Ketamine's Role in the New Frontier for Addiction Treatment & Mental Health with Brad Masters

Episode Transcript
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Speaker 1 (00:03):
Welcome to A Therapist, a Buddhist in you, a
sanctuary of contemplation andinsight where we explore the
profound intersection of therapy, mindfulness and holistic
well-being.
Today, our journey takes anintriguing turn as we delve into
the realm of innovative healingmodalities.
So picture this a gentle waveof transformation sweeping

(00:23):
through the landscape of mentalhealth care, a new horizon
illuminated by the promisingglow of ketamine therapy.
And no, folks, you're nothallucinating.
This is one trippy narrationyou can trust.
In this episode, we embark on ajourney guided by the wisdom of
a therapist, the compassionateteachings of a Buddhist and the

(00:43):
shared curiosity of all who seekhealing.
Ketamine, a substance onceknown primarily for its
anesthetic properties andhallucinations, has truly
emerged as a beacon of hope forthose grappling with
treatment-resistant mentalhealth conditions In therapy
rooms, research universities.
In therapy rooms, researchuniversities and medical circles

(01:08):
alike.
Its ability to heal and bringabout transformation is being
meticulously investigated,sparking both curiosity and hope
.
Today, as we gather in thesacred space, we invite you to
join us on a voyage of discovery, a journey beyond the confines
of conventional medicine andinto the realms of possibility.
Together, we'll explore thenuances of ketamine therapy,

(01:31):
seeking insight andunderstanding amidst the
complexities of mental healthand addiction.
And amidst these discussions,there's a pivotal question on
many minds how might ketaminetherapy intersect with a
delicate journey of recoveryfrom substance use?
Today, we'll delve into thiscrucial inquiry, shedding light

(01:52):
on its potential benefits andaddressing the valid concerns
surrounding its usage.
As we navigate this terrain, werecognize the unique challenges
and complexities faced byindividuals in recovery, and we
aim to provide insight andguidance that honors their
journey towards healing andwholeness.

(02:12):
So take a deep breath and allowyourself to be fully present in
this moment of exploration andinquiry, for in our shared quest
for understanding, weilluminate the path toward
healing and liberation.
And if you're so liberated,share this episode with others,

(02:35):
as collectively we can do thingstogether that we can't do by
ourselves.
And like and follow also goes avery long way for us, and an
offering of gratitude from us inthe form of US dollars will
help pay for this platform thatyou're hearing us on and courses
put on by Zoll in the nearfuture.
So let's get started.
So, zoll, we have a potentialspicy topic today, don't we?
Yeah, we do.

(02:55):
I'm excited.
So, as a Buddhist Zoll, whatare your initial thoughts on
ketamine as a treatment or amodality, as he's smiling
already?

Speaker 2 (03:08):
I don't know, I have different thoughts, different
opinions about it.
But I'm more curious about umthe conversation.
But I mean from the point ofview of the mind.
I'm always fascinated by themind because I've had some trips
in my active addiction too.
So, like that control way ofsupervised, way of what is being
revealed by the mind, it'squite fascinating.

Speaker 1 (03:30):
So yeah, yeah yeah, this is going to be a fun topic
today, isn't it For sure?
Well, let's welcome BradMasters.
He's a recognized leader in themental health sector, with a
wealth of experience and apassion for driving positive
change.
Brad's journey began in theresidential addictions field
before he transitioned to hisrole at Discovery Behavioral
Health, where he quickly rose tothe position of group chief

(03:54):
executive officer.
In this role, he oversaw themanagement of residential and
outpatient facilities,demonstrating a commitment to
enhancing patient care andexperiences.
Currently serving as thedirector of Client Experience at
the Mood Center, brad'sexpertise aligns seamlessly with
his dedication to creatingimpactful and successful patient
journeys in mental health care.
We are thrilled to have himjoin us today as we explore the

(04:16):
realm of ketamine therapy andits potential benefits for
addiction treatment and reallyall forms of health and
well-being.
Welcome, brad.
Thanks for joining us.

Speaker 3 (04:25):
Yeah, thank you.
Thanks for having me, guys.

Speaker 1 (04:27):
Yeah, well, let's get into it, shall we?
Yeah, let's do it.
Can you provide just a generaloverview of ketamine therapy and
very open?
We'll start there.

Speaker 3 (04:37):
Yeah, I mean I guess we can start with, used in this
form, what's actually happening?
You know how does it work.
Ketamine's been around for 50years.
It's been widely used as ananesthetic for surgeries Very,
very safe.
So do you think people?

Speaker 1 (04:55):
know that Like ketamine's used like opiates are
used for therapy and surgeries.
I mean, I think that mightsurprise people.

Speaker 3 (05:01):
It might.
I mean, what's interesting is alot of times I'll mention
ketamine to people oh, the horsetranquilizer, and it's like no,
it's actually soldiers carry iton the battlefield.
Almost every ambulance carriesketamine with them.
They actually use it even toput adolescents under for
surgery.
I mean, it's a very safesubstance and it's been used for

(05:22):
a very, very long time in a lotof different ways.
It wasn't until, I would say,probably mid-2000s, somewhere in
there they started to realizehow well it worked for
depression, and one of thetheories is that when depression
scales started to become moremainstream, they started
noticing that when they woulduse ketamine as an

(05:43):
anesthesiologist to put peopleunder and people were rating
high on their depression scales,they were coming out of surgery
and those symptoms weren'tthere anymore.

Speaker 1 (05:50):
They usually don't go together.
Yeah, surgery and lack of lowmood.

Speaker 3 (05:54):
Yeah, exactly.
So they started to do someresearch around it and
essentially what they found sothere's really four primary ways
when it comes to treatingmental health, that ketamine
works.
So the first thing is it blocksthe NMDA receptor, which in
turn affects chemical calledglutamate, which in turn affects
something calledneuroplasticity, so literally

(06:14):
the brain's ability toreorganize itself and build
neural networks and openpathways.
It's all enhanced, and thishappens one to three days during
and post your infusion, right.
Second thing is a chemicalcalled BDNF, or brain-derived
nootropic factor.
So this follows that samepattern.
So this surges during and postinfusion.

(06:35):
These are all controlledinfusions, controlled dosages,
those kinds of things right, allmedically monitored and above
board.
When BDNF affectsneuroplasticity as well.
Well, but what's really coolabout bdnf is its ability to to
heal cells and neurons that havebeen damaged due to depression,
anxiety, trauma, ptsd, evenchronic stress, right.
So you have this, thisco-occurring thing happening,

(06:57):
where you've got the brain'sability to adapt and the brain's
ability to heal kind of happenhappening simultaneously.
The third thing is somethingcalled the default mode network
in the brain.
So this is where it'shypothesized, this is where the
ego is so let's break it downfirst.

Speaker 1 (07:16):
So there's a medically monitored intake of
ketamine, yep, and then it goesto the brain and then what
happens?
So you've got the NMDA receptorthat gets blocked.
So the receptors are likethere's a receptor for opiates,
receptor for, like, serotonin,and feel good.
So okay, so we got thatreceptor.

Speaker 3 (07:37):
So that receptor gets blocked and then that affects
the chemical glutamate.
Glutamate then affectsneuroplasticity, so it's a
cascading effect.
Bdnf something totally separate.
That's something that thathappens as well.
Right, so there's really fourseparate mechanisms, four
primary mechanisms on why theythink ketamine works so well in
treating treatment resistantconditions.

(07:57):
Right, the default mode networkin the brain.
It's really interesting becausethere's a lot of mechanisms
that there's a lot of reasons.
This is important, but it'shypothesized that that's where
the ego is.
Interestingly natural thingsthat can quiet down the default
mode network of the brain whenit's overactive.
Meditation is one of them.
It takes a long time to develop, though Ketamine shuts it down

(08:20):
immediately.
What's really interesting aboutthat is when the default mode
network of the brain isoveractive, negative self-talk
is ramped up.
You might be internalizingthings external to a very
unhealthy level.
It can allow you to almost stepoutside of yourself for a
minute and gain a differentperspective.

Speaker 1 (08:39):
So when medically monitored ketamine is given, it
inhibits or it blocks part ofthe belief system.
Is the ego, part of the brain,correct, interesting?
Yeah, okay.
And the reason why that is sobeneficial for people with
suicidal ideation or depression.

(09:00):
Explain that to us.

Speaker 3 (09:02):
So suicidal ideation.
For example, negative self-talk, default mode network.
You got negative self-talkramped up.
The default mode network'soveractive.
So in turn you've got thatnegative self-talk that's ramped
up that the person's seeing norelief from whatsoever, right,
so consistent negative self-talk.
They can't see a way out of it.

