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The Differences In Addiction

August 6th, 2020
A picture of a young couple. Addiction is different in men and women, as well as different age groups

In this episode, Zach discusses the differences in addiction amongst recovering individuals. Zach is first joined by Michelle English, the co-founder and clinical director of Healthy Life Recovery in San Diego, California. They will be talking through how addiction affects women differently than men, and how care for their addiction can be specialized to better serve their needs. Following his conversation with Michelle, Zach is joined by Dr. Joseph DeSanto, an Addiction Specialist for the BioCorRx Recovery Program and the owner of DeSanto Clinics in Orange County, CA. Dr. DeSanto will be giving insight in to the ways teens are impacted by addiction, and how the young brain is affected differently that it would be in an older adult.

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: Hi. 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 please subscribe to get the most up-to-date information from leading experts.


We have guest Michelle English joining us on the show today. Michelle is an LCSW. She’s also the Co-Founder and Clinical Director of Healthy Life Recovery in San Diego, California. Michelle has almost 20 years of experience in counseling as well as 15 years of experience working in addiction recovery. She has her Master’s in Mental Health Counseling and is now a licensed psychotherapist.


Michelle, it is a pleasure to have you on the show today. Thank you.


Michelle: Thank you for having me on your show.


Zach: If you don’t mind, just tell the audience, our listeners here what got you started in the field of addiction recovery? Can you tell us a little bit about your background?


Michelle: Sure. I’m originally from New York City which is where I was born and raised. That’s also where I received my Bachelor’s Degree in Psychology and Education and went on to pursue a Master’s Degree in Social Work. During the tail end of my education for my Master’s Degree we had the tragedy of 9/11 occur. I was currently going to school in Manhattan and I was doing my internship in Manhattan.


With a lot of high stress shortly after 9/11, I had some mental health issues that I started dealing with; a combination of some anxiety and depression. I had experienced some losses of friends that had perished in the towers, also having to commute into Manhattan and be there for my schooling. My work at that time was very anxiety-provoking. I had turned to drugs for a short period of time and with that I had become addicted very quickly.


Upon receiving my Master’s Degree, I decided I’m going to make a geographic move and I’m going to explore what’s going on in California so I can move away from this new lifestyle that is encompassing mental health problems and self-medicating with drugs. I had tried some 12-Step programs in New York City, but they didn’t work for me. I moved to California and I immediately got into a 12-Step program and I became a person that was clean and sober in recovery. I had a sponsor. I was working the Steps.


I started working in the field of hospice with my degree, but I always had an interest in being in the helping profession to work with people in recovery. One day I was approached at a meeting by an owner of a facility and he had offered me a position to work for him. I took that on because of my interest and my past experiences. I worked at that facility for four, close to five years. That’s how I got into the field of recovery.


Zach: Appreciate that. I want to come back as well, too in your experience in Manhattan during 9/11, did you during that time, God it seems so long, 20 years almost or so ago at this point, but you were there and a lot of people were not. Did you experience personally but also did you sense within the city just a tremendous amount of I guess trauma that happened where people, you were part of that?


Michelle: Absolutely. Being a native New Yorker, things are very fast-paced and people are not very interactive with one another. For example on the street, there’s usually no eye contact. You don’t say ‘good morning’ to people. It’s kind of like robotic in a way; point A to point B, very fast-paced, a quick-moving place.


You mentioned senses. That particular day if you were in Manhattan, all of your senses became very aware. You could see smoke in the air. You could hear the hustle and bustle of people trying to get home when mass transportation was completely shut down. You could hear helicopters.


You can hear people trying to get a phone call in to make sure their family members were safe. It was hard because the cellphone towers were completely drained because there were so many people trying to communicate at the same time. There was a loss of transportation. There was a loss of communication. Whoever was there, you had to rely on your senses. You could see fire trucks, ambulances, helicopters.


It was just a very apparent state of panic, emergency, and desperation to get to your loved ones, to pick your children up from school to make sure that they were safe, to make sure that your friends were okay.


For me, I personally knew a few people that worked in that building that unfortunately did not make it out. There was also the issue that people were feeling of grief and loss. Beyond grief and loss of an individual, it was grief and loss of feeling a sense of safety and freedom in your surrounding area. When you live in America, that’s not something that you do it usually.


Zach: Right, absolutely.


Michelle: It was a very strong and very tragic event that affected many people that lived in the city.


Zach: I don’t want to interrupt, Michelle but as you’re talking it almost seems to me the word that comes to mind, most in my mind I would describe it is ‘very surreal’.


Michelle: Yes, absolutely surreal is a great way to describe it. Yes.


Zach: You mentioned your senses were heightened and right there in the middle of the city is, at least if you saw the first one get hit but certainly there’s a building on fire and then you see the second plane going in. It’s just like this can’t be happening.


Michelle: Right. People were watching this on live television. I remember that day. I was at my internship. I was fairly new there. It was the beginning of the school year in September. You see the first plane go into the building and the building is on fire. You don’t think it’s an attack and nobody was aware of that at that point.


You think there was an accident where a plane came down into the building, but then when you’re watching this televised and you see this second plane hit the second building then you know that there’s something wrong with this situation. At that point, you’re not safe.


Zach: Wow. I appreciate you being vulnerable to share that with the listeners on the show because, like I said before we all share that experience but you were there. There’s something to be said about that. I’m glad that 20 years later there’s still probably a tremendous amount of healing that needs to take place for some people.


I’m going to switch gears a little bit, Michelle. I know that you made a geographic shift. You mentioned that San Diego, that’s one heck of a shift. If there’s a geographic shift in America, that certainly qualifies moving from New York to San Diego. You shared with us in a previous conversation that women are more likely to be medically compromised by the time that they enter into rehab compared to men. Can you share a little bit more about that? What is that exactly taking into account?


