EP 3:11 Meth-Induced Psychosis with Patrick

So suspiciousness in and of itself isn't bad or even clinical. It's actually adaptive in certain settings. But when you're suspicious, just hanging out at dinner, when the people you're hanging out with at dinner have done or said nothing indicating that they're trying to harm you or plot against you, that's where it becomes kind of a problem. So you can think of suspiciousness and paranoia on a spectrum of like very, very mild And ordinary and not causing you a bunch of distress and not making your life difficult to the other end of the extreme spectrum, which is it's there all day, every day. And it's causing you to—

Chemsex, sexualized drug use among men who have sex with men, typically involving methamphetamine, mephedrone, and GHB, among others. Chemsex misuse is a worldwide epidemic that needs attention. dialogue, and hope for those lost in it, which is the purpose of the Aftermath Podcast. Please note the views expressed by the host and guests on this podcast are not to be taken as medical advice, and the content around sex and drug use can be triggering. Welcome back to the Aftermath Podcast. I'm your host, Dallas Bragg. So glad you're here. Thank you for joining us for another season. Hope you're enjoying the season so far. I've had some really big names this time and big topics, topics that really when I started doing the podcast, I wanted to cover and just never have. But today, before I get to the guest, I just wanted to give a little background. And for those of you who have been in the chemsex scene can identify with this, that there was a time when I experienced meth-induced psychosis and I had been up probably 9 days. That was my average. 9 days in a row. And typically I would just pass out. But on this particular night, for whatever reason, something clicked. And I spent the night curled up in a ball in the corner of my room thinking that I was surrounded, the house had been surrounded.

Yeah.

This was right after I was literally Arrested. I was arrested the first time and I was on probation. So I think that, of course, that had something to do with it. I really thought the house was surrounded. I thought that they were trying to get inside. I forgot how to use the phone. The natural way when I'm high from to use my phone was I went straight to Grindr and I started texting for help to people on Grindr. So you can imagine how that might have gone over. And so it was a crazy night. Just, I really thought it was true. I don't know at what point I finally passed out. So real and so vivid what I was seeing, the shadows moving in the windows, you know, the shadows in the window. So that was, for me, one of the only times that I had psychosis, but I was around so many men who were in it often while we used, but the men who stayed in it too after. I always had just a, just a soft spot for them. And so I have been looking for somebody with experience in this to come on the podcast and kind of help you listeners be seen and be heard. And to feel less stigmatized and less like you're crazy and help us understand this a little more. And so I found a gem, Dr. Patrick Lockwood, who's in LA. He's friends— he is a friend of our friend Mel McCracken, who's been on the podcast several times and will probably be back. But Patrick, can you introduce yourself? Please.

Yeah, absolutely. Thanks for— thank you. Really appreciate you having me on for various reasons. And this topic is something that's really important to me because of not only my professional life, but also a lot of the people I know in our community who struggle with this. So it's a personal thing and a professional thing for sure. So for the folks that have never heard of me or seen me anywhere, I'm a licensed clinical psychologist in California. I live in LA, roughly speaking, and I have spent most of my career in what I affectionately call Rehabistan because the different rehabs have different philosophies and beliefs, as you know. And so I've spent most of my life in a non-kidding sense. I've helped people With very severe substance use disorders that usually are called addictions. And I've worked at every level of care. I've worked in every kind of program, fancy rich programs, community mental health programs, psych hospitals. So I kind of know the entire system inside and out. And my other life is being a professor at California Lutheran University. So I have the privilege of teaching future doctors doing clinical supervision with them and things like that. And so as a clinical supervisor and as professor, as a treatment professional, I've tried to look at this problem we call chemsex as many different ways as we can. And, you know, just to toss something out there for you and for everyone, one thing that really sticks out to me about the challenge of psychosis when it comes to chemsex is it really adds a dimension to an already very complicated emotional issue that I think people are afraid to talk about because psychosis is kind of a spectrum. It's not like a black and white, you're psychotic or you're not experience, right? So if you think of, you know, the diagnostic version, of things, most psychotic disorders have kind of 3 categories of symptoms. There are the so-called positive symptoms, which are the hallucinations or delusions. And then there are the so-called negative symptoms, which are like poverty of speech, poverty of thought, uh, amotivation, stuff like that. Things that are absent that should be present. So you should have motivation.

Mm-hmm.

Right. And then you have just general disorganization as a person. Right. And so depending upon how much meth you use or whatever substances you're combining, you might be very disorganized just because of the polypharmacy of it all. Right. And if you find yourself in a chemsex situation where there's just lots of people, cuz it's like a bathhouse or an orgy or whatever it is, There's just psychological disorganization because of the setting that you're in. Right. And so chemsex to me is an extremely complicated problem, especially as it relates to psychosis, because you're already in settings, in my opinion, often that are disorganizing in and of themselves.

Mm-hmm.

