Human Up Season 1 Ep 13: Everyone has a Direct Connection to Addiction with Michael Adams

This is a transcript of Human Up Podcast Season 1, Episode 13 with Michael Adams, which you can watch and listen to here:

Dave: Welcome to the Human Up Podcast. I'm your host, Dave Marlon, and it's a great honor to have our guest, Mike Adams on the show today. Good morning, Michael.

Michael: Morning Dave. Good to see you.

Dave: Good to see you as well. Now Mike is the consummate behavioral healthcare professional. Went to an Ivy League school back east, really epitomizes an LCSW. He's also a very proud grandfather as well as a proud dad to two amazing women. Again, welcome Mike. It's great to have you here.

Michael: Good to be here, Dave.

Dave: We're going to just jump right into it. And you've been working in behavioral healthcare since the 1980s, and my first question is how do you think treatment has evolved in your, not one, not two, not three, but four decades of not just helping deliver behavioral health, but oversee and manage it from a presidential or vice presidential level?

Michael: Well, actually you're missing a decade there. I hate to say it, but I've been in behavioral health since the 1970s.

Dave: Wow.

Michael: So actually a lot has changed and a lot hasn't been a lot of advances in psychopharmacology that basically when I first started in this field, we had antidepressants that weren't very effective, had lots of side effects, actually had a lethality profile, and the SSRIs are much more effective. They have much smaller side effect profiles and much less other reasons for people not to take. People are always looking for reasons not to take their medications. So the SSRIs have been a real advanced in psychopharmacology. Basically, they're antidepressants, but they're also used to treat anxiety. They're used to treat trauma. They're used to treat obsessive compulsive disorder, so they're really a very versatile medication with very low side effect profiles. So that's been a significant difference in treating people with particularly depressive and anxiety disorders. In terms of the anti-psychotics, there's been a lot of movement with anti-psychotics with the evolution of the atypical anti-psychotics. Before there were just only a couple anti-psychotics. There was Thorazine and Stelazine and a couple other genes. Halal.

Yeah, halal, actually, halal was actually second generation, but those medications had some really nasty side effects in terms of tiredness, in terms of movement disorder, just a whole bunch of stuff, and people really hated taking 'em. So the atypical antipsychotics, just like the SSRIs, they're more efficacious. They have lower side effect profiles, and were likely to get better results and more compliance with the antipsychotics. The other advancement has been in terms of the mood stabilizers, which are used to treat bipolar disorder, and there's been a lot more availability, they found that a lot of the anti-convulsants were also useful for treating mood disorders. And so before, when I first started, there was lithium and that was it. And lithium had a lot of side effects. It could be toxic. It required a kind of pretty frequent blood monitoring. Whereas the new mood stabilizers really same kind of deal, are more efficacious and have lower side effect profiles house.

So that's on the mental health side. On the substance use side, even though a lot of these medications were available in the seventies and eighties, we see a lot more usage of anti craving medications like Naltrexone, which has been around since the seventies. Suboxone is more recent than that, but what we see with those medications is that we see really an amazing turnaround in terms of people basically in their treatment had to white knuckle their withdrawal and their recovery and their cravings. And so our success rate, particularly with opiates, was pretty minimal until Naltrexone and Suboxone came along. And that's still, even though it's evidence-based, it's still not totally accepted and probably not as widespread as it should be. In terms of new treatment, my personal opinion is that anyone who has a chronic opiate or alcohol problem should be on medication assisted treatment. I mean, the side effect profiles are minimal. It increases the success rate, it increases treatment compliance, and most of all, it reduces lethality. So the question, we still get the same resistance from patients, well, I don't want to be on any medications. I want to do this myself. The answer to that is, well, that worked for you so far.

And basically, I mean, there's absolutely no reason why people shouldn't be on medication assisted treatment, and it really is just resistance and denial and lack of education on the guard of patients that this is a medication. There's absolutely no reason not to take it.

Dave: Right. Yeah. I like the fact that you lump medication assisted treatment as the answer, not just Naltrexone or not buprenorphine. It's determining which one's right for the patient and making sure that they utilize one of those pharmacological interventions.

