16 - Insomnia, Interventions, and the Importance of Community in Recovery with Dr. Brian Licuanan - Revelizations

Episode Transcript
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(00:09):
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(01:23):
Hi everyone, welcome to Revelizations.
I'm your host, Brian James.
Before I introduce today's guest, I'd like to make an announcement.

(01:44):
I had a milestone with my podcast and I want to share it with you since you're the reason
I was able to reach it.
I got an email after I released my last episode with Roberto Cappodieci that collectively,
my podcast has gotten over a thousand listens.
I'm not sure how much time a thousand listens adds up to, but it's a significant amount.

(02:05):
So I wanted to thank you.
Thank you for when you're sitting down in your office while you play solitaire, you
have an episode of Revelizations playing.
Thank you for listening to me on your commute to work, on a road trip, on your way to play
some pickleball, exercising in your gym, on the toilet, and wherever else I had the
privilege of tagging along with you throughout your day.

(02:26):
I hope I've added some new knowledge to your arsenal, made you think new thoughts, and
most importantly, brought some extra joy in your lives because you've certainly done that
for me, truly.
Thanks for helping me reach this milestone.
I look forward to continuing to learn more about the world around me and sharing it with
you.
Even though you've done so much for me already, it would help me to keep making strides if

(02:49):
you could leave a review on whatever platform you listen to Revelizations and tell someone
about the Revelizations podcast.
That'll help me grow.
And on that shameless note, let me introduce today's guest, Dr. Brian Licuanan.
He is an author, speaker, family crisis strategist, and board certified psychologist practicing
out of Southern California with nearly 20 years of clinical experience treating highly

(03:14):
acute clients struggling with mental health and substance abuse disorders.
He also facilitates support groups for families needing to get loved ones into treatment and
provides family crisis interventions for families desperate for help.
Dr. Licuanan also has a specialized focus on insomnia.
Using cognitive behavioral therapy for insomnia, he helps address underlying behaviors in his

(03:36):
patients to improve their pre-sleep habits, which can then alleviate the symptoms of insomnia.
He is passionate about spreading mental health awareness and has appeared on The Doctors
Show, Dr. Drew Midday Live, Spectrum News, Fox News, KTLA News, Women's Health, and MSN
Health.
Today, he joins me as we talk about what got him interested in his specialties within mental

(04:00):
health, understanding insomnia and sleep hygiene.
Interventions for destructive behaviors.
The importance of family and community in the recovery process, eliminating enabling
behavior and more.
I hope you enjoy this episode of Revelizations as much as I do.
Thanks for listening, everyone.
Hi, Dr. Licuanan.

(04:22):
Thanks for being here.
I'm very excited for this conversation.
Hello, Brian.
Thank you.
I look forward to it.
Great.
So tell us a little bit about yourself and what got you interested into your field and
your specializations.
Yes.
Well, I am a licensed psychologist practicing out of California.

(04:42):
I have my PhD.
And a couple of things that I do on a clinical level is at the current time, 100% of my work
is telehealth.
I see clients all across California contracted with various entities, whether it be outpatient
clinics and hospitals, mostly in private practice through telehealth, and a lot of what I work
with at the current time on a private practice level are specializations in people struggling

(05:08):
with insomnia.
I work a lot with substance use disorder and a lot of family crisis strategizing.
These are for family members who have a loved one out there who is struggling, whether it
be with a substance or mental health, and they're just resisting help.
And so what I do is I strategize with the family unit on things that they can do and

(05:31):
hopefully how to get their loved one to a point where they can surrender and accept
help.
I'm also very passionate about spreading mental health awareness, so opportunities like this
that you provide, podcasts, talks, media appearances, writing articles, as well as I recently released
a book last May, a strategy guide to help family members get their loved one into treatment.

(05:53):
So that's mostly on a very general level of what I do on a clinical practice.
There, yeah, there's so much, there's so many different directions there.
I think I want to dive into insomnia first because I would just, I would hate to deal
with that.
Like everyone has those bouts of like a night where they can't sleep for whatever reason.

(06:14):
It's almost, you know, from the Geneva Convention, it is torture.
It is, you can't make someone be sleep deprived because it is an act of torture.
So it would be torturous on to me to be the person who is struggling with insomnia.
So what are the different types of insomnia and what are some treatments or some strategies

(06:37):
to help mitigate the impact of insomnia on someone's life?
Yes.
Yes.
Well, you're absolutely correct.
Insomnia, as you had mentioned, is a very, very debilitating level of stress on the body
which can have huge impacts, especially when it's chronic for a long period of time on

(06:59):
mental health or even on physical health, to the point where you were mentioning is
sleep deprivation was a form of torture for prisoners of war, even to the point where
they had found when doing interrogations for people who are arrested for suspected
crime is that there were people that were sleep deprived for so long that they admitted

(07:23):
to crimes that they did not even commit.
And so it is very impactful.
But insomnia in general is sometimes a lot of people think that insomnia is just difficulty
falling asleep.
But to get the render the diagnosis according to the Diagnostic Statistical Manual, the
for mental health and psychiatric conditions, it's either difficulty falling asleep or we

(07:44):
call initiating sleep, difficulty staying asleep, like you're waking up throughout
the night and then just waking up too early than your intended wake up time.
Like, for example, you want to wake up at 8 a.m. each morning, but you consistently
wake up at 4 a.m.
Has to happen for at least three or more times a week for at least one month.

(08:04):
And so those are the general symptomologies of insomnia, which we call primary insomnia.
And usually a lot of times with insomnia that I find, I actually specialize in a certain
treatment called cognitive behavioral treatment for insomnia, for short, CBTI.

