(This post was originally published in August 2013).
[This interview is a continuation of a conversation between Anna David and Dr. Drew Pinsky; the first part ran last week.]
Since I’ve known you, you’ve been a big advocate of AA but I’ve read that you were skeptical of it at first.
I went through a couple of transitions with it. I first was doing medical services at a psychiatric hospital and many times I would find these medical problems precipitating the psychiatric issue: a heart attack, cancer, neurological reactions. And I first became disdainful of psychiatry: I thought, “They’re not real doctors, why don’t they do an EKG?” At that time I was working on the drug addiction unit and I became an expert in just detoxing people—getting them off drugs. And I would think, “What is that goofy shit going on in that room back there, where they’re holding hands with those crazy steps on the wall? What is that?” And then I saw some recoveries. And I said, “Wow, I want to understand this.” Because in medicine, the best you can usually do is take the patient from dying to chronically ill. But in addiction, they can go from dying to amazing, better than you ever knew you could be. It’s a unique human experience that I am deeply affected by and want to be a part of. You see miracles. I’ve had people that I’ve given up on, kicked out—situations where I was becoming part of the problem because I was sort of enabling so I said, “Godspeed, farewell.” And they’ve come back to me four years later and they’re in a CDAAC program or they’re getting a PhD. They’re shaking my hand, looking me in the eye and saying, “I wasn’t ready to hear it then but what you said stayed with me and thank you for doing what you did.” It’s like magic.
It’s amazing to me how impossible it is to predict who will get and stay sober and who won’t.
You cannot tell. I still prognosticate—I still think I know, but I don’t know.
Do you think there’s any way to get and stay sober without a 12-step program?
I always hate taking categorical positions. But here’s what I know: when the addicts call the shots, they fail. So when someone says to me, “I’m willing to do anything—just not that 12-step thing,” I know that means it’s someone who’s not ready for anything. So you’ve got to be willing to go to any lengths and this works. But there are exceptions. If you’re a homeless person with no family and you suffer from mental illness and you have no education and no interests—that person could be put on replacement drugs. And there are all sorts of gradations from the ideal scenario to that. The question is: where do we employ these different strategies? Cognitive behavioral therapy works—I know it works but in my experience, it also works long term when the addicts also gets into recovery. Do you see it differently?
I don’t know. 12-step works very well for me but I also know people who are sober without it and their lives seem to work as well.
But what stage of their disease were they at when they stopped? Because that’s really the question. If you haven’t fully lost control, that’s where there are a lot of options.
That can be hard to tell because what’s out of control for one person isn’t out of control for another.
But would you agree that attachment is a necessary approach? Even if it’s cognitive behavioral therapy, it’s a person attuning to another person?
Yes. But what I see also is that addicts who didn’t suffer from much or any childhood trauma seem able to survive better without programs or therapy.
Yep. Correct. That’s about attachment problems and the affect-regulation problems. Trauma survivors have a deficiency in their capacity to regulate emotions—they’re too prolonged and too intense and too negative. As a corollary to affect regulation, self-esteem, sense of self and inter-personal functioning all goes downhill. And that’s a chronic thing that’s solved in an-inter personal context. So you need that constant interpersonal attunement. Now you could do that with a therapist. The problem is that when you’re an addict, you have special needs that get met by other peers who can call it out and say, “Me too” and appreciate it in a way that a therapist cannot. It’s a different function.
I wonder if there are exceptions to even that, though.
There are. All medicine is gradations and differences and nuances. And there’s such a thing as natural recovery: people spontaneously get better. It happens. Not someone who’s far gone but somebody for whom alcoholism just gets away from them—we see this with alcohol more than with drugs. Someone will say, “That’s the end of that.” And it just happens. Though they often find that they have difficulty if they don’t approximate or cobble together something just like people do in recovery—where they keep friends close, prioritize their lives, find a spiritual connection and try to be of service to other people.
Or they can just stay sober and act miserable.
Well, that’s a different thing. I don’t call that natural recovery. I call that white knuckling.
You’ve mentioned in interviews that shows like Teen Mom had a direct impact on teenage pregnancy—that teen pregnancies decreased as a result. Is there any information like that available in terms of what shows like Celebrity Rehab and Intervention have done for addiction?
I don’t know. But I would say that it’s elevated awareness in conversation so people are not as afraid of treatment. If someone has an acute psychotic episode—they are manic, psychotic and need to go to psychiatrist hospital…where does the press say they went?
To rehab.
Exactly. The problem is that that’s not addiction, that’s mental health. Let’s not confuse these things. But the fact is that rehab is embraced; we understand it. It’s not as disgraceful or shaming as it would be to go to a psychiatric hospital—that, we think, is for crazy people. So we have a lot of work to do on the psych side. But rehab is sort of more embraced. Still, I think on the heels of that, there’s this expectation that rehab is a fix and people get frustrated with multiple treatments. They don’t understand that part.
They believe that sending someone away for 30 days should solve the problem.
Which is ridiculous and I emphasize over and over.
This is the second in a three-part series of her interviews with Dr. Drew. Check for the third part soon.
Photo courtesy of CNN. Used with permission
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