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0:03I feel very nervous all you smart people
0:09looking at me and expecting smart things
0:16so I'll just state that it's a
0:20nerve-wracking position and I'm not even
0:22thinking about being filmed so I John
0:27strays Nick is dr. Strauss and I am
0:33tasked with talking about your brain and
0:37drugs and it's kind of a misnomer in
0:41that it's I think really it's about your
0:44relationship with addiction and with
0:47your patients who have addiction
0:50disorders I think that in some ways this
0:55were a terrible match for our patients
0:58because we are coming at them with a lot
1:01of cortex and they do not have a
1:05cortical illness they have a relational
1:09limbic so how to bridge that I think is
1:16part of the my challenge today so what
1:21you're getting here is the result of
1:2420-some years of working with folks with
1:28addiction listening to what they found I
1:32said was helpful or useful and also not
1:36hearing anything about what they've told
1:39me wasn't helpful so and again I
1:43encourage you in your training to do two
1:48things one is learn all this cortical
1:50information you're gonna get but also
1:53just also be working on how do you
1:56really just relate to folks who have a
2:00substance use disorder okay so I'm gonna
2:05give you a little talk about that that I
2:08this is based on a talk I give
2:12in the auditorium series and I I get
2:17lots of positive feedback from it so it
2:19makes me think I should be doing it as
2:23far as just helping them relate to their
2:26illness and again it's it's again the
2:30idea back to what Mike was already
2:32talking about about trying to you know
2:36have a medical model or a doctor talking
2:40to them about their illness it gives
2:43them some sense of importance for their
2:47illness but it also the way we talk
2:53about it helps them not take it as
2:55personally because so much of the pain
2:58of addiction is the personalization of
3:02it and just you know I must be a bad
3:04person because of what I have done so
3:08what you'll hear in this amalgamation of
3:12a talk that I give to them is just ways
3:15for them to understand how they can
3:18realize that the reasons they've acted
3:22the way they have is partly because of
3:24their brain being hijacked and I use the
3:26word hijacked like drugs and alcohol
3:29okay and it's also to change their
3:33relationship to their illness because
3:36the goal in my experience is not to make
3:40people hate their illness hate their
3:44addiction fear their addiction it's to
3:47get them interested in their addiction
3:50and to get them relating and caring
3:54about their addiction so we'll see if
3:57I'm successful communicating
4:00as well yes yeah I mentioned or maybe
4:04somebody may have gathered their
4:06information about the brain yeah aziz
4:09mahmud there's something somebody said
4:11that actually might increase stigma or
4:13there was that question yeah obviously
4:17that on science in addition yeah yeah so
4:34and again that's certainly in that and
4:39then my own experience that you know
4:41patients will stop me in the parking lot
4:44where all your best interactions are
4:45going to happen here and and say oh you
4:48know you're the brain doctor you know
4:50and oh you know I thought about that
4:52talk when I was dealing with this or
4:55that and boy that you know help me so
4:58that you know is why I think it's worth
5:00repeating but yeah I do feel like trying
5:06to deep personalize it is the key
5:09you know if because so much of this
5:11illness is very personal and it is a
5:14think it's more than a brain disorder
5:18it's a relationship disorder it's a
5:20relationship disorder with themselves
5:22and it's a relationship disorder with
5:24others so and then you'll see how I take
5:28that into some neurobiology very very
5:33simple so some of this is also based on
5:39George valiant who's a very famous
5:41researcher who's looked at addiction
5:44over the life lifespan and he values
5:47very much what he calls the tripartite
5:50brain okay so that's gonna be my bridge
5:53so this is your brain okay and this is
5:57what I'll say to folks you know so if
5:59you want your brain this is your brain
6:01and that there's three parts to your
6:03brain
6:04there's your wrist which represents your
6:06brain stem and then yours your cortex is
6:10represented by your fingers and that's
6:12what we usually think of when we think
6:15of the brain but actually the brain stem
6:19is what's kept alive when folks are
6:22quote brain dead but that that controls
6:25our eating our swallowing our
6:27temperature regulation but then there's
6:30this third part of your brain
6:31represented by my thumb which is the
