What is addiction? Why is it more dangerous than ever before?

I think that the challenge is trying to discover people before they slide down. As we've seen, people are unbelievably capable of adapting to patterns of use and being successful at work and being successful in their lives and at the same time having a raging drug problem. So again, being able to try to engage them early and try to say, hey, you may have a problem, maybe you want to get some help. Often people will still say no, but I think trying to engage people early and help them understand the early signs of addiction. Be really helpful.

Welcome to the MindBodySpace podcast, where you can boost your resilience just by listening. To help us help you, please subscribe to this podcast and sign up for the newsletter at mindbodyspace.com. There is now solid evidence that stress can affect our biology down to the cellular level, affecting our health, performance, and happiness. In these complex times, it's so important that we educate ourselves on useful versus toxic stress so that we can live our best lives. Hi, I'm Dr. Juna Bobby MD, a lifestyle medicine specialist and a fellowship-trained radiologist who's seen many preventable diseases from the inside out. My passion is sharing science-backed antidotes to toxic mental and physical stress so that you can focus on what's most important to you.

Hello.

Hi, John.

It's been so long.

I know it has been.

Yeah. Great to see you too. And Jean-Luc, can I call you Jean-Luc?

Nice to meet you, Juna.

Or Dr. Neptune?

Yes, absolutely. Very nice to meet you. Call me JL.

JL, I love that. I know we've been going back and forth with scheduling a little bit, so I'm really excited to have you here. You're both addiction specialists and I wanna get started with Jean-Luc, JL.

Okay.

Can you tell me a little bit about yourself and how you got started in this? I know you were a Division I athlete at Columbia University when you first started.

That's part of the story if you wanna go back that far. But yes, so when I was an undergrad at Columbia, I was a track athlete. At that time, the NCAA had a very interesting notion that athletes were influencers on campus. So this is a time, you know, NCAA was using the term influencer long before, you know, anybody was using it for social media. And the idea was that if you involve collegiate athletes in doing drug and alcohol peer education activities, you could positively influence other students. And, you know, remember this is, I was at, I started college in 1988. So this is a time where, you know, probably less of a dangerous drug environment than it is now, but still, you know, kids were doing a lot of experimentation with psychedelics and smoking weed and other things. And what we did, part of this grant was gave just regular presentations to, uh, residence halls, teams, and things like that. I probably did a couple hundred of those presentations while I was an undergrad. So that actually was a, a great way to get educated about drugs and alcohol and, and obviously develop some great, um, public speaking skills. Fast forward, uh, many years, uh, you know, I trained as a physician, internal medicine. I've had some additional addiction training as well and, uh, connected with John in 2021 on our current, uh, organization, which is Central Modern Recovery. And what we do is we help families and individuals that are dealing with a substance use problem. And, you know, a lot of the education that I used to do, or at least the tools, the functional capability of educating people and helping them understand what addiction is, has translated nicely. We've further extended that. Just recently, we launched a new course called Introduction to Drug and Alcohol Interventions. It's for families, and you can access it on our site. And it's a 10-chapter course that allows people to learn a little bit more about the intervention process and how they might be able to help a family. So that's, that's 30+ years, 35 years in a little bit.

Well done, Joe.

I also make digital courses, so I would love to collaborate at some point. That's great that you have a course that's accessible in that way.

I think, you know, the, the, a lot of this course, uh, technology has emerged because of the pandemic, because all of a sudden so many people who used to sell their expertise in person couldn't do so. And, uh, you know, you've seen really a quantum leap in the emergence of these online course technologies, and it is really a great way to learn, a great way to share your knowledge. For a topic that's relatively esoteric like interventions. You know, most families have no idea what we're talking about when we talk to them about interventions. Uh, I think it's a great way to educate people, get them started, and if they wanna do more, work more, more closely with us, then there's an opportunity to do that.

Yeah, that, that's wonderful. I love that. John is an old friend of mine. He was my favorite, uh, fellow student when we were training for Ericksonian hypnosis.

That's right.

In New York City. And we met there and, uh, I love John's voice. We used to practice on each other and hypnotize each So that was fun, but your voice was one of the best voices in the class. So I think that's, I'm glad to have you here.

I think that's one of the reasons why I, I probably went to that class, you know, cuz I, I've been told that I do have a, an entrancing voice.

So yes.

And Juna, you know that John was a professional voiceover talent in the past. You know that, right?

No, I didn't know that. I knew you were a chef.

I have done a little voiceover. I, I dabble.

Oh, I did not know that. So explain to us C-A-S-A-C and C-I-P, and I know you have other initials after your name.

Just to start off how I got into this business. In my former life, I was a New York City restaurant chef and sommelier. I grew up working in the wine and hospitality business. You know, I loved fine wine as a commodity. I was a buyer. I worked as a wholesaler, but in my personal life, wine eventually became more of a foe than a friend. You know, I did have to eventually get help for my, for my drinking. So I was, I was actually a subject of an intervention. I had a, a very supportive family that, uh, that helped me realize that, you know, life as I, as I saw it was just becoming totally chaotic and I needed to get help. So I did. And, uh, and my first job in, in the recovery business was working as a chef at a sober living facility in, in Brooklyn.. So, you know, I could share some of my, some of my recipes. And I had also taken a course when I was newly in recovery from the Institute of Integrative Nutrition to learn how to be a holistic health coach. So I really—

I love that place.

