EP 1:10 Medically Assisted Sobriety with Dr. Mark

Welcome to The Aftermath Podcast. This is your host, Dr. Dallas Bragg, a former crystal meth addict, now sobriety coach. Join me on my mission to increase awareness around the epidemic of crystal meth among the gay male population and create a repository of resources for current and past addicts, as well as their loved ones. This is The Aftermath. Trigger warning, this podcast not may, it will contain discussions pertaining to sex, Sex, drugs, and alcohol. If you feel triggered to use or relapse, please call SAMHSA's National Hotline at 1-800-662-HELP.

Repeat, trigger warning.

This podcast will contain discussions about drug use, alcohol use, and sex misuse. If you feel triggered to use or relapse, please call SAMHSA's National Hotline at 1-800-662-HELP.

So today I want to welcome, uh, Dr. Mark Morris, uh, with an MD from Emory University School of Medicine in Atlanta, Georgia. Our guest has a diverse background that includes military service at the US Naval Hospital in Key West, Florida, medical practice in Oak Ridge, Tennessee, and St. Petersburg, Florida. He is actively involved in Alcoholics Anonymous with participation in groups in St. Petersburg and Tampa. Dr. Mark is married with 2 children and 2 stepchildren. His spouse's name is Lois. He is dedicated— he is a dedicated volunteer with Partners with Haiti in St. Petersburg and the Judeo-Christian Health Clinic in Tampa. His personal journey began with discovering alcohol as a coping mechanism in his teen years to navigate a strained marriage. I can relate to that. Later expanding to include substances like marijuana and benzos. A pivotal intervention arranged by his children during their teenage years led to rehab and involvement in Alcoholics Anonymous. Following a divorce, he found a supportive partner with similar background, maintaining close relationships with his families. Committed to sobriety, he regularly attends meetings at his home group. One to one in Saint Petersburg, his journey has also inspired humanitarian work in Haiti and support for uninsured individuals in Tampa. He's particularly interested in sobriety approaches for the LGBTQ+ community, including medical medication-assisted recovery. Though he hasn't worked professionally in addiction, welcome, Dr. Mark. Welcome to the show.

Thank you so much for having me here. Great to be here.

Yeah, so we like to do a little wellness check-in on the show just to kind of break the ice. So I would just like to know, how are you doing today?

Well, I'm doing fine. I just heard though from Haiti that the area that we are working in, they're not going to be able to pay the salaries because The banks, the local banks have run out of money.

Oh, wow.

I mean, they just don't have actual money, excuse me, to give out and to pay the salaries. So I'm just so worried about the situation in Haiti that I'm in a little bit of a depression here.

Yeah, I understand that. Where does your interest in Haiti come from? Where did that originate?

It was sort of a just circuitous route. Some patients of mine had started this project the year before and invited me to go with them. And that was a little over 20 years ago. And I've just been going ever since. We had quite a nice operation going, still do, I might add, because the region of the country we work in is still safe and so forth. So we've got clinics, schools, but my part is our 2 medical clinics and then a mobile dental program where our dentist circulates. So, so we're carrying on. Like this afternoon, I'm going up to look at used dental chairs because my dentist friend down there is getting back trouble because the chairs don't really fit his height. So, you know, I need to get him a couple of dental chairs that actually work, you know, that kind of thing.

Yeah.

So we've got, you know, our partners there are fantastic in terms of working around difficulties and so forth. So we just have to carry on, basically.

Yeah, what's the workaround for banks running out of money?

Well, I haven't figured that one out yet. But, you know, like I work with a shipper here in Tampa who's from the area that we work in.

Okay.

And he has figured out how to get my boxes of supplies and medicines to the clinics every 2 or 3 months through all these years and all the ups and downs and earthquakes and hurricanes. Political instability. But the thing is, we've never in 20 years seen anything like what's going on now. It's so horrendous.

Wow.

And no obvious way out other than a lot of people getting killed because, you know, the country is flooded with weapons, or I should say that the capital city is flooded with weapons. So, you know, when you've got 15-year-olds carrying around AK-47s, this is not a group of people that's known for its wisdom in approaching problems.