Michael: And there's a lot of controversy about, particularly Suboxone since it is an opiate or an opiate derivative, but it works. And for a lot of people with chronic opiate use and abuse, it's much better than the alternative. So better than taking heroin or fentanyl,

Dave: If I had a dollar for every time a person who'd been injecting fentanyl and heroin would look me in the eye and say, Ooh, I don't want to try medication assisted treatment. I don't want to put something bad in my body,

Michael: My body, and you've been doing it for 30 years,

Dave: What came up while you were very eloquently talking about advances that we had, it kind of emphasizes the paradox because as we've had those advances, we've also exacerbated the problem by dramatic spikes in opioid use. In general, benzodiazepine use big increases as well as big increases in amphetamines, usually under the auspices of an A DHD treatment. It's interesting how that's been a double-edged sword. It's been very helpful to advance the profession. However, it's also brought a whole host of other problems.

Michael: I don't know that it's so much the advances in psychopharmacology that have brought out a problem. I think it has more to do with, again, not to get too political, but it has to do with big pharma, and it has to do with big pharma pushing their products to increase their revenue.

Dave: Well, as they're becoming more effective and more widely used. To me, it's almost a natural occurrence from an industry standpoint.

Michael: And on the therapy side, not to just focus on psychopharmacology. What all the research has showed us over the past years is that the most effective interventions are a combination of medications and on the psychotherapy side, there have been some advances. Mainly one of the criticisms of therapy was that it wasn't, and it was just kind of an art form that therapists that were good with talking to people and with insight and we're helpful in terms of helping people clarify, but it wasn't viewed as a scientific rigor. And I think there's been a lot more research into evidence-based treatment, and there's a lot more evidence-based and accepted mental health interventions that are viewed as science. For instance, CBT, cognitive Behavioral Therapy, D-B-T-E-M-D-R, those are all now in the field and somewhat into public are kind of accepted medical or clinical interventions. Whereas therapy was kind of viewed as for the rich worried well, or the Victorian women who went to see Detroit.

But in terms of, and there's some very useful tools. They're very structured interventions, and so it's good for training people that are interns or students and are new to the field, so they really have something that they can learn and they have something they can memorize and they have something that they can apply. So that's good from a training perspective. On the other hand, again, my personal opinion is that a lot of these therapeutic interventions become cult-like, and people follow CBTI always do CBT, and we go through the steps, and I think that there's some over reliance on that therapeutic rigor or interventive steps, and people kind of lose sight of the fact that therapy is a human interaction and we need to listen to people. We need to talk to people, and we need to, as investigators, we need to uncover what's behind their mental disorder or what's behind their substance use psychopathy. And sometimes that gets a little lost when you're a CBT therapist or a DBT therapist, and that's all you think about, and that's all that you do. I mean, there's a human side and there is an artistic side to therapy that people need to learn, and it's hard to teach. I mean, some people are naturally gifted at it, and some people gain it through experience, but it's not something that you can teach in school.

Dave: Right. It's interesting, I think of the paradox, again, while we're talking and so much, I get so many floods of amazing memories getting to work with you for decades and decades. One was something that you'd said, which used to really hurt me to my core while we were at solutions, you were like, it almost doesn't matter what the clinicians doing in group today. What matters is are they going to do it for 90 days or 180 days, almost downplaying the great significance of the group topic of the day, or whether they're using CBT or motivational interviewing. The much more important issue was for them to complete the course of treatment. Do you still believe that?

Michael: Absolutely. And not only complete the course of treatment, but also the therapeutic part, particularly in group therapy isn't the material to review for the day. The therapeutic part is the interaction with other people that have the same kind of issues and the help and support and insight that they can give you. And hopefully the therapist is there as a participant and as a manager of the process, and to make sure that that helpfulness stays on track and it doesn't devolve into something you don't want. But no, absolutely. I mean, the magic of therapy has to do with the interpersonal relationship with the patient, the therapist or the patient and the therapist and the other group members.

Dave: I agree. And to me it is magic, and I love watching that process. You and I, we co-founded Solutions Recovery in 2006, I guess 19 years ago. That was a hell of a journey. Let's see. What do you think Solutions Recovery did for the Las Vegas community?

Michael: Well, I think it was a very good treatment program that touched a lot of people and helped a lot of people. And it really did bring a new model to the Las Vegas area. The alternatives were inpatient, which is pretty structured and pretty rigid, and it's kind of like really mash kind of, let's put the patient together and get 'em back on the front line. It's not really therapy that's going to benefit a person. I mean, there's all kinds of things that people need to experience and they need to learn and they need to change. And that's done over a period of time. And particularly with insurance companies, utilization review criteria for inpatient, you're not going to be able to do that in three days or five days or six days. And not that that's, and I don't think that's the best place to do it in an inpatient setting with locked doors and people zed out on medication and all different kinds of problems and all different kinds of level of participation.

