The Truth About Addiction: Dr. Ben Shapiro & Dr. Brett Shurman Break It Down

Addiction isn't just a relationship with a drug. It's a relationship with yourself. You're not just about your chemistry, you're your question, your experiences, your traumas, and that's the underpinning of it. You have to know yourself, you have to have somebody who can guide you through it. If someone has a problem with substance use disorder, please call one call placement. That's 888-831-1581. And if we can't help you, we'll make a referral to someone who can. One call placement is affiliated with Carrera treatment, wellness, and spa and one method treatment centers. God, Dr. Ben Shapiro and Dr. Brett Sherman here today. Once you guys do me favor and we'll do a little character development for these folks. When at E-Start, Dr. Sherman. I'm an adult psychiatrist, an addiction psychiatrist. I have a private practice, and I also practice at Lawson's Sinus Hospital, both in the inpatient and the chemical dependency program there. And we have a new TMS company, Pacific Neuromodulation, for about a year. That's fantastic. So what's TMS? What is the M... Well, I know what it is, but tell the yours what it is. TMS is using... First of them what it is. TMS, Cranial Magnetic Simulation. It's the... Yeah, it's the name. It's using a powerful magnetic field to either stimulate or inhibit brain circuits. It's the simplest explanation, and it's used for tronol. It's used for numerous psychiatric and neurological applications. Yes, trauma is one of the things it's used for. It's used... It's big with the veterans community. It is. And getting bigger. Yeah. It's really effective for PTSD in our experience. Right. Well, no, it's definitely, definitely amazing. Yeah, it's amazing. Have a E-Dr. Shapiro. I'm also... Dr. Ben Shapiro. I'm also an addiction psychiatrist. I'm a sort of geriatric psychiatrist. I'm a little jack-a-ball trades. I have a background at a lesson psychiatry. I also do a lot of work in eating disorders. I just don't eat any disorder specialty. And then do a lot of substance abuse stuff in general. So I work at a few different rehabs, including your own. I also do some work for UCLA with Dr. Fong. Right. Not directly. I do know that Dr. Fong though. Yeah, we go back. And I'm interested, you know, Brett Knight share ownership of this. Are Pacific Neuromodulation, our TMS company, and the CMO. Where is it? There's going to be... There are three clinics. One, we're buying. So there's one in Pasadena. There's one in West Lake. Inside the cure clinic. In a four-season hotel. And there's going to be one in West LA that we're purchasing hopefully in the next three months. And we also... From that guy, what's that guy's name? It's the one on Olympic and Bundy, right? Yeah. What's his name again? Stuffed. Dr. Stumman. Dr. Stumman. But he's going to stay on and run the stuff. Not so much. Why? He's moving to Thailand. He's retiring. Oh, you found a little Thai girlfriend. No comment. No comment. Yeah, it's... It's awesome. Maybe more than one. Rod. And we have mobile capacity as well. So we can bring the TMS to someone's home or a residential program or... We actually did a case in Colorado. And there are new devices coming out. The way a lot less, which we're grateful for. Because these things are over a hundred pounds. The cooling systems are very heavy. How many people are you currently seeing a day in your TMS practice? Well, we just... Right now, it would be three. Because we just started about the... In March. So... Why TMS guys? Explain that to me. I want to do it even more. Tell me why. Crazy effective. Crazy effective, especially starting about five years ago. I've referred to TMS not been a TMS practitioner for like 25 years. It started out in 1985. It's interesting. Because the engineer who created it actually just gave it away. He got no patent, supported AI. So he made no money. He didn't make billions. But in 2020, it was the first... The fact that he didn't do that, hate to interrupt, but the fact that he didn't do that made the practice accessible. The science is always 15 years or so ahead in the practice. But by him doing that, it shortened that. He actually gives talks now at TMS conferences. What he's got to now, because he just gave way off. Exactly. He's got to look good for it. He's got to do it. So why is he... TMS was always reasonably effective for depression. That's what everybody knows. That's right. But it still wasn't really much better than Andy Depressives for remission rates until five years ago. Stanford came out with an accelerated protocol. It's called the St. Protocol. And they were getting remission rates in the 90 plus. Stanford came out with a... For what rates? As in getting completely better remission rates. So your talent remission rates? Is that relapse rates? Rates of two things. Relapse rates. Okay. So what the... Hold on. For that. For that. So what is a remission rate? That so someone's not depressed anymore? It means they're not... They have no depressive symptoms. Really? Yeah. And they go into remission often in two to three days. It always was effective at a reasonable remission rate up until 2020. And it was always non-invasive. No side effects. Basically no risk. So if people were failing traditional treatment therapy or meds, I would refer to it. In fact, that insurance won't cover it. Unless it used to be four meds, now it's two. So it has improved. That's right. Yeah. And it only... It is the big limitation of the insurance. It is a limitation. It's a limitation. You know, because they don't want to have to pay for it right away. If they don't want to have the paper, what's the most effective? And that's the biggest thing they're going to do. Yes. So the most effective are these accelerated treatments where you can get somebody better potentially now. There's a one-day treatment. It's amazing. But there's five days... We do one day, five days or ten days. So in 2020, these protocols came out that were super powerful. And they actually got FDA approved in 2022. That's when I started getting very excited and very interested. And that's between that and a personal story I have. That's why I got into it. But it doesn't just apply to depression. It applies to 20 psychiatric disorders and early learning. So the FDA is actually approved six. And those are