April 30, 2025 • 38 mins
Drugs don’t care where you grew up, went to school, or what you majored in. When you develop destructive habits, though, you have an opportunity to turn your life around by developing new, healthier habits. Dr. Jason Giles discusses the road to recovery from substance use disorders. Dr. Giles is a graduate of University of California Berkeley. He earned a degree in molecular biology and then earned his medical degree from UC Davis. Dr. Giles completed an internship in General Surgery, residency in Anesthesiology and Pain Medicine, and earned board certifications in Anesthesiology and Addiction Medicine. He was a cardiac anesthesiologist and pain specialist before devoting his full attention to addiction medicine starting in 2005. He is the author of a new book, “The Addiction Doctors Manual for Behavioral Health Technicians: What to Do When You Don't Know What to Do” and a previous book, “Outsmart Your Addiction.” His books can be found at https://www.amazon.com/Addiction-Doctors-Manual-Behavioral-Technicians/dp/1735081914 and https://www.amazon.com/Outsmart-Your-Addiction-Powerful-Developed/dp/1735081906 Dr. Giles can be reached at https://addictiondoctors.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.
We're always interested in hearing from individuals or organizations who are working in substance use disorder treatment or prevention, mental health care and other spaces that lift up communities. This includes people living those experiences. If you or someone you know has a story to share or an interesting approach to care, contact us today!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:12):
Welcome everybody.
This is Avoiding the AddictionAffliction, brought to you by Westwords
Consulting and the Kenosha CountySubstance Use Disorder Coalition.
I'm Mike McGowan.
Growing up around addictiondoesn't protect you from addiction.
Neither do drugs care about where you wentto school, what you majored in, how much
money you make, what you do for a living.
(00:34):
But when you develop destructivehabits, you have an opportunity
to turn your life around bydeveloping new and healthier habits.
That is not only the messageof our guest today, but it's
his life experience as well.
Dr. Jason Giles is a graduate ofUniversity of California Berkeley.
He earned a degree in molecular biologyand then obtained his medical degree
(00:54):
from University of California Davis.
Dr. Giles completed an internshipin general surgery, residency in
anesthesiology and pain medicine,and earn board certifications in
anesthesiology and addiction medicine.
He was a cardiac anesthesiologist andpain specialist before devoting his full
attention to addiction medicine in 2005.
(01:14):
He's the author of a new book,the Addiction Doctor's Manual for
Behavioral Health Technicians (01:17):
What to Do When You Don't Know What To Do and
a previous book, which is terrific,called Outsmart Your Addiction.
Welcome Dr. Giles.
Thank you very much.
Thanks for having me on your show, Mike.
I always like to start with thestory and so let's go backwards.
Let's start with your firstbook, Outsmart Your Addiction.
Like a lot of us, yougrew up around addiction.
(01:40):
Yeah, that's true.
So I'm a Southern California native, andthere's a time of knowing that you're
growing up around addiction, and thisis a time before that, so I grew up
around it because my dad liked to drink.
I didn't know what thatwas when I was a kid.
I knew a couple of things.
I knew that if I made him a drink, Iknew that if I fixed him for fortunately,
(02:02):
he drank a very simple drink, whichis, which was gin on the rocks.
It was gin and ice.
So I could make that from a young ageand when he was home and and asked for a
drink if I made that yeah, he was pleased.
And then soon after thathe was easier to be around.
Yep.
And that's what I knewabout it at that time.
And the other thing I know about,I think I mentioned this in the
(02:24):
book, which is that when he camehome at night or in the morning.
You could tell what kind of a day you werein for by how the keys went in the lock.
Right.
So if there was fumbling and droppingthe keys and evidence of persistent
intoxication, we would say nowthen we were in for good times.
'cause he was still drunk.
(02:46):
This is back before all the crackdownson driving drunk and so forth.
Yeah.
And but if the key went in easily.
Then we're in for a rougher time becauseit had been longer, since he had a drink.
And it's those kinds of things thatyou pick up as the child growing
up in an alcoholic or a substanceusing home or a home with mental
illness that you don't know, thatyou know that until, until later.
(03:08):
But looking back and when you getaround other people who grew up
with that, they're like, yeah,you know, my mom, I could tell.
And then they'd start tradingstories and you realize that
you're not the only one, but later.
You know, he got into a coupleof those DUIs, a couple of people
were interested in him being sober.
He started to get interestedin it himself and went to
meetings of Alcoholics Anonymous.
And I remember in elementaryschool going with him.
(03:30):
So there was a clubhouse not toofar away from where we lived, a
mile or two from where we lived.
And I remember sittingin the smoke field rooms.
And seeing these folks, andthey were they're good people.
And he went to that for a while.
My dad went to that for a while.
He ultimately did stop drinkingjust right before I left the house.
(03:51):
So, so that was good.
And then later when I discovered myown problem, which we can talk more
about, we had that thing in common thatwe had been through that sequentially.
And that was good.
I mean, that gave ourrelationship a chance.
We had common ground from havingbeen through that similar experience
together with getting sober.
(04:11):
On a chronologic basis, I got sober, muchyounger, but that has something to do
with the particular substance that I choseand also that the ground was prepared.
So I knew about this world a bit.
I knew it wasn't the end of theworld, although sometimes it felt
like that would be the end of theworld, not having something that
you could take or drink or use.
But yeah, relationships withparents in general can sometimes
(04:34):
be tricky and with an alcoholicfather and then a mother protecting
the kids, sometimes protecting him.
Sometimes those sort of dualrelationships that go along with
the codependence, that complexity.
Sometimes it's hard to seethe details of God's plan.
You know, all of that was on purpose.
(04:54):
All of that was the wayit was supposed to go.
Much of it as I was going throughit, I wished were different, but
that's one of the gifts of beingin recovery and being older is
seeing all the things along the way.
You know, seeing that my story, althoughit was unique for me is pretty generic.
There's so many similarities.
(05:16):
People get hung up on, or, or, it'sinteresting, I suppose it's probably
interesting to your audience that,you know, I was an anesthesia still, I
guess, but I just don't do it anymore.
Anesthesiologist trauma level one,trauma center hospital, high flying
transplant, surgery, all the like,movie and TV kind of intense stuff.
But in many ways I was stillthat kid from, you know, from
(05:39):
the, from the same house.
I still had those self doubts.
I still had that sense of insecurity.
I still had that... I f only I,and this is, gets back to making
the, the gin, if only I performwell then I can deserve to be here.
And that's messed up.
That's a messed up way of thinking.
Well, you talk about it in yourbook, and I think that's fascinating.
(06:01):
The parallels, you're right.
Every time you talk to somebody,it's like this substitute
gin for beer in the fridge.
Yep.
Substitute keys in the door towatching my dad's pickup truck.
And our story's the same.
But as you move forward, eventhough you grew up around it,
then you get to be a teenager andI think we divide up, don't you?
Into two.
You have the...
How do you mean?
What do you mean?
Well, you have those group peoplesay, I'm never gonna be around it.
(06:24):
And then some people go,well, I'll just use, and...
I'll be careful!
Yeah.
I was in the group.
Yeah.
I'll be, I'll be, I'm notgonna end up like him.
I'll be careful.
And how'd that work out for you?
Well, you know, here we are, right?
Yeah.
Here we are.
Right.
That's how it worked out.
I had to go through allof that to understand.
There's an intellectual understanding.
I saw a bumper sticker once that saidwhat, what did it say that recovery
(06:47):
is for people who been to hell?
Something like that.
There's not, I'm trying to remember,trying to remember how it, how it goes.
It's like church is for peoplewho want to go to heaven.
And recoveries for people who been tohell, I think it's something, something
like, something like that, you knowlook ostensibly on paper based on the,
the you know, degrees and whatever andtests I've passed and things like that.
(07:09):
I'm, I'm allegedly supposed tobe a smart guy, but that was
completely worthless when I said.
I'm gonna be careful and make surethat I don't develop a problem
with whatever the substance was.
I gotta ask you, 'cause this is thepart where I had to read it twice.
And, and I couldn't wait to ask you this.
So you're an anesthesiologist at somepoint, and you actually start your
(07:32):
book with a story that's familiarto me because my dad actually died
of the same operation that you wereoperating on when you start your...
Aorta surgery.
Yes.
And um...
Oh wow.
oh wow.
But, but his inside there wasnothing to attach it to because
of his lifetime of abuse.
So, and I'm sure you've seen that, right.
But you said you deliberately.
(07:54):
Set out to, maybe I'm putting this wrong.
You started to experiment withthe drugs that you were giving
people to see what they were like.
Yes, yes.
Curiosity, and so that was a blindspot for, for me, if you said, I
dunno, we have to, we have to imaginea scenario that couldn't possibly
have taken place, but let, let'ssay you and I are friends back then.
(08:15):
And and I say, Mike, I'm gonna tryout these drugs in the, in the drawer
that we use for all the patients.
Yeah.
Just to see what they're like.
