EP 2:7: Attachment Styles and Chemsex Addiction with Mauricio

Hey y'all! Oh my Lord, I am so thankful you are here this week. This is an episode you will not want to miss. This is an episode you will want to pay very close attention to. This is an episode where you're going to want to take notes. This week is full, deep, and potentially life-changing. Mauricio is a published author and is operating a chemsex clinic. You'll find more out about him during the episode, but let me tell you, this man is knowledgeable. The information he is giving in this episode could help many of y'all fill in the missing links of the whys and the hows you became addicted to meth and the key to dissolving it. Mauricio is on the cutting edge of new research around attachment theories, and he is interweaving it into explaining the predisposition to addiction and why we stay there. I want you to have something to write with and something to write on for this episode. I learned a ton. And I know you will too. Enjoy. 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. All right, welcome back to the Aftermath Podcast. My name is Dr. Dallas Bragg, your host. Welcome back, and I'm so grateful that you are here. I'm so grateful that you're taking the time out of your day, and you have millions— I guess millions— of podcasts to choose from, but you're taking the time out to listen to this one, and I am very, very honored and grateful that you are. And it shows that you are interested in the mission that this podcast has, which is to eradicate, or at least lessen, the epidemic of chemsex among our men who have sex with Amen. Around the world. Don't forget that there is a study guide that goes along with every podcast episode. The link to the study guide will be in the show notes. If you would like to join my mailing list, you can get this study guide in your inbox every week, as well as every Monday I send out a newsletter that is also a study guide. So I try to offer as many free things as I can, free resources for you as I can. And so the newsletter, it presents a topic Just like the study guide for the podcast. And then you'll have reflective questions, you'll have journal prompts, and you'll have exercises in there that can keep you kind of thinking about your recovery as you go, or you can share it with others. Um, I have a list now because I keep forgetting to mention things. Don't forget, speaking of free, do have a free course, Reframing Relapse. It's 30 days of video modules, journal prompts, guided meditations, and a free coaching session with me. If you're interested in that, the link is also in the show notes. And one last thing is, please, if you have, if you have rated and reviewed the podcast, thank you. If not, I would appreciate that. If you have, could you share the podcast on your social media? I don't know that anyone has yet, because if you have, you're not tagging me in it, but please tag me. I'd like to see it. But, you know, I know a lot of people don't want to advertise that they listen to a podcast about crystal meth. I get that. I get that a lot. But if you feel, if you feel led to do so, please share the podcast on social media when you see it coming out through Facebook or Instagram or TikTok or wherever you are, YouTube. Share it and get it in the hands and in the ears and in the eyes of the people who would benefit from it. Okay, there's my spiel. Thanks for sticking in there. Today I am really, really, really excited to offer a discussion about well, I don't know where we're going to all go, but attachment styles. And I have my friend Mauricio, otherwise known as Mao or Meow on Instagram. Uh, Mauricio and I met, um, through Controlling Chemsex. If you've heard me mention Controlling Chemsex before, I'm a volunteer for them. Uh, Controlling Chemsex is a free— I will— they say key working. So if you're in, you know, if you're in the UK, it's key working. Over here, you may better know it as coaching, but it's a free 8 to 10 coaching services for people, for guys who— or well, I guess, well, mostly men. Um, it doesn't have to be gay men either. There's some straight men that are coming through who are struggling with chemsex. And so contact Controlling Chemsex. They're out of the UK, but they offer services to anyone around the world. Starts with an email program, and then you get an assessment, and then you get assigned a key worker. Could be me, who knows? I take one client at a time. Um, and so anyway, we are both volunteering for them, and I don't know your history with them, Mauricio, but I— and then, um, but that's how we met, and that's how we've connected on social media. And so I'm just happy to have you here, and if you could tell us about yourself, please.

Of course. Thanks, Dallas. Uh, so yeah, my name is Mauricio Alvarez. I'm a clinical psychologist. I did my training, my doctoral training here in the UK. I live in London, but I'm originally from Mexico. I came here to do my master's degree in neuroscience, uh, developmental neuroscience. So basically how the brain develops and it leads to different types of, uh, you know, pathology and mental health difficulties. And then I went on to do my clinical training, uh, in UCLA clinical psychology. Um, My research in general has been around service development and how to make more complex interventions for mental health conditions that require more than just therapy. So where it involves getting involved with the police, with A&E, with hospitals, nurses, social services, and where, how you can integrate different arms of intervention into, you know, a multidisciplinary team. Then I went on to work in the Netherlands to implement a project and came back. And now I work primarily in the clinical field with chemsex. I manage a chemsex support service. Well, it's not only for chemsex, it's on high-risk sexual behavior. So any behaviors that feel out of control and that put people at higher risk of bloodborne virus transmission, such as HIV or hepatitis. But the largest chunk of clients we see are struggling with chemsex and a range of presentations and a range of complexities, from people that are starting to use chems and want to see if they can manage it, to people that have been on and off of rehab and that have been using for quite some time, and they're still struggling to find a way out of it. Um, as you mentioned, I volunteer as well with Controlling Chemsex. I'm usually on and off because I do have, apart from my full-time job, I do private work on chemsex and LGBT mental health. Um, but every once in a while I support Controlling Chemsex and I see maybe 1 or 2 clients. Uh, so yeah, probably even less than you, Dallas.

Yes.

But that's where we met. And, uh, yeah, I would say that the way that I work in general is focused on— I mean, I would describe my My approach is integrative, but in general, that doesn't mean much.

Mm-hmm.

I would say that I work primarily from a cognitive behavioral approach, uh, focusing on relapse prevention. But the biggest chunk of work I do has to do with relationships and how people that struggle with chemsex, uh, you know, they, they slowly start to recognize that it's more than just the drug that is driving the behavior. or more than just the beliefs they have and the schemas, but it has also to do with an ongoing pattern of relating with people that gets them— that makes it difficult for them to step back and have some perspective. And this is where the idea of attachment comes in. I think I've started working on this, I would call it like a theoretical model. It's a developmental model of addictions where I've been trying to integrate neuroscience and what we know about the brain, what we know about addictions and how that manifests in the brain, but also how it has lots and lots of links with social behavior, especially attachment behavior. And I can later explain what I mean by attachment. But a lot of research is starting to show that addiction is more than just the chemical component, but it has to do with multiple brain pathways That work both in terms of reward systems and motivation, but also social behavior and how we try to soothe ourselves in the face of danger, fear, and complexity. So that's the approach that I take. I would say that my sessions would be a bit different from what you would expect from a coaching session in that it's less about the skills and the techniques on how to cope. And more about reflection. We call this mentalization, or the ability to see yourself through other people's eyes and also yourself from their perspective. And, you know, to be able to change points of view, which in the case of addictions and substance misuse tends to have a big impact on that ability. So we get to see a lot of clients that easily misinterpret social cues or that read the room wrong, or that, you know, paranoia would be an extreme version of that. But it can be as simple as just missing a cue and misunderstanding something and being unable to stay creative and open and checking what's going on for the other person. So yeah, that's kind of a summary of the work that I do in the field. Yeah.

Wow. I don't know where to start. Wow. Yeah. So a master's in neurology, neuroscience.

Neuroscience. Yeah.

And then clinical psychology. So what brought you, what was your interest in Chemsex?

Well, I, it was at a turning point in my career when I was finishing my project in the Netherlands. I had to determine whether I wanted to stay in a service development kind of research or a more focused topic and I mean, being a gay man myself, I find it important to give something back to the community. And I had a few acquaintances that were struggling with chems, and the opportunity opened. Most of my background during my master's was around addiction, but I was focusing on opiate addiction in motherhood and their ability to care for their children and be sensitive towards them. So it kind of, it became a useful topic. Chemsex became interesting. I started to meet people in the field, and one thing led to the other, really. I, I personally don't have experience with any of the chems drugs myself, but I've seen the impact in, in parties and friends and acquaintances, and, uh, you know, the negative impact it can have on their lives. Unfortunately, the people that I met that struggled with chems were not on the managed way, if you want to call it that way. They were struggling to control it and it spiraled. But I must admit that I have met very few people that are able to quote unquote control it, but that need to be aware of how volatile that can be if they're not cautious. And a lot of that work I do with the clients that are less, you know, for the lack of a better word, chaotic. It's to help them recognize the signs and find alternatives before things start to spiral and get out of control, which is what can happen very easily with chems.

