The One You Feed - Special Episode: Exploring The Different Paths to Recovery

Episode Date: January 31, 2024

In this special episode, Eric is joined by Laura Cathcart Robbins, Carl Erik Fisher, and Holly Whitaker to share their personal experiences with addiction and recovery. Their discussion explores the complex definitions of recovery, challenging the conventional norms and emphasizing the need for a broader and more inclusive approach. In this episode, you will be able to: Explore the distinction between sobriety and recovery for a more holistic approach to healing Understand the personal experiences with addiction and recovery to broaden your perspective Learn how to measure progress in recovery, empowering yourself with tools to track personal growth Explore diverse perspectives on the use of medications in addiction treatment for a more informed understanding Gain understanding of Dry January in the recovery journey, uncovering potential benefits and insights To learn more, click here!See omnystudio.com/listener for privacy information.

I think when somebody is trying and they still experience a return to use or some other problem, they're still practicing. That's the thing that matters is putting intention and attention into a process of change. 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. 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. If you feel under-equipped and overwhelmed to make real sustainable change, you're not alone. That's why I'm going live on Wednesday at 7 p.m. Eastern to present my most popular masterclass, Habits That Stick, how to be remarkably consistent no matter what goal you set. Join me for this free masterclass where I'll be sharing the single most important goal to set if you want to stay motivated and encouraged to build your new habit. You'll learn a simple mindset shift that is crucial for making habits stick in the midst of life's chaos. And we'll also explore the five pillars of consistency, which are so important for making positive changes in your life. Get ready to transform

your habits and achieve remarkable consistency. Join me live on Wednesday at 7 p.m. Eastern. I'll also be sticking around to answer questions, so I look forward to connecting with you then. I really love meeting all the people, so I hope you can make it. You can register for this free masterclass by going to oneufeed.net slash habits. Again, that's oneufeed.net slash habits. I hope to see you there. 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. This is a collaboration episode with, of course, Eric Zimmer from the One You Feed podcast, and also Laura Cathcart-Robbins, host of the Only One in the Room podcast and the author of the memoir Stash.

Also joining is Carl Eric Fisher, addiction specialist, bioethicist at Columbia University, and a podcast host who is also the author of The Urge, Our History of Addiction. And we have Holly Whitaker, author of Quit Like a Woman. She's also the writer of The Recovery Substack. So enjoy this great conversation. All right. We are coming to you not quite live, but I'll just say that the we is Holly Whitaker and Eric Zimmer and Dr. Carl Eric Fisher and myself, Laura Cathcart-Robbins. We are colleagues and friends, and we have decided to come to you to talk about Dry January. Actually, not to you. We're going to talk about it amongst ourselves and what it means and just different things about sobriety and recovery. Like I said, I am Laura Cathcart-Robbins. I am the host of the podcast, the only one in the room. I am the author of the memoir Stash, My Life in Hiding, which is an addiction memoir that came out in March of 2023. And this is the second time that Eric Zimmer from

The One You Feed and I have come together to have this type of discussion in a dry month. The last time was dry July, this time it's dry January. And we're going to talk about what that means and what it might mean to each of us on this podcast. But that's who I am. And we're going to talk about what that means and what it might mean to each of us on this podcast. But that's who I am. And I wanted to just kind of go around and have everyone introduce themselves before we get started in this discussion. And Eric, do you want to go next? Sure. I'm Eric Zimmer, host of the One You Feed podcast. And I also run a program called Habits That Matter that brings together wisdom and behavior change so that we live our lives in a more meaningful way. And I'm really happy to see you again, Laura, and see you, Carl, and finally meet you, Holly.

It's been a long time. I've heard about you for years. Yes, same. And we've never crossed paths, so I'm happy that's finally happening. And so to Holly, do you want to go next? Sure. My name to Holly, do you want to go next? Sure. My name is Holly Whitaker. I am the author of the book Quit Like a Woman, which focuses specifically on alcohol and women and the recovery industry.

I have founded a recovery-based company and developed a modality to help specifically with alcohol use disorder. And I currently write the recovering column on Substack, even though I'm on a little hiatus from it and working on two books on this topic that we're talking about tonight on recovery. So really excited to be here with you all. Laura and Carl are friends of mine. So Eric, it's nice to meet you. I've heard about you for a long time too. And Carl. It's great to see you all. I'm Carl Eric Fisher, addiction psychiatrist. I'm a bioethicist at Columbia University. I wrote a book called The Urge, Our History of Addiction, which is a history of addiction from ancient times to the present day, interwoven with some of my experience as

a person in recovery myself, including some reflections on my family history of alcoholism. I host a podcast that's called Flourishing After Addiction that focuses on all sorts of different people, deep dive interviews about how we make sense of addiction and recovery. And I do have a sub stack newsletter that I just launched two weeks ago at Holly's Encouragement and so much encouragement that she named it for me because I can't name anything myself. All of my best titles come from friends. And it's called Rat Park. And I love it so much. So thank you, Holly.

I've got to say I'm a little nervous. And I don't know if I want to use the word intimidated. But I feel like because the three of you are so established and so well respected in this area that I want to rise up to the same level. And I just need to just be me and do my thing because I'm not educated in this area. But I've had a lot of experience of my own. And Holly's like, yes, you are. Oh, I'm like looking at you. You're who I call. What are you talking about? I know. But you know what I mean? I mean, you don't have any like professional credentials, but you are you sponsored. I mean, I'm sure

hundreds of people at this point. Thank you. Thank you. Yeah. So yeah, I mean, more than I do. Well, but yeah, okay. All right. I do have experience. I have something what I believe is valuable to contribute. And the first thing I wanted to bring up was my experience. So I've been sober for a little over 15 years. And when I first got sober, it was just literally taking away the substances. Like I stopped taking pills and I stopped drinking and I didn't have anything mind altering in my body. And that was sobriety for me. And it was excruciating. I was in an incredible amount of pain after I stopped.

