Understanding the impact of binary thinking on seeking help Binary thinking leads to confusion and inhibits people from seeking help or self-reflection. Our culture tends to characterize people as either addicts or safe, without allowing for the consideration of moderation or self-assessment. This binary thinking can contribute to a feeling of weakness and loss of control, which may prevent individuals from seeking assistance. Transcript: Speaker 2 I mean, you start with this essential binary, right? Which creates certainly confusion and also probably inhibits a lot of people from seeking help or pursuing moderation or even engaging in that introspective question of, is this Too much or do I have a problem, right? Which is the way that our culture characterizes people is either addicts or somehow safe or more complete or is it called a crisis? Speaker 1 Yeah, I’ve heard professional philosophers describe it both ways, which makes me feel more comfortable about my own pronunciation, acresia. But yeah, that weakness of the will that sort of loss of control. Yeah. Speaker 2 Yeah, which is this idea that an addict is somehow an (Time 0:06:49)
Reframing Addiction and Normalcy The concept of addiction being an aberrant or deviant behavior lacking self-control is being challenged as individuals are now recognizing that everyone exists on a spectrum. The binary division between being normal and being an addict is seen as toxic, and the speaker’s personal experience in psychiatric hospitalization led to the realization that this binary does not work. The speaker believes that there is no normalcy apart from addiction, and this understanding has helped to break down the traditional binary concept of addiction versus normal. Transcript: Speaker 2 Yeah, which is this idea that an addict is somehow an aberrant or deviant individual who lacks all self control rather than I think we’re getting to the place where we can acknowledge That we all live on the spectrum. But it’s still so bound. Yeah. You are or you’re not. And it’s still a concept that escapes an easy definition. Speaker 1 So I got into recovery because, and I’m grateful for the fact that this happened to me safely and it’s a function of privilege that had happened to me safely. But I was psychiatric hospitalized for a substance induced manic episode during my psychiatric residency. And so it was brought to NYU and I was hospitalized there where I’d interviewed for a residency. And so up till that point had been thoroughly baked in the notion that I was one of the healthy normals and I was always on the other side of that glass or the other side of that interviewing Table. And then all of a sudden I was one of them. And so I met that essential binary and it really helped me to break down that binary because I saw very quickly how it wasn’t working. It wasn’t working for me or for other people to have this clear, bright, dividing line between, you know, there’s lots of things you could put in opposition to addiction, addiction Versus healthy, addiction versus safe, addiction versus free. But I think the most toxic form of that binary is addiction versus normal as if there is a normalcy apart from addiction. (Time 0:07:31)
The Complexity of Denial and Addiction Denial of addiction is not solely due to stigma or a division between ‘us’ and ‘them’. Even in a future with a more compassionate view of addiction, denial may still exist. It is a basic human delusion for people to engage in harmful behavior while feeling unsafe to acknowledge the pattern, requiring deep compassion from clinicians. Transcript: Speaker 1 That’s a big part of it. I don’t think it’s all of it. I think that denial can certainly be exacerbated by overly reductionistic, essentialist idea that there are sick people over here and healthy people over there. So when there is a really strong focus on normalcy and when having an addiction or another formal mental suffering is held up as some sort of awful outcome, then yeah, people will cling Really tightly to a story of themselves about normalcy. They’ll say, I couldn’t possibly identify as somebody with an addiction problem because that’ll be terrifying. That feels life ending. It’s a fate worse than death. That’s a function of stigma and even more fundamentally, it’s a function of that really clear division between us and them. But I don’t think in some perfect future, if we somehow arrived at a much more compassionate view of addiction that nobody would have denial. I think there are many examples of people struggling with denial, including at times where I would say in the past, that there was a more nuanced and thoughtful view of addictive problems. I think that’s just basic human delusion that people can have a sense that they are engaging in a harmful behavior that is really hurting them and yet they see no other option and it feels Unsafe to even look at the pattern. I see that over and over again as a clinician and we have to be deeply, deeply compassionate about that. (Time 0:10:39)
Denial and Addiction: A Complex Human Delusion Denial of addiction and mental suffering is often exacerbated by the reductionistic idea of normalcy and the clear division between ‘us’ and ‘them’. Stigma and the fear of being labeled as ‘sick’ or ‘unhealthy’ lead people to fiercely hold onto a self-image of normalcy, even when they are engaging in harmful behaviors. This denial is not solely a product of societal views but is a basic human delusion, where individuals feel unsafe to confront their harmful patterns. Even in a more compassionate future, denial may still persist as it’s deeply rooted in human nature, and clinicians need to approach it with deep compassion. Transcript: Speaker 1 That’s a big part of it. I don’t think it’s all of it. I think that denial can certainly be exacerbated by overly reductionistic, essentialist idea that there are sick people over here and healthy people over there. So when there is a really strong focus on normalcy and when having an addiction or another formal mental suffering is held up as some sort of awful outcome, then yeah, people will cling Really tightly to a story of themselves about normalcy. They’ll say, I couldn’t possibly identify as somebody with an addiction problem because that’ll be terrifying. That feels life ending. It’s a fate worse than death. That’s a function of stigma and even more fundamentally, it’s a function of that really clear division between us and them. But I don’t think in some perfect future, if we somehow arrived at a much more compassionate view of addiction that nobody would have denial. I think there are many examples of people struggling with denial, including at times where I would say in the past, that there was a more nuanced and thoughtful view of addictive problems. I think that’s just basic human delusion that people can have a sense that they are engaging in a harmful behavior that is really hurting them and yet they see no other option and it feels Unsafe to even look at the pattern. I see that over and over again as a clinician and we have to be deeply, deeply compassionate about that. That’s just part of the self that’s just clinging on to some sort of imagined safety, even if it’s not actually safe. (Time 0:10:39)
