The One You Feed - Maia Szalavitz on The Case For Harm Reduction

Episode Date: September 14, 2021

Maia Szalavitz is an American reporter and New York Times best-selling author who has focused much of her work on the topic of addiction. She has won awards from the National Institute on Drug Abuse, the Drug Policy Alliance, the American Psychological Association and the American College of Neuropsychopharmacology for her 30 years of groundbreaking writing on addiction, drug policy and neuroscience.In this episode, Maia and Eric discuss her book, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction.But wait – there’s more! The episode is not quite over!! We continue the conversation and you can access this exclusive content right in your podcast player feed. Head over to our Patreon page and pledge to donate just $10 a month. It’s that simple and we’ll give you good stuff as a thank you!In This Interview, Maia Szalavitz and I Discuss The Case for Harm Reduction and…Her book: Undoing Drugs: The Untold Story of Harm Reduction and the Future of AddictionWhat “harm reduction” means in the case of additionThe truth behind why we have the drug policies that we currently haveDifferentiating between the terms dependence and addictionThe real problem of addiction being the compulsive behavior that’s ruining your lifeThe role of moderation in substance use in people in recoveryHow to know whether or not moderation or abstinence is right for youThe problem with a binary approach to drug useThe harm reduction recovery approach as any positive changeThe difficult but crucial role of being a beginner to learn what’s right for youMaia Szalavitz Links:Maia’s WebsiteTwitterFeals: Premium CBD delivered to your doorstep to help you manage stress, anxiety, pain, and sleeplessness. Feals CBD is food-grade and every batch is tested so you know you are getting a truly premium grade product. Get 50% off your first order with free shipping by becoming a member at www.feals.com/wolfIf you enjoyed this conversation with Maia Szalavitz, you might also enjoy these other episodes:Maia Szalavitz on a Different Lens of Addiction (2017)Judson Brewer on Addiction and the Craving MindSee omnystudio.com/listener for privacy information.

If locking people up were such a great treatment for addiction and such a great way to like solve people's problems, why aren't rich people going? Why aren't white people being locked up all the time? Welcome to The One You Feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like, garbage in, garbage out, or you are what you think, ring true. And yet, for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back

and dampen our spirit. But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf. I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really Know Really podcast is to get the true answers to life's baffling questions

like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallyknowreally.com and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. The Really Know Really podcast. Follow us on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. Thanks for joining us. Our guest on this episode is Maya Solovitz, an American reporter and author who has focused much of her work on the topic of addiction. She's been a guest on the One You Feed podcast before, and we even had re-released her original interview once just because we love what she has to offer. So this is a brand new interview with Maya and Eric discussing her new book, Undoing Drugs, The Untold Story of Harm Reduction and

the Future of Addiction. Hi, Maya. Welcome to the show. Thanks so much for having me. I am really happy to have you back on. We've had you on before and I found the previous conversation fascinating. And we're going to be talking about your latest book called Undoing Drugs, the untold story of harm reduction and the future of addiction. But before we get into that, we'll start like we always do with the parable. In the parable, there is a grandparent talking with her grandchild. And the grandparent says, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love.

And the other is a bad wolf, which represents things like greed and hatred and fear. And the grandchild looks up at the grandparent and says, well, which wolf wins? And the grandparent says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. Sure. So it's very apt in relationship to this book because the one you feed can either be kindness or the opposite. And with addiction and in relation to people with addiction, we tend to feed the bad wolf. and in relation to people with addiction, we tend to feed the bad wolf. And within ourselves, if we have addiction, we can see that as feeding the bad wolf, or we can see that as having sort of an attempt to self-medicate and not feed the bad wolf. But it is certainly very,

very true and true of learning in general, that the thing you focus on and the thing you practice the most will be the thing you're best at, whether it's shooting up or, you know, dancing. Yeah, yeah. And I was really struck by in your book, how generally, as you said, unkind our response to drug users is. And I even had to do a lot of, your last book was part of my learning on this journey, and this book is just even more of it, where I realized that so much of the way that I got sober, and you did too as well, and what was done and the things that were said and how that was done, that there was a lot of unkindness even in that. It worked in my case, which made me think that's what you needed to have. But it turns out, I don't think that's really what worked, right? I don't

think it was the unkindness that made it work. So before we go too far down into all that, let's start and talk about what does harm reduction mean broadly? What is harm reduction in the case of addiction? Sure. So it is basically the idea that what we should focus on is stopping people from getting hurt, not stopping them from getting high and stop people from hurting others, not stopping them from taking drugs. And that is just an amazing shift of framing because if we focus on hurt, we can't be hurting people more in order to fix them. Yeah, you say that the goal of a war on drugs is simply stopping substance use, whereas the goal of harm reduction is making people's lives healthier and better, regardless of their choice to take or not take substances. And this

is really a fundamental shift in the way most of us, even those of us that are in the recovery community, look at this, you know, we think that we've got to end the use. That's the primary goal. I mean, that makes sense, right? Okay, well, if, you know, let's just say somebody, a heroin addict is doing harm to themselves and the community around them, why not focus on stopping the use? Why is that not the best primary focus? Because the use is solving a problem for that person. And if you just stop the use, you don't solve that problem. And if you don't solve that problem, you're not going to successfully stop the use in the long run. And so the use is just a symptom of something that is going on for that person, whether they feel isolated or despairing or have some kind of mental illness or any of a million different things that it could be. But if you don't stop that, because people who are

using drugs, see drugs as the solution, not as a problem. And so if you're taking away someone's solution, you are not really going to help them. And really, if you look at it, what we care about is, is a person productive, happy, loving, kind? I don't care what's in your bloodstream. That doesn't have anything to do with me. What I care about is, are you able to be present in your own life and for other people? And that is what we want to achieve. And that may actually be achieved by just giving you a pure supply of heroin. Right, which sounds, on the surface, crazy. I'm reflecting the mainstream view.

