Episode 24: Dr. Harrison on the Hello Someday Podcast

This is an I Heart Podcast. Guaranteed Human. What does recovery look like when it's not designed for you? I'm Dr. Zenga Harrison. And in season four of Unaddiction Podcast, we're featuring Black and Brown guests sharing their journeys through the unique barriers to recovery shaped by their identities. These guests have not only defined recovery on their terms, but they're also creating pathways and communities that can help you or a loved one find recovery too. This week, we're airing an interview between myself and Kasey McGuire-Davidson, host of Hello Someday, a podcast for sober curious women. I break down the learned and inherited risk factors that can lead to addiction, scripts for talking about substance use, and important definitions that impact the stigma that people with substance use disorders face. I hope you enjoy this conversation. And if you're a sober curious woman, definitely go check out Kasey's podcast. I also previously talked to Zenga in episode 133. It was an amazing conversation about what you need to know about the risk factors for alcohol use disorder. We're going to take that conversation further today and so much more. If you're listening to this podcast, I know you love podcasts. So in Zenga also has a podcast called Unaddiction that I will ask her all about. But in the meantime, welcome. I'm so glad you're here again. Thank you so much. And I can't believe that was episode 133, like how many since then, right? Oh my God. I am around 200 and, you know, it'll be around 233 by the time I've got. Oh my God. So incredible. I know. It's been crazy. It's been over four years now. Wow. I love it so much. That's so cool. Yeah. I do too. It's like my favorite part of the job. Well, so I love this book. I was telling you I've been reading through it and I've got all the notes on it. And just to start, tell me about why you wrote this book. Yeah. So you mentioned that I've been practicing medicine for 20 years. Then I have always been an addiction psychiatrist. Like my passion is people who are drinking or using other drugs or substances in a way that they're questioning. Is this how I want to be using this or do I think this is helping me the way it used to? Type of thing. And really kind of like being a supportive and powering doc to help people define what they want out of their lives and, you know, mark out a pathway for how to get there. And so I had a previous podcast. Thank you for mentioning unaddiction, which is the current podcast. It was called In Recovery with Dr. Harrison and Jen Keane was a listener and she reached out through my website and was like, I'm sure you already have a book agent. But if not, can we chat? And I was like, Oh, why would you be sure I have a book agent because I'm never, ever, ever, ever going to write a book? And then it's clear who won that, who won that argument, right? Two years later, Jen was like, you're obviously passionate about people with addiction or people who wonder if they have it or don't, you know, we don't have to use the word addiction just like one a different way. And she was like, this will get your message out. And that's all she had to say in the rest of history. Oh, that's fantastic. So getting the message out, that's something that I'm really passionate about too. And I love talking to people like you who are experts about it. So much to go through in this book. But one of the first things that I think will surprise people listening to this podcast, but everyone else as well as you talk about the 75% success rate in the context of the impact of long term treatment options for addiction. Can you tell me about that? Yeah, so I'll start with the name of the book is a word that we made up on addiction. And kind of how we came up with it was like, okay, what are the things we need to unlearn that we think we know about addiction that is like actually one wrong to not helpful? Two, what are the things, what are the stigma that we need to undo? That's like keeping people from getting support or keeping people from getting better. And then number three, what are the conversations we need to uncover? And that's like the tagline for the book's six mind changing conversations that could save a life. And so the first thing we have to unlearn is that people don't recover. Yes. Right. 75% of people who have struggled with a substance in whatever way considered themselves recovered or in recovery. And it's three out of four. That is more than one out of four. And one out of four is very important because one out of four is still too high. And if we can unlearn other things that we need to unlearn and undo stigma and talk about it, we can get that one to four even lower. But the medical literature tells us for any condition that we're dealing with. When you believe there is a chance for you to recover, there is a better chance for you to recover. And so we can't only talk about devastation and people who are dying and the people that don't recover. We have to talk about them, but we cannot only talk about them. Can we start from a place of hope and possibility? Yeah. And then figure out how we get there for our supplements for more people. I love that so much because a couple thoughts I had when you were talking about this. I remember being back in my office in my corporate job. And one of my friends who by the way loved wine as much as I did, you know, whatever it was was like hungover on Monday after some bunko game with her girlfriends was talking to me about the fact I don't drink and it kind of cracked me up. She was like, yeah, but you decided to stop. You didn't have a problem without call. Actually, I think she put it in the present tense. She was like, you don't have a problem with alcohol. And that cracked me up in a few ways. One because why was it so important to her to make sure I was in ex category versus why category? And be what I said to her, I was like, well, yes, I chose to stop, but alcohol is addictive. And you know, it is designed to take you down the path of becoming more dependent on it. But be in my mind, I'm eight and a half year sober now. I was like four years sober at the time. I was like, I haven't had a drink for four years. I have zero problem with alcohol and Craig Ferguson at one point said like, I can get one really quick. Right. But what I loved about that is in my mind, I'm like, you were hungover on Monday. I haven't had a thing to drink in ex number of years. Like it cracks me up that you're like, oh, but you don't have a pro like as if if I had, it would be a lifelong thing. Anyway, I just, I thought that was interesting because now I haven't had a drink in eight and a half years. And I don't consider myself to be struggling with alcohol at all. I just don't touch that. That's right. No, you know, I think it's, it's this, um, this human phenomenon of needing to protect ourselves from the scary. So you are colleagues working in the same job coming in on Monday morning, kind of with a life that is similar in that way. And so it's probably very scary for her to see you as a person who had a problem with alcohol because maybe that means I could also have