Ep 2:34 Neurodivergence and Chemsex Recovery with Brian

It's a lot harder for us to get away from that impulse or that quick thing because we get stuck on it.

Yeah.

And it's like with, with OCD, you start obsessing and then you're compulsively obsessing over it. Um, it's, it's that mental—

The Aftermath Podcast is an outreach tool to help men who have sex with men break free from the addictive patterns associated with chemsex. Otherwise known as crystal meth or Tina. I'm your host, Dr. Dallas Bragg, a former crystal meth user, now recovery coach. Here you will find a repository of tools and resources intended to eradicate the epidemic that is plaguing our MSM population. Please note that the views expressed on this podcast are not to be taken as medical advice. Also, we will be talking about drugs and sex, so if you feel triggered to use, Stop listening and contact your local emergency system and/or your support network. Let's go. Hey, welcome back to the Aftermath Podcast. Happy you're here. Glad you're here. Um, today we're going to take another dive into neurodiversity, ADHD, all the good stuff, and how it relates to addiction, specifically chemsex addiction. You and I are taking together a journey. I think if you look back at all the podcasts, I'm learning a lot, and I hope that you are too. And just so you know, I approach these podcasts, these subjects, as if I don't know anything. I try to go as 101 as possible with the guest, and that's for your benefit, but also my benefit, to be quite honest, because sometimes I make assumptions or I have biases and I want to go very basic into the subject matter so that I can get a very clear understanding of where to begin. Sometimes that beginning part, if assumptions are made, you miss the, the, you're missing out on the whole issue itself and you're misunderstanding it. And so I really want to dig deep into ADHD, ADD, neurodiversity, how it relates to addiction because If you listen to the first podcast I had with Daniel Gillison on it, you will hear that I admitted that I had a bias toward ADHD. I have, I didn't know much about it. I had a friend who, who brings up her ADHD in every other sentence when we have a conversation. It doesn't matter what we're talking about, it comes up. And so I admitted that I have a little bit of a bias about it. I admit those things. For your benefit, because I want you to know that we're all human, right? And by the end of the podcast, if you listen to the whole podcast, you wouldn't know, you would have seen that my bias shifted. It evolved in my conversation with him. And it has since then. I really, I desire to be as trauma-informed as possible. I desire to meet everyone where they are with compassion and with empathy, but also I'm human. And I'm going to admit the biases that I have. I'm going to admit that when I don't know something and when I'm at a disadvantage. And so I want you to know that, you know, I hope that that appeals to you because I'm not trying to come off as something I'm not. But today we're going to take a deeper dive into this subject with a gentleman that he is a psychotherapist in New York City and he works with people with ADHD and he has ADHD, which I think gives another layer of— depth to this subject. Please don't forget that there's a supplemental study guide that comes out with every episode. The link will be in the show notes. Please also don't forget that I really want the currency of your likes, your shares, your downloads. If you could rate and review the podcast, uh, right now I just looked and we have almost 1,000 followers on Spotify and more than that on Apple Music. So really happy to see that we're continuing to grow, but I really want to continue to see the podcast get into the right hands. So when I say hands, the ears, the eyes, the minds, uh, the people around the world who, who want to listen, who need some type of resource. So without further ado, I'm going to bring my guest in. He is backstage, quote unquote. There he is. That's Brian. Brian Malloy. I'm going to introduce Brian to you guys.

Hi.

And I hope that you will, as we, as we talk here, make sure you go and look at all of his websites and his Instagram pages and just really sit back and enjoy this conversation and put your, learn your thinking cap on with me. But Brian Malloy is a mental health counselor LP who provides a compassionate, collaborative space for clients to explore their thoughts, emotions, and patterns. He integrates evidence-based approaches and modalities such as— brief psychodynamic therapy and mindfulness with a focus on authenticity, empowerment, and self-understanding. Brian works with adults navigating sobriety, ADHD, relationship challenges, identity development, and issues of self-worth. I think we can all identify with that. Um, his goal is to help clients build insight, strengthen coping skills, and create meaningful change in their lives. Welcome to the podcast, Brian. Hello.

Thank you for having me, Dallas.

So glad you're here to shed some light for us, for us who are hungry for knowledge around this topic. You know, it's just more and more people are talking about ADHD and I guess especially in, in my world of chemsex and crystal meth use. And I'll tell you, more and more people are coming to me saying that they're using crystal meth less for chemsex and more just to function as a, as sort of a, as an Adderall kind of effect in their life. So we can get into that a little more, but if you don't mind telling us a little more about yourself and how you got into this field and why.

Right, right. Well, as you said, I have ADHD. I was diagnosed in my late 30s, so that's not all that long ago. But I am also a recovering crystal meth addict. So I have that experience as well under my belt. And that is really what led me into the mental health field was navigating my own sobriety and really trying to figure out what the underlying issues were.

Hmm.

So, you know, addiction is a huge part of my story. It's a genetic factor that I, you know, kind of have lived with my entire life. My father was also a recovering addict.

Okay.

When he passed away, he had, I think, 14 or 15 years sober. His main drug of choice is the same as mine. So, you know, it's, it's, it's in me. Um, then you, you look at ADHD also, it's very genetic. It has been found that it, uh, runs in families.

Hmm.

So that is when I, I started looking at career changes, coming out as a, um, a classical singer, actor, um, working in nightlife. Doing everything and anything that would, that would keep me occupied when I wasn't using. I would be, you know, doing what I could. It was like, what can I do? What can I do to help? And mental health was where that took me.

Okay.

You know, how do I help other people who are struggling with these things? And how do they under— you know, how can, how can I help other people understand this? And I am what you consider a wounded healer, like somebody who has really went through the battlefield and has those scars. And that's how I help others. It's, I have the experience firsthand of dealing with these things.

Yeah.

Yeah, it's so important. And that's what I hear this a lot from men who want to go in my program is they say, my therapist is great, but they don't understand chemsex. Right? There's that element of understanding that this world of crystal meth use and whether anybody in the addiction industry, recovery industry wants to admit it or not.

Mm-hmm.

When you talk about men who have sex with men, crystal meth use, it's different. It's different. It's a whole different world and it should be treated differently. But unless you have experienced it, if you walked into that portal, then you really can't totally understand and relate to someone, in my opinion. I mean, there's some therapists I'm sure that have that ability to be that, you know, maybe meet you where you are, but to actually have lived it, that's—

Yeah.

