Latest / Conversations with Cumberland Heights / Inside the Science of Addiction Recovery with Dr. John Kelly | Ep. 43

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Inside the Science of Addiction Recovery with Dr. John Kelly | Ep. 43 · Conversations with Cumberland Heights

0:00
Very impressive.
0:02
Thank you.
0:03
We've come a long way. So.
0:05
Yes, even more famous.
0:07
Oh, God.
0:09
I'm nervous. Now.
0:09
Welcome to the show, doctor John Kelly.
0:12
We're going to be sure to pin your accomplishments
0:16
and what you do for work in the episode bio and all of that.
0:19
But it's good to have you and I.
0:21
I will be remiss if I don't mention that this is our second podcast
0:24
together.
0:28
Over 100 years ago.
0:30
Yeah. Yeah.
0:32
In Boston and in another life, we came
0:36
and and hung out with you at the Rye and met Brandon Bergman
0:41
and had some good conversations about the state of,
0:43
recovery research and, and talked about addiction treatment research.
0:48
And so I'm grateful.
0:50
I'm grateful that you allowed us to do that.
0:52
We did get to go to a Boston Red Sox game.
0:54
Yeah.
0:55
And I'll tell a funny story, because Boston does
0:58
have you know, Subway's what do y'all call them, though?
1:03
And we were on the red line
1:06
obviously has to be the red line.
1:07
I was going to take you to Fenway,
1:09
but we're going to this.
1:10
Me and a friend of mine. His name is Austin.
1:12
He was the other host.
1:14
Yeah.
1:15
And, and, and, he lives in Maine now, actually.
1:18
But we went to a game, and I had never been to Fenway.
1:22
And so we're, you know, as you get closer, you get
1:26
more, more passengers headed that way.
1:29
And red bull was interested.
1:32
I felt like I was on the set of Ghostbusters
1:34
because at some point you get on the red and we got on a old subway car,
1:38
you know, like you can tell a difference in ones that have been around for a while.
1:42
And it was so packed
1:44
that the
1:46
person driving the subway and the workers had to get out
1:51
and manually
1:54
push the doors because the weight had, you know, push the car down,
1:58
that the doors were stuck on the platform because there were so many people,
2:02
yeah, a little bit, you know, but but no one seemed afraid.
2:07
So we just kind of went with this is like a par for the course. So
2:11
but thank you for spending time today.
2:15
I wonder in your own words, if you describe,
2:18
you know, I know you've done what you did for us today in terms
2:20
of a presentation to our staff many, many times over, many years.
2:24
How would you describe what that was,
2:26
what you did for us today in terms of that presentation?
2:29
I guess I would describe it is I know who you, me.
2:36
Highest quality
2:38
research pertaining to 12 step.
2:41
And you sound like
2:44
I as well is, you know, kind of looking at the
2:48
the efficacy
2:49
and effectiveness of talks and treatment as well as the mechanisms through which
2:53
those treatments confer benefit to prevent relapse and promote recovery.
2:57
And does it always feel you?
2:59
I'm leading the witness a little bit, but one of the comments you said
3:02
that is most common after those presentations is the gratitude
3:06
and gratitude from staff that work and and a facility like Cumberland Heights.
3:11
And can you share what that sentiment usually is?
3:14
And usually you thank God this guy stopped speaking.
3:19
Yeah, right.
3:21
I'm sure. Yeah.
3:22
Yeah. Right. No.
3:24
Oh, what they say is, they're grateful
3:28
because the research really validates their personal lived experience.
3:33
So they kind of really underscore is that what they
3:35
themselves have observed and lived,
3:39
in their own company has been the stand alone company themselves.
3:43
But also how we support service workers around the country.
3:47
What I spoke you say the same thing.
3:49
Thank you for validating my, my, my, my vision
3:53
is very empowering and validating to, to get that verified scientifically.
3:58
Not that they needed it, but it kind of is empowering
4:02
to see that the data points
4:04
that, converge consistently on the same kind of benefit,
4:09
that's critical to engaging in these groups.
4:12
Why do you think that there's a lack of.
4:14
Because why do you think that there's a lack of, recognition over the
4:19
validity of these types of programs in our country?
4:24
Well, I think really,
4:26
you know, there's there's a couple of things.
4:28
I think one is the spirituality, religious kind of
4:32
overtones around post, which
4:37
I think is
4:37
viewed with skepticism from a medical scientific standpoint,
4:41
is that people somehow do that as not.
4:45
It's not conducive to scientific inquiry valuation
4:49
the same way as other kinds of treatments are.
4:52
And so, there's always a kind of question mark over that.
4:56
And then also, historically, there's been a lack of rigorous,
5:01
systematic application of scientific,
5:05
to that database.
5:07
And that database really has only come about in the last 35 years,
5:11
since this is true medicine back in 1990, hopefully more research,
5:15
specifically on treatment and specifically on AA
5:19
and all of us, because at that time there was very little research,
5:24
despite the fact that the majority of treatment programs were
5:28
and became the 12 step involvement and basing their treatments on 12 step
5:32
principles and practices.
5:35
And, you know, really up
5:36
until the first systematic review
5:40
of the treatment, in 2006,
5:42
we just did another 1 in 2020,
5:46
which, back in 2006,
5:49
I think there were 88 articles, eight papers published now in 2020,
5:53
when we published the latest one, there were 27 trials.
6:01
And so has been,
6:03
you know, a, a concerted, effort between,
6:09
subject the, the,
6:11
the available data, which is now very high quality,
6:16
courtesy of the Ministry of Medicine and the funding
6:18
from the National Institutes of Health and finally Veterans Affairs,
6:22
where we've been able to actually say a lot because of the
6:25
there's a ton of studies now.
6:27
There's dozens and dozens of trials looking at this.
6:29
We need to evaluate, systematically evaluate it,
6:32
and look to see is a real benefit.
6:34
And now we have other is.
6:36
So now that was only in 2020 that we really you know, we had to clarify
6:41
to with the degree of confidence that is on par
6:44
with other kinds of confidence in other medical treatments.
6:48
So I think that's going to change things going forward.
6:51
Yeah.
6:52
I think it's also important to point out,
6:55
for anybody that's listening, to understand the difference between,
6:59
you know, evidence based medicine and evidence based behavioral health,
7:03
you know, in that
7:04
when you go to your training programs, whether you're an LPC or a social worker
7:07
or a marriage family therapist or what have you, that you're introduced
7:11
to a series or set of
7:14
models, interventions and theories associated with that domain.
7:18
And you're taught how to reflexively adapt those to the person in the problem
7:23
in front of you.
7:23
And, and what's interesting about the research that you presented
7:27
today is how we're starting to compare some of those modalities,
7:32
some of those manual treatments with what we consider to be,
7:38
12 step care, 12 step addiction treatments.
7:40
And I wondered if you could speak to that a little bit, you know,
7:44
TSF versus CBT versus, M.E.
7:49
and some of those group mean differences that have been found and are fact in terms
7:55
of how they manifest and change in individuals who are addicted.
7:59
Yeah. Yeah.
7:59
Well, you know, what we're trying to make is that, you know, the
8:02
just the different kinds of comparison treatments.
