I think when somebody is trying and they still experience a return to use, there's some other problem they're still practicing. That's the thing that matters, is putting intention and attention into a process of change.
Welcome to the one you feed Throughout time, great thinkers 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
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Thanks for joining us. This is a collaboration episode with of course Eric Zimmer from the One You Feed podcast, and also Laura Cathcart Robbins, host of the Only One in the Room podcast and the author of the memoir Stash. Also joining is Carl Eric Fisher, addiction specialist bioethicist at Columbia University and a podcast host who is also the author of The Urge Our History of Addiction. And we have Holly Whittaker, author of Quit Like a Woman. She's
also the writer of the Recovery Substack. So enjoy this great conversation.
All right, we are coming to you not quite live, but I'll just say that the we is Hollywood Occur and Eric Zimmer and doctor Carl Eric Fisher and myself Laura Cathcart Robins. We are colleagues and friends, and we have decided to come to you to talk about dry January. Actually not to you. We're going to talk about it amongst ourselves and what it means and just different things about sobriety and recovery. Like I said, I am Laura Cathcart Robbins. I am the host of the podcast, the
only one in the room. I am the author of the memoir Stash My Life in Hiding, which is an addiction memoir that came out in March of twenty twenty three. And this is the second time that Eric Zimmer from the One You Feed and I have come together to have this type of discussion in a dry month. The last time was dry July. This time it's dry January, and we're going to talk about what that means and what it might mean to each of us on this podcast.
But that's who I am, and I wanted to just kind of go around and have everyone introduce themselves before we get started in this discussion. And Eric, do you want to go next?
Sure? I'm Eric Zimmer, host of the One You Feed podcast, and I also run a program called Habits that Matter that brings together wisdom and behavior change so that we live our lives in a more meaningful way. And I'm really happy to see you again Laura, and see you Carl, and finally meet you Holly. But it's been a long time. I've heard about you for years and we just have we've never crossed paths, so I'm happy that's finally happening.
And so to Holly, do you want to go next?
Sure? My name is Holly Whitaker.
I am the author of the book Quit Like a Woman, which focuses specifically on alcohol and women and the recovery industry. I have founded a recovery based company and developed a modality to help specifically with alcohol use disorder, and I currently write the Recovering column on Substack, even though I'm on a little hiatus from it and working on two books on this topic that we're talking about tonight on Recovery. So really excited to be here.
With you all.
Lauren Carl are friends of mine, so Eric, it's nice to meet I've heard about you for a long time too, and Carl, it's.
Great to see you all. I'm Karl Eric Fisher, addiction psychiatrist. I'm a bioethicist at Columbia University. I wrote a book called The Urge, Our History of Addiction, which is a history of addiction from ancient times to the present day, interwoven with some of my experience as a person in recovery myself, including some reflections on my family history of alcoholism. I host a podcast that's called Flourishing After Addiction that focuses on all sorts of different people deep dive interviews
about how we make sense of addiction and recovery. And I do have a Substack newsletter that I just launched two weeks ago at Holly's encouragement and so much encouragement that she named it for me because I can't name anything myself.
All of my best titles.
Come from friends and it's called rat Park and I love it so much. So thank you, Holly.
I've got to say I'm a little nervous, and I don't know if I want to use the word intimidated, but I feel like because the three of you were so established and so well respected in this area, that I want to rise up to the same level and I just need to just be me and do my thing because I'm not educated in this area, but I've had a lot of experience of my own. And Holly's like, yes you are.
Oh, I'm like looking at you. You're who I call. What are you talking about?
I know?
But you know what I I mean, you don't have any like professional credentials that you are you sponsored?
I mean, I'm sure, yes, the people.
At this point, thank you, thank you.
So yeah, I mean I want more than I do.
Well, but yeah, okay, I do have experience. I have something what I believe is valuable to contribute. And the first thing I wanted to bring up was my experience. So I've been sober for a little over fifteen years, and when I first got sober, it was just literally taking away the substances like I stopped taking pills and I stopped drinking, and I didn't have anything mind altering in my body. And that was sobriety for me, and it was excruciating. I was in an incredible amount of
pain after I stopped. I was in as much or more pain actually after I stopped than when I was using. And I got sober through a twelve step program which I'm still in and still a part of. And eventually, as I engaged in like the tenants of this program, the principles of this program, I started to feel some relief. And I think of that as my recovery rather than
me being completely obstinate. And I find that that's kind of scary for people, because at this point in my recovery, I don't value the abstinence as much as I value the work the recovery. So yeah, I feel like there's a distinction, and for me now that there wasn't before, and I know that things continue to evolve. I think you can be using substances and still have recovery. I also think that you can be completely abstinent and not
have any recovery. But I was wondering if you all had any thoughts on sobriety versus recovery and if you do what they are Yeah.
Well, I think that's a really powerful reflection and really complicated. We could probably have a whole day long retreat or seminar on that topic because for me, what it reflects back is the variety of different recovery experiences and the notion that everybody has a different experience of recovery. There's not one pathway to recovery. There's probably as many pathways to recovery as there are people who are seeking recovery.
But just to simplify it so I don't think of too much space, I had a positive and a negative reaction. Positive reaction is I think it's really crucial that people in general come up with their own notions of recovery and seek it out in a positive towards sense, not just stopping for many many people, not just limited to twelve separate recovery. That includes getting outside the self and finding some sort of advice or feedback so.
They're not just running their own show.
