This is the first part of the series After Quit Like a Woman: Exploring how neurodivergence, hormones, and cPTSD reshape recovery I talked about here.
Last time I shared a short podcast sharing what happened after I published my book, Quit Like a Woman; the week before I talked about leaving the United States. Next up is an essay about moderating alcohol and another about the 7 things I’ve done in my recovery since QLAW that have saved me.
This was originally recorded for the co-regulation podcast. You can listen to this in your favorite podcast player.
What if everything we think we know about relapse is wrong?
SHOW NOTES
What if the framework we use to understand addiction is actually making it harder for people to heal? Carrie Wilkens has spent over two decades building an alternative at the Center for Motivation and Change, one that starts with a radical premise: behaviors make sense. Instead of diagnosing and demanding abstinence, she asks what the substance is doing for someone, what pain it’s masking, what regulation it’s providing. This conversation explores why the word “relapse” itself is a trap, how families inadvertently push substance use underground, and why compassion—not control—is the foundation for real change. We talk about the complexity that gets flattened by disease model thinking, the scapegoating that keeps us from examining collective suffering, and what it actually looks like to create space for curiosity rather than judgment. It’s a conversation about unlearning fundamentalism, understanding co-occurring struggles like ADHD and trauma, and recognizing that people using substances aren’t morally corrupt—they’re in pain.
TOPICS COVERED
The founding principles of CMC and how evidence-based treatment differs from traditional abstinence-only models; why “behaviors make sense” reframes the entire treatment approach; how substance use is almost always secondary to underlying issues like trauma, ADHD, anxiety, and depression; why moderation isn’t necessarily harder than abstinence; the problem with the word “relapse” and reframing it as returning to an old behavior; creating environments where people can talk openly without shame; the role of families and why labels like “codependent” miss the complexity; balancing structure and flexibility across different recovery stages; the unique cultural stigma around substance use; why people with ADHD and neurodivergence are at higher risk; the importance of self-awareness and curiosity in behavior change; how “in recovery” identity can be both helpful and limiting; practical communication strategies through CRAFT and Invitation to Change; the connection between suffering and substance use; natural recovery statistics; CMC’s nonprofit arm empowering families; how societal scapegoating of addiction prevents examining collective failures around trauma and systemic issues.
ABOUT CARRIE
Carrie Wilkens, PsyD, is a clinical psychologist and Co-President/CEO of the CMC:Foundation for Change, a nonprofit improving dissemination of evidence-based addiction treatment. She co-founded the Center for Motivation and Change, which operates outpatient centers in NYC, Long Island, DC, San Diego, and a residential program in the Berkshires. Dr. Wilkens co-authored the award-winning Beyond Addiction: How Science and Kindness Help People Change and its companion workbook, both grounded in CRAFT (Community Reinforcement and Family Training). Her Invitation to Change approach empowers families to stay engaged and support positive change without requiring abstinence. She’s been featured on CBS Morning Show, NPR, Ten Percent Happier, and HBO’s Risky Drinking documentary. Her work challenges traditional treatment by treating substance use as learned behavior connected to underlying struggles like trauma and ADHD, prioritizing curiosity and compassion over judgment.
CREDITS
Original music by Adam Day
Sound engineering, editor: Adam Day, adamdayphotography.com
Producers: Holly Whitaker, Adam Day
Original art by Misha Handschumacher, cmisha.com
TRANSCIPT
Speaker 1 0:02
You know, unfortunately, there’s in the popular culture and in treatment, the kind of idea was, just get the substances out of the way, and life will, life will change. You know, just, just stay sober. Life will get better. To some extent, that is true. And a lot of people have a lot of other stuff they have to figure out. And if they don’t, they go back to the substance use, and it’s not because they’re bad people. It’s not because they don’t want to change. It’s not because they don’t care. It’s because they don’t know how to do things differently. And we have to have more compassion for that and understanding for that, and I think that’s where culturally, we still have a long ways to go, because that goes directly to your relapse question, right? It’s like I’ve made a bunch of changes, and I’m returning to substance use for whatever reason. There may be 15 different reasons there, and I’m not going to talk about it, and I’m going to go underground with that behavior because I’m doing something wrong, versus being able to step back and be curious about like, Huh, what’s going on for me? What’s going on in my life that’s making me want to re engage with substances.
Holly Whitaker 1:13
Hi everybody. It’s Holly. This is an episode that I recorded a while ago for the CO regulation podcast is part of this series that’s exploring the intersections of neurodivergence, hormones, CPTSD, addiction and relapse. I did another intro for that back then. I’m redoing this now today, on October 10, not long before we’re airing this. And I’m going to keep it pretty short here. This episode is an episode with Carrie Wilkins. Carrie is somebody that I knew of from the documentary risky drinking. Risky drinking was this like when nothing else existed. It was this incredible documentary, and Carrie was as I was building my career, somebody that was featured in it, and to me, she was just kind of a star. She reached out to me after my book was published, and it was, I don’t know, I mean, I always use Oprah, but I guess, like it was kind of like it was just like a very famous person reaching out to me who I deeply respected. By the time she reached out to me, I also knew that she was the founder of CMC and the FMC. So center for motivation and change is multiple things. It is an outpatient center in New York and California. It’s also an inpatient treatment center in the Berkshires. But also, Carrie and her co founder, Dr Jeff foot, have created many manuals. They’ve created something called the invitation to change, which is an evidence based method for friends and families to support people with addictions. They’ve written the book, Benedict. I could just keep going. But this woman is a pioneer. She is somebody that is so far ahead of the curve that it makes it painful to see what else exists out there. They have been doing what they’ve been doing for decades now. And you know, as I think we talked in this conversation, she mentions, like it’s phenomenal what has happened in the past decade, and then yet, you still look around and we have so far to go. And so Carrie is one of those people that I just, I think is one of the smartest people that exists about this stuff, that I think about all day, every day. And so we have a conversation that I’m really excited to share. One thing I want to just share with you. Carrie was one of the first people I interviewed for the book that I’m writing. I’m writing a book on relapse right now, exploring it. And Carrie and Jeff were some of the first people I thought of to talk to. I went to the Berkshires, and we sat down, and this was, you know, God, when was it? I think it was May 2024 maybe. And as I was researching for this book, I was still in a really, really big shame space with using cannabis again. And so you’re gonna hear that in here, because I enter I was interviewing people, and I was sharing with them what my experience was as part of the setup for the questions I was going to be asking them. And so I didn’t tell Carrie, like, Oh, hey, let’s kind of hold this because I’m writing a book about it. And we ended up just she asked me questions that and brought up things that I thought were really important for the sake of this episode. And so while I wasn’t planning on having this conversation, I’m really excited to share it. It’s very vulnerable, but I’m really confident and comfortable with this aspect of myself, and I think it’s a really important topic to discuss. So I hope you enjoy this episode, and thank you so much for listening and all of your support. Take care. Y’all you.
Holly Whitaker 5:11
All right. Hi Carrie, good morning, Holly, thank you for doing this. You’re so busy. I’m so excited to be here with you. Are you kidding me? Yeah, I know I’m really excited. You’re one of the most, like, exciting people. I know. I love our time together, and I am like, I’m extremely grateful that we know each other. I agree. I don’t even know how we were put in like, did I reach out to you? Is that? Do you remember how we were put in touch?
Speaker 1 5:36
No, when you wrote the book, put like, a woman, I reached out to you and told you how awesome I thought you were, and told you about the Center for motivation and change, and said, I’m referring all of my clients to your program. And you spontaneously reached back out. Oh
Holly Whitaker 5:51
my god, wait, did I respond to that? Or did I I think so, yeah, yeah, because you’re a star to me. So like you were in that documentary. Oh my god, I’m not gonna remember the name of it, risky, drinking the HBO, yeah, which is, like, legendary, right? And CMC is legendary. And so I yeah, I now I do remember, and I was just like, shut the fuck up, Carrie Wilkins and a cold called do. And it’s funny because I refer everyone I don’t have a program anymore, I refer everyone that I work with, like if I’m working with people one on one, or if I just, you know, I’m talking to anyone that needs guidance, I refer them to CMC. So
Speaker 1 6:30
also the universe put us in touch for all sorts of reasons.
Holly Whitaker 6:35
It’s kind of amazing. All right, so you and I had a conversation in May 2024 I was interviewing you for the book I’m still working on, on relapse. Interviewed you and Jeff, and you were so generous, and like, gave me a whole day. But when I went to meet with you, what I was looking for was just like, some understanding of how to conceptualize relapse and like the questions that it brings up, and what I found at the time, and I think I’ve evolved in my thinking a lot since that conversation, and probably because of you, I have always felt very radical, and I’ve always felt like I am really testing the boundaries of this thing and really pushing the boundaries, like that’s what I enjoy, I think in my work is like, who said we can’t Do this? And then I’m talking to you, and you are even more radical than me, like there’s just stuff I feel like that you think about addiction and drug use and recovery, that was even uncomfortable for me, and I felt extremely progressive. And so I kind of want to start with that and making sure our audience understands that you, you’re a very, I think, radical person in this space. And can you just talk, like, start a little bit about what it is that you do, like, what is your job, and what is CMC, and what does it do? And, I guess, kind of, how does it, how does it stand out from traditional rehab, recovery, treatment.
