Overcoming Addiction: An In-Depth Conversation with Dr. Jason Shiffman

This week we talk to Jason Shiffman, MD, MA, MBA, founder of Camden Center and expert in addiction medicine. Dr. Shiffman details his personal journey of addiction and recovery, showcasing how his experiences have influenced his empathetic and integrated approach to treatment. The conversation explores the complexities of addiction, innovative methods used at Camden Center, and the specific challenges individuals in the entertainment industry face. The discussion also emphasizes the importance of self-care for clinicians and offers practical advice on achieving emotional stability and maintaining a healthy relationship with fame.

 

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Episode Transcript

Speaker 1 (00:00):
Hey everybody, it's Sato McFarlane and welcome back to the
SINO Show.

Speaker 2 (00:04):
My guest today is doctor Jason Schiffman.

Speaker 1 (00:08):
Doctor Schiffman is not only an expert in addiction medicine,
but also the founder and medical director of Camden Center Facility,
known for its innovative and integrated approach to treating addiction
mental health issues. He's a board certifying both psychiatry an
addiction medicine.

Speaker 2 (00:25):
I'm very, very very excited about this interview. Welcome to
the show.

Speaker 3 (00:30):
Staying sober is really easy most of the time, it's
just almost impossible some of the time. My addiction really
really rooted me. I just remember just sitting at that light,
and it was that choice of knowing that if I
went that way what was waiting for me, but also
not being able to just tolerate being in my own
skin and being sober. You can't think yourself into right action.

(00:52):
You have to act yourself into right thinking.

Speaker 1 (01:00):
Welcome, and I also want to say he's a brother
in recovery as a start and recovery.

Speaker 2 (01:04):
We're to get into that.

Speaker 1 (01:05):
But before we do that, before we get start, I
want our listeners to know all the episodes of the
Sino Show are on YouTube. Just search the Sino Show
or click the link in the show notes. Also, we'd
love to hear from you. He got a question from
the show. Email us at the Sino Show at twenty
eighth ab dot com. We'll link this later on for you.
So here we go. Welcome a board, sir, twenty years. Congratulations,

(01:29):
thank you. That's a big deal.

Speaker 3 (01:31):
Thank you.

Speaker 2 (01:32):
It's a big deal.

Speaker 3 (01:33):
Yes, August third.

Speaker 1 (01:34):
August third, that's a that's a really big deal. So
I'm going to start with this. I want to give
a shout out to our brother Eddie g because he
brought us together. Yep, and Eddie and I told him
about He was so excited when I told him you're
going to be on the show. And we both were talking,
like about what I wanted to talk about. I said
to Eddie, we were taking what makes him so good
at what you do?

Speaker 3 (01:56):
Right?

Speaker 1 (01:57):
And you know, Eddie and smart cookie. And he said,
unlike most psychiatrists, you're very relatable. And I go, you're right,
he's very relatable. And why is he relatable? And I
said because he had an interesting childhood and you know,
and I wanted to start there. If you don't mind, sure, okay, yeah,

(02:19):
and because I think it makes you extraordinary at what
you do. But if you don't mind, talk about growing up,
talk about being bullied, tough dad. Yeah, so let's see.

Speaker 3 (02:32):
You know, Fortunately, I, you know, with my peers, it
wasn't particularly I didn't you know, my with my peers
was okay, but I did have a difficult and complicated
relationship with my dad. And interestingly, I don't know that
if if I hadn't, I'm sure I hadn't shared this
with you. So he was just in the ICU lat

(02:54):
To two weeks ago, and I had not spoken with
him in twenty about twenty years, and so I actually
made a decision to it was up in San Francisco.
I made a decision to go back up, to go
to San Francisco and to go to go see him.
I for complicated reasons that we probably gonna be too much,

(03:15):
too much detail for the show. I didn't actually end
up end up seeing him, but we did re establish contact,
which was so it's interesting that you're asking me about
that now, because it did kind of it's kind a circle.
So yeah, you know, I mean, I I think that
like probably every person on earth. You know, I didn't
have a perfect childhood, and there were elements of the

(03:39):
of what I like to call the relational landscape that
I existed in that were challenging for me in ways
that left I think, lasting effects in terms of the
the coping mechanisms I needed to to to develop as
a kid to get through them, you know, ended up

(04:02):
causing problems for me as an adult. And you know,
I kind of I kind of the metaphor I really
like to use for those types of uh, those defense
mechanisms we develop as a tourniquit. You know, they get
us through, They get us through what we need to
get through at the time we need it. But then
once we're through it, you know, then the tourniquit itself
starts becoming the problem because.

Speaker 2 (04:21):
It does Yeah, yes, it does.

Speaker 3 (04:23):
It.

Speaker 2 (04:23):
Well, let's let's walk up. Let's talk about your addiction.

Speaker 1 (04:26):
I mean, sure, it's it's it's you know, it's fascinating
because people look at you and it's like, no, this,
I mean this, you're straight up junkie.

Speaker 3 (04:33):
Yeah, I definitely. I was a heroin and cocaine addict.
Yeah right, Yeah, so I appreciated the good stuff.

Speaker 2 (04:41):
Yeah, I appreciate good stuff. But I mean, how did
you why do you want to become a psychiatrist?

Speaker 3 (04:45):
Oh well, let's see. So you know, I ended up
deciding to go to medical school on a little bit
of a lark. So I was I had gone to
graduate school for linguistics, which was not a particularly pragmatic
thing to do, and I that was when my drug

(05:07):
addiction really started to take off. And then I had
also another part of my histories. I had failed career
in music as well, so I had spent the year
after graduate school for linguistics trying to make it as
a musician. That's when my addiction got real bad. And
in a moment of you know, it was definitely one
of the bottoms that I hit. I was I think

(05:27):
I was kicking oxy contin. Actually that was back back when,
that was before before everybody uh figured out that oxycont
was bad for you. So I was kicking oxy contin
and had one of those moments of you know, it
was a bit of a moment of clarity in terms
of my addiction, and also a moment that I think,

(05:48):
really it was a deep, deep emotional bottom, and then
I just realized how sort of desperate and meaningless. My
life had become and I really didn't have any you know,
I had no idea about what I wanted to do,
and really, almost impulsively, I just decided I'll just try
to apply to medical school. And I think probably it

(06:09):
came from the I mean, it sounds I know, it
sounds weird to do that. I can say in retrospect
it might have been because you know, my parents are Jews,
you know, and you know what, there's a what's the joke?
When does according to Jewish tradition, when does a fetus
become a human being when it graduates from med school?
So I definitely grew up within that culture, and you know,

(06:31):
and so I and I think because of the shame
that was now shining through in that moment of kicking opioids,
I think I was just reaching for whatever I thought
could make that shame go away, and in a you know,
funny and then sort of sad, I think, and bizarre
attempt to try to make that feeling go I'm like,

(06:52):
I'm just gonna apply to medical school. So I ended
up applying for what's called the postback program, which is
a program that you take when you you haven't taken
any of the prerequisites for medical school. But you've already
graduated from college, and I'd done well enough in my
studies that I got into that program, and I just
put one foot in front of the next, and the

(07:13):
next thing you knew, I ended up graduating for medical school.

Speaker 2 (07:16):
So you weren't sober a lot of that time, right, No, So.

