0
SPEAKER_00
Hi, it s Elise Lunen, host of Pulling the Thread.
0
SPEAKER_00
Today is a special episode, the third of a four-part series on addiction.
0
SPEAKER_00
Today I m joined by journalist Maya Salovitz, author of Undoing Drugs, The Untold Story of Harm Reduction and the Future of Addiction, and The New York Times bestseller Unbroken Brain.
0
SPEAKER_00
Hi, it s Elise Lunen, host of Pulling the Thread.
0
SPEAKER_00
On this show, we pull apart the web in which we all live to understand who we are and why we re here.
0
SPEAKER_00
Pulling the Thread is about big questions.
0
SPEAKER_00
Why we do what we do, how we can understand our own experiences within a larger spiritual and historical context,
0
SPEAKER_00
the ways in which we might begin to understand ourselves and each other better, and what s required to heal ourselves and our world.
0
SPEAKER_00
I ll be joined in conversation by luminaries and wise elders, those who have laid tracks in their work and lives to help us bring meaning and understanding to a world that often feels chaotic and overwhelming.
0
SPEAKER_00
My hope is that these conversations spark moments of resonance and plant tiny seeds of awareness so that we might all collectively learn and grow.
0
SPEAKER_01
I think it s really important for people to realize that you can totally be an absolutely excellent parent of a traumatized child and the trauma had nothing to do with you and you couldn t possibly have prevented it.
0
SPEAKER_01
So I think, you know, assuming that there is trauma in somebody s addiction history, which is not always the case, but
0
SPEAKER_01
If there is, you should not immediately assume that it was bad parenting because sure, that can be the case sometimes.
0
SPEAKER_01
But again, there s so many different ways that people can be traumatized by so many different people.
0
SPEAKER_01
And it s also the case that so much of addiction
0
SPEAKER_01
has to do with people s temperament that will set them up for things.
0
SPEAKER_01
So if you are incredibly sensitive to stimuli, something that wouldn t traumatize someone else might traumatize you.
0
SPEAKER_01
And again, that s not your parents  fault.
0
SPEAKER_00
That s just how you were born.
0
SPEAKER_00
So says Maya Salovitz, a contributing opinion writer for The New York Times and author of two fantastic books about addiction.
0
SPEAKER_00
Her New York Times bestseller, Unbroken Brain, tells the story of her own heroin and cocaine addiction as a student at Columbia University in the 80s.
0
SPEAKER_00
She was expelled for dealing and barely escaped prison time.
0
SPEAKER_00
Woven together with the decades of work she s done as a journalist in the addiction space after entering recovery in her early 20s.
0
SPEAKER_00
In it, Maya offers a compelling case for why addiction should be thought of as a learning disability, in part because so many people grow out of it.
0
SPEAKER_00
Maya s latest book, Undoing Drugs, The Untold Story of Harm Reduction and the Future of Addiction, taught me so much and challenged so many of the stories about addiction I was holding on to.
0
SPEAKER_00
Ultimately, it s an optimistic book in the face of what feels like an overwhelming cultural challenge, a challenge that only seems to get worse every month.
0
SPEAKER_00
Maya explains why we re trending in this direction, and more importantly, what we can do to shift our collective fate toward recovery and what an expanded idea of recovery might mean, particularly if we engineer our processes toward harm reduction rather than pure abstinence.
0
SPEAKER_00
Might sound strange, but she explains why it s our future hope.
0
SPEAKER_00
Okay, let s get to our conversation.
0
SPEAKER_00
Thank you for all of your work.
0
SPEAKER_00
It seems like the most compelling work, and this gets into harm reduction, which we ll spend a large part of our conversation talking about, but so much of the work around understanding addiction feels like it has to be from inside the house.
0
SPEAKER_00
The people I know who are most compelling are those who have real experience.
0
SPEAKER_01
Yeah, yeah.
0
SPEAKER_01
I mean, I think especially because it s so stigmatized and so misunderstood, and there s so much bad information out there that people with lived experience in this area really have a critical role to play in terms of that.
0
SPEAKER_01
There can be some bad sides to that, which is that sometimes people who have a few months of recovery decide that they re experts and they don t look at anything outside of their own experience, and that can be problematic also.
0
SPEAKER_01
But I think the way around that is for people with lived experience to look at the research, read up, talk to people, understand some of the science, and then
0
SPEAKER_01
you have this really broad expertise that is incredibly useful.
0
SPEAKER_01
Because sometimes if you just have, well, this is what I was taught, and this is what I ve been told is the only way, when you encounter people for whom something different is true, then that can really cause a lot of problems.
0
SPEAKER_00
And some of the other conversations that I ve had in this series, Carl Eric Fisher, Holly Whitaker, are about where there s been a predominant myth or culture around recovery, how that can shut people out who might not resonate with what s presented as the only option.
0
SPEAKER_01
And it s ridiculous.
0
SPEAKER_01
We don t have this in any other area of science and medicine.
0
SPEAKER_01
We don t say there s just no one size fits all.
0
SPEAKER_01
You know, I think we can universally say that smoking cigarettes is bad for you and there s no counterexamples.
0
SPEAKER_01
But with most other things, different things are working for different people.
0
SPEAKER_01
And the way to understand that is by
0
SPEAKER_01
looking at the broader scope of things and putting your experience in context of that, rather than just being like, well, all those other people are wrong and my way is correct.
0
SPEAKER_00
Yeah.
0
SPEAKER_00
So it s funny.
0
SPEAKER_00
Interestingly, that you brought up smoking.
0
SPEAKER_00
My dad s a pulmonologist.
0
SPEAKER_00
And as a child, the two things that I was not allowed to do, one, smoke, and two, ride motorcycles.
0
SPEAKER_00
And anything else acceptable, including marijuana.
0
SPEAKER_00
But it s interesting, he came to my school and did the whole presentation around chewing tobacco and around tobacco and its impacts on lungs and whatnot.
0
SPEAKER_00
And I remember thinking, as I grew older, I was like, you guys aren t telling a great
0
SPEAKER_00
story here.
0
SPEAKER_00
It s only from the place of fear and shock and horror.
0
SPEAKER_00
And the images that they use are terrifying.
0
SPEAKER_00
But why don t you tell people that they can recover, that their lungs will regenerate?
0
SPEAKER_00
Because so much of the, I don t even know if I d call it mythology because it s real, but so much of the way that we deter people from using substances
0
SPEAKER_00
offers no hope and no redemption.
0
SPEAKER_00
Right.
0
SPEAKER_00
And so when I would see friends smoking, it was always like, well, I ve done it.
0
SPEAKER_00
There s no recourse here.
0
SPEAKER_00
Like I ve ruined my lungs.
0
SPEAKER_01
And I mean, that gets kind of at the heart of things around harm reduction, because people are afraid if you don t tell them it s all bad, that, you know, everybody s going to do it and ruin their health and whatever.