6:33limbic system and the limbic system
6:36actually is a very important network of
6:39neural connections and nerve bodies that
6:43has the primary goal of survival and
6:47that that has to do with two different
6:51parts one is increasing rewards and
6:56decreasing risks and then the other is
7:00mammalian and has to do with attachment
7:03because as mammals and some of those
7:07little animals that were in Mike's talk
7:10they have to relate and connect to their
7:13caregiver for the first year for us for
7:16mammals it's 10 years so there's a
7:19innate system of attachment that's
7:22involved in the limbic system and that's
7:25very important for all the ways that
7:27addiction starts messing up your
7:30relationships okay and that the reason
7:33you need to know about the limbic system
7:34is that's where all the drugs of abuse
7:37work they they're not messing with your
7:40cortex they're messing with your limbic
7:43system okay so and then I draw a picture
7:48just to just keep them engaged that way
7:52and so then I just redraw the tripartite
7:55brain you know and I just say that's
7:57that's your metric cortex
8:01and you have the brainstem and then what
8:07sits on top of the brainstem is the
8:17limbic system here you know so really
8:20complex
8:21you know MRI here you know and I thought
8:25I always have to get through my
8:26embarrassment when talking to folks with
8:28a lot of cortex so you know the patients
8:31they love this stuff but you know I have
8:34to get through my own my own issues so
8:39this is the limbic system and the
8:43brainstem
8:57and in particular obviously we talked
9:00about the cortex then with you all
9:07obviously we're talking about the
9:09prefrontal cortex you know this part in
9:11particular which has a lot of influences
9:14on our choices in our behaviors and that
9:18the limbic system obviously also takes
9:21in a lot of values from you know the
9:24environment from the surrounds to try
9:31and grow and so again just to emphasize
9:39the three different parts but though
9:41we're gonna primarily be talking about
9:43the limbic system and so the limbic
9:46system again the main function is
9:49survival and that it has to do with
9:54increasing decreasing risk increasing
10:02rewards and that was some what Mike was
10:07talking about about the rewards you know
10:10have you know have to do with the food
10:14sex water shelter and that and then the
10:24wrists are obviously all the dangers you
10:27know those predators
10:33and that then the other big part is the
10:35attachment system and then that is very
10:42much a part of the limbic system so that
10:46the fact that it is involved with
10:49addiction has a lot to do with all the
10:51different parts which we can talk about
10:53as far as your drug of choice replacing
10:58your relationships and reducing your
11:02ability to care for your children your
11:05loved ones but that that's a hijacking
11:08that goes on okay so I usually ask any
11:13questions so far I mean it's pretty
11:16straightforward right
11:17so and then the idea is okay so this is
11:21this is the system you got the other
11:24thing that is is key for the limbic
11:28system is that it has a GPS in it so it
11:33has a system putting all these risk
11:37rewards and predators within a context
11:41so it makes a map of where the rewards
11:46are where the risks are and where the
11:49attachment figures are and that it's
11:51it's a map that is built within your
11:54brain that you go back to unconsciously
11:59and that but that it's you can
12:01appreciate the survival capacity and the
12:05importance of having an ability to
12:08remember where the water is where the
12:11food is and so that we are constantly
12:14making maps and that this illness
12:17highlights that when it gets hijacked
12:21you know and some of the most confusing
12:25experiences that folks have with
12:28addiction can be explained with this
12:32model you know because they often
12:34personalize that just one example would
12:37be you know I swore that I was wanting
12:41to stay sober
12:43my conscious mind was I wanted to be
12:46sober I was in a treatment program I was
12:49a hundred percent committed to being
12:51sober I left the program and I found
12:54myself in my neighborhood of use and I
12:58must have not really wanted to be sober
13:01I guess I just didn't want to in that
13:04this is just to say no actually what
13:07happened was your limbic system got the
13:09best of you in that it took you back to
13:12a place that you were just naturally
13:16drawn to some folks that I give this
13:19talk to will talk about experiences
13:22they've had that they don't like to talk
13:24about about feeling like a tractor beam
13:27where they when they get stressed they
