Reconstructing After Addiction with Dr. Nicole Labor (Part 1)

Dr. Nicole Labor returns to Out Of The Blue The Podcast to talk about what “reconstruction” really means after addiction and why recovery is about building a life that can hold happiness, connection, and purpose.

Dr. Labor breaks down addiction neuroscience in plain language, including her unforgettable dopamine baseball field analogy that explains tolerance, anhedonia, and why “normal” pleasures stop working. From there, we zoom out to what drives substance use disorder in the first place: pain, trauma, and the fact that every brain interprets experience differently. 

We also dig into harm reduction, naloxone access, and the tough truth about stigma: sometimes the loudest judgment comes from people who quit easily and assume everyone else can too.

Stay tuned for Part Two.

For more on Dr. Nicole Labor:

Laborhood Change Project, Inc.

Out Of The Blue:

Transcript

Welcome Back Dr. Nicole Labor

SPEAKER_00 0:22

Welcome back to Out of the Blue the Podcast, where we celebrate those unexpected moments that change our lives and lead us toward healing, purpose, and connection. I'm Vernon West, and I'm here with my co-host, my son Vernon West III, the creative force behind our logo, our theme music, and so much of the soul of the show. Today we are thrilled to welcome back one of our favorite guests, one of our favorite addiction ninjas, Dr. Nicole Labor. Dr. Labor is a physician, educator, advocate, and one of the clearest voices in the fight against addiction and the stigma that surrounds it. Her new book, The Adictaholic Reconstructing, takes us beyond understanding addiction and into the next great challenge: how to rebuild a meaningful, joyful life in recovery. She's on the front lines every day helping people heal, helping families understand, and helping communities replace shame with truth and hope. Today we'll talk about her new book, Reconstruction Really Means, and the latest from the front lines of the war on addiction. Please join us in welcoming back Dr. Nicole Labor right here, right now on Out of the Blue the Podcast. Hi, thank you for having me back. It's nice to see you. Nice to be back with you. Our honor, it really is. An honor. Um so so where have you been since the last time we spoke? Because it was I mean, same same shit. Same shit today. Bigger pile. Bigger pile. That's what they used to call it. That's true.

SPEAKER_02 2:07

Yeah, no, just the same thing, you know, a lot of clinical work, a lot of um social media work, a lot of public education work.

SPEAKER_00 2:17

Same stuff. Yeah, and I love your social media stuff because it's very educational, it's illuminating stuff, you know, it's really spreading some important messages. Now, you've been out in Akron, you're still at the hospital that Dr. uh Bob was at, or did you move from that?

SPEAKER_02 2:35

No, yeah. They so actually they closed that hospital the uh a couple of years ago and they moved the detox unit over to the main campus of the hospital. Um, but I haven't worked there in probably eight years.

SPEAKER_00 2:51

But what you mentioned it to us on the last podcast, you maybe just mentioned you had worked there, I guess.

SPEAKER_02 2:56

Yeah, it was where I started my career. Okay, there you go. That's what it is. Yeah, I worked there for probably eight years. And then um, when I got pregnant, I left because I, you know, you when you're working in a hospital in detox, you're on call 24 hours a day, seven days a week. So I couldn't really do that with a newborn.

SPEAKER_00 3:15

And well, anybody that knows anything about the big book of AA and anything like that would agree that's an auspicious way to begin a career in this kind of field. Because where else the the place that the the magnum opus of uh of recovery has was born.

SPEAKER_02 3:34

I was like Dr. Bob reincarnated, like that was my job, right?

SPEAKER_00 3:39

That's crazy. That's crazy. I mean, woohoo, I mean, I know you didn't mean that. So, folks, she's kidding. Okay, this is the doctor that says fuck a lot. She fucks around with you, she will fuck around with you, so don't worry about that. She's not woo-wooing that she used to, she's reincarnated, Dr. Bob, you crazy motherfucker. So don't even think that. So you were there so many years. That's an amazing thing, anyway. And now it's where are you now?

SPEAKER_02 4:09

Um, I work, so I'm the medical director of a bunch of several different facilities. So, like uh one in Worcester, Ohio, where we have residential treatment, outpatient treatment. Um, you know, I'm there. We have uh a residential and outpatient treatment center in Akron that I also work at. And then um there's a uh statewide agency um that I'm that I work with that does uh again a lot of mental health and addiction, both inpatient and outpatient, just different places.

