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How to Treat Addiction · Why We Do What We Do

• 0:03
  You're listening to Why we do what we do. Welcome to Why we Do
• 0:16
  what we Do. I am your psychologically anthropologic host Abraham, and I am
• 0:23
  your just doing my best and throwing stuff at a wall and seeing what sticks
• 0:27
  host Shane. We are a psychology podcast. We talk about the things that
• 0:31
  people do and when they do them to access, sometimes to the point that
• 0:35
  we must intervene. And we are I think where we are starting to reach
• 0:39
  the tail end of a long series of episodes that have focused solely on addiction.
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  Yeah, I mean, and we're going to do I would imagine more
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  episodes later on substances and how they work and whatnot. But I think this
• 0:55
  is coming to kind of a natural conclusion where we're finally talking about you know,
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  we've kind of talked about the different problems, but now we're going to
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  talk about how those problems are resolved for folks that struggle with this type of
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  thing. Yeah, And we sort of peppered this in as we talked about
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  addiction and various capacities. We talked about AA, we talked about addiction for
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  various substances and disorders and that sort of thing, and this today's discussion is
• 1:19
  really meant to give a historical timeline of the different ways that people have attempted
• 1:23
  to approach support and treatment for people who have some kind of addiction. Yeah.
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  I'm excited to get into this, but before we do that, we're
• 1:33
  supposed to do holidays, right. Yeah, Well, this episode publishes on
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  May twenty ninth. We are at the end of May here, and it's
• 1:41
  worth acknowledging that this is Composting Day. It's also End of the Middle Ages
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  Day, which I'm going to say, is it though? Return to the
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  Middle Ages Day? How do I get? Yeah, that's the make It
• 1:57
  great Again, Make Middle Ages great Again, that's what MAGA stands for,
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  Middle Ages Great Again. That is Yeah. Also, Happy International Day of
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  United Nations Peacekeepers. Uh huh yeah, wild time. It's National Biscuit Day,
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  which I think if ever, if more people had biscuits, I think
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  they would be happier. Well, and I think that does lead directly to
• 2:19
  the next one, which is National Senior Health and Fitness Day with biscuits.
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  Yeah, I mean, if they're talking about emotional health, then biscuits are
• 2:27
  really the solution there. Yeah. As a Southerner myself, yeah, I
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  like biscuits. I can't say. I can't help it. Right, It's
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  paper clip Day. If you like those, I guess you know this one
• 2:37
  probably should be yours. But it is Pink Flamingo Day. It is Pink
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  Flamingo Day. I have wanted so badly to have a pink flamingo lawn ornament
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  and I have not gotten one yet, but I may get one because I
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  just ordered myself a Luchador mask for some reason, so we'll, you know,
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  I'm just I'm just at that stage where I'm like doing that thing where
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  I have the funds to buy stupid things every now and again. So I
• 2:57
  have a great gift idea for you now, Oh, I can't for this.
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  Today is also put a pillow on your Fridge Day. Is this like
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  an attempt to smother the fridgely? What's going on here? I genuinely didn't
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  know, and I didn't want to look it up because I didn't want to
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  ruin the mystique. That is a pretty delightfully mysterious sounding holiday. It is
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  World Digestive Health Day. Maybe because you put the pillow on your fridge and
• 3:20
  that improves your digestive healthy Maybe I don't know. It's also World Hotter Day,
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  which honors are just wonderful creatures. Yeah, that's amazing. I'm good
• 3:29
  with that. Yeah. It is Oak Apple Day, which I don't know
• 3:32
  what those are, but that's kind of cool. That sounds. I am
• 3:36
  an apple fan, so whatever it is, I'll eat it. Yeah.
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  It's also Week of Solidarity with the peoples of non self governing Territories, so
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  it is National flip Flop Day, which could also just be called National Abraham
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  Day because I love wearing flip flops. I was gonna say, that's like
• 3:52
  your thing is my thing. It's funny that you enjoy wearing flip flops and
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  I live in a place where I should wear flip flops and I hate wearing
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  flip flops. Right, it's backwards. It's backwards for you, Shane.
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  In case you didn't know this, it is National Alligator Day, so oh,
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  big fan of that. It's pink flamingo and alligator Day. It's just
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  Florida Day, that's right, that is that's kind of what that means.
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  And then finally it's World Tiger Nut Today, which I had never heard of
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  tiger nuts, but that's kind of what was a tiger nut? I don't
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  know, they kind of look like dried up chickpeas in a way. I
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  mean, I like chickpeas. Yeah. I looked up put a pillow on
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  your fridge day and it's a superstitious thing. So it definitely came from white
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  people in Europe in the early nineteen hundreds. Well yeah, and it became
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  popular around the world. Basically, you put a pillow on your fridge for
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  prosperity. Okay, great. Anyway, we actually don't just talk about holidays.
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  We talk about all sorts of things. We're history podcast, I guess
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  in a lot of ways, and definitely today because the topic at hand is
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  largely rooted just in a in a long timeline of how people have been trying
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  to treat addiction throughout the past amongst you humans. I do think that this
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  has a somewhat eurocentric vibe based on what I was able to find in the
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  research. I tried looking around to see what other things were going on in
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  different parts of the world, and I found like a couple of those.
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  But for the most part, this seems to be pretty sort of euro white
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  people centric, and I apologize for that. If people can send would like
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  to send resources that outline different ways this has been approached in other countries.
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  Then I'd be more than happy to do a follow up where we discuss those
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  things. Yeah. Absolutely, I would be super fascinating, because I mean,
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  just to be fair, when we start looking up resources and we start
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  pulling things, a lot of them tend to be like the most the ones
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  that get the most hits tend to be Eurocentric, and there's lots of problems
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  with that for obvious reasons. But that's kind of where this is coming from.
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  So it's not that we were specifically neglecting any other culture or perspective or
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  anything like that. It just so happens that the majority of research that just
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  shows up happens to be on this like from this, yeah exactly. So
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  Anyway, if you do end up liking the show and would like to support
• 6:04
  us, who can join us on Patreon, pickup some merch, leave us
• 6:06
  a rating and a review, subscribe, tell your friends all the things.
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  We'll talk about them at the end of this discussion. So let's go ahead
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  and dive into this. Let's let's start unpacking the history of treatments for addiction.
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  And one thing I found that was kind of fun was these quotes of
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  someone describing addiction from a reverend this is specifically with relation to alcoholism, described
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  it as the insatiable desire to drink, and one that I think was very
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  fun. He called it being addicted to sin, addicted to sin, addict
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  to sin. Like that just sounds like a party, does, sound like
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  a part What a ridiculous thing. I think, Actually that's a really great
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  way to lead into a lot of this stuff because so often do we find
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  religious terminology or Christian fundamentalism inside of treatment addiction and kind of the I guess
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  maybe the respective on addictions and drug use. And so that's why, you
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  know, I think leading with addicted to sin is so important for understanding the
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  rhetoric around any of this stuff. So yes, and like the philosophy underlying
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  the approaches that were taken. Yeah, so we're gonna skip a few things
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  in the history of this. There's a lot of history, so like,
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  just bear with us on this. Yeah, but people have been finding ways
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  to escape reality by smoking or drinking things for a very, very, very
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  long time, and we've kind of established that in our series so far,
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  right, Like, people have been doing this for millennia. I was gonna
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  say centuries, but I was like, that's not long enough. Millennia people
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  have been doing this. Yeah, and you know, there weren't that many
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  opportunities to get addicted to things, but people were just trying to survive throughout
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  most of human history. And then when those resources became abundant and people were
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  able to access it more or they it was more mass produced, then all
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  of a sudden, we've got a little bit more opportunity because we're not having
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  to survive as much in those spaces too. Yeah, even alcohol wasn't so
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  easy to come by that it could be consumed in excess to the point that
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  addiction was possible. That one has been around for a very long time.
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  Some people even argue, and we're not going to really get into this,
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  but some people argue that alcohol was like the reason that society's formed. I'm
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  like, oh no, I don't think that's probably right anyway, The point
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  being that, like that, we've had it around for a long time,
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  but it wasn't mostly so easy to manufacture that you could consume it to the
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  point where you'd become addicted. That's not to say it never happened, it
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  just was harder for that to happen. Yeah, could you imagine a society
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  centered around bud light? Oh wait, I mean we have that. It's
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  called nasca. I was like, I think, I was, like,
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  there's a racetrack in the middle of my city just for that culture. I
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  forgot about that, Okay, But as you said, we got to the
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  point where we could manufacture this alcohol and massive quantities. So yeah, Industrializationay,
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  Nevertheless, there were opportunities even if they weren't commonplace. And Aristotle actually
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  described it as quote incontinence of will, which is a I mean, yeah,
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  it's such a it's so it's so silly. But it's like, if
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  it wasn't about something so serious as addiction, that would be a very funny
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  thing to say. Like I think I'm gonna use that for people who like
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  don't follow through on stuff. It's like not a motivation issue. You have
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  incontinence of will, and in continents of you don't have, you don't you
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  don't have you can't go to the gym. As you have incontinents of will,
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  yeah, you need a will diaper for that. Pampers will pipe anyway,
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  all right, So will zip ahead a little bit in time because people
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  have been making beer for like well before recorded history, or versions of fermented
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  drink, and even you know, some animals will find fermented fruits and sure
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  get a little sloppy. But by the seventeen hundreds, when to skips out
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  centuries here, by the seventeen hundreds, alcohol dependency was common enough that it
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  started to be recognized as a problem that was difficult for people that they were
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  struggling with this. And so you had the development of some groups that were
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  specifically designed to help support overcoming alcoholism or alcohol addiction or dependency. And these
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  were alcohol mutual aid societies, sometimes called the Goodwin Association refers to the societies.
