How do we best tap into the positive side of recovery, beyond abstinence, sobriety, and remission? What does the science actually show about growing and changing in life after addiction?

There is perhaps no one better equipped to answer those questions than my guest on today’s episode of the Flourishing After Addiction podcast: Dr. John Kelly, Harvard Medical School’s Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine, and founder and Director of the Recovery Research Institute at the Massachusetts General Hospital. John is a pivotal figure in the world of this research, studying not just what goes wrong and how to stop addictive behavior, but also how people find their pathways and thrive in recovery. 

In this episode, we talk about the “active ingredients” or “mechanisms” for recovery, what drives people’s trajectories in recovery, what the research shows about how long it takes to make significant change once someone starts making an effort, and what all this research shows about how to best care for people with addiction and what we must improve in our current treatment system. We also talk a bit about his research on Alcoholics Anonymous and what that shows about the active elements of recovery.

John Kelly, Ph.D., is the Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School - the first endowed professor in addiction medicine at Harvard. He is also the Founder and Director of the Recovery Research Institute at the Massachusetts General Hospital (MGH), the Associate Director of the Center for Addiction Medicine (CAM) at MGH, and the Program Director of the Addiction Recovery Management Service (ARMS). Dr. Kelly is a former President of the American Psychological Association's (APA) Society of Addiction Psychology, and is a Fellow of the APA and a Diplomate of the American Board of Professional Psychology. He has served as a consultant to U.S. federal agencies and non-federal institutions, as well as foreign governments and the United Nations. Dr. Kelly has published over 200 peer-reviewed articles, reviews, chapters, and books in the field of addiction medicine, and was an author on the U.S. Surgeon General's Report on Alcohol, Drugs, and Health. His clinical and research work has focused on addiction treatment and the recovery process, mechanisms of behavior change, and reducing stigma and discrimination among individuals suffering from addiction. For more on John and his work, go to https://www.recoveryanswers.org.

In this episode:
 - A nice blog post by John about the many pathways to recovery.
- "A biaxial formulation of the recovery construct", with remission/abstinence/sobriety on one axis, and the positive consequences of recovery on the other.
- The 2020 Cochrane Review on Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder. A summary of that work here.
- many more briefs of research studies available here.

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A lot of us folks in recovery have big collections of self-help and memoir books, and with good reason. Books give us solace, they help us see how other people deal with similar challenges, they are a source of community through contact with other minds, and, as articulated by Eva Hagberg, this week’s guest on the Flourishing After Addiction podcast, books, and particularly memoirs, are a way of trying on different “moral selves.”

Eva is an author who has written beautifully about her own addiction and recovery in her  memoir, How to be Loved. It’s an honest and raw account that includes her experiences with chronic medical conditions, grief, loss, romances, and friendship. In this episode, we talk about being seen and wanting to be known, the creative process, what she has learned from memoirs—addiction and otherwise—and her own experience with different varieties of 12-step recovery. And, with my own book coming out soon, she gives me some great advice about focusing on what matters most.

Eva Hagberg is an author, cultural and architectural historian, architecture critic, speaker, and more. Her critically-acclaimed memoir, How to Be Loved, is out now from Mariner Books. In a fun twist, we also talk about an unexpected set of connections between recovery and architecture, related to her next project: a biography of Aline Louchheim Saarinen, forthcoming from Princeton University Press.  She teaches at Columbia University in the Graduate School of Architecture, Planning, and Preservation, and at Bard College in the Language & Thinking Program. She lives in Brooklyn. Find her at her website, or on Twitter.

In this episode:
- Ira Glass on the “taste gap:” “Nobody tells people who are beginners — and I really wish somebody had told this to me — is that all of us who do creative work … we get into it because we have good taste. But it’s like there’s a gap, that for the first couple years that you’re making stuff, what you’re making isn’t so good, OK? It’s not that great. It’s really not that great. It’s trying to be good, it has ambition to be good, but it’s not quite that good. But your taste — the thing that got you into the game — your taste is still killer, and your taste is good enough that you can tell that what you’re making is kind of a disappointment to you”
- Melissa Febos, author of Whip Smart, Girlhood, Abandon Me, and Body Work.
- A Round-Heeled Woman: My Late-Life Adventures in Sex and Romance, by Jane Juska
- Dani Shapiro, author of Slow Motion, Devotion, Inheritance, and other books.
- The sociologist Robin Room analyzing codependency and Adult Children of Alcoholics, in the context of other 12-step thinking: Alcoholics Anonymous as a Social Movement
- Erving Goffman, The Presentation of Self in Everyday Life
- Someday This Pain Will Be Useful to You, by Peter Cameron

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As Ram Dass once said, “If you think you’re enlightened, go spend a week with your family.” I’m thinking about this quote as many of us are grappling with the Omicron variant and trying to make the most of this winter break. This time of year can be hard for everyone, and I’m also thinking about all of us in recovery who have difficult family histories, for whom the holiday season might bring up difficult or outright traumatic memories. During this challenging time, I wanted to have an episode that was hopeful and full of practical teachings about both meditative and recovery practices. So I’m very grateful that I had the chance to sit down with Gary Sanders.

