We're Out of Time - Maia Szalavitz: Addiction Isn't About Drugs. It's About Pain

Episode Date: June 16, 2026

What actually helps people recover from addiction?In this powerful episode of We're Out of Time, Richard Taite sits down with NY Times bestselling author, journalist, and leading voice in addiction science Maia Szalavitz to explore recovery, trauma, harm reduction, and the role of compassion in healing.Drawing from both personal experience and decades of research, Maia challenges common assumptions about addiction and explains why shame, punishment, and stigma so often fail to create lasting change.This episode covers: • Maia's journey from addiction to recovery and becoming one of today's most important addiction author • Why addiction is often rooted in pain, trauma, and disconnection • The debate around harm reduction approaches • Why compassion may be more effective than punishment • What actually helps people get — and stay — better • The future of addiction policy and careAt the heart of it all, this is a conversation about why these approaches matter and creating more paths to recovery.

America locks up more people and arrests more people for drug possession than any other country in the world. We also have the worst problem in the world. So if this was going to work, it should have worked by now. It doesn't work because we don't arrest people for alcohol possession, we don't arrest people for cigarette possession, and we manage to dramatically reduce the harms related to those drugs. Now, if you catch somebody with possession of something that is dangerous, you may want to take that thing away from them,

But that doesn't mean you need to be a police officer, and that doesn't mean you need to put a person in jail. If someone has a problem with substance use disorder, please call one call placement. That's 8888-8-8-3-1-1581. And if we can't help you, we'll make a referral to someone who can. Please, we're out of time. One-call placement is affiliated with Carrera Treatment, Wellness, and Spa, and One Method Treatment Centers. Today on We're Out of Time, I'm joined by Maya Salivitz, one of the most important voices in addiction today. She's a New York Times bestselling author and journalist, known for her expertise in neuroscience and addiction.

She studied this at the highest level and lived through it herself. Her work, for some, is changing how we understand addiction, moving it from something people judge to something. we treat with compassion and science and pushing for real evidence-based solutions. Her latest book, Undoing Drugs, Takes a Hard Look at Harm Reduction and What's Actually Working to Save Lives. Maya, welcome. Thanks so much for having me. That's my pleasure.

When you sit with people who are struggling, what do you wish more people understood about what addiction actually feels like from the, inside? Well, basically that it's not fun. People assume that when you are actively using drugs, you're having such a great time that, like, you don't want to stop and that you are, you know, just in this bliss out state and you're very hedonistic and you are very selfish and all you care about is your own bliss. And what's really going on with a vast majority of people, people with addiction when they are actively using is that they are in some kind of emotional pain and they are attempting to use the drugs to solve that. And sometimes that's successful,

sometimes especially with things like stimulants, even though you know it's going to make it worse, you can't stop yourself from doing it. And so it's really maddening. But what it is definitely not is fun and it is not the case that people don't stop using because everything's great and they don't have enough negative consequences people don't stop using because they don't have hope that there will be anything that can give them what the drugs do even if the drugs aren't doing it so well anymore all right well let's paint that for the let's paint that because you're you're a former addict right and were you doing you were doing and yeah and were you smoking it shooting it shooting it or snorting it?

Basically, at the end, I was doing speedball, so injecting cocaine and together. Okay, no, no, I just wanted to know if you were real or not, because if you were snorting it, okay, then I just didn't want to have the conversation. All right. So you're real. Okay. So, yes, you start off initially because either you didn't get your basic needs met as a child or there was a specific or continuous trauma.

right? Something like that. I mean, in my case, as in probably most cases, it was a mix of things. I was a very nerdy, outsidery kid who couldn't had a real difficulty connecting with people. I wish I had known there was such a thing as the autism spectrum when I was growing up because I basically met so many criteria for it. But all I thought was that I'm selfish and bad and can't connect with people. and care more about ideas than people. So I must be evil.

That's crazy. That's crazy talk. But that's how we do it. We walk in shame-based. We're doing this stuff. The only thing I want to say for the viewers, because sometimes it is fun. Now, getting into it can either be fun

or trying to avoid pain. But initially, it starts off all fun. And then you graduate to fun with problems. And then you graduate to all. problems. I mean, also, like, I think, like, there's kind of a difference between seeking comfort and seeking bliss and both things can happen. Wait, wait, wait, wait. That was beautiful. That was beautiful. That's something that would come out of my mouth. Will you elaborate on the difference between comfort and bliss? You know, comfort is just, you want to feel safe and warm and loved and taking care of

and okay and bliss is you know whatever kind of ecstasy you use to pursue um but um comfort is a glass of wine and a joint okay bliss is shooting with a room full of hookers okay i mean you know that's the this would not be my choice but um uh the um i think that yes um it is you know there is And I think it's important to distinguish between these things because like if you're a person who is kind of very high in something that the psychologist calls sensation seeking where you just, your, your metabolism runs kind of low and you're kind of like, you really, nothing's intense enough for you. Or you have me, which is the opposite, which is everything's overly intense. And so like I'm not actually generally looking for extra stimulation. But. You know, again, this depends on your starting point. That's exactly right. You've talked about addiction is something the brain learns. How does that change the way we should be helping people recover?

