Ep #115: Why Harm Reduction is the Way Forward with Maia Szalavitz

By: Dr. Sherry Price

Drink Less Lifestyle with Dr. Sherry Price | Why Harm Reduction is the Way Forward with Maia Szalavitz

I’m so excited to share this insightful conversation with a very special guest on the podcast today.

Maia Szalavitz, a New York Times best-selling author, contributing opinion writer for the New York Times, and former heroin addict, shares the lessons learned from public policy in treating those suffering with addiction around the world. and what methods have been proven to work.

In her latest book, Undoing Drugs: How Harm Reduction is Changing The Future of Drugs and Addiction, Maia reveals that treating addiction by restriction, forcing total abstinence, or with extreme tough love has been shown to be ineffective.  She provides examples of public policy misconceptions and failures across the globe and how this has kept individuals from getting the proper help and support.

Enforcing the idea that a person with an addiction is powerless can be harmful, as it becomes a self-fulfilling prophecy.

Maia was a high-achieving teen in gifted programs who had the brightest future.  But when she fell into drug addiction, her trajectory changed.

Experiencing the legal system and treatment programs firsthand, she committed to understanding how we can do better as a society to help others who’ve gone down a similar path.  This book and her work have helped the world understand addiction in a whole new way.

In this podcast, you’ll discover how many societal notions toward addiction are misunderstood, why addiction isn’t a moralistic issue, how efforts to combat addiction in the past have fallen flat, and why truly understanding addiction, and substance abuse disorder, from a harm-reduction standpoint is a major first step our society can take toward changing it.

 

Check out the video of this interview over on my YouTube channel!

 

Are you a professional woman wanting to drink less and be in control of her drinking to live a happier, healthier life?  If so, join me inside EpicYOU and discover the skills you need to become a woman who can take it or leave it. Click here to join.

 

What You’ll Learn in this Episode:

  • How Maia’s work is changing the way people think and understand about addiction and treatment.
  • How outdated concepts like “hitting rock bottom” and others have prevented people from getting help.
  • Why harm reduction is effective, methods that have been proven effective, and how you can embrace this philosophy for living a healthier, happier life.

 

Featured on the Show:

Full Episode Transcript:

 

You are listening to the Drink Less Lifestyle podcast with Dr. Sherry Price, episode number 115.

Welcome to Drink Less Lifestyle, a podcast for successful women who want to change their relationship with alcohol. If you want to drink less, feel healthier and start loving life again you’re in the right place. Please remember that the information in this podcast does not constitute medical advice. Now, here’s your host, Dr. Sherry Price.

Hello friends, today I have a very, very special guest for you and her name is Maia Szalavitz. She’s an incredible writer and a much needed refreshing voice in the addiction and particularly the harm reduction field. Maia Szalavitz is a contributing opinion writer for the New York Times. She is the author most recently of Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction which is the first history of the harm reduction movement. And I have to say her book is amazing. I’m so excited to share more of this with you.

She has a New York Times bestseller called Unbroken Brain: A Revolutionary New Way of Understanding Addiction, wove together neuroscience and social science with her experience with heroin addiction. It won the 2018 Media Award from the National Institute on Drug Abuse. Her 2006 book, Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids was the first to expose the damage caused by tough love, youth treatment and helped spur congressional hearings.

She has written and cowritten five other books including a classic on child trauma, The Boy Who Was Raised as a Dog. And has written for numerous publications including Time, Wired and Scientific American. She lives with her husband and two squeaky cats in New York City. And I have to say, her other book is also equally amazing. And without further ado let’s jump into my discussion with Maia.

                                                                                                                   

Sherry: Well, hello my lovely listeners. I am so excited today because as I mentioned in the intro, I have a wonderful guest, Maia Szalavitz on the show with me today. Welcome to the podcast, Maia, I’m so excited you’re here.

Maia: Thanks so much for having me.

Sherry: So just to give a little background, I discovered your book, Undoing Drugs which I just have to show the audience here. It’s amazing. And once I read this book over my summer vacation I became a huge fan of yours instantly. And I even went back and read your New York Times bestseller, The Unbroken Brain which was just really revolutionary and how we understand addiction.

And when I was reading Undoing Drugs it really occurred to me how much you and your story and all of the work that you’ve put into this book has really advanced my thinking around addiction. And advanced my thinking on how to treat people and help people who suffer from addiction or we could just call it a substance use disorder. And so I really want to start off by saying thank you. Thank you for the words that you put in this book. Thank you for sharing your journey.

And I know when I share my journey sometimes it gets emotional and sometimes I’m like, “Oh my gosh, I can’t believe I’m putting this out into the world.” And so I really want to thank you for the vulnerability and your willingness to share because through your words, it’s helped me heal a little bit of my own journey. And I really, really want to thank you for that and seeing just addiction just a bit differently and how you bring in too what has worked and what hasn’t worked.