13:30feel pulled to their neighborhood of use
13:32where they just and they describe
13:35experiences of not wanting to go there
13:38but feeling compelled to go there and so
13:41that they're literally kind of
13:42consciously fighting the urge as they're
13:44driving or taking the bus to their
13:47neighborhood abuse okay so and that this
13:51is the GPS part of this this is one way
13:57to explain that you know it's just
14:00getting triggered okay
14:03so so again this is also where I have to
14:10do they usually the patients are like
14:12full of stories and they want to talk
14:13all about it so you all are be very good
14:15and just listening so I just any
14:19questions or comments please let me know
14:21because I'm used to play into a little
14:22bit more reactivity oh they're like oh
14:31do you mean this you mean like that you
14:34know that's why like I stopped caring
14:36about my kids you know and like oh do
14:39you mean like that's like a reason that
14:41like oh man just does this ever go away
14:45doc you know like you're kind of telling
14:50a kind of a tough story you know what
14:54what does this mean for my future you
14:57know so kind of those kind of reactions
14:59and how do you address reality of what
15:05you're showing okay yeah
15:07so I this is one of my favorite lines I
15:09said what do you want the good news or
15:10the bad news
15:13okay so the good news is is you can
15:17change this okay you know so and the bad
15:21news is is it never goes away that you
15:25you know because the survival system you
15:28know is is such an innate part of our
15:32makeup that once you learn these maps
15:35they never pay anyway so that they will
15:39always be potential triggers for you
15:45the cortex of the prefrontal cortex and
15:47limbic system okay yeah thank you
15:50that's a nice bridge so what I tend to
15:53do is I use a metaphor and so then I go
15:56into I said okay so what how does this
15:58look you know because I said one of the
16:02things that is a real challenge is that
16:04we have a way over investment in our
16:06cortex and that we think we can out
16:09think this illness and and in my
16:13experience that has not been the case
16:15now it's interesting we were talking
16:17about the higher education folks and
16:19that maybe they're at less risk
16:21maybe I mean so you know I'm I'm at the
16:24ski resort with a lot of injuries so I
16:26mean I may be talking to more the more
16:29severe spectrum but in my experience you
16:32can't out.thank this illness and in most
16:34things when and I've had I have some
16:36private patients with addiction that are
16:39high functioning and their cortex is not
16:42their friend in my experience you know
16:45they explain away a lot of behaviors
16:47with their cortex so I say a better
16:52metaphor for this is to think about your
16:55limbic system is your 800-pound gorilla
16:58and the cortex is your trainer of your
17:03gorilla and so it is extremely important
17:07to remember that is the scale you know
17:09some folks talk about elephants and you
17:12know writing a non elephant but I think
17:13the cortex and the gorilla trainer tends
17:17to be the one that patients have
17:19responded to the best and so your goal
17:23in this work you're going to do I'm
17:27talking to patients is to get to know
17:30your gorilla and it's you're never gonna
17:33get rid of your gorilla and your gorilla
17:37is your friend and but you need to start
17:40to know your gorillas better as far as
17:43as a trainer you know what are the
17:48triggers for your gorillas banana
17:51okay and so you you want to know first
17:57you know what are the environments that
18:00the bananas have been gotten in and what
18:03are the environments that have no
18:04connection to bananas that would be the
18:08first thing but then also as there's a
18:12whole nother series here about the
18:16neural hormonal effects on all this but
18:20I just boil it down to you know the
18:22typical a halt language that you want to
18:28be very careful that your gorilla is not
18:30hungry angry lonely or tired and so that
18:34and you want to think that simply like
18:37okay are you are you alone are you
18:39hungry are you angry are you tired
18:42those are the things that as a trainer
18:45with your cortex you want to be focused
18:47on for reducing your risk of relapse and
18:51all were ever doing is reducing our risk
18:54of relapse you never want to in my
18:57experience give patients some
18:59expectation that they will not use again
19:01you you want to deep ethology
19:05those those slips or whatever you want
19:09to call them use episodes so you use
19:12them in the sense of you know you want
19:15to minimize your risk of relapse miss
19:18and so then we just kind of have fun