OCD. Okay. It's just depression. It's just depression, anxiety, basically. Depression. Yeah. Yeah. Out of less than depression. Migraine. Pain. Bronic. Nicketyn dependence. Yeah. But it actually spreads to all addiction. There are studies now on many, many different substances. And as you know, there are no real medical treatments for many substances of abuse. So tell me about that. How does TMS assist in the addiction treatment? Just the basic protocols. There's different kinds of... If you talk about alcohol abuse, there's different reasons people drink. Some people drink Dubuoyed withdrawal symptoms. Some people drink you underline anxiety or other things. Some people use it for reinforcement. And those are actually different brain networks. And it's still in development. But if you target those different brain networks, you can really focus on... You have the potential to focus on the reason for the addiction and blend have really out kind of next level improvement. To see now anybody that is drinking to get well, right, is started drinking not to get well, but to quiet the mind. Absolutely. That's the other stuff, right? But I want to ask you a question a little more specifically. So, you know, there are certain circuits that affect impulsivity. There are certain circuits that affect reward. That's just so depending on the clinical reason someone's doing drugs, it could be all the above. You can do it all of those circuits. That's right. And it usually is, that's my point. Because this is like kind of like, you guys have the education. But I have... It's not just an opinion. It's 25 years of field research. Right. Right. Both using and getting sober. Right. So, from the ground level, it's usually all of it. Yeah. So, that's why all of the touch points need to be pushed. Even if you got... Because otherwise, what's going to happen is the human error aspect of it, right, is going to get in the way. You're going to miss a touch point. And that's... It's not a jizzle. Yeah. It's not just that they're vulnerable. They've got... They're not gliding through life. Right. They're they're whitenuckling a little bit because they're unsure. So, they're spending all their time kissing God's ass. Please help me stay sober. Please help me stay sober. Right. And there's no thriving or growth in that. Couldn't agree with you more. Well, that's why you're here. Only the people that agree with me get to come on. I'll try not to disagree, but I sometimes disagree. Please be disagreeable. It's better ratings. So, there's an interesting dilemma slash conflict within TMS because most of the studies only look at one site. And so, multi-site protocols, which is what we favor for the exactly the reason you said, are not well studied. And we're super excited about... What about in Europe? Even there, it's... Maybe they'll hit two sites. Okay. So, check this out. They're looking at each site individually. Right. Okay. So, if it gives a shit, if they're looking at each site individually, collectively, they deal with the same thing. That's our motto. That's why we do, we do. We hit multi-sites. And especially because at this point, the science doesn't support it's exactly this circuit. We're getting there. You know, looking at... It's still hard to find with what those are. You're a year off, man. You're a year off with AI every six weeks in its coming. Getting better. That's why we're in this business. Yeah. You're going to be able to tell, you're going to be able to do that exactly. So, the accelerated studies of depression, the one site, that imagine using accelerated protocols in five sites. That's basically what we do. Can you help erect out of this function? Yes. Asking for a friend of the viagra. I don't... I know. I'm talking about CMS. I'm talking about without a pills. Without pills from the... No, maybe ultrasound. TMS is actually just hits cortical structures. Yeah. Both of you have decades of treating addiction. If you had to describe what the f*** crisis looks like from inside your office, what are you seeing right now that the public has no idea about? That is a painful question. Death. I pride myself that in my practice over 30 years, more or less, I have literally two suicides. I treat various sick people. I should have four years statistically. But I have so many femoral deaths. I've lost count. I don't want to count. So, that's what we're seeing. Death, unintentional deaths. In fact, all of my deaths, none of them are suicide. They're accidental over us. Or being unaware that there's fattening in whatever, you know, Xanax, the person bought. And that's just unbelievably profoundly sad. I have at least 20. Tell me about Maria to you in a minute because I want to ask the same exact question. But do you meet with the families afterwards? Absolutely. Talk about what it does to the families. I ripped them apart. I've gotten the most harrowing phone calls during... I won in particular. This kid was in a rocket scientist, literally. And he had gotten sober. And he went back to school and unfortunately, there were parties. And all he took was some vikin and Xanax. But it was definitely a waste of f***ing, you know, in the autopsy report. And talking to that mom, first I talked to her when it happened because she found him in his room blue. He was staying at home. And there were 400 people at his funeral because he was an outstanding human being. And she'll never be the same. You know, it's unbelievable grief to lose a family member, particularly a child. It's unspeakable. That's my answer. How about you? As a doctor, what I'd add to that is it's unnerving. It's to ask sleep frightening to take care of a patient with like a strong gun on a f***. It's like Russian roulette. You know, and you see them come in not really having the size of what they're doing and really having the danger. I had multiple patients that like three, four near death overdoses and you try to explain them. It's tough. You know, it's different about this. You know, people were always dying of heroin, right? Sure. But the reason they died is because they overshock the mark. And what most people don't know and you guys can't explain it this way. Okay, you explain it in a way that gets people brain damage. Okay. But really what heroin, an intravenous heroin user is feeling what feels the best for him is to get as close to