity can be a musical activity. Do you play a musical instrument? Did you ever play an instrument? Even if it has been many years since you picked up your musical instrument, now is a great time to practice again. It is like riding a bicycle. You can practice and get good enough to enjoy playing in a short time. For example, I played trumpet in the 7th grade. After decades of not touching a horn, I am confident that I could play a scale and a few simple songs if I were to pick one up. ### What about musical composition? Are you a composer? While you may know how to read and write music, you can still enjoy musical composition if you do not. To create music, all you need is an instrument and a recording device. Your recording studio could be as simple as your voice and your phone with a recording app. Alternatively, you may have a computer setup with music software and an attached musical keyboard or beat pads. There is something about the creation of new music that is deeply satisfying. You are expressing yourself emotionally through music, and you are also creating an audible work of art to share with people close to you. Social media is a great place to share your musical creations with your friends. ### Video production is a fun way to create. Video production goes hand-in-hand with musical composition. Imagine that you want to share your music with your friends and the world. Online social media platforms are more aligned with sharing a video than an audio recording. One way to share music through video is to use a video creation program that allows you to combine stock video with your music. You can create short one-minute compositions and add appropriate video with fancy transition effects. Then, you can post the video on Instagram, Twitter, Facebook, LinkedIn, and Tik Tok, among others. Maybe your audio/video creations will lead to a new career! ### You can express yourself through graphic arts. Do you like to draw or paint? What about creating art on a tablet or computer? Whatever medium you prefer, you can express your feelings through your creativity and also have the fulfillment of producing new works of art. Again, like music and video, graphic artwork can be shared with your friends and the public through social media. When it comes to Instagram, visual artwork is ideal for building a social media following. There is something spiritual about the act of creating something new in the world. Creating art and music can support your efforts if you are trying to get sober and stay sober. The best way to get sober is to follow a program that includes filling your days with creative activities. ### Get a job to stay sober. If you are unemployed and spending a lot of time sitting on the couch watching TV, you may not be doing your best to stay sober. Keeping busy is essential when it comes to staying sober. When looking for a job, be sure to find one that supports your sobriety and does not undermine it. For example, working as a bartender or server in a bar is not a great idea if you are trying to stay sober. Ideally, working with sober people who support your goals will be best. Going into work for a full eight-hour day, five days a week, will at keep you busy. You will have less time to obsess over having a drink. ### Create a brand and a company. While starting with a job is a great idea, you may want to build a new brand and business in the long term. If you are enjoying creating music or art or making things such as websites or other creative activities, you can create a business out of it. If this is of interest to you, don't forget to learn about marketing and building a brand identity. Remember, you do not have to find this overwhelming or do it all at once. Take it a step at a time. You may find it helpful to take some online classes or even work with a coach. It may seem like a long and slow process, but if you keep working on it, one day, you will look back at what you have created with satisfaction. Creating a business can give you peace of mind, security, and freedom. And, it keeps you busy enough not to have time to drink. You must also always remember that it is your sobriety that makes creating great things in life possible. When you go back to drinking, you risk destroying everything that you have worked hard to build. ### How can I stay cool and calm in stressful situations? No matter what you do, life will present you with stressful situations that will test your resolve. When the stress is significant enough to make you feel trapped and powerless, you may get the overwhelming urge to have a drink again. While you must do your best to maintain sobriety, relapses do happen and are part of the condition of alcohol use disorder and substance use disorder. If you do relapse, remember that all is not lost. Get back on track as soon as possible to minimize physical damage and setbacks in your life. Of course, it will be best to avoid relapse in the first place. Getting to know yourself and know what your triggers are and when they present themselves. Then, you can prepare ahead of time to stop the progression of relapse before it even begins. Making critical changes in your life will help you to stay calm and centered. Learn to say no when people ask you to do things that lead you in a direction that will add stress to your life. You can learn to deal with triggers and live better and safer. If you want to know how to become sober, learn more about yourself, and what triggers you to use alcohol or drugs again. ### What do I do about my past mistakes? Part of the 12-step process is dealing with the wreckage of the past. However, you do not have to work the 12 steps to fix your past mistakes. In many cases, there is nothing to do other than let time pass while you work to build a better life for yourself. Alcohol and drug addiction is a health condition and not a moral failing. You may feel that you need to make amends to people for past actions to help rid your conscience of guilt. In some situations, people in your life should be making amends to you. How did your family and loved-ones treat you while you suffered from a health condition? However, forgiveness is an essential spiritual principle of healing. Forgiving others and learning to be grateful for the good things in your life will make a big difference in helping you to feel calm, centered, happy, and fulfilled in your life. Forgiveness and gratitude are part of learning how to become sober. ### How can I find balance in my life? If you have worked on the things I have already discussed here, you are well on your way to finding balance. Another recommendation is to start practicing meditation. How do you learn how to meditate? You can go into formal training for a particular discipline of meditation. Or, you can simply dedicate quiet time at specific times throughout the day to sit quietly without interruption and allow your thoughts to pass by without entertaining them or obsessing over them. If there is a quiet and peaceful place outside where you can sit, on a bench in a garden, for example, that can help. Or, just find a quiet place to close your eyes and relax. An essential part of learning how to get clean is learning to meditate. Most importantly, you must not be interruptable during meditation sessions. Make this clear to people around you that meditation is an integral part of your life. You may discover that some people in your life are toxic to your sobriety if you are not allowed even a few minutes to yourself to meditate each day. ### How can I avoid having a relapse with alcohol or drugs? Avoiding relapse is as easy as not putting a drink or drug in your hand. In recovery, people call using drugs or drinking, "picking up." You can think of this literally as picking up a drink or drug with your hand. Once it is in your hand, you may be beyond hope of stopping yourself. Yet, if you never pick up a drink or drug, you will not use it. You may think that this is an oversimplification, but it can be helpful to think of relapse in this simple, concrete manner. Going further, you can design your life in such a way that access to drugs and alcohol is difficult and even nearly impossible. You can create barriers in your life, in the form of new habits. For example, you may have developed the habit of reaching for a drink whenever you are in a stressful situation. Over time, you can develop a new and healthier habit of calling a supportive friend first. Once you are past the impulse of wanting a drink, you will have a chance to think about the consequences. With time and practice, you can build up your defenses against relapse. Avoiding relapse is a critical part of how to get sober and stay sober. ### How do I manage urges to drink or get high? One of the best ways to get past cravings and urges for drugs and alcohol is to allow time to pass in your recovery. While it may be harmful to obsess too much over clean time, clean time is essential. For physiological reasons, staying clean gives your brain and body time to heal and recover. Urges and cravings will diminish naturally over time. You can also make an effort to eat healthy foods. Proper nutrition and supplements can speed up the recovery of your brain and body. If you want to know how to get clean, start by putting down alcohol and drugs and then by eating healthy foods. Additionally, going to therapy can help you to learn more about yourself and develop tools to address urges. Therapy is an essential component of recovery from addiction. I recommend looking for a doctor of psychology who has credentials in addiction treatment. In treatment, you may also address issues from your childhood. Your therapist will guide you through this journey of self-discovery. You will learn how to heal from emotional injuries of the past. ### How to get sober and stay sober is an individual process that will be different for each human being. We are all different. There is no one-size-fits-all solution. Some people will do their best to [ stop drinking]( "Alcohol Addiction") altogether. Other people will find that medical treatment, such as TSM, can help them to control their drinking. There are a variety of support programs as well. From the Christian non-12-step program, "Celebrate Recovery," to the science-based "Smart Recovery," there are many options for support meetings. There is also LifeRing, as well as many varieties of AA-based 12-step programs. There are detox facilities and rehabs as well as The Sinclair Method that involves [medication-assisted treatment]( "MAT Program") to reduce drinking. Now, we even have FDA-authorized phone apps to provide cognitive behavioral therapy. This new technology is known as Prescription Digital Therapeutics. Beyond these peer support programs and medical treatments, there is a whole world of healthy activities that will help to support your recovery. As you progress, you will discover what works best for you. Going forward, you can create a life of happiness and long-term sobriety. ### Can You Die From Alcohol Withdrawal With Cold Turkey Treatment? URL: https://therehab.com/can-you-die-from-alcohol-withdrawal-with-cold-turkey-treatment/ ## When you quit drinking, can alcohol withdrawal kill you? Alcohol addiction is an insidious condition that sneaks up on you. Many people drink alcohol on the weekends and on special occasions for many years without any serious problems. For some people, they will eventually cross one line after another, bringing them gradually to a state where they are psychologically and physically dependent on alcohol. First, they may realize that a drink or two at night during the week helps the to feel better or sleep better. Then, when they start to drink too much and get a hangover in the morning, a drink or two in the morning takes away the headache. Eventually, you may find that you are drinking every day of the week, and consuming more alcohol than most people would be able to handle while still functioning with respect to everyday life. Along with daily drinking, you will likely have other problems, such as blackouts and legal issues, such as DUI or DWI charges. If your drinking has reached the level where there is no doubt that you are suffering from advanced alcohol use disorder, you may be aware of the dangers of quitting cold-turkey. Quitting alcohol suddenly can lead to a dangerous withdrawal syndrome that can certainly be life threatening. ### Do not use the dangers of withdrawal as an excuse not to quit. While there is danger in quitting, you should not use this as an excuse to continue drinking at a dangerous level. While there have been deaths from alcohol withdrawal, there have been many more deaths from excessive, ongoing alcohol overuse. It is possible to detox safely off of alcohol with medical assistance. When it comes to a safe, medical detox from alcohol, you have several options. First, there is the traditional detox and residential rehab pathway to getting sober comfortably and safely. If you check in to detox, you will be in a hospital-like setting for a week or two. During that time, your health status will be monitored around the clock by nurses or other healthcare professionals. During your stay, you will also visit with an internist or family doctor as well as a psychiatrist or psychologist. ### The primary purpose of inpatient detox is to prevent deaths from alcohol withdrawal. The detox process involves two major components. The most important of all is time. The alcohol itself is cleared from your system within hours to a day, but your nervous system has adapted to the constant presence of alcohol and needs several days or longer to readjust. There is no way to speed up this process. Once the alcohol is gone, your autonomic nervous system will kick into overdrive, and the risk of seizures and delirium tremens is highest in the first few days after the last drink. The second major part of detox is protecting your brain and body from the effects of acute alcohol withdrawal. This involves sedative medication to calm down your overexcited nervous system as well as important nutritional support to prevent permanent consequences, including brain damage. Detox facilities administer medical treatment to make the detox process tolerable and to prevent serious events, such as seizures, irregular heartbeat, and agitation, and confusion. ### Following your detox unit stay, you will likely be transferred to a residential rehab facility. While still a healthcare facility, the medical management will be stepped down in intensity from what you experienced in detox. Staff will more likely consist of addiction counselors and non-medical staff as opposed to doctors and nurses. In rehab, you will engage in group therapy as well as some individual therapy. Many rehabs employ an evidence-based process known as 12-step facilitation. The 12-step facilitator will meet with you and other residents and introduce the basics of 12-step programs, such as Alcoholics Anonymous and Narcotics Anonymous. When you have completed your rehab stay, which will likely last for up to four weeks or more, you will then step down to an outpatient rehab program. Outpatient treatment involves your going to group and individual therapy during the day four several hours at a time. In the evening, you will live at home or in a sober living home. A sober home is a place where you and other people recovering from addiction or alcoholism live together. There are strict rules in place to ensure that no one is using drugs during their stay in the sober living facility. Sober living also involves an atmosphere of recovery in which residents travel together to 12-step meetings or the meetings are brought to their facility. ### Is the traditional detox and rehab path the only way to overcome alcohol addiction? There are some major downsides to the traditional rehab method of recovering from alcoholism. Yet, it may seem like detox and rehab are the only solution, since alcohol withdrawal is so dangerous. Often, the detox and rehab components are combined at a single facility. Residents are considered to either be engaged in the detox or rehab phase of treatment, but all services are provided under one roof. So, when a family member investigates where to send their loved one for help, checking them into a rehab for a month or more seems like the only safe and effective way get them safely off of alcohol. Rehab is very costly. You may think that the cost reflects intensive twenty-four hour medical monitoring, with doctors and nurses checking the status of their patients, day and night. ### In reality, rehab consists mostly of activities such as meeting in groups, learning about the 12-steps, interacting with other residents, and generally being in a safe space away from family and life stress and easy access to alcohol or drugs. Even with minimal medical care involved, a 30-day residential rehab stay can cost tens of thousands of dollars. And, some rehabs have programs that require a minimal stay of 3-5 months, making the cost that much greater. If you have good health insurance coverage, the cost of rehab may not seem so bad. You, or your family, simply pay the deductible, and your insurance company picks up the rest of the bill. Insurance will often cover multiple rehab stays, so if you do not succeed the first time, you can go back and check in again. There are people who have gone through rehab many times, over and over, as long as their insurance will continue to cover the bill. However, if your insurance does not cover rehab, or if you are uninsured, a stay like that is not easily affordable. You may be able to save some money by going to an outpatient rehab, but the price will still be high. Another major downside is being cut off from the world for a 30-day stay in rehab. While some people have lost everything in their lives before going to rehab, many people are still working at their job and taking care of their family when it becomes necessary to [stop drinking alcohol]( "How To Quit Drinking Alcohol?"). It may not seem practical for people who have been functional in their lives to suddenly drop everything and disappear for a month. Who will take care of the family? Who will pay the bills? This brings up an interesting idea. What if many people who drink too much were ready to get help early on, but they didn’t because they couldn’t afford the time or money for a month or more of rehab? What if they waited it out until they hit rock bottom, losing their health, family, money, career, and possibly freedom, before they were willing to accept whatever help is available? ### What alternatives are there to going to detox and rehab to quit drinking safely? As an alternative to the traditional detox and rehab route, there are outpatient detox programs available. You may be able to find a detox program in your area where you can come in during the day to check in and get meds if you need them. An outpatient detox will allow for you to continue with your regular home life and you may be able to continue with work, though you will need time to attend the detox program during the day. For some people, outpatient detox may be a good solution. Another possible solution is a full home detox, managed by a concierge doctor or a VIP doctor. With home detox, the doctor makes a house call and evaluates you in your own home. The doctor then prescribes needed medications and monitors you personally or arranges for monitoring to be done by a home health nurse, or even experienced family members. In today’s world of the COVID-19 pandemic, more people are turning to telemedicine and telehealth services. It is possible to perform an alcohol detox program by telemedicine, though there are some limitations. To effectively provide alcohol detox safely via telemedicine, it will be important to have willing and supportive loved ones available to help observe the patient and administer medications and supplements. ### Can a sober coach or sober companion help with a home detox? For people who want to detox off of alcohol and skip the entire rehab process, they may opt for home detox via telemedicine or a house call doctor. An excellent additional service to make this type of treatment more effective is a sober companion service. An experienced sober companion is similar to having an alcoholics anonymous sponsor who is available onsite or by phone at all times to provide support. If you are familiar with the AA program, then you are aware that you can work with a sponsor at no cost. You are expected to check in with your sponsor regularly and to work on the 12 steps together. The program teaches that the sponsor/sponsee relationship benefits both sponsor and sponsee, hence, there is no need for payment either way. The difference with a sober coach or sober companion is that it is a paid, professional service. Your sober coach will call you and visit you, even if you do not reach out. Where an AA sponsor expects you to do your part of the work to get support, the sober companion will be there for you either way, as long as the service contract lasts. ### Is there another way to detox that is not as dangerous and that does not require the use of controlled medications, such as Valium or Librium? Part of the treatment for alcohol withdrawal is administering benzodiazepine sedatives to calm the patient and to help prevent seizures. Wouldn’t it be great to avoid the harrowing experience of detox altogether and still quit dangerous alcohol use? What if you don’t want to get so sick that a doctor has to give you potent sedatives to keep you from seizing? Can alcohol withdrawal cause death if you reduce alcohol intake gradually? The Sinclair Method is a treatment protocol that is gaining popularity in the US, and is already being used in other countries around the world. Interestingly, The Sinclair Method, or TSM, uses a prescription medication, that is non-controlled and relatively safe for most people. That medication is naltrexone, an opioid receptor blocker. [Naltrexone]( "Naltrexone Podcast") is already approved by the FDA to treat alcohol use disorder. It is available as a monthly injection, Vivitrol, or as a daily tablet. The difference in the typical use of naltrexone for alcoholism and use with The Sinclair Method is how the naltrexone is taken. With TSM, the Vivitrol injection does not work with the protocol, the reason being that the patient must have control over when they take the medication. ### Can you die from alcohol withdrawal if your doctor prescribes medication-assisted treatment? The patient also cannot take Antabuse, another common medication prescribed for alcoholism. The problem with Antabuse is that it makes the patient sick when they take it and drink alcohol. The Success of TSM depends on the patient being able to continue drinking in moderation for a period of time. The way TSM works is that the patient takes a naltrexone tablet an hour before drinking. When they do drink, they only consume a small amount of alcohol, for example, a beer or a glass of wine. The naltrexone blocks activity in the reward center of the brain, blocking the pleasure response of endorphin release that occurs with drinking alcohol. Over time, a process called pharmacological extinction occurs in the brain, diminishing alcohol cravings gradually. With each drinking session, the naltrexone effects help the patient to limit alcohol intake to one drink or less. Many patients who follow the TSM protocol are able to completely stop drinking or keep alcohol intake to a minimum. ### A major advantage of TSM is that, because alcohol intake is reduced gradually, there is less concern of having a dangerous alcohol withdrawal syndrome. For some people, this may mean there is no need to check in to detox. It does not replace medical supervision. A person who drinks heavily every day and is physically dependent on alcohol can still have dangerous withdrawal when cutting back, so it is best to reduce drinking under the care of a doctor, who may still recommend a medically supervised detox. TSM has helped many people to reduce their drinking. Medication-assisted treatment in general has a far higher success rate than rehab, therapy, or support meetings alone. Whichever protocol is followed, naltrexone is an excellent tool for doctors to provide to patients who can tolerate it. One other benefit to a tapering protocol, such as TSM, is that patients can avoid the alcohol deprivation effect. When a person quits alcohol, or other addictive drugs, they may feel great at first, but after a period of time, cravings set in and can get increasingly worse. The alcohol deprivation effect is a major reason why so many people relapse within the first year of sobriety. By using naltrexone to help reduce alcohol intake gradually, this dangerous effect is reduced or absent. ### Where can I learn more about alcohol withdrawal and recovery? Alcohol addiction and alcohol recovery has been a topic of many episodes on The Rehab Podcast on the Mental Health News Radio Network. If you are looking for a good [alcohol recovery podcast]( "Alcohol Recovery Podcast & Stories"), we cover topics ranging from traditional treatment and recovery programs to the leading edge of scientific research and upcoming treatment options. In fact, we even have an [interview with Claudia Christian](), film and television actress and proponent for The Sinclair Method for treating alcohol addiction. She has produced and starred in a documentary on the topic of TSM, "One Little Pill." Alcohol withdrawal is a serious topic. There have been many deaths from alcohol withdrawal that could have been prevented with proper medical care. So, in addition to reading articles and books, and listening to podcasts, it is important to see your doctor as soon as possible if you are concerned that you might have an issue with alcohol overuse. Your doctor will be able to assess you for alcohol use disorder and help you to formulate a plan to quit or reduce alcohol use. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### The Road to Sobriety: A Timeline of Alcohol Recovery URL: https://therehab.com/the-road-to-sobriety-a-timeline-of-alcohol-recovery/ Sobriety is a journey that many individuals embark on in order to overcome addiction and regain control of their lives. It is a process that requires dedication, perseverance, and support. The journey to sobriety is not an easy one, but it is a worthwhile and life-changing endeavor. In this comprehensive guide, we will explore the different stages of the sobriety process, the importance of medical addiction treatment, the benefits of recovery podcasts, the power of storytelling in addiction recovery, tips for staying sober during challenging times, the role of support groups in [alcohol recovery]( "Alcohol Recovery"), celebrating milestones, and tips for long-term success and relapse prevention. ## Understanding the Journey to Sobriety: A Comprehensive Guide The journey to sobriety can be broken down into several stages. The first stage is acknowledging that there is a problem and making the decision to seek help. This can be a difficult step, as it requires admitting that there is a problem and being willing to make changes in one's life. Once this decision has been made, the next stage is detoxification. This involves ridding the body of the substance or substances that have been abused. Detoxification can be a challenging and uncomfortable process, but it is an essential step in the recovery process. After detoxification comes the stage of rehabilitation. This stage focuses on addressing the underlying issues that led to addiction and developing healthy coping mechanisms. Rehabilitation can take place in various settings, such as inpatient or outpatient treatment centers, and may involve individual therapy, group therapy, or other forms of treatment. The final stage of the sobriety process is maintenance. This stage involves maintaining sobriety and preventing relapse by continuing to engage in healthy behaviors and seeking support when needed. Navigating each stage of the sobriety process successfully requires commitment and support. It is important to surround oneself with a strong support system of friends, family, and professionals who can provide guidance and encouragement. Additionally, developing healthy coping mechanisms and finding alternative ways to manage stress and emotions is crucial. This may involve engaging in activities such as exercise, meditation, or creative outlets. It is also important to set realistic goals and celebrate milestones along the way. ## The Importance of Medical Addiction Treatment in Alcohol Recovery Seeking medical treatment for addiction is an important step in the recovery process. Medical treatment can provide individuals with the tools and support they need to overcome addiction and maintain sobriety. There are various types of medical treatment options available, depending on the individual's needs and preferences. One type of medical treatment is medication-assisted treatment (MAT). MAT involves the use of medications, such as methadone or buprenorphine, to help manage withdrawal symptoms and cravings. These medications work by blocking the effects of opioids or reducing withdrawal symptoms, allowing individuals to focus on their recovery without experiencing intense cravings or discomfort. Another type of medical treatment is residential treatment. Residential treatment involves staying at a facility where individuals receive round-the-clock care and support. This type of treatment is often recommended for individuals with severe addiction or those who have not been successful with other forms of treatment. Residential treatment provides a structured environment where individuals can focus solely on their recovery without distractions or temptations. Outpatient treatment is another option for individuals seeking medical addiction treatment. Outpatient treatment allows individuals to receive treatment while still living at home and attending work or school. This type of treatment typically involves attending therapy sessions, group counseling, and other forms of support on a regular basis. ## The Benefits of Listening to Recovery Podcasts During the Sobriety Process Recovery podcasts can be a valuable resource for individuals on the journey to sobriety. These podcasts provide a platform for individuals to share their stories, offer advice, and provide support to others who are going through similar experiences. Listening to recovery podcasts can be helpful in several ways. Firstly, recovery podcasts provide a sense of community and connection. They allow individuals to hear from others who have gone through similar struggles and can offer insight and encouragement. This can be especially beneficial for individuals who may not have a strong support system in their personal lives or who may feel isolated in their recovery journey. Secondly, recovery podcasts offer a wealth of information and resources. They often feature experts in the field of addiction and recovery who provide valuable insights and advice. These podcasts can help individuals gain a better understanding of addiction, learn about different treatment options, and discover new strategies for maintaining sobriety. Lastly, recovery podcasts can serve as a source of inspiration and motivation. Hearing stories of individuals who have successfully overcome addiction and rebuilt their lives can be incredibly inspiring. These stories remind individuals that recovery is possible and that they are not alone in their struggles. ## Top 10 Addiction Podcasts to Help You Stay on Track 1\. "The Recovery Show" - This podcast explores various aspects of addiction and recovery, including personal stories, expert interviews, and discussions on different recovery approaches. 2\. "The SHAIR Podcast" - Hosted by Omar Pinto, this podcast features interviews with individuals who have overcome addiction and offers practical tips for staying sober. 3\. "Recovery Elevator" - This podcast focuses on the journey to sobriety and features interviews with individuals who have successfully overcome addiction. 4\. "The Addicted Mind" - Hosted by Duane Osterlind, this podcast explores the science behind addiction and offers insights into the recovery process. 5\. "The Bubble Hour" - This podcast features interviews with individuals in recovery and offers support and encouragement for those on the journey to sobriety. 6\. "Since Right Now" - Hosted by Chris, Jeff, and Matt, this podcast offers a candid look at addiction and recovery and features interviews with individuals who have overcome addiction. 7\. "The Recovery Show" - This podcast explores various aspects of addiction and recovery, including personal stories, expert interviews, and discussions on different recovery approaches. 8\. "The SHAIR Podcast" - Hosted by Omar Pinto, this podcast features interviews with individuals who have overcome addiction and offers practical tips for staying sober. 9\. "Recovery Elevator" - This podcast focuses on the journey to sobriety and features interviews with individuals who have successfully overcome addiction. 10\. "The Addicted Mind" - Hosted by Duane Osterlind, this podcast explores the science behind addiction and offers insights into the recovery process. ## Medical Addiction Podcasts to Keep You Informed and Motivated 1\. "Addiction Unlimited" - Hosted by Angela Pugh, this podcast explores various aspects of addiction and recovery, including the impact of trauma and the importance of self-care. 2\. "Addiction Recovery Radio" - This podcast features interviews with experts in the field of addiction and recovery and offers practical tips for maintaining sobriety. 3\. "Addiction Support Podcast" - Hosted by Lee Davy, this podcast offers support and encouragement for individuals on the journey to sobriety and features interviews with individuals who have overcome addiction. 4\. "Addiction Treatment Radio" - This podcast provides information on different types of addiction treatment options and features interviews with professionals in the field of addiction medicine. 5\. "Addiction Unlimited" - Hosted by Angela Pugh, this podcast explores various aspects of addiction and recovery, including the impact of trauma and the importance of self-care. 6\. "Addiction Recovery Radio" - This podcast features interviews with experts in the field of addiction and recovery and offers practical tips for maintaining sobriety. 7\. "Addiction Support Podcast" - Hosted by Lee Davy, this podcast offers support and encouragement for individuals on the journey to sobriety and features interviews with individuals who have overcome addiction. 8\. "Addiction Treatment Radio" - This podcast provides information on different types of addiction treatment options and features interviews with professionals in the field of addiction medicine. ## The Power of Storytelling in Addiction Recovery: A Look at Personal Accounts Personal accounts play a crucial role in addiction recovery. They provide individuals with a sense of hope, inspiration, and validation. Personal accounts allow individuals to see that recovery is possible and that they are not alone in their struggles. One example of a powerful personal account is the memoir "A Million Little Pieces" by James Frey. This memoir chronicles Frey's journey through addiction and his subsequent recovery. The book offers a raw and honest portrayal of addiction and the challenges of recovery, and has inspired many individuals to seek help and make positive changes in their lives. Another example is the podcast "The Recovery Show," which features personal stories from individuals who have overcome addiction. These stories offer insight into the challenges and triumphs of the recovery process and provide hope for those who may be struggling. Personal accounts also serve as a reminder that addiction does not discriminate. They show that addiction can affect individuals from all walks of life, regardless of age, gender, or socioeconomic status. This can help reduce stigma surrounding addiction and encourage individuals to seek help without fear of judgment. ## Overcoming Obstacles: How to Stay Sober During Challenging Times Staying sober during challenging times can be difficult, but it is possible with the right strategies and support system in place. Here are some tips for staying sober during challenging times: 1\. Plan ahead: If you know that a challenging event or holiday is coming up, plan ahead by creating a schedule or making a list of activities to keep yourself occupied. This can help prevent boredom or feelings of isolation, which can be triggers for relapse. 2\. Lean on your support system: Reach out to friends, family, or members of your support group for support and encouragement. Let them know that you may need extra support during challenging times and ask for their help in staying accountable. 3\. Practice self-care: Take care of yourself by engaging in activities that promote relaxation and well-being. This may include exercise, meditation, journaling, or spending time in nature. Self-care can help reduce stress and improve your overall well-being. 4\. Avoid triggers: Identify your triggers and take steps to avoid them. This may involve avoiding certain people, places, or situations that are associated with substance use. If you cannot avoid a trigger, have a plan in place for how you will cope with it. 5\. Stay connected: Stay connected with your support system by attending meetings or therapy sessions, reaching out to friends or family members, or participating in online support groups. Staying connected can help you feel supported and less alone during challenging times. ## The Role of Support Groups in Alcohol Recovery: Finding Your Tribe Support groups play a crucial role in alcohol recovery by providing individuals with a sense of community, understanding, and accountability. They offer a safe space for individuals to share their experiences, receive support and encouragement, and learn from others who have gone through similar struggles. There are various types of support groups available for individuals in alcohol recovery. Alcoholics Anonymous (AA) is one of the most well-known and widely available support groups for individuals seeking sobriety. AA follows a 12-step program and offers meetings where individuals can share their experiences and receive support from others in recovery. SMART Recovery is another type of support group that focuses on self-empowerment and self-reliance. SMART Recovery uses a cognitive-behavioral approach to help individuals develop the skills and strategies needed to overcome addiction. Celebrate Recovery is a support group that combines elements of spirituality and recovery. It is based on Christian principles and offers a safe space for individuals to share their experiences and receive support from others in recovery. Finding the right support group for you is important. It may take some trial and error to find a group that feels like the right fit, but it is worth the effort. Support groups can provide a sense of belonging and understanding that can be incredibly beneficial in the recovery process. ## Celebrating Milestones: Acknowledging Progress on the Road to Sobriety Celebrating milestones is an important part of the sobriety process. It allows individuals to acknowledge their progress and achievements, and serves as a reminder of how far they have come. Celebrating milestones can help individuals stay motivated and committed to their recovery journey. There are many ways to celebrate milestones in sobriety. Some individuals choose to mark their milestones with a special event or activity, such as going out for a nice dinner or taking a trip. Others may choose to celebrate with a small token or symbol, such as a sobriety coin or bracelet. It is also important to celebrate the small victories along the way. This could be anything from completing a week without using substances to successfully navigating a challenging situation without relapsing. Recognizing and celebrating these small victories can help individuals stay motivated and build confidence in their ability to maintain sobriety. Celebrating milestones can also be an opportunity to reflect on the progress that has been made and set new goals for the future. It is important to remember that recovery is an ongoing process, and each milestone is a step towards long-term success. ## Maintaining Sobriety: Tips for Long-Term Success and Relapse Prevention Maintaining sobriety in the long-term requires ongoing commitment, effort, and support. Here are some tips for long-term success and relapse prevention: 1\. Build a strong support system: Surround yourself with individuals who support your sobriety and can provide guidance and encouragement when needed. This may include friends, family members, therapists, or members of a support group. 2\. Practice self-care: Take care of yourself by engaging in activities that promote physical, mental, and emotional well-being. This may include exercise, meditation, journaling, or spending time with loved ones. 3\. Set realistic goals: Set realistic goals for yourself and celebrate your achievements along the way. It is important to set goals that are attainable and to break them down into smaller, manageable steps. 4\. Develop healthy coping mechanisms: Find alternative ways to manage stress and emotions that do not involve substance use. This may include engaging in activities such as exercise, art, or music, or seeking support from a therapist or support group. 5\. Stay accountable: Stay accountable to yourself and others by regularly checking in with your support system and attending meetings or therapy sessions. Accountability can help you stay on track and prevent relapse. 6\. Avoid triggers: Identify your triggers and take steps to avoid them. This may involve avoiding certain people, places, or situations that are associated with substance use. If you cannot avoid a trigger, have a plan in place for how you will cope with it. 7\. Practice mindfulness: Practice mindfulness by staying present in the moment and being aware of your thoughts, feelings, and cravings. Mindfulness can help you recognize triggers and make conscious choices to stay sober. 8\. Seek professional help if needed: If you are struggling to cope with your situation or find it difficult to manage your emotions, it is important to seek professional help. Mental health professionals, such as therapists or counselors, can provide guidance and support to help you navigate through challenging times. They can offer strategies and techniques to cope with stress, anxiety, or depression, and provide a safe space for you to express your feelings and concerns. Remember, seeking help is a sign of strength, and there is no shame in reaching out for assistance when you need it. If you're on the road to recovery from alcohol addiction, it's important to understand the timeline and stages of the process. In a related article, "The Six Stages of Alcoholism and Recovery," you can learn about the different phases individuals go through when overcoming alcoholism. From the early stage of problem drinking to the final stage of recovery, this article provides valuable insights and guidance. Check it out [here]() to gain a better understanding of your journey towards sobriety. ## Frequently Asked Questions About Alcohol Recovery ### What is the recovery timeline for alcohol addiction? The recovery timeline for alcohol addiction varies from person to person. It can take weeks, months, or even years to fully recover from alcohol addiction. ### What are the stages of alcohol recovery? The stages of alcohol recovery include detoxification, rehabilitation, and maintenance. Detoxification involves removing alcohol from the body, rehabilitation involves therapy and counseling to address the underlying issues of addiction, and maintenance involves ongoing support to prevent relapse. ### What are the symptoms of alcohol withdrawal? Symptoms of alcohol withdrawal can include anxiety, tremors, sweating, nausea, vomiting, insomnia, and seizures. In severe cases, delirium tremens (DTs) can occur, which can be life-threatening. ### How long does alcohol withdrawal last? [Alcohol withdrawal]( "How Long Does Alcohol Withdrawal Last ") can last anywhere from a few days to several weeks, depending on the severity of the addiction and the individual’s overall health. ### What is the success rate for alcohol recovery? The success rate for alcohol recovery varies, but studies have shown that individuals who receive treatment for alcohol addiction have a higher chance of achieving long-term sobriety than those who do not seek treatment. ### What are some common treatments for alcohol addiction? Common treatments for alcohol addiction include therapy, counseling, support groups, medication-assisted treatment, and inpatient or outpatient rehabilitation programs. ### What can I do to support a loved one in alcohol recovery? You can support a loved one in alcohol recovery by offering encouragement, attending support group meetings with them, helping them find treatment options, and avoiding enabling behaviors such as providing alcohol or making excuses for their behavior. ### The Stages Of Alcoholism And Recovery URL: https://therehab.com/the-six-stages-of-alcoholism-and-recovery/ ## Are you thinking about quitting drinking? To better understand what it will take for you to get sober, you may be interested in learning a bit about something called TTM to help you to understand the alcohol recovery stages. ### What is TTM? TTM is an abbreviation for the transtheoretical model. It is also known as the "stages of change" and has been the subject of various self-improvement books, including "Changeology" and "Changing to Thrive." TTM describes the steps that you will likely go through to get from where you are now to being clean and sober. These six stages of alcoholism and recovery will give you a better understanding of the road ahead that will lead to your ultimate success. ### Who came up with TTM? Two psychologists and their colleagues came up with TTM in the 70s. They based their work on a variety of psychological theories. They were able to distill these many theories down to six simple stages. ### Here is how you can thrive with the stages of change. The stages of TTM are as follows: * Precomtemplation * Contemplation * Preparation * Action * Maintenance * Termination By understanding this natural progression that occurs for many people on the path towards sobriety and recovery, you can make the best decisions possible to move forward quickly and safely. ### 1) Precomtemplation is before you are ready. The first stage that you will be in is pre-contemplation. At this point, you are not ready to take action and make a change in your life. If you are drinking too much, alcohol is causing problems for you in your life, but you have no intention to look for a way out yet. ### 2) Contemplation is the "getting ready" stage. When you reach this second stage, according to the transtheoretical model, you are getting ready to make a significant change in your life. You are contemplating the pros and cons of your harmful drinking. If you are familiar with the 12 steps of Alcoholics Anonymous, you may think of this as being the first step. At this stage, you admit to yourself that there is a problem. However, you may choose a different recovery path from the 12 steps because you decide not to consider yourself to be powerless as the first step of AA states. To know more check out our [Alcoholics Anonymous Podcast]( "Alcoholics Anonymous Podcast"). ### 3) The preparation stage is when you are ready. At this stage of TTM, you are finally ready to take action and do what you need to do to change your life. If you are drinking too much, you are now looking for answers. It's not easy quitting an addiction. There is nothing wrong with asking for help. At this stage, you are researching the subject and looking for the best way to move forward. You may consider going to detox and rehab. Or, you could try an alternative solution, such as the [Sinclair Method]( "What Is The Sinclair Method"). TSM uses the medication, naltrexone, to help you gradually reduce your drinking. Another consideration is therapy. You may want to find out if there are psychologists in your area who specialize in addiction and alcohol use disorder. If there is not a psychologist nearby, you may want to consider an online therapist. Telemedicine is flourishing in the field of psychology and psychotherapy. Going beyond telehealth is something called Prescription Digital Therapeutics, using a phone app to provide FDA approved and doctor-prescribed digital therapy. Digital therapeutics has the additional benefit of keeping you connected at all times to your doctor through your ongoing progress. ### 4) Now is the time to take action. The fourth stage is the action stage of TTM. When you are in stage four, you are taking action towards recovery and sobriety. You may have checked into detox to start treatment. Or, you have filled a prescription for naltrexone, which you will take an hour before your next drink if you are following the Sinclair Method to avoid alcohol withdrawal and alcohol abstinence syndrome. If you choose to attend 12-step meetings or another type of meeting, such as [Smart Recovery]( "SMART Recovery Is A Scientifically Based Addiction Recovery Program"), LifeRing or Celebrate Recovery, you may be going to meetings now and planning out your weekly meeting schedule. Whatever form of treatment you choose, I recommend that you also see your doctor for medical management and that you also go for therapy. Fortunately, doctor visits and therapy sessions are now available online. Whatever path you decide to take, you are currently doing something about your problem. ### 5) Maintenance of your new recovery. In stage five, you are continuing to do what is working for your [alcohol recovery](). You establish new and healthier habits that promote your program of recovery. This stage may last for six months to a year or two. Of all the TTM stages, this may be the most important. Some people say that it is easy to get sober but hard to maintain sobriety. During this stage of maintenance, you will see what works best for you and stick with it. Persistence is the key to success here. There is a saying in AA groups that some members get sober and then float away on a pink cloud. Some people even refer to this as Pink Cloud Syndrome. People who suffer from Pink Cloud Syndrome may believe that they have found a cure for alcoholism. Now it is time to move on with their lives. If you are feeling great and uplifted in the early days of your recovery, be careful. You may be floating on that pink cloud, and that is fine. Just be careful not to give into Pink Cloud Syndrome. You must stick with your program of treatment and recovery and see it through. Especially in this fifth stage of maintenance, your persistence in staying on track is critical. You can listen to [alcohol recovery podcast]( "Alcoholics Recovery Podcast") to stay motivated on your recovery track. ### 6) Termination or transcendence beyond active addiction. In this final stage of TTM, you have moved beyond the temptation to return to drinking. You are living your new life of recovery and success. In 12-step groups, members believe that there is no cure for alcoholism, so that they may disagree with this sixth stage. When you have been sober for a long time, and you don't think much about having a drink, it can be more of a matter of semantics whether you consider yourself to be recovering or recovered. You may find it interesting that proponents of the Sinclair Method refer to it as a "cure" for alcoholism. Saying that there is a cure is a controversial statement. Yet, experts who recommend TSM and call it the cure for addiction to alcohol still insist that patients follow the program for life. They say that if you were once addicted to alcohol, you could become addicted to drinking again. So, even if you have been sober for many years, you must still maintain a level of vigilance. You may consider yourself cured as long as you understand that the risk of your addiction returning is always there. ### Addiction to alcohol can go into remission. Experts often compare addiction to other illnesses to provide a better perspective. When they want to emphasize the importance of ongoing treatment and lifestyle changes, they compare addiction to diabetes or high blood pressure. This comparison to chronic disease processes can make the point that ongoing medical management is necessary. When it comes to the opioid crisis, some addiction specialists have compared opioid addiction to HIV. The point is that HIV was initially a terminal disease with no treatment. Many patients considered an HIV diagnosis to be a death sentence. Now, HIV is very treatable. The medical community considers it to be more of a chronic illness than a terminal one. With medication-assisted treatment, opioid addiction is also far less deadly. We should keep in mind that there is also a medication-assisted treatment for alcoholism. Naltrexone is an opioid blocking medication that is available in a daily tablet or a monthly injection, Vivitrol. The Sinclair Method protocol uses naltrexone to treat alcohol use disorder. Doctors also prescribe and administer Vivitrol monthly to patients who drink to help them quit. ### Addiction is a serious condition. We might also consider comparing addiction to cancer. Not all cancer is terminal. With aggressive treatment, cancer can go into remission. That means that it is gone, and the patient can go on with their lives. Yet, it does not mean that the patient can just forget about it. Unfortunately, when the disease is in remission, it can come back again. So, is a successfully treated cancer that goes into remission ever considered to be a cure? Doctors typically think of five years or more of no reoccurrence to be a cure. It may be useful to think of alcoholism, and addiction in general, this way. If you do not drink excessively for five years or more, you may think of yourself as being cured of alcoholism. Yet, you should be aware that your risk of going back to active alcohol addiction is higher than someone who has never had an alcohol addiction. I believe that we should compare addiction to more severe disease processes for the patient's benefit. Patients are often relieved to find out that they are physically healthy after a run of heavy drinking or drug use. Yet, they do not consider their addiction to be as dangerous of a problem as it is. Maybe if more patients saw their addiction as being as serious as a heart attack, they would be more concerned about keeping up with medical treatment and therapy. ### Is addiction a disease? There has been debate and discussion for decades about addiction being a disease or not being a disease. Experts from multiple fields in medicine and psychology have also debated over the definition of addiction. Is it psychological? Are there physical changes in the brain? Can addiction be treated with therapy alone, or does it require medical treatment? I believe that we have to go with the scientific evidence and clinical experience that medical treatment does work well for certain types of addiction. In addition to medication-assisted treatment, which works very well for opioid and alcohol addiction, we now also have a new technology known as prescription digital therapeutics. PDT works on a patient's digital device that they already carry with them. So, while the debate over what words and definitions to use for addiction goes on, we must be practical in our thinking about providing effective treatment for alcoholism and drug addiction. If we are to provide medication-assisted treatment and prescription digital therapeutics, we must do so within the context of clinical medicine. Therefore, we must also accept that alcoholism and various other types of drug addiction are medical disorders that benefit from medical treatment. Seeing addiction in this light will help change the addiction treatment industry to move in the direction of providing better medical care for patients. ### Are people who get treatment for alcoholism and addiction clients or patients? In the rehab industry, the "patient" vs. "client" issue is an ongoing debate, as well. Do we call the people who are admitted to rehab patients, or do we call them clients? It may not seem like an important distinction on the surface. Many workers in the rehab business use both terms interchangeably. However, the difference is critical. By calling people who are in treatment for addiction clients, we are minimizing the involvement and importance of doctors and medical science in their treatment. It is the medical doctors who must manage medication-assisted treatment and make sure that patients who will most benefit from medication get the treatment that will work best for them. Psychologists and psychiatrists can tailor customized therapy programs for individual patients to help them get through the transtheoretical stages so that they may stay clean and sober for many years. And, for the new technology of prescription digital therapeutics to be used, doctors and other specialized healthcare workers be there to administer this new form of medical treatment. ### We can integrate addiction treatment with the stages of alcoholism and addiction. Sometimes, it can seem like there are various factions in addiction treatment at war with each other. It looks like each group claims to have the one answer to solving the problem. The 12-step proponents may argue that abstinence and the steps are the only way. Psychologists and medical doctors, on the other hand, say that the 12-steps are unscientific and unproven. The fact is that we must work together and see the value in many different approaches to treating addiction. There is no one-size-fits-all solution. Everyone is different and deserves treatment as an individual. An essential principle behind the 12-steps is that of open-mindedness. By being open-minded, we can better understand the value of different perspectives in addiction treatment. There is value in group support programs. And, there is value in using medical treatment. Another critical area to consider is that of harm reduction. Harm reduction is the act of providing support for a person who is in the first stage of TTM, precontemplation. It means keeping that person alive and safe while they are in active addiction. By working together to integrating harm reduction with medical treatment, psychotherapy, and peer support and being open-minded to new ideas, we can be best prepared to help individuals to navigate through the stages of alcoholism and addiction successfully. And with a sheer determination you can [enjoy the alcohol free life]( "Benefits Of Quitting Alcohol And Living An Alcohol Free Life"). ### What Are The Benefits Of Quitting Alcohol And Living An Alcohol Free Life? URL: https://therehab.com/what-are-the-benefits-of-quitting-alcohol-and-living-an-alcohol-free-life/ ## Why is it so difficult to quit heavy alcohol consumption when the benefits of quitting drinking are so clear? Dr. Gabor Maté once said, "It is impossible to understand addiction without asking what relief the addict finds, or hopes to find, in the drug or the addictive behaviour." Taking this into consideration helps us to understand why people engage in chronic alcohol abuse, even when they are aware of how much better life might be if they quit their excessive drinking. A person who consumes excessive alcohol consumption regularly, or engages in binge drinking may be self-treating a mental illness. Or, they may have developed an alcohol dependence, engaging in heavy drinking to cover up the pain from past traumas. Yet, if you are drinking excessively, you may be aware that there are great benefits to quitting. Would you like to have healthier skin and improved skin tone? Would you like to have less brain fog? How would you like to be able to lose weight easily, improve muscle tone, and look healthier? ## What are the benefits of quitting alcohol and health benefits of not drinking? The benefits of being sober from alcohol include: improved mental health, better blood pressure, less belly fat, less liver damage, a reduced risk of breast cancer and liver cancer, and much more. Yet, alcohol addiction prevents a person drinking alcohol excessively from worrying too much about things like high blood pressure, weight gain, heart disease and liver disease. Telling an alcoholic that they have a fatty liver, or that cutting back on alcoholic drinks will promote weight loss will not motivate them right away to engage in moderate drinking, or to quit drinking booze altogether. Yet, reviewing the benefits of going sober with someone suffering from alcoholism is still helpful. While explaining to the alcoholic how wonderful [alcohol recovery]( "Alcohol Recovery Podcast") can be after detox and treatment may not lead to immediate changes, it does plant a seed that may lead that person to take the next step towards asking for help. It also helps to explain that getting past [alcohol withdrawal]( "What Does The Quitting Alcohol Timeline Look Like?") and withdrawal symptoms does not have to be difficult and uncomfortable. Alcohol detox can be medically managed to make alcohol withdrawal symptoms minimal and to reduce the risk of dangers, such as delirium tremens. A substance abuse facility experienced in addiction treatment and working with patients who have long-term alcohol misuse problems can help greatly with the detox process. ## What are some of the top benefits of sobriety? By reviewing the benefits of alcohol free life with a person who cannot stop drinking, we may touch on a particular benefit that appeals to that person. For example, an individual may not care about serious future health risks, but the idea of sleeping better may appeal to them. Improved sleep is a major benefit of staying off alcohol. People who drink excessively often find that they cannot get a good night's sleep, even when they are not drinking. The sleep that a person gets when they pass out, after a night of excessive alcohol consumption is not good quality sleep. Living a life of drinking to fall asleep leads to daytime fatigue and constant brain fog. Speaking of mental clarity, many issues of chronic fatigue, cognitive impairment, and reduced optimal brain function are related to heavy drinking. A great way to improve brain performance is to reduce alcohol consumption. Poor sleep is part of the problem, but many cognitive difficulties experienced by alcoholics are due to the direct effects of alcohol on the brain. Fortunately, the brain is resilient, so when a person quits or slows down alcohol consumption, cognitive dysfunction can improve dramatically. ## Is becoming a creative genius one of the benefits of sobriety? I remember a patient who had been alcohol-free for a few months coming into the office, excited to share with me information about a patented invention. The idea came to him in a flash and he realized that it was something that people needed and would find very useful. Not only had he overcome the mild cognitive impairment and brain fog symptoms due to chronic daily drinking, but he had moved ahead to have brilliant ideas and the energy to act on them. The memory loss, neurological symptoms, and cognitive problems that this patient had previously experienced had fully resolved, leaving him feeling like a creative genius. This particular patient was responding well to naltrexone treatment. Naltrexone tablets, when taken correctly, can significantly help to reduce alcohol cravings and erase the alcohol habit from the brain. Regular naltrexone use with moderate drinking leads to extinction of the alcohol obsessions and cravings. Interestingly, the patient wanted to attribute his genius inspiration to naltrexone. My opinion was that the reversal of his cognitive decline and overcoming mental confusion, leading to optimal brain functioning was simply because he stopped drinking alcohol. Brain health is an excellent reason to quit drinking alcohol and start living an alcohol free life. Brain fatigue can be a thing of the past, especially after one year of no alcohol. Thinking clearly is one of the benefits of not drinking alcohol. However, you don't have to wait a whole year to see the benefits of improved cognitive function. Mental fatigue quickly resolves when a person stops binge drinking or drinking heavily every day. ## One of the great benefits of quitting alcohol is less regret. People who drink heavily for many years often experience deep regret. They obsess over a major lost opportunity, or they have remorse about things they have done. I have heard patients express sorrow about things such as losing huge amounts of money due to bad financial decisions. Others have talked about bad decision making with regards to choosing a partner or how they treated their family. Often, when an alcoholic feels guilt and regret over what they have done in the past, they continue excess drinking behavior to deal with the grief and pain caused by remembering their past behavior. Older adults are more likely to have regrets about the past, because they may be at an age where some mistakes cannot be undone. Maybe it is too late to have the family that you planned to have when you were younger. Or, maybe the prospects of building wealth and a secure future seem less likely at your current age. One of the best weapons against regret is gratitude. Gratitude is a proven beneficial state of mind that helps a person to live a better life. Being more grateful is one of the benefits of stopping drinking. While you may have many regrets that are due to your drinking alcohol, such as not doing well in school, or ending up in a career that you are not happy with, you also have many things to be grateful for. Are you healthy? Do you have family or other loved ones in your life? It helps to make a thorough written gratitude list and to maintain the list on a regular basis. One of the best ways to minimize future regret and to increase the things you are grateful for is to start an alcohol treatment program. If you can quit drinking, or get treatment that helps you to moderate alcohol intake, then you will be in a better position to have more gratitude and less regret. The sadness of regretting the outcome of past mistakes may be one of the best motivators for someone to make the decision to get help to overcome an addiction. Less regret is one of the benefits of giving up alcohol. ## Less anxiety and depression are benefits of sobriety. Anxiety is a serious mental health issue. People may minimize the significance of anxiety, but it is debilitating for those who suffer from it. Imagine having a tight feeling in your chest nearly all the time, especially when you are out in public and around other people. Anxiety disorder can be overwhelming. Depression is also a serious condition that is as much of a problem as any serious physical illness. Suicidal thoughts are as serious as a heart attack, and must be addressed as such. Some people with a dual diagnosis of depression and alcohol addiction may be drinking to self-medicate their mental health problems. Yet, for many heavy drinkers, anxiety and depression may be a consequence of their drinking. Unfortunately, acute alcohol withdrawal, after quitting alcohol cold turkey, can lead to anxiety as one of the side effects of acute withdrawal. Depression symptoms may also arise quickly during alcohol withdrawal, even during a medical detox. Quitting drinking cold turkey is not always the best approach. Using a harm reduction protocol, such as The Sinclair Method, can help a person to reduce alcohol intake gradually. Some people who follow this approach can even become successful moderate drinkers. However, many TSM patients eventually reach a state where they have no interest in drinking, so they choose voluntarily to quit, becoming lifetime abstainers. Either way, one of the great psychological benefits of quitting drinking is a reduction in social anxiety, and along with it, less overall depression. While living an alcohol free lifestyle may not resolve all [mental health issues]( "Improve Mental Health"), It definitely helps with significant improvements in mood and emotionality. ## What about the physical benefits of being sober? For some reason, active addiction seems to prevent a person from caring about serious risks to their health. Warning an alcoholic about the risk to their liver with continued drinking rarely helps to motivate them to quit. Yet, it should still be discussed clearly with the patient who presents for alcohol addiction treatment, that there are major physical health benefits to quitting alcohol. As that patient moves forward with treatment, they will gradually become more concerned about their physical health. Staying healthy can be a great motivator to remain in recovery and avoid relapse. Avoiding liver cirrhosis and other liver damage, as well as heart disease can help, but focusing on health issues that affect lifestyle may be even more motivating. Men are very focused on issues of erectile dysfunction. Chronic alcohol misuse can definitely cause issues with sexual functioning that can be long-lasting, even after the person quits drinking initially. It may help to point out to a male patient that, if they quit drinking, blood pressure and blood flow throughout their body will improve. Erectile dysfunction often improves dramatically without alcohol. Another great motivator is that a patient may need less medication, as their health improves. No one likes to take pills every day. As issues due to alcohol, such as gastritis, high blood pressure, obesity, and others improve, there may be less of a need for chronic medications to treat various conditions. One of the benefits of quitting alcohol and starting a good exercise and diet program is significantly improved physical health. People who engage in a daily healthy lifestyle tend to need less medications overall. Of course, do not quit taking medications without seeing your doctor first. You should always consult with your doctor before making any changes to your medical treatment plans. Many patients who participate in alcohol treatment programs are also excited to see that they are losing weight without much effort. Alcohol causes weight gain, and excessive alcohol can lead to severe weight gain. After quitting alcohol, weight loss is relatively easy with a good diet and exercise plan. Imagine how great it will feel to not only be alcohol free, but also to lose weight and look healthier. ## If the benefits of being sober are so great, how do I quit? Quitting alcohol does not have to be difficult. You have the option to go the traditional route of detox and rehab if you are a very heavy, regular drinker. However, if you are an occasional binge drinker, or a gray area drinker, you may do well, quitting on your own with guidance from books, or a sober coach. There are elite concierge sober coaches who will be there for you 24/7 to help at any time when you have an issue with alcohol cravings or triggers. Another option that may work well is The Sinclair Method, or TSM, as mentioned earlier. This method of reducing alcohol intake is a form of medication-assisted treatment, because it uses naltrexone, an opioid blocker, to help retrain the brain to not obsess over alcohol. While TSM has not enjoyed widespread acceptance, it is a medically acceptable, evidence-based treatment plan. It should be said that there are many ways to implement TSM, depending on the specific patient. The basics of TSM are fairly easy and straightforward, but setting up a plan for each individual can be involved and requires extensive knowledge and experience in working with TSM patients. The best plan for someone seeking TSM treatment is to find an experienced doctor to work with. There are also certified TSM coaches to complement the work of doctors in supporting patients in their plan to take naltrexone regularly to reduce alcohol cravings. The C3 Foundation is an excellent source of information on the subject. If you are interested in learning more about the benefits of quitting alcohol, and the best ways to quit drinking or reduce your alcohol consumption, please contact us for more information. We provide concierge medical treatment throughout the state of Florida, from Tampa to West Palm Beach, and consulting services all over the world. ### Types of Alcoholics URL: https://therehab.com/types-of-alcoholics/ Alcohol plays a significant role in many people's lives, yet its misuse can lead to deep struggles with dependency and addiction. While alcohol use may be shared in social settings or as a coping mechanism, it's crucial to recognize when drinking causes harm. Identifying patterns of alcohol addiction can offer perspective on a person's physical and mental health challenges. Alcoholism takes different forms, each involving unique struggles and solutions. Recognizing the signs of harmful drinking patterns is crucial, as alcohol's effects are not limited to physical health but extend to mental health as well. There isn't just one kind of alcoholic or one type of alcoholism. By learning about the different types of alcoholics, we can better understand the nature of our own or a loved one's alcohol use and take thoughtful steps on the road to recovery. By categorizing and exploring the varying types of alcohol addiction, we can foster compassion, reduce stigma, and provide better support for those who need help. Read more: [Is Your Drinking Becoming a Problem? 7 Signs to Watch Out For]( "Is Your Drinking Becoming a Problem? 