Well, let's talk about that a little bit later. What, but what a great field to get into that lacks research. You know, I mean, it seems so wide open. It needs people like you. It really does. So great. Thank you for— thank you for what you're doing. Wow. This idea of an integrated approach to services, how does that work? How do you— how do you work with the hospitals, the police, the law enforcement? How do you bring all them in? Are you educating them on this, or—

Well, it, it goes in different angles. At the moment, I have the benefit that I work in the National Health Service, and the team where I'm working It's already integrated. So I work within a sexual health clinic, which my perspective, and this is a personal view, is the, the best, uh, placing or the, the best location for chemsex services. Uh, and we can get into detail later on, but, uh, most of the time and the places where I've, uh, chatted with professionals, they tend to be based in a drug and alcohol setting, which allows you to have more You know, capacity to manage risk and complexity. But it might perpetuate the stigma and this notion that chemsex is just about the drugs, when what I see in my clients and in the field is that the drugs are a mechanism through which people are able to engage in expressing their sexuality and sexual behaviors. And, you know, most of the time you don't get to see them if you wait for a drug and alcohol service, especially also because people don't— might not identify as having a drug problem. So going back to your question, being based in a sexual health service that's already set up within a hospital, and there are ongoing connections with, uh, at least with A&E and with the hospital. And I'm very lucky that the place where I'm working has good connections with the local authority, with social services. That is also the benefit of working within sexual health, that, you know, these services tend to be used to talking to the police in cases of domestic violence, in cases of abuse. So, it— I took that as an opportunity. This was already existing, and part of what we're trying to do is to connect them better through training, but also through having a quarterly— we call them working group, Where the different professionals, therapists, healthcare advisors, the police, nurses, commissioners, et cetera, that are working in the field join us. And we think together on what we're doing, the practices we're having, and starting to think of a, not like a single approach, but like as a unified way of working so that we're all on the same—

Mm-hmm.

mindset. This is important because what I've noticed is that sometimes with chemsex, services tend to replicate parts of the pattern that already exist, and this connects with attachment, but I'll get into that. Sometimes the services replicate patterns of isolation that our clients are experiencing. So the key presentation that we see through and through has to do with clients struggling with loneliness and how to manage that. And The types of drugs and the type of shame and stigma that are attached to them make people withdraw and kind of go inwards.

Mm-hmm.

And it's very difficult for them to seek help. And I think that sometimes this can be replicated within the services, that it feels like you're working in a silo, that you're one team specifically that has their own specific approach. And that might work, but that it, uh, I think that the best way forward is to work in a joint way. So that everybody's helping each other out and also helping not get stuck on blind spots that each service might have, whether it is around service provision and availability, or in terms of the approach that you might get focused on one specific way of working and not pay attention to other approaches that could be equally or more effective. Wow.

Yeah, I love that. I love it. So you've mentioned several times About the— in chemsex, there's the, there's the neurobiological, and then there's the psychodynamic. So there's the drug, but more than the drug, we're addicted to something else.

Yeah.

Can you talk more about that?

Yeah, sure. I mean, the way that I think about it is from a neuroscience perspective, and this is a very, very, you know, simple and gross simplification, but Any addiction, whether it is behavioral addiction or process addiction, you know, like for example, watching porn or substance use addiction, which is the one that we're most used to talking about, they are a set of within and between system brain adaptations. So it's different systems within the brain that communicate with each other that adapt to either the substance or the reward you're getting from specific behaviors that lead to changes in both structure and function of the different areas of the brain. Of course, there are certain areas that are more prominent to change during an addiction. And those are the ones that lead to the signs and symptoms that we know about addiction, such as withdrawal, tolerance, and dependence. So that's kind of a— book definition. Uh, in terms of brain functioning, the main areas that tend to be affected by drugs are related to reward processing, related to executive functioning, or it's the ability to regulate yourself, uh, but like regulating your behaviors and also emotion regulation. Um, and they might be changed in varying ways depending on the substance use, depending on the dosage, the frequency, You know, for example, in the case of Tina or all the amphetamine-type substances, they're stimulants and they tend to affect the noradrenergic and the dopaminergic systems that have to do with reward processing. So that's why you get really hooked. It's the equivalent of a slots machine. Everyone, you get the— every time you get the rush, it feels so good. That, you know, you— it becomes more and more prominent for you. But it really varies. Ketamine has a different approach to the system. G has a different set of neurotransmitters that get affected.

Mm-hmm.

But all through, in general, what is the common theme or the common pattern is that there's an increased amount of dopamine in the system. So it gets stuck It allows your neurons to keep extra dopamine in the, between neurons that, you know, make you with time less sensitive to it. And that's what we see with clients that have been using for a very long time that, you know, everything is meh, everything is mild, nothing causes reward, nothing gives you joy because you've basically used up for your—

Dopamine receptors.

the amount that you have in your system. This can be regenerated, but it takes many, many months. Um, and yeah, and it will affect you, everybody in a different way. Oh, what else I can say? I guess we think about it in neuroscience as the seeking system. It has to do with seeking rewards and wanting to get more. And that's why people feel out of control. It's as if their brains have been hijacked. Uh, it's, you know, the substance is so strong, and it varies, you know, it's not the same being addicted to nicotine and seeking the rush or the relaxation from having a cigarette versus the intense rush you would get if you're slamming or doing it intravenously, that it is tremendously high and pretty much impossible to replicate without, uh, the substance. So the person that is addicted to Tina, for example, is going to be— feel completely out of control. and at the mercy of the substance. Now, this is in terms of the neurobiological aspect. And this translates into behavioral things that we tend to see in relapse prevention. So looking at triggers, looking at cravings, and that is basically the way that the brain has been sensitized. For each person, it's gonna be different depending on what is present and what's available to them in the moment. But there tend to be certain patterns around it, you know, drug-related cues, like needles, like parties, like alcohol, etc., become more relevant to the person. And what's interesting, and this is where it shifts to the lens of attachment, is that— At least when I was working with mothers, that we started to see that social cues or cues related to babies depending on the level of addiction, they would change. So it could be in both ways. From mothers that— well, women that were using opiates before they got pregnant that were really, really addicted to the substance, and then once they have a child, they become less addicted because the child takes priority. But it can go the other way around where the social cues of the child are less relevant because a person is too hooked on the substance. So what it tells us is that it is possible in some degree to make a person less focused on the drug and more focused on social cues. Um, but I'll pause there because it's also like a lot to take in, and we then can think about that.

Yeah, yeah, yeah, yeah. And I'm taking us— I'm taking us off topic, I know, probably, but we're getting there. We're getting to attachment.

I think, I think it's part of it because, yeah, uh, you know, you, you do need these substances and they relate into social behavior.

Sure, sure. Okay, well, there's so many things you've said that, that I need to get to, but can we, can we back up to attachment? So what we're going to talk about today mostly is attachment theory and how it relates. So I read your— I, I read most. I did. I also— I didn't read all of your published study. Uh, by the way, um, Mauricio is a published author, published researcher, um, and it talks about how attachment style is bringing together these 2 worlds, the neurobiological and the psychodynamic. And as a—

Right.

And it, it kind of is an explanation of why one person gets addicted and one doesn't. So it started to make— it started to make me think of my brother and I. We grew up in this exact same household with almost the exact same conditions I became addicted to crystal meth. He didn't become addicted to anything. Um, and so what was the difference, right? So can you, can you tell us, uh, talk to me? I like to be talked to like I'm a 2-year-old when it comes to these things. But tell us what an attachment style means, and then why is it important for me if I'm, if I'm trying to stop using crystal meth or I'm in recovery? Uh, which, by the way, I Sidebar real quick. Something you said was not feeling joy will be regenerated, but it takes months. I just want to say, if you're listening to this, this is something I hear a lot, is I just can't find joy. Everything seems dull. And you are taking that as it's going to be forever.

