Experience, Strength, Hope: An Inspiring Story Of A Recovering Addict Turned Psychiatric Provider
Published On: August 23, 202251.2 min read
The journey to recovery demands changes in behavior and perception. To do that, we must understand the inner workings of what causes these behaviors and how to adjust them properly. Dr. Robbie Westerman, the Founder of Next Step Recovery AZ, joins us for today’s episode. Dr. Robbie is a recovering addict who abused substances for years. In his journey to sobriety, he found his love and passion for neurology which he now uses to help educate and guide others to recovery. He learned and now teaches how to properly rewire pathways and transition into healthier behaviors to overcome maladaptive tendencies. There are a lot of great insights from today’s episode. Dr. Robbie shares his Urge Theory of Addiction and explains the role developmental trauma plays in addiction. Join host Tim Westbrook to learn more about Robbie and be inspired by his journey with advice on how you can start your path to recovery.
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Experience, Strength, Hope: An Inspiring Story Of A Recovering Addict Turned Psychiatric Provider
What It Was Like, What Happened, And What It’s Like Today For Dr. Robbie Westerman
This episode is sponsored by Camelback Recovery, Arizona’s preferred sober living option to help AA newcomers stay sober during their first year in the program. If that’s you or someone you know, you are in the right place. My team and I, over the course of many years, have helped thousands of people to stop their suffering and continue on their path to recovery. Let’s get clear on one thing. We believe that a relapse or a slip is not a part of recovery. That’s exactly why this show is dedicated to you or any loved one you know in their first year of striving to live a clean and sober life.
The purpose of this show is to come clean with all of the misinformation that’s out there about recovery, addiction treatment, mental illness, and the strategies to stay sober in general. If you believe you are in the right place or know someone who is struggling with addiction, it’s my privilege to share this show with you.
I have no idea if you and I have ever met but what I do know is that AA saved my life. I also know that defining long-term recovery and live happy, joyous, and free is not about stopping your drinking, drugging, gambling, sexual indiscretions or any other addiction you may have struggled with or suffered from because, at Camelback Recovery, we believe that sobriety can and should be fun.
Any recovery process is not easy. It is challenging. It can sometimes be annoying. For most of us, it is often difficult to stay on the path, but here’s the good news. The self-awareness you gained from reading this, especially if you are in your first year of recovery, will help you make better choices, which will ultimately lead you to live a kick-ass sober life. Visit CamelbackRecovery.com to learn more about our treatment strategies for alcoholism, drug addiction or mental illness. We even offer recovery coaching so that you can enjoy the freedom and happiness you’ve always searched for.
I’m going to have a conversation with Dr. Robbie Westerman. He was not a doctor before he got clean and sober. He was just Robbie, the hopeless drug addict and alcoholic. We’re going to talk about his experience, strength and hope among a few other things. First, let me tell you a little bit about him and what his life looks like now. He’s a psychiatric mental health nurse practitioner who has been working in recovery for many years.
He has worked at the world-renowned Meadows for the last years, providing the most advanced treatments in trauma and addiction medicine. Dr. Robbie’s own development, including social and neuro-biological models, have stood out amongst his peers and he is a sought-after consultant by many agencies. He uses his Urge Theory combined with developmental trauma to explain complicated disorders and target treatment. Dr. Robbie, welcome to the show. I’m glad to have you here.
Thanks. I’m glad to be here.
Let’s dig into your story. Let’s start with your upbringing. Where you’re from? Did you grow up homeless? Did you grow up in a broken home? What was it like for you growing up?
Looking back, it’s very easy to recognize that there was a lot of dysfunction in my house. When we’re going through it, obviously, it’s not dysfunctional at all. It’s the only normal we know. It’s comfortable for many of us. I had no idea. Some of the things that were going on in my household were not very conducive to building formative relationships, building good habits, adaptive habits, and learning how to be independent.
My father was an alcoholic and my mother was very codependent, trying to always help and save dad. My father was also bipolar. There was a lot of anger, screaming and yelling when I was a kid, which I didn’t think was abnormal, but I didn’t want to be around it. I spent a lot of time hanging out in my room and isolating essentially. Looking back at it now, I never got to form those good strong bonds with other kids and my parents. Those things were not available to me during that time.
Where did you grow up?
Recovering Addict: If I’m willing to do it for dope, I’m willing to do it for something else. That’s how I treated most of the tasks.
I grew up in North Phoenix. I lived most of my life as a child in the North Phoenix, Deer Valley area.
Did your parents stay together or get divorced?
My parents stayed together until I was about seventeen years old.
When did you start experimenting with drugs and alcohol?
It’s very interesting because I remember candidly the first time I used alcohol. To rewind and give a little depth and weight to this experience I’m going to tell you about, I had a lot of anxiety in school when I was young. Now I know it’s because I didn’t form relationships, I didn’t learn that. I felt out of place and like, “Everyone else got this handbook. Where’s my handbook?” Everyone else seems a part of, and I seem apart from. Everyone else seems like a part of the herd or communicating. It seems like everyone likes me, but deeper down, I’m like, “What’s wrong with me? What’s going on here?”
I remember the shame. For no reason, it was unidentifiable. I would be sitting in the classroom and be like, “I don’t want anyone to look at me. I don’t know why. I don’t want to be seen or found out.” That all changed when I took that first drink of alcohol. I was 13 or 14 years old. We were out in the middle of the street. I was shy.
I remember drinking alcohol and felt like, “This is what I’ve been missing, this innate ability to connect to others, this feeling of fitting and feeling good in my own skin, the feeling of feeling handsome and able to talk.” Alcohol gave me all that stuff. It felt so good to feel at home finally. I felt like I finally belonged, that I was a part of, instead of apart from. It was me finding that herd and saying, “This is what I was missing.”
