Episode 80
Managing Recovery with Dr. Kevin McCauley

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Description

On this very intellectual and inspiring episode, we have a special guest, Dr. Kevin McCauley, a Senior Fellow at The Meadows. He shares how he became interested in the treatment behind substance use disorders while serving as a naval flight surgeon and how it led him to film and direct the two films, “Memo to Self” and “Pleasures Unwoven.” This conversation provides valuable insight into how addiction can be perceived and the interesting concepts, models, and determinants of such complex disorders individuals struggle with.

Talking Points

1. Dr. Kevin McCauley’s recovery story
   
2. The Navy’s Zero Tolerance
   
3. When the Choice Model meets the Disease Model
   
4. The 4 E Cognition
   
5. Does someone have to have trauma or bad experiences to become addicted to alcohol or drugs?
   
6. Do the cravings ever go away?
   
7. Why the films
   
8. We can’t just forget about The Disease Model.
   

Quotes

”That’s one of the poignant things about addiction is, that people with addiction are almost accepting of this fate, be it punishment, rejection, death. There’s a Thanatos instinct that takes over. Unfortunately, that is a part of addiction, but also trying to show people that it doesn’t have to be that way. There are ways out of this, there is a good life ahead of you in recovery. ”

-Dr. Kevin McCauley, Meadows Senior Fellow

Episode Transcripts

Episode 80 Transcripts

Brandon Burns chief executive officer for Peaks recovery centers excited to have you all back for another Finding Peaks episode we got a thriller today so I hope you got your popcorn your soda all the good things next to you take some notes because we got some information coming your way that’s pretty exciting join today by Chief clinical Officer Jason friezma LPC Lac all the clinical things and our special guest today Dr Kevin McCully is a Meadows senior fellow joining The Meadows Behavioral Health Team in 2016. a 1992 graduate of Drexel University School of Medicine he first became interested in the treatment of substance use disorders while serving as a naval flight surgeon where he observed the U.S Navy’s policy of treating addiction as a safety non-moral issue and returning treated Pilots to flight status under careful monitoring Dr McCauley wrote and directed Two films memo to self about the concepts of recovery and management and pleasure unwoven for all the viewers out there you I know you’ve seen it look it up it’s out there it’s great about the Neuroscience of addiction which won the 2010 Michael q Ford award for Journal realism from the National Association of addiction treatment providers to mouthful their folks but we got some special talent here today Kevin welcome and thank you so much for being here thank you Brandon it’s great to be here yeah absolutely um so let’s just dive right into it we’ve had the past two to three hours to practice today for this moment I always love hanging out with you and enjoying our conversations waxing philosophical about the industry the state of addiction mental health and so forth and you know one of the first things I think that would be you know great for the viewers out there you have your own personal story around addiction that you um at least in the way that I see it out there in the world and the experiences you’ve been very vulnerable sharing in those experiences and I think out of that you get a why you do the things you do at the end of the day and why you’re so passionate about the work and the disease model and all of these things within um uh this industry in particular and so I was just hopeful that you know you can bring the viewers a little bit close to that and share that experience with them sure well I’m uh can’t say that I was really much of a drug user when I was in high school or college uh but uh when I was when I left medical school I was in the Navy I had trained as a flight surgeon in Pensacola uh this was a very very happy time of my life I just I love being around pilots pilots are a fascinating group of patients because they hate doctors and so you’ve already got kind of a typical clinical situation but if you develop a relationship they they will come to trust you and they will come to you with medical problems and that’s the idea there’s this old saying that a flight surgeon never really knows how good a job he or she is doing because the mishap that would have occurred never did and I like that the flying was great I spent a lot of time throwing up but but it was right around that time that I had to have a surgery I couldn’t take the medication for this condition I had to have the surgery to get it fixed definitively if I wanted to stay in the Navy and I did and at the end of that surgery three and it was a very interesting moment because I remember asking the doctor are you going to give me something for pain and he was a urologist so you can connect the dots about you know what kind of pain we’re talking about and I can remember I was sitting in the bed the catheter he was here my mother who’s also a physician was here and he knew that I didn’t really need it and she knew that I didn’t really need it but I was scared and he wrote me for some oxycodone and that was it wasn’t my first exposure but I can tell you exactly where I was I can feel the planet spinning through space when I took that oxycodone and I took the medication it was time to go back to work that’s fine great that was a fun weekend and didn’t think more about it but then I got re-exposed again after a wisdom tooth extraction and then again after another medical procedure and pretty soon I had myself a pretty severe intravenous Demerol problem now this was the year 1997. if a pilot had alcoholism we had an excellent you know protocol for that I mean I had two alcoholic Pilots got them evaluated got them to treat them got them right back in the cockpit but drugs were a different story back then you you were handled punitively and so I realized I gotta fix this I gotta stop using and at the time I thought I could because I was very motivated to not do this anymore that was a terrible year that was just a very very frightening terrifying the sense of impending doom and eventually you know the Navy found out and they court-martialed me and they sent me to What’s called the United States disciplinary Barracks it doesn’t sound all that bad but it’s the military’s Maximum Security Prison at Fort Leavenworth and so that that was in many ways that was my first year of recovery and I I hope you never hope nobody ever finds themselves in prison but when you’re in prison you kind of wake up a little bit now that the drugs are gone and you sort of say gee am I am I a terrible person you know I mean am I a sociopath yeah it’s kind of an interesting existential question because you’re like how do you know if you’re not a sociopath maybe that’s the first thing a sociopath tells you that’s right you know you’re not a suspect don’t worry about it so it’s hard to figure it out um but I I really just was fascinated like like how did this happen and I think everybody with addiction has a quiet moment where they ask themselves why do I do this how did this happen and this is the Year 1997 