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  And there were these sobriety circles that were formed actually by indigenous Native American
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  peoples, and these were specifically designed using their tribal cultures and religions to support
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  and treat alcohol addiction. And they also had to, you know, obviously
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  use traditional sort of native medicines and remedies and that sort of thing. But
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  these were some of the earliest versions of any kind of treatment really to help
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  people who were struggling with addiction to alcohol. Right, and then comes along
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  Benjamin Rush, physician born in seventeen forty six, who grew up around alcohol
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  and alcohol dependency like some folks that we know, and although almost no one
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  believed him at the time, he strongly prosthlyzed that alcohol is a major health
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  concern by saying, quote, a nation corrupted by alcohol can never be free
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  end quote. So you know, for those of you in America who say
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  you're free, I'm just saying, like, there's a lot of alcoholic anyway.
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  He even talked about alcoholism and a disease like context, and was arguably
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  one of the first to do so as far as we know. Yeah,
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  as we said, with like Aristotle is a good example of people seeing the
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  dependence on things like alcohol as a personal failing. Essentially, right, the
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  incontinence of will. Maybe I kind of almost want to call this episode the
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  incontinence of will, but it's a treatment, so probably shouldn't. Anyway,
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  in this instance, we have this Rush guy, and had I had to
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  curtail my investigations to not make it an episode just about him. But he
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  was like this early pioneer in looking at treatment for alcohol addiction, and as
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  you said that he was one of the first people to describe this as being
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  disease like and sort of introducing the idea of addiction as a disease. Let's
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  review some of his innovative ways to try and treat drunkenness and alcoholism. To
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  cure drunkenness, Rush specifically prescribed shoving a feather down one's throat to induce vomiting
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  or, as he might have actually said, quote exciting a puking. And
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  if you if you walk up to me and try to shove a crow feather
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  down my throat, I'm gonna be so upset. I'm gonna throw up.
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  Like that will make me throw up, guaranteed because I have a terrible gag
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  reflex. But what A that's so awesome? Yeah, all right. Other
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  treatments for really, I say treatments quote unquote, treatments to drunkenness or addiction
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  included, but we're not limited to cold water, bats, blood letting,
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  which is I feel like, if you're really drunk, blood letting is terrible,
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  right, Yeah, you'll bleed a lot. Yeah, you'll bleed a
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  whole lot. Whipping and inducing negative emotions such as guilt, shame, and
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  anger in the afflicted individual, which I feel like alcohol do that on its
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  own, like you don't need to do that, Like it's a downer,
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  so like it's already gonna make you feel guilty and shame and anger at all
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  that stuff that you're feeling too. So yeah, if we didn't make this
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  all clear as we were going, he was. He really approached this from
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  a very religious angle, like this was the problem that needed to be cured
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  using faith and religious based techniques and interventions. And what was kind of interesting
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  though, is his approach was actually not as fully anti alcohol as it would
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  seem based on his rhetoric here. He actually says to hatred of alcohol seemed
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  to be largely oriented towards specifically hard distilled spirits such as whiskey and even he
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  talked about you're as wholesome and nutritious. So I think this was particularly in
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  relation to the fact that there weren't a lot of other safe alternatives for consuming
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  liquid, Like getting water into your body was difficult to do because people would
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  get sick. You know, there is giardia and the pollution that they had
• 14:20
  done to their water, and like you obviously can't drink salt water as humans,
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  so like the options were limited, and alcohol was one of the safest
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  ways for you to consume some form of water, so much so that even
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  children would often get like beer and stuff like that, particularly like things that
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  were left over from their parents and wine as a beverage, because there's just
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  not a lot of options for consistently getting water into your diet that is wild.
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  I guess one liquid we could look at too would be doctor Parnassis is
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  magic tonic to cure alcoholism. And so we're going to play an ad so
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  you can listen to that specific tonic right now. Let's get back to this
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  from the doctor Parnassis. Is that you said, yeah, doctor Farnasis miracle
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  tonic. Yeah, there you go. In the mid eighteen hundreds, Swedish
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  physician doctor Magnum Huss coined the term alcoholism. Yeah. There had been a
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  lot of other descriptions, and continents of will being one of them, but
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  there are other descriptions for what dependencied alcohol might look like. And finally in
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  the mid eighteen hundreds we get alcoholism as the name for it. And there
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  were also inebriate homes called lodging homes or homes for the fallen, and these
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  were institutions in Boston in the eighteen fifties that were modeled after mental asylums or
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  like you know, incarceration for mental health or other issues. And these used
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  detox abstinence from drinking culture, moral framing, and membership in quote sobriety fellowships
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  to try to reduce drinking. So there are a lot of different kind of
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  strategies they kind of threw into these places, into these inebriate homes to help
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  folks who are struggling with this. These were involuntary as far as I could
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  tell. It looks like basically you were committed to one of these inebriate at
• 16:12
  homes and were not permitted to leave, at least not until you were over
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  your addiction as it were. As you said, there were some multiple strategies
• 16:22
  that they might use to try and help induce or facilitate abstinence. But they
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  also had other specific, cutting edge, state of the art technologies such as
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  cocaine, opium uh huh, ether, chloroform, and something called chloral which
• 16:38
  I had not heard of before, but for our chemist friends, this is
• 16:41
  trichloral acetyl hide, which is a sedative of some sort. Yeah, and
• 16:48
  there's a really cool including the show notes a certificate of Is it a prescription,
• 16:52
  there's a prescription. Yeah, this is a prescription for I believe this
• 16:56
  is some type I can't read the handwriting on this, but some type of
• 16:59
  like opiate thing. Yeah, it's pretty interesting. So I think it's probably
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  worth asking or tient talk about this idea of like involuntary rehabs and whether or
• 17:07
  not that's useful. I mean, we know now that like a lot of
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  times, involuntary treatment is not the most effective treatment because people don't want that
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  right, Like they're not invested. Yeah, very much. So it's basically
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  like I'll do what you ask me to do, and until the moment I
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  am free to choose otherwise, right exactly now. In Britain in the sixties,
• 17:30
  in the eighteen sixties, I almost said just the sixties, the eighteen
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  sixties, which was many, many years ago. Drunkenness was often consequated with
• 17:37
  a fine or even jail time, up to several weeks or months in some
• 17:41
  cases. Could you imagine just like going on a bender, Like maybe you're
• 17:45
  celebrating like a graduation or something, and you had like maybe a little bit
• 17:48
  too much whiskey, and now you're in jail for three months, right,
• 17:51
  let's be such a bummer. Yeah, that was kind of it. It
• 17:53
  was we're unpacking here the history of attempts to manage this, and they had
• 17:59
  basic these a lot of lock up type things, and that was the case
• 18:03
  here in Britain in the eighteen sixties. Yeah. Now, the first medical
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  detox and rehab asylum, the New York State Inebriate Asylum, opened in eighteen
• 18:14
  sixty four. It was presumably the first of its kind, possibly in the
• 18:18
  world. Had a hard time pinning down something that preceded this, but this
• 18:22
  seems to be the first one that was designed specifically for this. Yeah.
• 18:26
  And in beginning in eighteen seventy nine, doctor Leslie Keeley, in collaboration with
• 18:30
  Irish chemist John r Auten quote unquote discovered by chloride and quote double chloride of
• 18:37
  gold injections, later shortened to gold cures. I mean that sounds nice,
• 18:44
  but basically they said that they could cure alcoholism with this kind of method and
• 18:48
  successfully launched nearly two hundred clinics across North America and even into Europe. And
• 18:53
  I found even some sources said that potentially over two hundred these were as you
• 18:59
  said, injections. Injections. This is a syringe and needle with some form
• 19:04
  of chloride and at least some instances I saw strychnine and that these go into
• 19:11
  your body. And then people who completed their program, they called them graduates
• 19:17
  and asked them to essentially speak on behalf of the treatments. It made doctor
• 19:22
  Keeley obscenely wealthy, and he marketed this saying, quote, drunkenness is a
• 19:26
  disease and I can cure it end quote. And so they, yeah,
• 19:30
  they opened all these clinics with the promise of injecting toxic substances into your body
• 19:36
  as the way to do it. Yeah, And so of course we know
• 19:38
  that this is pure junk, it's quackery, it's jive, it's pseudoscience.
• 19:41
  And in nineteen hundred it was exposed for being entirely fraudulent. At best,
• 19:45
  it was a placebo for some people. At worst, it was very medically
• 19:49
  dangerous. I mean, could you make the argument that doctor Keeley is just
• 19:53
  the Gwyneth Paltrow of the nineteen hundreds. Yeah, that kind of this was
• 20:00
  maybe like the og goop, right, gold cure was just goop, that's
• 20:06
  all it is. Yeah, Yeah, and so many people have followed in
• 20:08
  Keeley's footstep ever since. But this was, Yeah, this is just snake
• 20:11
  oil. There was literally nothing to this that was going to work effectively.
• 20:15
  It didn't work at all. Yeah, yea beyond the like maybe light placebo
• 20:18
  effect that you got for some people. Right, all right, we get
• 20:21
  to the eighteen eighties. Here we reach a man who we have discussed at
• 20:26
  length. I believe in this this podcast of ours, whose name is Sigmund
• 20:30
  Freud. He made him from such works as how I met your mother who
• 20:34
  was who was also my mother? That was going to be the joke.