I was in as much or more pain, actually, after I stopped than when I was using. And I got sober through a 12-step program, which I'm still in and still a part of. And eventually, as I engaged in like the tenets of this program, the principles of this program, I started to feel some relief. And I think of that as my recovery, rather than me being completely abstinent. And I find that that's kind of scary for people, because at this point in my recovery, I don't value the abstinence as much as I value the work, the recovery.

So yeah, I feel like there is a distinction for me now that there wasn't before. And I know that things continue to evolve. I think you can be using substances and still have recovery. And I also think that you can be completely abstinent and not have any recovery. But I was wondering if you all had any thoughts on sobriety versus recovery and if you do what they are. Yeah, well, I think that's a really powerful reflection and really complicated. We could probably have a whole day-long retreat or seminar on that topic. Because for me, what it reflects back is the variety of different recovery experiences and the notion that everybody has a different experience of recovery. There's not one pathway to recovery. There's probably as many pathways to recovery as there are people

who are seeking recovery. But just to simplify it so I don't take up too much space, I had a positive and a negative reaction. Positive reaction is I think it's really crucial that people in general come up with their own notions of recovery and seek it out in a positive toward sense, not just stopping. For many, many people, not just limited to 12-step recovery, that includes getting outside the self and finding some sort of advice or feedback so they're not just running their own show. The negative reaction I had is speaking from within the medical profession. There is a history of definitions of recovery being used to gatekeep in certain ways. It tends to be about power and judging people who use substances by saying what you're doing does not count as recovery. This is one of the things that I was interested in when I started my sub stack was all these different notions of recovery and everyone has a different definition,

different frameworks, different components of it. You know, just one example is an older, more conservative definition says it requires a sort of conformity to ethical norms, quote unquote, citizenship as part of recovery. Well, who's citizenship and who gets to decide? And for some people, recovery involves radical activism. And why can't that be a part of recovery? Well, who's citizenship and who gets to decide? And for some people, recovery involves radical activism. And why can't that be a part of recovery too? It's really tempting and dangerous. And I've seen it happen within the recovery community and also from the medical community down to the recovery community to use like different ideas about sobriety and recovery to discount other people's experiences. So do you think there's a difference between sobriety and recovery?

Or do you think they're one in the same? I tend not to use the word sobriety unless I'm working with a client and they value that. Usually it's a starting point for a discussion. A lot of people like the word sobriety in the context of emotional sobriety. And I like that. I strive for emotional sobriety. sobriety. And I like that. I strive for emotional sobriety. For me, it's a big intention not to snap at my child or even just to be generally crappy, just to be grumpy and not show up and be selfish around him. That's a relapse for me. Is it a relapse that's going to lead me to using alcohol?

No. Is relapse always the right word for everyone? No. It can be a very stigmatizing word. Some people really hate the word relapse. I favor a really broad and inclusive definition of recovery. And sobriety is, I think, in some ways even trickier. I don't know. What do you all think? Yeah. I mean, I think definitions mean different things to different people and can be used in different contexts. And, you know, for me, all of those words are problematic in certain ways and useful in certain ways, right? And for me, sobriety, meaning an abstinence from mood-altering chemicals has been really important to me. I don't think it's the end goal for everybody. I don't think it has to be the end goal. For me, it was the right end goal. And I'm glad to have achieved

that for a substantial amount of time. Now, the thing about recovery that I don't like as a word generally is it makes it sound like I'm going back to something. I'm going to recover something that I had. And honestly, for me, my sobriety journey has been about becoming something that I really never was before, right? And that's somebody who's able to deal with life as it comes to me without having to take mood-altering substances. It's somebody who can do the things Carl talked about, which is be more emotionally mature, where I don't snap at people, where I think about people other than myself.

So for me, recovery is useful in that we talk about recovery and being recovered from an addiction, right? But I think where it ceases to be useful is that I wanted a whole lot more than just being recovered from an addiction. I wanted to continue and still want to continue to grow as a human being and become a better and better person. And that is the place to me where it's not so much about going back. It's about going forward. You know, I think for me, sobriety is, I don't know how I feel about the word sobriety anymore. I think that it was very clear early on that it was a very important word to me. For me personally, when I started, my theoretical ideas around recovery are far more advanced than my personal bias. And so I could say when I started, my theoretical ideas around recovery are far more advanced than my

personal bias. And so I could say when I was in early recovery or in early sobriety that I believed in a harm reduction approach. And I did theoretically, but I was very threatened by those things. And I think on a personal level, I couldn't see how recovery could include the continued use of the substance that you were struggling with in a dependent or addictive way. And so what's changed is not so much how I view it, even though that's changed, like the outward theory that I have around what sobriety is or what recovery is. I have gotten deeper in my own process and my own path, like my biases and my personal feelings about it and my knee-jerk reactions around what these words mean and who can use them and what they're supposed to do has really, it's almost like just ascended to where the theory is. And I know that sounds really confusing, but I guess what I'm saying is I think like anybody in recovery, I've really struggled with who gets to use certain words and who doesn't get to use certain words. And I think that when Eric said that there's a lot of gatekeeping in the medical community around these words, I was thinking before there's a lot

of gatekeeping within the recovery community around these words. I think like far more than there is in the medical community because that's where I've experienced the most infighting and truly like complicated conversations around these words. And so just to be very direct and quick about it, I think like Carl, sobriety is a word and Eric and kind of, I guess all of us, like sobriety is this word that's kind of, it's just not key. I will accidentally use it. I rarely intentionally use it when I'm discussing anything. I think I conflated it so much with recovery early on. And to me, recovery, Carl shared with me Jan Brown's definition of recovery, which is, I think anybody who says they're in recovery can be in recovery. You're in recovery if you say you are.