Speaker 3 (07:19):
I, well, yeah, it's that was the short version of
the story. The more complicated version is, so I applied
to that post back program, it didn't start for six months,
decided that it would be a good idea for me
to move to Berlin. Again, these are the types of
thoughts we have in those types of moments. Because I'd
had a job at that time that I was I

(07:41):
was I could do it anywhere. It was a job
as a linguist. Actually, it was a job being I
would I was emailed a list of a thousand street names,
and I would do phonetic transcriptions for them. So that's
the kind of job actually that you almost need Heroin
to do, to be honest. So I had that job.
I wasn't going to start the postback program for another

(08:02):
six months. I moved to Berlin and thought, man, that
that'll be a good way for me to get away
from the heroin in you know, over a sixth street
down down in downtown. And uh. And of course I
found heroin in Berlin within about eight minutes of being there.
And so the way the story unfolded was my my
first day of my first real period of sobriety, was

(08:24):
my first day of of that that post back program.
And I remember walking around USC. I was cold, I
was in bad withdrawal. This was back before puper norphene
and all that stuff. So I mean I I just
detoxed myself with yeah, yeah, a little bag of weed
in a and I think I had a value, one

(08:45):
ten milligram value. That's all I had. And but yeah,
and I just you know, I started to go into meetings.
I started. I did this little outpatient CBT program called Matrix,
it was, and I just kind of tweak on red

(09:06):
bulls and do my physics homework and and and go
to meetings. And I put three years together actually that way.
And so that's that's how things started. I'll let you
ask other questions.

Speaker 1 (09:14):
I don't want to, Yeah, no, no, I think it's
important for I want the listeners to know this is
not you know, you just didn't go to school. I
mean you you you've.

Speaker 2 (09:24):
Overcome some real obstacles.

Speaker 1 (09:26):
Yeah, and I but I also it's where I started with.

Speaker 2 (09:29):
I think that's what makes you so good at what
you do though.

Speaker 1 (09:33):
I think you're very empathetic and kind and you really
give a fuck about your clients because you I think
you'll tell me you never forget being on the NOD
and the pain and suffering of addiction.

Speaker 3 (09:44):
And yeah, you know what's interesting, It's funny. I was
just so I do. I run the dual diagnosis program
at UCLA right now, and I do a psycho ed
lecture for for the patients there and in their families
every week. And it was funny, this just came up
and I hadn't thought about this in a long time.
I was thinking about we were talking. It was a

(10:05):
little lecture. Somebody asked a question about cravings and how
long those last four and how long you know you
need to avoid your triggers for and things like, you know,
the things we tell people to do in early recovery.
You know, is that going to be forever? You know?
And somehow, in the context of when I was talking
about that, I started talking about the things that I

(10:27):
remember that now twenty years later, that are still bad
enough that make me know I never want to go
back to that life. And what's interesting is almost more
than the pain of the withdrawal and the misery of
living with active active addiction, it was the months of

(10:51):
desperate cravings that I had when I got sober. And
it was actually at USC during that post backprogram. It
was funny because I lived in Westwood at the time,
and I would come out of USC up Vermont and
I would I would sit at that light to get
on the ten and I could either get on the
ten going west to go back home, but there was

(11:13):
another voice in me that wanted me to get on
the ten and go east of a few exits to
where I used to cop And I mean there were
times that I would I was sitting at that light,
crying like no, no, no joke, and I would and
I remember I'd have to call I ended up having
to call my sponsor almost every day for that first

(11:33):
three months just to get me through that sitting at
that light. And it's funny, because I mean, it's funny,
but it's that desperation of knowing what it would mean
to go back, because by that point I was done.
I mean, I was under no illusion of making it work.

(11:53):
And the pain was I'm not like a particularly rugged
or resilient individual. I don't have a high threshold for pain,
and so my my addiction really really rude me. And
and I just remember just sitting at that light. And
it was that choice of knowing that if I went

(12:14):
that way, what was waiting for me, but also not
being able to just tolerate being in my own skin
and being sober. Mm and so. And that lasted a while,
a long time.

Speaker 1 (12:23):
You know, I I you know, people say, you know,
you're always so happy. You know, you got like a
rainbow pushed up your ass. What's going on with that?

Speaker 3 (12:29):
Right?

Speaker 1 (12:30):
And okay, but part of it, yes, But here's the
thing I never forget. You know, I got sober twenty two,
but I was in such you know, my my alcoholism
was so bad that I had to get like a
towel and rig it to get my hand to hold
the drink in the morning, which is a lot of work.

(12:51):
And I never forget that. Yeah, And I think that's important.
Let's just get right into it. What do you tell
your clients when they say, I have these voices, I'm
on for whatever that is. What's the technique that you
teach people at the Camdeen Center.

Speaker 3 (13:04):
Well, you know, I think what I like to say,
and I think I made this up. It sounds really great,
So I hope I made it up. I either made
it up or somebody said it, but it belongs on
a bumper sticker. What I always like to say is
is staying sober is really easy most of the time.
It's just almost impossible some of the time. And and

(13:29):
and that's something that I say a lot to my
patients and when I give lectures about about recovery. You know,
it is the way, like the neurobiology of addiction works,
is it's just our reward pathway. It's just our motivational
system that's come out of balance with respect to a

(13:51):
certain thing. You know. And there's a probably no time,
not enough time in this podcast to go into all
the all the specifics of it. But you know what
what happens, what addiction, in my opinion, really is is
when the reward pathway, which is called you know, the
part of the brain that mediates it's called the mesolymbic
pathway when when when the when that part of the

(14:14):
brain becomes when the brain gets to a state where
that pathway gets so hyper activated in response to cues
of something that reminds you of something that either removed
pain or caused pleasure. When that when the brain gets
to that state and that pathway gets so activated that

(14:35):
the part of the brain who's responsible for reasoning through
your decisions, which is your prefrontal cortex, can no longer
inhibit it. That's the moment when we go from just
liking the thing where we end up becoming addicted to
actually being addicted to it. And so the easiest way
to be successful in staying sober is not to put

(14:58):
yourself into situations where you're going to get triggered, you know,
I mean that is in my opinion, that's like ninety
five percent of recovery. That's probably an overstatement. There's a
lot of other recovery that's important. But in the early days,
you know, when when it really is a struggle just
not to use moment by moment, you know, not putting

(15:19):
yourself in that situation is really important. So so you know, look,
I probably should have chosen somewhere not super close to
where I cop to go to to go to my
post back program. But you know, as another example, I
didn't go to San Francisco for probably five years in
early recovery because for the last several years of my using,
the only thing I ever did in San Francisco was used,

(15:39):
So that whole city just was a trigger for me,
and so I didn't go to San Francisco probably for
five years. There were a whole part of town after
I finished that post back prom I would go to.
When I go to areas of town for you know,
where you know the writing starts being in Korean and Spanish,
I'm like, okay, that's a that's a trigger for me,
but not anymore. You know that that was just it

(16:02):
to be that at that point in my recovery. And
so anyway, it's a long answer to your question, but
you know, the easiest thing to do is don't don't
put yourself in situations where you're going to get activated.
And then the other thing that's really important is figuring
out how to learn how to self soothe, because for
most of us, the truths that really drive us back

(16:23):
to using aren't really the external ones. It's when we
get activated and we have those feelings of anger or
anxiety or shame, and those are the feelings that we
used to anesthetize, you know. And then ultimately the way
we really get all the way better, in my opinion,
is doing enough good psychotherapy that we figure out what's
the what's the source of that emotional pain, what is

(16:46):
it that's generating those old, intense feelings that aren't really
about what's happening in the moment, it's about shit that
happened a long time ago, and then healing that part
of ourselves, because if you do that, that's really that's
really pulling the problem out by its.

Speaker 1 (17:00):
Did you start the Camden Center knowing that this has
to happen for people to really get well?