The negative reaction I had is speaking from within the medical profession, there is a history of definitions of recovery being used to gatekeep in certain ways. It tends to be about power and judging people who use substances by saying what you're doing does not count as recovery. This is one of the things that I was interested in when I started my sub sec was all these different notions of recovery. And everyone has a different definition, different frameworks, different components of it.
You know.
Just one example is an older, more conservative definition says it requires a sort of conformity to ethical norms quote unquote citizenship as part of recovery. Well, whose citizenship and who gets to decide? And for some people, recovery involves radical activism, and why can't that be a part of
recovery too. It's really tempting and dangerous, and I've seen it happen within the recovery community and also from the medical community down to the recovery community to use different ideas about sobriety and recovery to discount other people's experiences.
So do you think there's a difference between sobriety and recovery or do you think they're one and the same.
I tend not to use the word sobriety unless I'm working with a client and they value that. Usually it's a starting point for a discussion. A lot of people like the word sobriety and the context of emotional sobriety, and I like that. I strive for emotional sobriety. For me, it's a big intention not to snap at my child, or even just to be generally crappy, just to be grumpy and not show up and be selfish around him. That's a relapse for me. Is it a relapse that's going to lead me to using alcohol?
No?
Is relapse always the right word for everyone? No, it can be a very stigmatizing word. Some people really hate the word relapse. I favor a really broad and inclusive definition of recovery, and sobriety is I think, in some ways even trickier. I don't know, what do you ought to think?
Yeah?
I mean, I think definitions mean different things to different people and can be used in different contexts and you. For me, all of those words are problematic in certain ways and useful in certain ways. Right, And for me, sobriety, meaning an abstinence from mood altering chemicals, has been really important to me. I don't think it's the end goal for everybody. I don't think it has to be the
end goal. For me, it was the right end goal, and I'm glad to have achieved that for a substantial amount of time.
Now.
The thing about recovery that I don't like is a word generally is that makes it sound like I'm going back to something. I'm going to recover something that I had, And honestly, for me, my sobriety journey has been about becoming something that I really never was before, right, And that's somebody who's able to deal with life as it comes to me without having to take mood altering substances.
It's somebody who can do the things Carl talked about, which is be more emotionally mature, where I don't snap at people, where I think about people other than myself. So for me, recovery is useful in that we talk about recovery and being recovered from an addiction, right, But I think where it ceases to be useful is that I wanted a whole lot more than just being recovered from an addiction. I wanted to continue and still want to continue to grow as a human being and become
a better and better person. And that is the place to me where it's not so much about going back. It's about going forward.
Yeah, I think for the sobrieties, I don't know how I feel about the words sobriety anymore. I think that it was very clear early on that it was a very important word to me for me personally when I started.
My theoretical ideas around recovery are far.
More advanced than my personal bias, and so I could say when I was an early recovery or in early sobriety, that I believed in a harm reduction approach, and I did theoretically, but I was very threatened by those things, and I think like on a personal level, I couldn't see how recovery could include the continued use of the substance that you were struggling with in a dependent, addictive way.
And so what's changed is not so much how I view it, even though that's changed, like the outward theory that I have around what sobriety is or what recovery is. But I think what I'm trying to say is that I have gotten deeper in my own process, in my own path, like my biases and my personal feelings about it and my knee jerk reactions around what these words mean and who can use them and what they're supposed to do has really it's almost like just ascended to
where the theory is. And I know that sounds really confusing, but I guess what I'm saying is, I think, like anybody in recovery, I've really struggled with who gets to use certain words and who doesn't get to use certain words.
And I think that.
That when Eric said that there's a lot of gatekeeping in the medical community around these words, I was thinking before, there's a lot of gatekeeping within the recovery community around these words. I think like far more than there is in the medical community, because that's where I've experienced the most infighting and truly like complicated conversations around these words.
And so just to be very direct and quick about it, I think, like Carl, sobriety's a word, and Eric, and kind of I guess all of us like, sobriety.
Is this word. That's kind of it's just not key.
I will accidentally use it, I rarely intentionally use it when I'm discussing anything. I think I conflated it so much with recovery early on, and to me, recovery Carl shared with me jan Brown's definition of recovery, which is, I think anybody who says they're in recovery can be in recovery.
You're in recovery if you say you are.
Right, right exactly your recovery if you say you are
And I think, to me, that feel important. And I think words are Like Eric said, I think like there's really no words that exist in our lexicon that are not problematic because of what we've done to those words or how those words have been used, and so like even like words like relapse right or return to use or trying to find like what the adequate term is to reflect with the experiences of millions of people that all have these like vastly differing experiences, we're all trying
to casture with one word.
Is just it's a really, I think impossible thing.