And I want to dive into all of that today especially the legal system and the campaigns that we’ve tried and how they had good intentions and how they fell flat and made the situation even worse. So before we get into all that though I really want to start off our discussion with how you came into this space. And we’re going to talk more about the particular space, not just of addiction but of harm reduction which we’ll get into too. But what ignited your passion to go into this, research this and create such great work in this area?

Maia: Thanks. Well, I had my own personal journey with cocaine and heroin addiction which started when I was in my teens. And at that time I was in gifted and talented programs and sort of your super achiever kind of kid. And I ended up injecting dozens of times a day and being faced with a long sentence for selling cocaine. And I just wondered, what happened? How did I go from most likely to succeed to most likely to die of an overdose?

And so part of the reason I became addicted in the first place is because I’m the kind of person that has intense passions about things because that’s part of being on the autism spectrum. And so whatever I get obsessed with I really get obsessed with and I really have to study down to as many possible ways of understanding it as I can. So when I did get into recovery I was just like, “I’ve got to figure this out.” There’s something really wrong with the way we deal with this. It’s racist. It’s not effective.

And it is just very bizarre given what we actually know about the condition of addiction, where it comes from, how it develops and how people actually do get better.

Sherry: Yeah. And when I’m listening to your story, we all discover, I want to say a sense of relief when we discover a drug that works. And I work mainly with alcohol and women who overdrink. Maybe they wouldn’t call themselves addicts. I think I never saw myself as an addict, I know I used and heavily used but I didn’t see myself as an addict because again, of what I saw in the movie screens. It was you had to have it right when you got out of bed and I didn’t drink alcohol until much later in the day.

So I’m thinking, if I can abstain during the morning and I don’t have cravings in the morning, I must not be an addict. I just might be somebody who overdrinks and has this bad habit. But if you look at my use it’s clearly in the addiction category. It’s clearly overuse. It’s clearly no longer moderate drinking, it was severe drinking in terms of quantity and in terms of the length of time that I did it. But yet I still had this thing in my head where I didn’t want to be considered an addict or I didn’t feel it was that bad.

Maia: Well, and also I mean there’s a couple of things going on there. One is just obviously nobody wants to have a problem. So we would like to avoid thinking about it. But more than that, the stereotype of the person with addiction is just the absolute worst stereotype in the world, lying, manipulative, scheming, dishonest, sociopathic frankly. And the vast majority of people with addiction actually are not that way. There are some sociopaths among us as there are sociopaths among all human beings sadly.

But the reality is that most people with addiction kind of behave like people in love with somebody who’s married. And basically that means they lie about that and they do the rest of their lives as honestly as they were previously doing them. So of course you don’t want to see yourself that way for the reason of (a) if you see yourself that way you have to deal with it.

And (b) the reason of nobody wants to see themselves that way otherwise they have to really hate themselves and self-hatred is a large part of what drives addiction in the first place. So asking you to accept more self-hatred is more likely to make you want to drink more than it is to make you want to recover.

Sherry: Absolutely. And there’s some quotes that Gabor Maté has said that’s really highlighted kind of what’s going on for people. It’s that it’s not asking why the addiction because that could be, like you said, fuel more self-hatred but what are we escaping from or why the pain? What’s the narrative we have going on there? What childhood traumas maybe we have suffered? Or for me it was a form of perfectionism. When things weren’t perfect I didn’t know how to deal. My anger would get flared up.

And I don’t know if it’s because I’m a redhead and I just get hot tempered or I just fly off the handle. And this was a way to calm me down. And I found it as a solution. And so I knew my drinking caused problems, but to me it felt more like how I managed my emotions, particularly with anger.

Maia: Yeah. I mean and that is pretty classic. And what we’ve done by having this drug war and having this very moralistic view of this is that we’ve created this story, people with addiction are selfish, evil hedonists who all they care about is getting high. And they don’t care about anybody else or anything else. And they are that way just because pleasure seeking is the only thing they care about. And when you actually look at the people who have addiction, I’m sure you may find some such people like that.

I’ve never met anybody, maybe I’ve met one or two people like that but the vast majority of people that I speak with who have addiction are trying to self-medicate. They are not trying to have more fun than they deserve, or seeking honored pleasure, or any of these sort of moralistic ways we have. It’s just like what a lot of people don’t understand is we’re all wired differently. And so what’s tolerable for me may be agonizing for you. And what I love you may find disgusting. We’re just really different. Our brains are different. Our bodies are different.

And assuming that everybody can feel good in a social situation, or everybody can feel good when faced with a math test or having to drive down the highway very fast or whatever thing you may fear. The reality is that we’re all different and I might find a shirt that you love unbearably itchy to wear. And it’s just our senses are different, our experiences are different, our histories, our genes, all this stuff means that if I could choose what annoys me, that would really be great. If I could choose the things that I can’t really tolerate, that would also be fabulous but nobody can.