and 1997 Alan leschner had just written his addiction as a brain disease and it matters uh um article uh he uh was the head of the National Institute of drug abuse that at the time was a very um you know radical article it has since come in for a lot of abuse it’s kind of a lightning rod now but the neuroscience at that time was just starting to come together and so that’s if I wasn’t doing my job which was Leaf blowing I was very good at it actually it’s an excellent you know I was one of five Physicians there and we were all very good leaf blowers apparently this is what we should be doing um it takes a physician to do this work well you give a leaf blower to a sex offender and they don’t know what the hell they’re doing they just blow leaves all over the place but a doctor we know you know exactly how to do this well and uh when I wasn’t doing that I was just reading reading reading everything I could get my hands on and the stuff I read just was astonishing there really were reasons for this and over the last 25 years since that time the Neuroscience has gotten stronger the parts we didn’t understand have kind of filled in and so that’s basically what I do now is to try to really you know uh doing almost exegesis of that question can this really be considered a disease why why not what problems come with that what problems get solved with that and there’s you know just so much to learn I mean the Neuroscience just gets more and more faster this is a wonderful time I think to get sober beautiful I appreciate it yeah so I mean I’m going to jump in on like the counselor’s side and he’ll he’ll handle the brain side probably um I I kind of want to know like what moment you you came to grips with like both this the irony may be that you’re helping people in the military kind of have go in a restoration process right with a similar issue yeah and meanwhile you are face the worst punishment imaginable right right having an addiction I we maybe walk us through yeah in the Leavenworth Barracks which sound beautiful like this little food all that probably well when I was trying to you know stop on my own that was a gift I think I was given from the first unauthorized Percocet this is not something that I was supposed to be doing yeah I think there are a lot of clinicians are like well we all kind of do it no this is I had a secret clearance I wasn’t supposed to be doing this so there was a lot I was really trying to bring the normative values of being a naval officer and a doctor to bear on this problem and what shocked me is it would work for a little while and then it would fail and I had had a patient the first time that my first night actually as an intern at Oak Knoll Oakland Naval Hospital a young sailor came in with the Shore Patrol for a confinement physical this was a guy who it turned out to be addicted to heroin and he had tried so hard to stay off and then finally he just couldn’t take it anymore and he left and so they tracked him down and found him in a hotel room and they dragged him into the ER and my job was to kind of make sure that he was physically okay that he could be sent to the brig and actually he was on a ship so there’s a a little box that says is this sailor is this individual safe to go on a diet of bread and water it’s kind of an Arcane punishment that and I just remember this poor guy and he was so accepting of his fate he you know kind of felt I failed I deserved this and I just found that so tragic because the real answer was he never should have been put in that position there was a time that the Navy treated heroin addiction because it had a heroin problem it was a very very good Hawaii 5-0 episode the old kind okay where Dano goes undercover on a Navy ship the producers worked with the Navy ship to to help you know uh this uh sailor or at least help Sailors who had a heroin problem you’ll love the scene if you ever watch it I’ll send you a clip of it and and he’s going you know gosh you know I don’t know if I should turn myself in and and Dano’s like the Navy has a program you’ll go you’ll get an honorable discharge and everything I’m like what a great Navy how do you get into that maybe yes that’s the Navy I want to be in that was not the Navy I was in yeah and that was a policy decision that was made shortly after there was a flight deck mishap on the USS Nimitz and people who died were found to have cannabis in their system and that’s where the words you know Zero Tolerance came from they came from that particular incident and the Navy was Zero Tolerance on drugs but there were great policies for us other things like you know obesity or cigarette smoking or gambling or alcoholism which is what Betty Ford eventually that’s the treatment that she got so it was a very very isolating very lonely feeling um which took care of itself and uh and now the Navy feels differently they’re not sending people to Leavenworth anymore we have patients at The Meadows who are active duty who developed addictions and are now getting treated so that’s good so I’m kind of a special case I went to Leavenworth I like to think that I went to the Harvard of Prisons I I don’t know where you went to prison but with the Leavenworth so I didn’t just go somewhere I went to this you know it was incredible it was a big brick building that looked like it had should have bats flying around it there’s a there’s a lot of history behind it um but uh I think that that’s kind of one of the poignant things about addiction and I’m sure you see it is that people with addiction they almost are accepting of this fate yeah be it punishment rejection death there’s a Thanatos Instinct I think that takes over a death Instinct and that I think is is part of addiction and part of you know trying to show people that it doesn’t have to be that way yeah there are ways out of this there’s a good life ahead of you in recovery for me that wasn’t even a possibility at that time yeah I mean I appreciate your candor actually and how you uh talk through your story I think it’s so it’s just powerful to hear people kind of free from their shame I guess of what they’ve walked through and I should have known better and well I can’t say I’m entirely okay ongoing process makes sense yeah yeah thank you yeah sure and it and it sounds like you know uh and I appreciate the question there Jay and then you know going back to this model right you know that that silent question that people are faced with addiction or you uh are steeped in that are asking themselves quietly why did I do this how have I arrived here in that sort of moment and it sounds like when you arrive you know in that you know the the Harvard of Prisons there at the end of the day you’re asking yourselves like how the heck did I get here at the end of the day and um and it seems like right that there’s this Apex moment if I’m reading the history of our of our industry correctly where you’re asking yourself a question that’s being that’s coming from the choice model that existed and then it’s a sort of beautiful Apex moment unfortunately you’re sitting in the cell in this Apex moment reading that book but the choice model is about to collide with the disease model and I’m just curious how that resonates with you and if that’s accurate as I can experience because you you