Yeah, I feel like I learned so much just listening to each of you just then, like gatekeeping and problematic words and the idea that you're in recovery when you say you are in that self declaration. In Holly and Carl, you both mentioned relapse. My dad is an HIV doctor. He loves his work. All of his patients are living now, you know, they used to in the eighties when he first started. They die, and now they die of natural causes. They don't die from HIV or AIDS anymore. His patients
have a relapse is devastating. It's a return to a state that is probably going to kill them, right, something bad has happened and they are back to a state where they have to recover or work to recover, to get back to where they were before. For us in the twelve step community, a relapse, I feel is also seen that way. When the word relapse is mentioned and someone says that they have started using or drinking again, I feel the ripple through the room is that something
devastating has occurred. There's been a failure of some kind, a loss, not just for that person, but maybe for the community. Right, Like we all had a stake in this, and now we're all kind of reeling from this admission that something was picked up or someone had a drink, or someone shot some dope or whatever it is, or someone threw up when they're in recovery from an eating disorder,
whatever it might be, whatever that relapse looks like. And like I said, I think I said this in the beginning, I'm really hesitant to even use that word, but I think it's very problematic. I don't have another word for it, So one I wanted to see if you all do, and then just to hear your thoughts on Like for me, my old ideas were like, if you pick up anything ever, you're back to one and you may not ever make
it back. Like if you pick up anything ever, you're out there and you may not ever make it back, meaning if you drink again or you use again, you may not ever get this time back that you've amassed. Right, ten days sober, ten years sober, whatever it is sober meaning without use of any substances or alcohol. And so do you all think this is true? One? Do you think it's true that you lose something when you pick up again, if you pick up again and pick up
meaning drink or use again. And if it's not true, what might your new ideas be around this subject? And if you have a name for it that isn't as problematic as relapse, or maybe you don't think relapse is problematic, and that's the word to use, let's go to Eric first.
Yeah, I mean I think this is another loaded term. Do I think that we lose something if we pick up or use again. I think it depends on what we're aiming for. But in my case, yes, I do lose something. And you use the term relapse meaning in a dangerous condition. Right, Going back to drinking in drugs for people like me is a dangerous thing to do, right, It actually is, right, and it's far more dangerous today than it was fifteen years ago. Right, I was an
opioid addict, right, I was an intervenious heroin user. It is dangerous out there, right, and so not doing that is a far safer place to be. The other reason that I feel like I lose something is that to me, a length of continuous sobriety is what caused the craving
to use to go away. To me, that is the worst feeling in the world, that literal tearing a part of my soul, when one part of me is screaming, don't do it and the other part is screaming do it right, and so space away from that, Thank God, that goes away. So in that way, yes, I do think we lose something. Do we lose everything? No, That's where I think the mistake is.
Right.
In a lot of recovery communities, you could have five years and if you use, you are back literally to day one, and you are considered an absolute beginner. You failed one hundred percent, right, as if those five years didn't give you something. I was sober eight years the first time around, and I went back out and used. And did I lose something when I did? Absolutely? Did I have to fight my way back into recovery?
I did.
Were there people who like me had periods of sobriety that went out and have never made it back and several of them are dead. Yes, right, But I didn't lose what I'd learned in those eight years. It wasn't gone right. Matter of fact, it was part of what allowed me to come back, because I was able to see some things in myself that there's no way I would have seen before that period of time. So I think that's where the mistake is that we lose everything.
And I think this grading system we have of zero percent or one hundred percent is really problematic because we don't grade anything else.
In life that way.
And so it's a very tricky thing because I do think permanent abstinence is a very valuable thing, and I don't think we should only be grading zero, one hundred percent. We have to look at progress. And if I look back at my recovery story, and I would imagine most of you would say this about yours. There was a period of trying and failing, and trying and failing, and trying and failing. If we want to use that word, right, trying and learning would be a better way to say it.
Trying and learning, trying and learning, trying and learning, and then I was able to get to full abstinence. And I would much rather had that context in my mind as I was going through it instead of trying and failing.
Trying and learning.
Yeah, right, And so I think it is a useful term, and I think we lose something, But I also think that it can be problematic if it's applied too strictly. So those are just my thoughts.
Holly, What are your thoughts?
What were the two specific questions.
I was asking one if this is a word that you use, and but the first question was you know the black and whiteness around it? Is it a failure? Do we lose everything?
Yeah?
In the twelve step recovery of which I'm a member, you lose all the days, right, you do start counting again.
Does the book say you lose all the days? Or is that what the people did? But do you know what I mean?
Is that do or is that like just a norm or is that what the book dictates?
I think it's the people.
Yeah, I don't think the book says anything about counting sobriety.
No, the book doesn't say that that's right, So you don't actually in a right back to zero. It's what has been cultivated through the fellowship that dictates that. This one woman we had the same conversation, but she was telling me all this stuff that's written in the book and all the stuff that's actually just proliferates in the fellowship. And that's one of the things, which is it doesn't say in the book that you have to reset your
daycount if you use drugs and drink again. And I think the reason I bring that up is because I think, isn't that interesting that that's like such our human nature is to say, like, where does that come from? It comes from us saying you don't get to you messed up, you have to reset.
And go back to day zero.
It comes from this, like this, this idea that somebody with an addiction kind of has to you know, just take it, you know, and just do whatever it takes because you don't have any agency over this.
This is what the group says. You have to give back your days or whatever it is.
And so I think a lot of times when we're operating around words like this, we have to like remember, like a lot of this stuff isn't codified anywhere.
It's just stuff that we do because of.
You know, like what came out of like the group think or whatever, and also came out of whatever was operating at the time that those norms were formed. So when I think of like, there's some statistic I think, and I will try and find it so you can include it in the show notes. But I'm not going
to say this is one hundred percent accurate. Maybe Carl you know this, but I think it's like five percent of people that try for an abstinence space recovery actually make it from start to finish without return to youthse that very few people that are going for an abstinent in face recovery actually make it through without relapsing or without return to use. And so when I think of it, I think of like, and the problematic nature of it is that that figure that comes from research that I
will find and make sure is accurate. But when you think about that this is like a very normal If it's ninety five percent of people that are trying to not consume or consuming, or trying not to use or using, that's interesting too, write because it shows that this is
just like a normal occurrence. And that's how I view it really is, like return to use is just a normal thing as part of the process of trying to overcome an addiction to to a substance or whatever it is, and that like, of course we've turned it into this this naturally occurring thing that's actually like proof that you're trying, right, because like if you're relapsing, right, or if you're going back out, like you're.