Right.

You're taking that as it's going to be a part of your life for the rest of your life. And it isn't. What Maharishi is saying is that your poor— what you've done to your brain has— cannot be repaired in an instant just because you stopped using 30, 60 days ago, right? 90 days ago. It's going to take some time for you for it to repair so that you can feel joy and get joy out of life. But it, it can be— the brain is amazing. It will regenerate. Have some patience.

Okay, anyway, I need to say— I'm just gonna add— I think I'm just gonna add to that, that, you know, part of this work involves Both being a bit encouraging to people that are struggling at the moment that there is hope, and yes, many of it can be regenerated. But I think it's also holding in mind that the more extensive use, the heavier the use, the higher the degree in which the damage because these substances do damage, and you know it's well known that methamphetamine leads to the you know. brain damage and neuronal death, and those will not be regenerated. However, if you stop using at some point, even if you've been using for years, there is an increase eventually of dopamine. It might not be at the same level as it was before, but it's definitely not as bad as it feels when you're in withdrawal period or when you're craving or when you feel like you haven't been using. But we'll get into this aspect because it also has to do with natural rewards and how we build up those, the joy on the other side.

Yeah.

Now thinking of attachment, and perhaps for those who have never heard of it, and there's this very good book, it's called Attached by, I think it's Amir Levine and Rachel Heller. It's a really good book, very well known. And it talks about the way that we relate in our relationships. But if you've never heard attachment, it's this idea of, it's an evolutionary theory by this man called John Bowlby. He was originally a, you know, a clinician, a psychotherapist, a psychoanalyst that was following one of the many schools of psychoanalysis that is called the object relations theory. And it's this approach that suggests that it's not just about the unconscious, it's not just about what happened to you when you were a child, or, you know, the way that you experience life, it's also about the way that we integrate or internalize The most important people in our lives, and this is from birth. Uh, the main explanation or the illustration of this would be, uh, with ducklings and, uh, and, you know, many animals, but with ducklings is very common. John Bowlby was noticing that when the, the eggs hatch and you see a bunch of, of ducklings, the first person or the first being they see, in this case, or in most cases, the duck mom, they become imprinted into their minds and they will not get separated from them. That's why you see the mother duckling, the mother duck moving around and the bunch of ducklings moving behind them.

Mm-hmm.

And that's what, you know, they, then he started to notice that this behavior is not only within the same species. It could be if you hatch your own little chicken, And when the chicken hatches and they see you, you will become the primary caregiver. And this is very important because what it talks about is that it ensures safety. Attachment is about safety strategies and how we make sure that we stay alive in, in the face of adversity and complexity. In the case of ducklings, it might be, you know, how do we stay away from predators? In the case for us, it might be how do we stay clear from A violent dad, an abusive mom, people around us. So the thing is that they start— these representations are in terms of attachment theory, they're called internal working models. But it's these ideas of everything we integrate about our caregivers, you know, primarily mom, but it can also be mom, dad, and grandma, depending on who's in your household. These get updated. It's not like fixed forever and ever, but it comes with learning. So the more repetition of a pattern, the more consistent it's going to be and the more inflexible it's going to become. What I mean by this is, if you grow up in a household where you, your primary caregiver, name it mom, was constantly beating you or calling you words or being abusive or abandoning you, what you're learning is that the primary care figure is not real. It's either not reliable because it's consistently being unreliable, or it's a threat, which makes things quite complicated because it makes a, like a short circuit in the brain because your source of safety is also the source of danger.

Hmm.

So this is what we see in people with severe mental health difficulties, that when you talk about their upbringings, their own families, They have very confusing and incoherent sense about their, you know, their early life. I mean, it's worth mentioning, we all have a certain degree of incoherence. But for people that have been severely traumatized throughout development and have complex trauma, they tend to have incoherent and inconsistent narratives where they say, you know, my mom is great and is fantastic. And then 5 minutes later, they say, I've never been more abused than by my mom.

Mm-hmm.

And, you know, it's, it's kind of a back and forth. So this is in general attachment theory. As it went up, moved forward in time, there were 2 researchers that were key. One of them was Mary Ainsworth, the one that developed what we know now as the attachment styles.

Mm-hmm.

She was supervised by John Bowlby, and she tried to code these behaviors that we see in an experiment we call the strange situation experiment. In this case, it was with kids. Where they have a, you know, a toddler playing in a room with mom. Then the mom, some strange person, in this case a researcher, walks into the room. They interact for a little bit and then mom leaves the room and you start to see how the person inter— well, how the child interacts with the researcher. And also, and it's most importantly, how the child relates to the mom when she returns. Why this is important is because by observing how children relate to strange people and how the level of distress they experience when the mom or the caregiver comes back tells you about their sense of safety and the strategies they use to get comfort and to soothe themselves. So in the case of a secure attachment, you would see a child that is able to interact and play with the researcher. And when the mom comes back, you know, they might cry a little bit. Also, when the mom is away, they might cry a bit. But when the mom's back, they soothe themselves and they're able to continue with what they're doing. In more insecure attachments, whether it is an anxious or an avoidant one, you might see an anxious child that might not even interact with a stranger and it's just pasted on the door and screaming and shouting for the mom to come back. And when she comes back, she's protesting, the kid is protesting. Or the avoidant one that mom comes back, And they don't even pay attention to her. They're upset, they're angry with her. Uh, and then there's the disorganized, which is, you know, very complex behavior. You see the child kind of going in circles, not figuring out what to do, whether to play with the researcher, to not play. Is he okay with mom or not? Is he resentful or not? It's quite confusing. And it is because of that. They're not really sure if mom is safe or not. Right?

Mm.

So Mary, uh, this is Mary Ainsworth, and then you have Mary Main, which was a student of her. and just went into more detail into what we now know as the Adult Attachment Interview. And it's a very long and complex interview that it's done by trained clinicians. But with time, they developed a briefer, you know, 3 or 4 item questionnaire about how we relate to others. This is a very dense explanation of it. But basically, the typical, the most important thing is that attachment tells us about the type of representations or ideas we hold about ourselves, about others, and about the emotions that happen in between. A simple example would be, I see myself like in a secure attachment, the child sees themselves as lovable, the mom as safe and caring, and the effect they get is they feel soothed and happy. In a very disorganized one, it might, you might hear that the self is unlovable or unworthy. With another that is cruel and dismissive, and the affect is terror or anxiety. You know, and we keep on, as we were saying, that they get revisited, revised, and expanded to different contexts and scenarios. You might expect this to change depending on experiences. You know, the child is not only related to mom and dad, they also go to a school, they also then start going to work, they also start meeting friends and people. And these internal models start to also get adjusted with a certain degree. Okay.

That's a lot. So for the listeners, how, what, what happened in your early years is going to dictate kind of where you, where you are on this spectrum of attachment style, right? Secure, insecure, and then the insecure, you have anxious, avoidant, and disorganized. Why that could be important is what I'm hearing. You correct me, of course. Why that can be important for me is that whatever style that I might fall in dictates the beliefs that I have about myself and the world. Those beliefs that I have about myself and the world are going to be the lens through which I see the world coming at, how I respond, right?

Exactly how you respond to it.

Yeah, how I respond to external circumstances. So for instance, someone— this is a really, again, I have to use 2-year-old examples— someone ghosts me, right? So someone ghosts me, stops texting me, blocks me, or whatever. If I have a secure attachment, I might be, okay, well, that one's, that's done, moving on, right? But if I—

And it just— I'll, I'll step in. Why would you suggest that? Why would you say that someone with a secure attachment, what kind of belief they have about other people to be able to say, oh yeah, they're probably busy?

Um, I, the belief would be that, that, that there's nothing wrong with me.

Yeah. And that others are, uh, trustworthy.

Yeah. That people are inherently good or inherently safe to be around. Exactly.

Right.