19:21with that analogy of the trainer and the
19:25gorilla and so I'll say you know now
19:27what a trainer how smart is a trainer
19:29he's gonna go into the cage with the
19:32gorilla and present him with bananas you
19:35know and tell him not to eat you know
19:38and so we laugh about that and then we
19:40compare that to like folks who go into
19:42areas of their drug use and expect that
19:47they won't relapse
19:49and and I usually attend I say if you
19:52remember anything from this lecture
19:54remember this that where you put your
19:57brain it has more to do with your risk
19:59of relapse than anything else so if you
20:03put your brain in the environment of
20:06bananas you will relapse most likely if
20:09you put your brain where there's never
20:10been bananas you have much less chance
20:12of relapse and and so we just go with
20:18that and then we start talking about the
20:21other side which is well how do I fix
20:23this you know how do i how do i get
20:25better from this and this is where you
20:27start to say well you've got to start to
20:30again take back your brain and you take
20:34it back in two ways one is you start
20:38looking at what are the environments
20:41that you used in what were the things
20:44that you thought you were getting
20:46rewards from and how can you substitute
20:49other activities and so that's you know
20:53what other passions what other pursuits
20:55can you do that are separate from the
21:00prior pursuits and again using the
21:03800-pound gorillas as the kind of
21:06metaphor think at that level
21:08don't try and finesse it don't say well
21:13I'm gonna go fishing but I always drank
21:15when I fished but if I go and I use a
21:19different boat or if I use it you know
21:22it's like know if you drank when you
21:25were fishing don't ever fish again you
21:27know or we'll give an exception to that
21:31in a second find other hobbies or
21:34activities that you did that you enjoyed
21:37that you can do sober and so you get
21:42them thinking about that level of shifts
21:45and then obviously also partly what gets
21:50lost in the risk and reward is there's a
21:53lot of stories they'll tell about oh is
21:55that why I risked all sorts of things
21:57and I
21:58even think about it you know is that why
22:00I put myself at personal risk and it's
22:03like yeah this is a way to understand
22:05that that your brain was hijacked and
22:08that you weren't able to even assess the
22:10reward versus the risk it sort of
22:12flipped on it you know you begin to
22:15think rewards are actually risk but you
22:20you you start flipping it go ahead
22:23what about like sort of hobbies and
22:25pursuits a lot of the pressure he has
22:29that sort of the activities you used to
22:32enjoy me upon by the wayside because
22:34your time is what involved in sort of
22:36yes pursuing your addiction either so we
22:41usually try and encourage that go back
22:42to the things that you used to really
22:43enjoy find your passion your enthusiasm
22:46but you know that may be at odds with
22:48the recommendation of like don't do the
22:51things that you did while you used to
22:53use so how do you balance those two
22:54things I just add I would add the
22:57statement what did you use when you were
22:59doing that activity because if your
23:02gorilla is associating that and bananas
23:06don't go near it
23:08at least at least now in Oakland Erie
23:11but was it a was it a passion that you
23:14had before your addiction and that your
23:16addiction took away from you and if
23:18that's the passion then pursue that you
23:22know because that would be gold you know
23:24some folks you know we do this talk and
23:26they'll say oh you mean I should go back
23:28to fishing because I used to like
23:30fishing because fishing really
23:31bifurcates people he was all it was all
23:34either alcohol infused or it wasn't okay
23:38and so for some folks it's like never go
23:42near a boat again and then for other
23:44folks it's like ya know go back to
23:46fishing
23:47you know cuz that was never connected to
23:50two bananas you know so that's that's
23:53how I do that just but I asked that
23:55question like what was it associated and
23:58I just say because remember we're
23:59talking about a gorilla here okay it's
24:02not gonna figure that stuff subtly out
24:05you know you just and you really want to
24:07play carefully because
24:09you will go back to use if you don't if
24:12you don't train your gorillas correctly
24:14but again the idea here is your your
24:17your training the grill in the best
24:19sense of the word of relating to it and
24:21wanting to kind of take care of it you
24:24know because so many folks have a
24:25negative attacking view of their
