One Family’s Journey With Mental Illness and Addiction
The Skyland Trail 2023 Dorothy C. Fuqua Lecture was held on May 9, 2023, at the Atlanta History Center. The moderated keynote conversation and panel discussion provided personal anecdotes and expert input on how substance use and mental health disorders can coincide and how loved ones can support those affected.
Keynote Presentation: David and Nic Sheff, the father and son whose story inspired the movie, “Beautiful Boy,” moderated by Jaye Watson, host and co-executive producer of the PBS series “Your Fantastic Mind.”
Panelists:
- Carlyle Bruce, Ph.D., Skyland Trail Director of Psychological Services and Family Therapist
- Ben Hunter, MD, Skyland Trail Interim Chief Medical Officer
- Justine Welsh, MD, Medical Director of the Addiction Alliance of Georgia
Watch Video: Beautiful Boy: One Family’s Journey with Mental Illness and Addiction
Introduction: Beth Finnerty, President & CEO, Skyland Trail:
My name is Beth Finnerty, I’m President and CEO of Skyland Trail, and I just wanted to welcome all of you to the 11th annual Dorothy C. Fuqua Lecture. I’m joined on stage by my friend, Dr. Bill McDonald, Chair of the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine, a member of the Skyland Trail Board of Directors, and a member of the Skyland Trail National Advisory Board. We love Bill. We are so pleased to partner this evening with Emory University School of Medicine and the Addiction Alliance of Georgia to host this year’s lecture. The lecture series was established in 2010 and has been made possible by generous support from Duvall and Rex Fuqua, and Edwina and Tom Johnson. And I’m so pleased… I’m looking for them, I’m so pleased that Edwina and Tom are here tonight. And can you guys stand so we can thank you and show our gratitude to you guys?
[applause]
Now, I want you to know how this lecture series got started. It was actually Edwina’s brainchild to establish this lecture series in honor of Dottie Fuqua and her 90th birthday. We were at a birthday party together, and Edwina said, “I’ve got a great idea.” And so the lecture series was born 11 years ago, and it continues today. Dottie was a long-time board member and a friend of Skyland Trail, and a passionate advocate for mental health treatment. The goal of the series is to amplify the voices of mental health experts and individuals with lived experience and to elevate mental health as an issue of importance in Atlanta and across the country. So thank you all for being here tonight to help us honor Dottie’s legacy. I also wanna recognize the many members of the Skyland Trail Board of Directors and the Advisory Board who are here with us this evening. Thank you all for your leadership this evening and for this event, and every day that we are open at Skyland Trail, you guys are wonderful. I now wanna turn it over to Dr. McDonald.
[applause]
Dr. Bill McDonald:
Well, thanks, Beth. And this is a real honor to me, Dottie Fuqua was certainly a good friend of mine too, so I really appreciate all that you’ve done, Tom, to make this happen. The Addiction Alliance of Georgia is a partnership between Emory Healthcare and Hazelden Betty Ford. And one of the main missions is education and research, and really improving those and then providing expert advanced clinical care for patients. That’s really what we’re all about. And tonight, we really have a dynamic program, where we plan to outline both the challenges and the opportunities to care for people with addictive disorders. And to do this, we’ve got the viewpoints of the patients, families, and clinicians, so I’m really… I’m confident that you’re gonna leave here with a number of new perspectives on this. And I’m gonna introduce our speaker, but first I wanted to make a note to three people who are very important to the Addiction Alliance of Georgia, Tom Johnson, Frank Boykin, and Jack Hart, and if you all could please stand.
[applause]
Together they raised almost $10 million to get the Alliance started. And you did it Tom, I’ve got… All hats off to you. So it’s really my pleasure now to introduce our moderator for our conversation and panel discussion. Jaye Watson, many of you know, is an important part of the Emory Brain Health Center, and she’s an Emmy and Edward R. Murrow award-winning veteran journalist. She now has her own… She’s a host of an Emmy award-winning PBS television show, Your Fantastic Mind, which is on tomorrow night on PBS, and it’s currently in its fourth season. So please join me in welcoming Jaye.
[applause]
Moderator: Jaye Watson
Good evening, everyone. I’m so happy to join you tonight, and I know like me that you’re excited to hear from David and Nic Sheff. I really feel that we have a unique opportunity to experience this together, to be able to learn and share and be in the community on this issue that impacts so many of us. So toward that end, staff will be in the aisles collecting your questions for them, and for our panel tonight, please use the index cards included in your program to go ahead and write out your questions. Now to our guests tonight, David and Nic Sheff, father, and son, are both wildly talented authors. David’s book, Beautiful Boy: A Father’s Journey Through His Son’s Addiction, was a number one New York Times bestseller. David is the author of multiple books, including Clean, All We Are Saying, The Buddhist On Death Row, and Game Over. And he’s currently writing what will be the definitive biography of Yoko Ono. David is the founder of Beautiful Boy Fund, devoted to supporting quality evidence-based treatments for substance use disorders and research to further the field of addiction medicine. David has been a featured speaker at the United Nations and at countless conferences in schools and community events such as this around the country.
Nic Sheff wrote the best-selling memoir Tweak: Growing Up On Methamphetamines. His book is a raw, authentic account of his substance abuse and recovery that is rooted in mental illness. Nic also wrote High: Everything You Want To Know About Drugs, Alcohol And Addiction, We All Fall Down: Living With Addiction, and Schizo, his critically acclaimed novel about a teen’s downward spiral into mental illness. Nic is also a successful writer for film and television shows that include 13 Reasons Why, Recovery Road, The Killing, and many more. In recovery since 2011, Nic has traveled the country speaking about substance abuse, mental health, bipolar disorder and recovery. David and Nic’s books, Beautiful Boy and Tweak were adapted for the movie, Beautiful Boy. Please welcome David and Nic Sheff.
Jaye Watson:
My microphone. The TV person forgot their microphone. Hello? Hello, everyone. Good evening.
[laughter]
And about that movie, Beautiful Boy, David was played by none other than… I’m sorry, The Office’s, Steve Carell. Fabulous. And Nic was played by Timothee Chalamet. We’re gonna begin tonight with a clip from the movie, Beautiful Boy. I also think that very few people will experience that, watching themselves on the big screen being played by someone else.
What I was saying was that what they experienced is very unique, to watch yourself on the big screen being played by someone else, I know it was not an easy decision for you to put the hardest thing you’ve ever gone through out there. So what was it like to see it? What did you think of it? And did they get it right?
Keynote Speakers: David and Nic Sheff
David Sheff:
Well, Jaye, first of all, thank you for doing this, and thank you all for coming tonight to celebrate these amazing organizations. And we know from our own experience how many people are impacted by addiction and substance use disorders. And I think the conversation is so important, and I guess that’s what I would say about the movie that… It was weird for sure to have Steve Carell, Michael Scott plays me, and Timothee Chalamet plays Nic, and to create this weird event around this, what had happened to our family. But the part of it that actually felt good about the whole experience and made it really worthwhile in spite of the fact that it was scary and that it was overwhelming at times, and it was hard to expose our family in the way that we did, was that even more than books, movies reach a lot of people. And so a lot of people saw the movie, and I heard from them and Nic heard from them, countless people, who were impacted in really profound ways, and they said things, very similarly said, “I saw myself in the dad,” or “I saw myself in the child, or in the mom.”
And as we know, if somebody is sick with another disease, we talk about it, we are open about it, and because of that, we’re able to get help. But when it’s a substance problem, because of the stigma around it, because of the judgment that we feel, and the guilt that we feel, and the blame and the shame, everything that goes around drug use and addiction, we don’t talk about it. And so I heard from people who had never talked about the fact that they had a child who was in drug treatment, or… A mom and a dad had gone to see the movie together, and afterward, the girl just burst into tears and talked to the father about the fact that she was addicted to pills. And they had a conversation and she went to treatment the next day. So that’s sort of what the value is in the power of telling stories, and so we’re grateful for that, for that reason.
Jaye Watson:
Nic, what was it like for you to watch it?
Nic Sheff:
I agree with everything my dad just said. To me, personally, there is something about it that’s kind of a gift in a weird way, which is that it’s easy for me to get caught up… I mean, I’ve been sober for 11 years now, 12 years, actually.
[applause]
So it really was kind of a long time ago at this point that we went through the worst of it, and so it’s easy to get caught up in my life now and get worried about whatever stupid little things and fights with my wife or whatever. But having this movie exist, and just to be able to even just see a clip of it like that, it’s such a reminder of what we went through as a family, and so it makes me feel so grateful to be on the other side of it. And I remember when I walked out of the movie, after I saw it the first time, as hard as it was to watch, that was the feeling that I had the most, was gratitude to have survived and to be where I am now in my life, and with my dad and my step-mom, and my little brother and sister, and my wife. And just to have this full life. And that’s the cool thing about talking about these issues, is that there is so much hope out there, and I’ve seen it with myself. But I’ve seen it with the thousands of… Tens of thousands of people we’ve met traveling all over the country talking about these issues, people whose lives have just been absolutely destroyed by their substance use disorder and mental health issues, but who’ve been able to recover and put the pieces of their life back together, repair those relationships and build these really full amazing lives. So that’s the cool part.