Speaker 1 8:02
Well, I will start by saying, I wish it didn’t stand out. I wish that after 20 years of doing this, that more programs operated like we do, because it shouldn’t. It shouldn’t be radical. It really shouldn’t. It’s grounded in science. It’s grounded in how behavior change works. It’s grounded in understanding how substance use and other mental health and ADHD and learning disabilities all come together. So we didn’t make this up. We actually have, just from our inception, used what science has said are some of the most effective strategies for helping people change. So it should be radical, but why we could go into a whole historical, cultural discussion around that, I think going back to what I do. So my partner and I, Jeff foot, we’re both psychologists, and we started CMC almost 22 years ago now. And when we started, we really we’d been working in a pretty traditional substance use setting. Jeff was actually trying to bring motivational interviewing and cognitive behavioral strategies into this, you know, traditional treatment setting. And they were all traditional back then. What do you mean by traditional? So they were all 12 step based. They were all abstinence only, like Minnesota model, critical thing. Like, yeah, it’s kind of the disease model. Like, the only goal you could have was abstinence from everything. Yeah, right. So we were trying to bring motivational interviewing, in which is really trying to work with people’s internal motivation, and that requires you to be able to have a variety of goals, right? Because not everybody’s internally motivated to be abstinent yet, that doesn’t mean we shouldn’t be talking to them, yeah? And it doesn’t mean we can’t work with them, and it doesn’t mean we can’t be. Be curious about their internal motivations, right? But it’s still shocking to me. Like 20 years ago, literally, if you didn’t want to have the goal of abstinence, you couldn’t be in the program. But that’s still the case. I know for a large, large percentage of programs, that is unfortunately true. That’s what I’m saying. I wish, I wish the landscape had changed more than it has, and I’m going to give the landscape, the treatment landscape, some credit. It has changed enormously, I think because it had to, due to the opioid epidemic and people dying, they had to shift their ideas on what was acceptable, in terms of goals, medications used, all the things that many of us have been using for a very long time now. But you know, there’s, there’s some positive, positive change. I actually just had a treatment provider who, really, you know, has had it a little bit out for CMC from the beginning, and he, in a social setting, actually came up and apologized to me and said I didn’t actually understand what you guys are doing. I’m more open to it now, and I feel like you guys have probably saved a lot of lives that I couldn’t Wow, which, you know, was touching and made me mad all at the same time. Thank you. And I feel mad about that. Yeah,
Holly Whitaker 11:16
yeah, it’s really upsetting. And I think that that’s, it’s something that I’ve been thinking a lot about lately, is how tightly, like, how culture bound this one thing is like, it’s like, there is so much latitude that we’ve created in other spaces. We’ve, like, made a ton of progress in certain areas, like, if you just even think about like, gay marriage, right? Like, and how massively that shifted, like, our attitudes, our cultural attitudes toward that, but our cultural attitudes, and our individual and personal attitudes, I have found, because I talk to people about their substance use all the time, is so tied up, more so than almost anything else that I can think of. It’s so morally centered. It’s so puritanical, it’s so punitive,
Speaker 1 12:04
and it’s so stigmatized. I mean, it’s such a stigmatized problem, and it’s a the stigma is applied to the person with the problem, and it’s applied to their family, you know? So one of the things that studies show again and again is if you’re a family who has someone in it struggling with an addiction problem, people think something is wrong with the entire family, you know, like, there must be something wrong with that family if that person is abusing substances, even though, like,
Holly Whitaker 12:34
every family has, like, a sense, I mean, it would be hard to throw a rock. And I had a family that, yeah,
Speaker 1 12:39
but people don’t talk about it, and you can see, you know? And I think that’s part of what, when you came to talk to us, you felt like you had this kind of secret thing that you were, you know. I mean, it was like something that was somehow bad, you know. And I
Holly Whitaker 12:57
still have this, like, I still said that, yeah,
Speaker 1 13:00
completely normal. And so many people feel this way, but because there’s these kind of black and white rules of what it means to be in recovery or not, or sober or not, or in denial or not, right? We have all these black and white ideas around addiction. People just go underground, and they don’t talk about all the gray that’s in the middle and all the reality and complexity that is involved in this. For most people, people just don’t feel like they can talk about it.
Holly Whitaker 13:30
Well, I mean, I think that, like, one of the things, I was just looking over our notes from our interview, one of the reasons people feel like they can is because it’s fucking terrifying. Like we’ve Scared the shit of ourselves about it, and we, like, kind of keep that alive culturally, but it is like it’s so interesting because I just like, recently had this experience that was so jarring. I don’t know if we talked about it when we’re doing the pre interview, but I just like, I had a friend that I asked for a couple of benzos, like, and I think I’ve talked about this in another podcast, but it was such a startling encounter. They didn’t know me. I’d never talked to them about my history of addiction, but they do know that I’ve written a book on addiction, and they denied me, giving me a couple of their benzos be and wrote me an entire thing about people with histories of addiction and benzo use, and how I was already using them incorrectly. And I just like it brought me back to this, like, being the identified patient and and having, like, carrying that burden of like, I I’m the worst, right? Like, in the situation, I am the worst because, like, I am the identified person that has had this thing, even though. But
Speaker 1 14:33
if you just stick with what you said, which is you felt like the worst, yeah, that’s because, as a culture, we are constantly telling people, if you’re misusing substances, you’re doing something gravely wrong, yeah, right, so you’re doing something wrong, yeah. And one of the big things that we assign to that is that you’re somehow morally or character logically corrupt and are not you don’t have a. A, you know, good moral judgment, and you’re making bad decisions, you know, or you’re just out of control, which means all sorts of things. You’re lazy, you’re weak willed, you’re just not strong enough. Like a whole, the whole thing, pick your pick whatever poison there, in terms of how we understand it, and one of the things that we’ve always done at CMC is take the frame of any behavior makes sense, right? If somebody is doing something, there’s some way that that behavior makes sense to them, because we don’t repeat things that don’t work for us, right? So if we can be curious about what it is the substance is doing for the person, and bring curiosity to that so that we can understand them, we can potentially give them different a different skill set. You know, if they’re drinking for stress reduction, if they’re drinking because they’ve got PTSD or having flashbacks or using a substance to regulate their attention, if we can understand that, there’s a whole host of other strategies we can offer you that give you an alternative path, because it’s all it’s all learned behavior, yeah, right? You, over time, learned to use substances, yeah, because they worked in some way, and then you kept doing it right? But while you’re in that learning path, there’s a whole bunch of other behaviors you’re not learning. So if we’re going to help you, give that up. We have to give you time to learn the new behaviors. We have to give you time to learn to not engage in the old behaviors, right? So that’s an enormous amount of learning well,
Holly Whitaker 16:32
and it’s also not a medical issue, right? It’s not like a binary, like you either have this thing or you don’t have this thing. And I think it’s so it like just doing what you just said learning, unlearning, is still something that’s not popularly understood about addiction. It’s still understood. People insist it’s a disease. They have to believe it’s a disease, and it’s one of the biggest things that I feel like it’s so it took me a really long time to be able to kind of come around and say, I don’t see it as a disease like at all. I don’t like for so many reasons, but so coming back to, what does CMC actually do? So there’s multiple prongs here, but can you kind of give like, a couple, like, the overview of, like, how it is different, like, practically speaking, than what else is out there? Yeah.
Speaker 1 17:16
So we started, so 22 years ago, it was just Jeff and I, and now we have, I don’t know, 25 clinicians this point in the outpatient and everybody’s trained to in evidence based approaches to deal with the substance use piece of it. So whether that’s a deeply trained in motivational interviewing, so we can work with the find those internal motivations for to change right a variety of cognitive, behavioral, Dialectical Behavioral exposure based strategies to help people shift their relationship with substance. But part of what I think is most important is that all of our clinicians are trained to deal with the all the other parts of life that people are struggling with, because there’s almost always a co occurring thing that is coming along with the substance use. I personally and doing this for a very long time, I’ve never met somebody who just had an addiction, right? I just don’t even know what that
Holly Whitaker 18:10
looks which makes it secondary always, right? Like, doesn’t it in a think of it that way? Yeah, I do think of it that way. Yeah,
Speaker 1 18:18
if you anchor yourself in the idea that behaviors make sense? Yeah, right. So if I’m using a substance, there’s something over here that I don’t know how to I don’t know how to manage
Holly Whitaker 18:27
well, yeah. And because people that are managing well aren’t necessarily needing to alter their reality on a consistent basis, right?