24:29addiction and they wanted you to get rid
24:31of it like get rid of it doc I just want
24:34to be done with it I'm no longer an
24:36addict I don't find that's a useful
24:39long-term strategy you know for folks on
24:42our more severe end of the spectrum it's
24:45like how do you get to know your
24:46addiction how do you get to understand
24:49it understand what are the things that
24:51caused it what are the things that make
24:54it less likely to happen and and because
24:58there's so much hatred that gets into
25:00that you know and if you buy into that
25:02as a clinician it feels good initially
25:05because they want you to get rid of it
25:07but it doesn't work so it's so it's more
25:10how do you relate to that and then the
25:14other thing I say as far as the path to
25:16recovery is remember it's a relationship
25:19disorder so you want to focus on who
25:22you're hanging out with like how who are
25:25you putting yourself around and that's
25:28one of the real benefits of a a and na
25:31is you've got built in sober communities
25:33that just are you don't have to do
25:36anything you sort of fall into them but
25:38if you don't like that then you have to
25:40work harder to build your community of
25:43sobriety and so then you know but the
25:46focus is always on how can you build
25:49sober relationships and of course I'll
25:52just say against what always comes up
25:54says sex you know and like will Kenneth
25:57does that mean I can't have sex you know
25:59with anybody that I used with and or
26:03that is using and I say well what do you
26:06think do you think the gorilla is smart
26:08enough to tell the difference and they
26:11usually say no and they already know it
26:13but it does give you a metaphor that
26:15just they just and I just say you know
26:17you shouldn't you should stay clear that
26:19you know
26:20and we you know I won't get it but it
26:23gets kind of crude sometimes but we do
26:25have conversations about that plenty too
26:29which I really think at some point you
26:32can if you're gonna stay in this field
26:34you got to get comfortable with that
26:37kind of level of discussion because
26:39patients are very kind to us they
26:42understand what makes us uncomfortable
26:44and they won't talk about it but often
26:48that's the stuff they need to talk about
26:50you know which is what does this mean I
26:52should have sex with with this partner
26:55or not and because it's its limbic and
26:59so that I also find this model kind of
27:01can help us bridge it in a way that
27:04doesn't feel as forboden for us coming
27:08in from our training to talk about sex
27:12it's not something I'd say I start right
27:14away with but you definitely want to
27:17have it in there in the conversation
27:20they're there thinking about it and so
27:29then I just but I then I say and this is
27:31where you can start to reconnect to your
27:33relationships and that this is also
27:35where I try and do a little normalizing
27:38of the destruction of their
27:39relationships that have happened through
27:41their addiction career and how bad they
27:45feel about either their childcare duties
27:48that they've let go or their
27:50relationship that have deteriorated and
27:54so I start to just give them some hope
27:57that this is the way they can kind of
28:00start to reconnect slowly but to try and
28:03again work to reconnect with sober
28:06people your original attachment figures
28:10that your brain got hijacked away from
28:13and that that is also part of that
28:17recovery what you recover is
28:20connections go ahead you're like Dan
28:27Siegel oh yeah yeah obviously this
28:35little spot where your fingernails
28:36yeah yeah yeah connection yeah and that
28:41when you get emotional in yeah yeah yeah
28:45you know it takes time before those kind
28:47of reconnect a lot of people use
28:49substances almost sort of like a
28:50weighted blanket you know being able to
28:53regulate that controller
28:56yes when I think about things like DDT
28:58being really helpful because for a lot
29:00of our a lot of our patients have been
29:02using logic to lay their emotional
29:05regulation skills come stall that at
29:06about fourteen and so you know they
29:09might be forty four and they don't have
29:11adult coping skills for regulating their
29:14own emotional states other than their
29:16substance and we've just taken that away
29:17from them without taking away from
29:19themselves yeah and
29:27you best yep
29:29yeah well said yeah yeah I agree
29:34I just no other questions about the
29:37healing relationships as he did with
29:42other people but what about
29:43relationships just hearing those moments
29:47of deep shame and deep self blame yeah
29:49and how do you navigate what's the
