A New Way to Think About Addiction: The Stress Reducer Loop

Your go-to stress relief can become the biggest source of stress in your life, and that’s where recovery often gets stuck. I’m joined by Dr Gary Sprouse, the “Less Stress Doc,” to unpack his deceptively simple framework called the Stress Reducer Loop: a substance or behavior lowers stress at first, then starts causing harm, which creates more stress, which drives more use. Once you see the loop clearly, it’s easier to replace shame with strategy.

We also dig into why the way we talk about addiction matters. Dr Sprouse explains how the disease label can backfire for some people by making them feel broken, abnormal, and permanently marked, so they wait until rock bottom to get help. His alternative framing treats alcohol, opioids, smoking, shopping, even over-exercising as attempts at “treatment” for stress. That perspective keeps the conversation practical: how do we reduce stress, and how do we swap in a lower-harm stress reducer?

From Suboxone as a safer replacement for fentanyl or heroin, to relapse mechanics like brain “tracks,” inhibition, deprivation, and dwindling “quit energy,” we translate addiction medicine into plain language you can use. We also cover concrete stress tools like setting boundaries, changing expectations, and “de-lumping” overwhelming problems, plus why past trauma can silently consume most of a person’s stress capacity.

If this helped you see addiction, relapse prevention, and stress management in a new way, subscribe, share the episode with someone who needs it, and leave a review so more people can find the show.

To learn more about Dr. Sprouse's work: https://www.thelessstressdoc.com/

To contact Dr. Grover: ammadeeasy@fastmail.com

Transcript

Welcome And Episode Setup

SPEAKER_02 0:08

Hi, I'm Dr. Casey Grover. I spent years practicing emergency medicine before shifting my focus to addiction medicine. This podcast grew out of caring for patients, hearing their stories, and wanting to do better. Here we talk about recovery, medicine, and compassion. This is Addiction Medicine Made Easy.

The Stress Reducer Loop Explained

SPEAKER_02 0:38

This episode is an interview with Dr. Gary Sprouse. He calls himself the Less Stressed Doc. He's a family medicine doctor, and he's come up with a mental model of addiction, which he calls the stress reducer loop. Here's the overview. The thing, alcohol, cannabis, heroin, that you use to reduce stress starts to cause you more stress as it causes harm in your life. And if you keep using that thing to manage your stress, it actually starts making your stress much worse. And his model works to find a stress reducer in your life that causes less harm, like medication, while he works with you to reduce the amount of stress in your life. So a person using opioids like fentanyl with a bossy and overbearing sibling that is overwhelming would switch to Suboxone instead of fentanyl to manage stress and start therapy to put up boundaries to manage that overbearing sibling. And as you'll hear, he takes a lot of things that people work on in therapy, like changing expectations or setting boundaries, and he makes them really easy to understand and implement. So it's actually exactly what we do in addiction medicine. He just has a different way to think about it and approach it. And as you will hear, he's very passionate about this work.

Quick Clarifications On Key Terms

SPEAKER_02 2:02

A few clarifications before we start. The first, Dr. Sprouse points out that one could look at smoking as deep breathing exercises. I love this. My patients tell me this all the time. For me personally, when I am really stressed, I will take a deep breath, hold it, and then slowly let it out. It's exactly the same as taking a big drag on a cigarette. This is a really helpful point to discuss with people who are trying to quit smoking. Next, Dr. Sprouse mentions hypnosis with NLP. This is hypnosis with neurolinguistic programming. If you want to learn more about hypnosis, go back a few episodes and listen to the episode on drinking less through hypnosis with Georgia Foster. NLP involves working with how language affects the brain and behavior, and it's apparently a great augmentation for hypnosis. And finally, Dr. Sprouse mentions zapping tracks in the brain. What he's referring to is when we learn how to do something, like playing the guitar, speaking French, or how to start an IV, a tract in our brain grows and develops around that skill. And unfortunately, learning how to use alcohol or heroin is like riding a bike. Once that tract is there, it never goes away. And Dr. Sprouse talks about how great it would be if we could zap those tracks around addiction away, but that's not a thing. So in the meantime, we work on helping people develop new and different tracks to reduce stress through positive things in their life so that they don't have to go back to using or drinking. So with that, let's get started with Dr. Gary Sprouse, the Less Stress Doc.

Meet The Less Stressed Doc

SPEAKER_02 3:49

All right. Good morning. Happy Friday. Let's just start with who you are and what you do.

SPEAKER_01 3:55

Hey, so I'm Dr. Gary Sprouse, aka the Less Stress Doc, right? And so I'm a primary care doctor, and I retired a couple years ago. That was really nice. But while I was practicing, I was seeing all these patients with high blood pressure, diabetes, couldn't sleep, were overweight. And what I was realizing was stress was playing a big part of what was causing their physical problems because I was in practice long enough that I'd see somebody who was on high blood pressure medicine, and then you retire, and then all of a sudden they wouldn't need the medicine. And I was like, wait, there's something here. And so I started looking into what was causing stresses. And I came up with this concept that you'll understand this as a doctor. When we give medicines, they have really great benefits, but they have potential side effects. And so our job is then to reduce the side effects and maximize the benefits. But when I applied that to the human brain and the human skills that we have, here's what I realized: that the majority of human stresses are really side effects to our skills. So for the audience, because you'll understand this, but for the audience, what I would say is like we have this incredible ability to envision the future. The side effect is then we have to worry about it. So when someone says to us, we'll just live for today, that'll get rid of worry. And you're right, it will get rid of worry and you will be less stressed. So my grandson, who's one year old, he hasn't developed a skill yet of envisioning the future. And so he lives, like they say, he just lives for today and he's really happy. Yay. But he's also very vulnerable because he needs somebody who can envision a future to pay attention to make sure he stays alive, right? So what I realized then was my goal was to say, how do we keep our skills and lose the side effects? And so that became the part of my book, Highway to Your Happy Place, Rob Less Stressed. So the other half of that book was when I would say to patients, hey, I found a way to have you have less stress. And they were like, that's great. And I go, well, where would you be if you didn't have so much stress? And they're like, I don't know, I never even got that far. I only wanted to have less stress. So I was like, well, this is important. We need to find a destination. And so that's when I started talking about people's happy places. I realized they were all different, but they all had the same rooms. They just decorated them differently. Now, that was the beginning of what on my journey. But, and here's where the addiction part comes in. As I'm going through all this, I'm going, because people are under a lot of stress, they really don't know where their happy place is. Even if they know where it is, like I would say to patients, hey, where's your happy place? They're like the beach. I go, how often are you there? And they're like, I don't know, a couple weeks a year. So I'm like, well, that's 50 weeks out of the year that you're not in your happy place. That's not, right? So I realized people had to come up with some way to reduce their stress. And when people said to me, What do you do for your stress? I was like, oh, well, I read a book or I watch TV or I exercise or I drink some alcohol or right, other people smoke cigarettes or they'll do heroin or whatever. These are all different ways to reduce your stress. And they all work to some extent. And here was the insight.