And then when you add the chemical disorganization because of meth or whatever it is, Mm-hmm. It just makes an already difficult experience 10 times more difficult. So I feel a lot of sympathy for people in our community who go through this because they have this like quadruple whammy of an experience beyond just the shame around sex and sexuality and compulsive sexuality. Then there's that chemical version of it, but then there's also paranoia. So it's just, It's, there's just so much going on that's hard for any person to handle. You can be the smartest person or the sanest person or the healthiest person, but as we all know, meth is not something you can just mess around with casually. There's, in my life, I've never myself met a casual meth user. It sounds good on paper for some people.

Mm-hmm.

But it's, it's hard for that to be a casual habit. You know what I mean? Right.

Right. Yeah. Yeah, that's one of the questions I get asked often. Can I use this casually? Can I use this recreationally? And I'll always say, if you could, I would be doing it. I would be using it casually. Right.

Right.

Yeah. And if you could, you wouldn't be talking to me right now. Right. Yeah. So can you talk about then the spectrum of psychosis, if you If you don't mind. And what's the difference between psychosis and paranoia?

Well, paranoia is just one feature of psychosis, right? So let's talk about paranoia first and then we'll talk about like the spectrum idea, right? Because I think a lot of people have like black and white thinking about these mental health topics. And I want to make sure that, you know, the real complexity is honored so we can honor where people are at. You know, so paranoia is just a type of delusion basically, right? It's, it's a filter that your brain has, right? So there's different types of delusions. There's grandiose delusions where you think you're more special and amazing than you are. There's delusions of love where you believe people are in love with you when they're actually not, right?

Yeah. Yeah.

And so, and just so everyone knows, a delusion is just simply a fixed false belief, a belief that doesn't change when there's new evidence presented to you. Right. And so all of us have incorrect beliefs, but usually those change when we're presented with new evidence. But a delusion is a complicated system of beliefs that is resistant to true and accurate information. Right. So, you know, so a paranoid delusion basically is where the individual has fixed false beliefs about suspiciousness, about being harmed or being threatened that aren't grounded in actual experiences of threat. Right. So classic paranoia involves, you know, believing that a person you're interacting with has ulterior motives or hostile motives when they've actually not said or done anything in reality.

Yeah. Yeah.

That warrants that judgment of yours or just general suspiciousness that's not warranted. Right. So suspiciousness is perfectly ordinary. Actually, we should all have Or at least my opinion is we should all have some, some like garden variety suspiciousness because like that person might be staring at their phone and cut you off while they're driving. Right. So you should be a little suspicious of the people driving next to you. Right.

Yeah. Right.

Not in the sense that you have a psychotic disorder, but in the sense of like, is that person actually paying attention to the road or are they just staring at their phone because they're kind of selfish? Right. So suspiciousness in and of itself isn't bad or even clinical. It's actually adaptive. In certain settings. But when you're suspicious, just hanging out at dinner, when the people you're hanging out with at dinner have done or said nothing indicating that they're trying to harm you or plot against you, that's where it becomes kind of a problem. So you can think of suspiciousness and paranoia on a spectrum of like very, very mild and ordinary and not Causing you a bunch of distress and not making your life difficult to the other end of the extreme spectrum, which is it's there all day, every day. And it's causing you to read into things that the average person wouldn't read into. And it's making you really stressed out all day and it's causing a lot of impairment in your life. Right? So I think of it like very, very mild and not problematic to very extreme and all day and causing lots of problems and distress for you. If that makes sense.

Yes. Yeah. Yes. So fixed false belief, paranoid delusion. So a common one is there are cameras in my house, right? There are cameras in my lights or my sprinklers or my vents. Um, and no amount of picking apart, tearing apart, pulling from the wall. Proves even if you take the smoke alarm apart, you're not convinced that there's not a camera in it. Is that right?

Yeah, absolutely.

If that, if I'm in that though, what, or let's take it from both sides. If I'm in that, how do I then ease up on it? Is there a way for me to, if I, if evidence doesn't, doesn't resolve it, then what does at that point? Yeah.

So when I, when I think about most of these topics, I like to have a metaphor on deck that might make it easier to, okay, to have realistic expectations. 'Cause I think you and I both very much care about realistic expectations.

Yes.

As people, as providers. Right, right, right. So I think most people, now this is just a metaphor, so it's not literally true. Just so everyone's clear. So don't cancel me or whatever.

Right.

But like, but if you think of most of our mental health symptoms as reflexes, it really helps. So like, okay. A reflex that I don't think anyone believes they can control is a sneeze, right?

Mm-hmm.

So if your nose is irritated, either because of nose candy or because of allergens and pollen, or because, you know, it's all dried out because you're dehydrated or you're not drinking enough water or whatever, whatever's causing your nose to be irritated will force you to sneeze, right? That's a reflex. It's not under our control. I don't think people, to my knowledge at least, can't make themselves sneeze. And so no one in their right mind would be like, I need to sneeze less.