Speaker 2 (17:06):
Yeah, give me the vision, walk me through that.

Speaker 3 (17:08):
Yeah, you know, it's interesting. Things are always clear in retrospect, right,
you know you can Oh, that was the path, you know.
I would say what I knew when I started Candon
Center now twelve years ago, was the system through which

(17:29):
addiction and mental health care is administered is totally broken.
And that doesn't mean that there isn't wonderful life saving
treatment out there. There is, it's just being administered through
a system that is completely and totally fragmented and disorganized.

(17:49):
And so most people in recovery have the experience that
I did, which is having to piece together for themselves
the different parts of what they need at different at
the different times as they're getting better, with no real guide.
You know, if you if you talk to somebody who
is in recovery themselves, they'll be able to tell you

(18:11):
how they got better, you know, and that might work
for you, but it might not, you know. And the
lack even to this day, I mean, it's better now
than it was twelve years ago when I started canon,
but even to this day, the lack of integration, in
my opinion is is I mean, it's almost unethical in

(18:31):
my opinion, you know, the division between addiction medicine and
twelve step recovery and the various types of psychotherapy. Everybody
just argues with one another and sort of thinks that
their worldview is the truth, rather than understanding that their
worldview is a map of reality that shows certain aspects

(18:52):
of it, you know, And sometimes you need a map
that's got the streets and the houses on it, and
sometimes you need a map that's got the mountains in
the trees, and sometimes you need a map that's got
other other parts. And ultimately that is I think what
I at least intuitively knew when I started Camdon was
that what people, what each person really needs to get better,
is a system that is flexible and pragmatic and attuned

(19:16):
to what that specific person needs. It's like parenting, you
know what I mean, The way that you're a good
parent to one kid is different from you you're a
good parent to another kid.

Speaker 1 (19:24):
So what let's just let's I want to you know,
so many our listeners, you know, don't have the benefit
to be able to meet with an expert like you,
and so part of the show is just educating people. Okay,
and you know better than anybody.

Speaker 2 (19:40):
This ventanyl crisis.

Speaker 1 (19:43):
You know, I want you to talk a little bit
about that, what you're seeing, what you what we can
do to educate people, what we can do for prevention.
You know, I'd love your feedback on that.

Speaker 3 (19:53):
Sure. So yeah, there are actually I think multiple fentanyl
crises so and I think they have slightly different solutions
or approaches. So one of the crises associated with fentanyl
is that you've got ventanyl showing up in stuff that's

(20:20):
not supposed to be. People don't know it's ventyl. People
aren't trying to use ventyl. It's an adulterant. Now in
even cyclo stimulians, I mean, fentanyls shown up in people's
cocaine and they're amphetamine, and so you have a part
of the overdose epidemic that we are seeing is from
people who don't even know that they're doing fent There's

(20:43):
another sort of adjacent ventanyl crisis, which is even people
who know that they are doing fentyl are trying to
do opioids because ventyl is so potent it needs to
be cut, and because the people that are selling fentanyl
on the streets aren't doing a process called liophilization, which
is basically this way of ensuring that you are creating

(21:05):
a homogeneous product. When you cut something with something else,
you can have incredible degrees of variation impotency just from
bag to bag, even sometimes within the same bag. So
we've got people overdosing and not even getting the chance
to get to a bottom, to get to recovery because

(21:27):
they die of an overdose. So that's one I think
additional significant problem that the advent of ventnyl has created
overdoses were always there with opioids, but if you look
at the at the rate of overdose, it actually looks

(21:49):
it's funny if you this may be accidental. If you
trace it all the way back, even to the seventies,
it's almost a perfect exponential curve. That last little exponential
piece of the rate of overdose in the US is
is is due to this ventanyl problem. I think there's
another issue that is I would say about the opioid

(22:11):
crisis in general, not necessarily specifically fentanyl, which is the
need to triage the care. And what I mean by
that is, I think right now in addiction medicine there
is confusion about what harm reduction is versus treatment, versus

(22:35):
emergency treatment that you're trying to give to somebody to
keep them alive, versus treatment that you give to somebody
to help them get all the way better. And unfortunately,
I don't feel like most physicians in addiction medicine are
getting adequately trained in that nuance. I think what is
most salient to the field of addictions' that's my field,

(22:59):
is of course course the massive amount of death via overdose,
and so I think there has been a lot of
focus and advocacy within the among addiction medicine physicians and
within that community to really push the treatments that are
going to save people's lives who are dying on you know,

(23:21):
an active addiction. And you know, for example, buper norphine
is a wonderful intervention for that, right, I tend to
view buper norphine on the continuum from harm reduction to
to to treatment kind of closer to harm reduction most
I think most of my colleagues in addiction medicine would
disagree with me. I think it's important that I say
that so that I can you know, I'm not being

(23:42):
viewed as sort of a representative member of of of
of the of of ASM or but that that might
be one of the areas where my opinion differs a
little bit from sort of the typical addiction medicine physician
or addiction psychiatrist. Because you know, buper norphine, which is
you know, commonly the most common form that it's administrent

(24:03):
is typically known as sabox ow, and that's the brand
name for it, you know, for people who are an
active addiction and either are unable to or unwilling to
pursue a path of recovery to really get all the
way better, which, in my opinion, all the way better

(24:24):
requires abstinence because you can't heal the things you can
heal the source of the pain that your addiction was
anesthetizing for you without first stopping the emotional anesthetic. But
that that's if people want to do that, right I have.
I don't. I think unfortunately, there's a lot of very

(24:45):
moralistic and sort of energized arguments or debate right now
between people who are either pro or against buper norphine
or and and to me, that's like arguing about like
whether you know a cylind is good or bad. It's like,
I don't know, it's it really just depends on what
you're treating, you know. I do think that that buper

(25:08):
morphine for patients who are in active addiction, either unable
or don't want to really get all all the way better,
is a wonderful life saving medicine. And I also think
that reflexively putting everyone on maintenance puper morphine who comes
in for treatment, especially if that person is really wanting

(25:28):
to heal and really wanting to get all the way better,
you know that to me, it feels like sometimes the
doc is depriving the person of really providing informed consent
because a lot of times what they're not saying is, hey,
if you go on this med you know, it might
interfere with your ability to really heal the source of

(25:49):
the pain you were anesthetizing with the drug you were abusing.
You know, you know, it might also make you may
also makes you less likely to relapse and die, And
of course that's what the physician is focused on, but
I'm not sure that there is necessarily a lot of
awareness on the part of the physicians prescribing bupern orphine
that like, there are also drawbacks or risks associated with

(26:12):
that benefit.

Speaker 1 (26:13):
So a lot of parents watch the show Okay and
they would love you know, TV get your wise counsel.

Speaker 2 (26:21):
What do you say to the families?

Speaker 1 (26:22):
And I want to talk about the family dynamic and
how you treat it that I've got a kid he
just won't stop using.

Speaker 2 (26:28):
I don't know what to do.

Speaker 3 (26:32):
Yeah, it's really tough. It's really tough. So well, first
of all, there's a big difference between if your kids
under eighteen or over eighteen.

Speaker 2 (26:45):
Can you make that distinction because it's very important to make.