(09:23):
It's happening over and overand over and over again.
So imagine having thatprevailing thought all the time
and not being able to see a wayout of it, and then all of a
sudden, instantly, it's gone.

Speaker 1 (09:35):
So, for example, that internal critic that says
you're a piece of shit, youdon't deserve this, you're not
worthy of that, you suck.
You're never good enough.

Speaker 2 (09:46):
During this treatment during goes away infusion.

Speaker 1 (09:47):
Yeah, so the brain all of a sudden goes.

Speaker 2 (09:50):
Ah, exactly, okay, exactly, fascinating yeah, how
do you call that again?

Speaker 3 (09:56):
default mode default, mode network default mode
network yeah, and then finally,it's a.
It's a powerful um-inflammatory, which is also one of the
reasons it works so well forpain, so it treats chronic pain
too, really, really well.
But also been able to linkdepression and anxiety to
inflammation in the brain.

Speaker 1 (10:14):
So I think this is one of the reasons really for
years now that the wholequote-unquote wonder drug For
some people.
They've tried, like you said,treatment-resistant right
Certain medications for yearsand it's never been able to stop
the intrusive thoughts and orstop the horrible dark, low

(10:36):
depressive mood, yep, and duringthis treatment it can do
potentially both.

Speaker 3 (10:42):
It has the potential, yeah, yeah can do potentially
both they.
It has the potential, yeah,yeah.
And and I mean imagine it canalso help, you know, when that's
shut down help a lot withperception on things.
I mean a lot of times when theego's in the way, we can't see a
way out, right we're.
We're stuck kind of in themiddle of a situation like it's
not uncommon going intosomebody's room after after an

(11:03):
infusion and saying, hey, howwas that the person's like?
Why it's like I was on theoutside of my life looking in
for the very first time.
That can offer a glimpse of ashift in the way you think about
things and the way you perceivecertain situations in your life
.

Speaker 1 (11:19):
What are you thinking right now, Zal?

Speaker 2 (11:20):
Yeah, I have a lot of questions, but one thought that
comes to mind.
I don't want to go so farbacktrack, but as you're talking
, it makes me think about, sinceyou mentioned about meditation
too, so maybe you can expandmore on that.
But the analogy that comes tomind is about if there's a
destination, if I figure out howto get there, I get there, and
when I get back home, I know howto get back there.

(11:42):
But then what if I gettransported to that destination
and I don't even know how I gotthere, how do I figure out how
to get back there?
So that's the analogy that I'mthinking about the difference
between ketamine and meditation,and we've got relief, and that
can happen through meditation ora ketamine treatment.

Speaker 1 (11:57):
So how does that happen?

Speaker 3 (12:00):
Practicing meditation , you learn how to get there on
your own is what you're saying,and if there's something that's
providing that instantaneously,how do you know how to get back
there Is that.
I can't.
I don't know the answer to thatspecifically, but what I do

(12:22):
know is that there have been andI'd have to find the exact
articles, but I read somewherethe link between meditation
practice is actually gettingstronger post ketamine therapy
well, I think one thing thatwe've seen a lot and you'd
certainly talk about is thepossibility for new neural
pathways, correct?
Their neural networks.

Speaker 2 (12:36):
Yeah, yeah it does sound very beneficial, like the
way you describe about that egogetting out of the way, because
for some people like you'redescribing, when you're stuck in
that negative self-talk, it'simpossible to imagine life
without negative self-talk.
So when you end up having likea glimpse of how it feels, like
maybe it becomes like amotivation for that person to

(12:57):
maintain that.

Speaker 3 (12:58):
Well, 100%, absolutely, and I think you know
specifically when we're talkingabout suicidal ideation and
conditions like that.
I mean, I personally believeright now we've got somewhat of
a broken system in the mentalhealth field.
If you have somebody who'ssuicidal, essentially if they're
not willing to go inpatient orbe hospitalized and monitored on
their own, as a clinician, youhave to EP them, emergency,

(13:21):
petition them to where they gointo the hospital and they're on
hold.
A lot of times that situationdoesn't work out that well.
You know what you're reallydoing is you're kind of shoving
people down further insidethemselves.
There's a trauma response tothat.
A lot of times the police areinvolved.
You're being hospitalized.
The tools that we're using inall those different levels of
care are all the same, meaningthe medications that we're using

(13:43):
right, whether you're inhospital or you're going down
through the levels of care.
We now have something thatpotentially has the ability to
and it's not necessarilypotentially I've actually seen
it happen where, as long assomebody is appropriate, instead
of going to the hospital orcoming from that environment,
from the hospital, you're goinginto a ketamine chair and almost

(14:05):
instantly you're getting relieffrom those thoughts.

Speaker 1 (14:09):
As opposed to the shot of Thorazine, where all of
a sudden you're in a making thismore dramatic zombie-like state
.
Yeah.

Speaker 3 (14:17):
Yeah, and we're opening you up.
You're being opened.
What do you mean by that?
So it's not uncommon thatpeople can be resistant to talk
therapy.
They've had bad experiences inthe past.
They haven't been able to makea connection with a therapist in
the past.
It hasn't worked for them right.
I've had many people who havecome through and we always

(14:38):
recommend talk therapy inconjunction with ketamine
therapy.
I think it's a very importantpiece of it being able to
process.
In fact there's ketaminetherapy.
I think it's a very importantpiece of it being able to
process.
In fact, you know there's.
There's ketamine assistedpsychotherapy, which is a whole
modality around it.
Um, but patients who areresistant like I've had many
patients come through who areresistant to therapy and about
halfway through their sessions,uh, with ketamine, they're ready

(15:00):
for a therapist, they want totalk to somebody, they're opened
up.

Speaker 2 (15:03):
You know, know, they see things a little bit
differently, or or things are,things are coming to the surface
yeah, another approach that I'mthinking about, uh, maybe
you're familiar with thisinputism like mine is one of the
organs, uh, just like thehearts or the, the, you know,
lungs or things like that.
So in that way I don't own mymind, but it responds to how I

(15:24):
treat it.
So if I'm feeding negativethoughts into it, it responds
back with negativity.
So it's like an organ which isalso like a little living thing.
If I'm kind to it, it's kindback to me.
So I'm looking at it from thatpoint of view too.
About if ketamine as atreatment it's like you're
treating it in a kind way, so inresponse it's responding in a
kind way again.
That's how I'm makes totalsense we had.

Speaker 3 (15:47):
We had a patient, um, come through who, uh, was
dealing with suicidal ideation.
Um actually had to go to thehospital before we could get in
for an assessment, becausesafety first in all situations
always.
But we were able to coordinatecare with the hospital and they
were able to come directly to usfrom the hospital and they went
into the ketamine chair and Iwent in to check on them

(16:09):
afterwards and a big smile, justa large smile on their face and
I was like well, how was it?
How are you?
What's going on?
They said.
I don't really know how toexplain what just happened.
Like I came in here not beingable to think about tomorrow and
now I'm sitting here thinkingabout my finances and going back

(16:31):
to school.
I don't, and this was in anhour and a half, so it just the
perception shifts that canhappen are quick.

Speaker 1 (16:41):
I'm trying to think of this like a medical model
where I often use this thepancreas produces insulin,
sometimes it doesn't, so thendiabetic receives insulin.
So if the brain is notfunctioning appropriately, or

(17:03):
stuck, okay good, what do youmean by stuck?
Because I know you'll take thatsomewhere.

Speaker 3 (17:11):
Yeah, we can become stuck and trapped in our own
patterns, in our own brain, inour own thought patterns right.

Speaker 1 (17:18):
So the neuroplasticity, the way it's
wiring the active parts of thebrain, are doing something where
it's looping in a dark,negative way.

Speaker 3 (17:28):
Absolutely actually to go back to, to your question
like how do you learn to getback?
I think that's actually areally good example of
neuroplasticity, right.
I think you build thesepatterns over time and you're
right, like a solid meditationpractice, over time You're
training your brain to dosomething over and over and over
again and to respond a certainway.
Right, ketamine is basicallypriming your brain to be able to

(17:53):
change that and to build thosepatterns quicker, right?
So we talk a lot about whenyou're going through ketamine
therapy.
Sometimes the patients seethese profound shifts, profound
changes quickly.
I, I mean, I'm talking in liketwo to three weeks.
I've seen people their wholedemeanor's changed.
Other times people start to seesmall little shifts in their

(18:14):
life, like they're just thinkingabout something a little bit
differently, or, um, you know,we, we had somebody come through
with a ptsd reaction to loudnoises and they had a toddler in
the house.
So you can imagine that wascreating a lot of issues at home
and after I think it was two orthree sessions, the patient
reported the noises would happenand he would know how he would

(18:39):
normally react to the situation.
But he was able to think aboutit and not react and kind of
change his mind right.
And so we talked.
We talked a lot to patientsabout no matter how small or
seemingly insignificant thechange is in your life,
celebrating that and reinforcingit and building that, building

(19:01):
new patterns.
So I mean, we had um, we had apay and it comes through.
So, like the current treatmentmodel for ketamine iv and im
ketamine is six sessions overthe course of two to three weeks
.
The reason for that is is, aswe talked about the, the
glutamate response and bdnfresponse, you're looking to kind
of keep those things elevatedover that.