Speaker 1 18:35
And a lot of them, you know, in the name of your podcast, co regulation, a lot of the problems that are under, underneath the substance use tend to be related to emotion regulation issues, you know? So whether it’s, I don’t know how to manage my feelings because of my trauma history, I don’t know how to manage my anxiety because I have a primary anxiety disorder. I don’t know how to manage my depression, you know, I don’t know how to manage my trauma reactions or my relationships, right, like so maybe I don’t know how to resolve conflict in my relationship. Maybe I don’t know how to manage intimacy in rare relationships. Maybe I don’t know how to have sex over right? So there’s all this. I don’t know how to regulate myself without substances. So substances are helping me do something. So we have to kind of ground ourselves in you got to figure that out, that underlying stuff, because that’s where people need new skills, new understanding, so that they don’t keep going down this path of substance use. We have to help them not need it as much. And that’s I, you know, unfortunately, there’s, you know, in the popular culture and in treatment, the kind of idea was, just get the substances out of the way, and life will, life will change. You know, just, just stay sober. Life will get better. To some extent, that is true. And a lot of people have a lot of other stuff they have to figure out. And if they don’t. They go back to the substance use, and it’s not because they’re bad people. It’s not because they don’t want to change. It’s not because they don’t care. It’s because they don’t know how to do things differently. And we have to have more compassion for that and understanding for that, and I think that’s where culturally, we still have a long ways to go, because that’s that goes directly to your relapse question, right? It’s like I’ve made a bunch of changes, yeah, and I’m returning to substance use for whatever reason. Yeah, right. There may be 15 different reasons, yeah, and I’m not going to talk about it, and I’m going to go underground with that behavior because I’m doing something wrong, versus being able to step back and be curious about, like, Huh, what’s going on for me, what’s going on in my life? That’s making me want to re engage with substances, but we don’t
Holly Whitaker 20:49
really, I think, like, it’s so interesting, because even though I am so well educated in all of this, when it happens to you personally, there’s just no way that, like, there is no I think it’s very hard to hold that. I can hold that for everyone else, but it’s very hard to hold that for your own self. Like, it’s very hard for you to hold that permission of, I’m just doing this when no one understands that right, like, very few people understand like, I think one of the things you haven’t said that’s so wild about CMC is that, you guys, it is called like, you know, Center for motivation, motivation and change, right? I’m like, but so there is the opportunity there for people to decide what their motivation is and what their outcome is going to be, right? And that is what is so like, how many other treatment programs right? Because you have an inpatient, you have an outpatient and you have outpatient therapy, yeah, right. So how many other treatment systems, outpatient, inpatient, whatever combination, utilize that approach that allows for a client to make their own determination about what the outcome is going to be.
Speaker 1 21:59
I wish I could answer that question again. I think, I think an increasing number. I mean, there’s more kind of of these kind of private practices and group practices and, you know, like in terms of the residential end of things, I think probably very far and few between. I don’t really know of any you know that will just entertain. I mean, you know, if somebody’s coming to residential level of care, we’re going to be trying to encourage you to take six months to a year off of all substances, just so that you can practice being sober, being abstinent, shift the things around in your life. But I’m not going to shame you, and I’m not going to scold you if you’re like, Yeah, I’m really clear. I don’t want to use cocaine and I don’t want to use alcohol, but alcohol, but I’m ambivalent about pot. It helps me sleep, right? Yeah, I’m not going to go into a lecture of how you’re in denial, or how that’s not real sobriety, or any of those things. And that does actually happen in other treatment programs. I’m going to be curious about it. I’m going to help you think through okay, what are the signs that that decision is risky, you know, or what are the signs that you’re self medicating something else or numbing something else, and are over reliant on whatever substance that you want to keep in your life? And one of the things that I’m always saying to people who want to keep substances in their life is I want to see that that wish has some flexibility around it. I want you to be able to take it or leave it. And if you’re saying, I can’t ever leave it, I have to have it again. I’m not going to say, Oh, see, that’s a sign of how addicted you are. But I’m going to say that’s a sign like it’s a little risky, you know, that’s it risky, and sense of what that that’s your only pathway to get whatever it is that that gives you, right? I want you to have more tools in your toolbox, yeah, and pot being your only way to achieve X, Y and Z, yeah. I want you to have some flexibility, because if it’s just this is the only thing I can do to get this. You’re at risk for needing more and more and more of it, you know. And you’re a risk for that, like taking up more space in your life in a way that I’d like to help you not be so dependent on it, right? Like, I’m just, I just, I often will say to people like, I just don’t want you to feel emotionally or physically dependent on anything, and
Holly Whitaker 24:23
why do you want them to not feel that?
Speaker 1 24:26
Because, again, like, that’s just the rigidity. It’s like, that’s my only pathway, yeah, to emotionally regulate, I want you to have a whole toolkit full of things.
Holly Whitaker 24:37
Because that toolkit that that widening and expansion, I’m just trying to, like, put this into, like, as much of a like definition as you can. That expansion is what, what does that give you in your life?
Speaker 1 24:47
Well, it gives you a fuller life, right? Because the things in that toolkit are likely behavioral. So, like, just stick with, stick with using pot to sleep, right? Like. Like, if that’s the only thing that helps me sleep and I’m in a relationship, odds are my substance use is probably having some impact on my relationship, right? My loved one may not love that I’m smoking pot every night to go to sleep. So, you know, Can I smoke pot sometimes and not other times and actually figure out how to regulate myself in that relationship and calm myself and soothe myself. And can I meditate? Can I stretch before I go to sleep? Can I practice good sleep hygiene, you know? Can I take some magnesium or melatonin? Sometimes, you know, so that I you know, so that you just have again, this wider, fuller life toolkit that includes behavioral strategies and relationship strategies to achieve whatever regulation that you’re looking for via the substance, right? I want you to, I want you to have more options available
Holly Whitaker 25:50
to you. And the intention is just like to get somebody to experience a fuller life and to have more joy in their life, and to have more options and freedom and all of this, more connection, right, more
Speaker 1 25:59
connection to themselves, right? Right? Because, if I can meditate or stretch or work out or go for a walk in nature and learn that, oh, I can calm myself down, I can soothe myself, right? Like, that’s a much sturdier place to be in the world than the only way I can calm down is if I have a drink, right? Like, that’s a pretty rigid pathway, right? I want you to have and and it’s numbing, right? So the only way I’m calming myself is by having a drink. That’s a numbing you’re putting a chemical in there to regulate yourself. Versus, there’s 10 behavioral strategies that you can use that help you regulate yourself, you know, or regulate yourself in a relationship. Because you feel connected, you feel safe, you feel you know, you can venture your loved one and get it off your chest, whatever it is. So that’s part of what I’m looking for with people all the time.
Holly Whitaker 26:53
Yeah, and you primarily work with, like, what percentage of your work is with families, and which percentage of your work is with, like, people that are actually in addiction or so struggling with addiction,
Speaker 1 27:02
well, in both of the treatment so there’s two, there’s three. I have three children. I have the like my my 22 year old. The outpatient department, that is, you know, works with people who are staying in their lives. And we work with people everywhere, from 15 years old to 80 years old and their families. The residential program is my middle child that’s been around about 11 years now, and that’s a 15 bed facility up here in the Berkshires. And every client who’s here, we’re working with their family in some way, assuming their client, the client, wants that to happen. And then my favorite CMC child, I know you’re not supposed to have favorites, but I do is our nonprofit, which we started that about seven years and that ago, and that is really grounded in getting these evidence based ideas and strategies into the hands of family members and lay people, so that we can really shift this cultural norm that we started out talking about, which is like, if laypeople and family members actually know their loved one has options, that there’s a lot of different ways to approach this problem. There’s different ways to understand this problem. You can use communication strategies that lower your loved one’s defensiveness. You can learn reinforcement strategies that create an environment where your loved one can change like that’s how we change the world. And I say this all the time, there’s never going to be enough treatment providers ever to support the people who are struggling with substance use. So if we can empower lay people with effective strategies, we’re going to have such a bigger impact. So that’s what the nonprofit is designed to do and, yeah, success, which is
Holly Whitaker 28:43
cool. Well, I mean, I think it’s so interesting because what you are just describing is as a support system for the person that for the page, they identify patient, right? But I think what’s so important about your work with families is that you’re actually working the families are kind of the patients as well, right? Like it is, what I find about your method and your approach, is it allows, and it offers, like an invitation in for individuals that are trying to support somebody to do their own work and to see it as like also their opportunity to make some changes themselves, right? And so it’s more, it’s less about everyone’s attention on the one sick person denies all of their potential stuff and, like, inviting families in to be part of the be part of it, right? Like, it’s, can you talk a little bit about
Speaker 1 29:34
that? Yeah. And, I mean, I think I would start with, like, when you said, like, the families the patient. I literally felt myself have a like. It was like, Ooh, I don’t actually, I don’t think of them as a patient. And I think that’s part of the difference, because we’re not grounded in the disease model approach, and we’re not looking at everything as like, here’s a sixth person with a disease, and your family has a disease of codependency, too. Do you know people have used substances like forever and ever and ever? Right? Like humans like to be altered. There’s all sorts of all sorts of reasons why that’s true. It’s a and part of what people are doing when they want to alter themselves with substances is they’re trying to reduce their suffering, right? So the other thing we humans don’t do well is managing manage our suffering. So when I think about these problems, I don’t think of it as like sick people with diseases and my patients versus not. It’s just like we’re all just human beings trying to do our best. And if we can help you, be curious about what you’re doing and why you’re doing it, and curious about alternatives, and if we can help your family be curious, are there things that we can do differently that connect us and help us regulate and help us shift behavior? Great, let’s do it. Let’s learn these new things you don’t have to accept. You have a disease. I’ve never in my life said somebody had codependency. When somebody says I’m codependent, I’m like, I have no idea what that means. Tell me what it means for you. And it’s a bazillion, you know, you line 10 people up, every one of them has a different definition of what that is. Yeah, you know. So just like, Why use the word? It just white washes the complexity of this. And I really want your listeners, and I want all of us to just stay grounded in the fact that this is so complex, we want to make it simple, and it’s not. And every single time you try to simplify it by saying these black and white answers, you’re missing, you’re missing someone’s reality, and you’re missing the opportunity to help them or help
Holly Whitaker 31:41
their family. Oh, be curious as well, right? Yeah, yeah, all right.