So I think, you know, I called my book Unbroken Brain because we have this idea that addiction breaks your brain, the drugs hijack your brain. There's all this like stuff that is wrong with you. And I am not saying that addiction is not a problem. What I am saying is that what seems to happen in the brain during addiction that causes the actual addiction is that you fall in love with a drug or an activity rather than a person. And there's a specific set of changes that occur in your brain when you fall in love or when you have a kid. And those changes are meant to focus your priorities on either the partner or the child or both, depending on what's going on. And so when that gets misdirected towards a drug, it can be a problem. Like when you are parenting or, you know, being in a relationship, you have to persist despite

negative consequences, right? And addictions described as, it's defined as compulsive behavior despite negative consequences. But, you know, if you're going to be in love or you're going to have a kid, you're going to deal with all kinds of crap all the time. You have to persist despite negative consequences. Otherwise, you're not going to be able to do those things, right? And so when that's directed towards an appropriate target, that's a really important skill to have, right? I mean, also even in career, sometimes you need to persist despite negative consequences.

Otherwise, you're never going to be successful because you got drug addiction and alcoholism. It's the polar opposite. Yeah. And so, but what you are doing is you are. for you to get the drugs to get the alcohol to like say to stay in your addiction you have to persist despite negative consequences and what I what really drives me crazy about the way we see addiction in general is just that it is defined by persisting despite negative consequences in other words and negative consequences is basically a nicer way to say punishment um so if

punishment work to fix addiction by definition addiction wouldn't exist Right. Well, the punishment model never works. You know, when people come into treatment, they come in full of shame. You know, nobody comes to treatment on a winning streak. That's not the way it works. And so, you know, the old model of tough love and, you know, pull yourself up by your bootstraps and all that other stuff doesn't work. right love works yeah and i mean i think like what people you know because so many people do get help when they are at what seems like a bottom like the narrative makes sense oh you just make the worst

possible thing happen and then they'll get better but if you think about it for all of two seconds like okay who's more likely to get better a doctor with a family and a career and a house and a cat and a dog and children and all kinds of lovely awards or or a homeless guy. The homeless guy because the doctor has a cat. Right, there you go. If the doctor had a dog, it would have been the doctor. Okay.

See, well, this is about recovery capital. But the bottom line really is that if you have nothing, you don't have anything to get better for. That's right. And also, the homeless person is, depending on how long he's been on the street, has a learned helplessness. So he's completely given up. It's what's the use. Well, right. And I mean, like, I think like when and when you take somebody who's completely given up and punish them even worse, like that is not going to solve the problem. It's not only that. It's just cruel. Well, it's disgusting. It's repugnant. All right.

You've been open about your own experience with addiction. Was the returning point when you knew something had to change? Well, yeah. It was enough enough. Yeah, I mean, like, you know, by the end, I was basically like shooting dozens of times a day. And I lived with a car dealer. So that was made a kind of convenient. But. You were dating the dealer? I lived with him and I was doing my own dealing with him.

But the, you know, so I just had to get that. But the, anyway, so I was, I would just get up every morning. and like know that if I did it was going to suck and that I was going to feel horrible and I would not get any of the things I sought from it and then I would find myself doing it and then it's two in the morning and I needed to get some and come down and then I had to go to the methadone program because I was briefly on methadone and then they decided that I my addiction wasn't long enough that I could stay on maintenance but I was using too much so they just threw me out but the So anyway, so that was not a very good treatment experience.

But what finally happened was that I sort of found myself begging this guy who I didn't especially like for. And I thought, oh, what can I do? And then I was like, wait a minute, those are the thoughts of a person with addiction. Like those are like I had defined addiction at that point as like doing things that you feel morally bad about in order to get the drugs and then not being able to enjoy the drugs because you did them. And I was like, oh, okay, this is about to happen here. Because like, I didn't think dealing was morally bad at that time because I thought drugs were good, right? So I'm just providing a service. Anyway, but the- And this is a woman that went to Columbia people. Go on.

Well, I have to say, it was really funny. I went on Oprah once and I compared, you know, selling drugs to being a bartender. And she was like taken aback by that comparison. And I was like, no, like it's kind of arbitrary what stuff is legal. Now, one should not do illegal things, mind you. And one should certainly have serious regulations on substances. But the... But they both provide shit that gets you high and isn't good for you.

Yes, exactly. And, you know, our racist history is basically what shows like which ones are legal and which ones are illegal, not the relative harms from the substances. And that's like, you know, one of these things that is true but doesn't justify drug dealing. But anyway. So you got caught for dealing? Yes, this was about what were you dealing? What were you dealing? Yeah. So how much of it? Well, no, no, how much of it were you caught with when you were. Oh, well. Okay, this is a weird. It was supposedly two and a half kilos, but it actually wasn't. Two and a half kilos. That's only going to last you two and a half months. There you go. So, but anyway, that's a long and boring story. But the real, the real thing that happened. So that was two years before I ended up in recovery. And I got out on bail. And the first thing I did when I got out on bail was shoot up. So obviously, this was not pushing me in the right direction. How long were you in jail? like three days. My parents bailed me out.