Gary is a Buddhist teacher, person in recovery, and a joyful and energizing presence. As we discuss, he has had to practice deeply to get there. After an emotionally and physically abusive childhood, Gary was caught up in addiction, then embarked on a long road of exploring different mutual help approaches to recovery. From AA, to secular groups, to multiple Buddhist mutual help groups, Gary has explored several pathways to recovery. We discuss his path, his meditation practice, psychedelics, and how he needed more than extraordinary states of consciousness as part of his recovery. We also talk at length about metta (lovingkindness), and how lovingkindness practices were a central part of his recovery from addiction and trauma. I found our conversation calming and inspiring, and I hope you do too.

Gary Sanders is a teacher at Portland Insight Meditation Community in the lineage of Ruth Denison, in the Burmese lineage of Vipassana Buddhism. For more information, check out the PIMC website and their Facebook page. He can also be found as a regular contributor to The Tattooed Buddha, and Gary's website (though under construction at the moment) has a great repository of some guided meditations and teachings: Boundless Heart Dharma.

In this episode:
- The Buddhist Recovery Network
- 8-step Recovery, an alternative recovery program using Buddhist teachings.
- Secular Organizations for Sobriety , "a nonprofit network of autonomous, non-professional local groups, dedicated solely to helping individuals achieve and maintain sobriety/abstinence from alcohol and drug addiction, food addiction and more."
- Zen Mind, Beginner’s Mind, the classic book by Shunryu Suzuki Roshi
- Spirit Rock Statement on allegations of rape, sexual harassment and other misconduct we discussed.
- The Jhanas: “mental or meditative absorption,” “a set of states of deep and subtle concentration focused on a single object.”
- Lovingkindness: the classic book by Sharon Salzberg
- A Zen translation of the Metta sutra
- My interview with Kevin Griffin, episode 3 of this podcast.

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What happens when we define ourselves in terms of group memberships? How does culture and society affect our capacity for self-control and self-regulation? Why does the toxic binary of “us” versus “them” seem to be so powerful these days? How can we instead use our shared identities to improve our wellbeing and work toward harmony and flourishing?
 
 My guest for this episode of Flourishing After Addiction is Dr. Jay Van Bavel, a social psychology researcher who studies questions like these in his Social Identity and Morality Lab at NYU. “From neurons to social networks,” he investigates how culture and group identities influence our feelings, self-control, and even our sense of morality. We talk about the relevance of his work for addiction and recovery: how to harness his findings to work toward personal change, why to be skeptical of the usual narrative about self-control, and the urgent need to wake up to the “gravitational pull” of social groups.
 
 Jay Van Bavel, Ph.D., is Associate Professor of Psychology & Neural Science at New York University, an affiliate at the Stern School of Business in Management and Organizations, and Director of the Social Identity & Morality Lab. He is the co-author of “The Power of Us: Harnessing Our Shared Identities to Improve Performance, Increase Cooperation, and Promote Social Harmony." Find him on Twitter, and see more at his personal page, his lab website, and his book website.

In this episode:
- See this page on Jay’s lab website for his publications
-note in particular Jay’s research on maple syrup, and what that means for the relationship between food and identity
- Against Willpower, my article about why we should be skeptical about the usual model of self-control
- Identity Economics: How Our Identities Shape Our Work, Wages, and Well-Being. George A. Akerlof and Rachel E. Kranton
- Conspirituality: “a neologism portmanteau describing the overlap of conspiracy theories with spirituality”.
- Ward, Charlotte and Voas, David (2011) ‘The Emergence of Conspirituality’, Journal of Contemporary Religion, 26(1): 103-121. 
- See also the Conspirituality podcast by Julian Walker, Matthew Remski, and Derek Beres: “A weekly study of converging right-wing conspiracy theories and faux-progressive wellness utopianism.”
- Jay on polarization in the Guardian: The big idea: are we really so polarised?
- My interview with addiction recovery advocate Ryan Hampton on ideology and recovery

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Owen Flanagan is a philosopher who has long studied topics like consciousness, neuroscience, morality, and responsibility. But early in his career, even while racking up accolades for his pathbreaking work, drinking was already taking hold of his life. Things took a dramatic turn in the 1990s when a brain tumor and a medication reaction sent him over the edge.