0
SPEAKER_01
And the thing is, like, cigarettes in the form of tobacco
0
SPEAKER_01
are actually uniquely bad.
0
SPEAKER_01
And this comes out in understanding prevention for a lot of things.
0
SPEAKER_01
I mean, long-term users of cigarettes through tobacco, 50% of them will die a smoking-related death.
0
SPEAKER_01
Even fentanyl doesn t tend to do that at this point.
0
SPEAKER_01
I mean, we don t quite know the numbers on street fentanyl, but historically, before fentanyl, most people with other addictions died of their smoking addiction.
0
SPEAKER_01
Because most people without addictions also have smoking addictions, although that is less so these days.
0
SPEAKER_01
So it s really like when the truth is that it is actually that bad for you, it makes the scare tactics more effective than they are when that is not the truth.
0
SPEAKER_01
Like, for example, with marijuana.
0
SPEAKER_01
And so when people try to do prevention based on cigarettes, they have a much harder time because if you tell the truth, it s much more complicated.
0
SPEAKER_00
Yeah, but it s I think in your book, I m not sure whether it was undoing harm or unbroken brain.
0
SPEAKER_00
Is it 30% of people who smoke will likely become addicted where it s 10% roughly for other?
0
SPEAKER_01
Yeah.
0
SPEAKER_01
And what s interesting too, though, is that has changed somewhat because smoking cigarettes is so much less socially acceptable now.
0
SPEAKER_01
And so it used to be the case that I think the majority of people who smoked were pack a day smokers.
0
SPEAKER_01
And now the majority of people who smoke are people who smoke while they drink in college.
0
SPEAKER_01
And so they are not addicted smokers.
0
SPEAKER_01
And so it is by changing the environment, we change the addictiveness of the substance because one of the things that made nicotine so uniquely addictive is that you could, in the form of cigarettes, that you could do it anywhere.
1
SPEAKER_02
it was socially acceptable.
1
SPEAKER_02
And so that meant like you pick up a coffee, it s a cue to smoke.
1
SPEAKER_02
You talk to your friend, it s a cue to smoke.
1
SPEAKER_02
You have sex, it s a cue.
1
SPEAKER_02
Like it was just like everything.
1
SPEAKER_02
And now the places where you can do it are so limited that those cues are reduced.
1
SPEAKER_02
Now it doesn t mean that you get stressed and you don t want a cigarette if you are addicted, but, and that can obviously happen anywhere, but the cue related stuff is really reduced in the smoking situation by
1
SPEAKER_02
limiting the times and places where you can do it.
1
SPEAKER_02
And that s a useful lesson for other things.
1
SPEAKER_02
And like a lot of times we just think that, you know, addiction is just sort of like pure biology, but it s not.
1
SPEAKER_02
It always has to do with set and setting and with your own
1
SPEAKER_02
biology and your history of trauma and all kinds of other things like this and the culture.
1
SPEAKER_02
So it s an interesting area because it is so complicated, but that also means that we tend to sort of overgeneralize and that ends up causing serious problems.
1
SPEAKER_00
Yeah.
1
SPEAKER_00
Well, I thought that that was fascinating in Unbroken Brain, both your own story, but I hadn t heard the theory of addiction as a learning disorder.
1
SPEAKER_00
And I know that that book was published seven years ago, maybe, but that was so fascinating to me and so insightful.
1
SPEAKER_00
And in terms of offering hope, I think to anyone who s listening who maybe has a child who is going through addiction, the fact that so many people do out
1
SPEAKER_00
grow it.
1
SPEAKER_02
And again, fentanyl is causing issues because it is so deadly.
1
SPEAKER_02
But thankfully, the good news there is that most young people are not trying prescription opioids, are not trying street opioids, are just like, you know, maybe they want to try ecstasy, maybe they want to like smoke some pot, but
1
SPEAKER_02
We have these cycles of drug use in this country where like one thing is particularly trendy.
1
SPEAKER_02
And for the generation immediately after that, it s like, nope, not touching that stuff.
1
SPEAKER_02
Might do something different, but not touching that stuff.
1
SPEAKER_02
And I mean, this is how, you know, crack went out of fashion.
1
SPEAKER_02
Now, this doesn t mean that people aren t still addicted to it and there aren t still places where people are despairing and starting to try some of these things.
1
SPEAKER_02
But the sheer deadliness of the current opioid supply has led to a drop in the number of people who are taking that up.
1
SPEAKER_02
And that is definitely good.
1
SPEAKER_02
And this is like a fundamental message of harm reduction.
1
SPEAKER_02
If we can keep people alive, the majority of them will get better.
1
SPEAKER_00
Yeah, no, I think that that s not something that s known, that there s such a prevailing story, which again, and I understand it, this idea of let s keep people alive, let s focus on needle syringe, stuff that feels so obvious to us now, you were alive, you were living through, you were surviving through the AIDS epidemic and involved then, was somehow seen as aiding and abetting or encouraging
1
SPEAKER_00
drug use rather than preventing the spread of AIDS.
1
SPEAKER_00
Do you feel like that s shifted?
1
SPEAKER_00
Can you take us back and then sort of explain that central argument against harm reduction?
1
SPEAKER_02
There s this whole concept of enabling, which I think we need to get rid of.
1
SPEAKER_02
And it s this idea that like another person can control someone s addiction.
1
SPEAKER_02
that if you give people a lot of drugs, you are going to, you know, make sure their addiction continues.
1
SPEAKER_02
Now, obviously, if you have somebody chained up in your closet and you re giving them drugs, you might call that enabling, right?
1
SPEAKER_02
We have many studies now on actually prescribing heroin to people with heroin addiction.
1
SPEAKER_02
And that should seem to people to be like the most enabling possible thing you could do, right?
1
SPEAKER_02
Like that should make their addiction last longer.
1
SPEAKER_02
That should prevent them from hitting bottom.
1
SPEAKER_02
That should keep them from getting better.
1
SPEAKER_02
It absolutely does the opposite.
1
SPEAKER_02
The longer people stay engaged in heroin maintenance treatment, the more likely they are to become abstinent or to go towards more traditional forms of medication treatment.
1
SPEAKER_02
So that concept is just false, but we have this idea.
1
SPEAKER_02
It s certainly the case that drug trends are social and that when celebrities get into cocaine, other people might be interested in trying it.
1
SPEAKER_02
That s how capitalism works a lot, right?
1
SPEAKER_02
But when you re talking about something like addiction, when somebody is addicted to something, they re not deciding, today I m going to continue to use.
1
SPEAKER_02
It s just like, OK, this is what I need today.
1
SPEAKER_02
This is the thing that allows me to feel OK.
1
SPEAKER_02
And so I will seek this.
1
SPEAKER_02
So, you know, providing it doesn t stop that process or make it last longer.
1
SPEAKER_02
The definition of addiction is compulsive drug use that continues despite negative consequences.
1
SPEAKER_02
And this is agreed upon by all the major people who have thought about this for many years.