You would probably havea look of horror, right.
It's just, it, it's outrageous that idea.
And yet this is wherethe smarts do me no good.
And yet that sounded to melike a very reasonable thing.
(08:36):
I'll take it evenfurther, which is to say.
Who else should be experimenting withthese drugs than somebody who really
understands exactly how they work?
Good.
There's one thing to understand exactlyhow they work in the textbook or in
practice with giving them to otherpeople for surgery and so forth.
It's a whole different thing,taking them yourself, right?
(08:57):
So if you take 'em yourself, now the,this is sort of obvious, but the person
that's gonna be doing the analysisand say, whoa, how is this working?
And is this.
That person is under theinfluence of the drug.
Mm-hmm.
And that may be the crux of whatthe susceptibility to chemicals
is, is that you make a plan, and Idid this before, you make a plan.
(09:18):
You're only going to use this muchor only on this day or only at this
time, or only with these people,or only in this circumstance.
And then once the substance getsin your brain, and we take these
things in order to change the waywe feel, which is another way of
saying change the way we think.
We take these things to changethe way we think and then act
surprised when the new thoughtsare, Hey, how about another round?
(09:40):
Right?
Yeah.
I want another pitcher.
Let's go.
And, and, but of course, right, of course.
That's how the substances work isthey change us from I'm under control.
I'm being very thoughtful about this.
To what the heck, right?
We're here anyway.
So yes, that curiosity was the entree.
(10:01):
And I, you know, went through allthe stuff, tried things that are
not necessarily psychoactive inorder to feel what epinephrine
feels like and and so forth.
But yeah, once you get into theopiates, they have their own opinion.
They have something to sayabout what you're gonna do next.
And that has to do with biology.
We make our own endorphins, right?
We make our own opiates and we makethem to deal with pain and suffering,
(10:24):
but also they're neurotransmitters,they're chemicals that the brain uses to
communicate with other parts of the body.
So our engineers, our chemicalengineers that made this stuff
and extracted these things and puttogether a drug as potent as fentanyl,
that was my particular cup of tea.
It's so perfectly createdto activate this pathway.
(10:45):
This, everything's okay.
There's nothing to worry about.
And no pain, right?
No pain of anxiety.
No pain of loss.
No pain of regret.
It's so perfect for that, that once it'sin of course you'd wanna do it again.
I mean, of course you'd wanna keep going.
Of course you'd wanna get after it becauseit's engineered to create those feelings.
(11:08):
So, ostensibly, analytically,this makes sense.
You want the anesthesiologist tounderstand how this goes, and yet
the substances themselves willnot let you get away with that.
Very, arm's length analysis.
'cause they get in yourbrain and have a, have.
Change plans.
Do you find yourself incredibly gratefulfor your supervisor at that time because
(11:34):
you had support to steer you intohelp rather than throw you on a heap?
Oh yeah.
Yeah.
So Peter Moore was the chairman ofthe department and if it weren't for
him... So I got extraordinarily lucky.
Not just having somebody to, to be thereand help me through this, but there's
an unknown person who a few years,not that many years before I joined
(11:56):
the department overdosed and died.
Oh.
So the department had an experiencewith another one of the residents
who had lost his life behindsubstance use with, with fentanyl,
was found dead at the hospital and.
So that experience raised the, Idon't know, worry factor or the
(12:18):
awareness on the part of my chairman.
And so he was looking for this, itwas part of, it became part of his
pattern recognition was lookingto see, and I don't know because.
We never discussed it per se,but I suspect I was giving
off some kind of signals.
(laughs)
I was, I was, until that point, Iwas super careful and, you know, all
(12:42):
this activity took place after work.
When I say activity, Imean the use of the drugs.
But let's not kid ourselves, right?
So you can't use 'em at all.
But if you get to the point whereyou're using them regularly.
Then the next morning, and that'show the book opens with me.
Mm-hmm.
Mm-hmm.
Really needing some andnot, you know, not using it.
That's the maybe worst spot to be in.
(13:04):
And so it was obvious to him, Iguess there was some awareness
that he was able to muster.
Like, Hmm, this formerly sharp kid isnow a little ragged around the edges, or.
Shiny or, or sweaty or goose bumpy or,I don't know what I talked about in the
(13:25):
book, I wore a long sleeve gown, the kindthat the surgeons wear, that they put
their hands in and their gloves on, andget tied up in the back and do surgery.
Only I wore it the way you'd put abathrobe on, which is technically
backwards, but looks frontwards.
And so I always had that gown on andit's not that unusual 'cause it's
chilly in the OR and it's you know,some people do that as a, I don't know.
(13:48):
It's what, it's what a lot ofanesthesiologists wear is these
surgeon gowns over their scrubs.
But I went from never wearingone because I'm not usually cold
in the OR to always wearing one.
So then maybe that, maybe thatwas a giveaway, whatever it was.
Thank God because.
At one point I got apage, back in pager days.
(14:09):
This is the nineties.
So I got a, I got a page from the fromthe chairman, which is weird by itself
to get, you know, paged by the boss.
And so I called back and he saidAustralian guy said, not, not saying
that you not casting any aspersions,but there's a, there's a large amount of
fentanyl missing from the hospital supply.
(14:30):
And if it's all back there, you know,by tonight, then everything's fine.
And which is of course ridiculous, right?
It's ridiculous.
So I said, can I come talk to you?
Because the only way for itto be back, you know, would be
for me to be standing in there.
And I had left the hospital.
I got the page after Ileft the hospital that day.
So I went to his house and he said I'mreally happy that you, are talking to me.
(14:54):
We know what's going on, and and there'shelp for you and it's going to be okay,
and then you're gonna come back to thehospital when you're all done with your
treatment and you're gonna work here.
Everybody loves you and, and you'reterrific at your job, and you just got
this problem and we want you to come back.
Those are the words he said, butthat's not what it sounded like.
(15:16):
It sounded like we've got you.
You're never coming back here.
You're, you know.
'cause I felt so low, right?
I felt, I felt like I had let him down.
That's what, that's what I felt like.
Well, you know, you just, you made itsound like you could go right back.
I don't, I think people aren't,doctors don't understand this.
Like, you, you got intorecovery, they got you help.
(15:38):
But the road back togetting your status back.
Not right back.
Right.
I mean, well, how long back?
Because a lot of peopledon't understand it.
It was three years.
It was three years,
Yeah.
Yeah.
Three years.
Three years.
Three year interruption and...
And how many and how many hoops?
Oh boy.
Yeah, boy.
Like LeBron level hoops.
I think the Ringlingbrothers that many hoops.
(15:59):
(laughs)
It was, yeah.
You know, in the very beginning,and this turns out to be classic
and or in ordinary as well.
I didn't know 'cause it was happeningto me, but in the beginning all I
wanted do is hurry up and get betterso I could better get 'em off my
back so that I could go back anddo what I was doing because Okay.
All right.
Don't use, don't use drugs.
I got that.
Okay.
Let's just have a do over.
(16:20):
But what, what I didn't know and whatI realize a lot of people don't know.
Is that the substances arenot the actual problem.
The substances are the late finding.
They're the solution thatthen turns into a problem.
They're the solution thatthen becomes its own problem.
Okay?
So you deal with the substances.
Let's say you magically never use again.
(16:42):
They cut out the part of youthat wants to drink, right?
Or they cut out the partof you that uses drugs.
Not possible, but let's say it were.
You still are that person.
I'm still without the substances.
I'm still the guy who needs something inorder to manage his feelings, to be in
the world, to deal with my history, todeal with my family of origin story to
deal with all, all that, all that crap.
(17:03):
And, and now without, withoutdrugs, I, what are you gonna do?
We gotta find a different solutionbecause I couldn't live, and this
is where people come in, is they.
They can't live like they were, butthey don't know what to do next.
And that, and that was me.
So my real problem was the wayI felt about myself and the
way I behaved in the world.
(17:24):
That that was my, thatwas my real problem.
The substances were a failedsolution, but I needed a new one.
I needed a new solution, andthat's what the hoops were.
The hoop, they felt like hoops,but eventually it's, I don't know.
It's like any of these great.
Superhero movies where when they'regoing through the part that just sucks.
And then you start toget a little traction.
You're like, all right, CaptainAmerica's gonna make it right?
(17:45):
Or, or, this is whereThor picks up the hammer.
And, and, and so each one of thosethings, so I, you know, left, went
to treatment, found there were otherdoctors who'd been through this.
There are other an, you know, whereI went to treatment over the three
months that I was there, therewere a hundred days there were.
There were eight otheranesthesiologists over that time.
(18:06):
Now there were hundreds of guys in thethree, in the three, several hundred
guys in the three months, but therewere eight other anesthesiologists,
which seemed really important tome at the time that someone else
had been through this problem.
They had a very similar story.
I wasn't the only like fallen angel.
I wasn't the only one who did this.
They're like, oh yeah.
And then I, you know, thenI started using more often.