How The Loop Traps People

SPEAKER_01 6:59

But if you have a stress reducer that you've picked to reduce your stress and it's working, but then the stress reducer starts causing stress. Oh, now you're in trouble. Because now, and this is why I came up with this term, a stress reducer loop. So what happens out? So I'll give the example because this might help explain it to the audience. So you're at work, you have a bad day, you're coming home from work, and you're stopping at the bar and you get a couple drinks. That's your stress reducer. You're like, ah, and now you're like, oh, I feel so much better now. But as you're driving home, you get a DUI from the policeman. So now the stress reducer, the alcohol, just cause stress because now you got a DUI. Say you go home to your wife and you go, honey, I can't believe it. I had such a bad day at work, and then I got a DUI. It's like, what? You got a DUI? Yeah, and you're like, God, that's so upsetting. I'm gonna go get a beer. And she's like, What do you mean you're gonna get a beer? That's crazy. You just got a DUI. She goes, I know, but that's my stress reducer, right? So you can see how the loop forms. Your stress reducer starts causing stress, which makes you use your stress reducer more, which leads to more stress, right? And you end up in this loop. So the way out of the loop then becomes let's find a way to have less stress and let's find different ways to reduce the stress that you have, different stress reducers that don't have the same side effects. And then then you're back to normal. And so what I've been finding with the stress reducer loop model is that patients like hearing about it because they like this idea that I could be normal. All my patients just want to feel better. They do, right?

Stigma And The Disease Label

SPEAKER_01 8:39

So you're a physician as I am, and we've been trained in the disease model. And so we understand disease. Like we go, okay, here's a bunch of signs, here's a bunch of symptoms, and we're gonna put that together and put it in a box and call it this. It's diabetes, it's addiction, it's whatever, right? And then we treat the people that are in the box. We go, okay, you got this box of depression, so we're gonna give you this medicine, we'll see how you do, and you get better, and that's great. So when someone came along and said, No, addiction isn't a moral failing, it's a disease, as a doctor, like, yeah, right, that fits. It's got a bunch of symptoms. We could put it in the box and we'll treat the box and we'll see what happens. The problem with the model is that the patients, well, first there's a couple of problems with the model, but the first one is that patients don't like being called the disease. They don't like being broken and abnormal, and it's a lifelong disease that they're never gonna get rid of. Like, well, who the heck wants that? And it's not a good label, right? There's stigmas that goes along with it, there's ostracizing that goes along with it. So here's what happens to patients. They don't come. They go, I don't want to, I don't even want to hear about this because I don't want to get labeled all that. So they wait until it's the rock bottom, it hit rock bottom, and then finally, all right, fine, I'll I'll admit it. One of one of the people in my church has been having a lot of problems with alcohol. And so I met with him and I was like, dude, you got shakes every day. He goes, I know, I think I have Parkinson's. I was like, Yeah, I don't think so. He doesn't look like Parkinson's. Yeah, I know, but then I think it's my my medication. I'm like, yeah, I don't think so. How about we try this experiment with alcohol? And he's like, No, it can't be alcohol. And you're like, all right. So then he got in trouble, and then he was he had to go to jail for a little while and got sober, and guess what? His tremors went away. So now he's hit rock bottom. So I'm hoping that now he'll go, okay, I guess it was the alcohol that was causing the problem. I got to do something about it. But I don't want to wait till people hit rock bottom. And I'm sure you've seen this. People, when they hit rock bottom, are just as likely to commit suicide as they are to get sober. And so with the stress-reduced loop model, I can intervene with them. And what I found with the stress-reduced loop model is they don't have to wait because all I have to do is say, look, this thing that you're doing to reduce your stress is causing a problem in your life. Maybe we can find a different way to deal with this. Or let's look, let's explore what's causing all the stresses in your life and see if we can't get rid of those or at least reduce them, right? So I give you an example.