7 Signs to Watch Out For") ## Why Categorization of Alcoholism Matters The term "alcoholism" often invokes a singular image, but the reality of alcohol addiction is far more complex. Alcohol addiction isn't a monolithic issue and manifests in various stages and behaviors. The term "alcohol use disorder" (AUD) spans a broad spectrum, from mild dependency to severe addiction. Factors like genetics, mental health conditions, and environmental influences shape each experience with alcohol addiction. Understanding these different types of alcoholics allows individuals, families, and medical professionals to create recovery approaches based on specific needs. For instance, an individual struggling with binge drinking may need different care than one battling long-standing alcohol dependency. By identifying both the root causes and triggers of alcohol use, professionals and loved ones can provide tailored recovery solutions that lead to sustainable change. ## The Five Common Types of Alcoholics Alcohol addiction specialists commonly categorize alcoholics into five main subtypes. Each group reveals the diverse ways alcohol addiction can manifest and its varying levels of connection to mental health and behavioral patterns. ### Young Adult Subtype The young adult subtype is one of the most prevalent, involving individuals aged 18 to 25. Alcohol use in this group often begins as a form of social experimentation driven by peer pressure and cultural norms that glorify drinking. They frequently engage in binge drinking, defined as consuming excessive amounts of alcohol in a short period, which increases the risk of alcohol use disorder. This type of alcoholic often sees their drinking as part of a rite of passage, dismissing the potential risks of alcohol addiction. However, the combination of heavy drinking and limited awareness can lead to long-term health complications and dependency. By addressing these issues early, we can prevent binge drinking from escalating into sustained alcohol dependency. ### Functional Alcoholic The functional alcoholic defies the stereotypical image of alcohol addiction. These individuals manage to maintain successful careers, stable relationships, and societal expectations while engaging in frequent alcohol use to cope with stress. Unlike visible drinkers, functional alcoholics often keep their addiction hidden, making it challenging to identify the extent of their dependency. Despite their external stability, their reliance on alcohol creates underlying strain, both physically and mentally. Over time, their drinking intensifies, affecting [mental health]() and potentially leading to more serious issues like alcohol use disorder. Acknowledging the problem is the first step, followed by seeking structured help to break the cycle of addiction. For any form of [alcoholism](), understanding the emotional triggers driving alcohol use is key to achieving lasting recovery. ### Intermediate Familial Alcoholics Intermediate familial alcoholics exemplify how genetics and family upbringing can influence alcohol addiction. With a strong family history of alcoholism, this group often grows up exposed to heavy drinking, normalizing the behavior. They are also more likely to experience mental health issues such as [depression]() and anxiety, which further complicate their relationship with alcohol. These individuals often begin drinking during adolescence, making early intervention a crucial factor in preventing full-blown alcohol use disorder. Mental health treatment targeting both their alcohol dependency and emotional struggles can be transformative. Breaking free from generational cycles of addiction requires both awareness and comprehensive support systems. ### Chronic Severe Alcoholics The chronic severe alcoholic represents the most severe form of alcohol addiction. This type of drinking behavior is marked by persistent heavy drinking, which disrupts every aspect of life—from relationships to health and financial stability. Chronic severe alcoholics often face co-occurring mental health disorders, risky decision-making, and even legal issues, creating a downward spiral that can be life-threatening. This category of alcoholism is more than a loss of control; it is a dire call for immediate and structured intervention. Programs tailored to this group address physical and mental health challenges, providing them with the tools to rebuild their lives. ### Young Antisocial Alcoholics Young antisocial alcoholics comprise a unique group characterized by their tendency to engage in reckless behaviors alongside drinking. Alcohol use in this subgroup is frequently tied to emotional escape, impaired judgment, and impulsive decisions. Co-occurring substance use further elevates the risks associated with this type of alcoholism, complicating the recovery process. Their heavy drinking habits often stem from unaddressed emotional pain or mental health concerns, necessitating intervention tailored to their specific needs. With the proper support, young antisocial alcoholics have immense potential for positive transformation and addiction recovery. ## Triggers and Behaviors in Alcohol Use Alcohol addiction isn't just about the type of alcoholic someone might be. Environmental triggers, personal experiences, and mental health also influence it. Examining these factors sheds light on why someone may start or continue drinking. Understanding what drives individuals toward alcohol use is vital for tackling alcohol addiction effectively. Environmental, emotional, and social factors often play a decisive role in shaping harmful drinking behaviors, contributing to alcohol use disorder and alcoholism. ### High-Stress Environments Stressful environments, such as high-pressure jobs or constant financial challenges, are a common trigger for alcohol addiction. Many individuals use alcohol as a way to unwind or escape their stressful realities. For example, professionals facing relentless deadlines or caregivers managing overwhelming responsibilities may use alcohol as a temporary coping tool. When excessive drinking becomes the go-to solution for stress, it raises the risk of developing severe alcoholism. Managing stress through healthier outlets and professional guidance can prevent the progression of alcohol use disorder. ### Unresolved Trauma or Emotional Pain Unresolved trauma, such as childhood abuse or significant loss, dramatically increases the likelihood of alcohol use as a coping strategy. Alcohol provides temporary relief, numbing emotional pain. However, this relief is short-lived and often leads to heightened emotional difficulties, feeding into a vicious cycle of addiction. Trauma and mental health concerns, like anxiety or PTSD, are frequently linked. Without proper mental health support, individuals turn to heavy drinking or binge drinking, which only compounds their struggles. ### Untreated Mental Health Issues Untreated mental health problems, including depression and anxiety, are central to many cases of alcohol addiction. Those grappling with these challenges may turn to alcohol for relief. Unfortunately, regular drinking worsens mental health issues over time, creating a destructive feedback loop. Combining mental health treatment with addiction recovery strategies gives individuals the tools needed to break free from alcohol dependency. ### Cultural and Social Norms Cultural norms often glamorize alcohol and normalize heavy drinking behaviors, increasing the risk of addiction. Social drinkers, influenced by celebrations or peer pressure, may gradually increase their alcohol consumption, unaware of potential dependency. This is especially common among young adults involved in binge drinking or weekend benders, where cultural acceptance makes these behaviors seem harmless. Challenging these societal norms and providing education about responsible drinking are crucial steps in preventing alcoholism from taking root. Each of these triggers serves as a reminder of how deeply intertwined alcohol addiction is with individual circumstances. Addressing the root causes of drinking helps create pathways to a more sustainable recovery. For resources and support, explore the [stages of alcoholism and recovery]() to begin your healing process today. ## Exploring Patterns of Alcoholism Apart from categorization, alcohol addiction often follows predictable drinking patterns. These patterns expose how addiction develops over time and influences the course of recovery. ### Binge Drinking and Weekend Benders Binge drinking, for example, is widespread among social drinkers and is defined as consuming large quantities of alcohol in one sitting. Weekend benders follow a similar model but are contained within specific days and can leave a lasting toll on personal health. While occasional binge drinking might seem harmless, repetition increases the risk of long-term alcohol dependency. ### Routine Drinking Routine drinkers, in contrast, don't always display overt symptoms of alcoholism but rely on alcohol regularly. Whether it's a daily after-work drink or habitual weekend consumption, these patterns can expand into more severe forms of alcohol addiction over time. Such gradual dependencies often go unnoticed until significant health or personal disruptions arise. ## Why Professional Help Matters Seeking professional assistance for overcoming alcohol addiction is one of the most critical steps an individual can take toward recovery. Professional help offers a structured, supportive framework that ensures safety and provides targeted solutions. Unlike self-managed efforts, professional programs are equipped to handle the complexity of alcohol use disorder with personalized care designed to meet the unique needs of each individual. ### Safe Detox Alcohol withdrawal can be physically overwhelming and, in severe cases, life-threatening. Medical professionals provide a safe and controlled environment where individuals can detox without fear of complications like seizures or hallucinations. With constant monitoring and medical intervention, patients are shielded from the most dangerous effects of alcohol withdrawal symptoms. Another critical aspect of supervised detox is its role in alleviating the immediate discomforts of withdrawal, making the recovery process more manageable. By stabilizing an individual's physical health early, recovery programs prepare them to address the mental health challenges that often accompany alcohol addiction. ### Addressing the Root Cause Alcohol addiction rarely exists in isolation. Trained therapists in recovery programs specialize in uncovering and treating underlying mental health issues, such as depression, anxiety, or unresolved trauma, that contribute to addiction. Addressing these root causes is essential for long-term success, as it prevents individuals from returning to alcohol use as a coping mechanism. Through counseling, therapy sessions, or dual diagnosis programs, clients gain a deeper understanding of how their mental health interacts with drinking behavior. This holistic approach ensures that both alcohol addiction and related conditions are treated together, helping the individual rebuild a healthier, more [balanced lifestyle](). ### Long-lasting Change The goal of professional recovery programs isn't just sobriety—it's equipping individuals with the skills needed to maintain it for life. Structured programs guide participants in building coping mechanisms to handle stress, emotional triggers, and social situations without relapsing into alcohol use. This consistent support system helps individuals keep their focus on recovery and prevents the cycle of alcohol dependency from resuming. While professional care may appear costly in the short term, its long-term benefits far outweigh the risks of incomplete or failed recovery attempts. ## How to Help a Loved One Recognize Addiction Recognizing alcohol addiction in a loved one can be challenging, especially if they hide their struggles or deny their dependency. Knowing how to approach this delicate topic can make all the difference in encouraging them to help. It's essential to start by observing noticeable behaviors, which may include patterns of [binge drinking](), emotional withdrawal, or signs of physical health decline. These indicators often suggest a deeper issue with alcohol use disorder or alcohol dependency. When addressing the matter, it is essential to approach with compassion and empathy. Express your concern from a place of care, explaining that your observations are driven by your desire to see them healthy and happy. Early recognition of alcohol addiction allows for more opportunities to intervene and create pathways for adequate recovery, ultimately enabling your loved one to regain control over their life. Acknowledging addiction early creates more opportunities for recovery and progress. ## Alcoholism and Mental Health Mental health issues both contribute to and are worsened by alcohol addiction. Anxiety, depression, or post-traumatic stress may drive someone to alcohol use, yet prolonged alcoholism often exacerbates these issues. The cycle is damaging but also highlights how recovery must address both mental health and alcoholism simultaneously for meaningful progress. ## Finding Recovery The path from addiction to recovery isn't easy, but it is entirely possible with the proper guidance. Professional [alcohol recovery programs]() offer more than just medical treatment; they also provide emotional and psychological tools that prepare individuals for long-term sobriety. ### Benefits of Recovery Programs: 1. Access to individualized care based on drinking patterns and mental health needs. 2. Community support via group therapies or peer connections during treatment. 3. Post-treatment planning aimed at relapse prevention and lifestyle adaptation. ## Start Your Recovery Journey Alcoholism may feel overwhelming, but recognizing the different types of alcoholics is an empowering first step toward change. Whether addressing binge drinking, daily consumption, or mental health concerns tied to alcohol use, seeking support opens doors to lasting recovery. For more insights, resources, and recovery stories, visit The Rehab’s [Alcohol Recovery ]()podcast**.** Take your first steps toward healing today—because a brighter, healthier future awaits you! [Contact us]() today to learn more about recovery options, support services, and how to take the first step toward sobriety. ### Alcohol Cravings Explained: Why They Happen and How to Stop Them URL: https://therehab.com/alcohol-cravings-explained-why-they-happen-and-how-to-stop-them/ Alcohol cravings can feel overwhelming, confusing, and discouraging—especially for individuals working toward sobriety or managing alcohol use disorder. These urges are not a sign of weakness or lack of willpower. Instead, they are the result of complex biological, psychological, and behavioral processes shaped by repeated alcohol use over time. Understanding alcohol cravings explained: why they happen and how to stop them is a powerful step toward lasting recovery and improved behavioral health. For many people, craving alcohol becomes one of the most persistent challenges during alcohol addiction recovery. Whether cravings appear during alcohol withdrawal, early sobriety, or long after drinking has stopped, professional addiction treatment plays a critical role in helping individuals manage cravings safely and effectively. ## What Is an Alcohol Craving? An alcohol craving is a strong desire or urge to drink alcohol. Cravings may feel physical, emotional, or mental, and they can vary in intensity from mild thoughts about drinking to an intense craving that feels difficult to resist. Craving alcohol is common among individuals with alcohol dependence or alcohol use disorder, particularly during periods of stress, emotional discomfort, or exposure to triggers associated with past drinking. Alcohol cravings are closely linked to how the brain adapts to regular alcohol consumption. Over time, repeated drinking changes how the brain processes reward, motivation, and stress, reinforcing patterns that drive continued alcohol use. ## The Connection Between Alcohol and the Brain Alcohol directly affects dopamine levels in the brain. Dopamine is a neurotransmitter involved in pleasure, motivation, and reinforcement. When drinking alcohol, dopamine is released, creating a sense of reward that the brain remembers. With continued alcohol use, the brain begins to associate alcohol intake with relief, comfort, or pleasure. As alcohol misuse continues, the brain becomes less responsive to natural sources of dopamine, increasing reliance on alcohol to feel balanced. This neurological shift contributes to alcohol addiction and explains why cravings can persist even after drinking stops. Ongoing research continues to explore broader health implications, including [whether drinking alcohol raises the risk of stroke]() in individuals with long-term alcohol use. ## Why Alcohol Cravings Happen Alcohol cravings happen for several interconnected reasons. One major factor is physical dependence. When alcohol consumption becomes frequent or heavy, the body adapts to its presence. During alcohol withdrawal, the absence of alcohol disrupts brain chemistry, triggering withdrawal symptoms and strong cravings as the body attempts to restore balance. Blood sugar fluctuations can also play a role. Alcohol affects how the body regulates blood sugar, and drops in blood sugar may intensify cravings, particularly during early recovery. Emotional and environmental factors further reinforce cravings, especially when alcohol has been used as a coping mechanism. ## Internal and External Triggers Cravings are often activated by triggers. Internal triggers include emotional states such as stress, anxiety, boredom, or sadness. These internal triggers are closely tied to behavioral health and can increase the urge to drink alcohol when emotional regulation feels difficult. External triggers involve people, places, or situations associated with past drinking. Social events, certain times of day, or familiar routines linked to alcohol use can spark a strong craving. Understanding these triggers is an important part of managing alcohol cravings effectively. ## Alcohol Use Disorder and Cravings Alcohol use disorder is a chronic condition characterized by an impaired ability to stop or control alcohol use despite negative consequences. For individuals with alcohol use disorder, cravings are a central feature of the disorder. The brain’s reward system has been conditioned to expect alcohol, making urges more frequent and intense. Alcohol dependence further strengthens these cravings, particularly during alcohol withdrawal and early sobriety. This is why structured addiction treatment and professional support are essential for long-term recovery. Understanding the different [types of alcoholics]() can help explain why craving patterns and recovery needs vary from person to person. ## Alcohol Withdrawal and Craving Intensity Alcohol withdrawal occurs when someone who has been drinking heavily or consistently reduces or stops alcohol intake. During this period, withdrawal symptoms may emerge, including heightened anxiety, restlessness, and intense craving. Alcohol withdrawal symptoms reflect the nervous system recalibrating after prolonged alcohol use. Cravings during withdrawal can feel urgent and consuming. Alcohol detox in a professional setting helps manage these symptoms safely while providing support that reduces the risk of relapse during this vulnerable stage. ## The Role of Behavioral Conditioning Cravings are not purely physical. Behavioral conditioning plays a major role in why cravings persist. Over time, the brain learns to associate alcohol with specific emotions, environments, or rewards. These learned associations can trigger cravings even when physical dependence has subsided. This is why individuals may experience strong cravings months or years into sobriety. Addressing these learned patterns requires therapeutic intervention, not just abstinence. ## Managing Alcohol Cravings Through Treatment Managing alcohol cravings effectively requires a comprehensive approach. Professional addiction treatment addresses both the biological and behavioral components of craving. Treatment plans often include therapy, medical oversight, and structured recovery support tailored to individual needs. Behavioral therapies help individuals identify triggers, understand craving patterns, and develop healthier responses. These approaches support long-term addiction recovery by reshaping how the brain responds to stress and reward without alcohol. ## The Importance of Medical and Clinical Support Alcohol cravings are best managed within a clinical framework that recognizes alcohol use disorder as a medical condition. Alcohol rehab programs provide structured environments where cravings can be addressed safely, especially during early recovery. Medical support during alcohol detox and withdrawal helps stabilize the body and reduce craving intensity. Ongoing treatment reinforces coping strategies and strengthens resilience against relapse. ## Psychological Strategies Used in Treatment Addiction treatment programs use evidence-based psychological strategies to help individuals manage cravings. These approaches focus on awareness, emotional regulation, and behavioral change. One commonly used concept in treatment is urge surfing, which teaches individuals to observe cravings without acting on them, allowing urges to pass naturally. These techniques are taught and reinforced in therapy, ensuring individuals are supported as they build confidence in managing cravings over time. ## Cravings, Relapse, and Recovery Cravings do not mean failure. They are a normal part of addiction recovery and decrease in intensity and frequency with time and treatment. Understanding that cravings are temporary and manageable helps reduce fear and shame associated with them. Relapse prevention planning is a core part of addiction treatment. This planning helps individuals recognize early warning signs, respond effectively to cravings, and stay connected to recovery resources. ## The Role of Support Systems Recovery from alcohol addiction is strengthened by connection and support. Peer-based recovery programs, including alcoholics anonymous, offer community and accountability that many individuals find valuable. These programs complement professional treatment by reinforcing sobriety-focused lifestyles. Support systems help individuals navigate challenging moments, especially when cravings arise unexpectedly. ## Long-Term Sobriety and Brain Healing With sustained sobriety, the brain gradually heals from the effects of alcohol misuse. Dopamine regulation improves, stress responses normalize, and cravings become less intrusive. While the timeline varies, many individuals experience significant improvement in craving management as recovery progresses. This healing process highlights why patience and continued engagement in addiction treatment are essential. Recovery is not immediate, but it is achievable. Many people in recovery wonder [how long after quitting alcohol does your body heal](), as physical and neurological systems gradually regain balance. ## Why Professional Help Matters Attempting to manage alcohol cravings without professional help can be challenging and risky, particularly for individuals with alcohol dependence or a history of heavy drinking. Professional addiction treatment offers structure, expertise, and compassionate care that addresses the full scope of alcohol use disorder. Treatment programs are designed to support both short-term stabilization and long-term sobriety. They recognize that managing cravings is a process that requires ongoing support, education, and care. Physical healing is also an important consideration in recovery, particularly when examining [whether alcohol affects muscle recovery]() during sustained sobriety. ## Moving Forward With Clarity, Support, and Lasting Change Understanding why alcohol cravings happen and how they can be managed is a powerful step toward sustainable healing. Cravings are not a personal failing; they are a natural response shaped by brain chemistry, behavioral patterns, and past alcohol use. With the right knowledge, structure, and professional guidance, cravings can become more manageable over time. As individuals learn to respond to urges with healthier coping strategies and consistent support, the path toward stability, confidence, and long-term alcohol recovery becomes clearer and more achievable. At The Rehab, we are committed to helping individuals take meaningful steps forward through compassionate, evidence-based care. We invite you to take the next step with us and explore supportive resources for [alcohol recovery]() that align with your goals and experiences. Our educational and recovery-focused podcasts, including the [sobriety podcast](), [oxycodone addiction]() podcast, [buprenorphine podcast](), [morphine addiction podcast](), and [naloxone podcast](), are designed to support ongoing learning, motivation, and connection. We are here to support you with trusted information, personalized care, and a clear path toward lasting recovery and well-being. --- ## Recovery & Treatment Philosophy > Broader perspectives on addiction, recovery approaches, and treatment philosophy. ### What Causes Drug Addiction? Why Doesn't Drug Abuse Lead To Addiction For Everyone? URL: https://therehab.com/what-causes-drug-addiction-is-addiction-a-form-of-insanity/ ## What leads to drug addiction? Is addiction a form of insanity? There is a popular saying in 12-step recovery groups. In fact, the saying is a quote, attributed to Albert Einstein. You may have seen it somewhere on social media, as you scroll through Instagram, Facebook, or Twitter. Or, if you attend meetings, you have probably heard it repeated by group members. The quote goes something like this: “Insanity is repeating the same thing over and over, expecting to get different results.” I have no idea if Einstein actually said anything like this, but, of course, any quote is more impressive when attributed to one of the most brilliant scientists who ever lived. The reason this quote is used in addiction recovery meetings is to imply that using drugs and going back to use drugs again after quitting is insane. If a 12-step member looks you in the eye and recites the insanity quote with intensity and sincerity, it seems to be deeply profound. ### Of course, it is insane, doing the same thing and expecting different results. Or is it? Is this truly the definition of insanity? According to the dictionary, the word, “insanity,” refers to being mentally ill or foolish. But is repeating the same action over and over, expecting the outcome to be different at some point, foolish? Does it point to mental illness? When children learn how to walk, do we call them insane for getting up and falling down, over and over again? What did they think was going to happen when they tried to take a step? What about when a person who quit drugs and relapsed many times wants to quit drugs again? Are they insane? Should they just give up and keep using drugs? How about when someone shows up at the doors of a residential rehab program, wanting to check in for the tenth time to try to quit drugs or alcohol? Does the staff turn them away? Is it insane to go back to rehab over and over again without trying a different way? As you can see, boiling recovery down to a handful of quotes, catchphrases, and slogans that do not stand up to scrutiny can confuse a person trying to recover and make sense of their addiction. Where does addiction come from? ### What are the main causes of drug abuse? Is it the drugs that cause addiction or is addiction something that only happens to certain people who use drugs? Is addiction genetic or is it learned behavior? Or, could it be when a certain type of person is exposed to a certain type of drug under certain circumstances, drugs provide an effect that is desirable enough that the person wants to repeat the experience. With repeated use and getting a desired result, a powerful habit is formed in the reward center of the brain. As it turns out, the causes of addiction are complex and poorly understood. Even today, with extensive brain research and experience in treating addiction, experts still disagree and argue over the causes of drug addiction. When it comes to alcohol addiction, the initial cause seems to be more clear. People who have alcoholism in their families tend to have a higher risk of alcoholism. If they drink regularly, they risk becoming addicted to alcohol, more so than someone who does not have a family history of alcohol use disorder. While a family history of addiction also raises the risk of drug addiction in general, maybe we are not looking at the problem in the right way. Why is it that when we consider alcohol addiction, we focus on the one drug, alcohol, but with drug addiction, we group all other drugs together? ### Could it be that there are people with a genetic predisposition for opioid addiction? Could there be another type of genetic pattern related to stimulants, such as cocaine or methamphetamine? Maybe there are even finer, more granular distinctions to be made, within these classes of drugs. It is well known that most people who experience drug addiction have a “drug of choice.” While they may use other drugs for the experience of getting high, one way or another, they will always gravitate to, given the chance, the one drug that they prefer. The mechanisms involved in how genes are expressed and their influence on how a person interacts with the outside world are complex. To complicate things further, separating learned behavior from genetic predispositions is a difficult task. While scientists and philosophers ponder the origins and nature of addiction, it might be reasonable for us to take the position that it does not matter. Understanding how to help guide future children away from addictions is a good goal for addiction researchers. Yet, if you are working to overcome your own addiction, the origin story of your addiction is not necessarily relevant to what you need to do to move forward. Did you inherit it or learn it from your friends or family members? Or, was it a combination of a variety of factors? Most addiction treatments do not rely on analyzing the origins of your addiction. ### The doctor says I am addicted and have a substance use disorder. Is addiction a disease? Imagine going to a doctor to get help with a drug addiction. You started using drugs for a specific purpose. Maybe it was to feel better about yourself in social situations. Or maybe it was because of physical or emotional pain. It could have even been because of intense boredom. At some point, your drug use got out of control. You discovered that you were obsessed and could not stop, even if you wanted to. Then, people around you got involved in pressuring you to stop using drugs. During your doctor visit, the doctor asks you questions and takes notes. Depending on your particular addiction, you may or may not get a prescription for medication. The doctor may recommend therapy and group meetings. When you leave the exam room, you may be concerned when you see a diagnosis code circled on the paperwork that goes to the front desk. Is addiction a disease? Why do they have disease codes for addiction? ### Is being tall a disease? What would it be like to be seven or eight feet tall in the Middle Ages? What would people say about you? Would they accept you as you are, or would they call you names, assigning unpleasant labels to you because of how tall you are. Being so tall could even get you killed. What if you lived in a village that was under attack? Everyone runs and hides from the attackers. But, you stand out as an easy target. It is harder to hide and blend in with crowd when you are the tallest person in the village. People might call you a giant. They might make fun of you, throw stones at you, treat you as if you are cursed. Your family might even take you to a “healer” to undergo treatment for your “condition.” ### Can a disease be a super power? If you are very tall in today’s world, you have an advantage over people not as tall as you. Sports, such as basketball, are easier for you. CEOs of large corporations tend to be taller people. In the modern world, excess height is viewed as a natural advantage. It could almost be considered a sort of super power. It is interesting to consider that a trait that a person is born with and has no control over could be considered a disease in one era and an attractive, powerful quality in another. Addiction is a similar condition, that in our time, is considered to be, by the medical community, a disease. Why is addiction a disease? One reason is that there is medical treatment that is effective for certain types of addiction. In the world of modern medicine, if there is a treatment, there must also be a corresponding disease code to accompany the doctor’s diagnosis. Is it possible that, if the world were a different place, people who are predisposed to addiction might have the advantage in many areas over people who are not at risk for addiction? What if addiction, when the drugs are taken out of the equation, was a super power? ### What if intelligence was a disease? In the medical television drama, “House, M.D.,” there was an episode where a man with a very high IQ took a drug on a regular basis to lower his intelligence. The reason why he did this was so that he could relate better to his wife. At the end of the show, if I remember correctly, he chose to return to his life of self-medicating to lower his innate mental abilities. People with high intelligence levels do tend to have some unique problems in life that are not as common to people of average intelligence. The same goes for creativity, which could be thought of as a more difficult to measure form of intelligence. High IQ people and talented artists tend to be more depressed and anxious. They may have a higher incidence of mental illness, and even addiction. ### What drug did the man take to lower his intelligence in the show? Was he addicted? The drug that the man was using in that episode of House was dextromethorphan, also known on the streets as DXM. This drug is a drug of abuse for some people, but use is not thought to be widespread. While it is not a highly addictive drug, it could very well be a gateway drug for some people, leading to eventual full-blown addiction. DXM happens to be the active ingredient in the cough syrup, Robitussin, and some other over-the-counter cough syrups and capsules. One reason that young people abuse the drug is not because the effects are desirable, but because it is easily accessible. Anyone can walk into a pharmacy, supermarket, or gas station convenience store, and buy a bottle of Robitussin. Why would a teenager or college-age young adult abuse DXM? Possibly, simply because of boredom. People have a tendency to want to change their consciousness and see the world around them differently, especially intelligent and creative people. Once a person is used to taking a drug and getting high, they are going to be open to the idea of using other drugs. This is why any drug can be a gateway drug. Marijuana is another common gateway drug, and it will be more accessible going forward, thanks to the legalization movements in many states. ### Is boredom the most common cause of addiction? There may be a short list of common reasons for drug addiction. Boredom in the world of intelligent, creative young people whose minds are not adequately engaged is likely a major cause. I see this as a contributing factor for most, if not all, of my patients. Other causes include childhood trauma and abuse. While a serious trauma, such as being raped or assaulted, can certainly lead to an addiction, there are other, more subtle forms of abuse. When a parent ignores their child, possibly as a result of their own addiction, or even intentionally, this is abuse. This kind of emotional abuse is far more widespread than other, more physical, kinds of abuse. People with addictions who generally believe that their childhood was uneventful and not too bad, might look closer, with the help of a therapist, and uncover a personal history of emotional abuse. Drug use might start as a way to cover up the pain of trauma and abuse, or it could be a way to get attention in a family setting of emotional abuse. Because of the lasting effects of emotional pain, which is not so different from chronic physical pain, an abuse victim might be more likely to take opioids or alcohol over stimulants. ### Does everyone who takes drugs or alcohol to cover up the pain of trauma, or to deal with boredom get addicted? This is an excellent question! A wise teacher in my medical training once said to me that all families are dysfunctional. It was such an important insight to him, he stopped, looked at me, and repeated it to me again. If all families are dysfunctional, and at least one child is emotionally abused in every family, and alcohol and drug use are so widespread, why are there not more people addicted? Does this mean that not everyone who takes drugs or drinks alcohol gets addicted? Yes, addiction is a fairly uncommon phenomenon. Most people who try drugs will eventually put them down and move on with their lives without ever becoming addicted. This is true even of the highly addictive drugs, such as methamphetamine, cocaine, [heroin]( "Heroin Addiction Recovery Stories Podcast"), and [fentanyl]( "Fentanyl Addiction Podcast"). Some people will just not like them or tire of them after a while. There are often college kids who drink heavily while in college, and then they finally get sick of waking up with a hangover. They simply make a decision to quit drinking and that is the end of it. After quitting, they might still have an occasional beer or glass of wine, but without drinking to excess, so they can avoid the sickly feeling of getting drunk and having a bad headache the next day. ### What qualities lead a person to get hooked, unable to stop taking drugs? If a person takes a drug and finds the effects highly enjoyable, pleasurable, or very effective in relieving emotional pain, their brain’s reward center will respond by becoming reprogrammed over time to find the drug to be a necessity of life. As addiction progresses, the brain will see the drug as being just as important as food, water, and air. ### Are you addicted to air? Hold your breath for a few seconds, and you will agree that you at least have a significant dependency on the air that you breathe. That is how it feels to be addicted. When the drug is not available, the addicted person can think of nothing else other than where the next dose will come from. Even when faced with self-harm or harming others, they will continue to seek out their drug and use it. It is not so different from gasping for air. If you were trapped in a room filled with toxic gas and you could not get out, you can only hold your breath for so long. Of course, if a person is kept away from their drug of choice for a period of time, they realize, logically, at the level of their prefrontal cortex, that they do not need drugs to survive. Many people find that, when they cannot get their drug of choice after a while, that their addiction starts to fade away, and they can overcome it without help. The issue for other people, highly intelligent and creative people in particular, is that the effects of addiction are much more difficult to overcome. Addiction tends to hijack the higher decision-making processes in the brain. It somehow acts as a puppet master, pulling the strings to cause addiction-related thoughts and feelings to bubble up into conscious awareness. If you are smart, creative, and addicted, these thoughts and feelings, also known as cravings, will be very intense and hard to ignore. Your addiction will use your intellectual powers against you, coming up with very convincing arguments for you to continue with your addictive behavior. ### So, is addiction inherited or learned behavior? What causes drug abuse in the first place? Now, after looking at some things that lead a person to try drugs and what might trap a person in a long-term addiction, do we have a better understanding of addiction being learned or inherited? Is it nature or nurture? Genetic or learned? If intelligence and creativity are risk factors, these qualities have a significant genetic component. Just like height is a genetic quality, inherited from your parents, your level of intelligence is also inherited. While these qualities can be influenced to a small degree by environment, they are mostly inherited. Other personal qualities may also be risk factors, such as anxiety and empathy. These characteristics are likely related to a mix of inherited and environmental factors. So, when a person who has qualities that may predispose them to try drugs and then get hooked by a long-term addiction, and they are exposed to drugs, there is a significant risk that they will develop an addiction. Of the people who become addicted, some will continue long-term with functional use of their drug of choice, denying the existence of an addiction problem. ### Many people caught in active addiction are functional and in denial. Do you know anyone who you think might be addicted to drugs or alcohol, but they get by in life, going to work and taking care of their home life? You might be surprised how many people are out there, living their lives with an active addiction, but without any intention of doing anything about it. When a person with a drug addiction is exposed to a highly addictive drug, the progression of their addiction can be greatly accelerated. The alcoholic might move from wine or beer to hard liquor. The person who takes pain pills tries heroin or street fentanyl. Or, the cocaine addict tries smoking crack cocaine. While the drug itself does not turn a person into an “addict,” the interaction of certain drugs with people who are predisposed to addiction and already with a habit of using drugs or alcohol are at high risk when exposed to certain drugs that stimulate the reward centers in the brain more intensely than other drugs. ### How likely is it for a person to become addicted? The incidence of induced addiction is difficult to measure. Experts disagree on how likely it is that a person takes an addictive drug and becomes addicted. At the low end are the false claims made by the Purdue drug reps at the dinner lectures they held for local doctors to teach them how safe [Oxycontin]( "Oxycontin Addiction Recovery Podcast") was. They claimed that only a tiny fraction of one percent of patients might become addicted. I was at one of these lectures, and I don’t remember the exact number they put up on the screen, but I do remember a decimal with multiple zeros to the right. They made it seem almost impossible for someone to become addicted to Oxycontin, which we know today is not exactly true. More realistically, the number might be between 1% and 15%, depending on the population of people exposed to a drug and the type of drug involved. Let us assume that the chance of becoming addicted to drugs is 1%. This seems fairly low. ### Addiction is not common, but it can overwhelm the public health system. Yet, we must think of the large populations of our communities, states, and our country. One percent of 300 million people is three million people. That is a lot of people addicted to drugs, and a costly public health issue to address. The risk of death in surgery is also about 1%. And, in recent times, we are all aware that the risk of death from COVID-19 is about 1%. So, depending on how you view the issue, 1% can be a relatively high number. Not everyone goes in for surgery, but millions of people may be exposed to COVID-19, and millions of people are exposed to drugs or alcohol. As COVID-19 math has taught us, a small increase in risk can lead to much more serious problems. Our healthcare system has limits and cannot handle large percentages of the population getting sick all at once. When addiction rates go up, rehabs and detox centers get overwhelmed. Our local county detox and rehab program often has a waiting list to get in. The current level of addiction in the community, particularly opioid addiction, is high enough to outpace the public health system’s capacity in many communities. ### Toxic contamination of the street heroin supply with imported fentanyl analogs has lead to the current opioid epidemic. Because of the introduction of highly addictive and deadly fentanyl on to US streets, imported through the US Postal Service from China, the level of opioid addiction has created a crisis that has overwhelmed healthcare and addiction treatment services in many communities. This is why we have an opioid epidemic in the US. It is not so different from the global COVID-19 pandemic in the way that seemingly small percentages can cause a big problem when they occur on a large scale. While it is true that if you are currently addicted to drugs or alcohol and you want to quit, it may not be critical to examine your past and figure out why you became addicted in the first place. Such examination will be speculative and possibly not helpful in formulating an effective treatment plan. On the other hand, understanding what makes people susceptible to addiction and how certain drugs lead to further behavior that causes addiction to spiral out of control is important. At the level of public health for cities, states, and countries, small changes can make big differences. ### The best time to overcome addiction is before it even gets started. There is definitely a need for further research and discussion in the addiction treatment community. We also must take care in allowing drugs that may serve as gateways to be overly available. For example, psuedoephedrine, which has no abuse potential by itself, unless chemically altered in a clandestine lab, is kept safely behind the pharmacy counter. However, dextromethorphan, and other abusable OTC drugs and products, are available on the shelves of many stores and accessible to anyone. Marijuana is another drug that we must consider carefully. Legalizing a drug often leads to children believing that the drug is safe and socially acceptable. An alternative is to decriminalize, so that the drug is not legal, but the consequences of being caught with it are minimal. ### There is effective medical treatment for the most dangerous forms of drug addiction. For people who are already affected by opioid addiction, there are effective medical treatments that can give the addicted brain a chance to heal. These medication-assisted treatments, using medications such as Suboxone, methadone, or naltrexone, are highly effective. Making these treatments more available will help more people to overcome opioid addiction. Similarly, [naltrexone]( "Naltrexone Podcast"), when prescribed properly, is effective in treating [alcohol addiction]( "Alcohol Recovery Podcast & Stories"). Whether it is provided in the form of the Vivitrol monthly injection, or using The Sinclair Method with naltrexone tablets, this medication does work to help people reduce or quit drinking alcohol. It is also highly effective early on, before alcoholism progresses to a more dangerous stage. ### Addiction podcasts, books, and articles can be good sources for the latest information on addiction treatment and recovery. For more information on the topic of what causes drug addiction, you might be interested in tuning in to an addiction podcast to learn more about what leads people to become addicted. Additionally, there are a variety of books and journal articles that can be helpful in learning more about the topic. If you have found this article to be informative, I encourage you to read more of our blog articles. This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. ### Learn How to Rebuild Your Life After Addiction And Avoid Critical Missteps URL: https://therehab.com/learn-how-to-rebuild-your-life-after-addiction/ ### How do I live life after recovery from addiction? Quitting drugs is an opportunity to follow your dreams and live the life that you were meant to live. As your brain heals and you start to feel like yourself again, you will find yourself faced with some important decisions to make. Returning to active addiction never works out in the end. No one has ever said that they were happy they went back to drug use after being addicted. Each time you go back to using drugs or [alcohol]( "Alcoholics Anonymous Podcast"), you will be faced with the hard work and time that it takes to fight your way back to quitting and going through the healing process all over again. However, you do have the option to make different choices this time. There is no reason that you have to lose more time from your life to active addiction. Why start recovery all over again if you don't have to? ### Going sober? The best time to get started is now. Now is the time to finally get to work and get the things done that you have always wanted to do. After some time has passed from when you quit using drugs, you will start to see that you are capable of doing nearly anything. As long as you do not pick up a drug, and you keep working towards your goals, you will get better and better at achieving more in life than you ever imagined. All it takes is making a little progress each day. We will come back to discussing what you can do to stay drug free and find success in life. First, let’s cover a few things that you may want to avoid so that you will have the best chance for good health and long-term sobriety. ### After quitting drugs or alcohol, are you recovering or are you recovered? For many people who attend 12-step recovery programs, the answer to this question would likely be that a successful recovery does not end. They would say that recovery is a life-long process and that they are a “recovering addict” or “recovering alcoholic.” The word “recovered” is not used by 12-step members. Yet, the 12 steps of Alcoholics Anonymous and Narcotics Anonymous are not the only path to recovering from addiction and living a sober life. There are other peer support groups that do not share the outlook of the 12-step groups. And, there are people who recover with the help of doctors, including psychiatrists or psychologists, and with the support of their families. In fact, some people recover from addiction spontaneously, without any special medical treatment or stay in rehab. At some point, they realize that they have had enough, and they are ready to live life differently. So, it is perfectly acceptable to say that you have recovered from addiction and you are ready to move on with a life after addiction. What are some things that you should keep in mind as you embark on this new life journey? ### Above all, avoid taking that first drug. First, and most importantly, you should avoid drug use. Any drug use that is recreational should be avoided, and in many cases, prescribed medications can be problematic as well. While it may have been a long time since you have used drugs, and the cravings have subsided, drug use can reawaken the addictive thoughts and take you back to where you started, back to active addiction. It doesn’t take much to trigger those thoughts and feelings again. You may even feel as if you now have control over drug use. At first, you believe that you are able to limit how much you take and stop when you decide to stop. The thing about addiction is that it can sneak up on you. Before you realize it, your life is out of control again. It is not uncommon for a person to find themselves back in the middle of active addiction, wondering how such a thing could have happened again. They can always trace it back to that one first drug use that seemed harmless. At that point, when they took that first one, it seemed as if everything was under control. There is an ominous saying that comes up occasionally in recovery meetings, “It’s not the last one that kills you, it’s the first one.” ### Be careful not to replace on addiction with another. So, after establishing that you must avoid further drug use, what else is there left to do? Another thing to be careful of is to avoid replacing one addiction with another. Additionally, you should avoid performing dangerous activities in an attempt to recreate the rush of adrenaline that comes from using drugs. For example, some people, after quitting drugs, get in the habit of shoplifting. They take small items from local stores without paying. Most often, this behavior is not because of a lack of resources or a need to steal due to hunger or poverty. They do it simply for the thrill of getting away with it. Of course, what seems like an innocent and harmless activity can become a serious problem very quickly. You may think that a large retail corporation will not miss a small item, worth just a few dollars. But, this is not the case. Store security personnel are always on the look out for small theft, so they can prosecute and make an example of someone. Modern security systems employ high-tech, sophisticated software that time stamps and matches purchases with camera footage. Machine learning and facial recognition are also used. You may be surprised one day to find out, while walking out of a store with a cart full of purchases and a few stolen items mixed in, that they can catch you and it will be viewed as a serious crime. ### Some people do not need meetings or help from others to recover from addiction. Or, do they? Other concerning behavior may include gambling, smoking, drinking, overeating, and reckless sexual behavior. You may even know of one or more people who claim to have overcome drug addiction, yet they consume excess alcohol at every possible opportunity, or they gamble often, or engage in some other form of substitute addiction. When you see this type of behavior in members of your own family, it can be frustrating. Why do they get away with it and you are held to a different standard? Are you treated like the "black sheep" of the family? Are you the family scapegoat who can not do anything right in the eyes of your parents and siblings? Have you been marked as the family "addict" and watched carefully by each member of the family to make certain that you do not go anywhere near even a single drop of alcohol? They keep a watchful eye on you at dinners and parties as they drink glass after glass of wine, beer, or cocktails. This family dynamic is not uncommon. In families that beat up on one family member for being the black sheep, there are usually others in the family who also suffer from addiction, but somehow get away with it by camouflaging their addiction in various ways that are accepted by the rest of the family. ### Do not let malicious friends and family hold you back. Do not let your family drag you down and make you feel bad about yourself. Being the family scapegoat very likely means that you are a gifted person with a high level of intelligence and creativity, and the potential to do great things in life. Your family tries to equalize the standing of all family members by holding you back. Therapy can help you to recognize what is happening. The best way to fight back is to stay drug free and take your success in life to a level where they cannot deny your abilities and value as a human being. And, you can build a new, better family by forming relationships with new friends who are inspiring and empowering. ### Be mindful when you eat and be aware of your diet. Overeating and binge eating is a very common serious consequence that occurs for people after quitting drugs. The problem is that food provides a stimulation to the reward center of the brain that is similar to the effects of addictive drugs. When a person feels good while eating food, this is probably an evolutionary advantage, intended to help humans, and other animals, to learn to eat foods that help them grow and store energy. The problem comes up when the brain’s reward system is damaged, and the person finds the eating of high calorie foods to be comforting and difficult to control. Food addiction is a serious problem for many people and often starts with drug or alcohol addiction. There are groups, such as Greysheeters Anonymous (GSA) to help people to overcome food bingeing and food addiction. ### What about smoking and drinking too much caffeine? As many recovery group members can attest, smoking is a problem with people recovering from addiction. Unfortunately, nicotine happens to be one of the most addictive substances on earth. It may even be the most addictive drug of all. Lists of the most addictive substances often put nicotine at the top of the list, followed by other drugs, such as cocaine, methamphetamine, and [heroin]( "Heroin Recovery Stories"). A few years ago, people started to use nicotine vaping devices as cigarette replacements. Vaping became an unofficial way to “quit” smoking. Many people who used these devices continued to vape without any workable plan to discontinue the practice. They considered vaping to be a safer alternative to cigarette smoking, so they didn’t see any reason to give up inhaled nicotine. In the early days, experts did not provide clear guidance on why vaping was bad, they just made vague recommendations to not use these devices that had not been evaluated or approved by the FDA. Now, there are clear reasons to give up this practice, and the official reports on the dangers of vaping are in. Vaping can cause, among other problems, something called “popcorn lung” which is permanent damage to lung tissue. ### What is the best way to quit smoking? Also, should I quit drinking coffee? The best way to quit smoking is by setting a definite quit date that you will stick to. The date should not be too far away, maybe only weeks or a month or two. During the time until that date, you can follow a regular schedule of reducing your cigarettes, 10% per week, for example. Then, you should have support from professionals, including your doctor, group therapy, and possibly a psychologist or counselor. There are government funded programs available in many regions of the US that provide group support, education, and even free nicotine gum or patches. Your doctor may prescribe medication to make quitting cigarettes easier. When it comes to caffeine, the recommendations from experts are not clear. Recommendations have changed over the years. Currently, some experts state that caffeine may be beneficial in moderation. For now, if you drink coffee, consider limiting your intake to one or two cups daily. Also, using coffee as a vehicle to intake excess fat, sugar, and calories by filling your coffee with cream and sugar is not a healthy practice. As you can see, there are a variety of alternative addictions and unhealthy practices that people overcoming addictions find themselves caught up in. Knowing about these risks can help you to be aware and make educated decisions. ### Mindfulness, spirituality, and the brain. It also helps to remain mindful and even practice mindfulness as a discipline, actively bringing your awareness back to the present moment. Carefully consider your decisions and think before acting. Thoughts and feelings come and go. You do not have to act on them, no matter how much you think you want to do something in the heat of the moment. When you have a strong desire to do something that you know is not good for you, it may be the more primitive parts of your brain, including the reward center and the emotion centers fighting against the decisions made by the more advanced prefrontal cortex. According to some experts in neuroscience and spirituality, your conscious existence goes beyond the functioning of your physical brain. Imagine that you, the part of you that experiences the outside world and your inside thoughts and feelings, is something beyond what the neurons of your central nervous system are capable of creating. Think of yourself, your spiritual existence, as an observer and passenger, connected to your brain and body. You experience thoughts and feelings, and you are aware of the world and the actions that you take in the world. ### Do I have to believe in spirituality to recover from addiction? Having religious beliefs or a belief in something beyond scientific explanation is not necessary. You can think of this spiritual version of you as living in the prefrontal cortex, or you can think of it as being a spiritual part of you that transcends the physical world. There are scientists and doctors, even a world renown Harvard neurosurgeon, who believe in the spiritual explanation. Of course, there are also people choose to believe that consciousness and spiritual experiences will eventually be explained by neuroscience. In being drug-free, you have the freedom to follow your convictions and explore these questions. Either way, you will find that following spiritual principles, such as being helpful, charitable, grateful, and mindful, will help you to stay away from drugs and to follow your dreams in life. If you do choose to go to a 12-step program, spiritual principles are the foundations of these programs, without holding members to the specific practices of any particular religion. ### There are alternatives to spiritual recovery programs. If you would like to enjoy the fellowship of being in a discussion group with people who are going through or have gone through similar experiences in overcoming addiction, and you choose to avoid a spiritually centered program, there are alternative groups, such as SMART Recovery and LifeRing. SMART Recovery, for example, is based in evidence-based cognitive behavioral therapy (CBT). ### How do you know what you want to do when rebuilding your life after addiction? One helpful exercise is to think of what you wanted to be when you were a young child. Maybe you wanted to be a famous musician, an astronaut, a politician, a doctor, or a teacher. It can help to brainstorm and take notes. Consider asking trusted friends how they see you in terms of an ideal role in society and what they believe you would love doing in life. Write about the things you truly enjoy doing and see if you can refine those thoughts to break through and figure out what might work best for a future career or hobby. You do not have to get it right the first time. With whatever you choose to do first, even if it does not work out the way you planned, you will have gained valuable experience. When you do discover what it is that you love to do and you are able to successfully transform it into a business or career, you will find yourself looking back and connecting the dots. You will see that even the mistakes you made were necessary to bring you to where you are today. As you make progress in learning and trying things out, it is helpful to look back at the progress you have made to see how far you have come. This is an excellent mental exercise, to take a self-inventory of each small triumph along the way. ### Being grateful for your progress can help you to stay on track. Imagine being several years out from your last time using drugs. You may at times feel frustrated, because you think you are behind schedule on achieving a major goal. For example, your goal might be to have a successful business that can run without your day to day hands-on involvement. In evaluating your progress, you realize that you have started a business and it is not losing money. When you think about how far you have come from the day when everything seemed hopeless to your successes of today, you feel an immense gratitude for what you are capable of when you move past active addiction. Your goal might not be to start a business. Maybe you want to go back to school or you want to move up in your current career. Or, you might want to have a better relationship with your family. Whatever your life goals, looking back and appreciating your progress can help greatly in keeping you on track and feeling good about where you are today. Everyone starts from a different place when putting down drugs or alcohol. Some people have major legal challenges or financial problems early on. Do not let these obstacles overwhelm you or deter you from quitting drugs. You will get through each of these issues and put them behind you, one by one. ### Recovery takes time. There is no rush to get better and fix up your life. Healing from addiction takes time. If you can take small steps forward in taking the actions necessary to fix problems and move towards your goals, those little steps will add up to major accomplishments before you know it. When it comes to dealing with legal problems, it is usually the best choice to work with a qualified lawyer for your specific issues. If you have health problems, see your doctor. Asking for help and getting help from others is not at all a weakness. Being able to ask for and accept help is a cornerstone of being successful. While it is important to ask for help from qualified people when you have specific challenges, don't forget that much of the healing process takes time and cannot be rushed. Rather than getting frustrated that your life is not improving faster, you can simply remind yourself that staying drug-free is a major accomplishment by itself. ### Medical treatment for addiction has a high rate of success. If you are just getting started, and you are taking opioids or drinking excessive alcohol, you may be wondering what you can do to get off of the substances safely and comfortably. While opioids, such as heroin and fentanyl, and alcohol are the most dangerous substances to misuse, there is medical treatment for both opioid and alcohol addiction. The first step in getting help for these addictions should be to see a doctor who is qualified and experienced in providing medication-assisted treatment for substance use disorder. Specifically, you can see a [Suboxone ]( "Suboxone Podcasts")doctor near you for [buprenorphine treatment]( "Buprenorphine Podcasts") if you are using opioids. Or, if your drug of choice is alcohol, you can see a doctor who prescribes naltrexone tablets or the vivitrol shot. Also, look up The Sinclair Method for quitting alcohol. TSM is a form of [medication-assisted treatment]( "Medication Assisted Treatment Podcast") for alcohol use disorder that uses naltrexone tablets. Getting sober on your own is not easy. Medical treatment can make the process safer and more tolerable. ### Tune in to learn more about the best ways to recover and rebuild your life after addiction. To learn more about addiction treatment, you may be interested in tuning into podcasts on the subject of addiction recovery. The best recovery podcasts will cover all aspect of treatment, including medication-assisted treatment. You will find many great podcasts on the subject of addiction recovery and other interesting subjects on our network, The Mental Health News Radio Network. Whatever stage you are currently at in recovery from active addiction, now is a great time to reaffirm your commitment to moving forward and reevaluating your recovery program. A sober life is the best life. When you put drugs and alcohol behind you, there is no limit to what you can accomplish. ### Living A Sober Lifestyle after Rehab And Reaping The Benefits Of Sobriety URL: https://therehab.com/living-a-sober-lifestyle-after-rehab-and-reaping-the-benefits-of-sobriety/ ## How to stay sober from drugs and alcohol after leaving rehab At first, being in rehab can be a stressful experience. You are torn between your compulsion to keep using drugs or alcohol and your desire to feel normal again. You are tired of feeling sick all the time, but you still feel like you could just go out and get high or drunk just one more time. After a few days, you get used to the routine. Your entire day is planned around activities that promote a sober recovery. You become hopeful about your future and you start to believe in the recovery process. Yet, what happens when it is time to leave rehab? Some rehab programs last only a month. Others can last for anywhere from three to six months. Either way, at some point it will be time for you to graduate from the program and return to the real world. Rehab provides freedom from the usual stress of everyday life. You are spared the painful dynamic of a dysfunctional family. There are no drug dealers or bars in rehab. In rehab, they talk about living a life of sobriety and avoiding triggers, but you do not have to face those triggers during your stay. Getting clean and sober in rehab is not easy, but the challenge of returning to regular life outside of rehab is a whole new challenge. ## Living with sobriety in the real world. Fortunately, most rehab programs understand that the need for support does not disappear when you walk out the door. They often provide ongoing aftercare meetings and therapy. If your program provides these resources, you can take advantage of them to make for a smoother transition when returning home after rehab. Some rehab programs recommend sober living after rehab. In a sober living home, you will be in a living environment with other recovering addicts and alcoholics. There are strict rules and guidelines in most sober homes. You will be monitored for drug or alcohol use. And, you will be expected to attend recovery meetings on a regular basis. While sober living homes are not for everyone and not all of them are positive environments, if you are able to find a good sober home, it may be a better transition from rehab rather than going straight to living at home again. It depends partly on your home situation. Do you live at home alone? Or, do you have a supportive family waiting for you? On the other hand, is your family a major trigger for you to go back to using drugs or alcohol? Is your home located in an area where there are drug dealers or other dangerous triggers you might see when you come and go from home? The decision to enter a sober living home is personal and depends on a person’s individual situation. In some cases, going home to a supportive family is the best option. ## Is outpatient rehab a good idea? Some rehab programs involve a step-down approach, where you move from one program to another with gradual integration back into society and everyday life. You may start in residential rehab and then go to a partial hospitalization program, or PHP. A PHP is a program where you spend much of your day at the rehab facility, doing many of the same activities you were doing in residential rehabs, such as group meetings and therapy. The difference is that you go home at the end of the day. After completing PHP, you may then be transferred to an intensive outpatient program or IOP. IOP is very similar to PHP, but the difference is that you only go for a few hours daily and only several days per week. The next step may be a less intensive outpatient program, known as OP. During the series of step-down programs, the rehab facility may recommend that you live in a sober living home. As noted earlier, this will depend on your home living arrangement and individual situation. ## Should I continue seeing a doctor after leaving rehab? Rehab programs differ greatly in their dedication to medication-assisted treatment of substance use disorders. Some rehabs do not offer any form of medical treatment for addiction, while others provide a full array of options to their patients. If you were started on a long-term medical plan while in rehab, you should definitely make arrangements to continue that plan after leaving rehab. For example, if you were given Suboxone (sublingual buprenorphine/naloxone) for opioid addiction, it is critically important to continue treatment after you leave. Some short-term detox programs use Subutex (buprenorphine) for a fast detox off of opioids such as heroin or fentanyl. You are given a specific dosage on your first day, and a decreasing dosage each day. After a week or two, they have you stop the Subutex and declare you to be opioid-free. Unfortunately, fast detoxing with Subutex or Suboxone can be a recipe for disaster. In the past two decades of providing these medications to treat opioid use disorder, we have learned that the best way to get lasting, long-term success is to prescribe Suboxone for at least one year. A fast buprenorphine detox may work in the short term, but over time, intense opioid cravings can occur, leading to a high risk for relapse. Fortunately, more rehab programs are coming on board, realizing that they must coordinate for long-term [Suboxone treatment]( "Suboxone Treatment For Opiate and Opioid Addiction"). Some rehab programs provide an outpatient [Suboxone clinic]( "Benefits of Walking to Suboxone Clinics") for patients to continue treatment after they have graduated from rehab. Others will arrange for clients to see an outside doctor after discharge. If your rehab has started you on medication, but not arranged for your ongoing medical care, it is important for you to find a doctor who can continue prescribing Suboxone and arrange for psychotherapy. There are several excellent online tools to help you to locate Suboxone doctors in your area. With Suboxone therapy, getting clean without rehab is a possibility. All that it takes is making an appointment with a Suboxone doctor in order to start medication-assisted therapy (MAT). ## Should I get a Vivitrol shot before leaving rehab? Vivitrol is a special injection that is given in the muscle, providing a full month of medical treatment with the addiction medication, naltrexone. [Naltrexone]( "Naltrexone Podcast") is FDA-approved to treat both opioid addiction and alcohol addiction. There has been some evidence that it can help with other addictions, such as cocaine and methamphetamine addiction, and even binge eating. While not all rehabs offer Vivitrol, it is available in many programs. Some rehabs may strongly recommend it to qualifying patients, or they may simply have it available to those patients who ask for it. If you do agree to the Vivitrol injection, keep in mind that it is recommended, for best results, to take it for at least several months. Ideally, you should plan on six months to a year of treatment, and possibly longer. One problem that can come up is that Vivitrol is very expensive and sometimes hard to get approved by health insurance. There have been cases where patients were given their first shot in rehab and then had trouble getting their follow-up injections in subsequent months. If you or a loved one is in this situation, of course, it would be ideal to fight for your right to get the Vivitrol shot continued. The Affordable Care Act of 2008 included the Parity Act which promises that addiction treatment and mental health treatment will be as accessible as any other form of medical care. The Parity Act should guarantee that your insurance company will cover your ongoing Vivitrol therapy. Unfortunately, health insurance companies are well aware that this law is not often enforced, so they have no fear of ignoring it. An alternative to Vivitrol, if you cannot get access to it after rehab, is the naltrexone tablet. Any doctor can prescribe naltrexone daily oral tablets. While the Vivitrol shot may be better than the tablet form for opioid addiction, the tablet still works and is better than stopping medical therapy too soon. ## Are nutritional supplements important after leaving rehab? I once interviewed the founder of a nutritional supplement company on my podcast. Their supplements were uniquely designed to help people overcoming substance abuse. When quitting drugs, you may experience difficulties in mental functioning that can take a long time to recover from. In some cases, chemical imbalances in the brain can even lead to relapse. Ideally, if your diet includes the precursors to important neurotransmitters, which are usually special amino acids, and also important cofactors, such as calcium and magnesium, your brain will be able to recover more quickly. A healthy, well-rounded diet and additional supplementation can make a huge difference in recovering mentally from the effects of long-term active addiction. Unfortunately, many rehabs have no interest in providing healthy nutrition to their clients. They often provide high-carbohydrate snacks and meals without a great deal of thought regarding nutrition. The podcast guest from the recovery supplement company told me that it was unbelievable how much difficulty they had in promoting their supplement products to rehabs. At many programs, there was a complete lack of interest. When you do leave rehab, you have the ability to take control of your own nutritional health. Eating the right foods is essential. A diet consisting of fruits and vegetables and lean proteins, such as grilled fish or chicken, is good. Also, you should take a multivitamin. You may also be interested in brain function support supplements. L-tyrosine is an example of a supplement that acts as a precursor to several important neurotransmitters. Your brain is always producing more of these important chemicals and it requires the building blocks to be able to make enough for healthy brain functioning. ## Should I exercise after I graduate from rehab? Of course, exercise is a healthy way to keep your weight under control and to keep your heart healthy. A moderately paced daily walk for 30-60 minutes is adequate for most people. Additionally, exercise is good for your mental and emotional health. A nice early morning or evening stroll is a good way to clear your mind and enjoy a beautiful sunrise or sunset. If you also choose to go to the gym and engage in weight training, please be careful. Injuries from lifting weights can be disappointing, and may even lead some people to relapse. Gym workouts should involve an experienced and professional trainer. ## How do I find a good therapist when I leave rehab? Rehab programs include therapy and often continue to offer therapy after you leave the program, but in some cases, you may want to, or need to find a new therapist. An excellent place to start is to ask your doctor if they can recommend a good therapist. While therapists are a personal and individual choice, you should keep some important points in mind. If you are on medication, such as Suboxone, make sure that you do not get started with a therapist who is against the medication-assisted treatment of addiction. Having your therapist try to talk you out of taking your prescribed medication can lead to disaster. While it seems obvious that a licensed therapist would not contradict medical therapy prescribed by another healthcare practitioner, this is not always the case. In fact, some patients have had their primary care doctor tell them to quit Suboxone prescribed by another doctor. Before trying to intervene in someone’s medical care, therapists and other healthcare professionals should contact the prescribing doctor to voice their concerns. Giving a patient conflicting views of effective medical treatment for addiction can be confusing for the patient who is looking for clear answers from the medical community. Many of us who go into healthcare bring along our own beliefs and prejudices, but our commitment must be to providing evidence-based treatment in line with community standards. We are expected to understand standard treatments for medical conditions and why they have come to be accepted as a standard. Otherwise, you may also want to consider the credentials of your therapist. Are they licensed, psychologists or addiction counselors? How many years have they been practicing? Do they have a doctorate degree in psychology? ## How do I stay happy after I leave rehab? Were you happy during your stay in rehab? For some people, rehab is a miserable experience of being in the midst of drug withdrawal and experiencing regret for the events leading up to a rehab admission. For others, it can be an uplifting experience of embarking on a new spiritual way of living with hope for the future. If rehab provides one thing well, it is a sense of hope that getting more involved in recovery and working the 12 steps will provide spiritual awakening, leading to a new and better way of life. Regardless of your experience in rehab, leaving the facility prevents new challenges in learning how to be happy and find fulfillment in life. The people who were hopeful about the promise of the 12-steps may settle into the daily routine at home, their pink cloud dissolving away to reveal the cold gray reality of the daily grind of life. Quitting drugs often leads to a condition known as anhedonia. This means a lack of the ability to feel pleasure. It is the result of detoxing drugs out of your system and your brain’s long, uphill road to recovering normal functioning. Brain health supplementation, as mentioned earlier, may help with this brain recovery process. Still, there are rewarding activities in life that provide a sense of fulfillment that goes beyond simple pleasures. True happiness is better associated with this spiritual sense of fulfillment than with the pursuit of short-term pleasure-seeking. Even in a state of anhedonia as your brain recovers, you will be able to experience happiness as the result of engaging in more spiritual activities. ### Finding happiness through spirituality. Service to others is one way to experience a sense of lasting happiness. Knowing that you have done something to make someone else’s life a little better is a great way to feel better about yourself and about life in general. Some examples of service include signing up for a service position in a local 12-step group, such as setting up chairs or being a greeter. Or, you could volunteer at a local soup kitchen or hospital. If you have the resources, you might want to get involved with a charity, providing financial support as well as volunteer services to the same institution. Gratitude is another way to feel a sense of calm satisfaction with life, even when you are still dealing with the anxiety of early recovery. 