(18:28):
I'm like, and I started using more often.
They're like, oh yeah.
And then I, you know, then this happened.
I'm like, that's what happened to me.
And you start to realize, because Ithought I was the only one, right?
I thought nothing could help me.
And then when I found somethingthat did temporarily, I, I
thought I couldn't talk about it.
And then when everything was youknow, I'm on this Bronco and I can't
get off, who are you gonna ask?
Who are you gonna talk to?
(18:48):
Well, turns out thatexperience is also generic.
And then when you here when youadd the beer and the vodka and the
marijuana and then whatever elseanybody else is doing, that turns
out to be very, very, very common.
Like, oh, okay.
So I have that thing that severalother, several 70 million other
people have in the us, probably2 billion people have worldwide.
(19:09):
So I have that thing that they have.
Okay.
No.
That's all right.
That's actually hopeful.
Maybe I'm not the only one.
And then some of the other hoops werethis family stuff I talked about.
Mm-hmm.
Some of the other hoops were thebelief that if I... Book talks
about, it's one of my favorite linesthat I was a victim of the delusion
that I could rest satisfactionfrom life if only I managed well.
(19:34):
And that line piercedme like nothing else.
Because if only I can get it allgoing, then I deserve to be here.
And that thinking turns out tobe very common in our cohort.
Right?
Very common among the addicts andalcoholics and the source of all of my
discomfort, source of all, all of my pain.
I don't belong here, or there'ssomething wrong with me that's ordinary.
(19:57):
Everyone thinks that, you know, Idon't fit in weird at the party.
I want the new guy, whatever.
Everyone has that, that's all.
That's all normal.
Why is she with me?
She could do better.
That stuff.
That's not pathologic.
That's normal.
What's pathologic isthinking, I can fix this.
That's where the problem is.
Instead of saying, Hey, Mike, youever feel like you don't fit in?
(20:18):
You're like, yeah, I feellike that all the time.
Oh wait, mean that's normal?
Well, I don't know.
I feel it.
Okay.
I don't need to fix that.
I don't need to repair that feeling.
I don't need to change.
That's just, it passes by.
I don't need a drug to fix it.
So that, that was the big hoop, or thetiniest hoop, I guess, to get through,
which is, there's nothing wrong with you.
(20:38):
There isn't anything wrong.
There's nothing to fix!
Stop trying to fix it!
I think that those statements lead to thethrust of your work since then, right?
Yes.
You clearly come down on thebehavioral side, and I've spent a
long, long time, my professionalcareer working with youth, right?
Mm-hmm.
And learning the skills to cope withyour feelings, to problem solve.
(21:02):
I mean, it's a skill.
It's just repetitive habits.
And then it becomes a habit!
How did you know how to do that?
I don't know.
And just do, do it all the time.
I watched I watchedthe Dodgers last night.
Oh.
Oh God.
I'm a Brewer fan, so watch out.
Well, the brewers are strugglingright now, aren't they?
Yes, yes they are.
Yeah.
Yeah, they're struggling.
(21:22):
But the I watched the Dodgers last nightand you know, this, this guy that they've
got Shohei Ohtani, he, may, maybe, maybethe greatest player ever, certainly
one of the greatest players ever.
He he practices a lot, youknow, he hit a lot of baseballs.
He threw a lot of baseballs.
He ran between the bases alot and, and he hits a lot of
baseballs, and that's on display.
So, yes, it's impressive.
(21:42):
Of course, you know, that thatend to that game was, was great
for us and bad for Atlanta.
But the results of it are that he isin the habit of hitting baseballs.
He has talent, he has ability.
He has strength.
He has size, he has all those things.
But, but you know thatthat's not why he's so good.
Why he's so good is he practiced andpracticed and practiced and practiced
(22:05):
until he sees the game differentlythan somebody who hasn't played,
hasn't, hasn't taken it to that depth.
I was, you know, getting close to ShoheiOhtani level, good at being a drug addict.
I had all this training, I had all thispractice, I had all this experience,
had all this expertise, and thereason I make a joke about that is
that, is that it, the habit becomesits own, has its own momentum, right?
(22:29):
It has its own momentum.
If you go to the gym and if yougo often enough and consistently
enough, you become a gym goer.
And if you're a gym goer.
If you go to the gym,'cause you go to the gym.
'cause I don't know, Ialways go to the gym.
If you go to the gym, you just go andif you don't go, you don't feel right.
(22:50):
It's not that the gym is fun, it'snot that it feels good to do the, do
the exercise and go through whateveryou, whatever your routine is.
But the habit, we're, we'rebuilt to do things repetitively.
We, that's what learning is, right?
That's what proficiency is.
So we, so we say Shohei Ohtani isin the habit of hitting home runs.
And if you think about it, well,gosh, he is, you know, Aaron Judge
(23:13):
is in the habit of hitting home runs.
Buki Bets is in the habitof hitting home runs.
Christian Yellich, there we go, isin the habit of, of hitting home runs
and, and so I. Everything is habits.
Our relationships are habits.
Our, our waking routines are habits,the food we eat, and then the
cumulative effects of that, whetherwe're healthy or not, those are habits.
(23:35):
I like that because even beforehe hits a home, run his, his
routine is consistently the same.
He wipes the bat the same way hewaits, he bows to the umpire the
same way so that it's second.
So that the action, and to use yourwords, I think, I don't want the action
(23:55):
of then staying in recovery is justa continuation of routine and habits.
Exactly.
Exactly.
And you, you know, and so the life Ihave now does not look at all, like
the life I had back then, they'renot even in the same universe in
terms of what my, my daily schedulelooks like and my internal thoughts.
(24:16):
But, but that did not come easily.
And that's why it's so hard to getsober because you, you're dragging
these automatic behaviors with you.
Like, well, this is thetime when we have a drink.
Like, okay, why?
We always do, oh, that's nota really good reason to keep.
To keep drinking.
Right?
Because we always do.
(24:37):
And, and, and so when you firstlearn a new skill, if you think,
if you think about an analogy Ilike to think is about driving.
Probably most, most of your listenersknow how to drive or, or ride a bicycle.
It's even simpler when you, whenyou first learn how to ride a
bicycle, it's the hard, right?
It's hard, but what do we saylike learning to ride a bike?
Now you, once you have the skill,you don't have to relearn it.
(25:00):
Mm-hmm.
Most people don't ride abike for long intervals.
They hop back on, mightbe a tiny bit unsteady.
Oh yeah, that's right.
Now I remember this.
And then they go.
So the habit of continuing to usesubstances to manage your feelings
is also like riding a bike.
It's not easy in the beginning.
The alcohol burns when you first drink it.
The you smoke too much weed the firsttime you try it, or you don't know
(25:22):
what these effects of these drugs are.
It's, it's a disorienting, butyou practice like the gym goer.
And you get better at it.
And then you have that as the skill.
But the skill is not the drug use.
The skill is when I feel a wayI don't want to, I can take this
substance and change the way I feel.
And that's what addiction is.
It's the habit of managing your feelings.
(25:45):
It's a shortcut using a substanceas a shortcut to, to changing your
internal world, changing how you feel.
And so we say, okay, stop doing that.
Well, but I, what do I do?
And I need to change my internal world.
How do I, how do I manage when I, whatdo you do when you don't know what to do?
Right?
How do I feel differently?
I don't like the way I feel.
Well, there's ways to do that.
(26:06):
Meditation, exercise, helping others.
Pursuing your mission, whatever you'resupposed to be doing spiritual connection,
connecting with things bigger than you.
The, the, the higher powerjournaling, CBT, all kinds of
behavior modification things.
Taking a few deep breathswill change the way you feel.
Doing some pushups will changethe way you feel, right?
(26:26):
Taking a nap will change the way you feel.
There are many things that arenot substances that have great
follow on benefits instead ofbad follow on problems, but you
don't know how to do them yet.
And you're not in the automatic habit.
You're not in the automatic habit.
So that's why it's so hard 'causeyou've got this old system.
We're like, Hey, make a new systemthat's even more likely to be
(26:48):
automatic when you need to activate it.
It takes time.
It takes time.
It takes time.
Well, that's relapse, right?
That peoples give up on the time.
Yeah.
And aren't patient enough.
And how long at times doI have to wait to do it?
It's learning new skills is not easy.
No, no.
A friend of mine's a really famous guitarplayer and he's playing this huge concert
(27:12):
last summer and he's playing his piecethat he's played a hundred times before.
On shows and thousandsof times in practice.
And and he was playing somebodyelse's guitar and he hit a wrong
note on the, on the guitar.
And the guitar.
It was somebody else's guitar'cause it was a special thing and he
looked down at it and it wasn't his.
(27:32):
And so he, he moved to playthe next note correctly, but
he hit the wrong note again.
And thousands of people in theaudience, you know, one of the greatest
guitar players of all time and.
He was focused on the wrong notes,was thinking about the wrong notes.
Now, think about as a fraction ofright notes versus wrong notes.