A Better Conversation About Drinking

SPEAKER_01 11:14

So I did a lot of work in nursing homes, and there was a patient that got admitted to the nursing home where I work at, and he had a regular physician who came to see him. And so he was in because he was like in his 60s and he'd had pneumonia and he got weak from pneumonia. So they put him in the nursing home to get stronger for a couple weeks. So his doctor walks in and says, Bill, I see you're here for pneumonia and some rehab. And he goes, Yeah, yeah. And he goes, but I'm looking at your ER sheet and you're an alcoholic. And Bill looks, I'm like, What? What are you talking about? He goes, Well, it says right here that you drink four drinks a night. He goes, Yeah. He goes, Well, that makes you an alcoholic. He goes, What do you mean it's an alcoholic? I'm not an alcoholic. He goes, Yeah, you are. He goes, that's that's the top 10% of the alcohol consumption in our country. And he goes, but I don't have a DUI. I go to work every day. I'm a I'm a therapist. My wife doesn't give me a hard time, my liver's fine. Like, what are you talking about? He goes, nope, Bill, you have this disease of alcoholism and you're just in denial. Once you admit it, then we can get you some help. And so Bill's response was defyers doctor. He's like, I don't want to hear that. Who would? So they asked me to come in and see them. I was like, yeah, sure, I'll come in. So I come in to see Bill with my stress reducer loot bottle. And I go, okay, Bill, I get that you're a therapist and it's probably stressful because you're seeing people with problems all day. And I can see why a drink at night would make you feel better and relax you a little bit. I go, but do you need four? And he's like, what? I go, well, do you need four drinks? He's like, well, uh, I don't know. I don't then he started, but now we're having a dialogue. And he's like, Well, I don't know. Yeah. I said, Do you think two would work? Maybe one? He goes, you know what? Yeah, you're probably right. I said, because I'm gonna here's what I'm gonna say to you. Like right now, you're not having any problems from this stress reducer. But you're in the 60s, and it's gonna start causing problems with that kind of consumption. It's gonna start causing problems in your liver, your brain, your heart, and somewhere along the line you're gonna get in trouble. And if you just cut back to one drink a night, you probably won't ever get in trouble. And so as we talked, then he was like, oh, okay. And he was willing to say, yeah, maybe four is gonna cause a problem. So let me just cut back to one or two. Now, whether he did or not, I don't know, because he went home and I lost touch with him. But my point was that we were able to have a conversation without me labeling him with this lifelong disease, which to be honest with you, they had no proof anyway. Like, I can't do a blood test, say, Yep, you're an alcoholic, or there's no genetic test, there's no psychological test, there's no test that we could say, oh yeah, you're it, this is it, you're it, or you're the guy that's gonna be it. So with the stress-reduced loop model, I can now talk to patients, I can talk with them. And so here's what I've told people, and particularly when they're doctors, so they

Reframing Suboxone As A Safer Option

SPEAKER_01 14:09

understand this. I go, we have this medical model where we go, here's some symptoms, we'll call it a disease, and here's some treatment. So the stress-reduced loop model doesn't take it out of the medical model. It just doesn't call it a disease, it calls it a treatment. So now when you look at patients that are on heroin or fentanyl, I go, okay, well, look, you found this treatment and it works great, right? Opioids really reduce your stress. They make you feel good, they make you feel warm and fuzzy, but the side effects are horrendous, right? You're going to jail, you're, you don't even know what you're sticking in your vein, you're dealing with all these crazy people, all these illegal things that are going on. Let's, and here's what we do with all our medicines, right? If I find, if I give you a medicine for your Parkinson's, but it's causing too many side effects, I go, Oh, let me give you a different medicine that won't cause the same side effects. So, in my model, in the stress reduced loop model, giving somebody who's on heroin or fentanyl, giving them suboxin makes all the sense in the world. Because I go, okay, here's heroin and fentanyl causing all kinds of crazy side effects. Here's suboxin, and has some side effects, but not anywhere near what the side effects of those other things are. So let's put you on that. And then while we're teaching you how to have less stress and different techniques to use to do reduce the stress, then you won't need that any either. And that works. So in my office, I had 100 patients that were on heroin, and I was getting like a 95% success rate, switching them from heroin to suboxone, and then treating their stresses and getting the stress reduced and giving them other ways to deal with the stress they had left over. So the model will work, at least in the population that I had. And when I've talked to other physicians, they're like, well, maybe you cherry-picked your patients, and maybe you, you know, maybe you just had a special group, maybe you're something special, whatever. All I know is what I was doing was working. And the patients wanted to come and see me because they wanted to hear what Dr. Sprauss had to say, who treated them like they were normal, who treated them like they weren't, you know, brain jammaged, diseased, less than human people. And I'll tell you this one story that was this was very upsetting to me.

A System Failure And A Death

SPEAKER_01 16:26

A different patient at the nursing home had had had a really bad abscess because he had been sober for a couple of years on Suboxone, but then he ran out or he couldn't get the prescription filled, or something happened. And he ended up back on heroin, and then he got all really sick from that. So now he's in the nursing home to get better, but he's in his 50s, so he's pretty healthy otherwise. So he's there for three or four days, and we're starting to work on how to get him home and how to get him back on Suboxone. So we call the program that he had been at, and they go, Well, we can't take him back because he's not on heroin anymore. And you're like, wait, what? And he goes, Well, because he's not on heroin, we can't admit him to our program. I'm like, so I'm gonna have to give him heroin so he can get back in your program. Really, that doesn't make any sense. So they finally agreed that, okay, we'll take him back and we'll we'll skirt the rules, whatever the rules were. So they were gonna see him on a Monday. But on Friday, the nursing home got the notice that they're not gonna get paid by his insurance company anymore. So by Saturday, they're kicking him out of the nursing room because they're not getting paid. By Sunday, the guy was dead. Because he hadn't been on anything for a while. He went out, got some fentanyl or heroin or whatever, and overdosed and died. And that was bad, okay? But here's what was worse. When I got to the nursing room on Monday, I say, so what happened to the patient? They go, Oh, yeah, that guy, he went home. Yeah, he just overdosed and died. I'm like, what do you mean he overdosed and died? Like, well, he was a drug addict. This was gonna happen one way or another. And I'm like, wait, what? Are you kidding me? This is our reaction. This was our fault. Our system let this guy down. He was sober for three years on Suboxone, and he goes home on one weekend without the Suboxan that we should have been able to give him, and now he's dead. No, that was on us. And they're like, Yeah, whatever. And this is what I've seen is our reaction to people with drug addictions is almost that they're less than human. And second, is that they're inevitably gonna relapse and they're gonna die somewhere along the line of their addiction problem. And I'm like, oh my God, we have to do something different about this. There has to be a different way. And so then the stress-reduced lumile is this other way to look at the problem. It fits all the information that we have about addiction. It just doesn't call it a disease, it calls it a treatment. If I say to you, okay, you know, you have an alcohol problem, and we're gonna put you away in a rehab for 30 days, and you're like, so that means you're not gonna be able to go to work for 30 days, you're not gonna be able to talk to your family for 30 days, that means you're not gonna be able to have a phone, you're gonna have to lose all your past friends and contacts, all the places you used to go to. We're gonna wipe all those away, and then we're gonna start all over again, and then we're gonna get you better, and then you'll be fine. And if you do screw up at all while you're here, we're gonna kick you out. And then if you relapse and you get back, and we're gonna send you to my buddy so he can you he can make another 20 grand for the next month. And you're like, do we have any idea how stressful that is? Like, I don't have you ever been to a methadone clinic? Yes, I have. Right. So I went to one just to see what it was like. There was 300 people lined up at 5:30 in the morning to get their dose. Every day. Like, I can't even imagine getting anywhere at 5.30 every day to get my dose. And if I don't get the dose, then I'm gonna feel like crap the whole day. If I don't go out and use and get something else. And if I'm late because the bus was late or there was snow on the ground, yeah. If I don't get there by nine o'clock or whatever the cutoff date was, then I don't get my dose. That's crazy stressful. Why can't we gotta have a better way, right?