12-step sponsors often ask their sponsees to keep a daily gratitude list, writing down all of the things they are grateful for in their lives. Mindfulness and meditation are also helpful. Do not let the idea of meditation scare you. Anyone can meditate. You do not have to follow any specific rules or techniques. You can simply focus on one thing, such as a sound or the feeling of your breath at the end of your nose. Mindfulness simply means being aware of the present moment and what is happening around you. Rather than rehashing the same old memories and thoughts in your head, stop, look, and listen. Focus on being where you are at the present moment. Happiness is not spending money, buying stuff, eating fancy food, riding on roller coasters, or showing off how good you are at something to other people. These things can be fun in moderation, but can also become unhealthy in excess. Do not feel down because you are not going out to party on the weekend nights with your old friends. Just because you are not doing as well as you would like financially or in your career, there is no reason to obsess over it. Give yourself time and enjoy the simple pleasures of being alive. There is no rush to get back to the life you left behind when you started using drugs. In fact, that is not necessarily the life you should be getting back to. Now is the time to rethink who you are and what you want out of life. There is a whole new world available to you when you stop using drugs and alcohol. You have the opportunity to start over again and live a life beyond what you ever dreamed possible. To learn more about how you can enjoy your recovery, I recommend that you listen to the [best addiction recovery podcast]( "Best Podcasts On Addiction Recovery"), The Rehab Podcast on The Mental Health News Radio Network. ### The Best Rehab Centers Use Process Group Therapy. What Is A Process Group? URL: https://therehab.com/the-best-rehab-centers-use-process-group-therapy-what-is-a-process-group/ ## Group therapy vs individual therapy: Is process group therapy better? The importance of group therapy has been discussed on several occasions on our [recovery podcast]( "Recovery Podcast"). Group therapy for substance abuse, also referred to as Process group therapy, is a form of treatment in which a therapist acts as a group facilitator with a small therapy group. Even the best rehab centers in the world are known for including process group therapy. Often, the group members sit in chairs arranged in a circle. With this arrangement, members of the group session can listen to another participant while seeing their expressions and body language. **Everyone in the group therapy session feels as if they are equals in the circle. No one gets to hide out in the back row.** Group psychotherapy is implemented in most rehab programs, from residential rehab to private detox to outpatient programs, such as PHP, IOP, and OP. Because the 12-step Alcoholics Anonymous program is so thoroughly integrated into many rehab programs, you might think that the rehab psychotherapy group originated in AA and was borrowed from that program. Interestingly, the concept of the process group was developed at least a few years before the founding of Alcoholics Anonymous. A group of psychiatrists developed the idea well before the first AA meeting took place. In fact, it is more likely that AA borrowed the idea of group participants meeting together to share their common experience from the work of these psychiatrists. It does make sense that the founders of AA would want to include in their program what was considered cutting edge therapy for mental illness at the time, in the 1930s, when AA was founded. **Still, since 12-step facilitation is considered to be evidence-based treatment and employed by many rehabs, the influence of 12-step programs on rehab curriculums clearly exists.** Group treatment started out in the realm of psychiatry and psychology, was popularized by 12-step programs, and became a cornerstone of rehab counseling. In the interpersonal process group, there is always a group leader. The group leader may be a certified addiction counselor or even a doctor of psychology or psychiatry. In the group setting, the group therapist will help by facilitating the conversation. They may point out interesting topics that arise and encourage other members to share about those particular topics. Or, the group facilitator may moderate disagreements and hostilities, preventing the escalation of arguments that may arise among the group participants in the therapeutic group. Public 12-step meetings also typically involve a chairperson who acts as a group leader, but with a less hands-on approach. Unlike a group counseling leader in a residential center for addiction treatment, a 12-step meeting chairperson does not have to have any special credentials to lead a meeting. Their main responsibility is to open and close the meeting and call on members to raise their hands so that they may share. ## What is the purpose of the process group? Why would a rehab include group therapy at all? Why not focus solely on individual therapy? The idea of the process group is to give participants an opportunity to share similar experiences and similar issues with the group. When one member hears that another member has a similar problem, it can help by seeing that they are not alone in their experience. Addiction can be terrifying. People who experience active addiction may believe that they are going through something that is impossible to escape. They may believe that other people in recovery have it easier. During substance abuse treatment, a patient may be given hope when they hear that a real person, just like them, has gone through similar situations. This group — sharing relationship can give rehab patients hope, that if another person in their situation can recover, that they can recover as well. In facilities that employ highly trained addiction psychologists to moderate groups, they may use more advanced therapies in group sessions. Cognitive behavioral therapy (CBT) is often used in top rehab programs in the group setting. CBT can be applied in treating addiction or any mental health condition where the patient is capable of participating in the therapy. Inpatient dual diagnosis treatment centers often employ CBT as a part of individual and group therapy. CBT can even be used in online therapy. SMART Recovery is a non-12-step program that uses CBT in group meetings. Group leaders are trained in using CBT as a part of the program. ## What other benefits are there to the psychoeducational group meetings in rehab? In active addiction, many people start to avoid any social interactions. Drug or alcohol misuse becomes the complete focus of their lives, and they choose to engage in substance use alone. In order to improve social skills, the ability to form interpersonal relationships, and to reduce anxiety, groups can be a gentle reintroduction back to engaging in social interactions. By addressing social anxiety and other issues that are present as a result of active addiction, there is an opportunity for personal growth. A rehab client may learn in a group to see their personal challenges differently, learning to have a better distress tolerance when faced with adversity. A group may even practice important skills such as mindfulness, focusing on what is happening in the group in the present moment. When activities such as prayer and mindfulness are introduced into the group setting, the experience can become spiritual. However, the spiritual experience in group meetings may be more appropriate in public 12-step meetings rather than in the clinical setting of a center for addiction treatment. Yet, in a religious-based program, such as a Christian rehab, prayer and spiritual experience may be an important part of the program. ## Is process group therapy appropriate in psychedelic treatment for addiction? At this time, psychedelic therapy for addiction and other forms of mental illness is still a new field in the US, only practiced in research settings. Psychedelic drugs are, for the most part, still not legal for use in medical therapy in the US. However, in other countries, there are ibogaine treatment centers that use psychedelic drugs such as ibogaine and its derivative, 18-MC. While treatment is often provided in a very private setting, there may be instances where group therapy is employed. Outside the clinical setting, there are groups that meet, led by a shaman, who uses psychedelic drugs such as ayahuasca to induce an experience to help people to overcome issues such as addiction, dependence, or chronic pain. Ayahuasca is a natural drug from which the drug DMT is derived. In these sessions led by a religious shaman out in the deserts of Central or South America, group sessions may be an important part of the shared spiritual experience. Some participants have described feeling a sense of oneness with others. They may develop a new perspective on the universe and on their lives. There are also, in these countries, clinics that offer ayahuasca therapy as well. Some people complain that using this drug in a clinical setting is a form of cultural appropriation and that the only proper setting is with an experienced shaman. Of course, I am not recommending psychedelic therapy in other countries with more lax regulations or any drug-related therapy that involves following a shaman out into the desert. While there may be usefulness in these therapies when properly implemented and supervised by professionals, they are also highly dangerous. People have died seeking ibogaine therapy outside the US. The drug is known to be cardio toxic. Also, while there may be reputable shamans out in the deserts south of the border, how can you be certain that you are safe? So, while it may seem romantic to seek group therapy in a spiritual group under the stars in far off Mexico, out in the desert, vomiting up ayahuasca tea in front of the other group members, you may be putting yourself at serious risk of permanent injury or death. You could possibly develop a serious permanent mental health condition as a result of unregulated group psychedelic therapy. ## Is group therapy in rehab always a good idea? The idea that patients in rehab can only benefit from the experience of others by attending a group session is not completely true. If you are under the care of a doctor with experience of treating addiction, you can also benefit greatly from the experience of others. For example, if you are seeing a private doctor for addiction treatment, your doctor will be able to share with you statistics and data about the success of medical treatment for the type of addiction that you are working to overcome. Additionally, the doctor can share case studies of other patients who have gone through similar experiences. Of course, your addiction doctor is not going to give information that identifies the other patient in any way. Privacy is of the utmost importance for all addiction treatment patients. **Yet, hearing about success stories from your doctor can be inspirational, motivating, and give you great hope for your future in overcoming your addiction. Hearing about others who have passed before you and had success is a great motivator.** In fact, learning about past success stories may be a better way to motivate a patient and give them hope than sitting in a group of rehab clients who are at the same stage in treatment. If you are addicted to [heroin]( "Heroin Addiction Recovery Stories Podcast") and hear another group member state that they are addicted to heroin in the same way, how does that help to let you know that you have hope of getting past your addiction? A patient once expressed this exact concern to me, about the feeling of hopelessness in rehab when sitting in a group session. He told me that he repeatedly shared with the group that he did not feel as if he would ever get past the intense drug cravings that haunted him throughout the day, every day. Other members of the group shared that they felt the same way. The group leader encouraged other participants to share the topic and share how they felt about their hopelessness. The patient told me that he felt even worse, as if there was no hope for him at all after hearing that other group members felt the same way. In fact, the group leader then told the group that the chance of success in overcoming addiction was fairly low, so they better dedicate themselves to the recovery process so that they might be in the very small percentage that succeeds. Needless to say, this speech was not motivating in the way that the group leader intended. Telling a group that 1 in 10 might make it does not necessarily make anyone feel better or more hopeful. After the patient told me this story, I asked him how he would feel about the odds of success being at least 1 in 2. He agreed that it was much better than what his group leader had told the group in rehab. I was able to share with him statistics about medication assisted treatment and case studies about what qualities helped patients to be more successful. For example, sticking with medical treatment long enough is a great predictor of success. Another proven way to be successful in medical addiction treatment is to not let other people get involved in your medical treatment, telling you that you should stop your medication or take less without discussing it with your doctor. ## Can group therapy help patients who are receiving medication-assisted treatment (MAT) for opioid use disorder or alcohol use disorder? Group therapy as a part of medical treatment for addiction may be helpful, but it can also possibly be harmful in some situations. In a group setting where MAT is not accepted, a group member who sees a doctor for MAT may feel very uncomfortable. For example, the Narcotics Anonymous 12-step program has an official position against what they refer to as "replacement medications." If a patient takes Suboxone, they may be asked not to share in a meeting because the rest of the group does not consider them to be "clean." In addition to not being able to count clean time and celebrate milestones in their recovery with the group, they will also not be allowed to participate in service positions in the group. Hence, a person who takes [Suboxone]( "Suboxone Podcast") and functions perfectly well in society, at work and at home, may be made to feel like a second-class citizen in the NA program. The problem is that, over time, the influence of group opinion can wear on a person until they finally give in and decide to act as their group wants them to act. They may make the decision to terminate medical treatment early. So, where the best chance of success with MAT requires at least a year of treatment, a patient may quit after a few weeks or a few months, due to social pressure from a group. In this situation, the group "therapy" was definitely not helpful. Early termination of MAT has frequently led to relapse, and sometimes tragic outcomes. It is important that people surround themselves with people who support them in their success, not people who undermine them with criticism and differing opinions that are not in line with medical science. ## Is process group therapy good or bad? While I have presented a case here for avoiding group therapy in some situations, it does not mean that it is always bad. Group sessions can be very helpful for providing a sense of community and shared experience. Narcotics Anonymous meetings can be spiritual and inspirational, yet they may be best suited for people completing their MAT treatment. Also, it is important to note that MAT patients have no obligation to share with anyone the details of their medical treatment. There are issues of privacy in any group therapy setting. In rehab, it is interesting that privacy laws are so highly respected when someone calls inquiring about a client. For example, I was once contacted by one of my patients when he was in rehab. I returned his call by calling the main number for the facility. The receptionist told me that she could neither confirm nor deny the presence of my patient in their facility due to privacy laws. This was in spite of the fact that it was clearly documented that I was the patient's physician! I pointed out to the receptionist that it was interesting that she would protect the patient's privacy from his own doctor, but then place him in a circle of complete strangers and encourage him to divulge the most intimate, private details of his life to them. ## What if someone in the group knows someone else, personally or by reputation? What if a celebrity is in a group with a member of the paparazzi? Invasive photographers who stalk celebrities sometimes end up in rehab with addiction problems as well. Or, what if a member of the group is a prominent lawyer or a person who believes they were harmed by another group member? Or, they are members of the same profession, where addiction issues are frowned upon. The possibility of privacy violations in group sessions in rehab is endless. When someone is in a state of hopelessness, just coming out of active addiction, they may not care who is in the group or what they share with the group. Yet, it is possible that what they share with strangers might come back to haunt them later. On the other hand, putting the concerns of professionals and celebrities aside, many people have nothing to fear in sharing with the group. Being open in the group process can be very helpful in opening up about difficult issues. They say, in the pop psychology of addiction group therapy, that a person is only as sick as their secrets. It is true that the condition of addiction motivates individuals to keep things to themselves. A secret might be that a person has a secret plan to get high again after rehab. Maybe they still have a secret stash of drugs, or money to buy drugs. Maybe they are still keeping the phone numbers or social media contacts of their drug dealers. Getting these secrets out in the open in front of a group can be therapeutic. There can be a feeling that sharing such secrets with a group of multiple people is even better than just sharing them with a single person in individual therapy. For people who find group therapy to be beneficial for them, there is no reason to discourage them. Everyone is different, and there is no one-size-fits-all solution to addiction treatment. Process group therapy does help many people and should be made available to those who will most benefit from it. ### Is There Help For Parents Of Addicts And Support For Families Of Addicts? URL: https://therehab.com/is-there-help-for-parents-of-addicts-and-support-for-families-of-addicts/ ## Addiction and the family and how addiction affects families is a difficult subject to address during addiction treatment. Family involvement can vary dramatically among individuals who suffer from substance use disorders. In some cases, family support is very strong. In others, family addiction issues can tear families apart. Addiction affects on family can be devastating. And, sometimes, family roles and family history may be a contributing factor to the addiction problem in the first place. Various forms of physical or emotional abuse can lead to mental health problems that a person may self-treat with drug abuse, [leading to drug addiction]( "What Causes Drug Addiction?"). When family members are aware of what type of substance abuse treatment works best, such as [medication assisted treatment]( "Medication Assisted Treatment Podcast") for opioid addiction, the patient has an excellent chance of getting into successful addiction recovery. Family members help the patient get in to see a treatment provider, and within a short time, their life is back on track. However, sometimes the family dynamics are different, and there may not be as much clarity over what type of individual therapy will work for specific addicted individuals. Additionally, the effects of addiction on family and friends can distort the perspective of what must be done in order to help a loved one get past active addiction. ## Parents of addicts can be misguided by support groups that preach tough love. There are groups for families of addicts. For example, there is Al-Anon, and Nar-Anon. These groups are free to the public and provide a forum for discussion among family members and loved ones of people with addictions. These support groups for spouses of addicts and other family members and loved ones are places where people can vent about the troubles they have had with their addicted loved ones. Sometimes, they can be places where people find solutions to how to get help for a spouse, or adult children with a substance abuse disorder. Whether the problem is gambling addiction, alcohol addiction, opioid addiction, or stimulant addiction, substance abusers can make life difficult for their families. Addictive behavior can put a serious strain on the family in many ways. Families may face financial difficulties, or domestic violence issues relating to their loved one's substance abuse problems. In relationships, there are often codependency issues as well, which may prolong active addiction with enabling behaviors. For example, a codependent spouse may want substance misuse in the house to stop, but they are afraid of causing changes that might end the relationship. Unfortunately, some relationships do not survive addiction recovery, but it is of the utmost importance that the person suffering from active addiction get help. ## The impact of addiction on family can be addressed with effective family therapy. Family addiction counseling is a good idea, when family members are supportive. The best rehab programs incorporate a family program to ensure that all family members who are supportive know the best ways in which they can help. It is important for family members to approach addiction as a health problem rather than a moral problem. A person in active addiction exhibits behaviors caused by their addiction which are difficult to get under control. [Mental illness]( "Easy Ways to Improve Your Mental Health Today") is often treated as something that a person can simply get under control with will-power and self-control. During family therapy, the therapist has an excellent opportunity to make it clear that a person is an addict because they have a mental health condition, which, in many cases, can be medically treated. When an addict has a child, social workers may recommend that the child be placed with other family until the person is ready to get help. Substance abuse issues, such as heroin or fentanyl addiction, can be treated quickly, so that the opioid addict will be ready within a short time to start caring for their children again. Family sessions with a therapist are excellent to bring the family together and get past the issues of substance addiction. Family members are able to reconnect and relearn how to work together as a loving family again. ## How does addiction affect the family when their loved one attends rehab? In my podcast interview with a psychologist from American Addiction Centers, we discuss the importance of family involvement in many addiction treatment cases. As we noted during the interview, every situation is different, so patients in treatment must be evaluated as unique individuals, each with very different family situations. In another interview, my guest emphasized the importance of recognizing that family members do not necessarily have to be people who are genetically related. A person may make new connections with friends in recovery who can become their new family. For more great interviews from the best addiction recovery podcast, please listen to The Rehab podcast on the Mental Health News Radio Network. If you find the episodes helpful, please leave a five-star review and please subscribe. A family of people who are supportive of addiction recovery can be a better family than the family a person was born into. Being surrounded by loving support, and not harsh judgement, can make all the difference in the world. Of course, while a recovery network of support from a family of new friends is usually a positive force, it can occasionally be negative as well. Many people who go through the detox/rehab recovery process find themselves in sober living facilities where housemates may not always be good influences. It is important to navigate life very carefully in early recovery. If you are just getting started on the path towards long-term sobriety, it is important to be honest with yourself about who in your life is a good influence and who may be a bad influence. Choosing to surround yourself with people who truly want you to succeed is very important. ## Why are family members so far away and how do addiction effects on family drive families apart? In my experience working with people with substance use disorders, family members tend to live in far away places. To some extent, this may be related to where I live and work, in South Florida. Our region has been described as the rehab capital of the world. This title is not intended to be complimentary. The many rehabs found in South Florida are often small storefronts in strip malls, filled with people who have cycled through the rehab system multiple times. In some cases, the rehab client has travelled to Florida because they were promised by a particular rehab facility that they could recover in sunny Florida, sitting on a beach, sipping a non-alcoholic beverage, going to the gym, watching cable TV, and more. Family members most likely saw Florida rehab as an opportunity to have their loved one taken care of while they had some breathing room, away from the devastating effects that addiction has on the family. Family members believed at first that their loved one was going to Florida to be in a safe place, free of drugs and surrounded by therapy and recovery. Unfortunately, they often got caught up in corrupt rehab schemes that did not at all have their safety or recovery in mind. So, why do families not do something to get their addicted family member back home again? Reasons are complex and different for different families. Often, parents of adult children are still working at jobs or running a business, and do not have the time or resources to run around the country chasing after their child who is struggling to stay in recovery. Also, after multiple relapses, the prospect of long-term recovery may seem hopeless. Imagine how parents, spouses, and siblings feel when they find out their loved one is back in rehab again after another relapse. Often, they are not impressed at this point with another round of restarting recovery. It seems inevitable that the cycle will continue to repeat itself, with another relapse just around the corner. ## Is there hope for a chronically relapsing family member? How many relapses mean that a person is hopeless and simply cannot recover? Is there a number or threshold, past which family members might as well give up hope completely? Incredibly, there is always hope for a long-lasting recovery and long-lasting sobriety. Even if a person has relapsed 20, 30, 40, or even 50 times, even with multiple overdoses, trips to jail, and other frightening incidents, there is still hope. Many people have settled into long-term recovery after many, many relapses. Harm reduction techniques are ideal for keeping addicted family members safe during times when they are not yet ready to accept recovery. As long as an addicted person is alive, there is still hope for recovery. And, ideally, we should also support them in maintaining their health as much as possible. What is harm reduction? For opioid addicts, it means having naloxone in the house and available at all times. Naloxone is sold as the brand, Narcan, and is an effective opioid overdose reversal tool. Narcan is commonly sold as a nasal spray and can be sprayed in the nose of a person who is overdosing on opioids. I have spoken to many family members who revived a loved one with Narcan, saving their life. If there is an opioid user or opioid abuser in your home, and your doctor gives you a prescription for Narcan, make sure you fill the prescription, and then put the Narcan somewhere easy to find. Let the rest of the family know about it and how to use it. Normally, you would want to keep prescription medications in a safe place, possibly locked up if they are drugs with abuse potential. Narcan is different. If you have an opioid abuser in your home, they are not going to abuse the Narcan. In fact, there is no way that they can abuse Narcan. Naloxone does not get anyone high, and it cannot make other drugs work better to get people high. Narcan simply reverses an overdose. If your family member is found unresponsive, first give the Narcan, and then call 911. You may have to give multiple doses of Narcan, because street opioids containing fentanyl analogs can be so potent, they are Narcan resistant. ## What other harm reduction methods exist for families? You should not give a drug abuser money or drugs. Harm reduction does not mean enabling your loved one’s addiction. However, this requires further explanation, because many family members have misunderstood and misinterpreted the concept of not enabling addictive behavior. When I say you should not give your loved one drugs, this means no street drugs. Street drugs are toxic, contaminated, unreliable, and highly dangerous substances sold by criminals. Purchasing street drugs is also illegal. You should also never give a drug abuser prescription medication that was not prescribed to them. This is also illegal and potentially dangerous. Yet, taking someone addicted to opioids to a Suboxone clinic or even a methadone clinic can be life-saving. While the drugs dispensed or prescribed at these facilities are opioids, they are relatively safe, and provided in the context of addiction treatment. By offering to take a family member who is addicted to opioids to the local Suboxone clinic, you can help to get them on track and drug-free. Suboxone treatment is highly successful and is considered now to be the gold standard of care for opioid addicted people. While giving your family member in active addiction a handful of cash is almost always a bad idea, you may still pay to support them living safely in your home, if you are able to do so without jeopardizing your own safety and the safety of your family. If your addicted family member goes out and has a relapse, should you kick them out and change the locks? What do you think happens to a person in active addiction who is kicked out on the streets? I can tell you that in most cases, good things do not tend to happen in this situation. Do you really want your loved one in a dirty dark alley, buying or using deadly street drugs? Addiction experts agree that keeping your addicted loved ones close and making yourself available to help them to get help when they are ready is one of the best forms of harm reduction. I have seen both situations, where the family distances themselves and where the family stays close, and the addicted family member always does better with close family support. ## How does addiction affect family and friends with addictions to other substances and behaviors? Of course, while opioids have been in the headlines for years now, they are not the only addictive substances. Alcohol addiction is another serious issue that can tear families apart. And, in some regions, stimulant addiction, including meth or cocaine, is common. Each drug has unique characteristics that lead to unique issues for the family. A drunk person is at risk for crashing their car, causing serious harm to others. Or, they may come home drunk, scaring their children, and causing a sense of instability in the house with their ongoing, routine alcohol intoxication. A gambling addict tends to spend a lot of money and lose most or all of the money they spend on gambling. In extreme cases, they may spend all of their family’s savings, and even go deep into debt. Why do some addictions respond well to medical treatment and others do not? Most likely, it is because, while addictions share many traits in common, they are also different in how they manifest, based on the substance or behavior involved. For example, a meth addict will tend to engage in self-harming behavior, persistently using their drug and staying awake for days and weeks, neglecting their hygiene and basic self-care. Yet, the meth addict may not cause financial ruin to their families, because meth is relatively cheap and long-lasting. And, many meth addicts are able to continue working, until their addiction pushes to an extent where they exhibit symptoms of serious mental illness. On the other hand, a cocaine addict, particularly a crack cocaine addict, uses a drug that is very short-acting, wearing off in minutes. It is also relatively expensive. A cocaine user will quickly spend all of their money and their family’s money, and even start selling and pawning anything in the home of value. They will also have difficulty functioning in society because of a frequent need to buy and use the drug throughout the day. The effects of addiction on family can be much worse with some addictions compared to others. When assessing how addiction affects family and friends, it is important to understand this concept. ## Can the family help by moving their addicted loved one away from their drug of choice? While generally, people in recovery tend to recommend against geographical changes, because wherever you go, your problems will follow along with you, a move to a new location can help in certain situations. If a person is unable to obtain their drug of choice easily, it may be easier to commit to recovery. For example, a meth addict who moves with their family to a region where meth is not commonplace may get discouraged and seek help. Though, they may simply change their drug of choice to the similar effects of cocaine, which may cause more collateral damage to the family within a short time. The same might happen with a gambling addict. You can move them away from the casino, but what happens when they discover the excitement of online sports gambling, or something similar? When it comes to choosing a rehab, a geographical change may or may not help as well. For example, going out of town to a corrupt Florida rehab in a strip mall storefront can have tragic consequences. Yet, going to a luxury rehab in Maine, or a Navy Seal-run rehab in California might be highly beneficial. There are the dual benefits of getting away from the drug-using environment of home, and going to a secluded place where recovery is at the center of daily life for a period of anywhere from one month to 5 or 6 months. ## What is the best, next step for a family that wants to get help for an addicted family member? It all depends on the urgency of the situation. Do you believe that your loved one is in imminent danger from their activities? There are legal routes to have a family member placed in rehab, even if it is against their will. While this is generally not the recommended way to go, since it may alienate your addicted family member and make it harder to offer them help in the future, in some cases, it is the best option. Otherwise, it depends on the substance or behavior that is at the center of their addiction. If it is a gambling addiction, psychological therapy with a doctor of psychology, experienced in treating gambling addiction may be the best next step. In the case of opioid addiction, seeing a concierge Suboxone doctor may be the best option, so that the patient may get the best possible treatment and have a doctor who is available to them at all times and is willing to listen carefully, with caring, compassion, and empathy. Medication-assisted treatment is the gold standard of care for opioid dependence and addiction. [Alcohol addiction]( "Alcohol Recovery Podcast & Stories") also responds well to medication-assisted treatment. There is the full abstinence route, which may require an inpatient medical detox, or there is The Sinclair Method, which uses medication to help a person reduce their alcohol intake. Importantly, when an addicted family member goes to see a private doctor for addiction treatment, one or more close family members should go along and be involved in the initial consultation with the doctor, if possible. Having family understanding and family support behind the medical treatment greatly increases the chances of success. When family members do not understand the mechanism and goals of treatment, they sometimes overlay their own prejudices about addiction and addiction treatment. Having family encouraging a family member to stop successful addiction treatment early is one of the most common causes of treatment failure. The best chance for long-term success is when most, or all of the family is on board and fully supporting addiction treatment efforts. With understanding and empathy, having family support in addiction recovery is the best possible way to get past active addiction and work towards overcoming an addiction. ### Does Insurance Cover Rehab & Private Detox? Is there Rehab Without Insurance? URL: https://therehab.com/does-insurance-cover-rehab-or-private-detox-is-there-rehab-without-insurance/ ## Will Your Insurance Provider Cover Addiction Treatment At An Inpatient Rehab? Insurance and rehab can be a confusing topic. What does health insurance cover? Does insurance cover rehab? Getting your insurance plan to pay for drug rehab or alcohol rehab should be easy, but in many cases, it is anything but easy. All insurance coverage is supposed to provide at least some coverage for substance abuse treatment, but the question is, what exactly is covered? When you are experiencing active drug addiction, the last thing you want to think about is what is covered by your health insurance. You simply want to turn things over to a rehab center and let them help you to get better and recover from your addiction. Many inpatient treatment programs try to make things easier by having dedicated services for verifying treatment coverage. On the homepage of many rehab and detox websites, there is a button for verifying rehab coverage, where an online assistant will ask for your health insurance plan information and report back on your specific insurance benefits relating to drug rehab services. ## In some cases, full residential treatment is covered. treatment service may include many amenities, including holistic treatments. You may be able to get equine therapy, where you interact with horses, or even massage, acupuncture, and other spa-type services. Some private insurance plans have excellent coverage, and the rehab facility will be able to establish early on what rehab treatment will be paid for by the health insurance plan. ## What if your health insurance benefits do not cover as much of the treatment cost of a rehab program? While you may have a health insurance provider with excellent benefits to cover the best addiction treatment program available, more likely, you will find that your insurance coverage is more limited in addiction treatment coverage. For example, your plan may only cover an outpatient program and not inpatient care. While some residential rehabs will accept the lower payment intended for outpatient rehab only, in most cases, if your plan only allows for outpatient treatment, then that is what will be available for you. The benefit of inpatient rehab is, of course, a fully immersive program, where you do not have to worry about having any contact with the outside world for a period of time. While outpatient rehab can provide nearly all of the same services as inpatient rehab, at the end of the day, you will have to go home, without the protective environment of a residential rehab program. For patients with alcohol addiction, this can be especially difficult, because alcohol is a legal drug that is readily available. ## What happens when a rehab patient goes home and relapses? When you go to detox, they provide medical treatment to get the alcohol or drugs out of your system safely. Then, if you transfer to rehab, you will spend at least the next month learning how to remain alcohol-free or drug-free long-term. With various forms of therapy, provided in individual and group talk therapy settings, including cognitive-behavioral therapy, you will learn to address triggers in your life that lead you back to using drugs or alcohol. You will learn about yourself and your addiction, by working with experienced counselors and by listening and sharing in a process group at the treatment center. When you graduate from rehab, you will likely be offered an aftercare program. If you choose, you may attend aftercare sessions, where you continue with group therapy, and possibly individual therapy, on a regular schedule. Aftercare supports your ongoing recovery after rehab. However, even with detox, rehab, and aftercare, people still relapse after completing the program. In fact, relapse rates after inpatient rehab and outpatient rehab are fairly high. Some people only get one shot at rehab, so if they relapse, they will have to find other ways to get help. Yet, for people with good insurance coverage, detox and drug rehab may be covered many times. On my podcast, I once interviewed a man who claimed to have gone through at least thirty rehab programs before attending one that worked for him. His repeat rehab experience occurred in Florida, and he called it the "Florida Shuffle." Unfortunately, many other patients have had similar experiences, especially in Florida, once known as the rehab capital of the world. ## What does mental health have to do with relapse and returning to rehab? Many rehab programs promise to address dual diagnosis issues. A patient with an underlying psychiatric disorder that may be responsible for their addiction is said to have a dual diagnosis. That is to say that they have both a diagnosis of addiction, and they have a diagnosis of another mental health condition, such as bipolar disorder, anxiety, or depression. If the secondary mental health issue is not treated, with medication and therapy, the patient may return to using drugs or alcohol as a way of self-treating their mental illness. The fact is that mental illness is often misdiagnosed early on. Sometimes, even a very good psychiatrist can take time and multiple sessions to be certain of all [mental health conditions]( "Improve Mental Health") that a patient is experiencing. Furthermore, it can take time for the psychiatrist to adjust medications to optimize the patient's treatment. Unfortunately, most rehabs are not prepared to handle this process. While there are some rehabs that offer daily psychiatry visits, this is the exception rather than the rule. In fact, many rehabs do not offer even one single visit with a psychiatrist. And, even if the patient has a visit or two, it may not be enough to get to the root of the problem. ## How do medication assisted treatment programs address dual diagnosis patients? One argument on behalf of going to rehab is that a patient will get comprehensive addiction treatment services while checked-in. If a patient does not go to a treatment facility and goes, instead, to a private doctor for medical addiction treatment, how are psychiatric issues handled. The solution here is very straightforward. While seeing an outpatient private addiction doctor for medical addiction treatment, the patient may also see their private psychiatrist. Rather than engaging in the rehab experience, a patient can simply continue seeing their private psychiatrist for their mental health care. Outpatient psychiatrists often accept private insurance, HMOs, such as Medicare Advantage and Medicaid plans, as well as straight Medicare and Medicaid. Some psychiatrists also provide treatment of opioid or alcohol addiction with medications such as [Suboxone]( "Suboxone Podcasts") or [naltrexone]( "Naltrexone Podcast"). If the psychiatrist does not provide [medication-assisted treatment]( "Medication Assisted Treatment Podcast") for substance use disorders, the patient may also see a separate treatment provider for that service. When a patient and their family are able to make the usual choices in which doctors they are going to use, there is more flexibility than being locked into a rehab program. ## Is it possible to go to rehab without private health insurance? There are rehabs that take state insurance, rehabs that accept ambetter insurance, and rehabs covered by Medicaid. For people with Medicare, it is also possible to find a drug rehab that accepts medicare. It is also possible to go to rehab without insurance. One way to do this is by looking for drug rehab scholarships. What exactly is a rehab scholarship? Is it similar to a scholarship to go to college? Usually a scholarship is financial assistance for an educational program. When we think of rehab and other addiction treatment programs as providing educational curricula to help people learn to live drug and alcohol-free, it makes sense. Many rehabs provide several beds at little or no cost to the patient if they qualify for financial assistance. What is the best way to find out about rehab scholarships? Unfortunately, there is no rehab scholarship guide that I am aware of. While there are services, such as Needy Meds, that provide information on free and sliding scale programs, scholarships are often provided by for-profit rehabs which would not be listed in a guide such as Needy Meds. I believe that one of the best ways to discover scholarship programs at various rehabs is to call around to rehabs in your area to ask what they might have available. You might be surprised at how many programs are out there with availability now, or in the near future. In addition to rehab scholarships, other types of programs in the addiction treatment rehab hierarchy may also provide scholarship beds. For example detox, partial hospitalization programs (PHP), intensive outpatient programs (IOP), outpatient (OP), and even sober living homes may provide addiction scholarship spaces. In fact, scholarships for sober living are fairly common in many areas. ## How can insurance cover long-term treatment beyond rehab? Fortunately, many rehabs now offer aftercare programs that can provide continuing support of sobriety for their clients for months after graduating from rehab. Additionally, for the best chance for success, if a patient has either an opioid addiction or alcohol addiction, there is medication assisted treatment which has a very high rate of success. If possible, start the planning for long-term treatment at the beginning, before even going to rehab. Some rehab programs include long-term medical treatment beyond the relatively short stay in residential rehab. Other programs may initiate medical treatment in detox or rehab, but then either end the treatment quickly, before the patient is discharged, or they simply instruct the patient to seek ongoing care in their community. The problem with this lack of continuity, when a rehab starts medications and then tells the patient to find a doctor, is that it may not be easy to find local doctors who accept the same insurance and will work within the same guidelines of treatment. For example, if a rehab starts a patient on Suboxone, there may not be available doctors in the community who both prescribe Suboxone and accept the particular insurance plan of the patient. Ideally, rehab facilities should research and arrange for partnerships with community doctors if they are not providing long-term medical treatment themselves. If a rehab accepts a specific list of insurance plans, and they start patients on medication-assisted treatment, the rehab outreach staff should make arrangements to refer the patient to doctors who accept those same insurance plans. It is not difficult to maintain a database of community doctors, their availability to continue medical addiction treatment, and what insurance coverage they accept. Health insurance plans often provide an unbalanced approach to covering addiction treatment. In most cases, insurance companies prefer evidence-based treatments with the highest level of efficacy, and relatively low cost. In the case of addiction treatment, the system seems to be almost upside-down. Insurance often covers very expensive rehab programs, which can cost $20k, $30k, or more for just one month of treatment. Yet, they balk at the idea of covering an outpatient Suboxone MAT program that can cost under $10k for an entire year of treatment. ## Medication assisted treatment for addiction is often far more successful, and less expensive, than rehab alone. When we consider that Suboxone has a success rate of at least 50%, and abstinence-based rehab programs have success rates of below 15%, the decision of insurance companies to spend the bulk of their money on short-term, low-yield rehab programs seems nonsensical. While rehab may be the best option with regards to addictions that do not have medical treatments, it does not make much sense to avoid covering long-term medical treatment when it is proven to work very well. Alcoholism, or alcohol use disorder, also responds very well to medical treatment. Naltrexone has helped many people to reduce or eliminate alcohol consumption. Yet, insurance companies continue to cover upscale rehab programs that do not provide medical treatment for alcohol addiction. Recently, I have met several new patients who have attended some of the top premiere signature rehab programs in the country. These rehabs have names that almost anyone would recognize, even if they do not know anyone who has considered going to rehab. Incredibly, these patients did not find success at these programs. While some people do remain sober after rehab long-term, the dark secret of rehab is that the relapse rate is very high, even just months after graduation. No wonder insurance companies do not want to continue paying for medical addiction care after rehab. Imagine paying $30k for a month of intensive rehab, and then the patient requests ongoing medical care for the same condition. There is a mistaken idea that rehab can “fix” people within a month, and usually without medical treatment. ## What if insurance companies stopped paying for rehab altogether? Since 2008, there has been a law commonly known as “The Parity Act.” It is a part of the Affordable Care Act. This law states that insurance companies must cover addiction and mental health treatment just like they would cover any other medical condition. I find it hard to believe that such a directive was necessary, but apparently insurance companies were pretending that mental illness and addiction were not real medical problems, even though the medical community has thoroughly established that they are. For example, depression is as serious a condition as having a heart problem. Unfortunately, many people still have the attitude that addiction is a moral deficiency. Alcoholics Anonymous and Narcotics Anonymous, the major 12-step programs, perpetuate this idea by talking about “addicts” and “alcoholics” as having defects of character and shortcomings that must be worked on with a sponsor. Often, family members believe that their loved-one can simply “snap out of it” if they are put under sufficient pressure. Apparently, many health insurance executives feel the same way. In fact, even with the Parity Act of 2008, insurance companies still find ways to avoid paying for addiction treatment. While some rehabs have become very adept at fighting for reimbursement from insurance, others have struggled with insurance companies wiggling out of their responsibility, sometimes by simply saying to rehab executives, face-to-face, that they simply refuse to pay. ## Insurance-related abuses in the rehab industry have made getting insurance coverage for rehab more difficult. The situation has not been helped by some abuses that have occured in recent years by a small number of rehab programs. Overbilling for services has not helped the industry. It is very possible that backlash in the insurance industry, due to the billing abuses of some rehabs, may lead to a more difficult environment, where patients can not get their insurance to pay for rehab. What would people do if their insurance did not cover rehab at all? While it would be great if rehab programs would lower their prices to make the service more accessible to people who want to pay cash, it is unlikely that they will bring the prices down that low. The cost of providing staff, facilities, and supporting the pricey marketing programs used by many rehabs would make affordable rehab a difficult concept for most facilities. Fortunately, medical treatment programs for specific types of addictions, for example, opioid addiction, alcohol addiction, and even cocaine and meth addiction, are proving to be highly successful. Often, there is no need to sit in a rehab, attending daily group meetings, for an entire month. Even when insurance refuses to pay for outpatient, private doctor addiction treatment programs, they are far more affordable, compared to a month of residential rehab. And, in many cases, they are also far more successful long-term. The fact is that addiction is a chronic condition that can take many months, and in some cases, at least a year or more, to treat successfully. A couple of weeks of detox, or a month of rehab, can get the drugs and alcohol out of the patient, but it takes longer for the brain to heal and drug cravings to subside. ## Advances in medical treatments for addiction continue to develop. As the traditional rehab advocates continue to fight against medical treatment for addiction, claiming that abstinence-based treatment, without the use of medications, is the one true way, medical science marches on. There are new treatments on the horizon which will soon be available, in addition to the very successful medical treatments that are already on the market. Hopefully, the health insurance industry will get on board and focus more on scientifically proven medical treatments. There is also an opportunity for rehabs to develop solid long-term programs that integrate evidence-based medical therapies in a way that work better than rehab or medical treatment alone. I recommend listening to some of the interviews available on my podcast, which I believe is the [best addiction recovery podcast]( "Addiction Recovery Podcast") available. I have interviews with experts in the field, including a rehab executive who addresses the issue of comprehensive long-term care, including medical care. In fact she also discusses the difficulties with insurance companies fighting the Parity Act, avoiding their financial obligations to cover addiction treatment. If you are interested in learning more about this subject, or about other programs available, such as concierge online addiction treatment, telemedicine, and telehealth programs, please use our contact page to reach out. We look forward to providing more excellent podcast episodes and more useful information that can help you to make an informed decision. ### Can You Force Someone To Go To Drug Rehab With The Marchman Act? URL: https://therehab.com/marchman-act-florida-involuntary-rehab/ ## My family is threatening me with legal action if I don't quit opiates? What can they do? While laws regarding mental health vary from state to state, here in the state of Florida, there has been a statute since 1993 known as the Marchman Act. This law addresses drug addiction specifically. The Marchman Act makes it possible to court order a person into treatment, and with an extension granted by the court that treatment can last six months or more, according to expert Florida attorney, Marc Astor. ### What does it mean to Baker Act someone? There is another law known as the Baker Act which is often used as a verb. To "Baker Act" a person means to send them to involuntary treatment for mental illness. This may include substance abuse, but it can generally apply to any mental health situation where a person is a danger to themselves or others. The Baker Act is useful, but limited. It allows for involuntary examination for mental health issues for only up to 72 hours. This is not nearly enough time to address a serious addiction problem. More likely, it can cause a serious rift in a family and result in further substance abuse. While the Baker Act can help in many situations by getting people with mental illness much needed medical assistance, substance abuse is a different kind of mental illness. ### I know what I am doing and I don't want my family involved in my affairs. If you are using heroin or fentanyl or any other opiate, you may not believe that you have a problem with substance abuse impairment. As long as you have access to your drug, you believe that you can work and care for your family. In fact, coworkers and family members may not even have any idea that you are using drugs. Unfortunately, your ability to rationalize your behavior can lead to denial about your situation. Addiction is a serious mental health condition that affects your ability to make a rational decision. ### You may find yourself incapable of quitting on your own. Mothers have left their young children in the car unattended while buying heroin from the dealer. People have injected heroin, fentanyl or even opiate pills while sitting in their car in a parking lot. In fact, these actions are not uncommon at all. If you have been in these or similar situations, you may be aware that you have a problem, but you want to handle it on your own without involving help from family. The issue is that it can be difficult to distinguish the motivation for your decisions. Is it that you have reason to believe they will disrupt your life in a negative way or that you simply want to continue using drugs for "just one more day"? ### Is involuntary mental health institutionalization for opioid use a bad thing? I have seen the frustration of family members over re-occurring opioid relapses. Mothers don't know what to do about their adult sons or daughters going back to the streets for more heroin. Unfortunately, in today's high tech society, access to potent opioids is easier than ever. Drug dealers are using ride sharing services, such as Uber and Lyft to deliver drug packages. Dealers will show up at your door with a text or instant message. Social Media has made it ever more difficult to delete a bad person from your life, such as a drug dealer. You can delete a phone number from your phone contact list, but then you have to consider other actions, such as unfriending and unfollowing on various social media platforms. ### Preventing self harm. So, how do mothers, fathers, husbands, wives and siblings of a drug user try to stop the self-harm? In some cases, they put their confidence in new forms of medication that last for a full month at a time. Meds such as Vivitrol and Sublocade are examples of these new monthly injectables to control opioid addiction. I have witnessed mothers who see these treatments almost as chemical leashes that can give them a sense of security that their child is safe from opioid overdose. While these treatments do have a high success rate, there are many cases where it seems like nothing can stop a loved one from going back out to use heroin again. Overdose is always a risk with heroin. No one is safe from it, no matter how much confidence they put in their heroin dealer. ### Can a long-term treatment facility make a difference? In Florida, we have seen many fly-by-night substance abuse treatment programs. Many of these store front rehabs provide the minimum required services to meet state and federal requirements. They are more interested in a patient's insurance card than they are in assisting the patient in stopping drug use and staying in recovery long-term. On the other hand, there are good programs that really work. One example is a program in California that has a minimum stay time of five months. In an episode of The Rehab Podcast, which you can download [here](), the guest describes his experience in the five month program that includes intense physical activity and team building. This contrasts to his experience in bouncing around between at least 30 Florida rehabs. This is not to say that all Florida rehabs are bad. One serious problem with the traditional rehab model is that one month or less is generally not enough to make a difference. Not only does a program have to provide high quality mental health services and therapy, it must do it for an adequate time period. ### If my family uses the Florida Marchman Act to force me into mental health treatment for six months, how will I ever forgive them? At first, when you are court ordered to get an examination for substance use and then you find yourself forced into admission to long-term rehab and mental health services, you may be very resentful. When you are assigned to a legal guardian or legal custodian, you may resist and refuse involuntary examination and admission to psychiatric care at first. Placement into a treatment facility can be stressful, especially when you find that your heroin and "freedom" have been taken away. When you are taken into custody and no longer have control over your affairs, you may hate the family members who are behind the legal actions. This is not unusual. And, if rehab is not successful, you may feel justified in your feelings against your family. Yet, if the Marchman Act is used to petition for your admission to a strong rehab program and you are able to regain self-control and [overcome opioid addiction]( "Podcast With Adam Bisaga, MD: Overcoming Opioid Addiction"), you will likely thank your family for their help. Involuntarily being forced into emergency admission and stabilization is unpleasant at first, but can result in a positive, life-changing experience. ### What if I refuse to go along with the Marchman Act? What if they put me in rehab and I just leave? After placement in involuntary mental health services for substance abuse, some patients do get up and walk away from rehab. Initially, if the Baker Act is used to put you in a psychiatric facility, you may find yourself locked up, almost like being in jail. Yet, afterwards, most rehabs are not like jails or prisons. While it is recommended that you stay, no one is going to physically force you not to leave. However, if you have been placed involuntarily in a program with the Marchman Act, when you leave, you will be essentially breaking the law. At this point, your family, with the help of an expert attorney, may have an investigator track you down to return you to substance abuse treatment. While this enforcement may seem extreme, they are concerned for your health and they are aware that even one accidental overdose can be tragic. ### Is there a way to overcome opioid addiction without any need for the Florida Marchman Act or Baker Act? You may feel that your situation is hopeless. When you try to quit heroin on your own, you get sick. No one understands how bad withdrawal sickness can be if they have not experienced it. At 72-hours, cravings and sickness get to be so bad, it can be nearly impossible to resist the temptation to go back for more heroin just one more time. While you protest getting help, you may secretly wish for your loved-ones to force you to get help. Involuntary help, via the Marchman Act, may actually be a welcome relief for you. However, if you believe that putting your life on hold for up to six months is impossible, there are alternatives. If you are addicted to an opioid, such as heroin, you may want to consider medication-assisted treatment. This is treatment that uses medications such as methadone or Suboxone. ### The Suboxone alternative to the Marchman Act. If you get started on Suboxone, you will not have to deal with prolonged withdrawal sickness or intense cravings. Many patients describe the feeling of treatment as being like they were never addicted in the first place. Many patients have few side effects from the medication. There is even a monthly form of the treatment medication so you don't have to think about it between doctor visits. This form of treatment may be ideal for patients who are in critical life situations where long-term rehab can be detrimental. For example, a mother of young children may be able to return to normal functioning where she is able to fully care for her children successfully while on medication assisted treatment. Alternatively, if she is committed to long-term rehab, she may lose custody of her children and have difficulty regaining custody. The separation of mother and children can also be very difficult for the children. Some patients are worried about destroying their career or company by going to rehab. While we should always put our health and lives first, I have known patients who were in the midst of building successful business startups while also dealing with opioid addiction. By putting their company-building activities on hold for months at a time, they may be giving up a once-in-a-lifetime opportunity. Medication assisted treatment is a voluntary option that can help you to get your life back under control and allow you to continue with little or no down time. ### Can they still use the Baker Act or Marchman Act if I am doing well on Suboxone? This is an important question. More importantly, we must ask why would your family want to pursue legal action with Marchman if you are doing well? If you are not impaired and you are stable, without any current substance abuse issues, why in the world would they pay an attorney to have you get an involuntary assessment and have you committed to involuntary mental health services for substance abuse impairment? There are a some possible explanations. ### Some family members misunderstand how medication assisted treatment works. They may believe that Suboxone treatment is simply trading one addiction for another. If this is their belief, you can imagine how they think you are still impaired, even if you are functioning well without any problems. The fact is that if you are doing well on a medication such as Suboxone, ZubSolv or Sublocade, and you are clean from all other substances, you are considered to be clean and in recovery. To help educate your family members on this point, you may want to recommend the book, Overcoming Opioid Addiction by Adam Bisaga, M.D. You can download my interview with Dr. Bisaga [here](). His book includes a chapter for family members and another chapter for healthcare workers to explain these points. So, if you are legally forced to get an assessment and examination for substance abuse and you are following your MAT plan with your doctor successfully, do not be concerned. If you are clean and not impaired, you are unlikely to meet the criteria for court ordered treatment under the Marchman Act. While you may have to submit to involuntary assessment, a court is unlikely to make you give up your life at home and work to go away to rehab for up to six months. ### The importance of staying clean and following MAT protocols. When patients get started in [MAT (medication assisted treatment)]( "Medication Assisted Treatment"), they sometimes feel as if they have been cured of opioid addiction. The treatment can work so well, it feels like a cure. Unfortunately, there is no cure for addiction. Opioid use disorder is a chronic medical condition that can be treated, but not cured. But, because it gives the patient clarity of thought and peace of mind so quickly, sometimes patients are quick to take matters into their own hands. They may start altering their medical treatment plan without discussing it with their doctor. This is not a good idea. You should not change how you take Suboxone or similar medications without approval from your doctor. And, you must attend therapy as ordered by your doctor. Following the program is important. It will give you the best chance for success and it will protect you in maintaining your life without interruption. ### Harm reduction vs The Marchman Act. There are people who believe we should have safe injection sites everywhere. These sites would be locations where heroin users could use heroin safely. Services would be provided such as testing the heroin to be sure it is not contaminated with fentanyl or other poisons. Other services might include providing clean needles and syringes as well as education on available treatment options to quit heroin. Most importantly, an attendant would be standing by to provide emergency resuscitation with Narcan in the case of an opioid overdose. Some people believe that safe injection sites are enabling and that they encourage ongoing heroin use. Why would a heroin user seek treatment to quit if they can just go to the safe injection site every day? Would it not make more sense to force all people who misuse opioids into involuntary long-term mental health treatment? Why not just get them all off of the street and into a safe place? While the Marchman Act is a good idea for many heroin users and it does save lives, it is not going to work for everyone. People are all different and it is important to provide harm reduction and services to meet the needs of different people and different life situations. There is a place in the world for harm reduction, such as safe injection sites and also for The Marchman Act. This is treatment that uses medications such as methadone or Suboxone. --- This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician. --- ## Notable Podcast Interviews > In-depth interviews with authors, physicians, and experts in addiction medicine and mental health. ### Susan Bartz Herrick: Slow Dancing With the Devil URL: https://therehab.com/susan-bartz-herrick-slow-dancing-with-the-devil/ [spreaker type=player resource="episode_id=57894858" width="100%" height="200px" theme="light" playlist="false" playlist-continuous="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="true"] ## **A Mother's Story of Loss and Strength to Inspire Change** In a recent episode of "The Rehab" podcast, host Dr. Mark Leeds engages in an emotional and enlightening conversation with Susan Bartz Herrick, MFA, EdD., who shares her harrowing journey through the landscape of addiction and the healthcare system's labyrinth. Herrick, an embodiment of resilience and dedication, discusses the poignant story of her son, Luke, whose life was tragically cut short by an opioid overdose, as detailed in her book, "Slow Dancing With the Devil". The episode uncovers the raw and often untold [recovery stories of addiction]( "Recovery Stories"), shedding light on the myriad struggles families face when dealing with this crisis. Herrick's narrative is a testament to the devastating impact of the opioid epidemic, the challenges of navigating treatment for addiction and mental health issues, and the dire need for systemic change. Read more: [ 4 Easy Ways to Improve Your Mental Health Today]( "4 Easy Ways to Improve Your Mental Health Today") Susan Bartz Herrick, a steadfast mother and advocate, recounts the nightmare that unfolded when Luke became addicted to narcotics, following a prescription for OxyContin. This ordeal was compounded by the family's personal challenges, including Herrick's divorce and Luke's diagnosis with bipolar disorder. These complexities added significant obstacles to their battle with Luke's addiction, leading to a tumultuous journey through treatments and relapses. Despite facing seemingly insurmountable challenges, including Luke's near-fatal car accident which saw him clinically die twice, Herrick's resolve never wavered. She stood as an unwavering pillar of support, tirelessly advocating for Luke and seeking the best possible care for his needs. Her journey is not just a story of a mother's love and dedication but also a powerful call to action for improved healthcare policies and addiction treatment programs. The conversation with Dr. Leeds highlights the critical importance of education, advocacy, and systemic reform in addressing the opioid crisis and addiction. It brings to the forefront the urgent need for increased access to quality care and the dismantling of stigma surrounding addiction, emphasizing that real change is necessary to prevent more tragedies like Luke's. Susan Bartz Herrick's story, as shared on "The Rehab," is a compelling reminder of the human cost of addiction and the profound impact it has on families. It serves as a rallying cry for change, urging listeners to recognize the importance of compassion, understanding, and action in the fight against the opioid epidemic and in support of those struggling with addiction. ## **Transcript** Mark Leeds, D.O. [00:00:03]: Susan Herrick, welcome to the podcast. Susan Bartz Herrick, MFA, EdD. [00:00:05]: Well, thank you so much. I so appreciate your time. Mark Leeds, D.O. [00:00:10]: So, Yeah. I'm really excited about this your new book. And, you know, I got a chance to to read a, a preview of it, and, It it's a, it's an incredible story. I mean, of course, it's it's heartbreaking, and, and and it's real. I mean, it's not, like, fictional or anything. So, You know, it's very real for a lot of people. Yeah. So yeah. Mark Leeds, D.O. [00:00:34]: And I was imagining, you know, like, in a meeting of, know, maybe at, like, a Naranon meeting or a meeting where people are sitting around talking, it it almost seems like, you know, everyone could I imagine, like, what if everyone had a book, You know, the the book of their story. And, you know, instead of opening up and sharing just little bits and pieces, what if we could all pass around each other's books and Know the full story. And, you know, but it really it was really engaging and and, you You know, of course, there's there's a personal story and a much bigger story of of, you know, what was happening in our in our society and big business and government. So, yeah, tell please tell tell us a little bit about, like, how did this come about? What made you decide to write the book? Susan Bartz Herrick, MFA, EdD. [00:01:16]: Well, My son, lived through a nightmare and being his mother, we walked through it together. He, got addicted to narcotics before his major accident. It happened to me at the time, when Purdue was out passing OxyContin out like Pez. And, his father and I had gone through a terrible divorce so it was primarily Luke and I He was 14 years old He had a pilonidal cyst And, they operated and years later he told me he said, mom, that nurse gave me this one little white pill and made all my pain go away and after that it was on his radar but he was also given it The next year for a sprained thumb, after the thumb surgery and interestingly enough, the nurse was more concerned about the amount of Tylenol that he was taking Then the Oxycodone that was mixed in with it, they gave it to him for a sliver in his foot I was very fortunate at that time, I did go see a psychiatrist who Instantly diagnosed him as being bipolar. We had quite a round with, Depakote, Seroquel, Lithia, which made him just loony as all get out. And I went to see a psychologist who said, Ma'am, you have a very creative heartbroken son who is addicted to drugs and I suggest you find Suboxone so I asked him where I could get it and he said therein lies the problem uh-uh at that time and this is the early 2000s There were only 3 doctors in the country in our state of, North Carolina that, had taken the class, had the X waiver that could, give him the drug and he did wonderfully well on it. Unfortunately, about 9 months later, he was almost killed in a near fatal car accident. And, and what I mean, He technically died twice. Susan Bartz Herrick, MFA, EdD. [00:03:39]: They brought him back. He was crushed. 