Jaye Watson:
I watched and read interviews with both of you Steve Carell and Timothee Chalamet. And Nic, I thought it was interesting what Chalamet said about you in a print story that I came across, I think it was in W. “There was nothing about Nic and meeting him that robbed me of addiction or whatever my stereotype would have been at the time, and that was the learning grace of this movie for me. Addiction doesn’t have a face, it has no preferred class or gender, or race. I think it’s almost easier or something to be like, “Oh, well, that doesn’t affect me or my family or my friends, that’s another thing.” When the reality is, it’s everywhere.” And so it is everywhere, and to state the obvious, it’s worse than ever. It’s been five years since the movie, 15 years since your books. And we’re gonna get to that, we’re gonna get to the worst, to the things that need to be done when we bring our panel up, and what we can do and what needs to happen. I also will be honest in getting ready for this talk with you tonight, which I have to confess to all of you, I’m not gonna hold you hostage for four hours with this, but I need reading glasses, and I did wanna do this, so I have size 26 font.
[laughter]
Okay? Very happy about it, actually. But I feel like your story is so big and spans so much time, that if your story is planet Earth, the amount of time we have tonight is like Rhode Island or Liechtenstein. So we’re gonna dive right in and make the most of it. We already had some questions through from the audience, and we’re gonna weave them in, and like we said, people will come around to also get your questions when the panel joins us. So for the audience, I’d like to focus briefly on your backstory. When I’ve interviewed families about this, the parents usually said that they did not know that their child was addicted until pretty far down the line. That they had “busted them a couple of times, and had chalked it up to normal experimenting.” I think every interview I’ve ever done. So can both of you talk about when and how things happened? And what you thought was happening, David? Nic, what you were doing? And also if you thought it was under control?
Nic Sheff:
You can start.
David Sheff:
Okay. Well, you really said it. I think parents like me, are in denial in so many different ways, we want everything to be okay, we want our kids to be okay, and we look at the good stuff and excuse away the bad stuff. And when I first found out that Nic was using, he was smoking pot was the first thing, I found some marijuana in his backpack, I went to his teacher, I went to the school, and they told me what I wanted to hear, which was, “Nic is a great kid. He’s doing fine. Drugs are out there. Kids are experimenting. It’s a rite of passage. There’s a lot of peer pressure. Don’t worry about Nic, he’s gonna be fine.”
Jaye Watson:
And this was when he was fairly young?
David Sheff:
He was only 12, right?
Nic Sheff:
12. Right.
David Sheff:
And so I was heartbroken at first and I was scared, but they reassured me and I said, Oh, okay, good, he’s gonna be fine.” But he wasn’t fine. And his drug use escalated when he got into high school. And even then, I was still in denial, and I think that that’s something, that’s another reason that I think it’s great that the movie is out there and that we wrote these books, is that I wanna tell parents and others, teachers, anybody who’s in a situation where we’re around these kids, our kids, that it’s so easy to excuse away. And what we now know is that a lot of drug use is related to other issues that kids are struggling with, they’re dealing with stresses in their lives. And it’s so easy to just brush aside the bad stuff. But instead, what we wanna do is when we see our kids struggling, and not just with drugs, but if they seem stressed in school, if they’re being bullied, if they’re having a hard time academically, whatever it is, that’s the time that we wanna intervene if we can, and talk to their teachers, and talk to counselors and get them help before drug use begins, or if it does begin, before it escalates.
Jaye Watson:
Yeah.
Nic Sheff:
Yeah. And I guess for me, I think that from the beginning when I first started smoking pot, which was basically the first thing that I did, I think my body, or brain, or whatever reacted to it differently from my peers. I would say that it was almost from the beginning, right away, it just gave me this very immediate sense of relief, and I think before I started smoking pot, I’d felt really anxious and kind of uncomfortable in my own skin, and like, I remember looking around at all the other kids in my class and they all just seemed so confident, and they’d received some… And this is a cliche, but they’d received some instruction manual for life that I just never had. And so when I started smoking pot, it really took those feelings away at first, it made me feel less anxious, it made me feel like I could go to a party and talk to people there, and talk to girls, and so it was like the answer to my problems at first. And I definitely don’t think that everyone who’s smoked pot has that feeling, I think that was something that was unique to me, and unique to probably other people that have substance use disorder. But after I did it that first time, I guess I just wanted to try to do it as much as I possibly could because it did make me feel so much better.
And so up until I was like a junior, I guess, in high school, I was just smoking pot as much as I possibly could get my hands on it. And then I started drinking a little bit and I liked that too. But there was a certain point, I remember, where I was basically smoking pot from the moment I woke up in the morning to the moment that I went to sleep at night, and it kind of stopped working, it stopped giving me that feeling of relief that it had given me before. And I was just… I think I was in this sort of cycle where I was depressed obviously, and I was smoking more pot to try to feel better, and the pot I think was actually making me more depressed, and so I tried to smoke more to feel better. And anyway, so I just was in this cycle where I was getting more and more depressed, and I felt really helpless. And so I remember kind of making a concerted effort to try to find harder drugs that were gonna give me the same feeling that pot had given me originally.
And so I tried everything that was around at the time, pills and coke and hallucinogens. And it wasn’t till I found crystal meth that was like… That was kind of the one that I guess I’d been looking for and didn’t even know exactly what I’d been looking for it. And the way I tried crystal meth for the first time was very by accident, I don’t think I’d even ever heard of it at that time. It was way before Breaking Bad and all these ad campaigns to educate people about meth, so when someone offered me some speed, I did it. And yeah, the moment that that drug hit me for the first time, it was like this switch got flipped and I just became a completely different person, and all I cared about was getting more of that drug, and that’s when my life really spiraled out of control very, very quickly.
David Sheff:
Yeah, and we didn’t know. We were in the dark. I mean, Nic was good, I think all of our kids are pretty good at hiding what he was going through, and showing us what we wanted to see. ‘Cause still, until things really escalated, Nic was still doing well and he was still going to school, he was still doing well in school, he was still this fabulous big brother to our younger kids, Daisy and Jasper, and so it was really confusing. And it took until Nic’s drug use did escalate to methamphetamine and he disappeared, and he was gone for a few days, and at that point, I realized we were… Could no longer be in denial, that we had to do something.
Jaye Watson:
You’ve written about feeling guilty about his addiction among the many things that you felt. And I feel that as parents we tend to blame ourselves for everything anyway. You both wrote in your books about the divorce when you were little, being shuttled back between your mom and dad, and always missing someone. So in what ways did you blame yourself for what was happening with Nic? And do you still?
David Sheff:
I blame myself… I felt guilty about everything, I felt guilty, but his mom and I had a very difficult divorce, it was… And Nic was in the middle, and I know that it was traumatizing for him, and I know that didn’t help as he was growing up, and whether or not it was connected to his drug use, so it did connect to a lot of the struggles that he had when he was a kid, so I feel like it had to. But what I’ve learned since then is that there are some people who have… Who becomes addicted. There can be 10 kids who go out and smoke pot at school behind the building or whatever it is, and nine of them are probably gonna be okay. Their drug use will be… Potentially it could be harmful, and it’s not something we ever wanna encourage, but they’re not going to have the extreme drug problems that Nic had. And so what I realized is that… I guess I do blame myself for a lot of the mistakes I made, and I made a lot of mistakes.
Jaye Watson:
So does every parent.
David Sheff:
But I also feel that one of the big mistakes was something that I couldn’t know about then, which is what it means to be… To be an addict, to have an addiction, to have a substance use disorder. Because if I had, then I would have known what to look for and I would not have waited to get him help.
Jaye Watson:
It’s funny you bring that up because every parent I’ve ever talked to who’s lost a child to addiction talks about what they could have done differently, what they could have done earlier, what they should have done if only this. And you have Nic with you, you’re here. So when you look back at hindsight, have you ever thought, “Knowing what I know now, I could have stopped the addiction.”?
David Sheff:
I don’t know if I could have stopped it, but I certainly would have tried a lot earlier, I would have gotten Nic’s help. One of the things that we know now, and that I’ve learned, and I didn’t know then, and I still feel like a lot of people in our society don’t, in our culture don’t know is that addiction is a disease and it is treatable. If we can help somebody, then we have this insane sort of philosophy around this, around drug use and substance use disorder that, yeah, we can’t help people, we have to let them get worse and worse and worse until they finally get so bad that they hit bottom and they’re desperate to get help. But we know from every disease that people suffer, that we don’t want them to get worse, we don’t want somebody to hit bottom, we wanna catch them as soon as we can to prevent it from hitting bottom. So if I knew then what I know now, I would have known to look for the signs of addiction, of his drug use escalating, and I would have wasted no time at all in getting him help, bringing him to a professional, an addiction psychiatrist or psychologist, and started the process that… Even when we did do that, it was not an easy problem to treat and to solve, but I do believe that we could have. It wouldn’t have gotten as bad and it wouldn’t have lasted as long.