1
SPEAKER_02
This is not needing something to function, like needing something to function is dependence.
1
SPEAKER_02
And we re all dependent on a lot of things like each other.
1
SPEAKER_02
But the idea that like negative consequences is going to fix addiction and make you hit bottom and therefore you will get better,
1
SPEAKER_02
Like by definition, that is what works for one, because by definition, the condition would not exist.
1
SPEAKER_02
But also when you just think about like, who s more likely to get better?
1
SPEAKER_02
Somebody who is rich and has a ton of resources or somebody who is homeless and uneducated and traumatized and has nothing.
1
SPEAKER_02
I m going to go with the rich person for that, right?
1
SPEAKER_02
Because they at the very least can get treatment if they want it, for one.
1
SPEAKER_02
And they can be housed and they can have all these things that will allow them to get better.
1
SPEAKER_02
It s not the people on the bottom who get better.
1
SPEAKER_02
You know, it s not to say there s plenty of poor people who do recover, thankfully, but what allows people to recover is not giving them more pain and suffering, but actually treating them like human beings.
1
SPEAKER_02
And what allows people to recover is beginning to value yourself again.
1
SPEAKER_02
And that is helped by other people valuing you without judgment and without trying to make you change immediately.
1
SPEAKER_02
And that s why harm reduction is so powerful.
1
SPEAKER_02
Because the basic thing is, we don t care about you getting high, we care about you getting hurt.
1
SPEAKER_02
And we just want you to live.
1
SPEAKER_02
And when somebody comes at you with that attitude, it s so much more different than when somebody s like, you got to stop, this is bad for you.
1
SPEAKER_02
Like, you are worthless if you do this, like, you re destroying your life, you re destroying other people s lives, like, it s all stressing that person out.
1
SPEAKER_02
And from the perspective of the person who is addictive, the substance is, or the activity or whatever they re addicted to, is the thing that makes their life worth living.
1
SPEAKER_02
And so telling them that you re taking that away is not especially helpful.
1
SPEAKER_02
It just sort of shuts down the conversation.
1
SPEAKER_02
On the other hand, if you talk about what do you want, like how can we make your life better?
1
SPEAKER_02
That s so different.
1
SPEAKER_02
And that is, you know, with any other medical condition, like obviously sometimes if you have cancer or something like that and you need to go through a
1
SPEAKER_02
horrible treatment that s going to be painful before you re going to get better.
1
SPEAKER_02
But the whole idea is so that you get better, not that the pain is the thing that is going to make you better.
1
SPEAKER_02
We don t say like, if somebody has chemo that is like horrible and especially, you know, your hair s coming out and you re in pain and agony and throwing up and all this, we don t think that that is what makes it work.
1
SPEAKER_02
Like, we re perfectly happy when somebody comes out with a new genetically tailored thing that causes zero suffering and kills the cancer.
1
SPEAKER_02
We don t think, oh, well, you didn t go through the hard work of recovering, you know, but we have this really moralizing and it s so deep, it s so
1
SPEAKER_02
entrenched in the way we think about these issues, that when you sort of actually take the analogy to, you know, other medical conditions, it s like, oh, wait a minute, you re right.
1
SPEAKER_02
That is not how we treat other conditions at all.
1
SPEAKER_02
There used to be this thing where, you know,
1
SPEAKER_02
Oh, well, God cursed Eve to suffer in childbirth, so we shouldn t relieve labor pain.
1
SPEAKER_02
But, you know, we re beyond that now.
1
SPEAKER_02
We should be beyond this with other conditions as well.
1
SPEAKER_01
I m Rachel Martin.
1
SPEAKER_01
After hosting Morning Edition for years, I know that the news can wear you down.
1
SPEAKER_01
So we made a new podcast called Wildcard, where a special deck of cards and a whole bunch of fascinating guests help us sort out what makes life meaningful.
1
SPEAKER_01
It s part game show, part existential deep dive, and it is seriously fun.
1
SPEAKER_01
Join me on Wildcard wherever you get your podcasts.
1
SPEAKER_01
Only from NPR.
1
SPEAKER_00
Reading about early needle exchange and, well, I loved both of the books, but Undoing Harm was full of so many incredible stories about people who have worked on this issue in really stunning ways, and many people who have died, right, who have been fierce advocates who have also succumbed, which I thought was beautiful in its own way.
1
SPEAKER_00
But this idea with needle exchange or with heroin prescription, for example, that if you
1
SPEAKER_00
can, one, that if there
2
SPEAKER_01
there s some small intervention of care that people who, even though they might be addicted, are perfectly capable of choosing or wanting the safer option, right?
2
SPEAKER_01
Because that was one of the arguments was, one, you will increase it, and two, these guys are automatons, and they don t care.
2
SPEAKER_01
And that certainly wasn t true.
2
SPEAKER_01
Even for people, for addicts who already had AIDS, if anything, more than any others, they wanted to protect
2
SPEAKER_00
I mean, I remember there was this New York Times story about this, where the very first needle exchange in New York City that was set up to fail by the city government.
2
SPEAKER_00
And like they had this thing at City Hall, right across from the courts and the cops headquarters, which is, of course, where everybody doing illegal things is really going to want to go.
2
SPEAKER_00
But one of the guys that they interviewed there was like, yeah, I am already HIV positive, but I get the clean needle so that like,
2
SPEAKER_00
I won t share with anybody and I won t hurt them.
2
SPEAKER_00
We think of people with addiction as these like selfish zombie automata that are, you know, they don t care.
2
SPEAKER_00
There are jerks and assholes in every area and profession.
2
SPEAKER_00
There are people who give everybody else a bad name in everything.
2
SPEAKER_00
But among people with addiction, there s also just like among anybody else, there s also really lovely human beings.
2
SPEAKER_00
And having an addiction isn t doesn t make you a bad person.
2
SPEAKER_00
And being a bad person doesn t make you someone with addiction like there s some overlap, but the overlap is to do with things that pre exist the addiction, not the addiction.
2
SPEAKER_00
Now that s not to say that being addicted won t exaggerate your negative
2
SPEAKER_00
characteristics, just like being in love will do if you re somebody s trying to get between you and the person you love.
2
SPEAKER_00
But any appetite is going to stress your moral behavior to some extent.
2
SPEAKER_00
And any sense that this is the only thing I need to live can, you know, put you in under that kind of pressure.
2
SPEAKER_00
But for the most part, people with addiction are just people like anybody else.
2
SPEAKER_00
And some of them are absolutely lovely people, and some of them aren t.
2
SPEAKER_01
Yeah, but it was so interesting.
2
SPEAKER_01
And again, like this, I m sure is blowing some people s minds as an intervention, but that when you medicalize heroin, when you create a stable and safe supply for addicts, where they re not one sort of driven by that impulse, like, am I going to get it or am I not?