27 broken bones, first teeth fracture. He ended up with rods down his back and screws, and they had his pain medication. I I knew standing at the hospital bed when I saw the bag Morphine delighted that we were in for a much bigger fight than just getting his bones healed and we were right! After 2 months They let them, let him out of the hospital. We were not in North Carolina. We were down in Fayetteville. He had driven down to see, my mother. Susan Bartz Herrick, MFA, EdD. [00:04:23]: So we were in a different state, and they let him out of the hospital after being up to about two To 300, milligrams of OxyContin a day to, 2 weeks Anne told us to go find a doctor and somebody else to manage it. Well, nobody wanted to take us on. We found this split doctors who wanted nothing to do anymore with any, narcotics and the doctors who were, prescribing to the pain levels Well, my son had an incredibly high tolerance, and I do believe it was, inherited from, his his dad who was an alcoholic and, could sing, sitting, drinking, an inordinate amount of alcohol, walk and talk. Well, Luke's tolerance kept getting higher and higher And he was with a doctor who, adhered to the Portnoy School of Pain that you just treat up to the pain and they had him up to 6 even 800 mg a day and then dropped him so we were on our own trying to figure out what we were dealing with they said we needed a treatment center. At first, we couldn't go to 1 because he still needed some medication for pain and then when that was over, We didn't know how to go about getting help. Really went through 18 months of insanity. I did send them to a treatment center, and I thought 30 days would be enough. Learned a lot about denial on that aspect for me, because The treatment center said no. Susan Bartz Herrick, MFA, EdD. [00:06:19]: He needs a lot more. In the meantime, other doctors had him on, Xanax for the PTSD. He remembered his entire accident. It wasn't blocked out. So he had PTSD from that. He was a pharmaceutical mess, tried to get off everything his way by drinking alcohol. Well, You know, that was a mess too. Finally, I found a needle in his car. Susan Bartz Herrick, MFA, EdD. [00:06:50]: Not that I hadn't seen Other things. I did. My jewelry was disappearing. His bike went away and, I had the courage Well, actually, I knew at that point in time I was that he would not make it, that I would walk in his room and I'd find him there and I couldn't bear that. I thought I could bear getting the phone call but not me finding him because that did happen to a friend of mine about 3 years earlier. So I very, by the grace of God, I walked in his room with The needle 1 morning and said, listen. I know what's going on here. I'm giving you the 2 choices. Susan Bartz Herrick, MFA, EdD. [00:07:35]: 1 Is, I'm kicking you out in the street. No car, no money, no credit cards. You are on your own. I will get a restraining order Or 2, you are gonna go to a 1 year program as far away from here as we can find so you get the help you need and I walked in my office. I was expecting Another war to erupt but 10 minutes later he just came in my office with tears in his eyes and he said, Mom, I tried everything. I don't know how to stop. I want to stop. I'm such a bad person. Susan Bartz Herrick, MFA, EdD. [00:08:13]: I mean, just he took that It was a moral failing on his part that he couldn't walk away from these drugs and he said I need help So in 48 hours, we did get him on an airplane. We had to, this is in The book we had a very, interesting little trip that we had to take to try and find him some Suboxone to get him from keep from detoxing to get him on the airplane from North Carolina out to, California and, A very gracious, pharmacist made sure I got 2 tablets, but it was not legal. How we had to he was out the birdie here, did, wonderfully well, and came back. And thanks to the AA program, the, Men that he connected with, he really turned his entire life around. That's not to say he didn't, Have a couple relapses. But with us, our story turned, even More, complicated is he had to have surgery again, and this was to remove A, medical filter that had failed, so he had to go back into surgery Nineteen in scar down his front because they had to dig it out at, his aorta and put back on HUGE amount of narcotics again and that's when we really came in trouble at surgery Nobody knew how to treat a patient who needed surgery, who needed, medical paying intervention and yet who was who had substance use disorder? And, That's when I really started to figure out that the medical community We're still treating this as it was, not the individual's fault. Excuse me that that they were treating, it as well, we're dealing with an addict, and it's their fault! I mean they did not know what to do! The hospitals, the emergency rooms, they did not know what Suboxone was! A lot of the doctors we talked to did not know what Kratom T was. My son had to walk himself off a couple times, with that because we could not get, any help and they didn't seem to care. Susan Bartz Herrick, MFA, EdD. [00:11:09]: Yeah. Eventually, yeah. I I mean, he, something else had happened with it also is After we had the surgery, I'm very grateful to, the Duke Pain Management Clinic. There were no protocols on how to walk somebody down There was no detox unit there so the pain clinic created their own protocol of walking him down on Methadone and and a few other drugs. I mean, we were chopping pills in half and quarters giving it Special time to walk him down. And, but he got addicted to the Methadone So he did go into a 30 day treatment center. He thrived again, came out as strong as he was. Matter of fact, he was leading a lot of the groups there but 3 weeks after that, he had a blockage. Susan Bartz Herrick, MFA, EdD. [00:12:10]: They took him to the hospital and Instantly shot him up with morphine. I called my insurance company and said, listen. We have had a problem. He needs to go back in in an environment that could help him physically get off of the drugs. Mentally, he's okay, but physically Get him off and they simply stated, no. He only gets 1 treatment a year. I explained everything. So we, you know, we were really on our own trying to get everything straightened out. Susan Bartz Herrick, MFA, EdD. [00:12:41]: I mean, I went in debt probably over $200,000 having to pay out of pocket to get him back in. And, after the 3rd blockage, everything settled down. He had been studying on his own. You're a very bright man. He was in his late twenties at this time and got into the University of Pennsylvania. There is a special online class for students that had a break and, extra Circumstances. So he got in there. At the same time, he was finishing up his associate's degree in political science. Susan Bartz Herrick, MFA, EdD. [00:13:24]: He wanted to take, public policy on, and, he was doing fabulous Thanks. COVID hit. We had a perfect storm. One of the screws in his Neck was starting to impinge upon the spinal cord, so he was back in pain trying to manage his pain, trying to manage a few other things going on. A doctor had put him back, on Klonopin in order just to try to settle him. He was, I think metabolically dependent on him. He said it was much Harder to walk off of that but I will tell you a heartbreaking thing that happened here is he came home for 3 months to detox, to get off of everything and at this time only Zoom meetings for, AA, any groups we're on. And he brought home a bottle of Suboxone. Susan Bartz Herrick, MFA, EdD. [00:14:31]: He had an addictionologist in California, But he didn't feel he could use it or walk off on it or use it afterwards because the members of his group Would not accept him as being one of them and it was so important to him that he have his comrades, his tribe So I watched him just suffer and go through dopamine depletion he managed to get off everything EXCEPT The Klonopin, he went back out to California to pack up his things. He was going to move home, Ran out, asked a friend for Klonopin, and it was Fentanyl. So within 26 hours After he left to pack up to come home, he was gone. He was gone. Mark Leeds, D.O. [00:15:24]: Oh, wow. So so that's that's what happened. It was a fake clonopin. It was actually fentanyl. Susan Bartz Herrick, MFA, EdD. [00:15:30]: Yes. As as as much as I could tell, seeing that it was out at Los Angeles, they only mark that. On, his death certificate, they never did any Top screens, I know who gave it to him because, you know, and that they said, well, we're sorry that we don't prosecute. Mark Leeds, D.O. [00:15:52]: Yeah. Yeah. And that's happening a lot with the fake pills. I I know of, someone who their son went through a, An issue where where he was dependent on on, Xanax, and and he, you know, he was but but he wasn't getting it from a doctor, so he was getting it from whoever on the streets. And one day, I guess, got some fake Xanax. It was actually Fentanyl, and these pills are pressed to look just like the real one. So you can't tell the difference. Yes, ma'am. Mark Leeds, D.O. [00:16:17]: So he went to the hospital in both, Benzodiazepine withdraw and, opioid overdose simultaneously. So, yeah, it's really an a nightmare with I I I was wondering, you had throughout the book, you, A few times, you mentioned the statistic that Purdue not a statistic, but what Purdue claimed that the addiction rate was 1%. And and I remember them, and and I've kind of This has been part of my career that I Purdue like, early on, I went to work, at one of my father's clinics in in the late nineties, Early 2000. And one of the doctors there was prescribing OxyContin, and he believed in it. He believed he was helping people. He wasn't this is a doctor in his eighties who had been a surgeon, and now he's doing family practice. And people would come in in pain, and he'd prescribe it. And the Purdue rep was there every month. Mark Leeds, D.O. [00:17:07]: This, nice woman who looked like she's probably in her fifties. You know, he's in his eighties, and Maybe they targeted him that she appealed to him or something. And, I mean and and he believed it was safe. I mean, he even had Bottles of pills in in his drawer that, you know, someone said, well, these forties aren't working. I need eighties. He's like, okay. Give me that, and I'll give you the other one. And and so Just I remember once opening his drawer and there's, like, 3 or 4 bottles full of OxyContin, and nobody cared because everyone thought there's no addiction potential. Mark Leeds, D.O. [00:17:34]: It's not. There's no abuse potential, really, which is crazy because I'm thinking, like, well, that isn't oxycodone kind of like heroin? I mean, it is it is addicting, but somehow Being in this hard little shell, it they they're claiming it's not. But, yeah. I re so, anyway, I remember, Purdue took us to, like, a steak dinner at one point, and, he gave a lecture. And, I remember the the number being, like, a lot less than one. The the number the percentage of the likelihood of becoming an addict from getting a prescription of OxyContin that it was, like, something like 0 point 0 zero one. I don't remember the exact number, but it was a tiny little fraction of 1 and which is of course, we know is not true. I was wondering, do you know, like, what is What do we think now is, like, the real number? What what is the real percentage if if, you know, I guess it might be different if a person is predisposed, if they Are genetically, or family history predisposed to addiction, but, is it maybe, like, 5 to 15%? I would imagine it's somewhere in there, maybe. Susan Bartz Herrick, MFA, EdD. [00:18:35]: Yes, you know, I I, I did a lot of research after Luke passed away. It's it's how I grieved, how how I coped and what surprised me is to find out that there are precursors to addiction Rose et al. Published in 2019 in, Frontier Psychiatry A wonderful paper which lists all of the precursors and I went through that and I said my husband, my son had 2 thirds of these precursors if only I would have known! The, Also, too, that 2 out of 4 people, roughly, will become addicted to this substance because of these Precursors! 8 people will take and say, Ugh, I hate it! I have to get off of it! I know it's supposed to help me, but I I can't take it until I say, oh, wow. I like this. It's great. My son fell into that category. You know, we're, we're spending, at Purdue. I I have Ben, to, I don't know if it was a Purdue's party but I have been to one of these pharmaceutical parties. Susan Bartz Herrick, MFA, EdD. [00:19:59]: They are lavish! I mean champagne, lobster they get these doctors very well, in the en enjoyment mode and they sell them, all all of the drugs With Oxycodone, I know that, in the in 2001, the average sales rep at Purdue was making 55,000 annual, bonuses, kinda averaged 71,000, to add up to 240,000. At Purdue, paid 40,000,000 in Sales incentives, bonuses to its reps. Knowing that their data was bogus, they squished the graph, And the FDA did not catch it. But, you know, the the FDA at this time, they had 39 staff members that were responsible for roughly viewing 34,000 pieces of promotional material So they intentionally snuck it in and they're supposed to have, responsibility, you know, the RA, the Regulatory affairs department, is responsible for approving everything, and yet, The n a the the NIH has stated that, over these 20 years, the part pharmaceutical companies were forced to pay 19.8 $1,000,000,000 in penalties, with the dramatic upswing from the mid 2000 and the largest category of the penalty was for off label promotion. That that particular violation was just The visible face of this far reaching scandal and, I mean, they had kickbacks. They bullied academics, produced faked medical journals, and I think probably one of their most Recent scams was, the FDA's approval of, gabapentin. It's it was originally approved only as an adjunct therapy procedures but Parq Davis, which is Now, of course, in Pfizer, deployed a breathtaking array of covert material tactics to persuade doctors to prescribe the drug for all matters of conditions for which there was no evidence of efficacy from migraines to bipolar, and they even had a tactical plan, to encourage, titration in higher Dosage, they created a, the child neurology advisory board and recruited neurologists to to present case studies. I I have a quote here which is interesting. Susan Bartz Herrick, MFA, EdD. [00:23:09]: A Parke Davis executive told his staff That's where we need to be holding your hand and whispering in your ear and rotten for pain, rotten for monotherapy, for bipolar, rotten for EVERY Thanks. So who can we try? I mean, it it Yeah. Yeah. Mark Leeds, D.O. [00:23:28]: Well and and Purdue I mean, I think the pharmaceutical reps were, like, just the tip of the iceberg, like like you said. But I, you know, I saw in my early career, you know, the They they were everywhere. You know, they there was a an organization, Partners Against Pain, where they distributed paperwork, these fancy, pain assessments that doctors could put on their charts to To be, you know, to to look like they're doing the right thing, you know, that we're asking these patients all these questions and the patients will go through and fill out what what they thought What's expected of them. And so you have these monthly pain assessments, you know, which is probably a good thing, I mean, realistically. But but Partners Against Pain, I think, was was was Purdue's company. I I think they came from Purdue. There's the American Academy of Pain Management, And at one point, doctors thought that they were board certified if they took their test and got credentialed with them. And then the, the academy had to tell the doctors, we are not really board You can call yourself a a CPP, a credentialed pain practitioner. Mark Leeds, D.O. [00:24:28]: And I know that Purdue was very much involved that that there was know, if a doctor got in trouble, they would help him with with legal advice and legal support. And, and there, you know, there was people In the the Academy of Pain Management that that worked for Purdue directly, and they were there to to advise the academy, I think, and doctors. I mean, I I I don't know how precise I am being with this, but I know that they were everywhere. I know that that I would go to my norm not just that organization, but just going to, like, Conventions at the Osteopathic, Medical Society in Florida. I we'd go to their conventions, and this nice elderly doctor that was very well respected would get up and tell us that OxyContin is safe. He he would say he said something like my doctor just gave me a 20 milligram OxyContin for 10 days for my shoulder, and I Took it for 10 days and stopped taking it. I was fine, and all of you should feel comfortable with that. And, Susan Bartz Herrick, MFA, EdD. [00:25:20]: And it it it's interesting because where they got that information, They had hired Russell, Portnoy, who later was nicknamed the King of Pain and he is the one, just as it As you said, that got pain to be considered the 5th vital sign and still when patients Go in. They still are asked on that pain scale. We still use the pain scale that Portnoy started, then and His information and, he he quoted a study by Porter and Jake in the New England Journal of Medicine That stated only 1% of the patients treated with narcotics became addicted and you're right, it was Less than that, but they rounded it off and TIME magazine, described Their work is a landmark study. The problem was that it was not a landmark study. It consisted of a short 101 word paragraph Letter to the editor. I mean, the Oh, wow. That's where that came from. Mark Leeds, D.O. [00:26:31]: So it wasn't a study It Susan Bartz Herrick, MFA, EdD. [00:26:33]: was not a study at all. Wow. It was just a bit all. Mark Leeds, D.O. [00:26:38]: Even real real studies, you know, like, actual, Like, whatever, you know, double blind study you know, studies that are in peer reviewed journals that that are respectable. Some some of these studies when you really read the details of it I mean, actually, Luckily, now we have AI to look at some of these studies because I've and I've done that. I've gone and asked CHAT g p t, can you look at the study with me and, you know, can you find and it says, well, that's a good study. Well, can you find any problems with it? Yeah. They only had 30 people in the study, and, and and it was for This one study was for a device and, like, they also gave him medication and but all the stuff that it was finding was buried in, like, 10 to 20 pages of of data. And it's, you know, not easy to For 1 person to go through and take you know, when you barely have any time to read through all that stuff and, Susan Bartz Herrick, MFA, EdD. [00:27:20]: you Mark Leeds, D.O. [00:27:20]: know and, of course, we have the drug reps, like, holding these fancy color graphs up and saying, you know, look How safe this is. But, but, yeah, they're they can easily hide a lot of stuff in what looks like legitimate science, and it's not. Susan Bartz Herrick, MFA, EdD. [00:27:32]: It is not. It's not I mean, the pharmaceutical companies now are required to publish every single study. 20, 25 years ago, if they didn't like it, they didn't have to publish it. However, in doing research for a friend who had cancer and they wanted to give her a chemo and I I went online I found one study That said, it its efficacy was maybe 3 to 7%, but I thought, just one study? I'm sure there's gotta be more, but I couldn't find any. I had to go into the pharmaceutical company's website and, I mean, I dug down in the basement of that site until I found 6 other studies. Most of them not only said it it doesn't work, but it'll kill you. You know? So there there are so many ways around and what are p I mean, you're a position. I'm a professor or retired, but this is not my field. Susan Bartz Herrick, MFA, EdD. [00:28:41]: You know, How is Joe Public like me? How are we going to find this out? Our children are dying because of drug overdoses, some of the drugs that are coming out are not safe and they can help one become Dependent, how do we know? It's it's it's a scary world. Scary time. Mark Leeds, D.O. [00:29:05]: Yeah. And that and that's a whole other, drug epidemic that we're dealing with, the psychiatric drugs, antidepressants, and especially the Benzodiazepines. And for a long time, doctors felt like the these benzos are very safe because they don't kill people. You know, when they're taken by themselves, assuming they're not combined with Opioids and alcohol and other things, by themselves, they tend not to kill. But a significant percentage of people become very dependent and then develop long term protracted withdrawal with, Like, really severe consequences. And, you know, the med the benzos are not meant for long term use. And patients, you know, they get them for a couple weeks and they back to the doctor and say, wow. That really helped me. Mark Leeds, D.O. [00:29:42]: And prescription after prescription, then over years, problems come up and, You know, and and it's it's something that nobody's really talking about. And, you know, a lot of people in that community are saying, you know, when are we gonna have our moment? You know, our Purdue moment when somebody is held accountable for this. And, if you know, just because people aren't dying at the same rate they do from Fentanyl and opioids, I mean, they're kind of In a living hell. I mean, that there's no way out really, of some of these people living with this. So, and that's a that's a major issue, informed consent. You know, Doctors being aware. I mean, that's the first thing is, like, you know, doctors are already being, kinda guess of themselves by these companies of, you know, this is safe. We want you to do this. Mark Leeds, D.O. [00:30:24]: You know, at one point, the medical societies are saying, if you don't treat pain, you're gonna be disciplined. We could we could, take your pull your license if you don't treat pain. 10, 15, 20 years later, they're telling us the exact exact opposite. If you treat pain in the wrong way, we'll pull your license and maybe throw you in jail. And so, you know, we're all, like, thinking, like, hold on a second. You're pretty you sounded pretty confident, 15 years ago when you told us the opposite. And, No. It's it's just you know, of course, doctors are like, I don't want anything to do with it. Mark Leeds, D.O. [00:30:55]: I'm gonna either retire, never write those prescriptions again. But as far as, like, you know, when we say Purdue was deeply entrenched in the medical education, medical, you know, medical, system, the health care system, the Alcoholics Anonymous, Narcotics Anonymous, the 12 step programs are deeply entrenched in addiction treatment. And like you said, Narcotics Anonymous specifically has an official position against, using medication to treat addiction. If you can yeah. You can use medication for anything else, and they say and they have a pamphlet, a 42 page pamphlet. What do they call it? In time in times of, I I forgot the name of the pamphlet, but there's a pamphlet that says medical treatment is fine. It's not our problem. If you take opioids for pain, You're clean. Mark Leeds, D.O. [00:31:44]: That's between you and your doctor. But if you take something for addiction, whether it's Methadone, Suboxone, maybe even Naltrexone. I'm not sure about that one. But They have a there's a pamphlet that says, NA does not approve medications. You know, we treat addiction with recovery. Susan Bartz Herrick, MFA, EdD. [00:31:59]: Uh-huh. I I can understand where that came from. When you go back in history, Prior to the Harrison Act in, 1914, opium addiction Was treated as a disease. I mean, Freud, treated heroin addiction with cocaine but they were treating a disease when the HARRISON Act came out. You know, it was verboten to treat Any, narcotic with another narcotic and somehow that set. And a a, yes. A a started in the, 1919 36, 35. Well, they were dealing with the science that they knew at the time, but they did not know about neurobiology. Susan Bartz Herrick, MFA, EdD. [00:32:54]: So at that time, With the Harrison Act, it made sense, but as we've learned more about science, We have still been criminalizing the doctors for treating those until, you know, this last, act in, June of 2003 where they did away with the waiver but doctors are still very Hesitant, because in their mind, and this is the stigma, is they're still using the science of About a 100 years ago and when you look at a lot of the counselors, in order to be certified as a drug and alcohol counselor, in most states, the minimal requirement is, a GED. How can you understand the science and understand these, Findings that medical science is coming up with with the midbrain, changes If you don't look into it, you know, so that there there's there's this huge gap and they're treating everybody's addiction like theirs and it's interesting. AANA, they do not publish their, rates of Recovery. Some estimate it's only 23, 25%. I think I read that in in a, Harvard Journal. So, you know, it's it's quiet. They say, well, it's because people don't come forward. I've known people who, got sober, got clean and Went on, to do great things. Susan Bartz Herrick, MFA, EdD. [00:34:50]: I also know that 3 of Luke's sponsors, Died of, unintentional overdose. They had a trigger happen and because of what is out on the street These days, you can go down in a heartbeat. Mark Leeds, D.O. [00:35:11]: Yeah. Yes. Kinda, Yeah. If you walk into a, a meeting and, you know, you sit for the meeting and you hear, you know, people announcing, you know, I guess, at at some point, say, Talk about how much clean time they have, and or maybe meet with people after the meeting and, you know, 1 person has I I think, like, in NA, I think it's it's great if you have, like, 20 years plus. That's, like, really super impressive. And then AA is probably, like, you hear people with 40, 50 years sober and, But but, yeah, 20 years of of being cleaned from drugs in NA, you know, is super impressive. And you you might go to a meeting, and it's filled with people with Tons of clean time. You don't have a year, 5 years, 10, 15, 20 years. Mark Leeds, D.O. [00:35:51]: But it's a, a survivorship bias, you know, because The the people that it works for, they they stick. You know, the room holds on to those people that it works for, you know, that they have for whatever reason, They happen to you know, maybe they like to talk. Maybe they like to do steps. They for some reason you know, maybe there's people that were physically dependent on opioids and thought they were addicted, but they were But they were only physically dependent. You know, there's all kinds of reasons why a person might stick in a an NA or AA and say, wow. This really worked well for me. And it it can work for you too if you just do what I do. And it's kinda like you go to the gym and everyone's got big muscles, and you're like, wow. Mark Leeds, D.O. [00:36:26]: If I go here, I could have big muscles. But for whatever reason, the people The gym is full over the the success stories, and you don't see the 1,000 that came and went to that's just not for me. And, Susan Bartz Herrick, MFA, EdD. [00:36:37]: they don't understanding, dual diagnostic aspect. My son definitely was dual diagnostic. And There are some medications that are needed. You can't pray away a general anxiety disorder. You can't pray away a panic attack when the body just goes in into an overload I, met, someone through through the writing of my book His name is, Doctor. Arun Gupta And he is the author of The Preventable Epidemic. He's a practitioner much like you. He started off, Family medicine and then went to be certified and that's all he does is, addiction Medicine Now he claims that he has got 85% of his patients doing wonderfully well, having fabulous lives! But he manages them! They come in and see him just how are they doing. Susan Bartz Herrick, MFA, EdD. [00:37:47]: He adjusts the Suboxone Accordingly, sometimes, if there's a big, catastrophe, he'll tirit them up a little bit, but bring them down. And, of course, they have The counseling, diet, exercise, everything, it it's a full and integrated program. And, he is just claiming wonderful, results. I wish I would have known him when my son, was still here because he he knows all the drugs, how how to manage them. We were guessing And there's a lot of information out there in studies, but the general population understands the information at the 6th grade level. This is something that I taught. I taught in the Department of communication. I mean, I I had to call on my, medical friends to get dictionaries out to go through some of these papers to try to break it down into an understandable form and I tried to put a lot of that in the book to, Break it down for people to understand I'm I'm now, on a lot of Facebook sites of other parents who have lost Children and the stigma, the lack of information that they have, the guilt, They blame themselves. Susan Bartz Herrick, MFA, EdD. [00:39:16]: They blame why couldn't he just stop? He was just an addict. I mean, you know, and it breaks my heart because you would not say that to somebody who had cancer. You're not praying hard enough. You're not doing the work Hard enough. No. You can't have any chemo. I'm sorry. You know, we don't treat cancer like that. Susan Bartz Herrick, MFA, EdD. [00:39:37]: We do not treat heart disease. We do not treat diabetes, which is another chronic illness Those with diabetes, they have 20 plus drugs to deal with We only have free And only 1% of the huge millions that go to the war on drugs goes to research and development. Mark Leeds, D.O. [00:40:00]: Yeah. Susan Bartz Herrick, MFA, EdD. [00:40:00]: 1%. Mark Leeds, D.O. [00:40:03]: And that's that's another you know, as far as another, Company that that's deeply entrenched in in the, medical system. And and I think, you know, maybe, more problematically, In law enforcement, you know, some of these these companies, you know, like the company that makes VIVITROL, they apparently decided instead of going to market to doctors, they thought, let's market to, law enforcement and Prison wardens and tell people, like, everyone's you know, Suboxone is like like legal heroin. You need you need Vivitrol. Vivitrol is like the good one. And, Yeah. And and then the company that makes Suboxone, Indivior, when you know, I guess, when they were having issues with their patent, you know, with Subutex, which is a pure Buprenorphine, which works of course, works very well. They said, oh, there's a problem. Everyone's shooting up their their Subutex. Mark Leeds, D.O. [00:40:50]: We need to add, Yeah. Naloxone. There's never been a study that demonstrated the Naloxone was an effective abuse deterrent when added to any kind of opioid. But Everybody out there says, if doctors don't if if doctors prescribe Subutex over Suboxone without a good reason, you know, they're They're supporting, you know, drug abuse and diversion and all these things. They tried to make that same argument with SUBLOCADE, the monthly injection. I went to one of the first lectures on that, And the lecturer said, you know, you doctors in this room, if you don't immediately switch all your patients to SUBLOCADE like I did, you know, you're We found out now that they can chew up Suboxone and and get through that Naloxone, reaction. So, you know, they They've been like gaslighting and playing games with us for years. You know, they they didn't want the generics of Voxelon film to come out. Mark Leeds, D.O. [00:41:38]: It took an Indian company, doctor Reddy, to fight for that, and They won finally a few years ago. The same month that they won, the doctor Reddy won, and Indivior lost that fight. And and we had the generic Suboxone film that same month. And if you're cut off the Here to Help program where they were giving people up to a year free Suboxone, that same month they said, everybody on the program loses the program whether they still have time in it or not. And they sent it as a plain text fax, you know, not even you know? Oh my god. Nobody even put their name on it or anything. Yeah. So, I mean, there's a but we know that buprenorphine you know, we can call it Suboxone because it's like a genericized name. Mark Leeds, D.O. [00:42:15]: Right. Susan Bartz Herrick, MFA, EdD. [00:42:15]: But that's that's what I do. Yeah. Yeah. Mark Leeds, D.O. [00:42:17]: They should really lose they should lose their rights the name anyway. Yeah. I I I think they would. But, yeah. Anyway, so we know it works, and it's it's not like any other opioid. It has a, It it has a higher affinity for the receptor, the new opioid receptor, a higher affinity than other opioids. It has an effect on the kappa receptors. It's An antagonist. Mark Leeds, D.O. [00:42:37]: It has all these other things. So to say it's switching 1 opioid for another, it's is, you know, o o way, way oversimplifying. Right. And and finally now, there's experts that are saying, you know, this could just be over the counter. And and over the counter doesn't mean that the checkout line, it doesn't mean, know, you pick up your your Advil and your Suboxone. You know, it means that you go up to the pharmacy counter and say, you know, I'm I'm addicted to opioids. I'm taking Fentanyl on the streets, and I and I can't Find a Suboxone doctor, and the pharmacist could say, here, sign this form, and here's your Suboxone. Susan Bartz Herrick, MFA, EdD. [00:43:11]: Yeah. There's, Doctor, I see Daniel Snyder of The Pharmacist, Netflix Sarris. He is still fighting this down. He has started a group called EMMC, which is Enhanced Main streaming, MOUD Coalition and his whole goal is to get it available to absolutely everyone, and they're starting some, Study groups down where he lives, just to try to make this a, Well, their their goal is to take it to Congress, that they would have it totally available to everyone just as you said. Interestingly enough, I'm hearing and feeling a lot of pushback from a lot of the, Counselors. Because they say too, well, it can be abused, but everything can be abused. You go out, get Sunshine, it can be abused. You we but smart decisions have to be made based on science all during the COVID epidemic, you know, we're we're just stating, you know, follow the science! Why Addiction medicine, you know, it's there. Susan Bartz Herrick, MFA, EdD. [00:44:42]: We have information, but it is not getting out there. Mark Leeds, D.O. [00:44:47]: Yeah. Susan Bartz Herrick, MFA, EdD. [00:44:47]: It's not getting to the right people. I think stigma is the main thing which is holding it it back. We're gradually getting rid of some of the laws but the word has to get has to get out there and I I really do want to thank you for these podcasts Gass, because it's when people listen to all of these different topics, knowledge is power! And what one of the things that I was hoping to do in my book, yes, it's a memoir, but I have a lot of these, facts and figures in there written in a whole play and understanding way that people, can can learn and help stop the stigma and then take more positive steps this is an incredible crisis, and just going after fentanyl over the border is not gonna stop it. Mark Leeds, D.O. [00:45:45]: Yeah. But I I heard a thing on a radio show the other day. They said I don't know how accurate this was. They said that a, polls show that half of Americans are in favor of the military invading Mexico and going after the cartel people. And And, you know, of course, doctors are and, pharmacists are a lot easier to go after because they you know, they're not armed most of the time. But, but yeah. I mean, you know, because it it's like I mean, it's a major problem. Fentanyl, it shouldn't these people shouldn't be able but those people are scary too. Mark Leeds, D.O. [00:46:17]: The cartel, they're like the army. They're not. Don't think they're like they portray them in the TV shows where they look like mafia people. I think they're more like like a paramilitary army organization and, You know, they're they're deep of course, deeply entrenched also in government and everywhere. So maybe it's not that easy to go after them. But, but, yeah, the this medication I mean, and and pharmacies are a big part of the problem today. I mean, One one solution that that we thought was gonna work out, I think, was the these telemedicine companies during COVID. All these, like, tech companies kinda disrupting the The addiction treatment field saying, you know, we're gonna we're gonna have, like, 1 central company that that has all these nurse practitioners or doctors working under us. Mark Leeds, D.O. [00:46:59]: And we we can treat like entire states or huge regions of the country or even every state. You know, you can call 1 company and they'll put you on the phone with a practitioner for 5 minutes and your prescription gets sent to the pharmacy. And the problem is that now pharmacists are are very edgy about that, you know, and and pharmacists Get visited by inspectors every month that say why you're filling these prescriptions from a doctor 50 miles away and whatever. You know, they they were, like, they were they eased up on that during COVID, but COVID's over as far as they say now. But, yeah. So so I'm actually I'm seeing that myself personally, like, having to have conversations with pharmacists. Like, you know, I don't work for a telemedicine company. You know, this is my patient who is here with me here in Fort Lauderdale and it got Put on a job in Orlando for 3 months, and he's coming back. Mark Leeds, D.O. [00:47:45]: But can you please take care of him for these few months? And, you know, stuff like that. But, yeah, they're very edgy about that. They There may I've heard and sometimes pharmacists make up fake laws. Let's say, like, there's this law on the DEA website that says I can't do it. And And I've even I've asked them. I've said, you know, like, where is this law? I'm on I'm on their website right now. What is this DEA law? And they're like, will you go look for it? You know, we were told that that's a law, but, you know, but, yeah, it's just pharmacies are a big part of the problem these days of you can get the prescription really easily, but it's sometimes hard to fill it. Susan Bartz Herrick, MFA, EdD. [00:48:17]: Yeah. Yeah. Well, you know, we we need education. When you look at the number of physicians who like you who know what they're doing when they're treating someone with substance use disorder, opioid use disorder. The, Was the ASAM, claimed that there's, like, 7,000 only to treat 1,000,000? I wanna get my stats right for you on that. Okay, ASHAM, the American Society of Addiction Medicine 41,000,000 are at risk from dying from SUD There's about 7,000 specialists only to treat them. And in 2020, 41, 1000000 people aged 12 or older needed the treatment, but only 6.5% got it. Those, you know but Yeah. Susan Bartz Herrick, MFA, EdD. [00:49:34]: I'm I'm told Maybe you get 1 hour in medical school nursing schools 2, 3 years ago did not have any training in it I think every single emergency department needs to have Suboxone And yet when we went, they did not even know what that was. We need mandatory education and more than just an hour. I mean, this is an incredible chronic Disease that very few people know how to treat. Mark Leeds, D.O. [00:50:17]: Well, this is this is the year that We'll kinda see a test of what happens. This is a year that every doctor who has a DEA registration, which is probably most doctors, almost everybody. Every doctor required to do the full 8 hour course for treating. I don't know if you're aware of that. Susan Bartz Herrick, MFA, EdD. [00:50:32]: Yeah. Not aware of that. Yes. Mark Leeds, D.O. [00:50:35]: Yeah. Susan Bartz Herrick, MFA, EdD. [00:50:36]: Makes me happy. I did not know. Mark Leeds, D.O. [00:50:39]: So you may have heard they did away with the x number. You know? You don't need the the the x number anymore, but the The DEA solution to that was, no more x number, but every single doctor that we allowed to have a registration must do the 8 hour course. So Every convention now is part of your our live, training. Our live CME includes it's either 6 to 8 hours. I think it's it might be 8. I'm not sure. But, but, yeah, they're they have to do the full training now, every doctor. Susan Bartz Herrick, MFA, EdD. [00:51:04]: How how are they going to reinforce that just out of curiosity? Mark Leeds, D.O. [00:51:08]: It's required to To maintain well, there's gonna be a a box to check off on on renewing your DEA registration. So when a doctor replies, it you'll check off a box attesting that you did the training. And if you didn't and you check that box off, that's probably a very scary thing because you you never wanna do anything against them. Alright. Okay. If they tell you something, I still put my x number on even though it's not required now. I did the training in 2006. I was once told by a, an inspector, Every time you don't put the x number in a prescription, that's possibly a $20,000 fine per, per infraction per prescription. Mark Leeds, D.O. [00:51:44]: Someone told me that wasn't true. He was just trying to scare me. I I don't know. But, ever ever since then, I thought even if they've done away with it, Until someone tells me I'm not allowed to put it on, I'm still gonna write it in. But, yeah, it's, they've opened it up now, so we'll we'll see. I think probably Maybe by next year, you know, how how doctors respond to that that they've been kind of forced to do the training. Susan Bartz Herrick, MFA, EdD. [00:52:08]: No. I'm I'm I'm very pleased to hear that. My son passed away too a little over 2 years ago and about 3 3 weeks after I I went in to see my doctor and I told her what happened and of course she expressed her condolences and then said to me. You know, Susan, we are doing so much not to create any more addicts. And I looked at her and I said, yeah. But what are you doing to help the ones who already are, and the look on her face was priceless. She had it's like she hadn't even thought of that and all and, you know, it was a sad day. It was a sad I'm I'm very I'm very glad to hear this and I'm very glad for doctors like you who know, who understand, and who are advocating and putting things, putting this information out there. Susan Bartz Herrick, MFA, EdD. [00:53:05]: Knowledge is power, and we have to get the word out. So I never want 1 more person to get the phone call that I did. Mark Leeds, D.O. [00:53:13]: Oh, definitely. It's yeah. It's it's really horrible to, and and, you know, for a doctor to get that phone call, and then, I mean, of course, it's not the same, but but, yeah, I remember a patient that had been coming and doing really well, and he was just always busy running in and out and, you know, had a had a Really successful career and, but he his wife wasn't wasn't with him anymore, but he, and, anyway so at one point, I guess he stopped coming in. I didn't know what had happened to him. Then I found I got a call later on that they had found him with a, You know, in his home with a a syringe in his arm, and the wife called me and she said, was there anything I could have done? You know? If I had been with my husband, is there anything I could have done to have saved him or Prevented that and yeah. It's horrible. And, and I don't know that she could've even if she had been there with Tons of of Narcan to try to reverse an overdose. Who's to say she would have been in the room at that moment? The within that short period few minutes that she would have had to be there. Mark Leeds, D.O. [00:54:16]: But, but yeah. So so as far as the, I I did an interview with doctor Nelson from, Rutgers University. And it he's very nice to to do it. He did actually did 2 podcast interviews with me. And we talked about the the last interview we did was actually, he came on the 1st time to talk about over the counter, Naloxone, which is now a thing that Apparently because it had been out there for a while that you could go to the pharmacy and get a Narcan prescription get Narcan without a doctor's prescription in most states. But, apparently, the way they did it was there is a standing prescription from, like, 1 public health doctor that made that possible. And so now it's like, Yeah. Now it's officially over the counter, but not over the counter where you can just pick it up on a shelf. Mark Leeds, D.O. [00:55:01]: You still have to go to the pharmacist and fill out paperwork and whatever. But it was it's the 1st step towards making it fully over the counter and and competitive and better prices. And, But yeah. So we did a we did a episode about that. Then we did another interview where we talked about treating about induction of Suboxone, which is Kind of tricky. You know, that's something the doctors have to learn about when they do the training, that you can't just give someone Suboxone and say, I know you've been taking Fentanyl every day. Here, take the Suboxone now. Because they get sick from it, and then they never wanna take it again. Mark Leeds, D.O. [00:55:32]: Yeah. They get precipitated withdrawal. And we went over a couple of approaches because things are different now. Fentanyl gets Sequestered in the fat cells when you take it for a long time. You can't you with other opioids, even like heroin, oxycodone, You you can usually give Suboxone 12, 18, 24 hours later after the last dose of opioid. With Fentanyl, it's sometimes a waiting period of 3, 4, 5 days. It can be a long time. And so there's different approaches now. Mark Leeds, D.O. [00:55:59]: There's a microdose approach, which is called the Bernice method, where you start with a The person can still keep using you know, you you don't want them to. But if they can't stop, they can start the Suboxone at a very low dose and gradually increase it. And when it gets to a certain threshold, They don't Yeah. Yeah. The receptors are blocked and they can drop the other opioid. And another approach is called macrodosing, which is very Should be very interesting to every single ER doctor in the country. In most cases, you can give a a fairly large dose upfront, Sixteen to 24 milligrams, even 32 milligrams. And the, based on the the pharmacokinetics, the, The way that the drug works because of the high affinity, the receptor, and the partial agonist effect, you you can get just enough partial agonist effect with the Buprenorphine sitting on the receptor long enough that the person will probably either not have precipitated withdrawal or have very little of it. Mark Leeds, D.O. [00:56:54]: And so ER doctors are probably thinking, how can I give Suboxone? Because if they just came in and overdosed and they just took Fentanyl, how can I give Suboxone? Because they need to wait At least 24 hours or more. Susan Bartz Herrick, MFA, EdD. [00:57:07]: The who knows? Mark Leeds, D.O. [00:57:08]: So, yeah, they they can give it. They can they can give a large dose, which is Counterintuitive. It's a little bit scary, you know, thinking like, I'm gonna give 16 milligrams. Now they're gonna hate me. They're gonna get really sick. But it it actually works. I've Done it with a few patients, since having that conversation. And, you know, we're all in a shock, like, wow, that actually works. Mark Leeds, D.O. [00:57:26]: There's no precipitated withdrawal. There is a he did say there are there is a small percentage of patients that will have an issue, but these are ER doctors in a hospital. They have All the resources of the whole hospital to deal with any issues that come up, but most people will respond very well to a very large dose upfront. He said the old way of doing it of giving 2 milligrams and testing it testing the waters and waiting a little bit longer and giving a little bit more. That doesn't really work with Fentanyl. So People that need to look at the micro and the macro approaches, and, hopefully, they're teaching all this stuff in the in the new 8 hour course. Susan Bartz Herrick, MFA, EdD. [00:58:00]: This this is what I'm hoping too because, you know, with us, we had, surgery. They Tried to take the the filter out through his neck first Didn't work so they scheduled him 2 weeks afterwards Well, they just shot him up you know, with narcotics. Told him he had to wait 2 weeks. So What should he do? What could he take to get him off of that high that they put him on and then get him ready that he could go back under, you know, and Once again, no protocol. It it was horrific hearing information like this. Anesthesiologists need this information. How do you take a patient who needs surgery and get them off of what they're taking to be able to put them under, walk them back on. When we were going through it, They looked at us like we were crazy. Susan Bartz Herrick, MFA, EdD. [00:59:06]: Oh, he doesn't need anything different. And I, his mother, kept no screaming. Because because it does drop me. You know? And now I hear it's finally coming. These are very needed protocols, and I'm so happy to hear that they're coming, in this new, course that has to be taken. Mark Leeds, D.O. [00:59:28]: One one thing that That I I kinda related to in your book was, the rock when you're rocking your baby. You know, he's a little baby. You're trying to rock him to sleep, and probably a lot of us go through that. You know, you come up with all these routines. It's like, you know, ours is like jumping on the bed with the baby and just to get just the right rhythm for the baby So, you know, and playing certain music. You know, there were some songs work, some didn't work. And, you know, there there was another, guest on the podcast that he told me about a, there's a billboard in Frederick, Maryland where they they have an an ongoing overdose count, and they keep At it, they keep raising the number. The number every time you go by the billboard. Mark Leeds, D.O. [01:00:07]: And every every one of those numbers is a is someone's baby. I mean, it's it's, It's some baby that someone was rocking to sleep and, you know, these aren't just, like, numbers or nameless people or or junkies. I mean, these are, You know, real people. Your your son had a genius IQ, and then he went to Harvard also. Right? Susan Bartz Herrick, MFA, EdD. [01:00:25]: He got into the Harvard Continuing Education Program about 3 weeks before he passed away, he, he was in the BAAS program at You've been but he couldn't take the classes that he wanted there so he was trying to, port it over. These are the online, Extension Schools. But yeah. I mean, he he was he was brilliant. I finally got Apple to give me his papers off his computer. That was hard getting into, but, you know, so I can Still have a little piece to come back. Yeah. Mark Leeds, D.O. [01:01:08]: You know, a lot of people who have have the worst time getting, over an addiction are brilliant, creative, intelligent people. And, I I kinda see it as that they're like like superheroes, but, the drugs are like kryptonite and, you know, we need to Do do whatever we can to to help. You know, that's why that's like, an analogy I I use a lot that I think of it. That if you saw Superman with a with kryptonite around his neck in a dark alley. He'd say, look at that junky over there. And, all you need to do is take that kryptonite off of him, and he's Superman. Susan Bartz Herrick, MFA, EdD. [01:01:40]: Yeah. I Luke wanted nothing more than to to be sober. I did not know the term dopamine depletion at the time but I was just watching him spiral and fight and spiral and fight and here I Had the Suboxone and I said take it take it. Said I can't be in my groups if I take And he was a man of integrity. I said, why? And he said, I can't do that. That's not the program. He was a leader in These programs but he had been, for lack of a better word, brainwashed that he couldn't, You know? So, Yes. Mark Leeds, D.O. [01:02:22]: Suboxone stabilizes dopamine. Other opioids don't do that. Other opioids give us up and down dopamine levels, and Suboxone actually keeps it steady. So it actually does treat that. And, people yeah. They don't the programs don't don't acknowledge that or understand that Susan Bartz Herrick, MFA, EdD. [01:02:37]: You're welcome. Need to. Yeah. And one thing I am happy about embarking, Going back to Purdue, some of the monies are coming out now to be spent here in, North Carolina in The county, they are only giving it to organizations who practice, m a t m o u d d who use the medical aspect. There's a couple treatment centers That won't, and they've already cut them out. They said, no. We have to move forward going. Mark Leeds, D.O. [01:03:15]: Yeah. Oh, oh, that's something yeah. If you, if you ever have have any, places in North Carolina North Carolina recommend that That do, free or low cost your sliding scale Suboxone treatment. I I had a, listing on my podcast website of whenever I Became aware of, like, a free program. I would list it by state. And North Carolina I I get the most traffic from people looking for programs in North Carolina, And it's the one place where I was never able to identify a single program other than in jails or prisons, where a person can get free or or low cost a box on treatment. Susan Bartz Herrick, MFA, EdD. [01:03:51]: I'll check. Mark Leeds, D.O. [01:03:52]: Yeah. Yeah. Apparently, yeah, North Carolina, for some reason, it's like a every other state I've been most other states I've been able to find programs in. But, yeah, It's apparently, there's an issue with the the governor. Someone told me something like that, but but may hopefully, that's changing now. Susan Bartz Herrick, MFA, EdD. [01:04:07]: I mean, we're we are making progress, but I'll I'll I'll look into that. I will. It is needed desperately. Mark Leeds, D.O. [01:04:18]: Yeah. Definitely. Okay, Susan, Eric. Tell me the the title of the the book again coming out soon. Susan Bartz Herrick, MFA, EdD. [01:04:25]: It's called Slow Dancing with the Devil. Mark Leeds, D.O. [01:04:27]: Slow Dancing Susan Bartz Herrick, MFA, EdD. [01:04:28]: with to press. Yes. Mark Leeds, D.O. [01:04:30]: Slow Dancing with the Devil. Yeah. And definitely Fentanyl is definitely the devil. So, and and, yeah, Susan Bartz Herrick, MFA, EdD. [01:04:39]: it's cover of the book, Has a prescription bottle on it because it started with oxycodone. Mark Leeds, D.O. [01:04:50]: Yeah. Yeah. I oh, I was gonna just say the, I have a thing I've saved for I don't know if you've ever seen this or if you if your son or anyone that you know is on the Purdue patient assistance program where they get free OxyContin for a year, they get a letter the patient gets a letter saying, You're now approved to get up to 300 tablets a month of OxyContin of any strength. And I have a copy of that letter because it's unbelievable because people Would take that letter and come into their doctor and say, you need to give me 10 a day now, which is as much as 800 milligrams a day. Even if they were only getting Forty or 80 milligrams a day total. And they get this letter from Purdue saying, we're authorizing you to get you know, save up, get as much as you can. Don't say that, but they're saying you're authorized for 300 tablets a month, which is Criminal. Susan Bartz Herrick, MFA, EdD. [01:05:36]: Absolutely criminal. Mark Leeds, D.O. [01:05:38]: Yeah. Susan Bartz Herrick, MFA, EdD. [01:05:39]: They have The blood of so many young people on their hands. They really do. Yeah. Anyway. Mark Leeds, D.O. [01:05:49]: So thank you. Thank you for and and and I definitely recommend everybody listening, look out. When when is the book gonna be available? When can people get it? Susan Bartz Herrick, MFA, EdD. [01:05:58]: November It can be pre ordered right now on Amazon and, McFarland's Website, they they are taking, preorders. They're thinking November 3rd. So Mark Leeds, D.O. [01:06:11]: Oh, wow. Wow. It's, everybody preorder. Let's make it a best her before it comes out. Susan Bartz Herrick, MFA, EdD. [01:06:16]: Thank you, sir, and thank you for all that you do. It's so needed. I appreciate that. Mark Leeds, D.O. [01:06:22]: Thank you for joining me. ### Neurosurgeon Dr. Eben Alexander On Near Death Experiences And Sound Therapy URL: https://therehab.com/neurosurgeon-dr-eben-alexander-on-near-death-experiences-and-sound-therapy/ _The following is a transcript of a recent podcast interview with Dr. Eben Alexander, Harvard neurosurgeon, and near-death experience expert. You can hear our talk on[The Rehab Podcast on The Mental Health News Radio Network](), or you can [watch us on video on YouTube](). Below is a transcript of our discussion. An important topic in our talk is the use of sound therapy, specifically binaural beats. Dr. Alexander has made extensive use of this technology in recent years and he is a big proponent of its use in helping people to overcome anxiety and achieve states of relaxation and focus without the need for medications. I personally make use of binaural beats recordings to help me relax and get to sleep at night. For more information on this topic, please contact me using the contact form on this website._ Dr. Leeds: Welcome to [The Rehab]( "Recovery Podcasts") on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives and help people to get back on track to a path towards success and happiness in life. Dr. Leeds: Dr. Eben Alexander, it's an honor and a pleasure to have you on the podcast. Thank you for joining me. You are a neurosurgeon with decades of experience, you've done thousands, I think at least 4,000 neurosurgeries. You were a professor at Harvard University, and in 2008 you had a profound, life-changing experience, a near-death experience. Since then you've gone on to write three books. I know at least three books about your experience, and how it's changed your life, and you've gone out, trying to help other people to find their own experience and connection with the universe. I'll let you talk more about that. You've had the opportunity to meet with Oprah on her show, and Dr. Oz, and I think 20/20, and a whole variety of other great shows and programs, and radio shows, and podcasts. It's really incredible to get this message out, you know, the connection between mind and body and the universe. Dr. Leeds: So welcome to the podcast, and it'd be great if you can tell me more about everything. Thank you. Dr. Alexander: Okay Mark, well thanks for having me on. It's a real joy to be here. Yes, I have gone through kind of a radical reboot of my life, just in terms of my primary interests. As someone, I'd spent my life as an academic neurosurgeon, more than 15 years of teaching at Harvard Medical School. I thought I understood the brain, mind, and consciousness to some extent. Then in November 2008 all that got flipped completely upside down when I went through a week-long coma, to a very severe case of gram-negative case of bacterial meningitis. In fact, it was a meningoencephalitis. Meaning that my brain was also very infected by these bacteria. Dr. Alexander: That actually was a tremendous gift, because as a neuroscientist, even though in the journey itself, that is deep in this week-long coma, I had no memory of my life. None of my beliefs survived it. None of my religious beliefs or scientific knowledge. No language. I didn't have personal memories deep in this experience. Yet, when I woke up in the ICU bed on day seven of coma, the only thing in knew was where I had just been on this incredible odyssey that I describe in the book Proof of Heaven. But in fact, a tremendous amount of the journey has been in the almost 11 years since that occurrence, because it challenged everything that I thought that I knew, and I had always had a big interest in physics and in science. I was very much a materialist scientist. Dr. Alexander: I believed the physical world is all that exists, and that therefore they physical brain must somehow create consciousness. My coma journey showed me very clearly how that's just not true. It's not true at all. In fact, we're conscious in spite of our brain. This is something not only am I doing a lot of personal work in evolving my understanding of relationship of brain and mind, and understanding of consciousness, but I have also allied with literally hundreds of scientists around this world, who do study consciousness, and do realize that the simplistic assumption that the brain creates consciousness is not borne out by the evidence. In fact, there is plenty of empirical evidence that goes much further than that, to show that consciousness is fundamental in the universe. Dr. Alexander: This is an extraordinarily liberating and refreshing point of view, and the fact that it is intimately tied with the leading edges of the modern scientific study of consciousness is really phenomenal. That is what I believe will bring this true revolution of awakening for the world. Because the material of science, in terms of its notions of understanding consciousness has never even gotten out of the starting blocks. That's why we need a much bigger science. This is not about rejecting any of the science we have today, it's just about realizing that when we adopt a much greater kind of metaphysical model or supporting worldviews to kind of put all this together, that is not limited by the belief in paltry fiction of materialism and the false notion that only the physical world exists, we can really liberate humanity to much higher levels. Dr. Alexander: That I believe is the huge reason why I had this kind of miraculous recovery, but you know, it's not about me, it's really about the message. The message comes from millions of others who've had similar experiences. Not just that, the message comes from the scientific study of all aspects of non-local consciousness. That is the reality of things like telepathy, out-of-body experiences, remote viewing, or the psychic spy program, the ability to discern information at a great distance through means other than our physical senses. Even explanation of these millions of stories of near-death experiences, and what they bring to us, that before my coma I assumed them to be like many material scientists do, a massive hallucination. Yet, it's really folly to ignore evidence like that by just assuming it's completely false. The universe doesn't give us such robust evidence for something unless we're supposed to pay attention and modify our worldviews. That's exactly what this revolution in the understanding of consciousness is leading towards. Dr. Alexander: The good news is it will definitely bring a far more peaceful and harmonious world because it will debunk some of the most ridiculous assertions of separation and things like that, that come from materialist thinking. So I'm very optimistic about where it's all headed. I am doing exactly what I'm meant to do. I do not believe I was meant to spend the rest of my life in the operating room helping individual patients, as much as I love doing that, and I still am in touch with a lot of my patients who have continued to benefit from my interventions with them, and I love that. But this is really about the much bigger picture of tackling the understanding of the nature of reality, and that's what I think this whole discussion is all about. Dr. Leeds: In my practice, I work with people who are addicted, in most cases, to opioids, and in many cases, heroin. It's a scary thing. People are using heroin on the streets and they're getting Fentanyl, which is this toxic thing from China that they're putting into the heroin. Some people are not going to make it. I mean the treatment that we use has about a 50% success rate, and so you have people that they get into treatment and they start wondering what more is there to life? They've been living on the streets, and now they're in treatment and they're feeling better. When you go to a program like AA or NA, they talk about meditation and prayer and connecting with a higher power. That may not be easy for someone early in recovery to understand, because their thinking may be clouded by cravings for drugs and obsessions and I guess their physical brain is still healing from the trauma of using the drug. What would your advice be to someone who's just coming into recovery? Dr. Alexander: Well I think you know, I've had my own personal experience with alcohol and addiction in that back in 1991 my family was concerned about my use of alcohol. It had nothing to do with anything at work, but when I was not on call, I tended to drink more than was healthy for me, and loved ones around me pointed this out. I ended up in mid-1991 stopping drinking for good, and I'm glad I left it behind. But it was deeply kind of tied in with my own journey of self-worth. Those who read the book, Proof of Heaven, where I do mention briefly that I stopped drinking back in 1991. Will realize that I was also adopted. That plays in heavily to my own personal story about adoption wound being left behind by my birth mother when I was 11-days old really set the stage for a lot of kind of deep wondering as to whether or not I was even worthy of love, of this world. Dr. Alexander: Like many young children put up for adoption, I stopped eating. I went on a hunger strike, and you know, failure to thrive. They rescued me from that over about two weeks, but by then my birth mother was out of the picture. So I had to kind of wrestle with that through much of my life. I think it figured into my relationships with others, and certainly my ability to trust or not trust the world. That's a huge part of what my journey has been about. But something that is very important along the lines of this question of addiction, has to do with the fact that our ego, the little voice in our head, that kind of set of thoughts and memories that put together who we think we are, and what our relationship with this world is, and relationship with others around us. Dr. Alexander: That little ego is not necessarily a very reliable guide to getting to much more deeply know ourselves and our journey in life. So one of the things that Karen and I ... My life partner, Karen Newell, who is a co-author of our third book, Living in a Mindful Universe. One thing that we often teach in our meditation play shop using Sacred Acoustics, which I think you and Karen talked about a lot on your podcast earlier. One of the things we talk about is identifying that little voice in the head, the voice of the ego. I love how Michael Singer in his book, The Untethered Soul, he calls that little running stream of thoughts in our head, that voice of ego, the annoying roommate. I think that's a very important terminology to keep in mind. You know, that little voice in the head, which is also the means by which we have logical, rational discussions of ideas of concepts with other people. It's not just the voice of the ego, even the ego is kind of the primary interpreter. But it's important to realize that that voice, that language that it uses, is not really sufficient to explain a lot of things about who we are and our relationship with the universe. Dr. Alexander: A lot of that can be found by going deeper into consciousness. Once you realize that the little voice in the head, and that's the little voice that's right then when the alcoholic who's making a decision about whether or not to go into the liquor store and buy another fifth of Vodka, or what have you, that little voice is not our conscience, and it's not who we are. The deep mystery of consciousness, whether you're talking about the measurement paradox in quantum physics which directly goes at this issue of brain and mind and consciousness, or you're talking about what's called the hard problem of consciousness in neuroscience. Which is really the impossible problem of materialism to try and explain consciousness. Whatever you're talking about there, the mystery that they're trying to get at is the awareness. The awareness of existence. Dr. Alexander: You know, as René Descartes said, "I think therefore I am." I think there's a bit of confusion around all that, because if he was referring to that little running stream of thoughts in his head, he was dead wrong. If he was referring to the fact that he was aware of those thoughts, and that he could identify with that property of awareness, then he was definitely onto something. Because that property of awareness I would say is a fundamental property of the universe. It's not derivative from any physical matter, and it's one of the things that in modern consciousness studies really goes a long way in the neuroscience of consciousness, philosophy of mind, and resolving the deep paradoxes of quantum physics. They're all leading to this amazing [inaudible 00:13:00] that mind is fundamental in the universe. Dr. Alexander: That's the self-awareness, or awareness. Given the fact that we're really sharing one mind. So I think the first step for the alcoholic or addict, and this is something that's often utilized in the treatment programs by psychiatrists and psychologists who deal with the various forms of addiction, is the ritual sacrifice of the ego. There will be some way in which they will do a psychodrama or something like that, where that ego, that little set of thoughts and kind of preconceptions about self that come in our linguistic brain, are rejected and then allowed to be born anew. It is something that can be very effective at helping to rescue people from the spiraling drain around addiction and alcoholism. Is that ego sacrifice and rebirth. In essence, a lot of what Karen and I teach in our meditative workshops is a very similar process where you're actually acknowledging that little voice of the ego. Dr. Alexander: That includes going all the way back to the those childhood wounds. Like my wound at age 11 days that influenced my life, even to this point. Even though as I've come to recognize it, especially since my coma, I've been much more effective at dismantling its power over me. But I think that this is a very useful exercise to realize that when we question those beliefs and start to identify more with our true consciousness, that awareness, or what Karen often refers to as the neutral observer, that's that same observer that's there. It's the hard problem of consciousness, and is the observer and the measurement paradox in quantum physics. That observer is truly our consciousness. By getting in richer touch with that, and learning to put the little impish teenager of the ego mind and the linguistic voice in our head that keeps telling us those childhood wounds. You're not good enough. You don't deserve this. You know, all of the kind of traumas that we experience as children and misinterpret the message. Dr. Alexander: Which I would say is fundamentally a separation from source. Because all of our souls, I would argue, came in from that heavenly realm, and those who have heard me talk about it, realize how much I rely on the strong, empirical scientific data supporting reincarnation. Because you really can't make sense of this if you don't understand that our souls come back again and again to get it right. In fact, the whole world of transpersonal psychology, after the work of brilliant clinicians like Stan Grof, Michael Newton, Brian Weiss and others, is merely supporting the notion that to fully acknowledge the difficulties and challenges we have in this life, and that certainly includes things like addiction, we've got to realize we've lived a bigger existence. It's not just confined to this little lifetime. Dr. Alexander: I think when we take this bigger point of view, and when we develop techniques for going within, meditation, just as I do daily one or two hours a day using Sacred Acoustics. Those who want to learn more can go to SacredAcoustics.com to Karen Newell's website. But it really can be tremendously empowering to use these kind of Sacred Acoustic tones to go deeper into consciousness. When you realize that our consciousness is not created by the physical brain, and is not confined to this little three and a half pound gelatinous mass in a warm, dark bath between my ears. But in fact our consciousness is far grander than that. This is where I think the going within can be very powerful. Dr. Alexander: In fact, just some anecdotal stories. Karen has heard from several acupuncturists who work in centers around the United States where children who had tried suicide, tried to commit suicide, but had survived it and now were being sent for treatment. These acupuncturists were trying to stabilize them and help them very much. These particular acupuncturists would use Sacred Acoustics tone. It was interesting, we started hearing back from several centers that when these children would listen to these tones and be in this kind of simple, meditative state, they would have such an exposure to that broader consciousness, and that higher soul or self, that they'd come away saying, "You know, if I'd had this feeling and know this kind of experience was available before, I never would have tried to commit suicide." Dr. Alexander: I think that's very powerful. I mean one of the things that I've heard in the near death experience community, and this comes from the horse's mouth really, from Dr. Raymond Moody who wrote the book Life After Life back in 1975. Which first coined the term near death experiences, and really started this whole revolution of waking the world up to the power of near death experiences. One thing that Dr. Moody said is of all the things he had learned over the five decades that he studied these phenomena, the one thing he could say with the most assurance is that if someone tries to commit suicide and they witness some of those key features of an NDE, like the soul of a departed loved one, or of loved ones. Or that infinitely healing love force, that God force that so many near death experiences for thousands of years across all cultures have come back with, they never attempt suicide again. Dr. Alexander: What I say is these anecdotal reports that we're getting on Sacred Acoustic users, and yes, we are setting up the pilot studies to look at all of this more scientifically. But so far what we have to work with are the anecdotes. Just by giving people that kind of glimpse, to go within and in their own mind realize they're much more than just a consciousness that resides in this little physical body in the sense of here and now. And be tremendously empowered to help liberate them. It really gets right back to what you said at the outset of all of this, the work of 12-step programs. [Alcoholics Anonymous]() was the beginning, but of course it's been applied in narcotics and other types of addiction, sex addiction, love addiction, work addiction, exercise addiction. Dr. Alexander: There are many addictions that can kind of ruin our lives if we let them. Yet, we have a way to kind of connect with our higher soul in deep meditation that enables us to tap into that higher power. Now I know when I was first getting into recovery back in 1991, letting alcohol go, that higher power I was told could even be a light bulb. It just had to be outside of yourself. But what I think that really means is outside of your ego sense of self. The good news is, our very conscious awareness is something far, far more powerful than that little ego awareness. We have an opportunity by going within and exploring consciousness, to investigate that and start to prove it to ourselves. Dr. Alexander: When I talk about your higher soul that we connect with, that kind of higher power within, it's not really part of our ego so much, it's liberated from the ego and from that false sense of separation. That's what gives it so much power. I would say in fact, that near death experiences, when you look at them broadly across all cultures, from every religion, from atheists, agnostics, and others, what you start to realize is that they're all referring to the oneness of mind, the oneness of consciousness that we all share. I know a good friend of ours, Dr. Larry Dossey wrote a beautiful book called One Mind, which I highly recommend to people who want to learn more about this. Dr. Alexander: It's all about the fact that the modern neuroscience of consciousness is absolutely filled with examples of how our thoughts overlap, and how our mind is not really owned by us, but in fact telepathy is real, precognition is real, psychokinesis, the ability to influence material objects through mental influence alone is real. Then all manner of extended consciousness, like out-of-body experiences, remote viewing, past life memories in children indicative of reincarnation. All of these things of the bigger facets of consciousness have a scientific basis and have been studied. So it's really just up to the individual to start to explore this universe within, given the huge amount of scientific data that supports we're all really sharing the one mind, and that the brain is actually a filter that allows that primordial consciousness in. These are all ideas that we follow to tremendous depth in our book, Living in a Mindful Universe. Dr. Leeds: Some of the things you were just talking about, remote viewing and telekinesis, it brings me back to I used to love listening to the Art Bell show on the radio. It's funny you bring it up because I was just, the other day I was putting together a play list of all of his bumper music, because I used to love all the music he would play before and after. Yeah, I remember he had some experts on in that field of remote viewing and the military's use of remote viewing. Really interesting subject. I'm glad you also brought up Michael Singer. I had the opportunity when I was taking a class in Gainesville it occurred to me that I had read in his book that his temple is kind of near that area. So one night after class I took a road trip out to Alachua, wherever he is, out into the middle of the woods. I actually got to sit for ... He gave a lecture for like an hour, and then I got to meet him after. Really very nice, friendly person. Dr. Leeds: I've noticed when I've met or talked to or listened to or read from people who have had these spiritual experiences, in the case of Michael Singer from years and years of meditation and working with gurus. I also did an interview with Harry Derbitsky he's involved in something called The Three Principles, which is kind of an alternative to the 12 steps. They also talk about the same kind of a thing where you know, you have that chattering in the head, that monkey voice or whatever that just keeps talking and talking. That's not you, you're the observer in the back listening to that. Dr. Alexander: Exactly. Dr. Leeds: It's just really interesting, and you get this kind of feeling, you know, when I talk to you and when I talk to Harry, and when I got the opportunity to meet. I once went to a lecture with this spiritual leader, Ram Dass, who had started out- Dr. Alexander: [crosstalk 00:24:05]. Dr. Leeds: ... in the 60s he first got involved experimenting with psychedelic drugs and then moved onto meditation and spiritualism. You just get kind of this warm feeling that there's something more to the universe. There's things like prayer, love, gratitude. Recently I was reading a book by ... He's the founder of Mind Valley and he wrote a book and the talks about an experiment that they're doing with biofeedback and training the brain to reach different states. Very similar to what Sacred Acoustics does in training