I'm not necessarily reflecting my view. But if I'm approaching this from a mainstream view, I'm like, well, hang on, that sounds nuts. So why is abstinence not either the best or the only approach to solving someone's problems or reducing their harm? For some people, abstinence will be the best way to reduce harm in relation to a specific drug. There is absolutely no doubt about that. But we care about people living regardless of if they're abstinent. We value people who use drugs just like any other human being. And so caring this much about whether they have a substance in their system or not does not make sense when you think

about what we care about generally as human beings. And so if that substance is causing problems, that person should be able to figure that out over time. But in the meanwhile, we need to keep them alive because otherwise they could never recover. So what are some common harm reduction approaches that many of us would have heard of and would probably agree with? The term originated with needle exchange to prevent the spread of HIV and other bloodborne diseases. And people thought that, oh, people who use drugs, they won't protect themselves. They just won't bother. They like sharing needles, although we're supposed to be evil, selfish people. Otherwise, there was all this mythology about what would happen if you provided clean needles to people.

Well, in reality, if you provide clean needles to people. Well, in reality, if you provide clean needles to people, they will use clean needles because it works better for one. And secondly, people care about not getting HIV and other diseases if they can possibly avoid it. The reason people share needles is because they're scarce, not because it's fun to put somebody else's blood into your body. In fact, you can have horrible reactions. And it's just gross even to say it out loud. Totally. And I think it's worth personalizing this, right? Because you and I were both intravenous drug users in a similar timeframe. I think you were a few years earlier than me and

got sober a little sooner than me. But I was an intravenous drug user in the early 90s through mid 90s. And I got hepatitis C. I thank God did not have HIV. But like you and you describe in the book, getting a test like that for HIV for intravenous drug user around that time is a horrifying. It's scary. It's very scary, because that was a reality of those times and you were in New York where you were taught how to sort of bleach your needles I was in Columbus Ohio where I don't even know that that knowledge made it here but there certainly was no way of getting syringes consistently that didn't involve outsmarting the people at the drugstore. I personalize this to say that, you know, it really is important because I think I've got a lot of years of sobriety. You've got a lot of years of sobriety, but neither of us might have

had those and had the chance to contribute to the world in any of the ways we did if we had caught HIV and died. Right. And this is the thing. We don't value people who use drugs. We just see them as trash to be thrown away. They have nothing to give and that are selfish and evil and bad and wrong. And it always makes me really sad because I know so many wonderful people who use drugs, who used to use drugs, who sometimes use drugs. And all of us, you know, in this society, there's very few people that don't use caffeine, right? There's a lot of people who use drugs. And all of us, you know, in the society, there's very few people that don't use caffeine. Right. There's a lot of people who use alcohol. There's a lot of people who use nicotine. And yet some of those drugs we call drugs, and some of them we don't. And that's, in fact, why the book

is called Undoing Drugs, because that concept is based on racism and cultural issues, not science. So yeah, let's spend a minute there without going down what we could spend four hours on, which is why here in the US we have the policies that we have. Let's unpack a little bit the idea of what you just said, which is that we have three substances that are absolutely very much drugs that are legal. And then we have a bunch of other substances that are illegal and some that are sort of in between at this point, right? The country is going through a marijuana renaissance of sorts where we're making it more legal in a lot of different places. But say a little bit more in, you know, a minute or two about why do we have the policies that we have? Because they are unquestioned by a lot of people. It's like, well, alcohol and caffeine and nicotine are legal.

They're fine. Drugs are bad. Right. And I mean, we've had an entire billion dollar propaganda campaign to teach us that. People believe that things are the way they are because they should be that way. And that is a fallacy. And people have this idea that, oh, you know, some wise body of people, scientists and researchers sat down, you know, at the FDA or somewhere and said, you know, scientifically, alcohol, tobacco and caffeine are the safest drugs. So everything else should be

illegal. Now, there is absolutely no way you could come to that conclusion based on science. Marijuana, for example, is a lot less harmful than alcohol or tobacco. So when you realize that, you're like, okay, well, why are some legal? And it's basically like white colonialists could make money from some of them or thought they could or were able to do in some contingent fashion. And the others, they just decided to demonize basically like white colonialists could make money from some of them or thought they could or were able to do in some contingent fashion. And the others, they just decided to demonize because they associated them with certain groups of people. And when you look at the drug war and how long it's persisted and the results of it, I mean, if locking people up were such a great