You’re about thirteen when you have your first drink and did you experiment? When did it start progressing? When did it become a problem? When did you experiment with drugs and other things?
I knew that I couldn’t drink alcohol and go to school every day, especially being in seventh grade. It started out as I was very contained, like most at first. I was able to drink on the weekends or during the middle of the week. Stuff went downhill quickly when I discovered opioids. I ended up getting a girl pregnant.
How old were you when you discovered opioids?
Connecting with people is the biggest way to stay sober because you need someone to bounce ideas off, and you want someone that’s not going to co-sign your BS.
What happened? How did you discover it?
I was trying to get ecstasy with my girlfriend. I went to pick it up and they didn’t have any. He’s like, “I got this heroin.” I was young. I didn’t know anything about it. I was like, “Why not?” I remember bringing it home and my girlfriend’s like, “We’re not doing that.” I’m like, “All right.” I remember doing it. I felt warm blood hugging my insides. It felt good and salient. It felt like everything alcohol gave me, but I was able to function too.
Did she do it too or did you do it on your own?
She ended up doing it too. I did convince her. Unfortunately, she still has not sought out any help ten years later.
What happened after that first time you did it?
The first time I did it, I knew that I shouldn’t do it again because it felt too good. I was blasted into cloud nine. I slowly obsessed over it and wanted that feeling again. I yearned for that love, attention and inclusion that opioids brought me like alcohol. No one was going to stop me. I remember going to my first treatment at seventeen years old.
How does it happen that quickly?
You start using intravenously. It was a quick downslope for me. It was combining and out of control. I’m starting at treatment so young. I wasn’t ready. I feel like I would go to these treatments not ready. I was always doing it for somebody else. I was always trying to be able to have a place to stay. I want to stay at my parent’s house.
How did you end up at treatment for your first time?
The first time I ended up in treatment, I started mixing heroin with methamphetamine and injecting it. I drove myself. I had a truck.
Did you just say, “I need to go to treatment?”
Recovering Addict: It’s weird how the universe provides you exactly what you need, when you’re in line with the universe instead of your amygdala.
There wasn’t an intervention or anything. You just decided you needed to go to treatment.
My current girlfriend got pregnant with my daughter. I was like, “I need to man up.” I need to do the dad thing and the right thing. That was a primary motivator at first. Sometimes it’s good to get people into treatment, but it’s not going to keep you sober.
How many times did you go in and out of treatment?
It was around seventeen treatment centers.
This is for the man or woman who’s been to treatment multiple times. What was your lowest bottom? You’re in and out of treatment seventeen times. What does your life look like? How did you end up in and out of treatment many times? What did your parents say?
My family was pretty much broken up at that point. My mom and dad had separated. My brothers and sister were in the midst of their addictions too. It was an ugly situation. The lowest point of my life was when I was 21. CPS ended up getting involved. There was nothing more I loved than my daughter. She has lived with me since she was born, my oldest. They took her from me. They put her in foster care. I can’t even explain. I was wailing and screaming in the bed for days because that was like an extension of me.
I know it’s selfish that I was using. I know addicts love their children most of the time. It’s not like we don’t love our children. It hurts. It’s so much pain. The lowest point in my life was when my daughter called me on the phone and she was like, “Please come get me. Please get me out of here.” I remember wailing on the phone. I went into my room. It was awful. I’ve never cried so loud in my life laying there thinking my child’s in a respite home like, “Isn’t that important?”
How was she at that time?
She was four.
What happened? When did it work?
If you find something you love, the money will come, all that stuff comes with it.
At the end of my runs, I was 23. I remember sitting there. I had some heroin and needle, methamphetamine, and I was injecting bath salts and Wellbutrin. You name it. If I could put it into a needle, I was injecting it. There were bedbugs running around. I was living in squalor pretty much. Someone flushed the dope and called, “Go now.”
I got fired from my job. I don’t know how I maintained it, but I worked at UPS for seven years. It’s because it’s warehouse work. They aren’t checking up on you too much. Do your thing, show up, throw some packages around and get out. I had lost that job I had for seven years, which was a lot of my money and identity. It was just me and the needle.
How did you lose your UPS job?
I was already on, and some people are probably reading this work with me, my manager too. I love you, guys. They gave me many shots. They knew. My manager was good to me there. They came up to me and told me before, “You don’t look good. What is going on?” I told him, “I’m using.” They would send me to treatment. I get paid, come back and screw up, and then they help me again. There got to a point when I came in, my pupils were bigger than my whole eyeball. He’s like, “This is it. Go get a drug test. You’re going down with HR to get a drug test.”
They enabled you for quite some time for many years then, and then you got fired. You ended up in treatment for the last time. Did you know it was going to be the last time? There are lots of other people that go to treatment multiple times. What was your sobriety date?
Many years, May 15, 2013.
Did you know it was going to be your last attempt? You were like, “This is the time.” How many times did you say that?
This is why I always believe even if somebody is not ready, go to treatment because the stuff I had learned over the years in treatment, counselors telling me stuff and pounding stuff into my head, it ruined my using out there for a long time. It made me think out there. I use this analogy with my clients a lot. I can read all about swinging a golf club. I can know every factor, every angle, and how hard to swing elbow placement and placement. Does that mean I can go out there and hit birdie? No, it doesn’t.
