TDC Podcast 13 – Zach Rhoads on Outgrowing Addiction



hey everyone welcome to a new episode of the TVC I know it's been a while since the last episode I've had a bit of work to get through with University so that's led to a slowdown in the releases however that will only be temporary probably because of the slowdown and because I barely knew my way around audio equipment to begin with there were some audio quality issues on my side mainly in the beginning of the episode that should be fixed going into future ones for this episode I spoke with the Zack Rhodes a counselor who works with families and children Zack has co-written a new book called outgrowing addiction which delves into how and why a developmental approach to addiction is preferable to the disease model Zack also runs the social exchange podcast which I was lucky to be a guest on last year in the description you'll find links to outgrowing addiction along with the podcast and my episode specifically as always thank you to everyone who's supporting TDC this is a donation only project so every bit of support is greatly appreciated if you want to contribute you can find out how to support at the drug classroom comm slash support or by following the links in the description I'm here with Zack Rhodes Zack welcome to the podcast synth it's awesome to be with you thank you can you explain a little bit about your background and how you ended up working with Stanton Peel on this new book out growing addiction yeah well I'm right now I'm an educational or developmental you could say consultant for families and kids I work with kids who for a variety of reasons have difficulty meeting expectations and his behavior is deemed unacceptable by parents teachers peers sometimes the law so that's just a potted background of me Stanton's background if people don't know Stanton peels a psychologist and an addiction expert and author he's revolutionized the addiction field I would say in many ways since he wrote love and addiction which was his first book with Archie Brodsky he wrote in 1975 and in that book they both challenged absolutely everything about the standard model of addiction at the time and quite effectively you know the society at large has absorbed a lot of his principles about addiction and we can talk about those but unfortunately there's still a lot about our cultural attitudes toward addiction that are less than helpful sometimes even harmful and Stanton's life's work has been basically to stay ahead of the curve in terms of addiction theory and help steer in a positive direction I met Stanton because I have gone through a similar process I'm younger I'm 32 years old but I you know I work in schools and the reason I I do most of my work outside of school is now working with families is because I've run into the same sort of institutional blind spots that that sometimes put a ceiling on the ability for kids to thrive and so at some point in our working relationship I pointed out to him that patterns of self-defeating childhood behavior in kids that I work with they're so closely resemble addiction problems in adulthood and so my methods of helping kids find their way out of the cycles match Stanton's way of working with adults on addiction problems and so both my childhood developmental model and his adult addictive one are entrenched in wealth the whole process in general have been addicted or having some sort of a behavioral challenges is based on substitute methods for achieving some sort of satisfaction and status by seeking some kind of dysfunctional reward that will end up defeating more effective ways of coping and so we can also get into that and in a minute but I'll just ended it we we combined our views by developing an addiction theory that holds through holds true across the lifespan and we call it the developmental model of addiction and that's what the books about and we'll we'll talk a bit about the alternative model and how you view addiction and how it connects with some of your work with children but I think it's a little bit easier to enter that discussion if we have some background on what the standard model is now what you tend to hear from people in the addiction field in 2019 sure sure so the addiction model now or I guess a dominant model of addiction there is one of course gigantically dominant model which is the disease theory of addiction and that is propagated by the National Institute on Drug Abuse and it says that addiction is a chronic relapsing brain disease a lot of that implies that one should act more compassionately to people who use drugs and are addicted to drugs but it also implies that people are more or less unchangeable and so that's one way of looking at it so it's sort of a biomechanical approach to addiction and so any solution that you'd give in terms of that biomedical approach involves medicines or somehow oddly and ironically spirituality of 12-step models but there's also a way of looking at it that you can use harm reduction in order to allow people to stay safe and then they'll recover but unfortunately within that harm reduction movement even though they have adopted some of the principles were about to talk about which Stanton put forward a long time ago that sort of information is sort of just been assimilated to the standard boxes of the dizzies model and this idea that and I think this is the big one that drugs themselves can cause addictions and that addictions are only two drugs and I think those are the two biggest misunderstandings that that we largely have about addiction and even though I think the smartest people in the field including those who have the standard view like those who work at night and those who are doing a research related to the disease model they would probably agree that there is a big factor of environmental stuff and personal background that predisposes somebody to having a vulnerability to an addictive pattern but all of the research and public discussion about it ends up really focused on the drug angle and I'm sure even though they do recognize there's an important role of these other behavioral and psychological factors you still place more emphasis on on those being the predominant thing not just kind of a supplementary thing yeah yeah and you know I think that you go to a train in addiction training and a lot of times you'll hear you know if you work with people addictions or ask clinicians how they work with people it almost always comes down to any clinician worth his or her weight and salt is going to be working with them about you know on social psychological cultural issues and probably not so much on medical issues but if you were to go to a training from some of these professionals in the field they might start with well addiction is a disease and then they'll begin from that assumption and that is my argument is that beginning and our arguments the beginning from that assumption is the problem because not only is it wrong but there are large institutions talentless than it must be right and it's difficult to question easy to agree with so in that sense it's ideology interesting that you're coming to that view of being a negative and problematic concept even though a lot of the impetus for supporting that view of it being a disease seems to come from a compassionate view you know turning it into a medical thing so that you can try to reduce stigma in some way or at least not have people be outcasts as though they're doing something wrong and they need to take on the full blame of how they're impacting their family and etc you know so you kind of have the same desire to implement a more compassionate approach at you know and that's the same desire that people with the disease model have yet there's two fundamentally different views of whether that is actually benefiting people who use drugs and have addictions I completely thank you for pointing that out so that I can be seen as somebody who has compassion and that that's the angle that I'm coming from here because you're right I think that largely people want to be compassionate I think we've for the most part away from judging people as a moral failure or a sinner or doing something intentionally completely wrong when they're addicted but you're right I don't agree that deciding unilaterally that their behavior is the result of a disease process and then to label them as such is a more compassionate way forward I think that involving each human being in the process of their own life experience it is the only real humane way to do it at the center of your book and this model one of the main things is just observing that the natural trajectory of an addiction is very different than what people tend to believe so people tend to think that once you're on that path unless there's a major intervention you're just on a one-way street to essentially your life being ruined are you dying and even if you have a major intervention you're just gonna forever be