Ep. 1433: Where we take baby steps with Dr. Josh KingOur guest today is Dr. Josh King, an addiction psychologist at the Center for Motivation and Change in New York. We'll talk to him about the dangers of Internet and social media addiction, and some of the questions submitted in the past few weeks by 404...
Hey what's up everyone it's Wednesday February 26. 2014 this is the 404 show thank you for tuning in on Jeff Bakalar and I'm Justin you got Ariel Nunez once again Michael is in the back pollute his over his shoulder and Jews here. She's our first audience never ever happen. The program. -- live audience and she's here today to watch someone we've been talking about for very long time and -- finally glad you're here -- mister doctor Josh king. Thank you thank you for being here man. My pleasure it's a big deal we've been talking about this for like a month. -- -- an addiction psychologist at the center for motivation and change we've asked our audience to really sort of put together. Questions about addiction. Internet addiction any real kind of addiction that they think could be an issue for them. They've opened up their hearts. Right so we have to honor that transparency -- hoping some people through some stuff I still aren't so before we get into -- some of those specific questions from our listeners can you give us -- like a background of of what it is you specifically do. Add the center for motivation and change. Sure so this and -- motivations change is a group of about 25 or so. -- psychologists. Who are all using evidence based treatments to help people change substance abuse and compulsive behaviors. And what we're really built on is this idea that everybody can change -- has this and -- internal way of being able to -- change that our job. Is really to help them figure out how to make that change and so we used. -- is based techniques to help. People who first build up the motivation to make the change share and then to build up the skills that they need in order to make and maintain those engines I like the evidence part. You know that's that's comforting. That's a that's a given limited a lot of a lot of research has been done over the last 3040 years. That has really come up with some very effective techniques for helping people with substance abuse and compulsive behaviors and we employ all of them -- aren't we really -- to to use -- cutting edge science to help figure out how to best help people change. Excellent well we started asking people for their questions and concerns about three weeks ago. We got way more. And we more -- then I thought we would get trying get through as many as we can. There's gonna jump right in. If we if we did if we don't get you your question can we like maybe just like follower than -- to -- or something critical because our -- usually -- -- -- -- we'll figure out some editing -- you -- -- -- -- great story we'll figure something -- and some people -- -- some people -- we're just -- just. And on a mine is every one sounds that the gestures sound like the safest way to play this game okay let's jump right in. Pay for a four I'm getting caught up on small shows on the 38 year old single man and the severe alcoholic. -- turn to alcohol to deal with the trauma of leaving the cult that I was born into. And loosing most of my friends and family because of it that was over five years ago on the pain of those events is faded. But the addiction remains -- currently drink more than half a liter of vodka a day. Now. For people -- that's a lot of vodka to modify day. I desperately wanna quickly can I feel like I need some sort of support group of largely because of how is reason the fact that I'm now an atheist. I find the religious nature of AA revolting alcoholics anonymous. What would you suggest this is this has a lot of -- and now we're we're starting with the other cooperated started out -- some militants small but it what you know what this is you know I've I've really kind of respect. -- not you know I I think the whole sort of a thing people -- who don't know that AA is very sort of based in faith. Great. So. Back got a lot of stuff -- -- a lot to tackle AA is. First of -- as spectacular organization for those who don't know a lot about it I'm just gonna do a little bit share. -- it was developed in Newton. 1930s. Fish thirties forties. By a guy who Bill Wilson who was going through his own struggles with alcohol and at that point there is really not much that was out there for people. So -- and I went through and he worked with this aren't doctor out in Minnesota. And they came up with AEA. Plan a way to actually help people to try and changed their substance used to it to deal with alcohol right. Right and the day he came up with that -- the twelve steps that they had codify and and and and put into play and basically said. They followed this book follow this way and and you're going to. Do you much better picture this was revolutionary at the time. There was nothing there so it won't -- had changed the nature of substance abuse treatment at the time. Since then there it's helped millions of people. It's been widely -- available right you can find it in almost any city in the world you can find it. If you are on a clean you can find a way to you if you're having -- really intense cravings you can find ways to find anybody else who's in the program has our Tom you can. Page I think it's -- page -- W. Where you say that -- -- friend of bill w.'s and I say is still -- and then people lake. Other people who're in the know will be able to losses come up in and -- -- -- code there is because it right they're very serious but anonymous part yeah they don't want you know -- in the -- hey I'm I'm I'm struggling with over our -- -- -- I can somebody help me out right but they they wanna be able to attitude as a community help each -- out in the community -- -- was just spectacular yeah great I love the fact that you can go in any city in the world. And say like I really need to -- there and there -- meetings and in New York. We are a really unique place for a is there are so many meetings here that you can literally we -- -- Ten meetings in any three mile radius or a ten block radius -- That are going on within the next two hours -- so you can find. -- meetings pretty much anywhere and that part of it is is really great picture it doesn't really terrified of -- that many people addicted to alcohol. Well in a name -- the numbers for for people who meet criteria to need some kind of substance abuse treatment art are staggering in its 23 million people in the United States and its legal. And well and that was that's that's for all you all substances out -- for alcohol but alcohol is his legal I mean it's not very easy that doesn't include some -- like cigarettes and Johnson as a legal -- -- -- -- and there's never like there's no -- for cigarettes. Blue thing is like cigarettes won't. You know get into a car and drive and you know kill somebody know of -- -- -- -- really