(19:23):
That initial phase.
It's almost like a springboardright.
And then you do boosters.
Essentially most people startonce a month and then eventually
you try that back to once aquarter and then eventually,
with ketamine, eventually theplan is you don't have to come
back because you've kind ofbuilt those new neural networks
and those new patterns.
And this is what I mean by kindof seemingly small we.

(19:46):
We had a patient come throughwho, uh, the older couple, the
wife, was uh pretty severelydepressed for for many, many
years and, um, they had comethrough for the all six and they
were on their booster.
And I remember talking to herbefore she went into the room
and I'm like hey, how are youdoing, how are you?

(20:07):
I don't know, I'm not, I'm nota hundred percent sure, which
also you know, a lot of times wedo industry standards score,
score scoring on everybody.
So PHQ nines, gad, sevens, thatkind of where people are A lot
of times their scores, theirdepression scores, will show

(20:27):
improvement before, sometimes,before they recognize things
have changed, or family membersstart to notice things are
changing, depending on theperson.
So this in particular person,I'm not sure, maybe a little,
you know, I don't know.
And then the husband comes outand grabs me, he goes.
I got to tell you somethingLike what she's been getting up
every single morning for thepast week and a half and making
the bed.
For the first time in 20 yearsthat hasn't happened.

(20:50):
She hasn't never gotten out ofbed that early, seemingly small,
oh big, oh she, he or sheshowered every day consecutively
, all week, right, huge, yeah,those are huge things, and so a
lot of it is awareness too andin building those new patterns,
and I think it actually alignsreally well with what you were
just talking about in terms ofit's just enhancing that ability

(21:14):
to train the brain to get there, if that makes sense.

Speaker 2 (21:18):
Yeah, it does.

Speaker 1 (21:19):
I think that also highlights for me advocating for
people getting this type oftreatment.
Do this with processing, with atherapist yeah, you know,
getting the ketamine treatmentand then a therapist can really
help you identify what are thedifferences, what are what feels
like stuck points, how can wecreate new neural pathways,

(21:41):
whether it's a therapist or acoach that understands this
process?
I mean, that's huge for theI'll say, the acceleration of
creating those new neuralpathways.

Speaker 3 (21:51):
Completely agree.
I would say the two componentsof that that are probably the
most important are settingintentions prior to the session.
So coming in prepared,preparing the mind for kind of
what your intention is, whatyou're hoping to get out of it,
and then the processing session.
So coming in prepared,preparing the mind for kind of
what your intention is, whichyou're hoping to get out of it,
and then the processingafterwards.
So there's actually adocumented 24-hour post-infusion

(22:12):
to take advantage oftherapeutically, where I don't
want to use maybe the word openis too strong, but people are
more.
It's more fresh.
What happened in the room ismore fresh.
We give every patient a journalso you can journal about it.
The infusion time is anywherefrom 45 to 50 minutes but you're
in the room an hour and a halfso you have time to kind of

(22:33):
journal about anything thatmight have come up and kind of
recoup so that you know you canprocess that later.
But the intention setting isalso super important.
So you know what we talk abouta lot, for intention setting is
core beliefs are important inthat I think.
So let's say, you're comingthrough and social anxiety is

(22:56):
severe, social anxiety, right,and we you know you're talking
about with your therapist andand the core belief driving that
anxiety is I'm not good enough.
It's self-esteem issues, right.
So you might come into the roomwith a mantra of I am good
enough, I'm whole, I am enough,and you might be repeating that
going into your session and thenthat kind of gets reinforced.

Speaker 1 (23:18):
Yeah, the way I relate it where the energy goes,
the energy flows if there's nota blockage, correct.
Really, where the energy goes,the energy flows if there's not
a blockage, correct, right.
So if that that brain is notfunctioning the way it could be
in a healthy way, if it'sblacked, you're saying the
ketamine can help, like you,setting the intention can have
the energy go in the rightdirection and then the treatment

(23:38):
happens and then it begin thenew neural pathways right there
and then yeah, yeah, yeah, it'sum.
People can have some, somepretty amazing experiences one
more piece of the medical aspectin the physiological aspects.
I'm sure there's some listenersthat are thinking well, why,
for a lot of people potentiallywhy does an ssri or an snri or

(24:04):
wellbutrin or prozac?
Why is that not doing this forthem?

Speaker 3 (24:09):
completely different mix.
So since prozac came out in the80s, essentially, um, the
medications have all essentiallyworked very similarly.
Which is it really what they'redoing?
Is they're turning the volumeup on different chemicals.
The brain brain so, likedifferent classes of what you
just mentioned work on differentchemicals, whether it's
dopamine, serotonin, gaba.
But that's been the prevailingtheory is we're just turning the

(24:33):
volume up to correct a chemicalimbalance, which a lot of times
there is.
One Can be that for some people, yeah, and then sometimes
there's a source to that.

Speaker 1 (24:45):
You know, chemical imbalance, like, sometimes
there's a cause, and so theanalogy I give and it's not for
all, I'm speaking in generalterms that, like the SSRIs for a
lot of people, can be looked atas I'm trying not to get myself
in trouble here but like avitamin, when, like, okay, you

(25:08):
have so much serotonin, howevermuch you have have, and it
inhibits the reuptake of theserotonin, so it okay, you've
got this serotonin floatingaround.
However much you got will getabsorbed.
Oh, is it similar to like avitamin?
I guess it's like let's giveyou the, the resources that you
have and not lose it.
You know that's.
I'll probably keep this in andnot edit it out.

Speaker 2 (25:23):
Yeah, the other thing that I'm thinking about as you,
as listeners know and as youknow, that's I'll probably keep
this in and not edit it out.
Yeah, the other thing that I'mthinking about, as you as
listeners know, and as you knowtoo, is the.
The root problem of all mentalillness comes from a place of
isolation.
That, that's that disconnection.
Uh, but that part is takingcare of it sounds like, because
there's a team supervising,you're checking in, you're
reporting where you're at,you're setting intentions.

(25:45):
So that's like a very openlearning experience where this
patient is open to suggestions.
Because the difference is thatin my active addiction days I've
gone to places by myself andthen I cannot fix my mind with
my own mind, because it's kindof funny to think about it.
But in my tripping days I'vebeen put up by the waterfall,

(26:08):
had conversation with it, allthese things, but then it was
all by myself.
So I'm thinking about it thatway too so that's a very good
point.

Speaker 3 (26:17):
So everything is 100% clinical, clinically supervised
.
So it all starts with aclinical assessment by either a
psychiatrist or a psychiatricnurse practitioner and
everything is prescribed right.
Everything's medicallymonitored.
There's a team of individualsthere.
We're talking about attentionsetting.
We've put a lot of thought intoevery single room in terms of

(26:39):
visuals and how those affectneuroplasticity Visuals and how
those affect neuroplasticity.
Also, music and differentguided meditations and stuff and
noise-canceling headphones andhow that works with
neuroplasticity during theketamine treatments.
But this isn't about isolation.
This is actually about bringingthat stuff out and it's also
controlled.

(27:00):
There's a big difference betweengoing in the street and buying
ketamine and not exactly knowingwhat dosage you're getting,
going in the woods with yourfriends and doing it, or
isolating in a room and doing itright.
That would be abuse right,whereas this is medically
monitored.
The intention is healing rightRather than the intention being

(27:20):
escape, and doing itappropriately with professionals
, I think is super important.
So you know, ketamine is alsovery safe.
But all of the risk of ketaminewhen it comes to side effects
is during the infusion process,which is why we medically
monitor everything.
So those things include, likehigh blood pressure, nausea

(27:43):
anxiety is listed as one.
Nausea anxiety is listed as one, which is interesting because
ketamine works really well to onwith anxiety.
My experience with that is it'sall over what to expect like in
the session anticipation andthe anticipation of the session
itself.
But that's also one of the verybeautiful things about ketamine
is, you know, the medicationsyou just listed typically come

(28:04):
with a whole host of sideeffects.