treatment for addiction and such a great way to like solve people's problems, why aren't rich people going? Why aren't white people being locked up all the time? You know, it doesn't work. Right. It is not about what it seems to be about on the surface. And I'm not saying there's some great racist conspiracy here, but it is clearly the case that this policy is not fit for its purpose. It does not work. Right. And, you know, the most obvious example for me of that is that we tried it with prohibition. You know, we actually tried it. We said, okay, we've got alcohol here. Enough people said, you know what? It's not a good idea. It's harmful. Okay, great. Let's get rid of it. And we tried it and it just failed so utterly that we gave up and we said, all right, well, you know what, that one will be legal. And so I think we are as a country that the general belief is changing quickly. And, you know, we're seeing it happen before our eyes to some degree, way overdue, at least with marijuana, although I think there's a long way to go with other substances. I think one of the most telling things that we can say to sort of make the very short soundbite

of why so much of the war on drugs is to say, you know, to say it's a racist thing. What do we mean by that? There's a quote from Nixon aide John Ehrlichman in your book that's been making the rounds of different places recently. This is former Nixon aide John Ehrlichman in your book. It's been making the rounds of different places recently. This is former Nixon aide John Ehrlichman telling a journalist in an interview in 1994. He said, we knew we couldn't make it illegal to be either against the war or black, in this case, the war being Vietnam. But by getting the public to associate the hippies with marijuana and the blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders. Did we know we were lying about the drugs? Of course we did. Right. And that is a very rare summation of what is really going on with the war on drugs. Now,

this is not to say that there aren't a lot of people who truly believe in the drug war, of people who truly believe in the drug war and that who are not racist deliberately, but the whole sort of mechanism of it and the way that we enforce it. I mean, when you just look at what happened, we had an opioid crisis. We still have this overdose crisis right now. And what are we saying we should do about it? We're not saying we should lock up everybody who uses prescription opioids or heroin or illegally manufactured fentanyl. We're not saying that. We did say that about crack. What's different about the perception of who's using it?

I mean, it's just so in your face that it's almost impossible to ignore. And I think, you know, when a policy that's this destructive and this ineffective persists for so long, you have to look at other things going on culturally and see what they are. prescription opioids and heroin these days about what we do with those people, calling it an epidemic that we want to treat. The end users we are treating differently because largely the argument would be made they're white and with crack we did very differently. We locked them all up. That part of the drug war is different. But on another front, we've done exactly the same thing with this drug war, right? That's a really good point, because it's not like we actually aren't locking people up for heroin and fentanyl and all these things. We're still predominantly locking up people of color, but we're locking up plenty of white people for that, too. The rhetoric is what has changed. The policy itself has not really shifted. And this has caused a tremendous crisis because what we did during this overdose crisis is we said, oh, my God, like people are taking too many prescription opioids.

Let's just cut the medical supply. And so we did that and we thought, oh, that'll solve the problem. Well, you cut a supply of something that people are addicted to. Somebody's going to supply that market. And lo and behold, that's what happened. And of course, that made overdose deaths worse. The thing that always kills me about this situation is that, you know, when you're closing a pill mill, you have a list of every person who's a customer there because they have to have the real name in order to pick up the prescription. So why didn't we immediately offer care to all those

people? Why did we spend billions of dollars like identifying these people by like looking at prescription monitoring databases and all of this kind of thing, but do absolutely nothing other than throw them out of the medical system when we identified them? Right. Yeah. I read that piece you wrote about that. And I was really struck by that very question. Why didn't we? We did know exactly who these people were. We knew that they had, most likely, we could say, a problem. To your point, I don't think it's necessarily done out of malice. It's done out of, to me, complete ignorance.

A complete ignorance of what actually works. Well, there's that, and there's also the fact that we've made doctors terrified yes to prescribe opioids and that we're killing people with chronic pain and even we're just torturing dying people now because i just did this piece for wired about this algorithm that um ends up harming people that's in prescription drug monitoring databases. My email box and my Twitter feed is filled with these horrific stories of people with intractable pain who are now disabled and they used to be able to like play with their grandkids and now they can't get out of bed or people who are dying and they won't give them opioids. They're like, oh, your dose is too

high. I mean, who is saved by that? Like, what is the point of that? So it's really distressing. But I think like we have this false idea and that has unfortunately been sort of carried through with the lawsuits against the opioid manufacturers that these are evil substances. They're like cigarettes. We must stomp them out. They don't have any use. and if anybody says they have a use they are addicted or they are paid by pharma and that is just not true opioids are different like they do have a medical use and i would like some of these people to spend just one minute in the body of one of these chronic pain patients that i speak to and continue to have their opinion that even the modest relief that they're getting from opioids should be taken away. It makes no sense because

what we have done in this whole situation is we've said, oh, the innocent white people got addicted by doctors and they are victims. Bad black people took crack and they are criminals. And so we created this like line about how the opioid crisis was sort of accidental addiction, when in fact, 80% of the people who misuse prescription opioids do not have a prescription for them. They are taking drugs from somebody else's medicine cabinet or their friends or their family or buying them on the street. And so this idea that we just turned all these innocent pain patients into people with addiction. Now, certainly there have been some pain patients that got addicted. But for the most part, the people that got addicted were not pain