death as humanly possible without actually dying. Now that sounds really scary, but that's the truth. But it's also the only way you could die when you are shooting heroin. Okay. Now people are dying all over the place and the kids that are bombing are the straight A students, AB student kids on the weekend go into the concert, go into the party, go into the rave, right? And they're taking one pill or a half a pill and drop in dead within minutes. Okay. That's what's going on now. And the reason it's going on is because these kids have no tolerance for anything. So even a non lethal dose to a user who's built the tolerance is killing these kids. They don't even know they're using it sometimes. That's the whole idea. They're buying or they're buying something, you know, bargain for something and they're getting something entirely different. It was never safe to be a drug addict, but now it's like it's lethal in a moment. It's not it's not if it's when you're going to die. It's not if I have no head. I went over to death in my practice. What? I have no one who died from heroin because I deliver good care. But I here's how I put it. It doesn't matter how much people love you. It doesn't matter how good your doctor is or how good the treatment is. You're going to die anyway. 20 deaths today. Yeah. Now currently if you're using for sure. If you're using anything, I mean, even weed gets laced with it. It's crazy. Did you do you guys remember at the AFC championship game last year? They found those four kids face down in the snow. Yeah. From from weed. Yeah. Okay. Because it was laced with. If you're buying anything on the street right now or and on an online pharmacy. Yeah. Okay. You're screwed. You're screwed. Okay. You've got to get a script from a doctor. You got to get it from a brick and mortar pharmacy. Okay. And that's it. The end. And so therefore when someone comes in and isn't dead yet and you're treating them, the urge that I think to get them better is much greater and to prevent. And that's why you like the TMS because it's quick acting. Correct. And powerful. And probably the Vivitrol and we use all we use every tool available. This is just another tool that's super powerful and has no downside and is very underutilized for multiple. One is insurance, right? Well, it has is not going to get covered by insurance unless you jump through those hoops, which makes it really, really hard. But it's not just that. The machinery is each machine is on a high ground. Yes. And then what is it to make tame like a 20 grand, 30 grand a year ago? Yeah. That's about right. Actually, because you have to change the magnet out. But also like that. It's not well known. I had no idea. Yeah. You know, on my life, like good guess. Yeah. It isn't pretty. But that's the thing. Yeah. Right. That's that's why I want you guys to call me because it's like, well, it's common sense. The math makes sense. Also, the field as a general, a general principle is terrible when you're great at. They have not marketed themselves well. In fact, to the degree that the NIMH put out a nationalist in mental health, put out seven videos, essentially marketing TMS, ticklinitions. And even when people do know, they only know about depression and they often don't know about the new protocols. And so it's really underutilized. And it has so many applications, including addiction. But yes, it's not covered. Only thing it's covered is depression. So, you know, how people get around it, is it usually if you have another disorder, including addiction, you have some depression. So they bill it as depression, which they have. And you treat the depression. Well, they always have to nobody gets to treatment on a winning streak. I've never met anybody. Yeah. I don't know. I've seen your program. And I'm like, no, that's after they've been there for an after they've been there for a couple hours. They're like, oh, this is cool. Right. But nobody, nobody crosses the threshold like that. No. Yeah. All right. Let's get in. Where do you see the line between psychiatric illness and addiction? Or is there no line anymore? Are we treating the same brain pathways? Oh, they're definitely yeah, addictions of psychiatric illness. No question. Saints are you treating it the same way? It is. It is. It's an illness that we would view within psychiatry. Yeah. But, I mean, versus depression, anxiety, like, yeah. Yeah. But, but treatment those illnesses are complicated, just like addiction, like they're not just brain circuits and chemistry. And I tell you how I explain it. Yeah, please do. Yeah. It's all the same. Yeah. It all has to be treated the same. Sure. If you can't treat it the same, it doesn't, the roots don't take hold. I mean, I agree because I think that is a shift that has occurred within addiction medicine. It's like a good shift. Right. Right. Because otherwise, it's just A A and A is great. But there's like a support group. It's not. There's a whole bunch of other tools. Yeah. That's right. Yep. That's right. We always did it that way. From 2004, we've always done it that way because I didn't know any better. That's what things to me. So if it fixed me and I was as bad as it got, you know, I was doing, you know, I don't even think they do drugs like this anymore. I was up six to eight days at a time. You have to know the reasons. You gotta know the reasons why it's happening to some degree. A lot of times you don't know the reasons, but yes, you have to figure it. You have to understand that you've been lying to yourself all along. Right. Okay. And then it's all just been a bunch of bullshit. And then you have to show them along the arc where where they've been lying to, you know, a lot of times I explain like this all the time. A lot of times, you know, people don't know why they're doing drugs and alcohol. They have no idea. And then you have to unpack it. And let me tell you what it usually is. It's usually I'll give you something to cry about. What are you stupid? Right. And so you say to yourself, is a five year old, you're looking at yourself and you're going, you're frontal cortex isn't developed enough to formulate the thought, oh, my parents are just idiots. You can't do that because you're too small, right? And remember when you were small, everything was bigger. And if these people who brought you into the world don't