Why You Do Not Have A Broken Brain

 

Most people in recovery assume they have a broken brain, and it hinders them from getting better. But it is not the case. Every person in recovery always has a chance to succeed – all they need is the right support and treatment methods. Tim Westbrook is joined by Dr. Jason Giles, founder of Addiction Doctors, who has been helping people recover from addiction not just through clinical expertise but also real-life experience. He shares how he discards the notion of having a broken brain after going through addiction, and instead focuses on a long-term, intergenerational approach that focuses on the actual root of the problem. Dr. Giles also dispels the misconceptions about willpower, the three important things that make a difference in recovery, and how breathwork and meditation can lead to a powerful mindset shift.

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Why You Do Not Have A Broken Brain

A New Way To Understand Addiction, Recovery, And How To Actually Change Your Life

Welcome to another live episode. Our guest is someone I’ve been looking forward to having here because he brings something that’s rare in this space. Not just clinical expertise, but real lived experience at the highest level. Dr. Jason Giles is a Triple Board-Certified in Addiction Medicine, Anesthesiology, and Pain Medicine.

He’s been sobered for over 25 years. He spent the last two decades helping people recover from addiction, not just in theory, but in real world, high-stakes environments. He’s the founder of Addiction Doctors, a multi-specialty telemedicine group that’s helping detox and stabilize hundreds of patients every single day across the country. He’s worked with everyone from professional athletes to executives to families in crisis. He’s built programs to focus on long-term recovery, not just quick fixes.

What stands out to me about Jason is his perspective on addiction. He doesn’t see the brain as broken. He sees it as learning in the wrong direction. That shift in thinking changes everything about how we approach recovery. He’s also the author of Outsmart Your Addiction. He has another book coming out in 2027 focused on helping families navigate this disease. We’re going to talk about what addiction is, how recovery works. What it takes not just to get sober, but to stay sober and build a life that’s worth it. Dr. Giles, welcome to the show.

Thanks, Tim. That was great. Whenever I feel self-doubt or bad about myself, I want to read that because it sounds awesome. You made me sound very good. I appreciate that.

Identify The Medical Industry’s Shortcomings With Addressing Addiction

I came up with it myself. Take us back to your story. What was happening during your residency when things started to unravel?

We’ll jump right in. You guys heard a little bit about the story. Which is that at the beginning of my medical career, I went into Anesthesia. That was my training. This is in the late 1990s. There are a bunch of things going on in medicine, especially in broader medicine. We’re trying to figure out how to get more people covered with insurance and so forth. What that turned out to, which eventually led to Obamacare, fifteen years later.

At the time, there was this talk about taking over the management of medical care, all the way down to the individual patient level, by the federal government. That scared all the doctors. It scared all the practices that had been used to running things a certain way. One of the specialties that was most affected was Anesthesia.

The year before I entered training, a bunch of the residents left because they thought there was no future. This is not going to be a real job anymore. This is all going to top-down order, loss of autonomy, and no jobs, by the way, because we’re going to constrict the availability of surgery for people. The bottom line on that is when I got there, I was doing the work of two Anesthesia residents. My schedule was at least 100 hours a week. Quite regularly, more than that. One hundred twenty hours a week was not unusual at all. At least a week, a month of that.

A great training. I learned a lot. It was in addition to the hours and the isolation and the stress. The subject matter, the people who we’re dealing with, I was at a university level one trauma center. Gunshots, car crashes, burns, we covered the Shriners Pediatric Burn Center. We had a very unfortunate bunch of patients who had their lives changed in an instant.

There’s a culture in medicine where opposite of the recovery culture, you don’t ask for help. We’re supposed to be the tough ones. We’re supposed to just show up every day and not let it get to us. That’s the environment that I was in. Besides, my nature is not generally to ask for help. It’s not generally to say, “I’m struggling here.”

Addiction isn’t a broken brain—it’s learning gone in the wrong direction. Share on X

You take that pre-existing mentality or disposition and then add this enormous unbearable stress, including all the stuff we saw. I was looking for solutions. I had played around with substances when I was younger, but not to any great problem. Not to a situation where I would qualify for treatment or any of that. It was just kid stuff, experimentation.

Now, I had a different set of tools to experiment with. I remember it’s insane to think about using a narcotic to manage your feelings. As I say that, it’s insane. Under those circumstances, eventually, it sounded like a good idea. I made this deal that I would try fentanyl, which was the substance. Back when I told this story in 2006, I used to have to repeat that word because it’s a weird word. People hadn’t heard it. By now, the cat’s out of the bag. People have heard about this. It became popular.

Back then, it was the exotic, very high-potency narcotic that you could only get in the hospital. It wasn’t used outside of the hospital. I thought, “I need to do something. I’ll try this and see if it helps. If it helps, then I’ll have something in case it gets bad.” That was my thinking. That’s just putting your sleeve in the cotton gin just to see if it’s going to grab a hold. The opiates worked. That’s probably the worst thing that happened. I felt exactly the way I wanted to feel. I felt safe and understood. I felt like I had a solution to manage this pressure and feelings.

I left it alone for some weeks. I had another reason to use it. I left alone for a couple of weeks and then had another reason to use it. It was just Fridays because it was very contained. Only work a week and then just Fridays, but then Friday is a long time to go. It was Tuesdays and Fridays. Pretty soon, it was every day. The doses started to go up.

I thought I had essentially unlimited access because I had some creative paperwork. I was inventing patients. Some of these patients needed a lot of fentanyl. Believe it or not, even at a major university hospital. Eventually, the pharmacy was like, “This isn’t making sense. Why is this one guy using way more than anyone else?” Even with what I said about the workload and all the rest of stuff.

By the time I was coming to the attention of the statisticians in the pharmacy, I was at, what the book calls, the jumping off point. I was so ashamed. I was so terrified. All I needed to do was not use. I couldn’t manage to do that. I couldn’t manage to stop. Mercifully, this is divine grace. My department chairman got word from the pharmacist and gave me a page. This is in the days of pagers.

I remember sitting by the Sacramento River. That’s near where I lived. I don’t know if anyone’s had this experience. I didn’t think about killing myself overtly, not specifically. If I had died, that would have been okay. That’s how I felt. I couldn’t continue living this way anymore. Right then is when I got the page. In case you guys aren’t familiar with how the hierarchy works in the hospital, the chairman doesn’t usually page the residents. That’s not how it goes. It was already a sign.

He got on the phone, an Australian fellow. A great guy. He basically said, “We know what’s going on. We’ve had this experience before with residents who we found dead in the call room. You don’t have to go that way. In fact, if you agree to enter treatment, it’s all going to work out. We’ll have you back here. You’ll have a great life.”

I did not believe him. I did not think it was possible from where I was to get to feeling okay again or be accepted again or be a doctor again. I thought I had ruined all those chances. I didn’t have any better options besides driving into the river. That was plan B. I surrendered and said, “What should I do next?” Since then, when I’m in my right mind, I say, “What do I do next?” That’s how we got here.

Can anybody relate to being at a place where you just can’t imagine that your life could be better on the other side of addiction, of sobriety? You said the turning point was realizing you couldn’t keep your word to yourself. Why is that moment so important in addiction?

