May 7, 2025 • 32 mins
The field of addiction medicine and mental health has seen incredible innovation over the past two decades. Dr. Mark Hrymoc discusses those innovations and where they may lead. Dr. Hrymoc is the Founder of the Mental Health Center in Los Angeles, California. He has extensive expertise in the psychopharmacology of addiction and other mental health disorders. He is double board-certified in General Psychiatry and Addiction Psychiatry and was previously board-certified in Addiction Medicine. Dr. Hrymoc previously held the position of Assistant Clinical Professor of Psychiatry at UCLA, where he supervised training psychiatrists at the Addiction Psychiatry Clinic. He and the Mental Health Center can be reached at https://www.mentalhealthctr.com/
The views and opinions of the guests on this podcast are theirs and theirs alone and do not necessarily represent those of the host, Westwords Consulting or the Kenosha County Substance Abuse Coalition.
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Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:12):
Welcome everybody.
This is Avoiding the Addiction Affliction,brought to you by Westwords Consulting.
I'm Mike McGowan.
Innovation is the ability to see changeas an opportunity rather than a threat.
Well, I'll tell you what.
The field of addiction and medicine andmental health has seen some incredible
innovation over the last two decades.
We're gonna talk about where we're at,how we got there, where we might go.
(00:35):
Our guest is Dr. Mark Hrymoc,the founder of the Mental Health
Center in Los Angeles, California.
I'm envious already.
Dr. Hrymoc has extensive expertise inthe psychopharmacology of addiction
and other mental health disorders.
He is double board certified ingeneral psychiatry and addiction
psychiatry, and was previously boardcertified in addiction medicine.
(00:58):
Dr. Hrymoc previously held aposition of assistant clinical
professor of psychiatry at UCLA.
A team my badgers beat in the Rose Bowl,where he supervised training psychiatrists
at their addiction psychiatry clinic.
Welcome, Mark.
Thanks for having me, Mike.
Yeah, sorry I threw that in.
But we don't win all thatoften, so have to do it.
(01:19):
You know, I've been working in this fieldlike you for a long time and a lifetime
ago I worked in a hospital that had theaddiction treatment on the third floor.
Mental health was on the fifthfloor, and maternity was stuck
in between on the fourth floor.
We've come a long way since then.
Yep.
Yep.
Yeah.
They were seen as two different disorders.
(01:39):
Now we see, you know, addictionactually is a mental health issue
and they often feed each other.
Well, how did we get there?
Because it wasn't thatway, not that long ago.
Yeah.
I guess the founding of the field kindof came from two different places.
You know, mental health, psychiatry beingmore informed by conventional medicine, so
(01:59):
a lot of the kinda like western medicinevalues and, you know, thoughts on emphasis
on medication to treat conditions like,you know, depression, schizophrenia,
bipolar disorder, et cetera.
And addiction treatment reallystarted with AA in the 1930s, so it
was seen more of, you know, comingfrom, you know, general society.
(02:20):
And yeah, there was a physician involvedin the founding of AA, but it was
also a lay person bought and, and sothey together, you know, just, just
found, came from a different place.
So ultimately they did meet in the middle.
Well, it just makes sense, right?
That addiction and mentalhealth go hand in hand.
I, I've yet to, I love it whensomebody says, well, yeah, I've got
(02:42):
alcoholism and I'm clinically depressed.
It's like, really?
Right, right.
I mean, what you take has todo with your mental health,
Right.
Right.
Yeah.
I mean, alcohol is a depressant.
It can lower mood too, and thenthat even might drive more drinking
if a person is self-medicating.
So that's definitely one exampleof how they can feed each other.
(03:04):
Well, that's the easy one.
But you and I have worked a longtime with people who take a bunch
of substances stacked on top ofone another, and that can lead the
brain in all sorts of weird places.
Right, right.
For sure.
Yeah.
And behaviors too.
You know, sometimes substance useleads to problematic behaviors that
are compulsive, whether it's, yeah,gambling or sex and love addiction or,
(03:28):
or things like that can, you know, soaddictions can feed each other as well.
I think this is a silly questionto even ask somebody like you, but
I still get into discussions withpeople in the field about this.
It's difficult to treatsubstance use disorders without
also treating mental health.
Right?
Right.
But I still have people who insistif you treat one the other goes away.
(03:52):
Mm-hmm.
Mm-hmm.
Your thought.
Yeah.
They both need to be treatedsimultaneously because
they can affect each other.
And if a person isn't doingwell in one arena, then it's
going to destabilize the other.
So yeah, for sure.
They need to be both accounted for andeach have their own kind of treatment
plan and ideally simultaneously treated.
(04:13):
Well, how do you come at that?
Do you get to the, there's an old tape.
You're younger than me.
So I watched an old tape where when I wasgetting trained by Father Martin, right.
And it was old black and white tapes.
He called them chalk talks.
And he used a thing about, well, if youraunt was going into surgery and she was
(04:34):
pipe full of ether, you wouldn't do amental health assessment at that point.
You wanna get her off the etherbefore you assess where she's at.
Are we still at that sameplace with with drugs?
You want to be sober and detox beforewe see where their mental health is at?
No, because even the detoxprocess can trigger symptoms like
(04:59):
anxiety and insomnia, let's say.
So part of actually treating detoxincludes treating things that come up
which count as mental health issues.
They might be transient, they mightbe related to the actual process of
coming off of the substance, but.
They also might suggest that a person hasan underlying condition in that area too.
(05:20):
So yes, a person coming off of alcoholmight have high anxiety, but it might
be that they had an anxiety disorderor significant insomnia in the first
place that even made them predisposedto developing an alcohol problem.
And so there might be a short termanxiety component that we have to treat.
And then even after the detoxperiod, which usually is about seven
(05:42):
days max or so, then there couldstill be residual anxiety that we
would think of as more of like thechronic long-term baseline anxiety.
And that deserves attention to.
We've seen some incredibleinnovations that we would've never
thought of a couple of decades ago.
Talk about some of them,ketamine and the rest of them.
(06:03):
Sure.
So, I mean, I think even just to take 'emin sort of chronological order you know,
medications being used to treat addictionspecifically started with an abuse.
But by this point, 40, 50years ago kind of came out.
The one that makes you sick if youdrink, is always how people describe it.
And my follow up to that is like, it'snot supposed to make you sick because
(06:26):
you're not supposed to drink on it.
It's supposed to act as apsychological deterrent to drinking.
So that was the one of thefirst medications that came
out to treat addiction.
And then methadone for opioid addiction.
Also at this point out for 50years or so you know, definitely
helped a lot of people get offof very problematic opioids.
(06:48):
Heroin, namely but also perpetuateda physiologic dependence on opioids
but ultimately does reduce risk,health risk, other risks, et cetera.