Because you said safety, when it, safety is what this boils down to, right? is how safe you feel as a child. And, and so I can, I can really, I can really relate to the, the person that I wanted safety from, my father, was also who I felt danger from.

Hmm.

Right? And so the safety is also the danger. I can see how now when you're talking about this, how I can— I think disorganized, I've never identified as disorganized. I have the book Attached and I've read it. I've always thought that I was very insecure, anxious. Now that you're talking about disorganized, I think I fall more in that line.

I wouldn't think so. I think that it would be— yeah, I think that when trying to establish what kind of attachment style you've got, it's not so much about how much complexity and how much difficulty you had when you were growing up. There's lots of kids and lots of adults that grew up in very complex and traumatizing environments. that have a secure attachment.

Okay, why?

Because maybe there was the other caregiver that provided the safety. But perhaps in certain patterns, and in certain situations, you might find yourself a little bit less or a little bit more disorganized. But you can see it as primarily what style you've got. Now, the reason why I make it so perhaps a bit complicated at the beginning is just to kind of introduce all the different aspects that need to be taken into consideration.

Sure.

But Sure. What's key here is that it has to do with safety and it has to do with time and learning. So you might grow up in what could have been a very, you know, traumatizing environment, but with time and perhaps with therapy or through talking with friends, or perhaps you were sent to boarding school and the danger was removed from you and you can revisit that. But what's important is to pay attention to how we behave, how we react to that. That's the whole point of attachment and why it connects to neuroscience, that both neuroscience and attachment, they talk about 2 mechanisms. One is dopamine, which is reward. So basically, when mom comes back, I feel better and it feels good and I feel loved. But the other one is oxytocin, and that's the neurotransmitter for soothing, for self-care, for caring, for connection. So when you are addicted to a drug, both substances start to go up. But it's so strong on the reward system that it completely overtakes it, that the oxytocin is less relevant.

Okay.

When it comes to attachment, and you know, the more you're working with a client towards recovery, and they have more positive experiences, and they have Maybe better groups, very better community, a stronger community, then oxytocin starts to override and it's no longer as important or as triggering to use the drug. But in terms of attachment, that has to do with how we react to danger, how we react to perceived danger, to perceived stress. The difference between I am stressed and I'm anxious, I'm going to go home and do some mindfulness or do some yoga or do exercise. which would be a more secure approach, because you know that people aren't mean inherently, you're just, you know, life is complicated.

Right.

Versus I am anxious, and I have the belief that I cannot regulate myself, and that other people are out to get me. So the way that you would behave would be perhaps a bit more chaotic or a bit more, less consistent. You might become very clingy to your partner, Mm-hmm. You might see in the context of chemsex, people that get really intense cravings, and they almost develop a relationship to the dealer of, you need to give me the drug now. Are you there? Are you now? So yes, it has to do with craving. It's very intense. You get withdrawal, but there's an anxiety for wanting that relief really, really soon compared to an avoidance style, which you would have the guy that I'm fine. There's no emotion. I'm fine. Nothing's, nothing's wrong. You know, I might struggle every once in a while, but I don't really care. I don't mind people. I don't mind relationships. I'm impenetrable basically.

Hmm.

And on the disorganized style, and that's why I don't think you would be in a disorganized presentation. This is where we see, uh, frankly quite chaotic and dangerous and risky behavior sometimes because It is really hard to know what to do. You know, do I need the drug? Do I not want the drug? Am I— do I need help? Do I support, seek support from others? Do I need them? Do I not? So, you know, and of course, you would see that in time, you know, one reaction to one stressful situation doesn't determine your attachment style. It's what do you consistently do? So for example, if you're consistently dissociating, getting suicidal, self-harming, you know, running off the road and then all of a sudden you're crying and looking for friends and then you're fine and nothing happened. That's a disorganized approach to danger.

Okay.

Does that make more sense? That it's just, it's, uh, continue. You need to see it in, in general. Yeah. Yeah.

Okay. All right. Well then I'm anxious.

You're about it.

I know that.

Yeah. Yeah.

So yeah, that's a, that's, that's, um, That's interesting. So if I am thinking about what my, my safety or what my attachment style is, how is that important for me in terms of recovery from, from chemsex?

Um, that's a very good question. I think it depends on what attachment styles tell you, from my perspective, is What are your blind spots? What are your common approaches to distress? And also it will tell you what is your Achilles heel. So for an attack, for an anxiously attached person, perhaps relationships are really important and feeling connected. So if you know that you're anxious, as a therapist, if I know that my client is anxious, I might need to pay special attention to moments when they're on their own, or moments when the partner leaves, or where friends are on holidays, or the typical, it's a Saturday night and everybody's out and I'm dealing with FOMO. Why do you think that would be?

Me?

Yeah.

What? Well, I would think if you're anxious and if you're alone, We definitely feel unsafe.

Yeah.

Um, um, I know that— I know it was very hard for me to be alone for a very long time, um, in that it felt— it did feel like FOMO, but it just felt like I need— I, I needed to be— I needed to have that validation or that reminder, that affirmation, that, that I needed somebody to tell me they wanted me.

Mm-hmm.

And being by myself, I couldn't get that unless I went to social media and posted something to get likes, you know, something like that. Yeah.

So after all, what you're seeking is the reassurance from an external source. That's why you're anxious. You really need that. It's the equivalent of the child that is just banging on the door until mom comes back and doesn't even look at the very friendly researcher in the background, you know?

Yeah.

So Knowing that, knowing that, you're able to know, you know, it's useful that you know your triggers, it's useful that you know your cravings and how they come up, but also you need to prepare especially for those points where you know that you're a bit more vulnerable. Yeah. You know, that when you are in a socially complex situation where you feel rejected, where you feel abandoned, where you feel unloved, that it is very, very likely that you'll get triggered. So you have to prepare for that. Typically in a, in a clinical context, it would be, uh, you know, a client that has been trying to stay sober for some time. The friends go to Gran Canaria for Pride and, uh, they decide, you know, based on their, you know, their personal wisdom that it might not be the best idea to go.

Mm-hmm.

So they decide to stay in town, but all their friends are gone. They're all having fun. They're having really, really bad FOMO and there's nobody else to echo for them. So it's very likely, if not almost, you know, impossible, that they will relapse and they will want to use. You need to prepare. In terms of an avoidant one, yes, it would be the other way around. So whereas the anxious one might have a belief of, I'm, you know, unworthy, unlovable, I can't cope, for example, the avoidant might be, The others are unreliable or others are useless, unhelpful, and I can cope. I am invincible almost. So that's where you see, I think in your archetypes you were looking at, who was it? Like Delusional Darren, I think it was the denial. Oh, you know?

Yeah. Yeah. So let, let me mention that real quick. So Yeah. Uh, Mauricio and I worked together beforehand, so there was some Instagram posts that I made that presented Tina archetypes. So basically it was just different phases, different personality types, different characteristics of what different people go through in their journey from beginning to end of chemsex or crystal meth. So Mauricio has taken those and tied them into attachment styles, which I think is really great. So go ahead. Delusional Darren, is that what you're talking about?

Yeah, I mean, this is one example, you know, Delusional Darren, Crumbling Connor, it could also be, it could be Intermittent Ivan. You know, it's this idea that I don't really have a problem. I can stop whenever I want. I don't need anybody to tell me, which it could be seen as a secure approach. You know, for example, they might actually be able to regulate themselves and control it. But most of the time, it's not the case.

Yeah.

So where the anxious is really dependent and, uh, you know, needy of having another person to cope, the avoidant is the exact opposite. I don't need people to cope. I don't even have emotions. So these perhaps are the clients that tend to, uh, I mean, I'll get into types of use, so I'm not gonna get into it just now, but this is the idea is I don't need others. The disorganized might be those that This is— this one's a tricky one because it can lead to overgeneralizations and oversimplification. But you might be looking at very chaotic people, you might be looking at— where was the one that you wrote? For example, Guru Gary can be a combination of either dismissive or disorganized. So dismissive and avoidant could be similar.

Of course.