It’s not like you can say, “Okay, I will now decide that loud sounds don’t terrorize my nervous system.” You can’t do that. I mean you can tell yourself, this does not mean danger, it’s okay, you don’t have to fire all that adrenalin but it still happens. When we understand that people are wired in these very, very different ways, clearly some of them are going to seek to get to be more normal by developing various ways of coping. And drugs for many people work quite well, at least at first in order to achieve that.

Sherry: Yeah. And it certainly definitely numbs and dulls whatever we can’t tolerate or whatever pain that we are experiencing.

Maia: I just want to say, sometimes nulling or dulling pain is absolutely needed. If you’re wired such that every experience overwhelms you then a drug like say an SSRI antidepressant which will turn down the volume on your emotions, is not going to make you into a zombie robot who has no emotions. It’s going to make you into a better connected human being because you are no longer bouncing off the roof every time you experience an emotion. And so a lot of people think, numbing, we should never numb things. We should always just go towards them and embrace them.

Well, sometimes doing that means that you’re going to end up being a very selfish person curled in a ball because you can’t tolerate anything. And you’re selfish because you would like to deal with other people’s distress but it overwhelms you so much that you have to crawl in your little ball. So it’s really, really important to recognize that it’s not people wanting extra special fluffiness or something. It’s that people can tolerate more or less of different things, but fluffiness is good.

Sherry: Right. Some days we love fluffiness, a cozy blanket. But I like how you said that because that really is at least when I was practicing as a pharmacist, that personalized medicine approach. What works for one person may not work for another. And what side-effects come from a medication may not be tolerable for some person but may be tolerable for another. And the therapeutic effects make them more able to interact in a way that is more normal for them or that they enjoy.

Maia: If you start, if you just look at it like okay, if you give somebody who’s already feeling numb and is feeling disconnected from their emotions and you give them something that makes them even more so. That is going to make them worse, not better. But assuming that everybody starts at the same point on the scale and that going up is always good and going down is always bad, is wrong because if you start up here you need to go here. And if you start down here you may need to go here to get to some semblance of functionality.

Sherry: Yes, I agree. Now, let’s pivot and I want to talk about this concept of harm reduction because that is something that I practice in my programs with the women that I help. And you have so many beautiful ways that you describe it in both of your books that I’ve read. And I really want our audience to understand harm reduction better. So can you tell us in your words how you would describe harm reduction?

Maia: So harm reduction is basically the idea in drug policy or in health policy more generally that we should focus on stopping people from getting hurt rather than stopping them from getting high or from taking other health risks. Harm reduction accepts that people are always going to take risks and do things that we would prefer they don’t do. And instead of trying to just make those things harder to do or hurt them even further in an attempt to deter them, let’s reduce the harm and help them figure out what’s driving this and how we can keep people alive.

Sherry: Yeah. And you give some beautiful words to this that I have taken from your book. It’s really a philosophy for living. I mean that really hit home. I mean you talk about how harm reduction is about wearing seatbelts, reducing our harm when we get in a crash, should we get in a crash. You talk about it being like wearing masks and social distancing. That’s a form of harm reduction when COVID was rampant and so forth.

Maia: And nobody said with that in particular, we knew that it’s unhealthy to have no social interaction and that people were going to take the risk. People were going to hang out with each other if you didn’t have something like a mask.

Sherry: Yeah, or eating outdoors, or having ways to meet up so we don’t suffer mentally but do it in a way that’s going to reduce transmission of the virus.

Maia: Exactly. Or recognize that people are going to do it because if you don’t recognize that they’re just going to do it in the most dangerous way.

Sherry: Yes. And you talk about also this concept of radical empathy, and teaching, and empowering people to make changes in their lives. And one other concept I picked up from the book that you mentioned several times that really just sings at my heart. And it’s something now I’ve been implying and imploring more in my coaching with women is meeting them where they are at. And I think there is nothing more beautiful and preserving of somebody’s human dignity than meeting them where they are at.

And just some of the examples you gave in the book of that, it’s like we’re not having judgment, the way they do life is different than the way we did life or choose to, or different decisions. But that doesn’t make them, like you said, a bad person. It’s just they’re here and where do they want to go. And then meeting them right where they are so that they can make changes to improve.

Maia: Yeah, meet them where they are, we don’t leave them there. It’s really hard because if you want to sort of persuade people of something politically or policy wise, or whatever, you have to meet them where their views are which may be the complete opposite of yours and may make you crazy to have to interact with. So it’s a hard skill but it really, yeah, when we treat each other as equals, as people who are deserving of dignity and respect that’s when really amazing things can happen. Because historically the way we’ve dealt with addiction is we just want to punish it out of people.

