Flourishing After Addiction with Carl Erik Fisher

Dr. Ayana Jordan is a renowned expert in addiction and other mental health conditions, newly recruited to NYU to an endowed professorship for her fascinating research. For this episode of Flourishing After Addiction, I was excited to talk to her about new frontiers in her research, such as incorporating spirituality and health equity in addiction medicine. What I was not expecting was for her to share so openly and courageously about the way substance use problems have impacted her own family. It was a powerful conversation with a powerful voice in the field. It never fails to astonish me: the scope and reach of addiction into so many people's lives. Reading the stats is one thing, but to experience how it touches so many people, again and again, is truly striking.Ayana talks about her longstanding interest in integrating spirituality in addiction treatment, while simultaneously respecting people’s values and beliefs, and doing so in a responsible and effective way. We discuss her work on harm reduction, racial justice, and health equity. She helps us think through how to work effectively with the social and structural determinants of health. And, we tackle the controversial question: what's the point of spirituality in the medical treatment of addiction in the first place?Ayana Jordan, MD PhD, is a renowned expert in addiction and other mental health conditions in underserved populations. She is the newly appointed Barbara Wilson Endowed Associate Professor of Psychiatry in the Department of Psychiatry at NYU, also with appointments and leadership positions in their department of Population Health, as well as NYU Langone’s Institute for Excellence in Health Equity. The fundamental message of equity and inclusion has informed her research, clinical work, and leadership duties at NYU and beyond. She earned her MD PhD at Albert Einstein College of Medicine, and while training in the South Bronx, Dr. Jordan became passionate about serving racial and ethnic minoritized populations. She did her general adult psychiatry residency at Yale University, where she also served as chief resident. She has published dozens of peer-reviewed articles in numerous top-tier medical publications, serves on multiple editorial boards, and she is a thought leader who has given a wide range of keynote presentation both nationally and internationally. You can find her on her faculty page, Twitter, and Instagram.In this episode: - Information on naloxone (Narcan), including naloxone’s availability in all 50 states.- Lancet Psychiatry profile of her- for more on her research, see many more of her publications linked on her NYU pageSign up for my newsletter and immediately receive my own free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

Dr. Jeffrey Guss sits at one of the most fascinating and unusual intersections in all of mental health: between psychoanalysis, addiction treatment, and psychedelic psychotherapy. I wanted to have someone on the show to talk more about the “paradigm-shifting” nature of psychedelic psychotherapy: what that means exactly, and at a macro level, how this kind of therapy might provide some perspective on our current paradigms, like other forms of psychotherapy or mutual help groups. I also know Jeff to be an expansive and enthusiastic teacher with great love for these subjects, so it was a delight to reconnect with him on this episode of Flourishing After addiction.Jeff talks about his own experience with psychedelics and what drew him to psychoanalysis and addiction. He gives cautions about people who point to Michael Pollan’s work and say, “I’ll have what he’s having” (a la Harry Met Sally). We also discuss the neuroscience of psychotherapy and the neuroscience of psychedelics, but we also talk about moving past the “chemical imbalance” or “broken brain” formulations of addiction to think more about spiritual and existential dimensions of treatment. And, Jeff gives his practical advice for anyone wondering about whether psychedelic psychotherapy is right for them, for addiction or otherwise--including some really important cautions. Jeffrey Guss, MD, is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy, addictions and psychedelic therapy. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psilocybin-assisted psychotherapy in the treatment of cancer related existential distress, as well as a study therapist on studies of psilocybin-assisted treatment of Major Depressive Disorder and MDMA-assisted Psychotherapy for PTSD. Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He maintains a private practice in New York City.In this episode:- NYU Psychoanalytic Center- About sexual abuse in psychedelics: Psymposia ; Power Trip from Vox Media / New York Magazine ; CBC ; Psychedelic therapy has a sexual abuse problem- Albert Hoffman’s 100th birthday conference - Dr. Steve Ross’s  psychedelic research - Natural Mind, by Andrew Weil – (Preface and Chapter 1 free online) - Psilocybin for Alcohol Use Disorder trial at NYU- Fischman article: Seeing Without a Self- FluenceSign up for my newsletter and immediately receive my own free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