a problem with alcohol. And this is getting to like undoing the stigma. Yeah. I think the concept that we have of people that quote have a problem with alcohol is homeless, drinking out of a paper bag has lost everything is begging for money on the street. And if you think about the whole spectrum of what, quote, a problem with alcohol means, it goes all the way from when I have a glass of wine, I wake up with a migraine, but I keep having a glass of wine all the way to that very severe that I just described. But we've made it so scary and so dangerous to say out loud like, I don't think alcohol is doing for me what I wanted to be doing. So I'm going to stop like, can we just make that easy? Yeah. I don't drink alcohol. That's awesome. Yeah. But it's like, you don't drink alcohol. Yes. There must be summer in. And I do not be like back in the day when I was fully immersed in like wine culture and varied to, you know, all of my friends drank and everything else. I seriously believed that the only people who didn't drink were like pregnant. Yeah. And I had an issue with addiction, AKA like they can't drink or were super bored. And now it cracked my head. I know so many people who don't drink who are in incredible, but it is interesting to me. The other thing I loved that you wrote, and I wanted to ask you about is, so we have this 75% success rate in terms of the context of long-term treatment for addiction and recovery. And I wanna dive into like all the every single word and piece at a part, but those are people who have sought treatment and help and support for addiction. Now, there are so many people in this world, including women who contact me every day, and there are already on the path to getting support and resources, but who really struggle with this every day and don't seek support, probably 'cause they see it as this futile, I'll never stop anyway. What's the point? My life will be over, it won't work. But also it is positioned as this life sentence of deprivation and isolation and, you know, otherness from everyone they know. So I wish that more people who struggled with addiction, drinking, whatever it is, would seek treatment because of 75% recover, that's pretty fucking awesome, right? I mean, you don't have to feel that way anymore. So true, so true. And these are the conversations that we have on the unaddiction podcasts. Like, what was the scariest thing for you about thinking about stopping or changing, right? Because I think that's also important is that the definition of recovery is not abstinence for everyone. For some people, the definition is for abstinence, for other people, the definition is different. But like, what was the scariest thing and what I hear over and over is like, I had no idea how was gonna have fun. If I stopped using X, yeah. I had no idea how was gonna socialize at work when that happens at happy hour in a bar. I had no idea how I was gonna go on a girls trip with my friends and not drink, right? Like, it is those things that are very, very, very important to us and culturally at least here in the US, definitely other countries as well. We see alcohol as a connector. And other drugs also act as a connector for people. And so, yes, I wish more people, I wish it was safer for more people to even say, I'm not even sure this is a problem, but I think it might be early intervention. Early, right? And you don't necessarily have to like sign up for the life sentence of committing to never drink another drop ever again. You might get to the point where you're like, you know what? I don't need to drink another drop ever again. But like, let's just start with making it safe for people to wonder, be curious. I wonder if I made a change when I feel differently in XX way that I want to feel differently. And then just try it. Just try it. And that doesn't have to be treatment for everybody. Sometimes, I mean, I talk about connection more than I talk about treatment. And so I think about this the same way I think about diabetes. The doctor tells you like, ah, you know diabetes runs in your family, your blood sugar's a little higher than I want it to be even though you don't have diabetes yet. Maybe go join the gym. The gym is not treatment, but it's a source of connection and changing a choice that can help prevent an illness from developing, right? Ah, you know, alcohol used to sort or run in your family. And I know you're only drinking two glasses of wine at night, but you're telling me your mood feels a little crunchy. Why don't we just try a month when you'll alcohol and see if your mood feels less crunchy? I wish we could just get to investing in people's curiosity and just trying different things that doesn't equal. You have to go see Dr. Harrison. She's an addiction specialist and she's gonna make you vow to never do X ever again in your life. Which is like diagnosed yourself with something or something. You don't have to get diagnosed. You don't need a label. All you need to know is you're like, I wonder. If you wonder, we have an opportunity. Yeah, I love that. And that's the reason that this podcast is called, you know, the Hello Someday podcast for sober, curious women because I love the whole sober, curious movement. I mean, it's everywhere, right? Like New York Times. Good morning, Marca. Everybody's talking about it. Yeah. But also the idea is that to make it more approachable, but also like try, try to eat like longer period of time, alcohol free. I recommend a hundred days. That's what I started with. And then like see, 'cause that way you'll see that you can socialize and you can go on vacation and you can watch TV and after a hard day of work, you can try a different coping mechanism. And like at the end of that time, you feel better. One, you know, I have a group of women who are all, you know, in the process of going alcohol free. And just the fact that, you know, one of them said, oh my God, I woke up with like a cold, the flu, a migraine, I didn't sleep. I can't believe I used to feel this way every day. I can't believe how shitty I felt. And like I'm having one day of it. And I'm just like, now I know what healthy feels like. - Yeah. I love that so, so, so much. And this is like, you said you recommend a hundred days, which I love a hundred days, because I didn't think I'd be able to go on the girls trip or live and all this kind of stuff. The book is called Six Mind Changing Conversations. And there are actually scripts in the book, like how to have this conversation. And one of them is like, okay, we're going on a girls trip. And either I'm choosing not to drink, or I have a friend who's drinking, I'm worried about, how do we talk about it before we go? Like what is your plan for when you find yourself in a situation you're in a hundred days not drinking? What's your plan for when you go out to dinner? - Yeah. - And the server has great intentions and has been instructed by their boss to offer everyone a drink. And you're gonna say no. - That's where they make their profit margin, right? I was at a business dinner, and it started out with drinks. And so the server came around. I was taking everybody's drink and everybody was ordering an alcohol drink. And