Maia Szalavitz on Addiction - Re-Release

do something. Welcome to the one you feed Throughout time, great tinkers have recognized the importance of the thoughts we have. Quotes like garbage in, garbage out, or you are what you think ring true. And yet for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not

just about thinking. Our actions matter. It takes conscious, consistent and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction. How they feed their good wolf. Thanks for joining us. Our guest on this episode is Maya Salivits a neuroscience journalist and author who specializes in mental health coverage, with a particular focus on addiction, drug policy, neuroscience,

and media criticism of reporting on these issues. Her new book is Unbroken Brain, Why Addiction is a learning disorder and why it matters. And here's the interview with Maya Salivates. Hi, Maya, welcome to the show. I'm excited to get you on. Your book is called Unbroken Brain, a revolutionary new way of understanding addiction, and listeners will know that addiction comes up from time to time on the show. I myself, I'm a former addict, so we will get into a

lot of detail on that. But let's start like we always do with the parable. There's a grandfather who's talking with his grandson and he says, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love, and the other is a bad wolf, which represents things like greed and hatred and fear. And the grandson stops and he thinks about it for a second. He looks up at his grandfather and he said, well, grandfather,

which one wins? And the grandfather says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. I really like this parable because I feel that it is incredibly relevant for addiction. Addiction is a lot of repetitive behavior, and the more you repeat the behavior, the more likely you become to repeat the behavior because of the way human learning works. So that is a very true statement about the nature

of what will happen if you continue to repeat the behavior. Yeah. I first heard it in some twelve step meeting somewhere, and it kind of knocked me on the head at that point because it was so clear to me that I don't even know that I had been feeding the bad wolf so much as the bad wolf had been

eating me recently. But it just is a very straightforward to me, like, oh, if I take these sort of actions, then I'm going to have good things happen, and if I don't, then I'm going to continue to get more of what I've been getting. Yeah, I mean, obviously, like all of these things. It's it's oversimplified, but I think it's it's really important to realize that. Yeah, your brain becomes what it does, and the more you, you know, um, repeat an activity, the easier gets to do that activity,

and then the more likely you become to repeat it. Now, this is great if that activity is exercise or being kind or you know that kind of thing, but it is not so great if it is harmful drug. You right, absolutely, So let's start with the core premise of the book. And I'm just going to quote you here. You say, addiction is a developmental disorder, a problem involving timing and learning, more similar to autism, a d h D, and dyslexia than it is to mumps or cancer. So talk to

me about what you mean by that or developmental disorder. Sure. So, I mean, if you think about developmental disorders, they tend to have several things in common. Um. The first one is that they tend to affect like specific kinds of learning. So with autism, you have a problem with social learning, but you don't have a necessarily have a problem with other types of learning. With dyslexia, you may have a problem with reading, but not with other things, So it's

about a specific thing. Um. It's also the case that if you have one of these conditions, they tend to start at a particular phase in life. So there are three important phases of brain development in human life, and the first one is prenatal, the second is zero to five, and then the third is like adolescence and young adulthood. All of these disabilities tend to start at specific time.

So autism and a d h D start in early childhood, whereas you wouldn't see schizophrenia out or addiction generally until adolescents or early adulthood. So that gives us a clue as to kind of what's going on in the brain in relation to these things. And the other thing I mean when I talk about addiction as a developmental disorder

is that learning is critical to addiction. You can't get addicted if you don't learn that the drug helps you do something, because, for one, you wouldn't know what to crave, so it would be kind of hard to buy it, right um and um. Secondly, if it doesn't give you comfort or pleasure or some sort of relief, you're unlikely

to be repeating it exactly. And so you talk about this being a learning disorder, and the way that we tend to think of addiction is it's either thought of as a disease, which is a it's probably the more common paradigm this day, an age or a moral failing, and both those things are confusing. And I agree with a lot of what you say about that, and we'll get into that in a minute, But talk about the implications if addiction is a learning disorder and not either

a disease or a moral failing. Well, let me speak to the disease thing first. In the United States and worldwide, because of our influence, Um, this disease idea has really taken off. I don't mind if you call a learning disorder a disease, but the way we've seen addiction as a disease has been deeply problematic because basically, we argue in public that addiction is a disease. Meanwhile we criminalize