(08:26):
And the basic premise of that is that assuming someone doesn't have an untreated medical
or psychiatric condition, that a lot of times we engage in bad habits, which we call sleep
hygiene.
People are, for example, doing stuff in bed other than sleep and intimacy.
For example, watching TV on the electronics, paying the bills, having contentious conversations

(08:49):
with a partner.
And we start associating the bed with things other than restoration, sleep and serenity.
And so it basically looks at that adjusting our 24-hour clock, our circadian rhythms.
And a lot of times what's happening, those behaviors that we offer for sleep, which we

(09:11):
call sleep opportunity, we are engaging in behaviors that are counterproductive to efficient
sleep.
But you're absolutely correct, research has shown that chronic insomnia is a significant
predictor for relapse on substances.
We find that people with various medical conditions such as hypertension, even diabetes, it's

(09:36):
not atypical for them to have impaired sleep, weight gain as well.
And on a psychiatric level, people who have heightened anxiety, post-traumatic stress
disorder, depression, and various other conditions are having impaired sleep as well.
So it's a really, really important condition that needs to be looked at.

(09:59):
Over the years, we are finding medical providers and other clinicians.
It's no longer a secondary thing.
You go into a doctor for a stomach issue, oh, I have insomnia, okay, well, let's go
ahead and take some melatonin or prescribe some type of sleep aid.
We're looking at, they're looking at it and treating at it as a significant co-occurring
condition that what came first, the chicken or the egg, the insomnia, is the insomnia

(10:24):
causing your anxiety or is your anxiety causing your insomnia?
It doesn't matter.
It's an important condition to treat as well.
Yeah, it's majorly important because like, let's look at this as just like an evolutionary
standpoint of how important sleep is.
So a third of your life you're going to spend literally unconscious and it's because very

(10:45):
important, many important systems are running in your brain during that time.
So you're getting like, let's even think about weightlifting.
So weightlifting, you're sleeping, during the day you're weightlifting and you're breaking
your muscle down, you're breaking your body down and so your body doesn't regrow that

(11:06):
during the day.
When you go to sleep, your body secretes different testosterone, different growth hormones, HGH
and this is to produce the growth.
So if you're not sleeping, I think it's your pituitary gland, your pituitary gland isn't
secreting those hormones and it does it at like a very specific time.
I think it's, I believe it's like right when you fall asleep or something like that, like

(11:27):
when you're in deep sleep, you're getting these hormones and it's recovering and like
the, let's talk about your brain and like Alzheimer's and there's these metabolic processes
that are happening in our brain that are causing these buildup of, I believe it's beta amyloids,
like these proteins in our brain that are linked to Alzheimer's and like you said, it's

(11:50):
the chicken and the egg thing.
But when you go, so is the increase of beta amyloid, the presence of it in your brain,
is that due to Alzheimer's or like that's the chicken and the egg thing that I'm talking
about.
And like when you go to sleep, this process of sleep is very important like for the brain,

(12:11):
it's secreting cerebrospinal fluid all over your brain to wash all these metabolic waste
products throughout the day, otherwise they build up there.
And so insomnia just seems like it's such an important disease to look into because
it, like you said, there's diabetes, there's hypertension and which came first, but regardless,

(12:34):
everything is going to be exasperated by not being able to sleep, by your body not being
able to recover from the stresses from the day and then adding more days on top of that.
And then eventually, you know, starting to see these major degenerative, major impacts
on your quality of life.
Yes.
And you bring up a lot of points and, you know, the American Medical Association and

(12:58):
various other associations, on average, they say about seven to nine hours is the recommended
for an adult for average sleep and you're right, one third, if you think about it, one
third of our life, if we adhere to the seven to nine range of sleep is one third of our life.
And it's critically important. A lot of times people also don't realize insomnia is just one

(13:23):
sleep disorder condition. There's quite several others. And what happens, a lot of times people
think, well, I slept fine. I went to bed at 10 and woke up at six. But also people don't realize
is there could be a lot of processes that may be taking place that interrupt sleep,
which we can maybe talk about later, such as the sleep apnea. Snoring is a sleep disorder.

(13:47):
Sometimes people have these what we call periodic limb movements, where are these involuntary
movements that disrupt you from deep sleep to wakeful sleep. There's also REM disorder,
where you act out on behaviors or dreams. There's night time eating disorder,
where you wake up in the middle of the night and eat concoctually. There's sleep talking,

(14:08):
sleep walking. So a lot of those processes are disrupted to sleep and people don't really
realize that. And so a lot of times, number one, you can get assessed, whether it be a home study
or in lab sleep study, which is a test to really monitor a lot of the physiologies going on,
your breathing, eye movement, limb movement, and all of those processes to see if there's any

(14:32):
disruptions during the sleep opportunity time. And so that's one thing I want you to recognize.
A lot of times, it's either you go to a sleep study or a bed partner or a roommate will let you
know. There's sometimes people realize that they were snoring. Sometimes people do have this
thought belief that snoring means someone's getting deep sleep and, oh my God, you slept so well,

(14:56):
you were snoring so loud. And a lot of times, no, they are not getting restful sleep. And that's
why there's a lot of people who say, hey, I slept fine. I was asleep all night, didn't wake up,
but I'm so fatigued during the day. And so that's very important to look at whether or not there's
some type of co-occurring medical condition or maybe there's something going on in disrupted
sleep. And if I could say as well, there's two major sleep states that we go through in our sleep

(15:20):
cycle. It's the non-REM sleep, which has three major stages of sleep. That's from light sleep,
dozing off to deep sleep. And in the non-REM sleep, that's where a lot of these very important
functions are taking place. Release of growth hormones, blood pressure tends to ease down,
so does pulse rate. And if we're constantly being disrupted because of snoring,

(15:44):
movement, wake up to urinate, we are getting disrupted sleep, so we're never getting that
deep sleep state. And then we transition to the rapid eye movement, which is the sleep
state that everything is paralyzed, of course, except eye movement and our breath. And so we
cycle through those two stages throughout the night. But what happens in that night process

(16:06):
can be very, very disruptive to a lot of physiological functioning. What happens at night
too, our brain is also consolidating a lot of the data that we attain during the day, sensory motor
data, short-term to long-term memory processing, among all the other things that you had mentioned

(16:28):
with, yes, the cleansing and everything else. By point being, sleep is critically important.
And really talk to your doctor if you're experiencing symptoms such as fatigue,
memory issues, and any other thing that you can't figure out. Make sure you keep sleep as one of
those options to assess. Yeah, it's very sobering when you hear someone speak about sleep and how