Right, right, exactly. You're in recovery if you say you are. And I think to me that feels important. And I think words are, like Eric said, I think like there's really no words that exist in our lexicon that are not problematic because of what we've done to those words or how those words have been used. And so like even like words like relapse, right, or return to use or trying to find like what the adequate term is to reflect what the experiences of millions of people that all have these like vastly differing experiences we're all trying to capture with one word is just, it's a really, I think, impossible thing. Yeah. I feel like I learned so much just listening to each of you,

just then, like gatekeeping and problematic words and the idea that you're in recovery when you say you are in that self-declaration. And Holly and Carl, you both mentioned relapse. My dad is a HIV doctor. He loves his work. All of his patients are living now. You know, they used to in the 80s when he first started, they died. And now they die of natural causes. They don't die from HIV or AIDS anymore. to a state that is probably going to kill them, right? Something bad has happened and they are back to a state where they have to recover or work to recover to get back to where they were before. For us in the 12-step community, a relapse, I feel, is also seen that way. When the word relapse is mentioned and someone says that they have started using or drinking again, I feel the ripple through the room is that something devastating has occurred. There's been a failure of some kind, a loss, not just for that person, but maybe for the community, right? Like, we all had a stake in

this. And now we're all, you know, kind of reeling from this admission that something was picked up, or someone had a drink or someone shot some dope or whatever it is, or someone threw up when they're in recovery from an eating disorder, whatever it might be, whatever that relapse looks like. And like I said, I think I said this in the beginning, I'm really hesitant to even use that word, but I think it's very problematic. I don't have another word for it. So one, I wanted to see if you all do. And then just to hear your thoughts on, like for me, my old ideas were like, if you pick up anything ever, you're back to one, and you may not ever make it back. Like if you pick up anything ever, you're out there,

and you may not ever make it back. Meaning if you drink again, or you use again, you may not ever get this time back that you've amassed, right? 10 days sober, 10 years sober, whatever it is. Sober meaning without use of any substances or alcohol. And so do you all think this is true? One, do you think it's true that you lose something when you pick up again, if you pick up again? And pick up meaning drink or use again.

And if it's not true, what might your new ideas be around this subject? And if you have a name for it that isn't as problematic as relapse, or maybe you don't think relapse is problematic, and that's the word you use. Let's go to Eric first. Yeah, I mean, I think this is another loaded term. Do I think that we lose something if we pick up or use again? I think it depends on what we're aiming for. But in my case, yes, I did. I do lose something. And you use the term relapse, meaning a dangerous condition, right? Going back to drinking and drugs for people like me is a dangerous thing to do, right? It actually is, right? And it's far more dangerous today than it was 15 years ago, right? I was an opioid addict, right? I was an intravenous heroin user.

It is dangerous out there, right? And so not doing that is a far safer place to be. The other reason that I feel like I lose something is that to me, a length of continuous sobriety is what caused the craving to use to go away. To me, that is the worst feeling in the world. That literal tearing apart of my soul when one part of me is screaming, don't do it. And the other part is screaming, do it. Right? And so space away from that, thank God that goes away. So in that way, yes, I do think we lose something. Do we lose everything? No. That's where I think the mistake is, right? In a lot of recovery communities, you could have five years and if you use, you are back

literally to day one and you are considered an absolute beginner. You failed a hundred percent, right? As if those five years didn't give you something. I was sober eight years the first time around and I went back out and used. And did I lose something when I did? Absolutely. Did I have to fight my way back into recovery? I did.

Were there people who like me had periods of sobriety that went out and have never made it back and several of them are dead? Yes. Right. But I didn't lose what I'd learned in those eight years. It wasn't gone. Right. Matter of fact, it was part of what allowed me to come back because I was able to see some things in myself that there's no way I would have seen before that period of time. So I think that's where the mistake is, that we lose everything. And I think this grading system we have of 0% or 100% is really problematic. Because we don't grade anything else in life that way. And so it's a very tricky thing, because I do think permanent abstinence is a very valuable thing. And I don't think we should only be grading 0% or 100%.

We have to look at progress. is a very valuable thing. And I don't think we should only be grading zero or a hundred percent. We have to look at progress. And if I look back at my recovery story, and I would imagine most of you would say this about yours, there was a period of trying and failing and trying and failing and trying and failing. If we want to use that word, right? Trying and learning would be a better way to say it. Trying and learning, trying and learning, trying and learning. And then I was able to get to full abstinence. And I would have much rather had that context in my mind as I was going through it instead of trying and failing. Trying and learning, yeah. Right. And so I think it is a useful term, and I think we lose something, but I also think that it can be problematic if it's applied too strictly. So those are just my thoughts.

Holly, what are your thoughts? What were the two specific questions? I was asking one, if this is a word that you use, but the first question was, you know, the black and whiteness around it. Is it a failure? Do we lose everything? Yeah. In the 12-step recovery, of which I'm a member, you lose all the days, right? You do start counting again. Does the book say you lose all the days? Or is that what the people did? But do you know what I mean? Is that like just a norm? Or is that what the book dictates? I think it's the people. Yeah. I don't think the book says anything about counting sobriety. No. which is it doesn't say in the book that you have to reset your day count if you use drugs and drink again. And I think the reason I bring that up is because I think, isn't that interesting? That that's like such our human nature is to say, like, where does that come from? It comes from us saying