shoot out of the gates on the other side with all of these positive things that you’ve done on behalf of the industry and your expertise in professionalism and so what was it like just to be a part of that that moment and not only experiencing it on the societal level but at that patient level as well too right well I mean this is this is the question that’s fascinated me I mean where does responsibility come into it where does blame come into it the way I Envision addiction is that it’s a disease of volition and I use volition as kind of a catch-all term it’s not just the doing of something it’s the why what drove me why did this option pop into my head what is what is the menu of options that I’ve got to deal with this what are the affordances that my environment provides me to be able to meet this Challenge and then once I do it did I do it well was it effective and importantly what’s the effect of my social environment having done that all of these things together I consider the Rube Goldberg machine of volition and probably at the core of this is the problem in addiction which is my value calculator is broken and so the whole driver of why I should choose this versus that is off and and I think this this idea of the Bayesian brain I’m only just starting to grasp it but every value calculation that the brain makes contains a probability calculation and so what I have a tendency to do is not only overvalue drugs but overestimate the probability that they’ll work out as I have imagined and I undervalue the consequences that result and I underestimate the probability that those consequences will in fact come true I get the math wrong so there’s a certain part of my recovery that I just have to let go of I’m not going to have control over the Thunderclap craving or the the twists and turns I can’t seem to make that big decision I’m not going to use drugs anymore if I could I would have done it right and most people do do that and I should say that most people who have addiction they kind of mature out of it over time they make some changes and they just don’t do it anymore but for the person with active addiction who can’t make that the only choices that I can make are sort of peripheral choices that change the probability field and that is where do I live who are my peers what is my job you know these are things that I do have control over and so it became clear to me that I can’t make the big decision but I can break that big decision down into a thousand little decisions and each of those are easier to make and if I make enough of them they will add up to the big decision and that’s where I think responsibility enters into it once my addiction is moving and I’m craving and I’m using you know I really uh it’s not that I won’t be held responsible for the consequences but I don’t think that that I have the same degree of choice men’s Raya if you like the intent which is what the prosecutor will look for right not just the bad things happen but that I intended for that to happen I don’t think that’s present in the craving person with addiction who’s craving but if I had failed to keep that community of recovering people in my life if I had failed to meet the the normative standards words that are expected of a physician in recovery those little decisions are where I’m culpable and and could be you know held culpable if I’m not careful absolutely as you know I I got sober in a very very strict absence-based 12-step tradition I appreciate the fact that that is not the only tradition um and but I but I tried to do what the doctors around me did and and by using that that culture of recovery and those expectations of recovery I think that that’s you know that was the one decision that I made that helped me get out of this but I can’t say well I chose to get sober I just I don’t believe that it was that simple yeah yeah absolutely beautifully stated and for the viewers out there in the legal system it’s mensra and men’s uh practice Reyes right you’re you have an intent to do something and you actually act on that intentionality addiction the action clearly takes place it’s do they have the volitional intention did they mean to cause the harm that you know as a consequence of the behaviors at the end of the day and that’s the insertion there into the disease model that something is disrupting that component right or the the multiple processes that lead to that component within the brain system in the American legal tradition we’ve always been very very skeptical of diminished capacity in the British legal tradition it’s a much more established uh Doctrine the McNaughton rule but ever since John Hinckley took a shot at Ronald Reagan we just you know hate that whole idea I think that that’s something that the law will have to eventually come to accept that the the pop psychology beliefs that we have about choice and Free Will and personal responsibility it’s not that they’re eliminated by the Neuroscience of addiction they’re deepened and they’re more complex than we were giving them credit for so how do you you know in all of your conversations and talks I’m sure you have you know Jason’s had it in a in a talk I was at that got a gentleman in the back of the room stands up and says you how dare you say something like that you know and it’s not true and I imagine at times there’s like you know somebody standing up in the back of the room you know challenging that like how do what do you mean the person didn’t have intention to do this right and so what you know for the viewers out there maybe who are just being introduced to you and those who’ve certainly seen you talk in the background you know what is your you know common response that you’re bringing forward from that physician lens to help support that individual walk through that narrative right well I mean they were in the early days there were moments of sheer Terror so I mean I’ve given thousands of lectures now and I love to sit with a group of 15 people and you know hash this out but one of the first lectures I did publicly was for the Orange County Bar Association probably not the best thing to do while I was on probation in Orange County but the judge asked me to give a lecture so I gave a lecture and about 15 minutes into it this young assistant district attorney stood up and said stop saying you have a disease you don’t have a disease you didn’t shoot gasoline into your veins you shot drugs into your veins and you did it because you liked it you don’t have a disease you use drugs because you like it and that lecture went badly and I did not I was not able to pull that one out of the fire but I you know I mean this is the kind of thing that we’ve been like I was trying to think why is what she’s saying both right and wrong and I was actually reading the doctor’s opinion and the in the big book and it says that men and women drink essentially because they like the effect produced by alcohol and I it hit me I have a problem in the like system in my brain that that value probability calculator is in error and I have to take steps to compensate for that and so um the few things the the explanation of craving the this little business about something going wrong in the like calculator these things serve as uh very powerful sound bites or at least ideas