Jaye Watson:
Nic, in your book, Tweak, you write, “I wanna be good. Do good. Be a worker among workers. A friend among friends. But there’s also this part of me that is so dissatisfied with everything, if I’m not living on the verge of death, I feel like I’m not really living.” What was the verge of death, being high?
Nic Sheff:
Yeah, that’s interesting. It’s funny… It’s interesting to hear you read that, ’cause I don’t feel that way at all anymore, so…
Jaye Watson:
That’s good, that’s good.
Nic Shiff:
Yeah. So it’s funny. I think… Just actually, just to go back to what we were talking about before, the reason that I… A lot of the reason that I’m sitting here and that I’m alive, and I have so many friends who haven’t made it, who’ve overdosed, and who are… It’s just luck really. I hate to say that, but it’s true, I just got really lucky. And there’s nothing that… We did write that my friend’s parents who have died did wrong, it just… I got lucky that the times that I overdosed and wound up in the hospital, I didn’t take just the tiniest little bit more that would have killed me, and that my friends whose funerals I’ve gone to just accidentally took that little bit extra. And so, in some ways, we just have gotten so lucky. But I think to my dad’s point, the thing that I really try to encourage people is just to… Especially, for parents with young kids, or with anyone who’s struggling, is just to kind of try to protect them, I guess, as much as possible, and put this sort of armor around them and help get them through this very difficult time.
Because that feeling of feeling like, “I’m never gonna be satisfied. And if I don’t have drugs, I’m never gonna be happy.” That feeling does go away, it just takes time to go away, and so that’s the thing that I feel like there is… I don’t know what the word for it is exactly, but there’s almost like a time game or something, where it’s like the longer we can kind of help someone to stay off of drugs and alcohol, the longer we can help their brains to heal and start to repair some of the damage they’ve done. We can also help them get stabilized on medication, like psychiatric medication so that the levels of the chemical reactions in their brains and everything are more stabilized.
And for me, when I finally got on the right combination of Prozac and Lithium and Lamictal, or whatever… Those are the three psychiatric medications that I take. It all took time to get to a point where I was stabilized on the medications, where my brain was able to heal enough from the damage I’d done to it to start regulating itself normally. But the cool thing is, is that, as I said before, it does work, all those pieces can come together to allow someone to recover from this disease and to live a really great full life. But it does take time and it takes intervention from doctors and people that work in this field. And that’s the really amazing thing, that we live in a time where there are these professionals that work in the field of substance use disorder that really could make a difference in people’s lives, and can really save people’s lives, and they saved my life, so I’m grateful for that.
Jaye Watson:
Do you know how many times you relapsed?
Nic Sheff:
I think I was in maybe six different treatment centers, in terms of sober living and all the different outpatient… I’m not sure exactly how many times I relapsed.
Jaye Watson:
So why did it finally stick? Was there something different, or was it you that was different?
Nic Sheff:
I think it was a sort of culmination of everything. I think each treatment center I went to, I learned a little bit more, they helped break down my denial a little bit more, and I got some pieces of the puzzle. And I think, obviously, the goal is long-term sobriety and being a happy person that is like a functioning member of society and everything. But I do think that each time I had some period of sobriety, before relapsing, that was also helpful too, ’cause it was a time when I wasn’t out doing something that could potentially kill me obviously by using these drugs, but also it was a chance to help my brain heal more and to get further… Develop more life skills and everything. So it all was part of the process. I think the last time when I… The fact that I’ve been sober continually since 2011 is, I think a large part due to just sort of the cumulative effect. And then also, I think at that point, I just was so tired of beating my head against the wall and hurting myself and hurting everyone around me that I think I was really finally ready at that point to kind of do what was suggested of me and really take action to try to take the steps that were I was told to do. And so I started working the 12-step program, which has been a very helpful thing for me, working with a sponsor, doing all that stuff, working with a psychiatrist, getting on the right medication.
I really do sort of look at addiction as being kind of a perfect storm, as all these pieces come together to make someone an addict, or I think a lot of times there’s a genetic component. My grandfather literally drank himself to death. They say the younger someone starts using drugs and alcohol, the more likely they are to develop a dependency. Trauma, all these pieces come together. And I think for recovery, it’s kind of a similar thing, in the sense that there are all these different pieces that come together that allow someone to get sober and then to stay sober, and so it’s sort of a process of figuring out what are those pieces for each individual. And yet for me, medication, a 12-step program, working with a therapist… I mean, a psychiatrist and a therapist, and all these things have been what has allowed me to put together this time sober.
Jaye Watson:
David, you wrote about your own suffering when Nic was gone, when times you thought he might be dead, how you couldn’t function or sleep, or even the sound of the ringing phone was traumatizing. And I think a lot of people here can relate to that feeling. I swear I won’t keep reading from your books, but they’re phenomenal, this is the last clip I’m reading. “Our children live or die with or without us. No matter what we do, no matter how we agonize or obsess, we cannot choose for our children whether they live or die. It is a devastating realization, but also liberating. I finally chose life for myself, I chose the perilous but essential path that allows me to accept that Nic will decide for himself how and whether he will live his life.” What did choosing life for yourself look like?
David Sheff:
It sounds a lot easier than it was and is. Anybody who’s going through it realizes that it’s just hell.
Jaye Watson:
Yeah.
David Sheff:
And I spent so many years doing everything I could to try to save Nic’s life. Driving into the middle of some of the neighborhoods where I knew that he hung out in the middle of the night when he would disappear, really struggling with him to get him into different kinds of treatment programs and all that. I did it for years, but nothing worked. And so there was a period when I felt I had to step back. The other thing that happened was I had to… I forget about this sometimes, but I had a brain hemorrhage in the middle of all that, and I almost didn’t make it myself. And so at some point, I asked my doctor, the neurosurgeon, if it was related to the stress that I’d been under, ’cause I had been under this intense stress for years. And he said, “Well, it didn’t help.”
[laughter]
And so I realized that I also wasn’t gonna be able to continue to help Nic if I didn’t take care of myself. And it’s a really hard balance, we as parents are… It’s in our bones, it’s in our blood to worry about our kids. And I think that we should and we have to, and we have to do everything we can to help them. But at the same time, there is a delicate balance because we also have to take care of ourselves and survive, and take care of our other obligations. I had to work at some point, I had to do my best to try to take care of Nic’s little brother and sister. But it’s a balancing act, and it’s not perfect… There was never a perfect moment.
Jaye Watson:
We have time for one more question before our panel joins us. So Nic, what was your mental health diagnosis, and how old were you when you received it?
Nic Sheff:
So I’ve been diagnosed with bipolar disorder and depression, and… I’m probably gonna say the wrong bipolar disorder, so I won’t say it, but it’s… And I won’t try to guess, but it’s the one that’s a little less severe than the other one, I think.
Jaye Watson:
Well, that’s why we have the panel.
Nic Sheff:
[chuckle] Yeah, they can help to answer that question.
Jaye Watson:
They’ll help figure it out.
Nic Sheff:
But the frustrating thing I will say is that I did go to a number of different treatment centers and I wasn’t ever evaluated psychologically. And I remember there was a moment I think where my dad and I were together, something, where the doctor said to him at the last treatment, or one of the last treatment centers I went to, “Can I see Nic’s psychological testing?” And my dad was like, “What are you talking about?” Because no one had ever done that before. And so it wasn’t until I got to that treatment center that they finally did have me meet with a psychiatrist and do the psychological testing, and I got the bipolar diagnosis, and started to get on medication for that. And yeah, it really changed things and it really helped. And the fact that I went to all those treatment centers and no one thought to look at my mental health issues beyond just my substance use disorder issues is troubling, for sure. And I think more and more now, treatment centers are moving towards this, you know, a dual diagnosis model, and I think most treatment centers…
Well, I hope that most treatment centers now call themselves dual diagnosis and address both mental health and addiction issues. But not all of them do. And so I think that’s something that is really an important message to put out there is that, obviously not every person that struggles with addiction has a co-occurring mental health disorder, but a lot of us do, and I feel like it’s a safe assumption to at least check that out before just proceeding with just addiction treatment. And yeah, it was definitely life-changing for me to get that diagnosis and get on the right medication.
Panel Discussion
(Jaye Watson introduces panelists.)
- Carlyle Bruce, Ph.D., Skyland Trail Director of Psychological Services and Family Therapist;
- Ben Hunter, MD, Skyland Trail Interim Chief Medical Officer;
- Justine Welsh, MD, Medical Director of the Addiction Alliance of Georgia
Well, it’s a perfect time for our panel to join us, so we’ll begin with Dr. Ben Hunter, who is the Interim Chief Medical Officer at Skyland Trail. Dr. Hunter oversees all the clinical educational quality and research activities for the organization. Dr. Hunter completed his medical training at Emory University and a psychiatric residency at the University of Pennsylvania. Welcome, Dr. Hunter.
[applause]
Dr. Justine Welsh is a Child Adolescent and Addiction Psychiatrist, Director of the Emory Healthcare Addiction Services, and Medical Director of the Addiction Alliance of Georgia. Dr. Welsh’s area of clinical focus and research is in the treatment and prevention of adolescent substance use disorders, as well as opioid use in young adults. Welcome, Dr. Welsh.