And we just want to make them hit bottom, make them feel as terrible as possible so that then they will recognize that they need to see the light and stop this behavior. The problem is that addiction is defined as compulsive use that continues despite negative consequences which is basically a nicer way of saying punishment. So the idea that punishment would work is contradicted by the definition of the condition but here we are. So we have to, and harm reduction just says, “No, not that. What we’re about is helping people live healthier and safer lives that they choose.”

And helping them get to their goals, not our goals. I might think you should go to college, and go to graduate school, and go to medical school or something. And you might think I want to be an artist. And I might say that may not be such a great financial path necessarily. But you could also end up really broke in academia. It’s about respecting that people are making choices and can make choices. And the more you honor their ability to do that the better they will get at doing that. And this is the opposite of the whole idea of powerlessness in 12 Step.

Because okay, it’s perfectly fine to say you’re powerless over alcohol and that one drink is not a good idea for you because traditionally it will lead you to too many. But that’s perfectly fine and it’s actually true from picking up the first drink, great, go for it, that’s true for you. The thing is, if it doesn’t, you will then end up creating a self-fulfilling prophecy whereas you take one drink and then you believe you don’t have any control. And you’re also kind of like, I blew my two years of sobriety so now I may as well just say, “Fuck it.”

And so you’re setting yourself up for this abstinence violation effect, it’s called. And so in contrast, harm reduction says, look, okay, right now you’re say injecting drugs and know that puts you at risk for diseases that are carried by unsterile syringes. So here’s some clean needles, let’s start there. And then like you see, okay, well, I don’t want to get AIDS, I don’t want to get hepatitis. I also don’t want to just shoot other people’s blood which is just gross. And so yeah, clean needles, cool, I’ll do that, I’ll make that change.

And now you have seen that you’re empowered enough to make a change that could really protect your future health. And then that sort of gets you to see, well, I made that change, maybe there’s some other changes I want to make, let me try this and that. And that’s where harm reduction comes in. So many people just think, somebody comes in for a clean needle and goes, “You should be in treatment. You should get help. You really need to stop that.” Do you think these people aren’t told that a 1,000 times a day anyway?

And also just think about human psychology. Do we like being told what to do? We do not like, nobody likes being told what to do. Whereas if somebody says, “Hey, I’m a little worried about you, have you considered this?” When you have determined that they are sort of in a receptive state to hear that. But you first need to build that relationship and building that relationship by saying, “I have no expectation of you doing anything other than you’re doing right now.

You are valuable and important as you are right now. I want you to stay alive. Here’s a clean needle, here’s Naloxone”, whatever. And so that looks counterintuitive because it looks like they’re not telling them to go in recovery so they’re not helping. But when you look at the actual data, people are more likely to get into all forms of recovery if they engage in harm reduction than if they don’t. So the idea that if you give people clean needles, well, now I have no reason to stop, I’m just going to do this forever.

That is not how it works. You give somebody clean needles and they start to think, wait a minute, I can make some positive changes in my life, let me see if there’s other ones I want to make. And this person said if I ever wanted to do something, I could call, so I can call. And so it’s just like you attract more flies with honey than with vinegar. And your grandma probably told you that. And we just forget this because we think people with addiction are subhuman and can only be treated with violence, emotional or physical.

And that is just so sickly ironic because of course a lot of people become addicted because they were treated violently as a child, or neglected, or experienced many different kinds of trauma that people can experience. So understanding that people with addiction tend to be people in some kind of emotional pain that are looking for a way to feel okay. They’re not trying to be happier than everybody else in the world all the time and not have any responsibilities.

There may be some people like that but the vast majority of people with addiction who I know, and have read about, and have met, and that is a large number of people at this point, it’s just they feel isolated. They feel disconnected. They feel…

Sherry: Misunderstood.

Maia: Yeah. And I mean we have a very disconnected alienating individualistic society which is ripe for something to consume, we’ll fix you. And everybody is prey to that. And I think one of the things that’s really important and that I try to do in my work is that we need to humanize addiction. Because people are like, “They’re these zombies that have no freewill and they’re really other, and really different. And when you’re in that state you can’t be reached or any of that.” And it’s just not true.

It really is like being in love with the wrong thing. And so you are doing all the things you would do to protect your relationship or if it was a child, to protect that child. And so it has that urgency and that priority shift. But it’s not like you absolutely have no freewill.

Sherry: Yes. And I like how you broke down that powerlessness because that is something that my brain couldn’t embrace. I’m spiritual, I believe I was given freewill. I was given this wonderful brain to use and I was just not using it in the way that was supporting some of the good decisions in my life. And what I needed was not to be told I was powerless because that made me feel like subhuman as you mentioned, or less than, or inferior which made me want to drink. It’s like, well, if the only way to feel good and not inferior, well, then I could reach that by escaping, or numbing, or getting a bit of buzz going on.