And then as we kind of go a few moredecades naltrexone is an opioid blocker
that it was developed in the ninetiesthat ultimately was found to treat
(07:11):
both opioid and alcohol addiction.
And so that now is a available as along-acting injection called Vivitrol
which has now been out for about 20 years.
And there've been a handful of other meds.
Suboxone also buprenorphine, youknow, is definitely an improvement
upon methadone, still ultimately areplacement therapy, we'd call it.
(07:34):
And we also need to talk aboutnicotine, tobacco addiction or
now just calling it nicotine'cause a lot of people are vaping.
You know, nicotine replacement therapy.
So analogous mechanism of actionto methadone and buprenorphine.
It is a replacement.
It works on the same receptors and it'ssort of the same way, but reduces risk.
And so Chantix has also been avarenicline is a new medication
(07:58):
used to treat nicotine addiction.
That is twice as effectiveas nicotine replacement.
Works actually analogously toSuboxone, which many people don't know.
Suboxone works on the opioid receptorsin exactly the same way that Chantix
or Varenicline work on the nicotinereceptor, they sit on the receptor.
(08:18):
They stimulate it a little bitjust so a person doesn't go into
withdrawal and doesn't have craving,also has a high binding affinity.
It binds to the receptors so thatnicotine or whatever, or the opioids in
the case of Suboxone, really can't evenaccess the receptor in order to work.
So a person might decide that they wantto smoke a cigarette or vape, and then
(08:39):
they just don't even feel the nicotinebecause that Chantix is blocking it out.
So these are examples of a lot ofthe different, like, mechanisms
of action, of medications usedspecifically to, to treat addiction.
You mentioned yeah, ketamine sothat it is a kind of different
league, different ballpark.
Not used to treat addiction, certainlynot in in any mainstream setting but
(09:03):
has really been a great medicationfor treatment resistant depression.
And other treatment resistant mooddisorders like anxiety and PTSD,
post-traumatic stress disorder.
These types of interventionsare what are offered when
conventional pills don't work.
So someone you know, takes a fewantidepressants and they either don't
(09:26):
work as well as they should or have sideeffects or problems related to them.
Then we would consider either TMS,Transcranial Magnetic Stimulation
or ECT Electroconvulsive Therapy,commonly known as shock therapy,
is still done, not very commonly,often thought of as a last resort.
(09:46):
And then ketamine treatment.
So in my mind, these are the threeinterventional treatments for depression.
They are procedures as opposed to pillsthat you take done in a medical setting.
And ketamine really has helped alot of people even though, so it's
came out in 1970 initially as aanesthetic and pain medication, was
(10:07):
around for decades, widely used.
Considered one of the top 100 mostessential medications according
to the World Health Organization.
So it is just in general in medicine,a very important foundational medicine.
But then in the 2000's, research startedcoming out about its benefit for mood and
definitely in the last 15 years there'sjust been a litany of research coming out
(10:33):
really supporting its use as a medicationto treat depression that doesn't
respond to conventional medications.
And so the nice thing about it is itis six treatments as opposed to 30 or
more, which is what you need for TMS.
It doesn't require taking amonth or so off of work like ECT.
(10:54):
Really well tolerated, worksbiologically as an antidepressant.
But also experientially, and there'sa lot of interest in ketamine being
used as a medication to kinda helpgive people different outlook on life,
maybe reinterpret things that may havehappened to them so that they can process
things that they've gotten stuck on.
(11:15):
And see things in a different way.
Maybe be able to exhibit new ways ofthinking, new ways of behaving, et cetera.
So I could go on and on, but...
That was, that, that was great.
An answer to your question as I could makeit, and I still know it was really long.
No, it was great.
I, that's, that's, tremendous summary, butit begs for me about a dozen questions.
So, you know, it's not that longago that law enforcement was talking
(11:36):
about ketamine is, you know, SpecialK and people were taking it on
the street and cat tranquilizer.
I remember getting, you know,flyers that way and now we
see billboards for it, right?
Ketamine therapy.
So my questions for thatare, you said six treatments.
How did we get to know that?
And how do you determine ifsomebody is a candidate for these?
(11:58):
Third, you can lump them together'cause you're very good at that.
Do you get blowback from peoplewho still remember well, what,
isn't that one of those drugsI'm supposed to stay away from?
Right, right.
Yeah.
I think the important principleis that the same chemical
can be a medicine or a drug.
(12:18):
So the context really does matter.
And I kind of think of them as twocolumns, you know, and even using
ketamine as an example under the drugcolumn is what you're describing.
Like how is it used, the setting to makeit a drug is, that's recreational use.
It's not prescribed, it's given to peopleby their friends or, you know, some
stranger off the street or whatever.
(12:40):
You know, so the, the, the way inwhich it's, it's obtained and, and the
reason that the person is even usingit for the first place as opposed
to a medicine is done with a goodfaith visit between a physician and
a patient where everyone is honest.
No one has any ulterior agenda except tohelp that person with a diagnosed disorder
(13:00):
like depression or anxiety, et cetera.
And so.
You know, if it comes out of a goodfaith visit, then that's, you know
then qualifies then as, as a medicine.
So, you know, similarly, Xanax, youknow, can be a medicine or a drug.
Opioids can be a medicine or a drug.
You know, if you have a kneereplacement you're gonna need
some sort of pain relief.
(13:21):
So there you go.
And, and even if a person hashad a history with addiction,
you know, we, we don't want tomake people suffer needlessly.
I mean, we are merciful and compassionatein the medical business, and we
do want to, you know, treat anyanticipated pain or pain that comes up.
And so opioids are appropriate if,you know the context calls for it.
(13:43):
I mean that, I think that's,that's the main kind of difference
between medicine and a drug.
Well, okay, so how did we getto six rather than 7, 9, 12?
Yeah.
Through research studies one, ketaminetreatment can have a mood benefit
that lasts up to a week or so.
So it is a procedure.
A person has to come in the office.
It's a two hour appointment.
(14:04):
They need to be there, take time.
Also the rest of the day you, wecan't really have a lot of stressful
things or deadlines, you know, you'renot gonna getting sent back to work
after having ketamine treatment.
We do encourage you to.
Kind of just take it easy, et cetera.
So, you know, there was an interest inhaving a schedule that would allow for
(14:24):
ketamine to have benefits that last morelike months instead of just a week or so.
And so they basically found by gettingsix treatments within a three week period
leads to a benefit that lasts longer.
And I kind of think of it as.
Like, if you're gonna paint something,you want to put multiple coats of
(14:44):
paint, if you want that effect to stay.
And so, you know, getting the,the treatments in a repeated basis
is the most potent way and leadsto the longest acting benefit.
More treatments might makeit last somewhat longer, but
there's diminishing returns.