Melissa Febos is one of our most accomplished memoirists and essayists, a passionate and fiercely honest writer who, across several of her works, has often discussed her own path through addiction and into recovery. (Among her many, many accolades, she is the recipient of a 2022 Guggenheim Foundation Fellowship and a National Book Critics Circle Award.) I was thrilled to talk with her on this latest episode of Flourishing After Addiction and learn more about this harrowing and inspiring part of her life.There are so many gems in this episode. We talk about Melissa's experience of addiction and how she works her recovery program today . We discuss how her creative practice is part of that recovery; how evaluation, performance, and internal and external criticism was problematic for her; and how writing helped her in recovery. How her definition of recovery expanded over time. How she had to write to survive, and then to thrive. Whether you're interested in the craft of writing, or just how to craft a life, you shouldn't miss this one.Melissa Febos is the bestselling author of four books, most recently, Girlhood, winner of the National Book Critics Circle Award, and Body Work: The Radical Power of Personal Narrative. She is the recipient of awards and fellowships from The Guggenheim Foundation, the National Endowment for the Arts, MacDowell, LAMBDA Literary, The British Library, and others. Her work has appeared in publications including The Paris Review, Granta, The Believer, The New York Times Magazine, The Guardian, and many more.She is an associate professor at the University of Iowa. You can find her on Twitter, Instagram, her faculty page and her author website. In this episode: - her books:      Whip Smart     Abandon Me     Girlhood     Body Work Some of her recent longform: - "The Kindest Cut" in the New York Times Magazine- “Jeanette Winterson, My Therapist, and Me” in the New York Review of Books-  Girlhood excerpt in the New York Times-  “Do You Want to Be Known For Your Writing, or For Your Swift Email Responses?” in CatapultAlso mentioned:  Resmaa Menakem, author of My Grandmother’s Hands and The Quaking of AmericaSign up for my newsletter and immediately receive my own free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

From quite early in her life, Peg O’Connor felt a “double dose of shame” - from her lesbian identity on one hand, and her struggles with alcohol on the other. Her drinking problems almost got her expelled from high school, but instead she was able to stop. In her view, philosophy helped her immensely to get and stay sober, especially considering how she was not fully on board with traditional religious views or with Alcoholics Anonymous.Peg eventually became a philosophy professor, studying Wittgenstein, ethics, and feminist philosophy, and for decades she remained abstinent from alcohol. But then, 19 years into her recovery, searching for “something more,” she got more curious about 12-step recovery. At the same time, she turned her academic focus to face addiction more directly, and since then she has been writing about some of the most challenging ideas about recovery, such as surrender, powerlessness, spirituality, and “higher powers.”For this episode of Flourishing After Addiction, I was excited to speak with Peg about her most recent book, Higher and Friendly Powers, a compulsively readable, clear, and humane exploration of the notion of “Higher Powers,” using the philosopher and psychologist William James as a guide. It’s great fun. I hope you enjoy.Peg O'Connor is Professor of Philosophy at Gustavus Adolphus College in St. Peter, Minnesota. She is the author of the forthcoming book, Higher and Friendly Powers: Transforming Addiction and Suffering (Wildhouse Publications) and Life on the Rocks: Finding Meaning in Addiction and Recovery (Central Recovery Press, 2016). A recovering alcoholic, she believes philosophy has much to offer people who struggle. You can find her at her faculty page and her author website (<-- you can pre-order her book there!).In this episode: - The book Writing the Big Book (re: Hank Parkhurst) - Ralph Waldo Emerson on nature, morality, and transcendence- Talking Heads: Once in a Lifetime- "The First Lady" on Showtime- review- {not for the faint of heart!] The Dave Robicheaux murder mysteries.- the quote from my book, from the director of a treatment center in 1988: “Patients ask how important it is that they go to AA after they’re through here. I say, ‘I can give you a guarantee. When you leave here, if you don’t go to AA, you won’t make it.’” (page 249) Sign up for my newsletter and immediately receive my own free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