people with it. We also argue in public that addiction is a disease and the treatment is meeting confession and prayer, which isn't how we treat any disease or learning disorder. So, UM, what has happened is that the dominance of the twelve step paradigm for addiction has meant that we end up trying to argue that addiction is a disease while treating it as a moral failing. And this mixed up mush of things UM really kind of makes the disease idea

problematic when it wouldn't have otherwise been. So there's that now. The moral failing business is just you know, I mean, when you see people with addiction desperately trying to stop and then relapsing over and over, it's kind of hard to think that they're choosing to lose everything and to you know, be in these dire straight because they're having so much fun. Anybody who sees addiction knows that this

is not driven by everything so fun. So I'm going to give up all the rest of the good things in my life, Like that's just isn't what happens, So, you know, So that point of view UM is outdated

and not especially useful. So I see the learning disorder idea as kind of a way to really get at the complexity of addiction, which is that, like, it's not about you being a total zombie and having no control over your behavior the way some of the extreme disease models present it, but it's also not about you know, freely choosing um with ultimate freedom the way some of the moral models pres in it. What happens when you learn a habit is that it changes the way you

react to things. And when you learn in the way that addiction is learned, what it basically does is reset your priorities, just the way when you learn to fall in love, which is another learning process. Interestingly, when you learn that, it shifts your priorities, and that means that you will make very different decisions, like if I get a new boyfriend or something, I might get interested in

something I'm completely uninterested in normally, right. I think that when we bring learning into it, we understand the way addiction really is and the way it really appears, as opposed to the sort of idealized pictures of sin or disease. And I'm saying disease as in the disease models that we are stuck with, not the idealistic medical disease models that you might have in the absence of the history

of the twelve seven thing. Yea, let's explore that a little bit further, because the learning piece makes sense to me. I think we're gonna need to go into a little bit more what you mean by that, but let's start with the statement you just made about you learn to fall in love or you learn to be addicted, which the second one I understand. And at the same time, my reaction to alcohol and drugs was very prominent from the get go, right the minute I tried it. There

was a very strong reaction there. And so help me the first site, Yeah exactly, Yeah, So I mean, so it's it's the thing is that, like, um, there are a lot of people who take let's say, an opiate and it's like, oh my god, this is the best thing ever, this is totally amazing. Oh I love this. You know what, I don't want to ruin my life. I am never going to do this again. That is actually the most common reaction to taking a substance that

is ultimately blissful. That's a healthy reaction to it. So the thing with people with addiction is that you're not addicted at the moment that you have that you sort respond. You only become addicted after you continue to repeat it despite negative consequences. So while you can sort of put the start of your addiction at that kind of love it first site moment, the actual process needs to have up and before you are actually addicted. Does that make any sense? I agree? I think what I was driving

at was something that you explore in the book. Also, which is that these substances are often used as a coping mechanism, and so the addiction may begin, the process of becoming addicted to that substance may begin when you try that substance, but for lack of a better word, the seeds of that addiction have very likely or very

possibly been planted before that. Oh absolutely, And and you know, I mean, given that the vast majority of people who take even the most addictive drugs do not become addicted, we have to look at what's going on with that person beforehand. You know, if your life's already messed up and you get this blissful experience, you are far more likely to say, yeah, I want to give up what I have because what I have is horrible for you know,

and this is, you know, this is something that seems better. Also, like, especially if you have any kind of you know, social anxiety, drugs seem to solve them a variety of ways. One is that they are tend to be taken in social settings, and other drug users tend to welcome you as long as you use drugs, which is unlike most social settings, right,

And so there's that bit that makes it easier. There's also just the pharmacology, so that if you're a person who is very anxious, like alcohol or opioids might take the edge off. And if you're a person who's kind of understimulated or depressed, like a stimulant might you know, really make you engaged in things. And so when you see that you can use these substances to control the way you respond to the world. If you're just regulated, they're going to be way more attractive. Is that the

developmental part of this? Yeah, you know, we all start out with some kind of initial temperament. You know, we might be shy or bold or um, you know, over sensitive to stimuli or under sensitive to stimuli. All of this stuff genetics is going to give us. And then we have the environment where you know, you may get

tons of love and support, um, you might not. You might have some predispositions that are really extreme um that you know, may lead to mental illness and in certain situations, and those things are all kind of percolating during your development, and you know, if you let's say, like you know, in my case, I felt really different from other kids from very early on because I was extremely oversensitive and also like I was reading very early and got like

labeled gifted, and so I just my interests were completely different to the interests of other kids. Basically, so I just sort of got absorbed in ideas. And that would have been fine if I hadn't been decided that I was a bad person because I couldn't really connect with people. So that sort of internal decision of seeing myself as bad led to a cascade of things that ultimately sort of led to depression and probably then led to addiction.