(16:54):
important it is because you're not really conscious for it. And you don't tip, like let's just say,
typically you're just sleeping and you don't, you're not doing anything, but it's, there's so many
important things happening that you not getting sleep in such a major part of your day and just
the knock-on effects that it has when you're not getting that really, like deep sleep,

(17:21):
really good quality sleep. Like of course, something that you're doing, like staying in the seven to
nine hour guideline, like of course something that you're doing for a third of your day is going to
have major implications on the other side of that. You were talking earlier about the different types
of insomnia. And one of them is you wake up throughout the night or you wake up earlier

(17:45):
than when you're planning on. And based off of what you just said about, like there's very
different, like important body processes that are happening during certain sleep cycles.
And so when you don't get it, like it's having an impact on that. So let's say someone is falling
asleep, they can fall asleep very easily, but then they get up in like four hours or something

(18:12):
like that. Then the rest of the night they're tossing and turning. So what would you say,
how could you intervene in a sleep hygiene way that could correct their body, that circadian
rhythm that's saying, Hey, it's time for you to wake up. And like, I don't want to wake up. I
want to sleep for three more hours. How do you correct that? Yeah. And that is, that is very

(18:34):
common. And so I'll upfront that with that. Let's assume that there are no recurring medical or
psychiatric conditions. And so let me just talk a little bit about that, because of course, it's
very hard to sleep throughout the night if you have a extreme pain issue, right? Let's say you
just had back surgery, so it's going to be very hard to get consolidated sleep. If you have a

(18:58):
urinary bladder issue where you are still being treated for that and you're urinating once every
hour, two hours, it's going to be very hard to get consolidated sleep. And so I just want to
recognize that there are medical conditions that if they're not managed or diagnosed or not treated,
that will have a huge impact on the restorative and quality of sleep. On that same note,

(19:22):
psychiatric conditions, right? If someone has heightened anxiety that it's not being treated,
you'll be waking up because of racing thoughts, severe depression,
ruminating thoughts as well, post-traumatic stress disorder. If you have a car accident or you had
some tragedy happen, and that's not really processed work through, it's going to disrupt

(19:43):
your sleep. And so I'm going to answer this question presumably from the angle that there
are no medical or psychiatric conditions co-occurring that are at an acute level and
or not being treated that is impairing the sleep. But typically speaking, on a 24-hour
clock, once you wake up for the day, we have this natural, what we call sleep pressure.

(20:07):
That's just another word for sleepiness. The premise is the longer you're awake,
the stronger that sleep pressure is. And I look at sleep pressure as the equivalent of a gas tank.
And for example, if I'm in Orange County here, California, and let's say I want to drive to
Las Vegas and I'm using a gas-operated car, if I leave Orange County, California with

(20:33):
a quarter of a gas tank, I am not going to make it to Las Vegas, my full destination.
I'm going to have to stop along the way. And so to maximize my full destination, I want to leave
my home with at least near a full gas tank. And the reason why I use that as a metaphor is the
same with sleep, is that you want to make your destination, which is your wake up time. And a

(20:58):
lot of times people are going to sleep with not a filled gas tank of sleep, which is that sleep
pressure. And sometimes people will go to bed at a certain time and maybe they'll say their sleep
pressure is 60%, meaning just is that we want it to be 90% or more. And if you go to sleep at
60% sleep pressure, you'll fall asleep fine. It'll initiate sleep, but maybe three hours later,

(21:23):
you wake up because that sleep pressure has been minimized or depleted. And so you want to make
sure that your sleep pressure or sleepiness is, for example, subjectively speaking, as you measure
it 90% or more, is that you're really, really sleepy. So that sleep pressure can take you
through the night. And some ways we do that in the CBTI treatment is we delay people's bedtime

(21:48):
and to develop that sleep pressure, right? So let's say, for example, you go to bed at nine
and now we're going to start working on delaying your sleep pressure, your sleep time to maximize
or heighten, strengthen that sleep pressure. And hopefully over time, we can adjust that.
Another thing that we can slowly taper it back down closer to an ideal bedtime,

(22:12):
but what's critically important as well is the wake up time. Sometimes people believe,
have this myth that you can make up for lost sleep. Oh my God, I slept so bad. I was working
late last night and so I only got three hours of sleep. So I'm going to sleep 14 hours today to
make up. And so what that does is it disrupts your sleep opportunity for the next night.

(22:34):
It's not so important of your bedtime, but what's critically important is your wake up time
and to start that sleep pressure to build routine. So those are some of the things that we do on a
general level in addition to sleep pressure is adjusting people's sleep time. And of course,
looking at other things as well. The last thing that I was going to say is a very common issue

(23:01):
is people's wake up in the middle of the night to go bathroom, specifically urination. And unless you
gave birth to a baby recently and that's going to impact your urinary, you have a urinary bladder
issue, or you aren't taking very necessary medication where you need to take a lot of
intake of water, there's really no reason why you should be waking up in the middle of the night

(23:21):
to urinate. And so what I work with people to do is start draining your bladder, limit your
liquid intake several hours before bedtime and start draining your bladder, meaning go to the
restroom. And sometimes I ask people like, oh, I woke up like three times last night to go
bathroom. And I asked them, how much was your output of urine? Oh, really little. I said,

(23:42):
even though you're able to fall back asleep, that's still disruption to your sleep opportunity time.
So that's one of the most common things people deal with is these frequent urinations to the
middle of the night. And a lot of times there's not a condition or really true need to urinate.
So that's one of the sleep hygiene stuff that I work with people as well.
Yeah. And that makes sense because you kind of do that with little kids too. It's like, hey,

(24:05):
I'm cutting off liquids at seven o'clock. Like you don't need to be getting up to pee or you don't
want them to wet the bed or something like that. So you kind of do that for a younger population.
And then you forget about yourself. And it's, I think it's kind of like in culture to where you
think, oh, I'm just at that certain age or just get up and I go to the bathroom a lot. But yeah,
it's a lot of it is like what you're saying. You just not dehydrate your body, but you just,