I don't need people. It's actually that I have been enlightened and I am, you know, in a different realm of existence and I am quote unquote superior. You know, I'm, I, I know the drill. Or it might be that they're actually going through a psychotic episode and reality is no longer checking.

Mm-hmm.

So that's where you need to pay attention. In the clinical room, you might see this with clients that have been very severely abused, very consistently throughout life that they, you know, that you understand that they don't trust people. It is because life has treated them in such a way, and therefore it's easy for them to check out. They maybe dissociate quite a lot. They, uh, you know, even when they're not using, they might have a psychotic episode. They might get really, really paranoid. So that is because they're absolutely terrified, and that's the key point of the disorganized attachment. They're terrified and they're just—

Yeah.

Trying to grasp at whatever they can to get some sense of safety. And that's where it gets a little bit more complicated in terms of treatment. But those are the ones that you would probably want to work with in an inpatient unit or somewhere where there's more ongoing care, like a community mental health team or a peer support worker that can check in on them constantly. So that's in terms of the intervention. So I'm not going to get too much into the disorganized aspect of it. Uh, but yeah, it's something to keep in mind.

Yeah, yeah. I think it's helpful too for someone listening who— because I, I get the DMs, I talk to these guys, some of them will schedule sessions with me. They're living— they are terrified. They're living in fear of what's real, what isn't real, you know. Um, you know, this, this idea of Guru Gary, by the way, for you listening, um, he looks like a shaman, but he believes he's unlocked universal truths You know, he's caught in a loop of chasing spiritual revelations through the use, right? I've seen beyond the veil. This isn't addiction, it's enlightenment. And it's not in any way to poke fun of that, but it is something to— for you to, to recognize that if you're stuck in this loop and you're, you, you're constantly terrified of being watched or being followed or, you know, all of those things. What Mauricio is saying is inpatient treatment and some type of psychotherapy can really help you kind of detangle what's happening in your mind. And so that disorganized, I think of detangling some, some things for you, but you really do need to, to seek professional help.

And I think that's also to mention that, remember that attachment patterns and styles change with experience. So, I mean, once again, this would be an overgeneralization. And I by no means— my practice, for example, works in that it doesn't need to be abstinence-based. Some people do reach enlightenment and some people do see beyond the veil and have growth through that. It's less common than people think. But just as much as someone that is anxious, avoidant, or disorganized can move towards attachment security through positive experiences. It can also go the other way around. You get a lot of people like Wide-Eyed William, you know, first-time user, you know, everything is nice and friendly. And like most people in the chem scene, they were doing it out of fun. And, you know, they weren't really looking to tap out or avoid or anything. They were just, you know, provided by a friend, It seems absolutely fine. And then it starts to spiral. We all know, like horror stories around chemsex, you know, some people will never experience them. And I hope that that's the case for many. But for many, it's— it can, it can be a nightmare fuel with the things that they get to see sometimes in chills with people dying, with people, you know, being abused with all sorts of things. That if you're consistently experiencing that, you're making yourself more and more and more disorganized in the way that you relate to people, because people actually become dangerous and unpredictable, just as much as you wouldn't know what kind of chill you're getting yourself into without knowing the person. Does that make sense? So you can be very securely attached or be insecure, either anxious, avoidant, or dismissive. But the more trauma you're experiencing through being in unpredictable, chaotic, violent, aggressive, and abusive scenarios, the more disorganized your attachment style becomes, because you're, you're realistically speaking, you're in danger, and you know that. So that's in terms of the chemsex journey, this would be where people touch absolute rock bottom that, you know, your social safety strategies and your approaches to safety are no longer working. So you become chaotic, but it's not out of your own fault. It's simply things do not make sense anymore.

Yeah.

Yeah. Right.

I see that. I see that. And by the way, if you're listening, when Mauricio says chills, that's in, in the UK, they call it a chill out. Over here, it's just a party or a PMP or whatever. Um, yeah. So, and I would think once you get so disorganized that possibly you walk into a safe environment, but assume it's not safe.

Absolutely.

Is that right?

Yeah. Yeah.

Yeah. Um, okay. So the avoidant, back to avoidant, we're talking about, we're talking about that, you know, I, I don't need help. I don't need anybody. I can do this on my own, that kind of thing. So how, what does, what is the trigger for an avoidant person then? Like, how do they—

It would, yeah, it would probably be around I mean, it varies, but you would normally see that in people that are maybe getting intimate with someone. Like they're starting to have a regular partner, they're starting to build up something a bit more meaningful. And that raises alarm because the idea is people aren't trustworthy, and I'm starting to become vulnerable with this other person. So that might trigger a relapse, or they might— it might trigger cravings. So to understand it, it would be, whereas the anxious is looking for closeness, and when there's distance, they get distressed. The avoidant is looking for distance, and when there's closeness, they get distressed.

Interesting.

Yeah. So this would be something that, like in the consulting room, you would see that, you know, maybe they felt rejected by someone. And it's like, well, see, I was trusting them and I was being vulnerable and I let my guard down. All people are the same. That's why I prefer not to engage in relationships.

Yeah. Yeah. There's such thing as anxious avoidant, right? Because I think that is, I think I'm all of them, but I think anxious avoidant because I, I, in the past I have this, yeah, I need somebody close, right? I need somebody, I need somebody. And then when I get somebody and, and I'm there, then I will sabotage. I will break it off as quick as possible because I think they're going to hurt me just like everybody else.

Yeah.

So.

You're right. And this is where you start to think about more codependent relationships where, you know, attachment styles, when they're insecure, they're complementary because just as much as the avoidant is looking for closeness, And what triggers them is distance. So when they're with an avoidant person, so they will be hooked with the avoidant because they're actually moving away. And the avoidant will be seeking the closeness or the admiration or the validation of the anxious one. So they start to get attached. And when it comes with a person, Mm-hmm. you might have under certain scenarios or with certain topics, They might make you more prone to avoid and push away. But that doesn't mean that you're both, you might still be primarily anxious, you know. So for example, in my own journey, I noticed that I tended to be more on the anxious side. But when things got too close with specific kinds of situations and specific contexts, I would tap out. It's like the attachment style is kind of like the thermostat of closeness.

Hmm.

You know, being secure means that you're able, you have a wider range, you can move with more freely. That being secure, you can be secure and still be avoidant and push away, and you can be secure and still be a bit anxious. Remember, it's what's primarily your style.

I see.

Right?

I see.

So think, I think that this is where we, we shift a little bit before we get into the archetypes is just to recognize that even though attachment is shared by all humans, you, you can still have loving environment at home, caring parents, you know, friendly brother, etc. But then there's this extra factor of you might realize that you're gay, and that you're different.

Mm-hmm.

So you start to experience the sensation of being different, or stigmatized. It can be through bullying in school. It can be through being rejected by your parents. It can be that maybe things were going well at home, and then you came out and the entire family system collapsed. against you, perhaps. They could be out of abuse, violence, etc., that us in the LGBTQI community, we're more prone to feel, to perceive danger when perhaps there's no such thing, and it might just be based on our experiences. So it's not like a sentence, and it's not predictive, but it is very common for people within the LGBT community to be on the insecure side of things. Out of just simply the way that society is set up structurally, you know. So it's also to understand that, you know, depending on your experiences, if then you come, for example, from a very restrictive, close-knit community with very firm beliefs and move to a big city like London, like New York, Berlin, etc., where there's absolute openness, there's absolute uh, you know, freedom to do everything, and you're used to being to yourself withheld in an avoidant way, because you know that if you become vulnerable, you'll be in danger, then what happens is that you might end up going the extreme opposite. So you open up entirely, and then that's why people start to spiral in the community, because they're starting to feel a new freedom that they weren't able to experience.

Yeah.

So this is just to also give a shout to, you know, as much as I vouch for sobriety, that it's also not to stigmatize that for some people using hemp is like a helpful way of mitigating trauma difficulty for, for some time. The problem is when it becomes too dependent on that. Yeah, that you need a little bit more help.

Yeah.

Yes.