That really, the model that we brought to Las Vegas was a model of basically residential treatment or housing. So people lived in residential homes in the Las Vegas community, and their treatment was outpatient. Their detox in most cases was outpatient. Their intensive outpatient was outpatient. Their outpatient therapy was outpatient. And so it really was a model that was different. And inpatients, aside from the pressure to get people out from a financial perspective by the insurance companies, that kind of rigid structure, inpatient environment wasn't particularly good for building trust and people willing to be open and vulnerable in your treatment. So I think that that model of normalizing the therapeutic process in the home environment and in an outpatient setting was a lot more conducive to people getting well as opposed to a crazy person going to the hospital.

Dave: Right. Amen. Yeah, we help thousands, and I love the fact that it spawned many other treatment centers that are still thriving today. So yeah, I am forever grateful of that experience that me and you had, which we started when I got 90 days clean, which is amazing.

Michael: Yeah, no, and it was amazing. You had just gone through your, I think that was your first treatment and a successful one.

Dave: Yeah, so far.

Michael: And I was semi-retired. That was my first retirement. And you kind of energy and motivation about treatment and about recovery due to your own experience and your own recent success really motivated me and I think helped fuel the motivation for going through what we needed to go through to start the company

Dave: And keep it going. I mean, to me, I have nothing but awe and appreciation for that, which was my second career. It was amazing. It was funny, and I saw this sort of tongue in cheek while working with you and Joe Bradley a couple times, you would chide me about whether it was my addiction, my A DHD, some of my bipolar tendencies, some of my grandiosity about faith, and you always did it in a kind way, but in ways that helped me think about some of my inappropriate or unhealthy patterns in life, which as I've gotten clinically trained, I've appreciated more and more. Do you remember chiding me along the way?

Michael: No. And that word and that perception disturbs me. I don't think I ever chatted you. I don't think that I chatted you for your addiction or for any mental health issues you may have had. That would be against everything I believe in as a therapist. And for me, I separate our business relationship from our personal relationship and from the business perspective. I think there was frustration on both sides. You were kind of a more action oriented person. You wanted a resolution, you wanted action. Whether it was right or wrong, we need to do something

Dave: Ready, fire, aim.

Michael: If it's right, that's great, and if it's wrong, we'll fix it. So I think there was frustration on my part, again, from a business perspective about what I viewed as your impulsivity. And I think from your perspective, what did you used to call me? Procrastinator?

Dave: Yeah, case prevention. I remember the first 10 people I brought in, you explained each one why we couldn't have them come in even though they had good insurance or they were ready to pay, which help inspired me to go on my clinical journey so I could have a better understanding for that.

Michael: And I think that there probably was some truth. I probably tended to be a little overcautious or over analytical, and you probably tended to be a little impulsive.

Dave: Agreed. It's part of what made us a great team.

Michael: Yeah. No, no. I think it was a positive interaction, but I mean, certainly would never criticize you or anyone for their substance use disorder, for their mental health disorder. I mean, that's just aside from my training and my years of experience, it goes against my grain as a person to charge somebody.

Dave: In the early days, I had felt that I'd prayed to God and that God had called to me that I needed to open up a rehab in Las Vegas. And in the early days, you'd often have me, Dave, Dave, tell him how you talk to God. And then I would go into this thing that I a hundred percent still believe to this day, and I could tell that it met you with some amusement, but multiple times you teed me up with it and it was like pulling a string and I was like ready to feel like I was directed by God to try to help people

Michael: Again. That's a good example. Spirituality for a lot of people is really an important part of their recovery from substance use disorders. And even though I'm not a religious person myself, I still consider myself a spiritual person in a lot of ways. And I would never criticize anybody's religious or spiritual beliefs, particularly when it's going to help them succeed.

Dave: Right. Yeah. That's a really good reframe. Thank you. I'm glad we kind of talked this out.

Michael: Yeah, no shining boy. I like cringe. Oh my God. I know that's not me.

Dave: Yeah. Oh, I didn't have a negative feeling about it, but I did recognize our difference in spirituality. I did recognize my impulsivity, which each of these traits, I mean, I hope I'm managing them a little better, but I still have all the traits, as you know that I had early on, you quoted, everyone has a direct connection to addiction. We ended up trademarking it. It was an amazing tagline. What did you mean by it?

Michael: Who owns the tagline now? Is that American Addiction Center that owns the tagline, or do we still own it?