you're hearing on the -- -- it what it is sort of like of mostly isolated you know damaging yourself sort of thing illness. -- exactly as well let's let's not let's get back to our security nightmare a back door at thirty year old body so. He's he's he's young he's conflicting that he. He's an atheist so he thinks a might be a little so it won't do the really awesome things about -- and is it is that each a group is different. So not every age group is as spiritual as an access -- no friends so one thing I would recommend for him is. Find out I don't know where he lives but if there are multiple AD groups available to him. Check him out right try out different ones right you can actually go to multiple different. -- and and see which one fits the most every age group has -- different feel. So that would be the first thing that I would recommend if you because it's probably the most ubiquitous. Self help thing that's -- -- very accessible if that. Still doesn't work for him. The second thing is that. There is no real understandably they don't say well you have to leaving god Merck has begun critics say it's a higher power chairs or if you came. Think about higher power in this slightly different way or think about it as -- what is your higher power credit is -- that also works and I have to suspend his disbelief a little bit of suspension of disbelief. That and if that still doesn't work there are a lot of other groups out there that have nothing to do with spiritual -- I highly recommend things like Smart recovery SM ART. Smart recovery is. Goes off of evidence based techniques CBT kind of behavioral therapy techniques. So that you can actually be building up to very specific skills -- and how are you going to get through this day Harry you're going to do this that's not. I'm relying on a higher power I'm I'm. Clothing into will power trying to to get my way through this in the link to a -- by David -- -- specific skills for for -- I'm gonna get through. There is. He's not gonna -- two women for sobriety but I that there is a women except for -- there is it and I'd just a ton of different things out there. Including things like moderation management so -- saying I -- moderate. I -- -- give that a shot you know here's a group where you can go and try and figure out how that would be possible. If he goes to our website motivation and change dot com in that. Outpatient section. We actually have a list of resources of recommended self help groups call that he can check out and see him list of of different ones so that would be. One part of it the other part of it that I I think is really important is. For alcohol there are certain. Substances that are. Really dangerous to try and stop on Europe alcohol is one of them and because if you have if you're drinking half liter VM's have to -- half liter of vodka a day Virginian half liter five today you've you've probably have pretty strong dependents. And and -- measure resistance to intolerance -- -- -- -- a lot of tolerance so it you know you're you're up to a half they -- drank a half a -- of idea and I believe that. Out on -- floor later you would not be a pretty scene he's clearly he's functioning he's got a high tolerance. Which is built up over time. But that what that means is then that he also is copied particularly dependent alcohol -- -- and I as a teens. These are some of the ones that if you try to come off of them on your -- there's a possibility of having certain even life threatening seizures while so I would highly recommend that he does not -- to stop on his -- and that you go into. There are impatient detox is there are some outpatient -- -- Things that you can -- its use that and and there are addiction specialists and injection doctors. Two psychiatrists to who might be willing to to -- this. And an outpatient. As you basis. Who would help him to taxi get through -- -- it's it's safer need to to get off of on tape to withdrawal appropriately from the alcohol so. That's another really important point is if anybody's out they're listening and saying I really -- -- -- Q. If you -- if it's alcohol if it's bands there is you really wanna be careful about that practice. And you nobody wants you to. -- -- and then from trying to do some really good features. For sure I think that's great advice for anyone who wrote in about alcohol dependency and stuff like that. Quickly he said that he heard about. Therapy in Europe that involve stressed moderation rather than -- right abstinence have you heard about things like that. I don't know about this -- in Europe that's where moderation. Management. Comes in and moderation management is and have a free. Self help groups similar to that -- style except doesn't it's not talking about abstinence it's talking about. If you wanna moderate how can you try that merit in the idea of moderation is -- right -- I'm gonna try cutting down I'm going to track my -- -- gonna say is this moderation working forming or is it not working for if it's not working for me how to like. Know that it's not working how to YE gear change that decision the issue and how do I make sure how to I try and actually do this -- that it it will work out best weren't. So there there are there here. As well cool. -- we have a lot to get too so I want to kind of keep going here. Let's get into about two pills. My mother started -- me Valium when I was very young because I was XP experiencing a lot of anxiety and difficulty coping with school like many children do. Now I'm an adult I find that becomes psychologically dependent I tried. Cessation with the help of my psychiatrist. To no avail. I don't crave the drug but they need to take it every day to feel quote unquote normal on much more lucid mind not on the medication. But the withdrawal symptoms such as sleep does it sleeplessness and irritability. Are absolutely unbearable -- -- any hope that I can stop taking Valium. Or should I accept that this is something I'm gonna have to do for made my day today life. Don't except that this is coming in you have to there's no reason to do that shed remember -- as is one of those ones don't -- -- come off of and -- as is is particularly. That withdrawal is particularly difficult you mean if you're not having his life threatening seizures can be low doses and you're on. That cause. Significant. Withdrawal symptoms and they can last for. Potentially a very long time and so the first thing for somebody like this I would recommend is. -- -- -- -- -- Not all psychiatrists deal with addiction. Certain psychiatrists are really trained in addiction work and in really understanding how addictions work. In knowing what you should be doing in order to help that I do this taper and that's the kind of person -- wanna find somebody who does addictions work. I'm curious account. He still didn't of them only. Right I mean I know -- I'm I'm sorry about him her -- but it I wanna I wanna think about that that was my first sort of thing like -- tool. If I don't know if it's