Speaker 1 31:45
One of the things that I say to people is that everything that and I wasn’t conscious of this, but so much of what I’ve participated in creating is coming out of my own anger response about what was available, and it started in graduate school. I mean, actually started in my childhood, but we can go back to that. But in graduate school, you know, I went to a pretty traditional psychodynamic, great psychology program, but one of my last clients, you know, you have clients that you work with your last year, and you know she was coming late. She all my supervision was around her trauma and avoidance and everything, everything. My last session with her, she told me she was drinking two bottles of wine a day. I had never been so she was an alcohol withdrawal the whole time. I had never been trained to ask about substance use. I didn’t know how to deal with it. I literally felt, I still feel horrible about that, that working with that person, because I failed them massively. I failed them massively because my training program didn’t teach me how to assess for or be curious about substance use. So I just was like, okay, that’s never happening to me. So then I went to an addiction treatment program, and as a young psychologist, got into this addiction treatment program, and was kind of really like, I was like, wow. Like, people were really confrontational with patients. You know, I worked on a detox unit, and people were like, the clinicians were, like, yelling at the patients and mocking them, essentially saying things like, All right, we’ll see you next week when you come back. You know, just like, horrible kind of mocking of the clients. And I just was like, I don’t even none of this feels therapeutic to me. And at that time, you know, the mental health program was very separate from the addiction program. And if you had a mental health issue and got into the addiction program somehow, they would be like, Oh, we don’t know how to deal with this. It sends you back to the mental health program. You try to talk about your substance use, and they would say, Oh, we don’t know how to deal with this. So you’d end up with these clients just being shuttled between the two programs, with neither one of them being able to fully address what they were struggling with. And then at that time, the methadone program was completely separate from the Substance Use program, and they wouldn’t, because the groups were abstinence only. They would not allow clients on methadone in those groups because they were on a medication, you know, that was impacting their opioid receptors. And somehow, in the in the counselors minds, that was those clients were not abstinent, so they couldn’t
Holly Whitaker 34:26
be in the apps, like, 20 years ago and, like, it’s, this is in the 2000s
Speaker 1 34:30
Yeah, yes, not that long ago. So, you know, Jeff had me try to, I was one of the first therapists who tried to integrate a woman, from the methadone program who desperately wanted to be in a group therapy, and she did great, and we did great, but it was because I was able to sit with the fact that she was on a medication, and she was using a medication in a way that was, like, incredibly helpful for her and changing her life. But it’s just kind of mind blowing to think that that was not allowed. Occurred as recently as 20 years ago, and there’s still programs now that don’t want people on buprenorphine, you know. They don’t want people on buprenorphine. They won’t put people on you know, other they won’t allow people to stay on stimulants if they have ADHD, you know. So there’s all sorts of rules around medication still in these programs that are abstinence only. So the system hasn’t changed that much. But in terms of my childhood, I grew up in the middle of nowhere in western Kansas, on a, you know, in a lovely farming community, but I grew up with several women who had significant trauma and were using alcohol to manage their trauma. I mean, nobody knew that’s nobody knew that’s what was happening, but that’s what was happening. And I just remember feeling, I remember how they were looked at. I remember how they were whispered about. I remember how, you know, there was all that moral judgment in terms of, you know, their drinking, their drinkers. And remember feeling like, that’s not it like that’s, that’s, that’s not what’s happening here. And I didn’t, I didn’t have words for it as a as a young person, as a teenager, but even back then, I’m like, they’re drinking because they feel bad. Like that’s what’s happening. They feel bad. I don’t know why they feel bad, but they feel bad so so they I think it goes way back for me this, like, wanting to understand why somebody’s doing what they’re doing, so that you can help them with the underlying, underlying issue. I will say that unconscious is very powerful, and then I somehow managed to become an addiction and trauma expert over the course of my life. I’m like, yeah, there’s all sorts. I
Holly Whitaker 36:38
started this by saying, like, one of the things you’ve had to work with is your anger on this. On this. And what is it? What does that like look like, and what, what is it
Speaker 1 36:46
at? Well, just the injustice of it all, you know, like the black and white lens and the moralizing. You know, when we look at people with these struggles and we assign, assign bad judgments to them, like, it’s just, it’s not good, yeah, makes me furious. We’re just not helping people like and it’s just makes me furious, because it doesn’t have to be that way. Yeah, it really doesn’t. So I get angry at the injustice of it, and the the lack of compassion for the humanity that is in everybody who struggles, like it just, are we just humans who struggle? Everyone
Holly Whitaker 37:24
struggles. And this is kind of the like thing I was trying to say earlier, which is, like, one of the things I’ve been thinking about is just like the scapegoat ism of it, all right? Like the need, like, thinking even just about these women and they’re like, Oh, they’re drinkers. I mean, we need people to explicitly be out of control or wrong, so that we’re not like we need the scapegoat in our society to point to and say, well, that’s the problem, so that we don’t have to look like at our collective issues with with, for sure, rampant addiction across the board, in like almost every place you
Speaker 1 37:54
look, no and if you look at the statistics for people with substance use issues, you know the statistics of people seeking treatment who also have PTSD anywhere from 45 to 65% right? So instead of looking at like, wow, how are all these people traumatized, and what is going on in our families, what’s going on in our communities, that we have a bunch of people who are traumatized, self medicating. You look at the numbers of treatment seeking individuals who have neurodiversity and ADHD similar 40 to 60% so what is it that
Holly Whitaker 38:32
these, or even like, as you said, learning disorders or processing issues, right? Like dyslexia, there’s a huge correlation. There’s a huge correlation. And I mean, hormones is another big bucket, right? Of like, we know that women, when they start perimenopause, like, have higher rates of return to use or develop or
Speaker 1 38:49
starting or starting to drink. Yeah, yeah. But so we don’t have to look at those kind of failures in our system in terms of like, wow, we’re not helping a whole host of kids with learning disabilities and ADHD, and pretty quickly they’re realizing, cigarettes help me, yeah? Cannabis helps me, yeah. You know these, these kids with higher rates of neurodiversity, they start substances earlier, and again, because they work, they’re not bad kids. They’re finding substances that work for them, and then they’re using substances at a period of time where their brain is developing and then not developing because they’re using substances, and then they pop out at 35 years old with a very serious addiction problem. They’ve skipped over a huge amount of learning. Their brain has like been remodeled because they’ve been using substances the whole time. But again, like going back to your point, as a society, we don’t pause and bring any curiosity to what is it that’s happening in our families and our schools and our communities that people are needing to self medicate like if we can generously pause and be curious about that stuff? Again, that. How you prevent addiction.
Holly Whitaker 40:17
So I interviewed you last May 2024 and like you’ve kind of already touched on this, but I went to go see Carrie as part of, like research for this book on relapse. And this was also kind of my beard, of like I was using pot, and it gave me this radical in to meet with addiction specialists. And like people like you right? That are, you know, are like Katie wickowitz, who are leading the, you know, change, I think, in our society, and have really generous ideas about relapse, or ideas about addiction in the first place. And so I came to you, you know, to in the course of writing this book, to ask you and Jeff, you know, a bunch of questions. But it was also here, like I told you all before, I publicly wrote and and talked about, you know, my own return to use, or my own cannabis use or whatever. And I, you know, I just recently did this. I started to use pod again in like, mid 2022, and I want to, we’ll talk about that on a little bit at length. But when I was talking to you all, it was still for me, like very much, like I there was no one in my personal life that didn’t know I was very open with it, but I was not open with it, with the public. And I had also, you know, written a book that, at that point had sold hundreds of 1000s of copies, that talked about me not using pot, that talked about, like, my advocacy of, like, abstinence only and sobriety and and so I had this, like I was in this kind of place with it. And so one of the things I wanted to talk to you about during that, one of the questions I asked you, is why I felt no shame around the fact that, you know I’m, I’m, I formerly was a bulimic. I have had periods of time in the last few years, especially during the pandemic, where I benched and purged again. And I, you know someone, I talked about that at the time, like I talked about it on a podcast I was being interviewed on, and I just it was like, blip, no, no, I didn’t feel the second I benched and purged that I needed, that I was lying, and that I needed to go onto social media and tell everybody that had read my book, you guys, just so, you know, you know, like I did this thing, and I just was completely divorced from it, but when I started using POP, kind of the same idea that’s in the same ballpark, it’s a behavior that I used to engage in that wasn’t healthy for me, wasn’t a net positive, I felt like I owe that information immediately and that I was lying, so long as I kept using it and wasn’t disclosing that I was using it. And I’m wondering if you can talk just a little bit about where that comes from, like, where that piece of it comes from, why do we have these really, like, binary ideas about lying at like, specifically, or this shame specifically around drug
Speaker 1 42:59
use? So can I? That’s a great question. Can I be a good therapist and ask you why you think it was different for you?