• 20:41
  So that was good, that was great. So Freud here he really sees
• 20:45
  the light. He has this major epiphany about a magical drug, and his
• 20:51
  magical drug of choice here cocaine. He begins prescribing and advocating for cocaine as
• 20:56
  a treatment both for alcohol and morphine addiction. Okay, struggling with alcohol,
• 21:02
  get hooked on cocaine instead. Sure, he really liked it, and later
• 21:06
  in life he did start to back off his recommendation for cocaine as a treatment
• 21:11
  for morphine, although I think he mostly stuck to it as a treatment for
• 21:15
  alcohol. All Right, so in the eighteen nineties, the inebriate homes and
• 21:18
  asylums are faced with insurmountable issues that include things like ethical abuse, little evidence
• 21:23
  of support their treatments, stigma, economic depressions, demedicalization, and the switch
• 21:29
  to a criminalization for addressing alcoholism. And as such, these institutes start to
• 21:33
  close down and instead people are arrested and sent to insane asylums or the foul
• 21:40
  wards of hospitals or drunk tanks. So it goes from a treatment model to
• 21:44
  a criminal model pretty quickly. Yeah, yeah, there's just there's a relatively
• 21:48
  short segue where they started just incarcerating people without any pretense, and they would
• 21:52
  throw them in these gross places. They were like, as you said,
• 21:56
  the foul wards of hospitals is what they called them. Yeah. Now,
• 21:59
  how if you were very wealthy, and of course there were people around who
• 22:03
  were and were also addicts, which, as we've mentioned in this series so
• 22:07
  far, like addiction was widespread enough across various segments of the population that it
• 22:14
  wasn't necessarily seen as much as a class issue, even though there are many
• 22:18
  instances in which it was. Anyway, these wealthier addicts they got to go
• 22:21
  to these private institutions that were sanatoriums they called them, but they were sort
• 22:27
  of colloquially referred to as jitter joints, jag farms, or dip shops,
• 22:33
  which is just delightfully archaic names. Oh my god, I wish so much
• 22:40
  that like new generations came up with better slang than riz, right, Like
• 22:47
  I would kill to live in a world where like not like I don't want
• 22:51
  to go back in time, don't get me wrong, Like I don't want
• 22:52
  to go back this time. I want today something that's really wholesome and fun
• 22:56
  to be called a jitter joint. Like I think that would be great.
• 23:00
  I would absolutely go hang out at a jitter joint if it was something fun
• 23:03
  and wholesome today, Like I'd be like, let's go to the jitter joint.
• 23:04
  Like that would be great. I'd be a great name for our coffee
• 23:07
  shop, I think, yeah, absolutely, it sounds like why would do
• 23:11
  what we do is getting into the coffee business. So if you're a roaster,
• 23:15
  email us, we will start, we'll figure something out. We'll call
• 23:18
  our first bat's the jitter joint. We've been talking about it for years.
• 23:22
  But yeah, no, they in these institutions. It was pretty similar.
• 23:25
  They just weren't more. They weren't as much like jails as they were places
• 23:29
  to go take other drugs to try and get you off of alcohol. Right,
• 23:32
  But they would do some of these other weird archaic things to try and
• 23:34
  help. That was the point of these They were just for the wealthier of
• 23:37
  people. Yeah. Now, Theodore Roosevelt's private physician, in collaboration with Charles
• 23:42
  Towns, opens the Charles B. Towns Hospital in Manhattan, New York in
• 23:47
  nineteen oh one. This swanky resort costs two hundred to three hundred and fifty
• 23:51
  dollars for wealthy patrons per week, which is roughly thirteen thousand dollars per week
• 23:56
  today, and gleefully administered the famous Bella donna. Man I wish there are
• 24:00
  moralickxers around today too. Feladonna is described as a barbituate sedative and is commonly
• 24:07
  used for upset stomach and other pain management. Yeah. So basically, you
• 24:11
  go to these places that cost you about the cost of a car per week,
• 24:15
  and they would try and dry you out and would give you a bunch
• 24:19
  of pain management so that you weren't as uncomfortable while drying out. Sure,
• 24:25
  so there was that side note. I thought this was kind of fun.
• 24:27
  Bill Wilson, who we discussed in our Alcoholics Anonymous episode because he was the
• 24:33
  founder of Alcoholics Anonymous along with another Bob Smith. But it was you know,
• 24:37
  his kind of his brain child. He actually went to this Charles B.
• 24:41
  Towns Hospital treatment resource. That's wild. It all comes back, is
• 24:47
  back, keeps coming back. It does keep coming back. It stands the
• 24:51
  test. It's been in guest time every episode. I think, so yeah,
• 24:55
  this sweet. I think it's made almost every episode. Yeah, all
• 24:59
  right, So the Emmanuel in Boston open in nineteen ointy six. We sought
• 25:02
  to treat alcoholism with a combination of spirituality and psychotherapy. This approach helped establish
• 25:07
  some of the framework that would be used in the creation of AA. So
• 25:11
  it makes sense that you started seeing kind of like an overlapper of N diagram
• 25:15
  where the stuff was kind of used to treat alcoholism specifically. Yeah, and
• 25:19
  like their understanding of psychology in the way that it would be applied to psychotherapy
• 25:25
  was not informed. Right, This, I mean at the time was probably
• 25:30
  like cutting edge technology and science, but it was not very well understood what
• 25:34
  to do and how it worked. So it was largely a religious admonishment for
• 25:40
  being addicted to things right right, Right. In the nineteen tens, eugen
• 25:45
  X was pretty popular, and there was actually a state law or federal law.
• 25:49
  There was some government sponsored law that called for the sterilization of undesirables,
• 25:56
  which included people who were feeble minded quote unquote people minded disabled usually from birth,
• 26:03
  but could just be disabled in general, and addicts. So someone who
• 26:07
  is addicted to alcohol would be forced to be sterilized or what they described as
• 26:14
  being made a sexual and I think for a lot of them this was viewed
• 26:19
  as punishment, but at least some people who were administering these interventions thought of
• 26:25
  it as like a treatment, thinking like your genitals are the reason you choose
• 26:30
  to drink, So that I guess was their philosophy. You know, it's
• 26:34
  a good thing that we've moved away from that, that we don't do that
• 26:37
  anymore, or like any you have any discussions around sterilizing people, right,
• 26:41
  isn't it nice that we have advanced so far since nineteen ten? Anyway,
• 26:47
  I don't know if you could hear my sarcasm, but you know, yeah,
• 26:49
  it's ridiculous. People are still having these conversations. It's absorbed now.
• 26:52
  In nineteen nineteen through nineteen twenty four, some people established morphine clinics for morphine
• 26:59
  addicted people, and those were closed due to legal reasons. Lots of legal
• 27:03
  reasons. Yeah, and so we're going to get into a kind of interesting,
• 27:07
  weird dark time in the history of the United States as it relates to
• 27:14
  treatment and addiction. So let's get into a weird dark time in this episode
• 27:18
  and introduce some ads. Okay. As I said, things are taking an
• 27:30
  interesting turn here for a moment. Okay, So let's start with the government
• 27:33
  opened the first federal drug treatment center in nineteen thirty five. For whatever reason,
• 27:41
  they opened this and what was described in my resources that I found as
• 27:45
  Deep Kentucky. And so this is the first federal one, right, and
• 27:49
  they called this and other similar locations that followed narcotics farms. Narcotics farms.
• 27:56
  Okay, So we're at nineteen thirty five, we're all almost into World War
• 28:00
  two, were past World War One, and so there are more sophisticated drugs
• 28:04
  and opioids that are out. People have known about morphine for some time.
• 28:07
  Alcohol is still a thing. Anyway, So they have these narcotics farms,
• 28:11
  and this is a center for a drug treatment and federal addiction and drug research.
• 28:18
  Okay, and this is an important note here. Yeah, uh huh
• 28:21
  what they're doing. Many people check themselves in, but functionally this was a
• 28:23
  prison where they could conduct research on human subjects. I mean, I think,
• 28:27
  isn't that like part of the premise of Pineapple Express is they are doing
• 28:32
  that too, like in the middle of nowhere. Oh, I completely forgot
• 28:33
  about that. Yeah, the whole beginning with Bill Hayter and he's like he's
• 28:37
  doing the full time music. What a great scene. Some notable patrons included
• 28:44
  some of the most prolific jazz artists at the time. Because people hated jazz,
• 28:48
  they thought it was the devil's music. If you visited such a place,
• 28:51
  you would likely hear jazz music playing from somewhere nearby. And in part,
• 28:55
  these farms seem to have a the view that quote idle hands or the
• 28:59
  devil's playground, and that strategy for supporting addicts was to have them play music
• 29:04
  for up to six hours a day. If they didn't play an instrument,
• 29:08
  they were put to work for a long hour so if you're a musician,
• 29:11
  you got to hang out and jam with your friends and write some good records.
• 29:14
  If you didn't, then you were just working. And so for their
• 29:15
  quote unquote participation in the research, they were paid in morphine. Yeah,
• 29:22
  at the narcotics farm. Yeah. So yeah, it was weird, strange
• 29:27
  time. Yeah, but that was the thing. So those existed. Now,
• 29:30
  as we mentioned, alcoholics would want to come back to this. By
• 29:33
  the way, it's only getting there's a little bit of downhill from here.
• 29:37
  So Alcoholics Anonymous or AA forms in nineteen thirty five. This is the prayer
• 29:41
  child of Bill Wilson and Bob Smith. Gradually became one of the most well
• 29:45
  known programs in the country, if not the world. We did a whole
• 29:48
  episode on this. I think it was the first second or third episode in
• 29:52
  our series talking about addiction. Yeah, long story short about addiction. You
• 29:56
  can go check that out for like a really in depth review of of Alcoholics
• 30:00
  Anonymous. But yeah, long story short, it kind of works. It
• 30:03
  might have been better than nothing for some people, but it's right. Yeah.
• 30:07
  Now, between nineteen forty eight nineteen fifty there was an increase in the
• 30:11
  use of additional drugs to help treat the use of drugs, so drug to
• 30:15
  treat drugs, notably dis a full room. I think that's how you say
• 30:18
  it. That's what it looks like to me. That's what it looks like
• 30:21
  to me, which is I guess ant abuse was a drug that caused nausea,
• 30:26
  wohend smelling or drinking alcohol. Also in Fetamin's, barbituates and the new
• 30:30
  kid on the block LSD we're all used to quote unquote treat alcoholism. Yes,
• 30:36
  you'll note that earlier I said this is the prayer child of Bill Wilson
• 30:38
  and Bob Smith. I was gonna call it brainchild, but I thought that
• 30:41
  was too high of a status to give it. So prayer child was pretty
• 30:45
  child. I thought that was pretty actually, thank you. Okay, So
• 30:48
  you just mentioned nineteen forty eight to nineteen fifty we're starting to get LSD in
• 30:52
  as a treatment for alcoholism and whatnot, and then we get into the nineteen
• 30:57
  fifties and we're we're on a pretty firm downward spiral at this point. This
• 31:02
  is a tough time we're going to get into here. Yeah. In addition
• 31:04
  to the let's just get them hooked on something else approach, that people have
• 31:10
  been taking here by like, well, you're addicted alcohol, let's give you
• 31:14
  a bunch of morphine instead. There was also the development of this tough love
• 31:19
  strategy by a group that name looks like it's probably pronounced Sinanon, So like
• 31:26
  the alcoholics anonymous, it looks sinister. It does like sinister s yna n
• 31:32
  o n sin Anon, I assume is what that's supposed to be. Yeah.