Speaker 2 (28:05):
Very much so.

Speaker 3 (28:07):
Weight gain, sexual side effects, those kinds of
things.
Ketamine doesn't have any ofthose risks.

Speaker 1 (28:12):
So let's talk about some of the other risks
potentially a field of peoplethat are in recovery or have a
history of abusing mind-altering, mood-altering substances,
history of abusing mind altering, mind altering substances.
What are your initial thoughtsabout this population
potentially using this as amodality for change in health
and wellness for them?
Good question, so.

Speaker 3 (28:33):
I I mean, you know, I got my start in the substance
use industry, so fulltransparency.
When I first heard aboutketamine using this purpose, I
was like huh, we're using whatfor what?
Like I was very, very confusedbut also extremely curious.
You know, I think I would never, ever, ever say that any one
treatment is right for everybody.
You know, it's always anindividualized thing.

(28:55):
I think that everybody's in adifferent place with it.
I think there needs to be aclinical assessment.
I think I can make a very, very, very, very strong case for a
person, no matter what stage ofrecovery they're in, if their
depression is severe enough.
What's going to be more harmfulor drive them out First, the
depression or ketaminetreatments in a medically

(29:15):
monitored environment.

Speaker 1 (29:17):
I think Isn't that why some people use substances.
Substances I don't like the wayI'm feeling and I can
self-medicate with alcohol, withmy primary care physician is
prescribing me pot to deal withmy anxiety or depression and I
smoke three, four, five times aday like these are some

(29:39):
rationales people would fear ofusing yeahamine.

Speaker 3 (29:43):
So I would think the word that comes to mind most
often is escape.
Okay, typically, I think peopleare looking, you know, with
substance use disorder it's theescape right.

Speaker 1 (29:56):
Yes, instead of coping, escaping, running from
Escaping as a coping skill.
Okay.

Speaker 3 (30:04):
Ketamine when using this way is the exact opposite
of that.
Okay, it's almost running to.
You're opening up.
You're bringing things upintentionally.

Speaker 1 (30:12):
Okay.

Speaker 3 (30:12):
Right In a controlled environment, it's growth Right.
I think that the substanceshave never really been the issue
.
It's how we've used them in ourrelationship to them.

Speaker 1 (30:25):
Right, use them in our relationship to them.
Right.
It's a solution to otherproblems, which I enjoy doing as
a therapist and zah does as arecovery coach.

Speaker 3 (30:29):
Yeah, looking at underlying cause, conditions and
what's really going on, exactlyand and I think that you know
these substances can have andnot just ketamine, other
substances as well can haveprofound positive uses when used
appropriately.
The dosaging, the dosage ismonitored.

(30:49):
I think we talk a lot about inrecovery knowing your why,
especially even early inrecovery, you're going to a
wedding that's going to bealcohol there.
Know your why.
Why are you there?
If it gets to leave?
You know what I mean.
Know your why.
Right Personal responsibility,I think, using something like
this.
Know what's your why, why areyou using it?
Typically speaking, if somebodyis drug seeking, they're not

(31:15):
coming to a clinic like ours andyou know, going to pay the
money to be medically monitoredand the dosage controlled and
actually go through the steps ofactually doing it appropriately
.
I haven't seen a lot of thatBecause they get snuffed out
pretty quickly.

(31:38):
I imagine, yeah, and I talk to alot of the people that are
coming through the clinic.
The amount of calls I've gottenlike that are few and far
between I mean maybe less thanthan a handful, and typically
they all go the same way hey,are you guys doing?
You guys do ketamine there?
Yeah, what's the process?
Can I just come in?
No, you have to have anassessment by a clinical
professional and then you knowyou're medically monitored.
And well, what's the dosage?
Well, we start off at you knowit's a micro dose, it's 0.5

(31:59):
milligrams per kilogram.
And then we move up from there.
And how much is it?
And then you get into pricingfor the medically monitoring and
all that.
And once you're done talking,they're like okay, no, it's like
click, it's like I don't.
You know their, their questionsare more money and escape
rather than the motivation is.
Here's what's going on with me.
How can this help?

Speaker 2 (32:20):
yeah, it makes me think about, because in buddhism
, uh, the eightfold path which atranslation.
But the key word that I've beenthinking about is the path.
So if it's a path, it's takingyou somewhere.
So, which is what you're saying?
That if I have a purpose orintention of where I'm going, if
I'm using this as a factor toget there, it's different from
checking out, it's differentfrom I just want to feel this
way, I don't take care aboutwhere I'm going, I'm just going

(32:43):
to be stuck here.
So that's also how I'm drawingthe parallel between why am I
doing this and is it leading metowards something fulfilling?
Because there is a really bigemphasis on the sustainability
too, because I've been high,I've used drugs, but then they
weren't sustainable.
That low is really sudden.
But if it's like medicallymonitored and if you still have

(33:03):
that purpose of I just want tobe happier, I want to have
better quality relationship, Iwant to be more successful,
whatever it is, if there is likethat noble goal, this can fit
into that.

Speaker 3 (33:14):
Yeah, and what's interesting is, like the
patients that I've seen, youknow they're coming through.
The dissociative side effectfrom ketamine is typically not
what our patients are chasing.
It's like I've had patientsthat have come through where
it's like I've never known whatit's like to not feel depressed.

(33:37):
Or intrusive thoughts Outside ofthe treatment itself.
So this is like three, fourdays later after they've had
their treatment and thedissociative side effect and all
that has happened.
It's like I've had patientscome through where their anxiety
ramps up, so like they comethrough for treatments,
depression is almost like gonequickly because of that.

(33:59):
It's like they start gettinganxiety because they've never
known what that has felt likeand they're worried it's going
to come back, yes, yeah.
And then it all kind ofbalances out and they're like I
didn't even know life could feellike this.

Speaker 1 (34:13):
So foreign.
Yeah, the way I can relate todifferent forms of serenity, and
especially for the brain, isthat mental exhale, that ah, and
just the brain quieting down ornot racing or just not
constantly going with darknessor depression or ideation, or

(34:36):
just their own personal hell.
And it's just like to seepeople like that and part of the
reason why I've brought on fortheir whole life, since they're
seven years old, have been inthis ideation in their own
personal hell.
And this person was after thetreatment processing with me.

(34:59):
They were angry and the reasonwhy this person was angry is
they said, this is what normalpeople feel like, because I'm
angry that I haven't had theopportunity to feel what this is
.
And if I've been able to feelthis for my whole life, I'd be
able to function.

(35:20):
And he was kind of angry.
And then it was the angry atGod or all these things and like
, well, why has mine been broken?
You know all these things andlike, well, why has mine been
broken?
And just seeing that beginningstages of one of my favorite
quotes was it's like you shookmy Etch-a-Sketch brain and it
was finally clean.
All of the Etch-a-Sketch wasjust shaken off and it was a

(35:43):
clean slate.
It's like oh, we got somethingto work with now.

Speaker 3 (35:47):
It's wild.
I mean I um I've never seen.
Actually, what's reallyinteresting is the the closest
thing I can relate it to likewhen I was working in substance
use primary.
Um, there's that thing calledthere's the pink cloud, sure,
where somebody comes in and theyhave a couple weeks clean.

(36:08):
You know they're what're out ofdetox.

Speaker 1 (36:09):
What would I want to use again?
Life is great.

Speaker 3 (36:11):
And then all of a sudden it's like Crashes,
they're a different person.
It's like boom, they're on thispink cloud and it's like, you
know, there was something kindof gratifying about that from a
provider standpoint, because yousee, this instant shift.

Speaker 1 (36:27):
You earned it, congratulations.

Speaker 3 (36:29):
You see kind of this instant shift in somebody and if
they can maintain it there isalways the fear that it's going
to crash and you've got to teachthem to balance that out.
But you see people they canlike.
If they get it they can changepretty quickly.
And it's cool to see Mentalhealth primary.
You don't see that a lot.
You don't see people shift thatquickly.
Sure you health primary youdon't see that a lot.

(36:57):
You don't see people shift thatquickly.
Sure, you see it with ketamine.
I mean, you know some of thequotes.
I hear one of the things I heara lot from a lot of different
patients is the blocks are gone.
I hear that in different forms,like the things that were
holding me back.
The blocks are just gone.
I hear that a lot.
Um one patient one of the oneof the really cool things I
heard was he he put it reallywell he goes.
After the first treatment.
I could see pieces of my oldself after the sixth.

(37:20):
I am my old self, which ispretty profound yeah, I also
have another question.