Right? Right, right.

And as much as, you know, we can have a sneezing fit where we sneeze over and over and over again, and it's really upsetting and you get lightheaded and whatever, but no one thinks I have a pathological sneezing problem. Right. And I kind of think, I think of these intrusive thoughts and delusions in a very similar way. These are reflexive things that your brain is doing to keep you safe.

Yeah.

Right? Even though your brain is misreading the environment.

Okay.

And is misjudging how unsafe you are.

Okay.

The delusion itself, the paranoia itself is just a reflex, like a sneeze. And so you can't really keep yourself from sneezing, but what you can do is you can notice what's irritating your nose. Right? And likewise with the paranoia, you can notice What's irritating this paranoia reflex, right? So what are the stimuli that are causing you to misinterpret reality? Right. And I say cause very like casually, not like technically and scientifically, right? So you might look in the vent in your ceiling and think there's a camera there, or you might misperceive something in your vent or whatever.

Mm-hmm.

And you're right. No amount of taking the vent apart is going to get rid of that. But then the question is, is that what's causing the sneeze or is it your perception that's causing the sneeze? Right? So you're, you're looking at something, you're putting your attention on something. And can we do something with that attention? I wonder. So you find yourself staring at the vent.

Mm-hmm.

Could we distract ourselves for a little bit? For instance, distraction in small doses is very useful. It's like an intentional interruption skill, if that makes sense.

Yeah.

But it doesn't solve the problem. It doesn't get rid of the paranoia. It just temporarily gets you out of that fixation so that you can maybe engage in some of what we call metacognition to get your brain back focused on something else that's more productive. You know, or can we do some reality testing? If you're feeling comfortable enough in your skin, can we try some reality testing? You know, can we check on what do I believe? On what basis do I believe that this is real? Right?

Yeah.

You know, so distraction and reality testing are skills that take time to develop. But they don't solve paranoia. They just help you manage it once it sets in. If that makes sense.

Yes. Yes. I think it's important for the listener to know to manage the expectation.

Yes.

So if you're, if you're expecting to solve it, you may get disappointed. You may get frustrated. You know, you're, you're, you're going to setting yourself up for failure almost.

Yes.

But if you say, I'm going to manage this, this is here, it's not going anywhere. I'm gonna sneeze anyway.

Yes.

So I'm going to manage to sneeze. I'm gonna put my arm up.

Right, right.

So I don't blow snot everywhere.

Yeah. We're, we're kind of talking exactly that. Like we're, we're managing.

Yeah.

Because the paranoia does not magically go away even with the best psych meds, you know? So it's a question of, can we find temporary coping skills that allow us to feel just a little less worried and anxious? And also at some point start to feel more in control again, because most people with paranoia feel out of control.

Right, right, right. Okay. All right. Okay. So for you listening, is the distraction, the metacognition by distracting yourself And then the reality testing, you know, and what do I believe? But at the end of the day is in control of it and managing it. Just, just manage it because I, and you correct me if I'm wrong here, but one thing that I see is, is the response to it as well that can ignite it.

Yeah.

So when I look at the vent and I think there's a camera in it, if my response is, oh my God, I'm crazy. I can't believe this is happening. There's something wrong with me. I'm damaged goods. I'm never, I shouldn't have ever done that meth. Is this the rest of my life? Those kinds of thoughts to me are not healthy and can, I don't know if it's scientific or not, but it couldn't help matters, right?

Yeah, we call that catastrophic thinking or catastrophizing.

Right, right, right.

And so every time we're catastrophizing, it's usually making our life worse. Now, obviously there are examples where catastrophizing is perfectly useful. You get in a car accident, you should be catastrophizing because like, oh my God, am I hurt? Is my car screwed? What's going to happen? So the catastrophizing will force you to focus on the immediate situation and solve the problem. But catastrophizing while you're paranoid is definitely going to make everything worse for sure. So managing catastrophic thoughts through either reframing, perspective-taking, other cognitive coping skills, or just taking a breath, taking a step back and taking a breath. If you're in the headspace where you can kind of get yourself to take a breath and just try to center yourself, if you can for even 5 seconds, you know, that would be good. You know, anything that gives you a break from the immediate distress. Is good.

Yeah. So there's a billion examples. And if you're listening, I know, like, you, you think the same person is following you or, you know, all sorts of things. There's, there's cameras in your laptop. You know, it used to be the first thing when a guy would come over to my house for a chemsex party, he would, he would put duct tape on all the cameras, you know, on the laptops everywhere. Right.

Yeah.

Oh yeah. Duct taping the blinds down and all of that kind of thing.

Yeah.