What happened with the court case? So that took many, many years, but eventually it got dismissed in the interest of justice. By the time it was, by the time it was dismissed, I think I had six or seven years in recovery. And I was working with producer for Charlie Rose. And, you know, it was just like I was night and day from where I'd been during my active addiction. Okay, well, then let's then let's then let's understand. impact that. Yeah, you had an opportunity that most people wouldn't have. Okay. But, but, but you made the most of that opportunity because you strung that along for six years until you are a completely

different human being that was adding value to society. That's, you worked, you worked it out. Yeah, but I still think that it's really important to recognize that it's not fair the way we treat this. Okay, fine. So that's, that's, nobody does, nobody disagrees with that. Okay. I don't disagree. I don't know anybody who disagrees with that. But you're a policy person. Right. Let's talk about how, how would we fix something like that? Especially how would you fix something like that when the prison system in the United States is built? lot of it is built for profit. Actually, I think only 10% of prisons are for profit. What I think is at least is that, first of all, it makes zero sense to arrest anybody for possession, period. There is just no justification for that. It does not work. And I can tell you why they lied about Oregon if you want to. Wait a minute. Wait a minute. Why would we not arrest anyone for possession I'm not married to any position.

I want to talk about it. It seems as though if you're busted with a bag of pills or powder, right, that you've gotten from the street, not only do I want you arrested to break that pattern. I'm not saying I want you charged, but we're in an opioid epidemic and I'm scared of it and I'm a father. So I'm scared for other fathers and mothers. So what do you have to say to that? I mean, I agree with you as globally. Arresting people doesn't keep people safe. What it simply does is it filters people through the criminal justice system.

When you get into prison or jail, you are less likely to get treatment than on the outside. Like we, you know, you go to a jail. What is the first thing you do? They take away your medications. So if you happen to be on medication, that's gone. You don't get a health evaluation. Well, this isn't rehab. You're going to jail.

You've got drugs on you. They're not from a pharmacy. Okay. About every other pill and powder now has been it. Right? It's killing it. It's killing our kids. Why would you not want someone?

They take the drugs. So now you're out of harm's way. but I'm not saying I want these people locked up. I want the users locked up. But I think to have them booked, right, brought in, putting a holding cell, okay, like I was for 12 hours, okay? It's part of consequences because it didn't happen for you. No, that's not why I don't think so. It's because of the data.

The data is overwhelming. America locks up more people and arrests more people for drug possession than any other country in the world. We also have the worst problem in the world. So if this was going to work, it should have worked by now. It doesn't work because we don't arrest people for alcohol possession. We don't arrest people for cigarette possession. And we manage to dramatically reduce the harms related to those drugs. Now, if you catch somebody with possession of something that is dangerous,

You may want to take that thing away from them, but that doesn't mean you need to be a police officer, and that doesn't mean you need to put a person in jail. Jail takes arrests and jail costs a lot of money. I get what you're saying because you're data driven. Okay? I get that. But I'm on the ground, and I've given back 10,000 people back to their loved ones. The first treatment center I found was the finest drug and alcohol treatment facility in the world.

That's not my opinion. That was an award given by Newsweek. And if there's a God, and there is, okay, then our new treatment center, Carrera will be the number one treatment center this year. If I had a nickel for every person that told me they were arrested, they were looking at jail, and they came into treatment, and, got well, I'd be living in Lower Bel Air. It happens all the time. That is certainly true, but correlation is not causation. Which people in America are most likely to get arrested? That would be black people. Which people are least likely to have access to treatment? Again, black people. And poor people, they get treatment last. They get punishment first.

They get everything last. Right. That's how the world works now. But this isn't my point. My point is that, like, if arresting people is a good way of getting them into treatment, the people who get arrested most should be most likely to get treatment. And that is not the case. Well, wait a minute. You're talking about two separate things. You're talking about incarceration versus treatment.

Okay. If someone's getting incarcerated, how are they going to get treatment when they're being incarcerated? No, that's not what I'm talking about. If you just look at arrest numbers versus who is likely to get treatment, it is not the person who gets arrested. The person who... Okay, why? Let's unpack that. This is a million different ways that people get help, most of which do not involve arrests.

And, you know, there could be anything... Wait a minute. Let's talk about the treatment. What, why can't those people when they leave, okay, incarceration, why can't they go get treatment? And if they can't afford it, which they won't, okay, there's all sorts of places that take Medi-Cal, Medicare, Obamacare, and then there's even places that don't take anything,

like the Salvation Army. And then you've got places like AA where people go and they don't even get treatment. That's right. And nobody has to be, you know, AA exists and has been enormously, successful for many, though not all people, with no coercion whatsoever. The way people get in. Okay, that's not true. People walk in with court cards.

Hold on a second. No, no, no. But what I'm saying is A.A. was founded by voluntary people. And if you read the literature of the program, it is for people who want it, not people who need it. They are really not into coercion. They are into attraction, not promotion. Well, the justice system bastardized that by making

it a condition of staying out of jail. Right. And they should not do that. But the, um, the, the real, the bottom line is that like most people, like the reason we don't have money to afford treatment is because we're spending it on incarcerating people that we don't need to incarcerate and arresting people that we don't need to incarcerate. There's some truth to that. Absolutely. Absolutely. That's an Excellent point. All right. Let's move on, shall we? See, this is how the sausage gets made, Maya. All right. All right. Looking back now, what do you think actually helped you get better, not just get sober, but get better? I mean, certainly the community of 12th step was enormously helpful to me.