that was back when I was still drinking, but me and my husband decided to stop drinking. It's been like a year now. - Oh my God. - Oh, good fun. - Yeah. - You the last time we talked, you were like, I don't drink a lot, but I do. - Yeah, I barely drink. And then I was like, why am I even spending money? - But a year, that's amazing. - Yeah, so he was actually the one. He was like, I'm gonna stop drinking. I was like, okay, I'll stop drinking. So we haven't drink for like a year. We're like totally into non-alcoholic cocktails. That's like my God, me too. - Oh my God. - I love non-alcoholic beer. That's my jam. - Ooh, I hate beer. So I love non-alcoholic beer for other people. But for like the book launch, we did a total non-alcoholic spread. So we had non-alcoholic Heineken, non-alcoholic Corona, non-alcoholic sparkling wine, which is like sparkling wine, which is my jam. So now non-alcoholic sparkling wine is my jam. I love it. I can't tell you else anyway. Before that, I was at this business dinner, everybody's ordering a drink. So I was gonna get a Prosecco. That's what I used to drink. But the person before me, so it's like 12 of us. We're on like person number seven. I'm like number eight. Six people order alcohol drink. Person number seven says, do you have anything non-alcoholic? - Yes. - It's like, damn. And the bar happened to have non-alcoholic cocktail. They're like, yeah, we can do a blah, blah, blah. And he was like, I'll take that. And I was like, I was planning on ordering a Prosecco, but I'm gonna go for the non-alcoholic drink. He just ordered. And do you know of the next five people, three people chose to do a non-alcoholic drink? And two other people changed their order. - They didn't. - From the alcoholic to non-alcoholic. Like, he just unwittingly. - Yep. - Made it okay when we were all whispering about, like, bringing this so people think I'm still drinking. - None of that. Just was like, do you have anything non-alcoholic? And I was like, I'm just seeing you role model, how I plan to be going for it. It was incredible. So back to sober curious is like, you, hello, someday podcast. All of the people in New York Times, all of the people on the web that are like, yeah, I just decided to stop drinking. You're making it safe for somebody else to say, I'm gonna try it. Like, I love it so much. - I mean, I love it too. And it's become such a thing with like dry January, dry July, like the younger generation not drinking as much. Like, there's a zero proof cocktail menu or a non-alcoholic beer that's actually good, that's not crap. - Right. - On almost every single menu. And I mean, when I quit drinking eight years ago, I actually tried for the first time 11 years ago, that was not a thing. - Yeah, it was not a thing. It was not a thing. And it's so good. I mean, I talk about the cultural pressures. - Yes. - Right. - I love that. - I love the face. And this is one of them. I mean, we basically, you and I are the same. - Same age. - We're gonna say. - We were just, talking about that. We're the same age and when we grew up I think we pretty much started getting programmed with just wait until you can get smashed when you turn when you get to high school in elementary school we're seeing that on TV right and so you just grow up with this concept that there is no life without alcohol and there's amazing life yeah without alcohol so many people there's amazing life with alcohol before a lot of people there's not amazing life with alcohol so how do we create space yeah and the way it works too from my experiences it starts very innocuous and it starts because of your culture and you know although the first time I got drunk I like blacked out and just jumped but that was I was doing that on purpose for some ridiculous I didn't want to black out but I wanted to get super drunk because you know opportunity but you know when I was growing up it was like there was a bottle of wine on dinner table every night because that's what adults drank my grandparents had like happy hour before dinner and we're going to talk about all the risk factors nobody in my immediate family meaning like parents grandparents sibling whatever struggles with alcohol I definitely did but you know the underlying stuff of like anxiety or you know you various things we're going to talk about but also when I went to college I joined the women's rugby team and I had a very big keg college culture and the rugby team was like a four year crash course on problematic binge drinking and blacking out and throwing up and like if that was like I was like oh this is what we do right that's where you talk about culture to everyone I knew binge drank you know all the time it was like the purpose of drinking was to get so drunk that anything could happen yeah and you know it it does skew the way your brain works you know it does it does and you mentioned nobody else in your family has struggled with alcohol I imagine someone else in your family has struggled with anxiety or depression or cigarettes or or suicidal thoughts or food addiction or work addiction right like all of these are running through the same pathways in our brains and so that you experienced anxiety yourself made you particularly vulnerable yes to that keg culture yeah right okay I want to dive into the conversations and the factors but the one thing I also wanted to ask when we talk about that 75% recovery rate is everyone talks about relapse and I absolutely love that you talk about that relapse is not a part of the it oh my god that's right in that percent of people with substance use disorder recover and return to use in the first couple months in the first year where's the tipping point can you like teach us all of that stuff holdily 100% so I'm gonna go a little medical here and what I want people to know about the book is yes I'm a doctor this is not a textbook I wrote so good it'll like a conversation or at least that was my goal right but I'm gonna get a little textbook you doctorate or for just a minute facts right that's what you talk about versus reality totally and so in medicine when we talk about chronic conditions we talk about relapse and remission when you get diagnosed that is because you meet diagnostic criteria for fill in the blank diabetes high blood pressure alcohol use disorder if we're talking about alcohol addiction when you go into remission that means your symptoms have come down below the threshold that meets diagnostic criteria for active illness when you have a relapse that means symptoms of the illness have come back above that threshold we talk about like that person relapsed people do not relapse illnesses relapse we talk about you had one drink that's a relapse one drink does not meet diagnostic criteria that is not a relapse right and so what is so critically important when people say relapse is part of the disease I hate it throw it in the trash what is that because that like plants that seat when you talk about planting the seed like there's no other totally and you're just like like it's inevitable yeah like it's inevitable that would be like if I diagnosed you with breast cancer and I said I'm diagnosing you with breast cancer