2
SPEAKER_01
which only seems to heighten the addictive impulse when you can neutralize that and then ensure that people aren t taking something laced with fentanyl and you know obviously I think it s in Canada injection sites where they take the drugs on site in case they need to be revived.
2
SPEAKER_01
Absent
2
SPEAKER_01
that daily struggle to feed the addiction and what might be required in order to do that, they re suddenly left with time, energy, and maybe the idea that their life could be more.
2
SPEAKER_00
Yeah, what s really interesting to me about this is that we just dehumanize addiction and make it such this alien thing that it s like no other experience.
2
SPEAKER_00
And that s not true.
2
SPEAKER_00
That s not true of mental illness.
2
SPEAKER_00
That s not true of anything like, you know,
2
SPEAKER_00
It s like certain mentally extreme states are not common and most people don t experience them.
2
SPEAKER_00
But things like anxiety, we ve all experienced that.
2
SPEAKER_00
Not to the degree of having an anxiety disorder necessarily, but we can all know what fear is like and can imagine that if it was, you know, ramped up to a thousand, that that would be a horrible experience.
2
SPEAKER_00
But that doesn t mean that you re no longer human if you have the ramped up to a thousand version.
2
SPEAKER_00
But with addiction, we tend to think that it does.
2
SPEAKER_00
And so like, you know, think about when you get that thing that you ve always wanted, that you think is going to fix you.
2
SPEAKER_00
It might be a boyfriend.
2
SPEAKER_00
It might be a job.
2
SPEAKER_00
It might be a certain level of success.
2
SPEAKER_00
It might be a kid, whatever it is.
2
SPEAKER_00
You get that thing and it does not fix you.
2
SPEAKER_00
Whatever it is, it doesn t.
2
SPEAKER_00
That s just not the way human life works.
2
SPEAKER_00
And that s also true of heroin.
2
SPEAKER_00
And so when people are not in that, I just have to chase this all the time.
2
SPEAKER_00
And all my life is basically a career of chasing this thing that gives me purpose.
2
SPEAKER_00
You suddenly have to look at some other stuff.
2
SPEAKER_00
Now this doesn t mean that people don t be like, okay, well now I ve got the heroin sorted.
2
SPEAKER_00
I m going to chase cocaine or something.
2
SPEAKER_00
You know, people can do all kinds of things.
2
SPEAKER_00
healthy.
2
SPEAKER_00
But for people for whom opioids are that central thing, giving them a safe supply often allows them to stabilize the rest of their lives.
2
SPEAKER_00
And a unique property of opioids is that if you take the same dose at the same time every day,
2
SPEAKER_00
you will be completely tolerant to the high.
2
SPEAKER_00
So, you know, this is how methadone and buprenorphine work.
2
SPEAKER_00
So basically like I could be on some massive dose that would maybe kill you and you wouldn t know it because I would have that complete tolerance.
2
SPEAKER_00
Now that does not happen with alcohol, which is why we don t do alcohol maintenance.
2
SPEAKER_00
I hate the term medication assisted treatment because it s like, we know that the medication is actually what like
2
SPEAKER_00
causes the reduction in mortality associated with it, but we don t have alcohol assisted treatment.
2
SPEAKER_00
We do have, there are some places now that are doing sort of supervised drinking sites for people who are, you know, severe alcohol use disorder.
2
SPEAKER_00
And while this does not leave them entirely unimpaired, it again can have this same kind of stabilizing effect for people who are homeless and it allows an opportunity to reduce harm.
2
SPEAKER_01
Yeah, well, and like methadone, etc.
2
SPEAKER_01
There are a lot of medications for people who have addiction to alcohol.
2
SPEAKER_01
There are a lot of drugs.
2
SPEAKER_01
I don t think that they ve received the same PR.
2
SPEAKER_00
I mean, the thing is, because opioids have that unique tolerance effect that isn t the case with say, alcohol or stimulants or benzodiazepines, it is so much easier
2
SPEAKER_00
to stabilize people with something like methadone or buprenorphine or heroin itself than it is to do with alcohol or other depressants or, you know, stimulants.
2
SPEAKER_00
Now, stimulants, it s interesting because people are starting to look at like, well, what happens if we give people
2
SPEAKER_00
methamphetamine, you know, there s actually a prescription form of methamphetamine.
2
SPEAKER_00
What if we just give this to people who are addicted?
2
SPEAKER_00
Because there was this fear originally when you give heroin maintenance to someone, you re always going to have to up the dose and et cetera.
2
SPEAKER_00
That does not happen.
2
SPEAKER_00
Stimulants sort of have more of a tendency for that to happen because like they escalate like wanting so much.
2
SPEAKER_00
They escalate that like desire.
2
SPEAKER_00
So it s not satiating.
2
SPEAKER_00
It s kind of like, if you think about the pleasure of sexual desire versus the pleasure of sexual satisfaction, infinite satisfaction can always be satisfying, but infinite desire is bad after a while, if it isn t satisfying.
2
SPEAKER_00
But that said, there are people for whom stimulant maintenance does work.
2
SPEAKER_00
I tend to think that what that means is that you re probably treating ADHD, but those people stabilize and do not need infinitely escalating doses.
2
SPEAKER_00
Because if you give very high doses of stimulants, people don t become tolerant.
2
SPEAKER_00
They just can be psychotic.
2
SPEAKER_00
So obviously you do not want to get into that level of dose escalation, but that doesn t seem to happen for a select group of people.
2
SPEAKER_00
And there s more research on this going on to try to find this.
2
SPEAKER_00
And there are also some medications for alcohol use disorder.
2
SPEAKER_00
Most of them are not like the idea that we would find something that just stabilizes you, that kind of gives you the same effect, but there s something called Baclofen, which helps some people.
2
SPEAKER_00
and has that kind of stabilizing anxiety-reducing effect.
2
SPEAKER_00
Benzodiazepines have their own class of issues related to severe withdrawal afterwards for some people.
2
SPEAKER_00
You don t get that complete tolerance to the impairment thing.
2
SPEAKER_00
So it s interesting though, but yeah, we don t have as good medications for other conditions as we do for opioids.
2
SPEAKER_01
Yeah.
2
SPEAKER_01
Well, and there s just such a need for psychiatrists who really understand.
2
SPEAKER_01
A friend of mine is a functional psychiatrist who you should know if you haven t met him, but his whole thing is like there are so many nutraceuticals.
2
SPEAKER_01
What is ultimately the cause of severe brain damage with long-term drinking?
2
SPEAKER_00
Thiamine.
2
SPEAKER_01
So essentially he s like, there are just these core magnesium source, like so many things that are depleted that need to be restored that also can help with cravings, et cetera.
2
SPEAKER_01
Like it s a complex, we re talking about a very complex system.
2
SPEAKER_01
The other thing that I thought was so fascinating, going back to unbroken brain briefly, but you talk about the, not the causation, but the correlation between one high IQ and addiction, but also how there s typically some sort of other
2
SPEAKER_01
mental illness present.
