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Focusing on Wellness…Are We Missing Something?

Living in Los Angeles in 2020, one of the things that I am really aware of was that we live in a time where there is a lot of focus on individual wellness. There are whole sections of Los Angeles that are all juice bars, yoga, spinning classes, and Pilates. 

I was like, “What are people doing? Do they have jobs? They are just drinking juice and running all day.” Oh, it is beautiful, I like both juice and running, I have nothing against it.

LA is very health-conscious…but I do not think it is just LA. I actually think the United States in general is more focused on health. There has been more consciousness around nutrition, physicality, and working out. 

The Shift Towards Healthier Living

It was not like that even fifteen years ago. I mean, just as an example, I got sober seventeen years ago. At that time, there was a gym in the Tribute program where I got sober and only 2 or 3 people actually worked out in the gym. There are a hundred people in the Tribute program, but very few people went to the gym. It just was not that popular thing back then.

Same thing with eating. The food was fried chicken patties, rice, and beans. There was no vegan or special menus. But that rapidly changed. 

The clients that we get now say, “When am I going to the gym? When will I work out?” Almost all of them ask for this. I’d say, 80% percent of clients are very health-conscious. Whether they are struggling with it or whether they have a good routine, they are really conscious of health and that is just the reflection of what is happening in the larger society. 

Why are We Obsessed with Diet and Nutrition?

I sort of think back whenever I see something has changed at a social level I am like, “What is going on?”

I have talked about it in some previous videos. They kind of break down tradition and cultural containers and that we live in a time where everything is up for grabs. Meaning, we got to interpret things how we want and kind of do what we want. You cannot really decide how to be in the future based on how people were in the past because everything has changed so rapidly.

I think one of the responses that people had to the insecurity of our reality is to look at different places–new places–for salvation. 

Is Wellness the New Salvation?

Salvation is a religious word. Generally, ‘salve’ means they kind of heal. Salvation also means to be safe in some sense. Religiously, the salve came from service, salvation came from giving yourself to God. It came from a certain way of living. 

We no longer have the same kind of religious consciousness, at least not nearly as powerfully as we used to. We look for salvation in different areas. I think a lot of people look for salvation in the gym.

They think, “If I can just get my body to a certain place, if I could just eat the perfect food, if I can just get everything clean and pure inside, if I can become a pure vessel then I will be safe.” 

They may not be consciously thinking that way but their behavior is speaking in that language. 

On the one hand, I am a fan of being healthy, I am a post-modern man living in Los Angeles in 2020, I ride my bike, swim, wake up to green juice. I do all of this stuff. At the same time, I have this double consciousness where I am like this and I am just still going to die. Still, I got to be a good person, it is just this kind of obsession that we all live with. And there are worse obsessions to have.

What’s Missing in this Equation?

When it comes to how that interfaces with the recovery, I think we have got to be wise. I think we need to know that not all problems can be solved in the gym or what we eat. Exercise and diet can solve some problems and sometimes those things are connected to how we sleep, feel, and cope. 

But there’s more. Some of the stuff we are working on in treatment is in the domains of morality. Some of the stuff we are working on is in the domain of character and integrity.

You can be a really fit person that eats really healthy and have no integrity. You can also be a really fit person who eats in a very healthy manner but has a tremendous amount of shame. Often, sometimes, I actually think that we are also ashamed about how selfish and narcissistic we are these days. That we are working doubly hard for salvation, to walk around guilty saying, “Something is not right here.” There is some kind of different way of being.

On the one hand, I am pro-health because I would be insane not to be pro-health. On the other hand, I think we have to be wise and make distinctions about what is actually happening with us and what is motivating what we are doing. And is this the actual way to meet the need, the existential need that we have as humans for salvation and to heal?

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Addiction, Health Care, and Corruption in Treatment

It is no big secret that there is a lot of corruption that has happened in drug and alcohol treatment. I worked in the nonprofit treatment industry for twelve or thirteen years. I was not really that exposed to the wider trends of what was happening in drug and alcohol treatment and in mental health treatment. But as I founded my own place I started to be exposed more to the treatment industry as a whole. I do not even like the term.

Changes to Health Insurance

One of the things that happened was in 2009, Obama passed the Affordable Care Act. There were a couple of small but really important facts around Obamacare. One was, insurance companies were no longer allowed to exclude for preconditions. Before that, if you had cancer or if you had a history of “fill-in-the-blank”, an insurance company said, “We will not give you health insurance because of this.” They could no longer do that. 