And so the developmental pieces is sort of how all of these things interact over time in this kind kind of viraling fashion um that creates the complexity of the conditions we end up seeing in people. Yeah, you say that the role of learning and development addiction means that cultural, social, and psychological factors are inextricably woven into its biological fabric.

And I really like that because I've always thought that the disease model of alcoholism or addiction was particularly when you treat it as you mentioned, via moral mechanisms, it didn't make any sense, and that this felt like the word I would have used as a syndrome than a disease or a thing. It's this complex bringing together of

all these different factors that happened to equal addiction. Yeah, and I mean I think you know, the same is true of really all developmental disorders and all um psychiatric problems, because all psychiatric problems are nor nor developmental disorders. Like you don't suddenly appear fully fledged um person with schie

mania without the developmental history that gets you there. Like it's not like even though the symptoms might suddenly appear in your twenties, it's not like your brain hasn't been going down that path for a long way. And so people have historically left development out because it is so complex and individual. Um. But you know, reductionism can sort of only get us so far. It's great to you know, like say, okay, look, we can get this threat to

press the lever and it will take a ton of coke. Well, yeah, you would press the lever to take a ton of cooke if you had nothing else to do. Um. Also, so you know, so it's it's like we have to bring in you know, we've got to start with the reduction of stuff, but then we've got to bring in all these other pieces like genes, like culture, like timing,

and then see, you know how this changes things. And you know a lot of neuroscience and and you know psychiatry is now heading in this direction and trying to you know, now that there is big data and you can calculate these things with so many variables, we're being able to bring this stuff in and look at it more scientifically than you know we could in the past.

One of the implications of this, and I don't want to spend a lot of time on it because we already covered it in an episode with Johan Harry's his book Chasing the Scream, but one of the big implications of this is drug exposure alone doesn't cause addictions. So the drug itself is not the problem here, and our efforts to get rid of all the drugs is really

a misguided and feudal attempt. And we may talk a little bit about why punishing addicts doesn't work later, but I did want to just reference that for listeners if you're interested in that sort of thing. Maya's book definitely talks about it in our interview with Johan Harry does also I'm gonna stay a little bit away from the policy implications of that and focus more on the personal implications, but I did want to make sure we got that in there, because that's a big part of what you

talk about. Yeah, I think you know, on basically, if addiction is compulsive behaviors that occurs despite negative consequences, and we've spent the last hundred years of policy trying to fix it with negative consequences. It's pretty ridiculous. And you know, in the book, I talk about how, um, you know, the kind of like trying to stomp out O c

D handwashing by like banning soap. Now, you can have a harm reduction effect sometimes if you like ban a particularly harsh soap, right, but you're not dealing with the underlying problem. Um. But our supply side efforts have basically done the opposite. So we push people from you know, pharmaceutical drugs which are certainly dangerous but at least you know the purity and the dose to sentinel where you know,

we're just getting so many depths. Yep. We could probably spend two episodes on the failure of American drug policy and all the ways that it's misguided. But again we'll save that for different telling. But I do want to talk about that idea though, that this is a learning disorder that is characterized by a resistance to pun smith.

Let's talk about that, because this idea of having to hit bottom is very prevalent, and I'll have to say, like I still there's a part of me that feels, well, I have an interesting experience with this, So let's let me have you talk about that first. Sure, the problem with the idea of bottom is that it can only be defined retrospectively. So let's say I'm a person in recovery and I'm happily in recovery for several years. I believe that the thing that preceded my recovery was my bottom.

Now I relapse, Suddenly I have a new bottom. Now I relapse again, suddenly have a new bottom. I don't know what my bottom is till I'm dead, really right, Um, So it's a useless concept scientifically. It's also a really moralistic concept because it it kind of means that you have to hit this point of extreme degradation before you can stop, and that is just not with the research.

