In this episode Zach is joined first by Kelley Kitley, an LCSW, award-winning author and international women’s mental health expert. Zach and Kelley will be discussing the differences between men and women when it comes to addiction and recovery. Curious to learn how different co-occuring disorders affect men vs women? Tune and to learn more! Following his discussion with Kelley, Zach is joined by Dr. Jennifer Tippett, a Licensed Clinical Forensic Psychologist trained in the use of Harm Reduction to address addiction rates in various cities across the country. The two will discuss the often controversial practice, as well as some of the inequalities she’s seen over the years in substance abuse treatment field.
Welcome to Recovery Radio by Landmark Recovery with your host, Zach Crouch. In this program we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields, and help navigate the road to recovery.
Now, here’s the host of Recovery Radio, Zach Crouch.
Zach: Hello, everybody. I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.
We have guest Kelley Kitley joining us on the show today. Kelley holds an LCSW and is an international women’s mental health expert and award-winning author who has appeared in hundreds of publications, podcasts, live news, and radio. Her areas of expertise include anxiety and depression, PTSD, obsessive-compulsive disorder, enhancing relationships with couples as well as using a short-term model CBT.
Kelley also works with patients in longer term treatment to work through trauma, eating disorders, substance abuse, loss and phase of life issues.
Kelley, it is a pleasure to have you on the show today.
Kelley: Thank you so much for having me.
Zach: If you don’t mind, tell us a bit about yourself. How’d you get involved in the field, in psychotherapy, yes?
Kelley: As we were speaking very briefly before, I feel like my training started at a really early age. I grew up above my parents’ bar in Lincoln Park which is a neighborhood outside of Chicago. [Inaudible][01:55] Life was a party. We have lots of people around. We had regulars that came in and out of the bar that became like extended family members. Teachers that taught me at school would come in for happy hour. At that time, I didn’t think there was anything wrong with hanging out in the bar as an adolescent.
Zach: Normal.
Kelley: Yes, totally normal in my world and everybody else who spent time with us. When I started going down the road of experimentation and having my first drink at the age of 12, I really had a heightened awareness and a lot of substance abusers in my family that then led me to want to study social work in undergraduate school and then continue on in graduate school.
Zach: Was it mostly college or even high school where you started to sort of put two and two together like, ‘yes, maybe things are a little different in the old Kitley household’?
Kelley: My mom is in long-term recovery.
Zach: Okay.
Kelley: I think that’s probably when I became most aware of it and that was when I was senior in high school. My dad still abuses substances, but I started recognizing it a little bit more when I was away at school at college and noticed that I drank like everybody else or so I thought.
I was a binge-drinker and then I just started noticing my behavior’s changing like increased anxiety and doing things that I regretted or said and would go on extended amount of time in abstinence during college until two weekends later I’d go, “Oh, never mind. I’m fine,” and just kind of continued that pattern of drinking. I didn’t identify as an alcoholic, just didn’t think it was the healthiest of behaviors.
Zach: Sure. I guess when you’re in college and you’re able to take a step back because I think for a lot of people that happens where they were in this sort of, and for good reason, in this safe space of being at home with the family. Most people are and they’re in high school and that’s sort of a microcosm of society and what it looks like really, looks like; but then you take a step on. I went to a campus when I was 15, 20,000 kids and it’s a big school. I was far enough away from my folks that I wasn’t able to just go back each week.
Did you find yourself during those years especially the first couple of years when you’re making new friends in college that many of the same sort of patterns were present in their families, too, maybe not like they live in a bar, but some of the same sort of tendencies?
Kelley: Absolutely because I think we tend to, or at least I did attract those types of people and again, that just reinforced that normalization of excess drinking being okay. I actually ended up leaving after my freshman year and taking a year off to do some community service work out in California. That was really eye-opening for me because the people that I was surrounded by weren’t drinking the way my college friends were.
Zach: It’s fascinating. You did a whole year off to do community service in California.
Kelley: I did, yes.
Zach: Was this something that you decided to do or was it more…how did you come to the decision to do that? It’s great.
Kelley: Thanks. Yes, I’m a big advocate for a gap year especially right after high school into college. I wish people were taking more advantage of that right now during COVID.
Zach: Yes.