Today, Owen is a distinguished philosopher at Duke who is also in recovery. For the past decade or so, he’s been writing about his experience with addiction and connecting it to his long-running work on philosophy of mind and ethics. I’m grateful that he agreed to meet with me and share so openly about his personal history of addiction and recovery, including how he had to work with shame in order to overcome his addiction. We also discuss his latest book, in which he argues that shame has a crucial function in moral development, and that there are ways of working with healthy and mature forms of shame to promote positive values and flourishing—an idea with significant relevance to addiction.

Owen Flanagan, Ph.D., is James B. Duke University Professor of Philosophy at Duke University, where he also holds appointments in psychology and neurobiology, is a Faculty Fellow in Cognitive Neuroscience, and a steering committee member of the "Philosophy, Arts, and Literature" program. He studies philosophy of mind, cognitive science, contemporary ethical theory, moral psychology, as well as Buddhist and Hindu conceptions of the self. He is author of many articles and books, most recently How to Do Things With Emotions.

In this episode:
- One of Owen’s key articles about addiction: The Shame of Addiction
- For more on Owen’s story, see this great chapter by the writer John Horgan
- Books on the history of AA: Not-God, and Writing the Big Book
- Some perspectives on addiction we mention: Intertemporal bargaining in addiction, George Ainslie; Gene Heyman: Addiction: A Disorder of Choice; Hanna Pickard's work.
- The classic piece What is it like to be a bat, by Thomas Nagel

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Ryan Hampton, an alumnus of the Clinton White House, had an up-and-coming career in politics until the early 2000s, when he became addicted to OxyContin, then heroin. After he entered recovery in 2015, he became a prominent advocate on addiction issues, from community-based organizing to national activities, such as helping to release the first-ever U.S. Surgeon General’s report on addiction.

More recently, Ryan came face-to-face again with Purdue Pharma—the infamous manufacturer and marketer of OxyContin, controlled by the billionaire Sackler family. Purdue filed for bankruptcy in 2019 to protect itself from thousands of lawsuits, and Ryan became the co-chair of the Official Committee of Unsecured Creditors (U.C.C.), a powerful watchdog group that represented thousands of victims with claims against Purdue during the bankruptcy. Just a couple of months ago, the judge in the bankruptcy case signed off on a controversial settlement, granting the family immunity from future liability in exchange for a $4.5 billion payout. The day before the judge approved the deal, Ryan resigned.

I sat down to talk with Ryan Hampton about his experiences in the case, which he describes in his new book: Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis. We get personal, and he opened up about the way the case impacted his own recovery, and what he did to cope. We also discuss the insider details of the case, as well as how Ryan’s view of the problem evolved over time—how the case revealed to him that the problem is much bigger than the Sacklers or Purdue, and how it was an education in the deeper roots of the overdose and addiction crises. We talk about the relationship between advocacy and personal recovery, finding meaning and purpose in working for change, and what Ryan sees as the way forward after a dispiriting couple of years. I found it a wonderful lesson in working for change without succumbing to despair, as well as a stimulating discussion about what kind of change we need most today.

Find Ryan at his website, Twitter, Instagram, or Facebook. His organization is The Recovery Advocacy Project (RAP), a network of people and organizations across the country advocating for addiction recovery policies.

In this episode:
- How Ryan went from homeless and addicted to a nationally recognized advocate. (See his first book, American Fix)
- Burnout, and burnout as more than depleted energy or rest—how facing injustice can be a part of it. (For one piece on burnout and moral injury in physicians, which bears comparison, see this article.)
- Rigidity, ideology, and stigma within the recovery community, and how it hampers advocacy
- The crucial element of choice in recovery advocacy
  - What exactly went on in the Purdue bankruptcy case? (see also this New Yorker article discussing Ryan’s work)
- how State governments were not always allies in the Purdue case
- A major shift in Ryan's thinking and values: his realization about how much deeper the crisis was than Purdue or the Sacklers.
- Ryan’s thoughts about how to work for change today.

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In mental health treatment today, psychedelic-assisted psychotherapy is nothing less than a sensation, and some of the most promising results are in addiction treatment. Droves of people—from researchers and clinicians to underground shamans and private funders—are hailing the re-emergence of psychedelics like psilocybin, MDMA,  ayahuasca, and ketamine as a “renaissance.” But despite the hype and money being funneled in this direction, big questions remain. What do these substances actually do? How should we use them? And from a broader perspective, how are we supposed to integrate them into our existing, troubled systems?
 