This is before you got high, right? And so what we're talking about here to me is when you're not high, when you're not, you know, you're not high on crystal meth. When you're high, this meth-induced psychosis of when you're high, that comes in. And I'm guessing, do you help men? Do they do, are they able to recall any tools to help them through that when they're high? Like, is there something that we can help if, if you do use, if you have psychosis when you're, you know, you're chemically induced, is it, are there any chances that, that they might remember something or, or make it a little less?

Yeah, it's tough. I mean, 'cause like everyone's different when they're high. So there are some commonalities around euphoria and power and all that stuff and even psychosis too. But the idea that there's like a universal way people are going to be able to remember things or not, I don't know. Like I once, once upon a time, I used to run a treatment program called La Fuente, which is an LGBT spot here in Hollywood. And a lot of our chemsex folks had very diverse experiences with being like present while they were high. Like some people did have the presence of mind to remind themselves or use metacognition to reorient themselves. And sometimes, I don't know how much this has happened in your life or in your coaching life, but like sometimes people have like a moment of clarity in the midst of doing something that they're like, I can't believe my life has come to this or something like that. Right. And, and, um, sometimes you can capitalize on those moments.

Right.

Uh, I just think people are very different. You know, it depends upon how much meth you're actually using. If you're using other substances, if you're trying to come down with something, all these things, right? So I don't know, but if you, if you do have the presence of mind to go, hmm, can I do something to feel better right now? Then there's lots of things you can try. But for most people, it's a time problem. It's like you gotta wait until it's outta your system.

Yeah. Yeah. You know? Right. Right, right. Yeah. Yeah. Yes. Yeah. Okay. Thank you. This is, this is really helpful so far. Very helpful, actually. Is there, do you know why? And this is worldwide. You know, it doesn't matter where a man DMs me from. The paranoia, the psychosis, it has the very same, it's all similar, similar. Mm-hmm. You know, it's, it's all thinking that people are watching me. It's the paranoia of someone's after me. You know, the, the, the cashier is in on it. You know what I mean? Like, it doesn't matter. Like, from, from China, Australia, to Europe, to Canada, I, I get, I get these calls from men who are inside their home, scared. They can't speak to me above a whisper because they're convinced. Everything they do is being recorded. When I had a guy say, when he goes, he, there's a grocery store across the street. He puts a hood on, sunglasses. He runs as fast as he can, grabs the food, runs back. Like, this is his life. Is there any research? And maybe I should have done research, but I mean, why is it so similar no matter where? Is it just, and why does it affect the brain that way?

Yeah. Well, let's, I guess we could back this up a little bit, right?

Okay.

So I think first we should talk about what people, there's, there's like a dozen things I wanna say. I'm gonna try and filter it down to a couple so we don't spend 6 hours talking to each other. So, uh, I think you have things you wanna do too. So I would say, so we need to, I think, talk about what normal actually is, right? I think if we have a real candid conversation about what it means to be a regular person, I think maybe this will be less stigmatizing for people who are struggling with paranoia. So, okay.

Okay.

My, my understanding, you know, having looked into this both on the chemsec side of things, but just on like the, you know, I teach a lot of psychopathology classes for Cal Lutheran, so.

Mm-hmm.

I've done a lot of looking into how does the brain normally process information, especially emotional information, because I'm trying to teach people about other disorders. So one thing that I think a lot of people take for granted is the power of denial and how good our brain is at filtering out information. So like right now, you and I are both being bombarded by Dozens and dozens of sensations, visual sensations from the computers and the lights in our room and shadows and all these things.

Mm-hmm.

We're also being bombarded by sensations from our ears because we have headphones on and all these things, but we're also being bombarded by the sensations of our skin and the clothes that we're wearing and the temperature and push and pull. And So basically our brain is always literally being bombarded by dozens and dozens of sensations. And all day long, your brain does this beautiful job of just filtering out what you should actually quote unquote pay attention to. So our attention is very limited to a few things, 3 or 4 things, maybe, maybe 5 things if you're super aware.

Hmm.

You know, advanced meditators might be able to notice 6 or 7 or 8 things, but like most people only really attend, they put their conscious attention To a couple of sensations.

Okay.

Right.

Okay.

But, but that doesn't mean your brain is not being bombarded by dozens and dozens of sensations, maybe hundreds of sensations at any given moment, but your brain filters them out so you don't pay attention to them. Right. So the average person, if they could pay attention to all the sensations that are happening in a given moment, probably would lose their mind.

Yeah.

Because our brain's not good at processing hundreds of things at once consciously. It unconsciously processes a bunch of things. Right. So does that generally make sense?

Well, it makes sense to me. So probably everybody who's listening to you too. Yes.

Okay, cool. So part one of my little thesis here is we're bombarded by sensations all the time, but we have denial. That keeps us from paying attention to them because it's just not useful. Like, why do we need to give a shit about the noise outside? It's not going to kill me.

Right.

But, but now imagine, imagine you were to take a substance or have a meditative experience or something that could transform your ability to focus. And as we all know, methamphetamine is a phenomenal focusing substance.

