Flourishing After Addiction with Carl Erik Fisher

Zach Siegel is one of our most respected and prolific journalists on addiction and drug policy. He is also a thoughtful, introspective soul who thinks deeply about his own history of opioid addiction. In his many writings, he has often referenced that personal history, but he's never really had the chance to tell his own addiction story from start to finish. Until now! Listen to this episode of Flourishing After Addiction to hear Zach's origin story, plus a deep dive into his recent cover story in Harper's magazine about surgery for opioid addiction.Zach and I talked about some enlightening moments along his path, including the role of Suboxone in his treatment, anti-medication stigma, as well some big questions about identity: what does it mean to say you're in recovery, and how does Zach make sense of that idea in his own life?We also focus in on his recent, fascinating Harper’s story: a feature about deep brain stimulation surgery for addiction. In the piece, he describes how people with serious, intractable addictions receive this (technically) non-invasive surgery--a kind of neuroscience advance I myself researched as part of a fellowship in medical school. It's a terrific story in its own right, but it also invokes some big themes, such as the purposes of addiction treatment, or how human factors like relationships, care, and hope continue to be relevant even in what seems like the most reductionist biomedical treatment settings.Zachary A. Siegel is a freelance journalist and researcher living in Chicago. His work focuses on public health, mental health, and the criminal-legal system; he also reviews books, movies, and TV shows, on occasion; and he co-writes Substance, a newsletter about drugs and crime, with journalist Tana Ganeva. He’s reported for a variety of news outlets and magazines: Harper’s, New York Times Magazine, The Atlantic, and more. He holds a journalism position at The Action Lab of Northeastern University’s Law School, working on projects like Changing The Narrative. He also co-hosts a podcast called Narcotica with his friends and fellow drug journalists Troy Farah and Chris Moraff. Find him on his website and on Twitter.In this episode: -  Substance - his substack newsletter - his podcast Narcotica - Changing the Narrative (project of Health action lab at Northwestern)- Only Lovers Left Alive - A Hole in the HeadSign 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 little over 40 years ago, Dr. Steven Hayes experienced his first panic attack—when he was a young assistant professor in psychology, no less! In the intervening years, and drawing in part on his own recovery from panic disorder, he developed Acceptance and Commitment Therapy and produced a huge body of work that has revolutionized our understanding of human language and cognition. Today, he is one of the most highly-cited scholars in the world, across all disciplines of study. And, he remains a soulful and wise clinician, who generously shared some of his insights about addiction for this episode of the Flourishing After Addiction podcast.Steve and I talk about “psychological flexibility:” a revolutionary pivot toward working with our thoughts and feelings, rather than trying to fight or change them. One definition of psychological flexibility is to be open, grounded, and committed to values-based action. We discuss making sense of addiction in his framework, and he speaks out against the biomedicalization and over-categorization of the phenomenon. He talks about the centrality of values and why it’s necessary to find a life worth living as part of recovery. We discuss Steve’s understanding of spirituality and transcending a limited self-concept, and how that fits into his work. And—something I’m so happy Steve prompted me to do—he leads us all through a guided exercise to take perspective and to get a taste of dropping the small self.  I’m really happy that he’s given us this practice experience. Find a quiet place and give it a try (it’s only about 8 minutes or so, toward the end of the interview). Steven C. Hayes is a Nevada Foundation Professor of Psychology at the University of Nevada. An author of 46 books and nearly 650 scientific articles, he is especially known for his work on "Acceptance and Commitment Therapy" or “ACT”, which is one of the most widely used and researched new methods of psychological intervention over the last 20 years. His popular book Get Out of Your Mind and Into Your Life for a time was the best-selling self-help book in the United States, and his more recent book A Liberated Mind was released to wide acclaim. Dr. Hayes has been President of several scientific societies and has received several national awards, such as the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies. According to major indices like the Institute for Scientific Information and Google Scholar, he is ranked among the most cited scholars in all areas of study in the world. Read more at his website.In this episode: - His faculty page- the "new paradigm" in mental health treatment we only briefly discussed (good for clinicians to check out!): Learning Process-Based Therapy: A Skills Training Manual for Targeting the Core Processes of Psychological Change in Clinical Practice- His TEDx talk on psychological flexibility: How love turns pain into purpose - His  2nd TEDx talk: Mental Brakes to Avoid Mental BreaksSign 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.