That’s a good question. Part of my particular consolation, although I’ve taken care of a lot of people since then. I realize I’m as unique as ham and eggs. It’s very common. It’s thinking “I got this. I got a system. I got a plan.” From my perspective, I’m not a dummy. All of those skills for, as I said, inventing patients and outsmarting the pharmacy. Brinksmanship of “I should tell Tim what’s going on but no, maybe I’ll do it later.” All those thought processes I thought were helping me. That they were getting me through because this is just a phase. I’ve got this.

Step two is what you’re alluding to. You’ve got to cop. I had to cop to myself. I’m crazy. This is crazy. The thing I think has all this under control is every day making it worse. Coming up with new and elaborate, sophisticated ways to screw myself over. When the simple thing to say, “I’m hurting. I’m lost. I need help.” The intellect made that off-limits. That’s how they get you when you ask for help. That’s when they drop the guillotine blade on you. Just manage this on your own. In order to have this problem, you need two things. You need to think there’s something wrong with you, which I certainly did.

You got to think “I can fix this by myself.” You need both. If you don’t think there’s anything wrong with you, you’re not going to go down this road. You’d just be a regular person. If you think “I’m in trouble, I need help.” You’ll get help. If you have those two things like I had, which is, “I got this.” That’s a disaster. This Friday business, even with the hours, weekends were relatively less business, less elective surgery. Weekends were more just emergency cases. There’s a rhythm to the week. I didn’t work every single weekend. All I had to do was not use Friday.

Since the nature of fentanyl, by Monday, I would have been okay. From a physiologic standpoint, if anybody’s ever kicked opiates, the short acting ones. It’s not months of misery. It’s only a few days. Intellectually, I knew if you stop, you’ll be okay by Monday. This will all be behind you and the problem solved. It’s weird. As a doctor, I couldn’t take my own advice. I would make up a reason why just a little bit or how I would have too whatever. The insanity of the first drink, as they say, was right back on me. That’s a great question.

Did you ever find yourself going to work high?

No, that was the line. I had a lot of time to think about this. I wasn’t loaded when I was at work. However, that’s a very tricky legal definition. I was poorly slept. I had been throwing up, terrified, sweating, anxious, and losing weight. I was very scrawny. I had crap nutrition. An increasing share of my mental attention was devoted to this problem. Was I impaired? Absolutely. Was I high? No. That’s another example of justification.

If it ever got to the point, you start saying, “I’ll never do that. That’s insane. I’m not going to do it all the time. I’m not going to do it when I’m taking care of patients.” Technically, I had that little fig leaf of saying, “I didn’t just shoot dope right before doing this case.” I sure was looking at the clock. I sure was waiting for this day to be over. That’s impaired. There’s a word for it in businesses or in the work world. It’s presenteeism. You should be home recovering. You should be at the doctor getting help. Instead, you’re at work. It answers the question. Not loaded, but not in my right mind.

I understand. You bring up a good point. You’re never present to the situation or with whatever it is. All addictions are like that. You’re either high or you’re thinking about getting high. You’re drunk or you’re thinking about getting drunk. I know when I was out there, I was always thinking about it. I was high or I was drunk or I was loaded or whatever. That’s no way to live life. Miserable.

It’s taken some time. If you asked me that question in 2001, I would have been more bristly about it, more defended. With time, I realized that the only person I was successfully bullshitting was myself.

Treating Addiction Using A Long-Term Approach

We think that nobody knows, but everybody knows. Can anybody relate to that? We know you’re lying. That’s the first thought, is that “He’s lying.” You went through a monitor physician program with high long-term success rates. What are they doing differently that the general system isn’t?

This is one of my pet things. In fact, I just had this conversation with a young man, who’s 23 and two years sober. He had some mental health issues as well, which is quite common. It’s very common, especially the young people, with all these lockdowns that we went through. We hurt our young people with that in ways we don’t fully understand yet.

He got caught in that. His solution was chemicals to manage his feelings. He was using a few different psychoactive things in order to deal with how he felt and his symptoms. That’s behind him. It is a touchy subject in the treatment world, but we’re talking about the relatively crummy success rate in terms of the standard that we offer people. In terms of how we treat this problem.

I started this conversation by saying I was a resident, I had a lot of pressure. If we had time to dilate and spend more on a longer conversation, what was I doing in medicine in the first place? It’s not that easy to make it to that pinnacle of academic achievement. Something has to drive you. What’s wrong with this guy that he spends his twenties doing this? You have to be a little bit weird to be a doctor anyway. That’s probably true for a nurse or an attorney or anybody, or an entrepreneur. There’s something about you where you’re submitting yourself to this.

There were earlier causes. I grew up with an alcoholic dad who got sober. I had that childhood experience. That’s probably part of it. There’s a lot of alcoholism genetically in the recesses of my family. Maybe that’s a piece of it. It wasn’t an accident that I found myself in that situation. It’s because of the access or because of my thinking to use this weird solution. We treat these lifelong and maybe, intergenerational problems with a 30-day dip in health.

We’re like, “You’re sober now. Don’t do that anymore and you’re fine.” The wood has already been twisted. We’re the way we are. Whatever solution we come up with is going to take a lot longer than a 30-day dip in recovery. That’s why you’ll hear, “Keep coming back. Keep going to the meetings.” Keep at it because this takes a long time. This is like a series of grace and lucky things that happened to me besides the chairman. There are many.

 

Since I was a physician, I got into this program in California called the Diversion Program. It’s a five-year program. It’s five years long. It’s not five years of sitting here, having to listen to me and Tim in rehab. It’s five years of drug testing, attending groups, having to participate in, at the time, twelve-step recovery. That was, and may still be, the best longitudinal thing we have for people to get involved in something. Doesn’t have to be AA, but it’s got to be something that looks like AA, in my opinion. That’s what happened to me.

It takes a long time to get into a new set of habits. It takes a long time to, when I think a certain way or feel a certain way, have a different automatic response. Which is to call a friend or go to a meeting or help someone else or pray and meditate. These things that don’t come naturally. It took many years to develop these habits. This is a learning thing. The old idea of, “I feel bad. I want to use something to feel better.” I still have that. That’s still in there. It pops up sometimes. I’m like, “Where’d that come from?” It’s still there.

What changed, because I went into this long-term thing, is that’s not my first response. My first response isn’t I need a drink like it used to be. I need something to change how I feel. I don’t have that initially. I’m doing all these things. The self-care, this is going to sound weird. Once that gets put on autopilot, you got a good shot. It takes a long time to develop that habit. What I would wish for everyone reading this is that you could go to medical school. Go through what I went through so then you have to do this program. That’s not very practical. In the beginning, the issue is I don’t want to lose my license so I can’t practice medicine anymore.

I was ready to give up all of it if I didn’t have to feel that way anymore. I could set it all on the table. It’s been many years since I successfully completed that program. I still didn’t go back to that life. It can’t be that you have to stay in treatment the rest of your life. It wasn’t a treatment. It was just accountability until I had enough muscles or routine or automaticity to be a sober person. That’s probably it. Until I thought of myself as a sober person, until my identity was, “I don’t do that.” It used to be, “What can I get away with here just in case?” I don’t think of myself that way.

It’s like changing your identity. For me, when I first got sober very quickly, it was, “I don’t drink.” It wasn’t when I hear people say, “I’m trying to make it to 30 days. I’m trying to make it to 60 days. I got to make it. I got to make it to 60 days.” Those are the people that struggle in my experience. Changing your identity, even if you just start saying it, “I don’t drink. I don’t smoke.”