The Joy Side Of Sobriety

SPEAKER_00 4:46

So I'm a little bit all over the place. And mental health and addiction go hand in hand in so many ways. I mean, um because um I mean we were talking a few seconds ago, minutes ago, we were talking how post when you have some long-term sobriety, not enough attention is given to that. But going back to the fact the part that people do focus on, the early sobriety, which is what you're steeped in, right? You your your world is comprised of dealing with a lot of that. And that still is the front lines, that is where the rubber does hit the road. There is no long-term sobriety without that. And um, let's face it, that is a beautiful thing, long-term sobriety. That's the fruit of the garden of the 12 steps. Um and uh the I I believe in so much in it the 12 steps. I mean, uh not in a uh woo-woo kind of way. I believe in them as scientifically. I think that they they do actually if you do them thoroughly and you are absolutely rigorously honest to a fault, like you do the best you can, you can't think of anything else, and you do each step like that, it is an amazing thing that happens. You say, and then you get Bobby Flay in to help you with the uh the cake recipe, and you get you know, and you get a wrestler, you get a cake, man, and you're talking something you never would have expected. I personally was completely blown away by the cake. I mean, because I was just doing everything as I was so desperate when I came into sobriety, becoming sob wanting sobriety. I was like a pit bull, you know. Give me that sobriety. I didn't know how I was gonna get it, I didn't know how this stuff was gonna work. Quite frankly, I didn't think it was gonna work, but I think if they're doing it, just gonna do it. I have no I have no other way, but you know, I couldn't think of anything else. Believe me, I tried. And I and I did it so hard, but then when I wasn't looking, it's almost like when I wasn't looking, all of a sudden I realized it happened. I got uh I got no more obsession, you know, relieved of that pretty early on. But no, I but what happened after that was something beautiful that it became like I loved life again. I mean, that's the thing that blew me the way because I used to love life a lot because I was a pretty innocent kid. Um I was really um, you know, my f my classmates voted me president of my class. I was I was a nerdy smart kid. I wrote the really great class uh history. Someone told me about it not long ago, that I had everybody rolling the floor because I was pretty funny. And then I then I was also became a musician. I I covered all the bases as a kid, but I stayed really innocent and pure, and even though it started going into my music career, it was that innocent and pure purity that got me this big opportunity where I opened for Barney Reid totally out of the blue. And we play played for 12,000 people, and next thing you know, I was you know, we were hot. And um then I was not prepared because I was California sober. I was California sober. I my father had died from drinking and I was smoking a pot. I said, No, it's not booze, it's not gonna kill me, but it it does something, it definitely does something, and it makes you not use your full total intuition on yourself, and uh you're not in tune, you're just not aligned anymore with the true self once you throw something like that in there. Me personally, I'm not gonna judge anybody out there who's California sober, no judgment here. But for me personally, I not I never would have got the 12 steps, I never would have been able to if I didn't strip all that away and not have any go-to relieving of my pain. Because that's what it's about, really. Pain. Because I think that's childhood trauma in my case set me up for addiction. And it's not only that, but my dad was an alcoholic too. But that was part of my childhood trauma, not for nothing. But um, do you find that to be true when you're out there in the world getting the young kids or people coming into detox now? Same thing, or is it different?

SPEAKER_02 9:22

Yeah, I would say that most people have some degree of trauma. I just think that the the the issue that we run into is like understanding that every brain is different, and the way that some one person's brain interprets something as traumatic may be very different from the next. So it becomes really hard to kind of pinpoint or say, like, well, yeah, you didn't have trauma or whatever. Um, but really anything can be perceived by the brain as trauma. So, you know, people may go through something in childhood that everyone else objectively looking at is like, that's not traumatic. But for that person, their brain changed during that time and they internalized it as something traumatic. And so, um, yeah, I think everybody to some degree has something traumatic that every person with addiction at least has something or some sort of traumatic thing. Um, and again, it may not be some like catastrophic, you know, physical abuse or something like that. And it sometimes takes a long time to kind of find it because you know, yeah, yeah.