That's, that's big and that, that has to help your clients.

Yeah, yeah, yeah, definitely. Um, I know a lot of phenomenal therapists out there that have not been through what I've been through and are very helpful, um, with people who have been what I, what I have been through. Um, and it's because they listen. Without judgment. But when you have someone that has been there and has that experience, there's just a level of understanding where you don't have to explain anything. You can say it and I can just look at you and be like, okay. I don't have to ask a follow-up question. If you get the, you know, the eyebrow raise, Mm-hmm. Or kind of me, you know, squinting my eyes. I'm not doing that in confusion as a therapist who didn't have the experience. I'm doing that in, all right, where does this piece fit? Where is this layer? And that's what I'm navigating. And there's a safety when you are, especially A, a, a gay man who has sex, a man who has sex with men and then deals with chemsex, which is, there's so much there. If I was to speak to most straight women, they would be shocked at the things that I'd say.

Mm-hmm.

My clients don't have to worry about that.

That's right.

That's right.

Like, it's, I'm not, I don't like saying that I'm never shocked. Because I used to say that and then a client said something and I was like, oh, all right, well, I'm a little shocked. Um, and I, so, so I walk that back. I know how to handle that shock though. So there are a lot of things that don't necessarily surprise me or they don't necessarily faze me the way that they would someone else who just hasn't been there.

Mm-hmm.

So I think it's the safety, the safety that we have with each other.

Yeah. Safety. The psychological safety, that container you're in. That's why a lot of people come to me too. And the same with you, I'm sure, is like, like you're saying, there's this instant relatability. There's a brotherhood even, right? That knowing you've been there, right? Um, you know, it's interesting because I had a client say that he went to a, um, What is the sex? I'm not, um, is it SLA?

There's, yeah, there's SLA, there's SCA, there's SA. There's a lot of them. There's a lot of them.

Yeah. Is it Sexual Compulsive Anonymous? Something like that. Anyway.

Yeah. Yeah.

Um, and it was a mixed group. It was heteros, heterosexual and gay and men and women, you know, and one of the women said, this was like late in the year and Her sexual deviancy was that she had been with 3 men that year, you know, and then he was like, you know, by that time he had been with probably, I don't know, hundreds.

I mean, he had been with 3 men 10 minutes beforehand.

Right, exactly. On his way.

You know, that, that's whenever you, when somebody talks to me and they're like, oh my God, I was such a slut. And you're like, oh, well, describe slut. Like, I need you to let me know what you mean by that. word, and I do that a lot in session with all of my clients. Okay, can you explain that word for me? Yeah, I need to know what your understanding of it is, because slut to me is not sleeping with 3 people, because I can do that walking down the block.

Exactly right. Yeah, yeah, which just goes to show like the disparity of knowledge, right? And then you tell— a lot of my clients will tell their straight friends, you know, like some of the pieces of what's going on. And they're just like, like you said, the reactions you get can send you right back into this shame cycle and send you right back into silence and darkness, even if it's a raised eyebrow from a therapist or a friend. Right?

Right.

Right.

Right. And with that is that, like, pointing out that raised eyebrow. So in Emotionally Focused Therapy, we look at Um, triggers. And that's, it's a couples therapy modality. And that trigger can be something as simple as a raised eyebrow, which actually has nothing to do with whatever is going on.

Mm-hmm.

And then the partner just identifies that as a trigger.

Yeah.

And that sets them off and then they close up or they get argumentative or they, they do whatever that makes them do. We do that on a regular basis with other people. Just based on experience. It's like, all right, well, that indicates judgment to me. So now I feel judged, so I'm going to retreat and I'm going to close up and I'm not going to share.

Mm-hmm.

Yeah.

Yeah.

So if I'm— this is not what we were going to talk about, but if I— so I work with a lot of guys who are partnered and the partner has, doesn't use and hasn't used. Again, there's this gap of, gap of knowledge, right? Um, something like, are you okay? Is, is identified, can be identified to that person as a trigger.

Yeah.

There's something about that question instead of like, I, I had a friend too that was like that. Like I would say to her, are you okay? And it would, she would fucking go off and In like retreat and not, you know, and, um, not text me back and all this stuff. She preferred, how can I support you?

Right?

Which is something now that I ask more about. I ask more.

Yeah.

But if I'm in a, if I'm in a relationship, I'm the meth user, how do I, how do I go about that conversation of saying that, that statement in and of itself isn't quote unquote bad, but it triggers me. So do you just say, here's an alternative, or how would, how do you approach that?

Yeah. Yeah.

Yeah.

So I, I work with a lot of couples or just people dealing with relationships, and I work with a lot of individuals who are not addicts themselves, but have partners who are addicts.

Yes.

To learn how to communicate and understand better. Yes.

Yeah.

One of the ways to really come about that is I always recommend that you get in a calm space to actually talk about those things, because whenever you're in the heat and you're, you're stressed or you're triggered, you're not really going to be able to hit it head on. So what you want to do is be like, hey, I feel triggered. Can we come back to this in an hour? Can we come back to this tonight?

Okay.

And you come back to it and then you talk about how you can communicate and what would be a better way to communicate that. How could I have said this better? How can I support you is a really good one. Are you okay is very broad.

Yeah.

And it can be triggering for some people. Also tone. It can, it can make a huge difference.

That's, that's my problem.

Yeah.

Right.

Right.

Right. And gay men in general have a problem with tone. So, you know, we, we have to look at that stuff. I also recommend to couples to set up a check-in time regularly, whether it's weekly or every other week, so that when difficult conversations come up and need to be addressed, it's so normalized by time that comes up that you don't have the— it doesn't have as strong of an impact for you to kind of retreat. Or to be combative.

Yeah.

Because you're already checking in weekly.

Right.

So whenever it, you're, you're normalizing that, you start to normalize those conversations and then you can actually show up for each other a lot better.

Good. I like that because that's the advice I gave my client. I was like, yeah, again, not a therapist, but I was like, well, why don't you, you know, why don't you two have a designated time to check in on, on how the recovery is going every week. Yeah. Save that until then or something like that. Um, but yeah, I like that. Um, get in a calm space, have a check-in time. Hey, I felt triggered by that phrase or word or expression. Here's an alternative that I would prefer if you would consider using it. Are you available to use this or something like that?