Speaker 2 (37:27):
I don't know if it's an unanswerable question.
Uh, pretty much like, from thatpoint of view, at the
intersection between science andspirituality.
So, since this is like amedically monitored process,
like is there, how would youthink of it as spirituality
fitting into this?
Is there any aspect for thattoo?

Speaker 3 (37:46):
hard to answer, but a hundred percent I would say.
Say for sure I've had patientshave like I had one patient have
a complete inner childexperience.
Their inner child came to themand they had a conversation that
was so liberating and free,like from that moment on she was
a different person.
That was halfway through herseries of treatments.
I've had people who have lostloved ones, who have really

(38:10):
struggled with end of life stuffand like you know, crisis is a
faith Go in the room and in onesession just come out of there
knowing that everything's okay.
One patient you know was like Icouldn't see my loved ones that
have passed, but I couldeverything but see them.
They were in there with me, Icould feel them and it was just

(38:33):
beautiful.
There is absolutely a spiritualcomponent happening in that
room.

Speaker 2 (38:38):
Yeah, because I'm also thinking about when
somebody's depressed I draw theanalogy like a flower that is
withering the spirit.
The essence is dying.
When you water it, give, givenutrients, the spirit comes back
.
You know, so it sounds one ofthose, sounds like it's one of
those things, too, where lifebecomes light, springs out of
you again that feeling yeah,it's um, it's, it's really, it's

(39:06):
really cool to see so we'll getback to the addictions piece.

Speaker 1 (39:11):
I'll paint the picture and you might know where
I'm going with this, butanybody 30 years or older knows
about the death of Friends star,matthew Perry.
He was apparently receivingketamine infusions and, I think,
off-label application of IVketamine.
But the amount of ketamine inhis system at this time of death
meant that he must have alsobeen obtaining additional

(39:33):
ketamine from another source touse at home, and I imagine in
your field that this was, ohgeez right.
This doesn't look good.
Someone that's in recovery,very vocal about his recovery,
helping other people recoveryvery vocal about his recovery,

(39:53):
helping other people at the weekprior, a few days prior, taking
medically monitored ketamineand then, um, he dies.
So give us your perspective onthat, because that's a fear for
a lot of people.
Hey, it's not my drug of choice, but I could see how I could
have cravings or what.

Speaker 3 (40:08):
Yeah.
I well, first of all tragic,yeah, right.

Speaker 1 (40:12):
Um horrible.
Such an advocate for recoveryBig time.

Speaker 3 (40:17):
Yeah, um, and just a beautiful person, I think so he
was.
He was definitely an advocatefor ketamine therapy, I mean, as
he writes about it in his book,about how much it helped him
and how much he was an advocatefor it.
I think you know, in doing someresearch around it he, I would
say probably from the verybeginning, when he first started

(40:38):
using it, was going too often,like there's a pretty standard
medical model that you want tostick to and you don't really
want people there's someexceptions with chronic pain and
stuff like that but you don'treally want to be letting
anybody come to the clinic moreoften than what is appropriate.
Right, he was doing it probablymore often than what I would

(40:59):
deem appropriate from the verybeginning, and then at his time
of death I know he had otherthings in his system as well-
bupuprenorphine, ketamine andbuprenorphine those who knew and
maintained that he was cleanand sober to his death.

Speaker 1 (41:16):
but he did have his treatment earlier in the week.
But how do you get take-homeketamine and not have it
medically monitored?

Speaker 3 (41:28):
Well, maybe you don't go on a tangent about this.
So, um, yeah, his last recordedmedically monitored, supervised
above board ketamine sessionwas, I think, one week prior,
five, five days, roughly oneweek prior to that.
The thing about ketamine isit's got a extremely short
half-life.
The effects effects of ketaminealmost instantaneous.

(41:50):
That's one of the reallyinteresting things about it is
somebody.
They can come in for aninfusion and once the IV comes
out within a couple hours,typically people are back, maybe
a little fatigued, right Backto normal, but it's out of your
system completely within acouple of days typically.
So what was in his system atthe time of death had no nothing

(42:14):
to do with the medicallymonitored, supervised ketamine
session that he had gone through.
So essentially it leads itwould lead one to believe that
he must've been getting itillegally off the streets or at
home now.

Speaker 1 (42:23):
Um or not professionally prescribed by
that initial prescriber.
Correct yeah.

Speaker 3 (42:27):
Correct.
So you know, I think, anybodywith substance use disorder.
Is there the risk that ketaminecould induce cravings and stuff
like that?
Sure, I think that's why it's acase-by-case scenario.
Is it a complete rule out?
I don't think so.

Speaker 1 (42:46):
How do you assess that at the Mood Center?

Speaker 3 (42:49):
Well, it would start with a clinician I mean, it
would be the psychiatrist or thepsychiatric nurse practitioner
and I think it's just riskversus reward, right.
Is the risk benefit of thistreatment?
Is it worth it, right?
Like I said, if somebody isstruggling severely with
depression, treatment-resistantdepression, even if they're in
early recovery, how many peopleare dying by suicide in early

(43:13):
recovery because of depression?
Sure, many, many, many, many,many, many many.
And we have something here thatcould help right, or what's
going to drive them back outthat depression or medically
monitored ketamine sessions yeah, I I kind of am processing my
thoughts.

Speaker 1 (43:33):
As you know, people that listen know that I'm a
therapist hat and Zal's aBuddhist-inspired coach.
But we're also people inrecovery and 12-step recovery.
So we have two different hatsand our personal recovery model
in some ways is a lot differentfrom me as a professional

(43:54):
appropriately so, and I oftenuse the SAT analogy that heroin
is to cotton or oxycodone orfentanyl as alcohol is to
benzodiazepines Xanax orfentanyl as alcohol is to
benzodiazepines xanax.
So for a lot of the clientsthat come here and they see a

(44:15):
psychiatrist that hey, they'rehere because they're sober off
of alcohol now and gosh, Irelapse and some psychiatrist is
giving them xanax for anxietyand I go let's look at this and
what receptor and things likethat.
And yeah.
Do you see how that puts you atrisk?
Oh, I never thought that before.
So I educate and inform thembecause sometimes psychiatrists
just suck, or primary carephysicians and don't look at the

(44:39):
whole picture and risk factors.
So how do you help peopledetermine that?
I help my clients determinethat are considering this form
of treatment, pros and cons andrisk factors and why this is a
viable, safe option for them.
So I guess explore more of that.

Speaker 3 (44:58):
Yeah, so that would be all gone over in their
assessment with theirpsychiatric nurse practitioner.
Our practice manager is also alicensed substance use therapist
, so that expertise is in thebuilding during treatment teams
and stuff like that.
So I mean we take that, we takethat side of it seriously.

Speaker 1 (45:16):
Yeah, um, you know, our, uh, our medical director is
actually a do who wears anotherhat as medical director of a
substance use facility, um, andhe has a lot of experience with
ketamine I was shocked by this Iguess pleasantly, when I was
doing some of my research andlearning more about it that

(45:38):
ketamine is being used more andmore for alcohol and opiates
yeah, so talk about that yeah,so they're actually in some ways
like oh well, this cannot helpminimize risk factor of cravings
, potentially for, specifically,opiates or even alcohol, so
talk about that.

Speaker 3 (45:56):
So there is.
There's research being donecurrently about specifically
opiates one helping the detoxfrom opiates.
Also bridging the gap between.
So like fentanyl binds to thereceptor so strong these days
that there's a large gap betweenwhen somebody stops before they

(46:18):
can go on something likesuboxone.

Speaker 1 (46:20):
You don't want precipitated withdrawal, and
yeah, and the risk ofprecipitated withdrawal, which
just, which just means, uh, ittook it too early and this sucks
and I feel miserable.

Speaker 3 (46:30):
It's a withdrawal on steroids, essentially.
It's basically going in thereand kicking any of the opiate
out that was in there and it'sputting you right smack dab
where you didn't want to be inthe first place.
Oops.

Speaker 1 (46:41):
Yeah, exactly, Don't lie about your drug use.
Exactly right.

Speaker 3 (46:46):
So they've been using ketamine with some success on
being able to bridge that gap interms of getting people from
fentanyl, opiate use to Suboxoneand even being able to continue
with ketamine trips.
We always do an assessment onsomebody on what's appropriate
right, what's the appropriatelevel of care, especially with

(47:07):
something like alcohol.
I mean, you're talking aboutsomething that can be
life-threatening, right.
If somebody needs to go throughdetox or needs to be in
residential, that's where theyneed to be and then you can talk
about something afterwards.
But we've had folks comethrough who binge drinking.
They're kind of on that border.
They're teetering with usingthe substance inappropriately.
Maybe they are using itinappropriately but they're not

(47:31):
quite ready for residential.
They're not meeting thatcriteria yet.
One patient in particular I canthink about was dealing with
some pretty significant griefand was what I would call binge
drinking really on the edge, andcompleted all six treatments

(47:53):
and completely lost the will todrink through those six
treatments Completely, justhasn't had a drop of alcohol
since, which is pretty profound.