memes uh for people who are searching for something like that when they are in early recovery and I think um there’s tons that you’ll find in in every form of recovery certainly Lots in in AAA but but that’s I think what I do at the treatment center that I work at is a Is We I try to to to show people um that um that these explanations exist that’s a powerful argument you did this because you liked it but to understand what a like experience is we have to know a lot more it’s a lot more complex than we’re giving it credit for yeah I think you know we well I was gonna I was gonna yeah you saw me so Kevin what do you what do you see kind of dry like what breaks the like switch in somebody so I tend to take a sort of environmental approach um this is something you’ll be interested I mean all of my studying in the early days was about the brain if you look at cognitive science today it has sort of realized that that’s not good enough that that we really need more understanding of of how the brain is moving through the world and so this is the idea of embodied cognition that I can’t understand cognition just by looking at the brain I have to understand that I’ve got a body and the fact that I’ve got four limbs that changes my cognition this is the whole idea that trauma is kept in the body and that I need to actually look at that so those are the first two e’s of what is called for ecognition uh or excuse me the first e is is embodied the second is embedded my choice making my thinking exists in a world in a value system at a moment in history I have to take that into account too right that uh that um that there are tools that I have that there’s there’s an extended nature to my um to my cognition and my choices that I’m making the drugs work they are powerful tools that people discover very very very efficient but the fourth E I think is the one that’s so critical is that cognition and thought are enacted there is a dynamic coupling between my acts and the environment and what it feeds back to me so what this tells me is that there needs to be a strategy for each of those four e’s and so if I had to pick one if I just had to plant my flag somewhere to try to create something that would support a person’s healthy decision making for me it’s housing for me it’s the housing component if I had a dollar to spend on my addiction before I’d put it in the basket before I’d spend it on buprenorphine I’d spend it on housing because once I have safe stable secure sober housing then everything else works better and so to really look at the ecology within which my choices take place I think is is a very fruitful area and this is what I think people are doing and and peer-based Recovery sober living houses all the time the brain is just the start of the process I really need to look at the at the environment in which those choices are taking place that does it makes a lot of sense to me I mean because what I hear you saying is like in order for someone to enter recovery they do need to be safe right um and I think I I look at it as more than just kind of the brick and mortar safety like that emotional safety that like I I’m not going to be abused in this location or I’m not I don’t have to worry about my life being in Jeopardy um and probably a lot of my other basic needs are met that makes a tremendous amount of sense yeah uh I think what you’re saying um I mean it is it is curious are there other diseases that have these four e components to them as well I think so I think the in public health and that’s um kind of my area of study um we call them the social determinants of Health uh and these are all the things that make Health possible uh to be free from structural racism to be free from violence to have safe stable housing to have access to health care and mental health care to actually have an economic Future these are the really the drivers of of what make it possible to manage one’s chronic disease and again I think that that’s looking at the the embodied nature of the way I manage my diabetes let’s say right that’s looking at the embedded nature that I live in a world right now where there’s a certain technology available to me for managing my diabetes there are a few interesting medications that are coming down that that are very very powerful obesity reversers right right and so those are those are things I need to take into account there are tools in the world that I can use there might be support groups there might be I I had a I went through this um experiment where I had a little blood glucose monitor on my and it was so cool because I could watch How It Was fluctuating that didn’t exist in the past but it is really how I act in the environment I’ve really tried to think what is the most powerful Act of volition that in that a single individual can can uh can perform and I’ve done some exciting things I’ve you know taken off the deck of aircraft carriers and uh as in the back seat of course but there’s not really anything that the individual pilot does in that it’s actually a program in the plane the pilot just kind of puts his or her hands on the towel racks and then once the plane is about a quarter mile from the boat the plane the pilot takes over but it also takes the 3 000 people on the boat to make that happen so that’s a powerful Act of volition but it’s not an individual’s Act Right the most powerful and you tell me if you can think of something better I’m always asking that question the most powerful Act of evolution that an individual can engage in is injection drug use or smoking drugs the the change that occurs so quickly and the degree of change I think that once that person has experienced that that’s the rest of their life is really a workaround right and so the more we can Empower patients you know to be able to feel like they’re part of the treatment for their diabetes not just that they’re going to the doctor and the doctor is doing something to them and they better follow these rules that they’re a seat at the table of their health care that’s more of a of an ecological approach to treating diseases and you can put whatever chronic disease you want in there they’re all a little different but uh I think that that that goes beyond just what I can write on a prescription pad or a test that I can get or even a procedure I can do the patient has to be an active participant in that volitional act of of treating their chronic disease