Speaker 3 (26:48):
Yeah, so if your kid's under eighteen, you can mandate
treatment essentially because you can consent for treatment. If they're
over eighteen, you actually really are about You're probably powerless
in both cases, to be honest, but in with kids
that are over eighteen, you know you're legally powerless. You

(27:10):
know it's difficult, and I think the thing that I
just want to say is I don't feel like I
have a good answer for parents when the kid is
still a kid meaning adolescent. That's why I'm not an
adolescent psychiatrist. I don't really know. It's so complicated. I

(27:32):
wish I did. I'd probably be a better parent to
my own kids if I had a better understand your shit. Yeah,
you know, I try, But you know, the the reality
is is that being a parent's really hard because you're
always doing this dance when they're younger between giving them

(27:52):
autonomy and letting them make their own mistakes, but then
also having to protect them and and do things that
maybe they're unhappy with you about because they're not old
enough to make good decisions for themselves. That's hard what
I know about treating adult children, And to me, that's
you know, when you're talking about people you know that
are in you know, over eighteen, maybe starting to get
into their early twenties and older, I feel more comfortable

(28:16):
sort of providing advice about those scenarios. What I frequently
say to parents, and actually not just parents, to anybody
in a relationship with an addict, is that until that
person authentically internally wants to stop using, there's nothing that

(28:36):
you or anyone else can do to prevent them from using. Right.
It's scary, It's really scary, and I wish it weren't true,
But I think that is true. I actually think it's true.

Speaker 1 (28:51):
And.

Speaker 3 (28:53):
You know, so that's why, you know what, a lot
of times I get a lot of parents people calling me,
you know, asking for referrals or wanting me to help
prefer them or set up interventions. And of course I
do think that there is a role for interventions, you know,
I think interventions can really be life saving when somebody
is in such a tight and an inescapable hole with

(29:18):
their addiction, that it gives them the opportunity to get
broken out of that and to have the opportunity to
go in and in a place where their head can
get clear. Really, maybe come to a moment of clarity
that I think is one of the potential benefits of addiction.
I'm sorry of an intervention, but whether it's it's the

(29:40):
intervention or after order, or or before or without an intervention, ultimately,
people don't stay sober in the long term unless they
have decided that they don't want to use anymore and
they're willing to do whatever they need to do in
order to figure out a different way to live.

Speaker 1 (29:58):
Folks, he said, Know, this is a gentleman who's worked
with thousands and thousands of addicts, and this is something
that I subscribed to my phone rings off the hook
with people. It's just really comes down to are you
sick and tired of being sick and tired until then?

Speaker 2 (30:12):
Good? Luckily? Right?

Speaker 1 (30:13):
Yeah, it's really that simple. Yeah, talk about the Candet Center,
talk about the model. What's an average day there, what's
happening over there?

Speaker 3 (30:20):
Yeah? Yeah, sure. Well, so I started Camden Center. Right
after I started, I started the dual diagnosis program at UCLA.
And it's interesting, I mean, maybe what might be you know,
worth talking a little bit about, was why I started
the program at UCLA. So I'd had this experience in

(30:41):
my residency. So I mentioned, so I ended up going
to medical school at USC, I ended up coming to
UCLA for for psychiatry residency. I knew I wanted to
to to go into addiction psychiatry, and so at that
time when I was doing my residency, back then, the
only training you could really get with an addiction within

(31:01):
that program was working as a resident within the Addiction
Medicine UH Clinic. And that was a medication management only clinic.
It still is and and at that point, at least
within the Department of Psychiatry, if if patients wanted to
get addiction treatment, that was the clinic that they came to.

(31:22):
And I knew from my own experience in recovery and
in therapy a million years that you know, meds were
are an incredibly important and sometimes necessary, often necessary a
component of treatment for people to get better. But they're
not that they're not they're not sufficient. And so I

(31:45):
remember as a resident, I would do these you know
what what in the field are called biopsychosocial assessments. I
would do a really thorough assessment, probably much more thorough
than than is typical within psychiatry. But this was my passion.
You know, and so you know, the typical patient that
would come in to the addiction medicine clinic, you know,
would be obviously actively using subsubstance. I mean almost without exception,

(32:08):
living in some problematic dysfunctional relationship, almost without exception, having
had lifelong anxiety and depression, almost without exception, having some
form of developmental trauma, often childhood sexual trauma. And I
would create these formulations where I would say, hey, look,
this is what's going on now. This is their DSM diagnosis,

(32:31):
these are their symptoms, and this is how I think
we can trace what's happening right now all the way
back to its origins in their developmental trauma.

Speaker 1 (32:42):
And and.

Speaker 3 (32:45):
Let's create a treatment plan for them that kind of
works from the outside in where we address the acute
stuff that's happening right now, but then also give them
the benefit of our hypothesis anyway about why they're experiencing
what they're experiencing, so that they can then go after
they leave the clinic and be good stewards of their

(33:07):
own recovery. And so I would give these presentations and
the attendings without exception and be like, Okay, well that's
really interesting. Jason but we're gonna give them some weal
butcher and maybe some suboxone, and we'll see him back
in three months and you know, maybe they can go
talk to the social worker down the hall and she's
got some pamphlets. And I didn't like it. And it
it yeah, it it made me angry because I and

(33:33):
I think I subsequently probably burned some bridges which I
shouldn't have that you know, we all learned. But it
made me angry because I identified with the patients. I
didn't identify with the docs. I knew. I knew what
those patients were going through when they'd been on that
wait list for three months to get into the clinic.

(33:53):
They were coming to, you say, for help, to find
out what's wrong with them and how do I actually
get better? And and the meds were real important, but
that's not how you don't you don't recover from addiction
and trauma with wellbutrin and saboxone, right, yeah, that's right,
and so and and and not that wellbutriant siovoxone aren't,

(34:13):
like I said, completely synergistic with all of the other
things you need. But it was this recognition of we
were not serving they were looking to us as experts
to tell them what they needed to get better, and
it was that was it. So in any case, I
convinced UCLA to let me start the dual Diagnosis program,

(34:34):
which would at least incorporate psychotherapy and case management with
the medication. And ultimately that was mostly about convincing UCLA
that the program would make money. And then it actually
hemorrhaged money for two years after we started. It almost
didn't make it, but fortunately it pulled through. But you know,

(34:59):
the that program, the dual Diagnosis program at UCLA, exists
within the sort of overarching framework of a big hospital
based program, and so I I you know, I ended
up writing a cognitive behavioral therapy and mindfulness based manual
for that program, which is wonderful. But what I say
in the lectures that I give every week still at

(35:21):
that program is this is just the first step. You're
gonna need more than just some cognitive behavioral therapy, you know,
groups twice a day, you know, seeing a therapist once
a week and met. It's you know, it's an eight
week program. It's you're not gonna be all the way
better in eight weeks. And here and here's what you're
gonna need in order to actually figure out why you

(35:43):
ended up as an addict and what you need to
do to heal that source of pain that you were
anesthetizing with the thing you got addicted to, whether it
was a drug, whether it was sex, whether it was
whatever it was. What Candid Center is is I just
was like, Okay, I'm going to try to build something
that really gives people the opportunity while they're in treatment

(36:05):
there to really start to get all the way better.
And for me, what that means is it meant pulling
together clinicians that were the best at what they did
across a broad range of specialties. Internal medicine doctors, psychiatrists,
psychotherapists that specialize in behavioral therapies like dialectical behavioral therapy,

(36:28):
cognit behavioral therapy act you know, acceptance and commitment therapy,
therapists that specialize in psychodynamic therapies, therapists that specialize in
trauma therapies like EMDR, and somatic experiencing therapists that are
somatic practitioners, acupuncture massage, taichi nutritionists, or dietitians, life coaches.
These are all of the things people who are therapists,

(36:52):
but in their own recovery and have the ability to
help people, you know, get through the first three steps
while they're in while they're in treatment, and teach them
how to make use of this wonderful free resource which
is twelve step recovery, and then all of the related
things you know, you know, I think it's called recovery
Dharman now, and then all of the other community based
treatments that are available as well. My I would say

(37:14):
that the principle that underlies Camden is pragmatism. I call
it ecumenical pragmatism. And what I mean by that is,
if there's something that can help heal some part of
the multitude of things that need to get healed in
order for a person to recover from addiction and then
get emotionally and psychologically healthy, bring it in. Let's put

(37:37):
it in the toolkit, and then let's have a let's
have a model so that when a person comes in,
we can go, all right, which tools do we need
to use right now? And then as we move forward
to really help this person get out of the crisis
they're in now, but then heal this origin of the
thing that's causing the crisis, because otherwise you just get

(37:58):
treatment as usual, which is is you go into treatment,
you're there for thirty days or sixty days or ninety days,
and you come out you're out of that crisis. But
if you didn't ever figure out why the crisis started
to begin with, you know, it's it's unlikely that you're
not going to have another crisis down the road. So
that's that's that's the model.