That rounds off to zero, right?
(27:53):
But our minds go to this, right?
Like a, like a, like a paper cut orlike a right or that, that hole in
your tongue or what in your tooth,which should keep poking at it.
We focus on the thingsthat, that are messed up.
So somebody, somebody has a wickeddrug problem or a wicked drinking
problem, they get sober and they slipback a couple of times over years.
(28:18):
I mean, on a percentage basis, we wouldsay that's, that's pretty amazing.
Pretty amazing.
We don't have, this is what I, oneof the things that if I were, if I
were doing AA over or creating itfrom scratch, if I were Bill Wilson.
Oh, watch out here!
I would've a third category becausethere's, okay, there's the newcomer.
That's the person who's new to AA.
(28:40):
There's the AA member slashold timer who, who's got it?
Who's got it.
But what about the person who comes forsome time slips back to the old habit.
Comes back to AA.
What do we, what do wedo with that person?
If they're in the very beginning,we're like, ah, try it again.
Not So a few weeks.
Oh, you got a trip?
90 days.
Okay, try it again.
Try it again.
(29:00):
But if you've got somebody who'ssober a long time and they.
Whatever, have a bad day or decideto get curious or try something that
gets outta hand or who knows, right?
They don't, don't say, Hey, youknow, I need a little help here.
And they keep to themselves andthey, and they have a relapse
and don't die and get back.
You know?
Okay.
Actually, I don't wanna do that.
I want to, I wanna be sober.
That still doesn't work.
(29:21):
I wanna be sober.
What do we call, whatdo we do with that guy?
We call him a newcomer, right?
We say you're a newcomer,but that's not really fair.
It's not, it's not exactly right.
So we need, I don't know what it is.
I don't have a suggestion, but we need,we need some other way to, to regard
this spectrum of life that sometimeswith our eye on the ball, it's a little
(29:45):
easier and sometimes we go into a slumpand sometimes we recognize, right?
It's the first time we strikeout that maybe the beginning
of the slump or might not be.
So we don't know.
Oh gosh, actually, yeah.
You know, these things changedand my kids moved out and my,
you know, whatever, or my.
We had a third kid and I, whatever lifechanged, or we moved cities or had a new
(30:06):
job, or I got, you know, fired from myHHS job or other things happen, right?
Life happens and I went to a differentmeeting or I stopped going, or
I, and then we looking back, oh,that's when, that's when this began.
It's habits.
It's it's habits.
So we need to do another category.
Well, I don't know, maybe youcould, your listeners will come
(30:26):
up with what, with what that is.
It's, it's, it's not a newcomer.
That's not fair to say these 20 years,or these eight years, or these four years
that you lived under a different set ofrules and then slid back into the old set
of rules briefly or for a period of time.
It's not, not really new.
No.
They counted.
(30:48):
They counted.
And the reason I think it matters is ifwe don't count those, well what about why?
What does, what is this newperiod of sobriety then?
Does that not count also?
So it's I don't know, it's time,like time in grade or something.
We need some other wayto recognize the fact.
And you hear guys say, well, I used tohave eight years and now I'm back another
(31:08):
six years, so I would've had four.
You know, it's a problem.
I would've had 14.
Anyhow.
Well, I, I wanna let you go with thisbecause I think for the people who
listen to this, who work in the field andyour, a new book is designed for them.
We don't always speak the same language.
Mm-hmm.
So, you know, if, if we'repractitioners in your, you know,
(31:30):
the, the drug and alcohol therapistis talking to the psychologist,
who's talking to the psychiatrist.
You know, I have this conversationwith a good friend of mine.
We're not even in the same fieldon the same page when it comes to
language working as a team together.
And sometimes we argue over theselittle things or big things.
Yeah, harm reduction.
(31:51):
That's my, that's myfavorite one right now.
Harm reduction.
What's, you know, what's that?
Light beer or, or, just half a joint.
Is that harm reduction or, or?
There's a, there's a doc, I wasat a conference last year and
she's, she's prescribing fentanylto people with a history of opiate
use dis or fentanyl use disorder.
She's prescribing it under the,under the banner of harm reduction.
(32:14):
And I can't get behind that.
I don't think that reduces harmbecause what we're playing for
is something bigger, right?
We're playing for not just dealing withthe particular substance use disorder,
but dealing as I, as we were talking aboutearlier with the underlying situation.
What, why, what's a nice guy likeyou doing in a rehab like this?
How did you wind up here?
(32:35):
And that's the real problem.
That's, that's the actual problem.
The longer we keep people or,or allow people, or facilitate
people to be separate from takingresponsibility for their own lives,
the longer they're gonna be miserable.
So, I mean, that's, that's mymessage is, is take responsibility.
You don't takeresponsibility for your dad.
That's not your fault, right?
(32:56):
You're not, you're not responsiblefor the, for the avalanche.
You're not responsible forthe tides or the seasons.
But you are responsiblefor your personal conduct.
I saw this, I thoughtit was this, I did this.
It's just that it doesn't mean you'resupposed to be perfect all the time
or, or, or get it right all the time.
(33:16):
But that's ironically the freedomis in, in personal responsibility.
That's when you become an adult iswhen you stop looking for someone
else to be responsible for your life.
So that that language oftaking responsibility.
I don't know.
It's difficult in the therapy world also.
So I, I work with some greattherapists, great clinicians.
We have, you know, a, a big telemedicinecompany that helps lots, lots of people,
(33:39):
dozens of treatment centers where,where we're doing the medical care.
And I want the patients tocomplete treatment successfully
and stay sober forever.
That's, that's what I want for them.
And sometimes I wonder if thefield shares my ambitions.
Sometimes it, you know, there's abit of a dirty secret in the field,
(34:00):
which is keep coming back, right?
Mm-hmm.
And, and we're starting to get, we'restarting to catch onto that idea.
We're starting to understandthat value-based care is,
that is the catchphrase forlet, let's reward the helpers.
Let's reward the industry for peoplestaying sober rather than coming
back to re-fix the same brokenarm, so to speak, over and over.
(34:25):
I don't know.
I think, I think I think paradoxicallysaying, you, you can help yourself here,
here are the steps we took, which aresuggested as a program of recovery.
Recovery doesn't do those things for you.
They lay it out, but, but you haveto take personal responsibility
for your own life and go, I don'twanna live like this anymore.
(34:46):
I, I, I'm tired of feeling this way.
I, I want to have a life that I'm happyin and proud of and can share with others.
A life that's not of secrecy, alife that's not of self-defeating.
And so, but you haveto take responsibility.
You have to go.
Yeah.
No.
You know, if you're overweight.
You're overweight.
If you're smoking cigarettes andyou keep smoking cigarettes, who
(35:10):
else is, who else is responsible?
It's not.
It's not advertising.
Okay?
Advertising makes it more likely.
Your smoke.
It's not your peers.
Okay?
If you're around smokers, you'reprobably get more likely to smoke,
but, but you are responsible forgetting away from the advertising.
You are responsible forchoosing your peer group.
It always comes back to you.
Always comes back to you.
So I think that that is an optimisticand a, and and the most loving
(35:35):
position you can take, right?
Of course you need help.
Of course, of course you need the bicycleto ride, to learn how to ride a bicycle
because we forget we get off track.
But you are responsible forrecognizing that you're off track.
You're responsible forgetting back on track.
And, and I think ultimately, and this iswhat I guess I'm still in rehab, you're
ultimately responsible for helping others.
(35:57):
That that's for me.
Back to your top of your question.
The gift that I got by, bygetting into this life I have
I haven't paid it back yet.
Mm-hmm.
I don't, I don't feel, I don'tfeel, I, I still feel ahead.
I still feel like I have work to do toobecause, because of my family, because
of my health, because of my sanity,because of the beautiful things that
(36:20):
I've been able to observe, I think.
And because of how I feel about myself,I mean, I, I have, I sleep at night.
I have peace.
I'm, I'm not under the lash of.
You know, John Barley cornor any or anything else?
I don't, I don't have that in mylife anymore, so what's that worth?
I mean, how can I, how can I say thankyou to Dr. Moore who helped, helped me
(36:43):
with the confrontation and all the peoplein between, all the therapists, all the
counselors, all the helpers, and most ofall, and this is what I, my dedication to
the book is to, is to my patients becausethat's who I learn the most from, right?
I learn.
All these facets of the same problem.
Oh, that's another wayof saying the same thing.
Oh, that's, that's a fresh take onI haven't thought of it that way
(37:05):
before, but yeah, I see how that'sstill, it's still a habit problem.
You still have to take responsibility.
You still have to, so the lastthing I'll say about that is this,
which is the Serenity Prayer.
Most of your listeners probablyknow this Serenity Prayer, right?
Yes.
The, the Serenity Prayer is the greatestfiling system ever, ever devised.
The Serenity Prayer is it has two drawers.
(37:28):
It has the things I canchange and the things I can't.
Most things are in thesecond drawer, right?