Yeah. Well, I mean, this might be a little off topic, but if someone wants to donate to the cause, where would they go?

It's called Partners with Haiti. St. Paul's Catholic Church, St. Petersburg, Florida. There's a website with a PayPal.

I can put that link in the show notes if you want. Perfect.

Okay.

Well, I'm sorry to hear about that, and I'm going to really keep track of what's going on there. Now I'm hearing an echo.

Yeah.

Okay. So, I'm really interested in a couple things.

Sure.

The listeners of this podcast are going to be former or current crystal meth addicts or the loved ones of them. And I guess, you know, it seems like there's other people interested in the topic as well because we carry— we cover a lot of different topics. But the first thing I wanted to ask you about is this medical-assisted sobriety, and what does that entail? What is that about? And, you know, as if, you know, talk to me as if I know nothing about it, which is true.

What? Okay, all right. I would be glad to do that with the proviso that this is not hands-on experience. I have never had a practice where where addiction medicine was what I did. So, and then as you said in the introduction, my personal involvement is with 12-step programs, which are not typically crazy about things like medical assist or harm reduction as opposed to abstinence, that kind of thing.

Right. Right.

But I've tried to keep an open mind in terms of those things, and because, you know, the medical research does point to efficacy in terms of both medication-assist and harm reduction as opposed to abstinence. So, you know, I don't want to say that abstinence is bad. I just think it's important for especially for anybody who's suffering or who's trying to help someone suffering to keep an open mind in terms of things that might help. So, yeah, then, yeah. The second thing I would say is that it seems very clear that each substance has its own level of all of those things. And it's been You know, over the years, I mean, when I started with AA, groups often were very hostile to people coming in with stories of multiple drug use. And they made fun of people that would say, I'm an alcoholic and addict and codependent and they call those the and meetings. Yeah. But nowadays, nowadays, you never hear anyone's story that's only one thing.

Right.

I can't remember. that happening. So, so it's clear that, that 12-step groups have also kind of opened up a lot more towards things like treatment centers, things like medical assist, etc.

And I like hearing that.

Yeah. So, so—

If I could interrupt for a minute, I just want for the listeners to know That we've talked about a lot on the podcast, 12 steps. You know, a lot of guests have come on with different views of its efficacy. I just want to point out that talking to a medical doctor, just like with a disease, for instance, if you have 3 people with cancer, you're going to treat each person differently. Based on how they react, based on their personal needs, their background, their biology, everything. There's so many variables that come into play that you're going to treat the disease in a different way. So if we think, you know, and I think it's generally accepted in the 12-step programs that they treat addiction as a disease, why would you think that it's one treatment for each person? You know, it can't be abstinence for each person, but you do a diagnosis, you do your due diligence, and you personalize it, individualize it to the particular, and customize it, right?

Mm-hmm.

To the particular person. Sometimes it takes medicine, sometimes it takes harm reduction, sometimes it doesn't. But to shut it all out and to label you as relapsed and label you as not in the club because you take medicine, I think, is closed-minded.

I agree. Right. Yeah. So the, you know, the research, the medical research has been the biggest amount has been in terms of opiate use.

Okay.

So, and then I would say alcohol follows after that. And meth lags— meth cocaine lags way behind the other 2.

Yeah.

In terms of the amount of research that's been done and the strength of evidence for things like the medication-assist there. So the— just as a personal note here to add to the biography, My oldest daughter's first husband was a cocaine addict who died related to that.

Wow.

And his brother was an opiate addict who died of an overdose related to that. So our family has been very touched by this. And Those, those two tragedies, I mean, these were people that we loved.

Yeah.

And that, that certainly opened up our family to, to questioning whether, you know, cutting people off in the name of, you know, not facilitating their use is a good idea because You know, there's no way you can treat death, and yet you can treat use. And so, yeah, so those things are part of the reason that I'm really so interested in this approach.

Thank you. Thank you for sharing that.