So, you know, research has basicallyfound that six is the number that a person
(15:05):
would need to, you know, really kind ofoptimize the fewest number of treatments
to last the longest amount of time
I would think I may be wrong, but Iwould think that, as a standalone,
it works somewhat, but if you coupleit with talk therapy or other sorts
of therapy, it has a better effect.
(15:25):
There's some research suggesting that yes.
Not enough yet toofficially make it standard.
But there are a lot of believersin psychedelic assisted
psychotherapy in general.
Ketamine being the first medicine withpsychedelic properties that is actually
legal and available to prescribe.
(15:47):
And so there is a treatment modality ortreatment type called ketamine assisted
psychotherapy, where a person will havea ketamine treatment and a therapist
will have actually had a session or twobefore to kind of prepare them for the
medication treatment, and then they'llsit with them during the appointment or
(16:09):
to guide them through the experience.
Also be there to listen andinterpret things, you know, jot
things down for later discussion.
The goal being to implement thenew perspectives that a person
experiences under ketamine and to mosteffectively convert them into long
lasting changes in a person's life.
(16:30):
And so, yes, there is a beliefthat this helps and you know, being
a straight shooter and a doctor.
You know, I also need tohighlight that whenever we make
recommendations in medicine, theydo have to be based on evidence.
You know, and so there's a belief,there's a suggestion, there's a hunch,
and definitely anecdotal evidence.
I mean.
I and other clinicians working in thefield have seen this benefit exactly
(16:53):
exist where a person who gets therapywith ketamine does better than even just
ketamine alone or psychotherapy alone.
And so I think of it as like asynergistic effect where the total is
actually greater than the sum of itsparts, like one plus one equals three.
We're using that now.
And you said somethingabout first clinical.
Back in the previous century.
(17:14):
Oh God.
I like saying that, we heard anecdotallysimilar reports about LSD and then
at the turn of the century we heardit about ecstasy, methylene, doxy
methamphetamine, and people wereusing it in a therapeutic way.
But we don't have those studiesto show that it does the same way.
Do you think we have other chemicalscoming on the backside of ketamine
(17:36):
down the road a little bit.
Oh yeah.
There is a ton of research currentlybeing done, honestly, looking at
almost every single psychedelicbeing used for almost any psychiatric
indication that you can think of.
You know, including LSD, beingstudied as a treatment for anxiety,
(17:58):
which you would never expect.
Right.
MDMA, ecstasy being used as a to helpwith certain symptoms of schizophrenia
or other psychotic disorders.
So, this is research.
It's a research interest.
It is by no means a recommendationand certainly there's no
recommendation for people to attemptto have their own, to treat it.
(18:19):
Right.
And yeah, if, even if a patient asksme, I mean the, the big one that
there's actually a good amount ofresearch on that people have heard
about is, is like, psilocybin, youknow, doc, what do you think of me
taking mushrooms for depression or foralcoholism or, or things like that?
And, and my standard answer is,there's def there's, you know,
a, a, a signal of interest there.
You know, there's maybe an effect thatresearchers are interested in examining
(18:42):
and looking at, but it's nowherenear the level of being incorporated
into clinical practice guidelines.
The guidelines that doctors woulduse to assess, diagnose and actually
recommend a treatment for a person.
So it's, you know, too earlyfor primetime, basically,
You know, I'm from Wisconsin where we havea, a football team that's kind of good.
So that would include ayahuasca andsome of the other substances too.
(19:07):
And more research needs to be done.
Yes, yes.
And yeah, active ingredient,ayahuasca being DMT.
And then there's a related compoundcalled 5-MeO-DMT that both of which
are also being studied as treatmentsfor depression and other things too.
May is Mental HealthMonth, Awareness Month.
What are you seeing at the mental healthcenter regarding we, we have all these
(19:28):
reports of increased doom and gloom,and we're surrounded by negativity
and, you know, therapists that Italk to are booked to the nth degree.
There are no opening,no opening, no opening.
What are you seeing among your patientsand, and what would you say to people
that are experiencing some prettymuch deep depression and anxiety?
(19:51):
Depression and anxiety are medicalconditions that deserve attention,
that a person should not feel guiltor shame about seeking treatment for.
They're more than just quote,normal sadness or stress.
There is a difference between normalhuman emotion, which we do not consider
(20:13):
a disorder, hence the word normal andmood disorders, conditions, diseases
that ultimately can be diagnosed.
They run in families.
You know, a lot of the things thatare, we think of as medical illnesses.
Physical medical illnessesare consistently true for
(20:34):
mental health issues too.
And there are treatments that work,psychotherapy and medications,
and the combination of the twoalso yields a more potent result.
So, I mean, I'm a big advocate ofde-stigmatizing mental health conditions,
helping people understand them, helpingtheir families understand them too, that.
(20:55):
You know, this isn't just, you know,dad being lazy or mom being a nervous
wreck or, you know, anything like that.
Like they, they, they have a conditionthat deserves identification and deserves
treatment, and they can get better and thefamily system actually gets better too.
You know, mental health issues, whetherit's addiction or anything else, are
conditions that affect the whole family.
(21:16):
Not only the person that actually hasit, but the people in their orbit, you
know, definitely in their immediatefamily that are also affected by it.
And so the system can can use help too.
I know you formed the mental health centeror founded it with your, your wife, right?
Dr. Ellie Mizani.
That's right.
And I'm not asking you to stealher thunder, but I read that her
expertise is child psychiatry andadolescent psychiatry, and I've
(21:40):
worked with them my entire life.
We're seeing a huge spike in concerns foradolescent, young adult mental health.
Are you seeing that inyour practice as well?
Definitely you know, especiallywith the pandemic schools shut down.
That was a huge social stressor on somany people and changed the way that
(22:03):
kids even develop socially, you know, Ithink of a developing person sort of as
like wet concrete, and in those firstlike 18 or 25 years, you know, if you
make an impression or things happen,they can actually have a longer lasting
impact than if they happen when a personis in their thirties or forties, you
know, because their brains are stillsort of solidifying their behaviors are
(22:27):
their sense of self, their relatednessto other people, and so definitely the
pandemic alone has been responsible fora lot of mental health issues coming
up and also a lot of de-stigmatizationof mental health treatment, maybe
for a lot of people that really?
Got so bad that it became undeniablethat they needed help, whereas before,
(22:49):
like you'd hear things like, oh yeah,my dad doesn't believe in depression.
Or, you know, I, my dad just thinks I havea weed problem and I smoke too much weed.
But it's actually, you know,a, a cannabis addiction.
So, you know that definitelysociety is evolving too.
Well, I wanted to ask you thatand, and circle back to our
original, because, you know.
(23:11):
The research that we talked about.