The other was Parity Laws which meant anything that government healthcare decided to cover private insurance, on Parity, had to cover as well. So suddenly every insurance policy had to cover mental health and substance abuse. Prior to that period, most insurance did not really pay for treatment. You were either getting treatment at the community level or you had money or some really great insurance. 

The vast majority of people actually could not even get mental health and substance abuse treatment except at the community level…until Obamacare. And suddenly if you had a PPO plan  from Blue Cross Blue Shield or whoever, you could go to residential treatment. 

And because of the Parity Laws, at least in the beginning, it would cover full treatment. So suddenly, you could be a middle-class person from Ohio and you can get drug and alcohol treatment in Malibu on the beach. Unbelievable. You would not pay attention to it if you were not working in it. 

Enter Corruption, Greed, and Shady Treatment Practices

And it did a few things. Lots of people suddenly had access to treatment. But we live in a capitalistic society…so what happened was suddenly there is a lot of potential money in the system because now you have a couple of hundred million people who have these insurance cards in their wallet that now could be exchanged for money for treatment. 

Wow…that set off a very interesting chain reaction. So you have entrepreneurial-minded, generally narcissistic, people that somehow get this information. Maybe a very narcissistic client goes through treatment and instead of focusing on his recovery, he is counting how much money the treatment program is making. Then he goes to his narcissistic wealthy father and says, ‘I think we should open a treatment program’. At six months sober, an individual opens a treatment program. 

Then shockingly, because he is shady and he does shady marketing practices, it is successful and lots of people are going there even though the treatment is probably not very good. 

Then private equity and venture capitalists think: wow there is a lot of money in this treatment thing and they partner with the narcissistic owners of treatment programs. 

Next thing you know, you have five thousand treatment programs open up in Los Angeles between 2009 and 2020. Is it a surprise that a lot of them are not offering good treatment and are somewhat corrupt? 

For me, it is a very interesting story because I was supportive of Obamacare. If and when you asked me: Would you like people to be able to get insurance whether they had a precondition or not? I say, yes, I would. 

If you said: Would you like drug and alcohol treatment to be covered? I would say, yes that is great, and kind of calculate the full fallout of that kind of choice. 

Incentives Creating Barriers to Recovery: The Sad Truth

On the patient’s side, you have patients who have no money but possess an insurance card. They could live in the kind of house they never could live in without that insurance card, on the beach in Malibu. But they actually had to be pretty close to being loaded to be able to qualify to live in that house in Malibu. 

So you could imagine that there is a handful–and by a handful, I mean hundreds of thousands of people–who have gone in and out of treatment and continually relapse. They return to these residential and outpatient treatment programs. They have no money, they do not work, they just have this insurance card. 

I am sure some of them are doing it consciously–some unconsciously. It really is a story of bad incentives. It is a bad incentive for treatment providers that treat for profit–making money on people’s suffering. 

It is a bad incentive on the relapse end that if a client relapses, insurance pays more. Not for the insurance companies but for the treatment providers. 

And then it is a bad incentive for clients. I could just live in treatment, go to some groups, and do that for a few years. Then I just relapse. I can go back. I do not have to get a job. I do not have to go through the really arduous task of growing, learning, changing, and recovering. I can take an easy way out as long as I have an insurance card.

It is really problematic. It started to change, the government started to crack down and the treatment community. Obviously, it is not all treatment programs, but it is a really important lesson at the policy level that affects everybody in their daily lives, particularly those people seeking recovery and suffering from addiction.

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Mental Health: The Next Global Crisis

A while ago, I was having a conversation with a friend. We were looking at–this was pre-Covid–at the future. What do we think of the big crises that are going to happen? 

He talked about a possible war with China and kind of what we saw down the line for society. 

I said, “You know, I do not think it is any of that. I think that the world is so interconnected that it will not be some kind of us-against-them type of thing…I think it will actually be a global mental health crisis.

Mental Health Issues Are on the Rise 

If you look at the rates of anxiety, depression, and suicide–particularly in the US, but globally, too–they keep rising. 

And I actually do not have to look at the rates. I can watch my own mental health and well-being, as time passes and then go, am I okay? I know the amount of effort, work, and consciousness that it takes for me to feel whole and good every day. And I have support, privilege, and a lot of different things in my life going for me. 

And so there is this kind of huge question, why are people suffering so much with issues around mental health, substance abuse, and at its extreme… suicide? What is going on? 

Is Technology Taking Its Toll on Our Mental Health?

Very simple question. And I think that technology is a big component of it. 