the brain to get into different states of different brainwaves. They found that the best way to get to the target state was actually forgiveness. It was kind of unusual for their participants because they thought they were in this scientific study. They're hooking up their heads to EEG machines and following their brainwaves and getting biofeedback. Dr. Leeds: But then they were told the best way that you're going to get into the desired state, I think they were talking about alpha waves, was to forgive everybody in their life. Which wasn't easy. I mean when you start thinking about people that you think have wronged you in life, how do you forgive everybody? But then I guess in the bigger picture when you think none of this is real. I mean we're all, like you said, ego and then we're all kind of like a shared soul. I mean really what is there to forgiving people? I mean you know, what do you think about that? Those kind of things like forgiveness and gratitude and prayer? Dr. Alexander: Well I would say that two of the most powerful forces that any individual has to help guide their life in a positive direction are gratitude and forgiveness. These are extraordinary powers that when you start to explore them and work with them, you realize just how liberating, refreshing, and kind of reviving they are. Now, important to point out here, a lot of what I would say is evidence about the fundamental workings of the universe, for me comes from near death experiences. Very specifically, from the life review. Life reviews are reported to occur in anywhere from a quarter to a half of NDEs, depending on the series and kind of set of the investigator, et cetera. But the reality is, life review, and I've met so many people who have explained life reviews. I had my own visions of life reviews, although in my journey they did not involve the first life of Eben Alexander, because of my amnesia for the life of Eben Alexander. But I did see life reviews in ways that were very extraordinary, and of course included reincarnation as the crucial principle. Dr. Alexander: But the important thing to understand is that most people describe these not as you're witnessing memories of your life of residual soul lessons, as much as you're going back through those residual lessons, the important ones, and doing it. But experiencing that whole interaction from the point of view of those around you who your actions and thoughts influenced. That's the important thing. A life review is a beautiful example of how we're more like facets on the gem of the one mind, than individual, isolated minds. We're different perspectives of the one mind. We see that in that life review. It's a very important kind of awakening to the nature of reality, because it reminds us that living these lives, and having this sense of self and here and now, is really only part of the stage setting for that drama to unfold. Dr. Alexander: When we leave our physical body at the end of life, we have this extraordinary review of the life, and it's not a new age concept, in fact, the life review was written about by Plato 2400 years ago when he discussed the death of an Armenian soldier, Er, who is dead on the battlefield several days and when they finally put him up on a funeral pyre before they lit it, he came back to life. His story was very simple, when you die, you go through a review of all the most important features of your life, and the only thing that matters is how much true love you gave out to this world during your lifetime. Nothing else counts. That would echo today what millions of near death experiences say about the life review, and about their journey beginning into that afterlife. Of course, for near death experiences they don't die, they come back. Dr. Alexander: But the bigger reality is, I learned, to understand near death experiences fully in context you need to take the bigger picture and look at consciousness writ large. That is all manner of conscious experiences. All those examples of non-local consciousness, like telepathy and remote viewing, out-of-body experiences. Pre-cognition, the fact that we can know the future before it happens. Psychokinesis. The past-life memories in children that have been studied at the University of Virginia for more than six decades, with more than 2500 cases now. Where a very ready explanation is actually reincarnation. These were cases that were gathered scientifically with major efforts to prevent any kind of fraud or fabrication. When you look at that body of evidence, it's just way too strong to just ignore. Dr. Alexander: We have to take all of this in context. You were talking earlier about Art Bell, and I think also of George Noory and others who have helped from a media standpoint, to expose the world to all these various positions. Of course, for the material of science it's kind of like a game of Whack-a-Mole. You keep whack down on remote viewing, and whack down on out-of-body experiences. Whack down on near death experiences. Whack down on past-life memories in children indicative of reincarnation. Yet, from that media perspective they can back off a notch and say, "Well why don't we look at all of this?" That's really what I had to do as a practicing neurosurgeon who fully bought into the materialist model, who then had a big wake-up call. The gift of my journey was that wake-up call, that meningitis that was destroying my entire neocortex. Dr. Alexander: Of course, those who hear me say that, those in medicine, say, "Well it can't have done that, because look at him now." That's the miracle that they ignore by failing to acknowledge the information. Luckily the information now is very objective and validated, because in September of 2018 in the Journal of Nervous and Mental Diseases three physicians wrote a case report that took them more than two years to write and get published on my medical records. In that case report, which is available to anybody who wants to see it on my website, go to EbenAlexander.com, go to my blog pages, look back in September 2018, the blog I wrote on an independent medical review validating the facts of my case. In the fourth paragraph you'll find a link right to the medical report itself. Dr. Alexander: But the things that they found so interesting, these doctors who were not involved in my care, but were fascinated by this high level of recovery from a disease that normally just devastates people, kills them outright or leaves them horribly afflicted for life. How did I have this full recovery over two months? It really has no explanation in western medicine. In fact, in this peer reviewed medical article, these three physicians who were familiar with other cases of really miraculous healing and near death experiences that had been well-validated, they surmised that my miraculous recovery could be explained by the spiritual nature of my coma experience. So my NDE itself. To me, all that does is point out to all of us how we have the power within, just as medical science has admitted for more than six decades, that the power of belief is very strong indeed. That's why we use placebo controlled studies to assess any new treatment, is because we recognize that the patient's belief can be very powerful. Dr. Alexander: Once you realize this isn't just about getting rid of a headache by giving somebody a sugar pill, but that in fact people who've had advanced cancers, infections, even congenital deformity that they were born with, correct under the influence of mind over matter. You start to realize that's really the way this universe works. If it can work in our health, you bet it can work in the rest of our lives. I would say that any physical, mental, or emotional health is going to be fundamentally spiritual. Of course, many people gain spirituality through religion, but I would say that sometimes the orthodoxies of religion become very conflicting with each other. Whereas, the basic principles underlying all of the great religions, this notion of a great spirit, of oneness, of connectedness, of love, compassion, and mercy, these are concepts that emerge full force from this modern world of going within and exploring, coming to a deeper understanding of the nature of this one mind, of this consciousness that seems to rule the entire universe, and yet is not separate from it. We all have the power by going within to connect very directly with that power. Dr. Alexander: Just like in life reviews, people can learn incredible things about their lives and moving forward, and if they come back to this world after an NDE with a life review, their life is very much changed. But look what it does, it brings them much more into compassion, altruism, philanthropy, giving to others, because this is really all about taking care of each other. That's what this notion of the one mind really means when we look at it from an emotional standpoint, and not just a cognitive, intellectual standpoint. We're all in this together. It's all about that heart consciousness. That is something that has tremendous power to heal this world. Just like in the world of addiction and alcoholism, you run into a concept of what's called a gift of desperation. You know, things get so bad that you really have to make the choice to either change your life fundamentally or cease to exist. Dr. Alexander: Unfortunately, the disease is so strong that millions around this world have succumbed before being able to actually rise above it all. That's where I believe that meditation, centering prayer, this notion of a higher power as you come to realize that that higher power is actually the very source of your conscious awareness. It's the part of you that expands tremendously when you're liberated from the shackles of the physical brain at the time of death. That's why near death experiences describe what they do. That liberation is very powerful. But the good news is you don't have to wait until you die, or almost die, to get this. As a conscious sentient being we all have the power to go within, and explore and start to determine the very deep connections we share with the universe. Dr. Alexander: So I would say that spirituality in the modern sense, even though it may be engendered by some people through prayer and meditation and various religious systems, you don't need religious orthodoxy for this to work at all. In fact, the religious orthodoxy often greatly interferes with it. The very fact that we see violence between religious groups is an indicator that the orthodoxy has gained control and they've lost the sense of the original methods of the profits, which never, ever truly involve this kind of deep sense of conflict for those who are aware of this. Unfortunately, a lot of world is still in the dark about it. Dr. Alexander: But anyway, the sense of spirituality that I'm talking about here really just has two main ingredients. One is an acknowledgement of what's coming to the fore in the neuroscience of consciousness and philosophy [inaudible 00:35:57] that we really are sharing one consciousness. It's shared with all life, all sentience throughout the universe, not just shared among human beings. This is much bigger than that. In fact, our linguistic brain gets in the way of our knowing the deep power of that one mind, of that conscious force within us. But the spirituality contains not only a sense of that oneness of mind that we're all together, so if you hurt another, you're truly hurting yourself. This is something that's a fundamental lesson of the life review in a near death experience. Dr. Alexander: The other thing is a grand sense of purpose and meaning. I often talk about the importance of the reincarnation literature in science to help support this bigger view of mind. The only way to really understand that reincarnation is to understand it's not some blind mechanistic wheel of suffering where you're trying to get off the bus, but in fact is directed towards oneness with the divine. I would say essentially for me it was very helpful to read the writings of Pierre Teilhard de Chardin who wrote in the mid-20th century. He was a scientist, a paleontologist, but he was also a French Jesuit priest and he wrote a book called The Phenomenon of Man, in which he kind of expanded on our notions of evolution. Beyond the simplistic version of material science of survival of the fittest. By the way, that misinterpretation of Darwin has actually gotten us into huge, huge trouble with this notion in our modern corporations and armies, and people, that you become dominant in this world by defeating and vanquishing your enemies. As opposed to realizing what most biologists recognize now that collaboration and cooperation are the keys to success in the biological kingdom. Dr. Alexander: That's something that we're coming to realize in this bigger sense of evolution that Teilhard de Chardin spoke of. Which is that all of consciousness is evolving to what he called an Omega point. He also labeled it a Christ consciousness, but I would say it is a world of harmony and peace where we all acknowledge that we're in this together. That if we hurt others, we're truly hurting ourselves. There's not a deeper, more fundamental lesson that comes back from the who world of near death experiences, but it's one we can all benefit from learning. As I said a few minutes ago, the gift of desperation can be very powerful to help turn one around to avoid that bottom and to reunite with the soul we truly came here to be. I would say that all the hardships and polarization and conflict we see in our world today are actually a beautiful gift of desperation. Dr. Alexander: That in fact, it is now time for us to acknowledge the ecological crisis of climate change is absolutely undeniable, and every year it gets more and more impressive, even to the numb-minded who deny the scientific evidence. It won't be long before everybody will be realizing this is a horrific devastation that we must avoid, we must start getting off of fossil fuels now. We need to be responsible for this climate. This gift of desperation comes at just the right time to help us make all of these major corrections. To realize that all the war and conflict in this world has never done any real good for humanity at all. That in fact, we need to rise above it, there should be an end to all such war and violent conflict because it never gets us where we want to get. We need to open our minds tremendously, and that's where this awakening in consciousness and evolving notion of spirituality is both goal and purpose directed, and built on a principle of oneness of soul and mind. Dr. Alexander: This is the world we face today, and I believe I can be very optimistic about where I think it's headed. Dr. Leeds: For people who think that near death experiences are rare, you've mentioned the fact that in recent decades there's more near death experiences than ever before in history because medical science has progressed, and people are able to be resuscitated after being dead, where that wasn't possible in the distant past. Dr. Alexander: Right, that is no accident, by the way. Dr. Leeds: Yeah. Dr. Alexander: The universe did that on purpose. In the late 1960s doctors developed ways to resuscitate cardiac arrest patients. So before that time, it was very rare to have people get that close to death and come back. Basically, we had 5000 years of a world where you would have the occasional prophet or mystic who had taken such a journey, and they would come back and tell their story and try and help people to get onboard with it, but it was always a question of do you believe what that journey, or that mystic, that prophet says or not. But the good news is now this whole revolution is actually strongly based in science. The science of consciousness is what is supporting this gigantic shift in our understanding that will be revolutionary. It absolutely goes far beyond the Copernican revolution, where Nicolaus Copernicus basically moved the center of mankind's view of the universe from the earth to the sun. Very revolutionary, and something the church did not like. Dr. Alexander: But in fact, I think the revolution that's on us now about the primacy of mind, and the power of mind over matter is going to absolutely revolutionize humanity, all in a much more positive direction that what we've faced so far. Dr. Leeds: I think that's the incredible thing about your story is that when we hear these kind of things coming from different people, you wonder where is the science behind it. You're providing a continuity with traditional science moving forward, because you have a history. You're a medical doctor, a neurosurgeon, a scientist, and so you bring credibility and also continuity with the research. You've done studies, you've made sure that your experience was thoroughly documented and kept very pure. You've done extensive research, you talked about hundreds and hundreds of people who've had near death experiences. This isn't just something that's in the fringe literature, this is in peer reviewed medical journals, so it's not something that's rare or unknown. This is very solid, real scientific stuff that's out there, and people can research it and learn a lot more about what has happened. These things can't just be explained by brain chemistry and that sort of thing. Dr. Alexander: Absolutely, that's a very important point, and I would also say I often mention this revolution depends not just on the neuroscience of consciousness and philosophy of mind, but it depends quite heavily on quantum physics. When you think about it, physics is looking at the physical world around us, and understanding what are the natural laws that govern the workings of that physical world? What happens is as you examine physics more and more deeply, and this is what happened in the 20th century, you start finding that you cannot connect the dots as well as you would like to. In fact, if you try and pretend that the observing scientist is separate from the universe they're observing, you find, no, no, no, that's not the way it works. Every bit of reality is manifested as it presents through the prism of the mind. The mind is what ultimately governs all of this. Dr. Alexander: This is something the founding fathers of quantum physics tried to tell us. Like Werner Heisenberg and Erwin Schrödinger, and Wolfgang Pauli and others. They said consciousness is fundamental, it's not derivative from matter. They were very adamant about that. That is what has turned out to be the case. The interesting thing about quantum physics is it points out that there really is no reality until it's observed in the level of mind. In fact, those who kind of doubt this and wonder about it, I would steer them to a beautiful one-page essay that was written by Richard Conn Henry in the scientific journal Nature back in 2005. It's called Mental Universe, and he makes it very clear, he was the head of astrophysics at Johns Hopkins University. So no slouch in modern science, physics, cosmology. Dr. Alexander: He made it very clear in that one-page essay that quantum physicists were coming to acknowledge that there is a top-down organizational principle in this universe. Something that David Bohm had hinted at in his version of the interpretation of the measurement paradox in quantum physics [inaudible 00:44:52] a mental pilot wave. But in essence, quantum physics has done progressive experiments since the 1970s that prove that the best model for how this all works is what is called metaphysical or ontological idealism. That's the notion that it's all mental at the outset. For those like me before coma, and certain physicists who still argue that near death experiences are nonsense, that consciousness has nothing to do with quantum physics, they are just ignorant of the work being done in consciousness. That's their problem. Dr. Alexander: In fact, when you look at the best solution that many of them can come up with to explain results of experiments in quantum physics, are to postulate a universe that at every choice point where a sentient being is making an observation, making a choice about seeing the universe, that every one of those choice points ends up leading to a separate universe. The universe splits every time, infinite parallel universes. It's called the many worlds interpretation. To this day, if you take a poll among physicists, it's their favorite interpretation of the measurement paradox in quantum physics. Yet it really is kind of nonsensical. Others have looked at well can we look at a many minds interpretation? Things like that. Dr. Alexander: I think ultimately what the experiments are showing now is that we're really dealing with that mental universe where the mind is controlling all of emergent matter. That's why things like placebo effect actually work, because mind over matter has tremendous power. As we go into meditation and come to realize we are not that little voice in our head, that little stream of thoughts, but that our awareness is something far more powerful than that, that has existed in previous lifetimes and will exist in future lifetimes, all in this journey of growth and furtherance of understanding. That can be a very liberating concept. Especially to one who is slave to that crazy little voice, the ego, with all those childhood wounds, and all those feelings of unworthiness. This is about reuniting with your higher soul, which is on a far grander mission than all that. Dr. Leeds: Yeah. Definitely. It's interesting when you look at the history, when you talk about things that happen for a reason. In the mid-20th century there was the ... Suddenly the psychedelic drugs went from being something that were found in cactus's and shamans out in the desert were using, to suddenly Timothy Leary, Harvard professor, comes in contact with LSD and suddenly people are exploring consciousness with the aid of drugs. You know, the psychedelic drugs get out there, and of course get squashed by the government because anything that's chemically induced is not allowed. Dr. Alexander: Except alcohol of course, which they love. Dr. Leeds: Yeah, yeah, which you know ... So that kind of came and went. But interestingly, Timothy Leary later in life said that the future of expanding consciousness is not going to be drugs, it's going to be technology. He talked about cyberspace and virtual reality. He was talking about that decades before now when we're finally seeing actual virtuality is something workable. It's actually becoming usable. But interestingly also around that same mid-20th century time period, I think in the late 30s, early 40s, binaural beats were discovered. Or the idea, I forgot the guys name, Wilhelm something, the idea- Dr. Alexander: That was actually back in the mid-19th century. Dr. Leeds: Oh wow. Dr. Alexander: Wilhelm Heinrich Dove, was his name. Dr. Leeds: Oh, so even a hundred years before. Wow. Yeah, so the idea that you could have a tone, very close tones playing in each ear, and your brain perceives the beat, the lower frequency. I'm thinking like maybe say of a 400 Hertz frequency and a 410 frequency this side, your brain hears that 10 Hertz beat. Dr. Alexander: Exactly. Very important point, and I think just to amplify on the point you're making, every sound we've ever heard, every symphony, every chant, anthem, hymn, what have you, has been processed up here in the neocortex, in our acoustic cortex of the temporal lobes in circuits that have really developed in the last one to 10 million years, by and large. Contrast that with the effect of Sacred Acoustics and these binaural beats, they are actually influencing a circuit in the lower brain stem, the superior olivary nucleus complex that evolved more than 300 million years ago. From my point of view, this is one of the fundamental reasons why these differential frequency sounds can be so extraordinarily powerful and liberating transcendental states of conscious awareness is because they're impacting our consciousness way back in time from an evolutionary standpoint, and that's a general principle in evolutionary biology. Dr. Alexander: Is if you want to really get to know a function and how it works, follow it back in evolutionary time to its origin. That's what we can do by utilizing these kinds of sounds that affect the lower brain stem. I believe that is why they engender such an extraordinary kind of liberation. They set our conscious awareness free basically by monotonizing the information process going on in the neocortex, and helping us to step out of the illusion of the here and now. Dr. Leeds: Yeah, so in the past scientists have used these fancy sensory depravation tanks, you know, floating in salt water in a dark tank. Which is kind of a scary and extreme process, but we don't have to do that anymore, we can just put headphones on and lay back in bed and ... Now my favorite, I love Sacred Acoustics, I've been using the recordings, and my favorite, and I don't know if everyone has a favorite, my favorite frequency is the theta programs. I mean those are just my favorite, going into that maybe between four to six hertz, 6.3 hertz, and it's very meditative. A lot of times I just fall asleep at the end, but I usually have these really vivid dreams. Right before I fall asleep I go into, I guess, a hypnogogic state where I hear voices in my head and stuff. Dr. Alexander: That's what theta is all about, is that's where we live, that state of hypnagogia, or halfway between awake and asleep, is that theta range, a very hefty dose of it. In fact, my oldest son, Eben the 4th who just finished medical school he listened to theta for several hundred hours while he was studying for the medical boards part two, and his percentile ranking in that test went well above what it had been before, which he attributes to his listening to theta while he was studying. I know other people have used it for all kinds of things. I think it can be a very healing frequency, and it's very good background. I listen to forms of theta a lot. Dr. Alexander: So I highly recommend it. Again, you don't have to use these tones for sound journeys and meditations, cosmic womb is especially good background, that's a Sacred Acoustics title for pretty much any activity where you want to enhance your thinking, artistic creativity, what have you, I would highly recommend people try that one out. But you're right, people do find favorites. The good news is my iPhone is absolutely loaded, not just with the current Sacred Acoustics offerings, but with a lot of the other ones that never went all the way to commercial product, and yet are very powerful. I mean Kevin and Karen over the last- Dr. Leeds: Oh wow, so you- Dr. Alexander: ... nine years have put out a prodigious amount of very powerful and a mind-bending binaural beat and tones. Now I would just add though that Sacred Acoustics goes far beyond anyone else I know who produces binaural beats, and also a warning, never take binaural beats say from YouTube or off of an iTunes account assuming that they're going to have full power, because the devil's in the details with these, the tones, and the real power of them is in all the frequencies being available. Unfortunately in the modern era, especially with people acquiring such audio files from YouTube and other sources, that insist on compressing the files, what you get is not strong enough, much of the power signal has been stripped out of it. So I would encourage people, go to Sacred Acoustics website, SacredAcoustics.com, you'll learn a tremendous amount more there and have some beautiful free teaching videos on there. But they talk about all kinds of things from how to get into deep meditative states, to the best way to transfer these files so you don't lose any of the power of them. Dr. Leeds: Yeah, now I think I remember seeing one, I don't remember where I saw it, if it was on the Sacred Acoustics website, but there was something about a recording that could help to promote astral projection. That one intrigued me, because it's kind of something I've always been interested in, and I think I've even read that it's like maybe even a dangerous thing. Like you have to be careful if you leave your body to maybe not go too far, or not do it if you might be physically disturbed. Is that something, a state that can actually be induced by- Dr. Alexander: I would say yes, it is a state that could be induced, and the important thing to remember as you start, Karen is an excellent teacher about all this, and that's why I encourage people to go look at her free training videos on the website. But she starts by really kind of addressing the heart. I mean the first thing you've got to realize is for one thing, our notion that mind is stuck inside this brain, and is not part of this bigger mind, we need to let go of that assumption, but that we can do in meditation, readily enough. But then a very important thing is acknowledging that you're going to encounter, as you start visiting these bigger realms of mind and spirit, you're going to start encountering that baggage that you built up around your heart since you were a young child. Dr. Alexander: Those baby wounds, as Karen calls them. Like my being abandoned by my mother at age 11 days. That was a little baby wound that actually was giant, and it got in my way for a lot of things. Acknowledging it was a first step. But then there's the potential for release, and that's something Karen is an expert at teaching. Is that ability to release some of those hardships from the heart. Then people can really go deep. There's no cause for fear once you have freed yourself of those egoic kind of baby wounds, and those misperceptions about self and relationship with the universe. From that point on, there really is nothing to fear. People want it to be all hearts and pink flowers and all that kind of thing, and no, that's not ... Like my earthworm's eye view is a stage that I can learn to embrace. Dr. Alexander: But I do that by knowing that ultimately the most powerful force in this universe is one of infinitely healing, unconditional love. When you go into the spiritual space with that kind of knowing, and it's something that you build up the knowing as you go along, there really is nothing to fear there. It's all about learning, teaching, growing together, and helping other souls. That's really kind of the highest value here is to help other souls. So it really is a gift all round to have this kind of awakening, and to start exploring these mental realms. Dr. Leeds: One issue, when I see patients and they come in for medical treatment for addiction, the medication we're using is usually diprenorphine which is great to get people into a state where they're not suffering from the withdrawal and the cravings and obsession, you know, the physical ... I mean a lot of those symptoms are mental, but they're really physical. You know, the things that can [crosstalk 00:56:50]- Dr. Alexander: They're everything, and they're also, as I said earlier, physical, mental, and emotional health is fundamentally spiritual. In many ways they have to do with a disconnect from the universe. What we're trying to do is reestablish the strength of that very natural birthright of a connection with the formative powers of the universe. I think another point to make along these lines of addiction studies, I do not recommend the use of psychedelic drugs like psilocybin, DMT, LSD, on a casual recreational basis. Because if you have any kind of emotional and mental instability they'll really kick you off the edge of a cliff. But under the proper therapeutic intervention they can be very powerful. For example, work with psilocybin is now showing it probably to be one of the most powerful drugs ever studied to alleviate the symptoms you're talking about. Dr. Leeds: Yeah. Dr. Alexander: Withdrawal crisis in opiates, in nicotine, which is one of the most addictive substances known to man. Alcoholism, things like that. So work with psilocybin in a proper therapeutic setting in just one session can be enough to greatly diminish or eliminate the kind of symptoms you're talking about. I know Karen may have told you about a colleague of ours who's in an addiction specialist out in Utah, who himself had recovered from Fentanyl, he almost died from opiates, but one of the things he does to help stabilize his patients when they first come in in the throes of withdrawal, is to play the Om file, the Sacred Acoustics Om file. And give them 20 minutes of calm down. He says it's amazing how powerful even that simple step can be to help kind of blunt these symptoms. Allow them to start connecting with the universe in ways that are much more natural. Then just building on that with meditation and centering prayer. Dr. Leeds: Yeah, and like psilocybin I've heard that ibogaine is being used in other countries. It's not legal here, but some countries have these ibogaine clinics and people will go on a psychedelic three-day trip. One patient had told me a story of going to one of these clinics and said it was a very unpleasant experience, but the patient came out of it without any feeling of having been addicted to the drug that they were addicted to previously. Maybe now with psilocybin being decriminalized in Colorado maybe that's a step towards at least the possibility of it being researched further and maybe used clinically, at least early study. Dr. Alexander: Well I hope so, because the studies look very good at this point. You know, these are challenges that we've not done very well with in the past. The 12 Step program has been successful, but even they will tell you, the recidivism rate is well over 50%, it's still a very dangerous set of circumstances. What I would say is the reason the psilocybin works, and the reason these kind of meditations work is very simply by getting in touch with that primordial mind. The ultimate creative and evolutionary force of the universe, realizing that it is part of us. It's part of our very awareness, and that we can actually use that to grow tremendously, beyond the hardships of addictions and alcoholism, and all the kind of petty problems that our ego throws at us. So in his book Dark Night, Early Dawn Christopher Bache, B-A-C-H-E, actually compares head-to-head his work with high dose LSD for spiritual journeying, and the use of binaural beats. Dr. Alexander: He had kind of an earlier form, not as powerful as Sacred Acoustics, in my view, that he was using. But he came down saying in that book, Dark Night, Early Dawn, that in fact he got as much, if not more progress using the sound than he did the psychedelic drugs. I would say they're opening similar doors, but the drugs create such a big splash that I think it's safer and more effective to do it through sound. If you use differential frequency sound on a regular basis, I do it an hour or two a day, and I've been doing that for more than nine years, I assure you that in many cases it will have tremendous benefit by connecting with that all-powerful primordial mind. Dr. Leeds: Yeah, and there is some concern out there, I've read some articles where people are calling binaural beats a digital drug and they're concerned about ... I think the bigger concern is not so much the binaural beats and the sound programs themselves, but where they're coming from. Like you know, you talk about YouTube and I've seen these ones where they connect the ... The title will connect the sound program to a specific drug. Like get the DMT experience, get the LSD experience by listening, and it's kind of like I tell my patients, don't take anything off the streets. Kind of going out to these YouTube channels and putting on headphones is kind of like taking something off the streets. Especially when they start connecting it to drugs. When someone says, "Get the Adderall effect, which is probably not a good association, especially for the recovering addict. Dr. Leeds: So as far as these sound programs, is there any risk though, I mean when a person puts on headphones and listens to binaural beats is there any concern about any adverse effects from it? Dr. Alexander: Well I think there are some people who just find it uncomfortable. They'll listen and they might feel some heaviness in their heart or something, which I would assume is they're just beginning to get at that emotional baggage that they're going to be able to release. But for some of them, they feel like that's too much to deal with, and they'd rather do it some other way. So it doesn't work in everyone, although it's amazing to me how many people it does seem to work in. The other point I'd like to make is in many ways, the Sacred Acoustics art is kind of like training wheels. The more you use it, the more your mind starts to live in that theta state of, I don't want to label it with an EEG frequency, but for me, I know it's a theta state because we've measured it. Dr. Alexander: But you really your whole mind starts to develop in a way that's very positive. So that you start to live this life of oneness with all others, and of compassion and mercy, of forgiveness. They just become natural, gratitude is in every breath. So that's just part and parcel of what happens. So it's not like I view myself as having to listen to Sacred Acoustics to get this fixed. I use it really to kind of help me further evolve my relationship with the realms that I first discovered in my NDE. Again, you don't need to die or almost die to get this. As a conscious, sentient being we all have the power to do that. That's why I would encourage people to do so, and also for any of your listeners who want to learn more about this, but really don't have any money to spend on it, I highly encourage you go to EbenAlexander.com and on the welcome page is a banner that wiggles in your face. Your 33-Day Journey Into the Heart of Consciousness. Dr. Alexander: It's a 33-day email course that presents 33 of the main concepts of our book, Living in a Mindful Universe. This course has been taken by more than 8000 people around the world. It has a translate button, so people from all over the world, all different languages are participating. On each of the 33 days they're leaving comments, helping each other, leaving experiences. It's developing into this rich community of like-minded souls who are waking up to this much bigger reality of how we influence the world. You don't have to spend one penny. Just go to EbenAlexander.com, join on that 33-day course, and you are off and running. Dr. Leeds: That sounds great, because I know any course I've taken one of the biggest values that comes of anything of those sort of things, is the community. You know, connecting with a community of like-minded people. So that sounds really good. Dr. Alexander: It's very good. Dr. Leeds: You know, what I was getting at with when patients they come into treatment, they're kind of programmed to ask for medication for everything. They say, "Doctor, I can't sleep, can you give me a sleeping pill? I'm anxious, can you give me an anxiety pill?" So these sound programs they're like an incredible alternative. Dr. Alexander: They can be very, very good at that. A lot of people, in fact Sacred Acoustics has some products specifically for sleep, and one specifically for naps, and for people who have trouble with sleeping or want help with a quick nap, I would encourage you to go to Sacred Acoustics and check out those particular products. But there's a whole host of other things. Karen has a beautiful page on her website, "I want to ..." and then it has all the different things, creativity, reunite with the soul of a departed loved one. Enhance my immune system, or relieve stress, or hypertension. Things like that. She has pathways to all of that, so I would encourage people to visit SacredAcoustics.com, and follow the pathway she suggests. It's very, very powerful stuff. Dr. Leeds: I understand that there's a study about to be published, like a scientific study in a reputable peer reviewed medical journal, a study of Sacred Acoustics being used in clinical practice. Dr. Alexander: There is, it's a study that was done in conjunction with Dr. Anna Yusim, Y-U-S-I-M. She's a psychiatrist in New York, a brilliant psychiatrist, she wrote a beautiful book called Fulfilled. This book is one of the best books I've ever read on psychiatry and spirituality. It's a very powerful book. But anyway, yes, that study will come out, I believe it's in October, so this month, The Journal of Nervous and Mental Disease, I haven't even checked yet, but it basically showed that Sacred Acoustics gave about a 26% improvement in anxiety and depression symptoms in patients of Dr. Yusim's in New York City. That was compared with I believe 9% in control. So a tremendous boon by adding these tones, beyond the typical talk therapy, in alleviating anxiety and depression. Dr. Alexander: We have other pilot studies we're working on, we're trying to get Sacred Acoustics out into hospice centers to help induce episodes of terminal lucidity, and also potentially shared crossings. That is a near death experience, but happening in a loved one at the bedside when a dying family member crosses over, shared crossing, is actually with the soul of the bystander going along. Even to the point of witnessing a full-blown life review and then coming back to this world. These are well-described events that occur. What we're looking at is in the hospice setting, and we enhance their occurrence, and the strength of the spiritual lessons that people are able to bring back through the use of Sacred Acoustic tones. So there are several other ways we're looking at using Sacred Acoustics to really help, and do the scientific studies to prove their utility. Dr. Leeds: Okay, great. So thank you for joining me today, I really appreciate it. I want to encourage the viewers and listeners to go visit your website, EbenAlexander.com to visit Sacred Acoustics. It's SacredAcoustics.com, right, for- Dr. Alexander: Correct, yes. Dr. Leeds: ... their website. I encourage people to take the 33-day course. I appreciate it. Just one final thing, so people watching who might right now be afraid, they're afraid of death, they're afraid of walking out their front door. In your experience, would you agree people really have nothing to fear at all? Dr. Alexander: There is nothing to fear. It is actually shocker, because as opposed to everything blinking down to nothingness, it's actually an awakening to a far grander, richer world. Reuniting with our higher soul, and soul roots, going through that life review. I mean the only thing to be careful of is if you spent your whole life handing out a lot of pain and suffering, your life review might not be the most pleasant experience, but it's one that will build you up, and help you to grow stronger. The universe is very fair. We reap what we sow. Why anybody would think differently, I don't know. But that's what the life review is all about. There really is nothing to fear when you go into it with a heart full of love and compassion for others, and knowing that this is all about the higher good. You have nothing whatsoever to fear about dying. But it's certainly not the oblivion that materialists mistakenly promise you from their lack of experience. Dr. Leeds: Thank you. Thank you, Doctor. Thank you for joining me today. Dr. Alexander: Thank you very much, Mark. Great talking with you, hope to talk again soon. Dr. Leeds: Thank you for joining us today on the Rehab, on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to the Rehab podcast, and share on social media. I appreciate you taking the time to listen to the Rehab. ### Caught in the Crosshairs of American Healthcare by Lloyd Sederer, M.D. URL: https://therehab.com/caught-in-the-crosshairs-of-american-healthcare-by-lloyd-sederer-m-d/ ## Caught in the Crosshairs of American Healthcare by Lloyd Sederer, M.D. In celebration of this landmark book's upcoming release in 2023, I am updating this page, which is a transcript of my podcast interview with Dr. Sederer about addiction treatment in America, and in New York when he served as Mental Health Commissioner in the Bloomberg administration. ## A Transcript Of My Conversation With Dr. Sederer, Psychiatrist, Public Health Expert, And Author. _In this podcast episode, I speak with Dr. Sederer about a variety of topics. We discuss psychedelics for depression and how they might help in treating addiction. We also discuss[Suboxone]( "Suboxone Podcasts") medication assisted treatment and the importance of [naloxone]( "Naloxone Podcast") harm reduction and how it can help people who overdose on addictive substances such as [heroin]( "Heroin Addiction Recovery Stories Podcast") or [fentanyl ]( "Fentanyl Addiction Podcast"). Do you know why people become addicted? How does the reward center of the brain work and how does it relate to different types of addictions? To learn more, please read, or [listen to the episode here. ]()_ _We start out by talking about Dr. Sederer's new book, "Ink-Stained for Life," which is a memoir that includes 14 stories about growing up in New York paired with 14 essays that connect each story to the present, providing a narrative arc between events in the past with later outcomes that may have seemed unlikely._ _In addition to this episode being published on the Mental Health News Radio Network, I have also published it to YouTube on my official channel,[LeedsTube.com](). Some time stamps below are also links to the corresponding location in the recording published on YouTube. If you do click on these links and visit the YouTube version of this interview, please click or press the "like" button and the "subscribe" button. I appreciate your support. Thank you._ [spreaker type=player resource="episode_id=42230546" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] [[00:00:03.240] - Mark Leeds, D.O. ]()Welcome to The Rehab Podcast. [00:00:05.370] - Lloyd Sederer, M.D. It's great to be here, Dr. Leeds, it's an honor to speak with you. [00:00:11.190] - Mark Leeds, D.O. Thank you. So, Dr. Lloyd Sederer, you've been working in public health for about two decades now. In New York at the state level. You've worked at the city level. And, previously, you worked at McLean Hospital, which is the psychiatric teaching hospital for Harvard Medical School. And, I believe that was 1989 to 2000? [00:00:31.560] - Lloyd Sederer, M.D. Yes. [00:00:32.160] - Mark Leeds, D.O. And, you were the psychiatrist in charge. You rehabilitated the whole program, got them up to date for managed care. I just read your new book, "Ink-Stained for Life", which is a memoir of your life, going back to, I think, is it the ages of eight to 17 years old? [00:00:48.150] - Lloyd Sederer, M.D. Yes, it is. But each story, I tell 14 stories, but I match, or pair, each story with an essay on the theme of the story. The story might be about family. It might be about family business. It might be about running away from home. It might be about gambling, rich people, Jewish people. So, I write an essay developing the theme and relating it to 20 20. [00:01:16.680] - Mark Leeds, D.O. That's one thing I like about it. When I first picked it up and said, oh, this is going to be about your childhood, I wasn't sure if it was going to be a book I was going to enjoy reading, but as soon as I got into it, I really enjoyed it. And you do bring things back to the present. You talk about addiction. You talk about, like you said, rich people and Judaism. And, I think there's a lot in there for a lot of people. I would recommend this book to anyone. Anyone in the medical field, anyone who's a doctor or resident, medical student, thinking about going into medicine. I would recommend it to people who are addicted or have family members who are addicted, or people interested in what it's like to grow up in New York in the 50s. There's so much in there for a lot of people. I think pretty much anybody could get a lot out of the book. It's almost like sitting with you, and you being a mentor or a friend and getting your life story and history and your opinions on things, your philosophies. I love the story about the chicken farm. There's just really so much great stuff in there. You know, people interested in public health and why we really need public health and good people running it. I mean, it's just it's just so much good information in there. [00:02:16.880] - Lloyd Sederer, M.D. It's very kind of you. I also hope it will demonstrate, if people read it, how improbable my future was. Eight years old, I was this skinny, nervous, shy Jewish kid in the Bronx. And as you describe in the beginning, I've had a lot of jobs, really great jobs. So it's an improbable leap from eight years old to recent decades. ## How to consume shrooms. Could psilocybin be part of the treatment plan for substance abuse in the future? _Are shrooms legal or are shrooms illegal? Currently, the drug psilocybin, the active ingredient in a particular variety of mushroom, is not legal in the U.S., but that may be changing soon. A synthetic form of the drug has been studied extensively and shows promise in treating a variety of mental illnesses, including addiction. Imagine going to the addiction specialist for psilocybin-assisted treatment with mushroom capsules or sublingual strips. In this segment, Dr. Sederer explains that while psilocybin and ketamine are promising new medication-assisted treatment drugs, he is not at all a cannabis advocate._ [[00:02:45.840] - Mark Leeds, D.O. ]()And you've had a lot of really interesting life experiences. And I definitely want to talk about addiction and your experience in treating addiction, helping people with addiction. One interesting topic, you did talk a little bit about the use of of psychedelic drugs in the treatment of addiction, maybe for other mental health disorders. People have asked me about it. Now we have legal marijuana everywhere. And marijuana feels like when they say that if you have one tool, you have a hammer, everything looks like a nail. And they say it's good for everything, but there's definitely dangers. And maybe it's not as good as they say. But we have these psychedelic drugs that, they tried them in the 60s, and there werer Harvard professors and psychologists studying them and some good things being done. And then, suddenly it just got out of control. [00:03:30.470] - Lloyd Sederer, M.D. First, let me make a comment. I am not an advocate for widespread access to cannabis, to marijuana, because of its effects on the brain of young people, teenagers, young adults. Their brains are under-construction. It's a really potent drug. It's 60 times more potent than the stuff I smoked in college. So, I think we have a lot more to learn about cannabis and about quality control and limiting access, particularly to young people. But I am an advocate for one particular psychedelic drug, psilocybin. I am because psilocybin has been studied very rigorously in the Imperial College, London, Stanford, NYU and others. And, it was used first with patients who were facing their death. They were terminally ill with cancer, and they were also in enormous emotional distress facing the end. And the first cohort was five hundred people treated with an 80 percent improvement. Namely that that fear of facing the end went away, and it was replaced by a sense of, life is continuous. We are part of a larger universe, a much more comforting way of thinking about our moment on Earth and subsequently. Another thing about it is that it is safe when administered properly, which is namely synthetic psilocybin. Therefore, no contaminants, in a safe place with an experienced guide, and one or two trips do the job. So it's not just the trip, which is maybe six hours. It is in perpetuity, months and months and months, a year later, that the effects of altering a person's view of their life and therefore, what stress they feel. It persists. [00:05:38.340] - Mark Leeds, D.O. And that makes sense. There's a lot of spiritual philosophies where they talk about having a connection with the universe, or the universal mind. And and how thought is the problem. All of our problems come from our thoughts. And, it's easy for someone to sit down with a patient and say all these things. But, if someone is in active addiction or just coming out of it, it may not be easy to focus on these concepts and really understand what they mean. [00:06:01.620] - Lloyd Sederer, M.D. This is one treatment sometimes, two, and it works immediately. And we're all disposed to treatments that are quick, safe and effective. And that's what psilocybin is and it's been around for a long time. Thousands of people have been given it, and I think it may well be a big step forward for addictions and for other terrible states, refractory depression, OCD. [00:06:30.930] - Mark Leeds, D.O. And, another one you've talked about is ketamine, which is a different kind of drug, a disassociated anesthetic, used as an anesthetic for humans, for children, in fact, in the E.R., and has been proven effective in treating depression. [00:06:44.850] - Lloyd Sederer, M.D. Yes. And now ketamine is available as an inhalant, not just as an infusion. And, so it's become quite popularized. And there are many clinics, I imagine, in Florida, certainly in New York, where a person can go and receive it under the care of a physician. But, it's not without its side effects or ill effects, like you're saying, that some people become quite dissociated during and after it. And, it can be habit forming because it is that kind of drug. People have this extraordinary experience of energy and engagement with the world, and the first experience blows people away and it's hardly ever obtained again. ## Medication-Assisted Treatment _Next, we discuss medication-assisted treatment of opioid addiction with methadone,[buprenorphine]( "Buprenorphine Podcast"), and [naltrexone]( "Naltrexone Podcast"). While each of these three treatment drugs has its place, buprenorphine, the active drug in Suboxone, seems to be the best in terms of safety and efficacy. The problem is that there are not enough buprenorphine doctors to meet the needs in many areas. Dr. Sederer, during his public health career in New York, was able to implement policy that ensured that all mental health facilities worked with local Suboxone doctors to make medication-assisted treatment for opioid use disorder available to anyone who needed it. We also talk about Narcan spray, which is an overdose reversal treatment containing naloxone. Nasal Narcan administration saves lives, and it is important to make it more widely available and to provide nasal Narcan training to the public. If more people carried a naloxone nasal spray kit with them at all times, as Dr. Sederer does, we would have more opportunities to reverse overdoses and save lives._ [[00:07:34.150] - Mark Leeds, D.O. ]()From there, I wanted to ask you about, and I know you talk about this in your books also, about MAT, medication-assisted treatment, which mainly applies to opiate addiction, can also refer to alcohol addiction treatment, alcohol use disorder. MAT includes mainly three drugs. There's methadone, buprenorphine, buprenorphine being Suboxone and naltrexone, which is available in tablets and also Vivitrol, the monthly injection. Especially buprenorphine, since 2002, I think when they approved it and Suboxone became available, and Subutex, the widespread use has not been what we would have hoped for. There's a lot of fear, I think, of Suboxone being used and misunderstanding about it, but it definitely works in my experience. People who take it for usually at least a year do very well even when they decide to come off of it, and not everybody should come off of it. But people that do they tend not to have drug cravings when they come off. They do have significant opiate withdrawal symptoms that they have to deal with, but not the drug cravings. So it does seem that there's an actual healing occurring in the brain over that period of time that they're taking it. [00:08:40.030] - Lloyd Sederer, M.D. Yes, those are the three FDA approved medications and the first two are opiate agonists. They provide, they fill the opioid receptors, in some ways block it as well, with the buprenorphine. And the third is Vivitrol, which actually acts differently in that it prevents somebody from experiencing pleasure, so you can shoot up and you're just not going to get the hit from it. And that's also not been very widespread. It is a monthly injection. It's expensive. Not all insurers cover it, including Medicaid in many states. But, it is effective, and its effectiveness was proven, as you suggested, with alcohol as an addiction. It's a good drug. But, the one drug I want to add, I think may be the most important of all, and that's naloxone. Because people recover from addictions as long as they don't die from them first. And, what naloxone is, it's a reversal drug that, when somebody is going into respiratory arrest, it works immediately, saves lives, and it should be available on the counters, free in every pharmacy. And, New York City has tried to make it very accessible. And what's also important is that it used to be an injection, and even first responders, like firefighters, didn't like sticking a needle into somebody. But now it's a nasal spray and it works just as well. So, naloxone keeps people from dying while they're trying to get into recovery and stay in recovery. [00:10:33.700] - Mark Leeds, D.O. Naloxone is very important, and it's the rescue drug. A couple of years ago, we were talking about that it should be everywhere, on the walls where they have the automated defibrillators. Why not have naloxone there? And now, we've even talked about that it could be as common as hand sanitizer. You know, everyone could have it in their pocket or their handbag. The more of us that have it, the more chance we might save someone. [00:10:59.080] - Lloyd Sederer, M.D. I carry it in my backpack. [00:11:01.490] - Mark Leeds, D.O. You do carry it with you? [00:11:02.590] - Lloyd Sederer, M.D. Yeah. Two pack of nasal spray. [00:11:05.320] - Mark Leeds, D.O. That's great. I actually had a patient a while back that I had prescribed it, and I asked on a visit, the parents were there, and I said, "do you have the naloxone available?" And the mother said, "well, we have it in the house, but I locked it up because I'm afraid he might get to that and do something with it." [00:11:22.750] - Lloyd Sederer, M.D. If she doesn't understand the drug, she she batches it with others that are more addictive. [00:11:30.320] - Mark Leeds, D.O. And luckily, she understood after our conversation that, of all things, he's not going to abuse the naloxone. Luckily, it came out of the lock box, because it wasn't, within the year after that, they ended up using it successfully. And that patient is back on track and doing very well now. [00:11:46.180] - Lloyd Sederer, M.D. Yeah, I've not had a chance, thankfully, to use it, you know, in a shop or somewhere public. But, a friend of mine was in a Starbucks, also a doctor, and the bathroom door was locked and people were lining up and pounding on the door and no response. No response. So they got the owner, opened it and there was a man lying on the floor with a needle in his arm. And this friend squirted some naloxone in his nasal passages and he was revived. [00:12:18.010] - Mark Leeds, D.O. If someone is carrying naloxone and you happen to come across a scene like that, you're not going to hurt a person, giving them naloxone. So even even if you're not sure why they're there unresponsive, you can still try it. [00:12:29.530] - Lloyd Sederer, M.D. That's right. [00:12:30.610] - Mark Leeds, D.O. And it's really definitely important. I actually heard a story. From an E.R. about a patient that came in that had actually overdosed in the middle of an NA meeting. And so, in NA, those kind of meetings, they're not going to be responsible for having it, but members can bring it with them. [00:12:48.370] - Lloyd Sederer, M.D. In fact, many people who shoot up, use with other people, so it's a good idea, if you're a part of that world, for everyone to carry it, because you're not going to be able to administer it to yourself, but your buddy might, or one of the people in the room of an AA or NA meeting. [00:13:08.590] - Mark Leeds, D.O. Naloxone brings us to harm reduction, which I know you're in favor of. You've mentioned it in your books. Harm reduction, including naloxone, but also possibly including clean needle and syringe exchanges, supervised injection or supervised consumption sites where a person can go safely, use drugs under supervision. If they have an overdose they can be revived with a variety of methods, including naloxone. Another important thing, I actually interviewed someone on a supervised consumption site in Canada and they talked about how not only do they provide all these services, but they form relationships with the people that come in. [00:13:41.500] - Lloyd Sederer, M.D. Yes. [00:13:42.040] - Mark Leeds, D.O. And, that seems to be the most important part of it. [00:13:45.300] - Lloyd Sederer, M.D. That will help somebody get into recovery, get into treatment, stay with the 12 steps. It's always relationships. ## Harm Reduction and Risk Reduction Strategies. _While naloxone, available as Narcan nasal spray, is a major form of harm reduction that can help to people alive through active opioid addiction, there are other ways to provide harm reduction which are currently being used in other countries. Needle exchange programs do exist in the US, but they are very limited. For example, in Florida, where I live and practice medicine, we have only one such program in the entire state. For heroin users in Miami, the "IDEA Exchange" program protects them from the dangers of dirty needles, including an increased risk of HIV and Hepatitis. For users elsewhere in the state asking "where can I get clean needles near me?", they are not going to be able to find such a program in their area. In another episode, I interviewed Stephen Finley, who manages SafePoint, a supervised consumption site in British Columbia, Canada. Stephen Finlay is the manager of addiction services in the Surrey region for Lookout Housing and Health Society. British Columbia has allowed a variety of harm reduction strategies to be implemented, and they are proving to be successful. In this segment, I ask Dr. Sederer, as a public health expert, what are the chances of such programs coming to the U.S.?_ [[00:13:54.820] - Mark Leeds, D.O. ]()What do you think about that as far as the lack in the US of those? In Philadelphia, there was a case where someone was trying to open up a supervised injection site and the government was blocking, the federal government was blocking the opening of the site. Do you think that there's any hope that we're going to be like in British Columbia where they have all these different forms of harm reduction? Do you think that will come to the US? [00:14:16.360] - Lloyd Sederer, M.D. I don't think it's imminent. This country has certain fixed views, convictions about certain things, like opening a site for people to shoot up down the block. Moreover, the elected officials are really scared because, in a way, it's condoning the purchase of an illegal substance, because at these sites, a person has to bring their own stuff, their own drug, their own needles, so, which are illegal. So, the DA's and others oppose it vigorously because they don't want to be at risk for a federal suit. [00:14:59.470] - Mark Leeds, D.O. And, even in Canada and apparently Switzerland, they actually have medical heroin, prescription heroin. And, and I brought up, on this other interview, we talked about it and I said, well, that probably would help us a lot here, in getting people on Suboxone, because now that these contaminants in the heroin on the streets, whether it's fentanyl or some analogue to fentanyl or even some other kind of drug that's opioid-like that stays in the system for a long time, I've heard that maybe it's sequestered in the fat cells, but for whatever reason, they go twenty-four hours, like you would normally expect. They take the first Suboxone and they go into precipitate withdrawal, and sometimes even wait two, three, four or five days and they still can't start the Suboxone. And, it would be really helpful if we could put them on something known like a known opioid with a short half life and transition them. But we really can't do that. We can't use oxycodone. We can't use anything but those three MAT drugs. [00:15:53.130] - Lloyd Sederer, M.D. The closest thing is methadone. But also, it's methadone in the US, puts many people off. A daily observed treatment, you have to go wait in line for a drink while somebody observes, from little plastic cup. And everyday, go everyday. It takes a year or two before you're given a few days supply, especially with someone who may be working or trying to work. All those barriers, all those demands, put people off. [00:16:24.730] - Mark Leeds, D.O. There's a program, I think it started in 2015 at Yale, E.R. initiated buprenorphine treatment. And, it was very successful. And there's actually, I think, two programs in within a short distance from where I am, but I don't think there's a lot of these programs around the country and I don't think they're advertised in any way, that there's not any easy way for people to find them. Where someone goes to the E.R., the E.R. doctor gives the patient their first dose of Suboxone or buprenorphine, and then they're referred to a local clinic and they're able to continue treatment in most cases. I think that these programs are usually funded. So if a person can't afford it, all the treatment is covered from therapy, to doctors visits, to medication. And it seems like a really successful model. [00:17:05.080] - Lloyd Sederer, M.D. It's a great model. But, that transition from receiving it right away in the E.D., and the time to appointment at one of those clinics, and the very limited access of prescribers, doctors and advanced practice nurses who have the DEA approval to prescribe, it is very low. We did a study about that in New York in terms of trying to not only understand the presence of those prescribers, or those who are permitted to prescribe because they have the waiver, and those permitted to prescribe who actually prescribed. And only a small portion of those who are allowed to prescribe, prescribe. And, one of the things I did a little over a year and a half ago before I left, being the chief medical officer for mental health the state of New York, is I set as a standard requirement, licensing requirement for mental health clinics, to dispense naloxone, or to show somebody where they can get it for free, and to prescribe buprenorphine, which was never done. And, the reason we did it, I did it, was we actually looked at Medicaid recipients or a predominance of public health patients, and what percentage of them in their entire medical records, which we have as a state agency, either was diagnosed with an opioid use disorder or had taken opioids, had been prescribed in the registry in the past year. And about a little over 30 percent, one in three were in need of buprenorphine. So, we made it a standard and now we're trying to make it happen, and scale it up. And it's very slowed down by COVID as you can imagine. [00:19:04.980] - Mark Leeds, D.O. There is a program in Bangor, Maine. There's an article from two years ago, that they had spent a lot of time working on this program, getting it up and running. And it was very difficult, where they were determined to make one day access available for buprenorphine, that if a patient showed up for help, that they were almost guaranteed that they could start treatment that same day if needed. [00:19:24.780] - Lloyd Sederer, M.D. Right. Right. When I was in New York City in 2002, I was a mental health commissioner in the Bloomberg administration. And I worked at, one of my main campaigns was to introduce buprenorphine to people with opioid disorders in New York City. And it was extremely hard to get people to do it. And, one of the things that happened, as an unintended consequence, is that the black market started to sell it on the street when, at first when buprenorphine came out, I asked police chief, is this stuff being peddled on the streets? And he said, no, we don't, we haven't seen any instances, but a year or two later, it was sold on the street by drug peddlers. And, people bought it as a type of insurance policy, that if they couldn't get access to the dealer or the dealers didn't have drugs or the price was too excessive, or even if they wanted to reduce their dose to spend less money, they buy buprenorphine on the street. And, in some ways, that's pretty smart, if you know you're addicted and you know you may be cut off and how horrible the withdrawal will be, I think it should be accessible to people who are addicted and not all of these conditions and difficulties to get it. Buprenorphine is a life saver. And the point that you made earlier about at least a year of treatment is really important because some people think, well, a few months of this, six months of this. But, it's a year and a half that enables people to get off of it and stay off of opioids. So there's something about the longer term treatment that's different. ## Why is mental health so important, especially with respect to addiction? _Dr. Sederer speaks about the importance of identifying and treating coexisting mental health conditions when treating a person for addiction. We also discuss comprehensive psychiatry and what happens when seeing a psychiatrist. Psychiatric counseling is important and it helps patients, but the economic reality of our medical education system places an unreasonable financial burden on doctors, causing psychiatric services to be lacking when it comes to the amount of time a psychiatrist is able to spend with each patient._ [[00:21:16.110] - Mark Leeds, D.O. ]()The coming off of it is a difficulty. I think a lot of people are afraid of that, sometimes even afraid of getting started. I've had patients that have come off of buprenorphine and had a lot of difficulty and issues with long term effects of feeling, some depression, some opiate withdrawal symptoms of chills and aches. Some people have come off of it with very little problem, you know, a week or two or a month and a half. And that's an issue, one patient recently, and I'm wondering what to make of this. This patient, the family was concerned about a history of bipolar disorder. And, I know you talk a lot about that of comorbidities or coexisting conditions. The patient was started on a combination of an antidepressant and also Abilify, which is for bipolar, and then came off buprenorphine and was very successful, had very little withdrawal, like a week or two, was doing well and very happy. And, she felt good as far as not having the blocking of the opiate receptors, I guess, for long term use, that's one issue is you block the natural endorphin system to some degree and don't get the runner's high and those kinds of feelings. But in this case, I was thinking, was Abilify some kind of, maybe a wonder drug as far as helping people transition off, or is it just that she did better because the bipolar was treated a bit. It's hard to say, it's just one case. It's anecdotal, but it would be nice if there was some more research done in that area of helping people transition off of buprenorphine. [00:22:42.720] - Lloyd Sederer, M.D. Indeed, and your point about the fact that when someone has a drug dependence, frequently, they have a mental health disorder as well, and, to succeed, for that person to succeed, both disorders have to be detected and treated, in order for somebody to stand a chance. And in this case, this patient was treated for depression. And Abilify seems to be sort of add on drug for many conditions, not a good enough response with depression. People with a very troublesome impulsivity and self destructiveness, even some kids with ADHD, it sort of seems to quiet the nervous system. But it is an antipsychotic and it has a lot of side effects. And that's a concern, particularly with kids. [00:23:37.820] - Mark Leeds, D.O. Yeah, definitely not something that's going to be right for everybody. As far as psychiatry, in my experience, I took a month of a psychiatry rotation and I was really excited to learn about psychoanalysis and what psychiatrists do, and to be honest, in the area that I did it in Miami, a psychiatrist, in my experience and a lot of cases would see a patient for a few minutes, figure out what medications to give them. There wasn't a lot of talking, I don't think any psychoanalysis, but I know that that does occur. I know there's an organization, is that BPSI? There's an organization that teaches, I think, psychiatrists and other practitioners how to do psychoanalysis. And also, as far as MacLane, I had actually met someone that was a 12 step liaison at one of the signature programs there, and they mentioned that at that program, the residents of the rehab, if they're there for 30 days, every single day, they see a psychiatrist. And my thought was, if a psychiatrist is only handling medications. What do they need to see them for every day? But, do they actually get psychoanalysis, and therapy, CBT? Does a psychiatrist do those sort of things? [00:24:45.640] - Lloyd Sederer, M.D. Yes, but not that many psychiatrists provide any type of therapy, cognitive therapy, analytically oriented therapy. And, in some ways we've, as a field, been driven to do that. One, the supply of doctors who can prescribe is very limited. But second, it's an economic issue. So, if you are a doctor who spends forty five or fifty minutes talking with the patient, prescribing medication, maybe, if you work hard you may see ten patients a day and you'll make, a thousand dollars or twelve hundred dollars. It's not bad. But, if you have four patients an hour whom you prescribed medications to, and each one of those visits is close to what's paid for a forty five minute session, essentially you're quadrupling your income. And many young doctors, as you know, leave training with enormous debt, often two hundred thousand dollars or more. And many of them are living in cities that are very hard to afford living in. And, so there's the rent, they want a car, they have kids, they have to pay tuition. So, these doctors essentially can't afford to do what many people in our field like to do, which is to talk to people. They're driven to this by the economics. [00:26:21.390] - Mark Leeds, D.O. I can say in my experience that having the opportunity to spend an hour with a patient is definitely rewarding, it's definitely helpful for the patient. I feel like I've done more than just rushing into a room and out again. And you don't make as much money doing it, but you definitely feel better about helping your patients, having more time to spend with them. [00:26:40.600] - Lloyd Sederer, M.D. Yes, absolutely. And some people even change their field. There might have been a GI doctor, or pulmonologist. And they go back into training for psych residency because they want the opportunity to spend time with patients, talk to patients, not have eight patients in eight waiting rooms, and they want that experience of being able to form a therapeutic relationship and help somebody change the course of their life. ## The Sinclair Method: Using naltrexone to treat alcohol use disorder. _Naltrexone is a medication approved for treating both opioid use disorder and alcohol use disorder. It is an opioid receptor blocker that can be taken as a tablet or a monthly injection (Vivitrol). We briefly discuss TSM, an effective treatment for alcoholism that is gaining traction in the US._ [[00:27:13.680] - Mark Leeds, D.O. ]()I was wondering, are you familiar with the Sinclair method for treating alcoholism? It's using Naltrexone, but it's using Naltrexone, but the person continues to drink a small amount with the medication. [00:27:25.740] - Lloyd Sederer, M.D. I've heard of it, but I don't know beans about it. Well, tell us more. [00:27:30.240] - Mark Leeds, D.O. They take the naltrexone, a 50 milligram tablet, one hour before they're planning to have a drink, and then they restrict their drinking to half a drink or one drink or maybe at most two drinks, for example, a glass of wine. And then they stop. And, apparently the naltrexone, by blocking cravings, would help them to not drink anymore. And also, they call it pharmacological extinction of the craving over time. You know, you're kind of doing the end part of Pavlov's experiment where the dogs aren't getting the reward anymore, by blocking the opioid system. But the key part of it is, that they have to continue drinking a small amount, but they don't do it every day. They're not supposed to take naltrexone every day, only on the day they're going to have a drink. And then they're instructed for the rest of their lives, if they ever plan to have a drink, always take your naltrexone one hour before. [00:28:20.210] - Lloyd Sederer, M.D. Yes. It's a way of diminishing a person's response. So, it takes away the reward of the drink because their pleasure centers are blocked. So they may have, in the past, the more they drank, the more their pleasure sensors were activated, whereas here they have a minimal response and it doesn't get better because the drug puts a cap on that. And, that is a type of extinction as well. [00:28:54.360] - Mark Leeds, D.O. You've published, I think, 13 books total? And, you wrote a book two years ago, which is really great, I think also any doctor who treats addiction or any patient or family member should read this