really vulnerable to repeating these behaviors yet there's always been a real lack of research showing this is what people who have an addiction end up going through what does the research actually show and why do you think this alternative view of it being this lifelong essentially you're on a one-way path to to ruin why is that such a common view of the disorder that's such a good question man well the research shows I mean not only do addictive involvement as I said earlier include more than only drugs and alcohol but most people who take drugs and alcohol don't become addicted to them and of the people who do there's robust epidemiological surveys and evidence showing that most people overcome addictions to things and find more positive channels of life to pursue over time as long as they could stay alive long enough I don't remember this I forget the second part of your question it was just why even though there's not a lot of research supporting the view that this just continues throughout an entire life that is the common view even from the most respected people in the field yeah well because it seems like we're extrapolating from a truth about the minority of people for whom addictions or drug taking is ultimately destructive and does seem to last throughout the lifespan so I think that we're zooming in on what seems to be about 10 to 20 percent of people who become addicted to drugs who then also become a drugs in such a destructive way that they can't access resources or community or things in life that will get them ahead we look at that those people and say this is what all addiction must be and so we argue conversely you know if we zoom in on the eighty to ninety percent of people who take drugs and even could become addicted to drugs and then overcome that addiction on their own without any help which is what the research shows then we could be looking for well how did that happen for them and then if we want to expedite the process maybe we could use that information to help expedite the process of what we would call recovery and maybe that would also offer us some information about how to help the most the most disparage people among us that 10 to 20 percent who seem to be addicted for life and unfortunately those really tragic stories just have a real sticking power in our minds when we hear about them from celebrities or people in our own lives like those are the anecdotes that will stick with you and it's easy to forget the ones where either you didn't even hear about the people who were kind of using drugs in a somewhat problematic way but got over it you may not have even heard of those people or if you did that's not really an interesting story I mean that there's no there's no flashy element to that there's no story yes there's no story cuz that you know I include my own experience in the book and you know I was I had a heroin addiction and I used heroin for a long time in my life was pretty destructive while I was using it when I started writing a book it was in 2015 and I wanted to write a book about my experience and I realized that either I had to embellish or I had to write an uninteresting book two really great options because that's right so that was maybe that would better answer your first question how I came to write a book with Stanton I mean it just wasn't it was a non-story I I grew up in a pretty good family had some pretty good options in my life I had some problems so at one point had turned to heroin and then after a while I hated heroin and so I just got my life back together and it's not just that's not a Hollywood movie for sure it's not just that it's a misleading perception and that it might negatively impact treatment and or is just kind of stunting the development of better treatment it's really a dangerous and corrosive concept when people take this on board and say a family member thinks that they need even a parent thinks that the person who they're trying to help needs to have these severe consequences needs to hit rock bottom as they say in order for there to potentially be a behavioral change rather than that you could in a softer way you maintain a better connection to the family member and bring them along you know just like we do for any other mental health condition if somebody I mean like there is no other condition that comes to mind where that is the treatment modality like you kicking the person out and almost wanting to get them into a position where you know they're in jail or something because that will be the thing that gets them to turn around I mean I can understand that people come at it from still a loving place and from a place of being kind of desperate for a solution but I mean this is not a good way I can't imagine that this is a good way to to help somebody change absolutely so that is one of the reasons why we thought it could be a good idea to excuse me prescribe my model of working with kids do their problems first and then explain how our two concepts is my developmental my model working with kids through any kind of behavior and addiction they're really the same process and the reason we thought that'd be a good idea is like you say you know there's some mythology to clear up in the developmental and education world for sure but by and large even though I'm not always an agreeable person by the perception of institutions the parents and teachers and administrators when I'm finished working with a kid when I no longer do it's almost always the case that they move on to a more productive and happier experience and it makes me look really good and there probably are a lot of things that I'm doing that help it happen but I think all I'm really doing is using common sense and giving kids a space to articulate their own problems allow them the resources to move or dab it and then just let them mature because people mature that's been that's the normal course of things and as long as they're not headed down a destructive path people tend to be fairly resilient and that I don't get hit with a lot of pushback for that you do get a lot of pushback as soon as you enter drugs in the mix so as soon as you say there's someone's having this rough experience and then they also take drugs immediately it's like people think it has to be the drug that's creating the experience and I think like you're pointing out there's something that we think is maybe it is the Hollywood stories that we see but there's something like mystical or magical or different about someone who's having troubles while taking drugs and I think just the desire for a scapegoat yeah yeah absolutely true yeah so Stanton sees addiction is something again not limited to drugs but no different you know someone who's taking drugs if that their life problems aren't different than someone who isn't except that they happen to be taking drugs as one of the ways out of the problem so if it's not just the drug use that is the major factor in these addictions what are the common factors that are separating people who can use drugs recreationally or even self-medicate without much of an issue versus those who eventually end up with a problematic addiction well first I try to get people to consider how can a drug be more addictive in one society or culture than another which seems to be the case and and how could it be more addictive for one person than for another and how could it be how could a drug be more addictive for an individual at one time and circumstance in their life than for the same individual in a different time or space and so man if you took drugs out of the equation the answers seem to be obvious I mean people seek and find relief in different experiences at different times in their lives and under certain circumstances and and these experiences they seek may satisfy their needs while they simultaneously harmed them and that's it they can this can happen in ways ranging from small to large and sometimes people don't assist until they find superior ways of gaining life sustenance so we think that addictions have three basic components is the person experiencing the addiction that person's physical and social and cultural environment and that person's temporal circumstances or developmental circuits dances and each of these things can increase the likelihood of a person becoming addicted just as each can enable people to limit or or avoid or overcome addictions so if part of the argument is that people who are using drugs even in an addictive way maintain rational decision-making and can come out of it why is it such a common observation that when the relief of the drug turns to a clear net negative for somebody's life that they can stick with it for so long and I think that's the period of time in which the brain disease model kicks in and people are arguing that the changes with the top-down control of impulses and your ability to get relief and satisfaction from other things that those changes keep you in this this state of