love you, then you must be bad. And that's all you got at five. I must be bad. Totally. And then it gets reinforced, reinforced, reinforced, reinforced, pretty soon you got this 45 year old guy being run by a five year old mind. Okay. That got reinforced all the time. And it's like the intervention is, hey, you see how this is horseshit, right? You see that this was a lie that is keeping you beaten down. It allows you to be a victim. And there are, you guys would know as well, there's medication, there's all sorts of therapies to get you to realize what the truth is. Talk about truth. That is the truth that matters. Mm-hmm. I agree. A lot of it's trauma. Did that make, did that make perfect? Yeah. Martin K. He told me, yeah. Good. And then you need to, you don't have the circus to regulate your emotions or yourself. So you're going to find some way, some exogenous way, you're going to find drugs or alcohol because they make you feel better in the beginning. They, they actually saved your life in the beginning. Yeah. And really have real issues. Yeah. I always ask when I'm evaluating someone I think Dr. Shapiro does too, why did you do this drug? Like what was it doing for you in the beginning? That's an excellent question. Do they know sometimes, sometimes they know, sometimes they know when they do know it's very helpful. But, but a lot of times my guess is in this interview and this assessment process, you've got a third of the people that don't know maybe, maybe 10 or 15% that do and everywhere in between, they're just horseshitting you talking, trying to figure it out while they're telling you that that is true to you. No. But if they do know, it's very helpful. And well, how do you know when they're not horseshitting you in there? Well, I guess you know, how do you know? How do I know? It's clinical. It's the end. Until the end. I mean, that's a lot of a lot of psychological stuff. You know, you could go through the process of healing and recovery and then sometimes the discovery is late. But it is important. Absolutely. Yeah. Absolutely. That's great. For example, somebody says, you know, I couldn't stop my mind racing. I couldn't sleep. I was, you know, she told me to take a hit of pop. Exactly. And so, and that slowed me down. Okay. Now I'm thinking ADHD, bipolar, some kind of impulse disorder that helps me as it does. Do any testing? I do. I do testing when I'm confused when I can't figure out, you know, what's going on at all. Don't aren't there certain diagnoses that replicate each other when that comes up to mind with me is bipolar and borderline personality disorder. Like they kind of touch each other. One's like, one's like, I love you. I hate you. I hate you. And the other is, you know, I'm so depressed. That lasts a few days and you pull out of it and then you're manic for a couple days. And the only time you get here is when you're blown by it. The time course helps differentiate those things, but they do overlap. And in fact, this guy, Dr. Akiscal, a famous professor at UCSD, I think borderline was a subtype. I think he might have passed away, but he said it was a subtype of bipolar should be treated as sort of why and use this like, you know, use mood stabilizer. So it's not that way. It's any more borderline is much more about the attachment issues that you're talking about, all that disruption, early disruption versus like where there's a set of like the but if that was true, then I'd have borderline personality disorder and I'd up. It's not, it doesn't, it's a lot more complicated than that, but the things that trigger all those changes, those mutes have a lot to do with the relationships more than just sort of like an internal rhythm. I'll give you an example of the complications. Please, I'll use my wife's family, okay? Good. So, do we really want to do that? You can cut it. No, no, I mean, is she going to be pissed? No, I don't think she will be. Okay, you don't think she will be? She will not be. Okay, good. I mean, you're not, as long as you're not sleeping in the guest room, I'm not, I'm not going to use names. All right. So they had a very large trauma when they were little. It's like an epic Chinese opera and their father was assassinated in Taiwan. He was a minister in the government, taken from their home, which two of them actually witnessed. My wife was actually one years old. Doesn't remember any of this. Okay, so that was a big, big trauma. I had to move the US, no money, et cetera, et cetera, et cetera. Okay. Of the three of them, the middle one had a lot of depression from the time she was little. My mother-in-law was she when she saw she was probably six. There it is. But the oldest one, okay, it was nine. So, but the middle one had depression from the time that she, this after this happened. And my mother-in-law moved to, my mother-in-law moved to the US, kind of got a substitute, you know, husband, not a real husband for economic reasons. And he wasn't a great guy. He wasn't abusive, but he just was sort of a a nebish, you know. And the way these three girls interpreted him was so different, because the middle one's mood was depressed all the time. And so she interpreted him very, very negatively. Like, little things he would do, complain about money would become, you know, she would go to bed, the father. This is a stepfather. Okay. She would go to bed hoping he would die or she would die, you know. My wife would be like, well, what if father was taking and killed. The biological father was killed. And so now, now this is in the US. So now the stepfather, the little one is once in a dead, the middle one, middle one's my wife. And the middle one and the older one, you know, function fine basically in life. They had problems because it was trauma, right? But the middle one became a borderline. And the point I'm trying to make is when you have that chronic mood problem from a young age, that also affects your development, your attachment, your psychological profile. This is what I'm saying about it being complicated. Or so, because when you start off that way, you're limited and you're in your you interpret reality differently. And your right, your growth is also limited. It's yeah. Yes. And so she never functioned well and, you know, doing better. We got some little heartbreaking. Yeah. Yeah. It's terrible. Do you know what I, I want to