Flourishing After Addiction with Carl Erik Fisher Carl Erik Fisher

Judson Brewer ("Dr. Jud") is a renowned addiction psychiatrist and neuroscientist who has spent over two decades studying the mechanisms of addiction and the effects of mindfulness on behavior change. On this episode of Flourishing After Addiction, it was great to talk with him about some extraordinary connections between the science of addiction and contemplative practice.
 We talk about Jud's own experience with panic attacks, how he found mindfulness to be a powerful tool to work with anxiety, and how this personal experience helped him to see the connections between addictive cravings and the fundamental processes of anxiety. More broadly, we discuss how the urge to control our experiences is often the root of our suffering ("control is the problem, not the solution"). He connects this notion in how the brain's reward-based learning system works and how it can lead to perversely reinforcing unhelpful habits. And connecting this work to broader topics in contemplative practice, he describes how Buddhist philosophy and the concept of craving relates to the underpinnings of addiction he's uncovered in his neuroscience lab. We talk about the role of values and ethics in recovery and in treatment, including how to work with ethics as a practice without getting bogged down by a sense of obligation or guilt--approaching ethics with a sense of curiosity and openness, rather than judgment or rigidity.
And, to conclude the episode, Jud leads us through a beautiful guided practice of opening and curiosity, a mini-meditation to help us cultivate awareness and non-judgmental acceptance.

Dr. Jud Brewer is an addiction psychiatrist, neuroscientist, mindfulness practitioner, and author. He is the Director of Research and Innovation at the Mindfulness Center and an associate professor at the School of Public Health at Brown University. His research focuses on the neural mechanisms of mindfulness and how it can be used to treat addiction and other behavioral disorders. He has published numerous scientific articles, and he is the author of The Craving Mind (Yale University Press, 2017) and the New York Times best-seller, Unwinding Anxiety (Avery/Penguin Random House, 2021). He is also an experienced mindfulness teacher and has trained thousands of people in the art of meditation and mindfulness-based approaches to behavior change.

In this episode:
- Jud's website
- his apps for habit change
- Episodes mentioned: Melissa Febos, John Kelly, Elias Dakwar, and Eric Garland
- Jud's academic work connecting addiction science to the Buddhist concept of dependent origination: "Craving to quit"
- "Meditation experience is associated with differences in default mode network activity and connectivity"

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Zach Siegel is one of our most respected and prolific journalists on addiction and drug policy. He is also a thoughtful, introspective soul who thinks deeply about his own history of opioid addiction. In his many writings, he has often referenced that personal history, but he's never really had the chance to tell his own addiction story from start to finish. Until now! Listen to this episode of Flourishing After Addiction to hear Zach's origin story, plus a deep dive into his recent cover story in Harper's magazine about surgery for opioid addiction.
Zach and I talked about some enlightening moments along his path, including the role of Suboxone in his treatment, anti-medication stigma, as well some big questions about identity: what does it mean to say you're in recovery, and how does Zach make sense of that idea in his own life?
We also focus in on his recent, fascinating Harper’s story: a feature about deep brain stimulation surgery for addiction. In the piece, he describes how people with serious, intractable addictions receive this (technically) non-invasive surgery--a kind of neuroscience advance I myself researched as part of a fellowship in medical school. It's a terrific story in its own right, but it also invokes some big themes, such as the purposes of addiction treatment, or how human factors like relationships, care, and hope continue to be relevant even in what seems like the most reductionist biomedical treatment settings.
Zachary A. Siegel is a freelance journalist and researcher living in Chicago. His work focuses on public health, mental health, and the criminal-legal system; he also reviews books, movies, and TV shows, on occasion; and he co-writes Substance, a newsletter about drugs and crime, with journalist Tana Ganeva. He’s reported for a variety of news outlets and magazines: Harper’s, New York Times Magazine, The Atlantic, and more. He holds a journalism position at The Action Lab of Northeastern University’s Law School, working on projects like Changing The Narrative. He also co-hosts a podcast called Narcotica with his friends and fellow drug journalists Troy Farah and Chris Moraff. Find him on his website and on Twitter.

In this episode:
-  Substance - his substack newsletter
- his podcast Narcotica
- Changing the Narrative (project of Health action lab at Northwestern)
- Only Lovers Left Alive
- A Hole in the Head

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A little over 40 years ago, Dr. Steven Hayes experienced his first panic attack—when he was a young assistant professor in psychology, no less! In the intervening years, and drawing in part on his own recovery from panic disorder, he developed Acceptance and Commitment Therapy and produced a huge body of work that has revolutionized our understanding of human language and cognition. Today, he is one of the most highly-cited scholars in the world, across all disciplines of study. And, he remains a soulful and wise clinician, who generously shared some of his insights about addiction for this episode of the Flourishing After Addiction podcast.