Michelle: For many years now, gender differences and rates of substance abuse have been observed in the general population. In some treatment-seeking samples with men exhibiting higher rates of substance use, abuse, and dependence, in the last few decades, some surveys from the early 1980’s estimated the male-female ratio of alcohol use disorders and substance abuse disorders, even now and part of that is because there are some factors that can contribute to drug use and addiction and alcoholism.


There are certain mental disorders that are risk factors for developing a substance use disorder. Some of those include and some of them are unfortunate that women are more exposed to higher levels of stress, higher trauma rates. PTSD is a very large risk factor for someone to develop substance abuse and also eating disorders.


Zach: Yes.


Michelle: 90 percent of the cases of eating disorders are found in women and women are estimated to be two to three times higher at risk for an eating disorder. Among women with substance use disorders, the high rates of eating disorders have been reported. Those risk factors they all include the answer that I think you’re looking for.


Zach: Sure. One of the things, Michelle that at least at our facility here at Landmark Recovery we do with every patient that comes in is to do an ACE score with them. Is that something that you guys or part of your practice is consideration of the ACE score and how it affects people?


Michelle: Yes.


Zach: It’s incredible. That study has just opened me up especially to how mental health and also substance use disorder, it’s I think impossible to sort of parcel those things out and try to work on those things separately, say from a person’s overall health and well-being because I think and I hope that we’re moving more towards an integrated model of treatment that treats the whole person including substance use and mental health.


Michelle: Absolutely.


Zach: Chronic diseases are really what kill people most of the time. There are a lot of people who die from overdoses, but there’s a whole lot of people who go on living lives that are, we’ll call them actively using and they eventually die from complications from liver, heart, whatever it is.


Michelle: I agree.


Zach: Can you also share with us just a few other ways that drug use disorder impacts women differently than say, men?


Michelle: Yes. I have past experience at working at an all-women’s program where women received obviously gender-specific treatment. I have had other experiences in programs that treated both men and women. What I have found is that women they can be a lot more vulnerable than men. For example, women with a substance use disorder are more vulnerable to sexual trauma, physical trauma, and emotional trauma.


Women tend to go to different means to getting drugs. For example, some women turn to prostitution which also opens them up to more vulnerability to different types of trauma. Men, I had seen more drug sales to support their habits. Women that have children it could be more isolating for them where they’re addicted to substances or alcohol and they are trying to take care of their children and they’re more isolated so then you have more exposure to isolation and depression and responsibility when it comes to children involved.


Zach: It’s interesting you’d say that especially with the specific women’s issues that I guess as a guy that’s on the front end when I get a phone call from a mom and the mother will say, “I really need some help right now.” I’ll hear everything that she’s telling me.


Usually, as an example it might be “I’m working this job.” Perhaps, “I’m single, but I’m also drinking half-a-fifth to a fifth of liquor a day. I’ve got two kids and I need some help but I can’t come in to a residential treatment center because I’ve got kids and I don’t know who’s going to take care of them.”


Michelle: Absolutely.


Zach: That could be a really tough barrier for women especially when higher-level care would be necessary.


Michelle: Yes, absolutely. I’m actually seeing more programs that take women and children which is something that’s newer in the field, but I think it’s a necessity.


Zach: Tell me. You’ve been in this field for quite a while. 20 years is a long time. What types of women-specific care should addiction treatment programs implement to help with these gaps? You mentioned women who are allowed to bring their kids. Are there other things though that come up?


Michelle: Yes. What comes to mind when you ask that question is definitely gender-specific treatment so women can have a chance to focus on issues that women have specifically. I would think that addiction treatment programs can implement for women definitely an eating disorder component if that’s something that the woman is struggling with.


Also because women are more likely to be exposed to trauma and come into treatment with PTSD so having a trauma component to the program I think would be beneficial for women and also child care education. Sometimes women that are drug addicted and they have children they move away from what their children might need. It’s something that they might not have learned at home growing up so that can help. Family therapy component I think would be extremely helpful for women.


Zach: You bring up an interesting point, Michelle. I was thinking, too about the piece around eating disorders is an interesting one especially given that with drugs and alcohol there’s usually some science. A person gets arrested. There’s a DUI. There’s money missing from the banking account. There’s a litany of different things that can clue people in or just a person’s using and the loved ones sees that day in and day out.


Eating disorders seem a lot more tricky because I think it’s a cultural piece, too where we value youth and being thin. How can loved ones know that their person that they’re in a relationship with, the family member is struggling with an eating disorder? Are there signs that you look for as a mental health practitioner that maybe could be signs that family members can look for? That’s the first question. The second question would be how do you have that conversation with someone if you are worried about them?


Michelle: I’m glad you asked that question because I also do have experienced working with individuals with eating disorders both men and women. Obviously the first thing that would step out to me would be looking at someone that is underweight. If they look like they’re underweight that’s my first indicator, “We might be dealing with an eating disorder here.”


Another thing is to look at what drugs is this person taking. A lot of times you see people with eating disorders that are addicted to methamphetamine or they’re addicted to certain drugs that create loss of appetite and stuff like that. Those are some things that I look for.


Frequent trips to the bathroom are another indicator. I’ve seen clients that have some of the signs but they haven’t been willing to share. They might say, “I’m having anxiety. I need to go to the bathroom.” They come out of the bathroom and say, “I just threw up because I had anxiety,” but really it’s right after lunch. They just ate a meal and they’re trying to get rid of their food. There are a lot of things, indicators to look for people that have the tell-tale signs.