just get off topic for a second. You're talking about that story. And I feel myself welling up. I feel like I'm getting re-injured every time I do a podcast. Every time I talk to a client, because I've been doing it so long, it re-injures myself all the time. Okay. How are you guys not injured the way I am over such as this? There's something about it that like reminds you about your own narrative. No, it's just I know I'm heartbroken for children. See when you're as old as when you're when you're when you have children as old as I was after losing a quarter of ascended to drug addiction, you don't think you're going to have children. You thought you missed it. And then when you get it, you're so grateful for it. You don't just love your children. You love all children. Well, there you go. I redo her. I mean, we do feel pain. You know, my answer is I, I, you know, lie to my peloton really hard. After a day, you know, and pain varies depending on, I think he does have a point. If a story really resonates with your own experience, that's going to of course, even more same. But I'd rather have that pain and help people than not have it, you know. But how do you not? How do you like like I'm viscerally affected? You guys are not how? Yeah, but that is I doesn't. It doesn't appear that way. Well, we're this, we're kind of used to that. But in your, you know, we're not taught, it's not you don't have a relationship with the patient. You have a relationship with the patient and like real things with children. I do have a, I do have a child. Hello, there you're short of 11. Okay, you've got 11 year old. So five years ago, that child was six. So you don't do what I did. I've got a 12 year old automatically. I take the 12th of all, I put them back to the six year old and I say, Oh my God. Okay, but it's not just for my personal experience. It's for yours. Yeah. And yours. Yeah. I think also we have our training for better or for worse does teach you to detach and detach, but but when you're caring, caring for somebody, you have a relationship with them. I mean, there's a lot you go through a lot. Can you give somebody the same or better care when you actually care about that? Like the 1000% actually, there's signs of the importance to you. Give it to me. Well, if you look across therapies, different kinds of therapies, you would think it would matter which kind of therapy and it does matter some, but the biggest variable that predicts outcome and any therapeutic experience is the relationship with the patient, the level of empathy, the patient feels from the therapist. And it's true for psychiatrists too. Wait a minute. Even at the point where if you don't have a good relationship with the patient, it's not really argued. It's not responsible to take care of them because it can be in this good blog. I got that too. But what you just said was how the patient feels about you, the therapeutic alliance between the patient and you. We're talking about whether or not when you hear it. Let me say it a different way. You've got a friend who's got a child, who's struggling, but you love your friend. So you love your friend's child. And you're going to do whatever you can to make certain. Then another random guy comes and he introduces you to his kid and you're going to help this kid because this is what you do. Who gets the better treatment? Well, I think the thing is when you're in treatment with somebody over time, just like anybody, and it's a good treatment, you connect with them more and more. And you cannot deliver good care without caring. So occasionally you'll get a patient you just don't connect. And I have referred people out, you know, like we're just not a good match. That doesn't mean there's not like turbulence, but you have to resolve it. Let me tell you one other thing on the subject that I think you'll like because this isn't just related to therapy. So I believe as a UCLA psychologist, I believe, who did a study that looked at the relationship between a psychiatrist and the patient. It was a big drug study that already existed. It's like eight psychiatrists, drug versus placebo, nothing to do with therapy. And the question she asks is do individuals psychiatrists get better outcomes just with medication, or therapy? And the answer was yes, 25% better. The ones where the patients rated them is more connected, had 25% better outcomes. Definitely. With a... Okay, but they had better outcomes with you because they trusted you and they're still talking to you at least once a month. They get better. Yeah, for an hour. Yeah, yeah, absolutely. Yeah, so it's still a relationship. But it's even met. Yeah, I don't think that would be the case with just straight meds without without having a conversation. You guys, but that's the point. Yeah, is it even meds work better if your relationship is good? That's right. That's your point. Right. The two. Yeah. Yes. There is no... I say there is no medication management appointment because there's always a therapeutic element to it. There's always a relationship as you know. The therapy, but there are... Here's the thing. Do you know who I love? Who my favorite psychiatrist is? Danny Siegel. No one well. Okay, you do? Yeah. He just wrote a blurb for my book. Yeah. And I cried. It's good writer. It's not even that. It's like it just says you're legitimate. You know, it's a validation. And you see this? This is 25 years of crack. Right. This is like, you know, I remember I owned my last place and I couldn't write a check for bread and eggs and the market because I was in check systems for 10 years. Well, and I had like five houses. Yeah. Right. It's like you feel a certain fraudulent... Sure. Yes. And then you have, you know, the ambassador to the European Union in your house doing a podcast or you have a great like Danny Siegel, right? Or you have a great like Dr. Aiman that that you know wants to come on your podcast and have you on his, right? It's like, dude, that's not supposed to happen to people like me. But you guys get it because you take people like me all the time and you can be a testimony to the fact that we're the only group of people where you can find us in a dumpster. Seven years later, you're the district attorney. Half-storey is like that. It's amazing. I'm straight. All right. Let's move on. All right. How often are people