In the weeks prior to this episode, the story broke that the UK’s Middlesbrough clinic, which offered a pioneering Heroin Assisted Treatment (HAT) program, is slated to close because of budget cuts. Patients were allowed to self-administer medical-grade heroin (officially, diamorphine) under medical supervision. One of the key scientific studies that supports this intervention is the RIOTT Trial—“Randomised Injectable Opiate Treatment”—and I got to speak to the principal investigator of that trial, a giant in the field of addiction research, and the first knight to appear on the Flourishing After Addiction podcast: John Strang.Prof Sir Strang is a pioneering addictions researcher and practicing physician who, over the course of his distinguished career, has made major contributions to national and international policy. Of particular interest to those of us who are fascinated with the intellectual and cultural history, he’s had a front-row seat to the scientific and cultural evolution of views on addiction, including studies under his mentor, Griffith Edwards, another major figure in the addictions field who was instrumental in shaping modern medical definitions of substance use problems. We cover a lot of ground in this one, and while we tackle some weighty topics, ranging from fundamental principles in addiction treatment to the very definition of addiction, Prof Sir Strang has a gift for explaining these concepts in clear, articulate terms—a skill no doubt honed by years of interfacing with governments and departments of health. Above all, I think he does a fantastic job of returning to some of the key, pragmatic questions raised by these topics: what does it mean to have an addiction problem, and how do I make sense of my issues? What is the point of medications and other treatments for addiction? What are the core principles in addiction care? And in the end, just what kind of contribution can science make to better public policy and practice? I hope you find this conversation as useful as I did.Professor Sir John Strang is a physician and an academic. He’s the Director of the National Addiction Centre (NAC) and Head of the Addictions Department at King’s College London. He has been an addictions psychiatrist for nearly 40 years, and has led the group at the Maudsley Institute since 1995. He has published more than 500 scientific papers in the addiction field and has contributed to national and international policy, chairing policy committees and expert groups. In 2016, he was awarded a Knighthood in the Queen’s Birthday Honours for ‘services to Medicine, Addictions and Public Health’. Read more at his faculty page, and for more about the King's College London addiction center, see this link.In this episode:- the RIOTT trial-Griffith Edwards and some of his writing on the dependence syndrome-Drug Policy and the Public Good-Setting Limits: Gambling, Science and Public Policy- BBC: "Pioneering Middlesbrough heroin addiction clinic to close"- Gerald Klerman: Psychotropic Hedonism vs. Pharmacological CalvinismSign 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.

As I’ve written before, Beth Macy has an extraordinary gift for encapsulating our nation’s greatest challenges in gripping, intimate, and wise stories of everyday American struggles. She is a bestselling author of several books about addiction, inequality, and justice, and it was a great pleasure to talk to her about her latest book, Raising Lazarus, on this latest episode of Flourishing After Addiction. On a personal note, I’ve enjoyed seeing this book take shape behind the scenes, and we get to talk about her writing and research process a bit too—I was lucky to make a connection with her early in the process of releasing my own book, so it was fun to talk about how our work has informed each other and how her thinking has evolved over time.In our conversation, Beth opens up about her personal experiences growing up as a child of alcoholics and what she did to heal—as she notes, something she’s never discussed in prior interviews. Of course, we also talk a fair bit about her book, including how this work is focused on what she sees as the most likely solutions to our current crisis. It’s a big departure for her and a full-throated celebration of harm reduction. We talk about the innovative people she profiles, folks working tirelessly to provide evidence-based care and harm reduction services even in really inhospitable communities and situations. It’s a daunting topic, but Beth has also found a great deal of hope there too.Beth Macy is a Virginia-based journalist with three decades of experience and an award-winning author of three New York Times bestselling books: Factory Man, Truevine, and Dopesick. Her first book, Factory Man, won a J. Anthony Lukas Prize and Dopesick was short-listed for the Carnegie Medal, won the L.A. Times Book Prize for Science and Technology, and was described as a “masterwork of narrative nonfiction” by The New York Times. Dopesick has now been made into a Peabody award-winning and Emmy-winning Hulu series on which she acted as an executive producer and cowriter. Her latest book, Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis, was published on August 16, 2022. You can find her on Instagram, Twitter, and her personal website. In this episode:- The work of Gail D'Onofrio, MD, Professor of Emergency Medicine at Yale and pioneer in ED-initiated buprenorphine - Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care- Beth’s personal essay about her childhood on Oprah Daily- “By the book” interview with Beth- Beth’s guest essay in the New York Times: “The Two Simple Edicts of Successful Addiction Treatment”. Those edicts are: (1) “You can get better.” (2) “Don’t disappear.”- Link to all of Beth’s  books: Raising Lazarus, Dopesick, Truevine, and Factory ManSign 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. 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.