love it why you know we talked about this earlier it’s kind of you know we’ve talked about it on this episode a few times but you know with Jason present a few others you know gabber mate’s uh text of it’s not why the addiction it’s why the pain and I think underneath that as well too there are there’s this conflation between you know somebody seeking drugs and alcohol for uh pleasure when really the goal is in pleasure it’s to arrive at this I don’t feel happy I don’t feel necessary so the goal is you know getting to this more state of Happiness right uh as an experiencer in the world and drugs are hopeful to be the Catalyst but you know as gambaramonte sits it’s almost like the drugs almost work they almost get us to that moment right right in that regard and it was just hopeful you know through your career path and professionalism that you know when you hear that language what is how do you translate that right right so I think in the case of a person with trauma or the person who has a diagnosed psychiatric disorder it’s easy to understand the motivation to try to to you know self-medicate that pain but I think it’s also possible to have Addiction in the absence of all of that simply because the intoxicant is so powerful so when we look at a cell phone checking my email that’s not that powerful and intoxicant but the variable reinforcement of the of the schedule of reinforcement all of these things add up and I think that that there are some reinforcers there are some things that we can do that are intoxicating that are so powerful that you don’t need the initial motivation to seek it it’s just such a a massive change that that the person you know becomes locked on that it’s just so efficient why would I do any of these other things I’m trying to remember back what your question was I uh so yeah just oh yeah the probability thing so so his statement I think is very very interesting because what drugs do at least for me is they they open a world of possibility they they open a world of promise that the thing that I’ve been seeking might be just around the corner and that’s why I think that’s a good statement I think cocaine is not satisfying but it just sort of holds out the promise that maybe if I do just a little bit more if I do a little stronger if I have a different situation that the thing that I’m looking for will be there and I think that that’s a hard thing to cope with um drugs basically create a Marvel Universe for me that is a lot more attractive than this you know mortal coil here and they really do change the way I look at what is possible or probable and and now I’ve got to kind of cope with that because it it turns out to be an illusion yeah so you know we’re we’re disruptors on this episode right and that you know Peaks recovery centers and it’s one of the things we’re trying to you know drive home uh at the end of the day and one of the we talked about like earlier in the day talked about like restrictive access to care if you just run an absent in space model and your website says I can treat dual diagnosis and you bring that in you’re actually only creating a pretty narrow funnel of what you can actually treat and who will receive those Services uh accordingly and ultimately arrive at positive outcomes and so uh when where am I going with this Brandon when I think about uh disruption in this sense of things one of those features of our industry is that there’s always like an underlying thing that’s causing all of these things and I think what you really said there is disruptive of that massive narrative we have in our industry and it’s right size at times I don’t want to Dismount the entire industry but uh you know in that regard to say that you can have an addiction without all of those things you know being in place I think is is not something I’ve heard of like recent right there’s always something identifiable or we can pull back enough of the you know onion layers and Discover it at the bottom but um it strikes me as disruptive because of those narratives that exist in the industry but also it seems right-sized as well too that we don’t always have to have a villain right as a layer to this that’s causing these behaviors it can just be this experience was more powerful than I ever could have imagined it and that grip and that around the corner experience even though it’s not providing me the relief I think I need or you know cocaine’s miserable to be on in the first place but somewhere right around that corner is the driver of it um and I guess I just want to recognize I don’t even know if there’s a question to it yeah yeah um I guess with something like that as a question right do you experience when you say something like that across our industry people going no no no no no no nobody just picks up a drug and is addicted right they have all these other experiences you know what would you say to maybe that person standing up at a you know speech or something I think there is a narrative of well from the first drink I knew I was an alcoholic and I certainly even though it was multiple exposures to opioids I do seem to go back to that that one night and you know that extra uh oxycodone tablet um I I think it’s actually a much more complex pattern of exposure what I’m interested in is what was going on in that moment was what I was experiencing Euphoria or was it the lifting of a pre-existing smoldering depression because opioids are very powerful antidepressants and I think it’s hard for a person to parse that out but what I think a lot of people realize if not with the first use of the Second Use they learn pretty quickly that this intoxication I can put it to work I can apply it to my problem I can use it to you know get over my social anxiety I can use it to work that extra 12 hours things like that and so drugs have utility in that purpose so part of recovery would be letting go of that shortcut I’m a drug addict I got a problem with shortcuts right and that would be the abstinence model but that’s only one model when I when my mother found out that I was a drug addict the first thing and this is why I love my mother and and uh um we went to the same medical school about six years apart so uh I love the way she answered this she said we have to get him out of the United States we have to get him out of the United States where he’ll die and get him to Holland or someplace like that where he can use his drugs and not die so let’s unpack this because there’s a lot there first of all the idea that there is there is a group of drugs a a discernible definable fungible group of drugs that can be labeled mine I liked that idea very much that had a great appeal to me but you see what my mother did she immediately um fell back on harm reduction she immediately fell back on what can we do to make sure that he doesn’t die from this this is why I love my mother and why I’m I’m glad to be her son and so I think that that really has to be the first step you know what am I doing today to make sure that this person doesn’t die and if the absence model is getting in the way of that then we may just have to delay the absence model there might be some other tools and of course there are there are other tools that we can use but my mother didn’t understand though is that there is something called recovery and again I’m using a definition of recovery that’s very strict that is abstinence based it is really the expectation for a physician in recovery if they want to go back to practicing and that’s my standard that that doesn’t have to be everybody’s standard but I think at some point uh I have to live a period where I’m not actively intoxicated and it’s it’s taken me a lifetime to try to figure out all the little ways like sugar I’m still struggling with sugar now is that intoxication Like Cocaine was intoxication or Demerol no but it’s part of the problem it’s part of the problem and so that to me is is the argument you know four abstinence is that it’s no longer creating that noise that’s that’s uh um that’s biasing my value probability calculation I got to take the intoxication out I got to take all that dopamine out of the picture absolutely