that it's a melting on how he still getting these strictly you know that's got to stop to so -- Eight again in its. You wanna have the conversation with as many people was possibly -- -- your doctors and anybody who's prescribing you if you're getting it -- news from non prescribed places when delete those numbers from your phone the option iPhone. IPhone has done it the best thing for for my -- who -- you can possibly do they've made it really easy to block someone. Right and so you can block numbers of dealers really really easily in used to be that you had to call up -- -- Verizon and in. And you and memorize that number I bet whereas here you're not it's just sort of like piece of data. And most of the time people have the memory if you -- -- and enough for me it's not important to you people tend to memorize them. But if I block it right I can't make the call I can't do it out of -- -- incoming. They but he used to be a barrier to people blocking some thing to say right I have to call Verizon and I have to get on the -- and I say can you block this -- and -- say oh I don't -- to -- you know you get transfered to teacher places just that they can do something that the first and now it's just a -- -- pushed the button -- persons blocked. So I would say that would be one too is. Find this addiction psychiatrist that your with somebody even if if you like your psychiatrist great keep that person just -- to the addiction psychiatrist here to help get it off of the the -- -- And then third is find an addiction psychologist. Somebody who is is trained in some of these techniques of relapse prevention techniques CBT. To help. Learn right so when I'm feeling irritable. It when that happens -- -- -- tolerate that appropriately had a light touch used positive coping skills how to like. What are positive -- -- how do I deal with this in a way so that I can actually make the choice to. Do something different and I can actually they push myself and another direction can actually make it quick clean though of course a plea to the public. -- things -- looking at that camera can we is don't give anybody else your prescription Medicaid yes. Is to whom I noticed that endorsed or whatever it is all designed to let alone -- -- and right I've got settings eco ahead -- make. You're not a doctor -- -- my doctor please don't give anybody else your prescription medications and if you are done with their prescription. Throw the prescription even if it's penicillin. Even if it's -- LE SL I don't know I'm asking you I mean penicillin is not gonna be I don't I don't know of anybody who is abusing penicillin and anyway. But there's no -- and museum to keep -- And a year old prescription to Valium in your. In your reticence yeah I mean there's. There's a whole movement by the partnership for a turned freedom or that you may remember them per share drug free America and and username. We -- we work closely with them no apparent support network. And they have a whole site dedicated to you lake your leftover pills and how kids are getting into -- out and starting out with serious opiate addictions. Because they're getting into these copious that in just left in people's messenger so. Get rid of them. -- is really interesting is that in this email the person says that there -- they don't feel the cravings for it and yet they also say that there are addicted -- There's something biological going on here I'm assuming but that's because. You know this person is continuing to take the Valium. There's there's probably a little bit of misunderstanding as to or craving is his -- Cravings are -- she's saying. When I don't take it I feel irritable and not sleeping well. Those are things that are caught their triggers that are causing her to have created some cravings are really just your brain. Saying I I expect something like a dope -- -- burst -- I'm not getting it. So lake when that knowledge I'm not happy about this Rezko get mean that thing that's going to give me there's still communion because that's get in that is -- -- So when -- -- is she or he is saying I don't feel. A craving. And it probably is a Chris not sitting there saying that our intuition and value -- right now. Misses her -- number it is is claiming that do whatever it's doing for. From the site -- I -- I feel like I honestly get that this is convinced this is nowhere -- dangers but I get that with like chocolate sometimes get. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- If if she doesn't have coffee in the morning and it's not a very pleasant situation and that is her craving coffee and saying. You know I judge everybody is saying that I really -- I need this. Out -- we're just. Animals with crazy cravings areas that have nothing to us are let's keep this going here's uninteresting -- situation that someone wrote in. I -- to know if someone who slips into the into cocaine and marijuana for let's say five months. Taking these two drugs because a friend led you into that. I mean just admitted you know you're doing this and later you realize. That you are doing the wrong to yourself and you stop by your own consent after five years of not taking these drugs. Is there a moment in time that a person can fall back into the temptation again. Even though you haven't done these -- for five years so I think this person is saying. I -- like a five month binge where I went nuts with Coke and -- them -- done in five years but in my susceptible to. Quote unquote relapse thing. Susceptible yes. Very definitive but Philip Seymour Hoffman has taught us anything yeah I have relapse -- can happy sugar and likely will happen to some extent -- And that's not across the board it's not for everyone before many people who relapse happens. And for many people when -- does happen. Intends to go quickly down the same -- That's not this is there's there's a a popular saying of like you're wondering too drunk right if you're not drinking but you're -- if you have one drink. That's it you're just gonna go -- And that's actually there's not a lot of evidence for that and what there is evidence for -- and and if we think about how habits are formed and then the most current research on habits is if I take you and I I put you in an FM RI a functional MRI machine. That is watching your brain has its actually working so -- showing what neural pathways are lighting up. But it any hand at the you have. The of the neural pathway lights up the same. Register your building these groups everytime the you do something these -- in your brain about -- I move this muscle I do this thing in this is how this is what I'm expecting and so it goes down the path so that such a great evolutionary thing that we -- so that we can get really fast at things that we have to do. Well like runaway from a lion in this event sure it'll take you wanna know how to do that really quickly. Where it it comes to hurt us is a from doing something that that's not so healthy -- I'm doing something that it's given me a huge reward but