8:05
Now, in the last 50 years since the national, the
8:09
history of drug abuse in 1974, the National Institute
8:12
of Alcohol Abuse and Alcoholism in 1970,
8:15
there has been tons of new
8:19
treatments developed in the last 50 years.
8:23
Based on sound scientific
8:25
principles of classical conditioning, neuroscience, etc.
8:29
to be able to develop therapies as well as like social interventions,
8:34
including what you mentioned,
8:35
which is cognitive behavioral therapy and motivational enhancement.
8:38
That would be those are considered kind of state of the art.
8:42
For addiction, they are a kind of the potatoes of the food came on.
8:46
And the what do you do for the treatment world.
8:50
And or. The meeting three.
8:52
Or even three. Yeah. Even better.
8:56
All the treatment world.
8:59
I think it's just talking.
9:01
Yeah, yeah, yeah. So.
9:04
Yes. Right, right.
9:06
Yeah. About that.
9:08
Yeah. Yeah.
9:10
Yeah, sure.
9:11
And, and people are going to say, wow, he knows his stuff.
9:13
Yeah.
9:16
Yeah. So,
9:19
Oh, we don't make TSV.
9:21
Yeah.
9:23
So yeah.
9:23
So those are kind of again, they're based on sound
9:27
scientific theories, as you mentioned, principles.
9:31
And, and then the practice is to try and address those deficits,
9:36
that are associated with relapse and, and being able to,
9:39
you know, lack of ability to maintain behavioral changes over time.
9:44
And, those are, standard kind of standard practices.
9:48
There are others.
9:49
And so I continue to see management and family therapists, couples therapy,
9:53
specifically for addiction, which are also helpful, effective.
9:57
And then 12 studies cementation was developed in the 1990s,
10:02
what we call 12 step association, which was essentially post treatment
10:06
that was designed to which approach of musical is,
10:09
is designed to, you know, stabilize people and then get them involved.
10:14
And again, in this community of peers with lived experience
10:18
to have found a way out of addiction, an interesting dimension through
10:22
practice of the 12 step principles of AA,
10:25
and so treatment treatments were formally developed in the 1990s.
10:31
And then they began to be tested.
10:33
These 12 step treatments
10:34
because people wanted to understand, including as to the medicine,
10:37
as I mentioned, when they put out a volume in 1990,
10:41
broadening the base of treatment for outcome problems,
10:44
they wanted to get more rigorous data,
10:47
from the scientific community and really subject 12 to treatment
10:51
to the same kinds of standards that any other treatment.
10:56
Yeah, that's what's happened in the last 35 years.
11:00
And what I've talked about
11:02
today, in summary, was kind of the aggregate,
11:05
you know, kind of data, across,
11:08
really accumulation of of all the studies that have been done,
11:12
there has been hundreds and hundreds of studies done now on water treatment.
11:15
And I, most of those are nonrandomized study, right subset,
11:21
a large subset of several dozen studies which are randomized studies,
11:26
which was summarized, and we published a single,
11:29
the Cochrane Collaboration report, in 2020.
11:33
Now, that is a is kind of the gold standard in academic medicine.
11:36
It's it's this standard is the place where governments
11:39
or life treatment agencies and nations look to, to
11:43
to decide what to adopt and implement in their health care systems.
11:47
So, we wanted to do a review and subject to the 12 step
11:51
and I, to the same standard, that's what we did.
11:54
And what we found actually was a surprise to us.
11:57
I think the surprise to many people
11:59
was that 12 step treatments,
12:02
this fairly unsophisticated linkage of patients,
12:07
you know, education and linkage and monitoring, of patient involvement
12:12
in groups like that, you know, for serious alcohol problems, for example,
12:17
did, as
12:18
well as these other treatments that you mentioned, hydrotherapy
12:21
or motivational enhancement therapy, but they did much better
12:25
in terms of helping patients sustain remission across time.
12:29
Of course, up to three years, so 20 to 60
12:33
and higher rates of sustained remission across three years relative
12:36
to what most people would consider to be the standard of care.
12:40
Just like cognitive behavioral therapy.
12:43
So, not only that, did
12:46
they do as well or better when it comes to sustaining remission,
12:49
but they also were shown to dramatically reduce health care costs.
12:54
So because heart
12:56
patients who are in sustained remission, which patients,
13:01
who were assigned to post-op conditions were,
13:04
they were not ending up in the emergency room
13:06
or overnight stays in the hospital, which tend to be expensive.
13:09
So they're reducing health care costs there.
13:11
But also they utilized less mental health services
13:15
because they were sober in remission.
13:18
So there's less degradation and influence in the,
13:23
you're only in the neuro neuro.
13:26
Yeah. Perspective.
13:28
So there's quite a stability.
13:30
Right.
13:32
As well as,
13:34
a lot of people are using mental health counseling
13:37
to address things which can be addressed through peers, you know.
13:41
Yeah.
13:41
And that's what those studies found is that they were able to address
13:46
a lot of that, general and these recovery specific things
13:49
or other things, anxiety, depression through their peers.
13:52
So that were maybe a bit more of the same.
13:54
We didn't need to utilize, formal services that saved money.
14:00
Yeah.
14:00
What's interesting about the Cochrane review, just to highlight
14:02
that a little bit more, is it is the highest standard to
14:05
which any literature can go through to make sure that it is valid.
14:09
And, instead of kind of unpacking.
14:11
Well, wait a minute.
14:12
What do they mean when they say God
14:13
or what do they mean when they're talking about higher power?
14:15
It was really the recognition
14:17
that the mechanisms, whatever's happening, which we'll talk about in a little bit
14:20
because like further studies have been completed
14:22
that are trying to isolate what is it, what is being gained?
14:26
That's helping somebody regain what's been lost or stay abstinent.
14:31
It's important that that scaffolding,
14:35
if you will, the framework to the house.
14:37
I think I've heard you referenced it in presentations past.
14:40
That's what those treatments really provide.
14:42
You know, above what is available in an Ma
14:46
platform or scaffolding or a CBT and IT and I think that's why
14:50
people really resonate with it because it's that natural lived
14:54
experience of somebody saying, you know, that's exactly right.
14:57
You know, that's how I felt.
14:58
That's what I got out of a recovery experience.
15:01
I was around other people that it maybe wasn't a burning bush.
15:06
But the process over time is
15:10
what really helped me or this group that I was a part of change,
15:14
you know, in that plugging into that healthy community and the structure
15:18
that that provided, really unlocked an ability to experience recovery.
15:23
However, I defined that and ultimately you led everybody down to this,
15:27
this phrase that you repeated a few times, which is, you know, public health
15:32
free lunch, that that's what you equate these programs to.
15:35
I wondered if you could speak to the free lunch a little bit.
15:38
Yeah. Yeah.
15:41
Well, the idea here, of course, is that, you know,
15:44
given, you know, the benefits that I just mentioned.
15:47
Quite right.
15:48
Is that the Cochrane Library, Cochrane, beautifully published
15:52
and conducted through the company library, is considered the gold standard.
15:56
Yeah, yeah, a little bit of scientific rigor and evidence that this was applied
16:01
to any sort of benefit, even under the most rigorous circumstances.