Zach: I think that that’s a very…I appreciate that. I’m curious to hear from you, too being that you have worked with this population. What’s a good healthy metric or measurement for men and women to go by for health? I hear BMI tossed around a lot. There’s just so much. What do you look at?


Michelle: Treatment is complex and requires a multidisciplinary approach including for example, nutritional counseling and medication supervision. There are a lot of evidence-based behavioral treatments for eating disorders including cognitive behavioral therapy and interpersonal therapy.


To answer your question, I would look for healthy BMI absolutely. I would look for somebody that is having proper nutrition and also looking for symptoms of depression because depression is extremely prevalent with people that suffer from eating disorders. Typically they require treatment for their depression.


Zach: I have, I would say a very dear friend of mine. He is an Iron Man. He competes in Iron Man marathons. He’s done very well on those. As a matter of fact he’s gone to Hawaii. He’s been to…didn’t want to move probably ten, 15 years ago. Recently he just checked himself into rehab for that reason, for eating disorder. I never knew it. He was always just super thin and always in great shape.


I’m curious. In your experience, have you found that men with eating disorders the reason that they have eating disorders vastly differs from the reasons that women have eating disorders?


Michelle: Yes, absolutely. I have worked with a good amount of men that have eating disorders. One of the issues is that it’s harder to diagnose a man with an eating disorder because they are less likely to admit that they have a problem and it looks very different for a man.


Zach: Sure.


Michelle: For women, you would say they have anorexia and for men, you can say they have something called big-orexia where they want to be bigger and appear stronger.


Zach: Is that the same, Michelle as body dysmorphic disorder?


Michelle: Absolutely.


Zach: Okay.


Michelle: It is. There’s a workbook that I have used with clients that focuses specifically on body dysmorphic disorder. The men that are very strict gym-goers and they’re meal prepping. They want to be taking testosterone and they’re giving the reasons why they think they need it. A lot of these men suffer from extreme low self-worth, poor sense of self. They try to identify through the way that they look and they base their self-esteem on what their body looks like especially men that are shorter stature.


I’d comment these men feel insecure in our society because they feel that men that are taller are more valued and they’re better athletes. That’s what society depicts for them. Those are some of the men that they want to kind of beef up so they can compensate for where they feel and think that they’re lacking.


There is one man in particular. It was a pretty sad story. We worked together for a couple of years in my private practice and he had an eating disorder. He was morbidly obese. He went to move to Hawaii. We continued on with our therapy through tele-health sessions.


He went to a treatment facility for eating disorders and he was the only male there. The treatment was geared towards women and there were certain groups that he was told he could not attend because they were just for women. He was very discouraged by that. I found that very interesting that an eating disorder facility had very little resources for males.


Zach: Do you see this becoming more of a common thing with men developing eating disorders in this day and age?


Michelle: Yes.


Zach: What is this workbook that you work out of that you mentioned?


Michelle: The workbook that I am talking about is it’s a workbook that I’ve been using for many years. I’m actually grabbing it right now. It’s called The Body Image Workbook.


Zach: Okay. Who is that by, Michelle?


Michelle: The Body Image Workbook it is by Thomas Cash and he’s a PhD.


Zach: Okay.


Michelle: It’s basically a workbook familiar to people that are already in recovery and familiar with the 12-Step program because this workbook it has an 8-Step program that you work through with each client step by step.


Zach: Got it. When I think of eating disorders and substance use disorders to some extent do you see a lot of close parallels with like OCD, obsessive compulsive disorder?


Michelle: Absolutely. People that have anorexia one of the most common mental health disorders that you see with them is OCD where their thinking is very regimented. Their behavior is very regimented. It’s the most common thing. When you work in a…I used to previously work in an eating disorder facility. You are aware that the people that are coming in and they have a diagnosis of anorexia. They are more than likely to have OCD and they’ll need treatment for both.


Zach: Absolutely. This is a very, I think appropriate topic right now because I think that a lot of people are at home more often and there’s a lot more, at least I’ll tell you right now in our facility we have seen the spikes since this all happened, since the pandemic started with people calling in because you can’t really hide it as easily. You cannot hide the drug and alcohol use. I imagine the same could be said to be true about eating disorders.


Michelle: Absolutely. Right now I would say mental health and substance abuse is definitely something that is becoming more and more of a problem as we are all trying to deal with the situation that we have been in since March of this year.


Zach: Exactly right. Michelle, it has been a real pleasure speaking with you today. If people are interested in your services in San Diego, do you have a website?


Michelle: Absolutely. It’s healthyliferecovery.com.


Zach: Fantastic.



























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. Joseph DeSanto joining us on the show today. Dr. DeSanto is an Addiction Specialist for the BioCorRx Recovery Program. He’s a double board-certified physician with over 12 years of experience specializing in addiction medicine.


He’s also a graduate of Lafayette College and attended the State University of New York at Downstate in Brooklyn for his medical school training. He completed his internship and residency training at Cedars Sinai Medical Center in LA and now owns DeSanto Clinics in Orange County, California.


Dr. DeSanto, it’s a pleasure to have you on.


Dr. DeSanto: I’m honored to be here.


Zach: If you don’t mind, tell us a little bit about your background. How’d you get into addiction recovery?


Dr. DeSanto: How much time do we have? It’s hard when people ask me that.


Zach: All the time you need.


Dr. DeSanto: It depends on how far back you want to go because I think that’s what we’re going to focus on today is exactly how far back do we have to go to find out when I was…first of all, I always knew from a young age I was going to be a doctor. I didn’t know from a young age that I was going to be an addict and an alcoholic as well. That’s kind of where the diversions took place. I fooled myself for many years thinking that I could control this. This is not ruling or running my life. Little by little it started to creep in.