(24:31):
you're not chugging water right before you go to bed. And then that urge to go to the,
to the bathroom because is, is minimized. Cause like you said, one of the sleep processes is
your body kind of slows down that, that urinary production as well, like when you're sleeping.
So it's not like you're going to be producing the same amount of, of waste that you would

(24:53):
throughout the day normally. Cause your body's like, okay, I know what to do. I know to slow
the slow this down. And yeah, it's just, you kind of think like, okay, well little kids need to do
that, but I don't need to do that. I don't, I don't need to monitor my, how much I'm drinking
or anything, or you're on the other side of that. And you're, you think that you're supposed to be
drinking eight glasses of water a day. It's like, oh no, I've only had four. I better chug

(25:16):
four right before I go to bed or something like that. And yeah, it's the same thing.
And you want, and one thing too, I get a lot of people who are concerned, look, I'm going to be
dehydrated. And I said, number one, if you're drinking through the day, 65 or more percent
of our body's made up of water, you're not going to get dehydrated. I know that was a big concern.
And then of course drink more earlier in the day. But also if throughout the night, let's say,

(25:40):
for example, three hours before bedtime, you're drinking a bladder, you can have a small shot of
water or you can rinse your mouth with liquid. If you're getting dry mouth, you can chew on an ice
cube. So, but the point is, is really try to drain that bladder as much as possible. So it doesn't
get to the point where you have that urgency that'll wake up. And there's some times after where we

(26:00):
drink people's bladder is they just wake up because they've been primed to wake up. And so we have to
break that priming effect. Like every two in the morning, four in the morning, I would wake up
and they don't really have to urinate. And so because their body's been so conditioned as
their internal alarm clock to wake up. And so it takes time to break that as well.
Exactly. You're retraining your circadian rhythm too, because yeah, there's spikes of,

(26:25):
of hormones throughout the day for certain time that influence wakefulness, sleep, like getting
that sleep pressure, that melatonin, that naturally occurring hormone that we have and taking it
adds more, but like cortisol spikes or something like that's going to cause you to start waking
up when your cortisol starts going up. And so conditioning your body to like, Hey, let's,

(26:46):
let's calm down on that. I kind of want to, I, well, I definitely want to dive into your other
specialty of like interventions and helping people treat like really destructive behaviors. What got
you, cause this is, this is really heavy. Like you're intervening in people's worst moments when

(27:07):
you're dealing with that part of a person's life or family life. What got you interested in,
in doing interventions or, or helping people process through interventions and how to strategize?
Well, I think it out of opportunity. Number one is when I first got my PhD,

(27:29):
we have to have certain light hours for licensing. And so the psychiatrist who I was getting my,
what we call post-doctoral hours for California, he concurrently during the time of him supervising
me, he opened up a treatment facility for male and female adults struggling with significant

(27:53):
high acuity mental health conditions and substance use issues. And so he said, Hey,
I'm open to this facility. You want to be a part of it? I said, yeah, absolutely. And so
I did. And I was able to see some very, very highly acute mental health conditions untreated
bipolar disorder, even some of the psychotic disorders, such as schizophrenia, schizoaffective,
high level substance use disorders, chronic heroin use, meth use, alcoholism and opiates and so forth.

(28:22):
And so just dove right into it. I was working with clients on an individual level,
worked with clients in a group level, on a family level. And from there, it really got me
a good preview of all the dynamics and conditions involved with that arena. And then of course,
there was a passion interest in it. And one thing I didn't mention also is, so I was working there

(28:48):
for about 15 years. And concurrently there, I was also facilitating support groups through
the National Alliance on Mental Illness. And these were families who were struggling with loved ones
who are resisting any help. And over time, I was recognizing these current themes out there,
these struggles that people were dealing with, that we don't know what to do, we're afraid,

(29:12):
they're suicidal, they're psychotic, we're afraid they may be homeless, or they may never talk to us
again. And so a lot of these fears and questions and challenges started to become very homogeneous,
right? They were very consistent. And then my interventions, I didn't realize I was
formulating my interventions that were also consistent based on these consistent questions.

(29:33):
And so that's where my book came and where I said, you know what, I thought there was
something out there, a manual or something out there where it helps intervene people.
There'll be bits and pieces, like maybe a guide on how to set limits and boundaries,
a guide how to self-care. But there was not a step-by-step manual of knowledges and steps

(29:55):
to help the family member get to a place where they can accept and provide interventions to the
struggling loved one. And so that's where that came from. So it was more of an opportunity to
present to myself. And then from there, I realized, man, this is something that's a big need,
but I'm also very passionate about. Yeah. It's very interesting. You never,

(30:16):
you don't, there's so many different ways that you can go in life and you never really know
what's going to pique your interest. So just this chance of opportunity for you has really
changed the trajectory of your whole life of something that you didn't even really
particularly know. Obviously you are very interested in people's mental wellbeing,

(30:37):
but this specific niche of that, and you wouldn't know that without the opportunity and just the,
the seemingly randomness of life is always just really fun to think about. It's like,
I always say, it's like, you never know. Like maybe your favorite hobby in the world is
spearfishing, but you just, you don't know unless you try it. And like, you have to have that

(30:58):
opportunity and like, you got to put yourself out there. Yeah. And so you, you found this
opportunity and this specialty. And I love hearing that, that passion behind it and kind of just how,
how you arrive to that destination and interventions are tricky, at least from the

(31:19):
outside. I've never been a part of one. I've never seen one outside of culture. So there's
or like a, you know, a TV show or something like that. So I don't know if there's like this
Hollywoodification to where they don't seem like that, but they, they aren't as how they're
portrayed. And is there another way to do an intervention with someone without ambushing them,

(31:45):
without just suddenly surprising them that, Hey, we know you have a problem. Like you aren't keeping
this a secret. This is impacting us. This is impacting you. Here are the ways that it's
impacting us and please go get help. Is there, is, is that like the tried and true? Is there
another, is that the best results when you do it that way? So intervention, at least how I define it

(32:11):
is just a intentional plan and series of sequence of behaviors and actions to provide assistance in
this arena. Right. And a lot of times these interventions, you're right. Is there a Hollywood
part to it? And sometimes it can come off. You watch it and it's like an ambush. It seems

(32:34):
aggressive. It seems very forced upon. And, but that is just one form of intervention. And a lot
of times I would say when you get to that level of intervention, the families may have tried all the
other different types of approaches. That would be my presumed assumption is that they've tried

(32:55):
all the different, different avenues. And this is their last desperate call for that person to
accept help. And so, and we'll talk a little bit about some of them. So those other options,
I just want to clarify the, the interventions that I'm referring to that I felt like was very needed
doesn't include the struggling loved one, because I believe there had to be an intervention. Here's

(33:17):
a struggling loved one. And here's the family unit. This could be parents, grandparents, spouse,
adult children. I believe there had to be an intervention on this unit first, because if you
don't intervene on this unit, it's very hard to implement here. And what I mean by intervention
here is this family unit can be also engaging behaviors that are perpetuating the issue.