It’s a practical application. You get to know the book in and out. You can know everything there is to know about a subject. The fact of the matter is I knew everything there was to know. I knew the 164, all that stuff by heart, but I couldn’t keep a needle out of my arm. The issue was there was no practical application. I had and learned all the tools. It was just putting them into place and getting uncomfortable.
You went to treatment, and then what did you do after treatment? What was your first year like?
My first year consisted of being humbled. I didn’t have much, but I got a job after I did 90 days as BHT or one of those positions where I was able to work alongside people in recovery, which was super helpful because not only was I doing my own program, but I got to be very involved with other people, which was amazing that’s where I found a passion for this, but I stayed super plugged in. I would run into people everywhere that I went that were in the program.
Recovering Addict: The past and fear of failure and inadequacy prevents so many people from reaching the potential that they have inside.
I had so much fun in sobriety, doing trivial things, going to walk around at the mall, stuff that doesn’t seem super exciting, but when you’re with a group of people that you’ve gone through something together, go into conventions, meetings, watch buddies get chips, watching people get married, being around a bunch of people that want to succeed. That’s why we’re all there. We’re not there for any reason but to get better. I felt like they got grabbed up and they’re like, “You’re coming along.” It was a great feeling.
How much do you think finding your tribe had to do with you being able to stay sober?
I think 100%. Connecting with people is the biggest way to stay sober because you need someone to bounce ideas off. You want someone that’s not going to co-sign your BS. We’re addicts and manipulators. I can get anyone to co-sign my great idea, but I try to run it by Tim or Ron. They’re going to be like, “No.”
This is a good idea. It’s good to have those safeguards in the first year. When you’re down, your phone will not stop ringing. Constantly people are texting you, “How are you? I haven’t seen you at this meeting.” It was accountability, love, teaching and getting second opinions. I got all those things from my group.
I can relate. When I first got clean and sober, I remember there were a bunch of meetings by where I lived. I met with people with that I had similarities and people that I wanted to be like, people that were doing things that I wanted to do that was. That was what it took for me. Seeing people that have what I wanted, building relationships with them and seeing them day after day after day, meeting after meeting, watching them, their actions, how they interacted with other people and how they talked about their relationships with their wives, family members, and their friends, all of those things helped me out tremendously.
I see people that show up to meetings late. They’re on their phone the entire time, then they leave early and don’t stay connected to the group. Alcoholics Anonymous, NAs or whatever twelve-step program it is, even if it’s not even a twelve-step program, you’ve got to get involved with a fellowship of people that you get to know on a deep level, and then to your point, ask for suggestions, ask other people, “Tim needs to talk to somebody besides Tim. Robbie needs to talk to somebody else besides Robbie.”
That’s how we’re going to come up with the best decision and keep us on the path. I know what made you decide to work in the field. How did you become Dr. Robbie? How’d that happen? You were Robbie that the drug addict and alcoholic, a guy that worked in the UPS warehouse that showed up high every day and couldn’t pass the drug test.
Here’s how God works when we’re humble and trying to do the next right thing. I had a job interview at a shipping place. I did the interview and felt good. I’m sure they were going to hire me. They were bringing me back to the back area and were asking me a little bit about myself. I learned now that my business is my business, but I told them, “I’m in recovery.” All of a sudden, they’re like, “We’ll give you a call.” They were sending me to the back to sign the paperwork. I was like, “What paperwork?” They are like, “We’ll call you with it.”
I remember leaving and I was like, “I know that they didn’t give me the job because I told them that.” My wife’s like, “I applied at this Meadows place. They told me I didn’t have long enough sober. Why don’t you go do that?” I’m like, “I’m in logistics. I barely graduated high school. I can’t work at a hospital.” I applied and got the job. That’s not what I wanted to do. I wanted to work in shipping. Deep down, I knew what I wanted to do, but a part of me felt like, “It’s a long road to look up and to get there.”
It was tough looking at that road, but something I use that’s been very beneficial to me is knowing how hard it is to stay high out there every day. It is the most difficult job in the world. I don’t care if you’re a surgeon or what you do. Try to score drugs every day with no money. That’s why I know if you hire people that are in sobriety, they get stuff done. You don’t have to worry about it most of the time. I did micro-tasks of, “What’s my bag of dope for the day? I got to take the college entrance test. That’s my bag of dope.” I would have that mindset every day.
“What will be my drug today?” I took that attitude. If I can get my dope every day, I can accomplish a trivial task, like going down to the court, getting my address changed or getting my enrollment stuff together for school. I pretended that’s what I had to do. If I’m willing to do it for dope, I’m willing to do it for something else. That’s how I treated most of the tasks. I still treat stuff like that. That’s where I got the drive to do it. The passion was always there. I don’t know how. That worked itself out.
Whenever you’re doing the right thing, it seems like you’re strategically placed in positions of success.
I’m a big believer in consciousness and mindfulness. A lot of times, when we’re looking to the future, we’re in tons of anxiety and in fear. We’re paralyzed with everything we need to do. When we’re in the past, we’re in guilt, shame or inadequacy. The trick I have found is if you stay in the here and now, you get set up for stuff. I don’t know how it works. Don’t ask me. I look back at stuff that I did that has set me up now that I didn’t do anxiety or fear.
I’m moving along here and now. Sometimes, I’ll look back and like, “That was a good idea. I’m glad I got that stupid certificate that I did on a whim six months ago for no reason.” They say they need someone with this certificate. It’s weird how the universe provides you exactly what you need when you’re in line with the universe instead of in the amygdala and thought.