2
SPEAKER_01
I know you write about self-diagnosis of being maybe on the autism spectrum disorder.
2
SPEAKER_01
I don t know if you ve since been formally diagnosed.
2
SPEAKER_00
I was considering it.
2
SPEAKER_00
I got so many wrong diagnoses in the past.
2
SPEAKER_00
Why am I suddenly going to think that somebody pronounced difference?
2
SPEAKER_00
If you want to look up the criteria and look up my childhood, they match.
2
SPEAKER_01
Yeah, but it s so interesting, that whole conversation that you get into about both sort of the shadow and the potential redeeming factors of identity around diagnosis I think is so fascinating, right?
2
SPEAKER_01
One, to be seen or embraced or to recognize yourself in those pages.
3
SPEAKER_00
is as an explication for how you feel.
3
SPEAKER_00
And then also, obviously, it can be contained.
3
SPEAKER_00
Yeah.
3
SPEAKER_00
It has its downsides.
3
SPEAKER_01
Yeah, because I think this is one of our difficult questions of our times.
3
SPEAKER_01
You see kids online, they re embracing these diagnoses and stuff like this.
3
SPEAKER_01
And if they re embracing it as like, okay, this explains a lot about, you know, why I behave the way I do.
3
SPEAKER_01
And it helps make sense of stuff that didn t make sense to me.
3
SPEAKER_01
That s great.
3
SPEAKER_01
If you then take it and then be like, well, this means I can t do X, Y, or Z. If you put it as a limitation on yourself, it s a problem.
3
SPEAKER_01
but if you see it as like an explanation that can allow you to find workarounds for the things that you find difficult, then that s helpful.
3
SPEAKER_01
And so it depends on are you taking on this identity as a stigma and a limitation, or are you taking this on as like,
3
SPEAKER_01
Oh, okay, this explains why I can t deal with loud noises.
3
SPEAKER_01
Let me see what I can do to like make that better.
3
SPEAKER_01
And I think it s especially complicated when you re talking about teenagers because teenagers are so socially influenced by each other.
3
SPEAKER_01
and also so malleable still at that point.
3
SPEAKER_01
So it s really important to, if you are self-diagnosing, really think the whole thing through and be sure that you re not limiting parts of yourself that don t need to be limited.
3
SPEAKER_01
Don t say, well, I m aspie, so therefore I am never going to be able to have friends.
3
SPEAKER_01
You know, instead it s like, okay, I m on the autism spectrum, like,
3
SPEAKER_01
this is difficult for me.
3
SPEAKER_01
But I also know that I really need this.
3
SPEAKER_01
So how do I find ways to make it work where I can connect with people, but I m not masking myself too badly.
3
SPEAKER_01
And I m also just being able to be in a space where I can deal with my sensory whatever s, you know, because
3
SPEAKER_01
We do define ourselves.
3
SPEAKER_01
We also define ourselves in the context of others and how people see us.
3
SPEAKER_01
And that complicated feedback loop makes understanding and avoiding limitations difficult.
3
SPEAKER_00
All right, so I want to ask you to go into two things.
3
SPEAKER_00
One, for anyone who s listening who has a loved one, a child, a partner who is in an active addictive phase, what is your best advice?
3
SPEAKER_00
Then I want to talk about culture and I want to talk about harm reduction and what you see as our path forward.
3
SPEAKER_00
But let s start with the personal.
3
SPEAKER_01
So I think the, you know, people who have active addiction are struggling and it s really important to understand why they behave the way they do.
3
SPEAKER_01
And one of the things that a lot of people told me that they got from Unbroken Brain who were like relatives
3
SPEAKER_01
and loved ones of people with addiction was like, oh, now I understand like their perspective.
3
SPEAKER_01
And this is not like aimed at me.
3
SPEAKER_01
Sometimes teenagers will do rebellious behavior to piss parents off.
3
SPEAKER_01
That s not what addiction is.
3
SPEAKER_01
You know, once you re addicted, what you re doing is trying to be okay in yourself.
3
SPEAKER_01
And so, you know, what is it that makes you not okay?
3
SPEAKER_01
Like,
3
SPEAKER_01
Why is it that you need this extreme form of relief?
3
SPEAKER_01
What is it that you were trying to get from these substances, not what are these substances doing to you?
3
SPEAKER_01
Because when you look at it that way, then you can help them find healthier ways of dealing with it.
3
SPEAKER_01
And this may not happen immediately.
3
SPEAKER_01
And you have to really realize that you can t make someone want to change.
3
SPEAKER_01
You can invite them to do it and you can be welcoming and you can be supportive and you can help them see why changing would help them, rather than why they re changing would help us.
3
SPEAKER_01
So, more you can do that the more.
3
SPEAKER_01
you can sort of ally yourself with that person and really empathize and understand why they re doing what they re doing, then the easier it will be to help them find better ways of doing this.
3
SPEAKER_01
Because, like, nobody wants to be, you know, shooting up in the street.
3
SPEAKER_01
Like, it s awful.
3
SPEAKER_01
Like, first of all, you re not even going to be enjoying yourself at that point.
3
SPEAKER_01
You know, you re going to be worried about somebody like stop, you know, it s just going to be terrible.
3
SPEAKER_01
And then, you know, with fentanyl these days, you get high for all of three seconds and then you re asleep and then people are robbing you.
3
SPEAKER_01
This is not about people wanting extra pleasure and being irresponsible.
3
SPEAKER_01
And like, they re having so much fun doing this, like this is desperation.
3
SPEAKER_01
And so what is going to make somebody less desperate, not more desperate?
3
SPEAKER_01
And how can we connect to them?
3
SPEAKER_01
Because so much of addiction is about feeling like
3
SPEAKER_01
even when people are trying to show you that they care, not being able to believe that they really do.
3
SPEAKER_01
And it s complicated.
3
SPEAKER_01
It s slower than you would like.
3
SPEAKER_01
There definitely are people with addiction who are going to behave terribly and
3
SPEAKER_01
You know, and that s really difficult for family members.
3
SPEAKER_01
If you have somebody who, you know, actually, you know, is a very callous person, such people exist and they may steal from you and do things in ways that like, you can t comprehend why they would be able to behave that way.
3
SPEAKER_01
And so, you know, if you re dealing with people who basically have personality disorders, as well as the addiction,
3
SPEAKER_01
that gets much harder because for them to get better, they re going to have to address that.
3
SPEAKER_01
And it may be difficult for that to happen.
3
SPEAKER_01
Thankfully, this is not the case for most people with addiction.
3
SPEAKER_01
And you, you know, oftentimes the bad behavior is directly associated with the addiction and you resolve the addiction and that resolves the, you know, stealing from you or whatever kind of thing.
3
SPEAKER_01
But people who have been very severely traumatized or who have just
3
SPEAKER_01
severe mental illness and personality disorder, that is just a much more complicated path to recover from.
3
SPEAKER_01
And my heart goes out to people who are just facing that because it is just really, really hard.