I remember I had a nicotine habit from when I was nineteen up until when I got sober. When I quit my nicotine habit about a month after I got sober, which is another hard thing to do. Very quickly, it was, “I don’t smoke.” That’s identifying differently. Even if you’re just speaking it at first is so important, in my opinion. If I remember correctly, 90% of people relapse within 90 days. People that make it to a year have a 67% chance of making it to five years. Eighty five percent of people that make it to five years make it for life. That’s right along with your point.

There’s another one, which is in AA. AA is very hard to study because we don’t know the denominator. We don’t know who comes in and goes.

Who works the program.

Another thing, we don’t even take the roll. Who was here at the AA meeting? We don’t keep track. We don’t know how many people came in versus how many people made it or claim they made it. What does that mean? That’s another problem. The people who make it 10 years, they make it 20 years. Almost all of them.

It’s very unlikely to go out after 10 years if you get 10 years. It’s very hard in the beginning to imagine yourself at ten years. It’s consistent with this idea that. I like what you said it takes time to change. “I’m a gym-goer, I go to the gym.” Versus, “I don’t go to the gym. I’m not a gym-goer. I’m trying to go to the gym. It’s a new year. I’m going to try to start going to the gym.” You’re doomed.

This is the hit parade of lucky things that happened to me. My best friend who’s one year older than me got sober one year before I did. It was like having the guy with the machete going through the jungle just ahead of me. I would check in with Dave like, “What about this?” He had been to a year’s more worth of recovery than me and still has. We’re still the same.

He picked up this gem from a meeting, which I’ll share with you, which changed my whole life. This is the quote he said, “Be prepared to revise everything you think about yourself.” I had very rigid ideas about myself. I mentioned some of them. I can’t ask for help. I’m on the outside looking in. I’m different. I’m not good enough. I have these very fixed ideas about myself. As a consequence, I did all this crazy stuff to try to deal with those ideas.

That’s the point of taking the inventory. You look at it and go, “Is that even true, this thing that I think about myself? Am I a disorganized person? How do you get through college and medical school? That’s maybe not true.” Once I started throwing away or letting go of stuff that just wasn’t true, then the possibility opens up. Your yesterdays have not ruined your tomorrows. Anyhow, if I could bless everybody here with involvement in a long-term program, I would. Whatever that looks like. It’s tagging up. I did one other dumb thing.

We keep talking about AA because it’s been so essential and helpful to me and still is. I said something stupid. I thought of a very low-risk bet. There’s things you say that then hold yourself accountable for. I said, “If this works, I’ll keep going.” I thought the chances I’d have to pay off on that are about zero. How is this? This is a bunch of people talking about their problems and recognizing the higher power and showing up for one another. That’s going to get old very quickly.

Being of a service, helping another person.

I’m still here.

Addiction: Following A Bad Map With A Working Compass

You say addiction is learning gone awry or following a bad map with a working compass. Break that down for our clients here. What does that mean?

This is where I get a little bit controversial, but it’s for a good point. I’ll just take a survey. Anyone here ever heard that addiction is a disease? Unanimous. Anyone heard that? No one ever said it was a disease. It’s pretty unanimous. Let me take the total opposite tack. Anyone ever heard that it’s a problem of decision-making? It’s a problem of choice. You’ve got a defective chooser. How can those both be true? Either. That’s where some of the morality stuff is. You’re bad person because you’re an alcoholic. The disease stuff is what we’ve been at for about 30 years, calling it a disease.

ASAM came out with a big position statement in the early 2000s saying it’s a disease and it’s in the brain. If that were true, that should help. It should help. I don’t know if you’d get a badge saying, “I have brain disease.” Most of us don’t snuggle up to that idea. It doesn’t feel very good to say, “I have a brain disease.” If it’s true, I’m all for it. It doesn’t seem to be true. Here’s the strongest evidence I have. When do we choose to relapse? Are you drunk or sober when you relapse? You’re sober. When do you choose to get sober? When you had enough, when you’re drunk. What kind of a disease is that?

There’re problems with this idea. There’re problems with the choice model, too. For a long time, they just said to people with alcohol problems, “Snap out of it. Say no.” Saying no implies it’s a choice issue. Mental models, how you see this problem, and how you see yourself in relation to the problem turn out to be important. Very important because if you imagine yourself trapped or doomed, then your responses are going to be on that basis. If you imagine yourself as having options, you probably have a better chance of picking different things.

If you imagine yourself trapped or doomed, your responses will be on that basis. If you imagine yourself as having options, you probably have a better chance of picking different things. Share on X

Here’s the way it works. This reconciles both of them. I don’t think there’s anything wrong with your decision-making ability. We seek safety, certainty if we can, and optionality where we have choices. Anyone has a pet dog or cat? Does your dog know where to get a snack or treat? Does your dog know what to do to do that? Does your dog know how to avoid or deal with the threats and stuff? It’s true across every animal in the kingdom. It’s true across us. Intrinsically, we know what we want and what we want to avoid. That’s normal. That’s how we became successful on the planet, by being able to choose. That’s the compass.

That’s the take-me-to-safety. Where’s north? How do I find where to go? The problem is the map. If you heard my story, I had a shit map. I had a bad map, which is, “I want to feel okay and safe. I’m going to use drugs to deal with that feeling.” I got to that feeling. Unfortunately, there’s a lot of consequences and side effects that come along with shooting fentanyl in a professional environment, especially, but otherwise, besides. That’s probably true anywhere. There’s probably no safe place on earth. We can go, “Handle this.” I don’t think so. I used to have this fantasy that I would have another anesthesiologist. That we would take care of each other and make sure that we didn’t overdose.

That won’t work. Anyone else have this crazy idea? That’s not going to work. You need a third one. You need somebody to keep an eye on that guy and then you could take turns and shifts. Give you plenty but then make sure I breathe for you in case you go too far. Three guys aren’t going to be able to keep a secret. Someone’s going to fall apart. This is where I thought that that’s the map I had. “I need to mitigate the danger of this by coming up with a more elaborate thing.” My route to getting to feeling okay was the problem.

If you’ve ever been hiking and you see the trail and you see the trail. There’s all these people. Thousands of people have walked up and down this trail. It makes a path. That’s how the brain works. The brain makes a path. Sometimes, you’re just smoking a cigarette. You didn’t even think about it. You’re just tugging on the vape. You saw it’s automatic. You just find yourself at a meeting of AA. You don’t even know how you got there. Things become automatic, we’re creatures of habit.

The habits are the neurological equivalent of the map. Your brain is making these pathways. It’s muscle memory. It’s neurons that fire together, wire together. That’s science. You learned, “If I want to feel better, I take a drink.” That works and it works reliably. It’s great. Meanwhile, problems are coming up. This path is taking you through this disaster. Eventually, that solution becomes more of a problem than the solution. Your compass is fine. Your, “I want to feel better” part works. How I get to feeling better, that’s what you need a new map for. Does that make sense?

I’m thinking about, “My best thinking got me where I am.” I’m thinking about your identity and you have to change your identity. I think about one of the things that Joe Dispenza says, “We have 50,000 to 60,000 thoughts every single day. Ninety percent of our thoughts today are the same thoughts that we had yesterday.” To your point, hiking up Camelback Mountain, that trail is there. It’s just easy to keep on going up and down that trail. As you have that trail that’s wired, you have to change that. You have to change your route. It takes a lot of work.