we're gonna do everything we can do to get you in remission 75 percent chance that you're gonna recover but relapse is part of the disease I just told you like no matter what you do cancer is coming back that is awful and it's not even true right it's not even true okay so what we have to say instead is you know what I'm really concerned about your alcohol use it meets diagnostic criteria for alcohol use disorder mild moderate or severe right you have 75 percent chance of recovery from this illness and based on my medical knowledge these are the things we can do to give you the best chance to be in that 75 percent now there is a chance of relapse with this illness and what relapse means is these are the diagnostic criteria and the risk factors that drive your risk for relapse are xxxxxxxxx so we're gonna make a plan for xxxxxxx so that hopefully relapse does not become part of your illness process yeah that's the way to have the conversation yeah absolutely and so let's first talk about what are the things that will save stop drinking yeah say that previously you met the diagnostic criteria or you didn't or you did it's like fuck that right but like you stop drinking your intention is to not go back to it because you feel like shit and it took up all your thoughts and whatever it is what are the things that you would do to make sure that you're in that 75 percent the first thing is understanding your risk right and so this book is divided into six chapters and each one of the chapters is is dedicated to a certain type of risk so you can think of this framework in the first bucket for any chronic condition there are biological reasons why you develop it there are psychological reasons why you develop it there are environmental reasons and the environment splits into two that's the cultural environment as well as the physical environment you're born into a biological set of risk factors that's your DNA right so people don't know 40 to 60 percent of your risk of developing addiction is coded in your DNA the day you're born this is higher than the whole of the family history or because people in your family have also had those biological things like it's is it passed down or you happen to have similar okay it is DNA that is passed down to you just like DNA for high blood pressure is passed down to you DNA for cholesterol is passed down to you okay so 40 to 60 percent of your risk for developing an addiction coded in your DNA higher than diabetes higher than asthma higher than high blood pressure okay yeah born with it but that means 60 to 40 percent because we add up to 100 is psychological and environmental you are also born into early childhood experiences psychological risk factors you are also born into a cultural and physical environment so I call that inherited biological risk factors that's your DNA inherited psychological risk factors that's your childhood inherited environmental risk factors that's the culture and physical environment you grow up in that's one two three repeat those three again as you become an adolescent young adult older adult whatever's in the middle just adult I think me and you right now are just adults right yeah when you grow into that you start to acquire things things start to happen to you in life that can also be risk factors so biologically maybe you get a car accident and break a bunch of bones that's a biological risk factor maybe a doctor writes you a prescription for opioids that's a biological risk factor for people who are alcohol so curious maybe a doctor writes you a prescription for Xanax yeah and Xanax's alcohol and pill form works on the exact same receptor in the brain right that's a biological risk factor psychologically you develop the stress of racism the stress of discrimination the stress of gender discrimination the stress of being the only woman in the workplace the stress of being the only mom who's not a stay at home mom or the only mom who is a stay at home mom in your high needs kids or high needs kids are divorced right whatever relationship abusive relationships all of those things environmentally cultural environment you go to a school and join the rugby team and it's the keg culture physical environment you live in a place where all your knees are not being met, right? And so that biological psychological environmental repeats again. These are the six buckets. So your question was, how do you know what to look for? First is knowing what you have in each bucket. So inherited biological, do your addiction family tree have the conversations? There's a script in the book to help you have the conversation. There it is psychological, your ACEs, adverse childhood experiences. Know what they are, put a plan in place to start dealing with the impact they are still having on you. Can you give just a couple of examples of ACEs in case someone doesn't know what those are? Hold a lean. Also, you can Google ACEs, adverse childhood experiences, and you'll find it. I do not recommend that you just Google it and take it without having a support system in place for yourself. And the book goes through this, but ACEs are, for example, did you experience emotional abuse as a child? Did you experience physical abuse as a child? Did you have a parent who had a mental health condition or addiction? Did you have a parent who left the house because of divorce? Did you have a parent who was incarcerated? Right? And so there are 10. There are 10 questions, and if you get a one for every yes question, if you have a score or four higher, your risk for developing all sorts of chronic conditions and adulthood, including addiction, premature birth, obesity, cigarette smoking, premature, I mean, asthma, HIV cancer, like literally all kinds of things are associated with this. My ACEs score is five. My inherited biological risk is probably closer to that 60% because I have addiction both on my mom's side and on my dad's side to different substances, right? That allows me to understand my risk, but also allows me to start having a conversation with my kids about their risk. And then same thing, biological psychological environmental when you grow up. So Casey, what is your biological risk? If you've decided you don't want to drink again, then I need to look at how much biological risk we have because that means I have to do even more with your environment to try to undermine that risk. What's your ACEs score? We need to address all those experiences that you have. What environment are you currently in? What are the people, places, emotions, physical sensations? How are you going to talk to your friends? What are you going to say at work when your boss says, come to happy hour, right? We have to make a plan for all those risk factors to increase the chance that you're in the 75%. Yeah. Yeah. That was the longest answer ever. No, I love it. It's so important. And that last piece other than the hope and the curiosity is a lot of the work that I do is, okay, you want to stop drinking, but you keep going back to it. What is your home environment like? What conversations have you had? How can you have them without it being scary or getting pushed back? How do you go to dinner with your