Trauma, Pain, And Brain Differences

SPEAKER_00 10:28

I'm not sure I had a I agree with that so much because I don't think I had a real big traumatic thing. At least I've tried to done everything in my my hypnotism, everything to try to find out if there was, but I can't. I can't find any real childhood abuse thing that happened, other than my dad, you know, he was an alcoholic. So he did things like beat the shit out of me in front of my friends when I was 12, you know. That's not that's trauma, but I mean, um the um the thing about pain that I was talking about before it became picked up any weed was I didn't know I was in a pain. I think that was that was the thing I didn't know. And I that when I read your first book, that opened my eyes to that, and I I really didn't realize it. And I've shared about it uh for other people now in meetings and stuff, that I didn't know how much pain I was in. I really didn't know until I found something that relieved it. And then all of a sudden it was like, What? You mean people feel like this? What was I missing? Life is good. You mean you don't have to walk around feeling this all the time? I couldn't believe it, and I was a nerd, so I knew everything about it. I said, you know, the molecules to hydrocannabinol, and oh my god, yeah, ad nauseum. But um, so you your book, the first book, if people who are gonna get the second book, and you date people listening, you have to get the second book. It is the definitely the new testament as opposed to the old testament. The old testament talks about really, really, uh the yeah, it's that punishing God of the Old Testament. It's definitely something very real. The first book is so real and gritty and downtime, but it covers everything, it covers the brain chemistry. And you have that analogy of the people in the field catching the balls. That is the best analogy I've ever heard. So tell us again that that wonderful analogy about the dopamine receptors and the people in the field, because it really works.

SPEAKER_02 12:39

Well, and I'll say, like, so the the first book, Deconstructed, you know, that was like really a labor of love. You know, like I was so entrenched in that educating about addiction to the point of like moving the dial on stigma. Like that was the goal. I want everyone to really understand the brain science here in a way that's palatable for normal people, not just weird, nerdy, you know, scientists, um, to really grasp what's happening in the human brain when addiction occurs. And so it's it is like I talk a lot about my story, and there's there is detail, and I tried to get really in the in-depth, you know. So it does that, does that, yeah. Yeah, and well, and I also want to say, like, you know, that book was written in 2019. So before 2020, before everyone lost their ability to focus and read, and you know, so it was more in-depth because it was written for an audience that could read like that. The newer book is is actually was written with this idea in mind that people now only consume bite-sized information. And so the style of writing and the conceptualization of things is different in this book.

SPEAKER_00 13:58

You're making me afraid. This this kind of makes me afraid that I've become that person too, because when I read it, I was going, this is really so good.

SPEAKER_02 14:07

It's so easy to read, right? Because yeah, that's right, because that's how we are now. We're just like we consume small things. But you'll notice as you read through the new book, it starts out very like short bullet points, like these are, and as you get longer and longer into like the last the thrive chapters, that starts to get more in-depth, like the first book, because the hope is that if you're in the thrive portion of your recovery and life, then you do have the attention span and ability. A little bit more than a gnat.

SPEAKER_00 14:39

You you've gotten some attention span, yeah.

Writing Recovery For Real Life

SPEAKER_02 14:42

Right. So in in the addictive, in both of them, I use the analogy, or I talk about the um dopamine receptors. And essentially, we have a ball field, and that is your reward center, and your your baseball field is full of players, and they're standing there with their mitts up, and there's let's say a hundred players in the field. So it's a field saturated with players. And in order for your brain to say, I like this, this is something I want to do again, at least 10 players have to catch a ball. So every time you do something enjoyable, your brain dumps a bunch of balls into the field, a bunch of dopamine into the field. And if 10 players catch a ball, you go, Okay, I like this, I want to do it again.

SPEAKER_00 15:25

Now, that's where's the glutamate come in?

SPEAKER_02 15:28

Glutamate's a different area of the brain. Oh, yeah. Yeah, that's yeah, that's happening at a different level.

SPEAKER_00 15:33

Does it coordinate with the dopamine receptors in some way? It's happening simultaneously. What is that?