How food can really be used as medicine. So that kind of put me on my way and being a chef there at a sober living, they inevitably one day came along and they, they were short. Staff for a night shift. So I took, I took a night shift and then somebody needed a chaperone to get to school one day. So I really liked it. I was able to share on a peer level. So then the owner of the sober living said, if you, if you're passionate about this, why don't you pursue and get credentialed? So that's what I did. I started an educational academic path of, uh, so the CASAC acronym after my name is Certified Alcohol and Substance Abuse Counselor. I'm a licensed addiction counselor. I went on to, to be a counselor at an outpatient in New York City. I've worked in sober living as a coach, as a case manager, as a project manager. And then in 2016, I started my own recovery services business. I also got certified as a board-certified interventionist. I'm part of the National Association of Intervention Specialists and CIP, Certified Intervention Professional.. And that's what I was doing. And JL and I found out that our, our kids went to the same school on the Upper West Side, and we said that we're in the same line of work, so why don't we combine our talent? And we started Suntra Modern Recovery in July of 2021.

Exciting. So JL, what does Suntra stand for? What's that name about?

That's funny. That's a great question that not everybody asks. So, uh, you know, as you know, selecting a company name can be very difficult because these days you need a URL, you need trademark, you need social media handles. There's just a lot of things that you have to optimize for. So it can be challenging. The business was originally, the name we were looking for, versions of happiness. And there is a Hindu goddess of happiness. And I, I believe if I remember correctly, Suntra is like a misspelling of that. So that was the core idea.

That's why everybody misspells everything now, right? So we can get our URLs.

For sure. Well, I mean, it's funny, you know, there was a time during sort of like the the late teens, you know, the 20-teens where you had all kinds of weird company names.

Okay. Well, I like that, Suntra. And I was lucky enough to get MindBodySpace, which is I think pretty sought after now. That was a long time ago.

That's a great one.

Okay. So let's get started on some of the questions, if you don't mind, that we have for you today, some of my listeners and myself. So I wanna shed light on the biology and neuroscience of addiction a little more. And you know, to be honest, I would love to put you guys out of business. And I was just saying that jokingly because I know you won't go outta business cuz there's such a problem. I'm saying that because I'm so passionate about prevention and as a parent and a physician, a radiologist that saw a lot of disease from the inside out. And I know JL, you said it's not the same anymore. It's just a much more dangerous, uh, landscape these days. I wanna dive into that a little bit as well. Mm-hmm. Because I don't think most people understand that. And either of you, please feel free to answer. Can one of you define addiction? Because now addiction also in DSM-5 is now, as far as alcohol is concerned, it's a use disorder diagnosis, right? So there's a huge spectrum. Sure.

So these days we talk about SUD, substance use disorders, or AUD, alcohol use disorder, or OUD, opioid use disorder. And I think the simplest definition of addiction is compulsive use of a substance or engagement in a behavior, right? Because you have gambling addiction, sex addiction as well, but compulsive engagement in a type of behavior despite the negative consequences associated with that. That's generally the, the high-level definition of addiction. And, you know, addiction is a complex disease that involves neurologic aspects of the brain, the psychiatric aspects of the brain, the physiologic aspects of the brain. It affects cognition, it affects memory, it affects the motivational pathways. So you can get very complicated in terms of your definitions, but the simplest is this notion that you keep doing something despite the fact that you're experiencing negative consequences as a result of it.

John, do you want to add to that at all?

Sure. Yeah. And I'll give more of the layman's explanation. And by the way, Juna, I would love for you to put us out of business. I unfortunately don't think—

I was joking. That it's gonna be impossible, obviously as a mom and a physician.

Of course.

Yeah. And, and also I'm the daughter of an alcoholic who died in his fifties. My father, my husband's father also died of alcoholism in his fifties. You know, they both died when we were in college. It, it's just something that is close to my heart, you know? And my mom was addicted to Valium in those days when they prescribed Valium for everything. You know, even the Rolling Stones talks about it, right? The little yellow pill. So yeah. So all of this is very close to my heart and it's an interesting topping from the neurological standpoint for me as well.

Sure.

And I mean, dealing with the families that we do that come to us just seeking help and seeking a roadmap of how to help a loved one who's struggling in the best way and most caring and empathetic way, we have to to point across that, you know, their frontal lobe, which was responsible for rational, sound decision-making, is essentially hijacked when you're putting a daily diet of saturating it in alcohol or substances. Our essential point to families is if they just treat this like another disease, you know, that's really half the battle. I say to families, if this were pancreatic cancer or a pulmonary issue or type 2 diabetes, No words would really be necessary. You know, we would get our loved one the specialized care that they need and, you know, mobilize, put it into action. Unfortunately, with addiction, it's still— we've made great progress as a society, but still there is a ways to go because people still view it as a moral failing or a sign of weakness, something that you could, you know, just will yourself to get over. But it just doesn't work that way.

It's a chemical, yeah, chemical, societal, genetic, all of that, right? Mind, body, space.