SPEAKER_02 20:10

So if I can just ask, so it sounds like your model is that you identify that people choose substances as a way to manage their stress, and then that the complications of them using that substance causes harm and leads to more stress. And we make getting help for addiction inherently challenging, which only adds to more stress. Does that sound right?

SPEAKER_01 20:35

That sounds pretty good. Now, here's what I'll

Loops Beyond Drugs And Alcohol

SPEAKER_01 20:37

add though. So when I've when I started fleshing out the stress reducer loop model, here's what I realized. Anything that people do can become a stress reducer loot. So I was just talking to a lady yesterday on a podcast, and she goes, Oh, she heard the model. She's like, Oh, I used to have a book reading at stress reducer loot. I'm like, what? She goes, Well, when I was like in my teens, I used to read books like all the time to the point where my mom was complaining to me that I wasn't going out to play with my friends. I would literally stay all night reading a book. So then when I went to school the next day, I was groggy and half asleep. She goes, but I couldn't not read the book. In the book, basically she was withdrawn from reality and could live her life in that book. One of my patients has a shopping loop. So when she's upset, she goes out shopping. And then her credit cards are maxed, her husband's yelling at her, her closet's full, and that upsets her. So she, what's she doing? She goes out shopping. So it isn't just chemicals. That's what I realized. So chemicals are one option. So we see chemicals like alcohol, heroin, but caffeine, all these other things that we look, sugar, right? Then we have behavioral things, so like shopping or reading a book or exercise. Because I've seen plenty of people that are in loops from exercise because they're getting hurt, but they still do it because I gotta do it, right?

SPEAKER_02 21:55

So it's it's funny. I was the medical director of my emergency department during COVID. And exercise is one of my coping strategies. And as the world was falling apart, and then our community was on partly my shoulders as the medical director of the ER as locked down and all these protocols were happening. I exercised so hard I needed shoulder surgery and to wear a boot afterwards. 100%.

SPEAKER_01 22:16

So here's my friend, right? He's an orthopedic surgeon. He loves lacrosse. I'm like, dude, you've had eight surgeries on your shoulder. Why are you still playing lacrosse? He goes, I love it. It's great. It reduces my stress. I feel so good. I'm like, but if you get one more surgery, you're not going to be able to be a surgeon. That's what? No, stop. So, but here's the key. So the problem is all the same. The problem is the stress, not what you pick to be the stress reducer. The stress reducer has its own inherent side effects, but the problem is the stress. And I saw when I was listening to one of your interviews that you talked about be having PTSD from work you're working at ER. And I see this a lot. So people that have these more intransient problems, like they just can't get off of something, a lot of times the their stress is not present-day stress. Their stress is in their past. So they like say they could handle 100, but 80 is being taken up with the stuff from the past. So now all it takes is a 21 and they're above their limits and they're in trouble, right? And so one of the things that I got to learn was how to do hypnosis and non-linguistic programming, which I don't know if you've ever tried or not, but that was one technique that I found that worked very quickly and very effectively on transforming and reframing these past traumas so that they're not an 80 anymore. Maybe now they're a 20. That people can handle. And so then their reasons for using their drug or using their behavior or using their coping skills isn't as important anymore because nah they don't need it.

SPEAKER_02 24:10

We actually don't even talk about anything that's happening today or in the future. It's all just anger about the past. And you're right. She has so much stress from how she feels about her past that you're right. If her stress tolerance is 100, she lives at a 95 and one little thing happens and she's across the edge and she's drinking.

SPEAKER_01 24:25

Right. And so what you see is when people have those kinds of stresses, then what they do is they find they have to do their stress reducer more often and they have to find stronger stress reducers. So they're more likely to get into trouble. So we talk about things like marijuana being a gateway drug. No, it's not a gateway drug. It's like if I found alcohol and it really wasn't working because it made me feel sick in the morning, and I went to marijuana, which didn't make me feel sick, but it didn't really get rid of all that stupid stuff from the past. And then somebody, while I was doing marijuana, somebody goes, Well, watch, hey, I got some herring, want to try that. And you're like, What? Well, okay, let me try it. Like, whoa, that was really good stuff. And then you're like, but then you get used to the heroin. And somebody overdoses, I'm sure you've heard this, somebody overoses, and people go, Oh, what did where's the dealer that gave that guy the medicine? Because I want to go there, because that's good stuff. And then you find out fentanyl's even stronger. Oh, let me do that because that heroin wasn't working that great anyway. So you just keep using stronger and stronger things till you find the one that works. But when you're inside the stress reducer loop, you're creating your stresses. So it's never gonna work because you're gonna make it worse and worse and worse and worse.

SPEAKER_02 25:32

So you mentioned two things. You mentioned reducing stress, and you mentioned finding better stress reducers. Where do you want to start? I'd love to unpack those two with you.