(33:40):
So there's a saying in the recovery arena, the three C's is this unit didn't cause it,
you can't cure it, you can't control it. But on many ways you perpetuated the issue. And even
there's, I also say a saying, just because you're coming from a loving and good place,
doesn't always mean it's the right or the best place. And so working here, because they can be

(34:04):
engaging, whether it be enabling the issue. For example, one of the family members here could be
bailing that person out with financials, or maybe someone in this family unit isn't really
educated on mental health and that's causing a problem. Maybe one of these family members
struggled with their own traumas in their early childhood life and it's causing impaired

(34:25):
communication. And so everyone here has an equal responsibility and they have to work 100% on their
equal share. And so that's where I come in, is I intervene with this family unit, because you can
get this person help. Let's say they get to a place and the intervention works and they accept
help and they're in treatment for six months. But if they come back to this family unit and this

(34:48):
family unit hasn't evolved or changed or grown, the chances of this person reverting back to
those old patterns is very strong. And so that's where I focus on, because if you don't have
these people in some form of their own recovery and recognizing their responsibility,
this process is greatly limited in probability of long-term success.

(35:11):
It's very interesting that you're saying that, because you're not just saying that addiction is,
because one of the hypotheses of the idea of addiction is these chemical hooks. Like the
person is kind of just subdued and beholden to these chemical hooks, but you're approaching it
at a different angle of environment. And have you heard of the rat park study?

(35:37):
Go ahead. Tell me more about it.
Okay. Well, I'm probably not going to say it very well, but you're kind of alluding to this. So
researchers had two groups of rats. One group of rats was completely
in isolation. It was just a rat by itself and it had cocaine laced water and regular water.

(36:00):
And it could go to the cocaine laced water whenever it wanted. And it could just do it
as much as it want. And in isolation, as what would be predicted, it drank the water until
it died, until it eventually overdosed. And then on the other side of it, they had this rat park,
this, this amusement park to have everything that would have a rat live its most fulfilling

(36:25):
and happy life. They had exercise wheels, they had tubes, they had so much, like so many other
rats just to give them the best life possible. So they would take these rats, get them addicted
to like the cocaine laced water and then put them in this rat park. And the rat, even still having

(36:47):
access to that cocaine water would choose not to do that, to not basically anesthetize themselves
using that and then just go and enjoy life. And then if they took the rat back out of that
environment, what you're saying, if the family hasn't had their intervention, you take this rat
who was formerly addicted and who is, they've broken free from that addiction and you put them

(37:09):
back into the environment to where they were addicted, they will go back to that addiction.
And so you're alluding and saying that addiction is multifaceted and it's not just the person,
it's actually the environment as well that impacts the person, their addiction, their behavior. So
it's just hearing you say that, it's like, you think, oh, the person is cured. I can just keep

(37:32):
on being how I was. I can keep on giving them that money. I have my trauma, but since they've
worked through theirs, I can still keep communicating with them in the same way that perhaps led them to
the addiction, but that's on them. Yes. Yes. That is, you're hitting a lot of the points of the
impetus and driving force behind my book. And so one of the biggest things is as human beings,

(37:54):
naturally we are social beings, meaning that we are connected with people and people that are hermits
or they can live out in deep forests or caves completely by themselves is not really the norm.
That's the Unabomber, that's Ted Kaczynski. But even him, I'm assuming on some degree,

(38:14):
he had some social connection of some sort. I don't know. I don't know his story, but naturally
speaking, we are social beings, meaning that we are connected and a lot of our health survival
in this is through community. And so something I talk about later in my book are the most robust
attributes of a strong recovery program. And so recovery, we all had some form of recovery.

(38:39):
Recovery is just an intentional planet place for healthier living. We think recovery is just a
substance or a medical condition, which can be, but we're all in some recovery. You recover from
grief and loss of a loved one who passed away. And so I look at the most robust attributes that
are consistent in someone having a very strong recovery and increase in likelihood of long-term

(39:02):
success. And one of them hugely is community. In other words, for community is fellowship.
It's these people who will provide support and accountability in the family unit. Typically
speaking, are those people. Rarely in the almost 20 works that I've worked with people,
that there's maybe, I could literally count on a handful that people come into treatment

(39:25):
because they've struggled with a psychiatric or medical condition or a substance abuse issue,
that they have so much money in the bank. They've survived on their own and they can
survive on their own. They can rely on anyone. For example, once they leave treatment, they can
survive six months to a year paying rent and so forth. I would count on my hand how many people

(39:48):
I've ever come across. Usually the people that come into treatment, they're bankrupt, they max
their cards, they have poor credit scores. And so they need a family unit to support them. And by
the way, those handful of people who said, you know what, I'm doing this on my own. I'm disconnected
with everybody. Usually there are chances of long-term success. They struggle somewhere without

(40:08):
creating some type of community. And so yes, there's also the saying that I find with a lot
of families that I say communicate the families is sometimes we correlate the degree of pain and
suffering someone's cause is correlated to the degree of repair and work they have to do. Like,
oh, you can't, this is a structure issue. You've got to do a lot of the work. And it's what happens

(40:31):
is this person starts to feel very isolated, that they feel disconnected. But some of the
best cases I've ever seen is when that intimate family unit is part of this process. They feel
less alone. They feel hopeful, but they're also growing together and understanding what their part
is. I call it the coalition in the early phases of the treatment process. And this early phases