Going back out from somewhere, right, this is like part of what we do.
But we've carved this out to say this one exceptional thing that I think until like the seventies wasn't even a word that was like discussed in you know, in treatment settings as like a potential outcome. We've created a lot of fear around something that's just a normal part of the process, you know, And I think, like to be very clear what Eric said there was a huge consequence in certain situations to that phenomenon, right, but that is just.
Part of it.
And return to use the other piece about it. You asked like for you know, like what words I think I use return to use? But there's also like there's so many different definitions of relapse that there's really no
like one this is exactly what a relapse is. There's no working definition that we're all using and coming back to, you know, like somebody could say, I accidentally, you know, took a sip of my mom's wine and I've relapsed, right, and somebody might call that a lapse, and somebody might not even mention it because it was nothing.
You know, I love return to use and I find it just even then the idea of it to be really comforting because it doesn't feel as heavy or is blaming, as relapse might feel. And I'm wondering, Carl, from a medical standpoint, And I don't know if you do this, but if you were counseling people who have a loved one that's dealing with this, what words do you use when discussing return to use? And do you try to normalize it for them, like it's part of the process.
I tend to default to the cutting edge medical descriptions, which is what Holly has gone to in terms of talking about return to use. I also like to take a step back and ask about measurement in general, because whenever we attach a name to something, or we're measuring it or tracking it, including this notion of return to use, or if someone chooses to identify this way laps or relapse, the question is why is that the metric? Why is that the thing we're attaching to This also overlaps or
the question of recovery. Is our measure of recovery not using? Or is our measure of recovery thriving and feeling better? Is it interpersonal effectiveness? Is it feeling connected to a sense of meaning and purpose and being in connection with other human beings. Even in medical circles, you know, people talk about the immediate question, which is what language do you use or what do you measure in terms of
return to use versus relapse, et cetera. And even from the top federal agencies like NAIDA at the National Institute of Drug Addiction, there have been some recent opinions and advisories given saying we shouldn't just track if somebody stops using, because we've all met people who have stopped using in a very sort of tight and restricted and controlled way but have not developed in other ways. That's a thing
that happens, and more power to them, you know. I'm glad that people don't use if it's their choice, and I'm glad that people don't use if they're at risk of death with opioids and fentanyl and other types of dangerous substances increasing every single day. But I say that because a lot of times, in a medical context, people are really concerned about, like the rea. There's a whole therapy called relast prevention therapy. I think that's a good metric.
But if we're stopped there, then we're selling somebody a really stark and boring and dry vision of life, and that I think is actually one of the problems with dry january, which we could also talk about. I think dry january is fine. I think it's great in the sense that, like sometimes people stop use and then they confront the self and it's sort of like sitting down to meditation.
You see the activity.
Of the mind, and it's terrifying and can be miserable or overwhelming. But if you can get out through to the other side, it can be very beautiful and instructive. Okay, great, but it can't just be about stopping use. That's a starting point. That's almost like the meta point that has to exist above all the sort of like definitions and all.
Yeah. I have a coaching client of mine who did something that I thought sort of brought this together in a really interesting way. I probably shared this last time Laura when we were on but she was having trouble getting complete and total abstinence and would get very discouraged by it. I mean, she may have gotten this idea somewhere else. I don't know if she made up. Anyway, what she started doing was putting a marble in a
jar for every day that she was sober. And what we saw over the course of a couple years was a ton of marbles, right, maybe three hundred and fifty marbles a year, maybe three hundred and fifty five marbles a year. And she was also developing in all the ways that you talk about, Carl, And so again, in her case, we still looked at abstinence as a place we wanted to get to because those returns to use were problematic, right, They sometimes would last longer than a day or two.
They affected her quality of life exactly.
They affected her quality of life. But that was a really useful way of us measuring in a way that was actually I think you because there is something about measuring and celebrating success. And we can look at the twelve step program counting days as a you know, I think, Holly, you mentioned maybe it's a power thing, and I think there is some of that, right, But I think some of that also came out of us celebrating each other as we made progress.
Right.
One of my favorite things is to go to a twelve step meeting and see the whole room go crazy for somebody who has thirty days sober. Right, There's something that just warms my heart seeing yeah. Yeah. And so again, I think that with all these things, there's a point where terms and labels and measuring is useful and there are ways and it's not useful. And I think if people can look in their own life and say, in what ways is this useful to me? And in what
ways is it not? And that's what I thought was so ingenious about what my client did is she found a way of measuring that worked for her, that allowed her to see real progress, to feel good about herself, to see progress, but not get into this Z year over one hundred percent or I failed five times this year. Instead, it's like I succeeded three hundred and sixty times this year, right, And I just loved that approach to things. I thought it was a really wise way to handle this question.
Yeah, I love that too. You didn't share that before, I don't think. I don't think I've heard that story. I also wanted to just kind of put out their twelve step recovery tends to look down upon or disregard what I now know to be harm reduction. I had not heard that term before. Like, I remember meeting a guy at a meeting and he had come in because of heroin use, and he was taking chips and he was on suboxen. Is that how you pronounce it? Yeah?