Holly Whitaker 43:09
That’s like a million dollar question. I think that because it felt like, of course, I binged and purged again. You know, of course, I went and and back to old behavior in the middle of the pandemic, you know, like it was a fucking pandemic, and it didn’t that didn’t feel like a choice, like it didn’t feel like, oh, it made a I’ve made a choice for something that I shouldn’t be making a choice for. One felt like, Oh, you’re just doing this. It really feels like 80 you know what I mean? Like, even though I know I’m diagnosed with ADHD, it doesn’t mean that I don’t feel like shit when I’m late, or that I don’t feel like shit when I forget a deadline or don’t text someone back for two weeks, and I think about it every day. You know what I mean? Like, I feel like shit when those things happen, even though there’s a complete, like, logical explanation. And I was talking to someone the other day about this, her daughter is autistic, and she’s ADHD, and her daughter’s autistic, and ADHD, she doesn’t tell her child’s teachers that her kid has ADHD. She talks about the symptomology of it and says they’re diagnosed as autistic because ADHD is not really seen as a real fucking disease, right? It’s just something you’re doing. And I can’t put a word to it, I can’t answer the question, but there’s something around there where, even though I logically know I’m making this choice, I’m doing what I want to do with my body, I’m doing I’m an adult, and I trust myself, there’s something in it that feels inherently like I should feel bad about it, and I did feel bad about it. I mean, felt
Speaker 1 44:43
horrible. So I have ideas about it. I don’t know if this is true for you, but I think if you’ve spent any time in kind of the again, the more traditional abstinence only, kind of 12 step. Disease model spaces, whether it’s treatment or through self help, there’s a little there’s a little bit of that kernel of any substance use at all means you’re no longer sober and you’re back to square one, and there’s something really bad happening here, like it’s just that narrative is very powerful. It’s reinforced a lot. And then the world, everybody knows about AA, everybody knows about the disease model, everybody knows about you know? So, so whether you’re in that space or not, most people have ideas about it, yeah. So yeah, if you return to substance use after identifying as somebody who’s been sober or decided to abstain, if you kind of return to substance use, there’s a little sneaky, little sneaky narrative that’s kind of running around in your head, typically, which is, this is really bad. I’m failing. This is really bad. People are going to judge me. People are going to think, I’m back to square one. People are gonna think, say, people are gonna think, blah,
Holly Whitaker 46:03
blah, blah, right? It was my body. They’re not gonna, I mean, like, and for me, it had these, you know, knock on implications, but, but,
Speaker 1 46:09
you know, like, it’s a, it’s a funny thing in this space, and it’ll just, you know, you were so generously talking about your own bulimia, like when I first started CMC, a lot of other treatment providers, you know? Because again, back 20 years ago, most treatment providers were identified as being in recovery. And you know, they were, I was kind of their frame. And people would just flat out. They’d come and talk, want to talk about CMC, or they’d want to come market their programs, and they would ask me, am I in recovery? And I would say, why does that matter? Like, what are you looking for in asking me that question? And it was always like, do you identify? Do you identify with Do you understand people with addiction problems? You know, because if you’re not in recovery, there is kind of a belief that then you couldn’t possibly really understand what it feels like to be out of control, what it feels like to have a quote, unquote addiction, and I would always say to them, so the thing I very much identify and understand what it means to be out of control. I had terrible bulimia at the beginning of college, like I had my head in the toilet like multiple times a day. I was completely out of control and felt horrible about it. I never talked to anybody about it. It barely came up in my therapy. I worked on it, I resolved it, but I don’t so I don’t identify, and never have as somebody who had an addiction to food. It was a thing that I did during a period of my life for a whole host of reasons, but because I never identified that it didn’t become my identity.
Holly Whitaker 47:44
Well, you and I had the same experience, like, I think that, like, there’s a lot of people I know that don’t drink, right, or have gone through some kind of, you know, like, there’s, there’s a statistic. I think it’s like 52% of people that have had and his like, a substance, a history of like, substance misuse, natural recovery, right? And they don’t identify, or, just like, they don’t identify, only 48% of people that have had some sort of addiction to a substance or some situational like misuse, whatever. How do you identify it now, like I am so all over the place. Is it like substance misuse? What’s How are we supposed to be saying it now, is it substance use
Speaker 1 48:22
disorder? Yeah, substance use disorder still really like to have the disorder stuck attached to everything
Holly Whitaker 48:27
but, but like for only 40% of people who have had, you know, qualified for having a substance use disorder identify as being in recovery, right? And so that goes to show you, like it’s just like for me, because I took on there could have been someone that just stopped drinking 10 years ago, you know what I mean, and they’re not having this internal dialog. But it’s interesting that you said people that have been through traditional programs. Well, I didn’t go through traditional programs. I created my own program. It was completely like meant to counter this narrative about right? Because, but you understood the narrative, but I understood but the thing is, but no, but actually, I think when, you know, like, having a lot of time to reflect on this, it’s that I was in recovery. It’s that I was in the scene of recovery. And like, I, you know, there’s this one experience that I had that, like, just really paints a picture of it, like I was interviewed by a woman that identifies as being, you know, sober, and is, I believe in the program she interviewed me, and in between the time she interviewed me and the time she posted the interview, I posted an article about using ayahuasca and using psychedelics, and she disclaimed in our interview that I had recently admitted that I use Drugs and that she wanted to, like, trigger warn her audience, in case they found that out about me, and that she was platforming my work because I’m no longer whatever. And then went on to say that she’s like, you know, doesn’t what she doesn’t do and what she does, and that she’s sober from the neck up. And I think that, like, Oh my God. Like there’s just this,
Speaker 1 49:58
like, how those judgments come in? And so easily, but
Holly Whitaker 50:01
that’s what I but what I’m saying is that’s the water I’ve been swimming in. And even so, even if I have these really radical ideas, I think when we’re in recovery, we just like, kind of start, like, internalizing these ideas about ourselves without even really acknowledging it or noticing it anyway.
Speaker 1 50:18
Well, and I just want to make a plug. I do think, and haven’t quite figured out how to resolve it for myself, but I think so many of these words are traps, you know, like, just the are you in recovery? Like, it trapped you in a certain space, right that then made it so that you couldn’t have all of these other experiences allowed. Like, I just, it’s kind of fascinating to me, the labels we assign to addiction, stuff in particular, that really trap people in these black and white spaces. Of like, you have to be sober or not in recovery or not motivated, or not. Yeah, right. Like, it’s just like, it’s just not how behavior change works.
Holly Whitaker 51:04
But that, the thing is, I can go all the way about the labels, but then I get to in recovery and I’m just like, Oh, but I don’t know about that one, because being in recovery is a framework that gives an order to my life. Is something that I feel is a structure that has served me greatly, and is also something that I found to be, given my recent experience, entirely problematic. And so it’s this kind of tension, and this kind of brings me to the next question I want to ask. You know, I think that I wrote this out, so let me just read it like for me, it’s been a really hard come around on the idea of moderation, right? Not in, not in what I my work. I think that my work has consistently and more over time, right? I think, like I probably came in with some more black and white binary ideas, but over time, especially with exposure to so many people with so many different, you know, recoveries. And I, you know, we’re not even recoveries, but just experiences. I really, you know, feel this. I don’t know. I’m a, I’m a libertarian when it comes to like our bodies, you know, I just believe that we should never like we have, should have 100% control over what we do to our own fucking Corporal being given that it doesn’t hurt anyone else, right? But I feel that when it comes to moderation, because I don’t think I could moderate alcohol, like, I don’t think I could, or maybe it’s that I wouldn’t even try to moderate alcohol, or wouldn’t want to try, like, I think it’s a fucking horrible drug. But I had this idea about moderation, this outward looking, but then also probably this, like, kind of close to the vest judgment around it, like someone recently, a couple years ago, wrote an article asked me a question of, is it possible to moderate alcohol? And I wrote this essay that kind of haunts me about Sure, of course you could, but do you want to? You know, and I think that, and maybe it doesn’t haunt me as much, but I feel like I probably wouldn’t write it the same way in it, I’m just like, abstinence is just fucking easy. Like, I think that when you are trying to moderate alcohol, you are thinking about alcohol, you are spending a lot of energy trying to manage a substance that one or two drinks in, becomes harder and harder and harder to control, right? And so it’s, you know, why not just do away with the whole thing? And so anyway, but when I started using pot, right? And I had, I have, like, a complete rethink about this, I still feel compelled by this idea that I needed abstinence, and that I might still need this complete idea of abstinence, or maybe, like, want that. I think it for me, it likely is going to be the less stressful solution for me in my life, the easiest solution for me. But there’s so many thorny questions that come from that, like, for instance, how I was in active addiction with alcohol. I needed, you know, this really, really tight structure. I needed to feel like I needed to be scared shitless about alcohol. I needed to be kind of told. I needed to say I was an alcoholic, even I needed to, like, all of this stuff that I now look at and I’m like, wow, that’s really harmful. It was stuff that was really, really important to me when I was trying to navigate, you know, what was a pretty wicked addiction to alcohol. And so I know many people like that feel that AA is, you know, like they wouldn’t that was the only way for them, and then maybe later on, they evolve out of it, and they have looser, you know, flexible things. And I think for me too, I had my having a tighter beginning gave me, like, gives me more space now, right? Like having more rigid, like being afraid and following all the fucked up rules was, like, in a way, kind of beneficial having the forcing function of, like, you know, you have an alcohol problem, so you’ve got to stop drinking alcohol, you know, and all these things that get drilled into an early sobriety, again, harmful, when you think about it, in the long run, but, like, very helpful to somebody that, especially because addiction, like, deconstructs our prefrontal. Cortex and our executive function and our ability to actually, like, see reason. So I guess, like, my question is, how do you navigate, you know, like, if someone’s, like, severely gone, right, like, like, pretty far out there, in in deep addiction, how do you, I guess, like, navigate the tension between what’s helpful, like, being in recovery could be helpful, and then it could not be helpful for earlier stages versus later stages. Do you understand what I’m asking?