patients. And the people who were pain patients didn't get addicted. Right. You've got several articles out on the web that people can look for that I think are really worth reading if you don't want to read the whole book, although I highly recommend the entire book. But there are these, you know, where we talk about the standard narrative of this opioid crisis, which is first to blame was big pharma, because they went out and told us this stuff was safe. Second to blame was the doctors who just started dispensing this stuff like crazy, you know, and then the last to blame are the evil drug dealers for putting fentanyl in there. And there is blame to be ascribed in all three of those cases to varying and lesser degrees. It's there. But as you say, there's a fourth person to blame, or party to blame, and it's our policy, which, you know, I watched what was happening as I saw,

like, all of a sudden, we're cracking down on opioids, prescription opioids, I went, well, I know exactly what's about to come happen. We are creating a ton of street drug users. Yeah, what was amazing to me about this that, you know, a lot of people don't understand, if you think about your average chronic pain patient, who's like a middle-aged woman, how's she going to go buy heroin? You know, unless she has a long history of previously using other drugs, you know, it's not so easy to just go, what do you do? Go to the worst neighborhood you could find and say, can I have some heroin, please? Are you selling it, sir? You know, you're going to get ripped off.

The way people were able to go from the prescription opioids to the street was that they started on the street and they already knew how to buy drugs in that situation. Now, again, this is not universal. And there are certainly some people who, you know, after they went to their doctor, there was some drug dealer hanging out in the parking lot or something. For the most part, it is different populations of people. Right, right. I think there definitely is an extent like that you said, where, you know, I think that savvy drug dealers were like, okay, these pill mills are getting shut down. Here's our customer base. But your point is by and large taken. And I think it's important to make a distinction at this point between opioid dependency and addiction, because these are very different phenomenon.

And so someone who has chronic pain, and I've been living this a little bit over the last three years, because my mother has in the last three years, twice fallen and broken her hip or her back, and was in a car wreck, I don't know, three weeks ago, where she broke three ribs and has a punctured lung. So I've been familiar with how difficult we make it for people who are in real pain to get opioid medication. I think, luckily for my mom, I have been here to help advocate for her in a sane and reasonable way, or I think she would have lived in a lot more pain than she did. And we've navigated, you know, okay, well, we don't want her on these things long term, we got to watch out for addiction risk, right? Addiction runs in my heart. And so I do recognize that, like, you got to be careful with this. And as we typically tend to do, I think we've overreacted to the problem. And we've gone so far that we've made it very hard for decent doctors and people who are in pain to get the medicine they need. Right. It's just so ridiculous, because who benefits from your mom not getting her pain treated? You could say,

well, maybe you benefit because then you can't steal her drugs. But I'm sorry, that is not the way I want to make policy. I want to make policy based on let's treat the actual patient in front of us, your mom, not some elder person who might steal their medication. I mean, that's just not okay. That's right. So explain to us the difference between dependence, which my mother, if she takes an opioid pain medication for a long enough time, she will develop a physical dependence on that. But that is not the same thing as addiction. So what is the difference? Sure. So addiction is compulsive drug use or other kinds of compulsive behavior that continues in the face of negative

consequences. So it has to be harmful. It has to harm you or others, but it continues despite all kinds of punishment going on. Or let me just say it continues despite you facing and suffering through all kinds of punishment. In fact, if punishment worked to cure addiction, it wouldn't by definition, exist. So that's addiction. Dependence is physically needing something to function. And you could be dependent on Prozac. You could be dependent on insulin.

You could be dependent on certain blood pressure medications. But you're not out there craving these things, thinking about how wonderful they are, spending your whole life seeking them. They do produce relief, but not in the way that something like an opioid can do. And so dependence, when you need something to function, is not necessarily a problem, so long as you can get a safe and legal supply of that thing. If they made Prozac illegal, I would probably be in trouble, but I don't think I would be robbing drugstores. So, you know, it's just not the same thing. And I think a good example here is cocaine, because cocaine causes absolutely crazy levels of craving and compulsion and repetition. And you

find yourself doing it even when you don't want to do it. But you don't get sick when you stop doing it. You don't get physically ill. And so people used to believe that cocaine was not addictive because it didn't cause physical dependence the way something like opioids and alcohol do, where you're puking and shaking and you have this reliably predictable set of symptoms. So distinguishing between the two is essential because if you consider dependence and addiction the same thing, anybody taking certain medications for addiction treatment is considered as substituting one addiction for another. And so they are seen as just as addicted as somebody who's like shooting up 40 times a day on the street, even though the person on medication may be getting their children back, getting their life back, getting their job back, having a really

productive life and being completely indistinguishable from somebody on any other medication. Right. So that is essential to making that distinction. And it's also obviously essential for pain patients, because if the benefit of the opioid outweighs the risks, then that person should have the access to those medications. If they, on the other hand, are compulsively taking the drugs in higher and higher doses and risking more and more, then they have an addiction and we need to do something about it. The irony here is what we tend to do about it and the best treatment for it is an opioid. So we just need to give them a safe dose of buprenorphine or methadone, which are the

only ones we're allowed to give. So when you understand that the problem in addiction is not physically needing something, the problem in addiction is compulsive behavior that's ruining your life. And so you might still physically need something. I physically need something. I physically need Prozac. It could have just well been methadone, but I'm not going to judge because like Prozac happens to work for me and I didn't find methadone useful because I was still shooting I'm Jason Alexander. And I'm Peter Tilden.