diagnosed? I'm sorry. How often are people misdiagnosed, given antidepressants or stimulants when what they really need is addiction treatment? Are you taking that? Mm-hmm. How often do they hide their addiction all the time? If that's what we're talking about, I'd say, no, no, no, no, no. I think what the question was to me was, how often do psychiatrists misdiagnose a client or a patient when they really should have just gone to a top-notch treatment facility? I don't know about the percentages, but I'm just going to say, hi. Yeah. I get people all the time inappropriately on numerous medications, certainly addictive ones, benzo, stimulants, opiates, who often hid their addiction or don't really even realize they have addiction. You have to be really careful. If you put somebody on an oral without the site testing you're a scumbag. I've seen, please, I mean that's a strong statement, but all my statements are different statements. But I'm not married to any of them. I'm off time. If I have any doubt, I get site testing. That's right. Because it's so easy now with the internet and chat, GBT, let me just look up all the symptoms of ADHD and tell this doctor, you see it all the time. Then there's no matter all five minutes later. I want objective proof that you actually have an attention problem. The only way to get that is testing to your point. Otherwise, we're doing a subjective assessment, which is easy to fake. That's right. Because drug addicts never lie. Never. Never. That's right. Let's go through this thing. When families bring their loved ones to you, what's the one thing you wish they understood about addiction that almost none of them do? That it's a disease that kind of takes over your will. I think that they don't realize how profound it is, how deep and how it just controls their life and how important, how I really strict boundaries are, I agree with that data. It's a paradox because for families, because in a normal family system, somebody's having a problem, you help them out. Give them some money, get them on apartment, whatever. With addiction, it's kind of the opposite. Not that you don't help them out, but you said very strict limits. I can't help you unless you go to treatment. That's the hardest thing. They often don't get that for a while. It's a process to get them to that point. Since the patient has no will, someone's going to have to exert some will. That was the most beautiful answer I've heard in a long time. That's exactly right. That's exactly how it works. Wow. I love that. You know what I love most about it? Plains spoken. I'm trying to take notes from you. No, no, no, no. Really? You're both trained in the golden age of psychiatry, but now you're working with cutting-edge tools like neuromodulation and psych... You're doing mushrooms? Oh, I do some cellophilic research. Yeah. Okay. What do you trust more classic psychotherapy or these new frontiers? I didn't mean to throw water on it. Hey, listen, I've got to blank canvas, man. I'll give you my thoughts on that, but I want to hear yours. Well, it's not an either-word issue. I mean, I'm interested in patients doing better. I'm committed to their well-being. I'm a patient's doctor. I care about my patients. I want them to do well. I use whatever tools are necessary. Usually, you combine them. That's one of the amazing things with TMS. We're pushing these agenda to really involve aspects of therapy. When you go through TMS, these periods where you're much more receptive and you can grow more. Our company pushes it. You won't see that in other TMS clinics. They just stand there laying and give you TMS. We will listen. You need to exercise, eat well, get CBT for your OCD or whatever it is. It's especially important you do that in the next two weeks and the next two months because your brain is going to be better at these things. It's synergistic. But to answer your question, I think there's promise in psychedelics, but that's what it is. Promise. It is not here. You have to be very careful. You're careful with addicts, bipolar patients, schizophrenia, because you can really mess them up. Tell the audience about Ibooking. Do you guys know anything about it? I have some experience, limited experience, only a couple of patients do it in me. What does it do first? You know, honestly, I couldn't answer that question. I would be very, I mean, it has a lot of dangers because it's a lot of cardiac risks. That's one of the biggest issues with people who don't always understand. There's a lot of cases that people die from. I don't know as much as I should know about it, but I'm going to know everything about it because I made a decision the other day to try all these new things. Because I'm in transcendence, I don't care. I couldn't do, I couldn't, I couldn't wreck myself with drugs and alcohol if my life depended on it now. It's just you can't treat this many people, okay? And do what I've done and still suffer from that particular thing. It just doesn't make sense to me. So I want to try all of this stuff. You know, I did the toad poison and that's complete horse shit. Yes, I've had a bunch of patients do that. My experience, the biobagane isn't all that different than other associates or hallucinogens. They're a very effective short term. I think the long term is a question. And what I've seen is if that's all you did, whether it was a psilocybin MDMA, ibagane, you didn't know other therapy after that. Yeah, you're good for two months. Can you get MDMA from a doctor? No, no, but there are. How do you know that there doesn't have that all in? I mean, you did question. I mean, I don't recommend these things. Well, I patients find practitioners and some of them are actually pretty good. And what you can see is an amazing transformation in mood or trauma. But then if they don't follow that up, you know, with therapy, it's the daughter is a return it revert. Even ketamine, which is regulated and licensed, it's same problem. Yeah, they just don't laugh. They don't laugh. Can I tell you what my field is on? And I've never done ketamine. So I don't know. And I'm going to hate trying that. Yeah. Man, the drugs are so stupid today. Jesus. All right. But you know what my take on this is truthfully for the people that have never dropped acid or taken mushrooms. Okay. And then they're adulthood. They trip once. Of course, you