Speaker 1 (48:17):
And I think it has a lot to do with getting to the
core, getting to the root, youknow, getting to the core of
some of the issues that wasgoing on.
That was've had people that hadthe intention um had aids, not
professional medical aids.
You might know where I'm goinghere and whether it's trauma,

(48:38):
whether it's grief, whether it'swhatever it might be that we're
going through um ayahuasca.
Yeah, you know, for years,people that used asked me my
thoughts and I said you're aninpatient right now with me.
So that's my thought onayahuasca.
How is this?

(48:59):
Because some of the conditionsare the same, spiritual in
nature right the intention.
A lot of people do ayahuascafor that growth and change.
How is it different?

Speaker 3 (49:12):
Oh man, well, very different.
It's a very differentexperience.
Ketamine is a lot less of anintense experience than
something like ayahuasca.
The potency the potency is acompletely different ballgame.
Also time frame, time framecompletely different ballgame.
Also Time frame, time frame inthe journey itself.

(49:34):
Yeah, I mean, you're talkingbig difference, you know?
One of the other things aboutthis that's important is, I
think, psilocybin, mdma.
That'll actually probably beout for use later this year.
I think all of these thingshave a place clinically, but
we're not there yet withayahuasca in a medically

(49:55):
monitored environment.
That's appropriate, in myopinion.
So if somebody wanted to havethat journey and they were aware
of the risk factors or anythinglike that, I wouldn't
discourage it.

Speaker 1 (50:07):
But comparing ayahuasca to ketamine is a very
hard thing to do because they'revery, very different substances
and I mean ayahuasca, I imagine, is on a different receptor of
the brain and, yeah, it's apsychedelic.
But one thing that youmentioned with ketamine is the
different receptors and how itopens the chance for

(50:29):
neuroplasticity and I wonder ifthere's a significant difference
in terms of that aspect.

Speaker 3 (50:37):
I have no idea so I know, like psilocybin plays on
the serotonin 2a receptor, whichis is and I believe I believe
ayahuasca does the same thing,which is essentially the brain's
ability to communicate in waysthat it is unable to before,
like it just communicatesdifferently and kind of opens
things up.
But it's a very different, verydifferent experience.

(51:00):
What are you thinking, zal?

Speaker 2 (51:02):
I'm thinking about what Brad said earlier.
Very descriptively, you use theterm priming the brain, which I
really like, but also itbrought a lot of thoughts too
about the recovery process.
So that means that what do I dowith it?
I have a window to do somethingwith that, and a lot of people
who are in recovery knows thattoo, that it's not just about

(51:24):
stopping the use.
You got to do something aboutthat within that window to
sustain it.
So I'm thinking about it, andthere's a mentioning of this in
a bali canon in the buddhisttradition.
I don't think they were talkingabout addiction at all, but
that analogy comes to mind.
I love analogies, but like ifyou have a cut at the bottom of
your feet, every time you touchthe salt it's going to be
painful yeah so, like whereveryou go, it's going to be painful

(51:46):
.
So while you're not touching thesalt, that wound has to heal,
and after that, when you touchthe salt, it doesn't hurt
anymore.
So I think about it the sameway that this is what happened
to people who are in long-termsobriety they have less craving,
they will do something, butsince they're in that
quote-unquote spiritually fitcondition, they're touching the

(52:07):
salt, but then they're nothurting, it's not creating more
craving.
So it makes me think about thattoo, about that priming stage,
about what do I do with it.

Speaker 3 (52:15):
To go further yeah, and that relationship to
substances has shifted, I think,if I'm hearing you correctly,
and you know.
Let me ask you what is recovery?
If you had to sum it up in oneword, I can tell you a little
bit.

Speaker 1 (52:33):
Part of it is discovery, part of it's growth
that's the word I would use.
Part of it could be change.
I mean, it's all three of thosethings, I think.

Speaker 3 (52:44):
I tend to use the word growth, I think, because
personally I think recoveryceased when you stop growing,
when you stop learning, when youstop seeking to grow from
experiences.
Recovery stops happening.
When you're you, when you'retrying to escape you're, you're
moving backwards, you're notgrowing from experiences, you're
not, you're not applyingyourself.

(53:05):
So in that, in a lot of ways,the way ketamine works on
neuroplasticity and the brain'sability to enhance change, I
mean it actually fits reallywell in that concept.
But you always do have to takeinto consideration where is the
person's relationship withsubstances?

Speaker 1 (53:41):
You know, are we going to affect that treatment,
whether it's for physicaltherapy for a knee, whether it's
a medication that a doctor'sgiving them for high blood
pressure, Some people don't care.
The specifics, the first aspectof telling them what's happening
to the brain and why, and thenthe journey that they're going
to be on and we haven't eventalked about dissociation and

(54:03):
things like that and thehallucination process
potentially we haven't gotten todepth of that and then the
processing afterwards, whetherit's with therapy or the full
range of possibilities that canhappen outside of the treatment
and what could happen for thosefive, six weeks.
To intensively help someoneevery step of the way and I use

(54:27):
this analogy frequently it'ssetting up the conditions.
So a farmer can just throw someseeds down, but it's better, if
you turn the soil, pull theweeds, cover it up, wait for the
right season, water it, and tobest set up the conditions for
this change and this rewiring totake place.
And looking inwards, man, if wecan intensively help people

(54:48):
every step of the way and likesame thing with the treatment
plan and any treatment plan.

Speaker 2 (54:55):
Yeah yeah, I mean I'm enjoying the conversation.
I don't want to be.
I guess I've never reallyapproached it like to or against
, for or against kind of thing,but I'm just really curious
Because nowadays there are justso many different ways, and
whatever helps is great.
I think the more open theconversation is, the better for

(55:15):
people.

Speaker 3 (55:16):
I think curiosity is great.
I think that's important andthat's where it started with me.
Like I said, when I first heardabout ketamine being used in
this way, it was huh, but I wasalso.
I'm curious by nature typicallyand I know that you know if
something's getting a lot of, ifthere's a lot of talk about

(55:36):
something, there's usuallysomething there.

Speaker 1 (55:40):
I think most people are fearful and apprehensive,
which is fair, and I thinkthat's I think most people are
fearful and apprehensive, whichis fair.
Because of change of growth,because it's uncomfortable right
Even though in this treatmentthere's some benefit and
euphoria, where often I tell myclients whether they're sitting

(56:01):
in a chair and I'm doingexperiential work that most
forms of treatment there's goingto be a lot of discomfort, and
then to lean in the discomfortand then you'll rewire your
brain that way.
This is in some ways notcounterintuitive from that, but
like hey, it's not always.
This might actually alleviatesome of that discomfort, while

(56:22):
it can lead to change and growth.

Speaker 3 (56:23):
It can ways this might actually alleviate some of
that discomfort.
While it can lead to change andgrowth, it can.
And I mean there there can besome you know in I I haven't had
anybody have a quote, unquotebad experience I've had people
have some really powerfulexperiences okay.

Speaker 1 (56:37):
so never the panic attack, never the dissociation
where they're like oh my, my God, I mean, that's what people are
going to worry about.

Speaker 3 (56:43):
I can think of maybe one or two times where that's
and generally what the root ofthat is is not coming in in the
right, the inability to let go,and not coming in in the right
frame of mind.
It's almost like they'refighting letting go too much,

(57:05):
and that's kind of where thatcomes from, but not like the
quote-unquote that person's alltherapists afterwards, yeah well
they did.
Yeah, the quote-unquote bad.
Yeah, trip, yeah, you know thateverybody ayahuasca I hear like
the bad.
Yeah, that is is very, very,very uncommon.

(57:26):
Now I've had some people havesome powerful sessions with
tears and things, but not in abad way, more just kind of like,
okay, this stuff came up andit's supposed to let me journal
about it and this was this waspowerful um, even powerful or
foreign, and maybe not to thelevel of discomfort, but maybe
because it's so foreign.
Discomfort, yeah, because it'sso foreign, almost in an

(57:48):
enlightening way, these thingscan come up and people are,
these things that have held suchpower over you for a very long
time.
You all of a sudden can see itfrom a different angle, and I
think that's more.
What I see is like you know,you have these situations in
your life we all have them wherewe're kind of stuck.

