Addiction & Recovery Conversations with Brett Lovins

Dr. Kevin McCauley - Understanding Addiction as Both a Brain Disease and Human Experience

• Brett Lovins • Season 3 • Episode 5

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Dr. Kevin McCauley shares his journey from Navy physician to addiction recovery advocate, offering profound insights on the neuroscience of addiction and various pathways to healing.

  • Creator of the documentary "Pleasure Unwoven" about the brain science of addiction
  • Became addicted to opioids after surgery while serving in the Navy
  • Court-martialed and spent time in Leavenworth, where AA meetings provided crucial support
  • Now works as a senior fellow at Meadows Behavioral Health Care
  • Discusses evolving views on whether addiction is best understood as a brain disease
  • Explains craving as the central symptom that matters most to those experiencing addiction
  • Emphasizes the importance of connection in recovery while respecting different recovery pathways
  • Shares personal struggles with sugar addiction and its neurobiological similarities to substance addiction
  • Provides evidence-based information about cannabis addiction and weighs-in on "California sober"
  • Identifies connection as essential for sustainable recovery

Dr. McCauley's videos online:

Dr. McCauley also shared some podcast links with me about cannabis that you might want to follow to learn more:

Please subscribe to my channel whether you're listening on a podcast or YouTube.

Other useful links from Brett:

  • Sober Curious Consulting - Brett's Recovery Friendly Workplace consulting business.
  • Brett's YouTube channel
  • Washington Recovery Alliance - building the capacity of the recovery community to advance substance use recovery and mental health wellness by catalyzing public understanding and shaping public policy in Washington State.
  • Recovery-Ready Workplace Toolkit - providing information, tools, and resources to help employers from all sectors—government, for-profit, non-profit, and not-for-profit—effectively prevent and respond to substance misuse in the workforce from the Department of Labor.
  • Data on SUD in the US (2022) - from SAMHSA (Substance Abuse and Mental Health Services Administration). Link to my favorite PDF for statistics.
  • Addiction 101 - it’s not a moral failing—it’s a treatable illness. Get the facts about this misunderstood medical condition from my friends at Shatterproof.
Brett:

Hello there, my name is Brett Lovins. Welcome to Recovery Conversations, my ongoing series of podcasts and now videos on recovery stuff that I think is interesting and would have helped me back in the day and will hopefully help some people understand this complicated condition that many people in the US and elsewhere have have. Today's interview is a really exciting thing for me. Dr Kevin McCauley has been a big influence to me and others for a long time. He created a very popular and famous documentary called Pleasure Unwoven which I highly recommend. It gets shown in a lot of treatment facilities and it's the brain science of of addiction. It talks about the different parts of the brain, et cetera, and and I've shared his stuff with so many people over the years and so, anyway, I've I've gotten in touch with him and he said, yeah, let's, let's do a podcast. So, yeah, just have Dr Kevin McCauley on here. It's a big deal for me.

Brett:

Hope you enjoy the conversation. Please share it, please. I guess I need to say please subscribe Right on. Thank you, you want me to call you Kevin, right? Yes, please, okay, okay, this is Kevin. It's really nice to meet you in person. I've seen your videos for literally years and I've shared your content with lots of people and it's made a huge impact indirectly through me, and I know that because I get feedback about it. This idea of the disease model and for somebody who's afflicted with addiction or substance use disorder, having sort of a weight lifted off of them in a logical way, has been tremendously helpful for myself and others. So that's my preface.

Kevin:

So I'd love for you to introduce yourself, if you'd be open to doing that, to get there, as it is for all of us. Today I live in Sedona with my wife, christine. We went to high school together and then later came back together. Gosh, it's been almost 12 years that we've been together. It's astonishing. She came with two kids, three. One was out of the house, but I hit the jackpot with these kids I mean they we really get along very, very well. They're wonderful kids.

Kevin:

Um, I think, uh, samira is just about to turn 30 and Ethan's about to turn 23. Um, ethan lives locally, samira lives in Washington, and so we get the chance to go up to Washington every now and then. We, we always enjoy it. Uh, for my employment, I I am uh what's known as a senior fellow at Meadows Behavioral Health Care, which is mostly centered in Arizona. We have a number of different programs in this town, wickenburg, which is kind of a cowboy town. It's sort of where Phoenix goes to play cowboy. It's all old dude ranches. In fact, some of our programs are converted dude ranches and my job is to basically go to each program and talk about the neuroscience of addiction or at least where the argument is right now about whether addiction is a brain disease or not, and I try to stay up on things. I was just up in Seattle doing a lecture on cannabis. That's a very interesting topic, big growth area and let's see, I don't think that I had practicing medicine.

Kevin:

I went to medical school and I was in the Navy when I got addicted to opioids after a surgery. I never had a problem with that. I haven't really had a problem ever since then, but this was way back in 1997. And if you had a drug problem and you were an officer and you were assigned to the Marine Corps and you had a drug problem, you were in big trouble. And so I got in big trouble and they court-martialed me and sent me to Leavenworth for a year, which, looking back on, it was actually a pretty good place to sort of get some brain healing, because when I got out they paid for all of my treatment. The Navy paid for all of my treatment, and so I was very, very sad to lose my career in the Navy.

Kevin:

I really enjoyed being in the Navy and I, uh, unfortunately, because of certain circumstances we can talk about them Um, I wasn't able to get back to medicine, um, but uh, but there was lots of work to do. I don't know if you noticed that that uh, addiction is having a bit of a moment these days and so there's always been plenty to do, and so I've kind of worked at different treatment programs. I ran my own sort of recovery management slash sober living house in Utah for a number of years, and so it's been an exciting ride and I'm kind of trying to figure out, you know, like what do I want to end with? But you know, there's never been a better time to get sober. In my opinion, it's a much more complex field than when I, when I.