Again, I'll just reference it tothe point, the six ketamine visits.
Right.
One, how do you determinemedications for adolescents whose
brains are still developing?
And what I find is that a lot of kidswho experience that are self-medicating
and especially with cannabis, andthey like the, what I hear Dr.
(23:35):
Hrymoc is I'd rather smoke a jointthan take that crap they have me on.
They don't like the side effects ofsome of the drugs they get prescribed.
Right.
Yeah.
The goal of a good relationship with apatient and doctor is for there to be
(23:56):
transparency about benefits and sideeffects, unintended ones, and we always
want to choose medications that havemaximal benefit with minimal side effects.
And so there does need to be a dialogue.
But sometimes people aren't able to seetheir doc as often as could entail, and
(24:16):
so they might just try for a month ortwo, and then without a follow-up visit,
they just kind of go off it on their own.
You know, on some level they're,they're making the decision
instead of, again, the, thehaving that collaborative process.
So it's, and whether it's cannabisor alcohol, like we think of the, you
know, nicotine, the substances that aremore common for teens to get into and
(24:40):
perhaps even be self-medicating with.
They have an immediate effect.
So people in general are wired to bebiased towards short-term benefits.
And so if there's an immediate benefitreduction in anxiety, let's say, or,
or depression with use of a substance,that's a really potent reinforcer.
You know, like, okay, when Idid this, like I felt better
(25:02):
instantly as opposed to.
You know that if we think of traditionalSSRI antidepressant medications
like Zoloft, et cetera, you know,they need to take at least a week
or two to kick in if you're lucky.
Four to six weeks toreally have full effect.
And so there's already a discrepancybetween like the fast acting benefit
(25:23):
versus the longer term, you know?
But as we all know, short term benefitsdon't always have the same long term
benefits, and there is actually valuein investing that time and energy
into finding a medicine because.
These, these medicines actually do work.
There's actually been a lot of researchon cannabis for medical purposes,
and it's interesting that it hasnot shown consistently to benefit
(25:48):
any mental health issue, includingdepression, anxiety, insomnia.
People will say like, oh, it helps me.
And when they do, I don't argue with them.
I can't argue with personal experience,you know, and I'm open to listening
to, to their experience and, andbelieving them that, you know, maybe
that works for them, but you know, ithasn't helped enough people, not in
the way that medications has and, andbeen demonstrated also in research
(26:12):
studies to, you know, help like up to70% of people that might start Zoloft
for, you know, depression or anxiety.
That's, that's (laughs) acards and letter coming at you.
You know, every time I mentionstuff like that, I get a lot of,
whoa, you know, the, the pro weedcommunity comes at me, but CBD and the
(26:33):
gummies are not cheap, first of all.
Right.
Right.
And the research isn't quite there andI, I hear a lot of anecdotal stuff, but
I don't see, like, you, I keep lookingfor the studies and I haven't found 'em.
Right.
Right.
Yeah.
Yeah.
I mean, the conditions that there'smedical grade evidence to support its
(26:54):
use are for things like muscle spasticityand ms. Decreased appetite with cancer,
nausea associated with chemotherapy.
You know, there the glaucoma there,there's, there's certain types of
pediatric seizures have been like, there'sseven or eight conditions like that,
but again, not depression or anxiety.
(27:16):
That's been, again, showshown in large scale.
You know, the gold standard is placebocontrolled, double blind studies.
Like that's what we look for in,in medicine to be able to then say,
okay, this is a treatment that we'regonna be recommending to people that
have, you know, these conditions.
Where do you think we go from here?
Like we're we're talkingabout the innovations.
I'm not asking you to, to know, butwhere do you think we'll go next?
(27:41):
In terms of treatment for...
Yeah, like what's on the horizon?
Yeah, I, I mean the, I think a, anexciting new chapter in psychiatry that is
opening up are the psychedelic treatments.
You know, I think on a, on a certainlevel, we've plateaued with development
of traditional antidepressant andanti-anxiety medications to the extent
(28:05):
that big pharma has really scaled back ontheir investments in studying those types
of medications in the last 10 or 15 years.
And so the, the, but you know,psychedelics in terms of being used both
as medication treatments alone and, andsome of the studies that I was talking
(28:27):
about earlier, or do look at them asa medication alone treatment done in a
controlled setting, in a supportive way,but not necessarily combined with therapy.
And then there also is interest intherapy being combined with it too.
And, and there's a lot of interestand belief that a person going through
an experience like that might have adifferent reference point on their life.
(28:48):
And instead of, you know, always kindof looking at things from a certain
perspective for a few hours anyway, canhave the experience of standing somewhere
else and looking with the assistanceof their therapist on events that may
have happened to them, their currentlife, relationships, work situation,
et cetera, and being able to putthings into perspective for at least a
(29:12):
different perspective for a few hours.
And also, I'm, I'm, yeah, I, I think it'simportant not to be biased and become
a zealot about it either that theremight be false perspectives or erroneous
perspectives that then a person can atleast consider and evaluate after they
come back and think about what theydo wanna incorporate in their lives.
Because you know, we, wanna help themimplement 'em in their, those benefits
(29:36):
into their general lives, not justthe times that they might be using
that, those substances, let's say.
Right.
You know, this is so well balanced.
It's really been fascinating.
I'm gonna give you a little walk off here.
Every time I talk to somebodywho is in your area of expertise,
I gotta ask this, right?
You're surrounded bydoom and gloom as well.
You know, you read the news, you hearall the stuff, the negativity, and you're
(30:00):
surrounded with people with trauma.
We have a lot of therapists wholisten to this, who struggle
with their own secondary trauma.
How do you, and Dr. Ellie too, howdid the, how do you keep your own life
balance, life work balance, and howdo you keep the, from absorbing the
stuff that you're around every day?
(30:21):
Sure.
I mean, own life balance, you know,sleep, diet, exercise I always
talk about to patients and trymy hardest to adhere to as well.
I just, you know, think of liketaking care of your body physically
and mind as well as the importantfoundation upon which you can then
launch into other things in life thatare gonna be good and healthy for you.
(30:45):
Otherwise, taking timeto develop relationships.
You know, Freud said love and work are thetwo functions of a person psychologically.
And so yeah, placing emphasis onrelationships with your significant
others, your family, and developinga friend group, that can also be
supportive to you is vital too.
(31:06):
And then, yeah, work, I mean,people do well with some
meaning, purpose in their life.
Something that you know, gives thema sense of wellbeing and feeling like
they're doing something importantfor themselves and for the world.
And so developing a vocation of some typeand also hobbies that they're interested
in too is really important as well.
(31:27):
You are doing something reallyimportant for the world.
For those of you who listen, youknow, we have links to the Mental
Health Center of Los Angeles.