spouse? What do you say at happier? How do you go on a business trip? All of those things, because for me, it was one, the fear that life would suck. And everything that goes, how will I relax? How will I have fun? But it's my favorite thing in the world. But it's my only reward. I'm not going to get it, but then how literally, how do I go on a double day with another couple to celebrate something and tell them I'm not drinking or not dive over the table and like, grab the one drink. Right. Yeah. And just that block and tackling in a really practical way is like another step that is, you have to do. You know? You have to do it. And we literally go through scenarios in the book for how to do this. And what I say is, do you know why a race car driver can take that curve at 200 miles per hour? It's because they've practiced. Yeah. You know why they can safely get out of a crash? It's because they've been in a simulator. Why Captain Sully could land that plane on the Hudson River? It's because he had practiced, right? And so you don't want to be in a situation and have to figure it out. You conjure up those situations in your brain in advance and you practice, okay, this is what I'm going to do if this is what I'm going to do if. And then you also practice, if I find myself in a situation that I haven't practiced, this is my go to. Yeah. That I'm going to do. And the more you do those reps, it gets easier and easier and easier to say. I'm not drinking and people are like, what? And you're like, oh, you think that's weird? I'm getting the best sleep I was ever getting when I was drinking. Yes. Yeah. I love that. You already have your one line or cute up, right? Mm-hmm. Oh, yeah. And you know what you're going to order and you've told someone in advance, you're not drinking and you ask someone with you for support. That's right. All the things. All the things. So you talk about the 75% success rate, which by the way, I'm just going to keep saying some people over and over, over and over times before we finish. Yes. But you talk about it in the context of the impact of long term treatment for addiction. And obviously that doesn't only mean inpatient rehab, right? So tell me what the different factors are in terms of what you think of when you think of long term treatment for it. Because for some people, that's scary, right? Yes. I think I'm going to have 10, 12 step meetings for the rest of my life, right? And talk about what a horrible person I am, but also surround myself with people who are not drinking and label myself. So what are the sort of tears or options or any of that? Yeah. So I want to think broader, I want the word treatment to people to mean like your broader action plan. And so I'm going to talk about diabetes because I always do, because I think it's easy for people to grasp. And by the way, there's no stigma about that. And there's no stigma. That's exactly why I talk about it. It's just like nobody's like, oh my God. You have it. It's just a condition you treat. It's like an addiction. I take medication for anxiety and I also try to work out. And I also totally, all the things, right? Totally, right? And so what if we thought the treatment for diabetes for a person that had diabetes so severe, their blood sugar got so high they went into a coma. They had it going to ICU. They went in the ICU for five days and we were like, all right, that's it. That's kind of like the concept of detox. Like that's it. No. If we just get them out of the coma and send them right back out to the exact same set of circumstances with no medication, no support, no understanding of the illness, they're going to be back in a coma, right? What if we said, okay, we got you out of the coma. We took you out of ICU, we put you on the inpatient floor for a week, got your blood sugar totally normal. Then we discharged you. Good luck living with diabetes, nothing else, right? Diabetes is coming back. What if we said for the rest of your life every single day, you have to come to the doctor and get an insulin shot? That would be like diabetes is coming back because nobody can come back to the doctor every single day. Yeah, to not how we think about it, we think about it like you go in, you get stabilized, you come out, you get connected to some doctor that you can meet with in the beginning, frequently, until you figure out what's going on. And then as you stabilize and figure it out, you know what your warning signs are for when you need to get back. That's the way I want people to think about this. So, so curious, try it. Stop drinking. Whoa, felt the best you ever felt in your life. Make the decision. I'm not going to go back to drinking either at all or definitely not to the level where I was drinking before. Get your support in place. Get your medication if you need it. Get your therapy to dress those adverse childhood experiences. Get your stress, your support system to get those stressors down, get a new job, find a new spouse, whatever, whatever you have to do, right? So all of those things know what your early warning signs are. I am doing great. I don't need to see you every month. I'll see you every two months. I don't need to see you every two months. I'll see you every three months. I don't need to schedule a little appointment with you, but if I notice XXX and X, I'll reach out to you. And so that's what I mean by long term treatment. The same way you have your primary care doctor. You should have your person, whatever role that is that you know your early warning signs. They know your early warning signs. You can get in with them before your symptoms cross that threshold to your whole are relapse. Now I love that. And that is so true in my experience, not just for myself, but for so many of my coaching clients. And I stopped drinking. I had an online group that everybody was sort of on the path to not drinking. So helpful. A lot of people were three and four years on who were. giving support and encouragement and tips. And I had a sober coach that I worked with. I emailed her like every single day. We had phone calls every once in a while. And then when I was 60 days, so where I joined hip sobriety school, which was like this online core slash group slash whatever, with Holly Whitaker who wrote, like a woman, yeah, today. And so that was reinforcement. And then I started seeing a therapist once a week. And I got on some medication for anxiety or mood disorder. And like that was my first year. And it wasn't a like a horrible thing. It was like, oh my god, I'm finally getting healthy. I'm finally not waking up with a hangover, hating myself, feeling strung out with anxiety, craving alcohol, worrying about it. Like this was I worked out, you know, all the things. And then after a year, I didn't need to see my therapist anymore. And after, you know, I after a year, I stopped emailing my coach five days a week, but I had also everybody knew I didn't drink. It had become part of my identity. Yep. I felt good about myself. I had my sober friends, like good, good friends. And I also stayed in touch with my group. I knew that if I felt really anxious or panicked or whatever, I needed to like deal with it right away. You