Right?

Right, right. And you, you both have to be open to that communication.

Yeah.

Look, couples cannot work on things if one person is working on things.

Yeah.

That's, that's, that's going to, you know, completely— the, the relationship is just done until both people come at it and can actually work on things.

Well, I, I would like to have a whole other podcast with you about couples.

Yeah, we can definitely do that sometime. We can come back to ADHD for now.

Yeah, because the, you know, the, the, the part of the partnership, the gentleman of the partnership who isn't the addict really doesn't have a lot of resources. I mean, there's Al-Anon, but there, where's the support, especially, especially when their partner is in chemsex and, you know, in a chemsex addiction, where's the support for this guy?

You know? Right, right. It's, and Al-Anon is really kind of It, it, there, there, there is another program out there, um, for, I think, adult children of, um, I, I can't remember the complete acronym, but that's more for people who grew up with addicts, not people who are in relationships with addicts.

That's right.

So it is a very different thing.

Mm-hmm. Yeah.

Yeah.

Yeah.

Yeah. Okay. So Brian, can you tell us, I like to go, like I said in the intro, I like to go 101 and talk to me like a 2-year-old. But what, what is neurodiversity? If like, if I say, if somebody says I'm neurodivergent, what does that mean?

Okay.

So neurodivergence, um, I mean, it's, it's all in the word neurodivergence. Someone whose brain diverges from what is considered typical. What is normal? That can be a little convoluted depending on who you talk to.

Yeah.

So if we look at it very strictly as someone whose brain is, is built differently, the, the structure is different. We're looking at primarily Developmental and learning differences. So, you know, you have obviously ADHD and autism spectrum disorder. Mm-hmm. And these are both disorders that are on really on a spectrum. There's different levels, there's different types. You also have dyslexia, dyscalculia, dysgraphia, and dyspraxia. Which are, you know, basically the, the way your brain processes things. Within ADHD, the biggest structural difference is the prefrontal cortex is usually a little bit smaller whenever you're, you're born. And as you're a child, it develops a little bit more slowly. And there's an actual structural difference that you can't see on a typical MRI. It takes more testing than that, but there is an actual difference. Um, but then you have also the cognitive disorders that can be considered part of neurodivergence. Um, so that would be auditory and visual or nonverbal, um, learning disorders. And then You can add on another layer to this, and this is where it gets very confusing and very complicated.

Let me see.

The psychiatric and mental health conditions that you can add onto it. Because yes, as a mental health counselor, I work with ADHD and autism. Like I, I, I work with these things.

Okay.

And there is a mental health component to it because it's affecting executive dysfunction and all of that, that kind of stuff. You add in these psychiatric mental health conditions and you have bipolar disorder, obsessive compulsive disorder. And I mean, there, there's a huge list that you, that you can add onto this, like Tourette's, epilepsy, you can, it can be considered part of it.

Schizophrenia.

Schizophrenia. Yes.

Yeah.

That, that could be considered part of it. And the biggest one is PTSD or complex PTSD, which is, I'm sure you have had people talk about these things before on the podcast.

Yes. Not, it hasn't been the specific topic. It's, I'd like it to be, it's finding the people, you know, who can speak to it.

Right.

Right.

So, PTSD is exposure to one traumatic event, and that's your effect. And there, there's a lot more to it. I'm not gonna go too, too in depth. Complex PTSD is someone who is repeatedly exposed to traumatic events, and it doesn't always have to be one thing. It can be several things and it compiles. People in addiction, especially crystal meth addiction, tend to have a lot of complex trauma. There's a lot of repeated trauma in their history. Now, complex PTSD has a lot of similarities with ADHD, reason being executive functioning.

Hmm.

And the way it reprograms the brain with just the, the, uh, I mean dopamine and the way that the synapses start to fire is very different in complex PTSD and it has the same type of executive functioning, uh, functioning issues as ADHD does.

What is executive functioning?

Okay, good. So executive functioning is really when A person has issues. Well, executive dysfunction is when somebody has issues with the control center, so to speak. So your control center is planning, um, focus, organization, self-control, um, memory, all of that kind of stuff. So you have problems with procrastination, you get overwhelmed easily, there's emotional dysregulation. And this all happens in ADHD. This all happens with complex trauma and having to navigate all of that becomes very overwhelming and very difficult. So adding some language to that is very helpful for people with ADHD.

Um, yeah.

Yeah.

Yeah.

So that's executive functioning, executive dysfunctioning. It's like, you know, how do I initiate? And take charge and do what has to be done.

Okay.

Okay. So if a client says, you know, they have this dirty room or they have laundry to do.

I love the laundry one.

And they, they can't initiate it. They can't get it done.

Right.

I've heard, I've, I've heard clients tell me, or people say, well, it's my ADHD.

Yes.

Yes, 100%. So let me describe this to you. So something like laundry, and I actually use this example quite a bit. For a neurotypical person, you think to yourself, all right, I have laundry. Let me sort into the proper colors.

Mm-hmm.

And then I'm going to put this load into the washer. And then I put the soap in and then I push start and I let it go. And then when the alarm goes off, I move it to the dryer and I put it in with some little, you know, the little fabric sheets or whatever. And I dry it and then I fold it and then I put it up. Somebody with ADHD looks at laundry and says, shit, I have 20 things to do and I have to do 'em all right now. So in my head, I am already sorting the laundry, putting it in the washer, putting in the soap, putting it in the dryer, putting the dryer sheet in, folding it, and putting it into the dresser drawers or the closet before I've even looked at the laundry.

Hmm.

So I've always— I'm already fatigued. I'm already tired. I'm dealing with task paralysis at this point because I don't know where to start. And it's obvious, well, you start by standing up and making your piles.

Mm-hmm.

And task paralysis is one of my biggest issues actually with ADHD. It's something that I, I deal with quite often, and sometimes I, I need somebody To just be like, all right, let's do this. And not that they are doing it with me, but they're with me while I'm doing it. And we call that body doubling.

Uh, uh, I have heard that.

Yeah. And body, body doubling is, it, it, it's great for people with ADHD. Um, it's really, you know, it's, it's like a study group.

Yeah.