[applause]
And Dr. Carlyle Bruce is the Director of Psychological Services and a family therapist at Skyland Trail. As the family psychologist at Skyland Trail, Dr. Bruce provides couples and family therapy services to clients and their families. Dr. Bruce earned an MS in Clinical Psychology from East Tennessee State University and completed a Ph.D. in Clinical Psychology with a specialty in Child and Family Psychology from Georgia State University. Welcome, Dr. Bruce.
[applause]
So we have a lot of questions that have come in from the audience, and I have a few here, and I know they’re more there. “What is the best thing for a parent to do or say when it’s clear your loved one is using?” Oh, and we also said…
Dr. Justine Welsh:
One answer.
[laughter]
Jaye Watson:
But I’m not gonna point at people to answer. Right.
[laughter]
Dr. Carlyle Bruce:
Oh.
Jaye Watson:
Hi, Dr. Bruce?
Dr. Bruce:
You’re using? What’s going on? One of the big things I think is important is to not talk about things. So it gets to be really important to acknowledge that you do know that your child’s using, and to inquire what’s going on, and to start to dive into that.
Jaye Watson:
And so after you ask, I think a lot of parents run into brick walls or resistance. How do you know how far to go?
Dr. Bruce:
Well, there’s a magic formula.
Jaye Watson:
Okay, great.
[laughter]
Dr. Bruce:
And here’s the formula, you keep asking.
[laughter]
There is no magic formula, there is no magic answer to know how far to go. One of the things that is clear though, is that if you don’t ask, you don’t find out anything. If you continue to ignore the situation, it gets to be what David and Nic were talking about in many regards. Part of the challenge is I think that parents have a brain condition that’s not often talked about, it’s they’re a parent. And that’s a particular kind of brain condition, because parents, they dive in… They’re impacted in so many different ways. And they want to believe that their child is not doing something like this, they want to believe that, “My child would never use drugs.” And that is part of what gets to be the trap, I think.
Jaye Watson:
Thank you. Another question from the audience, what advice would you give to someone about to leave for college with a history of addiction in the family? And I know Nic this is part of your story, actually, I don’t know if you wanna weigh in on what people should do if a child is about to leave for college with a history of addiction.
Nic Sheff:
Yeah. Well, I would just say, just the more we can educate people about this disease, I think the better. I do think that it would have made a difference for me. I never had heard of the concept that addiction is a disease and that it can be passed down from generation to generation. As I said, my grandfather drank himself to death. I think on my mom’s side of the family, alcoholism goes back for generations, and I think if I had had some knowledge of what that meant, then potentially when I was using and I… ‘Cause I could see that the way I was using drugs and alcohol was different from my peers, even when I was 12 years old, just smoking pot, I felt different, it felt different to me than it did to other people, and so knowing about addiction as a disease, I think that concept could have been helpful, it would have been helpful before I went to college, and just would have been helpful in general in life.
David Sheff:
And also I was just gonna add that it really is the same thing, it’s, the conversation, it’s about, talk about it and talk about it and talk about it. And you can help, at least give somebody a leg up by talking to the school about it, talking to the school and getting… A lot of colleges now have sober dorms, they have support groups, they have counselors who are… That’s what they do. And I don’t think you necessarily have to wait for a crisis. In fact, you don’t wanna wait for a crisis to take advantage of those things, that can start the day before you even arrive at school to set it up so that there is a safety net.
Dr. Welsh:
And if I might just quickly pitch a resource. One of the things that I think wasn’t widely available when you were going to college was collegiate recovery programs, and we are lucky enough to have one of the best in the nation in our area at Kennesaw State University.
David Sheff:
Very cool.
Jaye Watson:
Thanks, Justine.
So at Kennesaw State University, KSU’s Collegiate Recovery Program, so it’s a program that supports individuals in recovery or seeking recovery and just provides that safety net for young adults who are entering college.
How do you define recovery? Is it abstinence?
Dr. Ben Hunter:
And I pick that question, I’ll take responsibility for that complicated question.
[laughter]
Dr. Hunter:
I thought maybe we could hear about that from you Nic and also just see from a medical standpoint of how we define that and what prognosis is in terms of different types of recovery that we’ve identified.
Dr. Welsh:
Yeah, so I’m happy to start. The reason I was hedging my response to this is that recovery is defined in many different ways. And for a lot of people, it’s individualized, and so recovery may mean complete abstinence, not using any substances for a prolonged period of time. There’s the controversy about whether or not someone has truly recovered, can you ever recover from a substance use disorder or do you simply enter a period of maintenance? That you still have to be vigilant because you are still at risk of returning to use in the future. So there are various definitions of recovery. Other individuals define recovery as not using the most problematic substance. So they may be in recovery from using heroin or using fentanyl, but they’re still continuing to use cannabis or to use alcohol, but they’re not causing problems in their lives, like something like heroin or fentanyl. So again, recovery is very individualized.
David, how did you manage to detach with love?
David Sheff:
Well, I guess it sort of goes back to what I said earlier, which I don’t know if I ever fully detached. But one thing that became clear at a certain point on this was, Nic talked about being educated about what substance use disorders are. And it was huge for me because up until then, I thought, “What’s going on with my kid? He’s out of control. He is doing things that didn’t make any sense to me.” He was doing things to me, to the rest of our family that was completely out of character for who Nic was, and once I started to go to groups at some of the treatment centers that Nic went to, and I started to hear about what it means to be, for a person to be addicted, and I realized that this wasn’t Nic. This was Nic with… His brain wasn’t functioning as it should, he was ill, and once I realized that then all of my anger and my blame and my resentment and my, “How could you do this to me?” It sort of evaporated and it all became about, “Oh my God, my poor son has this illness and what can I do to help him?”
Jaye Watson:
Can you discuss the tension between the idea that recovery doesn’t work until the person is ready and needs to hit bottom?
Dr. Hunter:
I think there’s a back end of that question too, which is also limiting the amount of harm that can come to someone while they’re seeking recovery. And I think there’s definitely a very 12-step oriented concept, but something that we’ve seen anecdotally over time and with statistics as well, that when people suffering from substance use disorders reach a point in their life where they really feel like they can’t go any lower, whether it’s being close to death or whether it’s losing their family or losing their job, or however they define rock bottom, success rates seem to go up. And at the same time, we do have many evidence-based treatments and we have approaches to dealing with substance use earlier on in the trajectory. At some level, I was thinking about what Nic said earlier about recognizing a different feeling when he was using than what his friends were experiencing, what his classmates were experiencing and kind of that idea of, “When do we intervene and how do we intervene?” I think the more information you get to someone and the quicker you get them into treatment early, the quicker you can head off some of the unfortunate consequences. Now, and I guess we think of, I think of the rock bottom as maybe a last resort, something that at some points we say, “Okay, we haven’t… “
“These first five treatment centers may not have worked, maybe if we get a little bit further, we’ll get to the point where something really sinks in.” And I think it’s a way to hold out hope, and I think in many cases it does work, but we really wanna introduce treatment as early and as often and as completely as possible. And one of the things I was really encouraged and inspired by reading the book, especially your book, David, was how quickly and frequently you brought Nic back to treatment, and there was never a period where you said, “You know what, I’m not gonna give up… Or I’m gonna give up on this. We’re just gonna give it a few years and then we’ll come back to a residential treatment setting or otherwise.” And I know that partially depends on resources and availability and willingness, but you guys both did a tremendous job, I think, of going back to the treatment repeatedly, ’cause you just never know how many times it’s gonna take. And I thought that was a really inspiring part of the book.
Jaye Watson:
Please discuss what Bipolar 2 disorder looks like using behavioral examples for family members. Bipolar 1, bingo! Bipolar 1 is more obvious than Bipolar 2, which can be very subtle and very difficult to diagnose.
Dr. Hunter:
We’ll be hosting a two-hour talk after this one for bipolar disorder.
[laughter]
It’s one of the hardest-to-understand diseases, I think, for families and for patients, because it’s represented so many different ways in popular media, in society, and really at the core, bipolar disorder is an episodic mood disorder that features discrete episodes of depression or mania, or sometimes a mixture of the two, what we call mixed episodes naturally. And I think the key is also to recognize what bipolar disorder is not. So mood swings are not necessarily a bipolar disorder. We see many people who say, “Wow, I really have trouble regulating my emotions, and I think I have bipolar disorder.” Now, it’s not to say that we don’t wanna be watching for something like bipolar disorder, but in some cases, again, there are many other reasons why someone might experience mood swings. Just to speak briefly to what bipolar disorder is, really the characterizing feature I think we’ve all experienced depression and know what depression is, but mania, again, is usually discrete, identifiable episodes where people will go through periods of either euphoria and/or irritability that are very noticeable typically to people around them.