Are you still in AA? No. I went every day for seven years, and I eventually got sort of more annoyed than serene from it. And so I decided to not do that anymore. I get it. How long are you still sober? Well, I have taken other substances at this point, but I have not taken since 1988. Okay.

Hold on. But no wreckage. No, no, I have not relapsed. I mean, I have had a weed gummy and had a glass of wine, but nothing dire has happened to me. So you've transcended drug addiction and alcoholism. In other words, that's not who you are anymore. Yeah. And also, alcohol was never my drug of choice.

No, no, I understand that. But you don't drink alcohol when you're a diabetic because alcohol affects your decision-making and then you're out to the dope man. So we know that whole thing. Yes. Okay. But the point I'm trying to make is, and for you. the viewers is this is a beautiful thing. You don't have to be labeled by a disease model for the rest of your life. You can actually do the work, okay, and go on to thrive in the world and not have a

label and drink. This is the example I always give and I get and I had it last night. went out to dinner with a girl, had a glass of wine. Okay. About three quarters of the way through the glass of wine, it starts to feel nice. So I said, that feels nice. And I pushed the wine to the middle of the table, right? Now, we both know that when you're active in addiction,

your first thought is, if that feels nice, more feels better. Yes, exactly. Okay? But that didn't happen. And that didn't happen years ago when that happened to me. And I was like, oh, that's good. And another thing that I noticed was I don't think about it. So if I think I'm going to dinner and I can't wait to have wine or a cocktail,

well, then I can never have wine or a cocktail again. Yeah. Okay? It's like you have to be rigorously honest with yourself, right? I mean, that was a beautiful thing. For me, I like don't mess with the things that were my drug of choice. Like, I don't want to go anywhere near that. Like, alcohol, even if I have two glasses of wine, I don't want more.

Like, that's the thing. Like, it's like after one, I'm kind of eh. And like that never happened for me. They're designed to more, more, more, more. That's their design. That's not it for alcohol. I mean, it's interesting because like, see, in terms of the, you know, the neurochemistry involved, like, you know,

is a stimulant, obviously. And it is sort of more acting on the dopamine aspect of wanting. It makes you want more. It makes you feel capable of getting what you want, and it makes you want more. Whereas is more like satiation and relaxation and calm. And so... Except for... Except for when you're sick, you're going to smack an old lady over the head with a brick and take her purse.

We all have that stereotype in our head of somebody who would do that. And the people who actually do that are people who've done that before they were addicted. That was a great comment. because you're right. Anybody with a propensity for violence prior to their using is going to be violent. But it's such a stressful life. Oh, I'm not advocating. The worst.

The worst. I want to talk about Matt, medically assisted treatment. Now, you're a huge advocate of it. Okay. I've always had the belief that the best. that the best medically assisted treatment is top-notch treatment in a treatment because you cannot unring a bell. Okay?

I'm not saying that other medically assisted treatment is not important. Absolutely. Very important. But really, the best medically assisted, and I can prove it. because if you've come in with a long duration of using and a high amount of usage, right, you come into treatment first time, you stay a month. Now, we both know that that's not going to matter. Okay.

At that point, for this particular individual, he'd need between 90 and 120 days, but he takes his will back, right? The next time he's out there, the amount that he, the duration that he uses is going to be shorter. And our experiences, every time they're released, their usage is, the duration is shorter and shorter until they get it. Now, they have to come back because their insurance cuts them off in 30 days. If they pay, you know, if they are a private pay patient,

they usually take their will back. But the ones that don't take their will back, the private pay patients that don't take their will back, we're at about 78.8 or 9 percent, which means that the people that actually leave when we tell them they're ready to leave. Okay. Get well about eight out of ten times. Okay. But even the others that, take their will back, eventually they get well for the most part. Okay. That's my proof. And it's, and it's not anecdotal. It's more like field research after 20 years. It's like if I put together the data, studies could be drawn from it. I mean, that's the level of field research that we're doing. All I can say is that if you look at the literature, we have two medications that cut the death rate by 50% or more. And these are methadone or buprenorphine. And if that's only true if you stay on them.

And in a world full of food, I cannot be a responsible person and say that you should come off those meds. Again, if you feel like you should come off and you're having side effects or you are sick of the stigma that we keep putting on these meds and you are sick of the hassle of having to get them. That is a perfectly valid reason. Why would somebody do methadone instead of buprenorphine? Because it is a full agonist and it lasts longer and for people, you can run up the dose higher. And so let's talk about that for a second. Let's do let's unpack one thing at a time. So they're still high. They're not. You're going to tell me you're not high on methadone. Yeah, I'm going to tell you that because if you. Okay, that's not true.

I'm sorry, you're wrong. Like, listen to what I'm saying. Like, when you are on the right dose for you at the same and you are taking it as prescribed at the same time every day and you are stabilized, you are not high. You can drive. You can work. That's buprenorphine. No, it's true of methadone as well.

I can show you the studies. It is not, you are not like. But I've been on methadone. That's your proof. personal experience. Some people are high. Some people. But I've treated probably 500 people on methadone. Do you know what it's like to get these people detoxed off methadone? I'm just saying that I'm going by the data. I think that you're the greatest. Okay. I don't have to agree with everybody on this show. And they don't have to agree with me. Okay. So why don't we leave it

there? Okay. Because you've got great points about it. from a data standpoint, but I've got from a lived experience standpoint. And so we both have our experience. That's all. Okay. Is that cool? God, that was, that was amazing. It should be a goddamn diplomat.