drugs not being a relief in just being a harm yet you're not changing at least not quickly yeah I mean that calculus completely ignores everything that I've just listed I mean it ignores any sort of context in a person's life who becomes addicted and it ignores the fact that again the vast majority of people who use drugs don't become addicted to them so the better question to ask is I mean I know you're playing just playing devil's advocate but but I've had a better question to ask would be what's going on in a person's life at the time that they take a drug that shows them that taking the drug even despite destructive consequences is better than the way their lives are now yeah many people are being confronted a lot of negatives and and people are encouraging them to change and and people even are reporting you know the user is reporting recognizing that they're there making a lot of mistakes that does build a persuasive story that it has to it has to get really bad before the rebound kicks in and people start taking it upon themselves to change that's important that they can change but there's this whole period of time before that switch in which for whatever reason people are just kind of going along in irrational course of behavior or or maybe it's a rational course and and people just they haven't encountered the the alternative tools to get them out of that yeah I think that your ones efforts to make change in an immediate sense have to be justified by some sort of you know some sort of give so if I start to try to make change in my life and if I start to if I do something right now that gets me slightly less addicted or or makes my life slightly better is it worth my effort to do this thing if tomorrow I'm still going to have a miserable life and still only going to be taking small steps forward so that's another way of looking at it rather than rather than saying well people go through destruction and then it seems like they get better think instead people start to balance their choices a little bit more and once they start to see the scale tip so far in favor of destruction that they can't seem to tip it the other way and they realize this is not how I want to live my life then then yeah they they'll start taking steps forward but again I don't think that that's has anything to do with hitting the worst point of your life before you can make any change it's more do I have the tools of is it is it so chaotic to think about even how I would start putting a dent in my problem that it would just be easier to take a drug or is there a way that I can think through my problem that actually makes me feel like I have a way forward and of course we don't turn everything where somebody is engaging in a behavior and it has some negative consequences and they don't stop until it gets to a certain point we don't call all of those cases diseases I mean that would describe a lot of relationships that people have and friendships that people have and engagement in sport activities where like it keeps going the wrong way they keep getting injured but for whatever reason they're continuing this recreational activity yet it to anybody else it would seem to be a clear negative it's interesting that once it's drugs we turn the same kind of thing into a pathology yeah and this is I don't know why I'm laughing in this story I'm about to tell it's just it's just sort of absurd enough time has passed now that I can tell the story and I think even the person I'm telling the story about might not know who it is so I feel safe doing it but I was I was a couple years ago meeting with an administrative team from a school and we were talking about a kid who was smoking a joint and the argument was whether we should send this guy to treatment before he got suspended so should we send him to treatment before he gets comes back into the school you know see a drug counselor or can he just come back and they ultimately decided to send him to treatment and so he just went for I don't remember how many months for drug counseling he didn't want to go and I knew enough about this kid's life that I knew that he smoked weed he did it just outside of school grounds a teacher song it was a dumb choice but it was one of those dumb teenage choices that almost certainly wouldn't last so fast forward he was getting at this time pretty good grades he was coming to school things were pretty good he had some social involvement he went to see counsel he went to counseling and it kind of messed him up for a while he had a horrible time in the school he sort of made enemies with people in the school and which wasn't like him and a couple years later we're at the meeting talking about the same kid and someone asked well how's he doing and someone said I'm really good you know he's not doing drugs so that's good and people all said oh yeah good good and then she said well and he's got a girlfriend so that's awesome two people's no good except that this girlfriend that the person had he got in a relationship with her and he shut out the rest of the world and at one point in his relationship it stopped being about I really like this person or I want to see her do well or I want our relationship to do well it started being more like I can't imagine her being around anyone else so I need her to myself and I need to be around her and she's all I've got so he was you know invested in this relationship for sort of selfish reasons and he just shut out friends he stopped going to classes he was doing horribly in school his social group was getting smaller they resented him for completely ignoring him and then they kept breaking up and getting back together I call that an addiction I call that a love addiction and administrators were talking about their metric for whether he is successful or doing well was whether he has continued to smoke marijuana since those couple years ago when he got caught smoking a joint and so that's sort of you know that's not the case exactly for all problems in schools or and that's not I'm not talking I'm not saying that all that minutes everywhere in America sort of run that sort of calculus but it captures the spirit of the problems we're talking about there's a couple things there one is you know the way that people measure success and it just kind of being about did you use drugs did you not use drugs but also if that was the primary thing for which they were recommending treatment that is in itself pretty concerning you're giving somebody who is still in their teen years and everybody knows going through those years that people experiment they they do different things and there's a very high likelihood that what you're doing at 16 will not be what you're doing at 19 even if you're just you just leave it alone it those things tend to change but if you give somebody a reason to turn it into their identity for them to become confrontational to authority figures you're putting them on the path to it being a bigger part of their identity there should be a much higher bar before you're recommending somebody needs treatment I mean I recognize it's probably a difficult thing when you're working with teenagers and you mean you can't have them just engaging in drug use and you know not wanting to it at all especially if you're not kind of keeping it within the family you know a parent being okay you know like oh you smoked a joint that's not a big deal in a different setting it you do have to respond but there's got to be something different than that yeah well you know they panicked and they looked at what their guidelines were rather than thinking things through on a human level only only ideology can make you make a helping professional who's an otherwise completely competent and caring person do so much to be destructive in a kid's life and I agree with you I that there's something really wrong that that you turn to let's get this kid addiction counseling just because a drug was involved and the opposite was true there's there's no problem at all when a drug is not involved definitely important to recognize drug use among the 10 or 20% whatever it is who use in the really pathological way although even a lot of them eventually change you know it's important to recognize that doesn't represent the typical drug use scenario but for that 10 to 20 percent if you're a family member or perhaps coming at it from the perspective of if you're a user tuning into I think this is getting a little out of hand or there's some consequences beginning to appear what is the appropriate way because if you you know if you're a concerned family member and you ask a professional for some advice it might not be particularly good advice when it comes to somebody who's using drugs but there's got to be some guideline for or you know what's a guideline sounds a bit too clinical but some suggestion for you know here's how you can try to help or get people to recognize there's a reason to change yeah then I agree