know, like, and trust me in eight years, I've gone back to my therapist who knows that I don't drink. And I keep myself in a good mental health place so that I don't go back to drinking or something else, right? But I don't I haven't seen my therapist in two years because I'm good. That's right. That's right. And you know, so I love so much. We talk about this in the book, The Magic Formula. And I say, what I love about the Magic Formula is that it's not magic. It is just your collection of things that keep you healthy as you are defining healthy. And I love that journey you just share with us, Casey, because that collection of things has to change over time because your life is changing over time. And the idea is like match your Magic Formula to what's happening for you right now. And so I would say people think of treatment and they're like, oh God, I got to be an AA everyday for the rest of my life. I'm going to be in a halfway house or I got to live in residential treatment. I would wager to say, Casey, that part of your treatment is this Hello, Someday podcast. Oh God, yes. I mean, one of your early warning signs would be like, if you could not bring yourself for I'm just going to say three weeks is probably shorter to not make this podcast. You would be like, this is a warning sign and I need to bring in supports. Yeah. Yeah. I mean, I tell people that all the time they were like, do you think it would be easier for you to go back to drinking if you weren't talking to people every day in a group that you're running doing the podcast. And I'm like, hell yes, because first of all, helping people in early sobriety reminds me how much it sucks. Like how much drinking is not what we see on TV and you talk about that too. It's like lamerized it is and how harmless it is and all those stuff. But like also, I get free therapy. Like I'm talking to you. I talk to other people. I reach out to people about the shit that I need. Like I'm like, okay, talk to me about marriage. Talk to me about like perfectionism. Talk to me about the pastor syndrome. But like that's the ongoing work and it's great. It makes me happy. Okay. I'm going to ask you a totally off topic question because I'm just curious and we're going to go back to it. So this is going to sound so stupid that I just want to know. So I went to my doctor recently, right? And I looked through, you know, they give you the report on all your numbers and blah, blah, blah, blah, and on there, I forget what there was, but it was like anxiety blah, blah, blah, blah, blah, and then they said alcohol use disorder severe. And maybe they said in remission, I don't even remember, but I read that. And I was like, can I get that downgraded? I was kind of pissed. That was there. Because I was like, dude, do you know how many of your clients, patients drink a fuck load? I haven't had a drink in eight and a half years. Why the shit on my chart? Is that terrible? Is your reaction terrible? Is it terrible that you're that it's in your chart? Your reaction is not. I'm wondering about my reaction. I actually told my my girlfriends. Yes, over. I'm like, first, why does this bother me? Because the anxiety thing doesn't bother me. So like, clearly, that although I still struggle with anxiety and I don't struggle without honey more. But B, I was like, it's inaccurate. Well, yeah, it seemed to me to be a crescent tense. Yeah. Thank you. It's it's it is legitimately an inaccurate diagnosis. Okay, tell me about that. Because I seriously was like, I want to go back to my doctor and be like, I'd like you to change that. You can. And I'll I'll give you exactly what you can ask them to change. Please. Okay, what is what tell us inaccurate? Yeah, it's inaccurate because we diagnose alcohol use disorder mild moderate severe in early remission or in sustained remission. Okay. Those are five mutually exclusive diagnosis. So we have 10 diagnostic criteria for alcohol use disorder. If you only meet one, you do not have alcohol use disorder. You have risky alcohol use. We should be trying to prevent you from transitioning. If you have two to three of those 10 criteria, you have alcohol use disorder mild. If you have four to five, you have moderate. If you have six plus, you have severe. If you have not met diagnostic criteria for three months, you have alcohol use disorder in early remission. If you have not met diagnostic criteria and remember, this is not just taking a drink. This is meeting. Yeah, those 10 diagnostic criteria for 12 months, you have alcohol use disorder in full sustained remission. And so what happens, this is like everybody's chart that I always ever see. You come in eight years ago, you have alcohol use disorder severe. You get three months, nobody updates the diagnosis to early. Right. You get a year, nobody updates the diagnosis to full sustained remission. And he's correct to keep that alcohol use disorder diagnosis on your chart because we should be practicing prevention right now. Right. Like I know if your anxiety is not controlled, that's giving me risk. I know if your blood sugar goes low, that's giving me risk, that's kind of stuff. But it should update it to alcohol use disorder in full sustained remission. I think your reaction, part of it feels like undermining all the hard work you've done for eight years, which is true. Second, it's communicating something about you diagnostically. That's not true. That never feels good. Third, I think about it like cancer. If you had cancer and then your cancer went into remission, when you read your chart, you want to be reminded that your cancer is in remission. Yeah. So I'm totally validating your reaction and when you can go back to the doctor and say, so I'm actually going to give you the code. Okay. You did it because alcohol use disorder, ICD 10, we use numbers to give the code is 10.2. That's what your doctor currently has in your chart. Okay. And your doctor just needs to choose 10.2.1. This is all right. Disorder in remission. All right. I am totally going to do that the next time. Yeah. And have a conversation about why it matters. Like I'm eight years not drinking. It's important to communicate that. Yeah. Totally. I'm with you. All right. I love it. Okay. See? I'm glad I asked. I get all the good information. So I loved, I have to tell you, when I read the title of your book, six mind-changing conversations that could save a life. I thought it was going to be like I've seen in some other books like a, you know, like a compilation of a client's story, right? Like, okay, this is, you know, Sophie and she XYZ and you know what I mean? Because I've seen that before. And I love those two. But what I loved about this was it was like scripts for conversations you can have. Not only about yourself, not only about how people can support you, but like how do you bring it up with your kids? How do you have the, if they are like so good, like elementary school, middle school, higher? I mean, tell us what the conversations are. So people can kind of dive in because this is the practical shit that people need. That's right. That's right. I tried to write a super practical book that everybody could see themselves in, whether