We are probably taking somewhere between twenty to thirty-five percent of our conscious energy absorbed on our phones, computers, and televisions. That is a lot of energy and attention on moving pictures and content consumption. 

All different kinds of colorful information. Manipulated information to keep you on there. 

So there is the whole addiction aspect of technology. There is also the unknown of what it does to the nervous system…but I think we are starting to find out. 

We become addicted to instant gratification. We become addicted to looking at something. We do not know how to just be. We always need to be doing something.

So we create turning to technology as an option to fill in the gaps when we used to just simply be. What kind of energy and attention are we putting on our phones and our computers, etc.? And what is that doing over the long term to our nervous system? We have no idea. 

Smartphones have only existed for like 15 years. Maybe a little less, right? So it means we have no idea what that means but we are getting a taste of it.

So technology is one huge component that everybody focuses on. It is like to me technology is nested in this larger context of the age that we live in.

Is Our Lack of Consciousness Contributing to Mental Health Issues? 

I come from a kind of philosophical background, a historical background. And so I could tell a story about there was a period of time in the West when everybody had religious consciousness. People then were thinking about being a good or bad person. 

I don’t even know if people think about that anymore. Now, we are thinking, “Do I feel good or not,” or whatever we think. 

People used to think about am I good or am I a bad person in relationship to God. In relationship, if you are Christian, to heaven and hell, right? And in relationships as the idea of being saintly or God-like or Jesus-like, right? So for eight hundred years that is the way people walked around constructing their existence. 

It seems kind of foreign to us now, but that was quite recently.

It was up until, I think the 1600s, and then continues to transition. Back then you had the enlightenment come along in the 1600s with modern science. The beginning of nation-states, the idea of the self. Out of that enlightenment came an idea of psychology. 

We started to think about what is happening. Who am I? What is going on in here? It was not so cosmically God, religious focused. It was more about, who am I? 

Descartes said,I think therefore I am. And he opened up this Pandora’s Box about who are we and where we are from and maybe there is no God. And we entered into the secular age, right?

A New Era of “Enlightenment”?

There was a pretty solid religious tradition that we came from. Prior to that, it was more of a tribal and agricultural existence. It was pretty predictable. Each generation, the same as the one before, generally, not a lot of “progress”. 

Then suddenly you have rapid progress, you have the throwing off of religion and then eventually you have the enlightenment. Which says through rationale and reason, if we all can be reasonable, we all could figure out how to create a utopian world.

 It is not about God. It is about reason, universal reason. What is the truth? If we all know what the truth is: scientifically speaking, philosophically speaking, we all agree on it. Then we can all agree and we can have built a utopian society that we all agree upon. Everybody in the world. 

Then the huge backlash…postmodernism comes. What about black people, what about women, what about that? The biggest deal was World War One and World War Two. Wait a minute; I thought we are all reasonable. Suddenly, we just killed a hundred million people in the most reasonable society we ever had. And it started in the most reasonable culture, the German culture, which was the most “advanced” culture of the time. 

But yet that culture, at least in World War II, decided they were going to try to kill twenty million people. And so it just destroyed this dream of building the foundations of society on reason.

Cultural Containers Are Dissolving

So I am telling the stories but it is really to understand that throughout all of human history there has been what I would just call cultural containers. I understand who I am supposed to be based on what my parents pass on to me from the culture, from their parents and from the environment. And that that culture has been rapidly changing and no period has been faster than the last hundred years. 

And so the most basic things that were fundamental of our society like, I am a man you are a woman, we now question. Well, is gender even real you know. What does it mean to be sane? What does it mean to be insane? What does it mean to be good? Who can be president? What are the job qualifications there? I mean the most basic notions have fallen by the wayside or have been questioned and deconstructed and torn apart.

Now, if you are born into the world, you really have no idea exactly how you are supposed to be. You are very distant from ideas of morality and religion. You are very distant from when psychology was a living, breathing, brand new way of being in the world.

Now, it is more of a marketing everyday thing that everybody is doing and so where is the moral authority? Where is the ground of being? Where is the moral authority that exists in society right now?

Technology is Just a Product of Changing Times

So in my mind, technology is actually nested in the fact that everything has changed. And there is so much change so fast that there is no stability. And so everybody, of course, is going to be on their phones because we want to be distracted from the fact that we have no idea what the f— we are doing. 

We had an idea when we knew that we were going to go to heaven. We had an idea when we knew we are trying to build a utopian society, be good American citizens and do good for our country. All of that got wiped away.