Kelley: I was going to a private college that cost a lot of money and my parents got divorced when I went away to school. My dad just said, “I can’t or I won’t pay for school anymore.” I didn’t know what else to do. I found an AmeriCorps program that would give you some money towards your college education when you were completed with the program. I knew I wanted to study social work so I did that program and then came back to Chicago and went to a state school that I was actually able to use that money to pay for some of my tuition.
Zach: Fantastic. Listen, I don’t want to get to far off topic but wow, that’s great. Let me ask you this question: how come it’s so important to do a gap year?
Kelley: Because I think that at the age of 18 or 19 we’re not really sure or at least many of us aren’t sure of what we want to do and the cost of college is extremely expensive and to be able to work on some self-development, whether you’re living on your own or having even a job experience or community service experience I think can be really transformative. It kind of sets the foundation for then hopefully a career that you might want in the future.
Zach: Yes. I think yes that a lot of people…I think that there’s some fear, too that parents probably develop with that. It’s like, “If you don’t go to college right away then you’re not going to go so we need you to go.” A lot of people I think would benefit tremendously from that.
Listen, I know that there are a lot of differences between men and women when it comes to addiction and recovery. Can you walk us through what some of those…what are some of those?
Kelley: The great news about the work that I do that I feel has done an advantage as a psychotherapist is then not only my professional training but also my personal experience and I can obviously speak to being a woman in recovery, but I think that one of the major things I would think would be anxiety that more women than men struggle with anxiety disorders. A very common thing that helps relieve anxiety is alcohol.
Zach: Yes.
Kelley: Alcohol also hits women harder and faster than men meaning that we don’t need as much alcohol.
Zach: Metabolism, right?
Kelley: Metabolism, hormones, all of those things and so women can develop dependence or abuse a lot more quickly than men who can. I think it’s equal that alcohol can be used to self-medicate, but oftentimes I think for women especially in what I’ve treated has been around any kind of post-partum anxiety or depression.
Again, that normalization of ‘it’s okay to drink because you’re a mom and you work so hard and you really earned it’ and so much so that I think our culture has really glorified this idea of like ‘mommy drinking culture, wine o’clock’. I’ve really tried to change that conversation and showing that was my own personal experience when my drinking escalated was after having four kids and working and feeling really overwhelmed.
Zach: As you’re talking about the anxiety piece, my wife she’s a licensed marriage and family therapist. She’s also an Episcopal priest. One of the groups that she runs now sort of intermittently, it’s about every month or so that she runs it, maybe every other month, but it’s a group for women who can’t get pregnant. It’s really an anxiety group and almost a grief group combined.
Kelley: Sure.
Zach: I think that that’s a big driver from what I understand at least, I’m not a woman but I can appreciate the struggles that we had, that what we went through trying to get pregnant with our second kid. This anxiety piece that you’re talking about for women, is a lot of this brought on just by the cultural sort of messages that women are sort of acculturated with from a very young age you think or is it pretty multifaceted?
Kelley: Everything’s multifaceted but I do believe that a part of that is the pressure to look good and be a good girl and…
Zach: Not get angry, be thin.
Kelley: Yes.
Zach: Don’t get pissed off, right.
Kelley: Exactly. I think those are all things that we learn at a very young age to kind of hold it all together and be good girls which can…that’s not human and we have as much faults as anybody else but maybe hide them more or are conditioned to hide them more which then results in that bubbling over into an anxiety disorder.
Zach: It’s interesting. My wife was raised in the South. She grew up in the South. One of the things that she learned early on because I think she’s talking to a lady, maybe it’s a friend of hers, about racism in the South and that so often what happens was Southern women in the South is that you don’t talk about those things but you learn to be nice. You learn to be nice with each other.
Kelley: Yes.
Zach: You want to smile. It sort of dismisses any sort of uncomfortable feelings that might come up because of these issues and I found that to be very interesting because my mom or my parents were not raised in the South. We grew up, like I said they grew up definitely in Chicago and it’s just different. It’s different there than it is even in Kentucky and I wouldn’t even really consider Kentucky to be a Southern state.
You mention anxiety. What are some of the different co-occurring disorders that primarily women struggle with when it comes to addiction, anxiety being one of those? Are there other ones that come up?
Kelley: Sure, absolutely; any of the mood disorders: depression or bi-polar disorder. A lot of times I’m seeing women in my practice who are struggling with an eating disorder as well as substance abuse or have a complex trauma. I think that might also be one of the indicators as to why there’s a higher rate of…or women in recovery or substance abuse can be more complex because there is a higher rate of sexual abuse or sexual harassment for women so again that self-medicating.