The question is not the how but, “This is what I want to do,” then you’ll figure out the how, even as simple as, “We’re going to be doing the Grand Canyon rim to rim in the fall.” I’m telling a few people about it and they’re like, “We’re trying to figure out how it’s going to work.” Some people want to do rim to rim, South to North, or North to South. They’re like, “We’ve got to figure out exactly how we’re going to get back.” I’m like, “You don’t have to think about that. You just got to say, ‘I’m going to do it,’ and then we’ll figure it out.” We always figure it out. That’s an easier way to think about things in my experience anyways.
No task seems too big when we have that mindset. It’s the fear of the past, fear of failure and inadequacy. It prevents many people from reaching the potential that they have inside. If I can accomplish what have I I’ve accomplished, which is nothing close to what I have wanted where I want to go, there’s no trick to it. It’s just, “Go. Don’t let anything, thoughts, fears, or that stuff stop you. You’ll make a path.”
I learned a way to think about the future. I was at a Genius Network meeting. There’s a guy named Dr. Benjamin Hardy, who wrote a book called Be Your Future Self Now. The premise is, ask yourself twenty years from now, “Should I go get this certificate?” Your future self is going to say, “Absolutely, go get the certificate.” “Should I use this dope right now?” “Definitely, not.”
It’s a way to look into the future or make decisions based upon the future but stay in the present. I don’t even think I heard of any books read about your future self and having a relationship with your future self. When did you decide, “I want to become a doctor?” What made you decide that? That’s a big deal. UPS drug addict, who barely finished high school to, “Now I’m going to become a doctor.”
The thing about it is I found so much passion and love in Neurology and people, but there was always a disconnect for me. I was a Suboxone patient for a long time, which helped me. I felt a lot of like bias. Patients would be upset with the doctors. Doctors are worried about patients and I’m in the middle, “How can we bridge this? Where can we have some understanding on some of the stuff that the patient is feeling for some of the stuff that the physician is seeing and have a neutral view some compromise.”
I was put on a rabbit hole for eight years. I wanted to learn every neuron, chemical pathway or signal. I worked with pharmaceutical companies. I love the Neurology of Addiction, how we can change our neurology and use therapeutics to augment it. I turned into a huge science nerd. I submitted papers to the Journal of Addiction Medicine. I’m on articles all the time. I treat meth addiction with special therapeutics that I use, gambling, sex addictions and those sorts of things, which I’ve been treating for years. I loved the neurology behind it.
I love knowing, “If we tweak this neurotransmitter and we add that, and then we do some social stuff out here that changes the behavior, then we may have different signaling.” I tell people this all the time, “If you find something you love, the money will come.” All that stuff comes with it. I get paid to do what I love. Every day, I feel like I’m stealing at work. I tell my wife this all the time. I feel like I’m ripping people off because I get paid money to go in and like talk addiction and healing. Who gets to do that? It’s always been a dream of mine. I love my people. I don’t even want to call them patients.
It’s almost like a friendship without crossing the dual relationship. I want medicine where they can call me any time. They can text me. I want to build like in the ‘40s, where people would go fishing with their doctors. That model’s gone. It’s all track meet medicine now. I hate seeing it. I know that we’re stressed for people, but giving the patient two minutes for an initial evaluation, not looking at your patient in the eye, not remembering one thing about your patient, their family, what they’re into, or their struggle. It feels good to say, “How are things going with your son?” Know one thing about your patient. It needs to change because addiction medicine and healing, in general, they say it’s 95% medications in psychiatry. I think it’s 95% relationship.
It’s building rapport. It’s almost like people heal from within. If they have a relationship with you, they’re going to trust you, believe in you, and take your suggestions. You said, you feel like you’re stealing from people. It’s like we’ve learned in the twelve-step rooms. You’re being of service, making a contribution, and bringing value, which leads to fulfillment, which is what we’re after.
Recovering Addict: Addiction medicine and healing in general is 95% relationships.
I was on a Facebook group that we have for addicts in Arizona. I was posting my services for free. I was trying to help some people out. I got a call from a treatment center and they wanted to talk to me. I was like, “All right.” I went there. They’re like, “We have to have you.” I was blown away. I’m like, “This is how God works.” I’m trying to help some people on Facebook.
I get pulled over here and offered an amazing opportunity to pretty much run an addiction program. That’s the juice of this program. Whenever you’re doing the right thing, it seems like you’re strategically placed in positions of success. It’s the meeting you didn’t want to go to, the thing you want to do, and the person you didn’t want to spend some extra time with. Those are the times when the dividends are reaped.
Let’s tell me about the Urge Theory of addiction.
It’s almost like addiction turns into obsessive-compulsive type disorder. Essentially we have three primal needs as human beings and most mammals, sex and reproduction or our species will die out, food and water, or we’ll die and then nurture. We nurture our young. We have to teach them. If we cut a baby from an umbilical cord, they’re not going to make it. Those are three programs that we’re born with, and they’re very high salient things. They’re worth a lot. We will die for those three things.
We will die for our young, mate, food and water. Essentially what happens is the use of drugs or alcohol covers some of those needs of nurture that we didn’t get. I’ll use me as an example. I was alone a lot as a kid. I didn’t get a lot of that social interaction. I felt anxious a lot. I found alcohol. It made me feel like I fit in. It filled that need of nurture and feeling a part of the herd. By feeling that need of nurture through alcohol, my body says in that ventral tegmental area, “Alcohol equals primal need.” It’s important. You will die for this. With most substances, that’s what’s going on.