I’ve been practicing addiction medicine since 2006. I’d always had an affinity for it because it encompasses so many specialties, neurology. I’m kind of a geek when it comes to science. I’m kind of a supporter of the underdog. I chose the specialty which probably has the highest rate of patient drop-off or loss and I could name relapse or something worse, God forbid. We read about that in the paper all the time.


I always was interested in breaking new ground and pushing the envelope with certain…for treatments and diagnosis. Addiction medicine had always been that specialty that never really had the proper research, funding or any idea of how somebody became addicted. I was always turned on by the actual science of it and just the existential thought of what makes one person an addict or an alcoholic and what makes another person just not have substances or alcohol be that important to them in their life.


It was that question that kind of led me. When I got sober back in 2012 and I haven’t had anything mind-altering or enlisted since then or a drink since then, I’ve had a lot of clear-minded time to kind of put things into perspective and really look at how my life had wound up and then unwound and where I am today. It’s been an interesting experience, path.


Along the way I’ve had a chance to talk to a lot of people who have struggled with drugs and alcohol. Looking back to their adolescence and childhood, even early childhood it kind of gave me an idea of where this actually starts. It doesn’t start when you get exposed to your first drink. It starts way before that.


Zach: Amen. Absolutely. A couple of things kind of came up for me as you were talking. You said that you knew from an early age that you’re going to be a doctor. Were your parents doctors?


Dr. DeSanto: My dad was a dentist, retired several years ago and he brought me to work a lot just because I wanted to. I was always interested in what he…I was an inquisitive child which, by the way is a risk factor for addiction later in life.


Zach: Now it’s going to be another question I was going to ask. Continue.


Dr. DeSanto: Most kids are afraid of the dark. I wanted to see what was in there. I would be the one guiding into the room to check it out. That’s a risk factor, ladies and gentlemen. I was exposed to the whole idea of caring for people. I think intrinsically I was, if you believe in pre-existence contracts and I know we’re not going to get into that part. You’ve already made your deals. You’ve already signed your contracts before you arrived here. I believe that that was always in my cards. I didn’t know how hard it was going to be and how twisted it was going to be.


My exposure to my dad’s practice showed me a different side of my dad that I didn’t put into perspective until later on in life about how much he cared about people and how he cared about people plus it just looked like fun. I didn’t understand what work went into it. All I saw was that people came in. They gave him gifts, the hugs and kisses. In Brooklyn, and an Italian neighborhood you’re very touch-feely to begin with.


Zach: Did you grow up in Bensonhurst or something? Did you grow up in Bensonhurst around that area?


Dr. DeSanto: I did. I did. You’re familiar with the area. Yes. I grew up actually in a place called Dyker Heights which is right next to Bensonhurst but essentially the same neighborhoods. I was just close to their families. You would think with my upbringing with so much love and not a lot of apparent hardships that I would not be predisposed to this. Lo and behold there were other things that came into play. Yes, my dad was a driving force into me becoming a doctor for sure.


Zach: I’m curious to know. You tell me how comfortable you are. Just in terms of your family background, was there evidence if you look back at your family tree were there substance use issues that were apparent then or even mental health issues that were apparent that weren’t addressed?


Dr. DeSanto: Without outing anybody in my family no, there were no apparent or sought-for-treatment issues that were in my family tree. There was nothing really to pinpoint. Believe me. I’ve looked back and I’ve grilled, even when my grandparents were alive I grilled them after I got sober. I said, “Any alcohol use?” I’ve never witnessed anybody.


We were comfortably intoxicated around each other during special times, but I never saw any morning drinking or any other warning signs of not being able to stop, guilt around alcohol. I never saw any substance use. I was never exposed to any evidence of substance use.


My parents were pretty straight-laced regular Republicans growing up; not that that doesn’t mean you can become…which I want to…disclaimer: it doesn’t mean that you will not grow up to be a drug addict as well. There are risk factors and there are protective factors that I run through the years. We’ve identified quite a few of them. Yes.


Zach: You mentioned that addiction really doesn’t start later on in life. It happens early on — adolescence, childhood. That was true for me, too. I remember taking the first puff of a joint when I was about 12 or 13 years old and I didn’t even know what was in it. I just knew that the buddy I was with we ended up taking these cigars and hollowing them out. He did it one time. He almost surprised me.


We would smoke these cigars anyway, but he took one of those and he hollowed it out and he put the green stuff in there. I’m inhaling this stuff and before I know it I’m here going in a circle with this guy freestyle rapping. I’m like, “What the hell? What in the hell is going on here?” I can tell you one thing, Joe. I loved it. I loved it. I knew at that point that I had found something that would just shut my brain the hell up because it just wouldn’t stop.


I’d be in school. I thought the teachers that were teaching whatever they were teaching were just simply boring and I needed more stimulation. I needed something else. I began hanging around with a lot of kids in my neighborhood and then also at school. We got into a lot of trouble. I remember I’ll just say this breaking and entering into cars. I got arrested and parents were pissed. I was around a group of teenagers and we just had this sort of…we didn’t think independently obviously because we were still growing.


There’s this idea I think you’ve talked about it before this, this idea of group think among teenagers and how it can lead into long-term addiction issues. Can you talk to us a little bit more about that and what that means?


Dr. DeSanto: That’s interesting that you mentioned group think. Group think affects all of us. Take a look around, Zach. Do you think there’s some group think going on with the adult population?


Zach: Absolutely.


Dr. DeSanto: Okay. Now take away pretty much life experiences, the ability to reason, increase your impulsivity, and inability to process shame and guilt and then you entered into the herd which is now kind of guiding you into…I was told and this is interesting. Jordan Peterson says that parents are responsible for their children up until about four-and-a-half years old.