Without question. And you know, it takes a village, it takes a family, it takes that point where it's just like, I can't do this on my own. And I speak from both professional and personal experience that, you know, I need help in order to do this. When I'm arm wrestling with my addiction on a daily basis, 99.999% of the time, It's gonna win with help, the right kind of support with changing the mindset where it's not me against the world. I'm not this unicorn in the wilderness with this unique set of problems that I'm too ashamed to talk to my family and loved ones about. Once our loved ones discover that help is just an arm's length away and they can avail themselves to an environment, to a compute, to a community that's like, you know, We're in this together. We can do this shoulder to shoulder and we can share and learn from each other's collective experiences.

And I love that you guys are available as a resource and I'm gonna put links to in the show notes for people to reach out. But I wanna go between starting something and then having to see you guys, right? So there's that whole length of time in between that maybe people can become more aware of if a problem is developing. I like what you guys said about the range of alcohol or drug use disorders because like JL said, it's about when it becomes a problem, when it's affecting your life and it's negatively affecting you. So there's a huge spectrum, right, of people and what that threshold is of negatives versus positives in their lives. And to get people to check that before it becomes a huge problem where You know, you need an intervention, for example. So how can we start to prevent or educate people to prevent addiction in the first place? Because I think we're up against a lot here, right? Society-wise. I mean, you know, everybody's drinking. That's very normal. If you look at any show on any channel, everybody's always drinking except for Jerry Seinfeld. So I don't know if you guys are fans of Seinfeld, but he's actually, he doesn't curse. And if you watch any of his episodes, they're not drinking. So he's one of the few people.

They're at the diner.

Yeah. If you watch Ted Lasso, I just started watching that. Like, I loved it, but every popular show, it's all about drinking and all about drugs and it's funny. They make it look funny and glamorous. And so we have a lot to go up against. So how does the brain become addicted and can you actually prevent before you get to that stage?

So in terms of how the brain becomes addicted, that's You know, the $64,000 question that there is a lot, a lot written about that. So billions of dollars being studied because if you can answer that question right, then you can do something about it.

Yes.

I think the evidence shows that there is a clear genetic element to this, right? That about 50% of susceptibility to addiction is genetic. So if you have a, a parent or a other person that's related to you, you know, you're at a higher risk. And that's like anything, right? That's like breast cancer. You know, we, We know that our genes are, make us susceptible to certain things. You know, my dad had—

but we now know that we could turn our genes on and off also, right? So Juna Bobby MD, for example, my dad was an alcoholic, but it's also how you define alcoholism. He was a highly functioning executive. Sorry to interrupt. Go on.

No, no. And I think you make a good point. And that whole notion of being able to turn on and off genes, I mean, I think that's the future, right? As we learn how to better tinker with our genetics or the epigenetics, I think we'll have a better idea of how we can manage addiction, but for now we know that about 50% is hereditary. And then the other per— the other parts are like your, you know, your environment, your experiences. Uh, we know that trauma plays a very significant role in this. And I think that what John and I see often when we're dealing with families is, uh, trauma being a huge driver and other adverse childhood experiences. So I always argue that if you really want to address addiction, you really need to think about adverse childhood experiences. Protecting people from trauma, doing the things that can help prevent the experiences that set people up for addiction later on. So you start small, and I believe that's the case for a lot of problems. I think if people had more stable employment, right? If we had a culture where people could have good jobs rather than jobs that maybe paid the minimum wage, that's another thing. I think you'd see less addiction as a result of that. So there's a lot you can do about addiction without talking about addiction. As it relates to the more proximal causes, I mean, I think a lot of it is educating people about what addiction is, 'cause I think a lot of people don't know what that is. I think encouraging an environment where maybe people aren't experimenting as much, and because I think what you know, uh, Juna Bobby MD, uh, certainly is that all it takes is a few doses of a benzo or a few doses of an opioid before you develop tolerance and you can become dependent on something. So knowing that, like, that's true and that's the case. And then I think trying to intervene early. So there's something called the SBIRT. I don't know if you've ever heard of that, S-B-I-R-T, but it's a Screening, Brief Intervention, and Referral to Treatment. And it's essentially a series of questions that primary care doctors can ask people when they're in the office who may be there for just a regular blood pressure check or whatever, and ask them about their use and do they have any problematic use. And if they do, can be able to make a referral. Because again, I think that the challenge is trying to discover people before they slide down, as we've seen. People are unbelievably capable of adapting to, to patterns of use and being successful at work and being successful in their lives, and at the same time having a raging drug problem. So again, being able to try to engage them early and try to say, hey, you may have a problem, maybe you want to get some help. Often people will still say no, but I think trying to engage people early and help them understand the early signs of addiction can be really helpful.

And If I could just tag onto that, I think there are so many people out there that are struggling in various stages of addiction that essentially segue very smoothly into the functional alcoholic, the functional addict, and very, very carefully put up this persona like, I have, I have everything together. You know, the bills are paid, the mortgage is paid, you know, the kids are in good schools. I've, I have nice cars in the driveway. Why are you accusing me of anything? You know, it's deep down. This is one of the cunning, baffling, and powerful things about our addiction is that it lays in wait. It says, keep that to yourself. Keep that tamped way, way down. And it goes hand in hand with the isolation because everybody is in too much shame or guilt or fear that if they communicate how it really is feeling inside, then The levee will break and everything will crumble to pieces. But I mean, that's why education, as JL said, and communication, you know, we, we truly believe that the opposite of addiction is really connection. And along with that communication.