And together on the Really Know Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer. Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you and the one bringing back the woolly mammoth.

Plus, does Tom Cruise really do his own stunts? His stuntman reveals the answer. And you never know who's going to drop by. Mr. Brian Cranston is with us today. How are you, too? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really, No Really, sir.

Bless you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really, no really. Yeah, really. No really.

Go to reallynoreally.com. And register to win $500, a guest spot on our podcast, or a limited edition signed Jason Bobblehead. It's called Really, No Really, and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. I think this is an interesting point and one that I've had to really sort of search myself on, and I know you have too, which is that I was able to get off of heroin completely and was not on something like methadone or suboxone, something that you

would take sort of in an ongoing way. And for a long time, I really thought that the way I did it was the only way or the best way to do it. And while I'm grateful it went that way, for me, is it better to get all the way off? Is it okay to be sort of in between? Does it matter? Or is it really up to the person? Yeah. I mean, I think, you know, all of our brains are wired differently. And there are people in this world whose brains are wired for whatever reason to need an external opioid to function. And if they have that, they are just like anybody else and can get on with their lives. If they don't, they will be compulsively seeking it on the street. And it is not any better or worse for me as a human being that I happen to need Prozac to

function. And, you know, I just don't see it as a moral issue. If we're going to actually claim that addiction is a medical problem and that it can result in or can be led to by certain brain issues, then treating it with a medication makes sense, just like depression or anxiety or whatever else. And so I don't believe it's morally superior to be on Prozac compared to methadone or to be completely abstinent of all substances compared to having to have the substances to function. I mean, that is simply ableism. You know, it is really, you know, for me, I have a lot of sensory issues and a lot of difficulty with emotional regulation if I don't have my Prozac or my Wolbutrin. And so I have found in my life that I am happier.

Everybody else around me is happier if I take these medications and I can function socially and I don't get overwhelmed as easily and I can do all things better. I really don't think this makes me a bad person or a lesser person than someone who achieves that through therapy or exercise or whatever. It just like, why would that be? Like, that just seems wrong to me. It seems like it would be the same thing as saying I'm a better person because I don't need a wheelchair. That makes a lot of sense when you put it in that context, because it's interesting, because what I think about is a yes, I am the same way in that antidepressant medications appear to be what my brain needs. Right. And there are people that will will make you feel bad for that. I get more natural remedies for depression across my desk of people that want to be on the podcast who insist like, you do not need those things.

It is wrong to take them. And my experience has been that even when I do everything that is recommended to treat depression, when I exercise, I eat the right sort of diet. I talk to people, depression. When I exercise, I eat the right sort of diet. I talk to people. I have connections in my life. I do all the things that I know treat my depression. And I think I'm pretty good at those things. I still find that I need the medicine, right? Or that the quality of my life is different if I take the medicine. So for me, where I get sort of hung up, right, or get a little bit stuck, and this is ableism, I think what you're saying, is because for me, where I get sort of hung up, right, or get a little bit stuck, and this is ableism, I think what you're saying, is because for me, I'm glad in some ways that, how do I want to say this?

I find that my recovery from depression is best done with medicine and with all these other things. If I only have one of those or the other, I find for me, it's less richness and quality of life, which sometimes leads me with substance addiction, like being on something like Suboxone to think, well, because I got so much out of recovery, wanting that for other people. But I think like we're saying here, one isn't better than the other and everybody is very different. And I'll let you respond to that.

And then I'm going to take us in a slightly different direction. Sure. I mean, I think the problem is that we get hung up on the idea that these are opioids. And therefore, having that thing in your system is numbing you and making you emotionally unavailable. And all of these things we say about people with active addiction that aren't even necessarily true about people who are chaotically using. But we sort of have this, you know, suspicion that like the people on methadone are just like not living their best life. And if they completely came off,

they would be happy, joyous and free and everything would be great. Now, the problem there, first of all, our methadone system is terrible and people would probably be more happy, joyous and free without having to show up at a clinic every day. But that is a problem of our system, not a problem of the medication. Secondly, it simply isn't the case that some people can function without certain chemicals. And that doesn't make them lesser or greater or, you know, I mean, I kind of look at it like for me, I'm sort of highly tuned up and oversensitive and, you know, just reactive all over the place. And so I need to turn the volume down. And this is good for me. Now, if you're already with the volume turned down, and you take something

like an opioid or an antidepressant, it might make you suicidal. It might make you feel numb and disconnected and all of these things, because like I'm trying to go from up here to here and the medication for these other people is taking them from here to here. And so I am demonstrating this on video, which of course is not going to be seen. But the point is that people are starting at different starting points and that the drug that makes me feel safe and comfortable and okay may make someone else horribly numb and despairing. And because of these huge individual differences, whatever works for you is what I want for you. If you feel that like, okay, you're functioning on Suboxone well, but like, it's still kind of numbing and you kind of think you could do better off,

we'll try it. And if it doesn't work, you could take it again. We have to get the moralism out of this. I mean, it drives me crazy, those natural people around antidepressants, because they have not lived in my nervous system. That's right. They do not know. That's right. You think you can empathize with other people, but you're only projecting yourself into them. And we can realize that, okay, like that guy's really into cars and I think cars are boring.