So typically patients will lose insight into their mania symptoms, meaning they won’t notice and they will not be aware that something’s wrong, and often they’ll feel fantastic during these periods. Again, the heightened euphoric state can be very intoxicating, pun not intended in this setting, but really, you’ll see distractability, you’ll see impulsivity in spending and sexual activity and travel are classic, you’ll see grandiose ideas, connections to higher religious powers or celebrities, Nobel Prize-winning ideas coming out in the middle of the night, you’ll see increased activity, so goal-directed things like writing books and writing screenplays and traveling around again, all of these things which, you know…
[laughter]
Can be so hard to distinguish from just a successful career in many ways.
[laughter]
Jaye Watson:
I was gonna say.
Dr. Hunter:
It’s really about, it’s about the difference in those discrete episodes from the rest of that person’s life and their kind of baseline functioning, so we certainly take it all into context. And again, when you talk to someone with bipolar disorder, you especially talk to their family member, maybe even easier, co-workers, friends, they’ll say, “Gosh, this was just a different person for a week or two or a month.” That is what you hear, you see. “I didn’t even know who this person was. This was somebody I didn’t recognize. They were talking fast, their ideas were flowing at a rate I couldn’t even keep up with.” And that’s a little different than saying, “My family member really struggles and they’re angry a lot, and I feel like they can flip a switch and be extremely upset with me in just a minute, even just because of something small.”
Again, you wanna watch because again, Bipolar 2 disorder, is a less severe version of bipolar disorder than Bipolar 1 disorder, Bipolar 2 disorder can be on the order of days in terms of the episodes. So sometimes people will only notice a few hours worth of the behavior when in reality it might be consistent over the course of a few days. So we’ll all just kind of end this soliloquy on bipolar disorder by saying that, thinking about bipolar disorder, again, the time frame you might wanna think about is, for Bipolar 2 disorder, again, less severe and typically with less functional impairment, you’ll see days of symptoms, and then for bipolar 1 disorder, the more severe version that often ends in hospital settings or even unfortunately in interactions with the legal system, you’ll see typically week’s worth of symptoms, so keep those time frames in mind. Again, after hours, we start to think about other causes for such symptoms.
Jaye Watson:
Thank you.
Dr. Watson:
And If I might just add to that, it can be extremely challenging to diagnose bipolar disorder in the context of heavy substance use. And so I’m not surprised that it was misdiagnosed, and it’s unfortunate that there are still addiction treatment facilities that don’t call themself treating the dual diagnosis, so substance use as well as co-occurring mental health disorders, and have the ability to differentiate the two, especially if they have programming where the individual is removed from substance use, like a residential program. So it’s not surprising, but it’s disappointing to hear nonetheless.
Jaye Watson:
So all of these questions are anonymous, but this is from Tom Johnson, it was just delivered to me on stage.
[laughter]
And it is, how could you afford all of the expenses for Nic’s treatment? And I think that’s a really good question.
David Sheff:
Well, it is a good question, and I hear from people all the time who are in the throes of trying to deal with their own addiction or a child’s addiction, or a husband or wives or partners, or whoever it is, and they’re trying desperately. People have mortgaged their homes and lost their homes. We were really lucky because in the first programs that Nic was in, I had insurance.
Jaye Watson:
And it covered it.
David Sheff:
And it covered it. In the second program Nic was in, his mom had insurance, but it got to the point where we were so desperate that I was begging and borrowing and stealing and making deals with organizations, and it took me 10 years to pay off some of the treatments. There are programs that I’ve learned about in some places that are for people who don’t have any resources and don’t have any insurance. There’s a place in Los Angeles I know about that deals with people who have absolutely no resources, and it’s a really good program. They see… That gets staffed by some of the best psychiatrists in that city, and so there are options, but it’s really, really hard and it’s a challenge. And it’s also criminal that we have to fight and fight and fight and fight to try to get treatment for something that is such a serious problem, such a serious illness.
The other thing I was gonna say about that was, when you hear words like substance use disorder and bipolar disorder or depression, all these mental… They’re just a word, mental illness, we get… It’s scary. And so when I learned after Nic was diagnosed finally that he had these conditions, my first reaction was, “Oh my God, how sad it is.” When Nic was visiting us at our house, and I went into his bathroom and there’s all the medications were on the table, and my first reaction was, “Oh God, how sad it is that my son is sick and he has to take all these medications.” But my next reaction was, “Thank God they figured it out, thank God he has these medications, thank God he takes these medications. Because it’s changed his life.”
Jaye Watson:
Today is National Fentanyl Awareness Day. The Fentanyl crisis has taken the drug problem to a new level, any suggestions on how to address it? And I think this is one of the things I mentioned off the top, that things are worse. Fentanyl is a big reason why. So any ideas on how to address it?
David Sheff:
Well, I’ll just jump in and say very quickly, the first thing is doing what you’re doing here tonight in your community is bringing people together to have these conversations. We don’t talk about it at our peril and it is terrifying. 120 people are dying every single day from Fentanyl overdoses, and it’s, they don’t have to die. And that goes back to this idea about recognizing problems early and getting treatment and figuring out whatever it is. It’s hard, again, to find treatment, but treatments are out there. I’ve learned about… I just forgot the name of the organization that we’re here for tonight.
[chuckle]
Nic Sheff:
Skyland Trail.
Jaye Watson:
Oh, Skyland Trail.
David Sheff:
Skyland Trail, that’s what I was gonna say. I knew it, but I was gonna say…
Jaye Watson:
It’s right there.
David Sheff:
No, the fact that you have a program that is incredible, that I’ve learned enough about not to remember its name, but to know that it’s a really, really good program, but that it deals with, that it helps kids. It’s so rare to have communities that have treatment programs for young people. And we know that adolescents are… That 90% of the people who end up having serious drug problems start when they’re young, and so the idea that we could treat this and we can catch it and we can also deal with some of these other things that can also increase the likelihood that someone is gonna have a problem with fentanyl. You were, I think, you were talking, so was it you were talking about that now kids are ending up in the emergency room because they’re smoking marijuana, just marijuana that has, actually laced with fentanyl?
Dr. Welsh:
Mm-hmm.
David Sheff:
It’s really scary.
Jaye Watson:
Dr. Bruce, this feels like a question for you, even though I said we’re not gonna… Is there anything you’d suggest to help people accept their addiction or address their denial?
Dr. Bruce:
That’s a really tough one because a big part of the issue is the denial, dealing with the saying, “Don’t even know why I’m lying,” piece of denial. Part of what I think is important is to find ways of lowering some of the anxiety so that a person can be more open to hearing some things. For instance, when parents may be struggling, a family may be struggling with some of the realities that were happening, even in this clip, there was that anger and that frustration that came out so quickly sitting around that table that automatically the walls came up, the pattern of going back and forth and getting locked in the conflict cycle so quickly jumped up, and finding some ways of opening that up so that there’s not as much conflict initially, lowering the anxiety, it’s easier than to take a look at self, I think.
Jaye Watson:
Thank you. Nic, this is for you. What is your relationship with Jasper and Daisy right now? These are Nic’s little brother and sister.
Nic Sheff:
It’s amazing actually. And it’s funny, I feel like that was kind of… I mean, it’s not funny, but it’s interesting, that my biggest regret, I think, was the impact that I had on my little brother and sister, ’cause I was 11 when my little brother was born, and 13 when my little sister was born, and so we got some time together when they were really young, and I got to be really involved in their lives and stuff, but then a big chunk of their childhood, I was on the street, and I took their parents kind of away from them in a way ’cause they were so worried about me, and I just felt really a lot of guilt for how much I’d put them through as total innocent young people, but the fact that we’ve been able to… There was an instance where I literally stole $5 from my little brother’s piggy bank in order to buy drugs, and the fact that we could go from that to me getting sober, I paid him back the $5 and I wrote him a letter apologizing and for both of my siblings, I feel like we’ve had a lot of amazing conversations where we haven’t just tried to brush it under the rug or not talk about it, we’ve really talked about what we all went through. And when I went to see the little…
I mean, when I went to see Beautiful Boy, the movie, the first time, I went with my little sister, Daisy, and we watched it together, and it was just super intense and it was interesting ’cause she’s not a very emotional person, so throughout the whole thing, and she didn’t cry or anything, and afterward we just were like, “Oh, that was so weird, or whatever.” But then the next day, I went to go visit her ’cause she was going to college close to where I was living, and I showed up with my two dogs and I was walking around campus, and she came down to meet me, and as soon as she saw me that day, she just suddenly burst into tears and I went up and hugged her and I think what it was was she just got to see me with my dogs, and it was such a happy thing that we were just gonna be going on a walk around her college campus together, and that juxtaposed with everything that we’d just seen in the movie and everything that we’d gone through the night before, I think that’s what really hit her and it hit me at the same time, and so I’m just so grateful that we get to have… We’ve been able to repair those relationships and she’s like, her and my little brother are like my best friends now, which is amazing. So I’m really lucky.
Jaye Watson:
Recent studies at Johns Hopkins and UT Austin have shown great promise with drugs like ketamine and psilocybin for the treatment of addiction and depression. What do you believe will be the role of these drugs in the future treatment of depression and addiction? And this is where I have to disclose that on our show next Wednesday night, the entire episode is psilocybin, a trial for cancer patients who are demoralized and it’s fascinating. So obviously I can’t answer this, but who can?
