See also: Harm Reduction Action Center, Denver's Biggest Syringe Exchange, Moving to Colfax
Westword: Why did you choose to focus your career on addiction?
Dr. Drew Pinsky: I didn't decide -- it just sort of happened to me as I moved through my career. I'm an internist. I was doing general medicine and during residency, I moonlighted at a psychiatric hospital and became very interested in the medical care of psychiatric patients. A lot of the medical problems were down in the drug unit and all of a sudden I was seeing lots of drug addicts and alcoholics. There was a guy then who had made a really critical discipline out of drug withdrawal, and that was fascinating to me because I was training at a county hospital at the time and the way we got (patients) off the drugs was very haphazard and really there was no systematic approach.
I got good at it and then I got to see lots of addicts and alcoholics, and then I saw young people go from dying to better than they ever knew they could be -- and that was amazing. So I became interested in what was happening in those rooms with those twelve steps on the wall and I started realizing as I was drifting into this that it was becoming a massive problem in our country. So I always had a tendency to move into what I thought was the medical problem of our time.
What prompted me to be on the radio in the first place was HIV, which at the time we were calling "GRID" (gay-related immunodeficiency.) We didn't have HIV -- we hadn't identified the causative agent yet. But I knew it was a big problem and no one was talking to young people about it so I just thought I should do that. The addiction treatment was a similar impulse -- like, this is a big problem and I wanted to get rid of that.
It is interesting with something like drug abuse is that it seems to have trends or comebacks based on the particular drug -- but drug abuse is always there.
There is a rise right now because of the pill addiction and people getting cut off from their pills and no one is then treating them, so they are turning to the streets. That's where the heroin increase is coming right now. Back then, there was an increase in drug use and it was becoming a massive problem. There was now an approach to it and it was being managed, but it became huge.
What is the biggest misconception about addiction for people who aren't addicts themselves?
That it's some sort of choice and that they have control over what they're using. It fits in with the umbrella of misconceptions about brain disorders generally -- we just don't like, particularly in this country, the notion that conditions of our brain can effect our judgment, our thinking and our free will. We want to blame people who have brain disorders -- they should somehow be able to magically rise above it. It's a profound misconception. Usually when I give lectures on this, people will come to understand that it's a brain disorder and they kind of grab around that. Or you can show them the science and then they'll go, well, why would someone drink in the first place? That's a more complicated issue, which is the new problem of our time, which is childhood trauma. Childhood trauma is really what puts the rocket fuel behind addiction.
You're coming to Colorado and you've been here before...
Oh, and let me gush about that for a second. Since I was there two years ago, I have referred to Arapahoe House a number of times, both personally/clinically and in the media. I am going to tell you something -- that is an unbelievable place. When I was there last time, I was surprised by the depth of support from the community that they got and how autonomous they were in their ability to provide resources to patients. I have not been disappointed. It is an amazing place and it is such a privilege to speak on their behalf.
As a recovering alcoholic, I write a lot about addiction. That's how I came to find out that Arapahoe House even existed.
How did you come to write about addiction? Because you are seeing it from the inside?
Yes, absolutely.
Did you go through twelve steps?
No, not me personally. But I have close friends who have and it has been very successful.
The Twelve-Step program is under attack right now -- if you have a bad-enough addiction that you need to see someone like me, and I don't know how bad your alcoholism got, but I know that my patients don't get better without Twelve-Step. The reason is -- aside from the fact that it works -- there is a really important part when you're really in addiction, which is that you need 24-hour, seven-day-a-week supervision. You need to be sat on for months and you need to be sat on by someone who really understands the distortion, the BS, the emotional component. All of the elements that go into being an addict in early recovery, you really have to be watched by someone very insightful into your condition.
There's just not enough money on the earth to put enough professionals together to do that. There's no place that insurance companies will cover that. People in the Twelve-Step program who have been through this and value what it has done for them -- and by the way, are kept sober by virtue of being of service to other people in this condition. They are happy to do it; their own recovery depends on doing it for other people. It is something that you just can't find any other way for people who are way, way down the road with this condition.
You make an great point, which is that something like Twelve-Step isn't covered by insurance or even given as an option. People who use the program have to find it themselves, which is often the hardest part for addicts.
How did you get sober?
I decided to stop drinking because I woke up one day and had an injury that was still bleeding and I didn't remember how it happened. I was in a safe, supported space and sort of found my way out from there. I just stopped.
See, there is such a thing as that. I mean people will deny that you can just "stop" drinking. It's actually called natural recovery. But at certain stages, you can't; my patients can't. You would not have made it to me. We would worry,though, about you having a relapse. And what I would encourage you to do is to get a therapist. You should work with somebody who can really watch you and see how your thinking goes and see what issues are unregulated and what is reactivating you back to your next drink.
I have actually gone to a couple therapists and didn't like them.