there has to be some sort of a standard some sort of an idea that we have about there have to be a clue it can't be something that we've just never thought about before but the the tricky thing is that each individual is gonna come from a completely different experience so it's gonna have to be a standard of in the helping profession that also allows for sort of fuzzy boundaries and flexibility I can talk about just in the context of schools again there are people in schools not coming to class doing drugs in the bathrooms vandalizing things for whom consequences at schools like I'm going to suspend you or I'm going to put you in a specific kind of classroom school has nothing to do with the kinds of concerns of these kids lives and I'm talking about just kids I work with and schools I work with so there have to be some sort of you know it's not all carrots and sticks it can't just be consequences or punishments a lot of times people will turn to in the child development realm diagnosing people so if people have a diagnosis then at least there's there are services to be had then you get into that problem so a minority of students maybe ten to twenty percent probably something around that and children and then also a minority of people with addictions to drugs there are not really good setups in society for them to contextualize themselves in maybe the best example would be something like the needle exchange that we have here in Burlington Vermont because the needle exchange is a place people can go and continue behaving the way they behave not trying to change all at once but they can go to a place and they can use drugs I guess around the place not permitted to use them there but they can find people who care about them no one's asking them questions no one's saying you can't do this or you to do this so I think the way forward is to figure out what the most common problems are among almost disparage people in our culture and figure out how we can meet people where they are with a whole range of problems and not just drug problems you know getting back to the point we were talking about earlier where why are people who are encountering these negative consequences not changing it could also just be that the drug use for them is the least of their concern when stacked up against so many other things that have to be addressed and as a society or as a family it's a lot easier to point to the drug when as opposed to pointing to a fulfilling job or housing or better relationships and there's a lot of things that that would be discussed in a normal therapy setting if somebody was dealing with depression or another mental health condition all these things would be taken into account and somebody would be viewed as a complete human not just a drug user it is so much easier to just point to the drugs and it gives this really simple problematic metric of success I wonder if some of it is just people kind of putting up their hands and adopting a lazy approach I mean it would be harder to adopt a comprehensive entire human based approach but that's also harder and it would require stepping away from this whole industry in framework that exists for if somebody has addiction they are sent into this whole machine that has a very clear way of dealing with this and it's not really the comprehensive approach yeah it's tough to think about how to make such an enormous shift that's why you know the best thing we can do is like how Stanton nested the concept within the concept of falling in love and having either a good and wanted love relationship versus having a relationship that you think is a lot of relationship turning super destructive the thing is I think people grow out of there and this is factually speaking most people go out of their major developmental challenges at all points in their lives and their addictions and all points in their lives for kids kids sort of naturally go through a sequence of developmental stages and they they have grow their labels and their problems as they start finding meeting later in adolescence and in adulthood and that's just that's a normal developmental process we can see that we expect did we just call it growing up for addiction people outgrow their addictions through very similar developmental stages just in adulthood and it can look a little bit different that they'll have to discover we've covered over values and skills and purposes things that motivate them relationships they'll have to assume responsibilities and work in their families and in their communities and this entire process of either helping people do it or letting them do it without placing some sort of a treatment kind of a method on them is as largely disparaged as blaming the victim it used to be it used to be recognized and accepted and encouraged more but it's we have disastrous societal and mental health and an addictive results to this whole medical approach I mean if we look at it and say how are we doing you can't exactly say we're doing great the negative consequences of people's destructive behavior and the negative consequences of the methods that were using we can see throughout society but like you say it's almost like we're incapable of conceptualizing them and addressing them and devoting resources to allow people to expand their horizons and to mature to grow up so I wouldn't exactly say unfortunately and spoiler and I hope people will still buy the book wouldn't exactly say we have the answers to every scenario actually I would say the opposite of that but I can't say that we need to be able to think through our framework in our measure of what it means to deliver flourishing good life and it's important just to show how the single answer that is usually provided or the single framework is is failing you know as you pointed out it's obvious that we're not we're not headed towards in five years there's gonna be no more addiction like we're we're curing this issue you know it's just it's just disappearing there is no sign that things are actually improving but there's a lot of stakeholders in this this area and then they have their model and unfortunate that model includes treating users as though they almost shouldn't even be part of their recovery like they would not a treatment provider would not frame it that way but there is this approach where you're treating somebody who has an addiction as though they they are so impaired in their decision-making that you kind of have to step in and make the decisions for them and this leads to forcing people into treatment in coercion whether it's sort of formally through a drug court or informally through families and then you hear about these stories of we've sent our kids to rehab a dozen times as though the sign that has been a dozen times is just clearly a sign that this is the right way to do it but it's a really hard thing to treat rather than the other possibility that maybe this is not the right thing or at least at the very least not the right thing right now and if you are asking the user and especially if there were more treatment options on the table for somebody that were more attractive than you have to give up drugs right now you know you're just gonna go through detox and stop using drugs forever why we think that is the jump people are likely to make I don't really understand and that only makes sense if if that option is being pushed on people because it doesn't seem to be naturally arising from a lot of users if you take away the coercion and the the pushing somebody with an addiction to this option that that is what people would try which is not to say they would not try something try some behavioral change no right that's you make the best points man and and I feel like I should have first consulted with you before I was interviewed by you I think that you're absolutely right and that that hits really the crux of my concern for the way we treat people both kids in schools with some of the worst problems and people with addictions especially people that tations to drugs it's that there's we do plenty of theorizing about what the solutions should be for these people as though they shouldn't have agency and what they think would be good for them and there's a real element of theft there I mean you steal people's goals you steal people's motivations you're not allowing people to come to these things on their own you're right I mean people don't there's something to be said for help lending a hand and helping people get on their feet and helping people be stable but there comes a time when you have to get beyond indifference and beyond stability to live a good life and after you have to be optimistic about the future and you have to be able to know that you have something to do with creating that kind of a future what does the overlap with other conditions like depression and anxiety seem to be so it would seem if those are really prevalent that those things could be more amenable to treatment