you don't get to, you messed up, you have to reset and go back to day zero. It comes from this, have to reset and go back to day zero. It comes from this, like this, this idea that somebody with an addiction kind of has to, you know, just take it, you know, and just do whatever it takes because you don't have any agency over this. This is what the group says. You have to give back your days or whatever it is. And so I think a lot of times when we're operating around words like this, we have to like, remember like a lot of this stuff isn't codified anywhere. It's just stuff that we do because of, you know, like what came out of like the group think or whatever, and also came out of whatever was operating at the time that those norms were formed. So when I think of like, there's some statistic, I think, and I will try and find it so you can include it in the show

notes, but I'm not going to say this is a hundred percent accurate. Maybe Carl, you know this, but I think it's like 5% of people that try for an abstinence-based recovery actually make it from start to finish without return to use. That very few people that are going for an abstinence-based recovery actually make it through without relapsing or without return to use. And so when I think of it, I think of like, and the problematic nature of it is that that figure that comes from research that I will find and make sure is accurate. But when you think about that, this is like a very normal, if it's 95% of people that are trying to not consume or consuming or trying not to use or

using, that's interesting too, right? Because it shows that this is just like a normal occurrence. And that's how I view it really is like return to use is just a normal thing as part of the process of trying to overcome an addiction to a substance or whatever it is. And that like, of course, we've turned it into this naturally occurring. That's actually like proof that you're trying, right? Because like if you're relapsing, right. Or if you're going back out, like you're going back out from somewhere, right. This is like part of what we do, but we've carved this out to say this one exceptional thing that I think until like the 70s wasn't even a word that was like discussed in, you know, in treatment settings as like a potential outcome.

We've created a lot of fear around something that's just a normal part of the process, you know? And I think like to be very clear what Eric said, there was a huge consequence in certain situations to that phenomenon, right? But that is just part of it. And return to use, the other piece about it, you asked like for, you know, like what words, I think I use return to use, but there's also like, there's so many different definitions of relapse that there's really no, like one, this is exactly what a relapse is. There's no working definition that we're all using and coming back to, you know, like somebody could say, I accidentally, you know, took a sip of my mom's wine and I've relapsed,

right? And somebody might call that a lapse and somebody might not even mention it because it was 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. 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. Bryan Cranston is with us today. How are you, too? Hello, my friend.

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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. Apple Podcasts or wherever you get your podcasts. I love return to use and I find it just even in the idea of it to be really comforting because it doesn't feel as heavy or as blaming as relapse might feel. And I'm wondering, Carl, from a medical standpoint, and I don't know if you do this, but if you were counseling people who have a loved one that's dealing with this, what words do you use when discussing return to use? And do you try to normalize it for them like it's part of the process? the cutting edge medical descriptions, which is what Holly has gone to in terms of talking about return to use. I also like to take a step back and ask about measurement in general, because whenever we attach a name to something or measuring it or tracking it, including this

notion of return to use, or if someone chooses to identify this way, lapse or relapse, you know, the question is, why is that the metric? Why is that the thing we're attaching to? This also overlaps with the question of recovery. Is our measure of recovery not using or is our measure of recovery thriving and feeling better? Is it interpersonal effectiveness? Is it feeling connected to a sense of meaning and purpose and being in connection with other human beings? Even in medical circles, you know, people

talk about the immediate question, which is what language do you use or what do you measure in terms of return to use versus relapse, et cetera. And even from the top federal agencies like NIDA, the National Institute of Drug Addiction, there have been some recent opinions and advisories given saying we shouldn't just track if somebody stops using. Because we've all met people who have stopped using in a very sort of tight and restricted and controlled way, but have not developed in other ways. That's a thing that happens. And more power to them. You know, I'm glad that people don't use if it's their choice. And I'm glad that people don't use if they're at risk of death with opioids and fentanyl and other types of dangerous substances increasing every single day. But I say

that because a lot of times in a medical context, people are really concerned about like the relapse. There's a whole therapy called relapse prevention therapy. I think that's a good metric, but if we're stopped there, then we're selling somebody a really stark and boring and dry vision of life. And that I think is actually one of the problems with dry January, which we could also talk about. I think dry January is fine. I think it's great in the sense that like sometimes people stop use and then they confront the self. And it's sort of like sitting down to meditation. You see the activity of the mind and it's terrifying and can be miserable or overwhelming. But if you can get out through to the other side, it can be very beautiful and instructive. Okay, great. But it can't just be about stopping use. That's a starting point. That's almost like

the meta point that has to exist above all the sort of like definitions and all. Yeah. I have a coaching client of mine who did something that I thought sort of brought this together in a really interesting way. I probably shared this last time, Laura, when we were on, but she was having trouble getting complete and total abstinence and would get very discouraged by it. I mean, she may have gotten this idea somewhere else. I don't know if she made up. Anyway, what she started doing was putting a marble in a jar for every day that she was sober. And what we saw over the course of a couple of years was a ton of marbles, right? Maybe 350 marbles a year, maybe 355 marbles a year. And she was also developing in all the ways that you talk about, Carl. And so again, in her case, we still looked at abstinence as a place we wanted to get to

because those returns to use were problematic, right? They sometimes would last longer than a day or two. They affected her quality of life. Exactly. They affected her quality of life. But that was a really useful way of us measuring in a way that was actually, I think, useful. Because there is something about measuring and celebrating success. And we can look at the 12-step program counting days as a, you know, I think, Holly, you mentioned maybe it's a power thing. And I think there is some of that, right? But I think some of that also came out of us celebrating each other as we made progress. Totally. 30 days sober. Yeah. Right? There's something that just warms my heart. Or a day. Yeah. Yeah. Yeah.

And so, again, I think that with all these things, there's a point where terms and labels and measuring is useful, and there are ways that it's not useful. And I think if people can look in their own life and say, in what ways is this useful to me, and in what ways is it not? And that's what I thought was so ingenious about what my client did is she found a way of measuring that worked for her, that allowed her to see real progress, to feel good about herself, to see progress, but not get into this zero or 100% or I failed five times this year.