That’s why it’s so hard. Five years until that other path, which is still there. It’s not that attractive. It’s not automatic. It’s not worn the way you would go. There was some construction near my house. The way that I would go home all the time, I couldn’t go that way. The construction was a sinkhole. It took a long time. They had to fix a bunch of stuff. It took months for them to fix it.

I would go down the same road. Turn around and go back the long way around. That happened so many times that I quit going down the regular way that I go. They fixed it and then they opened it back up again. Guess what happened? I kept going the long way because I was used to that. It’s an over-learned path that leads eventually to problems. Remember the three stages. It’s fun, fun with problems, and then problems.

In the beginning of substance use disorder, it’s great. It’s a relief. We tolerate the problems because it’s doing so well for us. Eventually, it’s, “Oh shit, I’ve got to do something about this.” That pathway is well-worn. Logic has nothing to do with it. Intellect has nothing to do with it. These are at the emotional level. These are, “I should take this same path because it worked before. I’ll just go back to the fun part without the problems part.” That’s how we get into trouble.

If the brain isn’t broken, how should someone here think about their own addiction differently?

It’s not. If you’re going to get well from this, we’re counting on your brain being able to fix itself. We’re counting on it being mostly okay. That’s the charge. No one’s coming to save you. You have to save yourself. Our working hypothesis, if you think about this, the whole treatment world is arranged around, “You’re going to get this. You’ll get it. You’re okay.” That’s our assumption. Otherwise, we’d probably just jail all the alcoholics or kill us all. If you can’t get better, well then what are we doing? We assume you can get it. We assume you can figure it out.

If you think of yourself as broken or damaged or ruined or irredeemable. If you want to get into the spiritual world or doomed, if you want to go a little further. If you think of yourself that way, your world gets a lot smaller. I’ll say it this way. How many of you guys like helping other people? That feeling of being useful. Me too. Made a career out of it. How many of you would want to be cheated out of the opportunity to help others? That doesn’t feel very good, but we do it all the time.

 

We don’t let people help us by saying, “I’m not worth it. I’m not good enough to waste Paige’s time by asking for help.” If you think of yourself as, “I’m worthy. I have stuff to contribute. If I can get this help, then I can help a lot more people.” If you think of yourself that way, not as having a broken brain, not as being defective, not as being irredeemable. If you think “I can get help,” then you’ll ask for it. Do you think, “I want to ask this girl out, but I’m not sure she’ll say yes”?

If you think you have a shot, you’ll probably ask. If you think you have a broken brain and you’re doomed, it’s busted, that’s it. You’re not going to ask for help. There’s a whole line of research in this called Efficacy Theory. If you think you can, you will. You can, and then you’ll be. My son’s coach used to say, “Get on your own team. Be on your own side. Be your own advocate.” Say, “I can ask questions. This is a doctor. This is just my sponsor. I can get help. I’m worth saving.” That’s what I’m saying.

I’m thinking of the placebo. If you believe it’s going to work, guess what? It’s going to work.

What’s the difference? Great. For me, that’s gummy bears. Those helped me a lot.

The Wrong Idea About Willpower In Recovery

Where do people go wrong when they think recovery is just about willpower or stopping the behavior?

It is about willpower and stopping the behavior. You will not get relief from the obsession to drink if you’re still drinking. This gets into the spiritual world. You will not be forgiven unless you ask for forgiveness. You can’t be continuing the activity and hope to get relief. I want you to take away the urge to smoke, but I’m going to keep smoking. There’s a drug, by the way, that capitalized on that called Chantix. Remember Chantix?

I do.

Chantix had this brilliant ad campaign which amounts to take the Chantix but keep smoking. That way you can say, “I’m working on it. You can keep smoking while you’re working on it.” It doesn’t work that way. You do have to have enough courage to put the plug in the jug or put down that syringe, in my case. You do need a certain amount of willpower.

Step three in the twelve-step says, “Turn to our will,” which is what we’re talking about. Willpower, turn to our will and our lives. Not over to God, but over to the care of God. That’s the trick. It means your will can be augmented by the will of others. You have to be on your own team. You have to do what you can. What you can is get yourself in a different environment.

You have to be on your own team. You have to do what you can. What you can is get yourself in a different environment. Share on X

You can get yourself around other people. You can stay out of the barbershop if you don’t want a haircut, so to speak. You can be honest. You can try new things. You can let go of the old things. All these things that you can have willpower around, that you need willpower around, eventually add up to seeing yourself differently.

It’s like those paddles that get your heart going again, the electric shock. No one’s coming along to give you recovery or give you sobriety. It doesn’t work that way. We can’t force it on you. You have to be a willing participant. The amount that you have to do is tiny compared with what you get. If you’ll just quit holding back, quit pushing away on the help.

You’re surrounded by help, by the way. Most of us are like, “I don’t need anything. I’m good. I got this.” If you go, “I have the willpower to let the world love me, to let the people help me who are good people trying to help me.” You’ll be amazed. It’s like power steering. You only have to turn the wheel a little bit and the car goes right where you want. I don’t know if that answered the question. You can get away from willpower, but it’s not enough. You heard my story. I’m like, “Don’t use.”

You talk about the environment. The environment always wins. You have to have enough willpower to say no. You have to have enough willpower to turn right instead of turning left. To help yourself, put yourself in the right environment and spend time with people that are living the life that you want to live.

That’s why twelve-step is so great because you’re putting yourself in an environment where people want to be clean and sober. They’re living the principles in all their affairs. Not all of them, but some of them are. They say, “Stick with the winners.” Sticking with people, changing your hobbies, and your interests. The people you spend time with, the way you talk to yourself, pray, and meditate. Do things that you didn’t do while you were focused on drinking and doing drugs. That’s what has worked for me anyways.

It feels uncomfortable.

At first.

If you think back, I pick on drinking because it’s handy, but so did drinking. The first time you drank, it didn’t taste good. It burns. You have to work through some of the negative effects of it. You stuck with it and you got good at it. It’s the same here.

You can get good at recovery. You can get good at self-care. You can get good at doing breathe work. You can get good at meditating, going to the gym, exercising, walking, and hiking. Whatever that looks like.

Forgiving yourself, being patient, all those things.

Three Important Things That Make A Difference In Recovery

You’ve treated high performers, athletes, executives, etc. What separates the people who stay sober long-term from the ones who relapse?

You’re not supposed to do this. This is an inside baseball recovery stuff. You’re not supposed to speculate on who’s going to stay sober. You probably wouldn’t have speculated that I would stay sober. I didn’t come in with the best intentions. I knew this wouldn’t work. I set out to prove it wouldn’t work by doing all the stuff, which is again convoluted. I wouldn’t have guessed that I would make it based on the drug I was using and all that stuff. My odds were poor on the surface. Obviously, things worked out differently.

There’s a couple of ingredients. The thing you mentioned already, which is “I don’t smoke. I don’t drink.” It’s this embracing of a different identity. The people who dither, they’re like, “I’m experimenting with this period of moderation, or I’m not drinking right now.” I had that too. I’ve told this story before. I had this idea that I would toast my daughter at her wedding. Glass of champagne and a room like this. Everybody gathered around. We’re celebrating my beautiful daughter getting married.

I’m going to propose a toast. You can’t do it with water. You have to use champagne. This is way back when I first got sober. The only problem was I didn’t have a daughter when I was in this discussion. I had no kids. I’m imagining this elaborate scenario where it’s going to be okay to drink. That’s a stash. That’s an off-ramp, back door. That’s less than being completely committed. Even though you may have broken your word to yourself before, have another go at it and say, “I don’t drink. I don’t smoke. I don’t do those things.”