Speaker 1 55:27
Yeah, and I’m just gonna be a broken record and go back to that point I made earlier which is, this is really complicated, and it’s really different for every single person. So your journey, right? Right. So when somebody says, is moderation possible? Like sending you a question, I have no idea. I have no idea it’s possible for you. I would have be irresponsible for me to answer that question, because I don’t understand your learning history. I don’t understand the impact the substance has had on you. I don’t know what you’ve tried, what you’ve not tried. I don’t know what your environment is like, right? So there’s all of these complexities around what look like. Simple questions, can you do this or not? Right? The and then going back to what you said about those kind of early strategies that you used to shift your relationship with alcohol, you created a certain learning environment for yourself, right? By kind of accepting, I’m going to, I’m going to accept these rules, right? These rules that I can’t have any alcohol. I need to do X, Y and Z to build my sober life, you know, like whatever it was, you know, there were probably really good guard rails that helped you create in an environment where you could learn new things. Yeah? So you took the alcohol off the table, yeah? You said, Yep, I’m not going to do that. I’m going to commit to that. I’m going to commit to it every single day in a variety of ways, right? I’m going to remind myself that’s my goal. And then you gave yourself a bunch of space to learn new things, how to be in your body, how to deal with your emotions, how to deal with your attentional issues, you know, whatever it was, right? So those, though, and I think that’s one of the things that the 12 step community does in a masterful way, which is, like it says, Here’s a community of people with similar goals. Here’s a foundational set of rules that help give you some space from this substance. It’s destroying your life, right? Yeah. And we’re going to give you all sorts of things to connect with. You can connect with the higher power, you can connect with the 12 Steps. You can connect with other people, right? So you can connect with lots of things that help you disconnect from the substance, right? So that’s a great learning environment. If that worked for you, fricking awesome. It saved millions of lives. I’m not going to take that away, and I’m not going to say, don’t if that identity and if that structure helps with you. Great. Where I struggle is when that community assigns that to every single person with the substance use problem. Because what we know is it does not work for everyone. And we know other people have underlying issues and other pathways that they have to they’re essentially on their own journey, right? And some people, I mean, there’s people that I’m like, your life would be so much better if you took substances off the table, and they’re just not going to do it. So I’m not going to again. I’m not going to shame that person. I’m not going to, you know, I work with this family who, you know, it would be amazing if their 27 year old son would decide to abstain from all substances. He has schizophrenia, and he has ADHD, and he has a whole host of other problems. He’s not going to abstain, at least right now, and they’re not going to cut him off and they’re not going to disengage from him, because what we know is that engagement and connection supports behavior change, so we want to find ways to stay engaged in ways that are supportive to him. You know, like, how do you not inadvertently end up paying for the pot he shouldn’t be smoking, and we wish he didn’t smoke, right? So we can wish for abstinence. That’s not where he is right now, and I’m not going to shame him, and I’m not going to not work with him, because his goal isn’t in line with what I think it should be, right? I’m going to keep I’m going to keep chipping away at it, and they’re going to keep chipping away at it, and that’s not enabling, and that’s not being codependent. That’s working with the reality of their son and their family. And I think that again, just always going back to this is really complex. Every single person with the problem and their family, they’re dealing with really complex things, and we’ve got to slow down and be able to help them figure out what variables in their environment and what variables in their relationship, and then their lives need support and potentially change so that things can can go better,
Holly Whitaker 59:51
that all makes sense to me. And still, if it’s all complex and there’s no answer and it’s all you know, individual based or. Yeah, we still need universal frameworks. Like, we still need like, you can’t like, if somebody’s like, I have an addiction, what do I do? Like, well, that’s, there’s no answer, because it’s all, you know, personalized and like specific to you. I think that there’s, there has to be some way that we capture this, to break it down, to make it simple for people to be able to engage with this that feels like attention to me of how do you give people information of how to engage with something you know, like a lot of my work, has been steeped in the first thing is this, you know. First do this, you know, and then do this and and trying to give it to as wide of an audience as possible, so that people can actually because so many people just don’t, right, so many people just don’t and there is something that feels like it makes it easier when you give people things they can understand.
Speaker 1 1:00:55
Well, so I’m going to do two things. I’m going to just observe the anxiety in you when I don’t give you a specific answer, right? It’s literally you can feel the fear, yes, like you want an answer, right? And that’s part of I think, what happens around people with addiction problems is it is incredibly scary, and they are doing a massive amount of damage to themselves and sometimes their families, and it’s understandably very scary, right? And so we want to control and we want to give rules, and we want to give very specific advice. All I’m saying is that when you get in that mindset, there’s a whole host of people you’re missing, I promise you, that are not relating to the rules, right? Yeah, so for whatever reason, maybe it’s just as simple as neurodiversity. Who knows? So the invitation to change approach, which is our approach at the Center for motivation and change, is grounded in a set of evidence based strategies, but that are applicable to a wide range of people, so and the core one being just this idea of behaviors make sense? Yeah, right. So if you can pause understand what is the substance use doing for that person, let’s just understand the behavior, because if we understand the behavior, then we can identify alternative coping skills, things in the environment, things in their relationship that could shift and improve so that they don’t turn to the substance use, right? So that is a foundational understanding what’s going on with this person you know. So behaviors make sense, being able to give them a menu of options so one size does not fit all right. So you person with ADHD need something very different than you person with horrible early childhood trauma who can’t sleep and has flashbacks every time you have sexual intimacy, right? That that person’s going to need something very different versus the 55 year old guy who’s or the 70 year old guy who just retired and doesn’t know how to manage retirement, right? So those, those people all need different things. So if we can behaviors make sense, one size doesn’t fit all be able to kind of accept that change is like, really hard. So like understanding, like, I have to have some self awareness of my emotions, my values. Like, what do I care about? Why would I want to change? Like giving people permission to identify what kind of person do I want to be, so that I can again shift my behavior so that they’re in line with that. And then think about all the communication and behavior, communication strategies that improve relationships and behavioral strategies that improve again, going back to that regulation, how do I take care of my body? How do I regulate myself, and how do I regulate myself in my relationships, so that I feel connected? So there, there are a variety of there’s a framework that you can take with everyone. But again, if you really want to help people, you’ve got to be able to give a frame that works for lots of different variables
Holly Whitaker 1:04:03
totally, which is so like, and I want to just point out here that your first step right, step one is behaviors make sense, right? Like, step one is identifying this and normalizing this is happening for a reason. Step one, in traditional frameworks, is diagnosing and admitting, right? It’s diagnosing the issue, either self diagnosing or being diagnosed, and then it’s admitting and accepting that you have an issue, and then it’s resolving the issue, right? So I think one of the things that, like, I am always pushing toward is like, I do want, I want to categorize, I want to put it into buckets. There is a lot of anxiety, of course, around this, there is a lot of fear on, well, what are the answers we need to be able to be able to give the answers without the answers. It’s just dangerous, right? Like, you’re just gonna be flying out there. But I do, like, for me, my brain just always needs to categorize and it needs to, like, make things concrete. And I think one of the things that just this has been a tension, like in our conversations consistently, which is, like, I want an answer, right? And I was. Like, when we were talking, I was like, What’s relapse? And you said, Well, you changed your mind. Like, that’s what relapse is, right? Like, you changed your mind, that’s it. And like, the the refusal of like endpoints, right? Of like, this is an ongoing, I think the hardest thing that most of us deal with, right, not just people in recovery, but especially like people around people in recovery, is that it’s a process. It is not something that just ends once you stop, you know, extinguish, one behavior. It’s like an ongoing process that shifts over time. And part of that process, like for I think, 80 something percent of people, just in like, it’s 82% and a study was reading yesterday, really, in alcohol, 82% of people will have a relapse event, or will have whatever will drink, a drinking event after treatment, after within the one year of treatment. And I think it’s like that is seen as like a standalone event, right? Like you had the sobriety now you have the relapse. Versus this is just a continuum, like this is just a behavior. This is the process of behavior change over time.