Instead, it's like I succeeded 360 times this year, right? And I just love that approach to things. I thought it was a really wise way to handle this question. Yeah, I love that too. You didn't share that before, I don't think. I don't think I've heard that story. I also wanted to just kind of put out there, 12-step recovery tends to look down upon or disregard what I now know to be harm reduction. I had not heard that term before. Like, I remember meeting a guy at a meeting and he had come in because of heroin use

and he was taking chips and he was on Suboxone. Is that how you pronounce it? Yeah. And I immediately thought, oh, he's not sober. Like, he's not doing this. He's just substituted with something else. That's not real sobriety. And I felt like that opinion was kind of carried through the group.

Like, the consensus was that if whatever you're, if you're using anything, then you're not, you're not in this thing with us. You're taking dirty chips, which means that you're taking chips while you're still using. And dirty cakes, right? Is that a word, dirty chips and dirty cakes? It is. It's absolutely a word. It's a term. Yes. And so, like I've said, now, you know, since I've been educated and educating myself, I see things differently, but I'm very much still learning about this. So I was wondering what the three of you thought about the black and whiteness of that, and if it has a place in 12-step recovery or just in recovery. I mean, once upon a time, and again, I think Holly made a good point earlier, which is there's the, if you want to look at 12-step programs, they're based on Alcoholics

Anonymous, and Alcoholics Anonymous published a book. And that book, you know, is intended to be sort of the core of the program. And then different groups add all sorts of things on top of that. And I actually think that's fine because I don't think a book that was published in 1939 should be the end all be all Bible of life. But there was once upon a time in recovery in certain circles, if you were taking antidepressants, right, you were considered not sober. I don't think that's even once upon a time. I think that's still. I really do think that's still. It may be. Yeah. And it just depends on the group, right? That's the thing. When we talk about 12-step programs, if we talk about them monolithically as one thing, we are missing the fact that there can be great disparity, right? Totally. I was part of 12-step programs

where antidepressants were considered absolutely fine. And what you're describing, Laura, Suboxone would be considered completely fine. But other groups would be like absolutely not to any of that. And a few years after I got sober, I met a guy who used to be my drug dealer, my heroin dealer. And he was sober on methadone. And like you, Laura, I looked down on him and I thought, I'm glad I didn't do that, right? Because I wouldn't get here. And I think this gets back to our earlier discussion about recovery, that there's more than just physical sobriety, right? I mean, I think everybody's path is their own, right? I think it's perfectly possible to be getting help. There's lots of

different drugs out there that help us achieve abstinence, right? I think that those can be used as a way of launching ourselves into these deeper realms of recovery that Carl has talked so eloquently about. So those are just kind of my thoughts. Yeah, I have strong feelings about this, of course. I don't know how to get out of this trap that we have such a deeply polarized opinion of medications in the United States. And I love this one discussion. I know I've discussed this with you, Holly, but it was from the 1970s. There's a bioethicist and psychiatrist who said we swing between psychotropic hedonism on one side and pharmacological Calvinism. Calvinism meaning that there's some sort of virtue in suffering.

And so individuals and cultures swing from sort of screw it, let's do everything back to nothing is good. And the truth of the matter, certainly at the population level, is somewhere in the middle. It would be very bad if everybody with every kind of addiction got put on Ozempic, for example. Like there's interesting evidence that Ozempic has some sort of effect, central addiction relevant receptors and has effects on gambling addiction and alcohol addiction, not to take us down too much of a rabbit hole. But, you know, ozempic has costs too. It has actual material costs, and then it also might reduce bone density and muscle mass and all sorts of other things. You know, like there are costs and benefits to suboxone. There are definitely costs to suboxone. There are ways that it can be diverted in harmful

ways. And there are ways that some people can experience maybe emotional numbing or things like that. But medications for addiction treatment, they're not even assisted treatment. It's for addiction treatment because medications are the only things in a research basis that have been shown to reduce death for opioid use disorder. Not attending 12-step groups, not going to a rehab, not outpatient psychotherapy, nothing. It's just medications. And so if we're interested in actually getting people in to recovery, whatever recovery means, whatever we want to call it, we have to be much less judgy about medications. I think like if you go to the coastal cities or if you go to places where there's like a higher density of people and groups, like you can find groups that are much more accepting of this, but you know, across the whole

national and certainly global addiction community, you can certainly find treatment centers where people will say, Hey, if you're on a heart medication, like a beta blocker that reduces anxiety, that's not real sobriety. You should ask your doctor to switch you to something else that's not psychoactive because maybe just taking the edge off a little bit. You know, I haven't used a self-prescribed mind or mood altering substance for a very long time now. I alter my moods in a lot of ways. You know, I still go to the ice cream and I still go to anger and I still go into like frantic overwork or whatever. You know, there's lots of ways I alter my moods. And the actual magnitude of changing someone's mood with Suboxone is so minor compared to the universe of other ways that people use

their mood. There's no universe in which it would ever possibly justify the scale of death that the lives left on the table represent here. Carl, do you think it's because there is the fear that they're getting a bit of hit and a bit of high and there's like they're altering themselves? Or do you think it's because it's cheating and it's not really like doing it the right way? I don't know. I think it's so overdetermined in the sense that there's so many different stories and narratives swirling around it. Some of it is just cultural inertia. That's part of why I was interested in the history of addiction is there was a lot of racist and sort of class oppressive stuff going on in the 1970s when methadone was first introduced. And, you know, because of that, and because of stories about who

