Pulling The Thread with Elise Loehnen

“Nobody wants to be somebody with a serious substance use problem. Nobody wants to be addicted to a substance. I mean, it doesn't feel good. Dependency doesn't feel good. And we end up in there anyway, right? So I think if we can bring compassion and understanding to, wow, it must really be working in a way that's really powerful for them to keep pursuing it. And then you've got the physical effects of substances, right? So then our bodies physically get dependent, you know, so it starts out as like, it's probably working for an emotional or something in our life and then we become physically dependent on it. And then it's a whole nother host of things in terms of how do you stop it? And people don't fully understand treatment in terms of there's medications available.”

So says Carrie Wilkens, PhD, a psychologist who is attempting to change the way we think about and address recovery and treatment—specifically by simply presenting evidence for what motivates change. AFter all, she is the co-president and CEO of CMC: Foundation for Change, a not-for-profit with the mission of improving the dissemination of evidence-based ideas and strategies to professionals and loved ones of persons struggling with substance use. 

As you’ll hear in this conversation—and throughout the entire series—we have not collectively been served by the mono-myth of addiction, that it’s only solved through harsh intervention and confrontation, that addicted people must hit rock-bottom, and that any involvement from concerned family and friends is inherently co-dependent or enabling.

As Dr. Wilkins explains, this simply isn’t true: In fact, evidence overwhelmingly suggests that harsh confrontation and intervention works AGAINST recovery, and that there is a very specific and meaningful role for family to play in what can often feel like a family illness.

The CMC:FFC team’s Invitation to Change approach is an accessible set of understandings and practices that empower families to remain engaged and be effective in helping their struggling loved one make positive changes. The approach has been widely used across the country and is utilized in trainings with laypeople and professionals. 

She is co-author of the award-winning book Beyond Addiction: How Science and Kindness Help People Change, a practical guide for families dealing with addiction and substance problems in a loved one based on principles of Community Reinforcement and Family Training (CRAFT), and co-author of The Beyond Addiction Workbook for Family and Friends: Evidence-Based Skills to Help a Loved-One Make Positive Change.

Dr. Wilkens is also the Co-Founder and Clinical Director of the Center for Motivation and Change, a group of clinicians serving all ages in NYC, Long Island, Washington, DC, San Diego, CA, and CMC:Berkshires, a private, inpatient/residential program for adults.

Dr. Wilkens has been a Project Director on a large federally-funded Substance Abuse and Mental Health Services Administration (SAMHSA) grant addressing the problems associated with binge drinking among college students. And she is a member of the Association for Behavioral and Cognitive Therapies and the American Association of Addiction Psychiatrists.

MORE FROM CARRIE WILKINS:

Beyond Addiction: How Science and Kindness Help People Change

The Beyond Addiction Workbook for Family & Friends

CMC: Foundation for Change

Further Listening on Pulling the Thread:

PART 1: Holly Whitaker, “Reimagining Recovery”

PART 2: Carl Erik Fisher, M.D., “Breaking the Addiction Binary”

PART 3: Maia Szalavitz, “When Abstinence-Only Approaches Fail”

ADDICTION: Anna Lembke, M.D., “Navigating an Addictive Culture”

TRAUMA: Gabor Maté, M.D., “When Stress Becomes Illness”

BINGE EATING DISORDER: Susan Burton, “Whose Pain Counts?”

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“I think what's interesting about healing, psychological healing, is there's always a narrative that helps. So sometimes when you go to therapy, and you tell a story, and in the story, you locate your despair, and it's a knot, and then with the therapist, you work through the knot, you feel better. And was all the pain really attendant to that knot? Or did you just kind of load up that knot with some of the despair that comes from being alive and then you kind of work through it and that story helps you live life better. And I think that's true also this idea of how we look at the different personality states and we can name them and we can give them ages and it's a story that helps us understand ourselves.”