16:06
And I can say,
16:07
you know, when you consider the these treatments that link patients to,
16:12
to a, to the step community
16:16
where they live and work,
16:18
not only does it produce
16:20
better outcomes, you know, very deadly disorder and we're talking
16:24
180,000 deaths attributed to alcohol each year.
16:28
In the United States, 3.3 million around
16:31
the world is a highly deadly disorder.
16:34
It helps them not only stay in remission, but actually reduces healthcare costs.
16:39
And it's free in the community.
16:40
When people live that from a public health standpoint, that's what I call.
16:45
And the closest thing that we have in public health to the free lunch, because
16:50
it's a freebie, it's just a natural thing that has occurred and grown now.
16:54
Henry Kissinger described it as America's gift to the world.
16:58
For example,
17:00
because it is
17:02
a free, indigenous, ubiquitous resource that alleviates
17:06
so much suffering and death and disability.
17:11
That is a free resource that is linked to,
17:13
can be linked to from treatment settings.
17:16
And so that is why I describe it
17:21
as the closest thing that we have to to a free lunch.
17:26
And importantly, some of the I want to call this out too,
17:28
because the samples from those studies are referencing the most severe cases,
17:34
as you mentioned. Right.
17:35
So because we know there are other data, we didn't talk about it much today.
17:38
But I think you've actually written
17:39
on this in years past, but that most individuals,
17:42
most Americans who experience, you know, a diagnosable
17:45
level of substance use disorder, resolve those issues in isolation.
17:49
In other words, without professional assistance.
17:52
I mean, there's data to support that.
17:53
But for those that need professional services,
17:58
and I think you said it very eloquently,
18:01
i.e. safe medical detoxification
18:05
and safe structure in a residential
18:09
or outpatient level of care to be introduced to these themes,
18:14
those that that a lot of the studies in the Cochrane
18:17
review are really talking about, those, treatment need population.
18:23
Isn't that true?
18:24
Yeah.
18:25
Yeah, yeah.
18:26
So, so all of those counties, that we summarized, they were all true.
18:30
And so yeah, it tends to call that treatment.
18:33
Yeah.
18:34
These are quite these are the more severe cases typically needing detoxification,
18:39
metabolic stabilization in those days, weeks.
18:43
That enables them then to be into think straight
18:46
and operate, you know, without those that burden.
18:51
One of the criticisms, rightfully so.
18:53
I think we should always ask ourselves questions and be critical, internally
18:57
and externally,
18:58
as to how we do things and why we do them and how they help people as well.
19:03
I'll wait a minute.
19:04
You know, Alcoholics Anonymous or 12 step culture, that's something free.
19:07
But you're charging me for it,
19:08
and it's just want to call out the discrepancy between, you know,
19:11
professional services and stabilization
19:15
and introducing you to the resources we have accessible, i.e.
19:18
the free lunch, because we know that the longer that you're engaged.
19:22
That was something that a lot of, I think our staff took away,
19:26
manifested by a
19:27
question, by one of our team members, which was, well, if you
19:31
is there a greater treatment effect, have we observed a greater treatment effect?
19:34
If we stack evidence based interventions on top of each other
19:38
in an acute time period?
19:40
And I thought your answer was really interesting and speaks to
19:44
I think what a lot of the data support in terms of engagement.
19:48
Can you talk about that a little bit?
19:49
Because I think sometimes, like you said in the presentation,
19:54
when I come to treatment, I want you to fix me.
19:57
I want you like a broken femur in my leg, fix my broken bone,
20:02
so then I can return to the lifestyle to which I was living before.
20:06
Right.
20:06
But behavioral health is, that change over time, not overnight.
20:12
And I thought that interaction we had with our staff
20:15
and you was really powerful.
20:17
Yeah.
20:18
I think, you know, the way I think about recovery,
20:21
fitness or the ability to stay in remission is like physical fitness.
20:25
Is that you
20:27
you need in order to stay physically fit.
20:29
You can't go to the gym for 30 days and then never go again.
20:33
To stay physically in good shape,
20:37
you have to keep you have to build in physical fitness
20:40
into your lifestyle to stay physically fit.
20:44
The same is true recovery fitness, if you will.
20:47
So in order to stay fitness, recovery to stay home,
20:52
it's kind of wash, rinse, repeat.
20:53
You need to find a lifestyle is conducive and supportive to long,
20:57
long term change is long term stability.
21:00
This is what people do.
21:02
Successful in recovery.
21:04
So the intensity versus extensive
21:07
intensive treatments are important in life saving.
21:10
Like you mentioned, detoxification, stabilization, acute care services.
21:14
Those can be life changing and life altering.
21:18
It's it's that's the intensive, you know, that's your 30 days.
21:21
You be in the gym 24 seven.
21:24
You know, you got.
21:25
Then what do you do when you're out of care?
21:28
You need to find a way to continue to do some kind of physical fitness.
21:33
Yeah.
21:34
That's going to help to stay resilient.
21:36
Yeah. Give. To adapt to the demands of life.
21:39
The same is true.
21:40
The demands of recovery, are real.
21:43
There's a lot of emotion dysregulation.
21:44
There's neurophysiological. Absolutely.
21:47
And recalibration that goes on in the early months and years of recovery.
21:52
And the central nervous system takes a long time to recalibrate and readjust.
21:57
Why? Because there's been chronic poisoning over sometimes decades, where
22:02
the brain is trying to adapt to these abnormally high levels of these substances
22:07
that produce these adaptations of patients, as well as necrosis death.
22:12
So they look at the central nervous system.
22:14
So there's a lot to be changed.
22:16
And people are very vulnerable early on, particularly in the first few years.
22:21
I mentioned today,
22:23
to be no more likely than anybody else in the general population.
22:26
The median criteria for these disorders in the following year takes
22:29
about five years of continuous formation for people with at least one.
22:33
So that means, you know, we're not talking about five weeks
22:36
or five months, but five years of elevated risk
22:39
relative to the general population.
22:41
The for your risk population, to be quite sure,
22:45
of one of these disorders in the following year.
22:47
So we're talking about a long term.
22:49
We have
22:52
when people need they need a
22:55
in an environment that is conducive and supportive to long term.
22:59
You know, the metaphor I was, the metaphor I use, I didn't use today
23:03
in my talk, but I think it's not a useful one, at least for me,
23:08
is this notion of, you know, like a sick plan.
23:11
We have a disease plan.
23:12
There's only so much you can do to that plant organism to to cure it at that time.
23:18
Rather, you can give it a little bit of moisture and TLC at that particular time.
23:23
But what do you have to do?
23:24
You have to create the right soil, the right temperature, the right moisture.
23:28
When you create the right conditions, that plant organism will not only survive
23:33
and thrive and flourish right, it's in the right environment.
23:37
Right conditions.
23:39
The human organism that's been poisoned chronically,
23:43
it was, from the from
23:46
again, we can detoxify.
23:47
There's only so much we can do any given time to human humans,
23:51
but rather we have to create the right conditions for that.
23:54
The mother nature to do her job.
23:56
When you take the poison away, you create the right conditions.
24:00
I call that psychosis.
24:02
Photosynthesis.
24:03
So it's kind of like a psychosis that occurs when these right conditions,
24:07
the social environment, the activity levels of physical activity
24:11
and jobs and education, as well as nutrition and emotion regulation.