Overwhelm And Simple Stress Tools

SPEAKER_02 25:42

Okay.

SPEAKER_01 25:42

Let's start with the stresses. So I started working with how to have less stress and how to find your happy place. But then I switched, and addiction was sort of underneath of that. And what I've done is switch and go, no, stress reducer loops are the main umbrella because that's what gets people into trouble to the point where they go, I need to do something about that. But underneath that umbrella is well, how do you have less stress? So let's look at being overwhelmed.

SPEAKER_00 26:06

Okay.

SPEAKER_01 26:07

So patients come in and they go, Oh, I'm overwhelmed. I don't know what to do, right? And here's the problem we get into as doctors. I don't know what you do in the ER. Do you do the ER anymore now? I don't know. I had to give it up with because of my PTSD. Okay. So in my office, people will come in and they go, I can't sleep, I'm not eating real well, nothing makes me feel happy. And we would call that depression, right? So we get those symptoms, we put them in this box, and we go, Oh, you have the box of depression. So we're going to give you an antidepressant. And then you see him back in a couple weeks, and they're like, like, well, I feel a little bit better, but you know. And then two months later, they come in and they go, Oh, it's really back again. This is horrible. I'm taking the medicine, like you said. And they're like, well, let me give you more, let me give you a second run. And you're like, here's what I realize. The majority of these people are not chemically imbalanced in their brain. The majority of these people are just overwhelmed. They have too much crap on their plate and they're past their coping skills. So they don't know what to do with it. So I use this thing called an S-curve where I go, okay, here's where you're at when you only have one or two problems and you're in control. But then all of a sudden you get a third problem, and now you're up here somewhere, like really quickly, and now you're out of control, you're overwhelmed, and you're past your coping skills, you don't know what to do. And what I say to them is, look, all we got to do is get rid of one of these problems, and you'll be back down here. So it's not as bad as it looks, right? And so then they go, Oh, okay. And so then we go, okay, what's getting you overwhelmed? And what I found, and this is important for you as a physician. So when I first came out as a doctor, my patients would describe me as this young whippersnapper doctor, right? And I go, yeah, I'm gonna fix everybody. I'm gonna, I'm gonna be awesome, right? Within my first day, I was getting overwhelmed because I had 20 people to see that were all having problems. I'm like, oh my God, how am I gonna fix all these people? This is crazy, right? You mentioned that word helpless, like you felt helpless. So fortunately, I learned early on that I had to make this empathy wall. And my empathy wall had to be thin enough that I could empathize, but thick enough that I wasn't getting overwhelmed every time a patient came in with a problem, right? And so I started looking, I won't make up my empathy wall. And there were two big stones that were there. One is that I can't fix anybody. That the best that I can do is give them the best advice that I can find and get the best at delivering the message so they can hear it. And it's so what that did then as a physician was it changed the metric of my success. So instead of people getting better as my success, my success came from giving them the best advice I could and best at being able to convince them that what I was saying was correct. And if I did those things as best as I could, then I did my job and I did a good job as a physician. If the patient got better because they listened to what that, well, that was even better, right? But if the person came back and their foot was still hurting, and I go, Well, did you do what I said? And they're like, Well, no, I couldn't. And you're like, my friend, who is a podiatrist, would freak out. He'd be like, Well, what the heck? If you're not gonna do what I say, or because he had this idea that he was gonna fix these people. And now I realized that no, my job is not to fix you, my job is to lead you in the right direction. You're the one that has to take the medicine, do the procedure, get the testing done, whatever. And if you don't, that's on you. Now I can get better at convincing you or persuading you, and that's again part of where my skill comes in. But fixing you, that's not what that's not what I'm gonna get judged by. And so that made it easier to be sympathetic and empathetic and yet still protect myself. So you're changing expectations. My expectations, right? Yes, exactly. And so then the second one was like, look, my problems max out of 10. Everybody else's problems max out of five. So, like, I know that your mom is dying of cancer and that's horrible. It's not a zero to me. I really care, but it's not a 10, it's a five. And when I tell this to a mother who was having problems with her son, and she was like, I'm exhausted. I'm like, What? She goes, My son, he's this, he's that, he can't do this, he can't. I was like, Look, his problems max out at a five. And she's like, Whoa. And she stopped for a second, she says, Wait, so his they're his problems. I was like, Yeah, like they're a five. Like, I I don't want you to, you know, abandon him, but they're a five. And you could see that her whole body language, we're doing this with my stepson. He's having some problems down in in Georgia where he lives. And I'm watching my wife pull her hair, I'm like, honey, his problems, they're his problems. Like, we can help and we can do the things we can do, but they're his problems, they're not ours. And so when you go from a 10 to a five, all of a sudden you got all this extra energy because when you've been giving everybody else a 10, yeah, it freaks you out. So if I built that wall, then it made it a lot easier to handle the load of what patients were coming in. So you're setting boundaries. Yes. But one of the ways to set the boundaries is by saying, hey, you're a five, I'm a 10, right? I'm here to help you. I'm gonna do the best I can. I'm gonna read every book that I can to figure out what's the best way to convince you to do whatever you're doing, and what's the best way to tell you which way to go. But that's what I'm here for. So that helped, right? So then that way it keeps people from feeling overwhelmed.