Steve and I talk about “psychological flexibility:” a revolutionary pivot toward working with our thoughts and feelings, rather than trying to fight or change them. One definition of psychological flexibility is to be open, grounded, and committed to values-based action. We discuss making sense of addiction in his framework, and he speaks out against the biomedicalization and over-categorization of the phenomenon. He talks about the centrality of values and why it’s necessary to find a life worth living as part of recovery. We discuss Steve’s understanding of spirituality and transcending a limited self-concept, and how that fits into his work. And—something I’m so happy Steve prompted me to do—he leads us all through a guided exercise to take perspective and to get a taste of dropping the small self.  I’m really happy that he’s given us this practice experience. Find a quiet place and give it a try (it’s only about 8 minutes or so, toward the end of the interview).

Steven C. Hayes is a Nevada Foundation Professor of Psychology at the University of Nevada. An author of 46 books and nearly 650 scientific articles, he is especially known for his work on "Acceptance and Commitment Therapy" or “ACT”, which is one of the most widely used and researched new methods of psychological intervention over the last 20 years. His popular book Get Out of Your Mind and Into Your Life for a time was the best-selling self-help book in the United States, and his more recent book A Liberated Mind was released to wide acclaim. Dr. Hayes has been President of several scientific societies and has received several national awards, such as the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies. According to major indices like the Institute for Scientific Information and Google Scholar, he is ranked among the most cited scholars in all areas of study in the world. Read more at his website.
In this episode:
 - His faculty page
- the "new paradigm" in mental health treatment we only briefly discussed (good for clinicians to check out!): Learning Process-Based Therapy: A Skills Training Manual for Targeting the Core Processes of Psychological Change in Clinical Practice
- His TEDx talk on psychological flexibility: How love turns pain into purpose
- His  2nd TEDx talk: Mental Brakes to Avoid Mental Breaks

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In the weeks prior to this episode, the story broke that the UK’s Middlesbrough clinic, which offered a pioneering Heroin Assisted Treatment (HAT) program, is slated to close because of budget cuts. Patients were allowed to self-administer medical-grade heroin (officially, diamorphine) under medical supervision. One of the key scientific studies that supports this intervention is the RIOTT Trial—“Randomised Injectable Opiate Treatment”—and I got to speak to the principal investigator of that trial, a giant in the field of addiction research, and the first knight to appear on the Flourishing After Addiction podcast: John Strang.

Prof Sir Strang is a pioneering addictions researcher and practicing physician who, over the course of his distinguished career, has made major contributions to national and international policy. Of particular interest to those of us who are fascinated with the intellectual and cultural history, he’s had a front-row seat to the scientific and cultural evolution of views on addiction, including studies under his mentor, Griffith Edwards, another major figure in the addictions field who was instrumental in shaping modern medical definitions of substance use problems.

We cover a lot of ground in this one, and while we tackle some weighty topics, ranging from fundamental principles in addiction treatment to the very definition of addiction, Prof Sir Strang has a gift for explaining these concepts in clear, articulate terms—a skill no doubt honed by years of interfacing with governments and departments of health. Above all, I think he does a fantastic job of returning to some of the key, pragmatic questions raised by these topics: what does it mean to have an addiction problem, and how do I make sense of my issues? What is the point of medications and other treatments for addiction? What are the core principles in addiction care? And in the end, just what kind of contribution can science make to better public policy and practice? I hope you find this conversation as useful as I did.

Professor Sir John Strang is a physician and an academic. He’s the Director of the National Addiction Centre (NAC) and Head of the Addictions Department at King’s College London. He has been an addictions psychiatrist for nearly 40 years, and has led the group at the Maudsley Institute since 1995. He has published more than 500 scientific papers in the addiction field and has contributed to national and international policy, chairing policy committees and expert groups. In 2016, he was awarded a Knighthood in the Queen’s Birthday Honours for ‘services to Medicine, Addictions and Public Health’. Read more at his faculty page, and for more about the King's College London addiction center, see this link.