Yes, sure does.

Yeah. Right? But the problem is when you're focusing, when you're hyper-focusing on getting laid or whatever it is, or getting high or both, that doesn't mean your attentional resources are literally only devoted to that. All of your other senses are now heightened, which means you can now pay attention to more things. Unfortunately.

Right.

So meth has this beautiful and tragic gift of allowing you to take that ordinary denial mechanism we all have to not give a shit about the dozens of other sensations, and it starts to erode it and allow your consciousness to pay attention to more things, which is anxiety-inducing and paranoia-inducing for all people.

Mm-hmm.

Right? Like, I'm just going to give a completely silly example. So most of us have the gift of denial all day around so many things because it's not evolutionarily useful. We'd lose our mind if we actually told the whole truth to ourselves. So for instance, right now, again, just making a completely hyperbolic example, right now we're sitting on a rock in the middle of space that's going thousands of miles an hour and could basically be bombarded by an asteroid at pretty much any time. Theoretically, NASA could detect it, et cetera. But like in reality, that threat's always there.

Mm-hmm.

Number one. Number 2, here in California, earthquakes could happen. Who knows at any time, just, you know, I'm near the coast, it could fall into the ocean and so on and so forth. That's threat number 2 is earthquakes. So threat number one is asteroids. Threat number 2, earthquakes. Threat number 3, nuclear war. I don't remember the name of the person, but there's a journalist who did research on like, how quickly would things happen? Could we protect ourselves from a nuclear war? And I'm pretty sure it's like, we have less than 45 minutes to get our shit together and we're all probably going to die anyways, basically.

Right. Right.

So threat number 3 is nuclear war. Right. And I can go on and keep listing things that are quite literally present threats that could realistically happen, but we're really just gloriously in denial about them all day, every day of our lives. Right. So I just listed 3 catastrophic things, right? But for the most part, none of us walk around catastrophizing about the asteroids, the earthquakes, or the nukes.

Right.

Because we believe that, you know, mutually assured destruction's going to keep us from nuking each other.

Right?

It's not true technically, right? But it's denial. So our brain, our brain is all day, every day engaging in ordinary denial. Like we have defense mechanisms to keep us sane. And sanity is not the absence of real information. Sanity is the absence of real information in a way that allows us to feel calm, Over time. That's all it really is. But there's a bunch of real information that is actually paranoia-inducing. Like your government literally is listening to you through your phone. That's not a meth, that's not a meth hallucination. We know that now.

Right.

Thanks to Edward Snowden and a bunch of other whistleblowers. Yeah. We know that the federal government has literally been listening to people through their cameras. So all the, the tweakers actually have it correct.

Believe it or not, you know? Yeah. Yeah. Yeah.

So, so, you know, we live in a world with actually constant threat, even though it's, you know, here in the West, it's, it's better than it's ever been. It's technically true that if you were to actually pay attention to all the real threats that exist in your life, then you would be a little suspicious and paranoid walking around every day. But most of us have the gift of denial. this normal defense mechanism, which is a reflex to not give a shit about these things and focus on the present moment or focus on this podcast or focus on work or whatever it is.

Yeah. Yeah.

Because we would just lose our minds if we thought about all the very true things all day. Right. So to me, one of the reasons why I just, long-winded answer to get back to why I think everyone has the exact same kinds of suspiciousness and paranoia is because It's actually very rational to believe that the people you're randomly meeting at the supermarket could kill you because technically they could.

Yeah.

Right.

Yeah. Yeah.

That, that cashier might have a weapon on them.

Sure.

That cashier, that cashier might be on drugs that makes them violent, for instance. Right. So those are not unrealistic threats. It's just that our brain loves to be in denial. About them because, oh, 9 times out of 10, that's not going to happen to me. So why should I care about it? Right. And so to me, I think paranoia is just acknowledging reality, unfortunately, that our brain's normally in denial about because it doesn't serve us to be out of denial about it, if that makes sense.

I see. I see. Yeah. See, this is a, this is a very, it's a perspective shift that I think can help a lot of people is that I'm just seeing, I'm just paying attention to reality that others aren't.

And adding a layer of meaning that most people don't.

Yes. And adding a layer of meaning that most people don't. So what is most in my control perhaps is the meaning I'm making.

Exactly. Because the attention's not going to go away.

Right. Right.

Not until you've had some time and you've gotten better and your body's regulated and your brain's regulated. But the meaning, this, you know, the suspicious meaning of like that person looked at me, right? And I think they have plots against me. It's that meaning that you can play with.

Right. Yeah. How can I play with that practically?

I mean, the coping skill from cognitive therapy is called perspective taking, right? So perspective taking is quite literally what it sounds. You're just paying attention to the original perspective you had, which is, I think this person's out to get me. And can we add alternative perspectives to that? Okay. We're not trying to get rid of or challenge the original perspective. We're just adding alternative perspectives.