The past.
Anyone else, the world, the tides,as we mentioned, and the stuff
that's in that skinny little folderis your attitude and your behavior.
Want my own attitude and myown behavior that that's it.
(37:50):
So I can change my attitude.
I can change what I do.
I. And that's, turns out all I haveto do if I do that, it's magic.
The world, the world will change.
Your world will change ifyou change your attitude.
Outstanding.
Those of you listen, know that we havelinks to Dr. Giles books, terrific
books, as well as some of your socialsand other podcasts that you've done.
(38:12):
We encourage you to listen wheneveryou're able, we encourage you
to get support wherever you can.
Thanks for listening.
Be safe and, your choices,your habits, your life.
Welcome everybody.
This is Avoiding the AddictionAffliction, brought to you by Westwords
Consulting and the Kenosha CountySubstance Use Disorder Coalition.
I'm Mike McGowan.
Growing up around addictiondoesn't protect you from addiction.
Neither do drugs care about where you wentto school, what you majored in, how much
money you make, what you do for a living.
(00:34):
But when you develop destructivehabits, you have an opportunity
to turn your life around bydeveloping new and healthier habits.
That is not only the messageof our guest today, but it's
his life experience as well.
Dr. Jason Giles is a graduate ofUniversity of California Berkeley.
He earned a degree in molecular biologyand then obtained his medical degree
(00:54):
from University of California Davis.
Dr. Giles completed an internshipin general surgery, residency in
anesthesiology and pain medicine,and earn board certifications in
anesthesiology and addiction medicine.
He was a cardiac anesthesiologist andpain specialist before devoting his full
attention to addiction medicine in 2005.
(01:14):
He's the author of a new book,the Addiction Doctor's Manual for
Behavioral Health Technicians (01:17):
What to Do When You Don't Know What To Do and
a previous book, which is terrific,called Outsmart Your Addiction.
Welcome Dr. Giles.
Thank you very much.
Thanks for having me on your show, Mike.
I always like to start with thestory and so let's go backwards.
Let's start with your firstbook, Outsmart Your Addiction.
Like a lot of us, yougrew up around addiction.
(01:40):
Yeah, that's true.
So I'm a Southern California native, andthere's a time of knowing that you're
growing up around addiction, and thisis a time before that, so I grew up
around it because my dad liked to drink.
I didn't know what thatwas when I was a kid.
I knew a couple of things.
I knew that if I made him a drink, Iknew that if I fixed him for fortunately,
(02:02):
he drank a very simple drink, whichis, which was gin on the rocks.
It was gin and ice.
So I could make that from a young ageand when he was home and and asked for a
drink if I made that yeah, he was pleased.
And then soon after thathe was easier to be around.
Yep.
And that's what I knewabout it at that time.
And the other thing I know about,I think I mentioned this in the
(02:24):
book, which is that when he camehome at night or in the morning.
You could tell what kind of a day you werein for by how the keys went in the lock.
Right.
So if there was fumbling and droppingthe keys and evidence of persistent
intoxication, we would say nowthen we were in for good times.
'cause he was still drunk.
(02:46):
This is back before all the crackdownson driving drunk and so forth.
Yeah.
And but if the key went in easily.
Then we're in for a rougher time becauseit had been longer, since he had a drink.
And it's those kinds of things thatyou pick up as the child growing
up in an alcoholic or a substanceusing home or a home with mental
illness that you don't know, thatyou know that until, until later.
(03:08):
But looking back and when you getaround other people who grew up
with that, they're like, yeah,you know, my mom, I could tell.
And then they'd start tradingstories and you realize that
you're not the only one, but later.
You know, he got into a coupleof those DUIs, a couple of people
were interested in him being sober.
He started to get interestedin it himself and went to
meetings of Alcoholics Anonymous.
And I remember in elementaryschool going with him.
(03:30):
So there was a clubhouse not toofar away from where we lived, a
mile or two from where we lived.
And I remember sittingin the smoke field rooms.
And seeing these folks, andthey were they're good people.
And he went to that for a while.
My dad went to that for a while.
He ultimately did stop drinkingjust right before I left the house.
(03:51):
So, so that was good.
And then later when I discovered myown problem, which we can talk more
about, we had that thing in common thatwe had been through that sequentially.
And that was good.
I mean, that gave ourrelationship a chance.
We had common ground from havingbeen through that similar experience
together with getting sober.
(04:11):
On a chronologic basis, I got sober, muchyounger, but that has something to do
with the particular substance that I choseand also that the ground was prepared.
So I knew about this world a bit.
I knew it wasn't the end of theworld, although sometimes it felt
like that would be the end of theworld, not having something that
you could take or drink or use.
But yeah, relationships withparents in general can sometimes
(04:34):
be tricky and with an alcoholicfather and then a mother protecting
the kids, sometimes protecting him.
Sometimes those sort of dualrelationships that go along with
the codependence, that complexity.
Sometimes it's hard to seethe details of God's plan.
You know, all of that was on purpose.
(04:54):
All of that was the wayit was supposed to go.
Much of it as I was going throughit, I wished were different, but
that's one of the gifts of beingin recovery and being older is
seeing all the things along the way.
You know, seeing that my story, althoughit was unique for me is pretty generic.
There's so many similarities.
(05:16):
People get hung up on, or, or, it'sinteresting, I suppose it's probably
interesting to your audience that,you know, I was an anesthesia still, I
guess, but I just don't do it anymore.
Anesthesiologist trauma level one,trauma center hospital, high flying
transplant, surgery, all the like,movie and TV kind of intense stuff.
But in many ways I was stillthat kid from, you know, from
(05:39):
the, from the same house.
I still had those self doubts.
I still had that sense of insecurity.
I still had that... I f only I,and this is, gets back to making
the, the gin, if only I performwell then I can deserve to be here.
And that's messed up.
That's a messed up way of thinking.
Well, you talk about it in yourbook, and I think that's fascinating.
(06:01):
The parallels, you're right.
Every time you talk to somebody,it's like this substitute
gin for beer in the fridge.
Yep.
Substitute keys in the door towatching my dad's pickup truck.
And our story's the same.
But as you move forward, eventhough you grew up around it,
then you get to be a teenager andI think we divide up, don't you?
Into two.
You have the...
How do you mean?
What do you mean?
Well, you have those group peoplesay, I'm never gonna be around it.
(06:24):
And then some people go,well, I'll just use, and...
I'll be careful!
Yeah.
I was in the group.
Yeah.
I'll be, I'll be, I'm notgonna end up like him.
I'll be careful.
And how'd that work out for you?
Well, you know, here we are, right?
Yeah.
Here we are.
Right.
That's how it worked out.
I had to go through allof that to understand.
There's an intellectual understanding.
I saw a bumper sticker once that saidwhat, what did it say that recovery
(06:47):
is for people who been to hell?
Something like that.
There's not, I'm trying to remember,trying to remember how it, how it goes.
It's like church is for peoplewho want to go to heaven.
And recoveries for people who been tohell, I think it's something, something
like, something like that, you knowlook ostensibly on paper based on the,
the you know, degrees and whatever andtests I've passed and things like that.
(07:09):
I'm, I'm allegedly supposed tobe a smart guy, but that was
completely worthless when I said.
I'm gonna be careful and make surethat I don't develop a problem
with whatever the substance was.
I gotta ask you, 'cause this is thepart where I had to read it twice.
And, and I couldn't wait to ask you this.
So you're an anesthesiologist at somepoint, and you actually start your
(07:32):
book with a story that's familiarto me because my dad actually died
of the same operation that you wereoperating on when you start your...
Aorta surgery.
Yes.
And um...
Oh wow.
oh wow.
But, but his inside there wasnothing to attach it to because
of his lifetime of abuse.
So, and I'm sure you've seen that, right.
But you said you deliberately.
(07:54):
Set out to, maybe I'm putting this wrong.
You started to experiment withthe drugs that you were giving
people to see what they were like.
Yes, yes.
Curiosity, and so that was a blindspot for, for me, if you said, I
dunno, we have to, we have to imaginea scenario that couldn't possibly
have taken place, but let, let'ssay you and I are friends back then.
(08:15):
And and I say, Mike, I'm gonna tryout these drugs in the, in the drawer
that we use for all the patients.
Yeah.
Just to see what they're like.
You would probably havea look of horror, right.
It's just, it, it's outrageous that idea.
And yet this is wherethe smarts do me no good.
And yet that sounded to melike a very reasonable thing.
(08:36):
I'll take it evenfurther, which is to say.
Who else should be experimenting withthese drugs than somebody who really
understands exactly how they work?
Good.
There's one thing to understand exactlyhow they work in the textbook or in
practice with giving them to otherpeople for surgery and so forth.
It's a whole different thing,taking them yourself, right?
(08:57):
So if you take 'em yourself, now the,this is sort of obvious, but the person
that's gonna be doing the analysisand say, whoa, how is this working?
And is this.
That person is under theinfluence of the drug.