One important vision I have for this podcast is to share diverse experiences of addiction and recovery. How people write about it, yes, but even more importantly, the nitty gritty of how they made sense of their own addiction and found their way to recovery. Today’s guest, Holly Whitaker, is a fierce, passionate, and incisive writer who has charted an adventurous path out of eating disorders and addiction.Holly is perhaps best known for her 2019 book, Quit Like a Woman, and she also got a lot of attention around that time for a controversial New York Times opinion piece called "The Patriarchy of Alcoholics Anonymous." We talk about her own experience of addiction and recovery, how 12-step recovery saved her life at first, but then how she charted a course to a different pathway. We discuss the complicated matter of distinguishing between the program of AA and the institutions around AA—and, what it was like to write openly about all this. Beyond that, it’s a wide-ranging and really energizing talk: anorexia and bulimia and their relationship to addiction in her experience. How striving after money and status, or craving after partnership and connection, can be related to addiction. Her changing perspective on what recovery means to her—from control and just stopping, to something more. The good and the bad of “self-improvement”, and the urgent need for and a vision for holistic recovery. I am grateful for the way she shares her experience so openly, and I hope it is useful to you.Holly Whitaker is the author of the New York Times bestselling book, Quit Like a Woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol. Her work has been featured in Vogue, New York Times, Time, The Wall Street Journal, Fortune, and many others. Holly focuses on the intersections of systems, culture, and individual experience and identity through the lens of addiction and recovery. She was also founder and CEO of Tempest (formerly Hip Sobriety), a virtual platform that offered education, community, and support services. She has a newsletter here and a podcast called Quitted. Learn more at her website, and find her on Instagram.In this episode: - Neil Gaiman on writing: “The moment that you feel that just possibly you’re walking down the street naked, exposing too much of your heart and your mind and what exists on the inside, showing too much of yourself, that’s the moment you may be starting to get it right.”- Two classic pieces came to my mind about the topic of AA vs the institutions around AA: William White and Ernest Kurtz on “The Varieties of AA and Recovery Experience” and Ernest Kurtz on ““Whatever Happened to Twelve Step Programs?”- Allan Carr’s “Easyway” books, e.g., Quit Drinking Without Willpower - Internal Family Systems therapy- press release about TempestSign up for my newsletter and immediately receive my free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

Taking care of our relationships is a crucial way we take care of ourselves and the wider world. Some of the most common questions I get in my clinical practice and from listeners are questions about how to navigate relationships in addiction and recovery: couples, parents and kids, or otherwise. So I wanted to have a clinically focused episode about this important issue, and it was my great pleasure to talk with my good friend and wise colleague, Dr. Bevin Campbell, a psychotherapist who focuses on relationships, addiction, and recovery.Bevin has particular expertise in and passion for working with couples, but as you’ll hear, we cover issues that are important for all human relationships, in families, at work, and beyond. We discuss the tricky distinction between seeing addiction as “caused” by relationship problems versus stepping back and getting perspective on the bigger cycles--i.e., situating the addiction as part of a system. We explore other, everyday addictions and how they affect relationships, such as compulsive internet use, working, gaming, or otherwise. She gives some extremely useful tips about anger and avoidance, grief and trauma, and power and coercion. And we reflect on that vexing question that, for better or for worse, so many people have in these situations: “how do I get my loved one to change?”Bevin Campbell, Psy.D., is a psychologist interested in all things related to love and attachment, from the challenges of staying emotionally connected to a partner to the pain of grief and loss. She sees couples in her Brooklyn-based practice, and is also a consultant to New York City agencies and community based organizations on understanding grief and loss and supporting bereaved community members. In addition to her clinical and consulting work she supervises and teaches psychologists in training. Follow her on Twitter or see her clinical website here.In this episode:- Attachment: An Essential Guide for Science-Based Practice (partially free online)- There is a "sweet spot" for maternal responsiveness, and responding perfectly to our child's needs isn't best for optimal development: “Maternal responsiveness and sensitivity reconsidered: Some is more” - CRAFT (Community Reinforcement and Family Training) therapy, developed by Robert Meyers - ...which draws on the Community Reinforcement Approach- Salvador Mnuchin- Michael Zentman- Beatrice Beebe- Donald Winnicott- A good article in The Atlantic about several of these topics. Sign up for my newsletter and immediately receive my free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