3
SPEAKER_00
I think that the point too, unfortunately, as reductive and essentialist as we ve tried to make this as a culture over time,
3
SPEAKER_00
it s complicated, right?
3
SPEAKER_00
There are unknown genetic factors.
3
SPEAKER_00
There might be trauma, you know, and there s obviously a really big trauma story right now, which is I m glad that everyone is becoming trauma literate.
3
SPEAKER_00
But what I also hear from people who have a child or a partner, specifically a child who is struggling with addiction, that that creates on its own stigma.
3
SPEAKER_00
Right?
3
SPEAKER_00
Where suddenly they re like, wait, now the prevailing cultural ideas that I ve traumatized my child.
3
SPEAKER_01
I think it s very important to say that trauma does not mean child abuse.
3
SPEAKER_01
Like trauma could be your mom died.
3
SPEAKER_01
It could be like a hurricane hit your house or you got somebody outside of your family.
3
SPEAKER_01
So I think it s really important for people to realize that you can totally be an absolutely excellent parent of a traumatized child.
3
SPEAKER_01
and the trauma had nothing to do with you and you couldn t possibly have prevented it.
3
SPEAKER_01
So I think, you know, assuming that there is trauma in somebody s addiction history, which is not always the case, but if there is, you should not immediately assume that it was bad parenting because sure, that could be the case sometimes.
3
SPEAKER_01
But again, there s so many different ways that people can be traumatized by so many different people.
3
SPEAKER_01
And it s also the case that so much of addiction
3
SPEAKER_01
has to do with people s temperament that will set them up for things.
3
SPEAKER_01
So if you are incredibly sensitive to stimuli, something that wouldn t traumatize someone else might traumatize you.
3
SPEAKER_01
And again, that s not your parents  fault.
3
SPEAKER_01
That s just how you were born.
3
SPEAKER_01
And so I think it s really important for people to recognize that when somebody tells a story of addiction with trauma, that it s not always their parents  fault, and that this is a really complicated disorder, and that in order to get better, it is often essential for people to have
3
SPEAKER_01
much better and richer social connections.
3
SPEAKER_01
But that doesn t mean that people didn t love them while they were addicted.
3
SPEAKER_01
They may not have been capable of taking that in the way they should have done because of these temperamental or traumatic or whatever kind of other experiences that might ve caused issues.
3
SPEAKER_01
But, you know, a lot of people want to be like, oh, well, you know, all you need is love to recover.
3
SPEAKER_01
And that s not true.
3
SPEAKER_01
Like you definitely do need love and connection to recover.
3
SPEAKER_01
But you might also need antidepressants and you might also need housing and you might also need education and you might also need any one of a million things because what allows people to recover is like feeling connected and having a sense of meaning and purpose.
3
SPEAKER_01
There s no way to just provide that for somebody because I can t like make you fall in love with me or something.
3
SPEAKER_01
Or I can t say, okay, you re going to love the oboe.
3
SPEAKER_01
So, you know, I m going to prescribe you become an oboe player.
3
SPEAKER_01
Like it just, we don t know what it is going to be that somebody is going to really get into.
3
SPEAKER_01
But that is the thing that often allows people to get better.
4
SPEAKER_01
And of course, we all know great musicians who still managed to be addicted.
4
SPEAKER_01
And you know, it is complicated.
4
SPEAKER_01
It is not just the one thing.
4
SPEAKER_01
And it s not just trauma.
4
SPEAKER_01
It s not just loss of connection.
4
SPEAKER_01
It s not just loss of meaning.
4
SPEAKER_01
It s just like a whole combination of different factors.
4
SPEAKER_01
And so this is why it s so hard to give people advice on like, okay, what do you do if your person is addicted?
4
SPEAKER_01
And so
4
SPEAKER_01
you know, what you want to do is like be open to the possibility that it s going to take a bunch of different things.
4
SPEAKER_01
And I mean, this is really true for most chronic conditions anyway.
4
SPEAKER_01
Like you talk to people with like long COVID or with any of these things, and it s like,
4
SPEAKER_01
20 different small things are essential to allowing that person to be able to function again.
4
SPEAKER_01
And it s annoying because I d like to be like, here, you just do this and you re fixed.
4
SPEAKER_01
And I should also say that for opioid addictions, we have two medications, methadone and buprenorphine, that cut the death rate by 50% or more if you stay on them.
4
SPEAKER_01
If that is the addiction that s going on there, people should really be on medication these days because the supply is so deadly that one relapse really can kill you.
4
SPEAKER_01
And we make it very difficult for people to get medications in ways that are livable, but this is the data.
4
SPEAKER_01
It dramatically makes you more likely to stay alive.
4
SPEAKER_00
So as someone who s spent your career, I mean, 40 years covering this intimately, I don t know if anyone has your encyclopedic understanding of this landscape.
4
SPEAKER_00
Let s just say you have that crown.
4
SPEAKER_00
So when you think about culture and where we are,
4
SPEAKER_00
And, you know, I have friends who live in Portland.
4
SPEAKER_00
I understand things are and it s unclear how that s going.
4
SPEAKER_00
I want to say something about that, actually.
4
SPEAKER_01
So Portland decriminalized possession of all drugs.
4
SPEAKER_01
It did not legalize anything.
4
SPEAKER_01
It just means you re not arresting people for, you know, OK, you ve got a bag of heroin or OK, you ve got like some methamphetamine or weed or whatever it may be.
4
SPEAKER_01
like they happened to do that just at the moment when fentanyl was spreading into Oregon.
4
SPEAKER_01
And so right when they did that, overdose deaths increased.
4
SPEAKER_01
It had zero to do with the decriminalization.
4
SPEAKER_01
Because if you look at how when fentanyl becomes
4
SPEAKER_01
dominant in a local drug supply, you see exactly that same uptick, regardless.
4
SPEAKER_01
So, who has the highest overdose death rate in the country, it is West Virginia, they do not have.
4
SPEAKER_01
Why?
4
SPEAKER_01
Because it s cheap to live there.
4
SPEAKER_01
They do not have a lot of street drug use.
4
SPEAKER_01
Why?
4
SPEAKER_01
Because it s cheap to live there, so people use indoors.
4
SPEAKER_01
Because if you think about it for two seconds, do you really think somebody who was not going to use opioids said, oh, I m not going to get arrested and put in jail for 10 days for it.
4
SPEAKER_01
I m going to try it now.
4
SPEAKER_01
That is not what happened.
4
SPEAKER_01
You know, or I m going to suddenly become, you know, like homeless people, wherever they are, tend to get arrested for low level crimes over and over and over.
4
SPEAKER_01
Like you talk to anybody who s who s been through that and it s like loitering and shoplifting and like the same things they go to jail for 10 days.
4
SPEAKER_01
They don t get treated.
4
SPEAKER_01
If you were to actually arrest all the people for doing that stuff, the jails would be filled full so quickly that it wouldn t function.