Any of the co-occurring components of the treatment can get tricky because oftentimes when I’m seeing women in my practice they’re not just coming in with one issue. It’s very complex. I think as human beings we’re complex anyway, but sometimes it’s recognizing what the primary treatment is to begin.
If I’m seeing somebody who is struggling with substance abuse and say, an eating disorder, really taking a holistic approach to treating both of them and getting back to the basics of just living a very abstinence-based lifestyle with alcohol as well as finding a new relationship with food or exercise. I do notice that sometimes once those are treated appropriately that the anxiety or the depression will lessen because some of the behavioral components can create that heightened shift in mood.
Zach: Certainly in the addictions field and it seems as though this is the case in the general mental health say, outpatient therapeutic community of providers at least that the training and understanding of how trauma affects people has become more pronounced especially in the last ten years. Are you in the belief, Kelley that anybody who’s worth their salt as a therapist, so to speak should be at least trauma informed?
Kelley: Absolutely. I think everybody…and that’s part of the change of the conversation as well is that we were trained in social work school the difference between a big T and a small t meaning, different categories of trauma. Oftentimes when somebody thinks of trauma they think of witnessing a death or suicide or someone being physically abused, but there are also different types of trauma for people. Divorce can be extremely traumatic for a child that may not even identify as that or know that that was a trauma.
They got older and kind of revisited what their childhood looked like because when they were younger that might have seemed normal, so to speak or having a traumatic birth experience that can really shape our thought process. There are varying degrees of outcomes of trauma, too — nightmares, increased startle response, just inability to connect with others. I think it’s crucial to a therapist to have some sense of trauma training.
Zach: You mentioned one of the big things that you worked on is eating disorder stuff. You talked about how behaviors heighten people’s experiences. I’m thinking about the whole act of what goes on with people who have eating disorders, the ritual that happens a lot of the time with that.
I would imagine a lot of women who have eating disorders and men that there’s been some trauma that’s gone on their life but separating the behaviors out enough that really abstain from some of those behaviors long enough so that they can then sort of process through some of these experiences that haven’t been processed through, that can be a pretty tall challenge would you say?
Kelley: Absolutely and being able to find a replacement behavior that may be more soothing than the self-harm through binge-eating or restricting in that I have found that a lot of the women that I’ve worked with they have such a sense of control around the eating disorder and certainly loss of control but to convince somebody or to get them to buy in to what happens when they release that obsession can be really profound.
Zach: I got to think that eating disorders are they some of the hardest to treat, hardest for you to treat?
Kelley: No. I think many clinicians would say that unlike substance abuse there’s a lot of relapse, there’s a lot of hiding and lying and having difficulty and shame for sure, but the difference that I always see between treating eating disorders and treating substance abuse is that we eliminate the substance in substance abuse treatment; with eating disorders you have to find a way to have a relationship that is healthy with food. We can’t just stop eating.
Zach: Sure.
Kelley: A lot of times it takes a lot longer and especially we live in a culture that is just obsessed with health and food and exercise and I’m very in tune with that. My sisters and I opened, after leaving the bar business and all working there; we opened a wellness studio called Renew. It’s a mind-body-soul practice.
We do meditation and yoga and different types of strength workouts but to not think, to not have that obsession of health and weight and calories but more a whole health just feeling your best self regardless of what size you are or what number’s on the scale.
Zach: I want to come back to something I brought up earlier at least with the whole issue of having kids, not having kids. Talk about the backend of that. How common is it for post-partum depression women in co-occurring disorder with addiction, how common is that piece?
Kelley: I don’t have the exact statistical number but what I do know specifically is that I believe it’s one in seven women will experience post-partum mood disorder and I would say maybe half of those have experienced a co-occurring substance abuse.
Zach: Got it.
Kelley: You can fact-check me on that one though.
Zach: No, I’m not going to fact-check you on that one.
Kelley: At least in my experience, a certain population for sure.
Zach: I think one of the things that I’m really happy about, there’s a large healthcare conglomerate here in Louisville called Northern Health Care. They have like four, maybe five hospitals. Anyway, what they have begun to do is really look towards an integrative model of treatment where meaning that they are actually having therapists at the outpatient medical offices.
Kelley: Oh, wow.