So So the same medications seem to come up in terms of the medical research on medication cysts. And with, I think, a few special notes along the way. And, you know, for instance, benzodiazepines have been useful In certainly in both alcohol and meth recovery programs and in terms of lessening the effects of coming off the drugs. So what I've seen in terms of alcohol, you know, the days when I started in medicine and we used to give— we just used to give alcoholics this thing that was basically a type of alcohol, but it was like foul smelling. And so there was no danger that they were going to get hooked on that. But along that line, benzodiazepines have proved to be a totally life-saving saving intervention for alcohol withdrawal, for example, and to a large extent in terms of stimulant withdrawals as well. So that is well established.

Okay.

And then beta blockers like propranolol, certainly well established in terms of, again, mitigating the effect of withdrawal syndromes. And so the problem with those is that they have not been very efficacious in terms of preventing the use in the first place.

Right.

And so again, you know, with— in terms of medication-assist, medications that that either prevent or treat withdrawal syndromes have kind of taken precedence in terms of the research that's been done over programs that prevent use. And there are a lot of reasons for that. I mean, one of the main ones is that withdrawals have a tendency, may often take place in a setting that's fairly controlled, where you can follow blood pressure, pulse, symptoms, sweating, you know, whatever, and blood levels too of various things. So it, of course, is natural, whereas use takes place in so many diverse settings But very few in terms of settings that you can control, you know, who is using how much, where, and that kind of thing. And, you know, as you know, working with addicts are very unreliable in terms of truth, you know.

Yep.

You know, asking how much and where and so forth will give you Maybe a little bit of information, but difficult to do a medical study on that.

Yeah.

So there again, in terms of like use syndromes, by far the most research has been done in terms of opioid use, but the research there is so positive in terms of outcomes.

Yeah.

And helping the whole situation overall, that in a way, that should be our model for going forward. Now, even there, you know, the state and federal laws are absolutely a hindrance to good medical practice. And I mean, just for instance, making methadone treatment such a hurdle for patients. I mean, you know, just the fact that patients have to go in person every day to get their medication to prevent a serious medical problem. I mean, the only thing that I can think of that The only thing that even closely approaches that is requiring, like, a tuberculosis patient to do observe treatment, you know, watching them actually take the medicine for the first few weeks of treatment, that kind of thing. I mean, there's really no other medical thing that requires that kind of, you know, come in every single day to— to see your provider. So, you know, a hurdle like that, I mean, because we're not talking about a population of people who are necessarily in the most stable conditions of their lives, you know, is like totally crazy.

Yeah.

But the research for opiate addiction has bled into the other areas. as well. And so, and so more and more you see, you see alcoholics coming from a, say, a 28-day program with, with a medical regimen that is going to help them maintain that sobriety.

Okay.

And, and I think even 12-step groups now are much, much more accepting of that approach. So, yeah. And, and, and then a lot of those same medications have proved to have some efficacy, at least in terms of cocaine or meth use.

So if I am a meth addict, and I want to go to drug treatment, rehab, you know, like you said, maybe a 28-day, 30, 60, 90, whatever, treatment program I want to, a question that I should be asking then before I go is if they offer medically assisted sobriety?

Definitely. You know, in other words, what's their approach to withdrawal symptoms? And then what's the approach to help going forward?

Okay, I guess, yeah, how long, how long would the— how long does a person typically have to be taking the medication? Does it just depend?

I don't think there's any research on that, on that point. So, you know, again, going back to the opioid use disorder, that, that kind of prevention can go on basically indefinitely. I mean, there's really no necessary endpoint in terms of that. Now, you know, what does happen in terms of success stories is that as people's lives become less chaotic and difficult, as they get back on their feet financially, as part of their families, etc., the need for the continued medical treatment may come down. But that, I think, has much more to do with the external circumstances of their lives than anything else. Because, I mean, addiction produces chaos in people's lives.

Yeah.

I mean, you've had that experience. I've had that experience. So, and, you know, it's even more nowadays, I think, than it used to be.

Yeah, yeah, yeah, that's true. I mean, if you go to treatment and then you return— I mean, we've talked about this on the show too— you go to treatment and you return to your same environment, your same friends, your same situations, you know, the likelihood that you're going to go back into the same routine is very high, right?

It is.

So maybe those, the people that have to go back to the same environment, they don't really have a choice. Maybe the medically assisted, medical assistance might have to go on longer to get them reacclimated and give them the space to create a different reality wherever they are.