If you can get them to four-and-a-half years old where they feel relatively good about themselves, they have some kind of resilience where you haven’t beat the heck out of them with childhood trauma and I think we really need to talk about that because addiction is absolutely trauma-based meaning that’s what sets you up for the risk factors. You’re four-and-a-half years old then you pretty much hand your kids over to society.


That could be preschool, regular school, daycare. Everyone that that child comes in contact with, if they are “accepted” and they feel good and they in return start to feel good about themselves, regardless of who they think they are to people and they don’t feel shameful or guilty about anything about themselves, even if they’re bad kids that’s the protective factor.


Now they enter into early adolescence where they start to develop their identity and who they are to people and now adolescents where they’ve got to start expressing that. If they don’t have the right filters or the right sensory equipment and then the proper filters to get the information from the group think, it could start a cycle that they could never really come out of.


We find that happens around six, seven, eight years old where they start to become emotionally immature and they start lagging behind with the ability to really feel good about themselves. They’re always playing catch-up, questioning what they see around them. You combine that with impulsivity they use to develop the people-pleasing skills. That’s where “peer pressure” is.


A lot goes into peer pressure obviously. It’s the group that you’re associated with and the person themselves. It’s how you relate to the group and how you feel like you have to…are there conditions in how you perceive joining the group. Group think has a lot to do with it, but it’s actually more of exposure. If you’re a parent and you’re worried about your child; what are the risk factors of becoming an addict or an alcoholic?


Don’t focus on them. Focus on the group that they’re associated with. Ask questions about their friends that they hang out with. Not if your son drives or daughter drives drunk, but are they getting into the car of the person, of a good friend that they trust and if that’s okay with them to get into the car when their friends are intoxicated. It’s a lot less of how risky their behavior is but the associations’ behavior. It’s interesting how the group think and the herd mentality comes into play there.


Zach: I get the impression, too especially at such a vulnerable time I think adolescence is a fairly vulnerable time for a lot of kids. Having this attachment to a group and feeling a part of is so powerful and I think about people, a guy that I know. Great guy, really smart man and he was adopted into a family, great family but his mom who he didn’t know, never met really she was addicted to drugs.


He ended up getting adopted by this great family, but even today and he went through his own addiction process. He’s sober now, but now even today he’s trying to form some relationships, intimate relationships and he has a really difficult time just with trust and vulnerability. I’m curious to hear from you. Does it start, as we mentioned early on even pre-verbal, we’ll say trauma, the lack of attachment I would say is a big one lend itself well to the addiction process?


Dr. DeSanto: Interesting. Can I ask you one question though, Zach? You had mentioned your exposure to substances. Are you in recovery? Are you sober now?


Zach: Yes, I got recovered. Yes, I got sober in 2007. Yes.


Dr. DeSanto: Good on you, man. How old are you, Zach? I’m sorry. I don’t know how old you are.


Zach: Yes. I’ll be 41 in September.


Dr. DeSanto: Okay. You’re a youngster. All right. Wow. Congratulations on sobriety and I’m assuming abstinence sobriety. There are different levels of sobriety. I just try to pin my definition on it.


Zach: Yes.


Dr. DeSanto: It’s easier for the brain to unwind when there are no substances present. If you want to talk about harm reduction, we could talk about that later. I think the question you’re asking is the resilience of an individual and how quickly can they rebound. Your friend who is still having a hard time developing stable relationships I got to tell you, even if you have not had an addiction issue growing up or as an adult, it’s difficult these days to make the proper social connections.


The cues that we used to rely on biologically as just a species are really gone by the wayside. We’ve become biological creatures now in a technological world where…God, we could talk about this forever. You’ve got artificial intelligence that’s affecting how we now interpret each other’s emotions. We’re now using mechanical things to try to interpret. I think I forgot your first question. What was the initial question?


Zach: Yes. Because attachment and trauma kind of go hand in hand and I’m curious to hear about how does…here’s a more specific question. How does pre-verbal trauma lend itself to developing a substance use disorder?


Dr. DeSanto: I think it’s really important. I think I want to have you clarify what pre-verbal trauma is.


Zach: I’m talking about, we’ll just say before the age of even a year, a year-and-a-half.


Dr. DeSanto: Okay. Right. There are definitely studies that show…I remember growing up that there was a group think, talk about group think that you left a baby alone. You don’t want to coddle a baby. That’s the way you develop resilience in a kid. How would a kid be able to take care of themselves? Absolutely that’s absolute nonsense. I’m going to try to avoid curse words here because I was going to use something stronger.


Why would you not want to provide as much physical contact and comfort to a child? I guess if you don’t know the science around it; the brain is still making connections and growing in infancy. Birth to six months, it’s super important regarding future of resilience and the brain connections that are made also the pathways that help an individual self-soothe and reward good behavior and by good I mean behavior that will benefit you as a species seem to go by the wayside.


Those connections are not as strong and the amount of your transmitters that are important in those connections are not reinforced if you as a child or as a baby were not held. Touch is extremely important especially the first week or two, not necessarily breastfeeding. I don’t want to give anyone the wrong idea. You don’t necessarily have to have that about feeding, the parent being seen as a source of food and nourishment, but just as contact.


It’s extremely important. You come from the womb, the uterus. You’re now in an exposed cold environment. Think about that just as a biological being. I hate to say, but that’s what we really are. We’re just sensory organs thrown from a warm swimming pool where everything’s taken cared of to, good God, where am I now? Why am I just laying here? I want some of this comfort and I don’t know how to speak. I don’t know how to express my needs. These two people or one person that keeps wandering by is not doing anything about it.