Okay.

Right? So if someone's actually psychotic, they still have like schizophrenia as a diagnosis. You don't challenge the paranoia. What you do is you help them tolerate the feelings. Like we were talking about, but then you also help them look at alternative perspectives if they're open to it. But if you're not open to it, don't force it.

Okay.

Right.

Okay. Okay. Okay.

Because when you force it, you're trying to confront reality and that does not work if you're experiencing psychosis, whether it's drug-induced or due to schizophrenia.

Mm-hmm.

So if you are a little more open-minded despite the paranoia you're experiencing, You can try adding alternative perspectives, but be careful because it might spin you out if you add a bunch of negative and suspicious alternatives.

Right.

Right.

It could go the other way. It could go the other way. Right. Yeah. That person is talking about me. An alternative perspective might be that person, the opposite, that person is not talking about me. Yeah.

Or they're having, or maybe they have a bad look on their face because they're pissed off at themselves or they hate their job. Right.

Yeah. Yeah. Yeah. Right. Yeah.

Cashier hates his job. The cashier had a bad day. The cashier's boss is a dick.

Okay. Okay. Yeah. If you're open to that, those are all true.

If you're open to it.

Yeah.

And if you're not, then don't force it, you know, because when you're, when you're in a very fearful place and you're very resistant, then pushing on yourself will not work, especially if you're paranoid.

Yeah. If you're struggling with paranoia, would this also be an opportunity to ask on what do I believe? The reality?

What bases reality? Yeah. You can ask yourself that question if you're up to it.

If you're up to it. Yeah. Okay.

But you know, my favorite thing is if someone is really struggling, the first question I always have is, what do I want to do to feel better right now?

Okay. Because usually there's something super simple.

I can take a breath. I can go outside and get some sun, or I can go to a quiet place or whatever it is.

Hmm. Yeah. Yeah. I love it. What about a word or a mantra or something like that? I guess anything that can, anything that can bring you out of it.

I mean, some people might respond well to that. Yeah. You're like trying to, you're trying to train your brain to like snap out of it. Right. That's, I think that's a great idea. Some people might do well with it. Some people might not.

Yeah.

Yeah. Yeah.

Yeah. I mean, I have a feeling this is very much individual to all of it, all everything, every treatment. So each person, if you're listening to this, just understand that, that it could work for you. It might not work for you. Um, but be, you know, trying it all until you find something that works, right?

Yeah. Yeah. And it requires experimentation in my opinion. Like I've never worked with someone clinically who was struggling with psychosis where I just had the perfect playbook and it just worked.

Yeah.

It's always, we've gotta experiment. We gotta play. I like the word play. We've gotta play with How much anxiety I can tolerate right now. You've got to play with how much reality I can tolerate right now. Like it's not, it's not black and white. It's very gray. It's very situation and person specific.

Yeah. Yeah. Okay. All right. Thank you. All right. So a big question I get is, will my brain, for lack of better words, heal? I don't know that heal is the right word here. 'Cause it's not broken, but will I, will it resolve over time if I continue on my meth-free, you know, consecutive timeframe? And I know there's probably no timeframe to tell 'em, but is there, do, are there rates, there are percentages, or, or, or is that also individual?

It's very individual.

Okay.

We, we have some like national level data that's Kind of helpful, but I, I, to me, I don't want to overpromise things for people. It's not, it's not very reasonable. I think most people I've met, especially in a treatment setting, can certainly have substantial symptom relief. However, the timeline, being patient with yourself is really important because I think back to the expectations thing.

Yeah.

If we're not patient with ourselves, then we usually set ourselves up for, you know, failure, right? And so, you know, do you expect to feel completely fearless or something in 6 months? Probably not super realistic. I guess it's possible. I mean, I don't know that there's a quick way for anyone to feel better if they're having meth-induced psychosis. I think it's a question of, are you doing everything that you have in your power right now? That's reasonable to feel better, right? Because some people, maybe they work a really complicated job and they don't have time to take care of themselves as much. Maybe they have certain disabilities that makes it harder for them to do good things that are for recovery. Like, you know, exercising is good for everybody's brain, but with the right kinds of disabilities, you can't really do that as much. So you have to find alternatives. And so, you know, Being reasonable and being patient is extremely important if you have meth-induced psychosis. And when I say reasonable, I mean like reasonable with yourself, expectations for yourself.

Hmm.

You know, it's okay to want to feel better quicker because you probably are terrified. You probably have shame and stigma and you're tired of being, seeing yourself as broken, right? I want to fix myself quickly. When you and I both know there's no such thing as fixing yourself. Number one.

Yeah. Yeah.