I don't wanna do it anymore. Great as do his neural pathways are really -- -- -- of ten and something that's as rewarding. For -- -- as substances. You're gonna have a very deeply engraved. In group. Ingrained. Neural pathway break so -- most recent research on on how these works is up -- if I'm building a new habit. The old habit doesn't necessarily go away it just gets dimmer and dimmer in the FM RI and the new neural pathways get brighter and brighter things every time I make the choice to turn left instead of right. I'm now building new neural pathways and sort of turning left you're gonna turn right and and that but -- train -- still exists in my brain. So fighting then start to go back to those habits -- -- random but I can assure and I -- a little bit now. It doesn't mean that I'm guaranteed to show. Right and that's the really important point is. -- there are no guarantees. In this thread I'm not -- dooms -- you up you used near this guy used some cotton and some Coke brightly. Yours yours over spirit Graham and her back to using it every day binge using it. So the idea is again like I want to be really really aware of what's going on from I want to be able to -- I -- -- stepping back into these behaviors how much do me on this site I used it once why do I use it what was going on for me what was the reward -- the benefits lower the costs to me. They really kind of thinking through on any of this. How long about -- this -- how long has this been going on my head chair I really really think through and you will recall functional analysis of like minded I use this time. And then that's gonna help you to prepare for the next time so that you can say aren't I don't want -- end up doing that again. Uninteresting com. I guess. That leads into another question we got asking specifically about marijuana. Obviously it's not a secret there's numbers that. You know prove -- -- provide evidence it's a very recreational drug I think something like seventy million Americans. Smoke it loses crazy and it's like almost a third of the country move. You know I think this question was specifically asking is it addicting. But like I said we can't blind our -- and and be like people don't use Coke -- only and they are okay. And look at The Rolling Stones right. I mean there's a lot of people who know that there are the best ever -- -- like -- militants for some people draw some blood work for you know they get the you know. So I guess like. You know maybe sort of put that all into into the you know perspective here like you know. Is it okay for some people to sort of do these things. You know how do you Hattie sort of balance the whole sort of think -- -- nobody wants to be addicted to anything -- and strives for something like that. So maybe let's start with answering the specific question is marijuana addicting -- and how what are your thoughts -- -- recreational drug use. So marijuana can be very addictive -- it and it's actually a really tough one for people to try and stop and once -- if there at that point. It's very difficult. To stop and if you know I would just be careful about I wouldn't these two cavalier about -- and certainly oh it's just -- it's it's. You know it's not that there's actually a really interesting side anecdote about -- -- the research -- pot which is that. If you wanna do -- government funded research and all almost all. Research that we're doing in the US has government funded in some way in if you -- -- government funded research on pot. Hi I recently learned that you can only get the pot from these and you know very structured government places. And then they use strains of pot that are like for your fifteen years old there are -- to sixties or seventies when like the -- -- is like skyrocketed. And that's right things particularly mysteries that are that. And stuff that is -- And totally not all that helpful and so there is lake city you know that whatever research they're coming out with is is already limited by the idea of why is nobody talk. Hearing about that. -- -- new list it doesn't meet because like it regardless of the potency like that's one thing and it's getting you hire or whatever it is. But you know the fact that it's being. You know. -- for all of the medicinal values of it. Cycle maybe we should you know. Use the latest sort of strains for what they might provide I have noticed -- you know they're making those decisions -- valuable -- -- about it was that this was thing is that do we know anyone who can write a story about this is this is crazy. I I would love to use to read some stories -- -- they think it's just you know let's have the research -- reflects what what's out there and -- -- really now let's loosen up some of these these government. Issues about other reserves of it reaching reaching can't really good research out there I can figure out -- working and what's not working chair that's a that's a -- that's another thing so. Anyway -- yes. Can be very addictive. I wouldn't be cavalier. About it the other question -- -- Was. More about like the recreational. Sort of drug use regardless of what it is obviously. Right you know a lot of people do this -- I have friends do -- I know people who do all kinds of drugs and you know for the most part they seem okay what are your thoughts on that. I -- -- I'm not endorsing and of course it's -- places. I I I think. It's gonna happen right and I think that every -- do what we want to really do is make sure that everyone is aware of one of -- people's awareness. You've probably heard about these things mindful listen my -- techniques it's all over the place everybody's talking about my infamous. -- this is this -- -- it was in year old 5000 year old technique that comes out of zen buddhism that. Is really about. Being aware in the moment what is going on for me what's happening for me how -- coming being more aware of what's happening around how to ID in this moment. And mindful this is is a really important key to all of this because the more aware idea of like -- reducing refer about the functional analysis. Is it why was I using -- why am -- using morally camera using more than I really want to is this going down to room that I don't particularly like is this happening in a way that. Canada -- they just doesn't feel like it's it's working well for me or am I missing out on opportunities then that's a sign -- Maybe this is something that I wanna look at maybe -- that I want to change or other people concerned about me. Me are other people saying they -- well yours smoking a lot of pot users and I German Internet like an awful yeah right based do you sleep flagrantly for the edges -- -- -- treated as for how long. You know there that's out there and that's a lot of hours of video games not waiting period and all those college is a dark styled Stacey didn't email me here and cool and I am -- today. -- and the idea is that. You know I start to look at this stuff can be more aware of it I can be -- catch something before it