So I’m about the opposite, about empowering people like you mentioned, treating them like a human because they are. And it’s not just because they have an addiction that they should be treated wrong, or bad, or made to be morally flawed. It’s just that they’ve made different choices and that we could meet them where they’re at like you say in your book so beautifully, show them empathy. And then teach them, teach them better ways. And as you mentioned with that needle exchange program.

So several times in the book I just saw it as when you go in and do these educational services where you’re teaching them how to use the needle and all this stuff. I used to think and I was taught that in pharmacy school that that might be an enabling approach. We’re just enabling drug users to use more. And there was such resistance to allowing these programs to be. And when you talk about it in your book, it’s like, but people wanted to feel cared for. They wanted to know that their life mattered.

And here, here is the way I’m helping you not get AIDS, or not get hepatitis B, or stay safe, because you matter. And I think when we can reach people and tell them that they matter, it’s not an us versus them or me versus you. It’s like you are on my team. You are wanting to help me. You see me for who I am and you don’t reject me. Because I think a lot of times…

Maia: [Crosstalk].

Sherry: Problem, yeah. We don’t feel like people understand us, or hear us, or see us. They only see the worst part of us.

Maia: Right. And also the whole enabling thing is just ridiculous. Enabling is really not a thing. Okay, you may be finding somebody who’s tying people down and shooting them up and okay, that’s enabling. And you can certainly find examples of people who have crazy extreme relationships. But the idea that if you give people clean needles, if you give them free heroin they will just never quit because they are being enabled is completely falsified by the data on what happens when you actually do that. When you actually do that people are more likely to get into more traditional forms of recovery, not less.

And so I can certainly see, okay, you’re enabling some evil politician to succeed or something like that. But when else do we want to disable people? Why would we want to do that with people with addiction? What you want to do is enable them to feel that they can get better. And sometimes that involves giving them a clean needle, or a safe place to inject, or heroin. But again if enabling was really a thing that extended addictions you would find that prescription heroin would make things worse which is not what we find.

And I mean there’s now enough data that there’s a Cochrane review on it which is it’s a form of evidence based medicine, not that they’re perfect. It’s just ridiculous at this point to even sort of use that phrase, with every other disease we want to enable rather than disable people. So if we actually believe addiction is a disease we should be wanting to enable people. We should want to enable them to get healthier, enable them to be where they are and enable them to begin a process of change. And we also have to recognize that some people are just going to continue using.

And that maybe they can be more safe about it. Maybe they can go some periods where they’re not, but for whatever reason they’re never going to be in the sort of glorious abstinence that you envision for them. And so that’s another hard part of meeting people where they are, because also we just don’t know. We just don’t know who is going to suddenly realize they’ve got to change and just do it all and somebody who’s not. You just don’t know. And rehab’s always trying to tell you, “You’re going to fail”, and whatever.

I mean and maybe some of them are doing that because they’re like, “Well, maybe they’ll say, “Fuck you. I’m not going to fail.”” And then they will succeed.

Sherry: Reverse psychology.

Maia: Yeah. Some people probably do that but it’s just also like they really don’t understand who’s going to get better and who’s not because it’s really not especially predictable. I mean you can look at the factors and you can say, “Okay, well, this person has a crazy history of trauma going way back, also has bipolar, is poor, has no education, has no family.” That person is going to have a much more difficult road to recovery than somebody who has much more advantages than that. And so you might be able to make a vague prediction based on that but it’s not going to be anything you could patent as a test.

Sherry: Right. So breaking down that one concept that I don’t agree with, you mentioned as well, this concept of powerlessness which to me feels outdated and it feels not in the right vein of what we should be helping people do. The other concept I want to talk about that I feel is a bit outdated and certainly wasn’t relevant in my life is this concept of hitting rock bottom. That only once you hit rock bottom will you be able to make changes, only once the consequences are so dang bad that’s the time that you’re more ready or more susceptible to change.

I mean I never hit a rock bottom, I just recognized that this is a habit. I don’t like feeling dependent on this every night. This is not how I want to stress relief. This is not how I want to manage my anger. This is not how I want to manage myself in this world. I want to learn other coping mechanisms or other ways to manage my emotions. And so I never had a rock bottom.

Maia: Well, I mean what’s also really dumb about the rock bottom concept, there’s many things that are dumb about it but even if you look at, I think it’s either in the 12 and 12 or the big book, I can’t remember which at this point. But they basically say, even in the 50s or whenever, 30s when they were starting this. They were like, “We soon found that people didn’t have to hit rock bottom and that some people could get sober then they still had two cars in the garage.” And so then they started this idea of raising the bottom and there’s high bottoms and low bottoms and blah, blah.