What are we doing now? We are posting YouTube videos and trying to make a buck and hope that I can find somebody I care about.

 So I think there is a larger story here about mental health. I tend to be an optimist against my better judgment. Which is to say, I do view this time period as a transition. I do think it is going to get worse before it gets better. But I think it is a transition into something else. I could not possibly say what that something else is but we are living in a very rapid time of transition.

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The Stigma of Addiction: Pros and Cons

One of the things that has been a great concern to the population at large when it comes to addiction–definitely the media, definitely the progressive end–is how we think about the world of addiction and the people going through the suffering involved with addiction. It is this stigma that comes along with the word “addict” or “alcoholic.” 

There are a lot of campaigns I see online like End the Stigma and people talking about their sobriety and what they have been through. Generally, I do not know if I would say I am a fan of that…but I definitely like people to do what they feel is right, whatever makes you feel good about yourself.

What Actually Creates the Stigma of Addiction?

I think that there is a misunderstanding of where the stigma from addiction comes from. 

What I would say is that the stigma from addiction does not come from the word “addict.” The stigma comes from when your brother steals your car battery out of your car because he has an addiction problem, and it pisses you off. 

So, the reason why there is a stigma around addiction is because the behaviors that come along, not all the time, for all eternity, but a lot of the behaviors that come along with a lot of people that have addictions are horrid. You cannot trust people. They steal from you. They lie to you. 

You try to have an authentic relationship, but they are incapable of having an authentic relationship. It is a giant pain in the ass to have a relationship with somebody that has an active addiction. 

That is where the stigma comes from. It is not the word “addict.” You can change the words all you want, but the reality of it is until addiction is not a pain in the ass, there is going to be a stigma associated with it.

Can the “Addiction Stigma” Be Useful?

Now, on the other hand, I understand what people mean because you want people to be able to overcome their shame of having addiction by being able to say, “I have this problem,” so they can get better. 

I agree with that, but on the other hand, you do kind of want some stigma against addiction. 

I am raising children in this world, and is it the worst thing if my kids think that to be addicted is not that great? 

I want my children to know addiction is not that great. So, I think we have a lot of confusion about what we mean when we talk about stigma, and even what exactly our goals are when we say “Bring down the stigma.” 

Does Changing Terminology Make a Difference?

Clearly, the goals are to be able to help people get better. I mean, that is simple, but I do not think we are going to do that by playing with language. 

I will give my funny example of this, “housekeeper.” It is an interesting word. To keep the house, I guess, is what it means. It is somewhat old-fashioned. It is not as old as “maid.” I very rarely hear people say, “Oh, this is my maid.” They say, “This is my housekeeper.” Now, the word changed somewhere from the ’80s and ’90s to now from “maid” to “housekeeper.” Prior to that, there was another word people used to use, it was called “servant,” right? Or the “help.” 

So, these words changed, but the reality of other people cleaning up other people’s shit for their whole lives is still the same. Do you want to reduce the stigma of the word “housekeeper”? Well, I do not know. Maybe we should take a look at whether it is cool that we have a society where a certain class of people, often of a certain race, spend their entire lives serving another class of people often of another race, if we really want to deal with the problem.

Is Language Distancing Us from What’s Really Happening?

I feel the same way about addiction. Addiction is a human phenomenon. People have been addicts and alcoholics for as long as people have been. 

So, yes, we want to acknowledge this is not a normal human part of life. We also want to acknowledge when it becomes a destructive addiction, it is not a good thing, and it should be somewhat stigmatized. 

There is another reason why I would not be so quick to get rid of the terms “addict” or “alcoholic”. 

We are in a time now with trigger warnings and people being very afraid of offending people with words–which is strange because we are in the most offensive times, in my opinion, that one could live in, but that is the hypocrisy of the time. 

So, people have a hard time identifying as: “Hi, my name is Shy. I am an alcoholic.” or “Hi, my name is Shy. I am an addict.” 

Whatever that is, and they go, “I do not want to identify because I am more than just an addict.” Of course, you are more than just an addict. I think everybody knows that, but what is the importance of identifying?

Well, in my mind, people are distancing themselves through language from the reality of what is actually happening. 

When I was in active addiction, it was not a thing that I suffered from, meaning it actually was in the realm of the anti-logical, of the being of me, not the just doing of me. 