than then something that is so pigeon-holed and focused on the drug yeah unfortunately we are sort of pathologizing those things too probably more than me than we should be but yeah at least people will will lay off a little bit when someone is depressed or anxious that's a little bit more of a broad concept I think with working with with anybody kids with problems with adults with those sorts of mental health issues or addictions it's always going to be best resolved by working collaboratively with people so that you can identify underlying problems and life deficiencies that need to be solved and you can let them tell you what those things are and consider which domains of life have to be improved in order to make headway and to discover existing skills and motivation and maybe develop new ones and to see the world as being accessible and inviting maybe even exciting most people facing any kinds of problems will find their way to the positive side of the balancing act on their own with enough time and without professional help but I mean you were mentioning that this is not to ignore those people who can't seem to correct course those people may require some extra help and extra resources but the the principles for life improvement I think are the same for all human beings whether the young old privileged or under-resourced and for all these people the very best thing we can do no matter what problem is is to foster an environment that's rich with opportunity so to encourage them to develop and develop skills on their own and become a productive and positive person and I think the worst thing we can do is to limit their ability to grow out of these problems or actualize their goals by convincing them that they lack this capacity there's clearly people who do get some use from the notion that they well they're suffering from is kind of their brain being turned against them and then you can kind of explain that through the brain disease model but it definitely does not seem to be the most encouraging way to view it I mean when you're kind of in the moment telling somebody that they have you know this is the reason that you're here this is the reason that you've had these consequences so far and while you're doing what you're doing to then saddle them with a the next 70 years of your life are going to be X that's not a jump that anybody really makes for any other mental health condition as far as I know that there's no evidence that jump should be made but it ends up becoming this really powerful thing and I can only assume that it turns into a self-fulfilling prophecy yes sure I mean the fact is I think your listeners will agree with this maybe everybody won't but people can use drugs and drink alcohol and live otherwise great lives I shouldn't even say the word otherwise and be living great lives so if somebody buys into that then it has to be true that you can have used drugs and/or alcohol at one point in your life in a destructive way and have come to a point where you mature into a life that is a great life and also still use drugs and it could still be a great life they sort of sort of tells people they can't do that that they tell people that you can monitor your success or how well your life is going by asking yourself am i doing a drug am i drinking and I mean you say we don't do this for any other any other help button or mental health problem which is largely true except that there is there is a position that people who were depressed enough or people who have enough anxiety or other sorts of conditions like that ought to be medicated and they better not go off their medications or else things are going to go haywire and I would push back against that a little bit – I think with that issue there's there's probably different phenotypes of there's people for whom there is truth to the idea that if you do not intervene then there is you could kind of describe it in the same ways people like to describe addiction it's going to be a chronic relapsing and it only gets worse kind of condition but that will only apply if there is not primarily a psychosocial reason for you being depressed or in this case being addicted you know if there are there's clearly some people for whom there's other drivers of depression starting from childhood onward and for whatever reason that is that is their neurobiological baggage but for probably the majority of people there is a much greater emphasis or there should be much gramps's on the circumstances leading to this condition and therefore if those circumstances are addressed if there trauma related brought to the surface and dealt with or if they're just things that need to change behaviorally and in your life then there is a point beyond your condition and you can just stop it and unfortunately we seem to be really bad at holding two models or two you know accepting that different people could be on different paths you know there are the people for whom this might be a thing that they're always predisposed to whether it's depression or addiction but for other people that is not that isn't the case but we'd like to have a single this is what this condition is for everybody and that's unfortunate I mean it clearly as you've been repeatedly emphasizing which is nice we need to be focused on the individual person and there's a lot of different stories to be told that go beyond just some little clinical description of addiction as though it's one thing which should just be obvious you know and you bring that up and I brought this up a lot with like we we are so fun with accepting this with sometimes other conditions or sometimes different kinds of drug use like with alcohol like everybody's fine accepting that there's different kinds of alcohol users you kind of have to accept it because most likely you are one and you probably want to view yourself as having a pathology but for other things especially addiction to other drugs it is just there's one model you said something really important there you made the what seems like a very obvious point the way you were talking about it that most people you would guess don't want to be thinking about themselves as having a pathology let you know something that's path a lot will be wrong with them that is precisely the point that that we're trying to make you know we're not saying insofar as our something neurobiologically wrong with somebody that causes problems that is that is so severe that you could say they're the kind of person that that needs intervention and it can't be some sort of a collaborative intervention then there are going to be much worse problems than their drug use that is almost certainly true so it's gonna be something legal or health-wise that's an immediate concern for everything else there really is only one way to intervene and we're not saying that you not to intervene interventions have to be done adults have to be adults and be there for for the kids that that they're attending to and people have to make arrests of people are breaking the law and so on and so forth but the only real successful way of intervening with either a culture or a human being is by getting them involved in the process by letting them explain what the problem is as long as we insofar as we want to be helpful if they can't explain what the problem is helping them understand their problem by asking questions rather than trying to tell them what it is and see if they can articulate it on their own and then try to come up with some solutions that would work for them and would work for you if it's a kid in school you might you might ask for I need this to happen because when I teach a class so on and so forth what do you need and then you ask a kid what they need and they might be able to tell you they might not and there might be more digging to do but ultimately they'll come up with something and you could reach a collaborative approach that sort of benign level of I'm talking to people in a vent intervening with people that I think has to be be way forward and we do give we do explain some what this isn't exactly a self-help book more of a more of a look at that theory but we we do give some good news at the end which is that when I started working with kids sorry I think I went on a little rant there but when I started working with kids I was 18 years old and I just needed a job I didn't care that I was working with kids my mother was a teacher and got me this job and I was at the YMCA after-school program I started as a substitute I didn't know anything I was doing didn't really care but I would go in and play games and sports just hang out with a group of school-aged kids and a few weeks into this job the director of the program pulled me aside and said Zach you have a real gift for working with our most challenging students would you like to work for this program full-time and I'm an eighteen year old kid I did I was addicted to drugs in high school I hadn't had my own rocky life