De-Lumping Problems With Shoe Boxes

SPEAKER_01 31:33

The second one is people have this tendency, and doctors do this too, is we have this thing that I call lumping. So you wake up in the morning, like, oh, I gotta go to work, uh, the coffee maker's not working, oh, my car needs to be tuned up, oh, I forgot to do this, oh yeah, I forgot this, that right. And you end up with this big lump of crap that you're like, I don't even know where to get started. And that gets overwhelming. And people, when they're overwhelmed, they tend to look like they're depressed. They just kind of withdraw, they pull back, they like they don't want to come out, they want to hide in their room. And you're like, So I tell people, well, you have to de-lump, and they're like, what? And I go, you need to de-lump, and they're like, what the heck is that, right? So I the medical term is compartmentalization, right? So I give people this visual so they can understand what I'm talking about. So I talk about shoe boxes, and they're like, What do you mean shoe boxes? I'm like, well, think about it. If you walked into your bedroom and there were a hundred shoe boxes, and the bottom was here, and the lid was there, and the right shoe was here, and the left shoe was back there, and there's a hundred and they're all over the place, you'd be freaking out. You'd be overwhelmed, right? But if you walk into that same room and there's the boxes here, and the shoes are inside, and the lids on top, and they're all stacked nicely in the closet, that's a lot of shoe boxes, but it's not overwhelming. And so then you just take one down at a time, you look at it, you put it back up, take another one down. So when you compartmentalize with your shoe boxes, then life isn't overwhelming because most of the time these problems that you've lumped together individually, they're not that overwhelming, right? Like I got this, all right. If it's the only problem I had, yeah, I can handle that. Or if this was the only problem I had, I could handle that. It's when you lump them all together, that's when you get into trouble.

SPEAKER_02 33:13

So you're basically taking some sometimes hard to understand concepts from therapy and making them simpler and more understandable for patients to reduce their stress. Does that sound right? I hope. Yeah, makes sense to me.

SPEAKER_01 33:26

Yeah. That's what I'm trying to accomplish. Because what I learned was have you been into a doctor's office with a family member? Been a few years. Yeah. So I went with my wife. She had an abnormality on her EKG, and I was like, it's probably nothing, but we should at least get it checked out, right? So we go see the cardiologist. And Carter's very nice, friend of mine, very nice, very knowledgeable. And she's talking to my wife, she's going, blah, blah, blah, blah, blah. Your ventricular this, and your rhythm is that, and your mayoric is this, and blah, blah, blah, blah, blah. And my wife's like, Oh, yeah, okay, okay. And I'm sure the doctor thought that my wife knew what she was talking about. And we we got when the doctor got done, I said, You understand that my wife didn't understand a single thing you just said, right? And she's like, What? And my wife's like, Yeah, I don't understand what she said. So it's making it accessible intellectually for patients. That's really we've we've been taught medical ease, right? Like we know how to speak doctor, right? But most patients do not. And so we have to be very careful because our job is to take this massive amount of information that's out there that's based on statistics, really, and then hone it down to you and then give it to you in a way you can understand it. Because it doesn't do me any good. I can explain a whole bunch of crap, but if you don't get it, it doesn't do me any good at all, right? So I've spent my career trying to figure out how to get all this immense medical information honed down to you in a way that you can digest it. And so the book that I wrote, I tried to do that. And when I'm talking about the stress reducer lose, same thing, but it's like I'm trying to make this in a way that you can understand it because you're the one that has to do something about it.

SPEAKER_02 35:02

Absolutely.

Building Better Stress Reducers

SPEAKER_02 35:03

Talk to me about what you recommend as finding alternative stress reducers.

SPEAKER_01 35:08

Well, so literally anything we can do can become a stress reducer. That's the cool thing, right? There's all kinds of stress reducers. Some of it just depends on who you are, what you like to do. Most people already have a number of stress reducers. One of the problems that I've seen when I've gone to lectures, one of the problems that I hear about is that people, this is what here's the theory is that people with addictions, the reason they get in trouble is they've narrowed their stress reducers down to one. Like all they do is heroin, or all they do is cocaine, or all they do, and they don't have other things to do, right? So one of the things that I say is like, if you are a smoker and I say to you, okay, we'll chew on carrot sticks, you're like, yeah, that's not really gonna work, right? Because that doesn't give me the same benefits that cigarettes do. But here's what I tell cigarette smokers think about what they're doing. They go, So, what is that? It's a deep breathing exercise, right? Well, you don't need to have a cigarette to do a deep breathing exercise, just do the deep breathing exercise, right? So those kinds of things. This is where hypnosis with the NLP comes in. There's two things that we talk about. So most people, somewhere online, figure out that what they're doing is causing problems and they shouldn't be doing it. Like they think, yeah, maybe I shouldn't be drinking alcohol or maybe I shouldn't be smoking a cigarette. But they just they get stuck. Most everybody that I saw, I would say 90% of the people I saw who wanted to get off heroin didn't really like heroin anymore. They were only doing heroin because they didn't want to go into withdraw, which is why Syboxin was so effective, because that allowed them to not go into withdraw and yet get a little bit of the same benefits they were getting. It would calm them down a little bit, just not as much as the heroiner, but had none of the side effects that the heroin had. But the problem that we get into is our brain, and this is normal now. So this whole process is normal. We have stress, that's normal. We find stress reducers, that's normal. And then our brain does what it's supposed to do, which is when you're doing something regularly, it makes it into an automatic track. So there's an anatomical track in our brain that says, hey, when that trigger goes off, go do that. And so what happens is that becomes an anatomical track that's there permanently until somewhere along the line, maybe in the future we'll find a zapper that can go in there and zap out the tracks that's not there anymore. And then we won't have this problem. And is this fascinating, right? We've seen people who get head traumas who are smokers. Guess what? They don't smoke anymore because the track got disrupted. And you're like, whoa, so there's an answer to how we get rid of addictions. Find a zapper to zap out the track and then it's gone. They are doing deep brain stimulation for addiction. Yeah.

SPEAKER_02 37:52

Very experimental.