Dr. Hunter:
So I think incredibly promising research right now. I think you get more excitement in psychiatry about the use of psychedelics to treat, especially resistant disorders and depression and anxiety, and things that have not responded, PTSD that have not responded to medications and psycho-therapies, in order to bolster those treatments and provide additional efficacy for treatments that are not getting the job done. Obviously very complicated in using psychedelics and other medications that are also used as street drugs in some situations to treat mental health issues, and that’s where screening and good psychiatric oversight really come to the forefront. But really in 2023, we’re thinking about mental health issues in a different way than we have in the past, we know it’s not simply serotonin deficiencies or dopamine excess in the brain that causes the symptoms we see. At some fundamental level, those things are involved, but really it’s about the way the brain communicates internally and the way different systems within the brain communicate with each other.
We talk about functional connectivity, that’s gonna be a key phrase for everyone to keep an eye on in the next few years. Some people have heard the term default mode network, which is sort of the baseline, sort of working in the background type of functional system within the brain. And what we’re seeing with psychedelics is, it seems like they have a disproportionate ability to change the way the brain systems communicate with each other, and bring about those results in a quicker and more direct way with some patients who have really struggled to get that effect from some of the other treatments that we know can also cause those changes. So to be clear, medications, good effective medications, psychotherapy, transcranial magnetic stimulation, and many other treatments that are evidence-based can bring about those brain network changes.
It just seems like for some people who have had really sticky kind of fixed ideas about the world and their place in it, psychedelics have had a disproportionate place in treating those people effectively. So very encouraging, still some more research to do, again, this is looking like it’s gonna be highly evidence-based by the time it all comes through. But again, a little bit more work to do on the research front before it’s released.
Jaye Watson:
What were the least helpful treatment systems modalities in your recovery? Or was it more cumulative that every treatment gave you something that ultimately helped in your recovery?
Nic Shiff:
That’s a good question. Yeah, and I did wanna say before too, there’s definitely not a correlation necessarily between the cost of a treatment center and how effective it is, I feel like there are some very, very expensive treatment centers that totally are not good at all. And I worked… When I was first sober, a long time ago, I worked at a treatment center in Malibu, California, that was, I think it was like 100 grand a month or something, which is ridiculous. And it was more like a country club where they were helping people do their dry cleaning, and so it just felt like there was not a lot of actual treatment that was going on there, so the cost of treatment is not necessarily an indicator in how effective it is. And I have friends who’ve gone to county-run programs and it’s completely changed their lives, and they’ve been able to go back to their families and repair those relationships and stuff, and… So anyway, for me I think the most effective treatment centers were the ones that were evidence-based and that used a combination of psychiatric treatment along with 12-step stuff was helpful for me.
I know it’s not for everyone, but that was helpful for me. I think that obviously punitive-based treatment centers, I went to one place that was all about punishing you if you stepped on the carpet with your shoes on, you had to scrub the toilets with a toothbrush, and that kind of thing did not work for me at all.
[laughter]
I already had enough trouble finding a reason to keep wanting to live and that kind of thing just made me not wanna keep trying, it made me run away from there and go back to using. So compassionate-based treatment, I visited a Methadone clinic recently, and I think there’s a lot of stigma around Methadone, and what really surprised me about the doctor there was that everyone who was there getting their treatment, the doctor was so positive towards them, and he knew all their names, and he was like, “Hey, John, it’s so great to see you.” And he turned what could have been a very stigmatizing kind of dark depressing thing into something that was really positive. And it was like, “Oh, we’re all here together to get help that we need for this disease that we have.” And I thought that was such a cool thing. So I definitely think as much sort of empathy and kindness that we can treat those who are struggling with, the better.
Jaye Watson:
This question is actually one for me, that we didn’t get to, and David, you were honest with Nic when he was growing up about your drug and alcohol use growing up, and it seemed in reading the book that you regretted telling him everything. So is it… Do you feel parents should or shouldn’t tell their kids the truth about what they did growing up?
David Sheff:
I want you to answer this.
Jaye Watson:
I know. And that’s… No way in.
David Sheff:
I’ll tell you.
[laughter]
Before I… I’ll tell you the truth. I don’t think it mattered that much. And I think it’s really an individual… About the family. And I think maybe the most important part is communicating and being honest, and I do feel like… I didn’t wanna glamorize it, I didn’t wanna make it sound cool. But I think that the whole point is to try to connect in the deepest possible way. I never… I just… It’s another one of those things I wish there was a black and white answer, but I don’t think there is.
Dr. Bruce:
One point I would add with that is, sometimes it’s important to be mindful of when things get shared. There are times… It’s important that there is discussion and there is openness and there is connection. Sometimes things can be shared at a time when it’s used to justify some other actions, and that’s something just important to, I think, think through and not just react. I was thinking about one of those scenes in the book, I think, David, when Nic, you pulled out a joint and asked your dad to smoke with you at that time, and that’s something I’ve heard from parents before that, do you use with your child? And I would suggest, no.
[laughter]
David Sheff:
I was gonna say, that in the movie, it’s worse because in the movie they actually have the dad, not me, the dad going out in the middle of the night because he wants to experience what his child is experiencing, and he goes out to some shady street corner and he buys some methamphetamine and he does some crystal meth. I never did that.
Jaye Watson:
Yeah.
David Sheff:
But…
Jaye Watson:
Yeah.
[laughter]
David Sheff:
But I regretted when I did smoke pot with Nic. At the time my brain was like, “Well, parents can have a drink with their kid, Nic’s trying to connect with me, it goes… ” But I knew even at the time that it was not the right thing to do.
Jaye Watson:
How does one prevent this addiction from happening to a spouse, child, family member, self?
Dr. Welsh:
I’ll go for that one.
[laughter]
The easy one. Again, there is not one answer. So what we know from studies is that about 50% of the risk for a substance use disorder is genetic, and we can’t necessarily change our genes, but we can do things to modify risk factors that are changeable, and to enhance protective factors. So earlier on in life, modifying risk factors would be delaying the onset of use so that you’re not starting to use substances during formative periods of development. If you’re going to be starting to drink, you have significantly less risk of developing an alcohol use disorder if you wait till the age of 21 versus if you’re exposed to alcohol at the age of 13, so that’s one modifiable risk factor. The others would be increasing protective factors, so connectedness to a community, connectedness to a school, addressing early on symptoms of mental illness, of depression, of anxiety, those types of risk factors. So again, it’s a little bit of a balance. But sometimes I will see families come into our office and they have done everything right, and they still develop addiction.
Dr. Hunter:
I’m gonna add one quick note, not to steal Carlyle’s thunder here, but as a psychotherapist, developing strong communication patterns in your family at an early age with your kids can be so fundamentally helpful. It doesn’t really matter whether we’re talking about substance use or any other mental health issue, or any other behavioral or general health issue, and anything really. The earlier you practice good communication and kind of teach that to your children and your other loved ones, I think the better things turn out. And that’s a skill that can be taught and developed, I think that’s a really important thing to recognize. While Dr. Welsh’s point about, again, not having a one-size-fits-all sort of preventive cure for substance use is absolutely true, I think every family does better, every person does better if they work to develop their own communication skills, and does that in concert with the ones they love and wanna help, again, avoid these issues in.
Dr. Bruce:
And I would also add, that’s one of the known documented protective factors for families and for young people, is having some good communication, some openness, some relationship connection with family, that’s a very important protective factor. And it’s often what we spend a lot of time with in family therapy, just dealing with communication.
David Sheff:
And I was gonna jump in right there, which is that… And to ask for help, because sometimes we feel as parents, we feel like we have to do it all and we have to figure it out, “Is my kid sad?” Or “Does he have depression?” Or, “We’re arguing” Go to family therapists, go to get help with that communicating, because a lot of the times, it’s just hard, and we get overwhelmed, and we do the best we can, but we can’t do it all. It’s a tough world, always has been, but it really feels like it’s tough for our kids, tougher for our kids right now, there’s so much going on, there’s so much stress.
Jaye Watson:
This is for the two of you. How is your relationship today? And what has helped the most from each of your perspectives?
Nic Sheff:
Our relationship is really good.
[laughter]
I mean, it’s funny, we live really close to each other now, which we hadn’t before, and so we get to go surfing together all the time, and I feel so grateful. And I think… Weirdly, I know this isn’t something that can not be duplicated really, because it was such a unique experience, so it’s not that helpful to talk about. But I do think that having written these books and traveling around the country and talking about this stuff, I do feel like it’s helped our relationship and helped us get through… Heal from some of the stuff that we went through. I don’t know if you feel that way too, but I do.
David Sheff:
Yeah. I think that, a lot of times I will hear from people who are in… They’re in the worst of it, and it’s the scene in the movie that you just referred to, where it’s all this tension and all this stress and all this anger is being expressed, and they’re in the middle of that. And sometimes it’s worse and they’re not communicating at all, and people always ask me, “Is it possible to heal? Can families heal? Can relationships heal?” And there were times when I might have said, “I don’t think it is possible that we would be sitting here together, and that we can go surfing together, and take walks together with our dogs and… ” But you asked about Daisy and Jasper, the fact that they adore Nic and he’s their hero and they all get along so well, and it just shows that it took us a lot of time, and it took a lot of hard work. But it really is possible, and I guess we’re a testament to that.