1) You have to be an absolutist about it. 2) We drift. Part of why recovery is so awesome is it will help you solve problems you don’t even know about yet. This is just saying, “I now have problems where I didn’t used to have areas.” You get successful, friends, a house, kids, and responsibilities. These things I didn’t have when I was going through these scuffles. If I had to read one book or figure out how to handle all the stuff, I have to deal with now like employees and all, all these things. I would have had no idea. I wouldn’t have known which questions to ask when I started.

 

In addition to the identity of, “I’m not a person who does this,” you need some support system that can grow with you, that can change with you. The most common one used in America is the church. It’s the most common support, celebrate recovery and so forth in there. The next most common is twelve-step. It could be anything.

It could be this friend, David, I told you about. We’re close and share all kinds of stuff. You need something that grows with you in order to stay sober. The people who don’t, the people who I get a phone call. It’s like, “Things were going okay, but then I had one and that went fine. I had another and that went even better. Why am I missing out on all the joys of life? Now, I’m in the ditch again.” Those people didn’t have an ongoing thing.

They went back to the old trail.

Which was happily welcome there to take them to the good feelings, but it goes through brambles and bad stuff. The last thing I would say. This is maybe the best practical tool I’ve ever come across, which is to tell on yourself first. If you’re scheming up a weekend or a plan or something, share it with somebody. “Tim. We’re all going to Vegas. I don’t drink.” I’m making this up as I go. That’s why it’s so lame.

“I’m not going to drink. I’m going to go there and just go to the wine tasting. Smell the wine and hang out with the beautiful people.” I watch Tim’s response. I probably get an extra data point. There’s probably a chance. If you have a good idea, then somebody who’s in recovery will go, “Let me know how it goes. Have fun.” Your idea is fine. You’re telling on yourself. Nothing happens. If you’ve got a bad plan, you can watch the response and get like, “Who’s going to this thing? When did you get into wine?” You start to get the questions. You realize, “Holy shit. I’m well down the road to relapse.”

The reason I say telling yourself first is if you don’t and you go back to your old life and your old strategies. You’re going to be able to keep that secret. Is that going to stay just between you and you? No, your life is going to deteriorate. It’s going to explode. Pretty soon Tim’s going to say, I’m picking on you, “What happened here?” “I went to Vegas.” You’re going to tell the story. You’re going to tell the story with all the crap that came along with it.

“I didn’t know you were going to Vegas.”

These are the three things that make a difference. Change in identity, get with a dynamic program that can grow with you as you grow. You get different problems along the way. Tell on yourself first. We’ll have to run an audit. In every case, whether they’re successful, accomplished people, or just regular folks who are accomplished in their own way. Those are always the ingredients. When you do the autopsy on why you go back to this thing that you know is bad for you. I didn’t see myself as done. I don’t have a program. This thing that was coming up, I kept it to myself. Those are some practical tools.

One Huge Change The Medical Industry Needs On Addiction Treatment

If you could change one thing overnight, whether it’s insurance, regulation or referral systems, what would it be?

If you asked me years ago, I would have said stigma. I would have said, “Let’s make it so that it’s okay.” Everybody has problems. You don’t feel embarrassed about getting a knee replacement or needing your appendix out. I don’t like talking about this, but I needed my appendix out. If we can make it like, “I had a drinking problem. Why can’t we talk about that?” I would have said that. That’s probably still there, but better. It’s much better. Celebrity Rehab and all these other shows have made it, and all the news.

People are aware that this is a problem, that there’s help. You’re not doomed. I don’t think it’s stigma. The way we treat this problem is still on an acute stabilization basis. If I could wave a magic wand, I said this a minute ago, I would send everybody to medical school so that they could get this program of longitudinal care. I don’t mean that literally because no one should. All doctors and no patients.

We need to change the way we think about this problem. We need to change the way we approach it. That’s why the compass map metaphor is so useful. It’s not like fixing a broken arm or getting your appendix out because it’s infected. It’s going to burst and kill you. These problems start long before you get to rehab. If you’re lucky enough to get here and only 2% or 3 % make it, you guys are lucky to be on the inside of this. Most people wouldn’t even get here.

Jamie Vink, who is on the show said only 10% of people that need addiction treatment or mental health treatment get it.

It might be less. At best, 10%. Most people don’t get any help. What we have to offer isn’t very helpful. We need to change the way we approach this from an acute problem. It doesn’t mean people don’t need detox because they do. To a longitudinal problem. This is where the disease people are right. We have to think about it more like Type 1 diabetes.

We’re still trying to work on how to fix the bad pancreas with the Type 1 diabetes. We may someday. In the meantime, it’s not, “Go to the ER to treat your ketoacidosis and then eat whatever you want in between.” That’s how we treat this problem. If you recognize yourself or you’re diagnosed, you’re identified as somebody with the problem I have. You need to change the way you live. Not this week, not for 30 days.

You need to change the way you live. That turns out to be the solution. The payers will come along because the payers are upset that we keep fixing the same broken arm when the problem is there’s that rug that’s loose at home. You keep stumbling over it and breaking your arm again. I was just in Washington. I know people who are working on that, and I’m one of the people, who’s working on these problems. The problem with shifting this is if you start to look at habit problems, habit illnesses, you’re going to wind up diagnosing everybody.

We look at substance use, big deal like fentanyl, alcohol, and catastrophe. If you look at gambling, which is a growing scourge with all the online betting. If you look at the phones, this is going to get touchy. We spend around seven hours a day on our phones. That’s a full-time job. They’re built to be addictive. They’re sticky. They show you the next thing. They’re hooking your attention just the same way that they light up the same centers in the brain that drugs and alcohol do.

How are you going to deal with that? You look at risk taking. You look at a workaholism. You start obesity, the overeating to manage your feelings. You start looking at those things. Who’s not included? Part of why we’re touching about this is it’s a culture. It’s not just the US why we’re a little bit like, “It’s these drug addicts. They need to just send them to rehab?”

Once you start saying, “How am I like this person who’s with this disease or choice problem or bad map? I’m very much like this.” This is the human condition. The spotlight starts swinging back around to the people sitting on the sidelines judging. They get them banished. Throw more money at it or get them out of here or pull yourself together. We don’t want to look at our own pound cake obsession or draft kings or whatever it is.

How To Take Personal Responsibility In Your Recovery

I’m going to open it up to questions here in a minute. First, I want to talk about responsibility and ownership. Your upcoming book is called Take Responsibility. That word can be triggering in recovery. What do you mean by it?

It means grab it. That’s the take part. Grab a hold of this. Be your best advocate. Responsibility is two words put together. It means you’re able to respond. You’re able to respond rather than react. “That guy pissed me off. I need something to deal with my feelings.” Being in a constantly reactive state, you’re making what Daniel Kahneman would say. These very impulsive, knee-jerk, short-term responses. These decisions are not right. You’re reacting to something wrinkling you.

If you have time to think about it, sketch it out. Talk about it with another person, like telling on yourself. You’re more likely to make a better decision. Take responsibility means take back your ability to respond to your life and to the world. Rather than being at the mercy of whatever one of these 60,000 thoughts that floats by. That’s the idea. It’s an empowerment message that you have the control to fix your own life. You’ll need help, but you’re in charge.

How do you balance compassion for the disease with personal responsibility?