Number two, it takes time for your brain to heal. Yeah. And so depending upon how long you've been using, what other drugs you've been using, what other behaviors you've been doing that hurts your brain, you know, it could take longer and we have to be reasonable. We have to be patient, you know? So, you know, if you have the resources and the time to Do extra things to take care of your brain and help it heal, to eat better food and get better sleep. And, you know, if you need meds, take meds. If you drink enough water, like all the simple stuff, do as much of it as you can. And all the extra stuff, if you have the resources, I hope you can do it too.

Yeah. Yeah. I, I, I, like you said, I think the most important step first is to manage the expectation.

That's right.

And set the stage, right? I asked a couple of places for questions, and I was just going to check one more time to make sure I didn't get any questions. There was a— and then I lost the question that I had when I looked. The psychotic meds you've mentioned a couple of times, are those difficult to attain?

It depends upon where you live because some areas have a lot of telemedicine nowadays and some areas don't. Right. So obviously it'd be ideal if you could go see a provider in person. Now, if you're having some kind of extreme symptoms, like if you're having excessive anxiety or excessive fear or panic, or the hallucinations are causing voices that are very, very loud and you can't control them, You can go to like an emergency room or an urgent care, and there's a good chance they'll prescribe you something to help you calm down right away. It might be a benzodiazepine or it might be an antipsychotic. That being said, in an ideal world, it'd be great if you could find a psychiatric nurse practitioner or a psychiatrist who can help you with Maybe some comfort medications like beta blockers or something to help you feel less anxious.

Okay.

Or, uh, if needed, if it's actually recommended, certain antipsychotic medications can help, but usually for delusions, they help less.

Okay. Delusions, they help less.

Yeah. So if you're experiencing a lot of grandiosity or a lot of paranoia, Or things like that. Sometimes medications, you know, will help a little bit because they're cutting down on how hyper dysregulated you feel, but the content will not shift usually because of the medications, but they might sedate you basically.

Okay. Okay. How about hallucinations and the, the, so I used to, do this only when I was high, but then sometimes when I wasn't, turn the shower head on, I would hear Billy Joel all of a sudden, you know, coming through. Or I would hear, I would be here and my window's closed. Somebody's walking, I don't know, a mile away. I could hear them talking in my ear. Right. Is that specifically or officially hallucinations?

Yeah.

And would the medicine help with that? Like, Yeah.

So antipsychotics, antipsychotics do help with hallucinations for sure.

Okay. Okay.

Yeah. And so like, depending upon who you're seeing, what kind of provider you're seeing, they might temporarily give you an antipsychotic. They'll give you like a week's worth of like a Zyprexa or something like that. As an, as an example, I'm not saying that's what you should take. It's just an example. Sure. So don't sue me or whatever. But, uh, Like in some cases they'll give you a very short-term antipsychotic while the hallucinations dissipate, especially if the hallucinations are really impairing your ability to like sleep or whatever, you know?

Yeah. I mean, we all know about the shadow people. We've all, you know, dealt with the shadow people and the voices and all of that kind of thing. You know, I had a, the only near-death experience I've ever had. was with, um, someone and he was psychotic. He had schizophrenia and we, we got high, high together and it triggered him and he turned into, uh, he, I guess, I, I don't know if it was whatever. I don't wanna diagnose it, but he turned into a different person. Breath, voice, everything about his face. He had a different name. And he Yeah, I don't want to go into the details. I don't want to trigger anybody because it was really bad, but I almost died. I was really close to dying. That was schizophrenia or something deeper for sure.

Yeah.

You know, I don't know whatever happened to him, but, you know, those kinds of experiences also linger with a lot of guys that I'm talking about. So Some guys go straight into paranoia once they inject or smoke and they get made fun of or pushed out of the house onto the street. They get, you know, they get, there's violence, kind of, they're treated violently because they're a buzzkill now. You know, they're, you know, and so those type of experiences while you're high are traumatic.

Yeah.

Um, and so what I know you can't, you know, I mean, the answer is see a therapist. Um, but are there any, any advice you could give us if we're still kind of dealing with that and it's affecting us now in our sober life?

Well, if, if people have like real trauma of some kind, um, And you need help, please definitely see someone if you can. I guess I think there are a couple of alternatives to therapy. So there are different types of self-help groups. So, you know, out here in LA, CMA is fairly popular, Crystal Meth Anonymous. And, you know, there's a lot of really good support there for a lot of people because A lot of people have experienced the things you're talking about and whatever feelings you might have about AA and related things, it's a lot of the same community. It's a lot of people who get it. It's a lot of people who've been through very traumatic and tragic things together. And so they will understand you. And sometimes just being with someone else who understands you can help you feel safer. And, you know, even if you don't actually join like a CMA or something, you might find somebody at a meeting that can at least be your friend.

Yeah.

And help you walk through this so you don't feel alone. Because to me, the worst thing is trying to deal with anything alone. You know, we are, we're mammals and mammals are a social species, which means we're, we're designed to feel good together. We're also designed to feel bad together. We're not designed to be miserable by ourselves. This really isolated world we live in is not good for anyone's sanity. So I hope that you find some kind of support, some group of people, or even just a couple of people if you can. And if it's professional, that's great. And if it's just self-help, that's also great in my opinion. You know, so I hope that if you are struggling with trauma, you try to walk through it with people who have your back and understand you to the best of their ability.