In this episode:
- the RIOTT trial
-Griffith Edwards and some of his writing on the dependence syndrome
-Drug Policy and the Public Good
-Setting Limits: Gambling, Science and Public Policy
- BBC: "Pioneering Middlesbrough heroin addiction clinic to close"
- Gerald Klerman: Psychotropic Hedonism vs. Pharmacological Calvinism

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As I’ve written before, Beth Macy has an extraordinary gift for encapsulating our nation’s greatest challenges in gripping, intimate, and wise stories of everyday American struggles. She is a bestselling author of several books about addiction, inequality, and justice, and it was a great pleasure to talk to her about her latest book, Raising Lazarus, on this latest episode of Flourishing After Addiction. On a personal note, I’ve enjoyed seeing this book take shape behind the scenes, and we get to talk about her writing and research process a bit too—I was lucky to make a connection with her early in the process of releasing my own book, so it was fun to talk about how our work has informed each other and how her thinking has evolved over time.
In our conversation, Beth opens up about her personal experiences growing up as a child of alcoholics and what she did to heal—as she notes, something she’s never discussed in prior interviews. Of course, we also talk a fair bit about her book, including how this work is focused on what she sees as the most likely solutions to our current crisis. It’s a big departure for her and a full-throated celebration of harm reduction. We talk about the innovative people she profiles, folks working tirelessly to provide evidence-based care and harm reduction services even in really inhospitable communities and situations. It’s a daunting topic, but Beth has also found a great deal of hope there too.

Beth Macy is a Virginia-based journalist with three decades of experience and an award-winning author of three New York Times bestselling books: Factory Man, Truevine, and Dopesick. Her first book, Factory Man, won a J. Anthony Lukas Prize and Dopesick was short-listed for the Carnegie Medal, won the L.A. Times Book Prize for Science and Technology, and was described as a “masterwork of narrative nonfiction” by The New York Times. Dopesick has now been made into a Peabody award-winning and Emmy-winning Hulu series on which she acted as an executive producer and cowriter. Her latest book, Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis, was published on August 16, 2022. You can find her on Instagram, Twitter, and her personal website.

In this episode:
- The work of Gail D'Onofrio, MD, Professor of Emergency Medicine at Yale and pioneer in ED-initiated buprenorphine
- Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care
- Beth’s personal essay about her childhood on Oprah Daily
- “By the book” interview with Beth
- Beth’s guest essay in the New York Times: “The Two Simple Edicts of Successful Addiction Treatment”. Those edicts are: (1) “You can get better.” (2) “Don’t disappear.”
- Link to all of Beth’s  books: Raising Lazarus, Dopesick, Truevine, and Factory Man

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Dr. Ayana Jordan is a renowned expert in addiction and other mental health conditions, newly recruited to NYU to an endowed professorship for her fascinating research. For this episode of Flourishing After Addiction, I was excited to talk to her about new frontiers in her research, such as incorporating spirituality and health equity in addiction medicine. What I was not expecting was for her to share so openly and courageously about the way substance use problems have impacted her own family. It was a powerful conversation with a powerful voice in the field. It never fails to astonish me: the scope and reach of addiction into so many people's lives. Reading the stats is one thing, but to experience how it touches so many people, again and again, is truly striking.

Ayana talks about her longstanding interest in integrating spirituality in addiction treatment, while simultaneously respecting people’s values and beliefs, and doing so in a responsible and effective way. We discuss her work on harm reduction, racial justice, and health equity. She helps us think through how to work effectively with the social and structural determinants of health. And, we tackle the controversial question: what's the point of spirituality in the medical treatment of addiction in the first place?

Ayana Jordan, MD PhD, is a renowned expert in addiction and other mental health conditions in underserved populations. She is the newly appointed Barbara Wilson Endowed Associate Professor of Psychiatry in the Department of Psychiatry at NYU, also with appointments and leadership positions in their department of Population Health, as well as NYU Langone’s Institute for Excellence in Health Equity. The fundamental message of equity and inclusion has informed her research, clinical work, and leadership duties at NYU and beyond. She earned her MD PhD at Albert Einstein College of Medicine, and while training in the South Bronx, Dr. Jordan became passionate about serving racial and ethnic minoritized populations. She did her general adult psychiatry residency at Yale University, where she also served as chief resident. She has published dozens of peer-reviewed articles in numerous top-tier medical publications, serves on multiple editorial boards, and she is a thought leader who has given a wide range of keynote presentation both nationally and internationally. You can find her on her faculty page, Twitter, and Instagram.

In this episode:
- Information on naloxone (Narcan), including naloxone’s availability in all 50 states.
- Lancet Psychiatry profile of her
- for more on her research, see many more of her publications linked on her NYU page

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