So says Akiva Goldsman, an Oscar, Golden Globe, and WGA-Award winning screenwriter whose credits include A Beautiful Mind, The Client, Batman Forever, A Time to Kill, Practical Magic, Cinderella Man, I Am Legend, The Da Vinci Code, Angels & Demons, Insurgent, and I, Robot. He’s on Pulling the Thread today, though, to talk about Apple TV+’s The Crowded Room, a psychological thriller starring Tom Holland and Amanda Seyfried on which he was both the writer and the showrunner.

So first, some warnings: Yes, there are spoilers, though in my opinion, nothing that will markedly change your experience of watching the show. In fact, knowing the back story made it easier for me to get through the first, very stressful episode. (It gets easier, and by episode three, I was riveted.) And also, a trigger warning: The Crowded Room and our conversation today explore childhood sexual abuse, which is also part of Akiva’s personal history.

MORE FROM AKIVA GOLDSMAN:

“The Crowded Room” on Apple TV+

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“I think it's really important for, you know, people to realize that you can totally be an absolutely excellent parent of a traumatized child and the trauma had nothing to do with you and you couldn't possibly have prevented it. So I think, you know, assuming that there is trauma in somebody's addiction history, which is not always the case, but if there is, you should not immediately assume that it was bad parenting because sure, that could be the case sometimes, but again, there's so many different ways that people can be traumatized by so many different people. And it's also the case that so much of addiction has to do with people's temperament that will set them up for things. So, if you are incredibly sensitive to stimuli, something that wouldn't traumatize someone else might traumatize you. And again, that's not your parents fault. That's just how you were born.”

So says Maia Szalavitz, a contributing opinion writer for the New York Times and author of two fantastic books about addiction. Her New York Times bestseller, Unbroken Brain, tells the story of her own heroin and cocaine addiction as a student at Columbia University in the ‘80s—she was expelled for dealing and barely escaped prison time—woven together with the decades of work she’s done as a journalist in the addiction space after entering recovery in her early ‘20s. In it, Maia offers a compelling case for why addiction should be thought of as a learning disability, in part because so many people “grow out of it.” 

Maia’s latest book—Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction—taught me so much and challenged so many of the stories about addiction I was holding onto. Ultimately, it’s an optimistic book in the face of what feels like an overwhelming cultural challenge, a challenge that only seems to get worse every month—Maia explains why we’re trending in this direction, and more importantly, what we can do to shift our collective fate toward recovery. And what an expanded idea of recovery might mean. 

MORE FROM MAIA SZALAVITZ:

Undoing Drugs: How Harm Reduction is Changing the Future of Drugs and Addiction

Unbroken Brain: A Revolutionary Way of Understanding Addiction

The Boy Who Was Raised as a Dog

Read Maia on The New York Times

Maia’s Website

Follow Maia on X

Further Listening on Pulling the Thread:

PART 1: Holly Whitaker, “Reimagining Recovery”

PART 2: Carl Erik Fisher, M.D., “Breaking the Addiction Binary”

ADDICTION: Anna Lembke, M.D., “Navigating an Addictive Culture”

TRAUMA: Gabor Maté, M.D., “When Stress Becomes Illness”

BINGE EATING DISORDER: Susan Burton, “Whose Pain Counts?”

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“As you grow older, your brain is able to keep rewiring all the time. And so we have this impression that the flexibility of the brain decreases as you get older. But in fact, it's just because your brain's job is just to figure out how to get by in the world and do a good job in the world. And once you've figured most things out, like, oh, these are different kinds of personalities, and this is how I need to do something at work, and this is how I use email and phone and whatever, then your brain does less changing only because it has successfully done its job, and it doesn't need to keep changing. The brain changes when there's surprise, when there's something that happened that it wasn't expecting, then it changes up. So, you still have plenty of plasticity even when you're 90 years old. It's just that most people aren't using it at that point because they say, Oh, I got it. I know how things work.”