29:52verbage you use and the three of us are
29:56the addition s and primary care fellows
29:58were primary care doctors okay and
30:01thinking about water
30:03you know in a primary care visit what's
30:05art like short what it is yeah yeah yeah
30:10yeah it's I think I think I think it is
30:18a tone it is a tone it mean it is a tone
30:22that your said you know and where you
30:25you you don't don't try and talk them
30:28out of their hate you know for
30:30themselves but because I think we I
30:35don't think it helps them if we come in
30:37with too big a difference as far as you
30:41know oh you shouldn't feel that way or
30:43you know oh it's a brain illness you
30:46know especially if it's just coming out
30:48of like a quick visit you know you
30:51should hold on to that and you should
30:54remember that but I think for for for
30:58them it's often like just receiving that
31:02hatred and just kind of absorbing it and
31:05just sitting with it and just sort of
31:08feeling the pain of it
31:09with them like this is a really horrible
31:12illness you know that's the first step
31:15on you you know just this is a horrible
31:18illness you know and then depending on
31:22how much nonverbal connection you feel
31:25with them you know maybe introducing a
31:27slight different way to look at it but
31:30maybe not
31:31you know just but just just normalizing
31:34this I mean I the longer I work with
31:36addiction as much as the spontaneous
31:39recoveries and stuff and it may be
31:41because we're here at this end of the
31:43spectrum I I hate this illness and it's
31:46illness destroys people it destroys
31:48relationships in a way cancer doesn't
31:51you know I don't know about head and
31:54neck cancer but I other than head neck
31:56cancer I might choose cancer over
31:58addiction if I had to choose it's really
32:03bad so just trying to be with that level
32:07and then the shame that the shame is the
32:10tough part because that's where they
32:12they've taken it personally and you can
32:15see the limbic system is all about
32:17connections relationships with others
32:20and with yourself so your brain is
32:23hijacked and you do do horrible things
32:26and you will think it's you because it's
32:30it's and that's the spiritual kind of
32:33cure you know I think the limbic system
32:36has a lot to do with your connection
32:38with the greater greater greater thing
32:41so that's where it's not surprising to
32:44me that those sort of treatments can be
32:47effective because it gives you a sense
32:49of connection to a greater purpose a
32:52greater entity but it's kind of trying
32:56to reclaim that
32:59the natural sort of limbic system versus
33:02what's been hijacked yeah yeah yeah yes
33:24yeah then it's done and now I'm fine
33:30yeah yeah I I just I I love those
33:38conversations especially in this lecture
33:41you know and I'll say okay okay
33:43everybody I said so how long did this
33:46take to get this way and you know you
33:50know all of them there have been twenty
33:52to forty years you know I said okay so
33:55how quick do you think you're gonna get
33:57over it you know and so I don't tell
34:00them I just say how quickly you know
34:05yeah I say you know I say you know the
34:09journey of a lifetime begins with the
34:11steps so take a step but I said I mean
34:15and that's this I just like playing good
34:17news bad news and I encourage you to use
34:19that model if you can cuz there's a lot
34:22of good news bad news that you have to
34:23carry simultaneously with this illness
34:25and so I just say the good news is is
34:29you can make some changes abandon you
34:31know this isn't gonna be you know quick
34:34you know we don't and I you know and
34:36I'll put out I said they say well in
34:39that often they'll say well can't you
34:40just figure out where to cut and and
34:44just cut it out and I'll say I'll say
34:46well you know look at look at what what
34:49system is getting hijacked I said do you
34:52want to stop enjoying life do you want
34:54to stop enjoying relationships I said
34:56that'll I said lobotomies work I said I
34:59don't think I don't think you want that
35:01so I said unfortunately you have to do
35:04you know and I'll play different
35:06metaphors sorry I'll mix metaphors here
35:08but you know yeah
35:09your own little brain surgeon and I said
35:11you have to start making so I'll do
35:13occasional like neural lectures about
35:16you know synaptic feet and you know
35:19building the different you know neuronal
35:21pathways and so that Eric Kandel stuff
35:24but that I've tended to shift away from
35:27that to just more of this simple lecture
35:30but that you basically have to do the
35:32micro surgery to start shifting but I