• 31:34
  This group was later identified as a cult, and they had its members
• 31:38
  participate in something they called quote unquote the game. And in this this was
• 31:44
  a public shaming exercise. Now, not to be fair, this wasn't out
• 31:48
  in the public. This is in their little culty inside group here. And
• 31:52
  during this game, these these public shaming exercises, the members would sit in
• 31:56
  a large circle and basically, just as far as I could tell the description
• 32:00
  of these and I read a few of them, they would basically just berat
• 32:02
  each other. They would just lay into each other over their hypocrisies and their
• 32:08
  failures and call them out for being terrible people. Basically, and as you
• 32:14
  can imagine, in a pretty toxic space like this, this devolved even further
• 32:17
  into just really aggressive, toxic hostility and even violence. That was largely at
• 32:23
  the direction of leadership of these groups. I think that we talked about that
• 32:28
  a little bit too in the Troubled teen industry stuff that we talked about,
• 32:32
  because they do talk about that inside of those like camps that they'll send kids
• 32:37
  to where they will do the game as part of like getting kids out of
• 32:40
  their troubled patterns of behavior. That is something that shows up in that too.
• 32:45
  So that did exist or still does exist in some spaces unfortunately. Yeah.
• 32:49
  I know, as a side note, Ronald Reagan was summoned from Hell
• 32:52
  during one of these hate meetings, and that's how he came into this world.
• 32:57
  So that's how we got a wrong Reagan. You know, it's a
• 32:59
  cult ritual that got us to him. So silver lining the syn and On
• 33:01
  was that its horror, weirdness and cruelty pushed people away from the more stigmatized
• 33:07
  view of addiction and toward a more compassionate approach, which is what we want
• 33:10
  to see a little bit more in these spaces where people are struggling. That
• 33:14
  of course didn't happen in nineteen fifty because the Synanon was taking off in the
• 33:20
  nineteen fifties, so there were other things also going on the nineteen fifties that
• 33:23
  also helped, I think, inspire a more compassionate, smarter approach to dealing
• 33:29
  with addiction. So in the nineteen fifties we had these other frightening methods which
• 33:34
  were not necessarily super popular, but they were attempts that existed to try and
• 33:37
  treat various addictions. This included electroconvulsive therapy or ECT. We did one of
• 33:44
  our earliest episodes ever as a podcast was on this topic as a brief refresherre
• 33:49
  on this. What they do is they place these electrically charged nodes against the
• 33:52
  patient's head and they will run waves of electric shock pulsed through the patient's brain.
• 34:00
  Also did something called insulin shock therapy. During this, patients are given
• 34:04
  extremely high doses of insulin to specifically induce hypoglycemia and a coma. Oh,
• 34:09
  that's the treatment. And finally they did what they called psychosurgery, which is
• 34:15
  a fancy way of saying prefrontal lobotomies, which is actually just a fancy way
• 34:20
  of saying jabbing a metal rod into the front of your brain and scrambling it
• 34:23
  around, usually through your eye socket. Yeah, we also did an episode
• 34:29
  on the Botomies if you want to check that out, which is a heroing
• 34:31
  journey. Yeah. So, in case it wasn't clear from my tone and
• 34:37
  from the content of my message, these did not work and were bad.
• 34:44
  They were mostly just like some of the most gruesome forms of torture. I
• 34:49
  mean, yeah, ecat probably was the least invasive of all of those,
• 34:52
  and that's being shocking someone's brain with electricity. Yeah, And to be fair,
• 34:59
  I think to be fair to ect like that is still a treatment that
• 35:01
  is around today that many people do swear by as being effective for certain types
• 35:06
  of interventions. It's a lot more sophisticated than it was back then. Back
• 35:09
  then it was a lot more like a punishment, is how it was being
• 35:13
  used. So just things to think about. Yeah. Also, during the
• 35:15
  nineteen fifties, membership in AA was exploding exponentially, and the disease model of
• 35:21
  addiction is published in mainstream medical texts and starts being treated as such. So
• 35:24
  we start seeing this kind of movement towards a disease model, and we actually
• 35:30
  see the VA start alcohol treatment centers in halfway houses and they start kind of
• 35:34
  building up during this time too, So you're seeing not just a movement in
• 35:37
  AA and a more compassionate approach, but you are also seeing this kind of
• 35:42
  move into like treatment centers. Yeah. Yeah, and the halfway houses weren't
• 35:45
  part of the VA, but they all sort of sprung into the existence around
• 35:49
  the same time. In nineteen sixty four, this is where we do get
• 35:52
  sort of a breakthrough here. Insurance companies start actually covering treatment for addiction because
• 35:57
  of the emphasis on alcoholism as a disease. Now you can see our episode
• 36:00
  in which we discuss the disease model of addiction, but because the sort of
• 36:06
  medical institute or infrastructure starts treating alcoholism as a disease, that did pave the
• 36:12
  way for insurance companies to start paying for treatment. It wasn't ubiquitous or mandated,
• 36:17
  but it was starting to happen, right. So, also in nineteen
• 36:21
  sixty four, doctor Vincent Dole and doctor Marie nice Wander or nice Wander,
• 36:27
  look it could be either one of those. Yeah, they introduced methodone as
• 36:30
  a treatment for narcotics addiction. So we start seeing a rise in methodone clinics
• 36:34
  for a minute. Yeah, yeah, I thought it was kind of cool
• 36:37
  to see that, Like we have who I believe is our first female doctor
• 36:42
  in the timeline so far who's also one who's in the space of some of
• 36:45
  the most effective treatments, which was sort of in the harm reduction sphere,
• 36:50
  which is kind of cool. Yeah, weird, weird men have been picking
• 36:52
  up for a long time, and so here we are, like now actually
• 36:55
  doing something effective. Isn't that cool? Very cool? The FDA approved Narcan
• 37:01
  in nineteen seventy one. We talked about this a bit in our harm reduction
• 37:06
  episode, but this is a drug that reverses the effects of overdose by opioids.
• 37:10
  This little invention goes on to save just tens of thousands of lives from
• 37:15
  people who would have likely almost certainly died from overdose if they hadn't had access
• 37:20
  to narcan. Yeah. Now, secular organizations for sobriety start in nineteen eighty
• 37:25
  five, and the similarly secular group Smart forms in nineteen ninety four, so
• 37:30
  we're starting to see more organizations and groups work on on this particular concern.
• 37:36
  We did a whole episode on the War on drugs in this suite of addiction
• 37:39
  themed episodes, But the war on drugs in the nineteen eighties starts again,
• 37:44
  we're talking about the history of interventions for treatment addictions, so for addiction,
• 37:50
  not treatment addiction, but interventions for addiction, and so this was kind of
• 37:53
  one of them. And this starts this massive incarceration campaign. It is unfathomably
• 37:59
  expensive, kills a boatload of people, and fails spectacularly. However, it's
• 38:05
  worth acknowledging this was really only the beginning and a long string of ongoing failures
• 38:09
  by magical thinking ideologue politicians who think not with their brains but with their buttholes.
• 38:16
  So I have a question for you. I'm not sure what your stance
• 38:21
  is on that. Would you care to illuminate us if that wasn't sarcastic enough,
• 38:23
  I don't think I'm thinking with their butttholes? Yeah, no, just
• 38:28
  in general, Like, it just wasn't clear that you disliked any of this
• 38:31
  stuff, and it was very clear that none of it worked. But you
• 38:35
  know, your message was a little bit I guess muddy I sat statement that
• 38:39
  you made. Yeah, yeah, yeah, Okay, fair enough. There
• 38:43
  seems to have been a lot of politicians who using their political rhetoric to get
• 38:49
  people riled up over things that are based on their feelings and not based on
• 38:54
  evidence, not based on science, not based even on practical outcome, and
• 39:00
  that that has been driving the bus for a long time. I mean,
• 39:04
  I would say at least since the eighties, if not well before then.
• 39:07
  But there's this like, let's just do the thing that evidence shows does not
• 39:14
  work at all because we feel morally righteously justified in our decision to do so.
• 39:21
  I think the war on poverty, the war on drugs, tough on
• 39:24
  crime, all of these have been ideologically driven and have shown to they don't
• 39:31
  work, they don't achieve the outcome they're supposed to achieve, but people will
• 39:37
  pour tons of money into it anyway, and time and effort and resources,
• 39:43
  and it just at best is a distraction from doing the right thing right.
• 39:47
  Yeah, And that's like the nicest possible thing I could say about it.
• 39:52
  And they just keep doing it. They just keep doing it. It's unbelievable
• 39:57
  that like this persists, this approach, I mean, so anyway, that's
• 40:00
  what I mean by people thinking with their buttholes is like this commitment to doing
• 40:05
  the wrong thing because it is politically expedient to beyond brand as someone who crusades
• 40:13
  around with these policies that don't work. Yeah, so basically they're thinking with
• 40:19
  their butttholes because they themselves are buttholes. Yeah, that's basically it just sentient
• 40:24
  walking buttholes. Yeah, that's the thesis of this episode so far. It
• 40:28
  makes sense if you think about it, because they're going spewing poop everywhere.
• 40:31
  Yeah, exactly, which is what buttholes do. Yeah, yeah, exactly.