We all are flawed human beings. Every one of us. As much as I have made it a life’s work to try to understand what’s going on, you never know what’s going on with people. I was just on a phone call with a nurse from one of the facilities where we work. There was some friction. My team was getting grumpy. I could tell she was also.

We are all flawed human beings. Every one of us. You never really know what's going on with people. Share on X

I reached out and talked to her. We were talking about work stuff for a while. I could tell there was something else. Once we had finished talking about the work details, I asked her, “How’s it going at home?” Which is not a work conversation. Her daughter is going through some challenges. Her teenage daughter is struggling. They’ve been in the hospital a few times.

The answer to your question about compassion is you never know what someone’s going through. You never know what their private struggles are and what they’re dealing with. If we could bully people into being sober, if that was the thing. If we could put our fists on our hips and scowl at them and they would stop drinking. There wouldn’t be Al-Anon. Right away, I just glowered at him and he stopped.

I don’t think you can incarcerate people. You can’t lock people up. They can be sober, maybe while they’re in jail. We know that’s not even true. We’re kidding ourselves. Recognizing that everyone’s struggling. This is like being kind to yourself, but adding some additional kindness to others. That’s the key. We all have feet of clay. We think we’re strong and tough.

You push at the right point and we’re all susceptible. No matter how much time you have, no matter how much you have your life together, appear to have all your stuff together, everyone is a human being. “This constellation of your idiotic behavior is something that’s upsetting to me because I care about you. I love you. I don’t want you to go through this. I don’t know all of what’s going on.”

We have to maintain humility, especially in treatment. We have to maintain a humility about we don’t know the additional dimensions. We try. We ask questions. We encourage people to be honest. They can only be as honest as they can. It’s the golden rule. How would you like someone to treat you if you were struggling? Probably that’s the right way to treat someone.

 

It’s like somebody that goes to therapy once a week for a year. That’s exactly why, in my opinion, it’s hard to get traction or progress if you’re seeing a therapist once a week or even for a year. You see him for an hour. The therapist doesn’t get all the context. There’s not enough time.

The first half of the meeting is like, “Last week we were talking. We’re out of time.” That’s our model. That’s what we have. That’s what the insurance will pay for. That’s the amount you can squeeze into your schedule between picking up the kids and making dinner. That’s all you have time for. We need better solutions.

What does taking responsibility look like for someone sitting in this room?

Everyone here, including me, has a future self. This person who you want to be, the way you want to conduct yourself, the way you want your life to look. Where you want to live, what you want to drive, the job you want to have. “If I had this, everything would be exactly how I want it.” Taking responsibility is you becoming the person who has that life. The gap between where you are and how you want to be is the difference between the behavior you have to engage in now to get to that stuff.

If you see somebody and they’ve got a life, “Stick with the winners.” That’s why they say that. “I wish I had that guy’s problems.” First of all, you don’t know. From the outside, it looks like “This is what I want.” The question to ask yourself and what to take responsibility for is, “How do I need to conduct myself now with faith and patience to get to that?” Maybe you need to learn something. Maybe you need to go to school or pick up a skill.

Maybe you need to practice the skill that you’ve been trained for and you let it go. Maybe you need to get better at asking for help. Maybe you need to get better at making your bed. Whatever it is, taking responsibility is saying, “I want this life. I’m going to do the things necessary.” Don’t wait. The old guys up here. Life is a lot shorter than you realize. At least one old guy and Tim.

I’ve heard it said that your problem is you think you have time. Get after it. There’s an urgency and a drive and an expediency that’s necessary to make that new path, if you will. You can’t just go, “I’ll just keep wandering along here. Maybe I’ll get a page from my chairman. That’ll change it.” It doesn’t work that way. You have to go, “Here’s my chance.”

Looking at the winners and where they’re at. It’s like, “What decision would that person make?”

That’s very helpful.

“Play the tape forward” is one of the things we often say in recovery. I want to open it up. We’ve got someone here who understands addiction clinically. He also has the lived experience. He’s helped people at every level. I am going to open it up to questions.

You had discussed the fact that there was a culture where you couldn’t ask for help when you were an anesthesiologist. You know how when you’re a pilot, you can’t ask for help. Otherwise, FAA gets dinged and they risk their job? Is there something like that for doctors, too?

Yes, it’s sometimes referred to as the conspiracy of silence. Even though the likelihood of having a substance use issue among doctors or pilots or anyone is the same. We know this. You’re not more likely to become an alcoholic or a drug addict because of your profession. There’s no profession that protects you from it. There’s a certain background rate.

You are not more likely to become an alcoholic or a drug addict because of your profession. No profession protects you from it. Share on X

In fact, the most common drug that anesthesiologists use is alcohol. That’s where they mostly get into trouble, just like everybody else. It’s the most common. There’s this belief that if I say I’ve got a problem, then I’ll get shunned. There’s some evidence for that. I went back to my story and all of what the chairman said came true. I went back and finished.

When I was done and stamped Officially Boarded Anesthesiologist, I was looking for a job or Board Eligible because I finished my residency. There’s this great outfit in California. It looked like a great place to work. My skill training was going to work out there. I was on the phone with their doc that was handling recruiting.

It was a big group. It was in a place where I wanted to live. It was like, “This might work out.” It got to the, “Anything else we need to know?” The way it was, I’m very public about my story. I don’t have to be because of what I went through. It could all have been shredded in a file. No patients were ever heard. I wasn’t impaired. It was just my health. They helped me take care of it and get better.

I didn’t have to say anything, but I did. I said, “I went through this.” I was sober for four or five years at that point. The response from this guy was, “We don’t want that kind of thing in our practice.” I said, “You have a hundred doctor group. You have that thing in your practice. Your colleagues, there’s fifteen or twenty of them who are struggling right now.” He didn’t like that very much.

It’s what you’re talking about. Some of this has to do with risk management. If you hire the guy who had a problem and then he goes on to cause some big harm or big disaster at the hospital. “Who hired this guy? It’s Dr. Smith who hired this guy.” Knowing that he had this history of a problem. Even though what we talked about is that program made me much safer than the average person already in his group. In fact, I would have been a resource to help those other people in the group that were struggling.

There’s a conspiracy of silence. This is a very open-minded group, but imagine if you got on an airplane. The pilot said, “Good evening, ladies and gentlemen. This is Captain Jones. I just want to let you know that I’m seven years sober. I went through this thing.” You guys might go, “That’s great. He’s awesome. He’s sober.” Most of the people on the plane are not going to be reassured by that. It’s fear from not knowing but yes, there is a reason why they keep it secret. Great question.

Hello, I’m Luis. A quick question. With the amount of years of your sobriety, do you still struggle with relapse or triggers or anything like that? Do they finally calm down or die off?

Are you ever safe? Do you ever have to deal with this anymore? Speaking personally, mostly, yes. I enjoy freedom from intense cravings or being pushed around by these thoughts. When they do burble up, I’ve got all sorts of automatic things I do to talk about them, including talking about it from the front of the room.

Some people don’t have them at all. Some people say, “Once I did this or once this happened, the drive to use was completely lifted.” Some people, even for a long time, still scuffle with the idea. Everybody’s a little bit different. I’ll tell you, what happens when you’re sober a long time though is when these thoughts come up.