You know, it, it helps you do what you need to do. Whether you're doing the same thing or doing something different, that's great. I have a friend that several months ago I was talking about body doubling and he needed to do something and I went over to his place and I wasn't doing anything. All I did was I went over there and he ended up doing everything he needed. And he looked at me and he goes, this shadow peopling is really great.

That's a different thing.

Yeah.

I'm like, that's, that's, that's, that's not exactly what it's called. And this is also somebody in recovery. So shadow People to people in, you know, recovery with crystal meth. Completely different thing. I'm like, but if this is how you remember, then it's helpful for you. It's okay.

Yeah. It sounds like, it sounds like when my son was little and it was time to clean his room.

Right.

And I knew that I had to give him one task at a time.

Yes.

Go and pick up all of your socks, put 'em in the hamper, and then come back.

Right.

Now go and pick up all your shirts and put, you know, because otherwise it was too overwhelming for him.

It, yeah, it, it just, it becomes too much for the ADHD brain to handle.

Mm-hmm.

Um, at one time, um, task paralysis is, is a big issue. You, you'll also hear it called analysis paralysis.

Yeah.

Um, because you get stuck analyzing what needs to happen first. And it becomes a problem with organizing or time blindness is a huge thing for people with ADHD who are, they, they miss appointments and they just, they miscalculate how long it's gonna take to do something and they get stuck in that analysis paralysis or task paralysis of it all.

Mm-hmm.

And they're just going over in their head, just, all right, what am I doing next? What am I doing next? And then, you know, I, I sat down several months ago. On a day I didn't have anything to do, I sat on the bed and 4 hours passed. I was like, what the hell did I just do? Because I was trying to calculate a day in my head, but I didn't have anything that actually needed to be done. And that never happens. I always have stuff that needs to be done. So that day I was like, I don't know, like I need to make up stuff to do. But I lost half of the day.

I mean, a lot of this stuff, yeah, a lot of this sounds like when you are high, cuz I used to get stuck like that. Like I, I knew I had to do something, but I could not get off the bed. Right.

Right.

And, and of course the, you know, the du— the night goes, the sun's coming up and you're like, what, what hap— what happened?

Right. And you know, I, I never thought about it like that actually. Um, but that's exactly how it feels. Mm-hmm. Is, is when you have been using And you just get stuck in doing whatever and you lose time. And that's, that is actually what happens with time blindness. 'Cause that's exactly how it feels. Interesting. And yeah, yeah, that is actually an interesting comparison.

I mean, I used to call it getting stuck all the time. I would just, I'm stuck.

I'm stuck.

Right. Yeah. Um, so, okay. So executive functioning. In terms of the control center, it's dysfunctioning. You're having planning, trouble planning, focus, organizing, self-control, and memory. So I'm assuming that that's gonna bleed over into trying to deal with a craving or a trigger in—

Yes.

In addiction, right?

Yeah. Yeah, yeah, yeah. Um, it's because we also have problems with impulse control.

Right.

Right.

It doesn't mean that that is an excuse to give into the impulse.

Sure.

But it's a lot harder for us to get away from that impulse or that craving because we get stuck on it.

Yeah.

And it's like with OCD, you start obsessing and then you're compulsively obsessing over it. It's that mental Um, preoccupation.

Yeah.

Yeah. Yeah. Yeah.

So if I'm helping 2 people with cravings management and one of them is diagnosed with ADHD or some type of other neurodivergency, if that's the word, how do I coach them? How do you maybe even, even in your own experience, how do I coach them on On not obsessively compulsing, uh, obsessively, um, fixating on the craving. How do I manage that if I'm, if I have ADHD?

Right. And that's challenging. That's very, very challenging. So a tool that I use, and it's not just for like cravings, um, this is used for people who do self-harm. They hold ice cubes until it burns. People with eating disorders do these type of things whenever they're trying to get past a craving.

Interesting.

Something that I do is I don't hold the ice cube, but I will take an ice pack and I'll put it on the back of my head.

Okay.

And, and I do that whenever I'm triggered by anything emotionally. And, you know, since I, I have my own trauma, my own issues that I have to, you know, keep in check whenever I'm working with clients. So sometimes I'm working with a client and I'm doing great, but at the end of that session, I need to do what I call a reset. And sometimes breathing exercises work. When it's very strong, you need something that's gonna pull you out of your body a little bit and reground you.

Yeah.

And the ice pack on the back of your head, under your armpit works really well for a lot of people. And just holding it there for really as long as you can.

Hmm.

Ice plunges are great for shocking the nervous system for people who deal with trauma. It's good for people with ADHD or doing, or in recovery as well, because it's, it's your nervous system is what needs reprogrammed.

Yeah.

And when you're stuck in an obsession, you need something that's gonna pull you out of that obsession.

Hmm.

So I just find ice to be very beneficial for that.

Yeah. Yeah.

Isn't that a tool too in DBT, dialectical behavior therapy?

Yes.

Yeah. Yeah.

The dunking your face in the ice.

Yeah. And I mean, DBT is a great therapeutic practice for people who are dealing with strong emo— emotional deregulation as well. So it, so it's good for people dealing with crystal meth addiction. Um, and it's the gold star for, um, borderline personality disorder.

Yeah.

Yeah. Yeah. I've heard that.

Okay.

Okay. Okay. So then when we're on some type of medication and I guess, does, does everyone, I guess it's a spectrum, right? So does everyone who's been diagnosed with ADHD need to be on medication?

No.

Okay.

No.

Um, so, so it's interesting. There, there's different types of ADHD. If you look at the DSM-5-TR, you're going to see it's, it's very basic. All right, you have hyperactive type, you have, um, uh, see, and I'm— my ADHD just kicked in and I forgot the type that I have.

Um, Wow.

Wow.

Wow.

Wow.

Where is my head? Inattention. Sorry. Inattention. So you have the inattentive and the hyperactive types.

Okay.

Or you have the, you know, the, the, the combined, but there's actually, you know, 7 types where you have limbic, temporal, like there, there's several different types, ring of fire, where your brain is just affected differently.

Mm-hmm.

Medication works for some of that, but not all of that. Everyone's brain chemistry is very different, and that's the reason, like, psychiatry is not an exact science.

Mm-hmm.

When dealing with ADHD or depression or anxiety or anything, a medication that works amazing for one person may not work at all for another.