So if you just ask yourself this question, who's more likely to recover a doctor with a thriving practice who has just gotten into trouble or a homeless stuff and quite obviously the doctor, right, yes, yes it is. We know this instinctively that like, if you have more resources, you are going to be more likely to recover, just

for obvious reasons. But the whole idea of hitting bottom tells us to take resources away from people and to try to continue to inflict negative consequences until there comes some point when this thing that is defined by not responding to punishment suddenly decides to respond to countliments. The first time I got sober, it came as a result of some pretty serious negative consequences pending, as did your Sobriety also at least seem to be motivated initially I

some negative consequence. So I while I recognize the idea that having to hit a bottom is a fallacious concept, because I actually got sober again many years later after I had a relapse, and I didn't hit any sort of bottom and got sober, So I don't totally believe in the concept, but I'm curious about what, then, do you believe is the motivation that turns people towards recovery

if it's not avoidance of negative consequences. I think this, you know, like if people continue using despite losing your families, losing their homes, losing their jobs, losing their loved one, you know, practically losing their lives many times, you know, this is a very inefficient way of spurring recovery, right, and it is quite likely to end up spurring death instead of recovery. So you're saying it can work in some cases, but it's a pretty bad way to make

it happen. Well, yeah, And I mean, what do you mean by work? Like? I mean, for me, I got arrested, and it's leasing a horrendous sentence because, um, it was New York in the eighties, and I had a lot of cocaine and we had the Rockefeller a lot. I kept using for another two years after that, so, you know, and my life was constantly getting worse during that time. I was using during the peak of the AID depidemic in New York City, when fifty percent of people were

infected IVY drug users, Like what I think happened? Um, you know, certainly I was, you know, cognitively terrified and aware of the potential consequences, but I kept using because I felt like I just couldn't survive any other way. I just couldn't see that I had other options. And I think recovery comes when you begin to be able

to see the options. And and I'd like to use this analogy of like, let's imagine your prisoner in a cell and there's a rug on the floor, and you have no idea that like under that rug is like a trapdoor that you could just walk out. Right. If you don't know that that's there, you can't escape, But

once you know that it's there, you can. And you can't make somebody sort of suddenly see the lot through negative consequences, like sometimes they do and sometimes they don't, And you can't make them suddenly see the light by like being loving and kind, because sometimes that helps and sometimes it doesn't. It is a very complicated process that's

highly individual. I tend to prefer the loving, supportive, hopeful approach because a it does less harm and be it is more likely to work on something that doesn't respond to punishment generally. But you know, there is a mystery as to how human behavior change occurs, and it's not a simple thing, but I do think, you know, insight is sort of necessary but not sufficient. Yeah, it is a fascinating subject of why some people get sober and others don't. It has mystified me the whole time that

I've been in recovery. I think it ultimately was at the bottom of the complete undoing of my belief in the spiritual type of God that often talked about, because I was like, well, that doesn't make any sense. It's it's just a mystery. And what you said there is interesting because I was pushed to go into treatment because of some seriously negative consequences. But you're right, it was the sudden appearance of hope that probably kept me going or got me interested in trying. So that is a

different way to look at that situation. Yeah, I mean, you know, like I was writing something today about learned helplessness, which is basically this you know, part of of these for studying depression um. And you can create this basically in animals by doing horrible things to them like unpredictable, uncontrollable stress um. And basically when you do this, after a while, the animals have stopped struggling and says, the

hell with it. And at that point, when you want to test an antidepressant, you basically see if it keeps the animal trying longer, right, and drugs that are effective at being antidepressants keeps the animal from giving up. Right. But once you get to that point of like learned helplessness, that's where a lot of people with addiction are kind of living. And without giving them hope, without giving them insight and a sense that they're worth it, it's very

hard to get them to change. And it's going to be you know, I mean, I think we need to recognize the role of trauma here. Um, if you've been severely traumatized and drugs are the only thing that allows you some moment of peace, you are not going to give that up until you find some other way of managing. And so like a lot of how harm reduction works is by helping people learn other ways of managing before they give up the drugs when they're not yet ready to do so, so that when they do, they have

a way of soothing themselves. Basically, and we recently had an episode where we talked about trauma and the role of trauma or you know, what's known as adverse childhood experiences on later life behavior, addiction being one, and we had we had gab or mate on who talks a lot about this. But I think what you just said there is really important, which is that a lot of people are using addiction, as we said earlier, as a

coping mechanism. It's not seen as the problem by us in the beginning because it's actually a wonderful solution to an existing problem, at least for a period of time. And so I really think that's an important piece of this, which is how do you cope with life in the absence of a substance. A matter of fact, I think that's probably of what recovery seems to me to be about,