4
SPEAKER_01
And when in New York we did, you know, all these low level drug arrests in the 80s and 90s.
4
SPEAKER_01
And we, of course, have absolutely no drug problem now.
4
SPEAKER_01
It s amazing.
4
SPEAKER_01
It s like, you know, if you just look at it in any of the statistics, like you just look at like, OK, what s the correlation between the rate of arrest for drug possession and the population level drug use?
4
SPEAKER_01
Zero.
4
SPEAKER_01
No correlation.
4
SPEAKER_01
It s like, this does not work.
4
SPEAKER_01
This has absolutely nothing to do with what is going on there.
4
SPEAKER_01
What is going on there is that they have had a pandemic, they have high housing prices, and they have fentanyl.
4
SPEAKER_01
That might sound like, oh, well, look at this correlation.
4
SPEAKER_01
It s huge.
4
SPEAKER_01
It s just like they did this and it went up.
4
SPEAKER_01
Well, the places that didn t do it went up the same amount when fentanyl came in.
4
SPEAKER_01
It s just a ridiculous thing.
4
SPEAKER_01
And if you just think about it for all of two seconds, like, OK, arresting people for possession, a lot of people have this assumption that, oh, we arrest people for possession and they get treatment.
4
SPEAKER_01
Well, who gets arrested the most?
4
SPEAKER_01
Black people, right?
4
SPEAKER_01
So black people must have the highest rate of treatment in the country, right?
4
SPEAKER_01
No, because arresting people is not a good way to get people treatment because if you think about it for five minutes, if you get arrested, you go into jail, it s a bureaucracy, you re already, let s say you re a diabetic and you re on medication, you may not get that medication for three or four days because they have to sort out all the bureaucracy and they took all their stuff off you, right?
4
SPEAKER_01
It s not a good way to treat any illness.
4
SPEAKER_01
Nobody thinks that the best health care is available in jails and prisons.
4
SPEAKER_01
Otherwise, we would see rich people going there for treatment.
4
SPEAKER_01
Like, this is just not what happens.
4
SPEAKER_01
And when you look at the rates of treatment for people of color, they are less likely to get treatment, and they get it later in their addiction careers than white people, but they definitely get arrested more.
4
SPEAKER_01
So you tell me, arresting people is good for the treatment of addiction, and how
4
SPEAKER_01
pushing people to the bottom is like a successful way, you know, I mean, what is the rest due to people, it stresses them out.
4
SPEAKER_01
I think there s this crazy statistic but it s something like maybe 20% of all the coven in the country was spread via people coming in and out of jails.
4
SPEAKER_01
If you look at the effect of jail on life expectancy and prison on life expectancy, every year you re inside takes two years off your life expectancy.
4
SPEAKER_01
It s associated with the spread of every disease that you can imagine.
4
SPEAKER_01
It s associated with more death from cancer, more death from suicide, more death from pretty much any condition you can imagine.
4
SPEAKER_01
So this is good for people s health.
4
SPEAKER_01
It s just like, basically what happened is some politicians understood that if you scream drug and crime, you can get elected.
4
SPEAKER_01
you know, Portland dared to like try to do, you know, or Oregon in general dared to try to say, wait a minute, you know what, this hasn t worked for 50 years.
4
SPEAKER_01
Why is it going to work now?
4
SPEAKER_01
And they stopped doing it.
4
SPEAKER_01
And so suddenly they re like, oh, stopping arresting people without instantly providing treatment for everybody is dangerous.
4
SPEAKER_01
Even though arresting people itself makes people less likely to recover because it makes you more likely to be unemployed and more likely to be homeless.
4
SPEAKER_00
How do you see it evolving?
4
SPEAKER_00
I know people are sort of watching Oregon.
4
SPEAKER_00
Do you think that in time, it s going to sort of stabilize?
4
SPEAKER_00
I just hope politically, they don t reverse it.
4
SPEAKER_01
Because first of all, they re everybody s like, okay, well, okay, we need to start arresting people again, and then put them in treatment.
4
SPEAKER_01
But oh, yeah, we just used
4
SPEAKER_01
funding from not arresting people to fund treatment.
4
SPEAKER_01
So where s this money supposed to magically materialize from to start arresting people again and pay for treatment?
4
SPEAKER_01
Portugal is such a good example.
4
SPEAKER_01
And a lot of that was the example that Oregon s Decrim was based on.
4
SPEAKER_01
And there was this ridiculous campaign by people to say that, well, what Portugal did is was arrested people and forced them into treatment.
4
SPEAKER_01
That is not what Portugal did.
4
SPEAKER_01
What Portugal did was give people traffic tickets, essentially, if they got them for possession.
4
SPEAKER_01
And you were supposed to appear before a commission that would invite you to treatment.
4
SPEAKER_01
If you didn t show up, you didn t go to jail.
4
SPEAKER_01
If you said, I don t want treatment, you didn t go to treatment.
4
SPEAKER_01
First period of time, they show dramatic reductions in overdose deaths, increases in recovery, and all the good things.
4
SPEAKER_01
Then they cut the money for treatment.
4
SPEAKER_01
And surprise, surprise, things start to get worse again.
4
SPEAKER_01
But it was not that they suddenly stopped arresting people and that it made things get bad.
4
SPEAKER_01
Right.
4
SPEAKER_00
That makes sense.
4
SPEAKER_00
If you could write policy again, another huge question, or even just like three things, you know, everyone should have a Narcan prescription in their house and know how to use it.
4
SPEAKER_00
Or I mean, what do you want to see
4
SPEAKER_01
Certainly, now naloxone is available over the counter in the United States, but it s stupidly expensive.
4
SPEAKER_01
But yes, certainly everybody should have it, should know how to use it.
4
SPEAKER_01
Any first aid kit that you have, it should be in there for if a kid gets into something or a teenager gets into something or a grandmother takes it twice.
4
SPEAKER_01
It s a useful drug.
4
SPEAKER_01
it doesn t do harm.
4
SPEAKER_01
Like obviously it s not going to solve someone s heart attack, but it s not going to make it worse either.
4
SPEAKER_01
So yes, absolutely that.
4
SPEAKER_01
I just also really think that we need to make medication available for people who are addicted.
4
SPEAKER_01
So, and including things like Dilaudid or OxyContin,
5
SPEAKER_01
cotton or whatever.
5
SPEAKER_01
Our biggest mistake, we had this overprescribing issue.
5
SPEAKER_01
Now, most of the people who were overprescribed actually were getting the drugs from somebody who was having it in their closet and not actually taking it, because most of the people who got addicted were not pain patients.
5
SPEAKER_01
And now we have this whole situation of pain patients who actually need medication, not being able to get it, even if they re dying.
5
SPEAKER_01
So what do we do?
5
SPEAKER_01
We cut the medical supply in half since 2011.
5
SPEAKER_01
What happened?
5
SPEAKER_01
Fentanyl, street fentanyl, not prescription fentanyl.