Kevin:

You know, there was pretty much one way that you got sober if you were a physician, and now there's sort of a number of different pathways, which is good, and so this is an exciting time, and so there with your podcast, there are a number of other great podcasts that I try to. You know I try to go on long drives, and the good news about Arizona is that the drives are very long, and so I get to listen to a lot of different podcasts and I'm very honored to be on yours, brent.

Brett:

Well, that's wonderful, that's a great start. I would love to just allow you or encourage you. So the disease model you know you've got quite a bit of content out there. You know the Pleasure Unwoven is sort of a famous documentary that you built that gets shown in a lot of facilities Um, and I think that this idea of is a disease or not is is really hard for a lot of people. Um, and, and I've seen some things that you share around that, and just watch one this morning where you said if I were to build a disease, that was most evil, what would I do? And I thought, wow, that is, that is spot on. So talk about, talk about the neuroscience a bit for our listeners.

Kevin:

Sure, well, that opening I haven't used it in a long time, but I used to use it every time I did a family group. I used to work at a place called Cirque Lodge. I did the lecture for their family group about the brain disease model, and I would open with that. I would show a picture of Mike Myers playing Dr no or Dr Evil I guess it was in the Austin Powers movies and I would say you know, if I was trying to be an evil doctor and I was trying to invent the most evil disease that I could think of, what would that be? Well, I would make it run in families, but without any particular pattern, so it would kind of hop around and affect one sibling but not another. I'd make its status as a disease already an argument. So before you even got out the starting gates, I'd make one of the symptoms loss of insight. So the person, even though they were very, very sick and everyone could see it, they wouldn't be able to see it themselves, and so these kinds of things they all really describe, I think, addiction very, very well. And so if I was trying to be a jerk, I'm not sure I could have come up with a disorder that could spread as much, you know, bad feelings and misunderstanding and argument far and wide. And since, um, since I was doing that, that would be like about 2009, 2010,. The the disease argument is as as evolved, I would say. And so, uh, you had asked me like why am I not so much of an evangelist for the brain disease model of addiction? Because I meet so many people who have great recovery and that's just not the way they see their experience. Some people, you say addiction is a brain disease and that just is very, very helpful. For them. It's a kind of a scaffold upon which they can build their own understanding of their own addiction. It's a great narrative, but for some people that just falls flat, and I wouldn't.

Kevin:

I think we're in a an area now of addiction treatment and certainly addiction medicine, where we really want to make the doctor's office as welcoming as possible, and so if I get the sense that the disease language is going to turn someone off, I drop it, it's not important, it's not critical. Lots of other things to talk about. I think that there are people who frame their experience more from a rational choice model Um and and uh, and so that's what I would keep my antennae up for is you know where's this person going and how can I, uh uh, meet that need? And I think that if you're a practitioner in this field therapist, doctor, nurse practitioner you kind of have all of these different models floating in your head at the same time and you can sort of borrow from one or the other as needs be. And I think that that's what the average addiction medicine physician specialist, for instance, family practitioner practicing in Yakima, washington or Puyallup, washington, and that's kind of the way they do it. They just kind of like how can I help this person understand what they're going through, make sense of it, create that narrative which will hopefully turn into a narrative of recovery. So so the brain disease model of addiction has. I still believe in it. I'm a prisoner to my education, so I think that it's a very good model. I think it's true.

Kevin:

But there have been some really good, fine, fine books written that make an alternative argument and I recommend those books. I think the arguments that they make are extremely strong. Some of them are very elegant and they are all trying to grab something that is true about addiction, something that we really need to pay attention to. I do think that their arguments can be defeated. But I try to celebrate the diversity of opinion that's out there. But I will say that that highly reductive, materialist, physicalist, highly reductive materialist, physicalist, dualist neuroscience model, it's painted itself into a corner a little bit. I don't think it makes it untrue at all. I think there's lots, lots more that'd be squeezed out of it.

Kevin:

But I kind of try to live in that area between the two. I guess I'm a perfect codependent. I'm trying to make everyone happy and making no one happy. But it's a fascinating argument and it's very complex. Everyone's got an opinion. Almost all of those opinions are wrong or at least have a major fatal flaw to them. And that's basically what I've been working on for almost 30 years now is ever since Alan Leshner, who in 1997 was the director of the National Institute of Drug Abuse. The job has since been filled for many, many years by Dr Nora Volkoff, but he was the guy who wrote the op-ed in the New York Times. Addiction is a Brain Disease and it Matters, and that op-ed has become something of a lightning rod for criticism against the brain disease model of addiction. But back in 1997, that was a very, very big idea. It was brand new and I would say it saved my life. It certainly gave me something to think about while I was sitting in a cell in Leavenworth, kansas.

Brett:

Oh, there's so much there, so I would love to. So I don't know exactly where this is going to go, but I love the disease model and so. So you're sitting across from somebody like that right now, but what I've found is and I am from Yakima, Did you know that or did you just-. I did.

Kevin:

There's a group called Macaulay Sound up in Puyallup, just about 10 minutes drive from you. Okay, the Macaulay propellers Macaulay sound. I generally tend to look for a swag the Macaulay name on it. So, uh, yeah, that's where. Uh you're, you are.

Brett:

Yeah, Well, I'm actually in Puyallup now, so you said, yeah, so right, due South of Puyallup. So it's ironic anyway. So so I'm, I'm of the of the ilk that that understands it through the brain disease and that works for me and that is very, very helpful and I think it can help other people as well. But I, I want to just give you the opportunity to talk to the person who, um, who doesn't see it that way, because, just to frame it up, if we're going to say that please correct me we're going to also say that the symptoms then are rough in terms of how families are affected by this individual who may or may not see that they have a condition. Just use the word condition to make it a little softer around the edges. That's really hard.