I will give an example of this. My cousin Jason has been playing baseball since he was 5 years old. People that play baseball, people that really love baseball, could spot a baseball player even when they are not playing baseball. They go, “You are a baseball player.” Then he will go, “You are someone who often plays baseball.” “No, you are actually a baseball player. I see the way you walk, the way you talk, the way you wear your hat, in the ‘being’ sense of it is like a baseball player.”

I would say if you have ever met somebody who is a really bad junkie, it has invaded more than just their activity. It has to do with their being. There is something kind of almost essential there where you go like, “Man, the way this person’s posture is and the way he kind of looks up at me It is like, he is kind of an archetypal junkie.” 

I am not saying that is great, and I realize that is probably somewhat offensive to go, “No, actually you are a junkie.” But I think it is that realization that you have, “Oh my God, I am a drug addict,” or at least “I am becoming a drug addict. I do not want to be that.” 

Not: “I do not want to do that anymore.” 

I do not want to BE that. I want to be someone else or something better.” 

So, I think when we get rid of those words, we are sort of white-washing the situation. 

I have sat with people with sleeve tattoos, out of the penitentiary, and in addiction programs, and I am like, “Hey, what are you here for? What is your drug of choice?” 

They go, “I am opiate-dependent.” 

I am like, “Opiate-dependent? Okay, doctor. What does that mean, you shoot heroin? You shoot dope? You do opium, right?” 

 I am not saying that to be offensive, I am saying it to get that person to connect to the reality of where they are at, and what they are becoming.

Being Comfortable with BEING

So, I think that… Because we live as a psychological society, we think about everything psychologically. We think about everything in kind of this far distance. We actually move away from the actuality of the being. 

Like, “No, I am an addict.”

And: “Guess what? Right now, I am not an addict. I have been sober 17 years. My ways of being who I am in the fibers, over time working on myself…I have not used for a long time.”

“I am no longer an addict. I can identify as I am an addict in recovery.” 

Or, “I am Shy. I am in recovery.” 

That is part of my being, too. I am a person in recovery. I am not doing recovery.

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When Do We Acquire the Knowledge of Self?

So when it comes to the notion of authenticity, RZA is like “He is my guy.” 

 

RZA is a producer and also a hip-hop MC of a group called Wu-Tang from Long Island. I grew up listening to him.

 

And I remember being 13 years old smoking weed in my cousin’s bedroom, listening to an album called Liquid Swords. And it was like an alien had landed and delivered an album from another planet. 

 

We were like, “Who are these guys?” 

 

And it is because their hip-hop lineage–like where they got their sound from–actually was not other hip-hop artists. They got their sound from Kung Fu movies. So it is a mix of hip-hop, boom-bap drums from the East Coast, Kung Fu sounds, and the Soul samples. It was really amazing.

 

Anyway, I heard this interview with Rick Rubin and RZA, and, basically, Rick was like, “Man…” (kind of like me) “Hey man, you are like an alien, but you are making–you started making this kind of music at like fifteen years old. Like who are you? How did you create Wu-Tang?” 

 

And RZA goes…He has his phrase. I will never forget it. He says in the interview, “Rick, I had knowledge of myself at a very young age…like 11 years old.” 

 

And just the way that he said it…I am familiar with Wu-Tang, RZA, and hip-hop. The way he said, “I had knowledge of myself at a very young age.” For me, it was like a theory about how human beings develop in a way that I had never thought about it. 

 

So I give a lot of credit to RZA for this because I think about human development and psychological development. I actually know about stage development from Kohlberg and Piaget. I know about how humans grow, learn, and transform. I know the great thinkers on the subject. 

 

But for me, my favorite right now is RZA…because there is not a category in developmental psychology that says, “When do we get knowledge of self in the way that he is talking about?” 

 

Because he is implying that he knew who he was supposed to be and what he was supposed to be doing at 11 years old.

 

This idea is so crucial. I am raising kids and I have expectations about how they are behaving in the world but they are also individual and unique souls. One of the things I want to understand is: when does this kid have knowledge of self? 

 

Because at that point, I have to trust what they are doing. I mean, I do not know if RZA’s mom, when he was smoking weed and watching Kung Fu movies was like, “Well, he knows himself and he knows exactly what he was supposed to be doing. So let me let him do his thing.” 

 

The other thing that struck me when he said that…For me that experience happened much later. I got sober at 21 years old. But if you were to ask me in the way that RZA was implying–or at least my interpretation of what RZA was implying–when I had knowledge of self, I would probably say not until my 30s. 

 

It was very interesting. So it is interesting to think about that as a category of being and how it relates to a notion of authenticity. How can you be authentic without having knowledge of self? Without knowing who you are? 