Yes.

Create different friends, right? Am I on the right track with that?

Absolutely. Right, yes. So, and you know, the challenges I think for LGBT community is that that presents one more hurdle that people have to jump over in terms of successful treatment and maintenance of a life that is safe.

Undocumented. What are the, what are the individual challenges you see with our community?

Well, for instance, you know, not all 12-step groups are really open to LGBT people or to hearing stories from LGBT people. Now, that has improved a lot in recent years. So, so that maybe— I mean, you know, when I first came into AA, it took me 3 years before I was willing to share with my community that was my rock support that I was gay, you know.

Oh, wow.

I mean, I was afraid. When you think about it, I mean, this was the '90s. Our friends were dying left and right. This was not a safe place. super conducive time to come out as being gay. And, you know, and that has changed so much in recent years.

Oh, yeah.

And the acceptance is so much greater. But still, you know, there's an undercurrent of anti-LGBT feeling that comes to the surface every now and then. I mean, you in North Carolina, we in Florida, are feeling this wave right now as our legislators pass a slew of laws that are either directly or in some veiled kind of way aimed at the LGBT community.

Yeah, so, um, yeah, it's, um, yeah, we have a, we have someone running for governor who doesn't really like us.

There you go. Well, we have that same kind of governor.

Yeah.

Yes. But, and this kind of thing does bleed over, I think, into treatment aspects because, you know, as you are such a big proponent of honesty, openness, and willingness to you know, share details of life that are, that are super uncomfortable is, is such a rock bottom part of successful sobriety.

Yeah. Yeah. Yes. You know, I'm— there's a lot of, there's a lot of meth addicts, not just gay meth addicts, but meth addicts who go to AA meetings because they don't even want to admit they have a meth a problem with meth at all, much less the details of it. Right.

Yeah, right. Yeah, absolutely. Yeah, I was— I had a member of my home group who, you know, had the most horrendous dental problems. And I mean, it was obvious that this was related to meth, but I never heard him actually say that in an open meeting, but I helped him get his life back on track by fixing his teeth because, you know, I mean, he had basically become a hermit because when he opened his mouth, it was so ugly. I mean, it was really, really awful.

Wow.

And just having a set of beautiful dentures Opened up a new life for him that sobriety helped, let's say. Sobriety plus teeth. Yeah, yeah.

I love that. Yeah, yeah. Yeah, so that kind of segues into the other part I want to talk about, which is your support, your heart, for those in addiction. And I know that you work to try to get people, you know, free healthcare. I know there's a lot that you do with that. But you have friends, you have a lot of acquaintances because, you know, if— the thing is, if you're in the gay community, if you're a gay man in the gay community, the chances are that you know someone struggling with meth are very high.

Absolutely.

This is why we do this show. It's an epidemic. It's attacking our population. It's everywhere.

Yes.

And I know it's all over Florida because I've visited.

Yes.

In my travels, in my meth travels. So one thing that I want to touch on is you don't— you haven't struggled with meth. How can— if I have friends like For instance, my own story. I was in a group of friends. We did drink together. We went out to bars a lot. We did things together and we partied. All of a sudden, I started inching my way into the meth crowd and I started inching my way out of the group. I would stop showing up or I would show up crazy or I would bring weirdos to the party and stuff like that. So, Friends of meth addicts, how can we— how can they support? What are some dos? What are some don'ts? And what's the key to supporting without being taken advantage of, but also providing an open space of non-judgment? Because I feel like that's something you do really well.

Well, it's something I try to do, let me say. It's hard to totally live that. And partly that is because, you know, first of all, because of when I got sober, and partly because of the fact that I was married, which protected me from so much. I mean, like, for instance, I never used to go to gay bars because they were gay.

Yeah.

And then, right, then after I got sober, I didn't go to gay bars because they weren't bars.

Right.

So, you know, my experience with that isn't super great. But I do see where, you know, Louie and I have a very strong, small community of people that that are LGBT. So, and so that friends group is like super important for us because we can get together and we can talk about things that outsiders would have no interest in or whatever, you know. So, I mean, it was kind of like in the early days of sobriety, I would go out to eat with a group of alcoholics, and we'd be sitting there laughing and talking about our suicide plans and things like that. You can see people around us kind of like, who are these people? Yeah, so LGBT, I think, feel that sort of thing so much more.