was using substances, primarily heroin back then, you know, methadone was over-regulated to the gills in a way that it still is today. So, you know, imagine in your mind right now, what is your image of a methadone clinic? It looks like a fortress. It's a place with barred windows and in a way that it still is today. So, you know, imagine in your mind right now, what is your image of a methadone clinic? It looks like a fortress. It's a place with barred windows and people have to line up in the cold, in the snow for hours sometimes. It wasn't until COVID that we started to get some take-home doses. You know, that sort of oppression made its way into methadone as just one casualty of the constant war on people that was disguised as the war on drugs. That has trickled down. That's trickled down into suboxone. You know,

suboxone is only just recently liberalized so that every doctor can prescribe it. People should know that because like a lot of doctors don't even know that, honestly. But this happened a little while ago. Right. It was controlled, right? Like you could only prescribe so much. Yeah. Yeah. You had to get a special waiver. You had to go through a special course and go through this whole process. You know, it was only a little while ago that that happened. And so few doctors went through the extra step of getting certified to do this. Even it was just like taking an online course and checking a box. It's just, we need much more massive uptake of it. It's been really suppressed. We're leaving so many lives on the table. You know, the opioid epidemic is not, we're not bending the curve at all.

It's horrifying. I talked to one researcher today. I talked to researchers who I went to med school and residency with and people who are in the research community, and they are burning out. I mean, they are really struggling because they're doing the research that you can pile up or journal articles that say Suboxone saves lives. These are the medicines that save lives, but it's just not happening because of, it's not because of a lack of medical research is because of the cultural stigma. And again, like the internal stigma within the recovery community. I think it's really just

deadly. Are there stats, Carl, on the number of people on Suboxone year over year? I'm just kind of curious because to your point, I don't know how many years ago, I'm terrible with time. It was this really fringe thing that I was starting to hear about. And now, you know, I think there's a whole lot more of it. And I'm curious, we may not be bending the curve that much, but I would have to assume that the uptake levels on that have to be going up somewhat substantially, or that just may be my own sense impression, which is why I'm asking about data. You know, I would love to get some data, put it in the show notes later. I can look into that, but I do know in an outline that you could double a tiny number and it's still a tiny number. That's the issue. It's such a tiny fraction. Like if we, you know, we're still at over a hundred

thousand overdose deaths a year and the size of our addiction workforce is tiny, tiny, tiny. And our addiction workforce is primarily directed toward alcohol. There are a lot of people with opioid use problems going to rehabs. I mean, that's really where the numbers are. That's why the tighter restrictions on suboxone prescribing were removed. But still, what we need is a cultural change. We need people to change the way they think about addiction and recovery and recognize that, you know, there's this sort of like pro-recovery slogan that sometimes people say to suggest that you can't just stop deaths.

They say there's a difference between stopping a death and saving life, which is true, but you also have to stop the deaths. If you don't stop the deaths, you can't, like, what are you doing? Stop the deaths. Get the people in the room. Dead people can't recover. Yeah. That was really helpful for me, Carl. I probably told all three of you that I sat with Beth Macy on a panel about a year ago. And she really hit this subject hard.

Harm reduction, harm reduction, harm reduction. It was actually the most I'd ever heard anybody talk about it. And I was still kind of like, yeah, but you're not on my side of it, right? You don't understand the consequences of someone like me, who was really, really ill with this, picking up anything and using it again. And I didn't really get what she was saying, but I got it when you were talking, Carl, that this is the way to bring these people into where I'm sitting now in recovery, that there isn't a meeting they can sit in that's going to get them in. I'm just saying recovery because it's just the word that I use, but there isn't a meeting or a talking

to or a therapist that's going to do the same job that a medication that makes them physically able to join in will. I've had several people in my family die from both alcohol and heroin. And so I feel like I have experience, but I didn't really understand that. And this gives me a lot more compassion. So I really appreciate it. 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.

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Holly, I know you wanted to talk about dry January. I want to talk about it just because everyone wants to talk about it. I personally have no strong feelings towards dry January. I can't remember if I used to or not. I think I used to be a little like tongue in cheek about it when it really, really blew up. Because it started about a decade ago in the UK. It was like the first many years that people did it, a few thousand people did it. And then, you know, it's like now, you know, millions of people do it to the point that

they're already exhausted by it and now are moving on to damp January because dry January is too, you know. And so, like, we've already been through three cycles and we've swung back and now we're going to. So, but I think, like, for me, this year I've heard a number of people, most of my friends are, you know, in some form of recovery. And so people I know talking about it, you know, and giving it like a little side eye and I kind of am surprised by it, by the number of like people I've heard disparage it this year. And like a year ago, a columnist at

the Cut wrote an article that was like, don't get sober in January. And a lot of people get sober in January. A lot of people into recovery in January. And we have kind of like, because we're so aware of the impact of diet culture and all the ways that like and hustle culture and productivity culture and workism and the ways that we're supposed to become new people on January 1st and now we've rejected that and now we don't want to become new people on January 1st we just want to sleep and I think we're missing the point like we're missing the point capitalism isism is going to capitalism, right? This really beautiful movement that I think is a wonderful idea that gives people a chance. Like there was Hello Sunday

Morning. I don't know if that's even still in existence, but it was this organization that allowed people in New Zealand or Australia to try three month or one month stints of not drinking. And this was, you know, like a decade or 15 years ago. And people would say it was like a local thing and they signed up for it as like a break from alcohol. They'd commit to a break from alcohol and they would say, I'm doing a Hello Sunday Morning or an HSN. And people would be like, oh, got it. And so it was this really sweet way for people to not have to go through the complicated process of deciding whether or not they're an alcoholic, you know, before cutting back their drinking and getting recognition that this is an important thing and it's socially supported. And that is what Dry January is to me, is this sense of there's visibility. It's conspicuous.