If your personal experience of a substance is that it is stabilizing you and you are doing well on it, like we should be not stigmatizing you for being on it. Of course. We should be like, you know, if, I just like the, you know, HHS or SAMHSA just came down to the memo saying like, oh, you know, you need to reevaluate every year. If somebody's on methadone or buprenorphine and it's like, no, like the- That's the first thing I think they've said that that I've agreed with in probably a decade. Go on.

But the patient should determine what they want. But all the pressure that we have in this country about medications in general from the culture, not from the medical, but from the is these are bad, your high come off. You don't get the message, this cuts the death rate in half, which you would get with any other condition we were treating if we had a drug that did that. Look, I like buprenorphine. I think that's, I think that's great.

And I, I, I, we use it. And it's, it's the gold standard. I just think methadone's a horseshit drug. If someone has a loved one struggling right now, what does showing up the right way look like? day to day? It's understanding where they're coming from and trying to help them understand that their life will be better if they change.

Not judging them, not like, you know, throwing them out of the house. I mean, if somebody is stealing from you or doing harm to you or your family, you may have to throw them out of the house. But don't ever do that for their own good because... Let me ask you a question. Let's go through this. This is perfect. Let's let's do an example. You've got an 18 year old kid. He's got gas cards and credit cards and his cell phone and a car, but he lives at home. His parents fund everything. Kid don't work. He goes to school, right?

But now he's doing drugs and he's doing more than just. just pot and, uh, and booze, but he's doing a little. And he's, uh, grabbing some press perks from the street because, you know, you need to keep your heart in your chest. So you need some opioids to calm down, right? What do you tell the parents at that point to do with that kid? Well, for the first, you have to find out where the kids at. Like, what does the kid want?

Because if the kid... What does the 18-year-old want? Yeah. If the kid doesn't want to change at this moment, they ain't going to change. Okay, what do you do if the kid don't want to change? So then what you have to do is there's a thing called the community reinforcement approach. And basically, the idea is that for the parents to understand why the kid may be doing this and to work towards getting the child motivated to change.

You just killed. You just killed that kid. No, I didn't just kill that kid because while you're doing that, you make sure they have done all this other stuff. Maya, Maya, that kid's dead. No, I mean, you throw the kid out. That kid's dead too. No, no, no, no.

On my life, that kid's dead. the hypothetical I gave you was the kids on impressed perks it's not if it's when he's going to die so I don't give a shit if that kid wants to get sober or not let me tell you why because I'm the dad and I got 18 years into that kid okay and I don't give a shit hold on I don't give a shit what he wants okay that kids go into treatment and then We can in our family systems program, we can work on where you're at and what's going on and how we can be of support and where we went wrong. If you succeeded in getting him into treatment. How do you get him into treatment?

That's what we're going to talk about next. How do you get him into treatment? Well, that's what I was talking about, which is the way, you know, if you look at, again, the research, people are twice as likely to get their family member into treatment. using this kind or supportive approach. Let me tell you how you get this kid. It's called the golden rule. The golden rule is, you know the golden rule, right? What's the golden rule?

Well, I know what you're going to say. What is it? The man with the gold makes the rules. That's right, because that's my kid. And I ain't letting him die because his frontal cortex isn't completely developed. And he's a idiot. it. Okay. Well, I mean, again, like, if you can successfully get them into treatment and you can if you cut their, if you kick them out, if you change the locks, if you take the car,

if you take the credit cards, if you empty the bank account, then the kids can die on the street. And that happens long time. Or listen, he's going to die anyway. That's not too. Hold on. Sometimes you have two bad choices and you just have to pick the. lesser of the bad choices. Right. And what I'm saying is, like, statistically, the lesser of the bad choices is to do what I'm suggesting because you're more likely to get them into treatment alive that way. Again, it is, you know, we have a different methodology of how we look. If you've got a kid, okay, that's going to cave and not be a little terrorist, then your way is much preferable. Trust me on this one. Okay. But if you've got a terrorist, okay, that's, that's,

just terrorizing the family and he's going to do whatever he wants and everything else, that kid needs a reality check. No, and like, again, I am not saying, I am not saying that if the kid is being a terrorist, you don't throw them out. I'm just saying that you, and I have, there are people that have done interventions and their kid died from the intervention, like the McGoverns who. Okay, but that is, hold on a second, but that's an outlier. What the, what is the parents supposed to do other than have an intervention?

You know, an intervention done right is just this. It's not, you don't bring the people that love the kid the most, who gives a shit. You bring the people who the kid loves the most. Okay. And then, and then all that goes on in that is what their behavior is doing to them. And I think that's great. I have no, I have no issue with doing that. What I have an issue with is that, you know, like people are told to help your kid with an addiction, throw them out and that and let them stay in jail if they're in jail and all of these.

That I don't do. You know, and I have seen the bad outcomes from this. You know, I have seen like, you know, Terry McGovern died in a snowbank because her parents were told to cut her off because and kick her out of the house from drinking. And she did. You know, there are, you know, they did an intervention on Kurt Cobain and he shot himself the next day. Hey, hey, I get it. There's bad things happen all the time. But on balance, the data is in my favor.