Dr. Mark Epstein is a hero of mine. He is a Buddhist psychiatrist and author who has been a voice of kindness and wisdom in our field for decades, and I’ve long looked to his work for inspiration and guidance. So it was an honor to speak with him for this episode of the Flourishing After Addiction podcast!Mark does not have a personal history of a “classic” addiction like a substance problem, but as he articulates so nicely in our interview: “from the Buddhist point of view, we’re all addicted.” We talk about addiction to thinking, addiction to the self as the primary addiction, and how Mark worked with his own anxieties and insecurities—a path that led him to psychiatric training at Harvard, almost 50 years of meditation practice, and many influential books at the interface of Buddhism and psychotherapy. (There were so many fun surprises in this interview, such as Mark’s training with George Vaillant at Harvard, a giant of psychiatric research and a non-alcoholic member of the board of trustees of Alcoholics Anonymous.) In particular, we focus on his fantastic new book, The Zen of Therapy: Uncovering a Hidden Kindness in Life. It’s a lovely account of meditation practice, therapy, recovery, ease, and working with the self. Mark Epstein, M.D., is a psychiatrist in private practice in New York City and the author of a number of books about the interface of Buddhism and psychotherapy, including Advice Not Given, The Trauma of Everyday Life, Thoughts without a Thinker and Going to Pieces without Falling Apart. His newest book, out now, is The Zen of Therapy: Uncovering a Hidden Kindness in Life. He received his undergraduate and medical degrees from Harvard University. For more, check out his website, and you can find him on Instagram and Twitter.In this episode:- Mark's most recent book: The Zen of Therapy (also discussed: Advice Not Given)- George Vaillant (a summary of his book, The Natural History of Alcoholism)- A fun book about Ram Dass and others at Harvard, The Harvard Psychedelic Club ("How Timothy Leary, Ram Dass, Huston Smith, and Andrew Weil Killed the Fifties and Ushered in a New Age for America")- Gestalt therapy- More on the Emmanuel Clinic - a repository of several articles on the early 20th century, pre-Freudian psychotherapy in the US that reported great success in working with alcoholism. (I like this article in particular)- Revenge bedtime procrastination Sign up for my newsletter and immediately receive my free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

With so much suffering today, and in the midst of a historic overdose crisis, you might wonder: why bother looking to the distant past of addiction? How can the history of addiction actually help us? For me, I found that I needed history to make sense of what happened to me and my family. After studying addiction for a little while, I saw that ideas dating from the origin of the global drug trade, hundreds of years ago, exert a powerful influence on how we understand and treat—or still fail to treat—addiction.  Today, I’m convinced that this history is a crucial route for giving addiction the care, nuance, and attention it deserves. But in the beginning, I needed some help from thoughtful scholars to see those connections.In today’s episode of the Flourishing After Addiction podcast, I was really happy to talk with my friend and colleague Ben Breen, a noted historian at the University of California, Santa Cruz, who studies the history of science and drugs. Many years ago, it was Ben’s help, and his living example of wholehearted devotion to the field, that helped me to see the promise of this history for helping us in the present.We talk about how ideas about drugs from the colonial period onward have shaped how we think about good and bad drugs—and so much more. He sketches the deep history of psychedelics, from the Amazon rainforest to the overlooked early history of psychedelic therapy. Drug scares about coffee. Cinnamon, tobacco, and unicorn horns. “Dry goods,” bath salts, and decriminalization. Imperialism, capitalism, and cosmopolitanism. How opium was turned into an exotic substance despite originating from Europe. And generally, how all these ideas come back to the present to affect how people make sense of themselves and their suffering.Benjamin Breen, Ph.D., is Associate Professor of History at the University of California, Santa Cruz, where he teaches classes on early modern Europe, the history of science, environmental history, and world history. He was a postdoctoral fellow at the Society of Fellows in the Humanities at Columbia University, and a lecturer in Columbia’s history department. He grew up in California and earned his Ph.D. in history from the University of Texas at Austin in 2015. He is the author of The Age of Intoxication: Origins of the Global Drug Trade, and he is currently at work on a new history of “psychedelic science” and Cold War drug experimentation. He has contributed to The Paris Review, The Atlantic,  Lapham’s Quarterly, and many more publications. He also created the history blog Res Obscura. For more, check out his website and find him on Twitter.In this episode:- George Psalmanazar, a mysterious Frenchman who posed as a native of Formosa (now Taiwan) and gave birth to a meticulously fabricated culture... and who also provided remarkably detailed descriptions of opioid addiction as early as 1764 - Decriminalization in Santa Cruz.- Mike Jay's new book on Mescaline- Khat and cathinones Sign up for my newsletter and immediately receive my own free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings. 