You're pledging to it. It's very, very much like a thing your friend might do, not because she's an alcoholic or she's pregnant or whatever, but because she wants to take a break after the holidays. And so I think when you're looking at like specifically alcohol and the barrier to entry like for treating alcohol use disorder or even just like on that spectrum, like I'm not talking severe, but just like addressing it, you have to go through a lot of hurdles because of the normalization and the idea that only people that don't like, there's a lot of stuff that prevents people from examining whether or not, you know, alcohol is showing up wrong. And I think that this is a really beautiful way for people to experience

that without having to go through all of the mental gymnastics and the hurdles to actually enter some kind of recovery, you know? And so that said, yeah, of course it's become commodified. Like some woman just wrote this article. I couldn't even read it. It was something about how I'm the devil and dry January is the devil and something else. And there's a lot of side-eye stuff at the capitalism component of it and the fact that not drinking or dry January or sober curiosity or these other like trends are somehow damaging and terrible. And I personally feel that needs to be set aside. And what we need to understand is that there's so few things that capitalism does right. And in this case, this is leveraging an opportunity for people to try

something out they wouldn't otherwise. And I guarantee you, January is probably the month that the most people get sober. It has to be. So I personally don't think there's anything wrong with it. And I think it's one of those places where I've chosen to not be upset about the commodification of recovery and sobriety or whatever that is. It's just let it be and let people do it. And that's my thoughts on Try January. That's a very generous way to look at it, I think. I don't know if I always looked at it this way. I think I was very, ugh, you know, when it really, really took off and everyone was doing it. And like,

there was this feeling that like, oh, but I'm really in recovery. I really had a problem. And then people are just trying it on for fun. And, you know, and I think that there was that sentiment that I had around it, or it's not real or whatever. Again, like personal bias, like deep inside, that was my gut reaction to it. But I think it's great. I think this connects really nicely to the story, Eric, that you had about the person who's putting marbles in the jar. I love that story. I'm going to remember it because it's about practice. That person was practicing and they wanted credit for those days that they practiced. And I think when somebody is trying and they still experience a return to use or some other

problem, they're still practicing. That's the thing that matters is putting intention and attention into a process of change. And why would we put that down? You know, I think dry January could be somebody's experience practicing with drinking and they might not stick with it. And then they see that and they see the difficulty with bringing their actions in line with their intentions and then they modify and they change. And then maybe it's only three years or five years later that plants a seed for some bigger change. Yeah. Carl, can I just say real quick, you might

know this better, but I think that the average time between identifying that you knowing you have something wrong and actually seeking treatment for it when it comes to, I think it's alcohol, but it might be all addiction is like 10 years, seven to 10 years. Is that right? Yeah. John Kelly, who directs the recovery research institute at Harvard, he likes to say eight, but you're exactly right. It's actually from the time, if I'm remembering it right from the time that somebody makes any intention to seek abstinence, the bad news is there's many, many returns to use. People can have problems along the way, but the good news is many, many people recover. It just takes a while. All of that is practice along the way. That's right.

You know, if somebody wants to practice, we're all in little bubbles. We like to talk about recovery. Probably people on this podcast like to talk about recovery. They might have some experience with it, but there are a lot of people out there who don't. And maybe that's their entry point. Maybe that's our entry point to practicing with change or looking at themselves. So why don't you put that down? okay, nothing to see here, right? Like they'll move on, right? And other people will start to see something, you know, I mean, I've heard stories of people say, oh, I took a month off drinking and I started to really see what drinking was doing in my life, right? And again, you know, your point, Carl, they may be a year down the road, three years down the road, but I only see a positive in things that encourage us to do that. And I also think when we start to say and truly accept, like there's lots of paths to recovery, there's lots of ways to get better. If we really accept that, right, then we can become

very encouraging of all of them. And we don't have to sort of, you know, to use your term, Holly, side-eye these different things or take hot takes on things, right? We can just go, good, somebody's trying to get better, more power to you, you know? Imagine. Imagine. Yeah. I also think though, and I agree with everything you all said, almost reluctantly, because I really don't want to like dry January. I know you don't.

I really, like, I feel like it's such a, like an amateurish thing. Like people are just trying trying out something just to see if it makes them a little bit healthier. I think most people are probably trying to lose weight or get back in shape and letting go of alcohol as part of that. Sure. But isn't that okay to have vain reasons? It is. It is. I was listening to you, Holly. I'm like, I'm going to be more generous with this because this is really a good thing. I'm going to embrace it. But I was reading, I don't know if you guys read this, TJ Holmes and Amy Robach. They were Good Morning America hosts who had the affair and now they have their own show. he's doing dry January and he was drinking 18 drinks a day. Yeah. And he's come up like against

like, whoa, this is a really big change for my 18 drinks a day in dry January. And I know we have to wrap up, but I was just thinking, shouldn't there be some kind of support? Because then you feel like he's got to feel terrible, right? Physically, my experience is it got worse before it got better. Like I felt like, oh my God, I need something for like the first 30 days, the first 60 days. Like I need anything. Like I would have taken or used anything to get rid of the feeling of withdrawal. Because I would imagine that the body or the brain wants something after it's used to having 18 drinks a day. So is it wise when someone is drinking, I would say that's excessively, I don't know if TJ Holmes would, but is it wise to

embark upon an abstinence, an abrupt abstinence, or should people who were maybe drinking excessively look for support as they go through it, knowing someone that can inform them that it's going to get worse, but then it'll get better. Well, this is not medical advice, but alcohol withdrawal can be dangerous. You know, it'll kill you. Not that it's extremely common, but it can be dangerous. So it is good for people who are worried about their health to seek out medical help, keeping into account that there are also problems with access. You know, like people might have trouble accessing good, which are all support.