You wrote a recent piece in the New York Times making the case for compassion over punishment, thousand percent. And you point to what's happening in New York where over-duty. prevention sites have reversed thousands of overdoses and are actually bringing death rates down. What stood out to you most in that data? So I think, you know, again, we are currently in a great phase nationally where overdose rates are finally going down and everybody's arguing about like what. Why is that?

Why is that before we go in this? Why are the, why are the? I mean, I think there's a few reasons. One is that we kind of ran out of people to die. There it is. And like that's the one nobody wants to talk about. And that is really, really horrible. They're dead.

Yeah. I mean, and the good news of that is the new young people are not coming in at the rate that the people are dying. That's exactly. And, you know, we saw this with. Do you know why? I'm going to just say why. Because of what you do, because of what I do, and because of what I do. and because what are the thousands of other of us do to let from the mountaintops screaming every chance

we get, this is bad and it's going to kill you. And it's finally taking hold. Well, and I mean, I think, you know, like this is what we saw with like the generation below they did a different drug. Now, the problem is, of course, if they go to a more harmful drug than a, you know, but with that generation, it was weed. And so it was less harm. But, you know, the, the, you know, people saw what happened to their older siblings in, in every drug epidemic.

You see this. People see what happens to their parents and older siblings. They're like, I'm not going to touch that stuff. I might touch this stuff, but I ain't touching that stuff. So the, this is good. And since opioids are pretty much the deadliest category in terms of immediate risk, you know, this is a very good thing. but it's obviously sad that we've lost so many people. And the other ones?

And the other one? The other factors that matter, I think, are we got a lot of naloxone out there. We, I think also it's hard to know whether, and I will rarely give law enforcement credit on this, but there is certainly a case to be made that the supply changed. Whether that happened because China actually cracked down, or because the dealers are like, we're going to kill all our customers, and that is not going to be good for business. I don't know, but there was definitely a reduction in the potency of over time.

And the reasons for that we could argue about it could be enforcement got it in some ways, but the thing with that is so horrifying is that it is so teeny that, like, you would have to catch all of it in order to make a dent in the supply. You could supply the entire United States opioid using population with two tractor trailers full of... I know. And you're dead and everybody's. And so like, right. So we don't want to, you know, I'm just saying like trying to crack down on supply of something that small is a very probably impossible task. But supply change did occur. And the, you know, so we got in Loxone out there. We expanded access. to methadone abuse, we supply issues. And, you know, I think, I think those are really the,

you know, and of course, what they call the death of the vulnerable. Okay. So back to the overdose prevention sites. Oh, yeah. Yeah. Okay. Right. So, I mean, the thing, the thing that I think is amazing about overdose prevention sites and harm reduction in general is that when you walk into one of these places, you see people who everybody else is literally crossing the street to avoid. And they are being treated with kindness and care. And people think, oh, you're enabling or you're like not pushing them to stop. You're not saying the moment they walk in the door, come on, you want to stop, you want to get treatment now? The reality is that that's not how human psychology works.

When somebody values you is when you start to value yourself. And the way people get better from addiction, as you were saying earlier, is because they have something positive to move towards. And when you see what happens in these overdose prevention sites, people are treated kindly and they go crazy because they're like, nobody ever says anything nice to me, you know? I got to tell you something. I love what you just said about that.

I've been against these places, okay? But I never considered how the person who is addicted feels to walk into a place and be treated well. Now that I'm talking it out loud, my first thought goes to. to, well, I put myself in the mind of the homeless person, right? I was homeless for a short period of time. So I put myself in the mind of the homeless person, and I'm walking into this building where I can shoot dope safely, right? And I walk in, and the first thing I'm thinking of is I get to shoot dope here without being hassled.

I can actually enjoy my eye. That's the first thing I'm thinking. Sure. But I don't know if I'm ever thinking these people are treating me well. That's not. Like the thing is because like you may not have been homeless for long enough to have experienced this. But the, um, if you look at even like you walk down the street towards a homeless person and your body tightens up. Like, people are like, it's, you're literally being shuntoned, right?

And you go into this place and people are like, hey, how are you? Like, it is the opposite of what you experience almost anywhere else where you are immediately being demanded to prove, to beg for your worth. Here, you just go in and I have just, I've watched this happen. And I saw it at needle exchanges and I saw it at a lot of other places, um, in my career writing about harm reduction and being involved with harm reduction. Like what happens is, you know, and a lot of the people who work at these places are sober. And what really, like, and I saw this happen many times.

Like people are like, well, how did you stop? But that's not what happens the first time they come in. The first time they come in, they're like, hey, I can get high. This is great. Yeah, but what percentage of those people that come in that are using these places get sober? If you go to, and this is a study on syringe exchange, but the people who participate frequently in syringe exchange are five times more likely to go into more traditional treatment than the people who are in that same neighborhood and don't participate. If that's true, then there would be no problem, okay, attaching therapy to using those sites, okay? But there is therapy at those sites.

So what you're telling me is, in order to go into that place, you can shoot up, okay, but you have to have a therapy session with somebody? No. You're going to walk in there and you're going to shoot dope. And the whole idea is to get you to live your best life and be part of society. Okay. Then therapy isn't something you have to do. It's something you get to do. It's the ultimate luxury.