Speaker 2 (38:17):
Well, and it's a it's an extraordinary model. Thanks.

Speaker 1 (38:20):
It's this goes to what I open with why you're
so good at what you do. You nail that you
related more to the patients than the doctors. But I
also love that you have the passion said fuck it,
I'm going to figure this out. And I'm grateful you
pissed people off because you've saved a lot of people's
lives and.

Speaker 2 (38:38):
That's powerful man.

Speaker 3 (38:39):
Thank you.

Speaker 1 (38:39):
Yeah, and you introduce a model that is it's kind
of revolutionary. It sounds simple, but it's not simple. What
you did. I mean, you curated the best of the
best and it's really it's spectacular.

Speaker 2 (38:50):
Man.

Speaker 3 (38:50):
Thank you. You know, I think thank you for saying that.
And yeah, I think that part of the other thing
that was became sort of the magic of Camden Center
was just it became a fun place to work, and
it became a really hard place to work. Yeah, and

(39:12):
one of the things, and this has been more recent,
and I owe this not to my own abilities, This
was really something that was in my blind spot and
had to get brought to me. You know, my developmental trunk.
I always feel like I'm doing something wrong, I'm not
doing it well enough, I'm stupid, I'm lazy. You know,
these are all the messages that I got, and so
I'm constantly trying to defend against that. And you know

(39:36):
the tourniquite that I put on to defend against it.
You know, one of them, well one of them was drugs, obviously,
but another one that was underneath that was just this
incredible drive, compulsive drive to just keep trying to prove
that I'm smart, that I'm good enough, that I can
work hard, that I can do it right.

Speaker 2 (39:56):
You know.

Speaker 3 (39:59):
You know, all the counter messages to the messages I got.
I got consistently from my dad, and so it enabled
me to do a lot of cool stuff, but it
also like really it burnt me out, and I'm not
I'm not good at self care in that regard. I really,
I mean, to some degree, I replaced Heroin with work

(40:22):
and and I and and the thing was, I ran
Camden like that. I'm like the nicest boss. Like I
don't ever get mad at people. I mean I do,
but I don't. I don't express it. I don't ever yell.
But but I think by the by the model of
how I treated myself, and I think by how I

(40:46):
promote you know who who got who got promoted who?
It was just the people that worked like me, that
would just do anything just for the patients, even at
the expense of their own self care. And and so
that's I So I was gonna say, I think the
thing is, you know, initially, I think one of the
things that really helped Camden get off the ground was

(41:07):
it was a bunch of really smart, experienced, well trained people.
I paid everybody well, you know, they were people in academia,
private practice that don't normally work in treatment centers. And
we just really had a good time. It was before
we had an HR department, so I was able to
joke around and make many jokes, you know what I mean.
So it was good. But then it got you know,
there was a period at Camden where I Camden needed

(41:28):
to change and I needed to change, and that happened
several years ago where we've really built in a lot
of systematic ways to take care of the clinicians. And
I think that's a really actually I'm gonna make it
a cry, something that's really important, because yeah, just I
lost to you know, really good two colleagues and friends

(41:48):
this year to suicide who were who were who were
really excellent clinicians and m and I don't think that
we do a good enough job of making sure that
we take care of the people that are responsible for
taking care of of others, you know, particularly mental health care.

(42:10):
And I mean all of us in mental health care
got here because you know, there's something, there's some that
wasn't right with us, you know, and then it becomes
so much part of our identity, you know, so much
part of our of our sense of value. What makes
us good people is oh, I'm a good therapist, I'm
a good psychiatrist. You know, I did all this stuff.
I've helped all these people, and in some ways you

(42:32):
end up I think it creates a It creates a
scenario where people feel like they can't reach out for help.
They have to hide if they're suffering. And so anyway,
you know, one of the things that we I know
I needed to implement it Camden and we did, you
know several years ago, was just really putting making one

(42:54):
of the pillars clinician or staff self care along with
another pillar of excellence clinical excellence and patient care.

Speaker 2 (43:04):
You know, so well, thank you for sharing that.

Speaker 1 (43:06):
Yeah, well, don't apologize, h Yeah, yeah, client comes in
healing trauma. Yeah, you talked about the voice is still
I'm not good enough. I'm not all this, all the
all the factory stuff from parents, right, yes, tell our listeners,
how do you heal from that? How do you placing

(43:28):
with new voices? How do you how do you get
rid of the old voices?

Speaker 2 (43:31):
What's the technique?

Speaker 3 (43:32):
Yeah, it's it's a great question, and I think the
so I'm going to tell you what I think the
answer is. But there's a wonderful saying actually from I
don't know, I heard it into a twelve step meeting.
I don't know, it's not the big book anywhere. But
if you can't think yourself into right action, you have
to act yourself into right thinking.

Speaker 2 (43:52):
Say one more time, please.

Speaker 3 (43:53):
Yeah, you have You can't think yourself into right action.
You have to act yourself into right thinking. And what
I think I think is really important. I like why
to start with that, because I think what's really important
that we miss about how we actually recover is it's
not like you have to learn something, but the way
that you actually recover is taking what you've learned, like

(44:18):
like it's a map, and then actually taking the journey
using that map. It's like understanding how to ride a
bike isn't the same thing as riding a bike, right,
you know? And so so yeah, I can talk about
how I think you get better, but I think what's
really important to understand is you have to actually do

(44:40):
the work, which means actually doing the therapy, all the
different types of therapy. It means finding a community, It
means having social support. It means learning the sort of
self soothing mantras and and and and little self care

(45:04):
activities that are the right fit to the right antidote
for your particular what I called it's not a term
I made up, basic fault, but basically it's a it's
a it's a term from a from an analyst.

Speaker 2 (45:17):
Uh.