yeah so something I wanted to ask you um you know 90 years ago or whenever the the big book was written um a part that always stood out to me even kind of when I was more practicing in an abstinence-based way in this profession um was the part where it says that at some point alcohol reached neutrality for some of the people working on the big book and then and then fast forward 90 years and all of a sudden we’re like okay there’s a craving State and it seems like it’s possible that that craving stick can be um resolved at some point and people can kind of find some more not just recovery but kind of freedom from from uh maybe the thoughts or the triggers of the cravings and I I just I’ve always kind of wanted to ask somebody that knows more than way more than me like do you see that like how do you see the resolution of the craving state in this compared to the neutrality so for a person in recovery so the person who’s no longer drinking right does the craving ever go away I think craving is a very variable experience a very hard experience to try to to frame in words but I do think there’s a phenomenology and experience of what it’s like to be a person in craving I’ve tried for the last 20 years to explain craving to people who’ve never experienced it I think there are a number of things that will drive my craving if I refer to have one right now for cocaine or something like that and that would be I guess I hate to be so uh um you know to use the technique but to use the language but the daily maintenance of my spiritual condition and I’m not a very religious person but I consider that you know am I am I hanging around people who are in recovery am I am I making choices to separate myself from that Old life am I am I exercising how’s my diet you know I’m not getting good sleep all of these things sort of create the foundation of of um of drive or need and if I’ve met those then I’m less likely to Crave I think over time uh it was hard because for the first two years I just craved every night and I just figured that this is what my life was going to be I was going to I feel fine in the morning and right around five o’clock I was gonna start thinking about cocaine and and 8 PM would roll around and I really want to use cocaine and I didn’t think that would ever end and finally it was my sponsor who said stop calling me every night and talking about your damn craving I’ve asked you to do steps four and five and you keep putting me off and so I did two things I I went on a drug called bupropion Wellbutrin which just kind of puts like a little scaffolding underneath the dopamine system it’s stimulant but not like Vyvanse or Adderall or anything like that very very weak dopamine Agonist and I did that four and five and then I hate to say it because I’m a scientist I want to know these things but the craving was never the same after that it did seem to shift something and is that possible with something like psilocybin does it sort of wipe out those craving connections and at least make things neutral again because that seems to be what’s happening is if you look at the connectivity in the brain of a person who’s an active addiction they have what’s called small worldedness there really is just a few very very strong connections and so whatever you input you get us the same output that there really aren’t a lot of options what these you know potential and theogens do is at least for a moment is they make every node equal which is interesting when you see alcohol kind of you know reach the quality and suddenly there’s at least a moment where the person can see other possibilities and other connections can be made that aren’t consistent with addiction it’s been my experience that this doesn’t last long that you’ve got kind of an open window there and you got to start shoving some traditional recovery things through the window but that would be interesting you know I I I think that it happened in a a more subtle way for me when I did steps four and five but I think it can happen in a Thunderclap way for people who have a you know like Bill Wilson in towns hospital but they don’t tell you about that is that they were shooting them up with all these anticholinergic drugs and it’s kind of surprising that he only had one spiritual experience right but it could be that we’re doing it in a more elegant way with these medications or perhaps ketamine or you know they’re I think they’re going to be a wide range of drugs that we’ll be able to use and at least for that moment the person can see other possibilities and the craving backs off I’m not saying it completely goes away but it no longer becomes the central driver but there was a time when I just thought eventually this is going to get me I’m just going to try to stay alive and so that’s the one thing I’m very beholden to 12-step recovery for is that I don’t crave cocaine like that anymore it just it just doesn’t happen that way yeah so yeah I appreciate it appreciate all of that um wonderfully stated I also just love listening to you in general you’re so passionate so professional so articulated clearly thought about this uh pleasure unwoven right I see how this kind of forms in my experiences and conversations with you uh and I know you have other you know films books uh that sort of thing but for the sake of the time you know the kids out there in that dopamine effect are only doing three seconds at a time on the Facebook so randomly yeah my filmmaking is not for yeah it’s terrible but in a tick tock world but for those who are going to get curious go on YouTube find your site you know get the DVD download it that sort of thing uh why pleasure unwoven and also for those who are you know kind of looking back at a 13 year old film at this point you know so let’s answer the why and then let’s also uh add to it what you would have included it if you were remaking the film today um so when you say why pleasure are you talking about the title no like you probably know the reference why why do this at all got it well just as a side you probably recognize the reference to the title so it refers to keet’s poem I think it was Keith’s poem about Isaac Newton who damn these scientists they want to unweave a rainbow and so uh that’s why I called it it sounds a little bit like a porn movie and that’s I think it’s part of its success actually that it does but it’s like can we can we actually kind of deconstruct what a pleasurable experience is and see if any of this process can go wrong but at that time there was no video presentation there Hazelden had some great films but they cost a tremendous amount of money they were basically meant to be used by you know one treatment center um there wasn’t a film for the people right right and I kept waiting for like Nova You Know PBS to make a a you know an hour-long presentation of the great scientist interview Nora volkov interview Rita Goldstein and George Kube and all these the only other thing that was out there was Bill moyers’s special from 19 I think 97. but that had really become quite long in the tooth so I I just don’t think that people communicate as strongly with Pros as they do with visual media I knew that it had to be a visual film and so I tried to to at least lay out the basic neuroscience and attempt to make