Yeah.

And if you're trying to get sober and yet all of your mates and and support and so forth are not interested in that, it is going to be a total challenge. So, you know, I mean, as you know from your 12-step experience, changing playmates and playgrounds is like, can be absolutely crucial, but for LGBT, it can be much, much more challenging.

Yeah, yeah. And I guess there's more of a sense of brotherhood and relatability and protection and loyalty, I would say.

Yeah, absolutely. Yes. Yeah. So, I mean, you know, the experience with my family over the years, though, has certainly opened up my mind to being much more tolerant of things like relapses because, I mean, One thing that all of those addiction problems have in common is that relapses occur.

Yeah.

And being judgmental about that seems to be totally counterproductive. It's much harder, I think, figuring out where you're helping and where you're hurting in terms of supporting someone that has relapses and so forth. And that's where I think people like yourself that can coach from their own experience is— it can be hugely useful because you're drawing on a fund of information that people really, really need. This action is helpful. This action is not. And helping people sort, you know, people that they love is—

Yeah, I really do think that's the agony of family members and friends in terms of they know the person inside there.

Yes.

Right? They know at the core who that person was before. And this person that they love and they truly want the desire to help. And then, but then they see the actions, the behaviors, the thoughts going through their head and they're like, this, again, this is not the person that I love, but I still want to, I don't want to cause a relapse. I want to help.

Absolutely right.

Yeah.

You know, with a couple of my granddaughters, I kept saying, oh, you really need to know what a terrific guy your father was. And that the addiction wasn't him. The addiction took him over. And finally they said to me, I mean, if he was such a great guy, you know, why did he do this and this and this? You know, I'm like, well, you got a point. Yeah.

Yeah. Yeah. So I wonder, I guess then the answer is, it depends in terms of if I have a friend and they reach out to me because they're stranded, right? They've been, they went on a binge. I haven't heard from them in a week and all of a sudden they turn up and I'm stranded here. I need money. I need help. I need food. I need water. I need A ride, you know, to what end does a friend cut that off and let them figure it out on their own and/or jump in and help? How many times do they do it?

Right. Well, I mean, you know, it's like the medications. There's a hierarchy there. Money is the most dangerous thing, really, in a way, because that's so likely to just be feeding the addiction.

Yeah.

But safety comes first, and if the only way you can provide safety for your, for your friend is with some money, then do the money. You know, that, that would be my, my thing. But so often, just a listening ear or sharing a meal, you know, Things that, that provide support without feeding the addiction are the best things. So, but treading that needle, threading that needle is, is very, very difficult. And yeah, you're never going to always get it right. That's for sure.

Yeah. Yeah, that's true. That is a good point. If you are a friend of a, you know, an addict is that if you overreact or if you get fed up, if you act out of frustration and anger, give yourself grace for that too.

Right.

Because you're in a strange and precarious situation yourself. And from your point of view, especially if you've never struggled with addiction, you become upset that Time after time after time, this person is still going and doing the same things.

Right.

You know, so understand that your reactions are valid and your reactions are normal. They're not always going to be the healthiest either, but just know that somewhere deep inside is the person that you love.

Yeah, exactly. Yeah. One thing, one thing in my experience was I sponsored a guy that I was really bonded with. We were about the same age, and he had the best story I've ever heard in all of AA. And we went, we took our show up to the detox, you know, on a regular basis and that kind of thing.

Wow.

But when he relapsed, The norm in our group at that time was that if someone relapsed, they had to change sponsors. And so I made him change, and he never got sober again.

Oh, wow.

So I just can't help but think if I had been less rigid, that maybe something would have changed. So, yeah. So, you know, rigid thinking is very difficult to overcome. You know that. I know you know that. Right?

Yeah. Yeah.

Yeah.

Yeah. I think, again, you have to set boundaries to protect yourself. But when you set so many and you're so punitive with, with someone who's in addiction, you actually could be adding to it. Adding to the shame, adding to the situation that they're in, adding to their want to relapse, right?