  Dr. Elias Dawkar is an addiction psychiatrist and psychiatric researcher at Columbia on the frontlines of investigating these questions. He has combined ketamine infusions with mindfulness-based relapse prevention and other addiction therapies and found some stunning rates of recovery. Despite being an accomplished scientist, though, Elias is no reductionist—a clinician and a committed meditation practitioner himself, he has a refreshingly nuanced and integrative perspective on the use of psychedelics. For him, addiction is just one manifestation of deeper efforts to free oneself from a “primordial suffering,” and he offers psychedelics in that spirit: “an opportunity for having the freedom the freedom they were looking for in the first place. The freedom, within themselves, from suffering.” In fact, he also has serious qualms about some of the ways psychedelics are being fit into medicine and the marketplace.

Elias Dakwar, M.D., is an Associate Professor of Clinical Psychiatry at the Columbia University Department of Psychiatry, where he is also affiliated with the Columbia Center for Healing of Opioid and Other Substance Use Disorders (CHOSEN). After completing a fellowship in Addiction Psychiatry at Columbia, he began studying the use of ketamine infusions combined with mindfulness training to treat cocaine use disorders. He is now a principal investigator on several large grants evaluating ketamine for the treatment of opioid use disorder, cocaine use disorder, and alcohol use disorder. His work has been published in the American Journal of Psychiatry, Harvard Review of Psychiatry, Biological Psychiatry, and other major scientific journals.
 
In this episode: 

 - Elias speaking at the Horizons Conference in New York City.

- The connections between psychedelics and other contemplative practices, like vipassana, Vedic mantra-based meditation, and Zen meditation, and how Elias brings mind-body practices into his clinical work.

- Elias’s perspective on recovery and addiction, and making sense of addiction as just one manifestation of a process of suffering.

- Albert Hoffman’s storied “Bicycle Day”, the first recorded LSD trip. (a cool illustration here)

 - The Immortality Key, a historical investigation into the role psychedelics have played in the origins of Western civilization

- The pitfalls of psychedelics: at the individual level, attachment to experience and reifying the trip itself. At the social level, how overmedicalization can miss out on cultural and community renewal as part of flourishing.
 
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Flourishing after addiction requires flourishing for all. The public health of addiction and recovery has several important lessons, not just how to respond to the overdose crisis, but also, and more concretely, how to think holistically about addiction and all the factors that support someone’s recovery. How to protect the mental health of ourselves, our families, and our broader communities, now and for generations to come.

Dr. Wilnise Jasmin is a family medicine doctor and leader in the city of Chicago’s public health system, where in addition to battling COVID-19, she directs the city’s Behavioral Health program. A crucial focus of her work is the opioid overdose epidemic, which disproportionately affects Black residents and is one of the drivers of an 8.8-year life expectancy gap between Black and White Chicagoans. But despite a brutal 2020 and 2021, as overdose rates soared across the country, the Chicago Department of Public Health actually reported a decrease in opioid-related deaths in the first half of 2021. In this episode, we talk more about how they managed this feat, and what those practices and approaches have to teach us about addiction and recovery.

Wilnise Jasmin, M.D., M.P.H., M.B.A., is the Medical Director of Behavioral Health at the Chicago Department of Public Health. She is part of the leadership team responsible for the city’s initiatives in the areas of violence prevention, substance use and prevention, and mental health. She specializes in both Preventive Medicine (Public Health)—which she studied at the Johns Hopkins Bloomberg School of Public Health—and Family Medicine, having trained at the Cook County-Loyola Family Medicine Residency Program, where she served as a Chief Resident. She is also a fellow in the University of California-Irvine Primary Care in Psychiatry program, and she serves as the Chair for the American College of Preventive Medicine's Annual Conference's Population Health and Health Systems track. You can learn more about how Chicago is fighting opioid overdose deaths at http://www.overcomeopioids.org, and connect with Dr. Jasmin on Twitter @wilnisej.

In this episode:
 - Naloxone (Narcan) in vending machines (and for a brief account and photo of a similar vending machine program in Las Vegas, look here).

- How Chicago worked on outreach with community groups to ameliorate a rise in suicides and overdoses--including how to forge authentic connections and dismantle stigma.

- Dr. Jasmin’s most important message for addressing stigma: not to say someone is broken or hammer on “disease” language, but to break down false divisions. "Substance use is not a 'them' problem. The face of substance use? You simply have to look in the mirror to see what someone with a substance use issue could look like. It could be anyone." 