Wonderful. Speaking of success, right? You were on an interview with Sam Jay on Pulse, right?

I was.

Yes. Yes. So she's very successful. She was a Saturday Night Live writer. She's still writing for them. I don't know.

She's got a lot of irons in the fire these days. You see her everywhere.

Okay, well, one of my favorite sketches was Black Jeopardy. So I'm like awestruck by Proxy that you got to have an interview with her.

She was fantastic.

She also had some addiction issues, right? She talked to you about?

She did. Well, it was more like a fact-finding mission for her where she's had these experiences in her life, some really dramatic. It was, it was a question sometimes of if I behave this way and I'm accepting of the chaos the pandemonium of my life. Does that mean am I an alcoholic? That in itself is really a key question there where you have to get outside of yourself and look at yourself from a third-person perspective because individuals and their resulting families really can just slip into this chaos as they know it is the new norm. I know that they're having a problem. You know, they just got this new job, but they're oversleeping again and not setting the alarm off. 'But maybe I should cover for them.' And that's where we have to educate them and say, 'No, you cannot do that. You cannot allow this to happen.' 'Cause that's really essentially turning a blind eye to what's really going on here. So, mm-hmm.

But also you can be in an environment where it's normal, right? Like for example, we know a lot of SNL famous people who had trouble with addiction, right?

John Belushi. Yeah, absolutely. Phil Hartman. Two examples of very functional alcoholics, incredibly funny, talented people. Robin Williams. But nobody knew the story until it's too late. So that's why JL and I, when initially engaging with a family, we say, we have to educate you on the basics. We have to give you a foundation of what we're up against, how formal this is, and how to put those respectful but firm boundaries down and say, we can't allow for the addiction to just hijack this family and, uh, unless the family drinks together, call the shots here.

JL, John, maybe it's better to ask instead of, am I an addict? Maybe, do I have a problem that comes from using? I really don't believe that anyone can have a problematic use and not see something slacking off, whether it's professional or cognitive or your relationships. There's an issue in there somewhere. When you're using.

I might disagree with that. Sometimes people really do have a problem with insight. You're a physician, so you're familiar with that concept. You'd be surprised at how many people's lives are sort of in a bad state and they don't really necessarily have insight that their substance use is a problem. And often you'll see people who make lots of excuses and explain that they're, it's not their problem, it's other people's problem, you know? So I think that's actually part of the challenge with substance use disorders in general. Is that unlike somebody who's got diabetes or hypertension, and remember there are a lot of people who are in denial about their diabetes and hypertension.

Yes.

So it's not just unique to addiction. Sure. Um, but in general, if the doctor tells you that your blood pressure is 200 over 100 and that's bad for you, most people will say, all right, I understand that's an issue and maybe I'll at least try these pills. And same thing if your HbA1c is 10, you know, I think people will understand that. I will say we do see a lot of people whose lives are really disordered because of their substance use. And for whatever reason, and again, it's one of those things that I don't think is well understood, there can be a difficulty with understanding the scope of the problem and how important it is to get treated.

Wow.

I would add to that any behavioral change, right? Whether you're trying to get off sugar or processed food, it's a challenge. But then addiction, there's another level of—

and to be fair to people with addiction, right? I mean, how many Americans are overweight, right? And know that being overweight is bad and will say, well, it's not my problem. It's, you know, it's society's problem for seeing me as overweight. So. You know, it's, again, I, I, I don't wanna stigmatize or, you know, say that people with addiction are unique in that way, but I think it's particularly strong in many of the cases that we see.

Mm-hmm. Okay, great. So going on with some of the questions, myth or fact, is there a gateway drug? You alluded to this before that you can have a few doses of something and become completely addicted. So can you just enlighten us on gateway drugs or like what you can do to prevent becoming addicted, what you should or shouldn't do, experiment. You said experiment less before, right, JL?

Yeah. So you got a couple things there. So first, certainly with drugs in the benzo class, drugs in the opiate class or opioid class, which are wonder drugs, by the way, and really are very effective at doing what they do.

And I love drugs.

Yeah.

If you need 'em.

Yes. Right.

When you need 'em short term.

Correct. And that's the thing that I always say is that, you know, a lot of people get started on a benzo for anxiety and maybe that works in the short term, but you shouldn't be on that for years, right? Same thing with opiates for pain. Opiates are indicated for short-term treatment of pain. So I think the first thing is understanding that some of these substances you can quickly become dependent on, quickly become tolerant of. So I think there's been a big move in specialties that prescribe those drugs to help people understand, like, there's a risk here to taking these medications and we need to think about alternatives. So maybe there are alternative drugs that do not cause dependence for treating pain. We know Tylenol works and ibuprofen work. And same thing for anxiety. There are Zoloft works for anxiety. Gabapentin works for anxiety. So, you know, having that awareness and thinking about that. And just as a side note, like in terms of experimentation, just realize that maybe the, the culture that we had in the '70s where people were trying all these different drugs and just trying to expand their mind, it's a different world now. We have drugs like fentanyl. Fentanyl is a contaminant in so many other different types of drugs. The first pill, the DEA has a campaign called now, I think it's called Not One Pill is I think the name of the campaign, which basically says that any pill you take, anything you buy illegally could have fentanyl in it and you could die. So you really need to be careful in a way that maybe we weren't careful, didn't have to be careful 50 years ago.