35:34say but remember keep it simple
35:37environment you know if you're in a
35:39barber shop long enough you get a
35:41haircut
35:41so don't for the barbershops you know
35:44and anyone you know and sometimes
35:47they'll challenge me with that I'll say
35:49well I I was I've been at a bar drinking
35:52water you know I said okay great
35:56I said you walk through a minefield ten
35:58times and you made it I said good luck
36:00do it again you know so I can be a
36:03little I can I can be a little and
36:06that's the other thing I'd say is don't
36:09be afraid to put a little emotion into
36:11what you say with your patients you know
36:14because this is an emotional illness and
36:18don't talk them out of it with your
36:21language
36:22you got to relate to them and sometimes
36:24a little confrontation in the best sense
36:27of the word a little challenge
36:30a little humor a little Sun you know
36:32gets I think gets more impact than than
36:35talking to them about dad I mean dad is
36:40important for us to know what's helpful
36:43what's not but for for patients it's you
36:46know and that's that's just something I
36:48and I'm at saying that you're gonna do
36:49that immediately but I'd really
36:50encourage you to work towards that and
36:53bringing yourself into it and we've all
36:56I mean I'll just say I mean I didn't get
36:59into this business because I wasn't
37:00connected with addiction okay so we all
37:03have personal addiction relationships in
37:06our past that you are what I would
37:10encourage the sooner the better to start
37:12to get to understand your own
37:14with addiction because that you I don't
37:18say that to my patients but you they
37:21pick that up you know as far as whether
37:24you are being honest with yourself about
37:27this illness and then they'll they'll
37:31open up you know because there are there
37:33you can imagine this illness is so
37:35stigmatized that they're waiting to be
37:37judged and they're waiting for you to
37:39sort of look away or look down or or
37:43have some judgment on them so the more
37:45we can kind of relate and it's kind of
37:47back that I love those slides you had a
37:49puppy dog and you know it's really
37:51getting back to that level of
37:53relationship you know it's and you know
37:56that I often I'll sometimes I'll say the
37:58limbic system we share with dogs and
38:00cats and that's why we feel so much in
38:04that level of connection with them and
38:07so that's you kind of want to get to
38:10that level with your patients you know
38:12and you know it you know you don't have
38:16to say anything to your dog and you know
38:18you have incredible connection so so you
38:21talk less
38:25other other comments or questions
38:34might be the first time they've had a
38:36conversation about substance abuse and
38:39they're probably not going to remember
38:41what you say but they will most
38:42decidedly remember how you made them
38:44feel
38:44and you amplify that shame signal which
38:48is already like so loud so that might be
38:52the first time they ever had the
38:54experience of talking about their
38:56substance use in a way that they didn't
38:57leave feeling ashamed and that's super
39:00powerful that's a shift in the
39:29attachment system so that's like being
39:33able to provide an attachment experience
39:35with the patient is actually going to
39:37compete with some of the other kinds of
39:39things that they're oriented to really
39:42valuable as a treatment relationship
39:45yeah yeah yeah and you know and again
39:49that it also was you know a model that I
39:52encouraged them I say so if you're in a
39:54that's partly what you're doing you're
39:55Reid taking back your brain so I try and
39:58emphasize like that's great if you like
40:00a a because not only you get two things
40:03one as you give you know they're well
40:06there there's there many things for me
40:07but once a lot about relationships and
40:10about getting a sponsor you know I have
40:13a person that you share your most
40:15serious you know step four Step five
40:18stuff you know where it's all about the
40:21horrible behaviors you've gone through
40:23this addiction but you're doing it
40:25within it
40:26context of a relationship with somebody
40:29that most likely hopefully will not
40:31shame you for it but also is just your
40:36your building environments of sobriety
40:40you know which is it's just that simple
40:42you know sometimes they want it to be a
40:45little more complicated you know I find
40:47that some of the folks I work with who
40:50you know are and the more more educated
40:55and you know they want to understand it
40:57cognitively they want they want to
40:59understand that they can out thank this