And so therefore we can see these, you know, individual differences here. But when it comes to our emotional reactions and the way we are in the world, you know, we don't seem to recognize that people are not all the same on this. And that like, if for me, weightlifting is fabulous and I'm like really into getting my deadlift up, which I have been lately, I can do 225. Wow. Holy mackerel. But I don't have the equipment at home, so I can't prove I can do 250. Anyway, the point is that somebody else might find that totally tedious and I might find whatever they're into totally tedious as well. It's just, we're different. And this is great because, you know,

we need scientists to be interested in viruses and interested in like lizards and all kinds of weird stuff that everybody else finds a little strange. But if we didn't have those people, how would we deal with a pandemic, right? People doing all kinds of obscure things that you never think would matter actually do matter. And also just in terms of being kind to others, everybody matters in terms of that. It breaks my heart that people cannot see this because it just creates this horrible prejudice. And it also creates this division within the recovery community that is not necessary. I feel like over the years we have gotten much closer to recognizing that my path is my path, your path is your path, I'm not going to judge, blah, blah, blah. But it's still, I think part of the thing is that people don't understand that with opioids in particular, tolerance to the intoxicating effects is pretty near complete.

Yeah. Which means that I can drive, I can whatever, if I can drive, but I don't drive. But anyway, that's another story. But I think the point is just that somebody who's on doses of opioids that might kill me could be completely safe on the road. And that's not true with alcohol. And so since everybody's kind of familiar with tolerance with alcohol, we think that, well, I know that the guy who's had five whiskeys and always does that is probably safer on the road than the guy who had five whiskeys and doesn't always do that.

I don't want to run the experiment, but the thing is that like tolerance to alcohol is not complete. You are still impaired. Yeah, and I think, you know, kind of boiling this all down is sort of whatever works for people. When I got sober the first time,

I think, you know, I looked at everybody who had any problem and I, I think, you know, I looked at everybody who had any problem and I thought, well, you probably, it's probably drugs or alcohol is your problem, right? You know, and abstinence is the way to go. I have come, you know, so far from that in the coaching work I do with people. Oftentimes, you know, if people are, if people are asking these sort of questions, you know, what can really be helpful is just to have someone to explore these questions within a non-judgmental way, because for some people, it may be abstinence. For other people, it may be moderation. It just really, really depends

on the person. It depends on what they want from life. I mean, there are so many variables. I mean, it also depends on the substance, because like, I have no illusions about safely being able to use cocaine. This is interesting because for me, anytime I wade into these waters and I hear about responsible drug use, a part of me inside goes, aha, yes, Eric. Right. I think that might work. And I'm curious, as a recovering person, how does that work within you? Have you chosen to remain sort of a, feel free to demur on this question if you want to, but have you chosen to remain sort of what we would classically consider

in recovery, in abstinence? And do you ever feel called by the sort of arguments towards moderation? And do you ever feel called by the sort of arguments towards moderation? Sure. I mean, I have now done a more moderation style, but I do not take ever opioids or cocaine. And I would take opioids if I needed them for pain. But thankfully, knock on wood here, I do not. And I hope to stay that way. I have taken other things and it has not been a disaster for me,

but I am very careful about my use of things, whether it's alcohol or marijuana. I'm very, very careful. And I think that for my own recovery, the first five years, I wouldn't even do antidepressants. And that was a mistake. Like I lost time in my life, where I could have been much more socially happy by thinking that abstinence from all these things was the only way. And then I spent at least another two years, just antidepressants, nothing else. And then after that, I did begin, you know, sort of experimenting and it didn't become a disaster. So I feel okay with it. I have to be careful. And like I said, I'm not entertaining any casual use of my drugs of choice, which were opioids and cocaine. And I never played around with methamphetamine and I have no desire to do that. So, you know, would I possibly take psychedelics? Maybe, but it's funny because I,

I just don't want to. And I had one experience kind of, I don't know, four or five years into recovery. I had to take, I don't know, Vicodin or something for a dental thing that was really painful. And I called my sponsor, I did the whole thing I was supposed to do. And when I took it, I was like, this is what I was chasing this, you know, I mean, it was really like, you know, it was disappointing, you know, and so it didn't create any craving. I think I never would have been able to make myself have the dental work that was very much needed if I hadn't known. And my dentist is actually in recovery. And so I trust him to say,

you will totally not need opioids for this. You might need a few for this, but I feel safe. And that's the thing that also drives me crazy about the way we have control over the situation, because one of the things that opioids are part of our stress system, they're part about the way we have control over the situation. Because one of the things that opioids are part of our stress system, they're part of the way our brains opioids are part of the way social contact relieves stress and anxiety and fear and being out of control increases stress. So if you actually want to not have people lose control over substances, you want to give them a sense of safety and non-anxiety about whether they will have the pain relief that they need. And I think that, you know, it is absolutely the case that