Before we go on, as with all urges, the ability to notice and let go is key to avoiding toxins. And for this, stress management helps out so much. So I just wanted to let you know that my new digital course, The Science of Stress Management and Resiliency Training, a self-paced course for busy people that gives you short digestible mini daily lessons that you can do on the go so that you can create habits of self-care that will actually stick, is now available on mindbodyspace.com. So make sure that you check that out.

So just as a side note there, you know, fentanyl, uh, for the longest time we've thought about as a contaminant in heroin or in, in fake OxyContin pills, but you're starting to find fentanyl in things like cocaine. I, we heard recently of a guy who thought he was taking cocaine and had a fentanyl overdose because the cocaine had fentanyl in it. So that's something to be careful of. Marijuana as well. Marijuana as well. So as, as I said before at the beginning of this, it's a very different environment and a much more dangerous environment now than certainly when I was growing up as a kid in the '70s and '80s.

Well, talking about the '70s and '80s, what about psychedelics? I had a woman on the show who is using ketamine for PTSD with veterans right now. She's amazing and they're doing a really great job. But I think that there's ketamine popping up everywhere. You could just buy it and people are having experiences without having specific treatment available. I'm not for that. I don't know what you think about that.

And John, we did a whole episode about that, a video.

Ketamine. Both know that medicines used as directed can be very helpful from pain management to mood stabilization to helping you sleep. Sleep, but if they're abused, if they are, you know, mismanaged, they're going to lead to greater difficulties and challenges. You know, you talked about gateway drugs. We historically thought that marijuana was always a gateway drug, could lead to bigger things. And marijuana itself has just been so adulterated now that it's become much more commercial and mainstream that it's true. Marijuana is not the marijuana that we were smoking in the '60s and '70s. It's, it is adulterated. It is stepped on. It can be deadly in itself. You know, it's now more commonplace to do interventions for marijuana. And I mean—

Oh, I want to hear more about that because a lot of people, especially kids nowadays and teenagers and young adults, they're going out with marijuana as something legal. They talk about, oh, well, I got this from somebody's prescription, so it's safe.

A child is taking anything from an antipsychotic to an SSRI or a something to treat their ADHD. And at the same time, they're smoking marijuana or using recreational drugs.

And also the THC content, what John was saying before, is much, much higher, right? Like an order of magnitude higher. So now you're talking about very powerful psychoactive substances that is legal. Now people can smoke as much as they want, right? You see people smoking in the street now.

That's the biggest thing. Yeah, it's normal all the time.

That's the biggest thing I had to get used to during the pandemic is the idea of like just walking down the street and smelling random marijuana odor everywhere I go. But as John was saying, like, these drugs are much more powerful, and because they're legal, in some ways people feel more— have more permission to use them. And we're starting to discover if you make a powerful version of cannabis available to a very large population, you're going to start to see people with marijuana use disorder because the drug affects them in ways that they can't control.

We saw something extremely shocking the other day. They're now marketing Kratom, which is an opioid that has gained popularity in smoke shops and delicatessens, totally unregulated by the FDA. People use it as what they perceive to be a safer alternative to opiates, to heroin, and they're marketing it as a pre-workout powder.

Oh, wow.

Which is—

can you spell that for me?

Which is insane. Kratom.

What is it?

Is K-R-A-T-O-M. Wow.

What about psychedelics? Also, people say you can't get addicted, but honestly, you can get addicted to that feeling. Maybe not the substance chemically, but maybe emotionally dependent. What do you know about that?

There's no question that people are getting addicted to ketamine, right? I mean, there ketamine for many years before was being used in a therapeutic setting, was being used in a, as a club drug, right? And people, there are lots of people who had problems with ketamine long before they started prescribing it in clinics. And as John and I talked in our, uh, the episode that we did, we did a video journal club about ketamine. You know, what you're clearly hearing in anecdotal reports is that people who are going in for ketamine treatment for their depression or for their anxiety or whatever it's indicated for, and it's actually, you know, it's being prescribed off-label, so it's getting used for everything. A fair number of people are starting to develop a dependence and a tolerance to the ketamine and starting to use the ketamine outside of what it's being prescribed for. So ketamine is definitely something you can get addicted to as well.

Mm-hmm.

And I mean, psychedelics taken as directed, say microdoses, can be very effective in treating depression, treating generalized anxiety. But I mean, if it's taken 6 times the, or 10 times the normal amount, you know, it's gonna cause problems. If ketamine is smoked instead of taken as directed, it's going to cause issues.

I do believe that psychedelics are very interesting, um, especially for people who have treatment-resistant depression who are not responding to SSRIs and SNRIs. I mean, I think that there is really something there. It's very interesting. But as with everything, you know, it's gotta be studied. We've gotta figure out what the doses are. We've gotta figure out what the treatment regimen is. And I think to some extent the popular sentiment has gotten ahead of the science, and I think we're, you know, using these psychedelics in a way that's not, we're not necessarily using it in the right way because we don't have the knowledge of what the right way is yet.