book. [00:29:06.150] - Lloyd Sederer, M.D. Can I show a picture of it? [00:29:07.710] - Mark Leeds, D.O. Oh, yeah, that would be great, if you could show the book. [00:29:10.630] - Lloyd Sederer, M.D. So here's the book. It's easy to recognize. It has a great cover, with all the pills. [00:29:16.680] - Mark Leeds, D.O. The Addiction Solution. ## The Addiction Solution: How to stop drugs. _In addition to "Ink-Stained for Life" and 11 other published books, Dr. Sederer has written a book specifically on the topic of addiction and addiction treatment, "The Addiction Solution." Here, we discuss this book and how different types of addictions and different types of substance abuse affect the brain and how specific therapies can target specific regions of the brain. We also talk about the stages of addiction that start with the stage where a person is not ready to give up drugs or alcohol. It is at this stage where harm reduction can be most effective. While addressing addiction's effects on the reward center is important, therapies can also target the prefrontal cortex as well as other regions of the brain._ _Specifically, we discuss cognitive behavioral therapy (CBT), contingency management, and spiritual peer support programs._ [[00:29:18.990] - Lloyd Sederer, M.D. ]()The Addiction Solution. Yes. [00:29:19.510] - Mark Leeds, D.O. And, I actually ordered, I the originally ordered the audio book, which is excellent. I could listen to it in the car driving. And, I liked it so much, I wanted to be able to take notes and highlight things. So, then I got the Kindle version and, I think that's important. You want to be able to look at it and be able to reference back to things, but both versions are excellent. [00:29:38.550] - Lloyd Sederer, M.D. Well, thank you. Thank you very much. The premise of that book, what got me to write the book, is my view fundamentally about substances. About drugs that change how we feel and think. And that is that, people use drugs because they serve them. They are useful to them. I've come to believe that that's where, we as clinicians need to meet people, understanding that they're doing this for a purpose. We're given to exhort people. "Don't you know, this stuff is going to kill you? It's ruining your family. You lost your job." That doesn't work at all, because they're having the experience of either pleasure from it, dramatic, and immediate reduction in pain, physical pain, mental pain. And, also drugs transport us, many of them, out of the everyday grind. So, there's a purpose being served and that's what needs to be appreciated. That's where the connection, I think, starts with a patient. That, "I understand we're doing this because it serves you and you're going to keep doing it until you find other ways that serve you in the same ways." [00:30:58.350] - Mark Leeds, D.O. And that's where harm reduction comes in. You talk about the stages of a person being ready and when their in that first stage, where they're not ready at all and you want to meet them where they are, at least you can put them in a safe place of: "here's, something that can save your life. We're going to keep that on hand, the naloxone. And if possible, here's a safe place where you can go use the drugs that we know you're not going to quit yet and form relationships with people that may help you when you're ready to quit." [00:31:23.640] It's so important that relationships, family, friends who care about you, not friends and family, who tear you down, make you feel better about yourself, but those that you care about and they care about you, AA meetings. These are support systems, and fundamental to a person tolerating the kind of demands that getting off drugs requires. [00:31:54.500] - Mark Leeds, D.O. People should know that you don't have to be drug free to go to a meeting, that you're definitely welcome to go to an AA meeting, NA meeting, sit in the room and listen. And, you could have used drugs that day. You might not even be planning to quit yet, but you are definitely welcome to go and sit there quietly and hear what they have to say and talk to people afterwards. [00:32:14.510] - Lloyd Sederer, M.D. Yes, that's, I think, a really good policy. I spent some time with a leadership group in AA a couple of years ago and what I discovered is that their numbers of attendees, it's pretty hard to collect because they're essentially independent entities with important privacy protections, but they have not, the number of people using 12 step programs, has not increased in two decades. Whereas we know that just population growth alone, no less, this storm of addictions that we're going through now, the numbers are greater, but they're not drawing more people. [00:33:03.350] - Mark Leeds, D.O. And, that's another interesting thing that you go into in your book, which I think is really interesting and critical for people understand, is that there's a lot of different kinds of therapy, and you even diagram the brain and talk about what kinds of therapy will work on different parts of the brain. And, for example, the meetings, the spiritual support, that works on the prefrontal cortex, the newer part of the brain that we have, and other animals don't have so well developed. And, the part of our brain that makes us different, maybe from a rat that keeps running back for more cocaine, that we can actually think things through and maybe stop ourselves. And, then you also talk about the reward center and different parts of the reward center and different kinds of therapy that work on those areas. It's really important that people know that there's a lot of different things they can do. Not just meetings, not just MAT medications. [00:33:52.710] - Mark Leeds, D.O. I try to emphasize by that tour of the brain, that graphic. Maybe you can put that up, or your producers can put that up, because there are four key areas, as you were mentioning, that allow us to intervene. And, addiction dependence is really a tough thing to quit. And, so if you enable these four different areas to quiet down, or to act more strongly, you've given the person comprehensive treatment. You've touched on their motivation. You've touched on their pleasure center. You've touched on their reasoning and judgment and also their hippocampus and amygdala, the memory centers, which are really important and responsive to CBT, cognitive behavioral therapy. And this is the example that you mentioned before, Pavlov's dogs. He taught the dogs to salivate to the bell rather than the food, and essentially demonstrated that we can change what people respond to. And one of the biggest problems with recovery, or remaining drug free, are cues which are bound in the hippocampus and very salient, very powerful. So, someone may see a drug deal going down. A friend may call them who is high. Prince dies. And, those cues are what trigger a relapse, someone may be not using for 10 years. And then there's this convergence of events, and maybe they're fighting with their partner, and a cue comes along and boom, the next day they're using as if those 10 years didn't mean anything. [00:35:47.060] - Mark Leeds, D.O. Have you heard of prescription digital therapeutics? Using an app on your phone to provide CBT and other forms of therapy? [00:35:55.190] - Lloyd Sederer, M.D. Yeah. For those people who can stay with it, it works. But, the retention rate is actually very low. Even if you get a prompt on your phone, it's time for the session or whatnot. It doesn't seem to hold people, maybe for a few sessions. But, retention is important and this is a chronic disease, a chronic relapsing disease. So, care needs to be ongoing. Not all the time, but regularly. And, someone needs to have the kind of care that they go to. [00:36:28.040] - Mark Leeds, D.O. One interesting thing about one of the apps I looked at, it provides another kind of reinforcement, which I don't think is CBT, and you do mention it in the book. On certain parts of the app when you get to certain points, they have you spin a wheel on the screen, and it's kind of like gambling. Spin the wheel and you might win an Amazon gift card. [00:36:44.440] - Lloyd Sederer, M.D. Right. [00:36:46.310] - Mark Leeds, D.O. Although I don't know if that's different. There's that were you spin the wheel like you're gambling and you get the gift card, and they say that lights up parts of the brain where you're getting that thrill of gambling. But then you also mentioned the treatment of actually paying somebody for being abstinent. [00:37:01.520] - Lloyd Sederer, M.D. This is called contingency management and it works. The problem is that a lot of regulators are, I think, myopic about this because they are morally opposed to paying someone to do what he or she should be doing. And, New York City, when I was there, the mayor wanted to have a program where mothers were paid to take their kids, poor mothers, single mothers, paid to take their kids to the pediatrician. And, the program was going to cost fifty million dollars. And the city council said we're not going to pay mothers to do what they're supposed to do. So we toss in $50 million. But it's still never got off the ground because there was, you know, people were still being stigmatized because they were being paid to do the right thing. But it works. ## The future of addiction treatment will be making what we already have more available. _In this section, we start out by discussing harm reduction again and the importance of making harm reduction strategies, such as naloxone spray, available to anyone who needs it and as often as they need it. We also talk about making treatment more affordable and more accessible. Part of the issue is the high cost of drugs, such as naloxone and Suboxone._ [[00:37:59.240] - Mark Leeds, D.O. ]()I think we need to look more closely at things that work, even if we don't agree with them. In British Columbia, Canada, there are areas where they have Dilaudid dispensing machines on the streets, biometric machines where you can get Dilaudid, which is intended to be crushed up and injected. And, it sounds crazy and I'm sure that will never happen in the US., But things like that are saving lives and keeping people from getting HIV, hepatitis, and maybe preventing them from getting endocarditis, heart valve infections. There are things that we might not agree with. Even MAT, a lot of people are against it. In fact, even Naloxone, there are stories of sheriff's departments where the sheriff says, we're only going to give one or two doses of naloxone and stop if that person keeps relapsing, and they really need to get it as many times as they need it, even if it's 10, 20, 30 times, or more. [00:38:52.170] - Lloyd Sederer, M.D. Yes. And, what's also under that reluctance is the cost. Because, those sheriff's departments, police departments, have to pay for the naloxone. And now with fentanyl, a single dose often doesn't do it. Two doses and then two more doses four hours later. So, the cost of administering, in some ways bankrupts these first responders. And, that's why it needs to be essentially covered, made possible free, particularly to first responders. So, that's not a factor. But it is a factor and needs to be fixed. [00:39:33.210] - Mark Leeds, D.O. And when it comes to drug costs, that was an issue with buprenorphine for a long time until, I think it was last year, the Indian company, Dr. Reddy fought Indivior, the maker of Suboxone, in court, and they finally were able to sell the generic Suboxone films, the buprenorphine/naloxone films, and now Indivior is being disciplined for restricting access to buprenorphine. I think part of that might have been that there was talk in the company about getting people hooked, which was a terrible thing to talk about, because people don't really get addicted to buprenorphine, they become physically dependent on it. But, a lot of issues with drug costs. There's actually a quote, and I don't remember where I saw it. I actually think it might have been Timothy Leary talking about LSD, where he made a comment saying, the drug is cheaper than water. And I think that's probably true of every drug. I think every drug is cheaper than water when it's made to scale. And it's not that the drug cost too much, it's just that they're charging too much. [00:40:32.490] - Lloyd Sederer, M.D. That's right. The profit margins. [00:40:35.520] - Mark Leeds, D.O. Naloxone costs, I think, one hundred fifty dollars for two doses at most pharmacies. And, it probably only cost pennies to make a nasal spray. [00:40:43.740] - Lloyd Sederer, M.D. That's right. Especially when it's made in huge volumes like you were suggesting. [00:40:49.020] - Mark Leeds, D.O. There's no reason why we can't all have access to it for free, maybe paid for by the government, or very low cost, maybe walk into a pharmacy and buy it for two to five dollars for a package or something. [00:41:00.750] - Lloyd Sederer, M.D. It's not just the profit motive, but also, many people think that this is bad behavior, taking drugs. They don't see it as a psychological, sociological, neurological disorder. They see it as somebody being bad or weak, and damaging their family, exploiting, stealing. And so, these are not people that they want to help. These are people that they want to be mad at, which, of course, doesn't work. It just drives people away. ## The super powers of a person in recovery from addiction. _While we should make addiction treatment available to all people suffering in active addiction because they are human beings, it is also important to note that addiction disproportionately affects high functioning people with a high level of intelligence and creativity. By helping them to overcome their addiction, they have the potential to do incredible things with their lives, including helping many other people._ [[00:41:42.120] - Mark Leeds, D.O. ]()Speaking of that, with people who are addicted, at least the patients that I've seen, tend to be people that have huge potential, they're not like your average person. The person who is susceptible to addiction is often very intelligent, very creative. Because, I think addiction uses those abilities against them and it's harder for them to break free of it. For example, I had a patient, which is a funny story, who's a very intelligent, high functioning guy that was using heroin, and his father came in with him. And, I was telling him that usually people who are addicted are very intelligent, creative, high functioning people. They get caught in addiction. And, he said to his father, he said, "Do you hear that, Dad? That's what I was trying to tell you." And the father just looked at me and said, "I never had a problem with addiction." And like, we just made our point. You know, you clearly are not in that category because it never affected you. And I've also compared it to, you know if you remember the old Superman movie with Christopher Reeve where they put the chain with kryptonite around his neck, that imagine if Superman wasn't wearing a Superman costume, and he was laying there, helpless with the kryptonite. If you saw him in a dark alley, you'd say, oh, look, it's a junkie. You know, he's probably high something, and not realizing he's Superman. And, I kind of see my patients that way. If you can take away this kryptonite, take away the active addiction, that these people are really capable of incredible things. They deserve to get naloxone if they need it a million times or get their MAT drugs. [00:43:09.240] - Lloyd Sederer, M.D. That's a lovely analogy of some guy lying in an alley, being wiped out by kryptonite and, who can be helped to stand up and contribute to society again, just like Superman. [00:43:24.990] - Mark Leeds, D.O. Doctors will get hooked and they have an incredible potential to help a lot of people if they can overcome their addiction. And, not just doctors. There's the politicians, there's artists, and people that have a huge potential to not only help themselves, they help a lot of other people. If we can just help them get past this active addiction, you just never know who that is lying on the side of the road, who needs our help or what they're capable of if we can help them get past this. [00:43:50.350] - Lloyd Sederer, M.D. Yes, yes. Naloxone is a little bit like the CPR that people learned if someone passed out on the streets, especially when it didn't require mouth to mouth. And a lot of people were saved by that, by random passers by, not by doctors who were there, or nurses. And in a way, that's where naloxone needs to be in terms of its standing in our country, other countries. This is the way to revive somebody, keep them alive. ## Public Health and Funding for Addiction Treatment. _Many people who need addiction treatment do not have access to care. There are programs around the country, often referred to as "pilot programs" that provide funded care to their communities. The problem is that there are too few of these programs, they are hard to find, and they do not have enough capacity to handle the needs of their communities. Even with the passing of laws in favor of improved addiction treatment and the promises of more funding, change has been slow in light of the ongoing opioid crisis._ [[00:44:28.320] - Mark Leeds, D.O. ]()Would you accept a position in national public health, helping the country, if you were asked by the new president coming in? Is there a place for that, for what you did for the state of New York, and the city of New York City, at the national level in the US? [00:44:43.650] - Lloyd Sederer, M.D. Well, of course, it depends on who the president is. But I think I'm done with government service and it's been a really good run for New York City and New York State. And the other thing, that even during those years that gave me pause about working for the federal government was that, there's a different horizon for change in cities, and states, and across the country. So in cities, you can do things and you can realize gains, make changes that appear within a year or two. At the state, it's three to five, and nationally it's five to 10. And, I'm too impatient, I think, for that kind of work. [00:45:32.400] - Mark Leeds, D.O. There was a law passed in 2018, just two years ago, I think it was the Opioid Emergency Response Act of 2018 or something like that. And, I actually interviewed somebody on the podcast about it. He was recommending that doctors, or the heads of medical facilities start applying for grants for funding, That this is going to be a great program to make a lot of changes. And, I don't know how much effect that that law has had, but at least I haven't seen myself, you know, a lot of programs coming up. Maybe they're out there, maybe they're hard for people to find. But, have you seen that that law has made any positive changes? [00:46:12.290] - Lloyd Sederer, M.D. I don't know about other states, but those grants are rendered state by state and New York State received, first 30 million dollars, and then I think another 15, I'm not sure. And, it was through the state agency for substance abuse, called Oasis, in New York. And they distributed that money to increase access to enable clinics to hire more doctors, to pay for naloxone so that it would be free and accessible. And that's visible. Whether it's going to make a population level change remains to be seen. But that's where it has to start. The money needs to go and be spent responsibly by some regulatory body that will ensure that the right things are purchased for the money. ## Ink-Stained for Life. _In Dr. Sederer's new book, "Ink-Stained for Life," he tells stories of his childhood, growing up in New York in the 1950s. There are many great life lessons to be learned and interesting connections made between the past and present. You may discover, while reading this book, that you see parts of your own childhood and life in these stories. As I say in the interview, I highly recommend this book, which you can[purchase here]()._ [[00:47:12.560] - Mark Leeds, D.O. ]()Dr. Sederer, I definitely want to highly recommend listeners get "Ink-Stained for Life," your new book. [00:47:17.930] - Lloyd Sederer, M.D. I have a picture of that too. [00:47:20.270] - Mark Leeds, D.O. Oh, great. Yeah. So there's a hardcover book. I would definitely recommend that. [00:47:25.580] - Lloyd Sederer, M.D. It's available in paperback too. [00:47:28.800] - Mark Leeds, D.O. So, you can get the book as a coffee table book. The Kindle, I highly recommend the Kindle because you can click on a word and get the definition right away, because you introduce a lot of great vocabulary. There's "haberdasher," there's "quotidian," just some really great words. I really enjoyed just clicking on the words to see what they mean. [00:47:51.170] - Lloyd Sederer, M.D. I love those words because the haberdasher was my grandfather, and that's someone who sells or makes men's clothing. And that's what he was, a salesman in the Lower East Side men's store. And they were known these men were known as haberdashers. So, it's not like it's a fancy word for me. It's a word that I heard when I was three years old, and five years old. Quotidian, I love because it's a nice way of saying "every day" without saying it. [00:48:31.880] - Mark Leeds, D.O. There's a lot of great stories in there. And for me, you know, being Jewish, but not observant really of my religion, but wondering where I stand in the world being Jewish. There was a great connection there, of reading your experience. A lot of great stories about living in New York, and seeing how my parents might have grown up, because it was around that same time period. There's just so many great stories about things that have contributed, working on the farm and how that led to, in the future, your public health career, and learning how to work together with other people. And, you know, the your experience with with the fireworks, that was interesting. [00:49:12.260] - Lloyd Sederer, M.D. I had a business selling illegal fireworks as a kid. But, what what I'm also trying to show there is the arc of our lives, how this thing or that thing heralds who we become. The experience of cleaning the chicken coops, experience with working the family business. These are all etched into us, and they do shape our decisions, including going to medical school, or being an attorney, or being an artist. It doesn't matter. They're etched in during those early years and you can see an arc develop. [00:49:54.080] - Mark Leeds, D.O. You also talk about the experience of being a smart person, but then meeting an actual genius and how that feels, or being well off, but then meeting people who are actually rich. And, I know that can sometimes make a person feel bad or even inhibit them from going further in something. [00:50:09.830] - Lloyd Sederer, M.D. That's right. [00:50:12.500] - Mark Leeds, D.O. For example, with me, I used to love playing piano and my parents sent me to music camp. And when I actually met real musical geniuses, it made me feel like, what's the point of going any further? [00:50:21.860] - Lloyd Sederer, M.D. Yeah, yeah. That can be discouraging. I went to a really good exam school in New York City, called Bronx High School of Science, and that's when I met some classmates who were truly geniuses. They were operating at a totally different level, and I would never get there. We would get a calculus problem and I'd labor on it, and this guy next to me, he would figure it out in twenty five seconds and it might take me an hour. And you knew that there are people who really are operating in that zone. Robert Ström, people never remember him, was one of the kids in my class and he was on the sixty four thousand dollar question, which many of your viewers may not recall, never saw. But, it was a quiz show where a contestant could win up to sixty four thousand dollars in a progression of getting the correct answers to questions. And Robert Strummer's was on that show, and he won sixty four thousand dollars. [00:51:28.250] - Mark Leeds, D.O. Oh, that's incredible. [00:51:29.720] - Lloyd Sederer, M.D. And he was like 15 years old. It's a little daunting, but each of us, I think, needs to strive to be as good as we can with our own native abilities complemented by hard work and not to try to be somebody else, but to be as much of ourselves as we can be, contributed as much as we can. [00:51:57.080] - Mark Leeds, D.O. That was another lesson you brought up, about hard work, that if you find what you love doing, it doesn't feel like work. Which I relate to with my blogging, that at first I was afraid to write. I don't want people to read what I write and tear it apart and point out what I wrote, what was wrong. But, once you find that that one thing or those things that you really enjoy, it doesn't feel like work anymore, [00:52:19.080] - Lloyd Sederer, M.D. Right. And as you describe describing, many people discover that they love to write, because they're not trying to be scholarly. They're not submitting this for a grade, but they're talking like we're talking to one another in everyday English about something they know a lot about. And then the words flow. And that's a beautiful thing. [00:52:44.400] - Mark Leeds, D.O. And if someone is sensitive about grammar, they've got some great grammar checkers now. [00:52:51.720] - Mark Leeds, D.O. Sorry to keep you for so long, and I really appreciate you coming on the podcast with me. [00:52:56.400] - Lloyd Sederer, M.D. I'm very grateful to join you, and recognize the kind of work that you're doing. This country, needs a lot more Mark Leeds's. [00:53:07.830] - Mark Leeds, D.O. Thank you. I appreciate that. ### Cracked Wide Open: A Filmmaker's Quest for Truth and Healing URL: https://therehab.com/cracked-wide-open-a-filmmakers-quest-for-truth-and-healing/ [spreaker type=player resource="episode_id=58909075" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] ## Unveiling the Layers of Addiction: A Journey with Paul Perrier In a deeply moving episode of a notable podcast, hosted by Mark Leeds, D.O., viewers are granted an intimate glimpse into the life and work of Paul Perrier, a multifaceted artist with a poignant story to tell. Perrier, once a photographer turned documentary filmmaker, has carved out a unique space in the realm of visual storytelling, focusing on the raw and often unexplored territories of human struggle, resilience, and the transformative power of art. ## The Genesis of "Crack Not Broken" Central to the discussion is Perrier's groundbreaking documentary, "Crack Not Broken," an unflinching look at the life of his ex-wife's oldest friend who spiraled into prostitution to feed her crack cocaine addiction. Captured in a single hour within a Toronto hotel room, this piece stands as a testament to Perrier's dedication to truth-telling through his lens. But more than that, it's a vehicle for change, aimed at sparking conversations on addiction and potentially guiding others toward the path of recovery. ## From Personal Tale to Public Platform Perrier’s journey from behind the camera to the author of “Cracked Wide Open,” a memoir detailing his evolution as an artist and the [recovery stories]( "Recovery Stories") he’s chosen to spotlight, paints a vivid picture of a man who has seen the darkest corners of human experience yet remains hopeful. His work, particularly "Crack Not Broken," transcends personal narrative to touch the lives of many, earning recognition on platforms as significant as the Oprah Winfrey show and an HBO addiction series. The podcast conversation explores the documentary's creation, its impact, and the broader implications of addiction in society. Perrier shares insights into the documentary's real-time unfolding and the unexpected journey that followed, transforming not only the subject's life but also those of viewers worldwide. ## The Power of Art in Healing One of the most compelling aspects of Perrier's story is his belief in art as a critical component of the healing process. Whether it's battling addiction or other forms of personal struggle, Perrier views art as a unique conduit for recovery and understanding. This belief is not only theoretical but also practical, as seen in his work's ability to inspire change and foster empathy among its audience. ## A Broader Conversation on Addiction The dialogue between Perrier and Leeds extends beyond individual stories to address the complex nature of addiction itself. They explore the stigma surrounding addiction, the challenging path to recovery, and the role of trauma in the development of addictive behaviors. This conversation also highlights the modern challenges of digital addiction, drawing parallels between substance abuse and the compulsive use of technology. ## Inspiring Future Artists and Advocates For aspiring filmmakers and artists, Perrier's journey offers both inspiration and caution. The path of an artist, especially one dedicated to uncovering uncomfortable truths, is fraught with challenges. Yet, Perrier's experiences underscore the profound impact art can have on both the creator and the audience. His story is a powerful reminder of art's potential to catalyze conversation, promote understanding, and ultimately, drive societal change. Read more: [ Learn How to Rebuild Your Life After Addiction And Avoid Critical Missteps]( "Learn How to Rebuild Your Life After Addiction And Avoid Critical Missteps") Paul Perrier's conversation with Mark Leeds, D.O., sheds light on the intricate web of addiction, the healing power of art, and the indomitable human spirit. Through "Crack Not Broken" and "Cracked Wide Open," Perrier not only documents the human condition in its most vulnerable states but also offers hope and inspiration for those caught in the throes of addiction. His work stands as a beacon for aspiring artists and anyone who believes in the transformative power of storytelling. As we navigate the complexities of modern life, stories like Perrier's remind us of the enduring strength found in compassion, art, and the shared human experience. ## **Transcript** Mark Leeds, D.O. [00:00:13]: Welcome to the podcast. Paul Perrier [00:00:17]: Thanks a lot, Mark. Great to be here. Mark Leeds, D.O. [00:00:20]: Thank you. So, yeah, I I see you have a you have a book out, and you had made a documentary at some point on a very low budget. And I can't wait to hear more of the story. And and it really took off and and, got the attention of some very interesting well known people. So, yeah, please tell us the story about that. Paul Perrier [00:00:40]: Okay. Well, the the book, that I've written is called Cracked Wide Open. It's a book it's a memoir about my life as a artist, a photographer, then I became a documentary filmmaker, and it revolves around a documentary that I shot 20 years ago called Crack Not Broken. And Crack Not Broken is is a real time documentary. It wasn't planned, and it's a story about my ex wife's oldest friend who became a prostitute to support her crack cocaine habit. And it was shot in a hotel room in downtown Toronto in an hour. And we used the film to try to help the subject, get to sobriety. And if that didn't help that happen, we were hoping that it would help other people. Paul Perrier [00:01:50]: Her story would help other people, inspire other people to keep trying to quit or get off drugs. Mark Leeds, D.O. [00:02:02]: And, that you were you were actually on Oprah, right, on Oprah Winfrey on the Oprah show? Paul Perrier [00:02:08]: Yep. Yep. So I screened this film, for the first time in September on September 12, 2005 at a theater 2 blocks from here, a repertory theater, and I invited family and friends and anybody who, you know, I had worked with to come. I think about a 100 people showed up. And, we screened the film and subject and I answered questions after. And after that, the film took on a life of its own. And then almost 9 months later to the day, we were on the Oprah Winfrey Show. Lisa was. Paul Perrier [00:02:54]: And, they were talking about my film or the film, our film. And that led to it being one of 4 independent films included in HBO's addiction series in 2007. So it went my film from, you know, showing it to friends, went around the world, and part of what my book is about is the reaction that my film that that film got from people because anybody who saw it, if you didn't react to this film, you're not human in some sense. Had you ever heard of my film? Mark Leeds, D.O. [00:03:39]: Yeah. Yeah. I'd heard of it. I have honestly, I have not seen the whole thing all the way through, and I and I really wanna watch it now. I've seen parts of it. Yeah. And and it and it really yeah. It does grab your attention. Mark Leeds, D.O. [00:03:48]: I mean, just, the story because it's you know, she her it I think her drug of choice is crack. Right? Which I think is where the name comes from of the film. And the, and it it you know, I think people kinda joke about crack. You know, it just comes up in conversation. And it's really an extremely tough addiction to overcome. I mean, opioids are tough. And, I mean, opioids are are much more deadly than crack. I mean, crack addicts seem to kinda linger around forever. Mark Leeds, D.O. [00:04:18]: Not too many people know. I mean, they they die from crack overdoses and medical conditions and and HIV and things like that. But for the most part, not too many people know crack addicts who have died from from crack. But everybody knows an opioid addict who's died from an opioid overdose, unfortunately. But crack is probably maybe a more difficult thing to overcome. I've even heard in the nineties, I remember hearing someone say that someone say that that a lot of crack addicts are switching over to heroin because it's easier on them and and gives them a path maybe to to to get get into recovery. You know? That it's such a hard thing to get over. And, you know, and and you just go and I guess it's the kind of thing where, like, smoking or overeating, you just make light of it. Mark Leeds, D.O. [00:05:05]: You're like, well, maybe I'll quit tomorrow. And and and but you just you just see it. And it it doesn't not like, maybe like opioids or alcohol where you black out. You actually see your life falling apart around you and very vividly, and and you're very aware of what's happening. And it's just a horrible way to descend into a life of degradation that just is very difficult to get to get out of. Yeah. So Paul Perrier [00:05:30]: Yeah. I mean, I was the I was really exposed to the world of addiction. I went into it, you know, wanting to help a friend in the only way I really could, which was by using my art. And I believe that art actually plays a an important role in the healing process, whether it be drugs or whatever addiction. I mean, my other thought is that we all have addictions, that there we all have something that takes us away from the, you know, grim realities of the world we live in today. And my mine is art. And, you know, I've I've like a drug addict, I get highs from, when my work is being shown and especially when my work is being shown and especially influencing people or inspiring people or talking to somebody like you who, you know, I don't know. We never met before, but you have your podcast and are trying to help people. Paul Perrier [00:06:31]: That's what my book's about too. And in that book, I tell, the story of my life and how I got to that room. Mark Leeds, D.O. [00:06:42]: Wow. And if somebody were an aspiring filmmaker today and and interested in in becoming a filmmaker or making a career of it, would would it be helpful to read your book to get started there? Paul Perrier [00:06:55]: Wow. Yeah. For sure. It it would. I mean, it might, it might dissuade them from doing it. I mean, art is a hard, hard thing to do, you know, and I I'm very honest about my journey as an artist. I mean, it started when I was 12 years old when I took my first photograph. It was a Polaroid Polaroid image, and I was 12 years old. Paul Perrier [00:07:24]: And when I saw that picture develop in front of my eyes, this was, you know, long before digital imaging and stuff, it that was magic to me. And, you know, I guess it's like, would have been like, I don't know, Hendrix picking up a guitar or something. It changed my life, and I've taken photographs since, you know, I've documented my life, which is interesting. I've because I've led a kind of interesting life. It's a it's a it's not a normal life being an artist. Mark Leeds, D.O. [00:08:02]: Yeah. And, like, has that has that like, have you been able to, throughout your career, like, has that been you've been able to, survive as an artist? Like, that's your your income? I mean, because I I think a lot of people love to be a a professional artist, and it just, at times can seem impossible. Especially these days where, you know, everybody everybody is a content creator and putting stuff out there. Now we have AI, and and that's terrifying everybody. But, yes. So you've made a career of being an artist? Paul Perrier [00:08:34]: Well, yeah, I made a career of being a commercial artist. I grew up in Montreal, and I moved to Toronto when I was 31 years old to pursue photography. And, yeah, I I I had a client. I was shooting for ad agencies, magazines. It it went my photography career went further than I actually ever thought it would. But then in 2007, what we're talking on now came out, and that leveled me as a photographer. It's like because everybody could do it and do it well, and you didn't need any knowledge. You could, you know, cameras take the, these phones take amazing pictures now, but, you know, you buy a good digital camera, you just have turn it on, put it on automatic, and it takes amazing pictures. Paul Perrier [00:09:35]: So that had a huge effect on my career where Well, my career, took a nosedive. And and it's part of the reason why I started making documentaries because I use the same technology that was hammering me to make films. And, you know, that's the film we're talking about cost me $45 to shoot. Mark Leeds, D.O. [00:10:04]: Wow. And well, you didn't have it. There was no iPhone back then. Right? So you definitely did not. But I know they had some decent cameras. Like, pre iPhone, they had those you know, you could even record to an SD card at 7:20 p video. So there was some pretty good equipment even at that time. Paul Perrier [00:10:18]: Yeah. My the camera I used was, it was a Canon, just a regular camera. I didn't bring lights. I didn't bring a microphone. I didn't know I didn't go down there thinking I was shooting a film. I I was going down there to interview or to I knew I was recording because that's part of the story, but I never thought that I'd walk out of there with this film, this powerful, powerful film, that, you know, when I saw it, I went, okay. I have a bit of a responsibility with this, I think. Like, my as you read it when you read the book, the first thing I wanted to do was just put it away and never see it again. Paul Perrier [00:11:03]: But then I went, no, there's a reason this happened. And, I mean, I just that's how it evolved. I just couldn't get it out of my mind, and it still affects me to this day. Mark Leeds, D.O. [00:11:18]: Yeah. Did what what was your intention going was it for an intervention? Like, were you going the woman's name was was Lisa. Right? Paul Perrier [00:11:25]: And Yeah. So, Lisa, it wasn't an intervention at all. What it was was Lisa was at our house. So Lisa had been in and out of, rehab clinics, which is that what you are rehab rehab doctor? Is that correct? Mark Leeds, D.O. [00:11:45]: Yeah. Usually, outpatient. You know, people come to the office, or we do it with telemedicine and mostly, opioids, alcohol, and and also Benzodiazepine dependence, which is not really an addiction. It's more of a and that's an interesting new drug. Some drugs are are very addicting, psychologically addicting. Some cause physical dependence, with addiction, and some cause physical dependence without addiction. So, yeah, crack cocaine or regular cocaine does not have much of a physical withdrawal, but it's very addicting. Opioids are both. Mark Leeds, D.O. [00:12:16]: Opioids are addicting and physical dependence, and the benzos are mostly just physical dependence without the addiction. So, yeah, like, sometimes people, like, just kinda think it's all addiction. But, but yeah. That so but but, yeah, for crack cocaine, it's not it's kinda like, tuberculosis treatment before they had the antibiotics for it. And nobody really knew what to do, so they sent people off to these sanatorium places to get some fresh air, and and hopefully they would get better, at least keep them away from society. So, yeah, sending someone with a crack addiction to rehab is kinda like that. You hope for the best, but it's not really a a great medical treatment. Paul Perrier [00:12:53]: Right. Right. So so she had been in a bunch of treatment centers over the years, and she'd get clean and then relapse when she got out. And, at one point, she was over at our house, for dinner, and she was clean. She'd been clean for a couple of months, I guess, and she was telling us stories about her life. And I asked her to look at a a it was a trailer I had made about a friend of mine who's a very was in a very bad situation with drugs, and I had been shooting videotaping him for a while. And I thought I had real I thought I had captured something interesting about addiction. So I asked her if she would look at the trailer, and she looked at it, and she said, yeah, you really captured what it's like to live as an addict in society. Paul Perrier [00:13:50]: And then before she'd left, she said, if I go back in if I ever go back into it, I'll call you and you can interview me. So it was 6 months later, I get I hadn't heard from her, get this call on a I think it was a Tuesday afternoon, and she just said, do you wanna come down and interview me? So I grabbed my camera and went and interviewed her. I didn't know it wasn't for film, and it wasn't it certainly wasn't an intervention. Mark Leeds, D.O. [00:14:19]: Okay. And, yeah. And I and I saw the I did see the trailer for it, which is really you know, I I recommend people look at that, and that really wants makes you wanna see the film. And and and I think she's talking about, like, pricing, you know, how what she charges men for prostitution. And and the first thing, I'm thinking is like your prices are way too low. I mean, you should be charging 10 times that or something. But I guess that's where the addiction comes in, is you know, it's just about getting the money and probably, you know, not really thinking that that through, or I I don't know how that works out. But Paul Perrier [00:14:57]: Yeah. I mean, I I think one of my biggest concerns when I got out of there was, like, I know the dangers of drug addictions, but the dangers I saw of her, how she was getting her drugs was that was Yeah. More alarming to me than anything. Like, talk about dangerous. Oh, yeah. I mean She was on her own. Mark Leeds, D.O. [00:15:24]: Yeah. I mean, just not I mean, not just the, risk of sexually transmitted illnesses, diseases. And, I mean, that's a deadly thing right there. But, yeah, abuse, you don't you don't know who you're bringing into the room. I mean, it could be someone that that's very violent or, you know, a murderer. I mean, there's you know? Yeah. Horrible. It's a horrible situation to be in. Mark Leeds, D.O. [00:15:45]: And, and I think, you know, when people get into that situation of of crack addiction, especially, their entire world just becomes all about there's money and there's crack, and we I need to find a way to put them together without the police getting in the way of it. And there's really not much more to to your thinking than that. Paul Perrier [00:16:04]: Yeah. I mean, she was a different person than the person I had met when I first moved to Toronto. Drugs had really changed her, and it was it's sad, and it's painful to watch, and it's painful to live through, and drugs and addiction are they tear people apart. Mark Leeds, D.O. [00:16:26]: Yeah. Did did she, now I remember reading that at the, at the Oprah show that that she had, I think, 16 days clean at that point. Did did she ever have any any long term success, like, after that, or what happened after that? Paul Perrier [00:16:44]: Yeah. So when when she appeared on Oprah, she had just started a 2 month program in California. Because of the film, a treatment center in California offered her 2 months of free treatment. And so while she was there, we got this, opportunity to be on Oprah. It had been going on for a while, but it finally came up and they said, you know, if you're gonna do it, it's gotta be this time, this show. So we somehow pulled it together, and, she was 16 days clean when she got there. Then she went back, after right after the show to because the show was taped in Chicago, and she went right back to the treatment center, finished her 2 months in in California, then I went out to, at that point, we were shooting a a sequel documentary because my my concept was that I'm interest interested to see if this film can actually help a person get to sobriety. And it it was. Paul Perrier [00:18:02]: Like, it was it had changed her life, and she was, you know, making media appearances. Now all these things are hard too. Like, there's a whole lot going on there. So Lisa was really brave to do all of this. But when she after California, we came like, I went out there, shot some stuff of her and some of the doctors who had treated her there, And I thought we had I thought it it was the Hollywood ending, literally, the Hollywood ending to this incredible story. And then when she got back to Toronto, she relapsed again and then, you know, kept trying, kept going back. She finally went into a long term treatment center outside of Toronto for a year and then went back to school and came back to Toronto, and she lives in Toronto now, and she she lives couple blocks from me. We don't talk anymore if we haven't for a long time. Paul Perrier [00:19:17]: I think the film and I assume the book might I do not sure she's happy with it. But, again, it was I had never finished what I had set out to do, which was to, inspire people to to try to quit their addiction. Mark Leeds, D.O. [00:19:43]: Yep. So so she is alive and well and successful in her recovery probably for many years as far as we know? Yeah. Yep. That's and and that by itself that's inspiring. And if that film can and your book can help people maybe skip over some of that, you know, the the horrors of of what can happen and and addiction. I mean, because I think people get to certain points where they have to make a decision. Are they gonna cross a a certain line and be willing to do something that they were never willing to do before? And, you have to make that decision. Do I, you know, do I steal my friend's wallet, or do I go to get help and go to a meeting or go to rehab? Or, you know, does someone make the decision to to go into prostitution or say that that's a line I'm just not gonna cross? And, you know, maybe looking at your work, at your film and reading your book, that could help someone to, you know, may may make that make the right decision and say, you know, that that's a line I really can't cross. Mark Leeds, D.O. [00:20:40]: And I'm I'm gonna make that, you know, the final. That's my bottom. I'm not going any lower than that. Paul Perrier [00:20:46]: Well yeah. And it totally did. It it achieved that because what my book chronicles is the the, the journey of the film and the responses I got from it. And, literally, there were people who wrote. We had a website at the time, and we're blogging, saying if I didn't see your film tonight, I'd think I'd be dead. So it, I'd it changed many people's lives, and and I think it it's also a good book for families of, of addicts because that's one of the hardest things to watch somebody you love, especially if it's a child or sister, brother, whatever, to be taken away like that. Mark Leeds, D.O. [00:21:40]: Yeah. Yeah. It's it's definitely very difficult for families. And it does help, I think, when someone you know, that's why sometimes the parents or the siblings or or spouses of someone with an addiction, you know, they'll go to support meetings and try to connect with other people going through the same thing to get a better understanding of it. And that's something that you're offering is is a, a look into that a view into that world of of what is it like. You know? What are they going through? And, you know, it's not just a junkie on the street in a back alley or a cheap hotel room. It's a real person who had a real life. And people have real stories. Mark Leeds, D.O. [00:22:22]: If you go up to anybody, you know, like who's shooting up in an alley, that's a person who had a job. They had parents. They grew up in a home. And not everybody grew up in a broken home or on the streets. I mean, you know, like, for example, Lisa, in your story, she had a had a very nice upbringing, grew up in a in a nice home, which is actually pretty, you know, more common than people think, I think. People do, can have pretty uneventful upbringings, you know, grow up in nice homes. They have all their toys and good school and nice neighborhood. And, somehow And they can Paul Perrier [00:23:02]: and they can afford it. Mark Leeds, D.O. [00:23:04]: Yeah. Yeah. One one thing leads to another. You know? There there's there's gateways. Now now everybody it's popular now to to say cannabis or marijuana is completely safe. It's not a gateway drug. In fact, I I was kinda shocked. I always knew it was a gateway drug. Mark Leeds, D.O. [00:23:19]: It seems obvious. I mean, there's anything that can get a person intoxicated in a in a situation in a social situation that makes them more open to the possibility of trying something they wouldn't normally try would be a gateway. So alcohol, marijuana. But, yeah, now when you look it up, everyone's like, well, marijuana is not a gateway. Marijuana is like it cures everything and it's harmless and it's never hurt a single person, you know, which is not true. That's just like the the pro cannabis. And and I'm not completely against it. I think it does help people. Mark Leeds, D.O. [00:23:48]: It definitely has, medicinal use, but it it can also be a gateway to to much worse things like crack and and fentanyl and heroin. Paul Perrier [00:23:59]: Yeah. I mean, I'd I agree with you. I my thing is any you can get addicted to anything. I'm we're I live in Canada where pot is legal, and I'm a pot smoker. I'm not an addict. I Yeah. I use it I use it more for creativity, as a tool. But yeah. Paul Perrier [00:24:23]: So could it couldn't smoking marijuana lead to further things? Yes. And but I think the the real thing that addicts have to deal with is the trauma that they're they're trying to cover up. Right? That's I think addiction from what I've studied, I'm not a doctor, but I certainly looked into it and have been exposed to it because when this when the film started going out like it did when it got to, you know, going around the world, I was being inundated by people, reaching out to me going, would you tell my story? And then they tell me their story, and I just go, oh my god. Like, it just got worse and worse, and I and I, you know, I couldn't because I'm I just didn't have the capacity. I was there was so much going on in my life, but I definitely listened and responded to everybody and said, you know, good luck if if nothing else. But, yeah, it's a it's a tricky addiction still has this stigma to it that it, you know, it's people who should just quit and just stop it and it but it's not that easy, is it? You know, a smoker will tell you, like, which I think is the worst addiction, smoking cigarettes, but that's legal. Yeah. And alcohol alcohol's legal, and I drink alcohol, but you know, I'm glad I don't have that problem because that's as bad as any addiction, and it'll kill you one way or the other if it takes control. Mark Leeds, D.O. [00:26:11]: Yeah. Alcohol is a very dirty drug that that's and and really, there's no good amount of alcohol. You know? Now they've they've come out with that where they say it's there's no completely safe amount of alcohol. But, you know, people there's people that don't have an alcohol addiction, and they can, you know, have a half a glass of wine now and then, you know, a sip of champagne once a year. But, yeah, it definitely alcohol is definitely a problem for people. Yes. Cigarettes, nicotine, some people would say it's the most addicting drug on the planet. There's nothing more addicting than nicotine, you know, with, things like methamphetamine and cocaine, like, probably right after on the list of most addicting. Mark Leeds, D.O. [00:26:53]: But, yeah, nicotine is at at the top. But, yeah, I think addiction is something that that affects a lot of people, maybe even everybody. And, and you're right. Trauma is is usually what leads to it, and and trauma is underlying most addictions. And trauma is not always definitely in your work, you've come across people that have had obvious trauma. They've been abused, beaten as children, have grown up in broken homes. But there's also more subtle trauma. Someone can have what looks from the outside like a perfect upbringing, and and maybe their parents weren't there for them. Mark Leeds, D.O. [00:27:29]: Maybe they, were you know, the way their siblings treated them was was not that nice or the way their friends maybe they were bullied. You know, so someone can appear from the outside to have, like, a great life. You know, their families have money, and they live in a nice home, in a nice neighborhood, great school, and they could still be suffering silently with with trauma. Paul Perrier [00:27:51]: Well, I I think we all we all have trauma in our childhood, and that there's something about that period in your life, like, if you that you're gonna go through trauma. Life is trauma. Life is trauma. It's highs and lows, and it's somehow controlling those lows and controlling those highs because each the highs are as dangerous as the lows, I think. Mark Leeds, D.O. [00:28:20]: Yeah. Yeah. That that's true. Yeah. Paul Perrier [00:28:23]: What, can I ask you, what got you into becoming an addiction doctor? Mark Leeds, D.O. [00:28:31]: I I just I mean, there there is, there there are people in my family that have issues with addiction and people that I know, and it was just a, an interest to me. And I actually, I I went to the they used to have a course. Yeah. Now now they've done away with it, but there was an 8 hour course you had to do to get certified to prescribe Suboxone and similar medications to treat opioid addiction. And in 2006, I actually went to the course by accident. I thought it was a different course I was going to. And I drove to Miami, which is, like, you know, probably a 45 minute drive from from home and showed up at this, Saturday course. It was like an all day thing. Mark Leeds, D.O. [00:29:05]: And I are some doctors there that I knew you know, I was familiar with. And, I thought, well, I'm already here, and it's already paid for. And and I have nothing else to do today. I might as well just sit through and and learn about whatever we're gonna talk about. And it was very intriguing, the fact that, here was something that could treat opioid addiction and and and get people off the streets and off heroin and off with pain pills and, into recovery. And it and it was still controversial. I think it still is to some degree, but people in my understanding about it that, when someone uses takes a medication like Suboxone, they're they're not acting or thinking addictively. In fact, it takes those highs and lows that that you get with street drugs and levels it off. Mark Leeds, D.O. [00:29:46]: The dopamine levels are more are more stable. And a person can feel very quickly as if they were never addicted in the 1st place and live a normal life as long as they continue the medication. And then that tapering off the medication long term can be difficult for for some people. But the medication itself is life saving, and it allows a person to get their life back very quickly. Unfortunately, we don't have that yet for, crack or methamphetamine. Alcohol, there's some promising things. There's something called the Sinclair method where people can take an opioid blocker, naltrexone, and and that can help them gradually taper off of alcohol instead of abruptly stopping it. So there's yeah. Mark Leeds, D.O. [00:30:26]: And and and the, psychedelic treatments are very intriguing, although that's still being, worked out and studied. And, you know, there may be some great things coming up in in the next few years as far as psychedelic treatment for all kinds of mental condition mental illnesses, including addiction. So yeah. So I I I just find it like a very intriguing thing of just, but, yeah, the the magic of treating opioid addiction with Buprenorphine, which is the main ingredient of Suboxone, it's almost miraculous. It's like people, like over a period of their 1st month, just kind of wake up and go from being you don't even recognize them in the 1st few visits. I that's happened to me many times that I see someone come in. I'm like, oh, who's that? And, oh, that that's who it is. Like, I don't even recognize them. Mark Leeds, D.O. [00:31:08]: They're not even the same person they were just weeks ago. Paul Perrier [00:31:11]: And and this is this is a, an approved drug? Mark Leeds, D.O. [00:31:15]: Oh, yeah. Yeah. Approved since, I think, 2000 is when they came out with the law allowing it. In 2002, the Suboxone was released and or it was approved by the FDA. And and the drug itself is actually around much longer than that. It was used for pain management before. It's it's a mild opioid combined. It's it's at the same time as a blocker, receptor blocker, and partially activates the receptor. Mark Leeds, D.O. [00:31:38]: So, technically, it's it's classified as an opioid. But when people say it's just trading 1 drug for another or trading an addiction for another addiction, that's not true. It defra is a different kind of a thing. A person goes they go from obsessing over their drug to just stabilizing and and starting to to be feel as if they feel just like they felt before they were addicted in the 1st place. And they're able to just kinda go back to work, back to family life. Yeah, that is not great for the, you know, rehab the rehab business, you know, as far as people going in and out of rehab over and over again. It's because people are able to stay out of rehab, when they when they stick to that treatment. But, Paul Perrier [00:32:16]: It is a it is a business. Mark Leeds, D.O. [00:32:19]: Yeah. Yeah. Definitely. You know, there there's some conflict of interest there, you know, when they they do benefit when people relapse and come back again. And, you know, so so ideally, it I think I think we're we're on the verge of of some groundbreaking treatments coming out that will help people with crack and cocaine and methamphetamine addictions better. Good. So, anyway, so, Paul Perrier [00:32:46]: so It's interesting it's interesting how you got into it by going somewhere you weren't expecting to. Like, that's what when writing my book, and I it took me 10 years to write this book. But just going back over your life and find these little things, what seems like coincidences or something, actually change your life and begin to make your sense of your life. Like, it took me, like, since I've written this book. It's been a very good for my mental health. I did a lot of introspection. I think writing is a great tool for people who are struggling with anything. It's it's another art form. Paul Perrier [00:33:34]: But like my book, and I only release my book as a hard copy. You can't get a digital version because part of what I wanna do is get people off their phones for a while. Not that phones are all bad. They're great. They're unbelievable tools, but what's going on now? I mean, from when I like, I grew up without, without any of this. Right? Like, I I grew up I became a teen in the seventies where there was no phone no iPhones or computers. And to me, that was freedom. And I I have kids. Paul Perrier [00:34:14]: I have 2 daughters who are in their twenties now. And, you know, I look at their lives and go, man, you you miss something with all I know I sound like an old man, but there was something about being unconnected and kids and everybody should get unconnected for a while. Mark Leeds, D.O. [00:34:35]: That never ending social media scrolling that they do is, I mean, unfortunately, it's not all that different from from crack use. It's safer. It's definitely a lot safer physically, but it's the same exact thing. You just keep going back over and over and over again saying, I'll stop after 1 more. I'll stop after 1 more. And you just find yourself hours and maybe even days later, just crashing, passing out, realizing you've done nothing, but kept going. Paul Perrier [00:35:01]: It's a worse addiction. I think it's worse than any drug addiction. Like, I'm I'm not I'm not exaggerating it. Like, I I'm a looker. Like, when I go out on the streets, I usually have my camera, but I'm looking at people all the time, and their heads are never up. Mark Leeds, D.O. [00:35:22]: Yeah. Paul Perrier [00:35:22]: Like, people are always on their phones, everybody. And it's well, not everybody. There's but the the majority. And and and communication, which is so easy now, is I find it's getting harder and harder to communicate with people because they don't know how to communicate. Mark Leeds, D.O. [00:35:42]: Yeah. Yeah. You've probably been in this situation where one of your kids is right in front of you and the best way to get through to them is send them a text message. Paul Perrier [00:35:50]: Right. Yeah. Yeah. And sometimes that doesn't work. Mark Leeds, D.O. [00:35:54]: Yeah. Yeah. You gotta find all kinds of new new ways to get through to them. Paul Perrier [00:35:59]: Yeah. I mean, hopefully, talking to them face to face is the best way to do it. Right? Mark Leeds, D.O. [00:36:04]: Yeah. Yeah. Ideally, that would be the definitely the best way. Yeah. So, yeah, Paul Perrier, thank you thank you for joining me on that podcast. And, where where can someone, get your book if they wanna read it today? Paul Perrier [00:36:17]: So it's available on Amazon. Just put Cracked, Wide Open. It'll come up. Yeah. It's an independent book, if anybody's struggling with addiction. But I also think, like you said before, if you're if you're an artist or some I I mean it to be an inspiring story for artists. Although it tells a very rough road, that's what you'll go through and hopefully, you'll find sort of some sort of purpose with your work. And I've found a purpose with my work, and I I plan to keep, hopefully, helping people and inspiring people. Mark Leeds, D.O. [00:36:59]: Thank you. Thank you. Paul. Paul Perrier [00:37:01]: Thanks. Thanks, Mark. Mark Leeds, D.O. [00:37:02]: Oh, give me let me just turn off the you know, Zoom is gonna cut us off in ### An Interview With Best-Selling Author, Lloyd Sederer, M.D. URL: https://therehab.com/interview-with-best-selling-author-lloyd-sederer-m-d/ [spreaker type=player resource="episode_id=58290469" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] ## Understanding the American Healthcare System: A Critical Analysis ## The Intricacies of Healthcare Explored Have you ever felt overwhelmed by the complexity of the American healthcare system? You're not alone. Many Americans grapple with understanding the nuances of this intricate framework. In this episode of “[The Rehab]( "The Rehab"),” host Mark Leeds, D.O., and guest Lloyd Sederer, M.D., embark on a deep dive into these complexities. They explore the labyrinthine nature of healthcare, a concern that touches each of us personally. As Dr. Sederer, a distinguished psychiatrist and public health expert, delves into the industry's challenges, listeners find themselves engrossed. His experience brings to light the immense hurdles within the system. The conversation is not just academic; it's a lifeline for those lost in the healthcare maze. Dr. Sederer's insights resonate with anyone who has navigated the perplexing world of medical care. ## For-Profit Corporations and Patient Care The influence of for-profit corporations on healthcare cannot be overstated. This dynamic drastically alters the landscape of patient care. As Dr. Sederer points out, profit-driven motives often overshadow the fundamental goal of health services. The priority shifts from patient well-being to financial gain. This shift is a critical issue that Dr. Sederer and Mark Leeds discuss with urgency. They underscore the importance of understanding how these corporations operate. Only then can we begin to see the effects on our personal healthcare experiences. It's a topic that directly impacts our lives and the care we receive. ## The Impact on Healthcare Workers Consider the healthcare workforce, tirelessly at the frontline. They too are victims of this profit-centric approach. Dr. Sederer sheds light on how the industry's focus on revenue affects these essential workers. It's a reality often overlooked but deeply felt by those within the system. The conversation between Mark Leeds and Dr. Sederer becomes more than an intellectual exercise. It's a call to acknowledge the human aspect of healthcare. Their words offer a perspective that connects with listeners who know healthcare workers or who have witnessed their struggles firsthand. ## Insights from "Caught in the Crosshairs" In his book "Caught in the Crosshairs of American Healthcare," Dr. Sederer offers an in-depth analysis. He explores the pervasive influence of profit-driven entities on healthcare. His writing serves as a guide through the convoluted system, providing clarity and understanding. The book is not just a critique but also a beacon of hope. Dr. Sederer proposes solutions that could benefit patients, healthcare professionals, and even the judicial system. These ideas are discussed in the podcast, sparking hope and engagement among listeners. It's a conversation that goes beyond the problems, offering pathways to improvement. ## Exploring Actionable Measures What can be done to address these complexities? This question forms the crux of the discussion between Mark Leeds and Dr. Sederer. They don't just dwell on the problems; they explore actionable measures. These suggestions provide listeners with a sense of empowerment and direction. The episode concludes on a hopeful note. The challenges of the American healthcare system are vast, but not insurmountable. Mark Leeds and Dr. Lloyd Sederer's conversation opens doors to understanding and potential change. It's an episode that not only enlightens but also inspires action and hope. ## Transcript Mark Leeds, D.O. [00:00:00]: Dr. Lloyd Sederer, Lloyd Sederer, MD. You're a distinguished psychiatrist and public health expert, and a prolific nonfiction author, about to release your or has it released yet, the 14th book? Lloyd Sederer, M.D. [00:00:21]: Yes. Yesterday. Mark Leeds, D.O. [00:00:23]: Oh, okay. Oh, great. So it's and it's already a bestseller from from what I hear. And you you are currently an adjunct professor at Columbia University, the School of Public Health. You've served as chief medical officer, and executive vice president of McLean Hospital, which is a Harvard teaching hospital. You served as mental health commissioner in New York City in the Bloomberg Administration, chief medical officer of the New York State Office of Mental Health, which is the nation's largest state mental health agency. And in those positions, you've done an incredible amount of good. I mean, that that just summarizes a huge career of decades where you've Probably saved countless lives. Mark Leeds, D.O. [00:01:02]: I know there's a great story you told me about how you instituted a policy that mental health clinics in New York had to offer Suboxone treatment, which is life saving. Lloyd Sederer, M.D. [00:01:10]: Yes. Mark Leeds, D.O. [00:01:11]: Yeah. That's incredible. And you've you've won a ton of awards. I mean, I I don't wanna take up all our time listing them, but, people people should go to your website and read your, your profile and definitely read your blog post and follow you on social media. But let's talk about the book, Caught in the Crosshairs of American Healthcare. It's a great book and and you talk about your experiences at, McLean and, issues in American health care, which I think we all know. I think anybody listening who is an American knows that health care is a mess. So you tell us a little bit about the book. Lloyd Sederer, M.D. [00:01:47]: 1st, Thank you for having me on, Mark, and I always love speaking with you online or otherwise. And thanks so thank you again. I tell stories. This is not a technical book. It has a lot of particular details here and there, but I think that the way to understand things is through stories. It's ancient way of communicating. So it's the story Told in different ways about how for profit corporations have taken control Oh, for medical care in the United States to the great detriment of you, me, Other other people who are dependent on medical care. And I use this in illustration, McLean Hospital where, I was, chief medical officer. Lloyd Sederer, M.D. [00:02:44]: As an example, because I it's a first person example. I was there. I was there during when the Impact hit when managed care hit when suddenly the referrals to the hospital tanked when we started to hemorrhage money. And it took 5 or 6 years, and we righted the ship, and it has prospered since then for the past 30 years. But I had that firsthand Very answer. It wasn't abstract, and I tell that story as well. And I tell it in some ways also by, Providing, clinical cases. So talk about some of the patients I've worked with. Mark Leeds, D.O. [00:03:27]: Yeah. Yeah. And and health care, I I I don't think there's any easy, great solutions. You know? You look around the world, and there's other countries that have health care included as part of the government. And, there there's a, like a a meme on social media that, you know, with all all this military action unfortunately going on in the world where they they show some fancy American bomber flying by. And they say, oh, the world's gonna find out why we don't have free health care, which is, you know, which could be you might say is good or bad. I mean, know, at least we might feel safe or the world feels safe in some degree, maybe, maybe not, but there goes our health care flying by as a multibillion dollar bomber. Lloyd Sederer, M.D. [00:04:06]: To me there needs to be another meme that represents not just spending money on bombers, but Siphoning money off to corporations, to insurance companies, to managed care companies, and, this is So fundamental, their regulations is called medical loss ratio, the percentage of dollars, Patient care dollars that can be siphoned off by an insurer, and it often is up to 15%. So we start out in American Health Care in all these ways and including, programs, Medicare, Medicaid, where the payer or the payer's manager administrative manager, like a managed care company, Takes 15% off the top. Mark Leeds, D.O. [00:05:02]: Oh, 15%. Well, that's that's, So what we pay for health care, I mean and and and, of course, like, we we pay a huge amount for health care. It's unaffordable to to most people. I mean, just the the thought of medical bills coming in. It's like, you know, what did I just pay for? You know, you get, like, this $1,000 bill for for a bill for $1,000 for going to the ER. And it's like, wow. Why am I paying $1,000? And then it's like, no. You didn't pay for your whole your whole visit wasn't 1,000. Mark Leeds, D.O. [00:05:29]: That was just for you to sit in a room. And now there's just a call from every doctor and radiology, and each different entity sends a bill. And, it it and there's no way that all that one Interesting thing in in South Florida, I think or maybe in the state of Florida, which I think is different from other states, is that there was a period of time where people had to get MRIs for for pain management. And this was kind of tied in with the pill mill, issue that, you know, for these Pill Mills to to try to be legal, they would require people to get spinal MRIs, you know, low back MRI. And so the MRI businesses jumped in and said, well, we can do MRIs for 2 or $300. A a study that normally costs 3 to $5,000, the same exact study. And in fact, if you if you went into the same MRI center with insurance, it would be billed for 1,000 of dollars, and they somehow figured out a way that on the side, they can charge a cash paying patient 2 or 300 for the exact same study. So we're definitely overpaying. Mark Leeds, D.O. [00:06:25]: These things are being charged a lot more than than the value of what they're worth. Lloyd Sederer, M.D. [00:06:30]: Yeah. It's like going into a marketplace, with shops everywhere and, you know, maybe a retail price In the window, but inside, if you talk to the owner, in this case, an insurer, you can bargain down the price so you can get it for cheaper. Mark Leeds, D.O. [00:06:49]: Yeah. And I think that, hospitals, like, what I've from what I've heard, and this is a good tip probably for people that get a big bill from the hospital, I think you can negotiate like we have a right to negotiate to get Medicare what Medicare would pay. So if they charge you $1,000 and you find out Medicare would have only paid $200 for that same visit. You should be able to negotiate with the hospital and and do it quickly. Because if you wait too long, you lose, apparently, the the window of time to be able to do that. Lloyd Sederer, M.D. [00:07:15]: Yes. That's true. With Medicare and that's traditional Medicare. That's not what's called Medicare Advantage, Which are the managed care companies that now provide insurance to 50% of Medicare beneficiaries. That's like 30,000,000 people, and they are for profit companies, and they are defrauding many of them in serious ways to frauding the federal government By what's called upcoding, putting a code for a higher rate or a higher risk adjustment so that they get paid more, by adding procedures like you were discussing a spinal tap. And they, they make They they make a lot of money, and they pretend or they they offer the client, the subscriber, It's gonna cost less. We're gonna have better access. It's gonna be better quality, and none of that is true. Lloyd Sederer, M.D. [00:08:19]: None of that. So it's, that They're fraudulent in their average parsing, and they're fraudulent in their billing. So fraudulent that the federal government, Health services has brought a lot of them, quite a few of them to, the Department of Justice, and the Department of Justice has taken them to court And one. But the sad part of that story is they get a fine. $10,000,000, whatever. And that's such a fraction of their revenue that They just pay the fine and keep doing the same thing. That's how greedy and that's how fraudulent, these some of these companies are particularly the Medicare Advantage companies. Mark Leeds, D.O. [00:09:10]: Yeah. And another point that you've made, is that things have gotten to the point where doctors don't wanna even be in this business anymore. And I know and my my father who Probably would have been, he'd be a little bit older than you at this point, but he, he had told me that, like, in the seventies when he started his practice that that I I think I heard it from other people also that that was the golden age of medicine, that that doctors were happy. They had good careers. They could have their own little practice, and and, and things changed dramatically. Like, when I went to medical school, HMOs were, like, well entrenched. In fact, that part of our education of learning managed care. And it was, in fact, other I remember hearing other doctors in in training say, You know, you you you guys all miss the golden age of medicine, you know, like when we were all happy and doing well. Mark Leeds, D.O. [00:09:59]: And, and I've also heard stories from you I've heard people say, that the business people in in the business of medicine saying that the best way to to be successful is to have patients be captive audience. And I think that ties in with what you're saying about Medicare Advantage is that Once you're in one of these plans, you're you're stuck. You know? You can't you only have, like, short windows, I guess, to jump from one to another, and and maybe there's nothing really good to jump to. You're jumping from one bad situation to another. Lloyd Sederer, M.D. [00:10:30]: This is a huge problem, workforce problem. Doctors fleeing medicine. It began with COVID, but has it has Been sustained so that it's now affecting our ability to get care because hospitals are not adequately staffed, Not with doctors, with nurses, with technicians. Very hard to get an appointment. And when you get an appointment, particularly primary care, you get a 10 minute appointment Yeah. With doctors mostly typing into the electronic medical record. So the whole Nature delivery of medical care has changed to to, in a destructive way since when your dad practiced. Mark Leeds, D.O. [00:11:12]: Yeah. Yeah. And and, you know, there there's, there's definitely things that we need in in medicine. Like, if if someone has something life threatening. And and, you know, like, they need a surgery for a trauma or they need a major surgery, and and they're gonna come out of it fine. And and without, you know, the medication or the surgery or the procedure, they would die, but, you know, they can live a long life if if they get that. Those things are essential. And some of them are very expensive. Mark Leeds, D.O. [00:11:39]: But then a lot of medical care, you know, kind of to me, it never made sense that that insurance would cover every Last thing in your healthcare that, you know, that, you know, like when I get car insurance, I don't expect it to pay for an oil change or tires. You know, routine wear and tear and routine service should probably be something that people pay for. But because, like you said, because big business is involved and insurance is involved, prices get driven up where, you know, it shouldn't cost what it costs to get basic service, to go to a doctor's visit or get a, you know, like we're saying, the MRIs are 10, 20 times more expensive than what they should be. And, you know, you hear about people going to Mexico and other countries and in some areas actually getting decent medical care for a fraction of what they get it for here for various reasons, whether it's, prices driven up by insurance or, I mean, they some people say it's because of, you know, fear of litigation, but I I I think it's more the, the the insurance and the fact that you can't charge one price and also deal with insurance, and so they drive prices up. Lloyd Sederer, M.D. [00:12:41]: Yes. And the primary purpose of a of a for profit corporation, The primary purpose is to make a profit. Yeah. It used to be that medical services, the primary purpose was to see serve the patient, To serve the family, to serve you and me. That has been wiped out, and it extends now. There was a piece recently in The Times because it has been shown over and over again that that's the case with for profit corporations. Huge insurers like United, Aetna, Anthem, That they've been squeezing the dollar out for a long time and in some ways in in the Spanish care plans fraudulently. But now not for profit hospitals, which about half of the hospitals in the country are not for profit. Lloyd Sederer, M.D. [00:13:37]: The ones we tend to know the most are university hospitals, University of Florida, whatever. And they're also behaving like profiteers, And that's because executive compensation, the CEO of that university hospital, actually not for profit, His or her compensation is determined 70 75% of their compensation is Determined by what kind of revenue, what kind of profit they bring in. So it's they're not they're not running an organization that's Meant to take care of people that are running an organization that's, meant to deliver a a profitable commodity. Mark Leeds, D.O. [00:14:26]: Even a nonprofit hospital is is playing that same game of of profit. Lloyd Sederer, M.D. [00:14:32]: Many many many are, And that's, become, just how ubiquitous The, greed and the destruction of quality ethical medical care has become. And that's why I wrote this book. Not I'm the only one, but I want to pitch in my voice because I've lived it. I saw what Was needed to save a hospital from going under from being sold, when threatened by Managed care when threatened by insurers. We did it, but it took a lot. It was a hard time and but we succeeded, and other people can seed. And I've people have asked me now, I've thought about this even more. Is there any are there any solutions to this, you know, corporate, Raping, if you will, of medical care. Lloyd Sederer, M.D. [00:15:34]: They're and I see 3. And these are 3 that are in our control. It's not waiting for a miracle from the federal government or the miracle of universal health. 