Dr. Hrymoc is attached to this podcast.
You can ask him questionsor research what they do.
Thanks for being with us today.
This was, excellent.
Well, well done, well done.
I really enjoyed this.
For those of you listening,thanks for listening.
(31:48):
Thanks for watching.
If you're watching thison our YouTube channel.
Wherever you are, I hope with theyou find love, courage, strength,
support, wherever you are.
Thanks for listening.
Be safe and keep looking.
I think it's right in front of you.
Welcome everybody.
This is Avoiding the Addiction Affliction,brought to you by Westwords Consulting.
I'm Mike McGowan.
Innovation is the ability to see changeas an opportunity rather than a threat.
Well, I'll tell you what.
The field of addiction and medicine andmental health has seen some incredible
innovation over the last two decades.
We're gonna talk about where we're at,how we got there, where we might go.
(00:35):
Our guest is Dr. Mark Hrymoc,the founder of the Mental Health
Center in Los Angeles, California.
I'm envious already.
Dr. Hrymoc has extensive expertise inthe psychopharmacology of addiction
and other mental health disorders.
He is double board certified ingeneral psychiatry and addiction
psychiatry, and was previously boardcertified in addiction medicine.
(00:58):
Dr. Hrymoc previously held aposition of assistant clinical
professor of psychiatry at UCLA.
A team my badgers beat in the Rose Bowl,where he supervised training psychiatrists
at their addiction psychiatry clinic.
Welcome, Mark.
Thanks for having me, Mike.
Yeah, sorry I threw that in.
But we don't win all thatoften, so have to do it.
(01:19):
You know, I've been working in this fieldlike you for a long time and a lifetime
ago I worked in a hospital that had theaddiction treatment on the third floor.
Mental health was on the fifthfloor, and maternity was stuck
in between on the fourth floor.
We've come a long way since then.
Yep.
Yep.
Yeah.
They were seen as two different disorders.
(01:39):
Now we see, you know, addictionactually is a mental health issue
and they often feed each other.
Well, how did we get there?
Because it wasn't thatway, not that long ago.
Yeah.
I guess the founding of the field kindof came from two different places.
You know, mental health, psychiatry beingmore informed by conventional medicine, so
(01:59):
a lot of the kinda like western medicinevalues and, you know, thoughts on emphasis
on medication to treat conditions like,you know, depression, schizophrenia,
bipolar disorder, et cetera.
And addiction treatment reallystarted with AA in the 1930s, so it
was seen more of, you know, comingfrom, you know, general society.
(02:20):
And yeah, there was a physician involvedin the founding of AA, but it was
also a lay person bought and, and sothey together, you know, just, just
found, came from a different place.
So ultimately they did meet in the middle.
Well, it just makes sense, right?
That addiction and mentalhealth go hand in hand.
I, I've yet to, I love it whensomebody says, well, yeah, I've got
(02:42):
alcoholism and I'm clinically depressed.
It's like, really?
Right, right.
I mean, what you take has todo with your mental health,
Right.
Right.
Yeah.
I mean, alcohol is a depressant.
It can lower mood too, and thenthat even might drive more drinking
if a person is self-medicating.
So that's definitely one exampleof how they can feed each other.
(03:04):
Well, that's the easy one.
But you and I have worked a longtime with people who take a bunch
of substances stacked on top ofone another, and that can lead the
brain in all sorts of weird places.
Right, right.
For sure.
Yeah.
And behaviors too.
You know, sometimes substance useleads to problematic behaviors that
are compulsive, whether it's, yeah,gambling or sex and love addiction or,
(03:28):
or things like that can, you know, soaddictions can feed each other as well.
I think this is a silly questionto even ask somebody like you, but
I still get into discussions withpeople in the field about this.
It's difficult to treatsubstance use disorders without
also treating mental health.
Right?
Right.
But I still have people who insistif you treat one the other goes away.
(03:52):
Mm-hmm.
Mm-hmm.
Your thought.
Yeah.
They both need to be treatedsimultaneously because
they can affect each other.
And if a person isn't doingwell in one arena, then it's
going to destabilize the other.
So yeah, for sure.
They need to be both accounted for andeach have their own kind of treatment
plan and ideally simultaneously treated.
(04:13):
Well, how do you come at that?
Do you get to the, there's an old tape.
You're younger than me.
So I watched an old tape where when I wasgetting trained by Father Martin, right.
And it was old black and white tapes.
He called them chalk talks.
And he used a thing about, well, if youraunt was going into surgery and she was
(04:34):
pipe full of ether, you wouldn't do amental health assessment at that point.
You wanna get her off the etherbefore you assess where she's at.
Are we still at that sameplace with with drugs?
You want to be sober and detox beforewe see where their mental health is at?
No, because even the detoxprocess can trigger symptoms like
(04:59):
anxiety and insomnia, let's say.
So part of actually treating detoxincludes treating things that come up
which count as mental health issues.
They might be transient, they mightbe related to the actual process of
coming off of the substance, but.
They also might suggest that a person hasan underlying condition in that area too.
(05:20):
So yes, a person coming off of alcoholmight have high anxiety, but it might
be that they had an anxiety disorderor significant insomnia in the first
place that even made them predisposedto developing an alcohol problem.
And so there might be a short termanxiety component that we have to treat.
And then even after the detoxperiod, which usually is about seven
(05:42):
days max or so, then there couldstill be residual anxiety that we
would think of as more of like thechronic long-term baseline anxiety.
And that deserves attention to.
We've seen some incredibleinnovations that we would've never
thought of a couple of decades ago.
Talk about some of them,ketamine and the rest of them.
(06:03):
Sure.
So, I mean, I think even just to take 'emin sort of chronological order you know,
medications being used to treat addictionspecifically started with an abuse.
But by this point, 40, 50years ago kind of came out.
The one that makes you sick if youdrink, is always how people describe it.
And my follow up to that is like, it'snot supposed to make you sick because
(06:26):
you're not supposed to drink on it.
It's supposed to act as apsychological deterrent to drinking.
So that was the one of thefirst medications that came
out to treat addiction.
And then methadone for opioid addiction.
Also at this point out for 50years or so you know, definitely
helped a lot of people get offof very problematic opioids.
(06:48):
Heroin, namely but also perpetuateda physiologic dependence on opioids
but ultimately does reduce risk,health risk, other risks, et cetera.
And then as we kind of go a few moredecades naltrexone is an opioid blocker
that it was developed in the ninetiesthat ultimately was found to treat
(07:11):
both opioid and alcohol addiction.
And so that now is a available as along-acting injection called Vivitrol
which has now been out for about 20 years.
And there've been a handful of other meds.
Suboxone also buprenorphine, youknow, is definitely an improvement
upon methadone, still ultimately areplacement therapy, we'd call it.