Well said. Well said. I had a boyfriend in high school who actually ended up in with full-blown mania after he used a lot of acid. So he, it was psychedelics and, you know, this is the interesting part too, and I'm gonna confess, I did experiment a lot in high school. Because I was growing up in an ACE environment, adverse childhood experience. And but I never really got addicted to anything, which is interesting because the minute I felt like something was wrong, I, I remember specifically thinking, you know, this is not good. Like if I was having a drink alone or had a cigarette or whatever it was, and I quit cold turkey. And so that's also very interesting to me and my husband who also has the genetics of addiction. He was able to quit smoking after packs of cigarettes a day. One day he just said, you know what, that's it. So the science and the neuroscience is so complicated, right? 'Cause why would I be able to just say, no, I'm not doing this.

And probably I think what we'll discover is that there are receptors in the brain, there are, you know, pathways in the brain that are dependent on your genetics. And I remember once I, I had a, a molars extract, And I was in tremendous pain and the doctor prescribed Percocets. Okay. And this is 20 years ago, so this is pre-opioid era. I took one of those Percocets and I felt profoundly depressed and profoundly dysphoric. And I just remember saying to myself like, wow, peo— people actually get high from this. I don't understand. And I think that the way my brain works is, you know, you, you connect that type of opioid, I think it's hydromorphone, it binds a receptor in my brain and rather than saying, Hey, thumbs up. It just happens to say, hey, thumbs down. Don't do that again.

Wow.

So I think that's part of the genetics, and I think that there are pathways that we can probably clearly lay out in the future and then hopefully manipulate in the future.

I was just gonna say, and you have to keep in mind that we're all unique in our experiences, and some of us that are more susceptible to addictive addiction are faced and are in a current period of absolute overwhelm. I know with me, whether it be Oreos or a medication, I know I'm gonna say, or aspirin, you know, one will work pretty good, but six will probably work profoundly better.

So, oh wow. So you have like a high tolerance.

It's just that mentality of just like, one is, one is, oh, I see that more is better.

No, but also your physiology probably can handle it better. 'Cause me being a petite, well, I'm not that petite, but a, an Asian female. I would feel the effects. I bet so much more than you, John, because if I had one drink, I could feel it the next day, or maybe even for 3 days. And that would, that's a great point. I think that's probably why, cuz I had so much pain from it. You know, even now, like I take baby doses of Tylenol, right? Cuz I, I don't need more than like a tiny baby dose for me.

But, um, the ability before you pick up that sleeve of Oreos, before you pick up, you know, that second bottle of wine. Before you pick up marijuana or something like that, the ability to pause, to take a breath, to get outside of yourself for a second, to say a little prayer or whatever is going to make you halt and say, wait a minute, you know, let me think about this before I take that action, which may be dangerous and detrimental.

Which also takes practice. And DBT, I wanted to talk about that cuz you guys do a lot of family DBT, which is dialectical behavioral therapy. Which is based a lot on Buddhist— I'm not a Buddhist, but definitely Buddhists had a one-up on us with the psychology and the way that they interpreted it. And also, well, Buddha himself, how he wrote about these things like a scientific experiment. So maybe you can enlighten us a little bit about DBT and Marsha Linehan's work.

Sure. Yeah, I really kind of fell in love and appreciation of DBT when I was a counselor at an outpatient facility in New York called Freedom Institute. And so really it's so helpful when it comes to addiction and family work. Uh, just the core principle of mindfulness, like I was saying, just the ability to stop, to pause. We say that everybody has this little burning ember in their soul and you try and keep it smoldering as we go about our daily life. There are things that can happen practicing life on life's terms where it's like you can get cut off in traffic or somebody can look at you the wrong way or You step into a foot-deep puddle, something like that, and then that little ember just flares up and then things start coming outta your mouth that after the fact you wish they hadn't come out of your mouth.

I can relate.

Yeah.

Dialectics, it's a little different from mindfulness, right? 'Cause they use mindfulness exercises, but dialectics is about being able to accept two opposing things at once.

Exactly.

Right. Oh, can you elaborate on that a little bit?

Sure. I mean, one of the DBT skills is, for instance, distress tolerance, the ability to be able to stand in a stressful situation and not have it completely fall apart for you.

So I can feel angry and I can still take a deep breath and calm myself down.

Exactly.

Yeah.

Using wise mind versus monkey mind.

Give us an example. Like pretend I'm somebody you're working with. Tell me about Wisemind.

Yeah. Wisemind is where we're in a place of peace and calm and where we're able to not just— the ability to just get outside of ourselves for a second and focus on one particular thought as opposed to the daily cacophony of thoughts that are just buzzing around in our head and approaching and applying that to the duties of our state in life.

And we can access that with the mindfulness exercises, right? Like John, you said you love the 5 senses one.

That's a wonderful grounding. Exercise that we like to do one-on-one with our clients. Try and settle into a situation. If we feel like thoughts are scattered and just jumbled up, start with, let me focus on 5 things that I can see in this room, and then go to 4 things that I can hear, 3 things that I can touch, 2 things that I can taste, and take it from there. You do that a number of different times. Puts us into the present moment. It takes us away from lamenting about the past and worrying about the future. It keeps us rooted in the present moment and we can put more focus in, you know, hitting it out of the park of the task at hand.