And I immediately thought, Oh, he's not sober, like, he's not doing this, He's just substituted with something else that's not real sobriety. And I felt like that opinion was kind of carried through the group, Like the consensus was that if whatever you're if you're using anything, then you're not you're not in this thing with us. You're taking dirty chips, which means that you're taking chips while you're still using and dirty cakes, right, And.
Is that a word, dirty chips and dirty cake?
It is, it's absolutely, it's a term, yes. And so, like I've said, now, you know, since I've been educated and educating myself, I see things differently, but I'm very much still learning about this. So I was wondering what the three of you thought about the black and whiteness of that, and if it has a place in twelve step recovery or just in recovery.
I mean, once upon a time. And again I think Holly made a good point earlier, which is there's the if you want to look at twelve step programs, they're based on alcoholics Anonymous and alcoholics Anonymous published a book, and that book, you know, is intended to be sort of the core of the program, and then different groups add all sorts of things on top of that. And I actually think that's fine, because I don't think a book that was published in nineteen thirty nine should be
the end all, be all Bible of life. But there was once upon a time in recovery, in certain circles, if you were taking antidepressants, right, you were considered not so.
I don't think that's even once upon a time. I think that's still I really do. It may be still, yeah.
And it just depends on the group, right. That's the thing when we talk about twelve step programs, if we talk about them monolithically as one thing, we are missing the fact that there can be great disparity. Right. I was part of twelve step programs where antidepressants were considered absolutely fine, and what you're describing, Laura, seboxone would be considered completely fine, but other groups would be like, absolutely
not to any of that. And a few years after I got sober, I met a guy who used to be my drug dealer, my heroin dealer, and he was sober on methadone, and like you, Laura, I looked down on him and I thought, hmm, I'm glad I didn't do that right because I wouldn't get here. And I think this gets back to our earlier discussion about recovery, that there's more than just physical sobriety, right. I mean, I think everybody's path is their own, right, I think
it's perfectly possible to be getting help. You know, there's lots of different drugs out there that help us achieve abstinence, right, I think that those can be used as a way of launching ourselves into these deeper realms of recovery that Karl has talked so eloquently about. So those are just kind of my thoughts.
Yeah, I have strong feelings about this. Of course.
I don't know how to get out of this trap that we have such a deeply polarized opinion of medications in the United States. And I love this one discussion. I know I've discussed this view, Holly, but it was
from the nineteen seventies. There's a bioethicist and psychiatrist who said we swing between psychotropic heatedism on one side and pharmacological calvinism, Calvinism meaning that there's some sort of virtue in suffering, and so individuals and cultures swing from sort of screw it, let's do everything back to nothing is good. And the truth of the matter, certainly at the population level,
is somewhere in the middle. It would be very bad if everybody with every kind of addiction God put on ozempic. For example, like, there's interesting evidence that ozempic has some sort of effect central addiction relevant receptors and has effects on gambling addiction and alcohol addiction. Not to take us down too much of a rabbit hole, but you know, ezempic has costs too. It has actual material costs, and then it also might reduce bone density and muscle mass
and all sorts of other things. Like there are costs and benefits to the box hone, they're definitely costs is a box zone. There are ways that it can be diverted in harmful ways, and there are ways that some people can experience maybe emotional numbing or things like that. But medications for addiction treatment, they're not even assisted treatment. It's for addiction treatment. Because medications are the only things in a research basis that have been shown to reduce
death for opiaduced disorder. Not attending twelve step groups, not going to a rehab, not outpatient psychotherapy, nothing, it's just medications. And so if we're interested in actually getting people in to recovery, whatever recovery means, whatever we want to call it, we have to be much less judgy about medications. I think, like, if you go to the coastal cities, or if you go to places where there's like a higher density of people and groups like you can find groups that are
much more accepting of this. But you know, across the whole national and certainly global addiction community, you can certainly find treatment centers where people will say, hey, if you're on a heart medication like a beta blocker that reduces anxiety, that's not real sobriety, you should ask your doctor to switch you to something else that's not psychoactive, because maybe just taking the edge off.
A little bit.
You know, I haven't used a self prescribed mind remoon altering substance for a very long time.
Now.
I alter my moods in a lot of ways.
You know, I still go to the.
Ice cream, and I still go to anger, and I still go into like frantic overwork or whatever. You know, there's lots of ways I alter my moods. And the actual magnitude of changing someone's mood with suboxone is so minor compared to the universe of other ways that people use their mood. There's no universe in which it would ever possibly justify the scale of death that the lives left on the table represent here, Carl.
Do you think it's because there is the fear that they're getting a bit of hit and a bit of a high, and there's like they're altering themselves, Or do you think it's because it's cheating and it's not really like doing it the right way.
I don't know.
I think it's so overdetermined in the sense that there's so many different stories and narratives swirling around it. Some
of it is just cultural inertia. That's part of why I was interested in the history of addiction is there is a lot of racist and sort of class oppressive stuff going on in the nineteen seventies when methodone was first introduced, and you know, because of that and because of stories about who was using substances, primarily heroin, back then, you know, methodone was overregulated to the gills in a way that it still is today. So you know, imagine in your mind right now, what is your image of
a methadone clinic. It looks like a fortress. It's a place with barred windows, and people have to line up in the cold and the snow for hours sometimes. It wasn't until COVID that we started to get some take home doses. You know, that sort of oppression made its way into methanone. There's just one casualty of the constant war on people that was disguised as the war on drugs that just trickled down. That trickled down in a saboxone.
You know.