untreated pain and agony is every bit as much a trigger as euphoria. And so if you're worried about euphoria, the best thing to do is have your sponsor there or whatever your recovery support person is. Make the doctor give you a prescription for only two pills, like get a lockbox. There's all kinds of ways that you can prevent yourself from doing something impulsive that will get you into trouble. But you can also take care of pain as needed. It's just so depressing to me because I just hear from all these people who like, you know, oh, they just told me I was a drug seeker and turned me away. And it turned out like I had a perforated colon and I needed emergency surgery later. And all of this kind of stuff to prevent something

that wouldn't actually, even if that person had been a drug seeker, who cares? It's like, they got extra safe drugs. Like they're in a hospital, there there's Narcan. It's just, I don't know, like the moralism there and the idea that like, we must suffer because it is good for our soul. You know, even for people who are dying, like, really? Like, why? I mean, it's interesting. I think that, you know, the pendulum has swung so far, anti opioids and anti, you know, pain relief for people that it's bound to come swinging back. The problem is it went too far the first time. Yep. We need to be in the middle. We got to keep not having extreme swings where it's like, yeah, opioids for all or like, no opioids for none. You know, the answer

is in the middle. It's complicated. It's annoying that it's complicated, but that's life. Totally. Yeah, I think it is complicated. And it is annoying that has to be that way. But it is. It's interesting, because where I've landed is I stayed sober about eight years off of opioids off of heroin. And then I went, as we would say in the program, I went back out and, you know, I drank and I did marijuana and I never went back to the opioids, never really went back to cocaine. And I spiraled completely out of control on alcohol and marijuana. So my general sense for me is like, well, they all seem to work about the same in my system in that I seem to have an equal propensity to abuse all of them. So for me, I haven't found the mood altering chemical that is safe for me. Right.

And I can like, I never, ever, ever encourage people who are abstinent to try moderation or to, you know, decide differently about what is their best path to recovery. If you are abstinent and it is working for you, that's fabulous. I applaud that. That is great. You don't have to prove you can do it moderately or any of these other things. Like, no, you are doing harm reduction for you. That is fine.

I understand how people can be threatened by the idea that some people can moderate and they can't. Like, it feels unfair. Totally. You know, people can sort of get in their head, well, maybe I could. But that is where you have to talk to somebody who's in abstinent recovery or who supports your own abstinent recovery about why, for you personally, that's a bad idea because we saw you do this two times ago and no, you did not stay in control. I mean, so it's funny because, you know, in the big book, it says like, you know, if you're not convinced, try some controlled drinking and, you know, you'll come back to us because you won't be able to do it. And if you don't come back to us because you can do it, that's fine too. That's right. Wonderful. Great news. Yes. And so like, I don't understand why there is such a sort of moralistic fight by abstinence treatment providers to like never let anybody experiment with control, even when that means you're just going to throw them out of treatment and they're not going to have any support for moderation. you

you talk about how our entire drug treatment model well there's three main models but two of the three uh sort of 12-step programs and the other sort of you know therapeutic treatment communities abstinence from all mood altering substance is the goal and the only success. And anything short of that is seen as failure. Why is that the wrong gauge of success? Or why is it wrong to only have that as a gauge of success? I know oftentimes people in meetings are joking when they say this. But you know, if they go into a meeting and say, I killed 10 people, but I didn't drink, I had a good day, you know, or like, I lost my job, I lost my house, and I didn't drink. So I had a good day. Like, that is not a good day. It's great that you drink. But what actually matters is your quality of life. And this is what everybody you know, like,

regardless of addiction status, we just all want to like connect with people, be happy, be productive, be, you know, safe and okay. And that's what matters. It's very hard to see that because we do become so fixated on the substances and on this idea, well, you know, because abstinence versus not abstinence is this nice binary and harm reduction is like a continuum. And as we can see with gender debates, people are freaked out by non-binary. That is not correct. And we should be allowing a spectrum of things because life is on a spectrum, but people i'm jason alexander and i'm peter tilden and together on the really no really podcast our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor

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Yeah, really. No really. Go to reallynoreally.com. And register to win $500, a guest spot on our podcast, or a limited edition signed Jason Bobblehead. It's called Really No Really, and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. Really like the black and white, good and bad, like light and dark, all of that kind of thing, because it's simple. And so we need to recognize, you know, complexity exists. And yes, sometimes complexity is going to freak us out.

But I think if you have to be so rigid that everything has to be black and white, you're not going to have a happy and comfortable life and productive, you know, I mean, because that rigidity is itself a compulsion. And I recognize that early in recovery, a lot of people who are abstinent are very rigid and maybe that's protective for the first two years or something. But if you can't, after that point, go to a concert and hear music or see an old friend and not lose it,

you're not living your full life that way. Recovery should be an expansion and growth and being able to do more things, not like contracting into a little ball and focusing only on the fact that you are absent. I mean, there are some people that have died by suicide rather than relapse. And I think they should have relapsed. I'm 100% on board. But it's just like, you know, that's like to think that that is a success. It's like crazy. Totally. As though we need to really keep our eyes on the ball and just be like, okay, what do we care about? People doing well.