(40:55):
can be three months, three to six months to up to a year. And this intimate family that I'm talking
about where I intervene are what I call this coalition. And I call it these people in the
rowboat. And usually these are people who are the most impactful, have the most influence,
who are maybe financing their support and treatment. These are the people that are most directly

(41:16):
related. And that's usually those are parents, those are our spouse, those may be the adult kids.
And I put them all in a rowboat, including this person. And let's say you have five people in that
rowboat. I tell them in treatment that if you are connected and want to be a part of this process,
no matter what has happened to this point, no matter who's done what, moving forward, all five

(41:37):
of you have to assume 20% responsibility, accountability of what's happened. And you
have to work a hundred percent on that 20% because you all bring something to the table. You didn't
cause it, you can't control it. You can't control it, but you've perpetuated. And if you've ever,
I like to use this analogy that I write about is a rowboat. If you ever rode a rowboat,

(41:58):
is that the best way to maximize velocity, which is speed and distance, is if everyone's
working a hundred percent on their share of responsibility. That does not mean that
everyone's as athletic, as strong, has the equal amount of stamina or as skilled. But as long as
everyone's assuming their share of responsibility work a hundred percent, you're able to maximize

(42:21):
that degree of success is because we think it's this person's deal. And that's why I don't
particularly like the interventions where the person's sitting across the room and they're
being flanked by the whole family. And it feels like you are the problem. You need to get help.
I'd rather it be that person joins the circle and they're all coming together as you know what,

(42:42):
this is what I need to do. I know I haven't been distant myself or I haven't been sober myself.
This is the work that I'm going to do. This is what I'm going to commit to. You know what?
I grew up in a dysfunctional family and I believe that is impacting our family unit. That's what I'm
going to seek help for and work on. And to me, that's where you see the most success.

(43:03):
And because the finger pointing could be very, very devastating for this person,
they could feel helpless and hopeless and actually will create distance rather than
coming this family together. And so to answer your question, community is critically important. And
this person has to work a hundred percent on their share of responsibility as well. That's what I'm

(43:24):
saying. But yes, community, I would say fellowship is probably if not one of the most important
factors, especially after this person gets help. It makes a lot of sense that approach
to an intervention because that vulnerability that you feel like when you're sharing, hey,

(43:45):
like I messed up too. Like I know I didn't cause you to get addicted to this, but like here are
some ways that I need to improve and I need to grow. This isn't a one way street. This isn't just
everyone else has it figured out and you don't, because a very easy result of that type of
conversation of it just being your fault, you're the problem is let's say they're dealing with

(44:09):
depression, their biochemistry is messed up. And so they're going to retreat and they're going to
form or reinforce this narrative that like you are a failure. If you were out of the picture,
everyone else would be, would be happy. Their lives would be so much better. Like the addiction
is the only thing that feels good. Otherwise you have to confront these very uncomfortable

(44:33):
feelings of I have hurt these people. Instead of these people saying like, Hey, like we love you
and like, like we're in this with you. Like that robot analogy is, is very powerful. Like, Hey,
this is a unit and we're going to keep this a unit. We want this all to work as functionally

(44:54):
as possible. And that, that's a really beautiful way to, to encapsulate that.
And sometimes if I may say with the roadboat, there may be some people and that's where I talk
about, there has to be a vetting process is that sometimes people aren't going to be appropriate
in that stage to be on that robot. Maybe you might have a parent who is struggling with his or her

(45:17):
own alcoholism and they're not ready to give it up. Or maybe you have another family member who
can't hold strong boundaries and maybe they still have work to do. So not everyone is going to be on
that boat. And sometimes people that we would want to be on the boat, they may not be appropriate.
And so that's where a vetting process takes place. Maybe somewhere down the road where I call them

(45:40):
the primary or secondary support system, maybe they will come in that picture at some point down
the road, but not everyone is going to be on that boat. And that's where I work with families
or help the families truly vet, ask these questions of who's going to be on that coalition
or the rowboat. Because if they're not going to hold to the vision and plan, then they can

(46:05):
really compromise the strategy and the trajectory of the recovery process at that stage.
So how do you intervene with a family member who is enabling them, who is giving them the financial
support or the person who is an active addiction is saying, if you don't help me, I'm going to kill

(46:26):
myself. How do you help navigate dealing with that like coercion or just feelings of guilt or
responsibility to help their loved one reach freedom? Well, there's two questions there. You
were alluding to how do you interview with a family member here, but this person is also

(46:48):
presenting with some of these statements or behaviors that may induce fear and guilt and
so forth. So let me address this one first with the family member. And one of the things we talk
about enabling, one of the things that I like to do and teach and write about are sort of dispelling
some of these stigmas around certain words that are thrown out there. And you mentioned one of

(47:09):
them enabling. And whenever you hear that word, it is equivalent to like a curse word when we're
talking about family dynamics and recovery. Oh my God, enabling you. And I say, well, no,
enabling is not a curse word. Enabling comes from a place of love. Our loved one is struggling
and in pain, we provide relief. If they're starving, we provide them nourishment. If they're

(47:33):
homeless, we provide them protection. So it comes from a place of love. But those behaviors when
dealing with, for example, this disease of addiction or untreated mental health is those
behaviors can perpetuate the disease, right? If someone loses their 10th job in one year
because of severe alcoholism and we provide them money for rent or we provide them home,

(48:00):
where is the motivation to stay sober or to do what it takes to keep a job, right? If someone
continues to cheat on you, for example, infidelity in the relationship and you continue to take them
back and there's no revisions, where is the motivation to stay honest and truthful? And
so enabling, like I said, comes from a place of love. And that's why I tell families to recognize

(48:23):
that. And also what you said earlier is what we tell the family member struggling is we are always
going to love you. We're here to support you. It's just that we can't support this lifestyle
any longer because we are doing more harm than good. We are doing more harm than good to the
family unit and to yourself if we continue to co-sign this lifestyle. But we're here for you.