SPEAKER_01 37:53

Yes. Um it's not zapping, so that's a different thing, right? So now, so here's what happened. So now we got this track in our brain, and we go, I don't want to use that track anymore. So you start making a new track. Okay, so instead of smoking, I'm gonna eat Twinkies. And it's like, okay, well, that's working. I'm eating Twinkies. This is good. Every time I want a cigarette, I'm eating a Twinkie. Well, oh my God, now my clothes don't fit anymore, and I'm 20 pounds heavy. Like, nah, forget this. I'm gonna go back to smoking a cigarette. Or this is interesting. So I was going to talk to a lady who was running an addiction program. Okay. So I drive up, and there's a lady sitting out on the loading dock of the building smoking a cigarette. I don't know who she is, right? I park, I pull in, I go in to meet this lady. Oh my God, this is the director of the addiction center's treatment and had been outside smoking a cigarette. So she's telling me all this stuff about how heroin addicts and alcoholics think they can do this on their own and they're, you know, dumb and like they keep relapsing and blah, blah, blah. And I go, oh, well, like, I don't know, do you like smoke cigarettes? She goes, well, yeah. She goes, but I'm I'm quitting again. And I go, what do you mean? She goes, well, I quit, but then my mom got really sick and that really stressed me out. And I started back, but I'm gonna quit again starting next week or next month or whatever. And I'm like, I didn't say this out loud because that would have been insulting. But I go, you realize you just said that you do all the same things that a heroin addict does. Like you're gonna try this on your own, you've relapsed, you got stressed out, and that's why you got back on it. Somehow you think smoking is okay when heroin is not okay. Whatever. I don't know how you how you figured that out. So here's what I've been seeing is that people can have all different forms, but that idea that a big giant stress comes along, or the skills that you were using to inhibit that track get diminished for some reason and you're back on.

Relapse Mechanics Inhibition And Deprivation

SPEAKER_01 39:48

And we know this, right? How many the percentage of laps is like I don't know, 80, 90%, right? I mean, it's really high. And yet, when someone laughs, here's what we say to them What the heck is the matter with you? Why were you so stupid? Why did you choose to go back on knowing all these consequences? What the hell is the matter with you? And then the person hangs their head in shame and guilt and like, oh, I don't know. And then that becomes another reason to go back at you is because they feel bad about themselves, right? So here's my question to them. I go, look, I understand that you got this track in your brain. So what happened that your skill of inhibiting didn't work that day? What happened? And I go, so what that does, and it gives them credit for all the times they've been inhibiting. Maybe it was a week, maybe it was a month, maybe it was 20 years, I don't know. Something happened where your ability to inhibit stopped happening. And all the time, every single time, there was like, oh, this happened and it freaked me out. And I don't know. So one of the examples, I had a lady who had been doing cocaine and she was doing fine, but she had lost custody of her kids because she had been having so much trouble with the cocaine. So she was out and out and about, and she was at a park, and there were her kids across the park, but she wasn't allowed to go see them. Well, that freaked her out. And then all of a sudden her inhibition went away, and she's like, I gotta go do some cocaine, which then got her in trouble, right? So in my motto, where I'm going, no, the the skill of inhibition is way different than the skill of choice. So choice, we go, oh, I want vanilla, I want chocolate. Inhibition's like, see that track? Not gonna do it. We're the only animal that can do that, and we're not that good at it. So, like, if I'm trying to lose weight and I go to a uh like a smorgasbord, and there's a bunch of donuts there, and I'm like, oh God, I want to lose weight, but those donuts look good. So you walk past it and like, no, I'm not gonna eat them. And then you walk past them again, and then you walk past them again. But by the 11th time, your inhibition goes away and you're eating the freaking donut, right? Well, that's not what I wanted to do, right? Because our ability to inhibit, we're not that great at it. The second is then this thing called deprivation. And what I see is when people are smoking, they don't feel deprived because they're smoking, right? But when they decide, and here's the word I use, use the word quit energy, Q-U-I-T energy. They go, okay, I'm gonna just quit. So I gotta put some energy into this. So I'm gonna struggle and inhibit, and I'm gonna go to a program and I'm gonna spend some money and I'm gonna buy knicker at com and I'm gonna do this and da-da-da. I gotta put some energy into the system. Okay. But over time, that energy starts dwindling. It's just like, ugh, I gotta buy gas, and gas is up now. So I don't know if I have money for the nicker at com. And at the same time, you're feeling deprived. You're going, you're sitting next to somebody smoking a cigarette, uh, and you're like, whoa, wish I could smoke that cigarette. It smells so good, right? So as your deprivation goes up and your quit energy goes down, somewhere where they cross, and now all of a sudden you're lapsing.

SPEAKER_02 42:53

I was gonna say you have all the same concepts we use in addiction medicine, you just frame them differently. I love it.

SPEAKER_01 42:58

Yes. And so when you see when you lapse, then you're like, well, so I can go, let's do rah-rah, rah, you know, and go, let's Richard Simmons go, yeah, come on, I'll let you, you can do this, right? And we'll build up your quid energy. Keep going. Well, there's a finite amount of quid energy. What works better is not let's make it so you don't feel deprived. So I would say to my patients in the room, I go, okay, when you walk out of this room, I never want you to eat mud again in your whole life. Ever. And they look at me like, yeah, okay, I think I can do that. And you're like, wait, well, why is that so easy? Why can you just sit here and say, I'm never gonna eat mud again in your whole life? Oh, that's right, because you don't feel deprived when you walk past a mud puddle and go, Oh, there's some really good mud, I wish I could eat it. No, but if you walk past heroin or cigarette, you'll be like, oh, right. So we got to figure out a way to not make you feel deprived, because then it takes no energy. So I know you I I know I know some cigarette smokers, and they'll tell me they go, you know, doc, I just put the pack down, never thought about it ever again. Never even crossed my mind. And I go, yes, because. And I was like, how could that be? And then I realized they just don't feel deprived. Whatever they've done, they picked up something else. Whatever they're doing, cigarettes are not a part of what they do anymore because they don't feel deprived. So it doesn't take any energy at all. So I was I was doing a smoking in class and I said, Look, you guys are giving up cigarettes. So I got to give up something so I can, you know, be empathetic with you guys. I go, I'm gonna give up Diet Coke. And they looked at me like, Sprouse, you drink six or seven Diet Cokes a day, there's no way you're gonna give that up. And I'm like, yeah, well, I'm gonna work on it, right? I'm gonna do this because I'm gonna be empathetic with you guys, right? So I gave up Diet Coke and I started drinking water. Yeah. Well, after a couple weeks, I was like, water's really boring, right? This isn't gone good, right? So then I found Mio, which is a flavoring, right? So now I put some Mew in, there's like five different flavors, so I could pick and choose, and the water's already ready there. I haven't had a Diet Coke in 20 years. Okay. And my wife drinks Diet Coke. So we can go on an eight-hour trip now when we're driving, because now I'm retired, we drive around, right? And there's a Diet Coke sitting right next to me, and I could care less as long as my water with me is there. I don't, you know, I don't want Diet Coke anymore, right? Like, nah, right? Turns out the water with me is better than the Diet Coke. So when you do that and you decrease the deprivation and you give people credit for their inhibition and you teach them how to be better at inhibition and you give them alternatives that work as well if not better, and you get rid of the stress that was causing the problem begin to, then things are a lot easier. And someone said to me, Well, it's not easy. I go, I didn't say it was easy. What I said is when you know what it is that you're trying to do, then it's straightforward and it's easier to be successful at what you're trying to do.

