Flourishing After Addiction with Carl Erik Fisher

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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Roughly 35 years ago, harm reduction saved Maia Szalavitz’s life. It was 1986 in the East Village, and though Maia was an Ivy League kid who read two newspapers a day, she had no idea that her regular intravenous heroin use put her at risk for HIV. Thanks to a chance encounter, though, Maia learned about some simple harm reduction practices that helped her stay alive through that deadly epidemic.

In the years since, Maia has become an award-winning author and journalist well-known for covering addiction, neuroscience, and harm reduction. Her most recent book, Undoing Drugs, is a sweeping, ambitious, yet tightly plotted and fast-paced history of harm reduction, ranging across the globe to tell a vivid history of harm reduction as a revolutionary movement. I was lucky to have her on the podcast to talk about the story of harm reduction, the elements that she argues makes it a truly revolutionary paradigm, and how her own lived experience with addiction and a drive for justice has motivated her work.

Maia Szalavitz is the author of the New York Times bestseller, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, which received the 2018 media award from the National Institute on Drug Abuse. Her earlier book, Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids, was the first to expose the damage caused by the “tough love” business that dominates youth treatment and helped spur Congressional hearings on the matter. She has also authored or co-authored six other books, including the classic on child trauma, The Boy Who Was Raised as a Dog (with Bruce. D. Perry). Her numerous essays and features have appeared from High Times to the New York Times. Her latest book, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, is available now. Her website is https://maiasz.com/ and you can find her on Twitter

In this episode:
- A simple yet powerful indictment of our current situation: “You can’t criminalize and destigmatize something at the same time"
- Her definition of harm reduction, and how harm reduction goes beyond concrete practices to notions of justice.
- How to think about coercion in addiction treatment, and how her own experience showcases the excesses and harms of the criminal legal system today. (See also her piece on the history of “tough-love” and its roots in a bizarre cult from decades ago) 
- How harm reduction is not in conflict with traditional 12-step recovery, and her stories of early harm reduction pioneers who were also active in 12-step recovery. (see also this oral history with Richard Elovich, as well as “25 years of AIDS”, a great panel discussion from 2006 featuring Allan Clear and several others—including Larry Kramer sparring with Tony Fauci)
- The need for an ACT UP for people with addiction
- The ways activism is part of flourishing in recovery: “"you have less space in your head to be obsessing about the drugs all the time when you're working on the activism" (about VANDU, the Vancouver Area Network of Drug Users)
- What the Biden administration is getting right about harm reduction, and what it’s missing.

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 Six percent of American adults say they are “in recovery” from a problem with alcohol or other drugs, but it’s not always clear exactly what that means. Even among researchers who study the concept, the definition of “recovery” is far from settled: does it require abstinence? does it necessarily involve lofty concepts like spirituality and citizenship? is the main point the absence of problems, or is there more to it than that?

Dr. Katie Witkiewitz is a psychology researcher who, for many years, shied away from studying recovery in her academic work. Recently, however, her work on the patterns and predictors of substance use problems has led her back to that loaded term, and she has since arrived at a broader and more encompassing definition of recovery than you might expect. We talk about why she advocates for an expanded and transformed understanding of recovery, how she makes sense of the phenomenon of addiction, and how the research on such foundational questions, while extremely complex, hold out tremendous hope and possibilities for healing.

Katie Witkiewitz is Regents' Professor of Psychology and a Scientist at the Center on Alcohol, Substance use, And Addictions (CASAA) at the University of New Mexico. She received her Ph.D. from the University of Washington in 2005. She is also a licensed clinical psychologist and has worked extensively on developing and disseminating a novel psychotherapy for substance use disorder: mindfulness-based relapse prevention. Her website is https://abqresearch.org/ and you can find her on Twitter.

In this episode: 

- A driving commitment for her work: “Everyone's doing the best they can at all times, with what we have in front of us, and there are causes and conditions that bring us to the places where we are."
- Katie’s surprising research findings on just how many people do well after treatment for alcohol use problems—including fairly large proportions who improve their well-being in non-abstinent recovery (see her paper What is Recovery?)
- Historical perspectives on the definition of recovery (see also this 2019 piece from the recovery science research collaborative)
- Upwards of 80% of people with Substance Use Disorder never get treatment. Why? Katie suggests that a lack of nuance about the many paths to recovery might be one important barrier. (see also Andrew Tatarsky on “Harm Reduction Psychotherapy”)
- How to talk about an expanded conception of recovery while still respecting and celebrating the benefits of traditional 12-step recovery.
- Disparities, paternalism, and racism in the research on substance use disorders, and her thoughts on some ways to ameliorate those problems.
- Some practical tips for avoiding common thinking traps about substance use problems, like the “abstinence violation effect” (aka the f*ck-it effect).

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I'm Carl Erik Fisher, and this is Flourishing After Addiction, a new podcast exploring addiction and recovery from the widest possible diversity of perspectives.

I'd love to hear from you. Please head over to http://www.carlerikfisher.com to connect.