Mm-hmm.

Also, how does it make you feel? Is it making you feel sluggish? Is it making you feel amped up? Are you experiencing a crash in the middle of the day after taking it? Yeah. So medication isn't right for everybody.

Mm-hmm.

And, you know, I, I kind of push that as if it's needed, if it's something you want to explore, find a psychiatrist that is Going to be by your side while you're doing it. I don't recommend going to the, you know, the primary care practitioner or, you know, a family doctor or something like that. It's, yeah, they, they can, they can give you the medication, but from my experience talking to clients that have gotten their medication from doctors like that, They don't sit there and go through all of the navigation of what it's like to be on the medication and how it works.

I see.

Most psychiatrists, hopefully, if they're, you know, if they're worth their weight in gold, they're going to listen to you and not just hand you a medication that you shouldn't be taking. Because especially Adderall, which is the most common, There is one difference between Adderall and methamphetamine.

Right. Yeah.

And it, it's just the added methyl.

Right.

It's like you look at the compound and you see one little thing pointing off of the Adderall and it makes it meth. So they're very, very similar. So you don't want to put that into your system, you know, for absolutely no reason. Now, if you're not dealing with meth addiction, maybe it's something you can look at and deal with. Mm-hmm. The way that Adderall affects a meth addict is also a little bit different.

Mm-hmm.

Just because meth is stronger than Adderall. So that's what we're used to.

Yeah.

So then you go into Adderall, you're like, well, why isn't this working the way that the meth did? Well, the meth is stronger.

Mm-hmm.

But the Adderall can still be dangerous.

Hmm. Yeah.

Okay. Okay. And, and back to, so you were saying earlier, so complex PTSD is much like, has, is, is similar to ADHD.

Right. It has similarities. I wouldn't say it's similar to, because the causes are completely different. Yeah.

Yeah. The causes are different. Okay.

So completely different for cause.

Yeah. Yeah.

So, so when I say similar, I mean the executive functioning issues are where the similarities are.

And you were talking about how it repro— they're similar in terms of how it reprograms the brain.

Yes.

Right. Can you talk a little more about that?

Yeah, yeah, yeah, yeah, I will a little bit. So I'm not a neuroscientist, so just my terminology and everything could be completely wrong for all I know. No, so complex trauma will reprogram the way the synapses in your brain fire.

Okay.

compounds, the dopamine, all, all of the good things that should be working in the brain to make you function and go about your day-to-day life.

Okay.

Start to misfire.

Okay.

And that starts to reprogram the brain on, you know, a chemical level.

Okay.

And At, at a physical level as well, although it's not really measured. So that's where the similarities are, is it starts to— the, the damage in the brain occurs and it reprograms the body.

Okay.

And, and the way you feel things.

Gotcha.

So trauma lives in the brain, it lives in the body.

Yeah.

And we don't always think about that. You know, there's, there's some great books and research out there on, on complex trauma.

Mm-hmm. Mm-hmm.

Would you suggest The Body Keeps the Score?

I think The Body Keeps the Score is a fantastic book. I suggest Trauma and Recovery by Judith Herman as well. Okay. That was the precursor to Body Keeps the Score. Uh, I feel like the first half of Trauma and Recovery is a stronger, like a, a stronger writing than the first half of Body Keeps the Score and then vice versa.

Okay. Gotcha.

The second half of Body Keeps the Score is a little stronger than Trauma and Recovery. It fills in some of the gaps.

Yeah.

So, but they build up, they, it, it built on that research.

Yeah. Yeah. Yeah. Yeah. Okay.

And, and so when you're saying that it affects the way we feel things, so how does a person with ADHD, how is it, how do they feel things differently?

So we feel things very strongly. Okay. We, we deal with emotional dysregulation. There's also rejection sensitivity dysphoria. Is something that happens with people with ADHD a lot. Um, so someone with ADHD not being directly invited to a party that all the friends are invited, like there's 5 close friends, everyone is going to this party.

Yeah.

But the one with ADHD didn't get a direct invite. They won't go. They'll be like, well, I wasn't invited because in their head they were rejected. They were left out. And they take that as this huge, like, affront. And it really hurts them.

Mm-hmm.

Even though it wasn't, you know, meant to hurt them. Um, and it, it's interesting how that works cuz that would, I was always like that. And whenever I found out that that was actually something, like I found out about ADHD and then I found out about this thing, I was like, oh, well that made sense. Like everybody would wonder where I was, but it was like I wasn't invited.

Yeah.

Which it hurt my feelings. And then I personalized it and they're like, of course you were invited. It was an open invite. We feel those things very strongly, but also, you know, a breakup hits us stronger than it's going to hit somebody who has, you know, is emotionally regulated. Our emotions are just stronger. They're more intense. And it takes a lot of work to navigate all of that. It's exhausting. Honestly, it's exhausting dealing with my emotions.

Yeah.

Which, you know, it makes— that's the meth addiction. It was like, all right, I could pick up meth. And for those first few hours, first 24 hours even, I'm good. I'm like, all right. I, you know, I feel kind of like what I think normal would feel like. Of course, my energy never went towards things that were productive and good, but—

Right.

You know, I felt like if it had, if those things had been in front of me, I could have done it. It also numbed those emotions, those strong emotions.

Right. Right.

So going back to that to keep using was a strong thing. So whenever you get sober and you're, you're having to face all of your emotions, you're already dealing with a challenge. Throw in ADHD where everything is intensified.

Mm-hmm. Mm-hmm.

It can be a lot harder.

Hmm.

Yeah. Okay. So somebody who has all this going on in their mind, so I, there's, there's, there's one guy who has, um, that I've talked to. He has BPD, I guess, about, um, borderline personality disorder. Borderline, borderline personality. And he's talking about the, the, the overanalyzing that's going on in his head all day, every day, you know?

Right.

And I, did I take that wrong? Is it me? Is it them? The meth puts a silence to all of that, right? So I'm guessing somebody with ADHD, somebody with some of the, any of these neurodivergent, would you say disorder? Disorders?

Yeah. Yeah.

I call it a disorder.

Disorders. I would say their reward for doing meth is even stronger than a quote unquote normal person because they finally get a relief, not just of From their trauma.

Yeah.

But from every day analyzing every day the voices and dealing with the, the strong emotions that they, they get a, a break from all of it.