is those coping mechanisms. Yeah, and I mean, you know, in the past, sort of under the disease models, the idea that people who are still actively learning or people who are still actively using could learn was like, oh, no, they're still actives. They don't learn anything, And that's just not the case. Um harm reduction programs has shown this

over and over and over again. Like people do use see needles, people do use safe injection facilities, people do begin to learn ways of coping before and they quit. So it is simply not the case that active users can't learn and can't change and can't make improvements to their life. So, you know, it's it's kind of weird that we have this idea that, like we should just take everything away before we help people get stuff that's

going to allow them to stay over. Yeah, harm reduction has just always seemed to me to be just an imminently common sense way to look at the problem. Like even you know, regardless of whether it's going to stop somebody or whether it's going to help somebody towards recovery, it just seems like, you know, harm reduction is just a good idea, but given our misguided policies, often we don't do that, although we see to be doing more

of it these days. Well, and I think, like, you know, here again comes a problem that is unfortunately part of the UM twelve up ideology, which is this notion of enabling. And you know, it's the idea that like, unless you remove all the support from somebody with addiction, they won't change.

And again we've see that that's not the case. But the biggest opposition to harm reduction has come from people who believe that you are enabling the person to inject or to do whatever it is that you don't want them to do by actually helping them stay alive. And I just find the moralism in those arguments to be really appalling because it's basically like, we think you're better

off dead than addicted. Yeah, it is. It is pretty bad logic into somebody who thankfully escaped HIV and AIDS but did end up with hepatitis C. I am aware of that issue pretty intimately. No, And I mean it's it's like you know, and and hepsey, it's just much harder to prevent being able to change than HIV because it's just a much hardier virus unfortunately. Right. Another area that was very interesting to me that I'd like to talk about is this idea of there being two types

of this. Probably in the right term, I just gonna use it mechanisms that different types of mechanisms that are happening in addiction. And you refer to it, or researcher referred to it as the pleasures of the hunt versus the pleasures of the feast, and then you also refer to it as liking versus wanting. Can you walk us

through that, because I just thought that was fascinating. Sure, now, I mean I find this really interesting too, and I think, um, it can kind of teach us a lot about how we behave because so if you think about it, um, you know, pleasure isn't singular, um, Like, you have pleasures that are about desire and about um, you know, I mean sex is really the obvious one here, being excited and um, having desire is pleasurable. It can also be

pleasurable to be satisfied. And that's so like the hunt would be the desire part, and the feast is where you are satisfied and satiated and comfortable. So wanting is like that desiring bit, and liking is like the satisfaction of that um. And you know, sort of these very primitive models of addiction where it's all dopamine dopamine dopamine never made that distinction and it didn't make any sense because if you constantly escalate wanting, it becomes severely non fun.

I mean, who wants to live in a permanent state of unsatisfied desire? That's like hell, right, Um, you know you could permanently you can escalate contentment and satisfactional you want. You may not be very motivated to do anything, but you will be happy. Um. But if you constantly escalate desire without satisfaction, you know, that's like the rolling stones.

It's not going to be good. So, you know, we do need to distinguish these between these things because they refer to different motivational states and they are you know, I mean, cocaine is sort of a classic example of a drug that escalates wanting rather than liking, and you can just be doing coke and doing coke and wanting and wanting and wanting, and you're never satisfied and it

ultimately becomes very unpleasant for that reason. Opioids, on the other hand, are sort of more statiating drug and although

they can escalate wanting as well. Um, but you know, it's like this is why it it's a lot easier to do maintenance with opioids than it is a stimulants, because if you have something that you can get to the satisfactory level of, it's a lot easier than if you have something that's constantly escalating desire, right, and things like methodone as as an example, methodone no orphine um, heroin itself possibly, Um yeah, Um, so yes, that's that

is what I mean. And I think, like you know, when we understand that addiction is defined as compulsive behavior despite negative consequences, we can see that maintenance can be recovery because you might still be physically dependent on a maintenance drug, but you aren't having compulsive behavior despite negative consequences, so you are not in active addiction. That makes total sense for cocaine for people who have been down that road.