Mm-hmm.
And that may be the crux of whatthe susceptibility to chemicals
is, is that you make a plan, and Idid this before, you make a plan.
(09:18):
You're only going to use this muchor only on this day or only at this
time, or only with these people,or only in this circumstance.
And then once the substance getsin your brain, and we take these
things in order to change the waywe feel, which is another way of
saying change the way we think.
We take these things to changethe way we think and then act
surprised when the new thoughtsare, Hey, how about another round?
(09:40):
Right?
Yeah.
I want another pitcher.
Let's go.
And, and, but of course, right, of course.
That's how the substances work isthey change us from I'm under control.
I'm being very thoughtful about this.
To what the heck, right?
We're here anyway.
So yes, that curiosity was the entree.
(10:01):
And I, you know, went through allthe stuff, tried things that are
not necessarily psychoactive inorder to feel what epinephrine
feels like and and so forth.
But yeah, once you get into theopiates, they have their own opinion.
They have something to sayabout what you're gonna do next.
And that has to do with biology.
We make our own endorphins, right?
We make our own opiates and we makethem to deal with pain and suffering,
(10:24):
but also they're neurotransmitters,they're chemicals that the brain uses to
communicate with other parts of the body.
So our engineers, our chemicalengineers that made this stuff
and extracted these things and puttogether a drug as potent as fentanyl,
that was my particular cup of tea.
It's so perfectly createdto activate this pathway.
(10:45):
This, everything's okay.
There's nothing to worry about.
And no pain, right?
No pain of anxiety.
No pain of loss.
No pain of regret.
It's so perfect for that, that once it'sin of course you'd wanna do it again.
I mean, of course you'd wanna keep going.
Of course you'd wanna get after it becauseit's engineered to create those feelings.
(11:08):
So, ostensibly, analytically,this makes sense.
You want the anesthesiologist tounderstand how this goes, and yet
the substances themselves willnot let you get away with that.
Very, arm's length analysis.
'cause they get in yourbrain and have a, have.
Change plans.
Do you find yourself incredibly gratefulfor your supervisor at that time because
(11:34):
you had support to steer you intohelp rather than throw you on a heap?
Oh yeah.
Yeah.
So Peter Moore was the chairman ofthe department and if it weren't for
him... So I got extraordinarily lucky.
Not just having somebody to, to be thereand help me through this, but there's
an unknown person who a few years,not that many years before I joined
(11:56):
the department overdosed and died.
Oh.
So the department had an experiencewith another one of the residents
who had lost his life behindsubstance use with, with fentanyl,
was found dead at the hospital and.
So that experience raised the, Idon't know, worry factor or the
(12:18):
awareness on the part of my chairman.
And so he was looking for this, itwas part of, it became part of his
pattern recognition was lookingto see, and I don't know because.
We never discussed it per se,but I suspect I was giving
off some kind of signals.
(laughs)
I was, I was, until that point, Iwas super careful and, you know, all
(12:42):
this activity took place after work.
When I say activity, Imean the use of the drugs.
But let's not kid ourselves, right?
So you can't use 'em at all.
But if you get to the point whereyou're using them regularly.
Then the next morning, and that'show the book opens with me.
Mm-hmm.
Mm-hmm.
Really needing some andnot, you know, not using it.
That's the maybe worst spot to be in.
(13:04):
And so it was obvious to him, Iguess there was some awareness
that he was able to muster.
Like, Hmm, this formerly sharp kid isnow a little ragged around the edges, or.
Shiny or, or sweaty or goose bumpy or,I don't know what I talked about in the
(13:25):
book, I wore a long sleeve gown, the kindthat the surgeons wear, that they put
their hands in and their gloves on, andget tied up in the back and do surgery.
Only I wore it the way you'd put abathrobe on, which is technically
backwards, but looks frontwards.
And so I always had that gown on andit's not that unusual 'cause it's
chilly in the OR and it's you know,some people do that as a, I don't know.
(13:48):
It's what, it's what a lot ofanesthesiologists wear is these
surgeon gowns over their scrubs.
But I went from never wearingone because I'm not usually cold
in the OR to always wearing one.
So then maybe that, maybe thatwas a giveaway, whatever it was.
Thank God because.
At one point I got apage, back in pager days.
(14:09):
This is the nineties.
So I got a, I got a page from the fromthe chairman, which is weird by itself
to get, you know, paged by the boss.
And so I called back and he saidAustralian guy said, not, not saying
that you not casting any aspersions,but there's a, there's a large amount of
fentanyl missing from the hospital supply.
(14:30):
And if it's all back there, you know,by tonight, then everything's fine.
And which is of course ridiculous, right?
It's ridiculous.
So I said, can I come talk to you?
Because the only way for itto be back, you know, would be
for me to be standing in there.
And I had left the hospital.
I got the page after Ileft the hospital that day.
So I went to his house and he said I'mreally happy that you, are talking to me.
(14:54):
We know what's going on, and and there'shelp for you and it's going to be okay,
and then you're gonna come back to thehospital when you're all done with your
treatment and you're gonna work here.
Everybody loves you and, and you'reterrific at your job, and you just got
this problem and we want you to come back.
Those are the words he said, butthat's not what it sounded like.
(15:16):
It sounded like we've got you.
You're never coming back here.
You're, you know.
'cause I felt so low, right?
I felt, I felt like I had let him down.
That's what, that's what I felt like.
Well, you know, you just, you made itsound like you could go right back.
I don't, I think people aren't,doctors don't understand this.
Like, you, you got intorecovery, they got you help.
(15:38):
But the road back togetting your status back.
Not right back.
Right.
I mean, well, how long back?
Because a lot of peopledon't understand it.
It was three years.
It was three years,
Yeah.
Yeah.
Three years.
Three years.
Three year interruption and...
And how many and how many hoops?
Oh boy.
Yeah, boy.
Like LeBron level hoops.
I think the Ringlingbrothers that many hoops.
(15:59):
(laughs)
It was, yeah.
You know, in the very beginning,and this turns out to be classic
and or in ordinary as well.
I didn't know 'cause it was happeningto me, but in the beginning all I
wanted do is hurry up and get betterso I could better get 'em off my
back so that I could go back anddo what I was doing because Okay.
All right.
Don't use, don't use drugs.
I got that.
Okay.
Let's just have a do over.
(16:20):
But what, what I didn't know and whatI realize a lot of people don't know.
Is that the substances arenot the actual problem.
The substances are the late finding.
They're the solution thatthen turns into a problem.
They're the solution thatthen becomes its own problem.
Okay?
So you deal with the substances.
Let's say you magically never use again.
(16:42):
They cut out the part of youthat wants to drink, right?
Or they cut out the partof you that uses drugs.
Not possible, but let's say it were.
You still are that person.
I'm still without the substances.
I'm still the guy who needs something inorder to manage his feelings, to be in
the world, to deal with my history, todeal with my family of origin story to
deal with all, all that, all that crap.
(17:03):
And, and now without, withoutdrugs, I, what are you gonna do?
We gotta find a different solutionbecause I couldn't live, and this
is where people come in, is they.
They can't live like they were, butthey don't know what to do next.
And that, and that was me.
So my real problem was the wayI felt about myself and the
way I behaved in the world.
(17:24):
That that was my, thatwas my real problem.
The substances were a failedsolution, but I needed a new one.
I needed a new solution, andthat's what the hoops were.
The hoop, they felt like hoops,but eventually it's, I don't know.
It's like any of these great.
Superhero movies where when they'regoing through the part that just sucks.
And then you start toget a little traction.
You're like, all right, CaptainAmerica's gonna make it right?
(17:45):
Or, or, this is whereThor picks up the hammer.
And, and, and so each one of thosethings, so I, you know, left, went
to treatment, found there were otherdoctors who'd been through this.
There are other an, you know, whereI went to treatment over the three
months that I was there, therewere a hundred days there were.
There were eight otheranesthesiologists over that time.
(18:06):
Now there were hundreds of guys in thethree, in the three, several hundred
guys in the three months, but therewere eight other anesthesiologists,
which seemed really important tome at the time that someone else
had been through this problem.
They had a very similar story.
I wasn't the only like fallen angel.
I wasn't the only one who did this.
They're like, oh yeah.
And then I, you know, thenI started using more often.
(18:28):
I'm like, and I started using more often.
They're like, oh yeah.
And then I, you know, then this happened.
I'm like, that's what happened to me.
And you start to realize, because Ithought I was the only one, right?
I thought nothing could help me.
And then when I found somethingthat did temporarily, I, I
thought I couldn't talk about it.
And then when everything was youknow, I'm on this Bronco and I can't
get off, who are you gonna ask?
Who are you gonna talk to?
(18:48):
Well, turns out thatexperience is also generic.
And then when you here when youadd the beer and the vodka and the
marijuana and then whatever elseanybody else is doing, that turns
out to be very, very, very common.
Like, oh, okay.