Right.

It, it's a huge break. It, it's just like, oh, I can, I can breathe. Not literally because that shit really fucks with your lungs, but like, right, exactly. You know, emotionally you can breathe a little bit.

And, and is the comedown then worse because, you know, your emotions are all fucked up when they come down because of what's going on in your brain trying to rebalance. So as, as someone with ADHD, is it even worse?

I wonder.

I would suspect that it is. Um, you know, since I have ADHD, that's the only experience I personally have on the comedown. And I don't know of any studies that have really studied that part. of ADHD in the comedown. I would say it, it is a lot more strong because even people who are just dealing with coming off of Adderall go through a huge rebound on trying to get back to what their baseline was. And sometimes that can take weeks.

Mm-hmm. Yeah. Yeah. Okay.

Okay. What else would you, in your experience, I guess, what else sets apart the experience of someone with ADHD and when they're dealing with an addiction? What do you think is unique or—

Hmm.

Is that, is that a question? Is that a good question? Um, when I'm thinking about the normal things like, okay, cravings, triggers, The other thing that, okay, here's a question. We are talking about planning, focus, right? Organizing, right? So in my program, I have, I really focus on systemizing in terms of if you have a weekend coming up where you don't have any plans and you're gonna be alone, I want you to create a detailed calendar.

Yes.

Of the whole weekend.

Sure.

Where am I gonna be? What am I doing? Who am I gonna be with? When am I checking in? If I'm asking someone with ADHD to do that, is that going to short circuit them? I mean, that's a lot to plan.

That is, that is a lot to plan. Um, but it's also, it's something that I recommend to people in recovery as well. Like, you, you have a weekend where you are free.

Yeah.

You better plan out every freaking moment if you're struggling.

That's right. That's right.

Um, you do not want a moment of downtime.

Yeah. Um, yeah.

Yep.

So it, it's good to, when you make that recommendation, make suggestions as well. Um, so it's like, you know, all right, maybe go to a movie from this time to this time and then meet a friend for dinner from this time to this time, throw some ideas out and that could help them navigate. Um, You know, when, when I talk to people, I'm like, look, if you need ideas, reach out, shoot me an email. I'll try to get back to you as soon as possible. There's no guarantee I'm gonna get back to you in the time period that you need me to, but I'm gonna do the best that I can. And just having that person say, hey, I got you, adds a little comfort.

Hmm.

to the person with ADHD, or is it like, what is it like a body doubling kind of? Oh yeah.

Yeah.

I mean, ish, it, it, it's, it's, I, I guess. So it's really just like, so I have, I have an example of like, for memory, I have a terrible memory. I forget shit all the time. When I look at somebody and say, hey, can you remind me of this? If they say, yeah, I'll try to remember and let you know. I'm like, good. I'm more likely to remember it.

Oh, interesting.

Because I just had somebody support me. I have that comfort of support. So whenever you're like, Well, you know, plan out your schedule, like do that. Reach out to me if you need me. They're like, oh, I have, I have their support. So they're more likely to go ahead and do it and not actually need to reach out to you. Then if they do reach out to you, it's not a big deal.

Mm-hmm.

You're still, you're still able to give that support.

Mm-hmm.

Now, if I tell somebody, hey, could you remind me this thing? Why can't you remember it? I suddenly feel shame and I will 100% forget.

Ah, okay. Interesting.

So, you know, sometimes it's just adding a little support and I think that's very important for couples and friends to really know whenever you're dealing with somebody with ADHD. So sometimes it's about the support.

Yeah.

Yeah. I think that that's a mistake I've made in the past. And, you know, the last podcast we did when I mentioned my, my friend before, even before that, I had another friend. And she, we worked together and, um, late for work every day. Right. And when she said, I'm on my way, that meant she hasn't even got dressed yet.

Right.

Right.

Um, and lost her glasses every day. Lost, you know, just constantly all that stuff. And I think I made, you know, I just made fun of her a lot and talked about her a lot, you know, in a very, in a very pompous way, probably. Um, but it was irritating to me, right? And I probably, for me, making comments like that probably made it so much worse, right? Because she's feeling this shame and this guilt and this pressure to remember, and she's probably making her forget more.

Yeah, and it can. It can. And we, we've all made those mistakes. Even, even like I've made those mistakes with people. I'm, I'm a lot more cognizant of it now, and I try to be more aware of it now. Um, but we all make mistakes. It's just how do we correct that moving forward? How do I say, hey, I see you. I'm, I'm sorry, I may have been a bit of an ass.

Yeah.

Yeah. Yeah. Okay.

So if, if I, if I've been diagnosed with ADHD and part of what you said, self-control, right? Um, impulse, impulse control, um, memory. I think that for the listeners, it's more even evidence if you have, if you've been diagnosed for ADHD to do what I said in terms of in early recovery from chemsex, you can't rely on self-control even in a quote unquote normal working brain.

No.

Right? Much less a neurodivergent brain. And so if you can't rely on self-control, if you can't rely on willpower, Then you're going to have to set up enough barriers and safety nets, um, um, and, you know, in, in your day, in your week, in your weekend, in your life so that you don't have a choice not to use. Right. If, if, right. I mean, there's more of a reason to do that, set it up that way.

Right, right, right. So when you enter early recovery, and this is, this is for anyone, I recommend putting up Every roadblock and hurdle you can.

Mm-hmm. Mm-hmm.

It's not going to stop you, but it's gonna give you pause.

Right.

And that pause may be the additional 30 seconds you needed to get through that, that moment of weakness. Moments of weakness are gonna happen. Relapse happens. You just have to move on from it and, and try not to beat yourself up for it because, because it, it's part, it's part of life. Um, you know, and I, I, I think something that we, or something that I have seen a lot in the recovery community is other people shaming people for relapsing.

Yeah.

And instead of showing empathy for it. And showing empathy doesn't mean saying, hey, you're fine. Everything's great. There's no consequences. It's saying, hey, come back. I got you.

Mm-hmm.

Like, you know, we, we're, we're in this together. Now, maybe I don't have the support or the strength to give that support to the friend that just relapsed. Maybe that's taking a toll on me, but being like, hey, I love you. Come back. I need to take a little space for myself. I don't want you to feel shame, but I also have to look out for my recovery. That's also acceptable.