24:17
Yeah.
24:18
And it's going to lead us into the ingredients
24:21
and how and what the ingredients of recovery
24:23
are for different groups is a function of their age or their recovery status
24:27
one of the things that I think
24:28
is really important for us to recognize is that when you come to treatment,
24:32
you might not be ready to be introduced to hard the hardest themes
24:37
psychologically to tackle throughout your life.
24:39
I think about it in terms of what we know and trauma care.
24:43
So, I'm a person in recovery.
24:47
I know that you know that about me.
24:48
I have a community of recovery that surrounds me.
24:51
You know, I've been I've been practicing recovery for 15 years.
24:54
And what I've learned about my own experience,
24:56
and also the experience of those around me, is that the the work
25:01
psychologically, spiritually, physically wasn't completed
25:05
within the 30 days of treatment that I went to 15 years ago.
25:11
In fact,
25:12
likely that work was pure stabilization.
25:17
I mean, I got to tell you, I was just,
25:19
you know.
25:24
I was and most people are,
25:27
you know, when they go to treatment,
25:28
are trying to do everything they can to just wake up in the morning,
25:32
put their pants on the right way and make it to group on time.
25:37
Whereas ten years down the road we might be reconciling with some serious
25:41
trauma work or physical health work
25:45
at that point.
25:45
That's only appropriate at that point, only accessible at that point.
25:48
So tier, you can't it's it is very unlikely
25:52
that we're going to pack in all the change
25:55
that needs to happen in treatment
25:59
over 22 days, over 28 days, and then say, we're so glad that you were here.
26:05
Good luck with you.
26:05
Go to your three meetings a week for the rest of your life or what.
26:09
Have you able to build a successful structure in recovery.
26:12
So I think that that is something, again, just to harp on that.
26:17
The power of recovery and the recovery
26:19
frameworks is being introduced and making sure that you make it
26:23
to the next engagement state, if you will post treatment intervention.
26:28
One of the unique data points and I, I didn't
26:31
I want you to know, I didn't speak up because I knew the answer of,
26:35
you know, the ratio or the percentage of individuals that make it to treatment
26:40
if they have a friend waiting there for them or not.
26:44
Can you speak to that?
26:45
Because that's really there's always a gasp in the audience.
26:49
Yeah, yeah.
26:50
There's a, there's an increase of yeah.
26:53
Yeah. You know that's really interesting.
26:55
Just you know what you're referring to is the studies that have been done
27:00
which have the, what they call warm handoff linking patients to
27:04
and how important
27:06
having that peer to peer connection.
27:11
Incredibly valuable.
27:12
There's a study done in 1981.
27:15
I mentioned
27:17
with, with people who never been to post-op meetings
27:20
before were randomized to receive the standard referral,
27:24
which was basically meaningless to
27:27
and was is the same thing.
27:30
Yeah.
27:30
I mean, listen to ten, but also a conversation with a peer
27:35
who was already in talks to have meetings and arranged to meet them at a meeting.
27:40
And so they compare those two different
27:42
experiments to randomized patients to, to see one of the other.
27:47
And then I asked the audience, you know, what proportion of patients don't
27:50
go to the meeting, go to the first meeting in a standard referral.
27:54
What percentage of the patients
27:55
got to the first meeting in the enhanced referral when they spoke to a peer?
27:59
And the answer, of course, is shocking because it's zero.
28:03
Nobody went in the standard for, okay,
28:05
these are people who've never been before to completely do it.
28:09
But just giving them, encouragement and a meeting list was completely useless.
28:14
Whereas in the other group, everybody went, everybody.
28:17
Everybody was 100% because we and in fact, 2 to 3 meetings in the first month.
28:23
Can you speak to how rare that is statistically,
28:25
from a research perspective, to have your protocol 0 in 100, it doesn't happen.
28:31
That's the only.
28:32
Right.
28:33
Right.
28:34
It's just a stark example of the power.
28:38
Yeah.
28:39
Now you do have to take that extra step.
28:41
It just shows the payoff.
28:42
If you're serious about really effecting change
28:45
and taking that extra step and getting appeared to connect
28:49
with your patients, who's already embedded in the community of lived experience
28:53
and recovery, that can make all the difference
28:56
to somebody actually making it over that threshold
28:59
into the first meeting and getting engaged by that community.
29:03
And we do know that people who are, engaged
29:06
in those meetings have 3 to 5 fold better outcomes. Yes.
29:10
And what were those ingredients?
29:11
Because there were three of them that you talked about that were interesting.
29:16
Now you could probably guess if you're listening, what would those things be?
29:19
You know, if you
29:20
if you quote unquote prescribed that, hey, I think it's a good idea,
29:23
Lauren, that you start going to meetings, you know, I'm your family.
29:26
We, we, we we want you to be around.
29:28
We want you to be safe, you know, and and, I like the way that you talked about.
29:32
There's a difference between going to a meeting and going to a meeting.
29:35
And what were those three things that you highlighted?
29:38
Yeah.
29:38
So the kind of two of them, ones that you may have heard before,
29:42
which is getting a sponsor using the sponsor,
29:46
who is like a 12 step mentor, somebody who's got that long duration
29:50
of recovery experience that can help you, early on in particular.
29:55
So having a sponsor using a sponsor,
29:57
going to three or
29:58
more meetings a week, was another, big factor.
30:02
Obviously, you have to go to meetings, right?
30:05
Fundamental real world meetings that we again, was was another avenue.
30:11
But an interesting one that came out was sharing.
30:14
So actually verbalizing saying something during the meeting,
30:18
have another additive effect independent of those other two.
30:22
So going to three more meetings, having and using a sponsor and then.
30:26
Also really participating in in the meetings was was also.
30:31
An additive independent.
30:33
And what was the different what was the outcome.
30:35
So this is relapse. Yeah.
30:37
So those three things I mean that's so fundamental.
30:40
But if you and it's more about not what we think about what those things
30:43
are actually doing, but the unspoken impacts that that might
30:47
otherwise have on your mental state, your emotional state.
30:51
So think about walking into a meeting that you don't know anybody.
30:54
How likely are you to then go and say, John, I really like what you said.
30:58
Will you be my sponsor?
31:00
How likely are you without that
31:04
guide to speak up?
31:06
You know, we don't know the cues.
31:08
We don't know the language or even the people.
31:10
And so it makes a lot of sense that when we look at those data
31:14
in terms of relapse risk over time, that participation
31:17
consistently attending three days a week, which is a commitment,
31:21
I mean, you got to drive there, you have to show up.
31:23
You have to make a decision that that's important to you.
31:25
I mean, that's something that sometimes we minimize, but that's a big deal.
31:28
If you have a family or if you have a job,
31:30
what time are you going to go and all that?
31:33
Not only that, do you have somebody that you're I like?
31:36
I would have a sponsor slash was it using a sponsor?
31:41
Because there's probably a difference there that I can identify
31:43
with having a sponsor and name or not, and then sharing
31:47
because I don't know about anybody else
31:49
that might be listening, but I've been to awful lot of them.
31:51
You know, certainly you don't need to share in every meeting you go to.
31:53
That's not what I'm trying to say.
31:55
But there is power.