Suboxone is only just recently liberalized so that every doctor can prescribe it. People should know that because like a lot of doctors don't even know that honestly. But this happened a little while.
Ago, right, it was controlled, right, like you can only prescribe so much.
Yeah, and you.
Had to get a special waiver, you had to go through a special course and go through this whole process.
You know.
It was only a little while ago that that happened, and so few doctor went through the extra step of getting certified to do the suboxone. Even I it was just like taking an online course and checking a box. It's just we need much more massive uptake of it. It's been really suppressed that we're leaving so many lives on the table. You know, the opioid epidemic is not We're not bending the curve at all. It's horrifying. I
talked to one researcher. Today, I talked to researchers who I went to med school and residency with and people who are in the research community, and they are burning out. I mean, they are really struggling because they're doing the research. You can pile up our journal articles that say suboxone saves lives. These the medicine saved lives, but it's just not happening, not because of a lack of medical research.
It's because of the cultural stigma and again, like the internal stigma within the recovery community.
I think it's really just deadly.
Are their stats, Carl on the number of people on suboxone year over year. I'm just kind of curious because to your point, I don't know how many years ago, I'm terrible with time. It was this really fringe thing that I was starting to hear about, and now, you know, I think there's a whole lot more of it, and
I'm curious. We may not be bending the curve that much, but I would have to assume that the uptake levels on that have to be going up somewhat substantially, or that just may be my own sense impression, which is why I'm asking about data.
You know, I would love to get some data, put it in the show notes. Later I can look into that. But I do know in outline that you could double a tiny number and it's still.
A tiny number.
That's the issue, such a tiny fraction. Like if we you know, we're still at over one hundred thousand overdose deaths a year and the size of our addiction workforce is tiny, tiny, tiny, and our addiction workforce is primarily directed toward alcohol. You know, there are a lot of people with opio use problems.
Going to rehab.
So it's really I mean, that's really where the numbers are. That's why the tighter restrictions on subbox when prescribing were removed. But still, what we need is a cultural change. We need people to change the way they think about addiction and recovery and recognize that. You know, there's this sort of like pro recovery slogan sometimes people say to suggest that you can't just stop debts. There's a difference between stopping and death and saving life, which is true, but
you also have to stop the deaths. If you don't stop the debts, you can't, Yeah, get the people in the room dead, people can't recover.
Yeah, Yeah, that was really helpful for me, Carl. I probably told all three of you that I sat with Beth Macy on a panel about a year ago and she really hit this subject hard, harm reduction, harm reduction, harm reduction. It was actually the most I'd ever heard anybody talk about it. And I was still kind of like, yeah, but you're not on my side of it, right, you don't understand the consequences of someone like me who was really really ill with this picking up anything and using
it again. And I didn't really get what she was saying, But I got it when you were talking, Carl, that this is the way to bring these people into where I'm sitting now in recovery. That there isn't a meeting they can sit in that's going to get them. And I'm just saying recovery because it's just the word that I use. But there isn't a meeting or a talking to or a therapist that's going to do the same job that a medication that makes them physically able to
join in. Well, I've had several people in my family die from both alcohol and heroin, and so I feel like I have experience, but I didn't really understand that and this gives me a lot more compassion, So I really appreciate it. Holly, I know you want to talk about dry January.
I want to talk about it just because everyone wants to talk about it. Like I personally have no strong feelings towards dry January.
I can't remember if I used to or not.
I think I used to be a little like tongue in cheek about it when it really really blew up, because it started about a decade.
Ago in the UK.
It was like the first many years that people did it, a few thousand people did it.
And then you know, it's like now, you.
Know, millions of people do it, to the point that they're already exhausted by it and now are moving on to damp January.
That's dry January is too.
You know, and so like we've already been through three cycles and we've swung back and then we're going so but I think, like for me this year, I've heard a number of people, most of my friends are you know, in some form of recovery, and so people I know talking about it, you know, and giving it like a little sight and I kind of am surprised by it by the number of like people I've heard disparage it this year, and like a year ago a calumnist that The Cut wrote an article that was like, don't get
sober in January, and a lot of people get sober in January, a lot of people into recovery in January. And we have kind of like because we're so aware of the impact of diet culture in all the ways that like in hustle culture and productivity culture and workism and the ways that we're supposed to become new people in January first, and now we've rejected that. And now we don't want to become new people in January first.
We just want to sleep.
And I think we're missing the point, Like we're missing the point capitalism is going to capitalism, right, this really beautiful movement that I think is a wonderful idea that gives people a chance. Like there was Hello Sunday Morning. I don't know if that's even still in existence, but was this organization that allowed people in New Zealand or Australia to try three months or one month's since of not drinking.
And this was you know, like a decade or fifteen years ago, and.
People would say it was like a local thing and they signed up for it as like a break from alcohol. They'd commit to a break from alcohol and they would say I'm doing a Hello Sunday Morning or an HSN and beoble be like, oh got it. And so it was this really sweet way for people to not have to go through the complicated of deciding whether or not they're an alcoholic, you know, before cutting back their drinking, and getting recognition that this is an important thing and
it's socially supported. And that is what Joy January is to me, is the sense of there's visibility, it's conspicuous, you're pledging to it. It's very very much like a thing your friend might do, not because she's an alcoholic or she's pregnant or whatever, but because she wants to
take a break after the holidays. And so I think when you're looking at like specifically alcohol and the barrier to entry, like for treating alcoholics disorder or even just like on that spectrum, like I'm not talking severe, but just like addressing it, you have to go through a lot of hurdles because of the normalization and the idea that only people that don't like there's a lot of stuff that prevents people from examining whether or not, you know, alcohol is showing up wrong.