Jaye Watson:
This is for Nic. How do you approach living without addictive temptations, avoiding them moving forward? Are there guard rails against exposing yourself to other addictive lifestyles, for example, gambling where you wouldn’t enter a casino?
Nic Sheff:
That’s an interesting question. I never really liked gambling very much though, I feel like I wanna get something for my money. I remember one time I went to a slot machine thing and I put in $5 and pulled the thing and just nothing, and I was like, “Well, I wanna at least get a sandwich or something.”
[laughter]
We’ll use $5.
Jaye Watson:
Give me a cookie. Yeah.
Nic Sheff:
Yeah, something. So yeah, gambling, it was… But I guess the answer is, is that I do have a disease, I have a couple of diseases, I guess, a couple of brain diseases, and so I have to do work to make sure that I’m treating those diseases. One of my best friends is diabetic, since he was a little kid he’s had to monitor his blood sugar levels and he carries around his little kit with him and tests himself, and has to give himself insulin and blah, blah blah, blah, blah, because he has a disease. So I have these diseases that I have to monitor and stay on top of, and I take my medicine every day, and every six months or so, I get my blood work done to make sure the lithium levels of my blood are not toxic, and I work with a psychiatrist who I’ve been working with for 15 years that I see twice a month now, and I go to 12-step meetings. So there’s stuff that I do to maintain my sobriety, to maintain my mental health. And I’m always working on myself and trying to make sure that I’m going the right direction instead of the wrong direction. The cool thing is that I have all these tools that I’ve been given. And I can use, and they work. So that’s the great thing. Someone was saying that it’s a disease that is treatable, and I don’t know if I’ll ever not be an addict, but I know that I could be in remission from this disease as long as I keep using these tools.
Jaye Watson:
Is pot a gateway drug?
[laughter]
Dr. Welsh:
I’ll take that one.
[laughter]
I’ll go for it. Yes and no. And so, I have mixed feelings about the term gateway, because not everybody who uses cannabis or marijuana is going to progress to other substances. But what we do know is that for those who are exposed to substances, again, at an early age, including cannabis, you start to get a solidification of some of the neural networks that then increase the likelihood of developing either a cannabis use disorder or progression to other types of substances. So not everybody who uses cannabis develops addiction to other drugs or addiction at all, but it does increase the risk in the future.
Jaye Watson:
Related question, what is the best way to educate our youth about the negative effects of marijuana use within a culture that minimizes this?
Dr. Hunter:
I would say, the first place we start medically is with data, we have excellent research that demonstrates this time and time again. Again, and I think it can be a really powerful weapon to combat some of the anecdotal evidence that people will bring up, “It makes me feel better. It relieves my anxiety. It makes me feel less depressed.” We can acknowledge that and respect that, that truth that someone has experienced, but also show the data that indicates increased rates of relapse, increased numbers of depressive episodes, and higher levels of anxiety over time when people use cannabis and other drugs. I think, again, contrasting that data, which is… That’s science, that’s kind of incontrovertible in a lot of ways, unless of course we receive new data. But putting that data in front of people so that they can say, “Okay, I understand that this makes me feel good, but really there’s some solid science.” And I think part of what you guys have clearly embraced is the idea that medicine is both experiential and data-driven and scientific. So we think of… We think of the story and the narrative that you guys present so eloquently here as one form of data, and we include that with the other kinds of data we have, we use the science to address those issues.
So again, I think one of the things you can teach your family members, and especially children early on, is the ability to evaluate data and information, and use it to make good decisions. Again, across many different facets of life too. So not just medicine, but how does science approach issues, how do we make good decisions using data in our family and ourselves?
David Sheff:
I was just gonna add, absolutely. And the other part… There was a survey done of… I forget… For 3000 or 7000 kids around the country, and it asked about why they use drugs, if they use them, why? Or if they don’t use them, why they think people use drugs? And the assumptions that the researchers had was that the number one and number two reasons would have been peer pressure because it’s cool, and everybody’s doing it. Or the other one was, “I just like the feeling of being high.” But that’s not what kids said, the number one reason that kids said that they use drugs was stress. And when we recognize that, then there’s a whole other kind of conversation to have, which is to ask what’s stressing our kids out and to do what we can to mitigate those stresses, and that happens when they’re very, very young. And we know that kids who are suffering whatever kinds of traumas in their lives, where kids who have mental illnesses, who are raised in families where there’s violence, there’s so many different ways that stress increases. Even in communities where there’s so much pressure on kids to excel when they’re five, if they haven’t filled out their college resumes by the time they’re 12, they’re gonna think they’re gonna lose out on life, we have to try to help them grow up in the healthiest way possible. And also, substitute the good drugs, people use drugs at a certain point because they do…
They can help with stress. The thing that Nic talks about, the fact that when he got high for the first time, it wasn’t that he felt amazing, it was that he felt this absence of anxiety, and that’s a huge, huge thing to realize. And there are other things that we can teach our kids and offer our kids to help them with their anxiety, professionals, if it’s serious, but athletics, art, all kinds of other things.
Dr. Bruce:
And I would also add that that gets to be part of the data that gets to be important to talk about also, not only just the statistics that reflect what’s going on in larger populations, but the personal data. What happens when you use? What happens when things don’t go well? Being able to come up with those kinds of situations and examples that point to, it’s not just positive, there are these other pieces that are important to point out also.
Jaye Watson:
Nic, was I… I feel like I read that in talking about prevention, you talk about the use of meditation and prayer to quiet the unquiet mind?
Nic Sheff:
Yeah. I’ve gotten into that a little bit. It’s funny, my 12-step sponsor is really into transcendental meditation, and so I went and did the classes and everything. And I did it for a little while, and it was helpful, but I think if anything, to me, the thing that helps my mind when it’s freaking out, is just to kind of… I don’t know if this maybe is a kind of meditation or something, but it’s just to kind of try to just slow down and take stock of sort of where I am in the present, and being grateful for the things that are around me. So a lot of times I feel like if I’m spinning out about stuff that could happen in the future, if I can just kind of slow down and be like, “Well, what do I have right now?” Right now, I have my dog that’s right next to me and I’m so grateful for my dog, and I have… Whatever… I have a roof over my head, and just doing those kind of things where I go away from fears of the future and instead can kind of just be grateful for the things that I have now, I feel like that can really calm me down. But I do…
I mean, I don’t know, I’ve gotten into doing yoga stuff and surfing is definitely like a meditation in a way, and in the 12-Step stuff, they have you do prayer things. And so I was raised to be very anti-religion and being an atheist and all this stuff, but in the 12-step program, it’s very spiritual-based, and so at a certain point, I think when I was just really desperate for help, I started trying some of the things that they suggested, like, yeah, praying for relief from the feelings that I had and it helped, I don’t know, that’s anecdotal, but it helps to me. And I’ve seen that with other people too that I work with in the program, that it does seem to give us some feelings of relief, and I’m grateful for it ’cause it has made my life better for sure.
Dr. Hunter:
Suffice to say, those are highly evidence-based practices, so meditation, mindfulness, spirituality in that form, yoga, there is very little that we have available to us that rivals the power to treat mental health issues as compared to nutrition, exercise, sleep.
Nic Sheff:
Sleep. Yeah, that’s a good one. Sorry, but yes.
Dr. Hunter:
So yeah, really, no. And again, this is not… This is anecdote, but this is also science, so I think that’s where everyone should start, if they start to feel themselves turning the corner in the wrong direction.
Jaye Watson:
“How do we get our son to trust us again after intervention and accept treatment?”
Dr. Bruce:
Stay present, I would say. One of the things that can happen so often is that distancing that can be present, that can happen. And I noted, for instance, in the book, David, you were present, you didn’t distance or cut off from Nic. Nic was available to you, you had boundaries, and you enforced those boundaries and you stayed present. So finding some ways of staying present in the midst of, “I don’t wanna be with you. I’m angry with you, you took me to this place, whatever,” finding some ways to stay connected means that there can be some hope for that connection later on, is what I would say.
Jaye Watson:
Nic, how long after sobriety before you felt normal and could manage your life?
Nic Sheff:
Sometimes it’s still a struggle, but I think it’s interesting ’cause they said… I remember when I was getting sober at a certain point, they said or I heard this that with methamphetamine use, especially, that it can take up to two years for your brain to get back to normal functioning or whatever. And two years seems like a really long time, but I do think that there’s some… I felt there was some accuracy to that. Like I do think around the two-year mark, things, the struggle started to get a little less intense or something, and definitely the cravings started to… I mean, they had gone away before then, but they really kind of left at that point, and I think… I try to talk with people about this who are sort of in early recovery, is that there is sort of, I think I mentioned this before, but this sort of time game or something, where it’s like, the longer we can just get someone through that difficult early stage, the better because it does start to get easier and as your brain starts to heal and starts to function more normally, it just, it’s not as much of a struggle. And so in that sense, there is this period of just needing to kind of hold on and get through it, and as much as we can help our loved ones get through that difficult time, the better. And it doesn’t always take two years, that’s a long time. But I did notice I turned a corner at that point, I think.