an argument for why it could be considered a disease but every time I tried to make that film if it was just like like this even a discussion it didn’t work and it would make people very very angry I would put little clips on YouTube and I well I guess that’s just the way social media works but I was amazed at the violence of the responses because this is really very basic to Human Experience this Free Will thing yeah so I disguised it as basically a National Geographic travelogue because you can take pleasure on moving and turn the sound off and it’s just a beautiful landscape of Utah you know just cars drive why is there car driving around so much you know because if and so by and who’s that idiot in the cowboy costume so it comes in as very low energy yeah and non-threatening because it’s just so campy right and I think that in that way it’s sort of subtly kind of it’s just sort of a um it’s really a challenge in Social marketing right how do you take this Healthcare message and deliver it in a way that people can hear without every defense going on yeah and so that’s I think it’s part of its success but it’s just you know even my kids today say are you going to make a new film with all those driving scenes it’s kind of the family joke and and the reason that I put the driving scenes in there was because we would we would do a segment that talked about say George Cube’s research and then we would move on to the next thing and the test audiences were saying it’s going coming too fast it’s coming too fast I’m thinking about what you just said and I can’t hear the next thing that’s being said and so these stretches of boring ass photography are my lame non-filmaker attempt to try to just you know slow the whole thing down the chapter markers too are really there so that therapists can just do a chapter you know not the whole fan film but just a chapter and inspired discussion so that’s kind of the structure and the strategy of the film what I would change in it what’s what’s wrong in the film is that it uses the dsm-4 diagnostic stick dichotomy it uses basically that line crossed that there’s non-addiction and then there’s addiction where there’s substance abuse and then there’s substance dependence and really what the epidemiology showed is that you didn’t have a diagnostic dichotomy you had a range you had a spectrum of severity and that’s why the DSM-5 came out with the substance use disorder spectrum that I wish I could change but otherwise the Neuroscience is actually holding up pretty well there’s lots more to talk about it’s so much more interesting if anyone has two hundred and fifty thousand dollars that they would like to give me I would be glad to remake that thing but that just doesn’t seem to be happening no one really just comes up to me and gives me that um but I also thought that it was important to do a film about the problem and that was pleasure and woven but really about the solution I really talk about all the hopeful things and exciting things in in recovery management like like programs for professionals or Collegiate recovery communities and so I tried to to make that second film as quickly as I can but that film pleasure on woven costs sixty thousand dollars and three people made it um memo to self was three times that wow so it was it’s hard to get that kind of money together yeah but my films make money yeah I mean we we made at least a million dollars on Pleasure unwoven so I’ll give your money back yeah you know need that that funding but someone else is going to come along and make an even better film and that’s that’s what I’m excited about I really am interested in the visual media that’s being made that’s telling the story of recovery because that’s what changed everybody’s attitude about HIV AIDS it was the fact that people wrote plays and music and poetry and films and they told the story and expressed the humanity of people who were dying of AIDS and that was what allowed that uh that Health movement to shift our understanding and our appreciation and our empathy for those patients I think that’s what I’m hoping for now this Renaissance of creativity that will tell the story of recovery and I think that that’s our best defense against the encroaching you know stigma that will eventually start creeping back in yeah yeah I’m not sure if I answered your question perfectly answered it that was that was awesome thank you for that ride I was also a rewrite on all those cars and pleasure unwoven as well too yeah I was hoping to call it campy too that’s my favorite hey man if I could afford a cast I wouldn’t be in the cowboy uniform I wouldn’t be dressed up like you know like Marcel proust like an idiot you know with these little Starbucks Madeleine cookies but what I learned is that filmmaking is like how are you going to solve a series of problems um I would have loved to use animation animation at that time cost a thousand dollars a second now it costs a thousand dollars a tenth of a second so there’s no real way to do the kind of Animation that you’ll now see on the on the real Nova show that came out about eight years ago uh on the Neuroscience of addiction um so it’s funny because filmmaking really you have to be a complete well if you’re a good filmmaker you don’t have to do this but if you’re a bad filmmaker you have to be a complete [ __ ] like and I just had to be just like a complete monster to get what was in here on film I I hate to tell you how abusive I and and uh you know it would be hard to go back into that because it is an a massive Act of volition to try to to get that image you know onto uh media um so I would I would need a lot of control uh if I was ever to try to do it again it would frighten me yeah yeah all right well we just got to find the funding I think we have the cameras yeah you do this is a great setup in fact the cameras you’re using were the very cameras we shot on so so uh Jay you got anything all right on the kind of the final way out here uh you know uh you know the thing that comes up we talked about a little earlier again it’s referencing Gabriel mate he’s a big figure in um in the substance use disorder space Mental Health primary space and for a lot of great reasons he’s writing some incredible books but the it seems like we’re at this new sort of Apex moment right we did Choice into disease and now we’re you know and then now we’re in this moment of I wouldn’t know what to call it but under the language the disease model of pathology processes right and Gabor mate seems to be really pushing that its process is not pathology and through your lens right I’m curious you know for the viewers out there what does that mean to you and um how do you how do you see this positively shifting this and how much of do you see the disease model still resonating even under maybe this new lens if it is this new Apex moment where we’re sure it’s complex um the trauma narrative is a powerful narrative and it’s given voice to many people and I think it’s a it’s a you know something certainly that I suppose it’s having a moment right now so it doesn’t matter what I think um and I definitely appreciate Dr Mateo’s humanity and all of his work and the power of his writing it’s important to understand that Dr mate is a Canadian and the things that work