So says David Eagleman, renowned neuroscientist, podcast host, and the author of many bestselling books about consciousness and the brain—along with more than 120 academic publications. Besides his perch as a neuroscientist at Stanford University, David is the co-founder of two venture-backed companies, including Neosensory, which is a pioneering wrist device that enables the deaf to hear. Yep, that’s right.

David is fascinating, and hopefully this conversation lives up to his capacity: We discuss the malleability of the brain to adjust to its inputs, the roots of synesthesia, how those who are born blind and deaf can now use touch to see and hear, and why we dream. Ultimately, we explore just how it happens that a brain trapped in a dark vault can create the vibrancy of our existence.

David is a TED speaker, a Guggenheim Fellow, and serves on several boards, including the American Brain Foundation and the The Long Now Foundation. He is the Chief Scientific Advisor for the Mind Science Foundation, and the winner of Claude Shannon Luminary Award from Bell Labs and the McGovern Award for Excellence in Biomedical Communication.

What’s cooler? He has served as the scientific advisor to several television shows (including Westworld and Perception).

Ironically—considering we both host podcasts and David is a neuroscientist—we had some technical difficulties during our conversation, but the hope is that this is not perceptible to you! 

MORE FROM DAVID EAGLEMAN:

Livewired: The Inside Story of the Ever-Changing Brain

The Brain: The Story of You

Sum: Forty Tales from the Afterlives

David’s Podcast: “Inner Cosmos”

David’s Website

Follow David on Instagram

David’s Company: Neosensory

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“I want to say that it's not just some idea about suffering, it's also a function of social and economic systems that are deliberately weaponizing an individualized view of suffering as a technique, as a strategy. I found across eras and eras and eras in the book is that addiction supply industries, which is what one scholar calls them, like the alcohol industry, the tobacco industry, they constantly come back to this hyper individualization in saying, you know, like, the problem is not in the bottle, the problems in the person. If so many people can drink, quote unquote normally, that means the problem is really with these sick people over here. And that happened with tobacco. And then very directly and deliberately, things like the processed food industry and other modern addiction supply industries have used the same language.”

So says Carl Erik Fisher, an addiction psychiatrist, bioethics scholar, author, and person in recovery. Carl is also an assistant professor of clinical psychiatry at Columbia University, where he teaches law, ethics, and policy relating to psychiatry and neuroscience, particularly where they converge with substance use disorders and other addictive behaviors. He hosts a podcast called Flourishing After Addiction and is launching a Substack, where he’ll organize his thinking around treatment paths and modalities. Most pertinent to our conversation today, he’s the author of The Urge: Our History of Addiction, which is a fascinating deep dive into our long cultural fascination with addictive substances, interlaced with his own story, and stories from his practice: In fact, the book opens in Bellevue where Carl is not functioning as a doctor—in this case, he’s the patient, after suffering an addiction-induced manic episode that put him into recovery. Carl is brilliant and kind, and also fluent in all the prevailing science about addictive behavior…science that hasn’t really ruled the day until recent years. Instead, the addiction space has been one of binaries—you’re compulsive, or you exercise choice; you’re normal, or an addict; you have no control to stop, or you have all the control and refuse to use it; and on and on and on.

MORE FROM CARL ERIK FISHER:

The Urge: Our History of Addiction

Carl’s Podcast: Flourishing After Addiction

Carl’s Website

Follow Carl on Instagram

Carl’s Newsletter

Carl’s Substack

Further Listening on Pulling the Thread:

PART 1: Holly Whitaker, “Reimagining Recovery”

ADDICTION: Anna Lembke, M.D., “Navigating an Addictive Culture”

TRAUMA: Gabor Maté, M.D., “When Stress Becomes Illness”

BINGE EATING DISORDER: Susan Burton, “Whose Pain Counts?”