Jaye Watson:
How do you combat the genetic predisposition for addiction, mental illness?
David Sheff:
Well, you said that we can’t fix it, we can’t change our genes, but the first thing is, is if we know that there is a genetic disposition, then that’s a lot of information that we have in our family, and so the conversations can include that. If I knew that about it, then maybe I would not have let those teachers and counselors tell me that it was fine, it was normal that Nic was out there smoking pot, I would have thought, “Well, Nic has addiction in his family.” And maybe we should have done some more serious intervention right away.
Dr. Welsh:
Yeah. And the only way to 100% prevent it is never to use drugs or alcohol.
Jaye Watson:
“How important is it to get a child with bipolar disorder help before he, she, they turn 18? I feel like I didn’t get my child help with the diagnosis and they are not able to admit the problem. How did being bipolar affect your addiction disorder?” So two questions, I think.
Nic Sheff:
Yeah, that’s a really good question. Yeah, there’s definitely tools that you have as a parent when your child is under 18, you can force them into treatment and that’s really fantastic. I was just talking to a father the other day whose daughter is 15, and he’s grateful for that, that at least he has that power over her, so I think that is something that’s as early as you can treat it as possible, but the counterpoint to that, I guess, is that a lot of times those mental health issues don’t really start to show themselves until right around that age or even a little later. I feel like for me, I think my bipolar disorder really started right around that time, around 18, 19 years old, so I was already past that point.
The way that it affected my addiction, I think it just made it so that my baseline, it was really hard for me to get back to a place of being like, just feeling okay in my own skin and so because I would feel so uncomfortable, either super depressed or kind of manic, it made me wanna reach out to drugs and alcohol as something that was gonna take those feelings away, ’cause that’s what I’d used in the past to take those feelings away, but then whenever I would put that mind-altering substance into my body, no matter what it was, whether it was alcohol, pot, anything, that invisible switch would get flipped and I just couldn’t stop once I started, so it really does, it does go hand-in-hand. And, I don’t know, so I’m sure there’s… I’m gonna let you, doctor has a better answer.
Dr. Hunter:
Yeah. No, and I think that’s just it. It is often very hard to recognize early, and often it’s anxiety or the depression that you see first before you see the mania that’s so characteristic, or the hypomania that you see that’s so characteristic of bipolar disorder. So the medical science, I wanna be really careful not to scare anybody here, we do know that the earlier we treat this, meaning the less time someone spends in manic episodes especially, but also in depression to some degree, the better they do over time. Now, again, that is not to worry anyone who’s had a few episodes in a teenager or an episode or two by the time someone is 30. We do see many people who reach treatment in their 40s, 50s and have had many manic episodes over time, many severe depressive episodes over time, and it does become a little bit more difficult to treat in kind of a population sense at that level, but really becoming aware of this in the teens is about as early as anyone catches it, typically.
It is highly genetically linked, so I think people with a family history of bipolar disorder should pay particular attention to some of the warning signs, and even if their child is only going through a depressive episode, you may wanna be on the look out for subtle signs of mania coming in. And that’s also to the point we’ve made multiple times here, a great person to counsel about the risk of substance use, both in terms of developing addiction, but also in terms of accelerating the cause of bipolar disorder. So there’s quite a bit we can do, and if you’ve had somebody who’s had a few episodes by the time they’ve reached college and you haven’t yet got it under control, you’re in good company, and I think the advice is just to, again, treat it as assertively and effectively as possible. And the goal with bipolar disorder is no manic episodes, so that’s our treatment principle.
Jaye Watson:
How do you help guide someone who has never been diagnosed to seek treatment?
Dr. Welsh:
I think you can talk about it openly without shame or stigma, which both are significant barriers for people to enter treatment, especially when it comes to substance use disorders. And then it’s all about enhancing a person’s internal motivation and reasons for change, and knowing that that can fluctuate by the moment, by the minute, and whatever opportunity you have to get that person in evaluation to get that person help, take it.
David Sheff:
And families are incredibly effective working together to get somebody who doesn’t see that they have a substance problem or one of these mental illnesses, working together and having repeated conversations and repeated conversations, and once again, sometimes getting help by a professional to have the conversations. It doesn’t work the first time, or it may not work the first time, but it might work the third time or the seventh time, or even the 10th time, but don’t give up.
Jaye Watson:
We’re down to our last few minutes, so not to put all of you on the spot. I was sitting here tonight with all of these people who’ve been so generous with their time and listening to us talk, thinking of that thing, you never know what someone’s going through. So I would love for each of you to give a piece of advice that you would give to someone who is here and impacted by addiction, and it doesn’t matter what it is, you all have met so many people who are hurting and desperate to help family members, any piece of advice before we wrap this up tonight? And whoever can go first, I’m not gonna point fingers. I know.
David Sheff:
Well, I’ll say, I’ll just say, you’re not alone, and to know that you’re not alone. One of my favorite writers is a friend of ours, our family, who… Anne Lamott, she talks about how we all… It’s my favorite quote ’cause I use it all the time, how we compare our insides to other people’s outsides. It looks like everybody else is doing great and their families, their kids, everybody is sailing through, but nobody sails through, and when we recognize that and we’re open about what we’re going through, yeah, we connect, we can start to heal and we can get advice and get help, so I would just say that openness.
Dr. Bruce:
I’m reminded of a line that’s been sort of stuck in my mind, Nic, from your book, in Tweak, at one point you said that you weren’t sure you were ready to do the work to maintain a relationship, and I’ve been thinking about that, that a big part of the struggle is how to maintain a connection with people, and it takes some work. And so I would say put in the work for the connection, put in the work for the relationship. It’s worth it.
Dr. Hunter:
I’ll be a little bit out of character here and say something extremely functional.
[laughter]
If everyone in here doesn’t know what Narcan is, please familiarize yourself with it and where to obtain it and how to use it, especially with the Fentanyl question we received earlier. And we understand that for all intents and purposes, fentanyl and opioids have infiltrated every line of drugs and other illicit substances that we see on the streets, and it’s incredibly hard to guess where you’re gonna find fentanyl next, having Narcan available, which is a reversal drug for people who are overdosing with opioids, is a way to save lives very directly. And don’t just get one, get two or three. Have them available, learn how to use them, and they’re now available at the pharmacy, you can go and they can teach you how to use them. It is very, very reasonable to believe you may save a life by having Narcan available in your house, in your car, just again, as many people as you can educate on the use of Narcan, the better.
Dr. Welsh:
And you actually took mine.
[laughter]
So I would say that recovery is possible and it’s something worth fighting for, but recovery is not possible if you’re no longer with us. So absolutely. Naloxone or Narcan, opioid reversal agent. And if anybody would like some training, come on down to the Addiction Alliance of Georgia, the Wesley Woods campus at Emory, we’ll give you free Naloxone and trainings.
Nic Sheff:
And it is kind of a cliche one, but I like the saying, they say people with substance use disorder aren’t bad people that have to get good, they’re sick people that need to get well, and I feel like that’s really so key in understanding this whole thing, is that, yeah, we’re people with an illness, but the great thing is, as we’ve talked about, is that it’s possible to treat that illness one day at a time. And oh, and beyond Naloxone and Narcan, medication-assisted therapies can be so hugely life-saving to people. It’s definitely a bummer to be on Suboxone or whatever a little bit, just ’cause it’s a bit of a hassle, but in terms of that being a lesser of two evils, it’s such a lesser of two evils, and you can live a totally full, amazing life being on medication-assisted treatment, and it can really save your life. So I’m a huge proponent of it, and especially at this time when so many young people are dying, it’s just never been more important than ever to raise awareness about that as well. Thanks.
Jaye Watson:
You guys are awesome. So to our expert panel, thank you, thank you for dedicating your careers to taking care of other people and furthering the science of addiction. And to David and Nic, thank you for sharing the hardest part of your life with us here on stage tonight, for being agents of change, for spreading the message, for pushing for things to be better. We are grateful. I know that you helped people in this room tonight, I know that people certainly feel less alone than when they walked in the door.
David Sheff:
Thank you.
Jaye Watson:
And with that we’re gonna turn it back over to Beth Finnerty.
[applause]
Closing Remarks: Beth Finnerty
David and Nic, thank you both for sharing your incredible story, your journey of recovery, hope, and just the love between you two, it’s just, it was so evident and amazing. And I’m so impressed, David, that you go surfing with Nic, that’s pretty amazing.
[laughter]
Thanks to our panelists, Dr. Ben Hunter, Dr. Justine Welsh, Dr. Carlyle Bruce and to our wonderful moderator, Jaye Watson, you guys, just thank you for having this wonderful conversation with all of us. I know I learned a lot, I hope you guys all learned a lot. And thank you to Dr. Bill McDonald and your entire team at the Addiction Alliance of Georgia for helping us, for partnering with us this evening. This has been a wonderful partnership, and I hope you all have enjoyed it.