We’ll never know what that process looks like through an individual, but we know that kids who were not picked up in retrospect, that were not picked up and held and nourished pre-verbally I guess you can call it tend to not have the portions of the brain developed that seem to protect us from really bad adult experiences and lead to lower resilience factors.


Zach: Got it.


Dr. DeSanto: It’s interesting, something as simple as picking up a kid, right?


Zach: Sure.


Dr. DeSanto: Yes.


Zach: You mentioned that you’re in the process of recovery and I am, too. I was 27. I don’t know when you got sober. How old were you?


Dr. DeSanto: 44.


Zach: Okay. I got family friends that actually got kids, 20-year olds. One of them is doing really well. He’s almost on a year sober at this point at 20. Have you seen any research or any [Inaudible][51:26] for that matter whether or not young brains or older brains find recovery more difficult?


Dr. DeSanto: I would think that that kind of study would be difficult because usually with studies we use the discernment is we separate populations into age so risk-stratifying and something like that based on age and just so many things are going…I’m not aware of any formal studies like double-blind placebos or case studies.


Having read enough and spoken to enough people and taken care of a large number of people from adolescence to…God, I’ve taken care of 14 years old all the way to 89. My oldest patient I believe to this day with a use disorder was 89 years old. I would think that each population, the young and the old have their benefits and definitely their drawbacks.


You look at an adolescent, a teenager. He hasn’t a lot of life experiences. Your emotional bar, it’s hard to set the emotional bar which can be a blessing and a curse because if you set the bar really high going into adulthood, you can become startled or frightened and that could turn into an anxiety disorder which could lead you to want to self-soothe if you find the right medication at the right time or the right substance like alcohol. Something as an adolescent it could be protective but as an adult could be a risk factor as well.


You really have to take each individual on a case-by-case basis. What usually lends the younger population to become addicts more readily is typically, like I said the friends that they hang out with, their exposure to substance use as a young kid so if you’ve seen your parents drink even if it’s not alcohol or use drugs especially illicit substances which you’ve now been told are “bad” by society and then you see your parents do it.


There are a lot of things that are at play there. Not only are they condoning it, you also have question about the authority in your life, “If my parents are doing this then they know best because they’re my world and they’ve told me everything I need to know about life up to this point aside from my teachers and my friends.” When they go into adulthood the rules mean less and less to them.


No, I didn’t have that. I accept that my mom did smoke and my mom smoked heavily. I currently smoke now. I’m just going to come around and say it. I’m not completely substance-free I guess, being exposed to nicotine on a daily basis. I think having seen my mom chain-smoke definitely was a risk factor for me. Science has shown that, too. If you start smoking at an early age, which I didn’t; I started smoking in medical school due to the stress.


The earlier you start smoking the more likely you are to become addicted to other substances. Just the presence of nicotine use in a teenager is extremely predictive of whether they’re going to develop a pattern of use in the future. Your exposure to things and how the mind processes that at a young age and also the mechanisms of the brain like the prefrontal cortex and the limbic system and our other cognitive wirings are still going through some tumultuous laying down during your teenage years.


When I say tumultuous I mean we found the plasticity of the brain is incredible over the past couple of years and Dr. Daniel Amen has done a lot of great scanning studies. He’s developed I don’t know how many…I’ve read everything he’s put out. He was the first person that I actually went to when I got sober to try to figure out what the heck is going on with my brain.


I know I’m all over the place. Eventually I’ll come back to answer your question which is another problem I have. ADHD is another issue which definitely predisposed me. You’re going to have to reel me in in about a minute, Zach. Give me a minute. This would be interesting.


Zach: Sure. Go ahead.


Dr. DeSanto: The first doctor that I wanted to go see when I got out of rehab, I read books like crazy. When I first got sober I finally had time.


Zach: Sure.


Dr. DeSanto: Thank you and just a desire to know addiction medicine. The doctor that helped me get sober, Dr. Dan he was an incredible driving force to be going into addiction medicine. He let me intern with him two years later and I learned almost everything that I know about addiction medicine from him and how to practice it.


I also got exposed to other doctors who were addicts in recovery and I saw just beautiful people almost devoid of ego. Dr. Daniel Amen was somebody that I wanted to see. He was the man on the mountain. I went. I got a brain scan.


Zach: What did you find out?


Dr. DeSanto: I found out that I was on the ADHD scale. I found out I was one of the highest ones. You meet with your doctor after the scan and the formal testing which is sitting in a room with just a computer screen and tapping on a button for an hour-and-a-half. If you have ADHD and you’re forced to do that, you can do it for about two minutes and after that you’re going absolutely insane. There’s nothing else to look at so you have to focus on the screen.


Regardless of all that, after the fact I sit down with my doctor for the discussion portion of the meeting. He opens up my file and the look on his face. When he opened the file he went, “Ooh.”


Zach: Yes.


Dr. DeSanto: I said, “Is that a good ‘ooh’? Is that a bad ‘ooh’?” He went, “It depends on how you look at it.”


Zach: It’s an ooh. It’s an ooh.


Dr. DeSanto: It’s an ooh. He goes, “Ooh. It says here you’re going to need probably amphetamine stimulants to help this type of ADHD you have. Seeing you just got sober that’s probably not a good idea.” I said, “What are my options?” He’s like, “You’re going to have to do it the hard way.”


Zach: What’s the hard way? What’s the hard way?


Dr. DeSanto: You actually have to learn about ADHD and learn what are the cues in society that set you up.


Zach: I’ve heard in terms of treating ADHD or ADD with a more natural sort of course. I’ve heard that meditation, exercise are extremely valuable in that respect. Have you found that to be true? Have you implemented any of those practices?