Zach: They have started to do MAT even at some of these offices as well or at least get them started there. I wonder if that’s something that your OB/Gyn clinics and things like that are going to start doing. I actually think that that is happening in one of the clinics here in Louisville at a Northern Health Care facility.
Kelley: Okay.
Zach: Could you see that as something that could happen more in the benefits of if they start to do that especially people with post-partum depression?
Kelley: Yes. I also feel like there needs to be some education on post-partum depression as well because I think common speak is that post-partum depression means you don’t attach to your baby or you want to harm your baby. Those are certainly real and happen in extreme situations.
It’s like a spectrum disorder and a lot of times women I think when they go for their six-week appointment with their OB/Gyn and they’re feeling okay. They’re like, “Whoo, I dodged that bullet.” A lot of times post-partum mood disorders can show up months after and it’s not just in those first few weeks.
That being first and foremost but I do think that what is important, too is that at least in Illinois there was a mandatory law passed that women when they go for their visit that they do an assessment that has signs and symptoms of post-partum depression, but having talked to a lot of my clients say they don’t really take those tools seriously. They’re just kind of in a hurry to get in and get out. I think that would be very beneficial to have within OB/Gyn.
Zach: Kelley, I really appreciate you coming on today. This has been an enlightening discussion. I appreciate the work that you’re doing in that beautiful city by the lake up there. Yes, right. I don’t miss it in the winter, that’s for sure.
Kelley: We’re all white-knuckling for November to hit.
Zach: You guys just had one of the hottest Augusts on record didn’t you?
Kelley: We did.
Zach: Yes, yes. It gets warm there in the summer time. Again Kelley, this is fantastic. I appreciate your time today.
Kelley: It’s my pleasure.
Zach: You’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.
We have guest Dr. Jennifer Tippett joining us on the show today. Dr. Tippett is a licensed Clinical Forensic Psychologist. Dr. Tippett has worked throughout the Denver metro area as well as New York, Boston, and Los Angeles in multiple settings including correctional, in-patient, and outpatient. Dr. Tippett has been trained primarily in harm reduction to address addiction and teaches from that theoretical framework.
As the Director of the Substance Use Disorder specialty program at the University of Denver’s Graduate School of Psychology, she is passionate about training graduate students to be responsible and informed clinicians. Dr. Tippett’s primary research interests include psychoactive and psychedelic substances as viable treatments for mental illness and addiction.
Dr. Tippett, this proves to be a very interesting subject in today’s sort of climate in our field and I look forward to getting into this more.
Dr. Tippett: Yes, definitely.
Zach: Tell us a bit about your background and how you got interested in addiction recovery as a study of focus.
Dr. Tippett: Yes. I always tell people it was the one thing when I studied at graduate school that I swore I would never do. My dad when he was 27 years started taking me to AA meetings and I was two on his weekends. I really grew up in the rooms hearing about model and relapse and kind of ingrained in that community. I knew a lot of people who have family members and other close people who struggle with addiction know it really wears on the relationship that you can have with others.
I convinced myself, actually quite well that that’s not why I was going into psychology. I had nothing to do with it and that addiction was sort of the last thing that I was going to do. I ended out throughout my training. I’m forensically trained. A lot of my work was in jails, prisons, and with really kind of high acuity folks and always, almost always there was an addiction component or some sort of misuse of substances that would come into play.
I don’t know this but this is well-known that within psychology training programs, you are lucky if you get one course in addiction. Most of us are not trained in that. I started to see these scenes in which the clinical underpinnings of what folks were dealing with which is not being addressed. I also saw addiction treatment [Inaudible][28:13].
As I kind of moved through my training, it wasn’t really until I was at W Hospital in New York and was paired with a mentor who was doing harm reduction outpatient treatment and she really kind of stressed this idea that these are human beings. This isn’t a set of behaviors that we need to make go away immediately otherwise they’re resistant and in denial and need to be punished. These are humans and we’re going to have human conversations.
That was when I really tried to think, “Okay maybe this is something I could do.” That sort of changed my mind at that point and then moving out to LA was sort of when I really kind of gave up. Yes, this is part of what I’m going to do with my career.
Zach: Kind of almost sounds like a calling.
Dr. Tippett: Yes, yes. I haven’t thought of it that way, but certainly I think a lot of those early experiences really set me out to land where I am now and to be able to look at things in a slightly different lens than maybe some of my colleagues who haven’t had as much personal experience.