• 40:35
  We don't like them. We don't like them. Now, the American
• 40:37
  Medical Association in the AMA officially labels addiction as a disease in nineteen eighty seven,
• 40:42
  and the Mental Health Parity an Addiction Equity Act of two thousand and eight
• 40:45
  and the Affordable Care Act in twenty ten both expand support and coverage for treatment
• 40:52
  of medical or specifically addiction of addiction disorders. So now we're moving into a
• 40:55
  space where people are recognizing this as a concern and they're putting in policies that
• 41:00
  actually provide some sort of treatment coverage for this instead of having to pay two
• 41:05
  hundred to three hundred dollars a week to go to an inebriate house. Now
• 41:09
  I knew. I knew when I was putting together the notes for this,
• 41:15
  this was going to be on the longer side of things. And I probably
• 41:17
  should have billboarded that up front, because we still are were just barely starting
• 41:22
  to get into the effective part of treatment for the timeline of a treating addiction
• 41:28
  here, So let's take a break for the advertisers, pour one out for
• 41:32
  them, and then come back to talk more about the ongoing future of a
• 41:37
  treatment for addiction. Sounds good. I think it's important to unpack that.
• 41:49
  Of course, more contemporary treatments for addiction include addressing why people start using these
• 41:55
  addictive substances or engaging in the addictive behaviors think gambling in the first place.
• 42:01
  And this often includes things that we've described in these episodes and in other episodes,
• 42:07
  such as cognitive behavioral therapy, which so far some research suggests has said
• 42:12
  about a sixty percent success rate of people maintaining sobriety for at least a year.
• 42:15
  It's pretty good. Acceptance and Commitment training which has a sixty one percent
• 42:21
  success rate, so even better. And then dialectical behavioral therapy or DBT,
• 42:28
  and this one actually does not have data aggregate it. The evidence does exist,
• 42:31
  but it's preliminary, but the data are still being collected on the effectiveness
• 42:37
  of DBT as an intervention for treatment for addiction right, and so, in
• 42:42
  many, if not most circumstances, people use drugs to access when they're faced
• 42:46
  with other challenges and often traumatic experiences. As such, interventions that address the
• 42:52
  needs and traumas of people suffering can be very effective at helping reduce substance abuse
• 42:57
  and behavioral addictions. This includes things like harm reduction strategies, which have helped
• 43:01
  many people reduce or eliminate their addictions by simply providing safety and shelter for people
• 43:06
  who are using. And you should check out the harm reduction episode because there's
• 43:09
  really great stats on how that works and how effective it is. Yes,
• 43:15
  and there's another one in here that we're going to spend a moment on,
• 43:17
  and the research goes back aways at least since the nineteen eighties is where I
• 43:22
  saw some of the earliest publications on this. Behavior analysts develop a system for
• 43:27
  treating addiction called contingency management. Now, this very catchy sounding intervention was founded
• 43:35
  on the behavioral principle of providing positive reinforcement to incentivize reward and subsequently increase the
• 43:43
  frequency and likelihood of some particular behavior. In this case abstinence from the substance
• 43:47
  in question, And this meant it is an entirely voluntary treatment and entirely in
• 43:54
  the control of the patient. They are empowered to choose to engage sobriety and
• 44:00
  they do so like that is the whole structure of this right. So,
• 44:04
  in this contingency management model or this intervention space, patients agree to regular tests
• 44:08
  which include tests for drugs, smoking, whatever substance they're using, and they
• 44:13
  earn rewards, usually money, for having low or no evidence of drugs appear
• 44:17
  on their tests. So, for example, an opioid user might visit a
• 44:21
  clinic once per week and take a drug test for opioids, and if they
• 44:23
  pass with a certain threshold, they receive some amount of money, let's say
• 44:28
  ten dollars to start, you know. Yeah, And so there's a lot
• 44:30
  of different ways that they've tried to tweak and adjust contingency management to see what
• 44:37
  makes it the most effective. Honestly, just the strategy of let's just reinforce
• 44:42
  not using drugs. You have to start asking other questions. You have to
• 44:45
  ask how often, how much? When should it increase, should it decrease?
• 44:51
  How do we modulate these systems, so often the monetary reward increases with
• 44:57
  consecutive successful tests. You can think, for example, they're trying to specifically
• 45:02
  increase the value of maintaining that sobriety, because if it's just a static reinforcer,
• 45:08
  just a static quantity, then they were a little worried, like maybe
• 45:13
  it's not worth it for them, Like some weeks they're like, eh,
• 45:15
  I could forego it. But if it's always increasing with consecutive that means that
• 45:21
  the longer you go, the better your payout is. So let's just say,
• 45:24
  for example, your first week is ten dollars, you maintain a clean
• 45:28
  drug test. The next time, it then goes up to fifteen dollars,
• 45:31
  then you maintain it again, it goes up to twenty dollars, up to
• 45:35
  some sort of cap whatever they might be. They're like up to one hundred
• 45:37
  dollars a test or something, or maybe a fifty or whatever. And then
• 45:40
  in some cases what would happen is if they then came in with a failed
• 45:45
  test, it would reset that track down to the lowest level and then you'd
• 45:49
  have to earn it back up again. Or I saw in some cases what
• 45:52
  they would do instead is rather than reset it, they would pause at a
• 45:57
  current level, and then as you had consecutive of successful weeks, they would
• 46:00
  start to increase it again. And those are some of the two variations I
• 46:05
  saw super interesting. Sometimes what they'll do is the money will be dependent on
• 46:08
  decreasing amounts of detection of a substance, so like they'll be weaning somebody off
• 46:13
  of a drug, and as they get less kind of substance detection inside of
• 46:17
  whatever test it is, as that rate lowers or that amount lowers, they
• 46:22
  get some kind of reward for that. And sometimes patients will actually get into
• 46:27
  some sort of lottery type ticket system where the rewards are available, and rather
• 46:31
  than getting regular payouts, they get increased entries into a jackpot style payout.
• 46:37
  So like it could be that maybe they don't get rewarded in monetary value every
• 46:42
  single time they have a clean test, but what they do is like they
• 46:45
  get an entry into a larger jackpot, which could be a pretty significant amount
• 46:47
  of money or a prize or something like that. Yeah, I described it
• 46:51
  here as a lottery, but I guess it's more like a raffle because like
• 46:54
  someone's gonna win it, right, And so as you said, like the
• 46:59
  longer they may contain the sobriety, the more entries they get, the more
• 47:01
  likely they are to get that payout. So they are trying to build that
• 47:04
  incentive right now. Sometimes the incentive is just cash. Sometimes it is vouchers
• 47:08
  for things like services or resources. It might be food or grocery that sort
• 47:13
  of thing. Sometimes it was gift cards, sometimes it was privileges, depending
• 47:17
  on the circumstance that they were in. So they play around with all kinds
• 47:22
  of different types of contingencies. Because obviously one of the things that I think
• 47:27
  was implicit inness that we haven't explicitly said so far, but I'm going to
• 47:30
  now, is that it can be expensive. Like a lot of people would
• 47:34
  see this and be like, why are we paying people to do a thing
• 47:37
  that they're supposed to be doing anyway. And we'll get into that a little
• 47:40
  bit, but the thing being that, like they're trying to figure out how
• 47:44
  can we leverage the system without really breaking the bank here, right, And
• 47:47
  sometimes what they'll do these systems will only be used to decrease the frequency of
• 47:52
  use, but not actually shoot for abstinence, So like it'll be a reduction
• 47:57
  to like maybe healthier level or safer levels or manageable levels or something like that
• 48:04
  until they can get some other treatment system. And there are actually a lot
• 48:07
  of different formats of this, right this has been extended to virtual formats which
• 48:09
  people can take certain tests via video conferencing software, like they can look at
• 48:15
  video smoking cessation and stuff like that. There's some different things that are out
• 48:17
  there to help kind of monitor and support this. Yeah, so they aren't
• 48:22
  obviously going to have people pee into a cup on camera, but what they
• 48:24
  have done is they've sent them little kits like where they can blow into a
• 48:29
  test thing that's hooked up to the computer. So that's a way that they've
• 48:32
  started to reduce the burden of transportation to these clinics where they can they get
• 48:37
  to see the person actually taking the test, they can confirm that they're doing
• 48:40
  it, but they don't have to travel anywhere, and so it might be
• 48:43
  a little bit more workable for them. Of course, they do then have
• 48:45
  to have internet and a computer of some sort to do this, but they're
• 48:49
  trying to lower the sort of barrier of entry and accessibility for people, particularly
• 48:52
  if they maybe are rural and it would be difficult to get to a clinic
• 48:57
  to do this. So, yeah, that makes sense. These are some
• 48:59
  of these spends on this idea of contingency management. It's been around for a
• 49:04
  long time. There have been tons of studies on this, I mean just
• 49:08
  so so many. Yeah, there have been special issues of journals that were
• 49:14
  dedicated just to research on contingency management. Again, that name terrible for behavior
• 49:21
  analysts are not known for naming things. Well, yeah, yeah. One
• 49:25
  large study that they did had over eight hundred participants randomly assigned to either the
• 49:30
  contingency management group or sort of standard care for addiction group. Now, the
• 49:36
  standard care presumably this is one where they're already like, this is an effective
• 49:40
  treatment. We think this works, this is what we usually use. This
• 49:44
  is how we try and support and help people recovering from addiction. And so
• 49:47
  they wanted to compare contingency management to that. In good circumstances, contingency management
• 49:54
  should do at least just as well as the standard of care. Right,
• 50:00
  do at least that well if they were expecting it to do, you know,
• 50:01
  anything, as a strategy, it should do at least as well.
• 50:05
  If that is not better. And so in this comparison, it showed that
• 50:08
  those in the contingency management group, the experimental group, they maintained sobriety for
• 50:14
  twice as long as the people in the standard care group. They were nearly
• 50:16
  twice as likely to maintain that sobriety. And there were four times as many
• 50:22
  people in the contingency management group that completed treatment compared to those in the standard
• 50:27
  group. So the outcomes not only did as well as the standard treatment,
• 50:31
  they did multiple times as well. They did much better I'll say much better.