Brett:

I see it in city council halls, I see it all over the place as people try to grapple with this. Is this a disease? And if it is, well, then that will change things about how we look at it. But that person is not particularly convinced. So will you speak to that person for a minute here?

Kevin:

Uh, you know my mind goes back to gosh. This would have been 1999, when I was standing in front of the San Diego city council and I was there with a bunch of folks from the uh, the needle exchange program in San Diego, the underground needle exchange and they were trying to get to city council to sign a thing because in California if the local group could recognize that hepatitis C was an emergency, then they could allow for a syringe service program to operate. And we were trying to kind of make the argument and it was going nowhere and to try to appeal to the welfare of people who are struggling with addiction and paint a picture of their future as parents, as fellow citizens, as family members. They could not care less and I really, to be honest with you, I still encounter that it's softened somewhat. I think people are a little bit more circumspect. So that's what I got my antenna up for is who am I talking to? I just did a lecture not too long ago for the Louisiana Supreme Court Conference and it's basically a room full of prosecutors and so you got to roll it out very, very carefully and I got a number of strategies, but I would drop the disease language for now, keeping in mind I would bracket out disease language for now, keeping in mind I would bracket out exactly what you said.

Kevin:

If it's a disease that puts us under a completely different set of laws and and and legal rationale. So I don't want to let go of that. I would more use the term at this point, disorder. I think you can hang your head on that. Hat on that and and I and I would. First of all, I want to know more about what that community is dealing with, what the person across from me is dealing with. Tell me how you see this, tell me you know how this like, like what's your opinion so far, and really kind of make it more of a shared learning experience between you know, expert and county commissioner, expert and family member, and I certainly would not try to diminish the very real harm that can come from you know some people's addictions, very real harm that can come from you know some people's addictions and sort of find common cause that you know what's the best way to handle this, what's the best way to get crime down, what's the best way to decrease infectious disease?

Kevin:

You know, I think in Portland and in Oregon they passed that it was a measure 110 or Measure 105, where they tried to bring harm reduction into Portland and they were going to have a syringe. They already had a syringe service program, but they were going to have a safe injection site and they were going to legalize or at least decriminalize to the point of almost legalization drugs. In other words, you couldn't be taken into jail if you had drugs on you anymore. And it was a disaster. I guess the first thing I'd like to say is at least they tried something. I mean, we were in a real emergency, you know. So that's very brave. But if you don't get that right, you're going to lose a lot more than you think you can.

Kevin:

And I have a degree in public health and everybody says well, harm reduction is a public health approach. No, they're not equivalent. Actually, you may go through a process of trying to fix a local public health problem and arrive at harm reduction. That makes perfect sense to me. I'm a big believer in it. Right, but that's not the way I learned it. The way I learned it is you make a stakeholder map, you figure out everybody in that community that you're dealing with, you make sure that you've got all of those voices. And unfortunately, they never got buy-in from law enforcement. They never got buy-in from the local business community, and so there was a backlash, and I don't think it happened for them, but it could happen anywhere else that you end up losing more than you could ever gain. And so I think that it's really important to recognize exactly what you said, that that real harm can come from this Not everyone with addiction, but most people who have active addiction.

Kevin:

There are some problems that are ongoing. The person will not be able to see that, because full conscious realization of what I'm doing in the midst of my addiction only threatens my ability to continue my addiction. So the way I see it is the brain kind of sheds its outer layers of consciousness, kind of like a dying star going supernova, and so I can't see it right. I can't see how my behavior is negatively impacting people around me. I can't see the instrumentalism that I have fallen in, where I'm literally using other people to get my needs met, and I think that one of the and I'll finish up here one of the kind things that addiction does for us is it blinds us to this stuff, and so in that early period of recovery we're still kind of, you know, not really seeing what we look like and what it is that we're doing.

Kevin:

And to me, recovery is getting ready for the day three, five, seven years hence when it finally dawns on you what you did. And if you don't finally dawns on you what you did, and if you're not ready for that, you'll kill yourself. And that's I think or at least not everybody, certainly hopefully not everybody but I think that suicide is a real risk for people who get into recovery and they don't have some protection in place to be able to convert that shame into helping another person reaching out to a newcomer, driving someone to a meeting because they lost their driver's license, stuff like that. And I think that that's why the abstinence model is always going to have currency, because you really can't make an amends for your past behavior unless you've stopped and you got to stop, and that's.

Kevin:

I don't want to hear that, yeah, who's doing the drinking, let's say, but that's not the average case. The average case is you can absolutely point to the harm that's being done because of that person's active addiction, and so I would be ready to join with that city council or that family member and say you're right, I'm not going to push that under the rug. I don't think it does them any good to push that under the rug. What's our most operational way to solve this? What's the practical way that will work? And so for a family, that would be immediately going to something like CRAFT, community Reinforcement and Family Training. So that's a you had asked me about. What do you do for the family who, when their person isn't ready to go, there are ways to do it. When their person isn't ready to go, there are ways to do it. And so that particular therapeutic approach craft is particularly well designed to not diminish the harm, but yet to come up with something practical.

Brett:

It's amazing how little I know, as much as I love this topic.

Brett:

Like you just dropped on me something that I'll go look up.

Brett:

I mean, this happens to me all the time, kevin, so thank you, that gives me another trail to chase.

Brett:

I'd love to go to the basics for just a second also, for because we both have lived experience, you just gave a, you just painted a picture that I can relate to, around what, what my reality was, and I like to think of it as golem, like, slowly but surely, the presence and and you've you've addressed that in the past with the brain chemistry around, you know how important the drug or alcohol is in the brain and you know, know that it's sort of like survival and I've heard people talk about the need to hold their breath. So that might be useful to the person, the family member and I'll also say, for anybody who's gotten some courage, gotten some curiosity. That snuck in here, because that would have been me. I wouldn't want anybody to know I was listening to this, but I might've snuck in here because that little voice was like things are not going well here and to speak to that to that person, because that is very useful to me to understand that my brain acts weird when it comes to this particular thing.