Thank you for saying that. It's a message we need to hear in America more often. Um, okay. All right. So if I'm anxious avoidant, if I identify— if I'm primarily anxious avoidant, I'm going to put in safeguards when I know I'm going to be alone or friends are out of town or those kinds of things. Somebody, somebody ghosts me and I know that's a trigger for me. I need to be— I need to have a plan in place of these are the people I reach out to, that kind of thing. If I'm avoidant It's when I'm getting close to someone, right? Or getting, you know, something around that, around that energy of, oh no, I'm getting too close. I'm going to go, I'm going to burn this all down and I'm going to go use, right? So put in safeguards there.

Or the, the, the avoidant ones are also more vulnerable to high emotional intensity. It might not be social. It might not be relational, but maybe they've had a really difficult week at work, or they're going through some family difficulties. And since the belief is that people aren't trustworthy, they need the drug to regulate themselves.

Okay.

So you get to see the ones like the avoidant stereotype would be highly achieving, highly performing, perfectionistic, perfect people that, you know, handle life perfectly well. But when things start to get a little bit too complicated, their emotional bandwidth is quite limited. So they need to use as a way of coping and to maintain this idea that they don't need anybody, because in reality, they don't, they just need the drug.

Right. And I'm sure it's very hard for them to ask for help.

Absolutely. Yeah. And it can be very humiliating and shaming. And it can be quite scary to be able to ask for help, especially if all their experiences of asking for help have been met with abuse and rejection.

And I'm assuming that they're perfectionism probably runs parallel to that.

Of course, it goes along with the idea that I must be perfect and I must do the best because I can only depend on myself. That's the key idea of avoidance.

Yeah, yeah, interesting. Okay, great. Good, good, good. Well, there's a thousand questions I want to ask, but I do— I know, for sake of time, we were going to get to the archetypes. So again, I, if you didn't see, I'll put the links to the Instagram post in the show notes so you can check out if you missed those archetypes. I had part 1 and part 2. So you picked some out and you're going to explain to us kind of what attachment style probably is related to those.

Do you want me to pick them? Do you want to maybe, maybe you're the, you've seen more common ones that say, actually, people tend to ask me about this one.

Sure, sure. Okay. So Puppet. Okay, how about Puppet? Puppet Paul is in this—

Hmm.

He's in the cycle of scrolling. He's going to the parties or the chills. He feels like he's not running his life. He feels like he's outside watching himself do these things. Like, he's going to— he, on the way to the party or the chill out, he's saying— his mind is screaming, I don't want to do this, but his body His body is taking him there.

What does it— remember, before I give you the answer, because maybe this is— we can do it as an exercise so that also the listeners can maybe try and do the exercise themselves. But sure, think of this person. Remember the strange situation experiment I talked about, you know, of the child with the researcher and the mom, right? What would you expect Puppet Paul to see as a child when the mom comes back? Hmm.

Interesting. How, what he sees when she comes back?

What you as a researcher would notice about the behavior of the child. Would he go jumping towards mom? Would he jump to the researcher? Would he get stuck halfway?

I think he would be confused about—

exactly.

Stuck and confused.

Yeah. Exactly. So that's an example of disorganized attachment that, you know, that You know, I mean, just once again, take it with a pinch of salt, but—

Yeah, yeah.

You know, probably you're looking at Puppet Paul in this internal conflict of, I want this, but actually I don't want it. And this is probably a reflection of the way that they learned, you know, Tina is what makes me feel better, but also Tina is destroying my life. So I, I go back and forth. And so that's perhaps a more disorganized— it could also be seen from an anxious side. I think that to make a decision, like to put a stamp on it, if you want, you first need to know what kind of behaviors are driving it. So it's very different to be scrolling powerless on Grindr. If the motivation behind it is I need someone, I want to be with someone, but I know that Tina is damaging, that would be perhaps more on the anxious side. Avoidant might be, I'm really lonely and really bored. And I don't really know what to do. But this is the only strategy I have. And I don't want to ask for help. That would be more on the avoidant side.

Yeah. Yeah.

Right.

So Puppet Paul could be any of them, huh?

I guess all of them could be any of them. But I think that if you want to put a stamp on it, I would probably suggest on the disorganized side of things, they run out of things. They've probably been stuck on the cycle for years. They've tried perhaps multiple therapies, they've been to rehab, and they keep on going back and back and back and back. And it's just simply that they don't really know how to contain themselves in a proper way. And yeah, yeah, back and forth. Okay. I'm Puppet Paul.

I'm disorganized attachment style. What do I do?

Well, first seek therapy. That's the important one.

Yes.

But, uh, other than that, um, I would say probably to, you know, I think with everyone is just to develop strategies to sit with that emotion first. And I, you know, it's easy to say that they just need to seek therapy, but actually they do, because what is likely is that they might step over themselves. That the reason why they're still using, if Puppet Paul is, because he doesn't even want to do that, it is because quite frankly, he doesn't know other ways.

Hmm.

So that's why it needs to go through a drug and alcohol survey, through therapy, to be able to notice what was it. This is how I would work in the session with Puppet Paul. What were you doing before you went to the chill? You know, were you at home after a day of work? Was it a Sunday? Was it a Monday? What triggered it? It might be like, it's just routine because it's a Wednesday and that's what I do. That would be more disorganized. It has nothing to do with people.

Ah.

It's just simply like the habit. So first is to identify what are your triggers? Where does it come from? And to identify what was the thing that tipped you over so that you can then problem solve and develop a skill. So for Puppet Paul, I'm afraid that what he needs to do is seek support.

Yeah.

There are other typologies that might be able to manage on their own, but this one seems like it's so entrenched that there's no way out of it without a third perspective.

Yeah. Yeah. It seems very, it seems compulsive. Her behavior, right? Yeah. Or impulsive too. Um, yeah, the, this, the, the disorganized thing too goes back to, I think, what you're saying about mom is my safety and I love my mom, but I also hate my mom. I'm scared of my mom.

I'm scared of my mom.

I'm scared of my mom.

So I love Tina, but I'm scared of it.

Yeah.

So yeah, maybe if I use a little bit less, you would normally hear these narratives. Maybe if I use but just a little bit less, maybe if I manage to get that sweet spot. That's the equivalent of the sweet spot between the researcher and the mom. It's safe enough, but not quite.

Mm-hmm. Yeah.

Okay.

So we have— this is, this is one that's been common lately. Partner Peter, I call him. He's caught between relationship loyalty and newfound desires, hiding his usage While trying to maintain a partnership built on trust. I love my partner, but I can't stop seeking these experiences. So there's, there's 2, there's 2 Partner Peters that I'm experiencing. One is in an open relationship, and when he's go— when he's going out, he discovers chemsex and then he can't stop. Or there's Partner Peter who's hiding it from his partner and going out and doing these things. So where do you— What's your take on that?

I mean, if you're, if you're taking both of them, I would be drawn to suggest that it's more on the, you know, the complementary relationship that I was talking about, where you've got one anxious and one avoidant. We see that a lot in the clinic, and we sometimes do couples work to help them notice what's triggering each other. Uh, you know, you would, you'd expect to hear one of the Peters being very concerned about losing the partner. And, you know, the use has to do with managing that distress of what am I going to do if I lose it? And you'd see the other one as being a little bit smart of trying to hide it a little bit. But the fear is about being caught rather than about losing the partner. But then when they lose the partner, that's what flips the role. So the anxious Pete might become a bit resentful and nagging and insistent and blah, blah. So it increases the temperature or the intensity of the intimacy. And the avoidant one will tap out. It's like, see, I told you everybody's mean and harsh and I don't want you and I need you. So then that pit will disappear and that will get the other anxious person more drawn to it. So they're triggering each other often.

Yeah. Yeah. Wow. What a cycle. Okay. Couples, you know, This is a tough one in terms of— I mean, therapy's got to be the answer here too. When a couple— so I talked to a couple yesterday who it's been a 5-year process of one getting away from, from meth, but there's— they've stayed together. One uses, one doesn't. What the, what the partner that doesn't use goes through in these situations is just horrific.

Yeah.