(07:34):
And we also need to talk aboutnicotine, tobacco addiction or
now just calling it nicotine'cause a lot of people are vaping.
You know, nicotine replacement therapy.
So analogous mechanism of actionto methadone and buprenorphine.
It is a replacement.
It works on the same receptors and it'ssort of the same way, but reduces risk.
And so Chantix has also been avarenicline is a new medication
(07:58):
used to treat nicotine addiction.
That is twice as effectiveas nicotine replacement.
Works actually analogously toSuboxone, which many people don't know.
Suboxone works on the opioid receptorsin exactly the same way that Chantix
or Varenicline work on the nicotinereceptor, they sit on the receptor.
(08:18):
They stimulate it a little bitjust so a person doesn't go into
withdrawal and doesn't have craving,also has a high binding affinity.
It binds to the receptors so thatnicotine or whatever, or the opioids in
the case of Suboxone, really can't evenaccess the receptor in order to work.
So a person might decide that they wantto smoke a cigarette or vape, and then
(08:39):
they just don't even feel the nicotinebecause that Chantix is blocking it out.
So these are examples of a lot ofthe different, like, mechanisms
of action, of medications usedspecifically to, to treat addiction.
You mentioned yeah, ketamine sothat it is a kind of different
league, different ballpark.
Not used to treat addiction, certainlynot in in any mainstream setting but
(09:03):
has really been a great medicationfor treatment resistant depression.
And other treatment resistant mooddisorders like anxiety and PTSD,
post-traumatic stress disorder.
These types of interventionsare what are offered when
conventional pills don't work.
So someone you know, takes a fewantidepressants and they either don't
(09:26):
work as well as they should or have sideeffects or problems related to them.
Then we would consider either TMS,Transcranial Magnetic Stimulation
or ECT Electroconvulsive Therapy,commonly known as shock therapy,
is still done, not very commonly,often thought of as a last resort.
(09:46):
And then ketamine treatment.
So in my mind, these are the threeinterventional treatments for depression.
They are procedures as opposed to pillsthat you take done in a medical setting.
And ketamine really has helped alot of people even though, so it's
came out in 1970 initially as aanesthetic and pain medication, was
(10:07):
around for decades, widely used.
Considered one of the top 100 mostessential medications according
to the World Health Organization.
So it is just in general in medicine,a very important foundational medicine.
But then in the 2000's, research startedcoming out about its benefit for mood and
definitely in the last 15 years there'sjust been a litany of research coming out
(10:33):
really supporting its use as a medicationto treat depression that doesn't
respond to conventional medications.
And so the nice thing about it is itis six treatments as opposed to 30 or
more, which is what you need for TMS.
It doesn't require taking amonth or so off of work like ECT.
(10:54):
Really well tolerated, worksbiologically as an antidepressant.
But also experientially, and there'sa lot of interest in ketamine being
used as a medication to kinda helpgive people different outlook on life,
maybe reinterpret things that may havehappened to them so that they can process
things that they've gotten stuck on.
(11:15):
And see things in a different way.
Maybe be able to exhibit new ways ofthinking, new ways of behaving, et cetera.
So I could go on and on, but...
That was, that, that was great.
An answer to your question as I could makeit, and I still know it was really long.
No, it was great.
I, that's, that's, tremendous summary, butit begs for me about a dozen questions.
So, you know, it's not that longago that law enforcement was talking
(11:36):
about ketamine is, you know, SpecialK and people were taking it on
the street and cat tranquilizer.
I remember getting, you know,flyers that way and now we
see billboards for it, right?
Ketamine therapy.
So my questions for thatare, you said six treatments.
How did we get to know that?
And how do you determine ifsomebody is a candidate for these?
(11:58):
Third, you can lump them together'cause you're very good at that.
Do you get blowback from peoplewho still remember well, what,
isn't that one of those drugsI'm supposed to stay away from?
Right, right.
Yeah.
I think the important principleis that the same chemical
can be a medicine or a drug.
(12:18):
So the context really does matter.
And I kind of think of them as twocolumns, you know, and even using
ketamine as an example under the drugcolumn is what you're describing.
Like how is it used, the setting to makeit a drug is, that's recreational use.
It's not prescribed, it's given to peopleby their friends or, you know, some
stranger off the street or whatever.
(12:40):
You know, so the, the, the way inwhich it's, it's obtained and, and the
reason that the person is even usingit for the first place as opposed
to a medicine is done with a goodfaith visit between a physician and
a patient where everyone is honest.
No one has any ulterior agenda except tohelp that person with a diagnosed disorder
(13:00):
like depression or anxiety, et cetera.
And so.
You know, if it comes out of a goodfaith visit, then that's, you know
then qualifies then as, as a medicine.
So, you know, similarly, Xanax, youknow, can be a medicine or a drug.
Opioids can be a medicine or a drug.
You know, if you have a kneereplacement you're gonna need
some sort of pain relief.
(13:21):
So there you go.
And, and even if a person hashad a history with addiction,
you know, we, we don't want tomake people suffer needlessly.
I mean, we are merciful and compassionatein the medical business, and we
do want to, you know, treat anyanticipated pain or pain that comes up.
And so opioids are appropriate if,you know the context calls for it.
(13:43):
I mean that, I think that's,that's the main kind of difference
between medicine and a drug.
Well, okay, so how did we getto six rather than 7, 9, 12?
Yeah.
Through research studies one, ketaminetreatment can have a mood benefit
that lasts up to a week or so.
So it is a procedure.
A person has to come in the office.
It's a two hour appointment.
(14:04):
They need to be there, take time.
Also the rest of the day you, wecan't really have a lot of stressful
things or deadlines, you know, you'renot gonna getting sent back to work
after having ketamine treatment.
We do encourage you to.
Kind of just take it easy, et cetera.
So, you know, there was an interest inhaving a schedule that would allow for
(14:24):
ketamine to have benefits that last morelike months instead of just a week or so.
And so they basically found by gettingsix treatments within a three week period
leads to a benefit that lasts longer.
And I kind of think of it as.
Like, if you're gonna paint something,you want to put multiple coats of
(14:44):
paint, if you want that effect to stay.
And so, you know, getting the,the treatments in a repeated basis
is the most potent way and leadsto the longest acting benefit.
More treatments might makeit last somewhat longer, but
there's diminishing returns.
So, you know, research has basicallyfound that six is the number that a person
(15:05):
would need to, you know, really kind ofoptimize the fewest number of treatments
to last the longest amount of time
I would think I may be wrong, but Iwould think that, as a standalone,
it works somewhat, but if you coupleit with talk therapy or other sorts
of therapy, it has a better effect.
(15:25):
There's some research suggesting that yes.
Not enough yet toofficially make it standard.