Kevin:

Sure, sure, well, I guess the symptom that everybody goes to. In fact I was just listening to Dr Anna Lemke. She's a, you know, a wonderful expert at Stanford University addiction medicine psychiatrist and she was just interviewed on the New York Times interview and they said what is addiction? And almost everybody goes to the symptom that gets everybody's attention and that's persistent or continued use, despite negative consequences. Personally, I don't think that's the most important symptom of addiction to the person who actually has it. Craving is the most important symptom to the person who actually has it because it describes the suffering.

Kevin:

But that whole idea that something has changed in the brain to overvalue the intoxicant to the point that the person you know either does not acknowledge or softens or you know doesn't, will not give credence to the negative consequences. That that's when people want to get in there and punish. And I think you pointed this out in your, in our emails. If addiction really is a disease that makes people with addiction patients, and patients have rights and you can't punish patients, you can't use emotional coercion to get them into treatment. There are laws against that sort of thing. So saying that addiction is a disease comes with an obligation. It comes with a set of obligations that we must hold ourselves to, and so to me, the idea is punishment's not going to work. That's what addiction is Increasingly. The threat of consequences or the immediate consequences no longer reliably predict the outcome of that person's decision-making process. So punishment doesn't work, except that sometimes it does, and that's the frustrating thing.

Kevin:

I think that this is, you know, when you talk about the heart, people who have heart disease, their cardiac function is going back and forth. I can remember, you know, a patient would have chest pain on one day but not on another day, and that's just the vicissitudes of physiology. Well, why should the brain be any less complex than the heart? So I think there are times when I exactly what you said, that I am like I don't want to do this. This is awful, I can't believe I'm doing this. This is not who I am. I've got to take some steps and tomorrow I'm going this. This is not who I am. I've got to take some steps and tomorrow I'm going to take them, and so it's.

Kevin:

It's really interesting how that, that insight is sort of, you know, going back and forth. So there are moments that you could catch me in the day which are perfect for intervening and getting me to go the extra step and maybe even getting into treatment, to go the extra step and maybe even getting into treatment. And then you can ask me 30 minutes later and you know I am completely blind and that's very, very hard, I think, for a family member to understand. And so what they tend to do is just get tighter and tighter and tighter and then you can start, you know, depending on where your philosophy is, bring in the fact that families sort of have this mini addiction, that's sort of orbiting around the person with addiction's addiction, and that's their own codependency and their own family script, and so now we're in a loop and it's very, very hard to get out of that.

Kevin:

I'm not sure if I answered your question, but that's the danger in using persistent use, despite negative consequences, as a definer for addiction is yeah, sometimes it works, but you can't count on it, and so there will be a moment where the person does not care that they will die or go back to jail or lose their kid. Their brain is literally saying the best way to get the kids back and straighten everything out with the probation officer and avoid that next bout of pancreatitis is to secure survival now right, by using the drug, because the drug has been equated by the brain with survival, and then we'll deal with that other stuff tomorrow. And that's the. You can call it whatever you want. Psychoanalysts would call it denial, aa calls it the insanity We've all got our terms for it. But it is that phenomenon where you know I am truly impaired and I'm not going to be able to find my way out of this alone.

Brett:

Does that make sense. It makes perfect sense. I'll just, I'll just come back at you with a couple of thoughts of what you just shared there. Yeah, so so one of you, you said cravings like when, when I'm hanging with anybody who's who's kind of fresh off the boat, if you will, you know who is experimenting in my, my case, in abstinence, although I do interact with people that are doing harm reduction things as well, and I think that's awesome as well I'm not my way or the high Well, my way has to be that. So I'll leave that there. I have to stay abstinent. I know that I have all the requisite research. I need to know that one sip and I'm in big, big trouble.

Brett:

Sure, you talked about cravings, and when I meet somebody who's new, my first question is Kevin, I'd love your thoughts if this is a valid question. How are the cravings? Because in my mind and I've met some people that go for months after their last drink those are tough individuals, because until those cravings start to let up, man, you use the word suffering, and I've heard you use it before. I mean it's intense, and if you haven't experienced it, it's not like I mean it's like rapid heart rate, I mean it's intense.

Brett:

So to the person that's listening, that might have snuck in here and is trying to learn a little bit about themselves, that's a real thing. And when you're in the middle of it, like living next to a waterfall, you don't hear the waterfall, it's just there, right, right. So I'd love to let you run a little bit with this idea of cravings and then the obsession of the mind. So I'm either craving or I'm thinking about how I'm going to get it, what I'm going to do, blah, blah, blah. And people from the outside go well, that's, that's, that's wacky. Yeah, yeah, you get it, I get it.

Kevin:

So, yeah, well, I mean, you know I had a sponsor who wrote a rather famous passage in the big book and he said you know that's your hook is to is to try to your own alcoholism. And the newcomer says how do you know that? How do you know that? And I think that craving is the one thing that we all share. It's why we gather in groups, quite frankly, because I need to be around other people who understand it, because the world will probably never understand it.