- One important way to prevent addiction: “Health in All” policies, a broader way of looking at all the many factors that influence health beyond traditional healthcare.

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For decades, clinicians have used mindfulness-based interventions to treat stress, physical pain, and mental disorders. But there’s more to meditation than “mindfulness” alone, and the next wave of researchers in this field is still working out how to incorporate other practices from the wisdom traditions that gave rise to mindfulness-based treatment in the first place.

Dr. Eric Garland is a clinical researcher who has devoted his life to developing a novel mind-body therapy called Mindfulness-Oriented Recovery Enhancement (MORE), which combines mindfulness with other practices and exercises to promote a greater sense of well-being and even self-transcendence as part of the recovery process. His work has strong evidence for efficacy in treating not just addiction, but also chronic pain.

Eric Garland PhD, LCSW, is the Distinguished Endowed Chair in Research and Distinguished Professor and Associate Dean for Research at the University of Utah College of Social Work, where he is also the director of the Center on Mindfulness and Integrative Health Intervention Development (C-MIIND). He has received over $60 million in federal grants to develop and test novel integrative health interventions, including trials of MORE as a treatment for opioid problems, opioid use disorder, and chronic pain. His website is www.drericgarland.com, and you can find him on Twitter. 

In this episode:
- The three pillars of Mindfulness-Oriented Recovery Enhancement, including “reappraisal”—skills for disengaging from and reframing negative thoughts—and “savoring”—using focused attention training to tune in to natural reward.
- The use of self-transcendence as a clinical intervention, including evidence about how even folks with severe problems can tap into a sense of transcendence and experience significant symptom relief.
- The challenges of “McMindfulness,” and how Eric thinks about doing mechanistic research on mindfulness without totally abandoning ethics, values, and meaning. (see David Loy and Ron Purser’s essay on McMindfulness here)
- A central question for his biological research: "how do you restore the healthy function of the reward system, so the brain re-leans what is and what is not important in life? what is and is not meaningful in life?"
- Eric’s counterintuitive approach to working with chronic pain by going directly into the heart of pain—and how this applies to mental pain such as craving.
- How to get from mindfulness to meaning—how certain types of mindfulness practice can lead to an enduring sense of meaning and purpose

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This episode’s interview is with Kevin Griffin, a Buddhist teacher who has trained with some of the leading Western Vipassana teachers—including Jack Kornfield, Joseph Goldstein, and Ajahn Amaro—and who himself is a leader in the mindful recovery movement. 

Kevin is one of the founders of the Buddhist Recovery Network, an organization that promotes the use of Buddhist teachings and practices for recovery and is respectful of all recovery paths. 

As we discuss, Kevin’s own path includes 12-step recovery, and for him, recovery is something that demands a spiritual life. A great deal of his teaching and writing is focused on integrating Buddhism and recovery, so I was eager to talk to him about what those teachings have to say not just about addiction recovery but also about flourishing in general. We talk about the notion of addiction as a fundamental human quality, from the perspective of Buddhist teachings, and how in Kevin's view the spiritual path of that recovery—from addiction or just from general human grasping and clinging—demands much more than mindfulness and meditation.

Kevin has been in recovery for 36 years and practicing Buddhist meditation since 1980; he is the author of One Breath at a Time: Buddhism and the Twelve Steps and several other books on Buddhism and recovery. He offers weekly classes on Zoom, has an extensive YouTube channel of his recorded teachings, and hosts a Facebook page on Buddhism and recovery. More information is at his website: www.kevingriffin.net

In this episode:
- How his own spiritual search became warped, and how he needed to face his drug and alcohol use more directly rather than use spiritual practices to escape his pain.
- Recovery as “much more than lifestyle—it becomes a life, a foundational way of living your life. We are trying to cultivate spiritual qualities which will become part of our entire life, and infiltrate every aspect of our lives".
- Mindfulness and meditation, not to “solve” one’s own pain, but to face pain more effectively.
- How he makes sense of 12-step ideas like “higher power” and faith in a non-theistic way.
- The role of ethical and moral training as a practical set of spiritual tools on the way to flourishing. The law of karma as the power of cause and effect and his conviction that there is a moral fabric in the universe.
- His reflections on working with despair and doubt during troubled times.
- The need for justice work as a part of recovery: "in order to heal and grow, we have to take in the pain of our past." (see also Bhikkhu Bodhi’s essay, A Challenge to Buddhists, which Kevin mentions:  “The special challenge facing Buddhism in our age is to stand up as an advocate for justice in the world, a voice of conscience for those victims of social, economic, and political injustice who cannot stand up and speak for themselves.”)

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