31:56
There is emotional power.
31:58
And being able to go and
32:00
and I think it's beyond our understanding of what's really happening,
32:03
of really forcing yourself to say, hey, my name is Nick.
32:06
I'm an alcoholic.
32:08
And commenting on
32:09
the topic for today, that's a much bigger jump
32:13
than just showing up and having your meeting sheet signed and makes sense.
32:17
There's power to that. Talk therapy.
32:20
One way of thinking about it is there's no talking in there.
32:24
I think, what what am I what I did someone training in clinical
32:28
training in San Diego.
32:29
The VA is in Diego in student there.
32:32
And, one of my supervisors, we serve in groups together.
32:36
And he would always say the veterans, you know, in our group is will
32:39
diagnose patients with addiction and other mental things.
32:42
He said, come on, guys, you just talk therapy.
32:43
If you don't talk, there's no therapy
32:46
to get them laughing. Yeah.
32:47
Because but it's true.
32:49
You know, it's talk therapy is 12 step meetings.
32:52
That's all therapy.
32:53
You got to talk to get the.
32:55
So you there's there's many of course therapy dimensions to catharsis
32:59
to imparting an exchange of knowledge and information
33:02
clarifying as you're told in your own mind, having that witness
33:05
testimony has a word for, you know, just people listening to what you have to say.
33:09
So there's all different dimensions to that.
33:12
And then think about the power of consistently doing anything.
33:16
Let's just say once a week for ten years.
33:19
I mean, like you said with the gym analogy,
33:21
you know, if I workout on the elliptical once a week for an hour
33:27
for five, ten years, what impact is that going to have on my physical?
33:30
No matter what I think about it, no matter what I think about it, John.
33:33
But I did it every week for an hour or three times a week,
33:37
and as a function of these data versus not doing any of that at all, of course,
33:42
there's going to be a positive impact that manifests in this case.
33:45
And, relapse risk.
33:48
You know, it's super, super interesting.
33:51
So I want to ask you, I think a oh, we got a lot out today too about
33:56
and we might actually post some of the slides as we're talking about it,
33:59
so that people can see the visualizations of what we're referring to as we're,
34:03
as we're referring to them.
34:04
But the ingredients of recovery was, I think, really powerful.
34:08
There are what we might say in terms of our nomenclature in the recovery
34:11
community is, is, there's, seasons to recovery.
34:16
And I think that we were able to observe some seasonality
34:21
changes and recovery maturity across cisgender,
34:26
sex and across what was it age?
34:32
Was it age?
34:33
Can you speak to that a little bit?
34:34
I know we don't have those pie chart. You know the.
34:37
Yep yep yep.
34:38
Yeah yeah it was it is interesting. Yeah.
34:41
Because there's not a lot in the mechanism.
34:44
Yeah.
34:45
Lisa if you don't know was how to say groups
34:48
like I can for this reference and benefit all the time.
34:51
How come when we, when we link patients from treatment to a data
34:56
that I wanted to do better. Well, that was, you know, the meetings.
34:59
But what happens if meetings or part of the program
35:02
follows that program and follows you?
35:04
How how does that translate into benefit?
35:08
And is it the same for everybody to people different in different ways?
35:12
Yeah. Different ways.
35:14
That was fascinating. Yes. Yeah.
35:16
So this is really an interesting area of what we call, you know,
35:20
you know, mediation and multiple mediation or moderated multiple.
35:23
We're looking at, you know,
35:27
the multiple ways that I can process benefit.
35:30
And then does it convert equally for everybody.
35:33
What do people differ in the degree
35:35
to which are they benefit, in those in those ways?
35:40
And, yeah.
35:41
So we found some really interesting things there.
35:44
And don't forget as
35:45
well, you know, you mentioned the word seasons.
35:48
There is a temporal dynamic aspect to recovery, of course, is early on.
35:52
There is certain needs that people have in general
35:55
at that stage of their recovery.
35:58
But you've also got other intersecting factors,
36:01
such as how old they are.
36:05
Because how old they are as a marker
36:07
for life context.
36:10
So if you're in your teens or 20s or 30 you may have different tasks,
36:15
developmental roles and tasks associated with your we do in life right.
36:20
And also if you're a man or woman is going to,
36:23
you know, women have different demands and roles than do men on average,
36:27
and at different stages of their life.
36:30
And you mix that in with different stages of recovery.
36:34
So there's all these dynamic aspects
36:37
and contextual factors you have to think about.
36:40
We don't always think about it would be delivering treatment.
36:43
Of course. We think everybody saying right.
36:45
Everybody has the same clinical needs.
36:48
Yeah that did that phase of recovery.
36:51
But it may differ if you're 20 years old, getting into recovery, if you're 40 years
36:56
old, if you're a man or a woman or a young man or young woman, etc..
37:00
Right. So there's intersecting factors in other ways.
37:03
And that's what we've done is uncover and discover in terms of the types
37:07
of mechanisms through which groups like for benefit differs.
37:10
What we find is the difference in different people at different times.
37:14
And it depends on the sex, the the sex as well as them their age.
37:20
So the life context as well as severity of addiction, for example,
37:24
we found that men and women, benefit to the same degree for participation.
37:30
And I think that the way they benefit differs quite dramatically.
37:34
The biggest risk factor for men, for women,
37:37
was low confidence in their ability
37:39
to stay sober when they're experiencing depression or anxiety.
37:43
Negative affects, broadly speaking.
37:45
So when women were depressed or anxious, they didn't have confidence in the ability
37:49
to cope with that.
37:50
They had a very high relapse risk.
37:52
That was the biggest predictor of relapse among woman for men.
37:55
That was not even present. That was not.
37:58
Fast is so fascinating. Yep.
37:59
For men, the biggest predictor of relapse for men was their ability
38:04
to cope with high risk social situations where alcohol was present.
38:08
So this could be a party or sportsman. Something like that.
38:11
And again, this is on average, but it's still fascinating.
38:14
Yeah, yeah.
38:15
But the the magnitude of these differences was so striking. Yep.
38:19
Right. Maybe we can put the slide up
38:22
in the course of this. Yep.
38:25
But the magnitude of that difference to me hit me right there I saw it.
38:29
Wow. Look at the for women.
38:32
This is such a stark difference that for women and men such a big difference.
38:37
But what was interesting because could be talking
38:38
about the mechanisms of behavior change, which I was, is that
38:42
they were using it to help them deal with it.
38:45
In other words, they benefited the same, but they used a very different ways
38:49
for women.
38:50
They weren't able to prevent relapse
38:52
by its ability to help them cope with that negative aspect.
38:55
For men.
38:56
They used to help them cope with the high risk social situations.
39:01
So the utilizing the same, ostensibly the same intervention here
39:05
in different ways to benefit them, to prevent
39:07
that based on their needs
39:10
and their life context and that particular phase in them.
39:14
Yeah. This was really. Interesting.
39:15
It's very interesting.
39:16
And in hindsight you would say, well, that makes sense.
39:19
But few of us would hypothesize that there would be those differences.
39:22
And I it's almost like maybe for men, you know, reconciling the work
39:28
that needs to happen related to identity, you know, who am I going to be?
39:32
How am I going to interact with in my who am I going to hang out with?