Kevin:

I've spent the last 30 years of my life trying to explain craving to people who've never experienced it, and it doesn't always go very well, and so it is a brain state that we fall into from time to time. And just imagine the worst grief for your child who died, turned all the way up. Just imagine you're wanting for something, or your thirst if you're in the desert, turned up a thousand percent. It is an inability to think about anything else but that intoxicant. The mind is constantly working, even when I'm asleep. It's trying to find ways back, it's trying to link things together. I'm sure I can make this work, and I think everybody, and I'll be honest with you. I said this in the movie, I say it sometimes in my lectures. I heard a person early on in my own recovery who was a heroin addict and they were describing sunsets and how sad they were and how that was when they always used heroin. And and this is why I like people with heroin addiction is that they just seem so plugged into the sadness of the world. They're just deeply, deeply, you know, empathic individuals, to the point that it might kill them if they don't get sober. And and she said, you know, I just want to, you know, feel that feeling one more time, where I, you know, push down that plunger and every cell in my body says thank you. And, man, when she said that it just stayed with me forever, that's the best experience or best words that I've ever heard. Described it that that person was very close to me and she died was very close to me and she died, uh, but I, you know, her words live on, uh, and I tried to capture that in the film, but in the film I had to really emotionally unload it, uh, because it just doesn't come off the same way, like if I was just, you know, sitting with a small family group or something like that, or or better, uh, people who are in recovery. I could deliver that in such a way that's very, very emotional, and I do less of that and I certainly couldn't do it in the film, but to me that really kind of you know, you'll hear these things which really capture what the experience of craving is like.

Kevin:

Now in AA they say that the craving doesn't come on until you've had the first drink, and I think that that's many people's experience. So let's really respect the bell-shaped curve and understand that we're going to have a huge heterogeneity in the way craving comes on for different people. Most people are going to be right in the center and they just recognize exactly what we're talking about. But I think for some people it comes on as what I would call occult craving, which means that it's craving but it looks like something else. It's back pain, it's neck pain, it's a moment of panic, something like that. It doesn't look like it's craving, but it is.

Kevin:

That's where I think the term hungry, angry, lonely, tired really comes in. Very helpful because it kind of says, okay, well, tired really comes in. Very helpful because it kind of okay, well, which part of these do I need to attend to? I might confuse craving with just being hungry. I mean in early recovery. I'm so disconnected from what my body is trying to tell my brain that I'm calling something craving, which is actually just a regular need that I can satisfy.

Kevin:

For other people they don't have craving at all. They did. Their whole experience of addiction doesn't seem to include, but that is a very small group of people. So I think that that if you want a defining symptom of addiction, it's the symptom that matters the most to the person who actually has addiction. The symptom that matters the most to everybody around that person is persistent use despite negative consequences. They all want to know why don't they stop? But I think everybody who's really experienced a bad craving in their head they say this is not right, this is not the way this is supposed to operate, this is not good.

Kevin:

And so that's why if I go to a meeting, if my first meeting is a meeting where someone describes their craving and I'm like how does she know that? How does she know that, then that's a really good first meeting, because suddenly I'm home. That's what Dr Paul used to tell me. He said you know, you don't share it to entertain. You don't share to teach. You don't share to do any of that you share, to make the newcomer feel more welcome, that they, that they have come home, that they're now among their people, and that's always stayed with me.

Kevin:

Uh and uh, you know, that's what I think every good meeting they it has that nugget where the newcomer can say, wow, okay, I get it. And, as Clancy I used to say, aa is not about the donuts or the coffee or the big book or the steps. It's about one alcoholic sitting down with another alcoholic and the two of them talking about what alcohol meant to them. And the newcomer is so moved by what the old timer says that he or she or they become willing to take steps that they don't even think will really work. And that, to me, that statement, that that's word for word, right out of Clancy I's mouth, that captures it. That, to me, is what AA is and I'm going to need that. I need to be around other people who understand that.

Brett:

Yeah, well, if anybody's listening and they want to hear my first AA meeting story, it's one of my podcasts.

Kevin:

Yeah.

Brett:

And my story is I am literally hovering off the chair on my way out.

Kevin:

Oh, out of the meeting.

Brett:

Yeah, and you know I use the metaphor. It's like, you know, hovering over a pit toilet at a, at a you know, campground. That's so good, I get the image, and I'm on my way out, and then somebody shared something that settled me back in and we, we, we bat these things around. It may have saved my life, you know, we say don't, I don't know that for sure.

Brett:

Yeah, but one thing I did slip after that time and then, as like that was a you use the word hook right in that moment I realized all this uniqueness that I thought was going on, right, going on in fact. And then the rest of that meeting, more and more shares, were like what you described. Right, again, everybody's different. You're going to hear different people are going to hear different things. To get them toward what I like to think of as a distance from the last drink. Yeah, but, yeah, this idea of connection, kevin, I I mean and that word would have pissed me off too, just so, I'm so, I'm clear uh, so, but, but I do think that there is something really, really incredible that happens when people with this condition because I understand what you're saying, yeah, you understand what I'm saying.

Kevin:

Yes.

Brett:

You know a bunch of people saying that stuff and we all understand what each other's saying. And then my spouse comes and is like what are you guys talking about, jeff?

Kevin:

what the hell? Yeah, yeah.

Brett:

What do you think about the connection Like how important is that? What do you think about the connection Like how important is that? And what advice would you give, say, the person who's you know curious about their own situation or family members when it comes to this connection idea?

Kevin:

Yeah, it's been said in a number of ways, that guy Johan Hari, he writes, he's written a great line. The opposite of addiction isn't abstinence, it's connection, it's social connection, and I don't disagree with that. I think that that's an excellent statement. I try to live my life by it. But you know, there are lots of heroin addicts who are actively using heroin and they're plenty connected right, women heroin addicts form little family units, in the same way that they form family units when women are in prison together for long periods of time. There's a folk medicine that goes along with urban heroin addiction.

Kevin:

So I don't want to say that every person who's actively using heroin is disconnected. There are some people who are really, really nice people and it doesn't, it's just. There are people in the world they just you just like them and they're just nice. And even if they were in the Hitler youth, they would make it a sunnier and more pleasant organization. You know, and and. So there are people in the depths of their addiction and you're like God, I wish I was as nice as this person. So I don't want to just paint like, like everybody who has heroin addiction is you know some person who's using, you know other people and being a terrible person and a criminal. I want to respect the fact that there are people who are actively addicted and they have lots of connection, but to me that connection, uh, is really my resilience, it's my overhead, right, uh. And if I don't have that, if I haven't worked to put that into place, then I'm, then I'm really operating with without a net. Um, I need to be in the community of a small group of other sober men that I can bounce my behavior off and they can kind of reflect back to me what I can't see, right. And so, you know, when my sponsor pulls me aside and says, hey, you know, I don't think you're quite seeing this right he's basically saying you know, you know you want to get divorced. You know, I said I heard you that you want to get fired. You're the asshole here.