(58:08):
You know, it's almost like youget to look at yourself, you
know, from a in a differentperspective.
You get, you just get to seethings that perceptions
everything.
You know, perception driveseverything.
It's almost like you can thesepowerful situations in your life
that have held such, you know,meaning and strength in a
sometimes in a very negative way, all of a sudden you see it a

(58:30):
little bit differently and it'slike oh, Zala, you're a life
coach, recovery coach,meditation coach.

Speaker 1 (58:36):
Based on what you were talking about, what
intention or what meditationskill set or practice or advice
would you potentially givesomeone based on what you heard
today?

Speaker 2 (58:47):
Yeah, I mean to emphasize again too, I'm not
although I'm not for or againstif I were to take a stand, I
really take a stand for aconnection, a community, like as
long as you're doing it openlywith other people, there's
always something to be learned.
So, because you know, I dobelieve from my own experience,
uh, is that mind in its natureis infinite, like it's limitless

(59:09):
, but that are capable of seeing, are capable of perceiving
what's happening is limited solike that.
That, to me, is where the theconnection with other people
helps, because sometimes I'll beable to see my own mind through
other people, you know.
So as long as I'm stayingconnected in that way, it's safe
.

Speaker 3 (59:26):
Yeah, you remind me I had a patient come in who
brought me in the room.
She sat me down.
She was like I just got to tellyou something.
I'm like what?
Tell me you know what happened.
How was it, brad, everything isconnected and I can finally see
that she just she walked out ofthat session with.

(59:49):
It was like she just knew, likefor the first time in her life
that and she like in her core,that everything's connected and
it's all one.
And it was such a profoundthought to her.
I still still talk to hersometimes and she'll always
bring that up.

Speaker 1 (01:00:07):
I think you'll have to tell your Moodsetter clients
to come to the RecoveryCollective for the mindfulness
communal meditation here everySunday, you know, so that way
they can all stay connectedtogether.
But I really think that, man,how cool would it be to have
some kind of processing communalgroup, for you know I just

(01:00:29):
whether it's processing it orjust being connected with other
people that have gone in thisexperience, whether it's a
weekly or bi clinicians, I thinkyou know, since getting into
this, I can really put peopleinto kind of almost buckets
right.

Speaker 3 (01:00:53):
You've got people who are really excited about where
this is going, and ketamine isreally, really paving the way
for a lot of other stuff.
You know, psilocybin, mdma iscoming, like these kinds of
things are coming.
These therapies are coming andthere's a lot of really good
research behind them and a lotof people are really, really
excited about it.
I would say the vast majorityof the people probably in this,

(01:01:14):
in this area, that I've met arewhat I would call closet excited
about it.
So they're like I don't know,enough to like say vocally that
I'm excited.
They're like I don't knowenough to say vocally that I'm
excited.
But it's kind of cool wherethis is headed and we need
something new and this isdifferent.
Then you have people who justhaven't heard about it at all,
who just don't know, and thenyou have resistance.
I think curiosity is importantin our profession mental health

(01:01:37):
profession, I think.
Personally, I think thesmartest people in the world
realize they know absolutelynothing.
I think the best cliniciansrealize it's not about them and
that keeps them learning, keepsthem growing.
I would never, ever, ever saythat any treatment is right for
everybody, but I can pretty muchguarantee you that there will
be somebody that walks throughan office if it's a clinician

(01:01:59):
and this would work really,really well for potentially
change their life, and if thatclinician hasn't taken the time
to get to know the new treatmentmodalities that are out there,
I think that's a shame.

Speaker 1 (01:02:11):
It certainly closed off because the Recovery
Collective provides some reallyneat integrative, holistic
services where I've had clientshave outer body experiences
during acupuncture and earlylife regression and therapy

(01:02:36):
sessions.
It was like the maybe ego.
Maybe the recovery had me going.
My clients don't need to altertheir mind to experience that
form of healing.
Now, that's without me knowingall aspects of what this is or
can be, but that was my initialconcern and a fear of okay,

(01:02:57):
they're taking a mind-altering,mood-altering substance.
Is that numbing them?
What are your thoughts on somepeople's fear with that?
Hey, they're taking thismedication and it's numbing them
.
What are your thoughts on somepeople's fear with that?

Speaker 3 (01:03:05):
hey, they're taking this medication and it's numbing
them I think it's the exactopposite, based on what I say
it's not numbing, it's opening.
You know, again, it's notpeople aren't coming in for the
escape, it's to face it.
It's to face the things thatare inside.
You know they, they can, theytend to come up in that session.
Um, they tend to, you know,show up and um, it's when you're

(01:03:29):
doing it with intent andpurpose.
So I see it as the exactopposite of of numbing or
escaping.
Um, I think it's, it's brave, Ithink you're, you're facing,
you're, you're healing, you'regrowing.
I think you're facing, you'rehealing you're growing.

Speaker 1 (01:03:45):
Part of the intention of this episode is to identify
our listeners and go okay,hearing what we're talking about
.
What concern or counter wouldthey have and fear or worry?
And one of the things is is itFDA approved?

(01:04:07):
And things like that, and I'llsegue or add this to the
question what are the differenttypes of ketamine or services
that your program offers?

Speaker 3 (01:04:15):
So we do ketamine IV and IM, which is basically the
only difference is how it'sadministered.
It's either via an IV or anintermuscular injection.
Essentially the difference isthe IV is titrated over about 40
to 50 minutes, so it's kind ofthe medicines being delivered
over that timeframe.
With the IM it's all going inkind of in one shot and it's a

(01:04:39):
very different experience from ajourney standpoint.
Then there's Spravato.
Spravato is S-ketamine.
S-ketamine Spravato has beenFDA cleared for the use of
treatment resistant depressionand suicidal ideation.
So it's a nasal spray.
It's essentially it's aderivative of the ketamine
molecule, so it's the S portionof the ketamine molecule and it

(01:05:05):
it works really really well.

Speaker 1 (01:05:07):
Different protocol, but it works really well.
Who and how determinestreatment-resistant depression?

Speaker 3 (01:05:14):
Typically it's the patient's history.
So the general rule of thumb istwo failed attempts at two
different classes ofantidepressant, and then you
have to be on an antidepressantwhile you're going through the
treatment of antidepressant andthen you have to be on
antidepressant way to go throughthe treatment.

Speaker 1 (01:05:25):
So meaning, whether it's a primary care psychiatrist
doctor gives a medication forspecifically depression yep, not
anxiety, correct.
Not PTSD, correct, depressioncorrect.
And then failed attempt,meaning that didn't work.
So the doctor gave you anothermedication, correct, and then
that didn't work correct andthen or it or it's not working,

(01:05:46):
and you're on it.

Speaker 3 (01:05:47):
Okay, and you're on it.

Speaker 1 (01:05:48):
And then that could be enough.
They see you guys andpotentially you guys would do
your part and then send toinsurance and then Yep.

Speaker 3 (01:05:58):
So we would do the assessment and then we would
send off to, we'd send theauthorization off to insurance
for approval and they would giveus either approval or denial on
a reason, and then we wouldwork with that patient.

Speaker 1 (01:06:10):
How friendly are the insurance companies with this?

Speaker 3 (01:06:15):
It's been an interesting experience because
it's new and they're not used toit.
This is the reality of what Iknow about right.

Speaker 1 (01:06:20):
What did you say this is kind of the reality of this
world, right, when it comes toinsurances, go ahead.

Speaker 3 (01:06:27):
Yeah, it's it.
It's a newer treatment and sothe insurance companies are very
large and and a lot of timesthere's a lot of different
departments and a lot ofdifferent um, you know people
you have to talk to to getauthorizations, and a lot of
them didn't even know that thiswas even an option, so it's been
challenging, but I think it'sbecoming more and more prevalent
and we actually really proud ofthe team.

(01:06:52):
We've been able to really puttogether something that is
working and getting our patientsauthorizations in a timely
manner.

Speaker 1 (01:07:01):
Some people might have a stigma against FDA and
non-FDA Medical doctors makemedical judgment all the time,
giving a medication that is not.
We'll call it off-label.
So how does that work in yourworld?
How is that okay?
Doctors do it all the time,yeah.

Speaker 3 (01:07:22):
So Spravato is FDA cleared for treatment and that's
why insurance we getauthorizations for insurance for
treatment-resistant depression.
So insurance we'll pay for itbecause it's been FDA cleared
for the use.
Ketamine the full molecule.
It's interesting becauseSpravato is a derivative of
ketamine and that's been FDAcleared, um, ketamine the full

(01:07:44):
molecule has not.
It's been fda cleared for avery long time as safe and
effective drug.
It just hasn't been cleared forthe use of treatment resistant
depression.
Yet.
Um, I'm sure it's coming.
The data is just too profoundfor it not to.
I mean it's just too kind, tookind of in your face and the

(01:08:06):
kind of the market strifepatients are seeing that it's
working.
There's enough of a collectiveout there that data around what
it would be clinically indicatedfor for our clinicians to be
able to assess and make judgment.