 

And I do not mean that in some complete sense. I just mean that in some sense where you wake up and you kind of just know who you are and you know generally what you are supposed to be doing and how you are supposed to be. 

 

It is not some fancy academic concept, but I think it points to something so important and so real about the human journey and the human soul.

 

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What does it mean to be vulnerable?

Being Vulnerable in Recovery

If you come to treatment or you are coming to recovery, one word you will definitely hear is vulnerability. The importance of being vulnerable in the therapeutic relationship–particularly in treatment–is something you might hear from a spouse as well. 

 

On the one hand, I think it is a word a lot of people have heard–definitely in California. On the other hand, it is a word that is often misunderstood. I think the way people automatically take the idea of being more vulnerable is allowing people to see and feel a certain domain of my emotional life, allowing people to see my sensitivity, allowing people to see my compassion, allowing people to see my sadness. It is what we think about when we hear the word vulnerability.

 

What is Vulnerability?

One definition I like that a friend of mine–Mordecai Finley–uses is: vulnerability actually is not about letting people see your softer emotions, it is allowing yourself to affect and be affected by other people. 

 

Vulnerability is on some level a certain amount of emotional openness that is not appropriate for every area of your life. For instance, when I am walking into Wells Fargo going cash a check, there is just no need for me to be vulnerable. 

 

Why is it Important to be Vulnerable?

 

In my home life with my wife, with my children, in a therapeutic process, in a transformational process, in an intimate moment with a friend or lover–in those moments being able to allow what is going on with that person to affect me. Often we will call that empathy, and also knowing that I am affecting another person.

 

That interpersonal exchange, that is the essence of what vulnerability is about. I think it is important–not just for a recovery process–but I do not think you can have a healthy life or healthy meaningful relationships without vulnerability. 

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Transparency in Treatment: What Does it Mean?

When you are entering into recovery there are a few terms or words, ideas that you will hear over and over again. And they are outlining the contours of the space we are inhabiting when we are working on ourselves to transform–when we are engaging in recovery, when we are looking at optimal well-being. 

 

Transparency in Treatment

In treatment in particular, one of the terms that they will use is “transparency”. And I will talk about the value of therapeutic transparency. What they mean when they say that is being able to talk about what is happening internally. 

 

First of all–this piece is really crucial–be clear. Understand what is happening inside of yourself. When you understand what is happening inside of yourself and being able to articulate it out loud so that you can be supportable or get the kind of support you need. 

 

Transparency as a Metaphor

They use transparency, obviously, as a metaphor. Meaning make yourself see through, so that I can understand what is going on, so I can come in and help you. 

 

I mean, on the one hand, that is an essential and completely valuable way of approaching transformation especially with outside support. On the other hand, you cannot take it completely literally, because we all actually have a right to privacy. 

 

What does Transparency Really Mean?

Really what we mean when we say “be transparent”, is share about the important therapeutic processes and things I need to know, the information that I need to help you. But those things that are private, that you are not comfortable sharing, or that maybe do not fit in this domain that you are working on, you can keep those to yourself.

 

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Medication Assisted Treatment

Medication assisted treatment (including Suboxone and vivitrol)

 

Medication-assisted treatment (MAT) is using pharmaceutical medications, prescribed medications to help treat active addiction. 

 

It’s different than just the psychiatric medication that you use to treat underlying conditions of depression and anxiety. MAT treatment is a specific classification of drugs that are used to affect the addiction directly. And so there are agonists and antagonists drugs that provide an effect similar to the drug you were using, but allow you to be more functional and reduce the harm around the habit. You don’t break the habit you use something that’s like a derivative of that substance that would be like subtext for opiates or methadone. 

 

It’s a similar molecular structure and has similar effects but you can manage it better and you don’t deal with all of the negative repercussions or most of the negative repercussions of using heroin. 

 

Then there are the blockers that stop the effect or deter people from using certain substances and abuse of a trial. That’s that classes of drugs. And basically, that’s it’s come into treatment in recovery very strong.

 

It started with methadone a few decades ago, and then Suboxone a couple decades ago has become very popular. 

 

And it’s understandable. Basically, we’ve been in the midst of a pretty serious opiate epidemic and people are dying. You have city officials, county officials, government officials, parents, loved ones and society as a whole having a conversation about what we do about this. 

 

There are lots of research studies that show that people have a better chance of achieving recovery if they use medication-assisted treatment. 