5
SPEAKER_01
Why did that happen?
5
SPEAKER_01
Because we cut all these people off without like providing any help for anyone.
5
SPEAKER_01
We actually made the overdose rate double since we, you know, more people now died from overdose when prescribing was going down than died when it was going up.
5
SPEAKER_01
And so, you know, is even actual prescription fentanyl safer than street fentanyl?
5
SPEAKER_01
A million times yes.
5
SPEAKER_01
This is the point of having an FDA so that you know what s in the stuff you re taking.
5
SPEAKER_01
And if you want to avoid overdose, you know what the actual dose is.
5
SPEAKER_01
So, you know, being legally able to prescribe
5
SPEAKER_01
For people who are addicted, a safer supply would make an enormous difference is still all kinds of huge barriers to prevent, you know, and obviously we do not want marketing of this, like the difference between supplying people who are already
5
SPEAKER_01
and making money by telling people that these pain medicines don t cause addiction in anybody, that s a huge difference.
5
SPEAKER_01
There are people who are already addicted and there s people who are not exposed.
5
SPEAKER_01
These are two different classes of people.
5
SPEAKER_01
They need different approach.
5
SPEAKER_01
This is not really that hard, but if we would do that, we could really dramatically reduce the death rate.
5
SPEAKER_01
And even if we could just like do things like make methadone available by prescription from ordinary doctors, just stop restricting
5
SPEAKER_01
opioids to people who are already addicted because what you end up doing then is pushing them to a street supply.
5
SPEAKER_01
You don t end up helping them and stop it away from pain patients.
5
SPEAKER_01
So safer supply.
5
SPEAKER_01
And just really like we need to completely redo our treatment system.
5
SPEAKER_01
Like our treatment system is based on old ideas that are not helpful.
5
SPEAKER_01
And, you know, 12-step programs can help a lot of people.
5
SPEAKER_01
They are free and available 24-7 in many communities.
5
SPEAKER_01
You do not need to give somebody a pretty place to live and spend $10,000 of my taxpayer money teaching them the 12 steps.
5
SPEAKER_01
When you are creating a treatment system, it should be based on stuff that people cannot get for free.
5
SPEAKER_01
This is not complicated, but really, really difficult to achieve because of cultural barriers.
5
SPEAKER_01
And because of, you know, so many people have made a living doing this for so long, and we re just about to pour tons of money into the system that already exists, and we know does not work very well.
5
SPEAKER_01
But if we were to, you know,
5
SPEAKER_01
provide safer supply for people and really make it accessible, that would make a huge difference.
5
SPEAKER_01
And ultimately, of course, we need to tax the rich, basically.
5
SPEAKER_01
We need a much more equal society so that there is a middle class and so that people do not despair and have hope and are not replaced by robots and have nothing else to do.
5
SPEAKER_00
And for people who aren t aware, the Minnesota model of rehab is built off of 12-step ideology primarily, right?
5
SPEAKER_00
And what you re suggesting is that we need something that s more science-based, CBT, loving intervention.
5
SPEAKER_01
We also need to understand if we actually are arguing that addiction is a chronic condition, treating it by 30 days inpatient does not make any sense.
5
SPEAKER_01
Like, we need to separate the treatment part from the dwelling part.
5
SPEAKER_01
Some people just need housing, and they may need sober housing or they may be non sober housing, depending on where they re at.
5
SPEAKER_01
But, you know, you shouldn t have to get your medical care in the place that you live
5
SPEAKER_01
to get addiction treatment.
5
SPEAKER_01
You need a safe place to live, that is clear.
5
SPEAKER_01
And you need individualized medical care, which is very difficult to give in a residential setting where one size fits all works a lot better.
5
SPEAKER_01
So creating systems where people can
5
SPEAKER_01
Like, oh, this person has depression, so we need to get them to a psychiatrist.
5
SPEAKER_01
Oh, this person has a high school education or less than a high school education.
5
SPEAKER_01
They need job training.
5
SPEAKER_01
Like, they re not the same person necessarily.
5
SPEAKER_01
And putting everybody through job training and everybody through depression treatment is not helpful.
5
SPEAKER_00
We could have gone in so many different directions because Maya s books, of which I haven t even read all of them, just are so encyclopedic in her examination and explication of all of the different facets of the space.
5
SPEAKER_00
And she, her own lived experience being addicted during the AIDS crisis, saving herself most likely by learning about bleach, which is not the best harm reduction technique, but was the only one available, was the impetus for her career.
5
SPEAKER_00
And so I think she was one of the people
5
SPEAKER_00
who s still alive and with us, who really intimately understands all of the different facets, and more importantly, the science.
5
SPEAKER_00
That s what I really loved about her book, is that she examines her own, what she had taken as face value early on in her career, or as some sort of essential truth that couldn t be teased apart, including stories about who she was because she was an addict.
5
SPEAKER_00
So she s very careful, really fastidious in terms of looking at, for example, what she was saying about Portland and how obviously there s a spotlight on what s happening in Oregon as an example or not an example for the rest of the country, but
5
SPEAKER_00
that when you actually look at the rates and you look at all of these other factors, nobody should be surprised about what s happening with unhoused populations.
5
SPEAKER_00
I highly recommend all of her work.
5
SPEAKER_00
You can read her with great frequency in the New York Times and in other places.
5
SPEAKER_00
If you liked today s episode, please rate and review and tell a friend.
5
SPEAKER_00
You can find show notes and full transcripts of the episodes at EliseLoonan.com.
5
SPEAKER_00
While there, please sign up for my sub stack.
5
SPEAKER_00
I send a short note every Wednesday about topics that are aligned with this show and a deeper dive most Sundays.
5
SPEAKER_00
Or follow me on Instagram at EliseLoonan.
5
SPEAKER_00
And finally, if you haven t already, please consider picking up a copy of my New York Times bestselling book, On Our Best Behavior, The Seven Deadly Sins and the Price Women Pay to be Good, available wherever you get your books.
5
SPEAKER_00
It s an exploration of how women have been conditioned for goodness, men for power, and all the ways we ve been programmed to police ourselves and each other according to these cultural ideas of what it is to be a good woman.
5
SPEAKER_00
I d also like to give a huge thank you to my sponsors who make this show possible.
5
SPEAKER_00
Please support them the way they support this podcast.
5
SPEAKER_00
This has been a presentation of Cadence 13 Studio.
5
SPEAKER_00
If you enjoyed this episode, please listen, rate, review, and follow Pulling the Thread.
5
SPEAKER_00
Available now for free on Apple Podcasts, Spotify, Odyssey, or wherever you get your podcasts.
5
SPEAKER_00
I want to give a shout out to Phil Svitek, Lauren Legroso, Mary-Kate McDonough, Ali Brockman, and the entire Kedans13 team for producing these episodes, and to Valero Deval for my key art.
5
SPEAKER_00
Take care of yourselves.
5
SPEAKER_00
I ll see you next time.