Speaker 1 (01:08:21):
I say this because I don't want people to that be the
reason why it scares people off, because you know there's
things like prosocin, which isgiven for, approved for
hypertension, but it's also usedto treat all the time for
nightmares and ptsd.
And clonidine, approvedcommonly for hypertension but

(01:08:43):
off labeled for, adabeled forADHD and off-labeled for cancer,
pain and hot sweats and certainpsychiatric disorders and
nicotine-dependent opiatewithdrawal.

Speaker 3 (01:08:52):
So there's so many drugs that are used off-label in
a very safe way want to bringup about ketamine when, in
regards to the fda, a lot oftimes I feel like, um, you know,
data around drugs can sometimesbecome skewed when too much
money is involved frompharmaceutical companies.

(01:09:13):
I think you know you can.
There's a lot of data andthere's a lot of indication.
We were talking about thisearlier and the opioid epidemic
was a perfect example of that.
Talking about this earlier inthe opioid epidemic was a
perfect example of that could beseen as a perfect example of
that ketamine not being fdacleared for use.
A lot of the data aroundketamine has been done and when
used in this purpose, by doctorswho have been seeing it working

(01:09:36):
and are using it off label, andso the research is still kind
of pure.

Speaker 1 (01:09:41):
And by pure do you mean that there's scientists and
doctors and researchers atuniversities that don't make any
money off of?
These researchers and assist tofind Right.
That's what you mean by pureyeah.
Okay, yeah, makes sense.

Speaker 2 (01:10:00):
This is our FDA related.

Speaker 1 (01:10:01):
I have no thoughts on these.
This is our FDA-related and Ihave no thoughts on these.

Speaker 3 (01:10:05):
We certainly touched upon a lot of diagnoses,
symptoms, disorders, but whydon't you give us a list of all
potential symptoms or treatmentsthat ketamine could benefit?

(01:10:26):
Benefit?
Yeah so.
Depression, anxiety, trauma,ptsd, even conditions like
fibromyalgia pain, lyme diseaseworks really well for the.
The link between chronic painand mental health, mm-hmm is
very interesting hmm, what it'slike a trauma response yeah,
absolutely, and it's interestingthat you know a lot of the

(01:10:49):
mechanisms that make ketaminework so well for mental health
mm-hmm it's the same reason whyit works so well for for pain.
Specifically blocking the NMDAreceptor helps block the
perception of pain and also thenthe neuroplastic effect, where
you know the brains ability toreorganize, can actually help
pain makes sense.
um, it's pretty interesting, so,like clients, that because we

(01:11:10):
also treat chronic pain andclients that come through for
chronic pain, we'll also give ajournal to and, and you know,
explain everything that can behappening.
And I think it's important.
I've had a couple chronic painpatients.
I don't need the journal, I'mhere for pain.
I'm like, take the journal,take the journal.
You never know what yourintention is going to be and

(01:11:31):
they follow it and it's, it'spretty amazing.

Speaker 1 (01:11:33):
They, they, they see some pretty interesting the
mindset with living in painconstantly.
It's just like a traumaresponse.
Yeah, absolutely.
Yeah, interesting, I guess.
Two questions Looking aheadwhat do you envision the future
of ketamine therapy for One,addiction treatment or therapy

(01:11:56):
in recovery, but also for allthe clients seeking ketamine
treatment?

Speaker 3 (01:12:09):
the client seeking ketamine treatment.
So, uh, specifically for um inrecovery, I definitely see a
really a fit in terms ofbridging that gap between, like
fentanyl and some of these moredangerous drugs and kind of
really safely getting people toa place where they can be on
suboxone and stabilized.
I think that's amazing.
I'm really excited about that.
There's even some clients havebeen able to successfully just

(01:12:31):
detox completely from opiateswith something like ketamine
without having to go.
I've seen some research on ittoo um, something like suboxone,
um, something like suboxone um.
So that's that's reallyexciting.
And I also think typicallypeople in recovery you know
inactive addictions have beenrunning from things for quite

(01:12:53):
some time.
They're not used to dealingwith their emotions and their
feelings and and there's a rootcause driving a lot of those you
know the.

Speaker 1 (01:13:01):
The use of the substance is a symptom, um, and
I think ketamine can help get tothe root when used
appropriately it's funny, forsome reason there's so many
people at like week three ofresidential treatment, whether
it's feeling more comfortableand I think the brain has begun

(01:13:24):
to change and the detox isfarther away.
But you know, I'm thinkingabout it, what we're talking
about today.
But the ability, for a lot ofdifferent reasons, to look
N-words often happens at thatthird week of safe and security
and doing that.
So I love the people thatstayed two months, but rarely
did that happen, as opposed tothe brain going I'm getting out

(01:13:44):
of here in a week.
So it was like oh so maybe oneway to help set up the
conditions for sure.

Speaker 3 (01:13:51):
I'm really excited about ketamine therapy for
suicidal ideation.
I think that I really thinkthere's a.
I think we need a lot of helpin that area.
When it comes to mental healthand you know I'm very passionate
about that personally you knowI've lost people close to me but

(01:14:12):
you know, died by suicide andwhat I've seen as a professional
what ketamine has the potentialto do, rather than driving
people down further inside ofthemselves and kind of
re-traumatizing, opening andgiving instant relief from those
thoughts.
It's powerful.
It's really powerful.

(01:14:33):
So I'm really excited about thefuture there.

Speaker 1 (01:14:38):
It's a good collective solution to health
and wellness.

Speaker 2 (01:14:41):
Yeah, I learned a lot from this conversation, so
thank you so much.
The final thought that I haveis, you know, like it's all
about the mind, and that's why Iwas excited about this session
too, about this podcast, becausein Buddhism we have this thing
called epidharma, which istranslated as like a Buddhist
psychology, but it's like a verydetailed analysis of the mind,

(01:15:02):
to the point of like a minutemoment of how mind works.
So it's so crazy how for me tosee something, for me to exist
in this moment in my mind,billions and billions of factors
have to come into, they have tomeet each other.
So, like the thing aboutdepression, the thing that I'm
hearing about ketamine is thatit's not about making the
problem go away, but it's aboutbecoming aware of all the other

(01:15:24):
things opening up to thespaciousness.
So whatever that helps withthat, that's my takeaway from
this conversation.
So my mind opened up a littlebit.

Speaker 1 (01:15:34):
Very cool.
Thank you.
We'll put it in the episodenotes, but tell the listeners
more about your practice andwhere they can reach you.

Speaker 3 (01:15:41):
Yeah, so Mood Center.
We're located in Annapolis,maryland, right off of West
Street.
You can look us up on the web,wwwthemoodcentercom.

Speaker 1 (01:15:51):
Awesome.
Well, thanks for being here,Brad.

Speaker 3 (01:15:53):
Appreciate you guys having me.

Speaker 1 (01:15:55):
In concluding our discussion with Brad Masters on
ketamine therapy and itspotential benefits for addiction
and other forms of treatment,it's important to acknowledge
the profound impact that thistreatment modality has had on
countless individuals.
Many clients, including myclients, have reported
miraculous changes followingtheir ketamine treatment
experiences that have persistedfor weeks, months or even years

(01:16:17):
and afterwards vanished justlike a brain exhale.
While this subjective evidenceholds immense weight and speaks
to the transformative potentialof ketamine therapy, it's
crucial to approach thesefindings with a balanced
perspective.
While individual anecdotes arepowerful, it's exciting for
additional research to fullyunderstand ketamine's efficacy

(01:16:38):
and safety profile.
As we move farther, as wecontinue to navigate the evoking
landscape of addictiontreatment, let's remain open to
the possibility of ketamine as aviable tool, while also
advocating for further researchto validate and really
contextualize these subjects'experiences.
So far, we're tracking theright direction.
We extend our sincere thanks toBrad for shedding light on this

(01:17:00):
topic and we encourage ourlisteners to remain curious,
informed and open-minded as wecollectively explore new
horizons in mental health care.
My name is Luke.

Speaker 2 (01:17:10):
This is Zal.
Thank you very much, Brad.
See you next time, see ya,thank you.

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Ketamine's Role in the New Frontier for Addiction Treatment & Mental Health with Brad Masters

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