Speaker 1 1:06:05
Do you remember what else I said when we had that interview? Which is, I really, really wanted to help you not use that word relapse, because, again, it just it pigeon holes. What is a very complex behavior? It’s a return to an old behavior. Yes, right? Yeah. That could be a one time event, that could be a repeated event, that could it could be a whole it could be, well,
Holly Whitaker 1:06:25
it doesn’t if there’s no, I mean, there’s no standardized definition for what a relapse is, right? It’s like, there’s so many different ways that people can interpret
Speaker 1 1:06:33
it. It’s just a like, it’s just some event happened or a So, it’s an old behavior. Old behaviors are always in your memory bank as working right, because they’re so going staying grounded and behaviors make sense, right? So alcohol just stay with that. Since that was your example, alcohol worked for you in some way that was deeply meaningful, deeply compelling. You kept doing it right to the extent that you had a problem with then you decide to take it out, and you learn a bunch of new things, and you try to build a life without alcohol. In your memory bank, there’s still a little pathway in there that says alcohol works for whatever social anxiety, whatever, right? So it works so that awareness doesn’t ever go away. It’s in there. Hopefully you’ve learned a bunch of new behaviors that work as well. You know, even better, ideally. But something happens, like a holly series of events can kind of stack up where it’s like, you know, my best friend, such and such, is there. I’ve been sober for two years. Maybe, maybe maybe it’s not going to be such a problem again. You know, people have all sorts of thoughts. They have all sorts of external kind of people, places, things, all those kind of things that set you up for deciding, I’m going to try it out. I’m going to try alcohol again, right? I’m just going to see how it goes. So you’re returning to an old behavior for a bunch of different reasons. Maybe it’s going to work. Maybe it’s not. I think the problem for me is that when we call that a relapse, and if you’re if you’re operating under the Yep, you relapsed, yeah, so that’s a bad thing, yeah, bad thing you just did there, yeah, you’re going to want to keep that behavior underground. You’re going to want to keep it to keep it to yourself, and you’re going to hope it works out right then, if it’s not so if, if you can just say, yeah, you went back to an old behavior that worked for you at one time. Did it work for you this time? How’d that feel? What was your experience? Do you want to do that again? Like, what was happening for you that put that behavior back on the table for you, right? So if I’m framing it as, yep, you went back to an old behavior that worked for you at one time, let’s be curious about why that came back for you. Like, what was going on? Why’d you think that was a good idea? And then being genuinely curious of, like, did it work? You know, it’s funny the number of times I say to people, like, so did it work for you? Did it work like you saw what was going to work, and they’re like, No, it didn’t, you know? I’m like, okay, great. Do you want to keep doing it right? But so I’m creating a frame where the person can talk to me about it and be curious about it with the people in their lives and within themselves, versus being like, Ooh, I did something bad. Need to keep that to myself, it’s gonna stay underground, and maybe I’m going to try it again, and, you know, like, I’m just gonna wrestle with all of that below ground. Yeah, that is what I’m always trying to disrupt. I want to I want to create space where you can tell me anything, because that’s allowing you to tell yourself anything and actually be really curious about it. Because when we talk about things and we share things out loud, it puts a different perspective, you know, like, if you keep something inside, you can kind of talk yourself into a lot of things the second say it out loud, you’re like, oh, that sounds like a terrible idea. So I want you know. So what we’re trying to do is create spaces where in the therapy relationship. Somebody can tell me what they’re actually thinking, what they’re actually planning, their ambivalence, whatever it is, I want to create space where they can talk about that. I want to create space in families where families can talk about that like, oh, oh, you’ve decided you want to try to reintroduce drinking. Why? What’s happening? How do you know if you’re going to do that? How do we make sure it’s not a problem again, right? So, so the conversations are above ground and collaborative, because that’s where real change can happen. And you may decide, Yep, that was a really bad idea. I don’t want to do that again. Make me feel bad, or, yeah, the second I did that, I felt terrible the next morning and said things that I regret. I don’t want to have that happen again, right? So it just creates a different dynamic around behavior change. And that’s, you know, it’s like figuring out how to be a good coach to yourself and have everybody in your life like, Be supportive, good coaches, not like the,
Holly Whitaker 1:10:54
you know, like, but again, I think, like, yes, 100% and like, how many people in our society give people that have a substance use issue that latitude. It’s it’s so I have had the consistent experience that very few people around that individual understand, like they’re constantly having to address the misunderstandings that exist around them and the decisions that they
Speaker 1 1:11:19
make. And you know, like, you’re going to have listeners who are like family members who are like, I’m not going to give my loved one that space. My loved one was ruining our family and ruining our life, right? You know it’s like, I’m not going to create that space. And you know, the family members who learn craft community reinforcement or the invitation to change part of those strategies are learning communication strategies that, again, create the space for you to have a collaborative conversation with your loved one, which gets them talking so you understand them better, and allows you to say, You know what? I understand. I understand why you might be wanting to introduce that. I really, I totally get that. And I just, I wouldn’t want to be around you if you’re drinking, yeah. So yeah. Then create space where you’re validating a reality, and you’re setting your own limits gracefully and collaboratively. And then you can say, You know what? So if you’re going to decide to re drink, I’m just not going to go to that event. So it’s not creating space where you’re like, Yep, we’re going to run every experiment here together. It’s actually being able to say as a loved one, these are my limits, and I think this is a really bad idea for you, but doing it in a way that your loved one can hear yeah and potentially take in, versus the shaming, the scolding, the lecturing, all the things that understandably happen when people are mad and afraid, right? They they want to lecture you into not doing that right, and then that again, that behavior goes underground. I want to do everything I can to keep behavior above ground, because that’s where we can observe it. We can be curious about it. We can find alternatives to it, and we can give you space to learn new things. Yeah, if it’s underground, I can’t touch it. I can’t Well, I mean,
Holly Whitaker 1:13:04
and that kind of comes to, like, I think the last thing I want to talk about here, because we’re coming up on time. So, you know, for me, I think that the using potigan was, like, a huge rupture for me, right? Because it was such a good, healthy thing for me, but it really exposed the extent of, like, my own fundamentalism, right, like that was applied against myself, and these like same tropes that I’ve been trying to kind of dismantle culturally in my work, that I was turning inward toward myself. And there’s a lot that goes into this, but I think, like, the easiest way to kind of pull this is that a lot of my recovery was really stitched to my work in recovery, and I think that this is a common thing, you know, I’ve like done a lot of research on the history of recovery, and it’s like one of the original things is like just schlepping people that were just barely sober into roles to help other people get sober that were then cast into these roles where if they got sick, it was not just or not got sick if they used drugs again. They would, it’s their job security, it’s serious. It’s their, you know, esteem and their, you know, whatever. And so I think for me, there was such a tethering to my work and recovery and my visibility as being somebody that had identified as sober and as like the model, I really used myself as a model. So I think that there’s, you know, baked into this. There is I lost my job, you know, like I was running a recovery company and I was the brand on the face of it. And I lost my job in a humiliating way and a cruel way, and I lost my community. I had built that company as a way to, like, create my own, aa, you know, to create what I couldn’t get because I wasn’t doing the program, and as a way to belong, even though I wasn’t doing it the way I was supposed to do it. And then I got thrown out of that community, you know. And so I think, like, that’s just one thing that happened. There’s also the pandemic. There’s also, you know, like. As soon as I published my book, quit like a woman. I had a massive pushback from the public around an article I wrote called The alcohol you know, the patriarch of Alcoholics Anonymous. It was like kind of canceled within the recovery community, and also just really uncomfortable in my position. So there’s just just that alone. But then you add into this, I had an ADHD that was undiagnosed and untreated, I didn’t get diagnosed until 2022 so I got sober in 2013 and I was stripped of my coping mechanisms. I used pot primarily to manage ADHD 100% like and I used alcohol and all these other things back in the day. But when I went through that rupture around Tempest, losing my, you know, with the way I made money, the way that, like my reputation, all of this stuff that like my purpose and my meaning, like I was driven so much by this work that I was doing, and it kept me in line, in a certain, you know, to a certain degree, because I was, I had to show up for other people. And so those things alone, you were enough to destabilize me and throw me back into it, you know, whatever, like I felt like before I started using pot again, I felt like a pre sobriety version of myself, right? I was going through
Speaker 1 1:16:14
probably a dysregulated state. Well,
Holly Whitaker 1:16:18
you know, when you look at a relapse like chart, you know, it’s, there’s high risk situation, and then there’s like, so I’m in a high risk situation, and I just don’t have any structure. Now, like, I’d always worked. I had never not worked since I was 14, and a massive amount of loss. I had no structure. I was undiagnosed ADHD. Throw on top of that, I had clinical burnout. I was losing my hair. I had gone deaf. I had, like, gone I had gone through like, I was so stressed out, and then I went into paramedic laws. So it was just this fucking cluster fuck. And if I’m looking back now, called The Perfect Storm, it’s the perfect storm. If I’m looking back now I’m like, it helped me not die. Poof. It was the only it didn’t. I was doing like, two yoga classes a day. I was doing all of my stuff. But there was no way I now know. I didn’t know anything about how ADHD showed up, especially after, you know, hormonal imbalance, especially after the loss of structures. And so it was just Yeah, it was a perfect fucking storm. And so what it did for me was just help me stop drowning for hours at a time, right?