Simplify Meal Planning and Preparation with Hungry Root Hungry Root is a service that simplifies meal planning and preparation by providing healthy food and simple recipes to fill your fridge, reducing stress, avoiding extra trips to the grocery store, and minimizing food waste. They achieve this by getting to know your preferences, recommending groceries, and offering thousands of easy recipes to put your groceries to good use. Transcript: Speaker 2 It’s that time of year again when we all get another shot at fresh starts. To that end, I’m in the process of going through every part of my life and establishing systems where I can set it and forget it. This includes meal planning. I’m so tired of that fateful moment every single night where I realize that we need to eat dinner. I don’t know how I’m always surprised at this revelation, but lo and behold, every day I fail to do any advanced planning around dinner and nobody can tell me what they want. They have no opinion or no opinion that is until dinner is on the table and it’s not what anyone wants to eat. This is why I’m thrilled to tell you about Hungry Root, a service that fills your fridge with healthy food and simple recipes so that you can take the stress out of meal planning and meal Prep and avoid a lot of extra trips to the grocery store. Plus, they help you avoid food waste by helping you determine exactly what you’re going to make and what you need in order to make it. Hungry Root is actually magic, like snapping your fingers and having all your recipe searching, grocery shopping and meal planning done for you. You take a fun, short quiz, who doesn’t love a fun, short quiz, Hungry Root gets to know you, your goals and how you like to eat along with which kitchen appliances you use. When they recommend groceries based on your preferences, whether it’s fresh produce, high quality meat and seafood, pantry staples, healthy snacks and more. They have all the snacks that my kids love, like fruit jerky, perfect snacks, peanut butter bars, parm crisps and simple milled crackers. And they sent us chicken tacos, chipotle macaroni and cheese and lemon chicken. Total, easy, crowd pleasers. Hungry Root goes beyond your weekly grocery haul with thousands of easy recipes that actually put your groceries to good use before they get forgotten in the back of your fridge. (Time 0:12:16)
Acknowledging High Functioning Addiction and Embracing Personal Responsibility High functioning addiction is rampant in our culture, with many people refusing to acknowledge that anything could be wrong. Embracing personal responsibility, especially through self-help practices, is crucial for those who want to work towards bettering themselves and serving others. Transcript: Speaker 2 And I think it’s so beautiful because what I do see, you know, high functioning addiction in our culture obviously is rampant, right? If 95% of people of significant margin, I would imagine of those people are still sort of moving through life functioning. But the way that, and I understand this instinct and I have loved ones who are very much part of what you talk about that refuse to sort of acknowledge that anything could possibly be wrong. You know, Gabour-Mate talks about this a lot. Like tell me you had a good childhood and let me ask you a few questions and sort of take it apart really quickly. And I probably live in this world of quote unquote self help, which is, you know, has its own stigma. And of course we can sort of laugh at it. But there’s a lot of it that’s really important. I just would like it to be rebranded toward like personal responsibility or something like this, which is particularly for those of us who want to work toward bettering or serving (Time 0:24:33)
Acknowledging and Addressing Personal Suffering without Comparison Recognize and attend to your own suffering regularly, without pushing it away or projecting it onto others. Avoid constantly comparing your experiences to others’ or engaging in oppression Olympics. Understand that suffering is not just an individual idea, but is also influenced by social and economic systems that weaponize an individual view of suffering. Industries like alcohol and tobacco constantly promote hyper individualization, shifting the focus from the product to the person. Transcript: Speaker 2 To attend to your own suffering on the regular. So you’re not pushing it into some sort of shadow or suitcase and carrying it around and projecting it onto other people or asking them to carry it for you. And I don’t know what the twist that’s required is that allows or how we move out of this, like who’s got it bad, you know? I don’t know how we move past that as not oppression Olympics, but this sort of like constant comparison or weighing our experiences against other people who we perceive to have it worse. But it seems like a big hurdle. Speaker 1 Yeah, and I want to say that it’s not just some idea about suffering. It’s also a function of social and economic systems that are deliberately weaponizing an individualized view of suffering as a technique, as a strategy. The thing I found across eras and eras and eras in the book is that addiction supply industries, which is what one scholar calls them, like the alcohol industry, the tobacco industry, They constantly come back to this hyper individualization, saying, you know, like the problem is not in the bottle. The problem is in the person. (Time 0:25:41)