How do we best tap into the positive side of recovery, beyond abstinence, sobriety, and remission? What does the science actually show about growing and changing in life after addiction?There is perhaps no one better equipped to answer those questions than my guest on today’s episode of the Flourishing After Addiction podcast: Dr. John Kelly, Harvard Medical School’s Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine, and founder and Director of the Recovery Research Institute at the Massachusetts General Hospital. John is a pivotal figure in the world of this research, studying not just what goes wrong and how to stop addictive behavior, but also how people find their pathways and thrive in recovery. In this episode, we talk about the “active ingredients” or “mechanisms” for recovery, what drives people’s trajectories in recovery, what the research shows about how long it takes to make significant change once someone starts making an effort, and what all this research shows about how to best care for people with addiction and what we must improve in our current treatment system. We also talk a bit about his research on Alcoholics Anonymous and what that shows about the active elements of recovery.John Kelly, Ph.D., is the Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School - the first endowed professor in addiction medicine at Harvard. He is also the Founder and Director of the Recovery Research Institute at the Massachusetts General Hospital (MGH), the Associate Director of the Center for Addiction Medicine (CAM) at MGH, and the Program Director of the Addiction Recovery Management Service (ARMS). Dr. Kelly is a former President of the American Psychological Association's (APA) Society of Addiction Psychology, and is a Fellow of the APA and a Diplomate of the American Board of Professional Psychology. He has served as a consultant to U.S. federal agencies and non-federal institutions, as well as foreign governments and the United Nations. Dr. Kelly has published over 200 peer-reviewed articles, reviews, chapters, and books in the field of addiction medicine, and was an author on the U.S. Surgeon General's Report on Alcohol, Drugs, and Health. His clinical and research work has focused on addiction treatment and the recovery process, mechanisms of behavior change, and reducing stigma and discrimination among individuals suffering from addiction. For more on John and his work, go to https://www.recoveryanswers.org.In this episode: - A nice blog post by John about the many pathways to recovery. - "A biaxial formulation of the recovery construct", with remission/abstinence/sobriety on one axis, and the positive consequences of recovery on the other. - The 2020 Cochrane Review on Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder. A summary of that work here. - many more briefs of research studies available here.Sign up for my newsletter and immediately receive my own free guide to the many pathways to recovery, as well as regular updates on new interviews, material, and other writings.

A lot of us folks in recovery have big collections of self-help and memoir books, and with good reason. Books give us solace, they help us see how other people deal with similar challenges, they are a source of community through contact with other minds, and, as articulated by Eva Hagberg, this week’s guest on the Flourishing After Addiction podcast, books, and particularly memoirs, are a way of trying on different “moral selves.” Eva is an author who has written beautifully about her own addiction and recovery in her  memoir, How to be Loved. It’s an honest and raw account that includes her experiences with chronic medical conditions, grief, loss, romances, and friendship. In this episode, we talk about being seen and wanting to be known, the creative process, what she has learned from memoirs—addiction and otherwise—and her own experience with different varieties of 12-step recovery. And, with my own book coming out soon, she gives me some great advice about focusing on what matters most. Eva Hagberg is an author, cultural and architectural historian, architecture critic, speaker, and more. Her critically-acclaimed memoir, How to Be Loved, is out now from Mariner Books. In a fun twist, we also talk about an unexpected set of connections between recovery and architecture, related to her next project: a biography of Aline Louchheim Saarinen, forthcoming from Princeton University Press.  She teaches at Columbia University in the Graduate School of Architecture, Planning, and Preservation, and at Bard College in the Language & Thinking Program. She lives in Brooklyn. Find her at her website, or on Twitter.In this episode: - Ira Glass on the “taste gap:” “Nobody tells people who are beginners — and I really wish somebody had told this to me — is that all of us who do creative work … we get into it because we have good taste. But it’s like there’s a gap, that for the first couple years that you’re making stuff, what you’re making isn’t so good, OK? It’s not that great. It’s really not that great. It’s trying to be good, it has ambition to be good, but it’s not quite that good. But your taste — the thing that got you into the game — your taste is still killer, and your taste is good enough that you can tell that what you’re making is kind of a disappointment to you”- Melissa Febos, author of Whip Smart, Girlhood, Abandon Me, and Body Work. - A Round-Heeled Woman: My Late-Life Adventures in Sex and Romance, by Jane Juska- Dani Shapiro, author of Slow Motion, Devotion, Inheritance, and other books. - The sociologist Robin Room analyzing codependency and Adult Children of Alcoholics, in the context of other 12-step thinking: Alcoholics Anonymous as a Social Movement - Erving Goffman, The Presentation of Self in Everyday Life - Someday This Pain Will Be Useful to You, by Peter CameronSign up for my newsletter for regular updates on new interviews, material, and other writings.