Right.

Yeah, I mean, this is really— it's a test of your ability to discern in this situation.

Yes.

You know, how far you should go and what's right and what's wrong.

Right.

For yourself and for them.

You know, in terms of medicine, the fact that we are getting such a core now of people that are really trained in addiction medicine, I think is going to— has a great promise for the future because they've become very, very important information centers doing medical podcasts and so forth.

Wow.

So I listened to a— I listened to a podcast, a medical podcast called The Curbsiders that does medical pop tests. They have a spin-off called Curbsiders Addiction Medicine now, and that group goes over things, you know, and how the field changes so rapidly. I mean, for instance, in terms of the way to use buprenorphine, there's such a movement now away from making people go into withdrawal before they can start the bup. And now there's— now they're much more likely to start with microdoses and go up and then gradually reduce the substance, as opposed to trying to do it, you know, one-two like that, which, you know, scared people. I mean, you know, withdrawal is so—

Yeah.

Awful for— I mean, no matter what your substance is, withdrawal is such an awful thing. And such— and it's so— it's such a driver of relapse because, because of fear of withdrawal, which is— I mean, this is not an irrational fear. Withdrawal kills people. So, um, it's, uh, it's super important to—

Yes.

to have this knowledgeable body of people that can help. So I see a lot of good future for that, but yeah, you know, we have a lot to overcome though too.

Well, and like you said, especially in the LGBT— LGBT— God, I can't even say it— queer community.

I just like to say queer community.

I like that. Yeah, in the queer community, there's even an extra barrier, right?

Absolutely.

Do you know if medical insurances will cover this treatment?

It varies, but typically they do. And the, you know, I mean, Obamacare has been very helpful in that regard because it, you know, mandated coverage for not just this but a lot of mental health disorders that that insurance companies hadn't been covering before. So, but, you know, cost is a huge barrier to successful medical treatment, medications, and access to care and so forth. So, but the value of care Whether it's medication or the kind of medical care that you provide by— with therapy and coaching, etc. I mean, those are— those things pay off in terms of less cost down the road. I mean—

Yeah. Yeah, that's a good point. Medicine alone may not be the answer. Medicine plus therapy or medicine plus coaching. I actually suggest to all my coaching clients to have a therapist too, go hand in hand because we do different things.

Yes.

And I do different things than a sponsor. So maybe you can have a sponsor too.

Right.

Whatever works for you in your path.

But I think that's so important because, because these are layers in the cake here. And, you know, you can't have just the icing like medicine. You've got to have somebody knowledgeable doing it. And then you've got to have a therapist that knows when this is, this is going to be helpful and for how long.

Right. Right, right. Yeah. And the therapist can diagnose specific, you know, mental cognition, cognitive type conditions or schemas, you know, somatic therapy. I mean, there's a lot of things that they can zero in on, you know, and I think that helps knowing. So if you come to me and you know you have a specific schema, maladaptive schema in your life, we can take that and Use that in our coaching.

Right. And that's something that a medical provider is rarely going to have that kind of insight. Right.

Yeah, yeah, yeah, that's true. Yeah, yeah, yeah. Okay, well, what have I not asked that you wanted to— that you'd like to mention or talk about?

Well, what— the only thing I would say is, you know, We need to all be watching the literature and so forth carefully because as things open up a little bit more, there will be some studies that help more in terms of what exactly is helpful in terms of meth addiction and the interaction between that treatment and medicine.

What would be— maybe if you can answer this— if I have trouble, if I'm having difficulties stopping the relapse cycle, if I can't break free from addiction, what would be a way that I could see if there's a study that I could participate in?

That's a good question. Most of the centers of research have been on the coasts. You know, San Francisco, there's a lot of active studies going on. Boston and Massachusetts, the same thing. And so these days, you're going to probably have to go through medical centers in New York City, Los Angeles, San Francisco. San Francisco, Boston, Baltimore, and Chicago. Those would be the most active things. And then those cities also do tend to have the strongest LGBT support networks going on. So the sources of information, I think online meth meetings or online meetings that focus on whatever substance or substances you're dealing with. That seems to have really come into its own as an information center for people to get to.