But there are a lot of believersin psychedelic assisted
psychotherapy in general.
Ketamine being the first medicine withpsychedelic properties that is actually
legal and available to prescribe.
(15:47):
And so there is a treatment modality ortreatment type called ketamine assisted
psychotherapy, where a person will havea ketamine treatment and a therapist
will have actually had a session or twobefore to kind of prepare them for the
medication treatment, and then they'llsit with them during the appointment or
(16:09):
to guide them through the experience.
Also be there to listen andinterpret things, you know, jot
things down for later discussion.
The goal being to implement thenew perspectives that a person
experiences under ketamine and to mosteffectively convert them into long
lasting changes in a person's life.
(16:30):
And so, yes, there is a beliefthat this helps and you know, being
a straight shooter and a doctor.
You know, I also need tohighlight that whenever we make
recommendations in medicine, theydo have to be based on evidence.
You know, and so there's a belief,there's a suggestion, there's a hunch,
and definitely anecdotal evidence.
I mean.
I and other clinicians working in thefield have seen this benefit exactly
(16:53):
exist where a person who gets therapywith ketamine does better than even just
ketamine alone or psychotherapy alone.
And so I think of it as like asynergistic effect where the total is
actually greater than the sum of itsparts, like one plus one equals three.
We're using that now.
And you said somethingabout first clinical.
Back in the previous century.
(17:14):
Oh God.
I like saying that, we heard anecdotallysimilar reports about LSD and then
at the turn of the century we heardit about ecstasy, methylene, doxy
methamphetamine, and people wereusing it in a therapeutic way.
But we don't have those studiesto show that it does the same way.
Do you think we have other chemicalscoming on the backside of ketamine
(17:36):
down the road a little bit.
Oh yeah.
There is a ton of research currentlybeing done, honestly, looking at
almost every single psychedelicbeing used for almost any psychiatric
indication that you can think of.
You know, including LSD, beingstudied as a treatment for anxiety,
(17:58):
which you would never expect.
Right.
MDMA, ecstasy being used as a to helpwith certain symptoms of schizophrenia
or other psychotic disorders.
So, this is research.
It's a research interest.
It is by no means a recommendationand certainly there's no
recommendation for people to attemptto have their own, to treat it.
(18:19):
Right.
And yeah, if, even if a patient asksme, I mean the, the big one that
there's actually a good amount ofresearch on that people have heard
about is, is like, psilocybin, youknow, doc, what do you think of me
taking mushrooms for depression or foralcoholism or, or things like that?
And, and my standard answer is,there's def there's, you know,
a, a, a signal of interest there.
You know, there's maybe an effect thatresearchers are interested in examining
(18:42):
and looking at, but it's nowherenear the level of being incorporated
into clinical practice guidelines.
The guidelines that doctors woulduse to assess, diagnose and actually
recommend a treatment for a person.
So it's, you know, too earlyfor primetime, basically,
You know, I'm from Wisconsin where we havea, a football team that's kind of good.
So that would include ayahuasca andsome of the other substances too.
(19:07):
And more research needs to be done.
Yes, yes.
And yeah, active ingredient,ayahuasca being DMT.
And then there's a related compoundcalled 5-MeO-DMT that both of which
are also being studied as treatmentsfor depression and other things too.
May is Mental HealthMonth, Awareness Month.
What are you seeing at the mental healthcenter regarding we, we have all these
(19:28):
reports of increased doom and gloom,and we're surrounded by negativity
and, you know, therapists that Italk to are booked to the nth degree.
There are no opening,no opening, no opening.
What are you seeing among your patientsand, and what would you say to people
that are experiencing some prettymuch deep depression and anxiety?
(19:51):
Depression and anxiety are medicalconditions that deserve attention,
that a person should not feel guiltor shame about seeking treatment for.
They're more than just quote,normal sadness or stress.
There is a difference between normalhuman emotion, which we do not consider
(20:13):
a disorder, hence the word normal andmood disorders, conditions, diseases
that ultimately can be diagnosed.
They run in families.
You know, a lot of the things thatare, we think of as medical illnesses.
Physical medical illnessesare consistently true for
(20:34):
mental health issues too.
And there are treatments that work,psychotherapy and medications,
and the combination of the twoalso yields a more potent result.
So, I mean, I'm a big advocate ofde-stigmatizing mental health conditions,
helping people understand them, helpingtheir families understand them too, that.
(20:55):
You know, this isn't just, you know,dad being lazy or mom being a nervous
wreck or, you know, anything like that.
Like they, they, they have a conditionthat deserves identification and deserves
treatment, and they can get better and thefamily system actually gets better too.
You know, mental health issues, whetherit's addiction or anything else, are
conditions that affect the whole family.
(21:16):
Not only the person that actually hasit, but the people in their orbit, you
know, definitely in their immediatefamily that are also affected by it.
And so the system can can use help too.
I know you formed the mental health centeror founded it with your, your wife, right?
Dr. Ellie Mizani.
That's right.
And I'm not asking you to stealher thunder, but I read that her
expertise is child psychiatry andadolescent psychiatry, and I've
(21:40):
worked with them my entire life.
We're seeing a huge spike in concerns foradolescent, young adult mental health.
Are you seeing that inyour practice as well?
Definitely you know, especiallywith the pandemic schools shut down.
That was a huge social stressor on somany people and changed the way that
(22:03):
kids even develop socially, you know, Ithink of a developing person sort of as
like wet concrete, and in those firstlike 18 or 25 years, you know, if you
make an impression or things happen,they can actually have a longer lasting
impact than if they happen when a personis in their thirties or forties, you
know, because their brains are stillsort of solidifying their behaviors are
(22:27):
their sense of self, their relatednessto other people, and so definitely the
pandemic alone has been responsible fora lot of mental health issues coming
up and also a lot of de-stigmatizationof mental health treatment, maybe
for a lot of people that really?
Got so bad that it became undeniablethat they needed help, whereas before,
(22:49):
like you'd hear things like, oh yeah,my dad doesn't believe in depression.
Or, you know, I, my dad just thinks I havea weed problem and I smoke too much weed.
But it's actually, you know,a, a cannabis addiction.
So, you know that definitelysociety is evolving too.
Well, I wanted to ask you thatand, and circle back to our
original, because, you know.
(23:11):
The research that we talked about.
Again, I'll just reference it tothe point, the six ketamine visits.
Right.
One, how do you determinemedications for adolescents whose
brains are still developing?
And what I find is that a lot of kidswho experience that are self-medicating
and especially with cannabis, andthey like the, what I hear Dr.
(23:35):
Hrymoc is I'd rather smoke a jointthan take that crap they have me on.
They don't like the side effects ofsome of the drugs they get prescribed.
Right.
Yeah.