see God in you. That's, I mean, that's my take on it. But that's my take. That's my take of prior. That's my contempt. My contemptual take prior to investigation. Okay. So I sound like I'm no different than it in an old time or screaming, get off my lawn. Yeah. But there's a thing that happens with psychedelics to add to that. They also, the reason they're therapeutic is they also see themselves in a way without like they can see the trauma of the experience. They're they're ego disconnects from it. They can see it some without the pain and that that's therapeutic. But it does not necessarily last. And that's the problem. It's the beginning and best. I think that that's something that you're so smart that you're hoping they see, but that they have no idea that that's what they saw. And the only way to get them to see it is afterwards to kind of guide them into what they actually saw. Yeah. No, I mean, they have there's there's a whole school of like psychedelic, psychedelic therapy. And that's what you do. I mean, you kind of guide them and you work with them. But you know, like a schmach. Yeah. Yeah. Exactly. But you got to do I just it's without that structure around it. It's a no. It's bullshit. And I like science because we're nerds and because it's truth, it matters. And so they're just isn't the science in terms of long-term treatment. And they're working on it. And so when it comes out where we can know that we don't even know dosing for these, you know, like, well, how much do you give? So people are doing it. These cowboys are doing it, you know, and they're doing it by empirical guessing. And there are some good ones. You know, I've seen some amazing beginnings. I've seen people see stuff, you know, like and forgive themselves in that experience. And then if they continue, it's a great beginning. That's right. But if they don't, not just go as a way. Most ketamine patients, I have, they just, they've returned back three to six. Whether we're talking about mood or trauma, actually, because they use ketamine for depression too. And it's fast, but it doesn't. That's why we like TMS. It's asking different. Which by the way, if you're going to do TMS and it's so effective, okay, how you're going to make money, we're going to talk to you. My point is that there's not going to be, I mean, seriously, guys, it's not like you're buying toilet paper where you always need toilet paper. It's not like you're buying ad-vill where you, you know, it's more like, you know, the treatment that we provide. It is. Right. And so you, and I know for me, you know, we're only marketing to like a million people in the country, at them, three hundred thirty five million people. So, you know, at a certain point, that ends, you know, how you're going to treat it. Well, I guess, theoretically, you could market internationally, right? Because if they're, if they're getting a cash pay accelerated protocol, you don't have to deal with insurance. That's great. I'm talking big, but we don't do this yet. But you theoretically, I know that the colleague Dr. Stubman has happy people come from China. Oh, yeah, other countries. So there is three point five billion or whatever eight billion, you know, to market to, you know, I love him on the podcast. Yeah, you want it. It'll be pretty time-weekly. He's on his way out to Thailand. Maybe a die-hard academic. But yeah, he will not make it simple. Yeah. For sure. But just to kind of go back to your, I mean, even with TMS, you still see, you know, relapses, symptoms come back. It's not a permanent treatment. It can be durable though. It can be pretty good. Yeah, it's about, and it depends on the person. It depends on the person. What else they do, right? With them. You got to, there's lots of things we can do. It's about, you know, best data, 50 to 60 percent of people with just depression will be well a year later. Doctors prescribe, opioids, benzos, and stimulates sometimes recklessly. From the inside, you consider this medical malpractice or just the system failing. It depends, I think. It's a bit of the system failing. The problem is there's a range of opinions. There's like a range of practices going back to five to ten years. And some things that people do, I don't think are reasonable at all. So I think it's a system that's you in part. I do think most doctors are well-intentioned. Yeah, I do. I do. But yeah, it's a system problem. Sometimes they don't do a thorough evaluation. They don't have any. Listen, when we both trained at UCLA, okay, 1994 and 98 for me, there was one addiction rotation in the VA inpatient that there was no addiction fellowship that Tim Fong runs. It didn't exist. So you got a whole generation of psychiatrists that know nothing. They have no idea that probably 30% or more of what walks on their door has a substance abuse problem. T's the why that is? Please, in flight, no, it's, it was terrible. Because in medical school, you get one week of addiction. Exactly. That's my point. Yeah. One week. Yeah. The reason, which is why, which is why it's so insane, and it's not you guys, because you guys are an addiction, when I have another doctor who's not an addiction, talk to me about addiction, yeah, I just like shut him up right now. So I got very don't know anything. I got very little training, but I realized over time, I'm like, oh my, I better know something about this. This keeps coming up. That's right. And so I, when I earned addiction, psychiatrist, correct. I got the training and I know how many of you there are. Not a ton. 1500 in the case. I was gonna say two. Yeah. 1500 addiction psychiatrists in the country. That's absurd. Yeah. And do you know who the president elect is? Oh, Dana. No, no, Dana's not the president of the election. Is she the president now? No, I thought she was on the Maybed, now the president elect. Yeah. Dr. Flaum. Oh, I did know that actually. Isn't that cool? Yeah. Actually, I came up in your podcast with him. Yeah. Yeah. Yeah. And see fancy. Yeah. That's great. You better Yeah. I would have. Yeah. I thought he's great. He was great. All right. He's watched the podcast. He's fantastic. He's an inspiration. Yeah. I don't worry. I jerked him around too. Like the whole time. Just to make it out of the thing. But I thought he handled your, you know, provocations pretty well. Actually, yeah, the ones that we