Diversity in Recovery Approaches The recovery ecosystem offers various methods such as prescriptions for alcohol, nutritional programs, and harm reduction. There is a concern that the rigid approach to recovery creates anxiety and control, making individuals believe that deviation will lead to death. This mentality hinders exploration of alternative recovery avenues. The stereotype of individuals in recovery needing help is challenged by the statistic that 95% of people with a substance use disorder do not recognize their problem or want treatment. Transcript: Speaker 2 I want to talk to you a bit now about the way that our recovery ecosystem is set up. And I want to talk to you about sort of methadone. And I know that there are a lot of prescriptions that I don’t think people really even know about for alcohol and to help with cravings and sort of functional nutritional programs, etc. And maybe I’m just oblivious because I’m not in recovery. And this is certainly true that Holly and I talked about this at length as well, but there’s so much anxiety and or control in the world of recovery that it wants to insist that it has to Be a certain way. And if you deviate from that, you’ll die. And if you explore other options or ask questions about it, that you are going to cause someone else to die because you will implant and they’re had the idea that moderation or harm reduction Or that there are other potential avenues to explore that would lead them back to the substance that they can’t touch. So where do we start? Speaker 1 I mean, we could start with the sort of knee jerk stereotypical image that most people on the street probably have a venturing recovery and getting help and getting treatment. You know, 95% statistic you mentioned earlier, that’s a really important statistic. It’s 95% of people with a substance use disorder don’t think they have a problem and don’t want treatment. (Time 0:30:18)
Challenging the Binary Model of Addiction Recovery The 1970s saw the rise of medicalizing and professionalizing traditional recovery, leading to the legacy of today’s treatment industrial complex. This complex perpetuates the old school binary view of individuals as either alcoholic or healthy normal, with a ‘pickle line’ demarcating the transition. However, scientific research from the early days of the National Institutes of Alcohol Abuse and Alcoholism challenged this binary model. Data collected by the NITurble A and processed by the Rand Corporation revealed that a significant portion of people diagnosed with severe alcoholism were able to return to moderate drinking without major problems. This challenges the traditional view of abstinence as the only solution for severe alcoholism. Transcript: Speaker 1 No, yeah. I’ll just say it briefly. I’d love to hear what you love about it too. But by the 1970s, there was a lot of interest in medicalizing and professionalizing traditional recovery. And so there is a really powerful, what one former center called the treatment industrial complex, like the traditional rehabs. And that’s basically the legacy of the system that we have today. This treatment industrial complex that was very invested in a sort of old school binary of your alcoholic or your healthy normal, that there’s a quote unquote pickle line that you cross. At this point, you’re not a cucumber anymore. You’re a pickle. That’s the way people would actually talk about. I’ve heard that in recovery meetings and in the treatment centers. So I heard it at an addiction conference that I went to last week, by the way, by one of the speakers. I mean, it’s just preposterous to me because it flies in the face of the science and some of that science was being done back in the 1970s. So very early days of the National Institutes of Alcohol Abuse and Alcoholism, which is a terrible name that they haven’t renamed yet. But back then, the NITurble A didn’t just do research. They also did treatment. And so they collected a lot of data about the very early waves of addiction treatment in the United States. One of the key questions they were looking at is what happens to people when they return to moderate drinking? And so it went to the Rand Corporation. The Rand Corporation people might know is a think tank that’s very closely allied with the government in Santa Monica. So they sent off all of these like punch cards and old school data and they processed it. And what the researchers found is that there was a significant portion of people who, even when they were diagnosed with very severe alcoholism, seemed to be able to return to moderate Drinking without major problems. Now, of course, there are people out there who return to moderate drinking and had terrible problems. (Time 0:38:35)
The Role of FDA-Approved Medications in Addiction Treatment FDA-approved medications can help people struggling with cravings and urges related to opioids and alcohol. Medications like anti-abuse can create a negative reaction to alcohol, while others can regulate cravings without eliminating desire. Despite underutilization, these medications can effectively reduce deaths related to substance abuse. Scientifically proven medications like suboxone and methadone have been shown to reduce death, irrespective of their effects on recovery or sobriety. Transcript: Speaker 1 Yeah, I guess the thing I’d like to say, because there might be people listening who were sort of wondering about the place of medications if they’re struggling with control, that there Are many FDA approved, perfectly safe medications that help people with cravings and urges and problems. Not just for opioids, but also for alcohol. In some of those are things like anti-abuse where you could take it with a partner. It kind of helps by making alcohol cause a bad reaction. So it’s unpleasant. Others for some people regulate craving and desire, but not in a way that makes you into a totally desireless zombie. And we’ve vastly underutilized those and alcohol kills tons and tons of people as well. You know, so that’s another failure. But when it comes to opioids, there are a lot of things that are really helpful. I think the 12 step is really useful for a lot of people with opioid use problems. I think the traditional therapy is really good. I think that there are many other alternative therapies such as therapeutic communities or whatever else, whatever works fine. That’s great. But scientifically speaking, the only things that have been proven to reduce death is suboxone aka buprenorphine and methadone, period. Regardless of what your views are about their effects on recovery or whether that counts as sober or not blah, blah, blah. (Time 0:44:30)