Sometimes, it’s about the weirdest thing. It’s the strangest thing. This has been a little while but one time, I thought I never had a problem with sake. The Japanese rice wine. I never got a DUI. “Certainly not sake. It’s probably okay.” These are crazy thoughts. Pascal’s Wager. “Maybe it’s okay. Maybe I could drink and it would be fine. Might be. What if it isn’t? What am I giving up? Some spoiled rice water? What am I missing?” Not much compared with what it could cost.

You can use your rational mind to think it through. My point is that when they come, they do rarely. When they do, they’re startling. I think, “Why is this happening to me? Why am I? I shouldn’t be.” The weirdest one is smoking a cigarette, which I used to go. Me and the neurosurgeon are smoking cigarettes in the back of the hospital, which is the funniest thing.

The guy worried about the brain is out back smoking. The guy worried about the heart is back there smoking also. That didn’t make any sense. Rarely, I’ll think, “I could. This has been almost 30 years since I had a cigarette. That’s what I need.” It’s startling because it seems to come out of nowhere. All it is, back to Camelback Pathway, I’m walking down the other path.

I wonder where that goes. I’ve been down that road a long time. That was fun. Bullshit yourself. “It’s only one. One cigarette’s not going to hurt me.” You’re into trouble. Everyone’s a little bit different. Some people are pushed around by those thoughts for a long time, but they fade. Anyone ever have a using dream? Anyone ever have dreams of using? Do you know what that means? It means you’re sober.

Anyone have a using dream while they were using? You don’t have them. You only have them when you’re sober. That is the process of your brain trying out scenarios. I haven’t had one in a long time. I would wake up pretty sure that this happened and then relieved that it didn’t. I’m grateful all over again that I’m not going through that. Sometimes, they’re not even conscious. They attack us when we’re asleep. That’s a good question. Did that answer your question, Luis?

Thank you.

Answering Questions From The Audience

Hello, Doc. My name is Keith. You said a couple of things that stuck out to me. My sponsor used to tell me using dreams were freebies. You mentioned there were three things that reconcile the choice and disease model. You said certainty, optionality. I don’t mean to put you on the spot if you were just coming up with this off the cuff. What was the other one?

Safety.

You had mentioned moderation later in the talk. I was already thinking I had a similar theory of moderation. My thing was that if I didn’t use the same drug three days in a row, then I wasn’t an addict. Which was my certainty. I was a garbage can. I had the optionality to switch between drugs. I was never an addict to any one particular thing. I just thought that was funny.

That’s a beautiful illustration of your compass working great. You want to get to these places of feeling like, “I can take it or leave it, but I’m going to take it. I’m taking something. I have it under control.” Under control is a sense of status, which is also an aspect of safety. Optionality means you have power. That’s what that means.

I appreciate that.

There’s a great study about pain. They put study subjects, which are usually medical students. That’s who they get to do these things for. They give us $20 and then they torture us. I did some of that when I was at school. They put young people in the MRI scanner. It was a pain study. They’re looking to see in the brain where pain responses are. They’re mapping the pain location in the brain part of the study. They would take a patch that’s connected to wires and then to a box.

The patch would get hot to a certain temperature. Not enough to damage the skin, but the nerves in the skin are feeling it as a burn. It’s not destroying the tissue or harming the tissue. It feels like it’s going to. This is what you’re signing up for. They burn your leg or it’s how it feels while you’re sitting in the MRI scanner. I don’t know who would sign up for that. A bunch of people did. They’re scanning the response as the temperature goes up. They’re looking at the part of the brain that responds. It’s happening right here in the insular cortex, the sense of damage.

The intervention of the study was they gave people a joystick in their hand that’s attached to the table. If you move the joystick back and forth, the faster you move it, almost like a fan. It’s like you’re waving a fan on a hot day. The faster you move it, the more it lowers the temperature. If they take it up to 40 or 41 degrees Fahrenheit, which is the burning temperature. You could wave your digital fan by moving this thing back and forth while you’re in the scanner scanning your head.

They’re looking at the part of the brain with the pain. Sure enough, the lower the temperature, the lower the sense of pain. It doesn’t seem to show very much. What they didn’t tell the study subjects is that that joystick is not attached to anything. It doesn’t do anything. It doesn’t change the temperature. The pad is burning their leg just as much. Their sense of control that they can do something about it is decreasing the pain as perceived in the brain, even though the physical pain is the same.

What does that tell you about your own recovery? It’s mostly how you see it. It’s mostly what you think. If you think, “I got all these things I can do. I don’t have to continue to feel bad. I’ve got this whole bouquet of choices for how to get out of feeling this way that do not include substance. Substance is one of them, but I can pick all these other things.” You can wave that joystick. You’ll have less pain. That’s part of that feeling of control. It’s that’s optionality.

I appreciate that. That was super helpful.

Whatever you think, whether you think you can or you think you can’t, you’re right. The placebo.

That’s it. The only thing wrong with you is you think there’s something wrong with you. Great question, Keith. Anybody else?

My name is Sarah. I just have a question. I don’t struggle with substance use but I do have addiction-type tendencies. A lot of obsessive thoughts. I was wondering if you still think about fentanyl and alcohol when you’re sober? I know it has a lot to do with your profession and stuff. On your off days or something. Do you still think about it?

Almost never. It’s very uncommon but I know exactly what we’re talking about in terms of these ruminative thoughts. My thing is fentanyl. I am aware that using other things is probably not a good idea. You can make a list. I never had a problem. With 7-hydroxy kratom, which didn’t exist when I got sober. I can make up that story and go, “It’ll probably be okay.”

I recognized early that I probably shouldn’t drink. That’s probably part of the whole thing. I remember very early, maybe three or four months in sobriety. Being in the grocery store, which I had never noticed. There’s an entire aisle that’s full of booze. I hadn’t paid any attention to that ever until I was sober. I remember feeling the way you’re describing these obsessive thoughts.

I didn’t know what to do. I was brand new in this world. One of the tools that they gave me was the serenity prayer. I started saying the serenity prayer, which doesn’t seem like it would defend much against the obsessive thoughts about alcohol. I’m not sure that it was very helpful because of the words per se. I’m still not sure. I said it to myself so many times in a row that there was no place.

There was no room left in my thoughts for, “What about that? That’s a big jug of wine. It comes in a box.” Being in this aisle by myself in enemy territory. I fought the obsession with a very obsessive behavior, which is, “Grant me serenity.” Except that’s why I just said it over and over again until I got out of the aisle. Until I got out of the store. I got the milk that I went in there for and made it home safe.

 

Part of why it’s so hard to get sober in the beginning or change any habits like getting off your phone. Part of why it’s so hard to get off your phone is in the beginning when you first set it down. Your brain is screaming at you because it’s used to this. It’s used to walking that path. It’s used to that feeling of relief that comes from doom scrolling to the neck, “What was this? No. Maybe the next thing.”

Paradoxically, meditation. I saw a t-shirt out there that’s heavily meditated. Meditation is the practice of not attaching yourself to your thoughts. You let the thought float by. Part of how we get stuck is we keep digging in on the same thought rather than letting it, “What’s the next thought?” If you keep asking yourself, “What else am I going to come up with?” Don’t over invest in what you think about yourself. That’s often a little door out of that cycle.

The other thing that Pennebaker writes about is writing. Writing slows you down. If you write out the thing you’re thinking, these obsessive thoughts, then you externalize it from your own mind. It’s another form of meditation. You can see it. You can see your thoughts. You’ll use a different part of your brain to interpret the thoughts. You’ll see them as, “Why do I think this?” That can help get you free also. Elijah has a great thing about this. He’s got some great tools for dealing with what you’re talking about, these symptoms.