and to be honest I had no idea what he was talking about that it seemed that I had a gift or a special skill so I just went to work and played basketball of kids and what I found out was that a lot of these kids I was spending time with in a really positive way for kids who before I began working there were isolating themselves or throwing temper tantrums getting in fights or otherwise experiencing anxiety and/or depression or trouble in their lives so it turns out I did have a unique skillset that I didn't really know about namely an ability to be responsible as a role model for kids on the one hand while also treating them in a way that made them feel open to and less afraid of experiencing natural environments and and doing so in a more optimistic way but this skill set is more so that I'm able to do so you know that I'm able to let kids express themselves to me but then also help them learn to do that among other domains of life in schools outside of schools and get them hooked up with the sort of resources and natural things that make them feel happy that's the good news is that that is so common sensical that we don't think that there is a special addiction theory that it takes a professional or somebody with a PhD to understand in a way that they could start helping people we think that parents and teachers and the health care professionals and addiction experts clinicians could all read this book and hopefully if it really does speak to them they'll say yeah kind of knew that and hopefully we're not saying anything profound more so we hope that we're saying something that lets them know and almost gives them permission to do what is common sense to them that the hard part is doing things that are common sense despite you know a cultural attitude that maybe doesn't make any sense and that should be really encouraging to anybody hearing it because most of us are not trained in this profession but I've heard from a number of people and it is just kind of common sense cool that the people who are most capable of helping somebody with any mental condition are those who are able to have a good relationship with the person and give them just give them this the basic human support that a lot of people are lacking and and they don't necessarily get from friends and family growing up and that has nothing to do with a clinical model has nothing to do with degrees or and those people any given one some are great some are not there's definitely benefits to having the additional knowledge of the conditions that goes more in-depth but any given professional therapist might not be as good as as the person next door who's in your community and can help in some other way and we hear about this a ton with people who especially with children a lot of stories about children especially in like disadvantaged areas and the people who come in and make a big change they're not a psychiatrist I'm not a doctor there's somebody who's a community person and helps it up a program or has some one-on-one contact and you're off I mean that that that initiates the change but that should be really empowering to everybody that you don't have to turn over the people that you care about to the medical model for for the medical people to help there's a lot you could do on your own it may not always work but it but it's not like you're you're helpless and and you get a lot of even parents who are who are thinking but it's the time this comes up for the first time you know when somebody's their childhood say 15 that the only response is to now you have to get an get the professionals involved and that's unfortunate that people jump so quickly to Oh somebody this is a specific kind of thing that I can't help yeah and it doesn't model the kind of thinking or or you know the forward thinking that it takes to ameliorate ones own problem you know it makes it if an adult is helpless to interact with their own kid or if a family member is helpless to interact with another family member because they're addicted what does that say to that person about their own ability to do so you know we have so much competing for our attention about things that could go wrong that beginning in childhood we have started seeing a cultural trend toward being protective of kids and doing things that are sending people to professional specialists rather than allowing people to explore you just experience the slings of either fortune or misfortune life throws at them in the real world sometimes the context of exploring the real world can go haywire and of course you'd need to intervene and help people back on the right track but more or less people learn through and there's robust literature on this I suggest anybody listening who's interested read anything by Jonathan hight he hasn't he has a new book explaining this to people learned through Play beginning in that's baby in toddlerhood I mean you explore the world through play in a context with fuzzy boundaries and then as you grow you continue to learn by exploring you don't call it playing at that point but you learn by exploring and just getting into situations even no problems on your own and solving them on your own so I think the best way that we can help anybody ever whether in toddlerhood in childhood as a high school student or adolescent or adult is to just if you're someone who thinks that you can help them figure out how to solve problems on their own or give them a step in the right direction and that that's it man and and otherwise people people tend to grow out of their problems on their own your book has a lot of helpful descriptions of individual cases and stories of people who've gone through addiction are there any that come to mind that really help to illustrate a more development based view of addiction well first my own so there is my own experience which is as somebody who's from a middle-class family and a very supportive one living in an area that is more or less supportive and has good schools and I never missed a meal I had it I had a lot in my life I even had sort of skills and talents to let me get jobs and do things on my own I was very misunderstood I think and I had a lot of trouble making forming intimate relationships with people or meaningful relationships with people and I think that I have always including now had this creative approach and had a resistance to ideology and a resistance to systems of things that make no sense and so it got painful after a while to continue questioning myself and feel like I wasn't relating to anybody and I started using drugs a lot and including heroin and that made me feel so much better for a while it was the only tool I had it was my only move for when things were going south and that was all couched in beginning in my development and I had to develop out of that process in mature in order to in order to both stop using drugs and just be a better and happier person in terms of in terms of kids there's some I tried to list some of the really most benign cases of childhood problems so there was one in the book that there was a student who was I mean he had dyslexia and he also he was diagnosed yeah I mean he was just before he's 18 so I think he still had his oppositional defiant disorder diagnosis which is really just that clinical term for doesn't doesn't listen to adults and ADHD and so he was he was being helped under the auspices of special education his teacher thought that he was just just being an ass you know he'd asked him to do something he wouldn't do it he had no way of articulating himself so he he responded being you know by yelling and doing everything except punching the guy in the face so the teachers like alright we need something his guidance counselor was saying well I know what it is it's you're trying to you're trying to make him right and he doesn't know how to write so he can't hear let's give him this special assignment where he can just and I don't even remember what it was so it was something that had he was given so there was there were two ways of approaching this kid one was people figured that his outward negative behavior must it just must be that he's manipulative and then the other kinder approach from this guidance counselor was no no he he can't write and he's got all these problems so don't make him do anything and neither of those I mean I think I like the he's got he's got problems don't make him do anything slightly more but not in the long run for sure I was asked to work with this kid 17 year old and I was asking him what's the deal and when I asked him he happened to be a kid that I didn't need to dig too much to figure out the answer he was saying they're people asking me to write and I can write actually I can write a lot I even write pages of stuff it's just that this topic is not interesting to me at all and it was a class about civics and politics and I just can't I look at the page and it just nothing happens and I just can't I don't know how to say