1st is patients and families. The second is professions, and the third is judicial, Not not federal government, but the courts. 1st, patients and families. And what I have Urge people and discover worst is you have to be a demanding patient or family. You can't just be meek or afraid of the doctor because you'll just get bypassed. Lloyd Sederer, M.D. [00:16:18]: And my experience is that the best patients Or what we used to call difficult patients. Now they're demanding, which is they're demanding what's due them. They're demanding to know What's the matter with them? Why is the doctor has proposed this plan? What the alternatives are? What the costs are? It's always our demanding patients that begin to tip the balance about what's going on. So that's Really, critical in terms of 1 solution. The 2nd solution is professions. And I'll just concentrate on the doctors for a moment because the doctors have 2 tools to win Against corporatization that they're starting to use, but not very much. The first is to unionize Because then they can strike, and striking is a very powerful way of Fighting back against control back control because if doctors go on strike, a hospital doesn't make money. Beds are unfilled, so we're basically then attacking the what's most important, to these companies, which is Revver, which is Prophet. Lloyd Sederer, M.D. [00:17:37]: The, the second is I know some examples of this, Particularly in California, there are large doctor groups that have very big contracts with insurers, Particularly Medicare Advantage in one practice in in, California Did not renew its contract with this private Medicare company. And we shocked everybody. 30,000 subscribers, 30,000 Patients and their families were suddenly had no place to go, had no doctor, had no care system to go to. That is Disruptive in a way that will change things painfully, but will change. So the 2 things are, unionizing going on strike and, basically, not doing business with these companies. And when asked, these large practices, why they do that, they say 2 things. Well, it's just too much of a burden to deal with them, the administrative hassles, And they pay poorly. Why should I renew this contract? And the third reason is, or third method of fighting back Is, judicial. Lloyd Sederer, M.D. [00:19:00]: And what I mean by that is that courts, administrative courts, can appoint A special master to a company to an organ to a state or federal agency. Basically, they are suddenly put in charge. Everything has to run through them, and that's how Culture can be changed because this is a a culture of greed, and a special master is there to see that The companies does right that it serves the people it's supposed to serve. And so the third is a Court appointed special master over some of these companies, particularly the ones, I imagine, who are repeatedly fraudulent Because of fines, they're not doing anything to change them. Those are 3, methods of fighting that are within our grasp Spend I don't need to wait, for a miracle. Mark Leeds, D.O. [00:20:01]: Yeah. And would that help as far as with because, You know, I see, like, probably the real problem is corrupt politicians. You know, they've they've done a lot to make sure that doctors are not corrupt. You know, they've you know, we can't even a a drug company can't even give us a free pen anymore. And, you know, when I first started, they could they could buy us tickets to Baseball or football game and and put us in a fancy box and get served dinner. And, you know, that that was probably kind of extreme, but, you know, we can't even accept a pen with the name of drug company because we're being influenced. But every one of these companies I'm sure has a lot of lobbyists that are doing all kinds of favors for politicians, and they don't You know, I feel like if politicians had to had the same rules that doctors had, you know, that that they can't get paid off and they can't have special favors and take a lot of money from people. I mean, all all the stuff that happens. Mark Leeds, D.O. [00:20:50]: I mean, it just seems like these companies can get away with anything. But may maybe by following, those three steps, that that you outlined just now that that at least, you know, I don't think we're gonna change politics and get rid of lobbyists and get rid of you know, change that whole thing. But, but there are some things that we can do now to to make a difference. Lloyd Sederer, M.D. [00:21:10]: Yes. Yes. The federal government, anyway, which might Stand a chance to correct things is paralyzed at this point. Mark Leeds, D.O. [00:21:21]: Yeah. Lloyd Sederer, M.D. [00:21:21]: And the divisiveness is is, appalling. And it prevents any action, so particularly a difficult action like holding payers or insurance companies or Private equity companies to task. It's never gonna happen, because of how funded they are in these pharmaceuticals as well, and because the federal government, the Congress, has decided, We're not gonna do anything, to help one another, which is not what government is supposed to be about. It's supposed It's be about coming together to help. Mark Leeds, D.O. [00:22:02]: Yeah. Well, that, that thing about private equity, that I think is a major thing that that's become a much bigger issue lately. I've noticed almost every private hospital in South Florida has been bought by 1 company. And I when I looked them up, they're one of the largest private equity companies. And now people are saying, only go to public like, the hospitals we used to be told to stay away from, the public hospitals, the county hospitals. Now people are saying those are the only places you should go because these companies are gonna kill people by trying to profit. You know? They the things that make them money are things that could be very dangerous to patients. Lloyd Sederer, M.D. [00:22:34]: Yes. And the and sometimes you you know the pride you know of Because they're massive, private equity companies, but sometimes it's silent or it's hidden because there, A hospital needs money to operate the building services. A private equity company shows up and says, well, we'll give you $4,000,000 a year for the next 4 years, so you can do this and that. But you have to pay us On our investment, not 4% like a a bond, but 15%. So also another way by which Money is siphoned off, and, basically, the hospitals and other doctor groups are required to, Fund indirectly. Fund these private equity companies, which do very well for their investors because they're Automatically siphoning off money from patient care. Mark Leeds, D.O. [00:23:37]: Yeah. And and I think, yeah, I think people also need to like you said, they need to be more informed. You know, if if necessary, bring when you go to the doctor, bring someone to to represent you, to be, you know, a family member that's knowledgeable. And now, yeah, now with some of these new AI tools, like, we can all be kind of be a genius, and we can take contracts and feed them into the AI and say, you know, read the fine print for me. And, you know, I mean and there there's things, you know, things that are, like, magical. Like like, Insurance companies, you can sometimes if you write a letter at the right time and fax it to the right number, you can actually get results. And you almost never get results when you call them on the phone and yell at them. Know, that seems like a tactic to delay things. Mark Leeds, D.O. [00:24:18]: And, there's, like, little tricks like, you know, demand a third party arbitration or something like that. You know, things like that. And and magically things happen when you say the right words, you know, as per, the fine print and the contracts. Lloyd Sederer, M.D. [00:24:32]: Yes. That is being a demanding patient or a demanding subscriber, which is not taking it, lying down. It is not letting yourself be exploited. Mark Leeds, D.O. [00:24:42]: Yeah. Yeah. Definitely. So, Dr. Lloyd Sederer, thank you for joining me, and, I recommend everyone Go to Amazon. Go to your nearest bookstore. Buy this book Caught in the Crosshairs of American Healthcare. It's a very good book. Very enjoyable read and a lot of insight into your experience at at McLean and, and also a lot of interesting analysis of the health care system and and solutions, ideas for what we can do today to make a difference. Mark Leeds, D.O. [00:25:11]: Thank you. Lloyd Sederer, M.D. [00:25:12]: you. Thank you, Mark. Always a pleasure to be with you. ### Escaping the Grip of Technology Addiction: Dr. Nicholas Kardaras on Digital Madness URL: https://therehab.com/escaping-the-grip-of-technology-addiction-dr-nicholas-kardaras-on-digital-madness/ [spreaker type=player resource="episode_id=58825695" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] ## Navigating the Digital Dilemma: Understanding Technology's Grip on Mental Health In a world where digital consumption is nearly as ubiquitous as the air we breathe, understanding the impact of our online habits on mental health has never been more critical. Today, we explore the profound insights of [Dr. Nicholas Kardaras](), a leading expert in digital addiction, to shed light on the dark corners of our digital world and its effects on the younger generation. ## The Unseen Epidemic The allure of the digital landscape is undeniable. From the endless scroll of social media to the captivating worlds of online gaming, technology has transformed the way we live, learn, and connect. However, beneath the surface of these engaging platforms lies a more sinister reality: the potential for addiction and its ramifications on mental health, especially among adolescents. Dr. Kardaras brings to the forefront the alarming parallels between tech companies and drug dealers. Both exploit the vulnerability of young minds, programming their products to be as addictive as possible. This comparison is not made lightly; the addictive design of online platforms, driven by algorithms that prioritize engagement over well-being, is contributing to a growing mental health crisis among the youth. ## The Litigation Against Tech Giants A significant aspect of today's discussion revolves around the lawsuits targeting tech giants, accusing them of failing to protect users from toxic content. These legal battles aim to hold companies accountable, arguing that their algorithms, which push harmful content to increase user engagement, are complicit in the damage done to young users' mental health. Read more: [ 4 Easy Ways to Improve Your Mental Health Today]( "4 Easy Ways to Improve Your Mental Health Today") ## The Chilling Effects of Screen Time Drawing from his extensive research and clinical experience, Dr. Kardaras shares chilling insights into how excessive screen time can lead to a range of physical, psychological, and social detriments. His book, "Digital Madness," serves as a clarion call to recognize and address the dangers lurking behind screens. ## The Path Forward As daunting as the current landscape may seem, there is a path forward. The conversation with Dr. Kardaras illuminates the urgent need for age-appropriate tech use and outlines strategies for fostering a healthier relationship with technology. Building resilience in the next generation requires critical thinking, moderation, and a collective effort to redefine our digital habits. ## A Call to Action This discussion is more than a wake-up call; it's a call to action. We are at a pivotal moment in history, where the decisions we make about our relationship with technology can shape the mental health and well-being of generations to come. It's time to rethink our digital consumption, advocate for safer online environments, and prioritize the mental health of our children over the profit margins of tech companies. ## Join the Conversation The insights shared by Dr. Kardaras are not just food for thought; they are a blueprint for change. As we navigate the challenges and opportunities of the digital age, let's commit to being part of the solution. By fostering open dialogues, advocating for policy change, and practicing digital moderation, we can pave the way for a healthier, more balanced relationship with technology. The journey toward digital wellness starts with awareness and action. Let's embrace the challenge, informed by the expertise of thought leaders like Dr. Kardaras, and work together to safeguard our mental health in the digital age. ## **Transcript** Mark Leeds, D.O. [00:00:00]: Doctor Nicholas Carderas, welcome to the podcast. Dr. Nicholas Kardaras [00:00:07]: Good to be here, Mark. Thank you. Mark Leeds, D.O. [00:00:09]: Thank you. So I see in the background digital madness, on your right behind you. And you are, I believe, one of the world's foremost, or maybe the world's foremost expert on digital addictions. And digital addiction is definitely a thing. I think everybody sees it. You get on an airplane, and the pilot is playing with his phone, scrolling through something in the front of the plane, and that's a little bit scary. You wonder what's happening in the cockpit. And surgeons and doctors and nurses, everybody has their phone out, no matter who Dr. Nicholas Kardaras [00:00:42]: they are. A couple of years ago, by the way, there were 2 pilots that missed landing at at O'Hare Airport in Chicago because they were on their laptops, and they missed their landing because of the they were distracted on their own laptops, and then they they got disciplined. But just just to chime in on your pilots on on screens Oh, wow. Comment. Mark Leeds, D.O. [00:00:59]: Well yeah. And and, of course, every kid every kid is glued to their phone, like and and I don't think anyone knows what to do about it. And where does it end? And I'm probably one of the few people, you know, in the country, that doesn't I don't have my phone in the house with me, and this is kind of an accidental thing. Everybody who brings their phone into our house has to clean it. You know, we all have to wipe our phones off with alcohol and clean them. And I don't like cleaning my phone. Not all the time. I do it occasionally. Mark Leeds, D.O. [00:01:25]: So I've opted to just leave mine out on a little table in the garage where it charges. So I'm the only person in the family that doesn't have my phone with me everywhere I go in the house. And it's definitely an interesting experience. You know? Like, they're all scrolling nonstop while we're watching TV, eating dinner, everything. And I'm looking around, and I'm like, you know, it just never stops. There's never any separation. Where are we going with all this, with this digital addiction? I mean, I see it gets worse than that, though. Apparently, people can get psychosis and actually have a breakdown and believe they're still in the middle of a game when the game is over. Dr. Nicholas Kardaras [00:01:58]: Yeah. Mark Leeds, D.O. [00:01:59]: Please tell us a little bit more about what can how far this can go, this digital addiction. Dr. Nicholas Kardaras [00:02:03]: Yeah. So and and thank you, by the way, for the introduction. Yeah. I mean, people say I'm I'm one of the foremost people on the subject because I discovered it. I was one of the first people that really began to look around the social landscape. And, as an addiction psychologist who, by the way, you know, I'm also in long term personal recovery from substance addiction for 24 years, I had been working in treatment centers and running programs, and I was a professor at Stony Brook Medicine. And, you know, about 10 years ago, I was looking around and seeing what you just mentioned, children, kids, adults, and they were beginning to show all the telltale signs of habituation or we what we might call addictive behavior. And the problem and and you mentioned some of the extremes, which I've worked with everything from gaming psychosis to indoctrination via social media. Dr. Nicholas Kardaras [00:02:55]: You know, I've been an expert witness on the capital murder case with a teenage boy who was YouTube indoctrinated into a political ideology where he committed horrific crimes. And so, yeah, this is this is the the land the the the water that we're all swimming in now is this digital immersion that we're all in and it's affecting all of us. But some of us are more vulnerable to these effects than others. So, obviously, children and adolescents and young adults. But what I write a lot about, what I try to speak out about now is what's the price that we're paying for our love affair with our shiny devices? Because when I wrote my first book, Glow Kids, in 2,000 and 16, I wrote an article for the New York Post called Digital Heroin. And I was analogizing it to because the brain imaging research had just come out at that point and the brain imaging research was showing that the effects on the brain, of screen time was very similar, almost exactly the same as chronic substance addiction. And so I was one of the first Paul Revere, you know, kind of, hey, this is this is a a a new impactful phenomenon. And so first, I had to raise the awareness that that this is habit forming. Dr. Nicholas Kardaras [00:03:57]: And I got a lot of pushback at the time. You know? That digital heroin article went viral, and I was on Good Morning America and CNN, a lot of new shows, basically, having to defend that people could become addicted or habituated to their device. Is now that's been asked and answered. It's an official diagnosis. I think we've all seen it. The bigger question that I look at with digital madness is what is that addiction leading to? And and here we have to look at our mental health metrics, our rates of anxiety, depression, suicide, overdose, ADHD, by all conceivable mental health metrics, we're on fire. We're at the worst that we've ever been pre COVID. In 2019, we're the highest rates of suicide and overdose, and depression. Dr. Nicholas Kardaras [00:04:43]: And then COVID was kerosene on that fire because the isolation quarantine and even more screen dependence led to these things. So what I try to talk about is it's it's antithetical to the way that we were all genetically designed to live as human beings. We're meant to be physically active, social, face to face social interaction. And think about what screen time is. It's a nuclear bomb to, so we're more sedentary now. So you have all these childhood rates of obesity and diabetes, and we have more heart disease and cancers. So we weren't meant to be sedentary, screen staring, isolated, atomized, meaning devoid, because screen time also sucks some of the humanity and some of the, you know, so many of the young people I work with, there there there's an emptiness there that happens. So it's not just addicting us, but it's also changing us. Dr. Nicholas Kardaras [00:05:35]: I think it's taking it's it's vacuuming out some of the core pieces of what make us human. And and I'm not saying let's go Amish, but we were essentially like drunken sailors when all our iPhones first came out and we weren't thoughtful enough about what might be some of the downsides of this. And now we're beginning to see some of those impacts. Mark Leeds, D.O. [00:05:56]: And so so maybe, to start out with it, rather than suggesting that we all throw our phones in the garbage and and don't look back, that, you know, maybe we start with harm reduction, but, like, being aware of it and and seeing what what small improvements we can make. You know, I think that sound seems like it would make sense. Dr. Nicholas Kardaras [00:06:15]: Yeah. And and one of the things I I like to talk about too is, you know, when we look at screen time, not all screen time is created is created equal. If you're, you know, Zooming with grandma, that's a healthier use of technology. If you're gaming 18 hours a day, you know, I've worked with adolescent young adult gamers who, you know, if you if if you Google World of Warcraft and, adult diapers, you're gonna find entire chat rooms of 18 year olds discussing which type of depends to wear because they'll be gaming for 3 or 4 days in a row without eating or going to the bathroom, without sleeping. All the telltale signs, the hallmarks of addiction. So, what I talk about, there's that, but then there's also social media. And social media has swallowed up the world and, you know, when we look at the political polarization they're experiencing, the spike in influencers and psychiatric influencers. So you don't just have the Kardashians and the Kylie Jenner's of the world, but now you have some psychiatric influencers that have dissociative identity disorder or borderline personality disorder and their followers are be their which are legion. Dr. Nicholas Kardaras [00:07:19]: These psychiatric influences are getting billions of views. Now these oftentimes adolescent girls are mimicking some of their psychiatric issues. So what I talk about is strengthening our psychological immune system. Right? Because we're not gonna change the world. We're not gonna be able to put the toothpaste back in the tube with social media or with technology. And and this is a metaphor, by the way, that I learned in my substance recovery early on is that being in recovery doesn't make the ocean less turbulent, but we learn how to become better swimmers. And so part of my narrative is how can we help our children, our loved ones, and ourselves become better swimmers in this toxic stew of digital overload of, you know, there are people that are doom scrolling and and, you know, it's exacerbating the depression and, you know, the world is ending in 5 years if you, you know, if you're if you were to believe all the content that we're seeing. And then we have children that just aren't developmentally far enough in their brain development to moderate. Dr. Nicholas Kardaras [00:08:21]: So so I talk about age appropriate technology usage. If you're a parent, delay the onset of screen time for your kids for at least for individual screens, like an iPhone or a Chromebook till at least 8th grade because at least the brain develops a little bit more at that point and there's a little bit more impulse control as human beings, us, as adult human beings rather, leaning into, leaning into face to face socialization, physical activity, hobbies that give us a sense of passion in our lives that are aren't based on being online. So, like, I do a once a week digital fast where, you know, my family and I, you know, there's one day a week where we're all unplugged. Nobody gets on the device. We do something outdoors or together, and that helps reset us a little bit at that helps kind of reset, you know, for those who have kind of moderate issues or wanna be a little insulated. I talk about, helping children develop a, the skill of critical thinking so they can discern what they read online because social media is if nothing else, but it's an emotions economy. And what drives engagement is things that tickle our lizard brain. So fear and, you know, and I hate the words misinformation, disinformation because I'm an anti censor. Dr. Nicholas Kardaras [00:09:40]: I'm a libertarian by by predilection. But, but can we help our young people discern what they're reading and use a critical lens to be able to can we teach them those basic skill sets? Can we teach them how to think rationally rather than emotionally? Because right now a lot of the clients have a treatment program in Austin, Texas where we treat young adult clients and it's incredible to see, the fragility, the psychological fragility, of some of our young people who have been raised in this digital stew. It doesn't engender resilience. It doesn't engender a lot of things that really make for a healthy human being. So pumping the brakes and and beginning to moderate is is to not as the adults to not be so drunk on our devices that we lose sight of our 5 year olds who, you know, don't drop the Chromebook into the crib essentially. Don't drink the Kool Aid of big tech and think that your 18 month old is gonna be somehow behind if, because that's narrative I hear a lot by parents that I've worked with is, well, little Johnny or Caesar are gonna be behind if they don't have a, an iPhone when they're 3. It's like, no. No. Dr. Nicholas Kardaras [00:10:51]: Sergey Brin, Larry Page, the Google boys, they were Montessori students. They didn't have tech till they were late teenagers. Jeff Bezos was a Montessori student. He didn't have, any technology, so their brains were allowed to develop creatively, robustly, and then they were able to navigate into, science and IT and all the things that they did. Mark Leeds, D.O. [00:11:14]: Yeah. Yeah. That that makes sense. And, and none none of them I mean, this is all like, what we're seeing now is unprecedented. All those guys had, you know, the early early technology. You know, like, I I grew up with a personal computer. You know, I think we got our first computer Dr. Nicholas Kardaras [00:11:29]: when I was, Mark Leeds, D.O. [00:11:30]: yeah, when I was 13. We got we got an Apple 2 plus, And I had wanted it for a long time because it had already been out for a while, and all my friends were talking about, you know, friends were getting computers. And we finally got it, and it was great. And we actually did get connected. You know, that was, like, after we got it, I'm like, you know, can we get the modem now? And it didn't connect to the Internet. It connected to to, like, local, Internet, like, bulletin board things. And, you know, there there was we all had our fun. It was kind of, I guess, similar. Mark Leeds, D.O. [00:11:57]: But now, it is kind of like how drugs like, how you you know, one time in history, they had the cocoa leaf, and people would chew on it to get some energy. And then somebody figured out how to make cocaine, which was highly addictive. And then someone figured out how to make free base and crack, and it just kept getting more and more addictive and more dangerous. And, we're definitely, I think, going that way. And I actually had a book. I ordered a book on Amazon. I read a little bit about it, but it was by a psychologist about, you know, instructing people on how to make games and things like games more addicting. Like, they actually have there's a science of making these things more addicting. Mark Leeds, D.O. [00:12:35]: And, so it's definitely, I think, following that evolution of refining more and more to, you know, to keep people more engaged and and do all the bad things that we're worried about here, you know, of figuring out what do they want, how can we manipulate them, how can we keep them here longer and get them to pay more money? Dr. Nicholas Kardaras [00:12:58]: No. It's the same work. And that's really the problem. There's an intentionality behind this. This isn't addiction by accident. Right? This isn't like, oh, wow. We created these cool devices and people happen to, you know, you mentioned, you know, in Peru, chewing coca leaves and all of a sudden, there were, you know, a group of people figured out, well, if we process these coca leaves, we can make them, you know, coca leaves 2 point o. I'm involved right now. Dr. Nicholas Kardaras [00:13:21]: There's 2 massive class action lawsuits. 1 against the gaming industry and one against social media companies, multistate, multi you know, they've gotten a lot of news coverage. I'm an expert witness and consultant on these class action lawsuits. And then what they're targeting is exactly what you're saying. There's an intentionality to purposely, habituate us or addict us to these devices targeting the most vulnerable because we know, as I said before, you know, if you target a adolescent female and you send her content about her body, if if if the because they're using, algorithms, private you know, in the very predatory way these algorithms act as heat seeking missiles, finding people's psychological vulnerability. So if if a social media platform senses by a profile of a young female that she's got body image issues, she's gonna get bombarded by toxic content about, hashtag skull and bone, skin and bones, a 100 calories or less, visual images of, anorexia. These are all images that make their, exacerbate their eating disorders, but also you can't look away. You can't stop the rubbernecking effect. Dr. Nicholas Kardaras [00:14:28]: It increases engagement because it activates their emotional lizard brain. And so, you know, the Facebook whistleblower, a woman called Frances Haugen, who testified in front of Congress about a year and a half ago, she released and revealed the internal emails and research of made on Instagram. And they had their own research 3 years ago showing that suicide rates were going up as a result of being you know, if you were a teenage girl on Instagram, your the likelihood of having suicidal thoughts or actions went up 12%. They knew that, and in the internal emails, the conversation was, well, should we dampen down the algorithm and make it a little bit less toxic? And the answer was, hell no, cause that's gonna decrease engagement. So the lawsuits that I'm involved with, are following the OxyContin Purdue pharmaceutical playbook and the big tobacco playbook saying, you harmed there's a there's hundreds of plaintiffs on this class action suit. People have been harmed by design intentionally. You knew that these products were harmful. You knew that they were habit forming because you made them habit forming because, you know, if you if you watch the documentary, the social dilemma, you know, they pull back the curtain, and these are the heads of the big tech companies who said, oh, yeah. Dr. Nicholas Kardaras [00:15:40]: Guilty as charged. We did these. We made these intentionally habituating. I don't think they they intended to kill people, but we know that for some really vulnerable people, this was a dangerous intersection. And and, you know, people have died. There's been suicides. You know, just 2 weeks ago, you had Mark Zuckerberg in front of the senate getting up. I don't know if you saw it and turning around and apologizing to the families in the gallery who are holding the pictures up of their kids who had committed suicide as a result of some toxic content on on Instagram and Facebook. Dr. Nicholas Kardaras [00:16:13]: So, a pox on their houses because it's one thing, you know, I I you know, people ask me, what's the difference between our kids get obsessed with other toys or gadgets. What's the difference between an iPhone and, you know, pick of any childhood toy? And, you know, what I typically say is, you know, while we've always had manufacturers that have targeted children with jingles and with all sorts of things to have kids buy stuff, they're using, as you mentioned, behavior modification 2.0, really insidious manipulative techniques by design that are now proven to be harmful to kids. And they haven't. So the lawsuits are looking for warning labels. They're not just looking for the the families to get settlements, but they're also looking for legislative changes in how these platforms operate. Like with social media in particular, they can't be sued right now. There is a thing called section 230, which was the Americans Communications Decency Act from the 19 seventies, which had nothing to do with social media. But essentially, they're saying we're not publishers of our content. Dr. Nicholas Kardaras [00:17:20]: We're we're we're just an independent third party, and if other people are posting toxic content, we shouldn't be responsible or shouldn't be sued for that. That argument, I don't think holds water. The lawyers that I'm working with don't think it holds water because, the analogy is like if, you go to your local grocery store and there's a bulletin board in the vestibule, and that bulletin board will have you know, people will post ads on that bulletin board, you know, 1 bedroom apartment, car for sale. Well, Well, if somebody posts on a bulletin board, you know, Ku Klux Klan meeting tonight, the grocery store is gonna say, well, we're not responsible for that Klan meeting. We didn't post it. That was just put up on our bulletin board. We're just the, neutral third party. The difference with social media companies is they will take those bulletin board messages like that clan meeting. Dr. Nicholas Kardaras [00:18:07]: They'll amplify the messaging. They'll gatekeeper it, and they'll send it to those folks who are vulnerable to going to a clan meeting. And so there is a difference between them being, neutral third parties and gatekeepers of some of the toxic content, which I think gives them liability for some of the stuff that we're seeing, happening. Mark Leeds, D.O. [00:18:28]: Yeah. Yeah. It does seem like algorithmic curation of content should be considered analogous to to creating content. It it is, like, a form of meta content, and and so they they really should be responsible. Dr. Nicholas Kardaras [00:18:42]: That's a perfect way of saying it. It's meta content. So because you're manipulating the messaging. Whether you wrote it or not. You're shaping, manipulating, and recreating it in the meta way exactly as you said. That's exactly right. Mark Leeds, D.O. [00:18:55]: Yeah. And and, of course, coincidentally, Mark Zuckerberg renamed his company Meta. So but that's that's Dr. Nicholas Kardaras [00:19:02]: what he wanted that's when he wanted us all living in the metaverse. Right? Living all in the virtual reality world controlled by Bzuk. You know? It was, you know, I grew up a Star Trek fan. Full disclosure, I grew up a Trekkie. You know? The original series, Kirk, Spock. And so Gene Roddenberry was a a tech utopianist. You know? So I wish I was shaped as a kid believing that technology was gonna be the panacea. You know? Because in Star Trek, there were no wars, there was peace, nobody there was, you know, nobody there was no more currency. Dr. Nicholas Kardaras [00:19:32]: It was this Shangri La utopia. And, so that was how I was wired as I, you know, went to my adolescence and young adulthood. And then, you know, you begin to see that, oh, there there's this is sort of a Faustian deal that, yeah, technology is wonderful in a lot of ways, but there's a price to pay. And and we weren't fully aware of that price to pay until we started seeing some of the the wreckage of our love affair with technology. Mark Leeds, D.O. [00:19:58]: Yeah. I mean, some technology is definitely good. I mean, plumbing, antibiotics. I mean, you know, there's definitely technology in the last few centuries and and maybe even recently. And, but, now the idea of going after these these big companies, like Big Tobacco and and Purdue, is is intriguing because, going after the the top dealers with fentanyl and cocaine and methamphetamine, that's not so easy because those are really scary people. There's people with armies and stuff that that are like their own country. And so, if I were a federal agent in charge of going after drug dealers, I would not want to have to go after those people with a whole army behind them. And I probably would want to start with and not that it's easy to go after big tech because they're wealthier than anybody. Mark Leeds, D.O. [00:20:47]: They dwarf the entertainment industry. People like to say, well, any big tech company could buy Disney easily. People don't, I don't think, realize how much bigger they are financially as far as their value and their power compared to companies that we think are big. But at the same time, you know who the dealers are right there. They have them in congressional hearings sitting at a table. There's our big dealers, the drug dealers of tech. Dr. Nicholas Kardaras [00:21:14]: Right. If you're a DEA agent, you'd rather go after Zuckerberg than the cartels, you know, for for personally. But, you know, you're right because the the cap valuation of I mean, $2,000,000,000,000 I mean, these are we shouldn't make any mistake about this. These are the wealthiest, most powerful. The tech oligarchs, 5 or 6 people at the top of the food chain and big tech are the, not just wealthiest, but the most powerful people that have ever lived because they don't just control a commodity. You know, I wrote in Digital Madness. I was looking at JD Rockefeller who had Standard Oil and who had, you know, cornered the market on oil. He controlled 90% of US oil, and he became the wealthiest man in the world. Dr. Nicholas Kardaras [00:21:56]: But he controls 1 commodity, oil. These folks control they're not ultra wealthy. They're not just monetarily flush, but they can they're the gatekeepers of what we see, what we think, how they shape our reality. So in the very real way, they're the most powerful people that have ever lived. And what I've heard about in Digital Madness is we haven't fully appreciated how ruthless they've been, not only in their their they violated antitrust laws. Beyond the doubt, they've been in front of senate antitrust committees. I mean, when you look at Jeff Bezos's playbook in terms of gobbling up Amazon's competition, or same thing with Zuckerberg, you know, when he gobbled up WhatsApp and all his competitors, They use really ruthless, business principles, and they've skirted around monopoly antitrust laws. And people, I think, were sort of lulled because, hey, gee whiz, these were the tech nerds. Dr. Nicholas Kardaras [00:22:47]: Right? They didn't look like Gordon Gekko from Wall Street or JD Rockefeller who looked like robber barons and these, like, nefarious folks. And so and and and from a cultural standpoint, when Bill Gates came out of Seattle and Steve Jobs came out of the Bay Area, they were part of a counterculture democratization movement. Right? Because before them, and I write about this in Digital Madness, big tech was Hewlett Packard and IBM. And and they were these monolithic corporate entities. And so the garage boys, you know, the the guys out of Stanford that were, you know, tinkering around with their, circuit boards in the garage were became counterculture heroes. So, So, you know, Steve Jobs with his black turtleneck was was, you know, became this, you know, there's that that iconic Apple ad. Remember where they they had the it was kind of a 1984 ad where they showed the big brother and then that there's, I don't know if you remember, but the this woman, Olympian throws the hammer at the big brother screen, and this was gonna be what was gonna make us all the democratization of information. And now it kind of the worm has turned, and now they've become the the corporate overlords, in ways that I think we were all lulled into thinking, oh, these guys are just the cool garage guys. Dr. Nicholas Kardaras [00:24:09]: They're not gonna, you know, hurt us in any way. Who who's afraid of the the tech geeks? So I think that was part of it. Mark Leeds, D.O. [00:24:18]: Yeah. Definitely. Yeah. I think and it is still there's still some appeal to that, and and there's different parts of the tech movement. You know, there there's open source and and and the the people that are, you know, fighting for for access to to free software that's not controlled. And there's so there are there are good people out there. And, you know, like, I I kinda like things like WordPress and the, oh, the the Matt Mullenweg, the creator of WordPress. And I I don't know if he's a billionaire, and if he has what his I don't think he's creating content or doing these algorithms, but it's really I like to listen to his interviews where he's very much in favor of people having their own voice and their own agency and being able to be their own platform. Mark Leeds, D.O. [00:24:59]: And I think that's, like, a positive thing. Dr. Nicholas Kardaras [00:25:02]: What I think what's what's missing, though, in in, you know, even OpenAI or ChatGBT with a lot of, you know, I write about this also digital madness. You know, there's a lot of scientific innovators currently in the last 50 years. They're not getting the ethics training. They don't have ethical discernment. So they get very myopic in their Frankenstein monster pursuits. Right? So doctor Frankenstein was in search of creating life. They didn't really think about what would happen if the monster runs amok. And so when a lot of these myopic scientists or tech developers, they've got their eye on the prize, but they're not thinking 6 generations ahead. Dr. Nicholas Kardaras [00:25:40]: They're not thinking what happens if the monster escapes containment. What happens with with artificial intelligence or artificial generalized intelligence, sentience awareness, which, you know, Elon Musk has warned people quite a bit about. You know? Like, this is one of the most frightening things that can go sideways. But you have a lot of these innovators who are just so tunnel visioned. Ray Kurzweil is the high priest of the tech industry. You know, he's a Google senior guy, Caltech, you know, genius. But he in this book, he writes about it. The the singularity is near. Dr. Nicholas Kardaras [00:26:12]: It's almost a messianic vision of the future. They think that the next generation of human evolution is gonna be this merger of AI or the a cloud like AI and humanity. That we're we're that this is gonna be what's coming next. And they're not they're not fully looking at what the unintended consequences of some of their innovations can be because they're too drunk on their own innovation. That's where I say, you know, there needs to be more ethicists at the table to say, wait a second. Or at least some oversight committee that at least is kind of reining in some of innovations. Because like you said, wonderful use of technology. We've invented antibiotics and cures to illnesses, but maybe we've also had some viruses who've run loose because of research without enough oversight. Dr. Nicholas Kardaras [00:27:01]: So, you know, things like that, that kinda worries me as we go in as we go boldly into the future, because the technology is getting exponentially more powerful, and will we lose containment? Mark Leeds, D.O. [00:27:14]: Yeah. Yeah. That that's, that would be good to have, you know, to bring ethics into it. And and and I know that there is some discussion with, you know, the AI people talking about holding back and slowing things down and and looking at at that. Now with gaming and and, you know, I think some people were under the impression, as this technology developed, that it was, you know, like 3 d gaming, you know, being in a first person shooter game, you know, like, which can be Apparently, if kids are wearing adult diapers and gaming 24 hours a day, that's not good. But at one point, there were studies that were being published or in the news saying that it was good for people, that it was good for brain development, that you could actually get smarter by running around in a 3 day world. But, you know, I guess, like, the downside, kind of like how caffeine and, you know, sometimes they say it's good, sometimes they say it's bad. And we used to think cigarettes were healthy. Mark Leeds, D.O. [00:28:07]: But, you know, I guess maybe the the the downside is worse than the the upside. Dr. Nicholas Kardaras [00:28:11]: Yeah. I mean, I wrote about it in glow because the only research that they showed that was beneficial with gaming was that there was an improvement of what's called the salience network of the brain. That's really, like, your hand eye coordination. Right? So if you wanna be a drone pilot, you know, good. It's good for your some of your hand eye development. But the the price to pay the Faustian deal is increased depression, anxiety, and the addictive factor. Right? And, you know, I've worked to some gay they were gaming 247, escaping the real world in two dimensional gaming platforms. And that one of my I still remember the day one of my gamers played League of Legends in the virtual, realm. Dr. Nicholas Kardaras [00:28:49]: And he came into my office shaking, saying, oh my god. That was such a powerful, amazing experience. I don't think I will I would ever voluntarily leave that. And, I mean, you know, he was insightful enough to realize that this candy was really tasty. And that's what I talk about. I talk about that we've created really honey coated digital cages. They really taste great, but we're in a cage now at the end of the day. And not only we're in a cage, but we formed a form of Stockholm Syndrome where we've, you know, rock starred our tech moguls. Dr. Nicholas Kardaras [00:29:21]: The guys who are habituating us, manipulating us, and imprisoning us in these digital cages, we've made them, you know, cultural icons. So, yeah, there's that. Yeah. Mark Leeds, D.O. [00:29:33]: It, yeah, remind when you were talking about Frankenstein, it reminds me there was that line from Jurassic Park, which I guess is also kind of an analogy of what's happening. Where the mathematician guy, he says, your scientists were so preoccupied with whether or not they could, they didn't stop to think if they should. And That's it. Yeah. I think that's what you're describing here. Dr. Nicholas Kardaras [00:29:59]: Yeah. It's the, peril there's a name for it, and I'm having a senior moment. The peril something, paradox. Peril rewards. It basically means a peril reward paradox. You know, what's and and you're exactly right. Just because you could doesn't mean you should. And, and that's what we're not seeing enough of. Dr. Nicholas Kardaras [00:30:19]: We're not seeing enough of pumping the brakes. And let's face it, you know, big tech oligarchs, they're driven by they're not driven by our well-being or our good. They're driven by, you know, there's a profit agenda and there's other, I think, other agendas as well. But, but so what can we do as people? I think we have to be aware. We have to have clarity of mind and vision to see what's happening in the cultural landscape to be able to say, this seems appropriate for me and my family to do. This doesn't. And and how can I lean into my humanity? Because it'll be really easy 20 years from now to have us all sitting in easy boys with their own toilet seats and and, you know, a vision pro, a virtual reality headset on, living in escapist fantasy worlds. Going back to Star Trek, the pilot episode of Star Trek, the cage, Captain Pike, you know, is is a quadriplegic and a terrible burn victim, and he gets given the choice to go to essentially a virtual reality planet where he has the illusion of being young and healthy and, you know, dating green women, versus being, a nonverbal quadriplegic in a wheelchair, and he opts for the illusion. Dr. Nicholas Kardaras [00:31:37]: So I look. I'm an addiction psychologist. I get why people lean towards escapism and self medicating. You know, if your everyday life is untenable, if you're suffering from mental health issues, depression, anxiety, you don't feel vertical mobility in your life, You you're gonna lean into the opioids or to alcohol or to other issues. The problem with virtual reality is it's so ubiquitous and so easy to access that it it it's gonna be a more seductive escape and a more available escape than the current ones that we have. Mark Leeds, D.O. [00:32:10]: Yeah. Yeah. Definitely. So, doctor Nicholas Carderas, world's foremost expert on on digital addiction, and your your book is digital madness. And and people can find that on Amazon. Is that the best place to to get your book? Dr. Nicholas Kardaras [00:32:25]: Yeah. Amazon, unfortunately. Gotta dance with the devil. Oh, yeah. Yeah. Mark Leeds, D.O. [00:32:30]: It's all books. Dr. Nicholas Kardaras [00:32:30]: But yeah. Amazon, my and the book before that was GLOW Kids. That looked a little bit more at, children and, the mental health effects of kids and screen time. So glow kids was 2016 Digital Madness is the book that came out this year. Looks at more social media and our mental health crisis. Mark Leeds, D.O. [00:32:48]: Oh, thank you. Yeah. Thank you, doctor Nicholas Carderas, for for joining me today on the podcast. Dr. Nicholas Kardaras [00:32:53]: Thank you, Mark, for having me, and, have a wonderful day. Mark Leeds, D.O. [00:32:56]: Oh, you too. Thank you. ### These Things Happen: A Journey of Addiction, Recovery, Acceptance, and Surrender. URL: https://therehab.com/michael-eon-these-things-happen/ [spreaker type=player resource="episode_id=56795109" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] ## In the throes of addiction, it's difficult to imagine a way out, let alone a path to personal revelation. Michael Eon, however, is an exemplary figure who has managed to transform his battle with alcoholism and addiction into a compelling narrative that offers hope and inspiration to countless others. A recovering alcoholic and addict, Michael’s journey to sobriety was multifaceted. Like many on the path of recovery, Michael found support in the [12-step program]( "12-step program") of Alcoholics Anonymous. It was during this program that he was encouraged to undertake a moral inventory, a process that pushed him to delve deep into the reservoir of his past and the memories of his childhood. ## It's no secret that confronting one's past, especially one tainted by addiction, is an emotional endeavor. For Michael, it unveiled powerful emotions of anger and rage, emotions he had long suppressed but were now demanding acknowledgment. While such a torrent of feelings might have deterred some, Michael, bolstered by the encouragement of his loving wife, channeled this emotional upheaval into writing. What started as personal journaling to capture these raw experiences slowly metamorphosed into a narrative, echoing his internal struggles, dialogues, and revelations. What emerged from these written reflections is a book - a poignant amalgamation of Michael's experiences during his days of active addiction and the subsequent path to recovery. ## But his book is not just a tale of addiction and recovery; it's a guide to introspection and self-growth. It's a beacon for anyone battling internal demons, assuring them that transformation, no matter how out of reach it may seem, is indeed possible. With the imminent release of his deeply personal novel, Michael stands poised, ready to share with the world not just his story but also the lessons he's gleaned from it. Whether you're someone grappling with addiction, someone who knows someone struggling, or simply a seeker on the path of self-discovery, Michael's journey will undoubtedly strike a chord. Eager to dive deeper into Michael's world? Check out his website: For those who found resonance in this interview, we invite you to explore more resources on recovery and self-improvement by visiting our sites: [https://therehab.com]() and [https://drleeds.com](). Thank you for joining us on this exploration of personal growth, redemption, and the power of storytelling. [Contact us]( "Contact us") at The Rehab for more information. **Transcript (machine transcription. Please notify us of corrections):** Mark Leeds, D.O. [00:00:04]: Michael Eon, author of these things happen, a new upcoming book, which is coming out on the 19th of, this month, September 2023. Welcome to the podcast. Michael Eon [00:00:16]: Thanks for having me, Dr. Leeds. It's good to meet you. Mark Leeds, D.O. [00:00:19]: Oh, it's nice to meet you. Yeah, so I I read this book and I I I loved it. That people are really gonna love this book when they when they get it. And it's, e even for people who have no interest in addiction or alcoholism or recovery, it it's a great story. It's it's just it really had me on the edge of my seat. I just wanted to see what's gonna happen next to each of the characters. And, you know, I kinda feel like I I I know them. And interestingly, I was I I've been back and forth to Brooklyn a lot lately because I have some family that lives there now, and I was just there a week ago. And so just reading through it, a lot of I think the whole thing takes place in Brooklyn, and a lot of the street names and locations were were familiar in the the trains and stations and things like that. So I I kinda had a feeling for it just from my because when I'm when I'm there, I don't I've tried not to take a car or take the train. I try to walk everywhere. So You see all the churches and all the people in the street and just wonder, like, you know, who are these people that live in these brownstones and apartments and go to these churches and things? So it was really, For me, it was a a great story. Yeah, so tell me a little bit about, like, what how did this come about? What made you decide to write this and what went into it? Michael Eon [00:01:28]: Well, I started, basically, I'm an alcoholic and an addict. And, And as part of my recovery in the 12 offset program of AA, I did it, I I went through the step and and, I started doing my writing in step 4, which is the moral inventory piece. And, of course, I had a ton of resentments And, as I was, as I as I was writing all that down, I started to remember all these different, things from from the past and my childhood And what I would start doing on the side is journaling these kind of memory stories, of things that had actually happened And, of course, there was a lot of anger and, and, rage in in that at the time. Because, you know, I was in a place where I hadn't done, you know, the recovery work, what I was abstinent. So that's can be a, a precarious place to to exist. And, my wife got ahold of some of them, and she was like, wow, you should you should write a book. You know, you should put these into a book. And, I started, I started, thinking about that. And I, I've crafted a, a more of a experimental story. It was about a guy kind of trapped, in a prison of his own making. So he's kind of trapped in his own head and he it was this conversation between him and a voice. And I was told as I started to to get down the road with that, that that was real experimental and, you know, probably not the traditional way novels are are written, and, and that I should try and bring it closer to, to more popular fiction. And that's how it, that's how it evolved. So it took a lot of, it went through a lot of iterations to get to, to the point, to, to where it is now in terms of a final book. But it is, it is based on a lot of experience that I had, both inactive addiction and in recovery. So, I think it can be helpful to you know, not just an addict or or an alcoholic, or or someone who knows, you know, someone like that, but but to anyone. I mean, the principles, that that are outlined in the book by various characters, who are in recovery are, you know, anybody can benefit from. So, so I'm looking forward to its release. Mark Leeds, D.O. [00:04:01]: Yeah. Yeah. And I can imagine that a lot of people, going into recovery and getting, you know, becoming absent and getting the drugs and the alcohol out of their system they kinda wake up and see how things are around them. And and I can imagine a person having resentments and being angry and And it's not totally unjustified. You know, families and, other people can really contribute. And, you know, you you show that in the story, you know, the sickness of a a family and, you know, someone growing up as a child and developing a an addiction along the way, you know, that it's You can see, like, look at what the parents did to them. Look at how they were treated, you know, and, that's, you know, I can imagine, like, that must be a difficult thing for someone to say, like, you know, what was your part in this? What did what did you do wrong or, you know, what mean, how how does someone come to terms with that? Like, you know, when you feel like it was other people. Michael Eon [00:04:55]: Yeah. That's a great point because, I remember when I was going through the process, of writing, on those resentments. And I got to, you know, what, what we call the turnaround section where we forget about what the other person did. And we look at what our part was. And, and, you know, I I I'm I need to go through each one of these and say, where am I being selfish, dishonest, and self seeking, and it's like, I'm like, how how could I be selfish. What did I do to have that happen to me? And, and the issue is, for me, what it all came down to is, first of all, I gotta forget about what the other person did because it's swollen inside of me since I'm a child. I gotta get it out of me. I have no drugs or alcohol to kill the pain anymore. And, I'm either gonna go back out, or I'm gonna try and give this a real effort. So that's the first thing. And the second thing is I have to realize that I had no bottom line for me was that, you know, I I can't control what other people do. I mean, in a sense, I wasn't just powerless over alcohol and drugs. I was powerless over people places and things. I mean, I had no tools, to deal with life on life's terms. And I had to say to myself, and of course, as we know, in 4th step, we realize that everything is driven by fear, fear that I thought I didn't have when I got there, but obviously, everything for me is driven by fear. And, and for me, it was, you know, self centered fear, fear of losing something I already had or not getting something I feel I deserved. And I had to come to terms with the fact that I can't control everything, and this fear of of of trying to make sure the world is the way I want it to be, you know, is irrational. It it it it it it only leads to futility because your expectations are always high and and you're always let down. So, so I had to let go of all that. I had to, you know, make amends to, to the people that I blamed for everything wrong in my life, you know, by basically telling them, hey, I I blamed you for everything. And I'm sorry. Because, you know, they they're all we're all human beings trying to make our way. And we all have, especially as a as a child, you don't realize that your parents had their own childhoods, their own struggles, their own ways of dealing with things, or not being able to deal with things. And, and, you know, just by virtue of the fact that they're my parents, you know, I thought they owed me, but the reality is we're all just trying to make our way. And if I don't if I don't understand that and and forgive that, then I'm I I'm you know, it's just gonna slow inside in the end. I can't you know, I'm gonna it's gonna cause me to go back out and drink, you know. Mark Leeds, D.O. [00:07:55]: Yeah. If if you were, you know, suppose if you were in a meeting and and someone, you know, and there was discussion about about god, in a higher power. And someone were to ask you, let's say someone had a parent sick and dying from cancer. And they said, why why would god cure or treat my addiction, but not cure or treat my parents' cancer. Michael Eon [00:08:18]: Yeah. I mean, for me, it's always been I'm not of the belief that that that god allows or it doesn't allow things. You know, because like you just said, that would mean for me that why did he do this for me, but not for someone else? And I can't imagine any kind of higher power or god or or or anything that that that could operate that way personally. That's my personal belief. I had always believed in a power greater than myself. But this per this idea of a personal god was always, an obstacle for me. And really, the way I view the steps and the way it asks, for me to, to trust and rely on a power greater than myself is a lot about me staying out of my own way, trying to not interject myself into the universe, to let the universe play out as it should, and to kind of create this relationship with this entity, you know, in in the back of the big book, there's a spiritual, appendix, and it refers to a higher power as an unsuspecting inner resource in all of us. And that's what I try and identify with. That, that kind of intuitive thought or that 6th, 66th sense, you know, I, I try it, you know, it's not a religious program, and I don't view it as a, a religious program. And I don't, I try to, to really, you know, I use the terms when I'm in meetings I use the term of higher power and not god because I know immediately people, you know, don't want anything to do with that. Sometimes, because of the way they're brought up into religion and things like that. But for me, it's, it's a power source and a combination of that, combination of the knowledge, that I gained from the 4th step in knowing who I am and how will I I, what character defects I have and, and how I can understand to, how, you know, to deal with those. And, and, you know, it's a combination of all these things that enables me to deal with life, you know, on life's terms. And, it's honestly for me, it's it's been a blessing, because I've gotten so I went in for my drinking and I stayed for my thinking and, and I I, you know, I, I I people don't people don't people who'd used to know me have no idea who I am today. Because it's it's just such a, 180 degree difference. Mark Leeds, D.O. [00:11:03]: Yeah. Yeah. That that's an incredible thing when people go into recovery and you you meet them later on and don't even recognize recognize who they are. It's like a whole different person and conversations are on a different level and it's it's, yeah, it's really incredible. Michael Eon [00:11:17]: Yeah. Mark Leeds, D.O. [00:11:19]: So I I think one of the one topic that came up and and that topic of of god does come up in the book, and it is it is really interesting, you know, how different characters, deal with that. And, I think also another, subject that comes up several times is surrender. And, you know, that kinda makes me think of, like, you know, some patients I've I've worked with where they've been in recovery before. They've had years of of time going to AA and being very involved in the program. Another back and active addiction. And, you know, they've kinda feel like they've tried everything. They've been to the best of of therapists. They've tried all the best medical treatments. They've been there. They've done everything. And, you know, now it's like, you know, they're kind of they want they know that they have to stop. They know that something has to change, but they just don't really believe that anything can work because they've been everywhere, tried everything. You know, how does that tie in with surrender, maybe, or how, like, What does surrender mean? And, like, what what could a person what what might someone say to a person like that where they just feel like nothing is gonna help them? Michael Eon [00:12:24]: Yeah. I mean, you know, the paradox of of the full step program is, is that, you know, in surrender that you actually find power. You know, you actually find the power, to deal with, to deal with life. And that that that's because you know, in that surrender, I'm I'm giving, you know, I'm removing myself will from the from from the pro you know, from what's happening. You know, I'm allowing, you know, I I use the term god or universe or higher power, force light, whatever it whatever you wanna call it interchangeably, but it's allowing things to play out the way that they should without my you know, without without me trying to manipulate what I want out of it. And so surrender for me is not just, you know, surrendering to to to the to my powerless, no over alcohol and drugs, but it's, you know, surrendering to to people places and things, you know, to look to to that idea that that, I mean, let me put it this way. My whole my whole world view before I went into recovery was trying to fit the world into me as opposed to trying to fit myself into the world as it is. And like I said, that that only leads to expectations that are never met. It it's just it's just a terrible it's a it's a it's a terrible place to to be. And, and I had to hit an emotional rock bottom in sobriety. You know, there's a term that's used occasionally called stark rating sober. I mean, I was stark or even sober. I was absent. I was going to meetings, but I was, but I, you know, I heard someone say when I was in this place, in this you know, in this place of of stark raving sobriety. And I heard someone say, you know, the real definition of insanity joining a 12 step program and not doing the 12 steps. And I when when I heard that, it it hit me because it was like I didn't think, you know, I was trying to pick and choose what I wanted. And I I feel that for me, because I worked so hard and because I hit such a despair in sobriety, emotionally that I was basically willing to accept what I was being told and to, and to give myself, you know, the opportunity to do what other people had done who seemed happy, joyous, free, serene, saying, you know, that it was either gonna be that, or I was gonna go back out and God knows if I was gonna get back, you know, come back and get, get back in if I was gonna make it out a lot. So it was like I had to I had to give it a chance, but I had to get to that point in sobriety where I was where, you know, where where things were horrible. I mean, I am I came closer to losing my family to losing, you know, my business, financial room, all these different things in sobriety than than I ever than I, you know, I came closer in sobriety than I had when I was active because when I was active, I, you know, it was just like, I wasn't present and, you know, wasn't bothering anybody. I wasn't, you know, destroying lives like I I did when I when I got sober, and I was like the same person. Same angry, hateful person causing destruction wherever I went, because I wanted things my way. And, and so it's hard because my my opinion is that is that it's not that the 12 step program doesn't work. It's that the person doesn't work. You know, I mean, I've seen people who who where it worked phenomenally. And I've seen people who are just in denial of the fact that they're either an addict or an alcoholic, or that, you know, they can just come to meetings and and not drink and that everything's gonna be okay. For me, that wasn't enough. You know, I needed to do the step work. I needed to become a useful human being. I need to pay it forward, which is part of the reason why I wrote this book, honestly, to to to give people, you know, show people what it was like, and what happened and and and what it can be like and have tools to to to help people deal. Because like I said earlier, I think I think the principles of the 12 steps can apply to everybody, not just attics. You know, everybody. The the thing with, like, the 4th step, for example, what a what a novel idea. Forget about what the other person did and look at yourself. Look at what your part was. You know? I don't think the majority of people today ever point that that, you know, that lighted themselves. You know, there was a saying I, I used to hear at meetings. I haven't heard it in a while. I said put down the, put down the microscope and pick up the mirror, pick up a mirror, you know, like stop analyzing and judging and, and, and, and, condemning what everybody else is doing, every little thing they're doing, and look at yourself, you know, and I think that's a huge I think that's a huge thing for for for anybody to do is because, you know, my wife used to say, and I don't know where she got it. Probably, Dr. Phil or something. I don't know. But it was like, like, you know, would you rather be right or would you rather be happy? You know, we've all heard that. And, and I was the one that always wanted to be bright. And so what I may have been right a lot, but it was but inside, it was showing me. And I, you know, and I didn't realize how badly it was destroying me, that, that philosophy, that attitude. Today, I'd rather be happy. You know, and I let things go. And, and I, like, in surrender, there is there is strength. You know? That's that's my experience. Mark Leeds, D.O. [00:18:30]: Yeah. Yeah. That's, it it does make sense that that the steps and and that way of thinking and way of living could help people even beyond addiction. And, I remember I I interviewed, another author a while back on the podcast. And, she had said something, and and I think there's a lot of different ways this could be interpreted. She said, the program, and and it wasn't AA. It was an AA derived program. Still using the big book and the twelve steps. But she said the program is about not being learning not to be a doormat. And, there's so many ways you could interpret that. And, you know, I just right away with, yeah, not not letting everybody walk all over me and tell me what to do. And, I think a lot of people that, you know, you know, what you were meant to be in life or or some version of of what you were meant to be in life. And this is a tie, something that comes up in the book, a theme in the book. Of, you know, that your family might shape you into something else. They they push you in the direction they want you to go. And one day, you wake up, like, maybe you're like, fifty years old or something. You're like, that that's not what I was meant to do. And, or hopefully sooner than that. But, that seemed that seems to be a part of it also of, You know, and also like what you're saying, you know, the the principles. And I think I I the first step, the principles are being an an open mindedness, you know, being open minded, like, Wow. What what what's my part in this? What could I do? And being honest and being willing to do something about it. So Michael Eon [00:19:56]: Yeah. For sure. I mean, you know, I, you know, one of the, one of the main factors, I mean, when I first came into recovery, you know, and I heard talk about fear, I would sit there and say, you know, I have no fear. I don't know what these people are talking about. But like I said earlier, for me, you know, if I'm being honest with myself, because like open open mindedness, honesty is huge, you know, that to thine own self be true because, you know, I have a healthy respect for my mind because my mind is is not necessarily my friend. You know, I don't know how I'm using that term, but it's that part of me that that denies, that justifies, that rationalizes, that makes things sound better than they are. That makes me do things that I know I shouldn't be doing. And, you know, I I treat that as almost a separate entity because, I I have to have control over that because for for all my life, it controlled me. And, you know, it, it led to anger and resentment and, you know, blame blaming everyone and everything for all my problems. And, you know, it's just, you know, I'm not saying that why I drank a drug. That's part of it. I mean, the other part of it is that I was I don't know how if, technically, if I'm born that way or what, but I know that when I put a substance into me that is my goal to bring, I want more of it I love the feeling. And when I don't have it, I'm obsessing about getting it. And, you know, and it's that combination of that and maybe environmental factors that, that, you know, led me into addiction that became uncontrollable for most of my life. You know? And It's a terrible place to be where where you're, you know, you can't live with it and you can't live without it. You know? I mean, that's that's where our I ended up, and hit a rock bottom. And and and it's it's it's I can't even, you know, to someone who who doesn't you know, who hasn't been there, it's really hard to explain, but it's, it's the absolute worst place to be. And, and I had to do something about it. So it's crazy. Mark Leeds, D.O. [00:22:18]: What what do you think about forgiveness? You know, there's some some people that say it's been scientifically studied and demonstrated that be that being able to forgive everybody in your life that is actually physiologically beneficial, you know, that your your brain is able to get into, like, an alpha state, apparently. That's the study they did. Know, if if you, forgive everybody, but which is not an easy thing to do, is is forgiveness part of the program, or is that something separate? Michael Eon [00:22:45]: Yeah. No. I mean, it it is. It's a it's a huge part in terms of making amends. You know, and like I said, I think I said earlier, when I was, when I was doing that, that step work, you know, I I I I held my family members and my father, for example, responsible for everything that went wrong in my life. And, and to be able to to sit down with him and and say, hey. You know, I blamed you for everything. You know, I, I don't know if you know it or not, but I blamed you for all of my problems, everything that went wrong with me, why I didn't go down the career path I on it. Why this? Why that? And, and I'm sorry. You know, I'm sorry for that. And he kinda looked like shocked and I don't think I think he had an inkling of understanding, but I don't think he knew the full extent, and we had the best conversation we'd ever had at to that. And, you know, he he said, though, you know, he appreciated it all that, you know, He I said, you can, you, you know, you can not be the way that that you are. You can change if you want to. And he said, no, I'm too old to change. And I said, If you cared enough, I think you could change, you know, and, and but we had a our relationship is great now. But previously, my my mindset the vast majority of my life was, I will never have peace until this man is dead and buried in the ground. You know, I mean, that was that was where I lived emotionally, mentally, for the vast majority of my life. So it I think it has a lot of truth, that study that you're referring to, because, you know, I felt I felt a ton lighter after that, just from that conversation, let alone all the other ones, you know, but the goal today is just to not create new wreckage to keep my side of the street clean and, and to try and, you know, pay back what was freely given to me. You know? So I go to meetings every day, and I sponsor, other men and, and take them through the steps. And, you know, it honestly, I I'm it it's surreal to even think about and have these, you know, hear these words come out of my mouth, but, it's been a blessing for me. And, you know, I'm very grateful. Mark Leeds, D.O. [00:25:15]: Do you do you think, like, were you open minded to some extent, or did you do you feel like you had the, capability of being open minded ahead of time? Like, do you think it because it does sometimes seem like there's people that, you know, like you said, like, your father, like, maybe that person just is never gonna get it. And but, do you think everybody has the the potential to be open minded and well, maybe these people are right. Maybe I do need to look at myself or try something different or think about things in a different way. Michael Eon [00:25:43]: You know, I think a lot of a lot of what we do as human beings, in terms of changing is is is pain motivated, despair motivated. And, and I I you know, I had had my share of that, and I became open minded into it. But when someone spends most of their life, creating wreckage and isn't held accountable for it and gets away with it and doesn't necessarily understand what they're doing or how they're treating people or things to that effect, then I don't I don't I don't see how they could be open minded, you know, so the best that we can do on the other side is just try and be an example you know, of what could be. And, and and and and, you know, it's this whole idea of of attraction, you know, not promotion. And, but so I think it depends on the person, and I think it depends greatly on on, you know, how their how how their how their how they truly feel their life is and whether they think they need to or not. You know? Mark Leeds, D.O. [00:27:03]: Yeah. Yeah. So in a in a way, you know, going down relatively quickly, like, of of a person who say has a really bad drinking problem and binge drinking, and, they they don't really last that long in the world drinking. They're, you know, they they just drink way too much and, and they end up in, hopefully, in recovery and, and discover the program. Opposed to someone who might be what they call now a gray area drinker, someone that maybe binges occasionally or just drinks too much, but it never gets him to that point. It almost seems worse to be in that gray area drinking situation. I mean, they, you know, may never get a DUI or may never destroy their life or lose their job. But the that kind of gradual, you know, maybe they just never reached the potential of what they could have been or they never really open their mind or open their eyes to to what's possible because they just have, you know, and, you know, I look around. I see a lot of people like that. You know, they're just always having a couple of glasses of wine with dinner, and maybe they take medication to sleep and things like that, but not to the level of where someone could clearly point them out and say you're an addict or an alcoholic, but they're just kind of in that gray area long term. Michael Eon [00:28:12]: Yeah. I mean, that's a great point because that's that I'm, I'm sure there are a lot of people like that and, and it's like, It's like that's where the, the honesty, you know, like, the honesty piece comes in about about, like, really, how is how, how do you think your life really is? You know, like, how, you know, you know, so you may not be a full blown addict yet or you may not be. But you're not you know, necessarily, you know, spiritually fulfilled and sane and serene. And it's like, you know, you're, where is the motivation to, to change or do something? You know, it's, it's a, it's a hard place to be. And I think, again, that's where, you know, the fact that, like, with podcast, all of this communication about all these things now, you know, we have much more than just TV and film and books. I think it's huge, especially when people talk, and and people listen, you know, because that's when people you know, we need more of that so that people can say, hey, you know, maybe I should do that, or maybe I do need to look at that, or maybe, you know, you know, because that's a huge, that's a huge area of people who, who, who, you know, aren't forced into recovery because of their addiction or, in despair or something happens or whatever, but still need still still have you know, you know, some form of spiritual disease where, you know, they're just not fulfilled and life is just not what it could be. And, and that's where, you know, I think that, there's a lot of solutions out there. I think one of the best things that people we can do is let people know that there there is hope and there there are, available, therapies and and books and and professionals, you know, to help. But you gotta it's up to the person. It's up to the individual to to make that you know, that first step when they're in that that that zone of, you know, not being a a a full addict or alcoholic and, you know, not necessarily being happy. Mark Leeds, D.O. [00:30:36]: Yeah. Yeah. And I I love the podcast format. Like, if I if it wasn't for everybody else in my family, I'd never subscribed to Netflix HBO and all these other things. I I would just have, all I would need is YouTube and a podcast app, and I'd had every everything I need there. But, anyway, so, yeah, I really, you know, somebody looks at your book and said, oh, it's a recovery book. You know, it it's not just that. It's way more than that. It's, It it really is kind of like, you know, you walk by one of these apartments and see in the window and the kitchen has lit up and you see the family and you're like, and you wonder, like, what's going on in there? Who are those people? And It kinda and I also saw it in my head as I was reading, as a movie, like, you know, like, when I walked by the TV, my wife saw it caught up in in a movie about these people living their lives and just the the stories and their characters are incredibly, like, you just get to know the people. And then when it's over, like, I I we just finished a a series. Like, a 1 season series, and I don't know if they're gonna make any more of them. And at the end of it, I felt kinda sad. I still think that, like, wow. I wish I could be back in that that world and with those people again. And I've kinda feel like that finishing your book, like, I kinda miss all those all those people. You know, I almost wish it was like an ongoing thing, like, an ongoing series. Like, what happens next to them? Yeah. It really felt like I was in a, like, I was watching the television show as I was reading it. Yeah. So, yeah, I -- Michael Eon [00:32:00]: 70s in the 90s, there definitely is room for for, another, another book a follow-up. You know? Mark Leeds, D.O. [00:32:09]: Oh, yeah. Yeah. That and, yeah, and just that that, you know, life in Brooklyn, life in New York is fascinating and how how it's different from, you know, like, I'm in South Florida and, like, everything is so spread out. Like, you can't go anywhere without getting in a car. You know, there's no good public transportation and everything is also far away and spread out. And, it's like a whole different life, like, where you're in the neighborhood and everything is all, like, in walking distance, sort of, You know, so it's and everything's kinda old and it's been there forever. And, you know, you know, so, yeah, it's a it's really it's a great book, but it is also like, a great book for someone who wants who does wanna learn about recovery and not just by going to a meeting or opening up a book. And, you know, it's is a great story that that kinda gradually gently introduces a lot of important things. And and it doesn't jump right in and say recovery is great. You know, everything is great. You know, it it does question things. You do. In fact, I wasn't even sure. And a lot of at a lot of points, like, you know, if I were to To if I were to to stop the book, like, partway through and talk to you, I might think, like, maybe you don't like the 12 steps or AA, you know, maybe you're, like, anti recovery. I'm not really sure. So you really do have to, like, get into the whole story and see it from all different points of view. Michael Eon [00:33:24]: Yeah. Because, I mean, you know, the different characters you know, have different viewpoints, you know, and that's what, that's what, is great is that over, over time, and over these these damage person relationships, you know, things evolve, and the thinking of, of the main character in particular evolves. And, And so, yeah, it it it, it's kind of showing, you know, all the different angles, all of the different, opinions or perceptions or sides of of the whole situation. And, you know, and and being in the Brooklyn setting, you know, and especially in the seventies where it flat half the book takes place, you know, a lot going on in in in New York City in the seventies. And I tried to weave a lot of that in there and, you know, you know, so you get you have you have trauma inside the home, and then you also have trauma outside the home in terms of the son of Sam and everything else going on. And but yet, like you said, the neighborhood is like one family. It's like a family. It's like a living organism and entity. And, and so there's there's you know, there's a lot of great and there's, you know, a lot of, conflict and challenge, and it obviously makes for a good story. Mark Leeds, D.O. [00:34:41]: Yeah. Yeah. And I think addiction is per per evasive. Like, even if someone isn't whole, you know, you might not be holding a bottle in your hand or a bag of heroin or or fentanyl or whatever, but, you know, maybe someone's, like, looking at their phone, like, oh, let me see how many legs I got on Instagram this morning or, you know, or whatever. I mean, you know, pack of cigarettes. I mean, the addiction is everywhere. So, you know, I think we all we all could use to to hear this story and to read the story. Michael Eon [00:35:08]: Exactly. It is everywhere. I mean, any any there's so many things that light up that pleasure center in the brain, today. And so easy to get, to get, hooked on things that it doesn't it doesn't need to come from, you know, a psychoactive substance or or alcohol. You know, it, it's everywhere, like you said, and, I mean, can be work, can be shopping, can be, you know, not just the the typical things. Can be social media, phones, you know, Mark Leeds, D.O. [00:35:41]: Yeah. Kids playing video games and buying stuff in the game and whatever, and Yeah. They have they have psychologists that are working hard to make sure those games are as addictive as possible. Michael Eon [00:35:52]: Yeah. It's kind of this. It's like an epidemic, really. Mark Leeds, D.O. [00:35:56]: Yeah. So, yeah, so what would be the best way? Is this book available for pre order? Michael Eon [00:36:02]: Available for pre order on, wherever you buy books, Amazon, obviously, on Barnes And Noble. Bookshop.org. It's, it's everywhere. It's, coming out on the 19th. And, Yeah. Mark Leeds, D.O. [00:36:18]: Okay. And and do you have a do you have a website that people can visit to go directly? I Michael Eon [00:36:22]: do. I do. It's located at [michaeleonauthor.com.]