I didn’t have an alcohol problem. I have an alcohol solution. The problem was I couldn’t figure out what the maladaptation was, how to work on that, and ultimately did not need alcohol to give me that missing need. The Urge Theory is to have an experience. It’s assigned a valuation. That’s what happens with every experience, good or bad. The amygdala stores the information based on somatic senses coming in and different pathways, “This tastes good. This doesn’t taste good. This is awesome. This feels good.” The amygdala essentially gives it a score, “Ten dopamine.” It’s tucked away. It’s saved, then what happens is we have thought. What happens when we have the thought is we pull from that saved sensory, that saved the experience.
The body runs it through its limbic system and says, “That’s a good experience.” You go onto an obsessive-compulsive type of ritual to obtain that dopamine release. The cycle goes on and on. I explain this a lot. We look at alcohol and we know we can get a nice dependence on alcohol. At the end of the study, they’re hooked up to functional MRI. Towards the end of the studies, you don’t even have to put the alcohol into the cage anymore.
You put it outside and you see the same dopamine. The brain is lighting up. That tells me, “Is it the alcohol or is it the perception of the experience, wellbeing, inclusion, and nurture?” That’s what it is. It doesn’t matter what it is that triggers that. It’s a perception. That’s why we give people Traxon to block dopamine. They don’t get drunk. The euphoria is much lower because the euphoria is in the perception of well-being. That’s the juice.
It’s the, “I’m okay.”
“This makes me okay. I need it because it’s an innate need. It’s a need of nurture and I will die for this.”
How do you get someone to get over that?
The euphoria is in the perception of wellbeing.
You got to be separated first. Number one is to get into treatment. I’m not saying outpatient. Inpatient treatment is always where we should start depending, but we need to rewire those neuronal pathways. They’re etched in their etched in. They’re never going away either. The goal is to start rewiring. We rewire by understanding what we were missing. We start out with, “What didn’t I get maybe as a kid? What didn’t I do as an adolescent? What need does this drinking do for me?” Drinking is not the problem. If you take away the alcohol from an alcoholic or drugs from a drug addict, they are 100 times more miserable.
If you don’t replace it with something, you might as well drink because you’re going to be unhappy. It’s about finding out what we’re missing, what we’re trying to cover up, what we didn’t get and finding a way to get that from within because we can put the money, the sex, and everything you want into here. It’ll feel good for a little bit stuff will look good out here, then it looks like, “I need something else. Put it in sex, drugs, money.”
The trick is we feel good here first, then everything out here starts to look a little better. When we do it from within, we fill our cup from within. It pours out. That doesn’t go empty. Putting stuff in goes empty. Bleeding it out where the magic happens, your perspective changes, ideas change, and your gratitude changes. It’s a much better place to live in.
You say that they need to replace the drugs with something else. What are the things that they can replace it with?
The maladaptation needs to be addressed. We address that through trauma therapy. We work on that. There are lots of healthy alternatives to get some good dopamine and adrenaline. Lots of people like to exercise, travel, climb the Grand Canyon and hang out with their significant other. There are so many things out there that we can get that physiologic dopamine push without moving into supra physiologic territory, then raising our set points and nothing of in ourselves will measure up to what a drug was giving us.
The bar is becoming lowered because we’re not trying to hit it with a drug anymore. It’s a lot easier to find pleasure in the small things like going to a new meeting, picking up a chip or going to a movie. There are many little things. We heal. We replace it with things that are wholehearted, healthy, don’t hurt other people, being of service.
Asking my future self, “What are the things I should do?” What we do at Camelback Recovery, the Sober Living portion of it, is teach people how to learn how to live. That’s what has to happen because everything has to change, new eating habits, sleeping habits. They pray and meditate, exercise, and hang out with new people and new friends. They become a different person. The only way to transform is to change everything completely. I go on a bike ride called Hour Power. It’s every Tuesday and Thursday at 5:30 in the morning. I’ve got to leave my house at 5:10. The most amazing thing is this bike ride through Paradise Valley.
It’s hard. I work my ass off. I’m with a bunch of people. There’s some laughter and some fun. I was on this ride. My eyes felt like they were going to pop out. I was riding hard. That’s the high. That’s the rush. It doesn’t have to be exercise or bike riding, but there’s something like that or the equivalent of that. That’s the drug and the solution. Thought of it, when I start to think about the bike ride, I get excited. What is the developmental urge model of disorders?
That goes in line with the whole Urge Theory that maladaptation at younger ages. It’s not always our parents’ fault. We transmit what we got. We can’t transmit something we don’t get and we can’t help but transmit what we do. When our parents are raising us, oftentimes, they’re bestowed a set of skills and has bestowed on us.
That’s like Jim Rohn said, “You’re the average of the five people you spend the most time with. You’re raised by your parents.”
Especially with technology these days and here take the screen, this will babysit you. There are many factors that are evolving the way this is shaping up for people. It’s intriguing with technology and how that’s going and the influence, that maladaptive pattern to socialization, to being able to function as a part of a community, leave you wondering most of these people, “What am I missing? What is wrong with me?” It’s an inherent missing piece because, like I said, we’re born with those programs of nurture. They didn’t have iPads in 500 AD. It was usually that the parents were very closely involved or if they were not, it happened to the parents, the community picked them up. We don’t see that anymore.
Recovering Addict: Is it the alcohol or is it the perception of the experience, the perception of wellbeing, the perception of inclusion, the perception of nurture?
That’s why we’re seeing this real rise in mental health crises during COVID. People are isolated. They are raising themselves. We need to get uncomfortable and learn different habits and skills. What kind of the developmental thing is your upbringing really has a lot to do with how you end up. You can go to the opposite end too. I see people that grow up in very chaotic environments in their life. Their OCD is heck because, “Nothing was stable when I was a kid, so everything’s going to be stable now.” I see that with a lot of obsessive-compulsive disorders.