Mm-hmm. And like literally brings us into our sensory motor cortex, right? JL, do you wanna add to that? Maybe your favorite exercise?

Yeah. So what I was gonna say is I'm, you know, very much into the, I think the physiologic aspect. Aspects of anxiety and managing those again. So I think there's the supratentorial, as we refer to as doctors, the part of the more complicated part of your brain. And then there's the more primitive part of your brain. But I think that often processes like anxiety and depression, they're not something you're thinking about. They're just happening in a very primitive kind of way. A practice that I find really useful is box breathing. Going back to what you were saying about Buddhism, what is old is what is new. And whether it's Buddhist monks or Hindu yogis figured this out a couple hundred or a couple thousand years ago, that if you can manipulate your physiology, you can sort of start to control some of these feelings that you're having and soothing the feelings that you might have around anxiety or depression. So I'm a box breather guy, and you know, that box breathing is just a simple concept of a breath in for a certain period of time, holding it for an equivalent period of time, letting it out for a period of time, holding it again for a period of time. And I think that that is a very effective practice. I've always found that, you know, whenever it's in my life, whether it's our organization, whether it's my family, my kids, I have two teenage sons, so this happens every day, that if I'm getting upset, that box breathing can be very useful. John and I were just talking about this 'cause we did a retreat recently related to this, but I'm a big believer that when you're doing the box breathing, what you're doing is you're starting to activate nerves that run through the body, your parasympathetic. Your sympathetic system, your vagus nerve, uh, you're putting traction on those things. And by doing that and by however it works, you can really materially impact emotional states as the physiologic translation of those emotional states by doing things like box breathing. And then, you know, there are, I'm sure, a variety of other types of, uh, practices like just going to the gym and lifting weights. I love to lift. Uh, it's another thing that I think can be very useful as well because our mind-body are connected. For sure.

Yes, for sure. It's one and the same.

And I'll tell you for sure, like I can definitely say my, my blood pressure is a little elevated. There is a huge difference in blood pressure pre-gym and post-gym. I used to think that running would actually have the biggest impact because obviously your blood flow is so much greater when you're running. But I have found that resistance training is like number one medication for blood pressure, hypertension. And I have dramatic drops in my blood pressure after I come back from the gym.

Wow. Are you gonna have to share your thing with me? I mean, your routine, because I'm also borderline hypertension all the time. Okay. And that's how I got into meditation as well. But so in the interest of time, I'm gonna ask you a few more questions.

Mm-hmm.

We already talked about how societal norm can be harmful when it comes to alcohol, weed, et cetera. Even we talked about sugar, you know, processed food, that's all I mean, normal in our society. What kind of practical tips, because we are all parents here, it sounds like, right? You guys have teenage boys and what kind of practical tips can you give to parents, teens or tweens at home or when they move away to college or school? I'm sure you deal with kids who are in boarding schools, et cetera. What kind of tips, maybe a couple of practical tips can you give them to catch it before it starts? When it starts, how to recognize it, and what to do if you already know you have a problem.

Between Jael and I, we have quite a few kids and I have two teenagers and I also have two twin 3-year-old boys. And the education and learning that I am getting and giving with my twins really helped me in my communication with my teenagers. It's a lot of like, uh, Communication where it's one of my twins, generally more often than not, you know, one's bold and fierce. The other one says, could be planning to go run errands or go visit a relative. He'll immediately just instinctively say, I'm scared. I'm scared about that. And it's getting beyond just reacting or just saying, don't be scared. There's no need to be scared, but really kind of getting to the root of it and normalizing the conversation. Conversation about why those feelings are coming up. I think a little elementary rooting in getting to the core of the issue, really having a solution-based type conversation is very helpful.

So what I'm hearing from you is you have younger kids and you're basically talking about emotional intelligence, like learning about your emotions, how to deal with stressful emotions or stressful situations. And talking about it before maybe perhaps they self-medicate.

Exactly. Or use a, take an action that's frowned upon. My one son will tend to pinch or hit more often than he should. We're talking about turning aggressive touch into gentle touch, replacing that action with a more appropriate action or verbalizing it, you know?

So learning these skills way early and you're, that's great that you're doing that with them.

Get on the horse now.

I agree. I say start with moms before they get pregnant even. And JL, what would you tell your two teenage sons before they go off to college? 'Cause I have two kids, one just graduated from college and the other one's a freshman. So we've had a lot of talks about this, but what would you as an addiction specialist, JL?

Sure. I think, uh, I have an 8th grader and a 10th grader. So we, so a couple things. So first, I think be connected with your kids. And talk with your kids and be open and honest and 100% real with your kids, you know? And I think that, you know, know who their friends are, know where they're going. You know, I always say that part of the reason I never got in trouble when I was in, in high school is 'cause my dad always waited up for me, right? I always knew like if I showed up drunk, I was gonna get knocked out, you know?

So, uh, you know, uh, so I think, well, you're not recommending them to knock them out.