Kevin:

And I, I that's what I'm talking about is that I got to get ready for that, as that that consciousness starts to dawn on me uh, that shit, I really did some terrible, terrible things and to not sink into that chain that really becomes, you know, such a motivator for you know, you know, suicide. I really think that's the biggest danger, not just depression, I mean, that's already there, not just anxiety disorder, and that's to me. That connection is me. When I'm putting that in place, I'm building that overhead, I'm building that buffer, I'm building that resilience that, when one of those days comes, you comes, I'm around people who basically have me and when I don't need it, I'm doing it for them. And so I don't think that, as much as I love the idea that more and more primary care physicians are practicing addiction medicine, that we're bringing more and more, you know, therapy models, addiction models themselves, medications into this AA isn't going anywhere. This is something else that Dr Paul said. He said don't run down AA when you share, because people need AA to live, they need it for their lives, and he chilled me when he said that and that's absolutely true is that there are lots of folks who want to talk it down. Believe me, I understand. I've always had a kind of love-hate relationship with AA. I still bristle at some of the concepts, but there are people who have been in the depths of their life and the only thing that helped them was that they were at a meeting with somebody, and they will be forever grateful for that.

Kevin:

When I got popped by the Marine Corps for using drugs, and I highly recommend that you don't use drugs when you're in the military. Only I had listened to that. They said not to use pot and I did that, I didn't use pot. But they never actually said Dr McCauley, do not also shoot Demerol, right? And so that left me a little hole, unfortunately.

Kevin:

But they threw me into solitary confinement and so I spent the first 90 days of my year-long sentence in solitary confinement, spent the first 90 days of my year-long sentence in solitary confinement. The only thing that they would let me out for at the Marine Corps Base Camp Pendleton brig was an HNI meeting that the Oceanside local AA group brought into the brig 7 pm Tuesday nights. And my God, that's the thing about solitary confinement. It controls for confounding variables very nicely, so you can do little experiments on yourself. And so when I would come back from that meeting, I was absolutely euphoric, and I don't know that if I was in the real world I would have quite noticed that. But I said to myself and I don't know that, if I was in the real world I would have quite noticed that. But I said to myself this feels exactly like 50 milligrams of I am Demerol, this is exactly it, and I think that the science is pretty strong on that.

Kevin:

Is that connection right, that fellowship, that I feel, that warm glow, as AA says, the camaraderie of people in a lifeboat who have suddenly realized that they're going to be rescued.

Kevin:

That's my opioid system and that needs to be healed. And whether that's harm reduction, moving to medication for opioid use disorder, moving to abstinence, something needs to be done to support that person's opioid system, otherwise they're not going to be able to join in that fellowship at a meeting. And I think that's the best argument for using duprenorphine is that when you use that, people are more likely to go to meetings, they're more likely to ask someone to be their sponsor. Whether they need it for the long term, we can worry about that later, but I've got to do something to bring this person's ability to have that identification back online, and so that's my argument is that AA might swell and then reach an equilibrium in this new world, but it's never going away because people really need to be around that and people are grateful to AA for their life, and so they will always, you know, be wedded to it in a way that you can't be wedded to other kinds of you know recovery support.

Brett:

Yeah, yeah, there's a, there's a lot today. And I'll just say to the person who's really uncomfortable with AA and I've met many and I'm sure you have as well there's a lot of other options as well. So so, kevin, you just made a really passionate uh, and I agree, and I I I kid around, but I do think it's the Starbucks of recovery. It's on every corner, at every hour and it's mostly consistent. So it's like, you know, it's just a fast way and for most of us, we have these moments and they sometimes don't last very long. And if you know, as terrifying as it is to go and hang out in one of those environments God, it's horrible, but then it becomes fun. We laugh, you know you laugh. Now we can laugh at a meeting, but we remember when we came in and people were laughing and were jovial.

Kevin:

Right, hell is going on here what is going on, and I think you can have the same thing at a smart recovery meeting, at a life ring meeting, at a celebrate recovery meeting at a women forriety. There's quite a bit of research that shows that all of these groups are, essentially, they have the same components, but it is that, you know, gathering with other people who understand, realizing I'm not uniquely bad, that there is a way out, that there are happy days ahead. I think that I just I need to be around other people who know how to stay sober, because when I first came to AA, I didn't know how to stay sober and I needed to be around those other people, and so I like the idea that William White came up with is that people who go to different meetings they kind of have dual citizenship. They go to AA and Smart Recovery or they go to Life ring and you know AA meetings and things like that or any meetings, and I think that that's true is that that that person, whatever their value system is. However, it is that that they need to absorb this information and write their own narrative of their own addiction and recovery. All of those meetings can help, and so I wouldn't want to say that AA is the only way to do it. But in terms of, I'll just tell you when they read how it works, when I was sitting in that ring of other inmates, the structure of the meeting, and people like why do you do the same thing every meeting? It matters. It matters to be in that structure, even though you've heard how it works a million times, it really is a very important thing.

Kevin:

Because when I got to Leavenworth, they would not let an H&I committee come into Leavenworth and so there was no outside. You know, no one was being held to the regular structure of a meeting and they were weird. I mean, you cannot believe how those meetings drifted at that. When I got there, people were saying you know my name's Kevin and I'm in discovery, like, in other words, I don't want to say that I'm an alcoholic or a drug addict, I'm Like, in other words, I don't want to say that I'm an alcoholic or a drug addict, I'm still discovering. There's a part of me that's see that structure that is very, very important. You know to hold the group you know to those, but but that's not a central authority, that's not an individual that we're giving our money to, and that's why I don't think it's it's. It can get meetings, individual meetings can get cultish, but it's not a cult, that's for sure.