They probably grew up in chaos. We look at people that are love and relationship addicts. They probably grew up with a father that wasn’t around, I see oftentimes. They’re gravitating towards something they didn’t have. You’re either gravitating towards something you didn’t have or trying to get away from something you didn’t like. It’s always a little bit of an overcompensation towards either way, and that’s where we find ourselves in trouble.
When you say consciousness is a key driver of success, what do you mean?
Do you remember the first time you drank?
Do you remember the sixth time you drank?
Definitely, not. I do remember some of the first couple of times, a couple of specifics.
Usually, the memories that we form, the first one is the most important. The first one is that one that we usually use for compare and contrast purposes for the rest of our lives. If you get bit by a snake, you’re probably going to walk by a snake and be like, “Whoa,” because you learned that. Essentially, being in consciousness is I’m not using a lot of that filter of fear, worry, and inadequacy to run these thoughts through. It’s more about operating in the here and now and doing the next right thing, something that feels like it’s from your heart. I tell people, “When you’re running stuff by that filter of fear or inadequacy, that’s where we get paralyzed that we don’t move towards our dreams.”
I tell people, “If you’re in consciousness, this is the next thing to do. I’m going to do it in a way we’ll work out. Here we go. Let’s do it.” We look at the very successful people, the Musks and Gates. These people seem very impulsive, but I don’t think it’s so much as impulsiveness rather than they’re very operative in the conscious. They seem very impulsive, but they’re not running things through that emotional filter all the time. It’s like, “Let’s pull this over.” Remember that bad thing that happened. There’s good in that, but we do that too much. We’re never going to get anything done.
We make decisions based on our experiences and reason not to do something, but the experience definitely helps you make a decision.
It’s there. When we dread it too long and like, “Last time I tried to start a business, it went horribly wrong. I don’t think I can do it. My heart’s in it. I love what I do. Let’s do it. Let’s see what happens. I’m not afraid to fail. Let’s go.”
When we fill our cup from within, it pours out. That doesn’t go empty.
All of the most successful people in the world fail after failure. I have a little art piece of artwork on my wall from Gapingvoid. The first time I saw this was at the Genius Network office. You can’t be afraid to fail because we’re going to fail. All of us fail. Just keep on moving forward. If you fail, learn from it. Get up and try again.
If we didn’t have a failure, we wouldn’t know what it is or it wouldn’t be worth talking about because it wouldn’t be something special, heartfelt, blood, sweat, and tears or an emotional connection to what you achieved. It’d be like, “I did that. It worked out every time.”
It’s the hard work that makes things worthwhile. It’s doing Grand Canyon rim to rim. It’s hard. It takes a long time. You go through lots of pain along the way. It’s the same thing as getting clean and sober. How much pain did you experience going to treatment seventeen times?
Not only that, even coming out of it, I first got sober when I was 23. I was paralyzed by all the life that I fucked up. How am I going to amount to anything? I don’t have a driver’s license or a place to stay. I’m looking at this heap of shit. I’m like, “How am I ever going to be anything?” It was scary to look at. Me, my wife and my two kids down the road, we ended up in a two-bedroom apartment on Northern 19th Avenue. We shared a 96 Accord with a bumper hanging off the front, but we were happy. We didn’t care. We were shopping at Food City.
It was like, “We’re sober. Our family is together. We’re happy.” Every time that I would put all into my endeavors, keep going to meetings and doing the right thing. It’s like, God gave me a little bit more. He’s like, “Here’s a little bit more.” I’m careful to recognize it’s not about what I get. It’s all about, “What can I give back?” You got to give it away to get it. It’s cliché.
It is, but it’s true. You’ve got to give it away if you want to keep it. That’s how we get to fulfillment. We used to think that we lie, cheat and steal to get the things that we wanted because we wanted the bigger house, the fancy car, fancy diamond ring, and all of those things because we think that that leads to fulfillment, which it doesn’t. It leads to emptiness, guilt and shame, which then causes us to go back out, drink and use. The pathway to happiness and freedom is to give it away.
Give it away and help out newcomers. Doing stupid stuff is not what I would have loved, like buying a bike at Walmart and dropping it off at a meeting hall. My wife and I all the time feel so good. Pay for the people behind you at Starbucks. I could never do that years ago ever, “How much for the car behind me?” “$3. The car behind that, $20.” “Let’s just do the first car.” That feels good. I love scholarshipping people. I ended up on a scholarship. Someone took a flyer on me. I got very big on, “We got to give back like that too sometimes.” I take on clients. I know you do, too, at times. That’s where I find the most joy. I do. Giving it away.
What does it take to rewire pathways?
It takes traveling it. I always talk about rewiring neuronal pathways like you got the I-10 and you got the little access road next to it. The little access road is the one you build in treatment. It’s not well-traveled. Nobody wants to keep up on it. That’s the access road. The more we travel it, the more that access road starts to turn into your five lanes. Hopefully, by the time you’re done, the access roads on the other side and that’s the old one. That’s the lie, cheat and steal one. It’s always there. It’s like if a cucumber becomes a pickle, it will never be a cucumber again. That road is there.
What happens, especially with alcohol, is what your body remembers. Once you take a drink again, your body knows, “We know how to reregulate. Dump off these neurotransmitters. We upregulate these.” That’s why we see people that binge drink. It’s the most dangerous type of drinking because your body knows right away, “Dump off all these neurotransmitters and you’re right back where you were.” You got to tilt it a little more. We look at binge drinking and those sorts of things. Your body remembers how to carve out that road quickly.