in Vancouver do not necessarily work in the United States if you said harm reduction 15 years ago your career was over you would never get funding you would always be on the periphery the political you know Wasteland doing very good work harm reduction has always been the national policy of Health Canada and so because Canada has a more Public Health understanding in general because people were actually willing to put on mass Canadians are just nicer people than Americans I think they are more higher evolved life form quite frankly because they can say things like sorry right Americans can’t do that so you’re never going to get safe injection sites or safe Supply into the United States and so I think it’s important to understand the the possibility landscape that operates in a country like Canada and how it’s different from the United States um and that would be that that sort of embedded nature of addiction I I certainly do respect the idea of not just reducing addiction to pathology to understand these processes I would like to know more about that I’m saying that the processes that are possible in Canada may be very difficult in the United States doesn’t mean we shouldn’t try doesn’t mean we shouldn’t try
when people ask if addiction is a disease at least 15 years ago people would say well we really have to you know let the doctors answer that question okay if you get the doctors in the room and you ask them that question they’re going to turn to the pathologists pathology is an amazing field five years of training after medical school that’s as much as a general surgeon and then there are usually more specialty training that you can get in addition to that there’s an old joke that uh surgeons know nothing and do everything and Internal Medicine doctors know everything but do nothing and Pathologists know everything and do everything one day too late you just understand the the massive fund of knowledge that a pathologist must have and a pathologist sees disease as injury whether it’s a big injury like a broken bone whether it’s a molecular injury right I don’t think that we should give up on the pathology model just yet because if you’re really trying to understand how things like structural racism housing discrimination not expanding Medicare actually create inflammatory states that lead to disease your best way of linking those two worlds is with the disease model is with that pathophysiology and that’s why I’m kind of interested and I don’t know much about it this idea of psychoneuro Immunology that that that really the very same inflammatory state that occurs in the lungs of a person dying of covid is occurring in the brain of a person who’s been traumatized or has addiction or has schizophrenia it’s just happening at a much lower grade over years and so we don’t want to give up on the pathology model because it’s also been the most successful human endeavor ever it has doubled the human lifespan in a hundred years and so I understand that it’s that it’s an annoying model that it’s highly reductive no one likes to be reduced that it’s purely materialist and it doesn’t understand so much more doesn’t understand the Ecology of how disease plays out but there’s a lot to be mined there how does housing discrimination cause disease your best way to understand that is with a pathology model so I would like to talk about both of those things I would like to know more about both of those things I think that they’re actually much less divisible if you take a public health ecologic approach to disease so we have to change some things in this country if we want to be healthier I think we learned a lot of horrible things in the pandemic that we weren’t even willing to put on a mask to save the life of our neighbor’s kid who’s getting better from cancer that is deeply deeply pathologic that was not the problem in Canada right right everyone did it yeah that was not the problem in Hawaii the state that I used to live in they were public health model no problem very very strict we I think have some well pathological you know understandings of personal responsibility and freedom and my rights versus your rights and who should have power and who shouldn’t have power and that is what made us especially vulnerable to the opioid epidemic in ways that other countries weren’t quite as and so um don’t give up on the disease model just yet there’s there’s a lot I think that that it can help us understand but I completely admit that the disease model is just one model uh to view addiction and Recovery yeah absolutely beautifully stated I also got to get you to use the word psychoneuro right without having to bring it up as a question so right I feel really good as a host for arriving at that and getting that language in there um through that last question and um you know with that Kevin again as we’ve talked about the viewers out there they’re getting tuckered out probably the bottom of their popcorn bowl bucket now empty on the soda they gotta go in that regard and before we take this out is there anything that you would love to send to the viewers how to find you your books your DVDs any of that information
yes I I accidentally you know if you’ve got the blower I’ll do the leaves uh you know I’m very touched that people have found the film helpful if you want to email me and my email is easy it’s Kevin T McCauley me.com I can send you the links to the streaming versions that I keep on Vimeo because nobody has a DVD player anymore right and if those are helpful to you you at least even a little bit that that makes me very happy absolutely beautiful well you you know the DVD still exists because I pulled you into the meeting today and they held up there like that’s the guy makes a great coaster at least these days it has some value yeah well in that regard uh you know uh you know Dr Kevin McCully thank you so much for being on this episode again a senior fellow of The Meadows you know here at Peaks We Are The Meadows is a it’s not just a professional relationship it’s personal as well too we’ve sent several staff members out there myself included president founder Chris Burns our other founder you know Robert Patton our therapist we’ve all kind of pushed into especially during the pandemic uh into survivors weeks and similar programming out at The Meadows there’s so much work out there process addiction substance use disorders mental health adolescent programming Eating Disorders you’re in multiple States you guys are doing wonderful things uh and the senior fellows is just such a special cast in The Meadows program and I just want to honor that you know and having you on here fascinating what they’re doing out there in Wickenburg Arizona and their other locations so I’ll do the real for you in that regard but uh for everybody out there again this is Brandon Byrne chief executive officer Peaks recovery centers find us on the tick tocks the Facebooks the Instagrams all the things out there we’re out there YouTube channel and so forth for more episodes again your vision’s important to us your questions are important to us send us all that stuff finding Peaks at peaksrecovery.com and until next time so grateful that you all joined us and we’ll see you again soon with other special guests here on finding Peaks take care