Loop Breakers And Prevention Early

SPEAKER_01 45:53

What's you uh what's your next project? Well, actually, I'm starting on this thing called loop breakers. And it's sort of like the alternative to AA or smart recovery or CR. So I want to have like a hybrid meeting where there's some people in the room and people can join online. And what I want to do is so AA for the people that AA works for, it's great, right? We just don't know how many people it doesn't work for. So I was talking to a business consultant, she's like, Who's you who's your avatar? Say, my avatar is the person who recognizes that they're in a loop. One, two, that they want to do something about it. And three, they've tried other things that didn't work. So I feel if AA works for you, go for it, right? I'm not, I'm not here to convince people in AA to come over to my place. I'm like, no, no, I'm gonna talk about the 80% of people who've tried AA, who've tried rehab multiple times, who's done this, who's done that, and they're still having problems. That's the person that I want to deal with, right? So come on with me. And in that meeting, what I want to do is actually educate people of what it is that they need to do. So I came up with this like 16 or 17 week, and I don't want to call it a lecture series, but it's information series, right? Because you can educate yourself out of an addiction. That's what I'm finding. Like if I give people the right tools, they're gonna get their own way out of it. They most people do not want to be in a stress-reduced loop. All of a sudden, they just don't know how to get out. And right now, what's happening is there's because they're in this loop, their stress has increased over time and getting worse and worse and worse. And when they finally admit there's a problem, by then they're like way messed up. I was like, I'm gonna find people. I what I would love to do is go into like two-year-olds and go, let me teach you how to deal with stresses too. Because guess what? Two-year-olds have stress reducer loops. Yes, right. They have their blanket that they can't get rid of, or they have their uh pacifier that they can't get rid of, and it's ruining their teeth. But you know what? You can't get it out of it, or you can't get that blanket away from that fancy toy. But for two-year-olds, guess what we do? We just take it away. And they're not smart enough to figure out how to get it on their own. But we can't do that with adults because they're smart enough to figure out how to get it without, even if we say, no, you can't have it, right? So what we have to do then is teach, and what I would rather do is teach people how to handle their stresses before a stress-reducer loop forms, because it's way easier to prevent one from happening than it is to treat one once it's there. Well said. As we get to the end of our time together, any last thoughts you want to leave us

Resources Final Takeaways And Farewell

SPEAKER_01 48:30

with? So I'm gonna be starting loop breakers probably September or somewhere in that range. So hang in there till then. I have a website, it's thelessstressedoc.com. And on there is uh a chapter of my book, The Worry Chapter. We didn't talk about worry, but in that chapter is there's a free download where they can take that chapter and find ways to not have as much worry. So they can keep their skill of envisioning the future, but without the fear of the worry that's what's gonna what might happen. Uh, and there's also a course in there about the book. So if you don't like to read, or you're driving along, there's even an ebook, or you can get this download of this course where it teaches you how to have less stress, basically. And because what I find is if you have less stress, then that desire to use these other things goes way down. You've put quite a bit of work into this. This is amazing. Yes. Well, what I like about it is it's taking all the information that we already know, it's just putting it in a different place. So instead of saying it's a disease, we're gonna call it a treatment. Well, we already know how to use treatments. We go, we're gonna find the best treatment with the least amount of side effects. Well, that's easy. If I have the disease model, giving somebody Suboxan with the disease model, it literally makes no sense. You're gone, you have the disease of opioids, but we're gonna give you an opioid to fix that disease. And you're like, wait, what? And so what you see is there's all this ambiguity about it, like all this ambivalence. Like, ah, I'll use it for a little while, but feel stupid to get now. I'm just gonna get them addicted to Suboxane. But if you saw a cock it as a treatment, you go, okay, we're gonna use syboxin as your treatment for stress, and it's gonna replace this other treatment that's caused all kinds of crazy side effects. Well, then I don't care as long as it doesn't cause side effects and it's working because you're back to work and you're back with your family and your kids know who you are again, and you're not going to the ER overdosing all the time. Well, then this is a good treatment. This is good, right? And then as we figure out, hey, maybe we can find other treatments, because Suboxin doesn't have no side effects. It has some. Like you have to go to the doctor every month and you have to hope the pharmacist has it and the pharmacist insurance will pay for it, and it tastes kind of crappy, or you got to get a shot every once in a while. So it's not no side effects, but it's a lot less than it was. But if I teach you how to handle your stresses with meditation or exercise or something else, well, then your life's even better, right? Well said.

SPEAKER_02 50:53

Love to say, thank you for joining me today and sharing your model. I look forward to sharing it with my patients. Cool, excellent. Thank you so much for listening to Addiction Medicine Made Easy. If you found this helpful, please leave a review. It really helps others find the show. And a huge thank you to Central Coast Overdose Prevention for supporting this podcast. And always remember treating addiction saves lives.