that to somebody in a way that they'll actually respond to me and give me what I need so I help this kid by involving him in a class there was a civics class and working out a deal with this teacher who I know well because I knew he would allow this to happen where this guy who happened I found out happened to be an incredible artist would do his assignments by drawing political cartoons and so he would go watch the news or read something about the news then he would sort of make make a a a meme a hand-drawn an analog mean and of this political cartoon and he then his assignment was to write you know like a paragraph or two about each of his political cartoons explaining what they mean and it turned out that this guy wrote an entire book full full of political cartoons and then descriptions you know pages of descriptions of writing that he produced generated on his own about the political landscape so here's a kid that was gonna be told he can't write don't make him do any writing don't make him do anything and he was just gonna be sat in this class and that was supposed to be the better way forward the more compassionate way forward I don't know what the consequence would have been of him doing that but I do know that the consequence of him finding a way to explain on his own what the problem was and be involved in the solution in moving forward and producing something meaningful to him and that actually showed that he had he has the skills and he can produce things he could he can do great in school if he's able to channel his own motivation that and then talking to Stanton later on it just it was so clear to me that these processes of when kids get in these cycles of behavior that can't seem to they can't seem to control and when when adults get into these cycles of addictive behavior that they can't seem to control the way Stanton talks about it the way I talk about kids it just seemed so obvious that they went together yeah I think that's probably my favorite example because it's so digestible there's just it's just common sense there's nothing magical about that example at all yeah the system just needed a little more flex in it and that provided an option it's definitely unfortunate with teenagers and you see this a lot whether it's with the drug issue or whether it's with other behavior stuff that clearly there has to be these standard models that people go through for school and at schooling and education and but if it's too strict you're kind of contracting the range of person who can feel comfortable in that situation and if they're made to feel uncomfortable then they can end up just thinking that the system is against them and that they're not meant to be part of it they're not meant to contribute so you build these really problematic dialogues that people have with themselves bad stories that they tell themselves and that would seem true for addiction as well I mean which we were talking about earlier where if you if you start giving that label to buddy or your first response to seeing somebody use drugs is a really harsh wag of the finger then you know they came to that decision with already having been exposed to the societal baggage that comes with using drugs so clearly they're aware that other people don't think they should but they still made that decision maybe there's a good reason than to ask why what are you trying to gain from this use is there is that use helping you are there other things that that could provide the same benefit but do it in a better way especially if you're young that dialog doesn't tend to happen I don't think when you bring this up before with with children of asking them what they want to change what could help them you know is occurring to me that I don't know that even happens too much in addiction treatment for adults like what are you aiming to get from this and what could we do to help I mean that I don't know if that is is typically the conversation being had but the second it is a lot of people might have a lot of stuff come forward and maybe after some digging because perhaps they don't even know what they need but there is something and it's not just stopping drug use and the drug use is probably a symptom that is arising from self treating some other thing and it's that other stuff that needs to be brought to the surface but you're only gonna find it through a dialogue that's what I that's a great point and what I was saying before that you know Stanton's book love and addiction started helping people since he wrote the book that the themes in his book have been applied across the board you know drugs themselves aren't the problem and one of the things that's been applied is that cognitive therapies and motivational interviewing which mean cognitive therapy is almost like a stoic journey is asking people to sort of articulate and maybe helping them articulate the landscape they're trying to cross motivational interviewing is saying you're asking the kinds of questions of people that help them produce the answers and solutions and people do kind of know I think that that most addiction let's say psychologists or clinicians know that those are proven to work better than any other mode of therapy but you're right when when we the context for that therapy is such that answering honestly that could get you into trouble then it's not gonna work you have to be able to people have to be in a situation where they can give an honest answer and know that they're going to be heard like in a school now I can talk I work I do work in a school but I also work independently and I create an environment where people kids can tell me things within reason of course and they know that I won't judge them for it if I'm in a school people can't tell me hey I've been using heroin at what let me compete so I talk to this problem with you they would be afraid that they're going to get kicked out of the school or something's gonna happen to them as a consequence and likewise people who are even people who are in therapy for addictions especially if they're if with it in some sort of an institution or rehab will need to be worried that if they tell the truth about their drug use often or even if they go to the to the doctor or something like that that they're gonna have consequences like let's say not being able to get prescription painkillers like they wanted to or they're gonna have to be medicated for the problem like they don't want to so there has to be an environment that is conducive for having these conversations as well as as well as using these methods of conversation and therapy and one of the problems there is as a society were almost viewing it as some kind of malpractice in a way if you're a a counselor or a doctor who's hearing about what's being framed as this really serious thing and you're not immediately responding with here's the treatment plan you know this is what we have to get you into otherwise you know if something happens even though most likely something won't and by doing that whole treatment plan thing you could make things worse in reality there's the concern that what if this gets out of hand what if I didn't do something and I'm sure this even you know heightened to a significant extent when you're dealing with teens absolutely it's like the whole issue is like a hot potato mm-hm you're so right like I was telling you about those administrators that didn't seem to mind that a kid was failing all his classes and having a whole timebut but just wanted to make sure that he wasn't smoking weed well nobody's gonna get in trouble because the kid has a bad relationship with his girlfriend that's exactly right exactly right so the responsibilities off of them which is such a you know that's that whole idea just turns turns people into just it's just so narcissistic eventually you know if you're working within the system that challenges you like you say for letting people talk through their problems and then you not immediately responding to it it's like they came to you with the problem they had the problem before you talk to them and you don't have to tell people and I would I would suggest not giving people some sort of advice on continuing doing something that's risky necessarily but and that's why I like you know like Andrew tatarskiy or Pat Denning and Ginny little the who do harm reduction therapy and the the whole basis for it is that come to us and we just want to hear what's up with you and how you think I might be able to help you and in any capacity that you thinks makes sense I'll help you out I'd like to see us get to that kind of a model switching gears a little is there a significant role of trauma do you think in these cases there's people like Cabramatta who receives a lot of attention and definitely has important points to make but really places a huge emphasis that essentially trauma which is kind of a loose term and concept unfortunately that it's a necessary possibly not sufficient but