 

Those studies are complex and I want to get too into that. They’re complicated questions to ask about those studies and their different opinions. It’s not univocal, and everybody has the same opinion. But I want to look at it in general. So what’s going on here? How do we think about this? 

 

You deal with different perspectives on MAT.

 

So if I’m a government official, and there are thousands of people dying in my district, or in my state, or in my city. I’m thinking, “How do I stop people from dying?” I’m gonna take 100 million dollars, and I’m going to put it into what statistically is the most beneficial thing, medication-assisted treatment, people have to stop dying. And it’s really all the government can do.

 

The government can’t assign an individual therapist, a psychiatrist, long term treatment, isolate people on an island, the government doesn’t have the ability to do nuanced individualized care. 

 

For each and every person who suffers from addiction, the government can’t assign treatment to even 5% of the people who need it. 

 

So I think, how do we stop an epidemic?  On that level, it makes perfect sense and I get it. On the individual level, it’s much more complex. I’ll give an easy example. If somebody is a poly substance abuser, let’s say somebody is 23 years old, they use and this is not uncommon. opiates or methamphetamine or cocaine or alcohol or marijuana. 

 

That’s a lot of young people, they use all kinds of stuff, whatever they get their hands on. They also lack discipline, and they lack a lot of structure and maturity. So they actually don’t know how to do basic things like make their bed. That’s something like 60% of the population and people in treatment right now. They don’t know how to live well. 

One of the things I’ve concerned about with Suboxone is the difficulty in getting off of Suboxone.

 

If you go look up, get off of Suboxone and go read the personal forums. You will see how incredibly hard it is. It’s kind of scary. It takes about 45 days, let’s say you’ve been on Suboxone and you started at a 12-milligram dosage, which is normal. And you’ve gotten all the way down to one milligram after three years. 

 

Then you decide, this is getting in the way of my growth, my psychological well being, and I don’t want to be dependent on this anymore. It’s been years. I’ve seen people want to get off one milligram of Suboxone, that it was a 45-day taper meaning take a little tiny bit just less than one milligram, little less over 45 days, and then another month without the substance to get through we call the acute and then sub-acute detox phases. 

 

Then you’re no longer having the physiological symptoms, but you’ve got months and sometimes even a year to deal with the underlying issues and depression that comes up after having been on this substance for so long. 

 

I’m really concerned about putting thousands or hundreds of thousands or millions of people on Suboxone medication over long periods of time. 

 

What that looks like if there are negative psychological effects down the road. I don’t think we know. Some experts say to never take people off Suboxone. Once they’re on for two or three years. You leave them on it forever. But there’s nobody that’s been on Suboxone for 50 years. It hasn’t been around that long. We don’t know what that means and what that looks like. We still use Suboxone individually. 

 

It’s up to the treatment providers to figure out how to effectively administer Suboxone in smart ways.

 

Then to compile that data and share it with the rest of the community.  

 

Vivitrol is another option. 

 

I’m a huge fan of Vivitrol, Vivitrol is a blocker, and what Vivitrol does is two things, it stops you from being able to get high immediately from opiates. You can do it in an injectable form, which is a little frightening, but it lasts a month. 

 

On the one hand, it physically stops you from being able to do your substance of choice. On the other hand, it’s psychologically really helpful if I’m obsessive, but I know I can’t get high. And I’m willing to get into recovery, it’s a great message to send to myself. You could do Vivitrol with very little side effects for a year and a half, or six months.

 

Even with Vivitrol, we don’t know the long term psychological effects.

 

It’s been around 20 years, but they’re not great research and study on this stuff. And everybody’s very different with how they respond to the medication. I’m in favor, in general, of anything that helps people recover and get better, and of course, in favor of people not dying. But we also have to weigh these different claims. And figure out how we use medications in a way that’s effective for individual situations. That’s not an easy task. It’s going to be everybody working together and having conversations like this about medication-assisted treatment.

 

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The Need to Control and Addiction

One of the common things that I come across with people that are trying to recover. So I sort of look at more universal elements that mean the thing about addiction, is it’s not really appropriate, it’s not accurate. To say… oh addicts do this, addicts do that. Because there’s a huge amount of personality, and… diversity, in the addicted population. Right? I mean, people– people are not the same, at all. 

 

One of the things you want to understand is what are the characteristics, that you do seem to cross boundaries.

 

you can say, okay, those– these would definitely want to get to, and I’ve talked about in another piece, around people-pleasing which I see you know, something like 75%, of people over accommodated people-please. And they don’t have healthy boundaries and they don’t know how to assert themselves, to create a sense of self in their lives. [/vc_column_text]

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The other thing I see is issues around control.