Dave: We sold all of it, although as you know, they ruined it in two years and ended up closing solutions. And Michael Cartwright was fired. Jared mens was fired. There's not anyone who knows that.

Michael: Yeah,

Dave: No, they purchased it.

Michael: I think it's a great tagline, and it really speaks to addiction. That addiction knows no socioeconomic class. It knows no color, it knows no religion. It will attack everyone, and everyone has a direct connection to addiction. Your direct family, your nuclear family, your extended family, your friends, your significant other. Everybody has multiple people that suffer from or have suffered from addiction or personally suffering from addiction. So it really speaks to not only the universality but the insidiousness of addiction is that everybody is vulnerable to it, either as someone who suffers from addiction or someone who suffers from someone else's addiction.

Dave: Jessica and I ended up penning a book about the solutions journey, and we talked about one particular client who we use, the pseudonym, we're calling it Saving Lily. It's named after a lady who we treated, I don't know if you recall her, but she was a particularly challenging case. A lot of trauma, schizophrenia, an opioid use disorder for a long time. Maybe it's hard a case as we treat it. Any thoughts or about treating Lily?

Michael: Oh, absolutely. I remember the case. She was, I don't remember. I think she was probably in her early to mid twenties when she came into treatment. All the things you just mentioned, she had significant opiate as well as polysubstance use. She was paranoid schizophrenic. She had all the classic symptoms of paranoid schizophrenia. She had hallucinations, she had a motivation. She had just the textbook, and she probably was one of the harder cases we treated because she was so chronically mentally ill. Although compared to other chronically mentally ill cases, she's pretty, in terms of the symptoms and in terms of her resistance, that one of the hardest things about treating chronically mentally ill people is that usually the onset is in late teens, early adulthood, people are at the peak of their physical and mental powers, and they're invincible and struggling to gain independence and to get focus and clarity and their life goals and that kind of thing. So these are all usually pretty young, pretty bright people. Certainly Lily was young and bright.

She also was very artistic. She had a lot of artistic talent. She was very sensitive. She wrote poetry, but she hated the fact that she was chronically mentally ill. And so that hatred of her symptoms and of her illness, I think in a lot of ways fueled her addiction. And it also fueled her resistance to treatment, particularly medications. And that's a pretty typical scenario that we see with chronically mentally ill people. Now, we solutions tended to see people with a higher addiction overlay and less of a mental health overlay. So the fact that she was so schizophrenic and so paranoid and so resistant, she was different. On the other hand, there's tens of thousands of young schizophrenic patients who go through the same kind of issues that she went through. And probably the most remarkable thing about her treatment, and part of the thing with schizophrenia is that it developmentally delays you and it isolates you from other people similar to addiction. And so she really had a difficult relationship with her mom. She really was wanting acceptance, and she didn't get it from society because she had all these bizarre symptoms. So she really felt like an outcast. And I think one of the nice things about the treatment of her was the community accepted her.

Dave: It was part of the beauty of solutions.

Michael: I'm teared up here a little bit, but the community accepting someone with that level of disability was really beautiful and healing for her.

Dave: Am so glad you pointed that out. When I remember her 18th or 19th day when we took her to the salon and we redid her hair and she came back and she started talking to people and was more accepted. And I mislabeled that as the positive effects of cleaning her and giving her a haircut and then dying her hair. So I considered it the beauty products kind of aspect, but you're a hundred percent that served as a catalyst for her to participate in the community that you and I built that really thrived and that community was the magic of solutions.

Michael: I mean, her participation and her getting the hair cut or getting her hair done, she was the normal person.

Dave: Right? Yeah. God bless us, man. That was beautiful. And I underappreciated how you know me. I was just paddling as hard as I could the whole time, barely coming up for air. Wow. You've had lots of careers. You would talk about state of Arizona and Cigna days. There was BHO days, there were solutions. There's HBI and Thrive activities. What's the favorite part of your career?

Michael: Well, actually, you kind of touched on it before. I think the favorite part of my career was I started out as a therapist. I was aligned one-on-one therapist doing psychotherapy with people, some of them chronically mentally ill, a lot of them chronically mentally ill, some of them worried. Well, and so a whole spectrum of people. And I was a pretty good therapist, and I enjoyed that one-on-one connection and helping people. But as I progressed in my career, I got more on the administrative side and managing therapist and developing programs. And I think that that really appealed to me in terms of increasing the scope of my influence.