() Mark Leeds, D.O. [00:36:33]: Okay. Great. Great. And, yeah, I recommend everyone go go visit and definitely pre order the book, and and read it. Yeah. I I just love this book. It was really great. I I hope it does turn into a TV show or a movie. Because that that would be great. And is there gonna be an audio book also? Michael Eon [00:36:48]: It will be an audio book. Audio book, ebook, paperback. Yep. Mark Leeds, D.O. [00:36:52]: Yeah. This this would work great as an audiobook in the car. Just listening to a little bit every day. So, yeah, Michael, Eon, thank thank you again for joining me today. Michael Eon [00:37:00]: Thank you, Dr. Leeds. It's been a pleasure. ### Writing and Recovery: Ginelle Testa's Journey to Healing URL: https://therehab.com/writing-and-recovery-ginelle-testas-journey-to-healing/ [spreaker type=player resource="episode_id=62160218" width="100%" height="200px" theme="light" playlist="false" playlist-continuous="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="true"] Ginelle Testa is a digital marketing expert with a master's degree in marketing, currently thriving in the ed tech startup sector. As the author of the memoir "Make a Home Out of You," she shares her personal journey through addiction, trauma, and self-acceptance. A seasoned writer, she has penned over 300 articles and participated in National Novel Writing Month. Testa also leverages AI for content ideation and is actively engaged on Instagram and TikTok at @janeltesta. ## Embracing Recovery: A Journey Through Addiction and Self-Discovery ### Understanding the Journey of Addiction Addiction affects many individuals across the globe. It often stems from a combination of factors, including relationships, substance use, and personal struggles. In this context, recognizing the [signs of addiction]() is vital. Many people may not realize they are developing unhealthy patterns until it’s too late. The road to recovery can be challenging but rewarding. It involves facing uncomfortable truths and making significant changes in one’s life. Support systems play a crucial role in overcoming addiction. Friends, family, and professional help can provide the necessary encouragement during tough times. Ultimately, understanding one's journey is the first step toward healing. By acknowledging past experiences, individuals can begin to reclaim their lives. ### The Role of Relationships in Addiction Relationships often influence addictive behaviors significantly. Toxic relationships can lead to codependency, where individuals rely on each other for emotional support. In many cases, unhealthy relationships exacerbate the cycle of addiction. Partners may encourage substance use or ignore the signs of a problem. Through recovery, the focus should shift to building healthier connections. Establishing boundaries and fostering independence are essential components of this process. Reflection on past relationships can provide valuable insights. Individuals can learn from their experiences and avoid similar patterns in the future. Ultimately, nurturing healthy relationships can pave the way for lasting recovery. Positive connections will support an individual’s growth and well-being. ### Body Image Issues and Their Impact Body image plays a significant role in mental health and self-esteem. Many individuals struggle with their perception of themselves, which can lead to unhealthy behaviors. Eating disorders often develop from body image concerns. These disorders can coexist with substance abuse issues, complicating recovery efforts. Addressing body image requires a multifaceted approach. Support from dietitians and therapists can help individuals navigate their feelings about food and self-worth. The Health at Every Size movement encourages self-acceptance. It promotes the idea that health is not solely defined by weight or appearance but by overall well-being. Ultimately, fostering a positive body image is crucial for recovery. It allows individuals to focus on self-care rather than harmful comparisons. ### The Importance of Professional Support Seeking professional help is essential for those struggling with addiction. Therapists and counselors provide guidance and support throughout the recovery journey. Read more: [Addiction and the Workplace: Navigating Career in Recovery]( "Addiction and the Workplace: Navigating Career in Recovery") Participating in support groups can also be beneficial. Sharing experiences with others who understand similar struggles fosters a sense of community. Various treatment options are available to address addiction and related issues. Programs like Alcoholics Anonymous or other support groups can offer valuable resources. Personalized approaches to recovery are vital. Each individual's journey is unique, and treatment should reflect their specific needs and experiences. Ultimately, professional support can facilitate healing. It empowers individuals to embrace their journey and work towards a healthier future. ### Overcoming Codependency Codependency is a common issue among individuals with addiction. This pattern often involves relying on others for emotional stability and validation. Recognizing codependent behaviors is the first step toward change. Individuals must learn to establish boundaries and prioritize their own well-being. Therapy can help individuals address codependency. Through counseling, they can explore their relationship patterns and develop healthier habits. Emphasizing self-care is essential for breaking free from codependency. Individuals must learn to nurture themselves rather than solely focusing on others’ needs. Ultimately, overcoming codependency paves the way for healthier relationships. It allows individuals to thrive independently while fostering meaningful connections. ### The Path to Self-Acceptance Self-acceptance is a crucial aspect of recovery. Embracing one’s flaws and acknowledging past mistakes leads to personal growth. Individuals must learn to celebrate their achievements, no matter how small. Recognizing progress reinforces motivation to continue on the recovery path. Practicing self-compassion is vital for fostering acceptance. Individuals should treat themselves with kindness and understanding instead of harsh criticism. Engaging in activities that promote self-discovery can aid this process. Exploring new hobbies or interests helps individuals connect with their true selves. Ultimately, self-acceptance is empowering. It allows individuals to heal and move forward without being burdened by past mistakes. ### Sharing Stories to Inspire Others Sharing personal stories can be a powerful tool in recovery. By opening up about their experiences, individuals can inspire others facing similar struggles. Writing about one’s journey is an effective way to process emotions. It allows for reflection and may encourage others to seek help. Books and articles serve as platforms for sharing experiences. They create connections among those who have faced addiction or related challenges. By sharing stories, individuals contribute to a larger conversation about recovery. This openness helps reduce stigma surrounding addiction and mental health issues. Ultimately, storytelling fosters community and understanding. It reminds others that they are not alone in their struggles and encourages healing through shared experiences. **Transcript:** Mark Leeds, D.O. [00:00:03]: Janelle Testa, welcome. Ginelle Testa [00:00:05]: Thank you. Excited to be here. Mark Leeds, D.O. [00:00:07]: Yeah. Thank you for being here. And you're the author of the book, Make a Home Out of Make a Home Out of You. Ginelle Testa [00:00:14]: Yes. It's a memoir. Mark Leeds, D.O. [00:00:16]: Yeah. It it sounds really interesting. So, yeah, please tell us more about the book and your experience that led up to writing the book. Ginelle Testa [00:00:23]: Sure. Sure. So the book is mostly about relationship and drug and alcohol addiction, but there's some body image stuff weaved in there. So it's the idea that I made homes and substances, behaviors, and people instead of making a home in myself and learning to, like, be comfortable in my own skin. So by the end of the book, I figure out how to start to do that. Not perfectly, but, yeah, it's a lot about recovery. Mark Leeds, D.O. [00:00:48]: Okay. And, what what drugs were like, I think alcohol was mentioned. Like, what drugs have you dealt with, as far as drugs of choice and drugs that have been an issue? I mean, I know food is is one of them, and alcohol. Ginelle Testa [00:01:02]: So I'd say early days, it was, like, when I was a young teenager from 14 to 16, it was drugs. So it was, like, whatever I could get my hands on. For some reason, drugs were easier for me to get my hands on than alcohol. I guess maybe because my dad was a drug dealer and I was stealing them from him. But, it was weed, opiates, ecstasy, coke, really anything I could get my hands on. And then from 16 to 21, it was alcohol. And I actually stopped drinking when I was 21, and I'm 32 now. So my my using and drinking was only about 8 years, and then I've been sober for for 10. Mark Leeds, D.O. [00:01:40]: Oh, wow. Okay. Okay. So that's in the past. And and, did you ever get involved in any of these medication things like naltrexone or or Suboxone and all those kind of things? Ginelle Testa [00:01:51]: I didn't have to. My my drug use was pretty short lived and not that, like I don't know. I do I wasn't using every day. I didn't get, like, addicted to opioids. I just was using them recreationally, so I feel lucky for that. And then the drinking, I just sort of went to AA and, you know, got better after that. I don't go to AA anymore, but I did go to AA for a long time. Mark Leeds, D.O. [00:02:15]: Oh, okay. And what if Tom what about the body image thing and issues with food? Like, is that some how long have have you, like, found, like, are you managing that well? Are you comfortable with that now? Ginelle Testa [00:02:27]: Definitely. So I wouldn't say it's food addiction. It was more eating disorder. So it morphed from anorexia to binge eating, and I dealt dealt with a lot of just discomfort around, like, eating. Like, I either ate too much or too little and couldn't find, like, some sort of healthy balance for me. And over the course of my sobriety, I've been able to work with dietitians, therapists, psychiatrists to deal with that as well. So I feel like I'm in a really good place with that. I saw a dietitian for years. Ginelle Testa [00:02:57]: I don't see her anymore because I feel good. But I found a lot of recovery through the Health at Every Size movement, the idea that people at any size can take actions towards their health, that I don't have to focus on weight. I don't have to focus on food. I can just focus on, like, being healthy and what that means for me. Mark Leeds, D.O. [00:03:13]: Yeah. Did did you ever get involved with, what do they call it? Like, Overeaters Anonymous or any of the related programs? Ginelle Testa [00:03:21]: I went to one meeting, and I found it pretty shaming. Like, they I I don't know. I really try not to emphasize on weight. I try to emphasize on, like I said, healthy actions. So they really harp on weight there and harp on, like, a strict food plan, and I none of that was really what the recovery route that I was taking. Mark Leeds, D.O. [00:03:42]: Yeah. Yeah. There there's I did an interview with someone about, it was partly about, Grace Heaters Anonymous, which is similar to to Overeaters Anonymous. But I think the difference is that they I think they carried on the food plan where Overeaters, stopped doing the food plan. But it was it it was it was interesting. I mean, there there was a lot of of 12 step things and and things about, you know, setting boundaries and dealing with with relationships and things, you know, not not just the food itself and the, you know, but dealing with things that that lead a person to to overeat. Ginelle Testa [00:04:17]: Yeah. That's the thing. It's rarely about the substance or the whatever it is. Like, my my main problem was sex and relationships. So that's I actually went to sex and law at x anonymous too in addition to AA. And feel like that's really where I dealt with the root of my issues was it was relational more than it was substance. Mark Leeds, D.O. [00:04:36]: Yeah. Yeah. What what were you ever involved? And maybe this is the thing of codependency, you know, being dependent on another person. Can you talk a little bit about that? Because I think that's something that a lot of people are dealing with, and maybe we don't understand what it is or or how it works. Ginelle Testa [00:04:55]: Yeah. Codependency was and still can continue to be a huge issue. I think codependency isn't resolved overnight. I've been working on it for, like, I don't know, 7 years. But, codependency looked like to me really like a lot of control within my relationship. So like wanting to control my partner, them wanting to control me, like feeling responsible for my partner and their life, or them feeling responsible for me. And just like this enmeshment where we sort of depended on each other to be okay. And that none of that works for me anymore. Ginelle Testa [00:05:25]: It it feels gross. And so I'm really working on, like, having healthy boundaries and partnerships, having yeah. Just responsibility for my own well-being and responsibility for my own self care and self soothing. Of course, it's okay to depend on I think codependency can sometimes be thrown around a lot. Like, oh, you shouldn't depend on others ever because it's codependent. I think there's a good balance. Right? Like, it's okay to depend on others a little bit, but when it's your only source of dependence, that becomes a problem. Mark Leeds, D.O. [00:05:52]: Yeah. Yeah. It it makes sense. And I think that's a difficulty for a lot of people with issues with relationships, you know, bad relationships. And what what about, narcissism? Has that played into the the story at all of of what things that have happened to you? Ginelle Testa [00:06:09]: No. I don't think so. I've been fortunate to not not deal with many narcissists. Mostly just people who are a little broken and codependent like me. Mark Leeds, D.O. [00:06:18]: Yeah. Yeah. Has the codependency, like, played in with with, you know, eating disorder or drug use in the past of, you know, like, 2 people saying it's okay for you to do it because I'm doing it also? Ginelle Testa [00:06:30]: Definitely. I remember in high school, I had a partner convince me to start selling ecstasy because he wanted us to have, like, a good access to it and good, like make sure we had it all the time and, like, didn't have to pay for it. So, yeah, I I was like, okay. Well, he wants me to do that. So I'll do it with complete disregard to, like, my well-being and, like, what that would do to me. Mark Leeds, D.O. [00:06:54]: Yeah. Yeah. And, so the problem during that time period was probably not so much the ecstasy, but but the the relationship issue. Ginelle Testa [00:07:04]: Definitely. Yeah. It was always about, like because if I wasn't in a relationship, I was pursuing a relationship and, like, pursuing the next thing. And I think it I was always, like, seeking, seeking, seeking, and there was, like, this void that I felt. So whether I was filling out with drugs and alcohol or relationships or, you know, eating disorder patterns, it was it was always something. Mark Leeds, D.O. [00:07:25]: Yeah. Ginelle Testa [00:07:26]: And it used to be. I shouldn't say that I'm not, like, perfectly healed. You know? We play whack a mole in recovery that, like, we deal with something and then something else pops up. It's like, oh, here. I'm I'm here to pay attention to you now. Yeah. Yeah. Mark Leeds, D.O. [00:07:37]: I I thought for a second, I thought you meant literally whack a mole because that's actually one of my favorite games. Oh. I I I think I can probably beat anybody at whack a mole, but I haven't played for a while. So I don't know. That's awesome. But, yeah, I I see what you mean, though. Like, that, you know, you you know, like, maybe someone goes in recovery to to stop using alcohol or or drugs or both, and then, you know, they develop a an eating disorder or or they start smoking more and and, you know, you now you have a new problem to to deal with. Ginelle Testa [00:08:05]: Exactly. So it almost never ends, but that's okay. That's, like, the layers of recovery. Mark Leeds, D.O. [00:08:11]: Yeah. Yeah. Yeah. I guess, like, nobody's finished with it. You're always, like, working on, you know, find you know? I I don't mean, like, you're looking for the next problem to solve, but there's always something to work on. Ginelle Testa [00:08:23]: Right. And I I go back and forth about, like, the term in recovery because I'm like, how many humans have trauma or some sort of addictive issue, whether that's with food or cigarettes or TV or something? Like, I feel like we're all dealing with something. So, like, how much is the term in recovery useful? How much is it not? Like, I do have addict addiction issues, so maybe it's useful. I don't know. I go back and forth about it. Mark Leeds, D.O. [00:08:46]: Yeah. Yeah. I mean, I mean, definitely, like, there's so, you know, eating disorders are are psychological and psychiatric issues that that people should be seeing someone qualified to deal with that. One one thing I've I've learned recently, I, you know, I I have a lot of patients that that I've worked with in in treating opioid, dependence. And then but then I find over the you know, that they also have other medical treatments that, you know, because I asking about what medications are you on, what doctors are you seeing, that that a lot of people are now getting on medications. You know, now they have weight loss medications or weight management medications that are actually working for people as opposed to everything that's come up until now. And it it's interesting, though, that that, you know, people are are reporting it it almost seems like, you know, like, when buprenorphine or Suboxone came out, it was kind of a miracle drug that it it it really worked well. But there there was a lot of pushback from the, you know, the whole rehab, recovery industry. Mark Leeds, D.O. [00:09:47]: I mean, NA is against it, and their credits anonymous has an official position that they don't approve of methadone or or Suboxone. Ginelle Testa [00:09:54]: I wasn't aware of that. It's supposed to have no opinion on outside issues. That's interesting. Yeah. Mark Leeds, D.O. [00:09:59]: They they they yeah. They don't have that's that's really interesting with NA, and I still I I wish I could talk to, like, the top people and interview them and ask, like, what is and I know that they don't all agree that there's people that that are within organization, there's a lot of people that don't agree with that, but that's the official position is they actually have documents. You know, they have all these pamphlets that you can pick up in a meeting and you can find them online. And I think the one for methadone is actually called Bulletin 29, and that was from 1996, and it's very much against methadone. And there's more recent ones against all any kind of medication for addiction. Right. And and and the thing is that you could take if you take Suboxone or actually buprenorphine, which is the ingredient in Suboxone, if if a person takes it for pain, that's an outside issue That that falls under they have a a thing called, in I think it's called in times of need or something. There's a 42 page pamphlet that basically says, if if you're taking something for medical condition, that's an outside issue, and it's none of our business. Mark Leeds, D.O. [00:10:59]: But if the same drug is used for pain, it it's outside. If it's used for addiction, then they don't approve of it, and you shouldn't be talking in meetings. You shouldn't be taking a a service position. You shouldn't be counting clean time. Ginelle Testa [00:11:13]: Oh my god. That's horrible. I had no idea that that was the case. Mark Leeds, D.O. [00:11:16]: Yeah. And that's Ginelle Testa [00:11:17]: AA isn't that way. Mark Leeds, D.O. [00:11:19]: AA has Ginelle Testa [00:11:19]: no opinion. Mark Leeds, D.O. [00:11:20]: Yeah. As far as I know, that's only NA. AA is different. AA, individual people in groups might have their opinions, but there's no top level position on on that subject. Ginelle Testa [00:11:31]: Wow. I wasn't aware of that. That's horrible. Because drugs are so useful to people. My dad is on Suboxone. Mark Leeds, D.O. [00:11:38]: Yeah. There's nothing wrong with it. It's a it's it is literally a it's a miracle drug. There there it's not perfect. I mean, it's difficult to get off of if a person's been on it for a long time and they decide I'm ready to try life without it. I mean, it it's not something that people have to be on forever. Everybody's different. Some people would feel comfortable staying on a a small amount indefinitely, but there's also a lot of people that that feel that they're done with it and ready to come off of it. Mark Leeds, D.O. [00:12:05]: And, you know, so so everybody is different. But, yeah, coming off of it is not easy that because it does it helps a lot with the addiction, but it creates a physical dependence, which is a different whole different issue, being physically dependent and getting sick when you try try to reduce it. But it's it is something that can be managed, and there's new ways that they're coming up with. There's some doctors that are talking about using the you know, they have a shot version of it, the SUBLOCADE. And there's another one called BRX80, but SUBLOCADE is from the same company as Suboxone, and it's a monthly shot. So some people have discovered that the shot can be a way to come off, like, after you've done a year or more of Suboxone that you could switch to the shot. And, and then kinda it it's like a natural kinda long term tapering solution because the shot can take months or even up to a year to to wear off. And, yeah, it's really I'm sorry to go get off the subject of of what we're talking about before. Mark Leeds, D.O. [00:12:59]: But No. Ginelle Testa [00:13:00]: It's really interesting. I had no idea about that. Mark Leeds, D.O. [00:13:03]: Yeah. But I I think the medical treatments are so, it's interesting how people want, like, a treatment, and then a treatment comes out and then they're like, well, I don't know. Maybe that's not maybe that's not a good idea. You know? Like like, these, all these diabetes drugs that now we're finding out, like, treat weight management so well, and people are resisting them and saying, like, you know, we we there's a shortage. Those should only be for the people with diabetes. There's a lot of problems with them. But, really, I I interviewed somebody recently, and she said it it it's made her for the first time feel like she's full. Like, she never knew what it was like to feel full after eating and doesn't binge anymore because she can eat and be done with it. Mark Leeds, D.O. [00:13:42]: And, you know, so I'm hearing good things about that. But and and not that I'm recommending it to anybody, but, yeah, but it is interesting, though. Like, when there there's a condition where there's, you know, support and and psychological treatments and counseling and coaching are the only thing available. And suddenly, there's a medical treatment that that comes out. It's like revolutionary, but the establishment might resist it for a long time. Ginelle Testa [00:14:06]: I personally feel mixed about Ozempic and those and, like, I forget what the other ones are called, but because I don't always think that weight is the core issue. I think there's a lot of weight bias, and there's a lot of that goes into medical teams. And I feel like it's more about, like, the actions that people are taking. Like, it's more about because I have friends that are that run miles and miles that are heavier than me, and I have friends that don't work out, smoke cigarettes, you know, all this and that are thinner than me. Like, weight isn't the core issue. It's, you know, it's more like the health actions that you take. So if if Ozempic is I have a friend that we had this conversation recently where I was like, oh, I feel weird about Ozempic, and Mark Leeds, D.O. [00:14:48]: she was saying that she struggles with emotional binge eating disorder and Ginelle Testa [00:14:48]: that Ozempic is helping her manage those cravings that she's not eating 4,000 calories before she goes to bed every night. And that's like yeah. If that helps her, then that's great. Mark Leeds, D.O. [00:14:59]: Yeah. I I think maybe it's possible that this is like a theory just just popped in my head just now, that, you know, when a person has diabetes, you know, that that he can measure their blood sugar is high on average for over a period of time. And then they have prediabetes, you know, where you can say, well, you're not diabetic yet, but we we see that your blood sugar is a little bit high in response to to taking, you know, eating sugar or whatever. You know, they have tests where they can say, well, you're not quite diabetic, but you're on the verge of becoming. And what if there's, like, a pre prediabetic, you know, where there's no physical signs whatsoever, but but there's a thing in the brain that's, like, pushing the person to that. And and, you know, because, apparently, these things like Ozempic and the other similar ones work not only on on the stomach and and and blood sugar and the and the pancreas and all these other areas. Apparently, it works on the brain also to, you know, to help take away the sugar cravings and the carb cravings and, make people feel satisfied with their their food. So, you know, maybe that that whole condition, you know, starts in the in the brain and and it you know, like a pre pre prediabetic or something like that. Ginelle Testa [00:16:03]: Yeah. It's it's interesting. My friend and I were just having this conversation where I was saying that the way that I healed my eating disorder recovery was by eating more and not in a binge way, but, like, by eating breakfast, eating lunch, eating dinner, and eating snacks in between. Because my problem was that I was restricting and then binging. And, like, so I think for me, I didn't need something like that. But it's not to say that other people don't need something like that. Like, who am I to say whether or not that's a necessary treatment? Mark Leeds, D.O. [00:16:30]: Oh, yeah. Everybody has has their own path and what works for them. But I I can relate to the whole you know, over the years, I've lost huge amounts of weight by, following crazy diet plans of, you know, excessive exercising and, like, I I I was thinking back to diet I did years ago where I had, like, 3 protein bars a day, and that was, like, my all I would eat, nothing else. And and then go on the, you know, the treadmill for an hour every day. And, you know, I think I lost, like, 50 or £60, and I'm like you know, everybody's all, like, congratulating me. Like, wow. That was great. You lost all that weight. Mark Leeds, D.O. [00:17:02]: And, you know, then within a short time, I'm, like, gaining it all back again. I mean, I I Yeah. Over the years Ginelle Testa [00:17:07]: saying it's about it's about the actions that you take. It's not about the weight. You know? It's like if you're if you're restricting and militantly exercising, like, that's not healthy either. Mark Leeds, D.O. [00:17:17]: Yeah. Yeah. It's really and that's the thing. It's hard to find, you know, like, a you know, I mean, for me yeah. I guess that that's the thing. You know, working with professionals is the right thing to do because, otherwise, if there's no plan, you know, I I if I have no plan, I would just go get completely out of control, like, you know, finishing people's food. You know, food gets left around. I'm like, wow. Mark Leeds, D.O. [00:17:38]: That looks good on the plate. You know? Like, Why would they waste that? And, yeah. I mean, it just, you know, just like when they they say tracking a workout, you know, when people work out and you should track your workout because otherwise, you have no idea, like, whether you're making progress or or not. I kind of agree with the the idea. Like and this is something in that gray sheet is anonymous program as I think that they are very strict about tracking food. And, you know, some people are not in favor of tracking, but I I don't know. What do you think about food tracking? Like, weighing weighing your food? Ginelle Testa [00:18:09]: Personally, like, absolutely cannot do that. I subscribe to, like, intuitive eating where, like, I pay attention to my body's hunger and fullness cues where I, like and that's that's where eating enough comes in because if I let myself get to the point where I'm starving, then I'll binge, and I'll eat a bunch of stuff that I and I'll feel bad. But if I'm like paying attention to my hunger throughout the day, and I'm like, oh, I could use a snack in between meals, and I'm like feeding myself enough. I'm able to like tune into that. So Yeah. I'm not able to do that though. So if if if you're not able to do that and food tracking helps you, then great. But for me, it's, like, really triggering. Ginelle Testa [00:18:43]: It reminds me of my fitness pal days where I was counting my almonds. Like, it it's really triggering. Mark Leeds, D.O. [00:18:49]: Yeah. Yeah. Yeah. Years ago, they, Weight Watchers had a, a plan. And then over the year, every few years, they changed their plans. So for people that kinda go back to them, you know, leave and gain weight and then go back and try weight watchers again. It's always some new flashy plan, and they have all these, like, fancy colorful pamphlets. And I remember they at one point, they they had 2 plans. Mark Leeds, D.O. [00:19:09]: 1 was, I think, like, the core plan, and one was the old tracking plan. And the old plan was, like, where you track points, which is basically calorie counting. You know, we're using their way of calorie counting. And then the I think it was called the core plan, and it was here here's all the foods you can eat, and you don't have to to keep track of them. But they did have a hunger scale. They had, like, a diagram showing I'm I'm I'm a little bit satisfied with my food. I'm a little bit hungry. I'm very hungry or very overfull, and you never wanna be at either full end of the scale. Mark Leeds, D.O. [00:19:37]: You wanna, like, track you know, keep always keep assessing yourself. I guess, like, in terms of the steps, like, I think it's the 10 step. Like, we are always, like, monitoring your, you know, your feelings or or what's happening. Ginelle Testa [00:19:47]: Inventory. Mark Leeds, D.O. [00:19:48]: Yeah. Like like, I guess you're, like, always think I don't know if it's the same thing really, but thinking, like, am I am I a little hungry? Am I too hungry? And, you know, but at at the same time, eating all these natural foods, you know, things that are, like, high in fiber and, like, fruits and vegetables and and lean meats probably. But, you know, so they had a whole series of what they call the 0 point foods. I I think, actually, that's how they do it now. I think they in their more recent plans, they kinda combine and mesh them together where you have the the 0 point foods that you can, in theory, eat as much as you wanna, but but you're not supposed to eat them. You know, like, for example, like, if you get, like, a big 3 pound bin of grapes, you know, even this though it's a 0 point food, you can't just binge and eat the whole thing because it wouldn't work. Ginelle Testa [00:20:30]: Right. Yeah. It's tricky. I don't know. I I don't like the Weight Watchers point system, but it's just not it doesn't work for me. Like, maybe it works for other people. Mark Leeds, D.O. [00:20:39]: Well, it was it's tracking, and, you know, tracking is like it I I mean, honestly, even though I I like it, I I have not kept been consistent with tracking for probably more than a few weeks at a time because it is, like, you know, even when they make it as easy as possible, like, they have like, I I like, I like an app now called Lose It, which is pretty good, and it's still annoying to have to type in the food or scan the food and everything. Sometimes it can pre track. You can plan your food for the day. But, you know, but, yeah, if if, you know, my eating plan includes, like, you know, getting, getting a pizza and nobody's watching how many pizzas I'm eating, It's and I'm not tracking anything. Definitely, it's not gonna work. I'll probably eat half the pizza at least. So I don't know. Sorry. Mark Leeds, D.O. [00:21:25]: I'm just but, yes. So tell let let's talk more about the book. Tell me about, like like, what made you decide to to write this book? Ginelle Testa [00:21:33]: Sure. Yeah. So National Novel Writing Month, Nanowrimo happens every November, and it's, like, it's a month where writers set out to write 50,000 words in 30 days. And it's, like, just a worldwide thing. So I started to jot down my addiction stories and, like, my trauma stories and, like, early things that have happened in my life. I just started to jot them down for that, and I did 50,000 words of it. And the next year, I did it again. And then the 3rd year, I was like, oh, I could do something with this and just started to patch the stories together in, like, a linear way, and made a book out of it. Ginelle Testa [00:22:06]: And, yeah, just the the idea of making a home out of you came to me, like, in recent years, like, the last 2 years, and it just felt like a thread that went throughout everything, like, all the eating stuff, the relationship stuff, and the drug and alcohol stuff. Yeah. It felt like it was thematic throughout the whole thing. Mark Leeds, D.O. [00:22:24]: Yeah. And so that that's, like, somewhere between 12,000 words a day? Ginelle Testa [00:22:29]: Yeah. It's 1600 words a day. Mark Leeds, D.O. [00:22:32]: Oh, okay. Which, I mean, you know, for people that think that's terrifying, it's it's manageable. You know, once you get used to it, you know, and even 2,000 words a day. I I mean, you know, it depends on the quality and if it's being part of a consistent book, but a person can write high quality. I I think I read somewhere that that Stephen King writes 2,000 words a day. But then, you know, he's also keeping track of all his characters and story lines and everything. Ginelle Testa [00:22:57]: And he's he's a professional writer. Like, he does nothing but write. So there's that too. Like, he doesn't have a job like most of us. Mark Leeds, D.O. [00:23:05]: Yeah. Yeah. So, now I was I saw I saw somewhere that you you have a I do you do you do digital marketing? I saw that you have a history of it. Or is that is that what we currently do? Ginelle Testa [00:23:17]: Yeah. Yeah. I work for a start an ed tech startup in digital marketing. I have a master's in marketing. Yeah. Mark Leeds, D.O. [00:23:23]: Okay. And and do you, do you work on the content side of things as far as doing writing? Ginelle Testa [00:23:28]: I do. Yeah. I'm a content marketer. Mark Leeds, D.O. [00:23:30]: Oh, wow. Okay. Like, would that be, like, more like blogs and SEO, or would it be more like copywriting advertising? Ginelle Testa [00:23:37]: It's more blogs, SEO, social media. It's that kind of content. Yeah. Mark Leeds, D.O. [00:23:42]: Oh, oh, that's great. So you already that that 16 1600 words a day was probably, like, fairly easy for you then. Ginelle Testa [00:23:49]: It's hard because I write for work, and then I go home and I write at night. So it's like sometimes I get a little drained, but, yeah, I I am used to writing a lot. Mark Leeds, D.O. [00:23:58]: Oh, wow. Wow. That's, what what do you think of all this, AI stuff? Like, everybody's just, like, you know, coming up with different ways to use AI to to do their writing for them. Ginelle Testa [00:24:09]: I think AI is so useful for so many things like ideating, catching mistakes, thinking about what to do next. It's not good for writing for you. You. Like, I do not recommend writing an essay with AI, but I do recommend being like, I have this idea. What should I do with it? And AI can give you a couple options or, like, here's this piece I finished. What's missing? Or, like, where when did I make a mistake? Like, those sort of things, AI is awesome for. But when I've written entire pieces with AI, it's just you could tell it's Mark Leeds, D.O. [00:24:38]: AI. Yeah. Yeah. I mean, there there is some stuff you can do if you keep and I'm sure you've done this if you keep developing the prompts and, apparently, I just I'm learning about this. If you you have to tell the eye to play a role. I didn't realize that. But, apparently, it's really important to tell it to play the role of a, you know, like, a professional copywriter or author of some kind. And the more specific you get about who the AI is pretending to be and and who the audience it's addressing is, you know, probably that makes a big deal and how it filters out its own information and experience. Ginelle Testa [00:25:09]: Oh, that's really interesting to know because I I'm taking a writing class, and I tried to have AI help me with the with some ideas, and it was, like, just spinning out junk. Like, I was like, none of this is usable. Mark Leeds, D.O. [00:25:19]: Yeah. Yeah. Actually, I'm yeah. I'm looking at this course, and and the guy showed that, he showed us the difference of he did a prompt where it would ask for, places to visit. I forgot what city it was. He said within a certain city, like, places to visit, and he just did, like, a a general open prompt of, like, what are some great places to visit? And it gave, like, the most common tourist sites. And then he said, you know, be like a a I forgot what it was. Like, a food expert and, on, you know, local, unique places or what. Mark Leeds, D.O. [00:25:48]: You know? Like, he gave it a very specific role to play, and and it found much better places. It the same exact AI gave a completely different list of of output, and it was much more interesting. Ginelle Testa [00:25:59]: I love that. Yeah. It's definitely worth fine tuning and being like, no. Not like that. Be do Yeah. Less, like, cheesy or whatever. Like, I give it prompts all the time. Yeah. Mark Leeds, D.O. [00:26:09]: Yeah. Yeah. So, you you can even, like, I think there's one with chat GPT. You can make your own. I I actually, just for the fun of it, made my own therapist. I I programmed it to, you know, all the different things of how I wanted it to deal with me and issues, and it it was interesting. I mean, it kind of I felt like it was kinda spitting back the stuff I I fed into it initially. You know, like, you know, it still wasn't like I mean, I I don't know. Mark Leeds, D.O. [00:26:34]: Like, if you go to a real therapist, do they actually ever give, like like, original things like you hadn't thought about? Like, I I don't know if a therapist would serve that function of of giving you ideas of how to solve problems. Ginelle Testa [00:26:46]: Sometimes. But, usually, she's just like, hey. Here's what you already know about yourself, so let's work with that. Mark Leeds, D.O. [00:26:54]: Yeah. So so, like, helping you to to, like, analyze what what you already know about yourself or to to see it more clearly? Ginelle Testa [00:27:02]: Yeah. She tries to, like, have me use my inner resources to solve a problem, you know, rather rather than being like, here's a new thing that I mean, sometimes she'll give me new ideas, but most of the time, it's like, let's let's work with what you already have. Mark Leeds, D.O. [00:27:14]: Yeah. So so the book so what led you to, like, going from doing the, the challenge of 50,000 words in a month to actually publishing a a real book and getting it out in the market and selling a book? Ginelle Testa [00:27:27]: Yeah. In 2016, I started writing professionally as a dating writer. So I I published 300 articles, and I was like, this publishing thing is really interesting. Like, I wonder if I could do that with my book and, like, this book that I'm creating. And I thought that yeah. I just thought it might help people, that my experience just like I experienced in the room sharing my story helps others connect, identify, feel less alone, and I thought that it would be helpful for others. Mark Leeds, D.O. [00:27:58]: And it Ginelle Testa [00:27:58]: was a passion I had. I just really wanted to do it. Mark Leeds, D.O. [00:28:02]: Yeah. Thanks. So did you are you did you sell is it self publishing, or did you go to a publisher and and, like, how how does it work? Ginelle Testa [00:28:10]: I got a hybrid publisher. So there's 3 paths. There's self publishing, hybrid publishing, and traditional publishing. Traditional is the traditional book deal where you get you get, like, paid to create the book. Self publishing, you pay for everything yourself, and you don't have, like, any of the benefits of traditional. And then hybrid is you pay for it yourself, but you get a lot of the benefits of traditional publishing, like distribution, and they do your cover. They edit it for you. They manage your data online. Ginelle Testa [00:28:38]: They yeah. So they did that hybrid route. Mark Leeds, D.O. [00:28:41]: Oh, that's that's good. Ginelle Testa [00:28:42]: Yeah. Mark Leeds, D.O. [00:28:42]: That's really good. So now the book, is it is it out already? Is it available? Ginelle Testa [00:28:47]: September 3rd. Mark Leeds, D.O. [00:28:48]: Oh, that's great. And and is it gonna be available on Amazon? Ginelle Testa [00:28:51]: Yeah. It's on Amazon, Target, Barnes and Noble, Simon and Schuster. It's it's all over, so it's very exciting. Mark Leeds, D.O. [00:28:59]: Oh, that oh, that's great. That's great. Yeah. And you're gonna, planning to be, like, a best seller up front of your category? Ginelle Testa [00:29:05]: I doubt it. But Mark Leeds, D.O. [00:29:08]: since Yeah. Ginelle Testa [00:29:08]: Since it's hybrid publishing, it's not gonna be, like, in bookstores around the country, like, you know, some books are, but that's okay. I mean Yeah. Mark Leeds, D.O. [00:29:17]: Well, if if if we can yeah. If we can get the word out, you know, you know, people, enough people preorder it, you know, you can get apparently, that that's the best way to become a best seller is get a lot of preorders. Ginelle Testa [00:29:28]: Yeah. Yeah. Exactly. So that's that's the hope. But, yeah, I mean, I'm just excited to get be getting my book out there, so it's it's exciting for me. Mark Leeds, D.O. [00:29:37]: That's really so who who would the the book be best? Like, who would you think would would best benefit from reading it? Ginelle Testa [00:29:43]: I think young adults anywhere from, like, 18 to 35. Probably the best audience for it because it's it's really a coming of age story. I think any anything younger than 18 is probably a little young to read it. There's it's pretty spicy. But, yeah, it's about it's about coming of age and growing into yourself, and it it it ranges from age 13 to age 29 ish. So it's, and I think people in recovery, especially, but anyone who has who struggles with, like, relationships or drugs and alcohol or body image issues, I think any of that will would be a fit. Mark Leeds, D.O. [00:30:22]: Yeah. Yeah. It it's, yeah. Sometimes it seems like like in modern times, like, a lot of these I I thought a lot of problems that people in my generation would kind of just go away because there's so much connection and and information available that, you know, because it just used to seem like, you wanted to be part of the in crowd because you wanted to act like you knew, like, what was cool and what was going on. And, you know, now, like, everybody has access to all the information in human history and, you know, but still, you know, the the same problems, you know, maybe even worse problems are have come up in in more recent generations now. Ginelle Testa [00:30:58]: That's a really good point that, like, the Internet didn't fix everything. Mark Leeds, D.O. [00:31:03]: Yeah. Yeah. Exactly. Like, it made new problems. You know, now now you have social media, causing even worse problems. And, and you think that people would know better than than to to get into, like, drugs and and especially smoking cigarettes. Yeah. You think that people would know better, but, apparently, like, the the little Juul thing got a lot of people hooked on on nicotine. Ginelle Testa [00:31:23]: Just be cool for teenagers. Like, that's that's a cool thing. Mark Leeds, D.O. [00:31:28]: Yeah. Ginelle Testa [00:31:28]: You know, there's no long term studies of, like, the impacts of vaping. Mark Leeds, D.O. [00:31:34]: Yeah. Yeah. Although yeah. But I I I feel you know, maybe, like, it seems like kids today are, like, more kinda open about how they feel or something like that. Like, there seems to be a little bit more awareness of of psychological issues and and mental health issues and and and feelings. So maybe that's a positive thing. Ginelle Testa [00:31:54]: That's very true. Yeah. Gen z is definitely more open to therapy and, like, talking about their feelings and, you know, embracing mental health issues that they can deal with. Mark Leeds, D.O. [00:32:05]: Yeah. So, if so if somebody wanted to like, do you have a website that people can go to to read read about your story and the book and things like that? Ginelle Testa [00:32:14]: So it's gineltesta.com, and it's also I'm also on Instagram, TikTok, Janelle Testa, so people can connect with me on all those platforms. Mark Leeds, D.O. [00:32:25]: Okay. Like like so on on Instagram, it would be, like, the at sign and janel testa would be your your name there? Ginelle Testa [00:32:32]: Exactly. Yep. Mark Leeds, D.O. [00:32:34]: Okay. And and, okay. And the and the what was the website again? Ginelle Testa [00:32:38]: Just my name, janeltesta.com. Mark Leeds, D.O. [00:32:41]: Oh, okay. Oh, that that's good. Okay. So, yeah, we'll put that in the the show notes for the podcast. Okay. Yeah. That's great. So, yeah, Janelle, thank you again for thank you for joining me today. Mark Leeds, D.O. [00:32:51]: Thank you. Ginelle Testa [00:32:51]: Yeah. Thank you for having me. --- ## About The Rehab Podcast > Information about the podcast, its host, and the practice. ### Home URL: https://therehab.com/home-2/ The Rehab Podcast [ ]() [ ]() [spreaker type=player resource="episode_id=49045845" width="100%" height="350px" theme="dark" playlist="show" playlist-continuous="true" autoplay="false" live-autoplay="false" chapters-image="true" episode-image-position="right" hide-logo="false" hide-likes="false" hide-comments="false" hide-sharing="false" hide-download="false"] # **Best Podcasts on Recovery, Sobriety & Addiction** The mission of this addiction podcast is to explore the worlds of drug addiction and substance abuse to learn new and better ways to help people on their addiction recovery journey, away from active addiction. We are proud to bring you the best possible informational programs on the medical treatment of addiction to alcohol and other drugs. We also address non-substance addictions. Our goal is to bring you all possible perspectives, from abstinence-based recovery, to medication-assisted treatment, to emerging new treatments, such as [ketamine]() assisted treatment. Recovering from active addiction is a challenge. Your goal is to stay clean of drugs and alcohol so your mind, body, and spirit can recover. While damage has been done, it is time now for you to heal so you can live a better life. One way to help you to stay clean is to learn as much as possible about the recovery tools that are available. For example, you may only be aware of 12-step support programs like AA and NA. Did you know that there is a science-based program called Smart Recovery that is an alternative? Meeting with other like-minded people is an excellent way to stay clean and find support. Yet, Addiction is a 24-hour condition. You may find that an hour-long support meeting, filled with recovery stories, helps to motivate you and gives you a sense of safety from your addiction. However, after you leave the meeting, the cravings and negative thoughts can return. What can you do late in the night, laying alone in bed when everyone else has gone to sleep? Who can you turn to for help and company? Fortunately, in today’s world, we have the technology to bring us free recovery podcasts by The Rehab with your host Dr. Mark Leeds. If you have a smart phone, tablet, laptop or other internet-connected device, you can find recovery audio online. In order to get started, you simply need to download a podcast app. If you use an iPhone or iPad, there is already a podcast app on your device. If you use Android, you can download an app such as Podcast Addict or the Google podcast app. In addition to podcasts on recovery, you can also find recovery radio stations online. While there are some excellent radio programs out there, a recovery podcast has unique advantages. In fact, podcasts are uniquely suited to the nature of addiction. This is because you can subscribe to your favorite podcasts and download the best episodes. When you feel like you are alone and in trouble and you need support right away, you will find that the best addiction recovery podcast by the Rehab with your host [Dr. Mark Leeds]( "Dr. Leeds"), the one that you can listen to immediately. You can plan for these moments ahead of time by subscribing to the best recovery podcasts in your podcast app. Start listening to podcast episodes while you are feeling good so you will know what will help you when you are not feeling so good. By subscribing to your favorite podcasts on recovery and downloading your favorite episodes, you will be armed with addiction recovery support at all times. It is important to have friends in recovery who you can call for support at any time. Live support meetings are also helpful and a great place to meet with members of your support network. Yet, no one can be available to speak to you any time, day or night, on the topic of recovery from addiction like a good podcast episode. ## Best Podcasts ## BLOGS ON ADDICTION RECOVERY ## Useful Tips ## Popular Posts [ See More On The Blog ]() ## This is why we need another addiction podcast. The mission of this addiction podcast is to explore the worlds of drug addiction and substance abuse to learn new and better ways to help people on their addiction recovery journey, away from active addiction. We have had our share of celebrity guests and experts on the show to talk about addiction treatment and recovery. Yet, our primary goal is to shed light on alternate ways of thinking about addiction, addiction medicine, and treatment. Much of the focus in recent years has been on the opioid epidemic and how to help people to overcome opioid addiction. In fact, since a significant portion of my practice focuses on [medication-assisted treatment]( "Medication Assisted Treatment Podcast") for opioid addiction, I did start out with the intent of this program being a [Suboxone podcast]( "Suboxone Podcast"). My goal was initially to educate people on Suboxone, buprenorphine and how medication is an important part of reversing the opioid crisis. However, as I started to speak with various guests, I realized that there were many spaces to explore, discover, and learn about with respect to addiction and addiction treatment. Suboxone treatment was only the beginning. Early on, when a guest shared their personal story about trauma and family dynamics, I realized that there were many perspectives to be considered. ### I made it a point to be open-minded. My intent in interviewing podcast guests is to be open-minded, honest, and willing to listen and learn about what my guest has to say. In one episode, my guest and I discuss the 12 steps of Alcoholics Anonymous and Narcotics Anonymous, and the spiritual component of the recovery process. I have gone through periods where I thought every addiction patient needed the 12 steps. And, I have gone to the opposite extreme in believing that they are not the best solution for many of my patients. The fact is that it is not about me or my beliefs at all. My opinions on programs such as alcoholics anonymous or narcotics anonymous are irrelevant. We all have opinions, and, hopefully, our understanding grows over time by being open-minded and listening to what others have to say. ### There is no one-size-fits-all solution. When the time comes to do something about an addiction challenge, whether it be [opioid addiction]( "Opiate Recovery Podcasts"), food addiction, [alcohol addiction]( "Suboxone Podcast"), nicotine addiction, cocaine addiction, or meth addiction, you or your loved ones may feel a sense of urgency and desperation. Where should you turn to when you are looking for help? From my perspective as an osteopathic physician, I might first recommend visiting an addiction specialist who is highly trained in the field of addiction medicine. Alternatively, there are people who might recommend an extended stay in rehab, where group therapy and addiction counseling are the primary starting points in the recovery process. There are people in favor of complete abstinence from drugs and medications who are against prescription drugs as part of a treatment program. And, you will find that other people have differing views on the role of medication in traditional treatment for substance abuse. ### Alcohol is a drug. Alcoholism and the field of alcohol treatment provide an excellent example of the clash between experts on how things should be done. Is inpatient treatment required, or can a “little pill” do the heavy lifting in helping a problem drinker to reduce their craving and avoid the intense feelings of alcohol deprivation? There are those people who believe that alcohol dependency is primarily an issue of endorphin reinforcement, requiring medical treatment focused on pharmacological extinction. And, there are those who are more focused on overcoming the learned behavior of alcohol use with spiritual methods and counseling. Most importantly, we must accept that alcohol is a drug like any other drug. Many people have control over their alcohol consumption, but for many others, alcohol addiction is a serious issue. If I were to decide to start a separate alcohol podcast, focusing primarily on the challenges of achieving sobriety, it would still be essentially an addiction podcast. There is no doubt that alcohol is an addictive drug. ### Nicotine is a drug. While I have focused on issues facing the opioid addict and people struggling with alcohol addiction, I do plan to confront the unique issues involved in nicotine and tobacco addiction. It has been said that nicotine is the most addictive drug on the planet. The reinforcing effects of nicotine as it stimulates the nicotine receptors, leading to increases in dopamine, are powerful. Tobacco users may feel helpless when attempting smoking cessation. Unfortunately, tobacco is legal, with politically powerful corporations behind it, always finding new and creative ways to market their deadly products. Yet, doctors are pressured by their state medical boards, and by the federal government, to combat cigarette smoking in their patients. Why not put the pressure on the tobacco industry? Why don’t we shut down it down altogether? No one needs a cigarette. In the long run, they would not be missed at all. So far, the solutions to helping tobacco users included replacement therapy, with nicotine patches or nicotine gum, and medication-assisted treatment. Chantix and Zyban are the drugs of choice for tobacco cessation. Unfortunately, these drugs have significant side effects and can affect a patient’s mental health status. Another solution, though not backed by the medical community, is the use of smokeless tobacco products. While these e-cigs have worked for many people, there are concerns about long-term consequences, including scary, irreversible conditions, such as “popcorn lung.” Recently, I have been alerted to research into the use of other medications to help people to quit smoking. Acamprosate, or campral, is a promising candidate, with several research studies to back its effectiveness. Naltrexone is another alternative. Interestingly, both of these prescription drugs are approved by the FDA for treating alcoholism. It is fascinating, when an older drug is found to have new uses that may have more positive impact that the original intended use. You can look forward to more of our addiction podcast episodes in the future that focus on tobacco use and nicotine addiction. While I have no intention of starting a dedicated nicotine podcast, I do intend to talk a lot more about this important subject. ### Is The Sinclair Method hype or harm reduction? How do doctors approach alcohol abuse and gray area drinking? Do they have a blanket order to send everyone with an alcohol problem to AA or rehab? What if a patient says they cannot put down the booze, and they refuse to get help? The Sinclair Method (TSM) is an alternative method of treating alcohol use disorder. Essentially, patients continue drinking while on naltrexone. TSM may appeal to the sober curious person who is in the first stage of confronting their addiction and is not ready to quit. So, while proponents of TSM have claimed that it is the cure for alcoholism and the best way to provide alcohol treatment, there are those on the side of traditional rehab who are against any treatment that does not involve abstinence. But, what about harm reduction? If a patient will not put down the beer, wine, whiskey, or cocktail, why not offer them something that may help with controlled drinking to reduce alcohol intake? Harm reduction, or the approach of meeting an addicted person where they are at right now in order to protect their health and safety, is not always well-received in the US. Harm reduction, when it comes to alcohol treatment may involve helping someone to cut back on heavy drinking and binge drinking. Of course, the ultimate goal is to help the person to achieve sobriety and to become a sober person. [Naltrexone treatment]( "Naltrexone Podcasts") is medication assisted treatment for alcohol dependency, and, it can be a form of harm reduction. ### Why are we so much against harm reduction? Harm reduction is an approach that can help to save lives. And, it can start now, right at home. For example, if you find that a loved one in your home is using heroin, what is the right thing to do? Do you kick them out and change the locks? Is tough love the answer? Or, do you keep the opioid overdose reversal drug, naloxone, or Narcan, in the house? Is allowing a person who is actively addicted to street opioids to stay in your home a good idea? It may be the best way to keep them alive and safe until they are ready to get help. In the US, there has been a backlash against harm reduction, particularly when it comes to opioid dependence treatment. Local sheriffs have come out and stated publicly that they will not allow their deputies to administer Narcan to the same person multiple times. Life-saving clean needle exchanges and supervised injection sites have been blocked from opening in the communities that need them most. In other countries, there has been a more pragmatic approach to harm reduction. From medical heroin to biometric drug dispensing machines, to supervised consumption sites, they are finding success in getting more people safely into recovery. The primary way that this works is not by giving in to their addiction, but by forming and maintaining close relationships with the victim of addiction. The goal is to keep people safe until they are ready to take the next step in moving away from active addiction. ### What about alternative medicine and integrative medicine? This podcast is not simply a Suboxone podcast or a Sinclair Method Podcast. While these topics may have been the focus of more than one episode each, the idea is to be open-minded about all approaches to addiction therapy. To take the integrative approach means to look at everything that is available now, or may become available in the future, and see how it might fit in for specific individuals. It is all about thinking outside the box and taking on new perspectives. In one episode, I interview an expert on dietary supplements for improving brain health. Overcoming addiction has a lot to do with giving the brain a chance to recover. By “filling the buckets” of nutrients that the brain needs, we can make this process faster and easier. Conventional medicine may often overlook the significance of nutrition and how it relates to wellness and healing. In addition to nutrition, we also have tools available to help with such alternative therapies as guided imagery, mindfulness, and meditation. Another episode focuses specifically on work addiction. However, the guest, the top expert in the world on work addiction, provides a method for getting started right away with mindfulness and meditation. By taking this tool that he provided in our brief 30-minute interview, we can apply its use to helping with other addictions, or even as an overall life-enhancing, performance tool. Interestingly, many methods that are helpful in addiction treatment are also helpful in the lives of people who do not suffer from drug addiction. In another podcast episode that was primarily about overcoming food addiction and binge eating, my guest discussed the importance of self-respect and setting boundaries. She stated that people can learn to not be everyone’s “welcome mat” to be stepped on and disrespected. This is good advice to consider, even for people who do not have an issue with overeating or drug addiction. I have discussed sound therapy, primarily the use of binaural beats, with at least two guests on the program. These meditative and fascinating sound programs can help to facilitate meditation and improved sleep. There have been studies to demonstrate their effectiveness in treating anxiety disorders and ADHD. ### Taking it all apart and putting it all together again. My intention for this addictions podcast was never for it to be all about sending everyone to rehab for 12-step facilitation and cognitive behavioral therapy. While I could have produced episode after episode of me sitting down with rehab therapists and administrators to have the same conversations over and over again, I never wanted The Rehab Podcast to be so limited in its scope. Not only has my intention been to educate and expand the horizons of my listeners, but also my own understanding of what it means to be addicted and how we can creatively bring many elements together and come up with new ideas to help individuals. As I have stated many times in blog posts and in podcast episodes, I believe that the people who struggle with addiction the most are the people with the greatest potential for success in life. They are often misunderstood creative geniuses who have been sidelined by their predisposition to addiction. Whether the cause of their addiction was trauma, emotional abuse, depression, self-medication, or even boredom, it is the people gifted with intelligence, creativity, and empathy, who find it most difficult to overcome active addiction. In order to address their unique needs and specific addiction issues, we must be open-minded and see things from an integrative perspective. ### Looking to the future of addiction treatment. It has been said that what we need in the future to help more people to overcome addiction is more of what we already have. The tools that we have to fight addiction, including medication-assisted treatment drugs, are underutilized. We must still overcome significant stigma. In addition to making better use of medications, such as Suboxone, [naloxone](), naltrexone, and methadone, as well as drugs to help with smoking addiction and eating disorders, there are new treatments on the horizon that are being researched today. You may have heard of medical marijuana, or cannabis, being touted as a treatment for nearly any mental health problem or physical ailment. Now that medical cannabis is legal, we have seen that it may have some benefit in specific cases of overcoming drug withdrawal, including opioid withdrawal. Other drugs being looked at include psychedelic drugs, such as psilocybin, DMT, and MDMA. Ketamine is a psychoactive drug that is already being used to treat depression, chronic pain, and addiction. In other countries, the psychedelic drug, ibogaine, is being used, though there are significant safety concerns with that treatment. In addition to novel drug therapies, there are also technological advancements, such as AI-assisted diagnosis and assessment of addiction and other mental health conditions. There are prescription digital therapeutics (PDT) that use smart phone apps to provide therapy and a real time connection between patient, doctor, and therapist. While we have some of these technological tools available today, they will only improve with time. We are now in an age of accelerated change and advancement where we will see major developments appear faster than ever. Possibly, with the combination of advanced machine learning and artificial intelligence, tools such as sound therapy, PDT, and others, will become more effective than we ever imagined. We may find that digital therapy has the potential to work as well as or better than medication-assisted treatment, even with the promise of new pharmaceutical agents. So, my goal, as a podcaster in the field of addiction treatment and recovery, is to have conversations with experts in the field, and people who have thought deeply about these subjects. I want to help myself and others to see the problems of addiction treatment from different perspectives. Rather than repetitively applying the same old therapies over and over again, expecting different results, we must see our patients and clients as unique individuals. Addiction is a complex problem that affects many regions of the brain. By improving our understanding of the science of addiction, and meeting at the intersection of science, medicine, art, and technology, we can work together to find a new hope in helping our loved ones to overcome their addictions. The Rehab Podcast is a place for deep conversations where we explore important questions about our understanding of the many philosophies and disciplines in addiction treatment and wellness care in general. I hope that you will join us here regularly to listen in on The Rehab Podcast! ## Free Programs Map [Here are some blog posts on the topic of how to find free addiction treatment programs](). The map below, representing the [states]() of the United States of America, provides links to pages for each state. On these pages, where we have information available, there are listings of free programs. We are in no way affiliated with these programs. If you have information regarding a free program or other relevant free services that are not listed here, please contact us on the contact page. Thank you.