Zach: What was your impressions of simply just growing up, so to speak in the rooms, you know when I say ‘rooms’ I mean 12-Step recovery and hearing about God, 12-Steps, meanings, all that? What were your impressions from an early age and then even now?
Dr. Tippett: Yes, that’s a great question. I think early on it was all I understood about addiction. My dad was what you might call an old-timer or an AA guru that…
Zach: I know those guys. Yes.
Dr. Tippett: Yes. You know those guys. They basically kind of hold court in the room and that was my dad. He worked his program every day and talked about it all the time. That was really, really just my only understanding. As I’ve kind of moved through especially as an adolescent kind of knowing people and watching people struggle and then as a professional looking at programs that were very hardcore ‘this is the only way to do it, you can’t do it any other way’.
I’ve watched people; I don’t want to use the word ‘fail’, it felt like failure to them. They would relapse or they would use or something would happen and there was just so much shame involved in it. It really started to reshape the way that I looked at 12-Step programs and really made me curious about how else can we support people because to say to someone ‘this is the one path, the only path and if you don’t take this path you’re doomed’ doesn’t sit well with me.
Zach: Yes.
Dr. Tippett: I think my ideas about it have changed a little over the course of my life.
Zach: Also I want to come back to something you mentioned about psychology, being trained as a psychologist and you noted that most people are lucky to receive an hour of training in that particular subset of our field — addiction, substance use disorder. Why do you think that is? What do you see needs to change even from a practical level?
Dr. Tippett: Yes. This is one of my favorites to talk to. I’m not sure at what point as psychologists we decided we don’t really do that. The field of addiction treatment in medicine is pretty heavily populated by folks who may be master’s level or may be bachelor’s level and then got some certification. For whatever reason, psychologists really kind of seeded ground to that and there was not a great deal of attention paid to training graduate students, doctoral students in how to treat substance use disorder.
It was just this idea that if someone comes into your private practice and says, “I’m drinking too much,” you say, “Go to AA.” I don’t do that. I don’t know how to do that. It’s really been left that way. When I introduce myself at the beginning of the school year starting with a new group of students, I always say, “There’s this meme on Instagram and it says, ‘two of the most surprising things about adulthood: cheese is expensive and the other one does cocaine.'”
It just really illustrates that just because you think you don’t use substance use treatment, I bet you do because you’re seeing a human being. Chances are they’ve been affected in some way by addiction either themselves or someone else. It’s so important that our doctoral students receive the training so that they can meet that challenge responsibly.
Zach: I’m thinking, too.
Dr. Tippett: Yes.
Zach: Dr. Tippett, I’m just thinking about even teaching people in those programs how to effectively triage somebody, does that makes sense?
Dr. Tippett: Yes, yes. Yes and I do a whole lecture on that just looking at what do we do for folks that meets them as an individual where they are. Our hope, the program I created at the University of Denver is actually a four-course series. It spans an entire year of doctoral level training. I’m happy for any of the programs to even just have one class in it. That’s even better than what we’ve been doing as psychologists.
Zach: I want to obviously keep that in mind. I’m going to ask you a question. You talked to us about spending time. You’ve spent some time in luxury higher-end, so to speak in-patient treatment centers and you call them non-luxury places as well. Have you seen a difference in the effectiveness of treatment or what are the biggest differences you’ve noticed between those two?
Dr. Tippett: Yes. Inequity in substance use treatment is a real thing. The barriers to get to treatment are huge and then if you can knock those then you got a whole other issue. During my time at Seasons in Malibu which is [Inaudible][34:41] as you can imagine there’s a price tag attached to it. The entire clinical team, your one-to-one person was a psychologist who specializes in this and this is what we did all day every day and this is what we focused on and really brought a doctoral level of expertise.
There’s a lot of other amenities in those types of places — acupuncture, yoga, there’s this idea of looking at people as a whole person and really meeting needs in multiple areas in different ways — family therapy, couple therapy, whatever we could do to tailor to help folks really address their addiction.
At the same time I was working there, I was at community mental health in Ventura County and doing a substance use group because we needed one. No one felt trained to do one and even though that wasn’t technically part of my position in that community mental health center, I was asked to do it because they knew I had experience.