To watch their other— to watch their partner destroying their life, losing their light, you know, destroying the relationship and those kinds of things. Um, but that's got to be therapy is the answer there. If you're listening, I would say, right?

Yeah, there's, you know, couples therapy, relational therapies, but also I think these ones have some hope in the sense of one of the two needs to take the secure role. It's easier said than done though. That's why therapy helps, but it is possible. So for example, if the anxious person is aware that they're anxious, and they've been doing a little bit of personal work, and they're able to regulate their use to a point where they're able to regulate themselves and think, because that's what happens when the attachment system gets activated, we can't think, and that's why we behave impulsively. But if you're able to regulate yourself, so that your partner is able to use you as a secure base, then that tends to restabilize the relationship so that you perhaps, if you know that you're anxious and you know that this is your trigger, when your partner comes back, you don't start being like, well, I told you next time and you're going to be in blah, blah, blah, blah, blah.

Mm-hmm.

You know, you might just be able to, you know, be consistent and coherent with your response. Your partner comes back, you express your discomfort, and you leave it there. You know, and then, you know, you might eventually need to make a decision whether that's the type of relationship you want to be in, which is the nightmare for them. For the avoidant to be more secure, they would have to be able to sit with recognizing their own guilt and knowing that they're probably playing with the partner. And that for an avoidant can be difficult because it's sitting with the guilt and the shame and the, you know, the harsh self-talk.

Mm-hmm.

So if you're able to regulate that, um, I can give you a book as well, suggestion for, for people to read that and to work on that.

Yeah.

But in both cases, just developing compassion and self-compassion and compassion for others. And that can take time, but it's usually helpful. Wow.

That's a tough one.

Um, those, those tend to be tricky ones because there's one solution, either break up Or you both get out of it, but you can't really do halfway. Yeah. Yeah. Yeah.

You have to be, it sounds like very self-aware, like you said, emotionally mature enough to say, my, my anxious attachment is being triggered right now. This is what I'm, you know, this is what I want to do, but I know it's only because of that.

Right. And I'm glad you mentioned that because I think that's the crux of the problem in cancer. That we're dealing with drugs that have such a powerful impact on the brain.

Yeah.

On precisely the reasons, the, on the, the precisely the areas that help you be self-aware, to self-regulate, to manage your emotions, that it sometimes feels even unfair to ask a client that is unable to regulate themselves to regulate themselves. But, you know, That's the bit that we have to work sometimes in the clinic on helping a client make this really honest decision of, okay, if you're going to be continuing your use in a quote unquote controlled way, you're gonna have to put an immense amount of work in placing all sorts of plans to manage that, because you will not be able to regulate yourself when you're in the middle of a high, or when you're in the middle of a craving. You know, Or you come to terms with recognizing that maybe you can't manage it and deal with the loss and the grief of losing that process, which is what you've been talking about in your latest podcast, on your latest episodes, on the loss of that part of you that is no longer allowed to be there.

Yeah, yeah, yeah. It's a grieving process for sure. This could— this relates to something you said earlier too, I think, in terms of Being able to see yourself from others' perspectives and change point of view. That's, that, so that's difficult, isn't it? To take yourself out to see how are other people seeing me?

Right.

How, I mean—

So we, we call that mentalizing. It's a growing area in, uh, in psychology. I really recommend you looking into it. I work a lot through that approach.

Hmm.

But it's this idea that it's beyond empathy. Empathy is being able to recognize that other people have their own lives and that they go through emotions. Mentalizing is being able to see yourself from the inside, from the outside in, and seeing others from the inside out, or the other way around. You know, it's this ability to put yourself in other people's shoes. The way it looks in a session It would be like, uh, well, my partner came back home and he, uh, he asked me about the dishes again. He always do that. He's just trying to, to rat me out and just trying to find a mistake. And you're like, okay, hold on, let's rewind that.

Mm-hmm.

When did you understand that it was on purpose? Well, it's obvious. He always does that. And it's like, yeah, yeah, yeah. But what time of the day was it? Uh, well, it was the middle of noon. We were just finishing lunch and You know, what else was going on? Well, there was a pile of plates and I could have done it myself, but no, he's doing that to berate me and he's doing it on purpose. Okay, let's pause that. What was going on in your partner's day? He's like, well, he's actually been telling me to do the dishes for quite some time, but I'm really busy and tired. So, well, he also is struggling at work and he's having difficulty with his parents at the moment. Okay, so let's think about, was it really on purpose? Well, I think it is on purpose, but maybe I can consider that he wasn't doing it to berate me. Okay, so you're making it a little bit more flexible. You have to be able to take on other people's perspective, change that. The problem is that once again, Tina affects the parts of the brain that allow you to do those shifts. So it becomes very clouded and it gets very confusing, with the extreme point being paranoia. The psychotic episodes you get where People are out to get me. Why? Because it looks like they're out to get me.

Yeah.

Right?

Yeah. Yeah. Interesting.

But it is difficult. It is a challenge, even for securely attached people. For everyone, it's complicated.

Yeah. Yeah. And the inability to judge, like, facial expressions and to judge where you're coming from and, you know, that That takes a while to build back to, I think, doesn't it?

That's why recovery from chems can be quite long. You know, one thing is to stop using, to, you know, manage your triggers and understand that. And maybe for a couple of months, you know, say 6 to 8 months, you're able to stay sober. Yeah, that's enough to get your brain to rewire, to start rewiring itself.

Yeah.

But then you also need to add a social component, you know, a supportive friend group, a community that is present for you, so that it helps continue the process. Otherwise, you end up with many people that we see in the consulting room that they might no longer be using, but they're in a deep, deep, deep depression.

Yeah.

Because they have nothing else. They're only focused on not using. Yeah. But they're not enriching their lives in any other way.

That's right.

So that's when you're thinking of perhaps moving to a more secure perspective.

Yeah.

To learn to forgive yourself that, yes, you did damage to your brain. You made certain choices that may have led you in all sorts of directions, but it's over. You need to rebuild. You need to be able to forgive yourself and try and connect with your friends. And now, you know, by that point, you probably have the skills to tolerate the shame of reaching out to friends that you were nasty to and be like, listen, I was in a difficult moment of my life. And, you know, I wish you can You get back to me. You see what I mean? It's like, this is part of the attachment point is, it's not just about stopping the use. You also need to recover your ability to trust others. I think that that is the key of chemsex.

Yeah.

It's the consequence of structural social situ— like circumstances that put, you know, men who have sex with men in this particular case, In a very vulnerable position to become dependent on drugs that are really heavy, that cause an effect on the brain that naturally you cannot replicate, and that just make you— it pretty much reinforces whatever sort of beliefs you have about yourself and others. So the recovery in itself is about rebuilding that trust, rebuilding that you can manage, rebuilding the trust that other people can support you, that you can reach out for help. That if people say, you know, you were really nasty, I don't want to talk to you, that you don't beat yourself up and relapse, that you say, well, maybe I'm gonna need to give them a little bit more time because I was nasty.

Yeah. Yeah. Interesting. Yeah. And to feel safe again too.

Yeah.

Yeah. I hope that you listening heard all of that in terms of— this is why I say when you have goals and you tell me my goal is to quit meth, Well, that's fine, but what can you— how can we go deeper, you know? Um, because quitting the substance, a lot of time I say it's kind of the easy part, that all of what you just said is the hard— that's, that's the work, you know, of it. So, um, we're coming, we're coming up on an hour 20. Do you want to take any more archetypes, or do you, do you need to go?

Yeah, no, no, I'm good. Yeah, yeah.

Okay. Um, so I think this one's kind of obvious to me, but I have Caretaker Carl. So he's the lonely provider using his resources. This is usually an older man, uh, using his resources to create the perfect party atmosphere at his home. Um, he's, he's the generous host, right? He, he, he's behind that generous host facade though lies a breaking heart.

Hmm.

If I take his, his quote is, if I take care of everyone else, maybe I won't feel so alone. And it's— I'm getting emotional because that used to be me.