You know, it is, as you describe, an escalating cycle of never being satisfied and chasing that satisfaction for long and awful periods of time, Whereas, as you said, with with heroin or other drugs, there is a satiation point where you're like, all right, I don't want anymore until you're no longer at that satiated point, right exactly. And

so what's the role of wanting then? Is it just that as you come down from that, now you want again because you're not there, Yeah, exactly, And I mean this is again my main names work because if you just stay at a steady state level of the drug in your system, you don't escalate either wanting or liking you're just you know normal. What about alcohol? Where does

alcohol fit in that? Alcohol is complicated because it's such a dirty drug in it it does um and I mean dirty in the sense of that it it activates multiple complex things as opposed to being very simply targeted to something. UM. So you know, initially, alcohol acts like a stimulant. It has this bi phasic effect, so first you feel kind of excited and up, and then you

feel kind of tired and sedated. And a lot of people sort of make a mistake with drinking where they think like, oh, if I drink more, I'm going to get more of that excitement, but you actually get more than the sedation. So one way to learn about moderation is to realize this and to not drink more when you think you should. Um. But um anyway, Like, yeah,

so alcohol is kind of both and that UM. I think that's one of the reasons why, you know, a drug like n altrek zone, which blocks opioids, is probably more useful in alcohol than it is an opioid, because with people with opioid addiction, they tend to be chasing a really strong opioid effect and completely preventing that completely preventing even your natural opioids from working may not be

so good for some people. But with alcohol, where you're not blocking the direct thing and there's other things going on, um, it may be more manageable. And it may also, um, you know, help with moderation. Yeah. I think that's an interesting idea. I explored this with someone not too long ago about was an l truck zone a good idea? And the concern was, Yeah, it's blocking opioid receptors and this person is wrestling with depression to start with, So

is this really the best approach? No, and that's a really bad idea. No, I think, I mean, you know, it's it's interesting because um, I think, um mail truck zone and vitral, which is a little long acting version of it. Um, I think they're very similar to antidepressants in that some people are going to work great for and actually make their mood better, and then other people are going to be a disaster for and make them

kind of suicidal. Um. And you really need to figure out which group you fall into before you take something. And it's gonna last a month, right, um. And you should not be coerced into you know, taking me anything like this. The other thing that we really really need to know about uh mail truck zone is whether vitral actually increases overdose death risk during the month or two after you stop it, because it could potentially sensitize the receptors,

and we really don't know this yet. Meanwhile, we do know that the other two drugs nothing down to briven orphin cut mortality by or more. And so you know, um, if I'm making a choice and they also don't block indogenous opiates, I'm going to tend to think that they should be the first choice. So let's now wade into the territory where the knives are going to come out

from someone somewhere listening or who knows. But we're gonna we're gonna wade into the sensitive territory of twelve step programs and are they effective, are they useful, etcetera, etcetera. And so I'm going to just state a little bit of what you say in the book, and then you can agree or disagree, and then we can kind of go into the discussion. And sure you talk about how a you recovered from a twelve step or via twelve

step program. So there's there's that piece and the fact that twelve step programs have been inserted into our national drug policy in a way that is very injurious. And I think that's a point that hopefully a lot of us, anybody, can agree on, which is that, you know, making twelve step programs the place where you just push everybody who's got any kind of problem against their will is probably

not a great idea. So, with with that in mind, tell me what else you know, kind of your where you are with with the idea of twelve step programs today, um, in your life and in general? Yeah, um, I think that twelve step programs are absolutely wonderful self help for people who find them helpful, and the only way to

find that out is to try it for yourself. Basically, some people are going to go and they're going to find a warm, welcoming community and feel as though they are part or something and they get the social supports that they need and it helps them, you know, remain sober and avoid relapse and and all that good stuff. Other people are going to go and say, this is moralistic, this is religious, this is spiritual. I don't like this. I don't feel comfortable here. Um, And it's it's just

not their thing. You know, with any other condition, we would not accept of treatment being a program that involves taking moral inventory and turning your life and will over to a higher power. Like we would consider that alternative treatment at best, and we would definitely not mandate it for anybody. And the fact that we do mandate it for people, and we do have a large percentage of our treatment programs saying that you know, this is the

only way to recover. It's an outrage. That doesn't mean the twelfth Step group as self help are bad. It just means that it should never have been married with medicine. And you know, A itself says that in the eighth tradition that, um, you know, we shouldn't be paid for doing twelve stepwork and teaching other people about the twelve Steps. Well that's exactly what goes on in at least of