I love that analogy of the little side road. If you’re in treatment, you’re building the little side road. The purpose of IOP, PHP, and Sober Living it’s like you’ve got that first year, which is the most crucial year. That first year, you’re putting all of your energy into building this road and making this road wider so that it becomes a freeway. You got the year to do it. Do everything you can. Get as many people on board, as much support, accountability, therapy, treatment, group, IOP, everything you possibly can do to build that pathway so that it’s the freeway. The old way of thinking becomes the little side street.
Recovering Addict: You take away the alcohol from an alcoholic, or drugs from a drug addict, they are a hundred times more miserable. If you don’t replace it with something, you might as well drink because you’re going to be unhappy.
I use that analogy a lot, especially when they’re not going to groups or they’re missing things. Usually, at a campus I work, I’ll point to a vending machine. I’ll be like, “How much are those sodas?” They know how much they are. They all drink sodas. They were $1. I’m like, “I pull some change out of my pocket.” I’m like, “I got $0.99. Do you think I can get a soda?” They’re like, “No.” I was like, “What will happen if I put it in there?” They are like, “You won’t get any soda.” I’m like, “If I don’t put it all in, I don’t get a soda.” They look at me for a second.
That’s this treatment experience. If you want the recovery in the book or that you see in other people, you got to put in your full $1. You can’t get the full reward without putting in full effort. You’re not going to get the full benefits and reward of sobriety if you’re half asking it or you’re putting in $0.99. You’re going to end up sodaless.
Half measures available are nothing. What separates your treatment approaches from other treatment approaches?
The DSM is a cool book for billing. I look at traits. Bessel van der Kolk and others will say the same thing. I don’t want to treat an umbrella diagnosis with an umbrella therapeutic. If someone’s got depression, the algorithm says, “Throw an SSRI at them.” Is that what’s going on? Is it a tired depression or a walking depression? I want to know, do I need to ups, norepinephrine and dopamine? Do I need a tickle this or that? I try to use the neurobiological approaches and pharmacologic approaches to treating the traits I see rather than treating an umbrella of traits.
I may use something that may not be for that specific umbrella, but it targets a lot of the traits under the umbrella. More traits do targeting under the umbrella in which it’s supposed to be. I try to look at that when I’m doing a diagnostic interview. I look at the traits. I don’t look at the diagnoses that are good for billing. I know how to diagnose and to DSM, but I want to know what I can do to change these traits that this client feels that holding them back.
I tell them, “Medication is not fixed. This is the augment.” SSRI is meant to cause serotonin to hang out in the synopsis a little longer without getting pulled back up. The body can say, “I think we need to make some more. This other one hasn’t come back. We started making more serotonin.” You want to end up pulling the augment out and making your own again. The whole goal is we augment, and then our body knows what to do.
I take thyroid medication. I had a doctor that said, “Your thyroid is not functioning at 100%. I’m going to put you on thyroid medication.” Sure enough, in 90 days, I was feeling great because I was a little tired. I needed more sleep. I was fatigued. My adrenals were bothering me and were shot. One year later, I’m still taking it. I’ve got another doctor that I’m seeing now.
He’s more of a naturopathic doctor. He’s like, “You shouldn’t still be on this thyroid medication. Thyroid medication is temporary. We want your thyroid to start functioning. I’m going to do this. I’m going to reduce this. I’m going to put you on this because we want your thyroid to start functioning so that you don’t have to rely on this crutch. It’s like when you put it on a cast. What happens to your arm? The muscle goes away. It shrinks. Use it or lose it.” That’s the same thing. That’s what I understand you say as well about SSRIs and that type of thing.
There are many therapeutics out there that are not used and are misunderstood. We look at medicated assisted treatment. All that stuff is great with the ultimate goal of getting off them, but every case is different. Anything we can do to improve the quality of life for somebody, that’s what this is all about. I know recovery is big time. We want abstinence as clinicians and mental health advocates. We want people to improve their quality of life.
I can’t not treat someone because they’re not going to stop drinking. That’s not how it works. My goal is to give them everything they can to improve their quality of life. Take away all the external things and all the things we’re told and all the things that we learn in AA. I’ll tell them, “It’s probably best to be abstinent and here are the risks.” I want people’s lives to get better and if that involves medications, okay.
You were on Suboxone yourself. Tell me, what’s your opinion and your experience with it for yourself?
When you’re running stuff by that filter of fear, or you’re running stuff by that filter of inadequacy, that’s where we get so paralyzed that we don’t move towards our dreams.
Oftentimes, with using high doses of opioids, your endogenous system shuts down. What happens is you’re getting huge dopamine spikes from fentanyl and heroin. Your body says, “I can’t do anything about what’s coming in. Tim’s putting in a bunch of dope. I don’t know what to do. What do I do?” What your body does is it starts dumping off binding sites. You’re getting huge doses of narcotics in you. What happens when we take those out? You’re left with no binding sites and essentially none of your own dopamine because you’re not making it. Hanging out with your kid doesn’t compare to a blast of methamphetamine. Let’s be honest with you.
We have this set point of feeling good. There’s your set point. We’re making this much dopamine. We went from zero to a little bit. Here is, “Hanging out with your wife and kids.” What Suboxone does is it causes a physiologic spike in dopamine. It brings the floor to about here. You only have to move down to about here to start getting some relief. Instead, sometimes, people can’t make it down there. The longer you’re using, the further this gets away.
What it does is it causes the body to make a little bit, nothing super physiologic. The body can only hold 24 milligrams of buprenorphine. It doesn’t matter if you take 1 million milligrams. The rest is getting peed and pooped out. It’s physiologic. What I do is for some people, I like to raise the floor up, so they start to experience some joy a little quicker.