And I think that this is.
A really beautiful way for people to experience that without having to go through all of the mental gymnastics and the hurdles to actually enter some kind of recovery, you know. And so that said, yeah, of course it's become commodified. Like some woman just wrote this article. I couldn't even read it. It was like something about like how I'm the devil and dry January is the devil and something else.
And there's a lot of like side eyed stuff. But the capitalism component of it and the fact that like not drinking or dry January.
Or sober curiosity or these other like.
Trends are somehow damaging and terrible, and I personally feel that needs to be set aside. And what we need to understand is that there's so few things that capitalism does write, and in this case, this is leveraging an opportunity for people to try something out they wouldn't otherwise. And I guarantee January is probably the month that the most.
People get sober.
It has to be, so I personally don't think there's anything wrong with it, And I think it's one of those places where I've chosen to not be upset about the commodification of recovery and sobriety or whatever that is. It's just let it be and let people do it. And that's my thoughts on Try January.
That's a very generous way to look at it.
I think. I don't know if I always looked at it this way.
I think I was very ough, you know, when it really really took off and everyone was doing it, and like there was this feeling that like, oh, but I'm really in recovery. I really had a problem, and then people are just trying it on for fun and you know, and I think that there was that sentiment that I had around it or it's not real or whatever again like personal bias, like deep inside.
That was my gut reaction to it. But I think it's great, you know.
I think this connects really nicely to the story Eric that you had about the person who's putting.
Marbles in the jar.
I love that story. I'm going to remember it because it's about practice that person was practicing and they wanted credit for those days that they practiced. And I think when somebody is trying and they still experience a return to use or some other problem.
They're still practicing.
That's the thing that matters, is putting intention and attention into a process of change.
And why would we put that down? You know?
I think RYE January could be somebody's experienced practicing with drinking and they might not stick with it, and then they see that and they see the difficulty with bringing their actions in line with their intentions, and then they modify and they change, and then maybe it's only three years or five years later that plants a seed for some bigger change.
Yeah, Carl, can I just say real quick you might know this better, but I think that the average time between identifying that you knowing you have something wrong and actually seeking treatment for it when it comes to I think it's alcohol, but it might be all addiction, is like ten years.
Seven to ten years, Is that right?
Yeah?
John Kelly, who directs the recovery research in suit at Harvard, he likes to say eight.
But you're exactly right.
It's actually from the time, if I'm remembering it right, from the time that somebody makes any attention to seek absidence. The bad news is there's many, many returns to you. So people can have problems along the way, but the good news is many many people recover. It just takes a while, and all of that is practice along the way, right, you know, if somebody wants to practice, we're all in little bubbles. We like to talk about recovery. Probably people
on this podcast like to talk about recovery. They might have experience with it, but there are a lot of people out there who don't. And maybe that's their entry point. Maybe that's our entry point to practicing the change or looking at themselves.
So why I put that down?
I would agree. I mean, I think anything that gets people to examine their relationship to substances is a good thing, right. And for some people, they'll examine their relationship to it through dry January and they'll go, Okay, nothing to see here, right, Like, they'll move on right, and other people will start to see something, you know. I mean, I've heard stories of people say, oh, I took a month off drinking and I started to really see what drinking was doing in
my life. Right. And again, you know your point, Carl. They may maybe a year down the road, three years down the road, but I only see a positive in things that encourage us to do that. And I also think when we start to say and truly accept like there's lots of paths to recovery, there's lots of ways to get better. If we really accept that, right, then
we can become very encouraging of all of them. And we don't have to sort of, you know, to use your term Holly side eye these different things or take hot takes on things. Right, we can just go good, somebody's trying to get better. More power to you, you know, imagine, imagine.
Yeah.
I also think though, and I agree with everything you all said, almost reluctantly, because I really don't want to like driyja anyway. I really like I feel like it's such a like an amateurist thing, Like people are just trying out something like just to see if it makes them a little bit healthier. I think most people are probably trying to lose weight or get back in shape, and letting, you know, letting go of alcohol is part of that.
Sure, but like, isn't that okay to have like vain reasons?
It is? It is, I'm trying. I was listening to you, Holley, I'm like, I'm going to be more generous with this because this is really a good thing. I'm going to embrace it. But I was reading I don't know if you guys read this. TJ. Holmes and Amy Roback. They were Good Morning America like posts who Affair and now they have their own show.
Yeah.
But he was saying saying he's doing dry January and he was drinking eighteen drinks a day. Yeah, and he's come up like against like, whoa, this is a really big change from my eighteen drinks a day in dry January.
And I know we have to wrap up, but I was just thinking, shouldn't there be some kind of support because then you feel like he's got to feel terrible right physically my experiences, it got worse before it got better, Like I felt like, oh my god, I need something for like the first thirty days, the first sixty days, like I need anything, Like I would have taken or used anything to get rid of the feeling of withdrawal, because I would imagine that the body or the brain
wants something after it's used to having eighteen drinks a day, So is it wise when someone is drinking I would say that successively. I don't know if TJ. Holmes would but is it wise to embark upon an abstinence, an abrupt abstinence, or should people who were maybe drinking excessively look for support as they go through it, knowing someone that can inform them that's gonna get worse, but then it'll get better.
Well, this is not medical advice, but uh, alcohol withdrawal can be dangerous.
You know, it'll kill you.