didn't, the ones that he didn't handle well. We cut. Yeah. For sure, because I want everybody to look like a king here. All right. Thank Quero is built around therapy first. You know, not a 12 step clone for sure. Okay. From your perspective as psychiatrist, why is this approach different and why does it work for the kind of clients who come here? I mean, people, you know, people are addiction isn't just a relationship with a drug. It's a relationship with yourself that comes first. Like some kind of early trauma. Stop. That was gorgeous. That was so good. Go on. I'm sorry. I didn't love to do it, but it was too good. Like it does it. It's, it's, you're not just a bunch of chemistry. You know, you're a bunch of your experiences and your traumas and like, that's what, that's the underpinning of like any of those problems. And you have to, you have to know yourself. You have to have somebody who can guide you through it, shepherd you through it. Those are your glasses, man. That's what you're looking through. Your life experiences and your traumas and you're just the whole thing. And that's the only thing. You know, it's funny. Yeah. If I was walk around blind forever and I had my first sponsor in AA and I were driving in my Jeep and I'm literally getting out of the car to look at where we're supposed to be, getting back in the car and going, looking at the street sign. And it goes, dude, you're blind. You need to get your eyes checked. I'm like, no, I know. Right? Right. I went to the doctor for his direction, the optometrist. And he said to me, how long have you been walking around blind? Now, if that's how you see and you don't have anything to compare it to, how the hell do you know you're blind? Right. Same thing, right? Do we create a metaphor? What's a metaphor? You know, I'm just kidding. Gone. My phone. We cut that. No, that stays. Yeah, you got me. I was like going to explain what I'm going to say. I know, which is ludicrous. You don't think much of me, do you? No, I think you know what a metaphor. I go on. And any just answer questions. I know, Betty. Your therapy is also in, you know, individually specific. AA is a beautiful, you know, community support with us structure. It's a sport. I mean, I think it principles actually overlap with a bunch of different therapeutic principles. Absolutely. It is not specific to you and your problems. It is not. That's the difference. You need both. Ideally, you'll be well. We need look. We need community. Yeah. Okay. But you can find community anywhere. Yeah. The other thing though is, you know, drugs become the end of becoming a sense of meeting for the person. You and that has to be replaced. What I'm trying to explain is that when you when you're addicted to a substance, but that substance, it's not just an addiction, it's sort of a belief. It's like an attachment to it. And you need you need to have, you need to kind of understand. You need to restructure that so that you have your other elements your life, bring meaning out. And so you replace it. It's, that's a beautiful, you replace what you held as, as most valuable, or something of equal or greater value. Yeah. And it shouldn't be there to begin, which is hard to do. But if you don't do it, you aren't getting clean in life. Great. I know somebody who says that all the time. Okay. If you could speak directly to a 16 year old who's about to try for the first time, what would you tell him? Don't do that. You're going to die. You know, I would say, yeah, you try to get out of it. Yeah. What are you trying to get out of it? Yeah. Yeah. I'm, let's, well, let's well play that. Right. I'm depressed. Yeah, that's not going to help. But you don't understand. I go to school every day. And these girls just talk badly about me all day long. They just won't stop. They're bullying me online. Okay. I can't take it. I have no friends. I'm laughed at. That's horrible. I'm so sorry. You're that. That's not going to solve it. We got to find another way. I don't know another way. Well, that's why you're here. That's where I'm at. Well, you're not giving me any hope. What other way? Because right now, the only thing I want to do, okay, is check out because I'm miserable. What do you got for me, doctor? I got a solution, but it's going to take some time. And we have to kind of spend some time together understanding what really understanding what that is and what really understanding your how you're really feeling and how else would go. I feel like I want to kill myself, but I'm not going to so you don't have to 51 50 me. I'm not contemplating anything. It's just that's the overwhelming thought that I have. I just don't have the desire or the courage. But a piece of you've brought yourself here today, yeah, my mother. Yeah, but isn't there somewhere in there a piece of you that wants to still live? There's the piece of me that doesn't want my mother to go through any pain. So you care about her. I love my mother. Okay. Well, that's that's an important part. You're part that brought you in here. You're love for her. We got to work with that. Okay. So you would so you would leverage her with the love of her family? I'd leverage his care his love for his mother. Not so much her. Maybe her. Oh, I was a woman. The guy. The guy that I was talking to. Okay. Yeah. That was beautiful. Yeah. Find some kind of anchor. This is usually least something. Yeah. All right. Hey, did I leave anything unsaid? You guys want to talk about anything? As you need to say anything, did you get done what you wanted to get done here? Do you look good? Did you did you have any books to promote anything? Books about addiction or books about TMS right? And you wrote not yet working on it. He's a dating service. Yeah. Yeah. You got a dating service? Everyone tells me the app. He started by the dating app idea. Everyone tells me to write a book but I've been busy treating patients for nerdy plus years. Yeah. Cool. Well, then you got to find somebody to write it with. Another doctor to write it with. He's an excellent writer. Do you have a book? Not a recent one. It's a little dry. It's a little dry. What a shocker. I actually just say to a chapter in I've a game for some time ago. You wrote a chapter on I've a book for like a while. Enderwire book. Yeah. With a fantastic. Yeah. See you next Tuesday. And they're good doctors too.