Yeah.

Yeah.

Yeah.

Yeah.

You know, I'm not the, I try to be because I just have such a soft spot for these guys, but they call me in this state.

Yeah.

I really try to be the best support that I can in terms of just giving them this space to allow them to be what they are and to feel what they feel.

Yeah.

It's just heartbreaking. It's heartbreaking. Um, do you see a difference in, and I won't keep you too much longer, but so there's the broader umbrella of sexualized drug use, and then there's chemsex, men who have sex with men. Do you see any differences in the way the psychosis shows up in maybe, and in the heterosexual demographic? Um, and, and I wonder why, if there's a difference.

No, that's a good question. You know, I've, I've worked with a lot of hetero folks who use a lot of meth and, uh, you know, I think the paranoia seems to be relatively similar.

Mm-hmm.

Um, mm-hmm. You know, uh, my very first job at the ripe old age of 19, all these years ago. was working in a drug rehab that no longer exists, unfortunately, in Missouri where I'm from called Daybreak. Daybreak used to be this like state-funded program where basically you either went there or you went to jail, basically.

Yeah.

And so at the time we actually had a lot of bikers because back in when I was a younger person, Missouri was the meth capital of the world, number one producers and distributors because we had all the bikers that could, You know, go live in the woods and distribute, you know, main highway through all parts of the country, basically. Right.

Like Hells Angels or something. Yeah. Yeah. Yeah. Yeah. Yeah.

And so I dealt with a lot of them and, you know, their paranoia was pretty much exactly the same. They always thought that regular people were out to get them. They had an, uh, a suspiciousness that wasn't earned, all these kinds of things. Um, And so I don't know that maybe obviously the sex is different, but the, uh, but even a lot of the sexual behavior was the same. There's a lot of group sex that they wouldn't normally be having if they were sober, doing a lot of outta control things they wouldn't normally be doing when they were sober. I don't know. I mean, there's some similarities, but there are also some differences in terms of like, you know, types of sexual behaviors and types of paranoia, but A lot of the paranoia seemed very similar, like suspicious of the cashier, you know, hearing voices, you know, in the other room, all these things, you know, shadow people, um, all seemed very similar. And, you know, across my career, it's, you know, all the hetero folks I've dealt with also seems pretty similar in many ways, just maybe different settings or different, obviously very different sexual norms.

Right, right. Okay. I was curious about that. Yeah. So kind of wrapping up, if you're listening, is show yourself some compassion, please, and understand that you're not broken.

Okay.

I'm just getting emotional. I feel like this must be my crying season because I feel like crying on all these episodes.

I don't know what's going on.

This is just This is near and dear to me because of my past experiences too, but, um, just seeing people in, in their sober state being trapped. It's, you know, there's a difference between, there's a difference between the men who know they're having a paranoid delusion and those that are just trapped inside it.

Yeah.

And just don't know it.

Yeah.

Yeah.

That's hard.

Yeah. Um, but go back and listen to everything that, that Dr. Lockwood said today and really take notes. Um, as you know, we send out a study guide with every episode. Pay attention to that. The link will be in the show notes. Um, this is very, very helpful information, and I think it's going to help you Just calm, calm down a bit about, you know, the fears that you have, but also manage them in a way that's, that brings peace to your life and just a little more peace every day. Patrick, is there anything I didn't ask today? Is there anything I left out that you felt like would have been important for us to mention?

I think I'd love to have a bigger conversation with you about the broader spectrum of chemsex at some point, but I don't think that that's on topic today.

I would love that too. Uh, when we spoke before, you were talking about 3 types of chemsex users. Yeah.

Yeah. I want to dig into that conversation. Yeah.

I want to dig into that. Um, yeah, this, this topic I really wanted to get to. I want to get to that. If you, if you don't mind, I would love to do another episode with you. I think you're going to be very popular. You're going to be extremely popular on this podcast. I can tell you that. Um, I, I feel like this, yeah, I feel like this is going to set a lot of men free around the world. You know, only half, only half of my listeners are in the US.

Interesting.

The other half, yeah, the other half are all around the world, all around the country, all around the globe. Um, and, um, we're all unified. It doesn't matter where you are. We're all unified by this same behavior and the same character, the same struggles. And paranoia is one of them. So I hope that this does set you free if you're listening. And I appreciate you being here. And thank you, Dr. Patrick Lockwood, for sharing your vast, extremely well-articulated knowledge here. I really, really greatly appreciate it. You've taught me a ton today. So thank you.

Glad to hear that. Thanks for having me. Appreciate it.

Of course. All right, guys, stay tuned and we will see you next week.