• 50:37
  Yeah, much much better. And now it was not a one hundred
• 50:39
  percent success, but it was much better than the standard care group. So
• 50:44
  so far looking pretty good, right. And so at this point in time,
• 50:47
  we've read so many of these studies. I mean, there's a lot
• 50:51
  that just show there's effectiveness, like some kind of effectiveness, right, Like,
• 50:53
  there's still a lot of work to do, but for the most part,
• 50:55
  people who want to decrease or eliminate their substance use can do so and
• 51:00
  maintain it for at least a year when they use contingent management as their method.
• 51:05
  It's specifically shown that they do really well and have pretty decent success rates
• 51:09
  with this stuff. And so I think it's worth pointing out This is kind
• 51:14
  of what I would describe behavior analytically as a brute force sure approach. This
• 51:20
  is a functional treatment strategy, and a functional I mean in this case meaning
• 51:24
  it is not addressing the function of the use of addiction. It's not getting
• 51:29
  after the why part, right, And because this is it's trying to just
• 51:32
  sort of superimpose a new set of rewards and incentives on top of an existing
• 51:38
  system of rewards and incentives for that person, which we're probably largely based on
• 51:45
  avoidance, like they're trying to mitigate something unpleasant in their life by using substances
• 51:50
  to distract themselves or feel better. And so this approach tries to basically superimpose
• 51:55
  a brand new system on top of that existing one without addressing the existing issues
• 52:00
  for them. And what that means is that this may not work if it
• 52:05
  does not also address the other environmental factors such as that person's motivations for starting
• 52:10
  and using substances, the setting events, environmental cues, and prevailing traumas,
• 52:17
  or other similar circumstances that may have had people using in the first place.
• 52:22
  So I think that's where you run into potential issues with contingency management, is
• 52:27
  that those things might still be present for that person even if they want to
• 52:30
  stop, even if they're trying that, until you have altered their environment such
• 52:36
  that those things are not still motivating and pushing them toward substance use, they
• 52:42
  might just go back to it. And again, this is more successful for
• 52:45
  a lot of people than other accepted treatments, but there still is this consideration
• 52:50
  of those other environmental factors. Yeah, I think it's so important because contingency
• 52:55
  management means that we're setting up contingencies to outcompete the current existing contingencies for that
• 53:01
  person. Right, we're trying to, at least we're trying to. And
• 53:05
  that's tough, Right, that's tough. And that kind of goes into this
• 53:07
  next piece too, when there is another treatment strategy that is all about environmental
• 53:10
  enrichment programs, and these programs are designed to empower patients to choose not to
• 53:15
  use substance by making their lives comfortable, safe, and engaging as engaging as
• 53:19
  possible. So environmental enrichment essentially means that people are given free access to shelter,
• 53:23
  food, safe places to sleep, social interactions, vocational training, engaging
• 53:27
  in fund activities, regular counseling, a judgment free environment and unmitigated access to
• 53:31
  their substance of choice. So in those spaces, all of their needs are
• 53:36
  met, they are safe, and they have access to whatever they need to
• 53:40
  thrive in a situation like that. So ideally they make it so that sobriety
• 53:45
  doesn't have to compete with other factors in their life right. And an important
• 53:52
  piece there, as you said, is that in the idea is that they
• 53:55
  could still choose to use their drug, whatever it is, but you make
• 54:00
  it so that they don't want to any longer and they can kind of wean
• 54:04
  themselves off at their own pace. And in theory, in theory, when
• 54:08
  people's needs are met in this way, they will choose to not use the
• 54:13
  drugs, even when those drugs are freely available to them. Unfortunately, so
• 54:19
  far, the evidence for this approach is largely confined to animal models, non
• 54:25
  human animals, and in these experiments, so I think, to be perfectly
• 54:30
  clear, there does not seem to have been a really solid demonstration of environmental
• 54:37
  enrichment with human participants in a real clinical setting. We've had like analogs,
• 54:44
  and then they've done this with animal models. And so in these animal models,
• 54:47
  what they've done is they either gave free access to or specifically administered a
• 54:52
  drug to some animals until they look like they were addicted to those drugs.
• 54:55
  We saw sort of a demonstration of what looked like addictive behaviors seeking them out.
• 55:00
  They certainly had enough quantity for us to presume that they should be addicted,
• 55:05
  right. And then what they do is they place them in these environment
• 55:07
  that is enriched with a whole bunch of other things to do. There's social
• 55:12
  opportunities, they give them a bunch of toys, they give them larger cages
• 55:15
  to move around in, and just other things to do. Right, So
• 55:19
  they're trying to make their environment as stimulating, as interesting, as safe,
• 55:23
  and as comfortable as possible. And then again they give them free access to
• 55:28
  this drug that they're addicted to. Right. I think it'd be interesting to
• 55:30
  see what it would look like for humans, Like if we could do that
• 55:34
  and do that well, But there's a lot of ethical and other things going
• 55:37
  on there. Yeah, IRB would be a nightmare for that. Yeah,
• 55:39
  It's like, could you imagine going to an IRB and being like, I
• 55:42
  would like to give my human patience cocaine, lots of cocaine like so much
• 55:45
  cocaine, like as much cocaine as they want. You University, can you
• 55:51
  fund this because I can't pay for all the cocaine that I'm going to give
• 55:53
  these people. Yeah, also all the food they want. Yeah yeah.
• 55:57
  In addition, I need like one hundred thousand dollars to make the lives pretty
• 56:00
  comfortable. Yeah yeah. Yeah. So what they found was both with monkeys
• 56:05
  and rats, they have shown that the environmental enrichment programs, in specifically what
• 56:08
  we're talking about, these animals are much less likely to use and use less
• 56:13
  of their addictive drug than those in groups who do not have environmental enrichment basically
• 56:17
  another set another way, when they have enough stuff to do, they don't
• 56:22
  want to do the drugs. Yeah, Like when they've got all their needs
• 56:23
  met, they don't want to do the drugs. That was exactly it is.
• 56:28
  They did exactly what the hypothesis suggested that they would do, which is
• 56:31
  that they would use less or none of the drug to which they were addicted
• 56:36
  if they were given a better world in which to live. That's what happened.
• 56:39
  That's kind of what we thought was going to happen. So like there
• 56:43
  is evidence, but again it's these sort of preliminary models not complicated by language
• 56:50
  and culture. So we are not quite at the place yet where we know
• 56:53
  that this will work, but we do have some analogs and some sort of
• 56:59
  versions of this in the research that say that it will work. Now.
• 57:02
  Right, here's an important thing, of course, as I mentioned earlier,
• 57:06
  we have these people who do not think with their brains, and they are
• 57:10
  going to go to town on the idea that we are compassionate towards people with
• 57:19
  addiction disorders as our strategy, and that we try and give them environmental enrichment,
• 57:23
  and misconceptions and myopic misanthropic ideologues are going to view this as like luxury
• 57:30
  living or definitely as enabling, as we already see with harm reduction, which
• 57:36
  is like already not a particularly luxurious way to go about things, right,
• 57:42
  or they might believe any other myriad incorrect beliefs about the environmental enrichment programs.
• 57:46
  But again, like see our harm Reduction episode on this, no one is
• 57:52
  choosing to use heroin so that they could go join this program. No one
• 57:57
  is like, oh, I wasn't going to use today, but now that
• 58:00
  I've got this space where I can go be comfortable, I am going to
• 58:05
  use instead, Like people are already doing these drugs out on the streets where
• 58:08
  it's like very unsafe, right, and they're in unsafe places, and they
• 58:14
  also and sometimes make other people unsafe because they are in spaces where they're around
• 58:20
  a lot of other people. And so like, no one is continuing to
• 58:22
  use so they can join these programs. The thing is like these are not
• 58:27
  actually nice places to be. These are places where people are struggling severely.
• 58:31
  They're in the worst times that they've ever had in their lives and trying to
• 58:37
  overcome them. And these are meant to be treatment spaces, their recovery programs,
• 58:40
  not spa resorts, right, right, So I think it's worth really
• 58:44
  understanding that when people go to an environmental Richmond program, which again doesn't really
• 58:50
  exist yet, but assuming that it did, we're not like this is not
• 58:54
  a place that they go because they're like, oh, let's kick a vacation
• 58:57
  and go to like drug rehab, Like that's not what this is going to
• 59:00
  be like, And nobody is going to start using drugs so that they can
• 59:05
  go to these places. They are recovery programs, well, you know,
• 59:08
  and I've been thinking about this throughout this entire suite because I think you bring
• 59:13
  up a great point about the perspectives and the misconceptions about all of this,
• 59:17
  and it ultimately comes down to how people view personal responsibility about their behavior.
• 59:25
  Like I think that that is ultimately the problem in all of it, is
• 59:30
  that there's so many folks that believe that at the end of the day,
• 59:34
  you are responsible for your behavior under all circumstances, which means you're responsible for
• 59:37
  helping yourself, which means that you don't need the handouts to help yourself.
• 59:42
  You should be able to pull yourself up by your bootstraps and do it,
• 59:44
  which we've I think that we've said it more than once on the show.
• 59:47
  The comment of pulling yourself up by your bootstraps was a sarcastic, satirical statement.
• 59:53
  It wasn't meant to be like a real thing, but a bunch of
• 59:55
  people took that as a real thing. And so there are people that struggle
• 1:00:00
  with this idea of helping others. And when we talk about addiction, we're
• 1:00:05
  talking about people who are in need of help. They need support and they
• 1:00:09
  can't do it themselves. There's not a person on this planet that believes,
• 1:00:14
  one way or another, that has gotten to where they are by themselves.
• 1:00:19
  Right, Like you didn't learn how to tie your shoes by yourself. Somebody
• 1:00:22
  taught you how. Somebody helped you do that. Somebody helped you through infancy
• 1:00:27
  somewhere. So like there's this idea that like help is for the weak and
• 1:00:31
  help shouldn't be freely given. And I think that ideology is the poison that's
• 1:00:37
  preventing larger addiction treatment programs from being more widespread and being useful for people,
• 1:00:43
  or like why people don't like them to begin with, because it means helping
• 1:00:46
  people in need. Yeah, yeah, you're exactly right. And as you
• 1:00:50
  said, it's kind of ironic because like the people who never found themselves in
• 1:00:55
  this position, they had help to begin with, Like yeah, and so
• 1:01:01
  like the reason that they're like, well, why don't you just help yourself?