Elijah’s coming in in a few weeks.

You guys are enjoying him if you’re still here. The substances are a symptom. By the time you get to the point of drinking or using, it’s because of these thoughts. That’s a great question. Thank you.

I was thinking as we were talking about the dreams and the free laps. You guys do breath work every other week here. Do you guys ever get tingly fingers? You ever get a head change from doing that? Do you guys know who Wim Hof is? The Iceman? I went to a Wim Hof event in San Francisco. We did three rounds of Wim Hof breathing. I’ve also done some work with Joe Dispenza. One of his techniques is the pineal gland meditation. I’m not going to go into it.

After the second round of Wim Hof, I was going for it. You guys ever go for it when you’re here with Kulter? I was going for it. After the second round, I could feel it. The pressure in my brain. I did the pineal gland. I woke up. I didn’t know where I was. I didn’t know what happened. That was a free lapse. Basically, it was not knowing where you are, what you did, how I got here. That was fun.

That’s a trick. There’s a bunch of these tricks you can put in the bag t if you want to quit smoking. If you take five deep breaths when you feel like you want someone’s asking about cravings and feelings. That’s sort of your question, too. If you take five deep breaths when you have a craving, you don’t have to do the serenity prayer like I did in the wine aisle. Five deep breaths will change your pH. It shifts you to an alkaline pH, which makes calcium work differently.

Which is why your fingers are tingling and your mouth is tingling when you’re doing these deep breaths. It gets you oxygen. It wakes you up. It changes your mind for three or four minutes while your CO2 is re-equilibrating. Usually by then, this, “I’ve got to have a cigarette or I need to hit the vape.” Usually, that feeling has faded. I like that.

You changed your state. Breathwork is one of the easiest ways to change your state.

It’s an easy access. These peak experiences that you’re talking about. The book says we’re not a glum lot. We give up all the party time and all the fun with problems or whatever the substances are. If you know people who are sober a long time, they’re pretty live wires. They’re doing other stuff. Don’t press them, too.

“Why are you jumping out of airplanes? It’s fun. I got to do something. You use meth. What does that have to do with it?” Sometimes, there’s these you have to figure out a way to use your forces for good. I like getting in the sauna. That’s one of my things. That’s another thing. If you get a hot sauna for twenty minutes, you go into this other kind of space.

It’s like, “What if I pass out here? Am I going to die? If I stay in, I’m going to stay one more minute.” You get into this conversation with yourself, but with good effects. Good results on your mental health, good results on your cardiovascular health, social bonding and sleep. Figure out a way to do the same. It’s a map to get to the same place with something that’s good for you rather than bad for you. Breathing is awesome.

Is there anything I missed? Anything I should have asked you that I didn’t ask you?

I’ll say the last thing. Think about yourself in the context of history. This helps me. When I think about all the people who were before me so that I could get here, not just my family. People who created this country, who figured out writing, who know how to make clothes. Built this room and airplanes to get me around and all those things.

Think about all of the people through history who did stuff that you’ll never know what they did that allowed you to be here. The brave guy who asked the girl for a dance. That was your great-great-grandfather. You don’t know that detail. In that context, think about the things you’re doing now and the effects they’re going to have generations from now. We usually live looking at our time horizon right here. Maybe you can see already. You guys are all sober. You can see already the effect that your behavior is having on the people around you. Imagine that carry forward for generations.

The ripple.

What you do today has effects that you can’t conceive of. That’s what I would add.

Get In Touch With Dr. Giles And Addiction Doctors

Where can people connect with you or learn more about you? Do you want to say anything about Addiction Doctors?

Addiction Doctors is the company that we work with treatment centers. We bring medical care, these ideas that I’ve been talking about to patients. We learned in the pandemic lockdowns that we can be more efficient with reaching people without driving around to all the different locations. The other thing that does for us is we have a great team. I can hire worldwide.

We have people that are all over the world. The talent pool gets great when you’re not stuck with people who just have to be able to be next to this place and that stuff. That’s going great. We’re able to help a lot of people. I’m interested in this 90% of people who aren’t coming in. I’m interested in the people who are too busy or don’t have insurance or can’t take the time or it’s not that bad and they’re quietly suffering.

That’s my interest. It’s not the ones with the broken arms, but the ones who are out there, metaphorically, doing the best they can before they get in here. I’m interested in policy. I’m interested in insurance reform. I’m interested in global effects on these things. I don’t know if you’re following. The fentanyl has gone way down, which is good. There are fewer people who are dying, which is terrific.

Weirdly, it has to do with relationships with the US and China and also the border being closed. They’re sending less of it, which makes the war on drugs work in that sense. We know that’s not true. We know the war on drugs isn’t working. It’s this supply destruction. I’m interested in these things, the bigger forces besides the day-to-day scuffle.

I write some stuff sometimes on Substack. We have a book coming out. I’m grateful to you for this time because what I have come to realize is that I have a pretty interesting, weird set of events that landed me here. There are other doctors who’ve had trouble. Not very many who’ve been through the kind of thing that I went through and then who did the response to it is what I’ve been through.

I realize that I haven’t been living up to my obligation to share my story. To bring my experience, strength and hope, as it were, to a wider audience. This is part of my mission. It’s more of this. If you’re reading this and you think, “He would be great on this show.” Get me on somebody else’s show so we can talk about these things. Kick the tires on these ideas and help more people. That’s the idea.

Thank you so much for your time. I appreciate you. We appreciate you. Let’s give it up for Dr. Giles.

To you guys, thank you.

 

Important Links

• Dr. Jason Giles on LinkedIn
• Dr. Jason Giles on Substack
• Addiction Doctors
• Outsmart Your Addiction: Learn the Powerful System Developed by a Doctor to Conquer his own Fentanyl Habit
• ASAM
• Al-Anon

 

About Dr. Jason Giles

Dr. Jason Giles, MD is a triple board-certified physician in Addiction Medicine, Anesthesiology, and Pain Medicine, and a nationally recognized leader in addiction treatment and recovery. With over 25 years of personal sobriety and more than two decades of clinical experience, Dr. Giles brings a rare combination of lived experience and medical expertise to the field of substance use disorder treatment.

He is the founder and director of Addiction Doctors, a multi-specialty telemedicine group providing detoxification, stabilization, and ongoing addiction care to patients across the United States. Through innovative care models and technology-driven solutions, Dr. Giles is expanding access to high-quality addiction treatment for underserved populations.

Dr. Giles began his career in anesthesiology before transitioning into addiction medicine following his own struggle with opioid dependence during residency. His recovery through a highly structured physician monitoring program—known for long-term success rates of 90–95%—shaped his treatment philosophy and clinical approach.

For over 15 years, he operated a boutique addiction practice serving high-performing individuals, including professional athletes, executives, and families seeking long-term recovery solutions. His work emphasizes sustainable recovery, brain-based healing, and relationship-centered care rather than short-term interventions.

He is the author of “Outsmart Your Addiction” (2020), a memoir and practical guide focused on using the healthy parts of the brain to overcome addictive behaviors. His upcoming book, “Take Responsibility” (2026), is designed to help families navigate addiction with clarity and effectiveness.

Dr. Giles is a sought-after speaker, educator, and podcast guest, known for his innovative perspective that addiction is not a broken brain, but rather learning that has gone in the wrong direction—a concept that is reshaping how clinicians and individuals approach recovery.