Or if you walk into your ER, you might get treated like crap. Yeah. And so that people might get stuck in a double bind there. And I also know that when I was trying to stop drinking as a young doctor, I kept on telling myself, ooh, I better not stop quickly. I better slow down. And so that turned into years upon years of rationalization. So it's very hard. I think in general, it doesn't have to be medicine. It's good to get help looking at those kinds of

rationalizations and, you know, is this nonsense or do I actually need to be careful? My own experience was that I had plenty of experience with silly rationalizations. Eric? Yeah, I mean, again, I think, yes, probably, you know, good medical advice says you get help. But again, I'm kind of back to who knows whether for, I don't even remember the gentleman's name, the 18 drinks a day, but he's actually due to dry January. He's now taking a look at something he may never have taken a look at before, right? Who knows where that will lead? And back to this idea of there's a thousand

different roads into recovery. I mean, I just, I'm in general in support of, again, like I said, anything that gets people to take a look at their relationship with these chemicals is a positive. And yes, if you're drinking 18 drinks a day for a long, long period of time, I'd suggest a little bit of medical help. I mean, I didn't even mean to laugh there. That's real. That's like, it just makes me laugh that that was the headline on my feed in the morning was TJ Holmes. He really was drinking 18 every single day, 30 days a month. That's what he says. He says easily has 18 drinks a day is what the headline says. And that he saved $3,000 already.

This is whenever this was on alcohol. Good God. January 3rd. January 3rd. Does anyone have any last words? Does anyone have any last words, anything that you were inspired to say when someone else was talking that you didn't get to say or just something you want to leave with the listeners? mean it in necessarily keep coming back to 12-step programs, but I mean it in general when it is, has anything to do with addiction or substance use, overuse, whatever you want to call it. Like, I think the message is keep coming back, keep trying. I love the way Carl put it,

keep practicing, right? Because recovery is available, but it rarely happens to us on the first or second or third try, right? It's something that happens through repeated effort to try. And so I would just say, you know, don't get discouraged and keep coming back. You know, there's lots of ways to get help. Keep looking for help. And there is a solution if you want one. Laura, I want to say these have been great questions.

You said at the outset that you were feeling a little nervous and you had no reason to. I think they're really wise in their directness. You're getting to the core of questions that a lot of people are walking around with and then feel really awkward to ask, like, what exactly is relapse? How bad is it if I go have a relapse or what does it mean to be sober? What am I even going for? There's almost a sort of, I don't know, it could be snobbishness in some circles or maybe just the sort of toughness in others, but a hesitancy to explore these types of things. And I think it's really, really useful

to just look closely because this is what life is made out of. You know, this is really what matters is how do I want the character of my lives to be my many lives? I didn't even mean to say that plural, but it's true. We're living new lives every single day. We have so many opportunities to reinvent it. Yeah. I just really appreciate returning to these core, core topics, because in recovery communities and medical communities, we can get twisted up in knots about what is right and wrong, etc. But, you know, at the end of the day, people are just trying to feel better, get better, do better. And this is all really special stuff. So I'm glad to be here with all of you. Thank you. Thank you, Carl. That was very sweet. And I do, I feel bolstered now. I appreciate that. Now, Holly. Thank you for organizing all this. I think like the one thing that I took away from this, and I've been thinking about a lot lately, is just how capable people are, and how smart they are about themselves and how little consensus there really is about what's right. And it just totally depends on who you talk to and what their experiences and what

their biases and what their opinions are. I mean, just sitting here in this group, I think that we take for granted that there is like, we believe that there exists some code and that if we just find it and read it and follow it, then we'll be fine. Like that there's an answer out there. And I think it's just so much messier than that. And I think a lot of us spend a lot of time looking around and making sure we're doing it right. And I think that it really just comes back down to that, you know, Eric said, right, of just trying. It's just about trying. And we don't give enough credit to trying and just showing up.

We complicate it. So I really enjoyed talking to all of you and hearing all of your different perspectives. And thanks for making this happen. And I'll just say really quickly at the end that I really appreciate this conversation. It was really nourishing for me. I'm going to take all of this and go out in the world with it and sound really smart. But also getting sober for me was the hardest thing I've ever done in my life. It was excruciating and humiliating and I didn't want to and I didn't believe in any of the things I was asked to believe in. And I still don't believe in a lot of those things. And yet, it's the best thing that I've ever done for myself. The life I lead today is because of what I did, because of that hard work. And to go back to the marbles in the jar and what Carl pointed out, practice makes a practice. The more you practice, eventually you'll have a practice. That's what's happened to me. Faith without works is dead, but work without faith still works for me. I've done this work and I've ended up with this life that I wouldn't trade it in as of this moment for anything. I really enjoy it and I am thriving. I really enjoy it. And I am thriving. And that's just something I never thought I would do at the beginning. I didn't think that was possible for me. So these types of discussions are oxygen for me, truly. And I appreciate all of you. And Eric, I've taken over the conversation, but thank you for inviting us to have this discussion on your show. Seriously. Yes, yes. It's been a pleasure. I'm happy to

talk to two of you who've been on the show before. And Holly, I'm so happy to have finally gotten a chance to have you on. And I think it was a great discussion. And the more often we all talk about these things, the better. So thank you all. 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. Now, we are so grateful for the members of our community. We wouldn't be able to do what we do without their support, and we don't take a single dollar for granted. To learn more, make a donation

at any level, and become a member of the One You Feed community, go to oneyoufeed.net slash join. The One You Feed podcast would like to sincerely thank our sponsors for supporting the show. I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really No 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 reallynoreally.com and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. The Really No Really podcast. Follow us on the iHeartRadio app, Apple Podcasts,

or wherever you get your podcasts.