gets too far right down the rabbit -- And that's where that's the best thing that you can be -- and so I there's no point me saying to people. Stop -- don't use recreational. It's not gonna ask not and I and how are you are listed right there are ours there is -- it's legal in places -- people are gonna get their hands -- -- -- they're gonna get their hands on -- they're gonna get their hands on -- like. I can't stop all of -- and and so the best thing I can say is be really really a way -- -- and then if there is a problem if there is if it's not working out. The -- the you wanted to be. Go and talk to someone. -- -- there's a lot of stigma out there that makes it feel like I can't I don't wanna talk about -- really embarrassing it's really upset go talk to someone. And I absolutely net -- -- and that really leads to a more general question that we've gotten from multiple listeners everyone really. I think a lot of people when we first said hey we're gonna have an addiction specialist. People didn't necessarily have specific questions about a certain drug or activity they just wanted to know. Am I do I have a problem. Thank you I -- like I drink a beer every night -- I have a problem I XYZ. Obviously we're not gonna get -- every less specific situation that these people have put. What is that some what are the signs that you do have a problem that you are. Maybe clinically addicted to some things but maybe generalize that get that information. So that they're. There are about eleven different criteria. And you have to -- two of them. In order to qualify as having a substance use disorder that seems very and they will they -- -- the the way that it works a little bit them in the most recent. In the DSM five that the assembly of the diagnostic and statistical manual that a disease viable it's the disease I would have the mental health disease -- -- that's -- that's a trip that book and edit and -- is I never -- read about it -- -- thumbed through these -- pieces that I -- this -- you start doing there and you're like oh my -- I have this settlement and I have this so -- got this. Stanza is -- don't -- it. -- -- -- -- I'm not to list all eleven of them because I think. Domain -- grey area right -- -- -- the idea and you can look them up online pretty easily but the the idea of almost all of them is. Is this happening more than I want it to -- is it happening in ways that I didn't want it to you. Is -- getting in the way of my life and is it causing problems for me am -- doing it more often than I was before. Do I feel like I can stop have I tried to stop and I can't and -- having withdrawal symptoms from right and when they stop using. To write to -- do I feel irritable sure -- have trouble sleeping and if you're starting to meet some of those things. And the answer is you should go talk to some -- -- I'm not saying that you do or you don't have anything. -- go talk to someone. -- have a conversation. And if it's if it's about substances -- -- -- about compulsive behaviors. Try to find somebody who specializes in that and -- because there are specialized techniques and are specialized things that people do. That are more effective that are. Filled with actually a very different way of thinking about substances I think. For it especially for substance abuse there's there's like a moralistic. Something that goes on our country where -- site up that's that's a really bad thing I don't wanna touch that -- find somebody who -- Does that on a regular basis and and and you'll hopefully get a much less judgmental. Not that everybody has judgmental but you'll find you know. Thanks a lot more kindness a lot more. -- feeling lately it's gonna work out lake. There's there's a positive way of dealing with this and and find those people seek out those people who are addiction specialists. And go talk to them saying you know -- do I have a problem and if I do have a -- I feel like it's a problem because. You know here's the things that I I've noticed or are problem in my life where had a -- help with that. Our work out the -- that sort of quick are there one of the is that one of the great you like I'm spending all my money on this thing. Yeah I'd say it's about time and money -- I ever spent excessive amounts of time invest in excess of arms and money am I not able to meet my other obligations because entertainment -- because I'm buying all XYZ. We -- a -- about the difference in the treatment between. You know substance abuse and out behavioral addiction. -- we got a for a couple emails from people that we're seeing that there are addicted to just being on their phones and that's just as they pick it up. Every five minutes check something else on your is that is -- -- different for that kind of -- in. Do addiction medicine specialist sort of hold that and it just -- high regard as substance abuse. So -- eight. Internet addictions and in technology addictions are -- are relatively new infecting didn't quite make it into the the new DSM because. They -- just wasn't enough evidence to be able to -- -- and this is the criteria that you need in order to say I do you have this or you or your you're dealing with this answer didn't make it in specifically there's there's references to -- they call it like problematic Internet use -- it's it and it's not very well defined. There there's also not a specific evidence based treatment that -- four. -- an addiction or problematic Internet use or phones. I think phones are top frame my from my pocket I felt deposit troubled times -- drive that I felt abuzz -- -- about my wife was there are. I don't have an asset error code red vibration settings and I the phantom vibrations in -- -- it's crazy but it's it's and it's that same thing right if we think about. The reward. The reward system in your brain right to open Muniz is the mean which neural transmitter -- the main player in in that way to fight anything and am doing that's interesting exciting that I like him from walking down the street and I see some -- I think is attractive if I'm walking in the street they see wait a doughnut and a window that looks really delicious. I am I get a burst of -- I mean. Great because I am thinking about how awesome is it can be when -- Get to have that or what would be like him I was with that person right it's like just awesome -- -- -- -- me Amber's right. Well if I use a substance that actually manufactures and two members. When my phone vibrates in my pocket and think or somebody's writings I wonder if it's interestingly who's calling and I. -- check this out. I'm already I'm free -- -- mean bursting -- because -- already anticipating. How awesome that's going to be. I get that feeling when I like I I'm addicted to Amazon. I think these are buying stuff on Amazon crimes like loving like getting packages and -- and connect the -- like the delivery note. When I was when I was a kid today -- -- summer camp and when the packages would come if you shot. The package was amazed control and I NN as it -- The possibilities are endless and and so before you even get to the package right you're just like so pumped up and people say that about substances -- right. That before that she -- knowing that you call your dealer in the that's happening that you're already and we'll start -- that you are releasing Joseph communion because your body already knows what it's about to do right so it's just -- it slips today it's is getting ready. So with the phones and things. It's this exact seem process. And so we actually want to deal with it the same way we wanna think about right what is the trigger. How -- to handle it differently had a white tolerate right I didn't pick up my iPhone and it. IE had to tolerate the fact that like my phone was in my pocket I had to use skills and I had to refocus my direct my my attention. -- you know what the question was and how -- responding because they would be really easy for -- yet -- my. Yeah it's great because I. Totally lost where I was in in the phone so -- It's using skills like that and practicing on a daily basis to be able to -- right how to ideas how to I start with something small. And then slowly worked my way -- and and get bigger -- so that I can then handle effectively earned the new video game came out and I just got it and I wanna play. I just wanna play historically for a week and I can't do that because I'll lose my job of his wife -- -- -- -- -- -- all this stuff if -- just disappear for a -- into video -- -- And you know I'm holds a view that may had a way not to that -- -- -- figure out another way of dealing with it so it's the same kind of skills -- Interdiction is tough because so much it is what you -- -- its its addiction to stimuli and there's so much of that to be had on the Internet I I think for a lot of people. There -- on the web is red it just because. You know you can have no idea what's going to be on -- today it's constantly updating is something that's happening right now -- recording this podcast now we're not reading it -- and that got effectiveness is really. How to -- my FaceBook. Direct -- search center right writers have -- -- 24/7. 365. And there's millions of people who are just -- out -- -- -- -- how can I can't I can't -- that area. So it's it's it's very difficult. -- is there is this stimulus yours and you then have to tolerate the idea of I'm pulling back from this -- yeah it's okay not to now I know but I know what's happening right break is that additional search for god bread that FaceBook is there but I am choosing to step back from it. I'm choosing to make this choice and then I have to tolerate the feeling that comes with that which includes your body saying -- Oh yeah I'm missing that could you do it -- -- -- bad stuff is good -- attribute. For that must be so tough I mean obviously substance abuse recovery is really difficult as well but just the fact that you have to be faced with using computer so much. And modern life and you're addicted to the Internet you know you have FaceBook available to you at all times and it's -- your phone or work on your computer. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- And the reason that I'm gonna be -- stick. -- about that is because I think people get very. They say -- -- attic drama this area and -- -- I've been diagnosed alcoholic you can actually be diagnosed alcoholic there is no diagnosis for alcoholic. Alcoholic carries a certain level -- for many people that term that phrase -- supremely hopeful. Great they find it later right now -- identified this and then. I can understand there are people other people who are like me right I'm not just some kind of weird like half up in the world but but I'm an alcoholic -- is hopeful. But for other people there's -- I do. I don't feel that I do feel like an alcoholic -- with all the things that go with alcoholic drink you guys were talking about. There Ridder -- Philip Seymour -- and I remember listening to the show. Cinemanow and listen in this going to be do -- we've. On the other -- -- -- now -- like I love -- -- -- I'm gonna do on my commute home today Ares I don't know yeah business reason yeah I think you should for a -- -- you right out yeah that's and I haven't -- have you -- but I'm great recommend that time you visitors group saying things and people were talking there's a lot of stuff out of the -- people were talking about you. They Cassie just didn't look like use an -- and I like I have this is your graph and grid of what I heroin addict legislation was shivering in an Alley somewhere in Israel that he wasn't doing you. And kind of leaning over and and you know on the street and use a high functioning person and right but that's exactly it and that's why I'm so careful with the words that I chooses because for a certain population. And and it's a large population. Terms in the stigma around words like addict or alcoholic or you know heroin addicts -- drug user things -- are going to make -- -- I'm not that. And I'm not that picture that I have in my head and so -- I cut and even though I kind of want things to change -- -- -- get help is if I tell anybody. That's what they're gonna think I think right. And so I don't want anything to do with that and so I'm not gonna do it and so visited my big things lake -- we have to be thoughtful. About like the words and and these things about -- diagnosis and an addict and addiction and and alcoholic and all these different words because. I don't want the statement I want people to know that actually there's a lot of hope and that there's kindness -- kindness is going to help you solution effectively. You also think that you know we talk about -- -- and you know the only guy who started that developer. He completely you know turn away for 50000 dollars a day and his reason was because he felt the game was too addictive. ID -- -- things like. At the biggest games of 2000 AS study this and -- every -- -- on my phone -- and whenever I plan I think is an SLA because you're still getting the PC era Soviet -- -- -- that I Wear it around a lot you know I'm addicted to this video again on addicted to a floppy bird they may not be addicted to -- they may just have happened and that's probably two separate things that people should read right now they are two separate things that people should recognize -- also aware that they were not been changed everyone's vernacular grid is again it seems -- the way everyone talked here and that's okay but I wanna. B I want people to know that there is like make. Addiction. Earth addict the word addict prediction as is a slightly different things that the word -- it's a label and for some people it's outrageously helpful and great people can identify with -- they can understand it -- its super helpful. But for other people it's a barrier to getting help -- and so I'm I'm not opposed to it in in fury. I just don't like the stigma around share it and I I would I would love to change that idea of this stigma that comes along with substance use. That