Speaker 1 1:17:25
Again, that foundational understanding of all these ways that that behavior made sense, like coping with a massive amount of loss, coping with like not knowing how to regulate yourself, you know, and how do you regulate yourself in the pandemic, when we’re all totally isolated, right? And all sorts of scary things are happening, right? It’s an enormous amount. And so part of how we’re always looking at things, and how the invitation to change looks at things, which is like, Oh, I hear you’re suffering. You just outlined 45 seconds of massive suffering, right? Yeah, I can assign judgment to that and think, oh, Holly, you just weren’t taking your your sobriety seriously. I can’t believe you went back to pot, right? Or I can say, Wow, that was a lot of suffering, and the part of your brain that knew a substance, pot would soften some of that suffering, okay, I get that I can have compassion for that. I hope you can have compassion for that. And what else do you need? What else do you need so that if, if pot is not how you want to resolve that pain, what else do we need to help you learn? And what do we need to shift in your environment so pot isn’t how you deal with that pain, but what we can collaborate around, and what we can have compassion for, is that you are in pain, right? You’re not a bad person. You’re not a bad person who wasn’t taking your sobriety seriously. You’re a person in pain that decided to use a substance to make your pain go away, okay? That deserves a lot of compassion. And I think that’s if that’s the other thing that we have not talked about enough, which is people who are using substances are suffering. They really are. They’re suffering, and we’ve got to have more compassion for that and understand that underlying pain, it can look like really bad behavior on the surface, like really difficult, bad, dangerous, maddening behavior. There’s something about that person that is in pain because they’re needing to numb themselves, they’re needing to they’re needing to use a substance to manage something, and it’s usually pain, pain of disconnection, pain of not understanding themselves, pain of depression, pain of anxiety, you name it. So we’ve got to bring more compassion to that, because that again, shifts how we approach the problem, and it shifts how we try to help people.
Holly Whitaker 1:19:47
When you and I sat down to talk, one of the things that you said was, you know, you talked about a composite patient, right? And you you talked about this person that had been in and out of seven rehabs, right? And so this is, you know, just so everyone knows this isn’t a real person. This is a composite. But, like, we’re talking about, like, you know, a bit a patient of carries that was in and out of rehabs and was later in life, like, had gone through something that had triggered, basically, this person to drink. They were drinking a massive amount of alcohol. They had gone through multiple rehabs. They could not get sober, but it was late onset. By the time they got to you they were, you know, like what we would call, like a hopeless case, right? And, or what the society would call the hopeless case. And you got down to, well, this person had, you know, been through, like, a series of traumatic losses, and they just started drinking a lot more. And one of the things that you said to me in this was, I don’t know if you have an addiction, and you you like you start with this assumption with every person that you see, which is, I don’t know if you have an addiction. I know that you have trauma well.
Speaker 1 1:20:56
And I don’t want to leave your listeners with some whitewashed version of, there’s no such thing as addiction, because, you know, there are, there are people who, I mean, we know addiction kills people, right? People die because they are unable to stop using substances. They become so physiologically dependent on it, their brains are remodeled in a way that just makes it so they they can’t change course or die of accidents in part of their journey, or whatever it is. So we know addiction kills and we know substance use shorten lives. So I don’t, I’m not whitewashing that at all. Yeah. All I’m saying is that when I sit with somebody, and most people come to me with some level of substance use, you know, sometimes quite severe. And so, yes, that’s a piece of what we’re looking at, and I’m always looking at and what else, yeah, so what is that behavior doing for you that you don’t know how to do in some other way? Because that’s what I have to help you figure out we’ve got if you’re going to learn an alternative path so that you can disengage from that substance that is killing you, right? I’ve got to help you relate to your body in different ways. We might have to help you with your brain chemistry. You might be need to be on medications that help you not go down that pathway. We might not have to change your learning and your living environment, we might have to help you with, like, a lot of really dramatic things might have to happen for you to be able to disengage from that substance. But I approach everybody with the I don’t know what that is. Let’s go. Let’s let’s start exploring. Let’s try to figure it out. I’m just not going to be like, here’s your recipe card, right? It’s like, we’re going to build this together as I get to know you and as you get to know yourself, and I’m going to try to create space in our relationships where you can be curious and reflect on yourself, because what we know about habit change and behavior change is self awareness, being able to self reflect and be able to think. Is this working for me? You know, can I learn something else like, that’s foundational. You have to have some self awareness. And I think part of what happens in these word boxes and kind of in this like way that we think about addiction, is that we make it so people can’t really give themselves permission to step back and be curious about themselves, because they think they have to do it in a certain way. And if they’re not doing it in that way, they’re doing something wrong or doing something bad. And so they’re essentially trapped.
Holly Whitaker 1:23:32
Well, I mean, there was no room for, like, just to get in my own experience, like, curiosity isn’t on the table. You’re using drugs again, you know, like, you don’t have time for curiosity.
Speaker 1 1:23:41
You have to have curiosity for behavior change to happen. You do curiosity. You have to have space for those two things. And you have to have room to screw up. You have to have room to try something and have it not go well. Yeah. Like learning new learning requires the tolerance of setbacks.
Holly Whitaker 1:24:00
You have to learn experientially correct, like you have to learn, and then you’re robbed of being able to experience things because you’re cognitively, you know, held to the standard you shouldn’t do this thing. Yeah, I think this, like, this goes to, you know, we’ll stop here. This really goes to, like, you know, just this, like, fascinating thing of, you know, I was reading, I don’t know ifs for addictions by Martha Sweezy, and she just talks about, you all, even an intake can be traumatizing, you know? And it’s just like, we don’t even think about that. It’s just like, not even the conception of but the way we like, even just diagnose somebody could further re traumatize them. Like, it’s not helping, right? It’s, there’s so much that’s in this that doesn’t assume these other issues. It assumes one issue, and that in that way, in not looking at all the things and the whole picture of it, and looking down these other pathways, or allowing the space to be we don’t know yet, we need to kind of understand what is this. Is this, you know? So it’s
Speaker 1 1:25:02
no, and I’m gonna say that this is true for families too. Yeah, you know, because families don’t seek help, because they are geared up to be told that they’re part of the problem, right? They’re doing something they didn’t raise their kid well, or they’re enabling, or they’re codependent, or a whole host of other things, versus being able to be like, hey, like, let’s let you step into this space of self awareness and curiosity and learning new things too, because you really want to help your loved one, there’s no reason why you would have the skills to do this. There’s no reason you didn’t go to school for this. Nobody anticipates having addiction in their house. Let’s, let’s help you too. So I just our mission, really is to like to just shift how we approach this particular problem, because when we, when we approach it with a desire to control it, with a desire to make it very black and white, you know, with a desire to punish it. Yeah, we are not helping people. Yeah, we’re just not. And the science based, evidence based strategies are all about self awareness, curiosity, practice, you know, trying new things. It’s just like, and we just need to keep as a and you do a wonderful job of this is like helping people consider alternative pathways to approaching this problem which affects just about everybody. Yeah, everybody knows somebody with addiction, you know, or struggle with some behavior. And I think that’s going to get worse, whether it’s gambling or social media or gaming like it’s all we’re every family is going to be impacted in some way. So if we can collectively start to talk about these behavioral problems in a different way and realize like how our brains are getting hijacked and how our environments do or do not support change, then maybe we can have a positive impact. So that’s what I would like to keep doing, and I’m grateful for everything that you’re doing out there in the world, same. I mean, send a different send a different message. Yeah, I
Holly Whitaker 1:27:06
appreciate you so much. Thank you for having, as always, like, just a great conversation. I really hope that I can get you back on to just focus. Yes,
Speaker 1 1:27:14
let’s have another two hours. Yeah, totally. I think,
Holly Whitaker 1:27:17
like, the family aspect is so under explored, and I really want to do one that just focuses on providing something for people I just have never met anybody that’s a family or a friend of loved one that is equipped, well,
Speaker 1 1:27:30
it’s literally the name of your podcast, yeah, it’s the name of your podcast, co regulation, yeah. Like, that really is what needs to happen
Speaker 2 1:27:37
in sample or part of recovery, like, part of your recovery toolkit is people, right?
Holly Whitaker 1:27:41
Yeah, yeah. Well, thank you so much, Carrie.
Holly Whitaker 1:27:52
Thank you for subscribing to recovering producers, Holly Whitaker Adam Day and Kate signs sound engineering and editing. Adam Day. You can find Adam day’s work at adamday photography.com original art by Misha Hancher. You can find mishas work at C misha.com if you’d like to support this show financially, you can do so by going to newsletter dot Holly whitaker.com you you.