However, in this situation, you should have to go to therapy. in order to use those things. We have this saying if you attract more flies with honey than you do with vinegar. Of course. This is what harm reduction is. I have been to these places many times. I have looked at the literature on this. There is zero evidence that people who participate in needle exchange use longer than people

who don't. The evidence goes the other direction. I didn't say no. And that makes sense to me, by the way. That makes sense to me because you're getting out of the culture. okay, which so many of us romanticize when we're shooting dope, right? Well, what people find is that, you know, again, it's like there are people who work at these places who are doing better and they serve as role models. And over time, people tend to get better.

And that is what happens. You know, it is. And, you know, it's because like people think that you go to these places and they're there, shoot, shoot. And it's like, you know, a keg party or something. There's a difference between loving somebody as they are and wanting better for them. The same kind of magic you see when somebody is doing a 12-step call and it works. It is just about one human being being there for another. And you see a lot of people getting better.

And you don't see like the bad outcomes that people. people think they're going to see. Like, for example, like in Switzerland, they have programs where you can get free. You can go get free in Switzerland. Yes. Wait a minute. So like right outside Davos when they're like the. No, they, I mean, they're Swiss.

They're very uptight. So it's inside and it's in like very controlled circumstances. Oh, so they just don't. So they just, so they're hiding it. No, they're not hiding it. It's just a clinic, you know. Um, so, um, but anyway, um, the people, again, the people who participate in these are more likely to get into traditional treatment compared to people who don't.

And long, I don't know anything about that. The only thing I want to do now is go to Switzerland. I want to go to, I need to see this shit for myself. It's counterintuitive and it, it, you know, it works. And again, different people will have different experiences of different things. And this is why I never say, everybody should be on methadone, everybody should be on Suboxone, nobody should ever be totally abstinent, or everybody should do 12 step, or nobody should ever do 12 step, or whatever it is. I feel like people need to find their way and that compassion is generally safer than being tough. Always. And that's the general rule. Okay. And that is you're a thousand percent right, but better's better. And

And we always thrive to be better. Okay? Just because somebody didn't die, that ain't the win. It just is. We have to have, we have to set a higher bar than just not dying. That's what I'm saying. The thing, my problem with that logic is that it basically results in the idea that if you're still using, you should die. No, no, but I didn't say that.

That's for, listen, you can't make a statement. and then think to yourself, okay, well, this population of idiots is going to interpret it this way. That's not my problem. Those idiots can stay on their side of the room and I'm not. I'm just saying, I just saw a SAMHSA memo that says, like, we'll pay for naloxone and we'll pay for wound care, but we won't pay for hotlines that people can call so that they don't overdose. and we won't pay for sterile water for injection. And that's what happened to syringe exchange.

If you want to have safe injection, you should have safe water. And the bottom line is that like, you know, if people aren't alive, they can never recover. For sure. I'm not saying, listen, I'm not saying no to medically assisted treatment. I'm saying once you're there, okay, once you're on methadone, okay? It's like stay there, stabilize. I'm good. But to not have a therapist, okay, that you're seeing continuously while you're on these things

to help you get to a place where you and I are, you and I were in a place where we couldn't stay sober for five seconds. Okay. And now we have transcended addiction. Now, if that's true, why? not afford the same opportunity to the guy on methadone. I agree, but don't force them to get counseling. If you want my tax dollars and community, society to pay for these things,

then what we're saying is, fine, we'll pay for this, but we're going to pay more, okay, so that you can eventually become part of society. What you're missing by doing that is that a lot of, of people don't walk in the door then and you get more deaths and you get more HIV and you get more hepatitis C and you get more hepatitis B and you get all kinds of things that you wouldn't get if you keep people healthy until they're ready for therapy and then they get the therapy. At the same time, we're seeing efforts to pull funding from harm reduction programs. What do you think happens if those resources go away?

I think that, yeah, you're going to see more death. You're going to see more disease. are going to see, you know, more problems. I think what's sad to me is that before all this, we were working towards integrating harm reduction into the system of care so that somebody who is wanting abstinence treatment and they happen to be at a needle exchange and they say, look, I'm fed up with this. I want help. We need that linkage, right? That's the first thing they cut money for because they're like, well, we don't want to support harm reduction. So we're going to cut the the referrals. It's crazy. So the, you know, again, what we want to see is a full spectrum of opportunities for people to get better. And that means everything from, you know, 12 steps to

like I would ideally say free. What I think would work and what I think is sad about this attack on harm reduction is just that harm reduction comes from the place that a policy should reduce more harm than it causes. You say these programs can actually improve communities, not just save lives. That's interesting. Why do you think that part of the story goes missed, but before you, that's no. Before you say that, what are you talking about? How does it actually improve communities? You mean harm reduction.