39:35
Are we going to watch, are we going to be able to go to Fenway Park,
39:39
as we talked about earlier and have a good time without drinking?
39:42
You know, and that pressure of what that means for
39:46
what my life might look like if I participate in this program,
39:50
you know, versus inability to cope with, might I say, life on life's terms,
39:54
not to say that those other things aren't at some point, also, moderators
40:00
for certain individuals, but on average, I think that
40:03
that visualization is super powerful and could change to John.
40:06
Maybe how
40:08
we present these
40:09
resources to different populations in a treatment context.
40:12
And in terms of what the group topics are in terms of how we support people
40:18
in those early days, you know, and we we also saw differences or we
40:23
I didn't run any of the analyzes, but you we also observed differences in age.
40:28
Is that right?
40:30
Was it 30 and under and 30 over.
40:32
Yeah 18 to 29 year olds and 30 plus.
40:35
Right.
40:36
Which which on the face seems okay.
40:40
That makes more sense when you're younger.
40:42
I have different needs.
40:44
I have different life contexts that maybe topics,
40:47
outside of group are going to be a little bit different.
40:50
So, can you speak to those?
40:53
What were those off the top of your head?
40:55
So again, very similar kind of,
40:58
storyline in the sense
41:00
that the younger people, the 18 to 29 year olds and young young adults,
41:05
they've benefited to the same degree as the older adult.
41:08
And so, you know, that they benefited derive
41:11
as much we as prevention benefit from my anticipation,
41:14
the way that they benefited different, different dramatically.
41:18
So for young people, what was really helping them
41:21
to maintain this level of remission and recovery
41:25
was his ability to help drop the high risk people out of the network.
41:29
That was also true for for the older adults, but less
41:34
and in the older adults, it also helped not just drop the heavy drinking drug use.
41:38
Doesn't that also have resulted in having individuals into the network?
41:44
That was not true of the young adults, probably because there were fewer
41:48
young adult people in those meetings that they were recruited to.
41:52
The part of the study. On the network.
41:55
So, in other words, it's it's
41:59
maybe harder for the people to find other younger people
42:03
who they recruited into their social network as opposed
42:08
to you.
42:10
But what was also
42:12
interesting was that we only explained
42:15
half of the same amount of the effect as we did for the older adults.
42:20
So we explained 50% of the effective.
42:22
I know we mentioned adults who are young adults, unexplained 25%.
42:27
So even though benefit benefited the same, you could only explain
42:30
half of the amount of the way to a benefit.
42:34
So we got to work to do, to understand more about both groups.
42:38
Of course, if you want to explain 50% of the impact of a doctor,
42:42
whether we know, but in the young adult group of 25
42:47
outcome was explained for me.
42:49
I'm sorry very much.
42:51
So, you know, some other closer things
42:53
like impulsivity.
42:58
And, yeah, that's really interesting.
43:00
Do you know how those data were measured?
43:04
I'm curious as
43:05
to how the, negative affect or, you know, changing, relationships.
43:11
I mean, I assume that was,
43:14
a survey of some kind that was implemented in the sample.
43:17
Yeah, yeah.
43:19
Yes. And so, yeah, based on the
43:24
the nature of how many, how many relationships,
43:27
you know, what the status of these people in their closest was. Yep.
43:31
The drinking drug using, how much.
43:34
Yeah.
43:36
Yeah.
43:37
And then they go to that change over time.
43:38
Yeah.
43:39
I just think that's really interesting, especially the and I appreciate you
43:42
calling it out to in the presentation that hey look, although this is significant
43:46
and it's interesting, it only explains 50% of the of the variability
43:49
between AA participation in this case and relapse risk.
43:53
Correct.
43:54
You know and so how we might identify what those things might be,
43:59
whether it's impulsivity or, or oh man, I that seems like
44:03
a bottomless pit of different ideas that you could throw in there,
44:06
but I, I'll be curious to see if we can replicate that
44:10
in some ways and close that gap, you know, explain 75%.
44:13
Explain 90%.
44:15
Was it common in research that's of that?
44:19
One of the things we were talking about at lunch
44:20
is machine learning not to go down a nerdy black hole with you today, but,
44:25
you know, the model, probably don't remember exactly the type of model.
44:29
Well, the the, mediating
44:32
moderators pass model essentially,
44:36
which is limited to our own thinking about what might be significant.
44:41
I mean, we the researchers, as part of the study, hypothesized, okay, wait,
44:46
we think it's going to be these dynamics and we're going to test that.
44:49
And it just so happened that you got an incredible effect, 50% in 25%.
44:54
Do you see in the future that technology
44:56
might help us close that effect size.
44:59
Gap.
45:01
Or do you think that it'll still be, kind of our relationship
45:05
to what we can envision the relationships might be?
45:07
Are you following me in that?
45:08
Yeah.
45:09
No, I think you know, I think there's always going to be
45:14
advancements with
45:15
technology, technological aid and computer processing.
45:19
Yeah.
45:19
Is that over the last several decades now, just the
45:25
magnitude improvements in terms of our,
45:28
process, you.
45:31
Know, more precision.
45:32
Precision?
45:32
Like there's
45:34
a particular, you know, phenotype expression, to be honest,
45:38
because, you know, all of our categories are going,
45:40
this is what the variability in the expression, representation
45:44
of those symptoms that I but is the same variability
45:48
now that to sort of affecting them.
45:50
And the classic example is addiction substance use disorder.
45:54
If it tends to have a highly variable presentation that's the same.
45:58
So just like many other things, not everybody is the same.
46:02
And so if we can get closer to identifying, you know,
46:07
particular approaches in particular needs of things
46:10
with, with particular people, specific people, ideally we're on to a winner,
46:15
of course, the dream of precision medicine goes back to the expressions
46:19
that you have a particular treatment that's a good fit for like a key this for.
46:25
Ideally before
46:27
the maturity of the disease state.
46:30
Yeah.
46:31
Things get bad.
46:32
Yeah. Yeah.
46:35
Yeah.
46:35
So you know I think there's two things.
46:38
One is measurement, you know, getting the right messages of the right things.
46:43
You know, knowing what to measure.
46:45
And of course that comes from all theory, about how,
46:50
how people affected decisions, and the things that we need to target
46:54
the treatment and addiction.
46:58
So this theory and there's measurement
47:00
and then there's the how do we how do we analyze it?
47:04
How do we analyze it?
47:05
And with these kind of what we call now big data, into which
47:10
you had a little bit of lunchtime that was very organized, kind of nice.
47:15
All those data points, with the patients with, you know, measures
47:19
to be able to help patients better by identifying, patients
47:24
who are maybe not responding as well as who would like
47:27
to be able to identify those that can help them better.
47:30
So utilizing those kind of big data. Yeah.
47:33
To be able to supplement.
47:34
With an acceptable range of reliability and validity, you know, to answer
47:39
very similar questions.
47:40
With care.
47:43
Yeah.
47:43
And it's it's going to be interesting especially, you know, I mean,
47:47
I've seen such a significant change even in 24 months
47:50
when we talk about big data or algorithms or I even hate to say the buzzword.
47:54
So I'm not going to, but and how we can answer questions.