Dave: Your impact. Yeah.

Michael: So it wasn't just this one person that hopefully I was helping now I could help 30 people or a hundred people or a thousand people, which really was rewarding. And I think that the idea, and it wasn't any easier to manage therapists than it was to manage patients, to get therapists in tune with what their calling was and what the expectation was from them as therapists. And not to lose sight of the fact that they were a human being and they were treating human beings. Sometimes we get caught up in our process and don't think about what really we're doing. And then I think that since I've moved into program consultation with other behavioral health organizations, which I really enjoy in terms of trying to help existing organizations improve their services. And the other thing that I didn't expect as part of my organizational relationships, I started supervising master's level students.

And I never envisioned myself as doing that. I never thought that I would enjoy that, but I found it very rewarding and surprisingly gratifying to work with people who have worked in the field, people that have gotten their bachelor's, people that have gotten their master's, and now they're looking for independent licensure. So they know a lot of book stuff and they're excited, motivated the field, but they still don't have a lot of experience or knowledge. They still don't have a lot of confidence. And so working with therapists to kind of help ground them in terms of what therapy's really about, it's not about only about what you learned in school. That's kind of helpful background. But it really is developing your interpersonal skills and your motivational skills and your ability to impact on another person's life is really important for them to understand and not take it too seriously. On the other hand, take it seriously in terms of this is really an important relationship, but it's not all about you as a therapist.

Dave: Right? Yeah. I know many of your students and I love hearing mechanisms from them. And each time I do, it really warms my heart. Again, appreciating the broader impact that you have. And as one of the best of the best in our field, you helping to mentor and to train masters level clinicians is exactly what you should be doing. It would just be a terrible waste for the behavioral healthcare field if you weren't. So thank you for continuing to do that.

Michael: Its been fun. I don't know the human up. Is that a Dave Marlon tagline or is that a big, stronger tagline? But I think that's really important in terms of the field that we're in, is it really is important to human up and to do the right thing and to realize that we're humans helping other humans. And that's really important. And I think for, again, if I comment on your journey, I think that your recovery from addiction, the gains that you've made with some of your mental health issues have not just been a mechanical learning of things that you need to do and things that you need to change and things that weren't particularly useful for you in the past. But one of the things that's always impressed me about you and your recovery journey has been your purpose has been to become a better human

Dave: Being, hands down.

Michael: And I think that's admirable. I wish more people in this field and more people in recovery or on a recovery journey would understand that,

Dave: Right? It's not ceasing drinking

Michael: That

Dave: Was but a symptom. The symptom was I was trying to medicate this organism that wasn't healthy and that I need to start thinking, acting and behaving in a healthy way and to develop a self-esteem. And yet, the only way you could do that is by doing esteemable things.

Michael: And again, that's one thing that I've learned from the substance abuse side is that it's about gratitude and it's also about helping other people. And part of being a good human and part of being in strong and stronger recovery has to do with when it's not all about you and your needs, but it's about other people and helping other people, there's nothing more healing for people that have issues than to help other people. I'm thinking about a lot of the times back in solutions when I tend to be pretty selfish and pretty self-absorbed. And one of the things that you implemented was particularly around the holidays, that we would have our patients who were in treatment go out to soup lines and help feed and help take care of other people that were homeless or less fortunate. What an incredible therapeutic intervention.

Dave: You know what? I tell this story often, but when I was in treatment myself, somebody came and talked to me the first day and they had a particular conversation, and then two days later, a lady came into treatment and she was going through some of the same stuff I went through carrying on, not knowing what was happening, not used to this new surrounding. And I walked over to her and she's like, what do you want? And I was like, well, I just want to let you know they're going to wake us up at 6:00 AM and we have to make our bed and go to breakfast. So I would take a couple deep breaths and get ready to wind down. We got to fall asleep soon. And she looked at me and she just acknowledged I was a fellow patient. I wasn't looking for money, I was just trying to offer some kind advice. And that was the beginning reminder is that a three day guy can help a one day guy better than anybody or a two. So don't think because you don't have a lot of recovery time that you can't be of service. And now in two days, I'll be 20 years clean and sober.

Yeah, thanks. But to me, a 20 year guy is really good advice for an 18 and 19-year-old guy. So we still have use for ourselves along this human experience. And you're right. We all need to human up. Thank you for spending this time with me, Mike. I love you forever. You're as quality of a human as I've ever met. Thank you.

Michael: Thank you, David. And keep up the good work. Thanks.