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“I think what one of the things that's interesting to me is like when we think about what causes distress and a life that goes awry, there's so much attention to different causes, but the way that the story, or the diagnosis, or the treatment interacts with our identity, I think, is not thought about as much. Like, the way that the very intervention itself changes our sense of who we are feels like it gets neglected. There's this sense that, you know, the diagnosis is describing something that is always solid and real and less thought given to like, well, how does that diagnosis interact with a mind? And how does the mind change knowing that the mind has been characterized this way?”

You might recognize Rachel Aviv’s name from The New Yorker, where she’s been a staff writer for a decade, covering subjects like medical ethics, psychiatry, criminal justice, and education. She’s been a finalist for the National Magazine Awards twice, and in 2022 she won one for profile writing. In 2022, she also published Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, a recipient of the Whiting Creative Nonfiction Grant and named by The New York Times as one of the ten best books of the year. In It, Aviv tells the story of four people and the treatment they underwent—or not—for their mental illness. It’s a gorgeously told, layered exploration of all that we don’t know about the brain and the mind, and how various treatment modalities restructure our lives—including the stories we tell about who we are. Okay, let’s get to our conversation.

MORE FROM RACHEL AVIV:

Strangers to Ourselves: Unsettled Minds and the Stories That Make Us

Read Rachel in The New Yorker

Follow Rachel on X

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“For years, I was asking myself whether or not I was an alcoholic versus really asking myself whether or not alcohol was actually providing any benefit to me. And for me, it was just like, This realization when I stopped drinking that I had been asking the wrong question for my whole drinking career and like, why are we not asking the question? We're just like, we're drinking, it's compulsory in our society. It's exceptional if you don't drink. And then it's also this very addictive drug that's marketed to us in a way that totally overrides our ability to like make rational choices around it. It's like the most socially accepted drug that you can use and like, we just don't have meaningful conversations or informed consent or any, you know, so for me, a huge part of me quitting drinking, which I did in 2013, it was this realization of Intellectually understanding I had been asking the wrong question which for me was a huge empowerment and part of the reason I was able to quit.”

So says Holly Whitaker, author of the New York Times bestselling Quit Like a Woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol. I had heard about Holly long before I met her, primarily because she was disrupting recovery culture and many people did not like this. But the more I learned about her, the more I spoke to her, the more I witnessed her impact on culture, the more I was completely taken by both her brilliance and her willingness to say the things. Be warned: If you read her book, you’ll never think about alcohol again. In its pages, she recontextualizes the way we’ve been trained to normalize booze—and also the way the current recovery scene is shaped for the consciousness, and egos, of men. She’s created companies in the vein of a feminine-centered recovery, and it feels like she’s just getting started in the way we talk about addictive substances—and addiction. Those who struggle will find a lot of relief in her words, and I understand why. 

MORE FROM HOLLY WHITAKER:

Quit Like a Woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol

Holly’s Newsletter

Holly’s Website

Holly’s Podcast

Follow Holly on Instagram

Further Listening on Pulling the Thread:

ADDICTION: Anna Lembke, M.D., “Navigating an Addictive Culture”

TRAUMA: Gabor Maté, M.D., “When Stress Becomes Illness”

BINGE EATING DISORDER: Susan Burton, “Whose Pain Counts?”

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“If there is this part of you that you think is inferior, the weak spot, something you're ashamed of, etc., it's one of these things where if you believe it's true, there's a part of the human soul, we call it part X. It doesn't want you to have any kind of forward motion, doesn't like it, it wants to render your life failure. It wants you to never re change your potentials. And it wants you to hate yourself, which is the biggest thing. So, the genesis of the tools came from the idea, we have to be active about dealing with this.”