I would sort of go from being in Malibu and talking about what resources can we pull because we have them all at our disposal to sitting in a room with folks who are like, “Yes, I don’t know where I’m going to sleep tonight so I don’t know why you’re talking to me about my heroin use. I’m just trying to survive here.” There wasn’t support. There wasn’t the same amount of resources.
The conversations were sometimes very similar but the context that people are coming from were hugely different and what I could offer was completely different. In this country and I don’t think that that’s specific to substance use treatment, whether you have financial resources or not matters when it comes to both effectiveness and what you can access. I just think it’s glaring in this space.
Zach: Yes and I think that the difference, so to speak between the extremely rich and even your middle class and lower income folks is just going to continue to grow over the years, decades. I’m curious because it raises a question for me. [Inaudible][36:58] in terms of if you’ve got money, a lot of money and you want to spend $50,000 to 60,000 for a month’s worth of treatment because that’s usually what you’re going to get at some of these high-end places.
Is it more important, because I’ve always sort of been schooled in the idea that the length of time, not the best time but the length of time that you’re in treatment is really indicative of how well you’re going to do longer term and 30 days for those people in an IOP or outpatient is it going to cut it? Are those funds more effectively spent on if you’ve got $50,000 you could probably go somewhere, a lot of places for a year or more and it would be a more effective use of your money?
Dr. Tippett: Yes. Yes. I had a patient who got in for in-patient and ended up staying 60 days because he could afford that out-of-pocket and then did a step down with a higher-end sort of sober living residential program and then went to stayed in a hotel room in Santa Monica for the next two months so that we could keep working together in therapy so because he had those financial resources, he was able to create a program that spanned almost six months because to your point, that’s exactly right.
30 days is a drop in the bucket especially if you’ve got a longtime addiction. This is what you’ve got. This is what you know how to do. It’s just long enough to get sort of dried out, look around, and start to consider something different. If your insurance is out, you’re out. You’re on the street. That’s not a great step down process from almost anywhere, some places but it’s tough.
Zach: Yes. I know that you’re at the University of Denver there and I know your research was that psychoactive and psychedelic substances as really viable treatment for mental illness and addiction. Where are you with that research? What have you found so far?
Dr. Tippett: Yes. We’re still at the very baby steps of that research. I definitely want to give credit or credits to some of the studies coming out of like NYU and Hopkins really looking at alcohol use disorder, nicotine use disorder, even some smaller studies around that are looking at opioid use and whether psychedelics can intervene especially in the cravings for substances and that’s coming out in really positive ways.
My particular students right now are looking at things that are a little more critical. They’re looking at the effectiveness of psychoactives around trauma and therapy and some things like that. We haven’t expanded quite into looking at substance use yet but we’re really hopeful especially based on some preliminary data coming out some of those bigger institutions.
Zach: I was thinking about the studies that you mentioned that NYU and John Hopkins. What are the substances…are we talking like LSD? Are we talking about ayahuasca? What are they looking at?
Dr. Tippett: Psilocybin primarily. Ayahuasca can be pretty jarring although it’s gained this huge popularity through some of these almost tourism companies down in South America. LSD is just such a commitment. It’s a 12-hour commitment. It’s really hard to do in a lab setting although looking at the history even of AA, Bill W really did credit quite a bit of his sobriety with his use of LSD.
We know that some of these compounds we’ve known anecdotally and through other means can be really effective. It’s just sort of narrowing down how we replicate this in a lab and how we explain it and how we best use it. I don’t think any of us are advocating that people take a bunch of LSD and go run around in the field and then claim they’re free of their meth addiction.
I think that we’re getting very curious about how these compounds work in the brain that might allow for, through plasticity and some regrowth of neural pathways that could change things about cravings and especially cravings, memories and allow the brain to maybe heal a little bit.
Zach: I was thinking about we all live in a very obviously capitalist country here and the pharmaceutical companies have so much power from the lobbying efforts to just the amount of capital that they have. Do you see any sort of interference just from pharmaceuticals getting in the way of any progress that these studies can have because it poses a threat to maybe the validity of them?
Dr. Tippett: Yes. Yes. We’re starting to encounter some of that especially when we look at the rate of SSRIs or antidepressants and how well they actually work, their effectiveness and then looking at things like MDMA or psilocybin and what the preliminary did and are saying about that.