The goal of a good relationship with apatient and doctor is for there to be
(23:56):
transparency about benefits and sideeffects, unintended ones, and we always
want to choose medications that havemaximal benefit with minimal side effects.
And so there does need to be a dialogue.
But sometimes people aren't able to seetheir doc as often as could entail, and
(24:16):
so they might just try for a month ortwo, and then without a follow-up visit,
they just kind of go off it on their own.
You know, on some level they're,they're making the decision
instead of, again, the, thehaving that collaborative process.
So it's, and whether it's cannabisor alcohol, like we think of the, you
know, nicotine, the substances that aremore common for teens to get into and
(24:40):
perhaps even be self-medicating with.
They have an immediate effect.
So people in general are wired to bebiased towards short-term benefits.
And so if there's an immediate benefitreduction in anxiety, let's say, or,
or depression with use of a substance,that's a really potent reinforcer.
You know, like, okay, when Idid this, like I felt better
(25:02):
instantly as opposed to.
You know that if we think of traditionalSSRI antidepressant medications
like Zoloft, et cetera, you know,they need to take at least a week
or two to kick in if you're lucky.
Four to six weeks toreally have full effect.
And so there's already a discrepancybetween like the fast acting benefit
(25:23):
versus the longer term, you know?
But as we all know, short term benefitsdon't always have the same long term
benefits, and there is actually valuein investing that time and energy
into finding a medicine because.
These, these medicines actually do work.
There's actually been a lot of researchon cannabis for medical purposes,
and it's interesting that it hasnot shown consistently to benefit
(25:48):
any mental health issue, includingdepression, anxiety, insomnia.
People will say like, oh, it helps me.
And when they do, I don't argue with them.
I can't argue with personal experience,you know, and I'm open to listening
to, to their experience and, andbelieving them that, you know, maybe
that works for them, but you know, ithasn't helped enough people, not in
the way that medications has and, andbeen demonstrated also in research
(26:12):
studies to, you know, help like up to70% of people that might start Zoloft
for, you know, depression or anxiety.
That's, that's (laughs) acards and letter coming at you.
You know, every time I mentionstuff like that, I get a lot of,
whoa, you know, the, the pro weedcommunity comes at me, but CBD and the
(26:33):
gummies are not cheap, first of all.
Right.
Right.
And the research isn't quite there andI, I hear a lot of anecdotal stuff, but
I don't see, like, you, I keep lookingfor the studies and I haven't found 'em.
Right.
Right.
Yeah.
Yeah.
I mean, the conditions that there'smedical grade evidence to support its
(26:54):
use are for things like muscle spasticityand ms. Decreased appetite with cancer,
nausea associated with chemotherapy.
You know, there the glaucoma there,there's, there's certain types of
pediatric seizures have been like, there'sseven or eight conditions like that,
but again, not depression or anxiety.
(27:16):
That's been, again, showshown in large scale.
You know, the gold standard is placebocontrolled, double blind studies.
Like that's what we look for in,in medicine to be able to then say,
okay, this is a treatment that we'regonna be recommending to people that
have, you know, these conditions.
Where do you think we go from here?
Like we're we're talkingabout the innovations.
I'm not asking you to, to know, butwhere do you think we'll go next?
(27:41):
In terms of treatment for...
Yeah, like what's on the horizon?
Yeah, I, I mean the, I think a, anexciting new chapter in psychiatry that is
opening up are the psychedelic treatments.
You know, I think on a, on a certainlevel, we've plateaued with development
of traditional antidepressant andanti-anxiety medications to the extent
(28:05):
that big pharma has really scaled back ontheir investments in studying those types
of medications in the last 10 or 15 years.
And so the, the, but you know,psychedelics in terms of being used both
as medication treatments alone and, andsome of the studies that I was talking
(28:27):
about earlier, or do look at them asa medication alone treatment done in a
controlled setting, in a supportive way,but not necessarily combined with therapy.
And then there also is interest intherapy being combined with it too.
And, and there's a lot of interestand belief that a person going through
an experience like that might have adifferent reference point on their life.
(28:48):
And instead of, you know, always kindof looking at things from a certain
perspective for a few hours anyway, canhave the experience of standing somewhere
else and looking with the assistanceof their therapist on events that may
have happened to them, their currentlife, relationships, work situation,
et cetera, and being able to putthings into perspective for at least a
(29:12):
different perspective for a few hours.
And also, I'm, I'm, yeah, I, I think it'simportant not to be biased and become
a zealot about it either that theremight be false perspectives or erroneous
perspectives that then a person can atleast consider and evaluate after they
come back and think about what theydo wanna incorporate in their lives.
Because you know, we, wanna help themimplement 'em in their, those benefits
(29:36):
into their general lives, not justthe times that they might be using
that, those substances, let's say.
Right.
You know, this is so well balanced.
It's really been fascinating.
I'm gonna give you a little walk off here.
Every time I talk to somebodywho is in your area of expertise,
I gotta ask this, right?
You're surrounded bydoom and gloom as well.
You know, you read the news, you hearall the stuff, the negativity, and you're
(30:00):
surrounded with people with trauma.
We have a lot of therapists wholisten to this, who struggle
with their own secondary trauma.
How do you, and Dr. Ellie too, howdid the, how do you keep your own life
balance, life work balance, and howdo you keep the, from absorbing the
stuff that you're around every day?
(30:21):
Sure.
I mean, own life balance, you know,sleep, diet, exercise I always
talk about to patients and trymy hardest to adhere to as well.
I just, you know, think of liketaking care of your body physically
and mind as well as the importantfoundation upon which you can then
launch into other things in life thatare gonna be good and healthy for you.
(30:45):
Otherwise, taking timeto develop relationships.
You know, Freud said love and work are thetwo functions of a person psychologically.
And so yeah, placing emphasis onrelationships with your significant
others, your family, and developinga friend group, that can also be
supportive to you is vital too.
(31:06):
And then, yeah, work, I mean,people do well with some
meaning, purpose in their life.
Something that you know, gives thema sense of wellbeing and feeling like
they're doing something importantfor themselves and for the world.
And so developing a vocation of some typeand also hobbies that they're interested
in too is really important as well.
(31:27):
You are doing something reallyimportant for the world.
For those of you who listen, youknow, we have links to the Mental
Health Center of Los Angeles.
Dr. Hrymoc is attached to this podcast.
You can ask him questionsor research what they do.
Thanks for being with us today.
This was, excellent.
Well, well done, well done.
I really enjoyed this.
For those of you listening,thanks for listening.
(31:48):
Thanks for watching.
If you're watching thison our YouTube channel.
Wherever you are, I hope with theyou find love, courage, strength,
support, wherever you are.
Thanks for listening.
Be safe and keep looking.
I think it's right in front of you.
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