You must have been raised in an alcoholic family and those traumas have to be processed or they are a constant problem. I was. And that actually leads to my next question -- I was talking with another person in recovery and she said you had said at one point that women who are alcoholics must have a history of it in their family. She says she doesn't have any history that she knows of. Is it always genetic?
There are several ways of looking at that. One of the ways the scientific community describes the genetic component of addiction is they will say that alcoholism is 60 percent accounted for on the basis of a genetic component alone. Sixty percent of alcoholism is created by the genetic component. So not 100 percent -- but I always say that it is a necessary but not sufficient cause for addiction. Because there has to be some genetic potential, in my opinion, because I have just never seen it otherwise.
Usually with somebody like that, I will question them more about their ethnic heritage. Usually you will find that there is some Scottish, Irish, North American Indian, Central European -- you usually find the genetics and follow that lineage and, lo and behold, you'll find the alcoholism. So you could have a mild genetic burden that has not yet been expressed what we call phenotypically. There are some people who have a profound genetic burden where it is just exploding all over every family member all the time. So although 60 percent of it is accounted for on the basis of genetics, the genetics themselves can be more powerful in certain situations than others.
Then there's the more nuanced issue, which is that some people have certain personality disorders and develop severe substance use and can look like addiction, but can actually not be addiction, per se. They will benefit from stopping, they will benefit from Twelve-Step, but it's not quite addiction as I know addiction. It's more the personality issues -- and that is not unusual.
I get asked a lot how someone who is outside of the addiction can help someone with addiction. What is the best advice or step someone can take?
There are several layers to that -- one is to realize that you can't do much, if anything. What I always tell people is it is like the plant, Audrey II, in Little Shop of Horrors. What happens when you go in the room with Audrey II? You get eaten by the plant. The alcoholism is exactly the same -- if you're not an alcoholic and you're in the room with the alcoholic, the disease plays into your biology. If you're a mother or son and you love that person, the disease will take advantage of that.
I was talking to a couple of alcoholics last night and we were talking about this very issue and someone asked that question. One of my guys in recovery said, "This is how it works: It's like, oh yeah, I know you love me. You know what would really help me right now? If you gave me fifty bucks so I could go buy hamburgers or pay my rent." Of course that goes right in their arm, or whatever. The disease just takes advantage of everything. That's why I always say it is a relationship disease, a family disease.
So Audrey II is a perfect model for this -- if you go in alone, you will be eaten by the plant. So you have to have somebody there with you. If you don't have somebody there with you, you're going into the plant. That's why you need a therapist or Al-Anon or some sort of support from an objective person who has been where you've been, ideally, who can stand there with you.
When I go in to a room with an alcoholic, I always have a nurse or someone with me. Because I will start going in to the plant, too. I won't see it and it will play on something deep in me and off it goes. So there's the realizing that you can't do much, then getting that support, then educating yourself and then I do think that you can actually do something, which is stay at them. I have many patients who got better because somebody whom they really care about finally got through to them and said, "I'm out of your life." Leaving and being prepared to leave is often not just necessary, but the most powerful thing you can do. It is really what gets their attention.
Or, going to Al-Anon. Changing the dance you do -- going to Al-Anon will change how you relate to the addict/alcoholic. That almost more than anything else, just going to a program like that, has the potential to motivate the addict into treatment. They know the jig is up when you start setting boundaries with them and start really seeing the bullshit and realizing what the disease is doing; they suddenly fear abandonment and start getting willing to change.
My last question is related to Colorado specifically and our legalization of marijuana. I know that you have strong feelings about this and the idea that marijuana is addictive -- what do you see as the danger in the future?
What? You've legalized marijuana in Colorado? You're kidding?! (Laughs.) Listen, here's the reality: I don't know why people think I have very strong feelings about it, because I do not. I don't believe it is my position to advise on the law. The law is something the people decide and they have decided in Colorado and hats off to them for exerting their constitutional privilege. I have no problem with that whatsoever.
However, there will be medical consequences and I am here to help. That's always been my position. I don't care if people get high, I don't care if people drink. That is up to them. But when they want to stop, I am here to help. Already, we're starting to collect data on the consequences of the kind of pot people are using, the intensity of use -- and it is going to be a problem. There are lots of medical consequences from this, and people learn. Hopefully we will have a rational conversation about it and hopefully we will be able to help those who get strung out. Pot is a really hard one to stop once you fall in love with it.
Dr. Drew Pinsky is the keynote speaker at this year's Arapahoe House Fundraiser and Luncheon on Thursday, September 18, at the Seawell Ballroom in the Denver Performing Arts Complex. Tickets start at $75; to reserve a seat or learn more about Arapahoe House, visit the non-profit's website. Be my voyeur (or better yet, let me stalk you) on Twitter: @cocodavies
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