Mm-hmm.

We need to lead with more empathy. In cities with stronger, you know, recovery, um, you know, programs like, and by stronger, I really mean larger. There's, there's more going on, but you know what, what do you do when you're from a small area?

Yeah.

You know, you have to come up with other ways to be occupied, but staying as active as possible in early recovery is very important. Stay busy.

Yeah. Yeah. Yeah.

Stay busy. Put as many roadblocks and hurdles as you can.

Right.

Everybody, everybody that's listened to this podcast knows that I'm a big proponent of that. Um, we don't, we, we don't want to, a lot of guys are like, they don't want to feel infantilized, right? They don't want to feel like they're a child, but there's really almost no way around it because you, you, to me, and you tell me if you agree with this, but I always tell people, look, you have to, if you're not going to go to rehab or if you just got out of rehab, you're going to have to duplicate that experience now.

Yeah.

So what do you do in rehab? You don't have access to your phone or it's monitored.

Right.

Right. Somebody tells you where to go at all times. Your whereabouts are always known, right? You, you're connecting in groups every day, right? So even if you just take those 3 things and say, I don't have access to my phone, or I'm going to block the apps off my phone so that I can't download them.

Right. Right.

I'm gonna tell people where I am at all times. I'm gonna have a plan. Like, I'm gonna be checking in with people. Like, you're, you're, you're just duplicating that experience because it worked. There's a reason why it worked. You're abstinent in, in that container.

Right. Right.

Yeah.

Yeah. I wonder how, if you agree with me on that.

No, I, I, I fully agree with you. Um, it, it's sometimes you have to look at yourself in the mirror and say, all right, well, if I don't want to be treated like an infant, then I need to fucking grow up.

Right, exactly.

Yeah.

I'm glad you said that.

I mean, it, it's, it's, it's the harsh reality. It's like, you know, that, that's, that's what I would tell a client.

Yeah. Right. And I have said that, like, you don't wanna be treated like an infant, but you're acting like one right now.

Right. Right. And sometimes, you know, you, you just, you just need to point it out sometimes.

Yeah.

Yeah. Um, and in, in early recovery, yeah, that, that's really how it is. It's like, all right, I kind of need somebody to baby me. I know I did.

Yeah. Right.

I, yeah, I, I needed everything like basically planned out to a T for me. That's right. And, you know, would that work for me now? Probably not, but it did then.

Mm-hmm.

And that's what was important is it, it did when it, and when I needed it to.

That's right.

And it's not what I wanted. I did not want that at all.

No, no one does.

At all. So it's, you know, sometimes you, what you want and what you need is not always the same thing.

That is exactly right.

And, and I, I use that in recovery a lot. You know, I use it in psychotherapy, but I use it in recovery a lot because when people are looking for their sponsor, and that's a very important thing if it's somebody in recovery in a 12-step program.

Mm-hmm.

What I wanted in a sponsor was not what I needed in a sponsor. And thankfully I realized that whenever I came into the program.

Yeah.

Because I went for what I needed, not for what I wanted.

Yeah. Yeah.

Lovely. I like that mic drop on that one. Um, before we talk about your practice, is there anything I missed that would be important to talk about today in terms of ADHD, neurodivergence, addiction?

Right, right, right. I mean, there's so much, so much to really to talk about there. There's a lot, there's a lot here. I think one of the most important things whenever it comes to ADHD and addiction is stop saying you have ADHD whenever you don't. That's a problem we're running into it. Like, I go into meetings and people are like, oh, my ADHD, my ADHD.

Yeah.

Bitch, you're just neurotic.

Yeah.

Like, that's nothing to do with ADHD.

Yeah.

Granted, it is fairly common.

Right.

Um, so ADHD and substance use disorder, not just crystal methamphetamine, but in substance use disorder, is around 20 to 30%.

Okay.

Is what studies show. Now, in studies of crystal meth users, You average anywhere from 20% to around 50+% in those studies whenever they're studying crystal meth addicts that have ADHD.

Okay.

So there, there, it, there is a large percentage.

Yeah.

And, and that's important to know. But whenever somebody just starts saying they have ADHD and they don't, Yeah. It starts to stigmatize those that actually do deal with it on a regular basis.

Yeah.

And we need to remove that stigma because we are already dealing with shame as addicts. We are already dealing with shame as gay men.

Mm-hmm.

Why the hell do we need to add more shame onto somebody?

That's right.

Because we're adding more stigma. And then you have all these other factors. that, that play in, like the person may also be dealing with shame about, you know, their, their HIV status because that's something we run into.

Yep.

So how much shame can one person take?

That's right.

So that is so important. We need to get away from just saying, oh, well, I have ADHD when we don't. If you want to get diagnosed, go get diagnosed. Yeah, you can easily do that for whatever reason it is, um, or for the purpose. That's gonna be dependent on who you see. So if you see a psychiatrist, that's probably gonna be the most thorough assessment that somebody will receive for ADHD, and that's to get medication and medication management. You're gonna have to see a psychiatrist for that evaluation.

Yeah.

Yeah.

Every state in the United States is different on who can diagnose. So there are, you'll hear some people say only doctors. Only you have to have a PhD or a PsyD to be, to diagnose. That's not true. Every state is different. Now in Canada, I do believe that actually is true in Canada.

Okay.

But I'm not 100% certain. You have to check the laws and you really have to look into it because it's just, it's dependent on location on where you can get diagnosed. So, you know, I know in, in New York, A clinical social worker can diagnose you. A mental health counselor with diagnostic privilege, they can diagnose you.

Okay.

Okay.

Um, it depends on the purpose. For medication, you're gonna have to go to a psychiatrist because they're the only ones that can give you the medication. So they need to do the assessment.

Yeah.

Um, yeah. Now for working with a therapist and trying to learn how to regulate everything, Yeah. You can do that with anyone that is labeled under a psychotherapist, social worker, mental health counselor, marriage and family, um, professional counselor. There's so many different, um, licensures that, that are covered in different states. Um, so yeah, that is very important and that information does need to be out there for, for the listeners to know if they, if they think that they actually deal with ADHD.

Yeah.

They should learn that stuff.

Yeah. Yeah.

Good. Good.

Thank you for the statistics. I even asked you for those and forgot to ask.

Yeah.