at least a necessary condition for developing addiction what role do you think that plays is it generally like how close to that model argue I'm on board with 90% of things that Gabor Ma Tei says he's a good example I mean he's sort of the the leader in trauma theory about addiction I mean of course people encounter traumatic events in their lives if they're addicted almost by definition if you're addicted to something at least by our definition that that is sort of traumatic but I don't think it's the most economical response to the problem to pathologize it again and say that it's trauma as some sort of a brain condition that's where I lost in pain I respect the war my taste so much so it's stuff going against him like this but factually speaking when he starts describing trauma as changing the brain and in a way that produces this sort of a pathology and then that necessarily leads to people having addictions and that every person with an addiction has experienced a sort of a chemical brain change through traumatic events and has experienced trauma I'm not on board with that I don't think that there's evidence for that and I think that if there were evidence for that it still wouldn't be the most economical useful way to look at things you still you can't avoid looking at things through a lens of practicality and and what can be done now in life so I would say that those principles of like cognitive therapies looking being future oriented and developing skills and resources and motivation that still would hold true and and not change whether or not we think somebody has had traumatic events or they haven't but I think that that's not true I think that the trauma uber alles sort of argument is is overstated as a final question where do drug replacement therapies fit into this because they are sometimes the gold standard as far as evidence-based treatments go for addressing addiction but on their face would be placing a huge emphasis on the drug you're literally providing a an alternative chemical to satiate the need and that could be taken as evidence I don't think it does but just framing it this way it could be taken as evidence that well there's the sign that the drug is this really key factor how does the fact that things like booop an orphan or methadone those being a really good treatment for opioids or even heroin or hydromorphone or whatever how does that fit into moving the conversation away from the drug per se being really the key factor I think it's like you said it at first they're giving people methadone and suboxone and if we're to believe that methadone or suboxone or let's say vivitrol or now track zone which are opiate blockers to say that they are responsible for people getting past their worst problems but does put an emphasis on drugs it's just it puts an emphasis on different drugs so my wife is a clinician at an m-80 clinic medication-assisted therapy clinic here in burlington called the Chittenden clinic and she and i have a lot of conversations about this you'd have to be a monster to take away something like that that works for people and which they want you know this is people go to this the clinic because that's what they want to do and I of course I couldn't possibly be consistent with everything that I'm saying now and say that people shouldn't get methadone or shouldn't get suboxone or that giving them that is bad because it's a drug and they're going to get addicted to it or something like that so I certainly think it has value but I do caution people even though it seems to be the gold standard as you say that the drugs themselves aren't doing the work our attitudes around these drugs are doing the work somehow we've gotten to a point luckily that we have like an opioid kind of drug suboxone methadone that people can take and and become stable if they want to and while they access therapy to improve their lives and that's that's good but if we are operating under the notion that particular drugs are good and others are bad and so taking these good ones is what's going to help and that their medicines that leads to some unfortunate consequences like people saying that they should be on these drugs forever or it leads to consequences like drug courts rather than mandating the 12-step treatment well they might mandate treatment and the only treatment the only game in town for treatment is methadone or suboxone so in a way it's like a false choice and and coercion to take these medicines so I think that as we move forward it's extremely humane to be offering these medications it seems to have helped a lot of people but at the same time as we're seeing more methadone and suboxone clinics around the country we're not seeing a decline in drug deaths and certainly not seen a decline and and the sort of despair around and loss of connection as as my friend Johann Hari would say enemy so I just caution people to continue to think through what you know what is useful and what's not in a person's life rather than put too much emphasis on drugs themselves doing all the work to wrap up where can people hear more from you because besides the book which I definitely recommend people get although I don't think it's out yet you also have a podcast that people can hear a lot from you and your guests so where can people learn more and when is the book coming out and where can people get it thank you the book comes out May 15th then they can you know find it in fine bookstores everywhere beginning then they can also order it from our publisher upper access press I think they can order it now so if they wanted to you know if you if you pre-order the book on Amazon right now you get a discount if you want the book now and don't want to wait for it I think there's a little bit of an upcharge so but you can go to the publishers website up or access press.com yeah my podcast is called the social exchange podcast I talked to people who are experts about a variety of social issues and I'd ended up talking a lot about addiction in drugs and have professionals on you've been on the podcast so people could listen to that episode and I work at Stanton peels program which is an online non-step program called the life process program and that's for people who want to get you know get passed or ameliorate addiction related problems and I've also developed a family plan for the life process program that which people can access and that's at life process program calm and we host a podcast called the LPP life process program podcast that they can find at that site there will be links in the description to all of that and I definitely recommend everybody listening check it all out the book podcasts and all the other materials and thank you for coming on Zack Seth it's a great pleasure to be talking with you thank you so much for having me

15 comments

  1. Great talk. Can really identify with it. From age 17-24 i had a real drug problem, mostly amphetamine, cocaine and mdma, but also alot of psychedelics (hello rave scene, still love you) i also had depressive tendencies since my early years. like you said in the podcast, i had to realize myself that my live could be better without drugs. Went cold turkey, didnt even use alcohol for 3 straight years and got my life back on track. Today i can have a fun night with friends and then go on for months without even thinking about using. But i feel a lingering inside me that a few wrong decisions could easily send me back to a bad relationship with drugs. I think a good and healthy set of friends and family is really important to cope with this and to suppprt you if you ever start to go on the wrong road again.

    Thank you alot for this great podcast and the things you do for us, we really appreciate the work you put in and the knowledge we gain from you! <3

  2. Very good! I like the discussion about how addiction is a dysfunctional habit rather than being a "lifelong disease". SMART recovery has helped me far more than AA or NA ever have

  3. Seth. I have a question. My son and I have been debating it and we respect your knowledge so perhaps put it to rest. In regards to addiction. My son feels there's little or no difference in the addiction a street junkie and a medical pain management patient goes thru. I'm not talking physically…drug symptoms are basically the same for all. I'm talking about the psychological aspect. I've maintained a junkie has something that causes him to abuse then suffer later while pain patients know to taper themselves, etc. Any thoughts on this or related matters say on addiction in pain patients would be great! Keep up your most important work!

  4. This is a great presentation. Although, purporting that "marijuana is an addictive drug", is wholly preposterous.

  5. Splendid, always happy to see one of the most informative podcasts release a new episode.
    Thank you for all the effort Seth, your work is greatly appreciated!

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