there is there's help and there's hope in that do you know there are treatments out there that are really helpful and. And alcoholism is not a diagnosis. But you can be diagnosed so it's not a disease. -- that's a very. Part of -- -- we won't. Well is it the short answer is that. The AMA has labeled spa substance abuse and disease right but but not everybody is talking about the same idea of disease share when they're saying it's a disease -- -- -- some people are both. My bushing in other things are some people are saying it's a brain disease. Some people are saying. That it's just like you know having diabetes or something in union too -- to be -- like it's gonna be there forever some people are saying it's a remaining in relapsing disease and some people are saying that there's actually a moral component to this disease rate that you are. But there's a moral peace to what's going on in that you are. You know. It morally having -- having issues the you have to deal with and so. I'm very careful with the disease model because while I do you think that there are for some people write your brain is just functioning and set up in a way that. And this is you're gonna really struggle with this and that's -- going to be. The situation and and and that you are going to always have the struggle and that might be somewhat produced by you by -- -- so heavily in so long that I've I've. Really -- my brain and in a way that I can. -- certainly get it all back or that it's. -- it was you were pre disposed to write great there's there's a lot or the combination of the two X but I I'm careful about the disease models -- is it hereditary Kennedy hereditary. -- certain parts of it are necessary. Then again if we -- to go back through everyone's family tree and and -- -- and mental health issues that go back throughout everyone's family tree. Almost everybody you know as somebody who's a relatively closely -- relative who had some kind of substance abuse problem. Who had some kind of mental health problem like schizophrenia or major depression. Great these are all then they're all sort of have these markers of having some kind of hereditary piece to it right. Not everybody is schizophrenic sure not everybody has a substance use problem so there you have to have more than just having it be hereditary for it to become a real issue. I'm sure a lot of that is also exposure to those substances when you're younger and if you grow up with that in your house so then it's not necessarily. You know passed -- -- you genetically. But -- situation -- And it absolutely can be it can be about again about reward and right I -- no one else in mind immediate family has any has substance use problem but. I -- -- it and the reward was so powerful for me and that. I just kept going back to the well and I didn't know any other way to help with this issue and then once it -- got out of out of my own control. Who was no longer about the reward but then every time -- -- I just felt like. Crap -- concern now I need that in order to adjust kind of feel okay in the day and then I need something else in order to help me feel better about the stuff that still in my life and so -- And when when I'm dealing with somebody who is struggling with the substance use problem. I'm really thinking about so how does this fit into your whole life. -- this is not an isolated thing that you have a whole life that's going on and how are you benefiting. From these substances that's another thing it -- and talked about seems to be the the big sort of crux of the whole thing is how is it affecting your life outside of like the time when you're doing the substance -- what he's doing -- and not just in the negative -- -- how are you benefiting -- from this and they they don't talk about -- -- -- -- -- people don't talk about. They -- what how do you benefit from you know ten hours on the Internet and how do you benefit from you know smoking crack and right what are you get from -- and if we think about what you get for me then we can search -- there are so how can we replace that sure how to even think about replacement. Interest and wanna get through another specific. Question and -- -- run out of time we'll try -- get to. Maybe one more after this this from musician who's been doing. Who's been through the -- -- ten years. He plays guitar in a band at bars and weddings and other functions. It's probably only job in the world where you get he did drink. Because as you -- not know bars give bands writers and they are allowed a certain amount of drinks every night. So -- out three nights a week at a bar wedding and I'm playing in the band I have a couple of drinks. So after years and years of this I now feel the urge to drink every night. Not to get blind drunk but it's like a little itch that needs to be scratched. I feel like it's not a big enough problem to go make a fuss about it but I have tried to stop but I can't. And my addicted to alcohol and from this our story is -- a big -- problem that actually need to go out and seek help for something like this content. So if that it. -- mean the question isn't about are you addicted or are you not addicted. From there are brought these in that the -- AAA which is and government organization that oversees alcohol and and I'm. Alcohol abuse. It has some guidelines and some standards that says that if you are a man and you drink no more than four drinks and a day or fourteen drinks a week -- -- considered a low risk -- that means you have two drinks a day seven days a -- -- low -- -- wow that's still seems like a lot to me it's still -- right that's moderate drinking that's -- -- national guideline for moderate drinking and you know for some people might think I was drinking half liter of vodka -- a -- he's surpassing that easily -- -- -- for -- -- -- is. You know this big and you're having to of those red and five of those -- there -- it is -- a -- is a shot and -- are having half -- thing how many shots happiness natural remedies for women it's three drinks for -- -- and seven drinks for peak then so if you're within those guidelines and your -- moderate drinking. Sensor keys if you saying I drink no more than two drinks a day and I never go over that and -- -- I'm. Doing that then he would fit under federal guidelines as -- as a moderate low risks drinker and thank. Of course he has one more drinks on any night then you surpassing happened that's it it's not like go to one and done thing -- -- You know there are you doing that -- years and there are yours are rightly or you sort of -- underneath that scale. If he's writing into the podcast and saying I've actually tried to stop I'm I'm aware that it's like I I feel like. There's a problem here then there's probably something there that that he's not particularly liking. In his life in the way that this is set up and feeling like I feel like I have to do this I feel that it's so I think it's scaring him. Yeah I mean I I I would be scared too if I felt like every time that I need