American treatment centers every day. And so a lot of you know a A old timers and and uh, you know an A people are like, yeah, like we should never have accepted this kind of weird marriage because you know, I'd like to use the analogy is like cancer treatment, like it may be that your faith is the only thing that allows you to like show up for all that horrible chemo, right, but you don't ask your faith based support group leader for what dose of chemo should

be the best? Right, You ask your oncologist, is right, and you work with your doctors on the medical aspect, and you keep the faith stuff you know UM as the support you know. And this doesn't mean you can't be as religious and as believing and as spiritual as you like. It just means that, you know, modern medicine is different. And while we can have these things support and complement each other, when we try to mix them,

it does not work very well. And the other problem on that occurs with just the top step UM ideology is that a kind of has been used to encourage this very insulting and demeaning form of treatment where you know, you get counselor saying you know, when is an attic line, when their lips are moving, you know, and where you get like all this like stuff aimed at forcing you to hit bottom and you know, sort of forcing you to feel like you're immoral and bad. And you know,

for women and minority that can be really harmful. I'm sure it's harmful for some men. Too, but it's like especially harmful for groups that have historically been powerless. We don't need to be told that any or thank you very much, we need to be empowered. Yeah, for sure,

I agree with with a lot of that. Talk to me about medicine though, and the role of medicine in a learning or developmental disorder or in a where we said earlier that most of what constitutes recovery is a means of coping with things, which is not exactly a is that a medical thing? How to cope with something? I mean again, like you know, this gets to our weird disciplinary boundaries. Um, I think that you know, I mean, is cognitive behavioral therapy simply teaching is good teaching therapy?

Like right? To me? Like that ends up like being semantic, right, But if you know, I think the reality is that if we see people with addiction as students who need to learn better coping skills rather than sinners who need to be forced to repent um, we will have a much better power dynamic in our true eatment centers, right, and people will feel a lot better about themselves. And and you know, so I think you know, yes, a lot of what is needed for recovery is stuff that

is needed for mental health in general. And given that most people with addiction either have trauma or mental illness or both, you need to figure out what the person is trying to cope with and what skills they lack and then help them find them. And and that's going to be a really different process for different individuals. I mean, like giving you know, a CEO job training and a g E. D. Is not very sensible. Some of the ones I've met might I mean, it might help, is

all I'm saying. Well, right, okay, let's not current company that I might know at this time in my life. Not. I don't mean you guys, whoever you are is listening. I'm cheusing too, but like them at the point just more being if you you know, again, if you have like no education and no work history and no home,

you're gonna need very different things. Then if your primary problem is like depression, and um, you know you've got a home, and you've got a husband, and you've got kids and you know all these other things, Um, it's really gonna depend you know, like giving depression treatment as the primary approach for addiction to somebody who's homeless, well, that situation is pretty darned depressing, right, it's unlikely to so you know, so you need to be sort of

sensible and and you know, like biopsychosocial thing often gets tossed around, but if you actually recognize that and actually really enact that, then you will provide the appropriate things for people, um, you know, as needed. And I mean, I think this is why we often get this ridiculous thing where you know, oh, if you're going to go on method home, you must have counseling. Well, um, the data doesn't support this, and it's expensive. Why don't we

just give counseling to the people who want counseling? You know, Um, it's just like it it seems it seems you know again, it's it's sort of this moralistic, controlling thing going on. And and once we understand that people with addiction are people like any other people, and they have the range of goodness and badness that everybody else has, um, you know, we can start you know, recognizing humanity, treating people just like people and figuring out, like, why are they behaving

this way? It's not because drugs do something bizarre to you. It's because people figure out ways to like deal with what they have going on inside them, and we need to like help them rather than you know, keep trying to harm them. Yeah, and I think that's a great place to kind of wrap the conversation up. I think what you said there's is so important and I think that, Yeah, I couldn't agree more that treatment for these things needs to be it's a it's a cliche word, but holistic,

right that. I've always thought that about depression too. It's like, my depression responds to a lot of different things, and I would say my addiction does too. It's it's a variety of factors I have to deal with for that to be effective. So being kind to each other is always a good message. So thank you so much for taking the time to come on. The book again is called Unbroken Brain, a revolutionary new way of understanding addiction, and I'm sure this is going to get some people

stirred up, which is always good. So thank you so much for coming on. Thanks for having me. Okay, thanks Bye.