Speaker 3 (45:19):
But but each one of us has our own injuries
from our own traumas, and we there's little and it's
like if you, if, if you, if you injure your
knee growing up, there's little exercises you can probably do
every morning to just make sure your knees warmed up
before you go out on the day, out on and
start using it. It's doing those things, those those little

(45:43):
emotional self care actions that are important. So to answer
your question, though, the the model that I developed at
Camden Center is based on something that sounds very fan
that's actually pretty simple. It's called the Camden Diagnostic ontology,

(46:03):
and what that is, it's just a framework for figuring
out what the origins of what you're experiencing are. And
it starts with the idea that the things that bring
us into treatment, addiction, self injury, eating disorders, phobic behaviors,

(46:28):
other types of compulsions, all that stuff that cause crises
that land us in treatment, those are all just solutions
that have become their own problem. What they all have
in common is their emotional anesthetics. And those of us
that end up with those problems are people that have
chronic pain, chronic emotional pain that isn't about what's happening

(46:48):
right now. If you're anxious or depressed because there's a
tiger in the room, or because you know, you just
you know, somebody just broke up with you, that's not
that's like contextual appropriate. We don't like those feelings, but
that's not the kind of anxiety and depression that leads
somebody to become an addict. If there's a tiger in

(47:11):
the room and you're anxious, it's pretty clear what to
do to not be anxious anymore, right you know, if
you're if you're feeling sad because or bad about yourself
in the context of a breakup, you know, I should
probably use a different example because breakups tend to trigger
our core traumas, but I fuck it, I'm just gone
with that example. To the degree that you're able to

(47:31):
recognize that the bad feeling is about the actual breakup,
it's kind of clear, like, oh, you know, this is
something that's time limited. It's not going to overwhelm me.
I'm going to be okay. If you're feeling anxious or
depressed all or most of the time in the absence
of anything dangerous or sad happening right now, what do

(47:53):
you do, right, you know, what do you do about that? Well,
the answer is nothing thing until you find something that
takes that pain away, you know. And for me, it's interesting.
You know, I used alcohol in cannabis and snorted cocaine
for you know, as a normy for a long time

(48:14):
before I became addicted. And I never really got addicted
to those things. What happened was I when the first
time I tried heroin enough of it for it to work.
It's interesting. I thought it was going to be this overwhelming,
transcendent experience. I grew up, I grew you know, I
grew up in the nineties, so it's like, you know,

(48:35):
Heroin was like that was was cool back then, you
know what I mean, you know, and I was like,
oh man, this is going to be I was expecting
to be like acid or something, you know, like something,
and it wasn't. It was literally I remember it to
this day. I was standing in the hallway in my
apartment in Westwood. It just felt like a little not

(48:56):
in my chest untied. That was it. It just felt like,
oh man, I'm okay. It just felt like me, but okay,
it's felt like me but not worried or like me,
but not feeling like I've like shame, and so getting

(49:17):
back to your questions, like the longest answer ever to
your question. You know what the canon diagnostic ontology does
is it basically says, look fixing, helping someone healing the
dysfunctional coping mechanism, the drug use or the sex or
whatever it is. That's relatively straightforward. What we know is

(49:38):
that if somebody got addicted to something or is engaging
in compulsions that are are are ruining their life, it's
because there's this underlying pain that they can't find another
way to make go away. And the reason that humans
will experience anxiety in the absence of something dangerous, or

(50:00):
depression in the absence of sort of shame and the
absence of something sad happening, is because we have a
system that we evolved to have that to create something
that I call trauma templates. So human brains use templates
to take information that we've learned about the world and
apply it to what's happening right now, not just for traumas,

(50:22):
for everything. I walked into this room and I saw
that chair. I've never seen that particular chair before, but
before the photons. Before my brain had registered the sensory
input from that chair, my brain did what's called the
template search and matched it with my chair template. And

(50:44):
as soon as my brain and this all happened preconsciously,
as soon as is my brain figured out that that
object was a chair and activated my chair template. My
entire lifetime knowledge, my thoughts, feelings, and behaviors related to
got projected onto that object, and that's what came into

(51:04):
my consciousness. I didn't even have the option of experiencing
that object as anything but a chair. So our brains
make templates for things that are common, like chairs, but
they also make templates for things that maybe only happen
once or twice, but scared the shit out of us
or really hurt us for good reason. Right, if you
get attacked by a bear, it doesn't really help you

(51:27):
to remember to just be afraid of that one particular
bear that attacked you, Right, it makes sense for you
to develop a bear attack template. And then what happens
is is the next time that you see a bear,
all of the defenses that enabled you to survive the
original bear attack, the anxiety, the hypervigilance, the muscle tension,
all that comes to bear on the present moment, and

(51:54):
it helps you survive that. Now, the problem is is
that if we get trauma templates that are who easily activated,
then they start getting triggered even when there's no bear around.
And so you know, and that's basically like what PTSD
or complex PTSD is. So you know, if you had

(52:14):
like bear attack PTSD, what that would mean is you're
not just getting your bear attack template when you see
a bear. You're getting your bear attack template activated just
because the leaves rustle. And then what happens is every
time the leaves russell, your brain goes, oh, match this is,
I know what this is. Match it to the bear
attack template, and all of the anxiety and tension and

(52:37):
mortal fear associated with the bear attack you start experiencing
right now. But because there's no bear around, you don't
even realize that it's because of your bear attack template.
You think you don't even know what it's about. You
just know the leaves rustled, and you're scared shitless. So
if you apply that to the traumas that we experience
when we're developing, which why and large are traumas related

(52:58):
to failed or insecure attachment, or not being safe around
the adults around us, or not being safe later around
the peer groups that we're in. Then you can start
to sort of understand how someone who didn't feel safe
in their family some of the time, or didn't feel

(53:20):
safe in their peer groups some of the time, or worse,
you know, got hurt, you know, physically or emotionally at
that age when you know when you're powerless at that age,
you really are. And the thing that I like to
say is it's not actually trauma that makes something traumatic.
Humans can recover without clinical trauma from the most horrific stuff.

(53:46):
It's what happens after the trauma. If you're able to
return to a sense of safety and control afterward, then
that right sizes the trauma template and it makes it
so that trauma templates only getting activated when there really
is something bad happening. But if you're not ever really

(54:08):
able to return to a sense of safety and control
after the trauma, then that's what makes our trauma templates
have like hair trigger activations. They become like fire alarms
that go off every time you're making pasta right. And
that's what we used to not feel, you know, the
reality for me was before I found Heroin. I walked

(54:31):
around most days with a fucking not in my chest
and in my stomach, and I didn't know what it
was about. I just knew that it had something to
do with feeling that who I was was someone that
wasn't worthy of respect, wasn't worthy of love or attachment,

(54:53):
was somebody that if people got to know me, they
would end up figuring out that I was bad in
some way, stupid or or annoying or whatever. The characteristics
were of the role that I played in relation to
the people that I got hurt with when I was
grown up, you know, the main one being my relationship

(55:13):
with my dad. You know, that was a big one
for me and I, you know, I feel like I
should say, you know, look, my dad's not a bad guy.
He did the best he could with what he had.
He just you know, had, I think probably a lot
of his own developmental trauma. And you know, who I
was as a kid really upset him a lot, and
he didn't have a good ability to control his rage.

(55:36):
And so you know what that meant was I got
hurt a lot. You know, I triggered him, and he
didn't have other skills to manage those feelings other than
taking it out on me. So yeah, and so when
I you know, so for so in my early adulthood,

(55:57):
I would try to make that feeling go away any
way that I could. But it was there in fact,
to be honest with you, it's still there a lot
of times when I wake up in the morning, even now.
But the difference now is, you know, I wake up
in the morning and I got a little bit of
that feeling, but I know what to do. I'm like, nah,
I know what this is. This isn't about what's that.
This feeling is not about what's happening right now. This

(56:18):
is that old fucking feeling from when I was nine, ten, eleven,
twelve years old, and it's not about what's happening right now.
And I can pop out of it, you know, usually
by ten fifteen minutes up, you know. And I got
a whole bunch of crazy shit that I do in
the morning now, stretching, breathing exercises, little little self affirming
mantras and stuff that you know, happen to be the
good antidotes for me. And ultimately, kind of getting back

(56:41):
to your question of CAM, then what we try to
do is really help people figure out like what that's
going to be for each person. The ones that work
for me are not going to work for you, right
because you didn't you know, I don't. You didn't have
my dad and I didn't have whatever your shit was,
you know what I mean.