There’s definitely going to be attempts to sort of patent and market synthetic psilocybin. I think down the road, way down the road some pharmaceutical companies I think right now the push is trying to keep their market share on ‘just take your Prozac, you’ll be fine’. Prozac doesn’t work fine. I’ll vilify. ‘Just take some more pills.’ Yes, they have a very vested interest in this.
Zach: I think that one of the biggest arguments probably is going to be and rightfully because it seems counter-intuitive potentially treat drug addiction with drugs. Can you talk through that just a little bit like what’s the sort of reasoning because I’m sure there are pretty bright people doing these studies?
Dr. Tippett: Yes.
Zach: Informed people for sure.
Dr. Tippett: Yes. Yes. Yes, it’s just really counter-intuitive especially because historically I do a whole lecture around America’s very tortured relationship with substances particularly like alcohol and marijuana. We tend to try to classify substances as good or bad like heroin’s bad but oxy is good although now we’ve decided ‘maybe oxy’s not so good after all’.
I tend to tell people there is no such thing as a good or bad substance. It’s about how and why you use it. If you really think about psychedelics and psychoactives it can mean MDMA, psilocybin, things that fall into that range as just a substance and you look at the properties in the body and what they do in the brain as compared to something like methamphetamine or cocaine. They work very, very differently.
When we think about drug addiction, if we’re just categorizing any of those subset of behavior that needs to be mapped out you don’t really care why they’re happening or where they came from or how the body’s responding. You just need to stop. Go to your meeting; work your stuff and just stop. We miss so much of the texture.
Drug addiction, at least the way I think we’re beginning to conceptualize and understand it is part of a physiological process in the brain that affects executive functioning, memory, decision-making, all of these really specific parts that we see psychoactive and psychedelic substances impact in a really positive way including things like I think I mentioned earlier, like memory reconsolidation, effects in the nervous system.
I talk a whole lot about regulatory systems when I teach. I teach a course called The Neurobiology of Addiction, Trauma, and Attachment. When we look at the way that people regulate even within their own systems, it really makes them vulnerable to using something outside of themselves like a substance to manage and that’s where we sort of meet that if we look at things like the psychoactive substances that seem to affect these systems in a very positive way.
It’s not just like I said, it’s definitely not you go out in the field and talk to God and suddenly you’re cured. We think there’s a physiological at a neural developmental level that makes this a viable treatment option.
Zach: I’m curious to hear, too just because I think in our culture what we often think of as something that eventually gets accepted that wasn’t accepted before, there are various platforms right now. We’ve got social media, Facebook, whatever. There’s a strong component of sort of group think that goes along with people who have a platform and they start using it and approving it versus outcomes on the acceptance I’m thinking of these psychedelic substances.
Number one, how do you sort of get this stuff out there to the public so that they can make informed decisions and it’s not sort of bastardized by some community that really is not informed on the outcomes?
Dr. Tippett: Yes, yes. I think that one of the biggest pressures within the community of those of us who are doing this research because we’re well aware that there’s a lot of underground groups and “gurus” and people who purport to understand how that works and it’s a real fear.
It’s a fear I have that this will somehow get twisted and turned into ‘this is a cure for everything’ or whatever sort of like you mentioned, sort of bastardizes the science instead of those of us really wanting to be very careful in these studies and say, “Look, this is the science and this is how it works and this is what we know about it.” It’s a real fear in the field and I think something we’re all trying to address as best as we can.
Zach: Speaking about, this is I think this is jumping ahead a little bit too far but if this does get approved and it’s approved for depression or quitting alcohol or whatever it is, it can pose a big threat to the 12-Step premise which is basically that it’s absence only. This is the way that we dip. How do you combat that push back from them because it’s going to happen for sure? How do you even invite them because it will be on you guys, people who are proponents of it to invite them into a conversation about this stuff?
Dr. Tippett: Yes. I think that that is going to be a really interesting conversation to start to have. The lore is, I don’t know if there’s anything documenting this but going back to my mentioning of Bill W and his use of LSD the lore is he went back to the AA [Inaudible][48:47]. He was going to tell people. Bill said, “Oh no, no, no. We cannot talk about that. You cannot talk about that.” This conversation he does this sort of pushed back has already happened.
I think that it will be interesting to see as 12-Step and especially things like AA are having to evolve a lot of the ways in which they’ve done things. The insistence on a higher power has led to the development of things like Smart Recovery or other methods and means.