I almost forgot and I was like, oh yeah, yeah, no, I do have some statistics here that I can provide you.

Yeah. Yeah. That's good. Good. I like this. Yeah. I mean, you know, stigmatize, stigmatizing each other even more. I mean, I always say you can't, you can't solve addiction with what caused it. which is mostly shame, right? Right, right. Um, so, okay, well, let's take a look or talk about your practice. You're in New York City. You're a New York NYC-based psychotherapist that specializes in LGBTQ+ issues, ADHD. So what is CNM?

Consensual non-monogamy. So consensual non-monogamy or ENM, ethical non-monogamy.

Ethical, right? Okay.

Yeah, yeah, yeah. So, um, you hear both terms used.

Yeah.

Um, and, uh, you know, a lot of gay couples are, are non-monogamous. It's just to what extent. That doesn't mean that they are polyamorous. It just means that there's some sort of openness to the relationship.

And you therapize the group or whatever, or—

Usually it's an individual or the couple. It depends. Um, yeah, yeah, yeah. So, you know, the, the, We deal with the couple or the primary couple, or it's just one person trying to navigate their own, um, um, non-monogamy with their partner. Um, so when dealing with that stuff, I do recommend like drawing up contracts, um, of what's acceptable and what's not, which sounds very businesslike, but it takes away the gray area of, well, maybe I could get away with doing this because the way you perceive something may not be the way your partner perceives something.

Mm-hmm.

Yeah. Yeah. Interesting. I dated an ethical non-monogamous couple once and they, yeah, the rules were very precise about when we could sleep with each other, what was allowed, you know, how they got that. Right.

Right.

Right.

And dealing with polycules, like a polycule is like a couple that like, well, it's like 3 or more in a relationship together that gets even more complex because that primary, the primary relationship has to be very strong before you can bring in.

Yeah.

Anybody else?

Yeah.

Interesting.

Yeah. Okay.

Sorry. And then substance use and trauma. Um, you're, we're going to put your Instagram page in the show notes. Um, Breakthroughs, Breakthroughs with Brian. Are you accepting, you're currently accepting clients?

Yes.

Yes, I am. I have some spots open. Scheduling can be a little complicated, but I am accepting clients at the moment.

And only New York City or anywhere?

New York State.

New York State. I mean, sorry.

New York State. So yeah.

Okay.

Um, I primarily see people via telehealth, so anywhere in New York State, as long as the client is located here, I can see them.

Okay, great. Good. Anything you wanna say that I see you have Mending Men's— Mending Hearts Men's Group, Healing After Heartbreak?

Yes. Yes. And that is a men's group that is currently not running.

Okay.

Um, but it runs when we have enough people interested.

Okay.

At a certain time, because you need a certain amount of people to do a, uh, to, to do a, you know, a, uh, a group, um, therapy. Yeah.

Breakup, separation, divorce, whatever brought you here.

Yeah. Yeah. Yeah.

Okay.

It's all about heartbreak.

Like that.

Yeah. Interesting.

Wow.

This was, whew, this was a, even though it was a deep dive, I still, like you said, I think we just hit the, we just hit the next little level today.

Barely skimmed the surface. There's so much on this that we could talk about.

So.

Yeah. Yeah.

Yeah.

But I think, I think for those of us, you know, the, the rest of us or whatever, I mean, some of what you said, I'm thinking to myself, oh wow, maybe I did, maybe I have ADHD. 'Cause this, um, the rejection dysphoria, you know.

Well, because it, it exists in, in other conditions as well, or other conditions. It, it, it exists in people in general. But it's, you know, like people with borderline personality disorder or bipolar disorder also deal with that. So it's not everything that I mentioned only happens in ADHD. It happens in other things as well. So there are so many factors, and that's the reason an assessment or a proper evaluation is important.

Yeah.

That clinical interview with somebody that knows what they're talking about and what they're looking for.

Mm-hmm.

Can sit there and be like, all right, well, all of this sounds like ADHD, but these sound like other things.

Yeah.

Because there's a lot of misdiagnosis out there.

Mm-hmm.

And ADHD gets overlooked a lot for depression or anxiety.

I see.

Bipolar disorder. Like, these are things that need to be ruled out. Whenever you're, you're looking at it. But then there's comorbidity, and comorbid means that it's more than one condition, more than one disorder. So it's like a lot of people with, um, ADHD also have an anxiety disorder. That's 25 to 50% of people with ADHD have anxiety.

Yeah.

There is depression is anywhere from 18 to 53%.

Wow.

For ADHD and depression to become morbid.

Mm-hmm.

A lot of these things coexist.

Mm-hmm. Mm-hmm.

Not always, but often they do. And then it's also what happened first? Like, are they like, is this person with ADHD actually dealing with all of this because of struggles of ADHD? A lot of times, yeah. A lot of times that anxiety is just amplified.

Yeah. Yeah. Wow.

A lot there. But I think if anything, if anything, this podcast, you know, can help us be more, like I said, sensitive, more trauma-informed when we're, when we're talking to somebody who says, I have been diagnosed. Because you, you've made it clear that self-diagnose, somebody who self-diagnoses is different.

Yes.

If you've been diagnosed with ADHD, kind of, you know, how to deal, how to think about how to approach them and, and how to support them. And so I think if anything that comes with that, but also If I have ADHD and I'm trying to, and I'm in recovery, if I'm trying to stop using, there's a different approach that I might have to take.

Right.

And so I think this is valuable information.

Right.

So there, there, there are differences in the way you may need to approach recovery and we're, we have enough trauma being in recovery.

Yeah.

We have enough trauma. We do not need to add additional bullshit into people's lives. Yeah. Especially for people who just want to throw more stigma. Yeah, let's, let's be more compassionate and empathetic to each other.

Because, right, right, the queer community stigmatizes each other enough.

It's horrible. It's horrible. We have enough against us. So let's, let's love each other as much as we can.

Yeah. Yeah.

Thank you, Brian, very much. I appreciate this very a lot. Thank you for taking your time today. And guys, I hope you enjoy the conversation. If you want to join in, you can comment on Spotify, you can comment on YouTube, you can Contact Brian directly or me, and we'd love to to join in discussion about this. I know this is going to be a hot topic. The other the other podcast we did on this topic was really popular, so this one is going to be even more so. So thank you guys. We'll see you next week.