• 1:01:05
  And like you didn't have to help yourself, right, everything was handed
• 1:01:07
  to you. You know, you got a small loan of a million dollars.
• 1:01:10
  Yeah, exactly. So I think there are and to be fair,
• 1:01:14
  like there are a lot of people who managed to find their way through these
• 1:01:19
  circumstances by themselves. It does happen, yeah, but then we have to
• 1:01:22
  ask how did that happen for them? And usually what that meant was like
• 1:01:29
  they had some other support somewhere else that gave them the skills that they needed
• 1:01:32
  to make their way out of it. Well, and even then it shouldn't
• 1:01:36
  be necessary that they should have to do that. That's true, yeah,
• 1:01:39
  exactly, is like just because that person was successful, like that was a
• 1:01:43
  fluke, right, we can't depend on that, and we also like shouldn't
• 1:01:46
  have relied on that to be the need for them in the first place.
• 1:01:51
  And again, thinking about like why people choose to use, and there are
• 1:01:54
  people who are like in the sort of high up, elite class situations who
• 1:02:00
  use because there's this culture around partying and like you know, whatever goes on
• 1:02:06
  up there, and that's how they really get into it, and then they
• 1:02:08
  end up at a very low point. But like most people who are using
• 1:02:14
  these substances are not in that situation, right. They're using for a lot
• 1:02:17
  of reasons, but usually it comes down to things like they don't have a
• 1:02:22
  lot of other resources available to them, and if we address that fact by
• 1:02:25
  giving them a world in which they do have their needs met, most people
• 1:02:30
  will choose not to use, but it is worth like we do have to
• 1:02:34
  understand, like what are what are the prevalent circumstances for the person, what
• 1:02:37
  is going on for them, and that's how we're going to make the best
• 1:02:42
  i think, therapeutic choice to help them navigate a way away from their dependence
• 1:02:45
  on those substances. Absolutely, I think in the end it all its contextual.
• 1:02:50
  It just depends on the person and what's going on for them. But
• 1:02:52
  considering that for most people, these are situations where they are often faced with
• 1:02:57
  desperation as a regular part of their daily life, so much so that they
• 1:03:00
  probably don't even recognize it as being desperation, right, and our face with
• 1:03:04
  just sort of ongoing trauma and reaffliction of like traumatic events over and over again,
• 1:03:09
  just kind of rubbing the salt and the wound, and then are being
• 1:03:12
  blamed for that, like, right, something bad happened to you, and
• 1:03:15
  like now oftentimes it starts when they're very young, their children, and they're
• 1:03:20
  like that's your fault, Like you just need to get over it is basically
• 1:03:22
  the message that they're sort of given and like how defeating and like wildly inappropriate.
• 1:03:28
  That is right, that has never solved anyone's problem. And so what
• 1:03:30
  we're proposing here is not even like I don't know that this is always going
• 1:03:36
  to work, but everything else that we have done so far hasn't really worked.
• 1:03:39
  I mean, some things have been more effective than others, right,
• 1:03:42
  Like we've sort of started to land on more effective ways to go about supporting
• 1:03:46
  people in these spaces, and I think they're getting better and better, and
• 1:03:50
  this is definitely the best it has ever been, right, is the time
• 1:03:53
  we're living in now, And like a lot of our ideology about this has
• 1:04:00
  just it has led to nothing but backwards, like backward pedaling and getting things
• 1:04:05
  wrong and making things worse for most of the history of treatment addiction, right,
• 1:04:11
  I think that's the perfect summation of all of this, Right, is
• 1:04:14
  that you know, there are a lot of different things that people have done.
• 1:04:17
  There are some things that kind of work for some people sometimes, right,
• 1:04:20
  And that's really that's treatment for addictions, right, Yeah, there are
• 1:04:24
  a lot of things that sort of work for some people sometimes, Like that
• 1:04:29
  is the thesis, yes, but we do know there's but there are some
• 1:04:32
  things that are more effective. And ultimately, what you're finding and when you
• 1:04:35
  get into the kind of the nuts and bolts of all of this is that
• 1:04:40
  there's not a single magic bullet to solve all of it. It's a combination
• 1:04:45
  of support, of therapy, of drug treatment, of all the things that
• 1:04:51
  go along with this, function based treatment, contingency management, all these things
• 1:04:56
  that are going on. It's a combination. It's a treatment package, right,
• 1:04:59
  It's a comprehensive suite of interventions individualize for that person to support that person
• 1:05:04
  and get that person to where they need to be to thrive. And whatever
• 1:05:09
  that support level looks like, and whatever that support level is is going to
• 1:05:13
  be entirely dependent on that person. But we do know that there are some
• 1:05:16
  things that don't work, like jailing people. We do know that there are
• 1:05:20
  some things that do work, like contingency management and CBT and DBT on some
• 1:05:26
  level and act on some level. Right, So putting all those together only
• 1:05:30
  increases the chances that people are going to thrive and get to sobriety or at
• 1:05:34
  least a level of sobriety that's manageable if we can combine those things that work
• 1:05:38
  better exactly right. And I think that that's a fantastic way of sort of
• 1:05:42
  laying out our options here. Consider the fact that everybody who is suffering with
• 1:05:46
  addiction to someone's child. So let's use that to assume that every person we're
• 1:05:51
  talking about, dear listener, is your child specifically, right, And would
• 1:05:57
  you rather your child die and so and be in prison for the thing that
• 1:06:03
  they're dealing with, or that we spend the money to try something else that
• 1:06:10
  we are fairly confident is going to help if not work very well, right,
• 1:06:14
  you know, at least make things better if not help. This is
• 1:06:16
  your child we're talking about here. The choice is, like, you spend
• 1:06:19
  the money on something that that maybe doesn't look like you would expect, like
• 1:06:26
  the sort of moral approach to what addiction is. But we do we spend
• 1:06:30
  the money on it to try and help them, or alternatively, they end
• 1:06:33
  up in jail and they die. Right. I think the choice becomes obvious
• 1:06:36
  when we think about this, like stop thinking about this as some stranger and
• 1:06:41
  start thinking about this as a loved one, because like, they are somebody's
• 1:06:45
  there's someone's child, there's somebody's sibling, there's somebody's parent. In many cases,
• 1:06:49
  like this is a human being, and let's think about them as being
• 1:06:54
  our own kin and how we would want to address it that, like if
• 1:06:58
  they were our child, right, And I think that that makes the approach
• 1:07:00
  very clear, Like we're not sending our child to prison. I mean there
• 1:07:03
  are parents who would do that sort of thing, and booh yeah, yeah
• 1:07:08
  boo, Like we want what we want, you know, the best for
• 1:07:11
  our kids, and so we're going to treat other humans as if they are
• 1:07:15
  kids because they are somebody's kids, right, we were going to make the
• 1:07:16
  choice that it's worth investing in their longevity rather than having something terrible happen to
• 1:07:24
  them. Yeah. I think the mark of an advanced society is how well
• 1:07:27
  it takes care of its people, and the mark of a disadvanced to that
• 1:07:30
  society's adds. Okay, we've run so long on this, I think we
• 1:07:43
  kind of have reached, as I said, a sort of natural stopping point
• 1:07:45
  in our discussion here. It's not like we've covered everything there will ever be
• 1:07:49
  to say about addiction and various things related to substance and behavioral excess. That'll
• 1:07:54
  definitely be a thing that comes up again, but I feel like we've more
• 1:07:58
  or less said what we had in mind to say about addiction. Yeah,
• 1:08:01
  so I think we'll probably about at the point where we'll start closing this out
• 1:08:04
  here, maybe do a quick rerun of a previous addiction based topic than an
• 1:08:10
  nostalgia episode, but I think we'll get back to our sort of regularly scheduled
• 1:08:14
  programming after this. If you've been with us on this journey, thank you.
• 1:08:16
  We've enjoyed having you with us. This has been fun. I'm glad
• 1:08:20
  that we spent the time to talk about this the subject because it affects just
• 1:08:25
  a huge amount of people. Right Hopefully you learn something. Maybe you learn
• 1:08:29
  something new about yourself as you're exploring this, maybe you've developed a level of
• 1:08:32
  compassion that you didn't have before. But whatever it is, we hope that
• 1:08:35
  you have gotten something really valuable out of it, because I think that this
• 1:08:40
  was one of the most I think enlightening and for me, one of the
• 1:08:45
  most impactful series that we have done so far. Like the series of episodes,
• 1:08:48
  I think that I have come out of this a better person as a
• 1:08:51
  result of just spending time in it. You know, Yeah, I feel
• 1:08:55
  the same way, and I'm proud of the work that we've done on this.
• 1:08:58
  I've enjoyed learning and describing these things. If you would like to share
• 1:09:02
  your thoughts and experiences, we would love to hear from you. You should
• 1:09:05
  email us directly info at wwdwwdpodcast dot com, or you can reach us on
• 1:09:11
  the social media platforms and let's have a conversation. Happy to get it started.
• 1:09:15
  We're not saying goodbye, We're just saying until next time, which will
• 1:09:18
  be next week. Because we never stop. Uh huh, we never stop.
• 1:09:23
  But I think that's all that I have to say about the history of
• 1:09:26
  treatment for addiction. Anything you would like to add before we get to our
• 1:09:29
  recommendations. No, I think that's good. I think that covers it great.