At some point it becomes a point of practicality and if you’re saying, “Look, John Hopkins has a stack or research. Cambridge University has a stack of research. Do you want people to get better or do you want them to just keep doing what you’ve been telling them to do? What’s your real interest here? Let’s come together in a way that supports those who are trying to change their lives and save their lives rather than sit in dogma because this is the way we’ve always done it and this is the way we say it has to be done.”
I don’t support anyone using it. There are a lot of [Inaudible][50:01] if you have a family history of mental illness or a current diagnosis of psychotic disorders, certainly not. Coming together with some of these age-old institutions that purport this is their mission, great, we have a new tool; do you want to help us? Can this be a partnership? I think that that’s where it will really come in.
Zach: Yes.
Dr. Tippett: Hopefully.
Zach: It takes time.
Dr. Tippett: It all takes time. Think how long it took for us to accept [Inaudible][50:32]. People still push back. They’re not really sober. Yes. I don’t really think that people have to suffer in order to find relief.
Zach: There have been a lot of discussions on YouTube. I think a lot of it has extreme validity in that addiction when it comes down to it you take away the substances and what you find a lot of the times with people is the failure to form healthy attachments. This isn’t just with substances where the unhealthy attachment happens because you find alcohol, drugs, whatever but it can be the same with sex. It can be the same with gambling, spending, eating.
You said that there’s an area or a subset of people it wouldn’t be appropriate for. Would it not also be appropriate for people with process addictions?
Dr. Tippett: In so much as worrying that it would become, the psychedelics can become addictive?
Zach: I’m thinking you’ve been through therapy. You’ve done a lot of work on this and yet there’s still this thing, whatever it is for you that is not maybe mind-altering. It is mind-altering but it’s not a substance that you ingest. It is a process and can psychedelics help with that.
Dr. Tippett: Yes. I don’t think anyone has quite looked at that although my off-the-cuff response would be yes because I tend to conceptualize use of substances and use of other behaviors like sex, like porn, like food as coming from very similar places and they have very similar effects on the brain. My hypothesis again, absent any hardcore research will be yes absolutely.
Zach: Where do you see this going in the next couple of years? Would we go so far as to find some sort of FDA approval for psychedelics at some point you think?
Dr. Tippett: Yes. I think that’s coming down the pike. I have heard from most folks the fact that MDMA will probably be approved within the next couple of years or so, maybe four or five years out just based on the studies that are coming out especially from MAPS and the Expanded Access Study. That is the expectation.
There’s a lot of fear that it will be ruled out in sort of the same way that marijuana was legalized and that it can only go so well and then a lot of criticism around that, a whole podcast in and of itself, but a lot of attempts to try to control and manage the way in which this might become medically available.
Zach: Yes.
Dr. Tippett: It will be interesting to see.
Zach: It sure will. It sure will. I really appreciate you coming on the show today to talk to us about this. I think that this is probably going to have a part two in the coming months ahead. Dr. Tippett, if they are interested in learning more about this as a viable option for treatment is there a website that they could go to and learn more about that?
Dr. Tippett: None at this point and you could certainly do the classic Michael Pollan’s How to Change Your Mind has a great history of psychedelic use and an overview of some of the current studies. You could look at John Hopkins has the Center for Conscious Research. That’s where all of their studies are housed. maps.org also tends to keep a running list of current research.
At this point, it’s illegal for anyone to distribute any substances outside of a research program. It’s not happening anywhere except for the places that are being carefully monitored but those are some places if you’re interested in learning more you could go.
Zach: Quick sort of last question because I had a dear friend of mine he chose to get out of Florida and do a ceremony using ayahuasca. Is that considered illegal at this point or no?
Dr. Tippett: It’s I believe yes. Any of these underground ceremonies, I always tell people to just be so incredibly careful. They’re not necessarily well-versed in the science behind the substances, interactions with other medications you might be taking, and there’s often this kind of culture of ‘Here you go. Here’s your substance. Great, you have this experience. Bye’. There’s not a lot of follow-up.
Integration is something that people overlook all the time and it’s one of the most important pieces and often that is overlooked. I tend to strongly warn people away from sort of these underground groups.
Zach: Fantastic. Keep up the good work.
Dr. Tippett: Thank you.
Zach: Dr. Tippett, thank you again.
Dr. Tippett: Yes, thank you so much for having me.
Zach: I appreciate it.
Listen, also if you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.
Until next week, I’m Zach Crouch with Landmark Recovery Radio.
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