they feel like addiction has never been part of their lives, somebody else's life, whether they're curious, this sort of thing. So the first, the conversations follow that framework that I told you inherited biological psychological environmental and acquired. So in inherited biological, it's how to have the conversation with your family about how addiction has affected our family and it helps you in making that addiction tree. And that's not easy, right? Like a lot of families, this is a taboo subject that nobody is gonna bring up. And so like, how do you have that conversation with your family about what our risk is, DNA-wise, as a family? Inherited psychological is how do you have one, understand your own ACIS score, adverse childhood experiences? How do you have that conversation with someone to support you in thinking about all those harmful experiences that you had as a child and how they are still affecting you today? Inherited environmental is how do you have the conversation around how the culture you grew up in and the physical environment you grew up in is still affecting your choices today. - Yeah. - Effecting your life experience today. And then when you come into acquired biological, you had an injury or developed an illness or a doctor wrote a prescription. How do you have a conversation with your doctor about your risk for addiction and the risk of the prescription they're writing you and how you put a safety plan around that prescription? - Yeah. - Inherited psychological is about positive childhood experiences, which nobody ever talks about, but which totally like negate adverse childhood experiences. And so it's like, how do you have one, how do you have the conversation with yourself to understand your own emotions? And then how do you talk about those and have conversations with friends? And then also how do you talk about the discrimination you've experienced and how that drive your risk and then inherited environmental is how do you have the conversation about what my physical environment is today and how and why I need to change that. And so it just go, oh, I'm sorry, I think I didn't mention the script with your kids, which you mentioned, which is every single age. Like I started talking to my kids when they were three. And now they know how to talk about addiction with their friends. - Oh my gosh, like my kids totally know 'cause my son was eight when I quit and my daughter was two. And of course in the beginning, I didn't talk about a ton of stuff with them. I was just like, yeah, I haven't had a, I don't, my son of course, I had a bad day. He's eight, you know, he was like, oh mom, want me to get you a glass of wine? I would like fuck. But they know, right? That's mom, I mean, I can't tell you how many women have said that the kids go in and tell me about your mom and like what's her favorite drink? And it's like gin and tonic and they're right. But you know, knew that. And then of course, because when I had gone further, like my son and my husband got me for my thousand days, I'll call free, I still have it in my office, right behind me. They got me a big glass jar and put 1000, like little marbles in it. And it just made me so happy and just proud. - I love it. - It was amazing. It makes me a take every year on my sober birthday with like, I remember they did the number five with all strawberries and blueberries. - And incredible. - So they're pretty great. But like I've had my daughter on my podcast when she was nine talking about like how we talk about alcohol what she knows about it. And you know, so I love that you did that because so many women, they're like, what do I say? In a way that's helpful and they understand, but not like, oh my God, Bob was a drunk or whatever it is. 'Cause you know, it's not that. It's mom decided not to drink and that's super awesome. And that is super awesome, right? And it's super awesome. And you also can make the decision not to drink if you choose to make that decision at some point. - Yeah. - You have a role model that you've seen lives an amazing life that way, right? So people often talk about addiction as a family illness on community illness, which is absolutely true. So is recovery. Like when you think about those positive childhood experiences and what we talk about in the book is that all of these work as adults also. So even if you didn't have them as a child, you can put them in place as an adult. Part of that is were you able to talk about your emotions? - Yep. - Did you have community traditions? Did you have somebody you knew would stand up for you? And so like your husband and your son giving you a jar of a thousand marbles on the thousand day, you already know when you go to a restaurant and the service says, can I get you a drink? And you're like, I don't drink. And they're like, what? Your husband and your son are gonna be like, listen. - Yeah. - Right? Yeah. They're just like, yeah, no, my husband still drinks, you know? And it's not a thing, but he's super proud of me for not drinking. - I love it so much. - In the beginning, he didn't want me to stop drinking, right? He wanted me not to like pass out on the couch. (laughing) You know, it was like part of our thing, but like that's the evolution that you go through and you have a new normal and the new normal is great 'cause mom never passes out on the couch and dad can't wake her up and she's not hungover and pissed off and whatever it is, right? - Right, right. - Yeah, that's awesome. - All right, I love this so much. You go through like the coping mechanisms and mental health and policy and personal, like all the good stuff that you need to know. - I just, have we not touched on any misconceptions or myths that you've addressed in your book? Like I just want to be like, we're not gonna go through them all, but here's the things you think you know that are not true. - The things you think you know that are not true, one, people don't get better. - Because 75% of people recover, we said we're gonna keep saying it. Two, it's everybody else. It's all of us. - Yeah. - Three, you have to be drunk in the gutter. - Yeah. - Or to be a problem. There is, I would love to talk about the cage question. - Yeah, do that with just a second. - Please, please. - So what I'm really, really, really advocating for the same way for breast cancer, we want everybody to do their monthly breast exam because the earlier you catch a lump, the better chance we have for sustained remission, no relapse. The same is true, so I tell people, if you ask yourself either about yourself or about somebody you care about, should I be worried the answer is yes. - Yeah. - It doesn't mean you have a diagnosis. I don't care if you get a diagnosis or not, but if you say, should I, the answer is yes. And so here's a scale that I can give you as called the cage. See, have you ever thought you should cut back? If yes, give yourself one point. Hey, have you ever been annoyed when somebody else mentioned you're drinking to you? Give yourself a point. Have you ever felt guilty because drinking prevented you from doing something you plan to do or you said, I'm not gonna drink today and you still drunk. Like, have you