Not that it's extremely common, but it can be dangerous. So it is good for people who are worried about their health to seek out medical help, keeping into account that there are also problems with access. You know, people might have trouble accessing good which are all supported, or if you walk into your ear you might get treated like crap. Yeah, and so that people might get suck
in a double bind there. And I also know that when I when I was trying to stop drinking as a young doctor, I kept on telling myself, ooh, I better not stop quickly, a better sload And so that turned into years upon years right, rationalizations, So it's very hard. I think in general it doesn't have to be medicine. It's good to get help looking at those kind of rationalizations, and you know, is this nonsense or do I actually
need to be careful. My own experience was that I had plenty of experience with silly rationalizations.
Eric.
Yeah, I mean again I think yes, probably, you know, good medical advice says you get help. But again, I'm kind of back to who knows whether for I don't even remember the gentleman's name, the eighteen drinks a day, but he's actually due to dry January, He's now taking a look at something he may never have taken a look at before, right, Who knows where that will lead? And back to this idea of there's one thousand different
roads into recovery. I mean, I just I'm in general and support of again, like I said, anything that gets people to take a look at their relationship with these chemicals is a positive. And yes, if you're drinking eighteen drinks a day for a long, long period of time, I'd suggest a little bit of medical help.
I mean, I didn't even mean to laugh there. That's that's real. That's like, it just makes me laugh that that was the headline on my feed in the morning was d J. Holmes.
He really was drinking eighteen every single day, thirty days, that's what he says.
He says easily has eighteen drinks a day is what the headline says, and then he saved three thousand dollars already. This is whenever. This was on.
January third.
Does anyone have any last words, anything that you were inspired to say when someone else was talking that you didn't get to say, or just something you want to leave with the listeners.
Well, I always wrap up discussions like this with an old twelve step phrase, which is keep coming back, right. And I don't mean it in necessarily keep coming back to twelve step programs, but I mean it in general when it has anything to do with addiction or substance use, overuse, whatever you want to call it. Like, I think the message is keep coming back, keep trying. I love the way Carl put it, keep practicing right, because recovery is available, but it rarely happens to us on the first or
second or third try, right. It's something that happens through repeated effort to try. And so I would just say, you know, don't get discouraged and keep coming back. You know, there's lots of ways to get help. Keep looking for help, and there is a solution if you want one.
Laura, I want to say, these are great questions. You said at the outset that you were feeling a little nervous, and you have no reason to. I think they're really wise in their directness. You're getting to the core of questions that a lot of people are walking around with and then feel really awkward to ask, like what exactly is relapse? How bad is it if I go have a relapse?
Or what does it mean to be sober? What am I even going for?
There's almost a sort of I don't know, it could be snobbishness in some circles, or maybe just the sort of toughness in others, but a hesitancy to explore these types of things. And I think it's really really useful to just look closely, because this is what life is made out of, you know, this is really what matters is how do I want the character of my lives to be? My many lives? I didn't even mean to say that plural. It's true. We're living new lives every
single day. We have so many opportunities to reinvent it.
Yeah.
I just really.
Appreciate returning to these core core topics because in recovery communities and medical communities, we can get twisted up in knots about what is right and wrong, et cetera. But you know, at the end of the day, people are just trying to feel better, get better, do better, and this is all really special stuff.
So I'm glad to be here with all of you.
Thank you, Thank you, Carl. That was very sweet, and I do I feel bolstered now. I appreciate that now.
Holly, thank you for organizing all this. I think like the one thing that I took away from this, and I've been thinking about a lot lately.
Is just how capable people are.
And how smart they are about themselves, and how little consensus there really is about what's right. And it just totally depends on who you talk to and what their experiences and what their biases and what their opinions are. I mean, just sitting here in this group, I think that we take for granted that there is We believe that there exists some code and that if we just find it and read it and follow it, then we'll be fin like that there's an answer out there.
And I think it's just so much messier than that.
And I think a lot of us spend a lot of time looking around and making sure we're doing it right. And I think that it really just comes back down to that, you know what Eric said, right of just trying, it's just about trying, and we don't give enough credit to trying and just showing up.
We complicate it.
So I really enjoyed talking to all of you and hearing all of your different perspectives, and thanks for making this happen.
And I'll just say really quickly at the end that I really appreciate this conversation. It was really nourishing for me. I'm going to take all of this and go out in the world with it and sound really smart, but also getting sober for me was the hardest thing I've ever done in my life. It was excruciating and humiliating, and I didn't want to and I didn't believe in any of the things I was asked to believe in, and I still don't believe in a lot of those things.
And yet it's the best thing that I have ever done for myself. The life I lead today is because of what I did, because of that hard work. And to go back to the marbles and the jar and what Carl pointed out, practice makes a practice, you know, the more you practice, eventually you'll have a practice. That's what's happened to me. You know, faith without works is dead,
but work without faith still works. For me. I've done this work and I've ended up with this life that I wouldn't trade it in right as of this moment for anything. I really enjoy it and I am thriving, and that's just something I never thought I would do at the beginning. I didn't think that was possible for me.
So these types of the discussions are oxygen for me, truly, and I appreciate all of you, and Eric, I've taken over the conversation, but thank you for inviting us to have this discussion on your show.
Seriously, Yes, yes, it's been a pleasure. I'm happy to talk to two of you who've been on the show before, and Holly, I'm so happy to have finally gotten a chance to have you on. And I think it was a great discussion. And the more often we all talk about these things, the better, So thank you all.
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