Speaker 1 (56:54):
Well, one of the things I think you guys do
very well, and the art of healing trauma is you
make people feel safe to say they're scared, to say
I need help.

Speaker 2 (57:05):
You make them feel safe, they don't feel judged.

Speaker 1 (57:08):
Yeah, that's the most important thing, and you just start
feeding them love.

Speaker 3 (57:14):
I couldn't agree more. And you know it's really interesting
is I used to I used to really be so
much more drawn to the psychodynamic and trauma therapies than
I was to the behavioral therapies. And the thing that
I and the reason was was because what you just

(57:34):
said is part of the of the methodology of psychodynamic
and trauma therapies. What those therapies understand is that it
is the relationship. It is the relational stuff that's happening
in the room between the therapists and the patient that
is creating a sense of safety for that patient. And

(57:56):
the minute you lose that frame out, you're done, done done.
And in fact, what therapy is, in my opinion, is
taking things that are scary and moving little parts of
them a little bit, one little spoonful of a time
into a frame of safety and then metabolizing it. That's
actually how humans process it. If we can do that

(58:17):
at the time, right when the trauma happens, then we
don't get PTSD from it, right, you know what I mean.
If if we're able when something bad happens or we
get hurt to go find an ally who can reassure
us that we're we're good, we're leveled, that they're with
us right or wrong, you know what I mean, and
let us feel the feelings and validate them. Then they

(58:40):
then then that's how we feel. And then those feelings
just kind of become right sized and take their place
in the history of our life and the history of
our timeline, you know, and and so and what Anyway,
what I came to realize was that the really good
behavioral because behavioral therapy is also amazing cognit behavioral therapy,
you know DBT and amazing life saving. And what I

(59:00):
come to realize is that the really really good therapist
whether they're doing DBT or CBD or ACT or tsychodynamic
therapies or any of the trauma therapies, what they all
do intuitively is they know how to relationally make their
patients feel safe.

Speaker 1 (59:17):
Yeah.

Speaker 3 (59:17):
Yeah, and that's I don't even know if you can
teach that.

Speaker 1 (59:19):
You can't teach it. You can't teach that. I think
you'll appreciate this, and this going back to triggers. When
I drive on the ten freeway, yeah, and I see
an amber alert, I never stare at it because the
next word is child deduction. And then I'll think about
being at thirty five hundred North seventy fifth Street, and
I teach my clients know what your amber alerts are.

Speaker 2 (59:40):
So I think healing traumas you got to get ahead
of it.

Speaker 1 (59:43):
You got to get ahead of you got to really
be honest, like you know, when am I out of
my league?

Speaker 2 (59:47):
I can't do this, I can't go down. There's certain
things I just can't do anymore.

Speaker 3 (59:50):
Yeah. Yeah, I'm so glad you mentioned that. One of
the things that is the most important principle of trauma work,
in my opinion, is knowing your patient's window of tolerance

(01:00:12):
and always staying within it. So good Man and I
think that ultimately our job is healers is to help
people be their own healer, meaning either the steward of
their own care. And that principle is actually true in
all every every modality has that principle. They just say

(01:00:35):
it in different ways, you know. And so if you're
doing trauma therapies, they talk about doing resourcing. If you're
doing CBT or DBT, of course they're much more analytical
and concrete, but they'll talk about sud's scores, and what
they'll talk about is they will create a fear hierarchy
in doing in the doing of exposure work, and you

(01:00:56):
start at the lower levels of the exposure work, and
you don't get people over if you if you're, if
you're if you say a ten out of ten is
uh sub subjective unit of distress, A SuDS is the
term that's used, is the highest. You don't really want
to move people much beyond seven. This is what you say,
because otherwise it stops becoming an exposure and starts becoming
a new trauma.

Speaker 2 (01:01:18):
Right.

Speaker 3 (01:01:19):
So, but but that, but teaching people that for themselves
is really really important. It's knowing where your window of
tolerance is and knowing that this is a journey and
you're going to get stronger and stronger. What your window
of tolerance is right now is just going to get
wider and wider. Is you get better and better? Based
on something you and I were saying earlier, which which

(01:01:41):
was that it's people don't really get better until they
want to get better, meaning you know, this was related
to your question about you know, if you've got a
kid or a loved one who's who's in an addiction,
you know, what can you do? And and we talked
about the fact that really until somebody wants to stop using,
hits the bottom and decides that that they that they
want to get better, there isn't a lot that you
can do. Unfortunately, just hitting a bottom and wanting to

(01:02:04):
get better it's necessary, but it's not sufficient for recovery,
meaning because if all that was needed was just hitting
the bottom, then hell man, that would be a lot easier.
You know, there wouldn't be any twelve step meetings, there
wouldn't be any treatment centers any of that. So so
the question is, well, what what is sufficient? What is
it that is actually needed for someone to get better

(01:02:25):
from an addiction, and I think the answer to that
question is there are. Of course, it's different for each person,
but I do think that there are a couple sort
of significant pillars or significant processes that need to happen

(01:02:48):
in order for a person to really be successful in
getting better. So one is literally just help the helping
the person maintain abstinence. The metaphor I like to use
with addiction is addictions like being on a planet, like
a bad planet, and the gravity of the planet is

(01:03:09):
holding you to the planet, and each day that you
put between you and your last use is like being
on a little ship that brings you another mile away
from the planet. The way that gravity works is, you know,
the farther you get away from the planet, the less
strong the gravity pulls you. Right, So when you're on
the planet, it's pulling you the strongest that it's ever
going to pull you, and if you're a million miles away,

(01:03:30):
it's hardly pulling you at all.

Speaker 2 (01:03:31):
Right.

Speaker 3 (01:03:33):
Analogously, you know, putting thirty days together, staying sober for
thirty days when you've already got five years of abstinence
is a piece of cake. Putting thirty days together when
you've got one day of absence probably the hardest thing
you're ever going to do. So part of what is

(01:03:53):
necessary to getting too sufficient for recoveries one is there
needs to be something in place to help the person
just remain abstinate. That's the reason actually why residential treatment
centers were invented. There's nothing magical that happens in residential
treatment that can't happen at home or an outpatient therapy.

(01:04:14):
There's nothing magical that happens out in the desert or
the mountains or whatever that can't happen in Los Angeles
or San Francisco or wherever else. The reason residential treatment
came into being is because it physically removes people from
their addictive substance or behavior, and it's sort of guarantees.

(01:04:36):
It physically guarantees they're going to get thirty days away
from the surface of the planet, and thus the poll
is going to be a lot less strong when they
return to their troops. Right. So that's one piece. And
there was actually a really excellent study that showed this,
and I probably shouldn't even mention because I don't remember
the name of the study, but essentially it looked at

(01:04:57):
a cohort of several thousand patients over eight years. And
this was what's called the post hawk analysis, which is
just not what you not what makes a good study,
but it's like, oh, here's something interesting that we looked
at that we figured out when we got all this
data together. And one of the things that this study

(01:05:18):
saw was it tracked people for eight years and it
was just addicts in any type of recovery. I don't
even remember what the original research question was, because the
part that was interesting to me was this post hawk
analysis that they did. What they saw was that was
the following if they took all of the people in

(01:05:41):
the study at the first day of the eighth year
of the study, so these people had already been in
the study for seven years, and they put them into
i think four different buckets. People who on that first
day of the eighth year at that moment had less
than a year of sobriety, people who had between I
think one in three years of sobriety, people who had

(01:06:04):
three to five years of sobriety, and people who had
more than five years of sobriety at that point in
this And then they looked at, Okay, what percentage of
the people in each bucket made it through the next year,
that final eighth year without using it all. And it's
And what you see is is that like almost nobody,
right who had less than a year made it. You know,

(01:06:27):
a fair number of people who had between one and
three years made it. And like every like something like
eighty to ninety percent of the people who I think
had four or more years I can't remember what the
buckets were made it through that last year. And to me,
what that is good evidence for is that nothing, nothing

(01:06:48):
is as effective at helping somebody stay sober then how
long they've already been sober.