So I have that thing that severalother, several 70 million other
people have in the us, probably2 billion people have worldwide.
(19:09):
So I have that thing that they have.
Okay.
No.
That's all right.
That's actually hopeful.
Maybe I'm not the only one.
And then some of the other hoops werethis family stuff I talked about.
Mm-hmm.
Some of the other hoops were thebelief that if I... Book talks
about, it's one of my favorite linesthat I was a victim of the delusion
that I could rest satisfactionfrom life if only I managed well.
(19:34):
And that line piercedme like nothing else.
Because if only I can get it allgoing, then I deserve to be here.
And that thinking turns out tobe very common in our cohort.
Right?
Very common among the addicts andalcoholics and the source of all of my
discomfort, source of all, all of my pain.
I don't belong here, or there'ssomething wrong with me that's ordinary.
(19:57):
Everyone thinks that, you know, Idon't fit in weird at the party.
I want the new guy, whatever.
Everyone has that, that's all.
That's all normal.
Why is she with me?
She could do better.
That stuff.
That's not pathologic.
That's normal.
What's pathologic isthinking, I can fix this.
That's where the problem is.
Instead of saying, Hey, Mike, youever feel like you don't fit in?
(20:18):
You're like, yeah, I feellike that all the time.
Oh wait, mean that's normal?
Well, I don't know.
I feel it.
Okay.
I don't need to fix that.
I don't need to repair that feeling.
I don't need to change.
That's just, it passes by.
I don't need a drug to fix it.
So that, that was the big hoop, or thetiniest hoop, I guess, to get through,
which is, there's nothing wrong with you.
(20:38):
There isn't anything wrong.
There's nothing to fix!
Stop trying to fix it!
I think that those statements lead to thethrust of your work since then, right?
Yes.
You clearly come down on thebehavioral side, and I've spent a
long, long time, my professionalcareer working with youth, right?
Mm-hmm.
And learning the skills to cope withyour feelings, to problem solve.
(21:02):
I mean, it's a skill.
It's just repetitive habits.
And then it becomes a habit!
How did you know how to do that?
I don't know.
And just do, do it all the time.
I watched I watchedthe Dodgers last night.
Oh.
Oh God.
I'm a Brewer fan, so watch out.
Well, the brewers are strugglingright now, aren't they?
Yes, yes they are.
Yeah.
Yeah, they're struggling.
(21:22):
But the I watched the Dodgers last nightand you know, this, this guy that they've
got Shohei Ohtani, he, may, maybe, maybethe greatest player ever, certainly
one of the greatest players ever.
He he practices a lot, youknow, he hit a lot of baseballs.
He threw a lot of baseballs.
He ran between the bases alot and, and he hits a lot of
baseballs, and that's on display.
So, yes, it's impressive.
(21:42):
Of course, you know, that thatend to that game was, was great
for us and bad for Atlanta.
But the results of it are that he isin the habit of hitting baseballs.
He has talent, he has ability.
He has strength.
He has size, he has all those things.
But, but you know thatthat's not why he's so good.
Why he's so good is he practiced andpracticed and practiced and practiced
(22:05):
until he sees the game differentlythan somebody who hasn't played,
hasn't, hasn't taken it to that depth.
I was, you know, getting close to ShoheiOhtani level, good at being a drug addict.
I had all this training, I had all thispractice, I had all this experience,
had all this expertise, and thereason I make a joke about that is
that, is that it, the habit becomesits own, has its own momentum, right?
(22:29):
It has its own momentum.
If you go to the gym and if yougo often enough and consistently
enough, you become a gym goer.
And if you're a gym goer.
If you go to the gym,'cause you go to the gym.
'cause I don't know, Ialways go to the gym.
If you go to the gym, you just go andif you don't go, you don't feel right.
(22:50):
It's not that the gym is fun, it'snot that it feels good to do the, do
the exercise and go through whateveryou, whatever your routine is.
But the habit, we're, we'rebuilt to do things repetitively.
We, that's what learning is, right?
That's what proficiency is.
So we, so we say Shohei Ohtani isin the habit of hitting home runs.
And if you think about it, well,gosh, he is, you know, Aaron Judge
(23:13):
is in the habit of hitting home runs.
Buki Bets is in the habitof hitting home runs.
Christian Yellich, there we go, isin the habit of, of hitting home runs
and, and so I. Everything is habits.
Our relationships are habits.
Our, our waking routines are habits,the food we eat, and then the
cumulative effects of that, whetherwe're healthy or not, those are habits.
(23:35):
I like that because even beforehe hits a home, run his, his
routine is consistently the same.
He wipes the bat the same way hewaits, he bows to the umpire the
same way so that it's second.
So that the action, and to use yourwords, I think, I don't want the action
(23:55):
of then staying in recovery is justa continuation of routine and habits.
Exactly.
Exactly.
And you, you know, and so the life Ihave now does not look at all, like
the life I had back then, they'renot even in the same universe in
terms of what my, my daily schedulelooks like and my internal thoughts.
(24:16):
But, but that did not come easily.
And that's why it's so hard to getsober because you, you're dragging
these automatic behaviors with you.
Like, well, this is thetime when we have a drink.
Like, okay, why?
We always do, oh, that's nota really good reason to keep.
To keep drinking.
Right?
Because we always do.
(24:37):
And, and, and so when you firstlearn a new skill, if you think,
if you think about an analogy Ilike to think is about driving.
Probably most, most of your listenersknow how to drive or, or ride a bicycle.
It's even simpler when you, whenyou first learn how to ride a
bicycle, it's the hard, right?
It's hard, but what do we saylike learning to ride a bike?
Now you, once you have the skill,you don't have to relearn it.
(25:00):
Mm-hmm.
Most people don't ride abike for long intervals.
They hop back on, mightbe a tiny bit unsteady.
Oh yeah, that's right.
Now I remember this.
And then they go.
So the habit of continuing to usesubstances to manage your feelings
is also like riding a bike.
It's not easy in the beginning.
The alcohol burns when you first drink it.
The you smoke too much weed the firsttime you try it, or you don't know
(25:22):
what these effects of these drugs are.
It's, it's a disorienting, butyou practice like the gym goer.
And you get better at it.
And then you have that as the skill.
But the skill is not the drug use.
The skill is when I feel a wayI don't want to, I can take this
substance and change the way I feel.
And that's what addiction is.
It's the habit of managing your feelings.
(25:45):
It's a shortcut using a substanceas a shortcut to, to changing your
internal world, changing how you feel.
And so we say, okay, stop doing that.
Well, but I, what do I do?
And I need to change my internal world.
How do I, how do I manage when I, whatdo you do when you don't know what to do?
Right?
How do I feel differently?
I don't like the way I feel.
Well, there's ways to do that.
(26:06):
Meditation, exercise, helping others.
Pursuing your mission, whatever you'resupposed to be doing spiritual connection,
connecting with things bigger than you.
The, the, the higher powerjournaling, CBT, all kinds of
behavior modification things.
Taking a few deep breathswill change the way you feel.
Doing some pushups will changethe way you feel, right?
(26:26):
Taking a nap will change the way you feel.
There are many things that arenot substances that have great
follow on benefits instead ofbad follow on problems, but you
don't know how to do them yet.
And you're not in the automatic habit.
You're not in the automatic habit.
So that's why it's so hard 'causeyou've got this old system.
We're like, Hey, make a new systemthat's even more likely to be
(26:48):
automatic when you need to activate it.
It takes time.
It takes time.
It takes time.
Well, that's relapse, right?
That peoples give up on the time.
Yeah.
And aren't patient enough.
And how long at times doI have to wait to do it?
It's learning new skills is not easy.
No, no.
A friend of mine's a really famous guitarplayer and he's playing this huge concert
(27:12):
last summer and he's playing his piecethat he's played a hundred times before.
On shows and thousandsof times in practice.
And and he was playing somebodyelse's guitar and he hit a wrong
note on the, on the guitar.
And the guitar.
It was somebody else's guitar'cause it was a special thing and he
looked down at it and it wasn't his.
(27:32):
And so he, he moved to playthe next note correctly, but
he hit the wrong note again.
And thousands of people in theaudience, you know, one of the greatest
guitar players of all time and.
He was focused on the wrong notes,was thinking about the wrong notes.
Now, think about as a fraction ofright notes versus wrong notes.
That rounds off to zero, right?
(27:53):
But our minds go to this, right?
Like a, like a, like a paper cut orlike a right or that, that hole in
your tongue or what in your tooth,which should keep poking at it.
We focus on the thingsthat, that are messed up.
So somebody, somebody has a wickeddrug problem or a wicked drinking
problem, they get sober and they slipback a couple of times over years.
(28:18):
I mean, on a percentage basis, we wouldsay that's, that's pretty amazing.
Pretty amazing.
We don't have, this is what I, oneof the things that if I were, if I
were doing AA over or creating itfrom scratch, if I were Bill Wilson.
Oh, watch out here!
I would've a third category becausethere's, okay, there's the newcomer.