But the other thing that contradicts the idea that you sort of have to make people absolutely miserable until they quit and this is where it ties in with tough love and with all of this don’t enable thing. Because you’re enabling them to avoid bottom and they need to hit bottom to get better. And so bottom is ridiculous, it’s a narrative device. Basically let’s say I get, you know, I have five years in recovery after my bottom, and now I’ve relapsed. And now I have a new bottom.

And the other thing is just that okay, who’s more likely to get better, a doctor who has $3 million in his bank account and four lovely children and a supportive wife, and a meaningful job that is very high status or a homeless guy who has nothing and no education? Now, I’m going to bet on the doctor. But if you’re going by the bottom principle you have to vote for the homeless person. And this completely falsifies that instantly to anybody with any commonsense.

And then some people will argue, well, yeah, the doctor’s getting enabled and so that keeps him from hitting bottom and he’s going to do worse. But in reality if you look at those recovery programs that only take doctors, they have enormously high success rates. And some idiot started, “Well, look, we should apply these particular programs which have an enormous amount of surveillance to poor people.” And I’m like, “No, not unless you give them a medical degree, a high status job etc., first. Then you can give them that program and it will have that success rate.”

But to say that you’re taking somebody who has no resources and giving them only the surveillance and the control that you give people who have, no, this is just gross.

Sherry: Yeah. And what you mentioned there and you mention in the book is that not everybody’s definition of success is total abstinence. And if that’s our measure and that’s our only measure of success on the road to recovery is total abstinence then like you said, we can go five years, or days, or months not using. And then kind of when you have a slipup or they call a relapse, they make a big deal out of it and they focus on that one time of failure. And they miss the months, the weeks, the days, the coping mechanisms you’re learning, how your life’s improving.

They miss hundreds of successes only to focus on this one failure which when you focus on that one failure and then you take it personally as a character flaw or a moral failing then you’re more likely to slip up again because you feel so bad about yourself rather than recognizing all the wins.

Maia: Yeah. Well, also, I mean the thing about that, I have said this many times, but I think if you’re going to be in a continuous abstinence program like a 12 Step program, let’s say you have five years, you slip for a couple of days. My argument would be you go through 90 days again and you get your five years back because those five years were not erased by those five days. And I mean the reason I say get the 90 days back for stabilization, whatever, I think that that would sort of satisfy the desire to have status by how long you’ve been there which all groups pretty much do.

In a way that’s much more fair and much less humiliating. I also think, yeah, if you think that abstinence is the only measure of recovery and well, I killed someone today but I stayed sober so it’s all good.

Sherry: Ridiculous.

Maia: Yeah. No, but people say things like that. What we really want to measure is how are people doing at love and work as Freud said. The two things that you want to be doing that you need for a meaningful good life, love and work. Okay, how are you doing with these things? And do you have a house? Are you employed? Is your mood okay? Are you able to function? Now, as much as this, obviously some of this will end up being ableist and you need to whatever, but the bottom line is people need to recognize that recovery is different for different people.

And that what works for me may not work for you. Some people, if they use opioids, they can never use alcohol because it’ll just take them right back there or because they’ll misuse the alcohol. Some people can just be like, okay, I had a problem with opioids but I don’t really like alcohol that much so I can do it in moderation. Similarly, weed or whatever else, I just think if we measure sobriety by what’s in your blood steam, it’s just not good.

Sherry: It’s very myopic, that’s why in my program I say we talk about drinking less than 10% of the time, 90% we are talking about your life. What’s going wrong? What don’t you like? What do you need? Other coping mechanisms. I didn’t know that there were coping mechanisms for anger. I didn’t know there was anger management. That was a new term to me, just not something I’ve come across. And so it’s really about educating yourself and finding different tools to manage where you feel like, oh. And if I managed my anger I find that I don’t overdrink.

And that helps me become this person that I want to be which I talk about a person or a woman that could take it or leave it. To me that’s a term I guess a lot of people talk about as a controlled drinker. I feel like I can control my drinking when my anger is under control and when my stress is under control. So I can moderate very easily. It’s not difficult. It’s not like something I’m obsessing over or I’m thinking I don’t get to have alcohol today, or woohoo, I get to have alcohol today. It’s not so important to me because I’ve learned other tools that help me for my life.

And so I think a lot of us are turning to alcohol and that’s what the studies show in the last particularly two to three years because with COVID, and the shutdown, and the kids came out of school, a lot of that fell on the responsibility of the female of the household. And so some of the females had to walk away from work. Or some of the females had to disengage from work or cut back on hours in order to support their children and do what’s good for the family. And some people weren’t wanting to do that and so that’s increased stress.

It’s increased depression because they aren’t finding the meaning that they found outside of the home. So all of this has led to a skyrocketing of overdrinking among women. And it’s turned into the new mommy’s little helper I call it. It’s like it’s how I get through my day, we joke and it’s on rosé all day t-shirts, and mommy’s sippy cup we hear and the mommy wine culture. And so I loved that part of your book where you talked about some people are able to be a controlled drinker.