Speaker 1 (01:06:54):
Yeah, that's really that makes so much sense. Let me
ask you this, what is your requirement for people to
go away for treatment, meaning to go to residential treaty. Yeah,
residential treatment if.

Speaker 3 (01:07:04):
And only if they cannot remain we're talking about addiction,
remain abstinate where they live, right, You got to come
back at some point, right, So, and that might be

(01:07:26):
an overstatement. I do think there is a benefit to
immersive treatment and to some degree just being taken away
from all of your stressors. So I actually should probably
restate that I do think you know, people are complicated
cases are complicated. You know, even in cases where somebody
might be able to remain abstinent living at home, there
might still be other reasons for them to go to residential.

(01:07:48):
But by and large, the benefit that you get from residential,
which is kind of a guaranteed thirty forty five ninety
days of abstinence, it comes with a cost because the
day the day you leave residential and come back home,
you now are in this unfortunate situation where that day

(01:08:08):
is the day you lose all of the clinical support
and the relationships that you had with your with your
therapist in the residential program, and it's the same day
that you get re exposed to all of your triggers
and stressors where you live. So one of the things
that we've done at Canada is we have this program
we created it's called an Individualized Support of Living Programs.

(01:08:31):
It's great. The problem with it's just super expensive because
the reason it's expensive is because we match the patients.
They live in one of our houses, but they're matched
with a twenty four to seven care partner and it
provides some of that same level of containment that you
get by going to residential, but it does it in
the environment in which they live, so they're not being

(01:08:52):
sheltered from their triggers and their stressors, and it avoids
this problem that I called the recidivism cliff that often
happens when people leave residential treatment.

Speaker 1 (01:09:04):
So we live in Los Angeles, a lot of interesting folks.
You treated a lot of interesting folks. Help educate our listeners.
I don't care how much fame money nobody gets out
of this thing. There's no shortcut. Just because you blah
blah blah doesn't make you mean. Can you talk to
your experience working with people in Los Angeles?

Speaker 3 (01:09:26):
Yeah, I mean I'm assuming what you're asking, specifically my
experience working with people like in the entertainment industry with
who are famous, and yeah, and you know, I have
to be honest. I mean we've definitely worked with quite
a few number of those patients. It's exactly the same
as working with somebody who isn't famous, with an additional burden,

(01:09:50):
with an additional difficulty I think, which is it is
oftentimes the thing that underlies the addiction, the pain, anxiety,
and shame, whatever, that that that the person was trying

(01:10:10):
to anesthetize with the substances which the same thing that
is the drive to become famous. It's it's you know,
it's it's hard, really hard to make it in the
entertainmentustry is so much harder than it almost any other industry,
you know, almost every other industry. You know, even if
you don't make it to the top, you got a
reasonable chance of making it somewhere, right, you know, ninety

(01:10:33):
nine point nine percent of the people who try to
make in the entertainmentustry don't don't don't make it at all.
And so it takes an a tremendous, tremendous amount of
drive and commitment in order to achieve success. And it's not,
by the any way guarantee. I'm not trying to say

(01:10:53):
that people who don't achieve success and the entertainmentstry aren't
also committed. But what I'm trying to get at is
that drives comes from that same place of wanting to
feel valid, lovable, worthy of respect, worthy of love and attachment.
And the fame in some ways is a lot like

(01:11:15):
a drug, because when you can go out into the
world and get validation, it's like a salve for shame.
I mean, that is that is just it's human nature
and so one of the things that I have found

(01:11:36):
that is challenging about recovery when you're famous is you
have to kind of figure out how to reorient towards
the fame and towards your career because you know, look,
when you know, you and I in our jobs or
anybody else and who's not you know, in the entertainment industry,

(01:11:58):
we're not selling ourselves right when you're When you're in
the entertainment industry, you are the product, not just when
you're in the movie, and not just when you're releasing
an album, and not just and you know, I think
what it does is is it makes it really really
hard not to be vulnerable all of the rewards and

(01:12:20):
all of the pain of your work. You know, I
can't tell you how many people I've worked with in
the entertainment industry. Where I mean social media is I mean,
it's devastating for most people. But you know, when you
are in the entertainment industry and you you are a

(01:12:42):
public figure, the amount of vitriol that people will write
about you is and and I think it is those
who seek fame to begin with, or seek the career
in entertainmentstry. It's like are oftentimes even more sensitive to
that than those of us who didn't go into the

(01:13:03):
entertainment industry. You may have more sensitive to be I'm
pretty I'm probably as sensitive as there. But uh the
but but uh yeah, so it's it's I would say
that is that's probably the main thing. The recovery piece
is the same. It's all developmental trauma. It's all trying
to figure out how to get rid of bad feelings
that aren't about what's happening right now. The difference is

(01:13:26):
is just when you're famous and addicted to something, you've
got to figure out how to get unaddicted to the
substance or behavior you're addicted to, And then you have
to figure out how to have a healthy relationship with
your career and your fame so that you're not trying
to use it to fill up a hole that it
can fundamentally can't fill.

Speaker 1 (01:13:41):
Okay, we're at Ushila, there's one hundred people there. You're
giving a little talk recoveries from three days, Max's a
year and you and the question from the audience member is,
and we'll close the show with this, what's the most
important thing to help me wake up and stay sober?

Speaker 3 (01:14:02):
Yeah. So first thing is don't use no matter what,
and the second one is I think the most important
thing is figuring out how to develop a sense of
loving self connection. I think ultimately that's what it is.
That's what will make you feel safe, that's what will

(01:14:23):
calibrate your emotional system. That's what will make all the
different parts of you be the right size and work together.
You know, you know in twelve step, anger gets a
really bad rap. I don't think any emotion is bad.
I don't think anger is bad. I don't think anxiety

(01:14:43):
is bad. I don't think pleasure is bad. It's just
about all of the different parts of ourselves being in
balance with one another, and ultimately, the way we come
out of balance, the original think that then sets off
the the process of becoming progressively more out of balance,
is when we get disconnected from ourselves. And if you

(01:15:07):
can do it, you'll feel it when you and I
mean listen, that's the feeling Heroin gave to me. Heroin
when I that first time I felt it standing in
my hallway and that nod in my chest untied. I
what I know now what I felt was it was
just the sense of being lovingly connected to myself, which
is I think the natural state. I actually just think
that's the natural state.

Speaker 2 (01:15:28):
You know. Thanks for being on the show. Sure, I
love you. I appreciate you.

Speaker 1 (01:15:32):
The Sino Show is a production of iHeart Podcasts, hosted
by me Sina McFarlane, produced by pod People and twenty
eighth av Our. Lead producer is Keith carnlik Our. Executive
producer is Lindsay Hoffman. Marketing lead is Ashley Weaver. Thank
you so much for listening. We'll see you next week.