That's the person who's new to AA.
(28:40):
There's the AA member slashold timer who, who's got it?
Who's got it.
But what about the person who comes forsome time slips back to the old habit.
Comes back to AA.
What do we, what do wedo with that person?
If they're in the very beginning,we're like, ah, try it again.
Not So a few weeks.
Oh, you got a trip?
90 days.
Okay, try it again.
Try it again.
(29:00):
But if you've got somebody who'ssober a long time and they.
Whatever, have a bad day or decideto get curious or try something that
gets outta hand or who knows, right?
They don't, don't say, Hey, youknow, I need a little help here.
And they keep to themselves andthey, and they have a relapse
and don't die and get back.
You know?
Okay.
Actually, I don't wanna do that.
I want to, I wanna be sober.
That still doesn't work.
(29:21):
I wanna be sober.
What do we call, whatdo we do with that guy?
We call him a newcomer, right?
We say you're a newcomer,but that's not really fair.
It's not, it's not exactly right.
So we need, I don't know what it is.
I don't have a suggestion, but we need,we need some other way to, to regard
this spectrum of life that sometimeswith our eye on the ball, it's a little
(29:45):
easier and sometimes we go into a slumpand sometimes we recognize, right?
It's the first time we strikeout that maybe the beginning
of the slump or might not be.
So we don't know.
Oh gosh, actually, yeah.
You know, these things changedand my kids moved out and my,
you know, whatever, or my.
We had a third kid and I, whatever lifechanged, or we moved cities or had a new
(30:06):
job, or I got, you know, fired from myHHS job or other things happen, right?
Life happens and I went to a differentmeeting or I stopped going, or
I, and then we looking back, oh,that's when, that's when this began.
It's habits.
It's it's habits.
So we need to do another category.
Well, I don't know, maybe youcould, your listeners will come
(30:26):
up with what, with what that is.
It's, it's, it's not a newcomer.
That's not fair to say these 20 years,or these eight years, or these four years
that you lived under a different set ofrules and then slid back into the old set
of rules briefly or for a period of time.
It's not, not really new.
No.
They counted.
(30:48):
They counted.
And the reason I think it matters is ifwe don't count those, well what about why?
What does, what is this newperiod of sobriety then?
Does that not count also?
So it's I don't know, it's time,like time in grade or something.
We need some other wayto recognize the fact.
And you hear guys say, well, I used tohave eight years and now I'm back another
(31:08):
six years, so I would've had four.
You know, it's a problem.
I would've had 14.
Anyhow.
Well, I, I wanna let you go with thisbecause I think for the people who
listen to this, who work in the field andyour, a new book is designed for them.
We don't always speak the same language.
Mm-hmm.
So, you know, if, if we'repractitioners in your, you know,
(31:30):
the, the drug and alcohol therapistis talking to the psychologist,
who's talking to the psychiatrist.
You know, I have this conversationwith a good friend of mine.
We're not even in the same fieldon the same page when it comes to
language working as a team together.
And sometimes we argue over theselittle things or big things.
Yeah, harm reduction.
(31:51):
That's my, that's myfavorite one right now.
Harm reduction.
What's, you know, what's that?
Light beer or, or, just half a joint.
Is that harm reduction or, or?
There's a, there's a doc, I wasat a conference last year and
she's, she's prescribing fentanylto people with a history of opiate
use dis or fentanyl use disorder.
She's prescribing it under the,under the banner of harm reduction.
(32:14):
And I can't get behind that.
I don't think that reduces harmbecause what we're playing for
is something bigger, right?
We're playing for not just dealing withthe particular substance use disorder,
but dealing as I, as we were talking aboutearlier with the underlying situation.
What, why, what's a nice guy likeyou doing in a rehab like this?
How did you wind up here?
(32:35):
And that's the real problem.
That's, that's the actual problem.
The longer we keep people or,or allow people, or facilitate
people to be separate from takingresponsibility for their own lives,
the longer they're gonna be miserable.
So, I mean, that's, that's mymessage is, is take responsibility.
You don't takeresponsibility for your dad.
That's not your fault, right?
(32:56):
You're not, you're not responsiblefor the, for the avalanche.
You're not responsible forthe tides or the seasons.
But you are responsiblefor your personal conduct.
I saw this, I thoughtit was this, I did this.
It's just that it doesn't mean you'resupposed to be perfect all the time
or, or, or get it right all the time.
(33:16):
But that's ironically the freedomis in, in personal responsibility.
That's when you become an adult iswhen you stop looking for someone
else to be responsible for your life.
So that that language oftaking responsibility.
I don't know.
It's difficult in the therapy world also.
So I, I work with some greattherapists, great clinicians.
We have, you know, a, a big telemedicinecompany that helps lots, lots of people,
(33:39):
dozens of treatment centers where,where we're doing the medical care.
And I want the patients tocomplete treatment successfully
and stay sober forever.
That's, that's what I want for them.
And sometimes I wonder if thefield shares my ambitions.
Sometimes it, you know, there's abit of a dirty secret in the field,
(34:00):
which is keep coming back, right?
Mm-hmm.
And, and we're starting to get, we'restarting to catch onto that idea.
We're starting to understandthat value-based care is,
that is the catchphrase forlet, let's reward the helpers.
Let's reward the industry for peoplestaying sober rather than coming
back to re-fix the same brokenarm, so to speak, over and over.
(34:25):
I don't know.
I think, I think I think paradoxicallysaying, you, you can help yourself here,
here are the steps we took, which aresuggested as a program of recovery.
Recovery doesn't do those things for you.
They lay it out, but, but you haveto take personal responsibility
for your own life and go, I don'twanna live like this anymore.
(34:46):
I, I, I'm tired of feeling this way.
I, I want to have a life that I'm happyin and proud of and can share with others.
A life that's not of secrecy, alife that's not of self-defeating.
And so, but you haveto take responsibility.
You have to go.
Yeah.
No.
You know, if you're overweight.
You're overweight.
If you're smoking cigarettes andyou keep smoking cigarettes, who
(35:10):
else is, who else is responsible?
It's not.
It's not advertising.
Okay?
Advertising makes it more likely.
Your smoke.
It's not your peers.
Okay?
If you're around smokers, you'reprobably get more likely to smoke,
but, but you are responsible forgetting away from the advertising.
You are responsible forchoosing your peer group.
It always comes back to you.
Always comes back to you.
So I think that that is an optimisticand a, and and the most loving
(35:35):
position you can take, right?
Of course you need help.
Of course, of course you need the bicycleto ride, to learn how to ride a bicycle
because we forget we get off track.
But you are responsible forrecognizing that you're off track.
You're responsible forgetting back on track.
And, and I think ultimately, and this iswhat I guess I'm still in rehab, you're
ultimately responsible for helping others.
(35:57):
That that's for me.
Back to your top of your question.
The gift that I got by, bygetting into this life I have
I haven't paid it back yet.
Mm-hmm.
I don't, I don't feel, I don'tfeel, I, I still feel ahead.
I still feel like I have work to do toobecause, because of my family, because
of my health, because of my sanity,because of the beautiful things that
(36:20):
I've been able to observe, I think.
And because of how I feel about myself,I mean, I, I have, I sleep at night.
I have peace.
I'm, I'm not under the lash of.
You know, John Barley cornor any or anything else?
I don't, I don't have that in mylife anymore, so what's that worth?
I mean, how can I, how can I say thankyou to Dr. Moore who helped, helped me
(36:43):
with the confrontation and all the peoplein between, all the therapists, all the
counselors, all the helpers, and most ofall, and this is what I, my dedication to
the book is to, is to my patients becausethat's who I learn the most from, right?
I learn.
All these facets of the same problem.
Oh, that's another wayof saying the same thing.
Oh, that's, that's a fresh take onI haven't thought of it that way
(37:05):
before, but yeah, I see how that'sstill, it's still a habit problem.
You still have to take responsibility.
You still have to, so the lastthing I'll say about that is this,
which is the Serenity Prayer.
Most of your listeners probablyknow this Serenity Prayer, right?
Yes.
The, the Serenity Prayer is the greatestfiling system ever, ever devised.
The Serenity Prayer is it has two drawers.
(37:28):
It has the things I canchange and the things I can't.
Most things are in thesecond drawer, right?
The past.
Anyone else, the world, the tides,as we mentioned, and the stuff
that's in that skinny little folderis your attitude and your behavior.
Want my own attitude and myown behavior that that's it.
(37:50):
So I can change my attitude.
I can change what I do.
I. And that's, turns out all I haveto do if I do that, it's magic.
The world, the world will change.
Your world will change ifyou change your attitude.
Outstanding.
Those of you listen, know that we havelinks to Dr. Giles books, terrific
books, as well as some of your socialsand other podcasts that you've done.
(38:12):
We encourage you to listen wheneveryou're able, we encourage you
to get support wherever you can.
Thanks for listening.
Be safe and, your choices,your habits, your life.
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