 

 Human beings in general, addicts in particular, are people suffering from addiction, in particular, tend to be control freaks. And there are lots of ways that– that manifests.

Somebody who’s a control freak isn’t necessarily an overt control freak. 

 

Like if I look at myself, and I say, what are the ways that I defended against the world and attempted to predict and control outcomes so that I could feel safe? I was– I was never overtly controlling. As you can imagine, I did it with words… and rationale. Right, if you hear me speak… my biggest defense mechanism, the way to keep people away from me, was to understand what was happening around me, try to be predictive and to use a language, as a barrier.

I could hypnotize people with my speech, that was one of the ways that I maintain control. 

 

It’s why for me, it took me a long time to figure out how to do individual therapy, talk therapy because I’m good with words. And so I can… talk and talk and talk and talk and I’m not necess– you know, once I had worked on a lot of the shame, I can even talk about the issues but it wasn’t having a transformative impact.

The talk therapy, group therapy was really good for me. 

 

Group therapy I had so many eyes on me, that I couldn’t control… each person, because I got some you’re looking at me over here, and over here and this and it was too much. And so it made me more vulnerable, which is what I’m trying to do and try to let go of control.

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Boundaries, Assertiveness, and the Right to Say “NO”

 

In Recovery you need to have boundaries, assertiveness, and use your right to say “NO”

 

Usually, people don’t want to be in a relationship because they don’t want to be with that person anymore. The question that the party asks that is being broken up with is usually, Why? But they don’t mean it. Because nine times out of 10 there’s only one answer because I don’t want to be with you anymore. 

 

 

Human beings are naturally kind of narcissistic. 

 

So somebody breaks up with me, and I love them, and they don’t love me that I don’t understand. But I do understand because there are people who have loved me who I didn’t love in the same way. So I get that, right? We have all of these complicated interactions that require a lot of clarity, about what my rights are. And when I do that, it’s sort of like cleaning my room. 

 

 

People that can’t handle boundaries, are going to leave your life relatively quickly. 

 

You’re going to attract people that have good boundaries, and so, your whole life system changes real quickly when you begin to do that. It’s hard work and it’s uncomfortable.

I usually start back when people smoke before they vape I used to start with people with cigarettes because there’s a whole game of cigarettes and everybody smokes. And a lot of them don’t have any money. So ever got the cigarettes, it’s like, you know? if it’s not Newport’s. Now, they’ll come up to you and be like, “Oh man, can I bump a cigarette.” you know, and it’s like, eventually, like, Oh, my God, I’m giving away all my cigarettes, you know, what do I do? So you start making excuses. You know, so people come down and say, “Look, I get a cigarette.” and you say, “It was my last one.” And that’s the common responsible distributed rehab. 

 

 

If you don’t want to, you don’t want just say no, right? 

 

You say, “Oh, it’s my last one. I left the box in my room.” you know, I’m not going to go up to get it, right. One of the things that I have people practice with cigarettes and things like this are plenty of examples, is say no without qualification. And if they keep harassing you about it, ask them if, if you have round heel the right to say no. 

 

 

If you want to learn how to be a little more authentic and assertive, be honest with people.

 

If somebody wants something from you, and you don’t want to give it to them, and you can’t justify giving it to them, except for that you feel bad. That’s not a good reason to give somebody something most of the time, you know unless it’s saving their life or they’re hungry or something like this. 

 

 

So basically, it’s training people how to be authentic

 

I don’t want to do this. I don’t want to hang out with you. And training people how to say that. No, I’m not going to give you a cigarette. Why is your last one? No, it’s not my last one. So why aren’t you giving me a cigarette? Well, hang on before we go down this road of why I’m not giving you a cigarette. Can we agree, that I have the right to say no to you about it? If they say yes, that’s the end of the conversation, you say Oh, great, then we don’t need to discuss this other thing because you just get that I have the right to say no. If they say no, my direction will be just Walk away. If somebody doesn’t think you have the right to say no in a relationship, I would just walk away 

 

 

A great part of recovery is when you start drawing those boundaries and being respectfully assertive in your life, and seeing what it does for your life.

 

A little territorial about how much of yourself your going to give, you suddenly start to get clear about who you are when you stop and start then you begin to have a sense of self, then you begin to have a moral code you made to feel good about yourself and you attract people around kind of people you want to hang out with, that also know how to say yes or no and appropriate wise. Next thing you know you got a different life.

 

 

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