47:57
So hopefully we'll be able to pull because like you
48:03
said, it's hard to it's hard to have the partnerships in a lot of ways.
48:07
This is why forces work is so important at the national level,
48:09
is sort of having a centralized clearinghouse
48:12
that it's, at least at some level, is starting and saying, hey, listen,
48:15
these ten things are really important.
48:16
Let's try to do our best collecting that.
48:18
And then naturally, this will evolve and, it'll be interesting
48:22
to see to how it changes as a function of the data input.
48:27
We talked about that a little bit.
48:28
You mentioned it.
48:29
You know, whether that's a digital phenotype,
48:33
you know, for psychology or, or, the presence of,
48:37
of diagnosable trait
48:40
that you can model and smartphone data or wearable data.
48:43
Do you know of any work that's emerging related to that?
48:46
I mean, are we on it,
48:47
as in terms of our research groups throughout the country focusing on those?
48:51
Yeah, it has a biomarker as well as kind of EMR. Yep.
48:57
So both so kind of real time
49:01
you know was moment to moment assessment.
49:04
Yeah.
49:04
Not essentially for anybody listening not a survey
49:07
data inputs that are not classically.
49:09
So when you think about research you know you're not filling out a Likert scale.
49:14
Yeah. Yeah.
49:15
So there are there are lots of instances now.
49:19
And there has been.
49:21
Yeah.
49:21
Long in terms of ideally being able to identify, you know, biomarkers
49:27
running in imaging all kinds of things, you know, and you know, it factors any,
49:33
any kind of biomarker was built up, looked at a lot.
49:37
Now with the wearable devices
49:38
where you've got passive monitoring of heart rate variability.
49:42
Also, and temperature
49:46
you can maybe and the idea is is that autonomic is autonomic
49:50
factors, autonomic arousal factors that can be monitored.
49:54
And to the extent that they give
49:58
clues or cues or early warning signs
50:01
to relax, they may be able to be utilized in two ways.
50:05
One is to understand the mechanics of the symptoms of relax and recovery,
50:10
as well as, early warning signs
50:13
that could be present before speech forms awareness.
50:17
So there may be things going on under the, under the hood.
50:20
That sounds like awareness that coming to conscious awareness, aware
50:25
of these autonomic arousal factors in the sympathetic nervous system,
50:29
for example, that like stress and and other factors.
50:33
So again, if we can identify those through these passively passive
50:37
monitoring devices like Fitbit type devices,
50:42
then you can understand more of those.
50:45
It's hard because it's just so complex.
50:47
Yeah.
50:48
And dynamic is a challenge.
50:52
Because, you know, what are,
50:56
central nervous system, time
50:59
doesn't mean, you know, even though it's highly coveted intervention.
51:03
So I might get craving, but if I'm motivated.
51:07
I can intervene.
51:09
I can say, you know what I'm feeling that
51:11
I don't want to go down, I need to improve my 911.
51:15
Yeah.
51:16
Well we have a very common spot where you get meaning
51:19
you need to get out of this venue, this situation right now.
51:23
So this is it. But as you move.
51:25
So it's not just a matter of, you know, understanding the the biomarker
51:30
because there's lots of ways to avoid that.
51:32
Not only in some cases, in some cases not.
51:36
So this is where it becomes complex.
51:38
And you think, well, this question is I wait a minute,
51:40
I thought that predicted for me, but it doesn't get you.
51:43
Some people who are more motivated
51:44
will cognitively intervening to prevent that from happening.
51:48
So it's you know again the bio psychosocial
51:50
and dynamic aspects, which makes, you know, predicting
51:55
human behavior very difficult.
51:56
Yeah.
51:57
And that's the dream of measurement based care, which is very celebrated.
52:01
And and the private treatment world with survey psychometrics
52:04
which is very powerful, very valid, very reliable.
52:07
But it'll be it's going to be an interesting next decade
52:11
to see how we might be able to reduce, reduce risk,
52:16
you know, really,
52:17
you know, like you said, like because it might be that even for somebody
52:22
who has established recovery, that their the algorithm is telling them,
52:25
hey, you're at risk for relapse. And what do you do with that information?
52:28
Almost like your, you know, your recovery score.
52:31
Now, you know, these popular, B2C applications like woop, you know,
52:35
and your rest rate and your recovery score and people not knowing what to do.
52:39
Am I really rested?
52:40
Am I not rested?
52:41
And kind of how
52:42
those algorithms mature over time are going to be really interesting.
52:47
I do want to change the subject,
52:48
because I think that there's a lot of folks that are interested in
52:51
in other manifestations of addiction.
52:54
You know, we talked a lot this morning about alcoholism,
52:58
about classic addiction, you know, i.e.
53:01
methamphetamine or stimulants or what have you,
53:04
and an inability to you know, stop
53:08
using in spite of tremendous, negative consequences. But
53:14
what we're saying from a provider
53:15
perspective, too, is the, influence
53:19
impact of other addictive behaviors like gambling,
53:24
gaming, and pornography.
53:28
And I wondered if you had any comments about that
53:30
because we know, you know, neurologically that the same pathways are activated,
53:34
associate with those behaviors and activities.
53:36
And, sometimes I wonder, if we should be doing more work.
53:41
When I say we, I mean the provider network, you know,
53:44
should we be doing more work in terms of how we identify,
53:48
frequency?
53:49
And intensity of use or along those domains
53:53
and how that might impact somebody's recovery trajectory
53:56
outside of abstinence from using or drinking.
54:01
Yeah.
54:03
Once we're seeing these increases
54:05
and all of these things work for you online pornography.
54:08
Yeah.
54:10
Access to gambling.
54:11
Now this would be
54:14
sports apps, bidding apps.
54:16
And then of course digital access to digital self-care as well as gaming.
54:21
Yeah.
54:22
Video, which is very handy for, you know, predicting again,
54:27
as I use that word addiction, you know, you know, we use it can be overused
54:31
to, to apply to all kinds of things.
54:35
But I think it is a good fit.
54:38
The addiction have always been factors that certainly began with,
54:41
probably for several other things as well.
54:47
Gambling, I think is a well
54:49
articulated, well defined,
54:53
kind of fits
54:54
more of the classic paradigm of addiction, that we see with psychoactive substance
54:59
use disorders, alcohol, amphetamine, opioids, etc..
55:03
As opposed to sex or food addiction.
55:05
Yeah, I understand it.
55:07
It could be, you know, that for certain people it's just not as prevalent. Now.
55:12
I think there's more work to be done with sex and food.
55:15
They operate through the same pathway as you mentioned.
55:18
Very similar
55:19
pathway also minus different degrees.
55:22
But you need those two things to survive as opposed to heroin
55:25
is not a, necessary portion of our diet.
55:28
Yep, yep.
55:30
Yeah.
55:30
So, you know, it's, it's, certainly,
55:35
you know, they're very important in their own right,
55:37
but they're also important as co-morbid factors.
55:40
And, treatment of security studies, sort of,
55:44
because some people may have comorbid alcohol and, marijuana other side by some.
55:49
So it's good, but also other behavioral, so behavioral
55:53
like sex life can be to
55:56
exercise maybe other problems.
55:59
Maybe they're not haven't risen to the same level as their presenting problem,
56:04
whether that be amphetamine or alcohol whatever.