(48:47):
We love you. We're waiting for you. And so what it does is it makes a person make a choice like,
wow, I have this family unit that loves me but I engage in these behaviors that prevent me from
being a part of that family unit. So it gives them a choice. When you tell them you can't do this,
you can't do that, you can't drink anymore, we're done with you. Until you get better,

(49:08):
we don't want you. That really struggles and it actually creates this separation rather than
connection. So that's what say the family unit. For this person, I talk about it in my book,
it's called the 80-20 model. And the 80-20 model is the disease. And the disease is just any entity
that causes impairment in our life, a medical, psychiatric, greed, lust, envy, wrath, if you want

(49:34):
to, materialism, racism, hedonism. Those can be your disease if it's chronic and causes impairment
in your life. And so we all have a version or version of our own diseases. That's why we all
have our own recovery. But I call the 80-20 model. The 80-20 model is a pie chart of someone's
struggle. Eighty percent of why this person's struggling is valid. They could have a medical

(49:57):
condition. Maybe they were born with a condition. Maybe they had trauma in their life. Maybe they
had abuse. Maybe they have alcoholism in the family. Maybe they have financial distress.
Eighty percent of why that person's struggle is that disease part is valid. The 20 percent that
I talk about of the disease is manipulation. Manipulation is getting people to do things they

(50:18):
normally wouldn't do. And we can manipulate in thousands and thousands of ways. That's the guilt
you talk about. I'm going to kill myself if you don't help me. I'm never going to talk to you again.
What's life living for? Or they use intelligent charisma, money. I'm not going to give you any
money. I'm not going to support the kids anymore if you do this to me. That's 20 percent that
creates the barrier for people to work on this 80 percent. And that's what families need to shut

(50:42):
down. That's where I work with families to shut down that 20 percent. And for example, if someone
says, you know what? Well, if you're going to do that, I'm going to kill myself. I feel for you.
That's not something we want. You sound like you're in a lot of pain. That's not an option that we
want you to explore. We want to help you the best way we can. So that's coming from a supportive

(51:05):
way, but we're not saying, okay, okay, okay, fine, fine, fine. Don't kill yourself. And because we
take it very seriously, but that's a form of manipulation, but we still take it seriously.
We validate the person saying, hey, you seem like you're in a lot of pain. We want to help you.
That's not something we want to happen, but we're not going to jump on there. And we're not going
to co-sign that manipulation. And what that would sound like is, okay, fine. Rather you be alive,

(51:28):
but what actually we'll do is perpetuating. And I've had some family members who I know
my daughter's upstairs. I know she's taking Xanax. I know she's drinking tequila up there,
but as long as she's not in the streets being violated. I know my son is downstairs in the
basement. I know he's using that money for marijuana and he's not going to school, but as
long he's not homeless. And so what we're doing is we're actually perpetuating and worsening

(51:53):
that lifestyle because that daughter can die upstairs. That son can hurt someone or die
downstairs. And so that's kind of how I tackle that as well is the family unit has to shut down that
20% that I believe is that manipulation part of the disease. Yeah. That's an interesting take on
it because if someone says they're going to do harm to themselves, well, the result of them

(52:18):
doing the activities, enabling the or not enabling the addiction, but acting out on the addiction
that can result in the same thing. And so the family member is put in this very interesting
situation to where one is more timely. I guess if the person is going to harm themselves,
like that's immediate, but maybe I get more time with them if they keep on doing this addiction

(52:42):
and maybe they just, they wake up, they don't want it anymore. And so it would be very easy to
logic and be manipulated into enabling that behavior to allow them to continue in their
addiction. Like, okay, yeah, I guess you won that argument, that little intellectual duel
because I love you so much. Like I just, I don't want to not be in contact with you.

(53:08):
Yeah. And you can't love someone out of the disease. And so here's the thing. What do you
do with someone like, I want to kill myself is let's get you the help that you need. Right. And
so in that case, right, some people also research has shown continuously, sometimes families are
afraid, like, oh, for God, if we talk about suicide, it's going to make them think about suicide.
Research has shown that that is never the case. Actually, it actually has a beneficial effect

(53:31):
because a lot of times they want to talk about it. And so if they're at that point, like, you know
what? I don't want to, I want to die. I want to kill myself. Number one, let's get the help that
they need. Call 9-1-1. They need that help. And so we want to provide that support. We never say
you're manipulating. No, you won't kill yourself. Go ahead and do it. Obviously we never do that
because that's not healthy way of thinking for them to have that conversation to begin with.

(53:52):
But if it's a manipulation part, you know what? Let's get the help that you need. You know,
can I bring you to the hospital? Let's get you psychiatric unit. So if you are using it for pure
manipulation, I'm not, I'm fine. I'm fine. I'm fine. I'm fine. But my point is we still take
it seriously, very seriously, because that is part of suicidality. Suicidality is not just
the plan to kill oneself. It could be, hey, you know what? I'm going to walk across the street

(54:14):
and not look both ways because I don't mind if I die. You know, I'm not going to wear my seatbelt.
I'm going to drive recklessly because if I get hit and don't survive, it won't be so bad. That's
still very serious. Of course, it's not as serious as someone saying, you know what? I have a gun,
I have a plan, and I'm going to kill myself tonight, as opposed to this. But it's still
serious because eventually if you stay there thinking those thoughts of being reckless and

(54:35):
not minding of dying, you could end up in this place. And so we take suicidality very, very
seriously. So one thing I like to tell family members as well as part of one of my must-knows
is the three inevitable consequences that I intervene with family unit here is for untreated
mental health or addiction when it's getting to a very, very high level chronically is family

(54:57):
members have to accept that the three natural consequences of untreated mental health or
subsediction is they can end up in jail, institutionalize or hospital, or they could
lose their life. They can also be homeless, but eventually if they're homeless and get untreated,
they end up in jail, hospital, or they lose their life. I tell family members we can never accept

(55:18):
emotionally our love and losing their life, but we have to accept the reality that if they don't
get help and their condition's getting worse, it's a progressive disease, that possibility is
very, very real. And so that is what helps family members deal with that part. And once they accept
that reality, then they're able to take the interventions because a lot of families stay

(55:39):
stuck there. Well, we'd rather have them alive than die. And that's the disease winning that battle.
Right. That's where you start to feel like the disease is the terrorist in the home that a
psychiatrist who was in the military referred to it because that's what it does. That fear,
the terrorist in the home alters your life, disempowers you and holds you hostage,

(56:04):
emotionally hostage. And you're saying we care about you. We're not going to be held emotionally
hostage by guilt and fear any longer. Yeah, that's really great. And just
having those difficult conversations. I'm definitely, and I'm sure the family members
are definitely appreciative that you're there to have those conversations with them.