Dr. DeSanto: Absolutely. I think ADHD can be managed by diet alone and then everything else is an added bonus. I could talk about this for another hour. ADHD it can be managed nutritionally. The amount of processed food that we’re potentially exposed to is ridiculous in society today.


If you can have organic and as raw ingredients as possible, keep you blood sugar maintained, chunk your time, make sure you stay on schedules and you stick to those schedules and don’t feel bad or good about it, not put any emotional attachment, really work on yourself. Exercise is super important, daily, regular exercise even if it’s for 15 minutes. You’re getting endorphins. You’re mixing your brain up so you’re not going into these repetitive cycles.


You’re giving more oxygen to the brain. You get a chance for creative time during that period especially if you walk or run. There are a lot of things that go into play. Meditation absolutely has been show to, in certain parts of the brain that intimately lay down the pathways for ADHD can be altered and can be changed.


That’s another thing that I did. I learned transcendental meditation which I had heard about from Howard Stern. I heard about it from a David Lynch. David Lynch is one of my idols growing up. I was intrigued by his movies and that’s another hour, Zach. You and I are going to have to have a few hours in the future.


All of these things led me to…and being introduced to naturopathy. Some good friends of mine were just recently graduated from Bastyr College in Washington. Naturopaths that said, “Come on in. We could definitely help.” Armed with all this information, going to naturopaths, having the time to have daily intravenous therapy of amino acids and the science behind that is not that strong, but I did it anecdotally and I did it because it felt good, too.


They put a cocktail together that literally nutritionally got me high. You could get high from food, a good meal. You know what it’s like being sober and having a good meal.


Zach: Sure.


Dr. DeSanto: You actually can feel nutrients nourishing your brain.


Zach: Emily and I had recently…I picked up a steak and we split a steak. It’s probably I don’t know six ounces a piece or something like that. We each had a baked sweet potato with some steamed broccoli and just some olive oil all over that. I got to tell you. After I ate that, I slept better that night. I felt better the next day. I didn’t want to have soda or anything like that.


I want to kind of come back to a couple of things to what we’re talking about previously because I think it’s pertinent to what we’re talking about now. I know you mentioned ADD. There’s a gentleman. He’s still around. He’s a bit older now. He tells this story all the time. He was the founding…he wasn’t a founding member. He was a big piece of the Kentucky Physician’s Health Foundation and he’s a doctor.


As he was going through med school, as you did, he found a way to shut his brain up and that way that he found to do it was to drink. When he was drinking, when he drank, he was able to study. He was able to concentrate. He was able to do quite well actually.


I’m curious because we’ve been talking about addiction as a kid and then addiction as an adult. What are the biggest differences between those two populations, between addiction as a kid and then addiction as an adult?


Dr. DeSanto: It all depends when you’re first exposed to an addictive substance.


Zach: Okay.


Dr. DeSanto: As a child you have your brain and you’ve got risk factors. Is the brain processing information properly? Are you making the correct amount of neurotransmitters and in the right balance? If you’re not and you’re exposed to a drug or a substance early on in adolescence, the earlier you’re exposed to the substance the more of it you take. The more likely as a child going into early adulthood and late adolescence, you’re likely to become more an accelerated addict.


Zach: Sure.


Dr. DeSanto: The Type A and B alcoholism really underscores what you’re talking about, Zach. Say I’m in my office. I would consult with a 60-year-old who wants to stop drinking.


Typically those are the Type B alcoholics where they’ve slowly brewed over time meaning they had a decent relationship with it where they were heavy drinkers, but didn’t start to develop an obsessive or compulsive use of alcohol until they hit certain sentinel events like divorce or a death of a spouse, any major life influence and then a step-wise degrading of their quality of life and then more drinking and then it turns into a vicious cycle.


They’re typically the type of people that relapse over and over again because their relationship with alcohol over time has not been as dramatic. They’re like, “Yes, I heavy drank. I drank in college. Who doesn’t? Yes, I drank pretty heavily during the 1980’s. Who didn’t? Snort a little cocaine, yes that was normal.” It was syntonic. It felt good. To try to separate a 60-year-old from a bottle of booze is hard. It’s hard. You’ve got to make it psychic or an emotional change in a 60-year-old; way harder than an 18-year-old.


Now that said if I get an 18-year-old who is drinking the same amount as a 60-year-old, that 18-year-old is typically in a lot of trouble meaning if they have a tendency to start to now convert to other drugs which a 60-year-old alcoholic, guess what? When you’re 60 and you’re addicted to booze, you’re less likely to become addicted to something else because you’re on team alcohol.


Your brain has developed that reflex pathway of that coping mechanism, but when you’re an 18-year-old and you’re exposed to alcohol you have a different relationship with it. It is doing different things for you. It is shutting off like he was able to shut down his brain, your doctor friend so he could study.


Zach: Right.


Dr. DeSanto: They use it for the same thing. You’re self-medicating with whatever you come across and if it’s not laying down a pattern or a cycle of negative consequences which your body can do it then you’re going to do it over and over again. You’re not getting sick from it. Young addicts are typically more hard-core. We see the Type A alcoholic. They will start drinking.


They’ll develop cirrhosis in their 20’s which is extremely rare for a 20 or a 30-year-old to have cirrhosis, but we’re seeing younger and younger, highly addicted to alcohol youth that are developing cirrhosis, fatty liver which is the precursor to cirrhosis, fatty liver and scarring and then jumping tracks to different substances or using them at the same time.


Adolescents and young adults are typically more likely to be polysubstance users. Now that said if you can interrupt that cycle and put them in a proper environment where they can actually separate from the substances and I don’t know if you’ve seen the opioid epidemic what that’s turned into which is basically the fentanyl epidemic now.