• 1:09:33
  If you are joining us for the first time, welcome. You did
• 1:09:36
  not have to listen to all of the other episodes in the series on Addiction,
• 1:09:40
  but like I said, I'm pretty proud of how they turned out,
• 1:09:43
  so I think it's worth going back and checking out if you want to learn
• 1:09:45
  more about those or any of the three hundred and sixty seven other episodes that
• 1:09:49
  are are in our archive. Because we've been we've been at this for a
• 1:09:54
  little minute, which is which is cool. We actually just crossed that seven
• 1:09:56
  year threshold, so which is wild. Keeping going yeah, yeah, we're
• 1:10:00
  loving it. Our podcast would be a second grader now, I think,
• 1:10:03
  yeah, so weird or something like that. Maybe a first I don't know,
• 1:10:06
  we're in elementary school. Anyway. You could also support us by picking
• 1:10:12
  up some merch, leaving us a rating and review. You can join us
• 1:10:14
  on Patreon, you can subscribe, tell a friend, all those things.
• 1:10:17
  If you do join us on Patreon, you get extra behind the scenes content,
• 1:10:20
  access to early episodes, all that sort of thing. If you hadn't
• 1:10:23
  noticed, we have launched a new format called minis. Those release on Mondays.
• 1:10:28
  They do a sort of truncated short episode where we just unpack something in
• 1:10:31
  like fifteen ish minutes. Most of them have been shorter than that. A
• 1:10:35
  couple will be longer, but that's around what we're trying to do with those
• 1:10:39
  mini Still look for those if you're interested, And as I said, you
• 1:10:42
  get all that bonus stuff by join us on Patreon. And there's a group
• 1:10:45
  of people that joined us on Patreon already, and because they have been so
• 1:10:48
  generous with us with their resources and being around and hanging with us, we
• 1:10:53
  like to thank them. Each and every episode in your name could also be
• 1:10:57
  on this list. And I think that you do want to hear your name
• 1:11:00
  said in my voice, because that's what these people signed up for, and
• 1:11:02
  that is Mike, m Megan, Mike T, Justin, Kim, Joshua,
• 1:11:06
  Brad, Stephanie, Olivia, Brian Ashley, Kiara, Christy and Michelle
• 1:11:11
  Forever and always thank you. Yes, Ah, we adore y'all, you're
• 1:11:15
  the best. Thank you to my team of people who help me make this
• 1:11:17
  podcast so that it comes out every week and sounds like a podcast and not
• 1:11:21
  like some Rando recording in his basement. And that is Justin, who does
• 1:11:26
  our audio production and sound design, writing in fact checking from Shane Jess and
• 1:11:30
  myself. Our social media coordinator is Emma Wilson. Shane, is there anything
• 1:11:34
  that I forgot you would like to add before we get to our recommendations?
• 1:11:38
  Nope, that's it, cay Let's recommend some things. Recommendations. All right.
• 1:11:49
  So I want to see a movie and that movie is called if If
• 1:11:55
  Heard About as in, Yeah, it's written and directed by John Krazinski.
• 1:11:59
  Oh, I didn't know that, yeah, which I think is fascinating because
• 1:12:02
  the only other movie I know for certain that I've seen that was written directed
• 1:12:06
  by John Krasinsky is a quiet place, yeah, which is fantastic. Yeah,
• 1:12:12
  But I gotta say I was incredibly impressed with this, all right.
• 1:12:15
  So John Krasinsky is also and he's the dad in this and it's really about
• 1:12:19
  this twelve year old girl who's kind of coping with really tough things that are
• 1:12:24
  going on in her life, like life things like. But John Krasinsky's the
• 1:12:28
  dad. John Krasinsky's the dad. Oh I thought it was Ryan Reynolds.
• 1:12:30
  Ryan Reynolds is a character in this movie who was really great in this movie.
• 1:12:33
  But yes, John Krazinski is the dad in this movie. He does
• 1:12:36
  not take center stage, like he's very like kind of like because it's really
• 1:12:40
  about this girl and like navigating growing up, like she says on more than
• 1:12:45
  one occasion, I am not a child, and so it's kind of like
• 1:12:47
  her navigating that. But it's really about she starts seeing imaginary friends, and
• 1:12:51
  she starts like kind of thinking that she's going crazy because she's seeing all these
• 1:12:56
  imaginary friends. And Ryan Reynolds is kind of helping her navigate some of that
• 1:13:00
  stuff. And it's the cast and it is incredible. The grandmother is Fiona
• 1:13:03
  Shaw, who is the aunt in Harry Potter. She is like, OK,
• 1:13:08
  she's like me. She's in a bunch of stuff. She's really great.
• 1:13:10
  Yeah. Liza Cologne Zaias is in it. If you're not familiar with
• 1:13:13
  her work, she is Tina from The Bear Oh and I love her to
• 1:13:16
  death. Yeah. Ryan Reylds is in it, like you just mentioned.
• 1:13:18
  But the voice cast is absurd. So and they voice all these different imaginary
• 1:13:25
  friends that are really creative and fun. So there is Steve Carell, Aquafina,
• 1:13:30
  Emily Blunt, George Clooney, Bradley Cooper, Matt Damon, Bill Hayter,
• 1:13:33
  Richard Jenkins, Keegan Michael Key, Blake Lively, Sebastian Manscalo, Christopher
• 1:13:40
  Maloney, Matthew Reese, Sam Rockwell, Maya Rudolph John Stewart, and Brad
• 1:13:45
  Pitt. Wow. That is an all star cast, if ever there was
• 1:13:48
  one. Yeah. Yeah. I think the best gag though, is that
• 1:13:51
  Brad Pitt plays an imaginary friend that's invisible, so he's never in the movie
• 1:13:56
  at all, and he never has a line. That's pretty good. Yeah,
• 1:14:04
  it's a pretty it's a pretty good gag. Not his first time doing
• 1:14:06
  that, actually, actually that's the third time he's played an invisible character in
• 1:14:11
  a movie if you count Fight Club and Deadpool too, So yeah, it's
• 1:14:16
  so great anyway, it's wonderful. It's incredibly emotional, and the story is
• 1:14:23
  just whimsical and fun and just a it's just a really great, great movie.
• 1:14:28
  So strong recommendation on that. Awesome all right. It looked like one
• 1:14:31
  of those like kids movies that's sort of like, yeah, I might check
• 1:14:34
  that out some point when it comes out, you know, on streaming or
• 1:14:38
  something, but wasn't like really super interested in it. But you've you've given
• 1:14:43
  the hard cell, I think, so I think you got to see it
• 1:14:45
  because it doesn't act like a kid's movie. It's like it's got that touch
• 1:14:47
  to it, but it's like got a very sweet, emotional, wholesome kind
• 1:14:50
  of core to it that like strikes all the heart strings for an adult,
• 1:14:55
  Like it makes you kind of go oh, like, yeah, I forgot
• 1:14:59
  that, Like I've grown up been taking things too seriously, like I need
• 1:15:00
  to go back to being a kid a little bit about stuff. So it's
• 1:15:03
  very very sweet, all right if the movie if yes, while we're on
• 1:15:08
  the vein of movies that have an F in them and John Krazinski, whose
• 1:15:12
  partner is Emily Blunt, who is also in that movie. I am recommending
• 1:15:15
  the movie Fall Guy also, I think in the vein of movies that that
• 1:15:19
  strike the chord for adults. Yes, and also star Ryan's and starring Ryan's
• 1:15:25
  this is Ryan Gosling and Emily Blunt, so there's there's some overlap here.
• 1:15:30
  Essentially, this is an action movie about stunt performers, but it's like there's
• 1:15:32
  so many movies that sort of do this thing. It's like it's it's a
• 1:15:35
  movie about making movies that essentially turns into like an action thriller with like actual
• 1:15:44
  steaks, while in the movie it's a movie so it's not actual stakes,
• 1:15:46
  both actual stakes, and it also has Aaron Tyler Johnson and there's a bunch
• 1:15:50
  of people in it. It's it's a really fun, wild action movie.
• 1:15:55
  It's very silly, very over the top, it's very comedic. It's like
• 1:15:59
  really fun to watch. But Ryan Gosling is just a hoot in this,
• 1:16:02
  I'd say, honestly, more than anything, it's actually about the relationship between
• 1:16:06
  Ryan Gosling and Emily Blunt, and it just does not have the same kind
• 1:16:11
  of rom colm type formula that I've come to expect from movies, where it's
• 1:16:16
  like they you have your meet cue and then they start to become really passionate,
• 1:16:20
  and then something happens that tears them apart, and then they reconcile and
• 1:16:24
  get back together, and that's like every movie ever. This one's actually a
• 1:16:27
  lot more like it's a bit more chaotic than that, and also it's more
• 1:16:31
  just about the relationship evolving in sort of a good direction the pretty much the
• 1:16:35
  whole whole time, after the initial event that kicks off the whole movie.
• 1:16:41
  So anyway, it's a really really fun movie. It's super ridiculous and and
• 1:16:46
  just it's it's a good time. So go check out Fall Guy if you're
• 1:16:48
  in This is not for kids at all. Lots of drugs and violence and
• 1:16:56
  like people dying and that sort of thing, and it's actually a very very
• 1:16:59
  well to movie. Also includes Hannah Wattingham, which people will know from Ted
• 1:17:02
  Lasso if they watched that, and Teresa Palmer is a great cast, really
• 1:17:08
  fun movie strong recommends. So if you're into action movies, over the top
• 1:17:11
  silliness, go check it out. So fun. I love that all right.
• 1:17:15
  Again. When we started the series of episodes on addiction. They went
• 1:17:17
  longer and longer, and some of them being our longest ever, and this
• 1:17:20
  one is trying to be that again, and so we're going to close it
• 1:17:24
  out here. Thank you so much for joining us, for being around for
• 1:17:28
  this. We've had a lot of fun unpacking these. As said, reach
• 1:17:30
  out to us. But I think that we can say thank you, dear
• 1:17:32
  listener for being with us, and thank you Shane for recording of me today.
• 1:17:35
  Of course, I think we'll go ahead and sign off there. This
• 1:17:39
  is Abraham and this is Shane. We're out see it. You've been listening
• 1:17:43
  to Why we do what we do. You can learn more about this and
• 1:17:46
  other episodes by going to WWD WWD podcast dot com. Thanks for listening,
• 1:17:53
  and we hope you have an awesome day.