Yeah.

So there are published lists. I mean, the National Institute Institutes of Health website is a place that you can go if you're looking specifically for a study that you might enroll in. But you're probably going to get just about as good information from your peers in someone like a coach that's talking to a lot of people, or let's say an online group where you just throw the question out.

Yeah, yeah. So if Let's say I am an addict, meth addict, and I don't want to go to treatment. I don't feel like I need to go to treatment, but I want to explore medical-assisted sobriety because I am relapsing, but it's not enough to go to treatment. So what would I— if I approach my medical— if my physician, what kind of questions would I ask?

Well, the first question is, is to ask, is your physician open to the information that you're having trouble with addiction? Because many people are going to be going to docs that probably have no idea that they're even struggling with it. So, Yeah. there's so many different layers here. But assuming that you've got a doctor that is, that knows that you're struggling with this. You just ask, are you open to helping me with medication-assist? These are some of the medicines that have been used: naloxone, buprenorphine, or bupropion. That's so difficult for people to know the difference between buprenorphine and bupropion.

Yeah.

Yeah, I have no idea. So anyway, that's the kind of thing, and you know, I'm sorry to say most people are not going to find primary care providers that are very knowledgeable about those things. So I think it's going to be helpful for most people to actually have done some research on their own on those things. What is the What are the things with naloxone that, let's say, your group that you go to, if you're going to online meetings, what do they say about that? What do they say about bupropion, Wellbutrin, for helping and so forth?

Yeah.

But I think it's I think it's very important nowadays not to think in terms of medication-assist as being the only thing that you do. You know, yes, you've got to, you've got to have coaching and therapy and a good firm support group, you know, for the medication-assist to have any effectiveness.

Yeah. Yeah, good, good point. Good points. Okay. Well, this was very informative for me. I hope that if you're listening and you have tried everything, or if you're feeling pressure from anyone in the recovery community for not using medical assistance for your sobriety, If you're feeling that kind of pressure or that shame, get away from that person. Get away from that group. If you go to your doctor and your doctor gives you the side-eye and doesn't want to support you, get a new doctor. Got to be another doctor in the network, right? You may want to try a queer doctor, somebody that also understands that part, but I would keep asking until you get—

Support.

An answer. And just know that if you go that route, if that's what's best for you, it's not a relapse and you don't have to start your days over. You don't have to get a new chip. You don't have to feel bad about it. That could be the answer, the link for you. It could be what's between you and sobriety. It could be what's been missing, you know, but like Dr. Mark said, also couple it with— Finding a support group that will support your decision and help you through it and give you the kind of container and safe space that you don't feel judged, that you feel heard and seen, and that people are just available for you, right? I mean, that's really such a big key is that to be available, just be there without trying to fix things, without Giving advice, you know, without intervening. Just be present. That would be my biggest advice too for a friend or, you know, of an addict as well, is just be present. That's all you have to do. You don't have to try to fix things. Yeah. So—

Beautiful.

Okay. Well, with that being said, I just want to say thank you so much, Dr. Mark.

Thank you, Dr. Dallas. I appreciate it. I appreciate this opportunity.

Yeah, good, good. Okay, well, with that being said, I'm going to sign off and I will see everyone next time.

Hey, Dallas here.

Are you tired of stacking up the white chips?

12 steps hasn't worked for you?

Been to treatment several times? Feeling pretty hopeless? If you're asking yourself, will I ever be able to get past relapse? Will I ever be able to string together a substantial amount of sober time? I'm here to tell you that oftentimes the answer to relapse is a slight shift in perception. Actually, any growth in life— spiritual, mental, emotional— it's one perception shift after the other. I'm giving away my free 28-day Reframing Relapse online course to help you shift your perceptions about your addiction, your relapse, and yourself. This 28-day program has daily journal prompts, guided meditations, and 2 free 30-minute coaching sessions with yours truly. At the end of this 28 days, you will look at relapse through a different lens and change the course of your addiction cycle. I promise you that. I could give your money back, but I'm not charging you anything. If you're interested, the link will be in the show notes, and I look forward to seeing you there.