56:07
Or might be maybe the presenting with a gambling addiction.
56:11
But they have co movie alcohol.
56:14
Which is,
56:15
you know, any kind of a co facilitator of the gambling
56:20
to drink and, and, and this inhibits that and
56:24
kind. Of hand in hand.
56:26
And hand.
56:27
Exactly right.
56:28
And they're off to the races literally.
56:31
I have a friend.
56:33
I have a friend, who, who runs a program in Colorado
56:36
and, he it's a, it's a program for for young adults.
56:41
And, it's a transitionary program.
56:43
So it's a classic treatment in terms of, you know, you're it's a phase system
56:48
where over the phases you graduate to higher levels of,
56:52
for lack of a better term, privileges
56:56
in terms of what you can do and your, and your living quarters and all in all this,
57:00
one of the things that you earn back is your phone.
57:02
And we've been having these interesting conversations.
57:04
He's he's a you know, he's a clinician.
57:06
I you know, I, I tell him he's a researcher all the time.
57:09
You know you just he's anecdotally collecting this information
57:12
his and his, health system and he's and what he's doing,
57:16
which I haven't told you about, but what he's been doing is monitoring screen
57:20
time reports, you know, that we all get, which is very depressing.
57:23
Once a week when I receive it.
57:25
How much you what was your average daily,
57:27
you know, number of hours and minutes that you're on your phone.
57:29
And he's just been writing this down,
57:32
you know, in Excel and what he's been observing anecdotally
57:36
is that higher screen time
57:38
within this population is associated with.
57:43
Increased risk for relapse
57:46
and leaving the program altogether.
57:49
And so he's been starting to implement just group like he's
57:52
just trying to figure it out.
57:54
You know you're not trying to publish a paper.
57:56
You know he's trying to help the individuals that are in his programs.
57:59
But it just has me thinking about,
58:02
maybe we should be talking about this more, you know, these things
58:05
that these appendages, you know, that we walk around with every day and.
58:09
And what kind of power they might have, what kind of stimulus they might introduce
58:14
unknowingly that, that, that we otherwise didn't have a problem with 15 years ago.
58:19
Well, 2007, whatever that math is, you know, before
58:22
somebody was leaving treatment.
58:24
So it's really interesting.
58:26
I'm grateful to you, Doctor Kelly.
58:28
I think the word,
58:32
you know, I don't want to
58:32
make you uncomfortable, but you are a bridge.
58:36
You know, I think that, if I may say
58:38
so, what your work has really meant
58:42
to the field at large
58:43
and to our recovery communities is really a bridge.
58:46
I think there was a documentary a couple of years ago,
58:49
the anonymous people, Greg.
58:55
Yeah.
58:56
And, I think one of the lines in that documentary,
58:59
I'll give him credit anyways, and everybody that put
59:01
that together was that, you know, part of the problem with our,
59:04
with our programs, in terms of data and in research is, is largely
59:08
that we're speaking in a language that other stakeholders can't hear in
59:12
that other sciences speak in, which is peer review.
59:14
And one of the things that I really because it's not easy
59:17
to write over 200 peer reviewed papers and to fly down to Nashville
59:22
for two days and and present on your findings.
59:25
But I do think that
59:27
your work is having a tremendous impact on our ability to communicate
59:32
what's really happening,
59:34
you know, and how it helps people change so that we can help more people.
59:38
Because I've heard that addiction is not going away, you know?
59:41
So I just want to thank you for the two decades plus of work.
59:46
Before I let you go, what would you tell families?
59:50
Just pragmatically,
59:51
what would you tell families to look for in a treatment provider?
59:55
What's important
59:58
that they might see, in order to make
1:00:01
what you believe would be an informed treatment decision,
1:00:05
I'm going to hold you to it, too.
1:00:06
We can cut it out.
1:00:08
What do you think?
1:00:09
Well, let me first say I've been told a lot of things in my life.
1:00:16
Yes, it is.
1:00:18
Right.
1:00:19
Thank you for saving, the,
1:00:25
Yeah, I think, you know, if you're asking
1:00:29
what the family look for in good treatment.
1:00:32
Good treatment from,
1:00:34
I think actually have a list of recovery answers.
1:00:38
I was early, but the recovery research
1:00:41
website is recovery and so forth and on.
1:00:44
There's a lot of information on the website
1:00:46
about addiction treatment and prevention, recovery.
1:00:51
The 11 things to look out for is on there,
1:00:53
where people can actually go and, and kind of,
1:00:57
get the right questions to ask if they're getting a treatment provider.
1:01:01
But one of the hallmarks I think is, is, is,
1:01:05
the accredited by some external agency, like,
1:01:08
a car for Jake.
1:01:10
So one of these, the, the external, credential from,
1:01:14
that's a good time, a whole month because it's a testament
1:01:16
to their willingness to be kind of
1:01:18
to be open, to be transparent about their practices
1:01:22
and be very skeptical that if a program didn't have something like that.
1:01:26
So that's one goal that you can look for right off the bat that they
1:01:30
confrontato accredited.
1:01:33
So, because that's the quality.
1:01:36
Absolutely.
1:01:38
And, you know, I think having,
1:01:42
credentialed licensed staff evidence based treatments,
1:01:46
all of these things, do they do outcomes measurement?
1:01:50
Do they incorporate measurement based practice into their paradigm
1:01:54
so that they can improve the quality of care?
1:01:56
Again, a whole lot.
1:01:57
To me, that would be a hallmark of a good quality program.
1:02:01
You know, I should actually try and improve that.
1:02:03
I'm measuring the patient was the response of the
1:02:06
of the patients that they were treated that what we do here,
1:02:10
which is admirable and I think, programs that have adopted that and adapted
1:02:15
that to their to their own context,
1:02:18
getting an awful lot of, good quality, treatment, the program that's,
1:02:24
that's really trying to help patients.
1:02:27
And in the true sense.
1:02:29
Yeah. Thank you. So much.
1:02:31
I'm just catching, you know, I just get on the other hand, I'm
1:02:34
very skeptical of any program that says, you know, we have an 87.6%.
1:02:38
Thank you for your rising success rate, whatever that is.
1:02:42
You know, what is success is, patients
1:02:45
that they treat are in remission for five years after treatment.
1:02:48
Never qualify exactly what they mean by success.
1:02:52
But those things, those things are kind of, very misleading.
1:02:57
Yeah.
1:02:58
I think those kinds of statistics.
1:03:01
But it's at a time when people are very vulnerable
1:03:03
and they're desperately looking for help.
1:03:04
So that's not helpful. Yeah.
1:03:09
Any sites that have had those
1:03:10
specific statistics on, quote unquote success rates?
1:03:13
Yeah. Well, thanks again.
1:03:15
And we really appreciate you spending time down here.
1:03:17
I'm really glad that I was able to serve you your first meet in three.
1:03:20
Shout out here in Nashville, Tennessee.
1:03:23
If you're interested in learning more about Doctor Kelly and his work,
1:03:26
we're going to pen the website associated with the Recovery Research Institute.
1:03:30
Recovery answers.org and the description.
1:03:32
Please like, follow, share and subscribe.
1:03:35
We appreciate you guys listening. Until next time, see?