Brett:

Any of those groups Well, I'd love to ask you a question that I get a lot and that I deal with. So this has been a great conversation, Kevin. I'm really appreciative. That's fine.

Kevin:

I'm having a good time. I don't know why I don't do more of these.

Brett:

Yeah, well, it's, it's. It's awesome to have you here, um, so there's many things that I want to ask you, but I'm just going to, I'm just going to kind of do something different here. One of the things that I've struggled with in in, you know, fairly long-term recovery I'm coming up on 12 years and it would have sounded like a big number to people you know coming in. So it's, it's a bit right, that's a lot of weekends, a lot of a lot of things. The one thing that I still struggle with among many as a human being is I'm not gonna drop the f-bomb but I want to blank sugar. Oh right, and I've met very few in recovery that don't struggle with sugar on and off and I I can think of people that have been sober a long time, that are old my friend in Spokane, old timer like this and he comes in and shares honestly about it, but it is a thing and even in the big book it talks about and there's sweets around and stuff. So help me, kevin, help me.

Kevin:

Yeah, oh well. So help me, kevin, help me. Yeah, oh well. So you know, one of the medications that can be used to help people with alcohol use disorder is naltrexone, which is an opioid blocker, and all the research is really for the extended release formulation of naltrexone. The pills people take them, then they don't. They don't really have the power, but when a person's on extended release naltrexone, the hope is that they will crave less and if they do drink they won't get as drunk, because you need your opioid system to get drunk from alcohol. And if you take that out with an opioid antagonist like naltrexone, people drink. It's good, but it's not like they remember and they drink fewer days before stopping.

Kevin:

But here's the problem it doesn't work equally in everyone, and one of the ways that you can figure out is this naltrexone going to work in this patient is you can get this rather sophisticated and expensive and not insurance covered pharmacogenomic testing to figure out is this a person who's going to respond to this medication? Or you can simply ask the person a simple question do you have a sweet tooth? Because people who have a sweet tooth are more likely to have a favorable reaction to naltrexone and that, to me, says everything, have a favorable reaction to naltrexone, and that, to me, says everything. Is that the reason that I love sweets is that I've got a certain kind of opioid system that not everybody has. And so, like my wife says, she says I don't really like sweet things and I'm like what? I don't get it. The words I understand the words. I see that they're linked in a sentence subject, verb, object but I don't understand how you can have that experience, because I have struggled with this my entire life, that and sleep, and I think that that's also somehow linked in there, and they're all sort of brought together by Kevin McCauley's unique balance of mu and kappa and delta opioid receptors and all of that.

Kevin:

And so when I, you know, overeat sugar, uh, that's my addiction. Uh, it's, it's, it's not as bad as alcohol, uh, but I need to be careful. And you've, you know, you've seen my goofy little. You know, periodic table, right, I won't talk about that right now, but the point I'm trying to make with that is that the drug that's most likely to kill me of all those intoxicants is not alcohol, and it's not opioids, and it's not fentanyl or meth and it's not nicotine, because I tried to become a smoker when I was. You know I'm a cocaine addict. I should be smoking that's what I said to myself in treatment and I'm sucking down Marlboro Reds and it's just not taking. But sugar, that is the drug that is most likely to kill me in the long run.

Kevin:

Sugar, the danger of that, the cardiovascular effects of having a high hemoglobin A1c all of these things are the remnants, sort of like the big bang, the echo that remains throughout the universe. That's what remains and that I still struggle with. And that, the powerlessness and unmanageability I can apply, that, uh, and I can become a little bit more conscious and I can have moments where I'm doing much better with sugar, but I, I, the general pattern is to fall back into that. You know, drinking a, a can of Coca-Cola uh every day.

Kevin:

I can remember sitting in the chow hall at the at the United States disciplinary barracks. I can remember sitting in the chow hall at the United States disciplinary barracks that's what they call the military prison at Fort Leavenworth thinking, shit, I got to stop cocaine. I love cocaine. I don't want to stop cocaine. Is it really that bad? I'm sure there's a way. Well, all right, fine, all right, I'll stop the cocaine, but at least I don't have to stop Coca-Cola, right? Because even in prison I can get Coca-Cola. I can go up to the little dispenser and get myself a nice couple glasses of Coca-Cola.

Kevin:

Well, guess what it turns out? That's a big part of the problem. That's a big part of the problem. And so I think that that's one way that addiction can play out is in that sort of cluster of attachment and opioids and alcohol and sleep and sugar and all of those things that go together for that particular kind of person with addiction. Another person might have one that clusters around other groups of behaviors and chemicals. But that I think is an important lesson, is that as we get sober from the big ones, we're kind of backing out one by one, dealing with these things. But ultimately, when I fall into one of those periods of the year where I'm eating a lot of sugar. That's my addiction, that's the remnants of it.

Kevin:

I will just give you a part two here and just open this door and express my bias. Is that since going on those GLP-1 medications, that is gone? And I cannot wrap my mind around how, all along, this was just the hormonal communication between this segment of my small intestine and my pancreas that it came down to this GLP-1 receptor. And I'm talking about these drugs. You've heard of them Manjuro, wagovi, ozempic, all of that. The race is on to find something that these damn things don't work on. But I've always wanted to be the kind of person, like my wife, who can have two bites of a dessert and say that's delicious and put the fork down. I can't even imagine what that might be like. But since going on those medications, now I'm that person about that. But I've gone from a person weighing 235 pounds to a person who weighs 185 pounds. I've got all these nice Italian suits in my closet that I can suddenly wear again. I have zero cocaine dreams, whereas before I'm not saying it was bad, but I would have one here and there, a handful a year.