And you mentioned several studies on page 94 that talks about how, if you implement these strategies for healthier wellbeing, healthier lifestyle habits. That people gradually do cut back and don’t have so much desire for the alcohol, that controlled drinking or moderating your drinking is achievable. Can you speak to more of that?

Maia: Yeah. I mean again, yeah, there are definitely some people for whom it isn’t or for whom it’s basically they’re so obsessive about the control that it’s easier to just not do it. But there definitely are many people who can manage their alcohol use perfectly fine by making sure how many days they’re drinking, how many drinks they’re drinking, are they drinking water in between? Why are you doing it when you’re doing it? What is, like you were saying, in terms of if I’m doing this to stuff down anger, then I’ve got to do something else to manage the anger.

And then actually I can probably enjoy the drink better. There’s a lot that goes into it but it is easier for a lot of people to just not do it because if you don’t do it, that’s one decision. You’re just not doing it. But if you’re doing it then you have to be like, “Well, should I have a second glass of wine or not? When is that okay, when is it not okay? How am I feeling in the morning?” So you have to sort of moderate yourself more. And after you have one, your inhibitions are a little bit lowered and you have to account for that.

And typically what people do is be like, “Okay, on this day I’m only having x amount and no more.” And so that way they know they can have up to x but over x is going to be considered problematic and that they need to think about it the next day, why that happened and work to minimize that and figure out what their natural limit should be and shouldn’t be and what circumstances are okay. And it’s like if you’re going to a wedding every day, Really, well, I’m at a wedding I can drink all I want. Then you’ve got to start not showing up at strangers’ weddings.

Sherry: A wedding crasher.

Maia: Yeah. Moderation Management is an organization that some people have found useful in terms of that. There are a bunch of things, new books and organizations aimed at women, Sober Curious and for just making alcohol a smaller part of your life. And I think all of that is definitely healthy. And you just have to find what works for you and not feel bad about yourself. If moderation doesn’t work out or if you used to be abstinent and now you’re moderating and it’s going well but you’re feeling guilty because all your old friends think you have crossed over to the drug side.

For many years in my recovery I did not drink or do anything other than my antidepressants. And there was a few years where I was just like, “Well, I just don’t want the disapproval of these people and that’s why I’m not doing it.” And then I was kind of like, “Well, I’m not even hanging out with those people anymore, do I really?” But yeah, it’s like if your entire friend group is 12 Step, moderating may not be the best idea for you.

Sherry: Right. Because of the judgment and all that that comes with it?

Maia: Yeah, you’re probably going to lose all your friends and that is much more harmful.

Sherry: Right, because nobody wants to be isolated.

Maia: And it’s just really bad for you physically, emotionally, whatever. Some of those studies seem to show that alcohol is healthy and there’s still some controversy over if a certain lower level of drinking is healthy or not. But a lot of that may be just that social people drink and the socialization that comes with the drink is either mitigating the harm from the alcohol or making it look like the alcohol is having a protective effect when in fact it’s the socializing that is around the alcohol that is having a protective effect.

The one thing I can say for sure is that the healthiest thing people can do is have strong relationships with each other. And the amount of that that people need will vary by their personality. But when you have strong secure relationships with people, you’re much less vulnerable to stress. You’re less likely to get PTSD. If you do get PTSD you’re more likely to recover. If you do get addiction, you’re more likely to recover, you’re less likely to get it in the first place. Stress is socially mediated.

And so the way we, if we can sort of wire ourselves to each other instead of to a substance, our recovery is going to be a lot easier.

Sherry: Social connection and connection in general with others is so important. I listen to multiple podcasts and I know Dhru Purohit does a lot on social connection. And he talks about the quality of your relationships adds more years to your life and your lifespan than if you were to exercise every day, eat organic and healthy, not smoke, have perfect cholesterol and perfect blood pressure. Those will give you four extra years I think is what he said on his podcast. Whereas if you have these strong social networks that gives you seven plus years of longevity.

And it’s true, it’s true and I think that’s one of the things really standing in the way of drinking less is if your friend group is all drinkers and you’re social and you’re out all the time and you meet up at bars. And it feels kind of weird at first. I always tell my ladies, “It feels weird at first to order a water, or a club soda, or a mocktail but nobody really cares what’s in your glass.”

Maia: No, they really don’t care as long as you’re not nagging them about their drinking, they really don’t care, they don’t.

Sherry: They don’t. You know what I mean, right?

Maia: Yeah. And I mean also you can pretend you’re drinking. You can just order something that they don’t see and it looks like a drink. I mean a lot of that is more problematic in younger groups of people before they sort of age out of that kind of partying lifestyle. The mom wine drinking thing, that is a different kind of situation to face. But I do think people can support each other in whatever choices they’re making.