People doing well by whatever measure, you know, and this is why, like, in the harm reduction community, there's this idea that recovery is any positive change. And some people feel that's too loosey-goosey or whatever. But the kernel there is that if you are getting better, and your life is getting bigger, and you are able to do more and more things and connect with people and all of this kind of stuff, that is recovery. It's not recovery if you are suicidal and you really feel that the only thing that is valuable is the fact that you haven't taken a particular illegal substance. Yeah, I think this speaks to the idea that like if somebody was smoking crack,

you know, every day for years and robbing places to get the money, and they stop doing that and they go to smoking weed three times a week by the abstinence only model, that person has completely failed. And by any sort of objective standpoint, we would say, well, that person is in way better shape than they were before. Now, if that smoking pot three times a week is not causing them problems in their life and is even helping them in the same way that we go, well, go out after work and have a couple beers. It helps people relax. Like, okay, we have no problem with that. So I think it is recognizing that we're different. We just need different things and we want different things and that's okay.

that we're different. We just need different things and we want different things and that's okay. Yeah. I mean, I think like one of the things that is sort of really problematic with the abstinence model is this idea that the first drink gets you drunk and that like, if you slip at all, you have lost all your time and none of your previous recovery counts. Because what that does is it means that if you have a sip, you're just going to go guzzle it because it's like you've already blown it. And that is known as the abstinence violation effect. And it can cause real problems. I mean, there's a really fascinating study that I talk about in the book

where they gave people who were heavy drinkers who had no interest in recovery. They were doing this experiment. They had this bar set up and they basically gave them either placebo alcohol or actual alcohol. And sometimes they told them that the placebo was real alcohol. And sometimes they told them that the alcohol was placebo. And it turned out that people's drinking escalated when they thought they had alcohol, not when they actually had alcohol. So what that shows is that it's the belief that's driving that behavior and that the belief is causing problematic things to

happen. Now, I'm not saying again that somebody in recovery should be like, yes, I can have one. That's, that is not the point of this here. The point of this is that if you do have one, you don't have to have 20. You are not a zombie. And while you may have less and less control over time, you still don't ever become a zombie. You can always begin a process of change. And that may not be visible to anybody else at first. You may be going from 10 drinks a day to five drinks a day. But for your body, that's like amazingly better, right? And then, you know, it's all about learning better ways of functioning. And no learning happens instantly. If you try to learn things, and you don't make mistakes, you're not going to get any better. And it sucks being a

beginner at things. But the only way to get better is to practice and to make mistakes and to then learn how to correct those particular mistakes. And so, you know, that's really what harm reduction is about, because what you're doing while you're still using, some people may not ever be able to get into a significant form of recovery for them if they don't first, while they're still really chaotic, begin to get the skills to be able to maintain that. You know, you may be so traumatized and so, you know, just overcome that if you try to give up the substances first, you're just going to get worse. Instead, if you learn while you are still using that, okay, I don't necessarily have to respond this way when this happens. This is kind of driven by that. And I can try other

methods of coping and I can, over time, begin to build on that. And so, you know, it's just, we have everything so backwards, basically. Yeah, I look at the process of getting even to abstinence recovery, if that's what the goal is, is yeah, it is a constant learning process. You know, I often think about an analogy that's useful is like learning to speak a language. You know, when you start, you can't speak it at all, you know, and then you slowly learn to speak it in more and more circumstances. But you might still run into certain cases, you're like, well, I'm learning French, and I go to France, and I'm like, well, my God, I can't speak it here. Right. But if you keep doing it sooner or later, you'll be able to. And that was my experience and what I've seen so many people do. And I agree with you. I think for

those of us who appear to need abstinence, I think there's benefit in consecutive days of sobriety. I think there is a benefit in it. And the fact that that's the only thing we measure is wrong. We don't measure anything else that way. If you exercised 50 days out of 55, we would be like, that is a success. Okay, you're doing great, right? It's a rounding error. I have a proposal for fixing this, not that it will ever be taken up. But I do believe that let's say you have 10 years and you use for like a couple of days and then you go back and are, you know, going to meetings for 90 days and are abstinence for 90 days and doing what you're supposed to do. I think you get your 10 years back. It doesn't make any sense that you would lose it. You've learned all those things

during that time. You are not the same as somebody who just comes in and has three days after 10 years of drinking. That is absolutely true. And the same is true if you have three months or nine months or six months or three years. Like if you're doing it, if you're in recovery, you're learning all along the way there. And for people who would like to think about addiction as a learning disorder, check out our previous conversation with Maya, where she has an entire book on this, which is wonderful called Unbroken Brain. And I'm going to need to wrap us up because we are over time. You and I are going to continue in the post-show conversation for a little bit, and I want to talk about tough love. I want to turn our attention to the families of people who have substance issues.

And listeners, if you'd like access to this post show conversation and lots of other ones, as well as ad free episodes, and the joy of supporting something that matters to you go to one you feed.net slash join. Maya, thank you so much for coming back on. I love talking to you the first time and I've enjoyed it so much this time. Thank you as well. This was really fun. If what you just heard was helpful to you, please consider making a monthly donation to support the One You Feed podcast. When you join our membership community with this monthly pledge, you get lots of exclusive members-only benefits. It's our way of saying thank you for your support.

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