Kevin:

Let's say and that's just that voice is quiet and I just I don't know what to say about that. There's so much to be absorbed there about what these medications can and cannot do. I will also say they are very depressogenic, and what I mean by that is it doesn't just take away your enthusiasm for alcohol or cocaine or sugar, it takes away all your enthusiasm. So there's always a price to be paid for that benefit. So I don't think that this is a cure by any means. But to get into a state of mind where I can say I'm not going to overeat today, I'm not going to eat too much, eat too much sugar today, to to be that person for the first time in my life, that's a real shock and I think we're going to we're going to have to learn a lot more. I don't think they'll ever be a cure, but they might. They might get a lot of people more in, people in the door, and that would be good yeah.

Brett:

So, so we've been. We've been playing around like this, uh, this, you know this place in our brains. For me, similarly, it feels similar. The sugar thing yeah, I'd love to bring cannabis to the conversation. I know it's late in the conversation, but we're we're in a time when, you know, the statistics show that the younger people are drinking less, but there's a lot of speculation that you know, cannabis use is going way up. Uh, right, and I, you know I've gotten questions many times from people Is it okay if I, if I you know, can I be California sober is is a commonly said thing. I'd love your, I'd love for you to, if you have time, kevin.

Kevin:

Yeah, it is not okay. It is still active addiction. There is no California sober. The risk of going back to the original drug is absolutely there. Even the people who kind of made that term popular have recognized that they can't be California sober.

Kevin:

There really is something called cannabis intoxication, a cannabis toxidrome. There really is something called cannabis withdrawal and there really is something called cannabis use disorder or, if you like, cannabis addiction. And so this is my new. I'm just going to you're not going to see this, but I'm going to put up here that I just recently had to write this lecture and I wanted to write the lecture. It's very interesting, but in doing like several months of research on cannabis and I can point you to some really, really good podcasts on this these are the 10 things that I learned about cannabis. We have gotten to the point now where more people are daily users of cannabis than our daily users of alcohol, users of cannabis than our daily users of alcohol, so those swapped and that is directly related to the increased access to extremely potent forms of cannabis. There really are things like cannabis withdrawal and cannabis use disorder.

Kevin:

You can become addicted to cannabis. There's more evidence than not that cannabis is a gateway drug into other addictions. That is a very, very problematic term but it will not go away. The idea that you can prime cocaine addiction with nicotine, that is solid science at this point that nicotine crimes cocaine addiction. That if I smoke a cigarette and then the next week if I use cocaine I'm much more likely to become addicted to it, that is settled science. That cannabis doubles the risk of first episode psychosis and of going on to develop schizophrenia. So people who are daily users or heavy users and heavy users is defined by 300 or more days per year Absolutely you are increasing your risk of psychosis. Cannabis is far more dangerous when it's combined with tobacco. So you know, vaping cannabis alone or eating an edible, that is harm reduction for cannabis. If you're a person who uses, you know who smokes a blunt, because when you there are a number of these different combos, when you put cannabis together with tobacco, they're toxic, the bad things go up. You know substantially, you know substantia Cannabis increases the risk of cardiovascular disease. So it absolutely is linked to more heart attacks, more strokes, because there are plenty of cannabinoid receptors on our vasculature and in our heart.

Kevin:

Medical cannabis laws and recreational cannabis laws increase the use of cannabis in general for that state, but they don't increase youth use, and that's a good thing, right? So passing even recreational cannabis laws has not seemed to increase youth use of cannabis. We'll have to see how that plays out, but young people are far smarter than we often give them credit to. Legalization was not associated with a decreased rate of opioid overdose. It did not affect that. So you can't say, oh well, bypassing these laws were decreasing the opioid problem. That has not been borne out. It was true from 2016 to 2011, I think. But then the numbers completely swapped around and there is no evidence that cannabis is effective for anything but pain, but chronic neuropathic pain, right, spasticity associated with multiple sclerosis and the nausea associated with chemotherapy, and also wasting disorder due to diseases like HIV, aids. But otherwise, cannabis for anxiety disorder no, it does the opposite increases the risk of anxiety disorder. So those are the things that I learned.

Kevin:

It's a fascinating area. There are cannabinoids. The cannabinoid system plugs into almost every other system in the body. So when a person you know vaporizes cannabis and inhales that you know, it's just astonishing the range of of you know effects that it will have. But we never really took the time to figure out how can this be used as a safe medication. We absolutely jumped ahead, even in Washington, and Washington has, I think, some of helped people who want to use cannabis recreationally in a safe way. Other states didn't do that and so, yes, it really will become, I think, more and more of a problem. There was ever enough harm in cannabis to be able to overcome the harm of the drug war? I think is a debate, and so by dismantling the drug war, even though we've legalized recreational cannabis, I don't think. I think in the long run we're better off. But now we need to address that and more physicians are able to do that, and that's, I think, a good thing. That's what I learned about cannabis in the last, uh, six months.

Brett:

It's a very fascinating area, just want to. I just want to say thank you so much for for meeting me. It's a big deal to me. Uh, it'll be, thank you. It'll be a cool thing for me to share with people that I've shared your content with. It's just really cool, man, and thank you for the work you do. Thank you and good luck sharing the message. Okay, all right, take care, my friend.

Kevin:

All right, have a great day Take care.

Brett:

Bye-bye, hope you enjoyed the conversation. I hope you'll subscribe to my channel. Whether you're listening on a podcast or on YouTube, or on YouTube, I'm going to continue to crank these things out and, yeah, I really. You know my why in all this is straightforward I'm trying to help some people, I'm trying to give voice to some voiceless, trying to give perspectives from the days of when I was fully addicted to alcohol and drugs and to be somebody that's now in long-term recovery and the way I think about it and the people that I Like to interview along the way. So thanks for checking it out, until next time.