I'm taking it. Sure. Yes. And so, first of all, they clean up a lot of the needles that are on the street otherwise. And this is one of the things that on point, which is the safe injection site in Harlem. them here. They have crews of people who go out and make sure that nobody's just, and also people bring them into the, so that, you know, because like, you don't want kids seeing that, right? And one of them- Or touching it and getting poked by it. Any of that, but so-

And normalizing it for them like, this is okay. None of it. No. And I mean, so when, but, you know, like, like I wrote about in the times, like, this is literally across the street from like, elementary school and they what's across the street from the illness safe the overdose prevention site um it's like catty corner to it um and so the um the person who um runs the school um is a big fan of them and she basically she told me um you know well when a kid falls down um and a kid is screaming we just scoop them up and love them. And when they are, you know, they may do things wrong a million times, but we're just there to like support them and help them grow up and get them to be better. And that's what these guys are doing just with the people who are a hell of a lot less sympathetic

than toddlers. And so you're still well-meaning. It doesn't matter that you're wrong. Well, anyway. You're so well-meaning. Well, but I know. I'm right. But anyway, we will not go there. I love you for that. I will talk about the fact that, you know, yes, they clean up the waste. They also, because people are shooting up in there, not on the street, they're not in front of the kids. And because... They're coming out of the place at some point, and they're coming out slumped over. No, they're not actually because, like... Oh, they're coming out completely upright and with briefcase and a three-piece. You know, they get to chill there for a while.

So they can come out reasonably well. And yes, this is, again, they are not driving there. It is new. Do you remember what it was like shooting? Can you say that again? I close your eyes. Remember what it was like shooting? Okay.

Now tell me that these people are walking out completely fine. I'm just saying in a few hours, they are fine. In a few hours, they need another shot. Well, whatever. I'm not like, all I'm saying is that like when you have, when you're treating, treating the people who are seen as the horrible people that everybody hates with kindness. Kids see that and they don't think like, oh, I want to grow up and go to that safe injection site because I see how messed up those people are.

But when people respect their community, the respect goes two ways. No, you're a thousand percent right. And if that principal that runs that school, and I'm sure she did because if she loves it across the street from her, that I'm sure she had the foresight to explain it to the children and tell her what you're just describing, that it's that it's about kindness and empathy and we don't throw anybody away. Yeah. And I mean, and it's also like, you know, these people are sick.

Nobody wants to be sick. That's right. You know. And look. I mean, like, have you ever seen a kid walk by a person who's like in the fold and be like, yeah, that's what I want to do when I grow up? No. You do not see that.

Kids are not stupid. No, they're not. And I mean, also, like, you know, they just, they see something wrong. I want you to think of habitat for humanity merged with a kibbutz. Okay? There has to be places in America where you have a ton of land and you can help teach people how to do their own. skills. This one does the framing. This one does the foundation. This one does the electrical.

If it's voluntary, I'm fine with it. I'm a results based guy. You don't know what you want right now. I get that you're an adult, okay, but you're inebriated. There is no meeting of the minds because you're not right. So as a society, this is the way we're going to roll. And you put them in these places and you care for them and you give them therapy. But let's just pass. that I don't think we should be rounding up anybody. And I think that like people. Rounding up is a little is a little is a little much. How about how about, okay, you're on the street.

Okay. You may want to live like this because you've been out here so long and you've got to learn helplessness. So you've given up. Okay. But I don't really give a shit because you're not going to be here on the street because it's not good for the community for for society. And it's certainly.

isn't good for you. So we're going to fix this thing. It doesn't work. It's been tried. Many countries have these compulsory detention centers that are basically farms like this. And they come out and they go right back to poverty. That's because it wasn't a love call. That's because it was something that no, it's because people don't stay in recovery if their lives aren't better afterwards. That's exactly right. And so if and so if you're, in recovery, okay, your life is going to get better on the way out. I've never seen somebody get sober and their life get worse. I haven't seen it. I have. When you zoom out and look at the system as a whole, treatment, policy, messaging, where do you think we need the biggest shift? Now we're in the

solution. There we go. Again, I just think that if we see people with addiction as human beings with dignity and people who are not monsters or children or criminals by nature, people who have a problem and are trying to solve it in the wrong way. If we see that as the problem, not the particular thing they're self-medicating with, sometimes that particular thing can be bad also, obviously if it's... But the point is that, like, Underneath addiction is a lot of pain. And if we don't understand that and try to fix it by giving people more pain or more coercion, it's not going to work. If they're in pain, should we give them therapy?

If they want it, yeah. The thing with therapy is that, like, let's say you have trauma, which is an enormous percent of people who have addictions. Trauma PTSD and the experience of trauma, is an experience of complete powerlessness and helplessness. And in order to recover, the person has to be in control of the treatment. They have to feel that they are safe and that if it needs to stop for now, that that can have to you. Let me ask you a question. There's only two types of people that come into treatment, only two.

People that want to get well and people that want to get the heat off. Okay. I want to stay married. I want to keep my job. right? I want to stay out of jail. That's a true statement. And they're typically 50-50. Okay. The people that come in to get the heat off don't want to come in, but yet 50% of them stay sober. Why is that? Well, they realize that it's better. But they didn't want it.

I'm not like, I'm not saying people need a perfect motivation to want it. I'm just saying that if people aren't, especially people who are traumatized, if they aren't, if you're forcing them to do something that they are not ready to do, they ain't going to get better by that. They're going to get more traumatized. Is there anything else we didn't cover or that you want to tell the viewers? No, I think, you know, yeah, I will just leave it at that. Thank you. you were magnificent. This was a great episode. Where can people reach you?

Yeah, I mean, I think the best thing is my website, which is Maya S-Z. So that's M-A-I-A-A-S-Z.com. Be thankful that I didn't spell out my entire last name in my website because nobody would ever find it. Thank you so much. What a blessing it was to have you here. I'm so grateful to you. See you next Tuesday. We're out of time.

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