So says Phil Stutz, the creator of the Tools. You might know Phil from his bestselling book of the same name, or its sequel Coming Alive. Or you might know him from the Netflix documentary Stutz, which is a profile of him as a beloved psychotherapist who doesn’t practice in a particularly traditional way. What you might not know is that Phil is actually a psychiatrist—he received his MD from NYU and then abandoned the standard approach, feeling like he wasn’t helping patients at all. He created The Tools for exactly that: To provide practices for people to move through life’s obstacles, rather than just listening to them talk about them. Ad nauseum. One of the things that I love most about Phil’s approach is the way in which he uses the spiritual, or what he calls “Higher Forces.” Foundationally, he believes that a beneficent universe will move in as soon as you put yourself in motion, unlocking creativity and growth. His latest book, Lessons for Living: What Only Adversity Can Teach You, is a beautiful collection of essays about aging, hard times, and obstacles. It’s equal parts moving and practical, much like Phil himself. 

MORE FROM PHIL STUTZ:

Lessons for Living: What Only Adversity Can Teach You

The Tools: Five Tools to Help You Find Courage, Creativity, and Willpower—and Inspire You To Live Life in Forward Motion

Coming Alive: Four Tools to Defeat Your Inner Enemy, Ignite Creative Expression & Unleash Your Soul’s Expression

“Stutz” on Netflix

The Tools Website

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Starting next Monday, I’m doing another special series—this set is about addiction. You’ll hear from four distinct voices in the space, covering harm reduction, new paths to recovery, codependency, and the shape of addiction in our culture. This is just scratching the surface, but hopefully the beginning of conversations in our own lives, as addiction touches us all, in its myriad forms. While this set is focused on substance, we'll be back with more in this space—and if you want to get started, you’ll find links to two previous episodes on this theme. Dr. Gabor Maté, who spent much of his career working in the most addicted corner of North America, explains why trauma is central to understanding addiction, and Dr. Anna Lembke, explores the role of dopamine and the delicate balance between pleasure and pain. You can find those links in the show notes—and I’ll see you on Thursday for a regular episode of Pulling the Thread, and Monday for the beginning of this special episode.

SHOW NOTES:

ADDICTION: Anna Lembke, M.D., “Navigating an Addictive Culture”

TRAUMA: Gabor Maté, M.D., “When Stress Becomes Illness”

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“I’m grateful for seasons. I'm so happy that there can be a winter and there can be a spring and there can be a summer, that it can't always be summer, can't always be bright and happy. And, you know, my book is a bit about that. In winter, the stone fruit loses its leaves and it falls down and it saves its energy for spring. It's okay to sleep. I feel like when life served me a winter and I dropped my leaves for a bit, I came back stronger in spring. I'm just grateful for that idea of that constant change, not just in the world, but in ourselves, and how exciting that has been. And that's given me a whole new fresh perspective. I keep saying a lot, I want to ripen like a peach. I'm okay for my skin to get wrinkled and my flesh to get soft. I really just want to get really sweet and juicy on the inside and and enjoy that process.”

I met Richard Christiansen more than a decade ago, though we didn’t become very close friends until very recently, when strange fates brought us together. We have spent the past three-and-half years birthing new versions of ourselves: We kept each other as close company as I wrote my book and launched this podcast, while Richard left the world of advertising to launch a beautiful brand called Flamingo Estate. You’ve likely seen Flamingo Estate in magazines or on Instagram—it’s Richard’s home, and garden, and also the inspiration point for a range of products like, oh I don’t know, honey made from the bees in Lebron James’ backyard, to Terrazzo bars of soap, to the best olive oil I’ve ever tasted. I’ve never met anyone like Richard, to be honest, who has both a fantastical imagination and incredible design aesthetic with his feet firmly planted in the soil. Richard grew up on a farm in Australia—from a whole family of farmers—and being in the garden is his first home. He has a deep and unabiding reverence for the natural world—Jane Goodall is one of his close friends, after all—which is part of the reason why its the foundation of his brand. He calls nature the last great luxury house, and he sees no reason why a gorgeous tomato shouldn’t get the same photographic consideration as a handbag. We had a wide-ranging conversation about creativity, abundance, pleasure, and fantasy for this special friendsgiving episode.

MORE FROM RICHARD CHRISTIANSEN:

Flamingo Estate

Follow Flamingo Estate on Instagram

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