Zach: Right.


Dr. DeSanto: What’s coming behind fentanyl is really, really frightening because we’re having a hard time keeping track of the molecules now and the strength compared to fentanyl is just astounding. Kids are looking for stronger and stronger drugs. They have a higher incidence of overdose rates.


We see that now unfortunately on an annual basis. We have to tally the numbers. We were finally making some headway but with the COVID quarantine that’s completely turned on its ear. I don’t even want to see what the numbers this year are going to look like.


Zach: I can tell you at least from an optic stand we’re seeing a lot more people coming in with alcohol problems right now. The opioid problems have not gone away by any means, but I think that because people are at home more now and if you had some sort of pre-existing addiction or substance use problem present it’s become amplified.


Not only that, I think it’s also that you’re not able to hide it as well. If you got family around and they’re present more, you’re present more. A lot more people are working from home. It’s just more visible to people today.


Dr. DeSanto: It really is as isolated as we think we are. If you’re not living alone and you’re with somebody else, guess what? Your covers are lifted, everything. If you are in a marriage right now and you have survived so far and actually could tolerate each other, congratulations.


You’re probably going to have a very happy, I can’t guarantee it but probably going to have a happy or at least a consistent marriage over the years because we are seeing each other for who we really are.


Zach: Absolutely.


Dr. DeSanto: First of all it’s the Age of Aquarius so it’s hard to lie to anybody anymore anyway. The veil’s being lifted. The Latin term for apocalypse is lifting of the veil. We are going through an apocalypse. Good, bad or otherwise, we have to see this as is. Alcohol usage, funny that you’re saying that. Yes. Everybody delivers now, man. Imagine that.


Zach: Imagine that. Just sort of a last kind of jumping off point here in terms of the question, I wanted to ask you something because you mentioned that you had some parents yourself who were really involved in their careers and we all are it seems like. Most people are working just a lot.


I’m curious to know in terms of educating your kids like if you’ve got teenagers especially, how do you have a good enough relationship with your children to have that conversation about substances and how to critically think through some of these things so that if you stave off using until you’re 21, your chances of developing a substance use disorder of any kind, if you don’t use any substances until you’re 21 your chances of developing a long-term substance use problem go way down?


How do you have, how do you set up the dynamics to the family, this is a long question I guess, to help have that conversation and in a constructive way?


Dr. DeSanto: I’ll keep it as short as possible because we could go on for another hour just on this alone. Just take a look at the science. A good questionnaire to give parents is the Adverse Childhood Experience questionnaire.


That’s ten questions and go over that with your spouse or significant other or by yourself if you’re a single parent and look at the trauma that you’ve…”the trauma” that you put your kids through — exposure to substances, exposure to divorce, has there been legal complications in your life, did you spend time in jail, were you not able to clothe or feed your children on a consistent basis, were they exposed to violence, had any domestic violence in the house.


Limit the amount of negatives that you can do and also try to increase resilience. I’m trying to take the emotional aspect out of this or the objective aspect out of it. I’m sorry, subjective and make it as objective as possible. How are you setting your child up to accept themselves no matter what, be able to rebound from negative experiences without falling apart and how to seek and ask for help without feeling bad or without expecting it conditionally and self-image?


Having a child be accepting of themselves to be able to look in the mirror no matter what’s going on physically which is nearly next to impossible. These are all such tall orders, but if you can get as close to the mark as possible and consistency and boundaries.


Boundaries are super important. I see parents all the time and they ask me the question. I ask them actually, parents who’ve lost children through overdoses, “What is the one thing you wish you could have done differently?” One thing consistently is “I wish I would have been stronger with my boundaries. I wish I would have said ‘no more’ and stuck to my guns.” Consequences are super, super important.


Zach: Sure.


Dr. DeSanto: It kind of puts a child’s experience into perspective about what’s going to happen to them if they do. It can set up a subliminal subconscious “I better not do that” but not feel bad about it, nothing like a Roman Catholic kind of you’re going to burn in hell over this.


Zach: Right.


Dr. DeSanto: Not that at all; it’s how our brain is more likely to go to the dark naughty place versus not going there. The resilience of just being able to it’s not really how we fall down, it’s how we get up, how well we get up. I’ve seen plenty of people fall. I just haven’t seen that many people get up the right way. If we can teach our kids how to do that…


Zach: Sure, absolutely. I think that you nailed it, resilience. Stuff is going to happen. It just will with kids, with families, but the resiliency piece is huge. As I mentioned earlier, I think that friend of mine who had been through a pretty traumatic certainly start and he’s gotten himself on a better path. He learned from the family that loved him enough a tremendous amount of resilience.


Dr. DeSanto, thank you for everything today for coming on the show; really appreciate it.


Dr. DeSanto: You’re welcome, Zach. This was a great interview. I had fun. I’d like to talk to you offline. I want to hear about your life experiences. Yes.


Zach: That would be great. Love to do that.


Listen, 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.


Thank you for tuning in to Recovery Radio. New content for this program is available every Tuesday at 12nn Eastern Time and 9am Pacific Time with all episodes available on demand on the Voice America Health and Wellness Channel and through our content partners: iTunes, Stitcher, TuneIn, and Google Play podcast. Please remember to subscribe, rate, and review so we can continue to create quality content to help save one million lives in the next 100 years. You don’t need to struggle through addiction alone. Live the life you’ve dreamed on the road to recovery.

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Landmark Recovery was founded with a determination to make addiction treatment accessible for all. Through our integrated treatment programs, we've helped thousands of people choose recovery over addiction and get back to life on their own terms. We're on a mission to save one million lives over the next century. We encourage all those struggling with substance use to seek professional help.

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