go well they can just feel this hitched to it. And really you can turn assure continued -- I won't want to -- I don't know that I want to tonight but I feel like I have to do and if I've tried I can't. So what I would say for that person is right. The guidelines distance is is are you addicted -- are -- not there there less important to -- then you know houses affecting your life and if it's affecting your life. Then I would say they go talk to an addiction specialist I would start out and say they -- I -- -- to an addiction psychiatrist. I need to talk to somebody and -- -- for so how dangerous is it for me to not drink you know right now. -- remember alcohol withdrawal withdraw you don't -- don't get into two -- situation. But then I also gonna say they are and let me go to a psychologist or an addiction psychiatrist who specializes in these types of motivational interviewing and and that's one of the evidence based -- answer this community reinforcement approach that's another evidence based approach. Or CBT kind of be real therapy or DBT dialect will be -- -- let me go to the people who are are working in these. Modalities. And say -- Help me figure out how to do this didn't think I need some help on how on skills does my life is not conducive to not drinking Mariah so it's gonna be an extra. Effort to figure out how to do that. You talk a lot about like people realizing. That it's changing their lives like you you -- -- it is it is it changing my life is it affecting the people around me. Aren't there some people that don't realize that aren't -- some people that are so compromised by their substance abuse that they. Can make those decisions. Yes and no. Yet there's a great article in New York magazine right now by -- the photographer Graham dot Mac -- can go. Where he actually he he -- self photographs of himself using heroin and and it's it's it's very powerful and in and he sits down with his girlfriend to. Was with him before and they broke up and other back together and he's totally sober and he's talking about it and and she's asking him these very personal questions -- Did you know me did you want to stop it of course and wanted to stop like I do you always know within its really hard to you so I would say that. The majority of people have some level of awareness that things are not going -- Maybe not so much in the beginning maybe it takes a little bit of time. The idea that you have to hit bottom. I don't actually believe that may think that that's a really tough one especially if you're a family member watching and people are telling you might know they've got a hit -- -- but if I can think of -- was my kids I wouldn't be -- just sit there and let them hit bottom that's that's so scary and dangerous to -- like would have their bottom his death yet which I don't I don't want that -- so I want to to figure out ways that I can I can be involved and and so we want to make sure that people have ways and places to turn. On that note I'd like to plug -- -- I don't answer okay actually I like to -- it first of -- if you have a substance abuse problem or if you are concerned about it. One place to go is you can come to our website motivation and change dot com. But we've got up there I'm we we talk about our own services we have an -- com. Rehab that can literally just -- the couple weeks ago last week. That is up in on the Berkshire's. In Massachusetts we have outpatient services. And we have a whole group of online services that we're really working to to. Push and build. Because we want to you helped make sure that everybody who wants something has some access and so I would go to our blog. The CMC blog. And you can read articles that we've written and mean it and that some -- -- -- tips for change for individuals summer of them are things to be thinking about some of them are for family. And all kinds of things about. What you can do to you to think about it for yourself to it to -- change. The other place that I would recommend if you are a family member if you're somebody who's worried about somebody else if -- -- friend if you're and it literally anybody who's worried about somebody else. We have a book that just came out com it's called beyond addiction it's kind of sub title in his house science and kindness help people change and it's. Just a spectacular. Book did it really is about how can you as somebody who cares about somebody else help. -- make change. And it's it's just a powerful. Book that says you have the ability to help somebody may change without them having to hit rock bottom without them having to go through all this. And we and we want people to to really just learn about what. -- -- things that he can do to help them so. There are some things out and on our web -- we also have links to other resources the people I that are available for people whether it's. We have -- we have -- we have twelve step meetings we have you know evidence based treatment things we have self help groups. Room it's about what works it's not I'm not here to push an ideology and evidence based treatment I'm here about what is going to work for different people solution -- help them get the help that they need. Excellent you could also follow the center for motivation and change that's act underscore the C and C. And again the website for that book beyond addiction. Is beyond addiction book dot com. What's that -- on the Twitter page -- Live tweeted our show -- their -- not a path path nearly alternatives that those stuff spread now that's awesome -- just a little side note we talked all about like addiction like food addiction and stuff like that and Doctor King -- to bring as much of -- so that we could somehow. Play NT I -- kind of bracket you're running a bit better at. It okay -- -- yeah thank you for being here man this is absolutely say it's my pleasure helpful. And -- some really powerful stuff -- and great advice really appreciate that. And on behalf of our listeners thanks for help and it's my pleasure and -- really -- and so impressed speeches I think this is a really tough thing to to go out there are sure about and people really put themselves out there and thank you. -- for a -- writers really I mean putting. There's sort of like well being in our hands is definitely a big risk for that kind of setup over. I can't I can extend that out I think they put -- loving him in my but I like it yeah that's the identity of the vessel for that is mind -- but thanks again to everyone who wrote in. And you can keep writing in and will somehow get them yeah absolutely and boom you're find a way to attack author and out. Awesome well thank you doctor for being here that's gonna do -- for us we're back here tomorrow with a brand new show. The 44 at cnet.com. Is the email address follows on FaceBook Twitter it's a grim read it and all that good stuff. We'll see you tomorrow I'm Jeff Bakalar and I'm Justin -- thanks again to mr. -- things -- for being human and thank you also -- up for CS tomorrow later.