(56:24):
So pivoting a little bit and talking about treatments, I'm pretty excited about the current
trajectory that we're on for treatments to explore non-conventional treatment methodologies, going
more into like psychedelic medications like ketamine, MDMA, also known as ecstasy. And

(56:45):
have you heard of Ibogaine? No. Okay. Well, we won't really spend any time there, but Ibogaine is
really promising from what I've heard because addiction takes so long because it messes with
the physiology of the brain that Ibogaine actually intervenes quickly. So it takes a long time for

(57:06):
those neuroreceptors to start responding to what normal levels of the neurochemistry.
It takes like a year or something after that. So that whole time, the person who is in addiction,
who's since recovered still has a dull sense of life. Ibogaine has this potential property

(57:27):
to repair those neuroreceptors in a very short amount of time of 24 hours, 48 hours.
And this is, you know, it's a psychedelic, so it was banned under the substance controlled act
in the seventies, but they're starting to do research on it now. And it has other implications
because it can potentially grow gray matter back for Alzheimer's and Parkinson's. Yeah.

(57:52):
Yeah. So like the CTE and stuff. Yeah. So it's really exciting, assuming, you know,
how many really exciting breakthroughs have there been over the years that turn out not to be the
case, but Ibogaine is safe as long as it's taken in a clinical setting with magnesium,
because otherwise you could develop a heart arrhythmia that could kill you, you know.

(58:16):
But there's a Mexican clinics in Mexico that do this. And so that's really exciting. But
what is your opinion about like ketamine and MDMA to help treat treatment resistant depression?
Yeah. One thing I say, and if I can upfront, you know, though the title of my book involves

(58:37):
the word treatment, how to get your resisting loved one to treatment. I like to clarify because
treatment doesn't just mean the formal process of getting help, going to a residential or inpatient
facility, which could be a form of treatment if appropriate. Treatment can also mean how to get
your resisting loved one to a point of accepting help. With that said too, treatment can look in

(59:02):
various forms, right? There's all kinds of different modalities for sometimes it's trauma
focused treatment. For some people it's going to a facility. For some people, some churches or some
cultural beliefs have their form of treatment to get them back. And so I'm open to anything.
And ketamine, of course, ketamine, we've had people who present to treatment addicted to

(59:23):
ketamine and now it's part of psychedelics, people abusing psychedelics, but now researchers
shows. And so I am open to a lot of things. There's a lot of different research and developing,
whether it be shrooms, other things. And like you said, just of course doing it monitor as well.
One thing I find with people as well is with that research exactly right under clinical

(59:44):
trials, under supervised care is you get a lot of people that are microdosing on their own. Like
they heard microdosing, they read something that they're microdosing. And so they're microdosing
their THC use and so forth. And so you get a lot of people, unfortunately, that are trying to do it
on their own. But no, I'm open to any different modalities, especially if it's research, it's

(01:00:04):
diligently and managed environments that yeah, I'm open to a lot of things. And one thing I tell a
lot of people too, I'm not against, I work in addiction. I wrote a book about substance
disorders, but I'm not against alcohol. I'm not against THC. I'm not against painkillers
or opiates because there are people out there who can engage in a glass of wine periodically or have

(01:00:28):
it with their dinner and not get dependent on it. And now there's some people that can smoke THC
for insomnia, anxiety, and not get addicted to it. And there's people that can take a regiment
of painkillers, opiates, and not transition to heroin or able to stop it. It's just that

(01:00:52):
when there's people who have a family history or a personal history of substance addiction,
or they have an underlying mental health condition, a mind-altering substance can
make you more sensitive to that underlying condition, worsen existing symptoms, or bring
about the onset of a condition sooner than later. And so a lot of times when people
try to argue, well, it's natural, this and that, or some people can manage alcohol,

(01:01:16):
I said, yeah. But unfortunately, you don't fall into that category because you have a history
of suicidality, you have a history of addiction, and so forth. And so it really buffers that
conversation and people say, yeah, that makes sense. And so I think the more you tell people
that they can't do something, the more resistant we are. That's the human condition.

(01:01:39):
There becomes this emotional battle that takes place. But to answer your question,
I know there's a lot of research going on it. There's clinicians being certified in it. And so
I think we have to go with everything with an open mind, especially as technology advances.
There are a lot of things out there that we first thought were detrimental that are probably

(01:02:01):
beneficial and probably help in curing in some levels. Yeah, that's a really great philosophy
to not just be so rigid, to be open to certain types of unconventional treatments. When
if you're in addiction, why would I give you another substance that's counterproductive?

(01:02:21):
That makes no sense. But in reality, somehow through brain chemistry, like this actually
inhibits the desire for that substance. So I really like the open mindedness of that.
But thank you, Dr. Licuanan. And this was such a fun conversation. And this is so informative.

(01:02:42):
Thank you for your time. And if people want to get in contact with you, if people want to find
your book, where can they do those things? Sure. Sure. I'm assuming you've dropped this
in the narrative, but with the spelling. But on my website, drbrianlicuanan.com,
you can find my services. A lot of my media appearances are on there, as well as a little

(01:03:06):
excerpt from my book, and also a link to my book on Instagram at Dr. Licuanan and at TikTok at
Dr. Licuanan. And so my book is best attained on Kindle or paperback form on amazon.com,
how to get your resisting loved one into treatment. Thank you so much,
Dr. Licuanan. I really appreciate it. Thank you so much for having this conversation.

(01:03:37):
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16 - Insomnia, Interventions, and the Importance of Community in Recovery with Dr. Brian Licuanan

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.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}16 - Insomnia, Interventions, and the Importance of Community in Recovery with Dr. Brian Licuanan