41:00illness and they can do everything you
41:02know and I that's I find that much more
41:04challenging and just keep it simple you
41:07know just do the simple stuff about
41:14other any other what just to be interest
41:17to just feedback right and this is what
41:19I'll do with the foot what would what's
41:20helpful about this model what don't you
41:23understand or don't find is useful I
41:25mean I just am always interested in just
41:29feedback from that level but what are
41:34you getting from the talk
41:37are you not getting from the talk yeah
41:41so so one thing I find that with
41:49patience setting and it's always very
42:03helpful for the patient good take that
42:09one it's an opportunity for us is for
42:20them because they have no sense they
42:23have a sense of the problem and how its
42:24inflicted on them but they don't have
42:26much of a sense of what how they can
42:28think of it and what I usually tell them
42:30is imagine that each your day begins
42:33when you wake up and you decide what
42:35you're gonna imagine their day begins
42:38after they've been starving so it's old
42:40dinner and then everyone says just
42:42relate to food the same way
42:45and a lot of families can relate to that
42:49much more because you know they're sick
42:51of the system there are tired of its
42:55importance
43:05yeah well they they felt the the impact
43:11of the Olympic is hijacking and they've
43:15this isn't this isn't the concept this
43:18is a felt experience and they're furious
43:21and they're also incredibly sad you know
43:25because they lose you lose your your
43:28loved one through this process and you
43:33know really cunning baffling and
43:36powerful way and so yeah so it's it's
43:42it's not I find I have to be really
43:47really centered when I talk to the
43:50families because they are so mad and so
43:54desperate they feel anxious and and
43:57you're getting the whole kind of so that
44:00yeah you really it's much more
44:02challenging than working one-on-one
44:06and so it's this weird mix of
44:08normalizing what they're going through
44:10but then also trying to kind of give
44:13some sense of understanding to the
44:16addictive process but I try and air very
44:20there's very much towards understanding
44:23their pain and their anger and their
44:27anxiety and their fears but more than
44:30explaining addiction you know so and it
44:41burned all the bridges the family yes I
45:03tend to make a joke about it just
45:06because it's so painful otherwise but
45:08it's you know I say well you know go go
45:10look where the light is
45:12you know like who wants connection with
45:14you who's sober don't don't say who do
45:18you want who want who looks like they
45:20want connection with you start there you
45:23know and don't start with the folks you
45:27want connection with but have given you
45:28all sorts of signals not to connect you
45:31know I say it's just rebuilding your
45:33rebuilding your attachment system I said
45:36so start where where somebody's
45:38interested in connecting with you and go
45:41there you know and
45:42maybe just your neighbor you know and
45:45maybe just start there you know but
45:48don't you know your daughter who you
45:51have you know use their credit card or
45:55you've done don't start there because
45:58you know what often will happen is
46:00they'll go there and I'll have a
46:01horrible experience and you know all the
46:05rage all that shame and everything just
46:07comes out and then they just they you
46:10know take that all worsen the situation
46:21you know and I try I do a lot of humor
46:24cuz it's a pretty dark illness okay I'm
46:28sorry to tell you if you didn't know it
46:30already but this is a pretty dark
46:32illness I mean I I started off saying
46:36I've never worked with addiction and
46:38then I ended up with addiction work and
46:40I was like and I really was amazed it
46:43like this recovery thing because in
46:45mental health I was I was on the
46:46inpatient service and nobody got that
46:48much better you know but here you know
46:51some of these spontaneous form ITER's
46:53are folks who are doing the work they've
46:54become these wonderful new people and I
46:57thought oh this is an awesome illness to
47:00work with now I don't know it's tempered
47:07looks like it's like it's really rough
47:09you know it's a tough tough illness the
47:14brain the survival mechanism and this
47:17helps me sort of hold on to the fact
47:19that this is such a challenging disorder
47:22to recover from so
47:29come on sir thank you was that it was a
47:32helpful useful is it here okay all right
47:35all right
47:35thank you I appreciate it all right
47:37thanks for your and see

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