Sometimes I’ll give injectable buprenorphine, which lasts almost eight months. I’ll let the buprenorphine slowly exit the body as the endogenous system fires up. That’s where you get the synergy. The Suboxone’s leaving the body and the system’s firing up on its own. We get that beautiful little synergistic crossing of paths there.
How long did that take for you before you were able to wean off? How long were you on Suboxone and what did that taper like?
I was on Suboxone for 9 months and my taper was 3 months. I tell people, “It’s not a race to get off it. You can do this over 3, 4 or 5 months. No one cares. Whatever feels right.” People ask me, “When do I do it?” I’m always, “Let’s look around. What has changed? Are you stably employed? Are you able to feed yourself? How has yourself?” I look at that and then I’m like, “Maybe it’s a time to give it a shot. You can always go back on it. Let’s see how you feel.” There is no magic number because for some people, even getting a roof over their head takes years. Some people’s lives get repaired pretty quickly. That’s someone that I would take off quicker. I don’t think there’s a magic answer, but I strive for between 12 and 18 months.
It’s case by case, and somebody needs to make sure that they’re connected to a good doctor that listens to them, pays attention to them and is aware. The doctor spends more than two minutes with them. You can make and help them make a good decision.
We’re not doing anyone any favors by guessing. It’s very easy to ask the question, “Do you have a job or a house? Are you paying your rent? Are you living with the roommates?” They’re very simple questions. We can get a lot of data, “He’s stably employed. He’s paying his bills. He’s got his driver’s license.” “Do you got insurance? That’s a big deal. Liability or full coverage?” Getting the data points to know, “This person is acclimated. They’re plugged in. Let’s give it a shot.” “How do you feel about reducing the dose a little bit? Let’s see how you feel. How do you feel about reducing the dose again?” You let them get on their bicycle and go.
Some people think that they need to be on Suboxone forever. Are there cases of people, in your opinion and experience, where people need to be on Suboxone forever?
My opinion is, as a clinician, I’m more worried about the quality of life. I’m not so much worried about absence. The absence is great. That’s the gold standard, but if it’s going to keep a woman from losing your kids to CPS or her from prostituting or a man from robbing somebody at gunpoint or driving under the influence of fentanyl, I am much more in the school of, “Let’s give him the best quality of life we can for them and do damage control for the people around them.”
I’ll be like, “You sink or swim,” when they got two little kids there or meeting somebody at the corner. I take that into consideration. Some people’s bottoms may be lower, and so far, they’re willing to climb. We got to meet them where they’re at. I have high expectations like, “I want you to get here. I’ll meet you where you’re at. I’ll go as far as you’re willing to go.”
Recovering Addict: We need to get uncomfortable and we need to learn different habits and learn different skills.
Is there a question you wanted me to ask you that I didn’t ask?
That does it for our time with Dr. Robbie Westerman. If you learn something that resonates with you, please share it in the comment section of YouTube, Facebook or LinkedIn. Every comment counts. What you share could resonate with someone else that is struggling and potentially save their life. Go ahead, share the one thing that resonated with you in the review section of iTunes. It’ll just take 60 seconds out of your day, but what you share could not only save you but could also save someone’s life. I hope that our paths cross. Robbie, I appreciate you very much. Thank you so much. I enjoyed spending time with you. Goodbye.
I am a mental health provider working across the lifespan. I have worked with all ages, in all settings, and exposed to many cases which have helped to strengthen my treatment approaches and skill as a diagnostician. I completed my DNP in Psych at the University of Arizona. My background specialty is addiction medicine and dual diagnosis. My niche is specifically in opioid addiction and the ever-changing crisis that we are dealing with. My education spans 9 years starting in substance use treatment, moving into adolescent psychiatry as the supervisor of an 80 bed acute inpatient adolescent department, then into geriatric psychiatry as the supervisor of a 30 bed stabilization unit, then into SMI and community mental health at Copa health. In those spans I have also worked and consulted various substance use treatment centers in the Arizona area. Employment experience includes The Meadows Behavioral Health for 8yrs, Destiny Springs 90 bed IP acute stabilization hospital for 2yrs, Vogue Recovery for 1.5yrs, Fountain Hills Recovery, Avenir Behavioral Health, and Copa Health. Currently I serve as provider at Willow House at The Meadows, director of addiction medicine at Fountain Hills Recovery, director of psychiatry for Indian Health Homes, and serve on AZ AHCCCS behavioral health planning committee directing SAMSHA block grants and appropriation of funds.
As a member of the recovery community and former heroin addict, I understand first hand the pull, destruction, and pain of addiction. As a provider and scientist, I seek to understand the complex connections at both a micro (neuro) and macro (social) level. I believe bridging both is the missing link in many modalities.
I am very in tune with advanced addiction neurology, treatment modalities, and emerging advances in the field. I have extensive knowledge in addiction pharmacology and the kinetics of drugs of abuse and treatment. I regularly speak on MAT therapy, specifically on OUD therapy, but also versed in stimulant disorder, CNS treatment (BZD/ETOH), and synthetics.
Prior to medicine, I was a manager at a Fortune 500 company for 7 years. My cross-training in high-pressure managerial roles has enabled me to develop a caring yet assertive and functional approach with clients. I focus on the utilization of evolving treatment modalities and basic neurosciences of addiction to take a multidisciplinary approach so clients can have sustained and lasting recovery. My calling is to not just make a dent in this area, but evolve the way in which we approach treatment and put forth real change.