I'm not, I'm not recommending that, but I am serious in terms of saying, you know, talk to your kids honestly. Your kids will tell you about stupid things that their friends are doing, right? And by having the discussion, you can say, hey, listen, you're telling me your friends are vaping. You're saying that's a stupid thing. That's great. You're reinforcing it yourself. It's not like me telling you that vaping is stupid. You realize it yourself. Your friends are showing up to the high school dance and they're drunk. You think that's stupid? That's really great. And I, I think as a parent, just being able to listen and to communicate and be aware of what's going on, I think is important. I think supervision is important. I think, again, being aware of where your kids are, knowing what they're doing. My son, when he was a freshman, I had some friends from his high school who were hanging out in Central Park at night and I was like, there's nothing good going on at Central Park at 9 o'clock at night, so you're not going out. Right. And I think also, you know, showing proper or showing normative behavior. My wife and I, we don't really don't drink in the house. We'll buy a six-pack of beer. It might last us a month. We're not using substances in the house. I think as a result, the kids are seeing a certain type of behavior that they come to assume as a norm. And I think those are the kinds of things that they can take with them when they go to college. As I've told my kids many times, Very soon you will not be living in this house and you will be responsible for yourself. And these are the things you're going to need to do to be successful. Drinking alcohol, using other substances can get you in trouble. And we want you to understand that and to be 100% real about the risks there. And you can manage yourself when you go out.

We all know how challenging it is to maintain healthy and positive, upbeat communication with teenagers. But, you know, we want to kind of set the stage for them to want to keep in touch with us, you know, when they go off to college and be okay with reporting how things are going, even when they're not going so great.

Yeah, I think, um, being a parent who is now an empty nester, I think it's really important to not be afraid to ask, even if they seem irritated. It's more important to ask a lot. And even I was intimidated sometimes, like I didn't want to, you know, butt in sometimes, but I think it's really important. So young people are listening to this. Or young adults are also listening to this podcast. So if you're away at college or at boarding school, or you're at school and all of your friends are doing this thing, it seems really fun, it's glamorized everywhere. How do you stay grounded? This is a very difficult thing to do, right? Peer pressure, societal pressure. So what would you say to these kids out there?

I would say don't be afraid of utilizing those grounding techniques and skills that get you out of these feelings of overwhelm and angst and stress and anxiety that we tend to walk around with way too much. Listen to your body, really be responsive to the signals that, especially pain. Pain is a very powerful messenger to take that emotional pain to make sure that the mind-body connection is strong and take the time for yourself. You know, we tend to just be everything as parents, you know, the three of us will move mountains for our kids, but you know, you have the ability to just listen and respectfully just, uh, the time for the self-care that is needed. I think it's so important.

I like to talk to them about, you know, what's normal, like what is normal. And if you look back, you know, I always tell the story about when I went to medical school at NYU and there were ashtrays in the attached to the chairs in the auditorium. So I don't wanna date myself, but they, they hadn't renovated yet. Let me say now they don't have this room anymore, but when I was there, there were ashtrays. It was so interesting because doctors used to smoke. They used to smoke. Moms who were pregnant used to smoke, and that was normal. It was normal not to have a seatbelt, you know? So I like to say that science has caught up and now we know so much more about the brain. About performance and about thriving.

So, you know, even if you're at a kid at a small New England prep school and there might be less than 100 kids in your class, you know, I think a lot of it comes down to who your friends are, going back to what I was saying before. And when maybe sometimes if the cool kids are getting high, maybe the cool kids aren't the kids you wanna hang out with. Maybe try to find people who are more like you, who share your views and who share what's important to you. And you know, there's, you'll always be able to find somebody who is not getting high. And I think determining that's something that's important to you, I think can, can get kids through that difficult period because it is really hard to be a teenager. As a middle-aged adult now, I can easily, it's easy to forget, you know, what it was like to be 16 or 17 and want to belong. And especially if the culture of belonging is using, that can be very challenging. I think helping kids understand that there is risk to using, and as I said before, it's a very different world than it used to be. And that there's still lots of interesting people that you can interact with who might not, uh, be using. So I think that's what I would recommend.

Yeah. And I wanna speak to the cool kids out there that it is cool to be sober and do things sober as well. And there's a lot of celebrities now who are actually some of the most successful ones are not using. Like it was almost like when we were growing up, all the rock stars used.

Mm-hmm.

But now like some of the, uh, very popular people like Pink or Taylor Swift, they're not, they're not doing drugs.

Robert Downey Jr. A lot of productivity goes down the drain.

So anyway, thank you so much. You guys are doing amazing work and I would love to have you back on. I want to hear more about interventions actually, because that is something I know is powerful, but sometimes controversial. So if you'd come back, I would love it.

Yeah. And I'll just, we'll leave you with intervention isn't necessary. Necessarily what you see on the show, the A&E show Intervention, you know.

Oh, okay.

It can be just a change of doing things differently.

And, and John, I want to say you give us hope because we know that it's reversible. We know that addiction can be cured.

Oh yeah, it can be put in remission indefinitely, you know, with more awareness. Just the life beyond our wildest dreams, to use a little clichéd saying.

And with the right help.

That's right.

Don't be afraid to ask for help.

That's right.

That's a big deal. Thank you. Thank you guys.

Our pleasure, Juna.

All right. Thank you, Juna, for the invite. We appreciate it.

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