And I think this is also with harm reduction, look, if your friend wants to still do the whole mommy drinking thing and you don’t, you can still be friends with them as long as you’re not being judgmental and they’re not being judgmental with you.

Sherry: Yeah, so good, everybody gets to make their own choices.

Maia: Yeah. And I think when we treat each other that way a lot of the sort of clash that seems to be between harm reduction and abstinence goes away. Because abstinence is just kind of the most extreme form of harm reduction you might say, but that does not mean that it is superior to that. It’s going to depend on the person and so if we recognize this is my path, that’s your path then we’re not going to be like, “Oh well, that person can drink so I can drink.”

Sherry: Right, exactly. And I was just thinking as you were talking because as we’re heading into the holiday season, another message we get a lot, is don’t drink and drive. That’s harm reduction obviously. And we can all support that, whether we’re abstinent or we continue to drink but we do it more responsibly, so yeah.

Maia: Well, and that’s the cool thing about the designated driver because that gives a social world to somebody who’s abstaining. And that person may be the biggest partyer on other days but showing that that person can not do it when they shouldn’t. And also that they’re just as accepted in the group, maybe even more so because they’re doing the pain in the butt thing.

Sherry: Right. They’re sacrificing for the fun of the group.

Maia: Exactly. And so that I think is such a brilliant harm reduction thing because of that because it’s not like you must not drink. It’s like you must not drink and harm people, which would happen if you drove.

Sherry: Right. Well, Maia, as we wrap up our discussion today I want to just give you an opportunity. Is there anything you’d like to add or share with our listeners as we wrap up or maybe share one small change that has helped you in your journey towards recovery?

Maia: Be gentle on yourself and take care of yourself and your friends. The pandemic has created a situation where we’re all more stressed and we’re all sort of, you know, whatever predisposition we have, to whatever mental disorder we may have, we’re one step closer to that disorder because of the enormous stress society has just been on. So try to chill as much as you can. I mean try to not, not disconnect, meet people where they are. If this person doesn’t want a mask and you do, whatever. Obviously if you’re talking about somebody who’s immune compromised, this may be different.

But the point is, we all have different risk tolerances and this can create enormous social stress. And it has done throughout the pandemic and it’s made politicizing protecting yourself, it has politicized it. So be easy, do what you can to protect yourself and take care of yourself and your friends. But try and let go of as much of the judgment as possible especially on yourself because that stuff can really eat away at you in a really harmful way. And do the things that you need to do that you know for you that relieves stress, whether that’s going to the gym, or singing, or whatever it may be.

Sherry: Yeah, water coloring, any of that. And I just want to end cap this with what I found on page 73 when you were talking about this quote that is from the goddess of harm reduction, Edith. And I just wanted to read it to our listeners. ‘I looked at my own case. I felt so stigmatized that I felt that I wasn’t any good. And then when I finally realized that there was nothing wrong with me, that I was just struggling with the problem. And that I was doing the best I knew how, I began to meet myself where I was at and get better’.

And when I read that, Maia, that brought tears to my eyes. And it’s such a beautiful capture that you’ve put in this book but really to meet ourselves where we’re at and just make one small step. One small change through love, not through hating ourselves but really just recognizing, this is just a problem that we can overcome.

Maia: Yeah, she’s just amazing.

Sherry: Maia, this has been so, so wonderful to have you on the podcast. Thank you for the huge contribution that you’ve made to the field of addiction and really shining the light on harm reduction and what really works for people and what hasn’t. And I love how you went back into the past and looked at the, Just Say No to Drugs campaign and that didn’t work. And how we can learn from that and making this an issue that doesn’t have to be stigmatized, that we don’t have to treat people less than or inferior. And that we can meet them where they’re at.

And for all of you who are listening, pick up a copy of this book. Undoing Drugs will just pull at your heartstrings. It’ll teach you some things about if you are struggling or maybe you have loved ones who are struggling, it really is a fabulous book. Goes right into the science, the history, how we handle addiction, as I mentioned. What’s effective and what’s been ineffective at minimizing drugs and use. And it also ends with a beautiful pathway forward. So I appreciate all your efforts in putting this out into the world, Maia, and the impact that you are making in all you do.

And it really inspires me and actually validates my work and makes me feel good about this work as well as we’re doing it together because we are meeting people where they are at. Thank you. Thank you so much.

Maia: Thank you as well. And it’s always good to hear that my work is inspiring and helping people so thank you.

Sherry: Wonderful.

                                                                                                                   

If you want to change your relationship with alcohol and with yourself, then come check out EpicYOU, it’s where you get individualized help mastering the tools so you can become a woman who can take it or leave it and be in control around alcohol in any situation. EpicYOU is the place for women who want to be healthy, confident and empowered to accomplish their goals and live their best life. Come join us over at epicyou.com/epicyou. That’s epicyou.com/epicyou. I can’t wait to see you there.

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