ever felt guilty over alcohol? And E is for eye opener. Have you ever needed to drink first thing in the morning or thought about drinking? Like, it's the first thing on your mind when you wake up. Those four questions are called the cage. If you answer yes to one of those questions, there is 77% chance that you have an alcohol use disorder, whether that's mild, moderate or severe. Even the 23% that don't have an alcohol use disorder have an opportunity to not develop an alcohol use disorder. So ask yourself those questions. And this is the other myth that I wanna bust is that it's dangerous to ask for support. It's not dangerous to ask for support. It's dangerous not to ask for support. There are so many ways. So if you're thinking to yourself, I wonder, give yourself the cage or take the cage on behalf of somebody you're concerned about and ask for support. It is the safest way. Don't ignore the lump. Don't, don't. And you know, there are different ways to get support and we can talk about all that and I've talked about it in previous episodes, but it doesn't mean you have to make a huge declaration. - That's right. - To anyone. There is support available. That is, you know, completely private, completely confidential, whatever it is. - Totally. - Yeah, I was the first three out of those four. - Yeah. - And like drink first thing in the morning. - No, unless you go out to brunch. - Right. - I love how we like switch what we do. - Yeah, exactly. I mean, a mimosa, bloody berry. Like that's just totally, brunch straight, right? - Totally. I mean, I was on the plane the other day because I think I'm on a plane every other day. But I was on a plane the other day and I was on a six a.m. flight and we were leaving on time. So it was five, 40. 5 a.m. And the flight attendant came around and said, "Can I get you anything to drink before we take off?" And this person said, "I'll take a red wine at 5.45 a.m. and I don't jump in strangers' businesses that are seated across the aisle from me." But I thought to myself, "Man, I wish it was safe for me to jump across the aisle and just say, I'm just saying if you need any support here or some ways, like if you're worried about yourself." Yeah. Because at 5.45 a.m. that's an eye opener. Yeah, yeah, totally. And I always say to people because they're like, "Oh my God, all my friends drink, but like nobody else is worried about it." blah, blah, blah. And I was like, "Dude, anyone who is drinking with you the way you're drinking, they wake up at 3 a.m. worried about their alcohol consumption. There is zero chance." Like it just doesn't happen. You guys are just not talking about it. Yeah. We want to make it safe to have the conversation. Yeah. Yeah. Okay. One thing we talked about before we jumped on here. And I know I got to let you go is we both said that we don't love the term alcoholic. Can you tell me why? Yeah. I hate the term "ick" for anything. So I hate diabetic. I hate schizophrenia. I hate alcoholic. I hate asthmatic. And the reason is because that is not who you are. You are not an alcoholic. You may be a person that struggles with alcohol use. You may be a person that has a diagnosis of alcohol use disorder. You may be a person that just doesn't want to drink. But the struggle you have with alcohol will never ever be the most important thing about you. It will never ever be the thing that defines you. It's one thing that you're going through. And so I just always start with the person first to remind us that first and foremost, you are a person. And then second, we can use words to say what your current life experience is. But don't take on that definition. Yeah. Yeah. And don't force that definition on somebody else. On anybody else, like people use it so casually. They'd be like, "Hey, oh my god, her dad was such an alcoholic." And I'm like, "I hate it." Also pisses me out, well, mostly, unless they are in a 12 step program and they self-identifying that is fantastic, whatever helps you. But like, especially for people who have never struggled with addiction when they are casually labeling somebody else. And I'm just like, "WTF, like in 100% STFU." How about that? Yes. Yes. Yes. I believe I have like occasionally said that in a much nicer way. Be like, "Dude, uncool." You can't go like, "So uncool." And you don't know what the fuck your target is. Yeah. So uncool. Yeah. Okay. One more last one. It's like rapid fire. When the hell are the medical directives information going to change? I mean, I know there's huge lobbying stuff. But like, the American Cancer Society finally said what three, four years ago that no amount of alcohol is zero risk factor for cancer, which they had known for fucking ever. But like, Ireland is putting labels on every single wine bottle and beer bottle saying like, "Alcohol causes liver, you know, severe liver disease, alcohol causes cancer." Same way as tobacco. US? I'm not hearing shit. Yeah. It's two things. So one, I forget what the statistic is, but something like, it takes 22 years for medical practice to change, which is crazy. So we're in the midst of it, but it's very slow to money talks. Yeah. And alcohol lobby is so rich and it is so ingrained in our culture, which I talk about in the book. And that's the reason why it's so slow. But listen, young people are the future. Young people are like totally our hope because they're like, "Is cool to not drink?" Yeah. And drinking, you know, and so it will come, but it is going to be so slow. So that's why we can't depend on the external forces. We have to start with these conversations just like this. Yeah. And this book and just let it broadcast into people's individual minds. Yeah. It is so slow. All right. I love talking to you. I love your book. It's called Unaddiction. You guys should totally pick it up. Your podcast is called Unaddiction. And tell us where else people should look for you, find you, anything. Yeah. So you can find me on Instagram, Facebook, formerly known as Twitter now called X Threads, LinkedIn at Nzinga MD or in Zenga Harrison MD. I co-founded this company Eleanor Health, which I'm so proud of. So please check out EleanorHealth.com. And then the book is in print, audio, and digital everywhere in stores online. Do you read the audio? I read the audio. I love it when the author has had to audition. I have to audition to narrow the audio. But I like, you're like, I'm a fucking podcaster. I could do this. And it was so, it was awesome. I had, I had so much fun narrating the book. But yeah. So if you want to hear more of this voice, get the audible. Perfect. Thank you so much. Thank you, Casey. Thank you so much for tuning in. And if you like this episode, please check out my book Unaddiction. Six mind changing conversations that could save a life available at Barnes & Noble, bookshop.org, union scoring company, Amazon, and wherever books are sold. We want to hear from you. If you identify as Black or Brown and have a recovery story to share, something you've learned, a stigma that you've undone or a conversation that you've had about addiction, send us a voicemail at speakpipe.com/uapod. That's speakpipe.com/uapod. This is an iHeart podcast. Guaranteed Human.