So I think it is also part of recovery. You know, the more you're out of the, you know, out of the woods about it, you start to become compassionate and empathetic about the situation, about other people. And, you know, it's, it's hard, even though, you know, on a first impression, it is definitely an anxious style.

Sure.

But it might not only be that, it might also be that they are out of it. And they are just trying to provide care for other people, especially nowadays, where we're seeing younger and younger and younger people starting to get involved in the scene. Yes, that it might come from a genuine sense of care and compassion. But my question to caretaker Carl would be like, how much are you willing to give? Because that's the point of anxious attachments is they forget about themselves and to the point that they are left with nothing because it's easy. It's better to be empty and left with nothing than alone. Whereas the other one on the, the, the mirror of it on the avoidance style, you might end up with, I want to have everything as long as I don't need to feel that.

Hmm.

Even if that means that I will end up alone.

Hmm, interesting, interesting angle. Interesting angle. Okay, uh, well, let's do one more. Um, there's Chameleon Caden. So he's young and strategic, usually probably a sex worker, right? He's trading intimacy for stability, convincing himself it's just business. I'm just playing the game smart. This isn't about dependency.

I think that that's, you know, being cautious generalizing with sex workers, because it's an important part of their world. But I mean, the description in itself, it's, it's a bit avoidant, you know, it's like, I don't need to deal with emotions. This is just a transaction. You could also consider there's a subtype within the avoidant style, which, or it's in between the insecure and disorganized, but it's the dismissive attachment. You see that a lot in perhaps more narcissistic personalities where the other is kind of irrelevant. But it is a way of protecting yourself, being understanding that, you know, if you're doing sex work, you're dealing with lots and lots and lots and lots of people that used you in different ways. And it is adaptive, after all, to be a bit avoidant and to be a bit dismissive, because otherwise you get overwhelmed with emotion.

Sure.

So the question for Chameleon Caden would be more about like, you know, fine, this is strategy, this is business, but where are you in all this? It might initially go to, well, I'm— I've got money, and I've got everything, and I'm very popular and famous, etc. But it's like, but how do you feel about yourself? Like, that is about how others perceive you, but how do you perceive yourself in all that? There's lots of sex workers and performers that have a very secure approach to it. And maybe they're don't have an issue.

Yes.

There might be others that say, you know, as long as I am safe financially, and perhaps popular, I don't have to deal with perhaps lots of insecurities that I might have about myself, or the, you know, I don't have to deal with trauma, I don't have to deal with difficulty with what happened with that client 2 months ago. So it's a strategic way of short-circuiting your brain and your emotional pathways to be like, okay, this is as much as I'm able to tolerate.

Mm-hmm.

Um, but once again, it depends on how you see it as a global approach, because you might be seeing that in the chem scene and for client work, they're dismissive and avoidant because of strategy, but that perhaps they compensate in potentially helpful ways by being, uh, I don't know, maybe they're the caregiving Carl on the other side. You know, that with their good net— uh, close-knit group, they're very caring and supportive and they're like the heart of it. So as long as you're able to see that there's this complementary side, that they're also caring for themselves, it's not necessarily problematic. You know, it's convoluted, but I think that it's important to discuss it because sex work is part of the chemscene. And, you know, sometimes it's just about adapting to very complex social dynamics that you have to consider when you're doing sex work.

Yeah, yeah, yeah, I do. I'm glad you said that. I do think it's important not to to generalize all sex workers are this or that. There is this, yeah, like you said, adaptability. It could be very secure. It could be like, this is, this is a business, right?

I mean, perhaps there's— I've met sex workers that are quite securely attached in their way of understanding relationships, and that when they use, they have very clear and strict rules about when and under what circumstances they're going to use and how much and But it requires a lot of stability, self-determination, self-control, and lots and lots of planning to not let that, you know, spiral into out of control.

Yeah, I would guess a secure attachment is more likely to control it than an insecure. Is that right? Or do you— is that— I guess there's no— yeah. Is there— are there any studies out there that show in the chemsex world, like, Most are insecure as opposed to secure attachment? Is there anything?

No, but I am aware that they're putting together a paper, uh, in the next couple of months. I'm, uh, it's here in the UK. I'm not sure which university, but I've heard conversations about it. Uh, I mean, the, the typical understanding of addiction theory is that it's very rare to see someone addicted and secure because For you to be secure, it implies that you're able to self-regulate. So yes, I think that if you take that premise, you could say that perhaps the secure ones are more capable of controlling it.

Yeah.

Once again, remember that attachment changes. So it can— this is what I tell my clients, you know, you might be able to control it, but you might have had a really bad luck day that you happen to fall into the wrong party And seeing the right kind of things that might just tip everything over.

Yeah.

So I think that what I find helpful when it's— when talking about attachment styles, both within addiction and outside of it, is to recognize that being insecurely attached is not synonym of pathology or of problem. It's not necessarily problematic to be insecurely attached. And it is also not the panacea to be securely attached, right? You can be very securely attached, but tremendously insecure. You know, you can be like very scared of people, but you know, when it comes to, you know, maybe you live in a, you know, picket fence house with very limited complexity and difficulty with wife and kids and everything is fine. But whenever you, that someone breaks your bubble, things crumble. So you can be insecurely attached. And that means that, yes, you're very resourceful. You might have lots of strategies. The problem is when you depend too much in a strategy. So it is healthy to be anxious, to get anxious, and for your attachment system to activate. If you're in a loving relationship that is being threatened with collapse, it is adaptable to be anxious because you need to repair it. Oh, it is helpful to be avoidant because otherwise you become hyperdependent on people to manage.

I see.

Right.

Yeah.

But, you know, yes, it's helpful to move towards the secure side so that you're not pulled from one side to the other constantly.

Okay. Yeah. So yeah, it's helpful to have, it's kind of in moderation, right?

Yeah. Sometimes you hear clients that say, you know, well, I'm an avoidant and that's it, as if it was an identity. label. And no, you have avoidance strategies. You're— when your attachment system gets activated by all sorts of things, when with danger, yeah, you tend to use avoidance strategies, you withdraw rather than approach. If you're anxious, you just get really needy and distressed and hyperactivated.

Yeah.

Yeah.

Interesting. Wow. Well, Mauricio, this was wow. This was so good. This was meaty. We could probably talk for another hour, but I have to go. And I know you have to go.

Yeah.

What— is there anything that I missed today?

No, not really. I think that just for people listening, there's a couple of books that you might want to have a look at. One of them is, well, the Attached book that you have already mentioned.

Yes.

There's another one called The Compassionate Mind. It's by Paul Gilbert. It's the, like the Bible of compassion-focused therapy that works really, really, really, really well with trauma.

Okay.

It has to do with self-compassion and developing that as a skill. It's a really hefty book. It's really thick, but it's a very interesting one. And the other one is by Walt Odette. It's called Out of the Shadows.

Okay.

It's a recently published one, I think. I think it's Out of the Shadows: The Psychology of Gay Men, I think it's called. Yeah.

Okay.

I've heard that. It gives you a lot of perspective to understand why not only different generations relate to trauma and complexity and stigma in different ways, but also to put them into perspective historically. And what this guy has seen in the consulting room after, you know, I don't know how many years of client work. I find it really insightful and quite healing also to read it. Puts things in perspective. Nice.

I will put the link to these books in the show notes. Is there anywhere people can find you if you're open to that?

There is, but I'm gonna— I'm still building it up because I'm probably primarily working it privately. Sorry, with the NHS. And I'm working on building my social media in that sense.

Okay.

But once I have it, I'll let you know so that you can put it in the description. Sure. Otherwise, you can find me on, I mean, the typical LinkedIn and Psychology Today. But Psychology Today is mostly for British clients. So, okay. But yeah, you can find me Mauricio Alvarez, psychologist, London on Google. Yeah.

Sounds good. This has been, this has been Very helpful, and I think it's going to be really beneficial for the, for the listeners. I appreciate you being here so much.

And I appreciate the invitation. Thank you.

Of course. All right, all right, guys, I think you'll probably need to listen to this one over, and be sure again, pay attention to the study guide and get as much out of this as you can. And we will see you next week.