SPEAKER_02 15:38

Yeah, so well, so what um where glutamate would fit into this would be every time balls get thrown into the field, glutamate is the announcer at the stadium going, Holy crap, did we see what just happened there? Let's let's write that down, folks. Like, you know, keep in mind. Yep. Okay. So that's glutamate. It's logging the the cue with the re response.

SPEAKER_01 16:03

Okay.

SPEAKER_02 16:04

So you do something you enjoy, like go to a baseball game or you know, hang out with your family or whatever, something that you enjoy, you dump like 25 balls in that field, 30 balls in the field. And so 10 players probably will catch a ball because they're pretty packed in there. But what happens when you start using substances, highly rewarding substances, um, including your uh California silver THC molecule, they all dump, let's say, a hundred to two hundred balls in that field. Yes, they do. And so when you repeatedly do that over and over and over, your team manager goes, Okay, I'm not gonna keep paying salaries on all these players.

SPEAKER_01 16:55

Too expensive, working too hard.

Dopamine Baseball Field Explained

SPEAKER_02 16:58

Starts pulling them off the field. So the receptors downregulate, and eventually you're left with, let's just say, 12 players on the field total. And now they're scattered and they're few and far between. So now when you go to a baseball game or you do something that you enjoy, you play your guitar or whatever, you dump your 25 or 30 balls into that field like you used to. Well, those 10 players that need to catch them probably aren't gonna get to them in time before they get sucked back out of the field. So you no longer enjoy things that were previously enjoyable. Yeah, that's true. You can no longer get joy from things that are naturally enjoyable because anything natural is gonna release 20 balls or so.

SPEAKER_01 17:44

Right.

SPEAKER_02 17:44

So the only way that you ever feel normal anymore is when 200 or you know, 150 balls are thrown into that field. And so that the remaining 10 or 12 players are able to get to to a ball in time, right? But because it's only 10 players catching balls, you can't ever feel any more pleasure than that, right? So you kind of just stagnate, you become tolerant, you can't have that euphoria anymore. And now you're not you're using to feel normal, but you're really just using to escape feeling shitty from not having the balls.

Harm Reduction And Naloxone Reality

SPEAKER_00 18:20

Yes, sir. That's exactly the path that happens, right? I mean, I can remember it clear as bell, you know, because I definitely rem I like to remember that. I want to keep never forget that because um, yeah, because that's my that's helpful, you know. That that that keeps me sober, it keeps me appreciating sobriety. I love sobriety, I really love it. You know, I love the way you talked about moving the needle on stigmatizing it because it's so important an issue in my mind, is the stigma that it all has. It's stopping any kind of it's it's it's such an uh impediment to helping people and still is. Um you mentioned harm reduction in this book as well, as part of uh some of the things in this capital H harm reduction, you know, and there's you know, this little lower lowercase. We had a guest on, Gary Langis, who's that's his gig. I mean, he's a harm reduction person for Northeast US New England. And he started uh he's the one that uh pioneered getting uh the anoxin uh with the proxin. Right. He he pioneered that. He they wouldn't the co he made he got co-ops to take it with them in their cars when they could they encounter people that OD'd and at first they wouldn't, it was illegal and they wouldn't do it. Then he went to Washington. So he the the hoops he had to jump through just to help people, and he's all about harm reduction, providing safe uh IV sites, you know, clean works and all of that. I mean, it's such a stigma that people don't they'd rather they don't want him in their city. If there's they want to open one, they they they don't like they want all these junkies coming here, these dirty, rotten, you know, there's business people, there's all kinds of people that get hooked on drugs. It's not just uh whatever you stigmatize is so wrong. I think it paints a picture of someone uh who's been caught in the web of addiction that doesn't take into consideration that it goes from what and from yale to jail, we used to say you know, it doesn't matter. You know, anybody is susceptible to addiction. And for for the for the for the mindset to be stigmatizing it, man, that's such a good work to do to destigmatize it. How do you think that has changed? Do you think that that's that needle has changed at all? Or what do you think? Have you moved it?

SPEAKER_02 21:01

Yeah, well, yeah, I think, I mean, I think to a large degree we we have done an okay job in in moving the stigma. Um, I think that there's still, I mean, obviously it's still out there, right? And it still does exist, but I also think that I think with the with the birth of whatever uh you want to call it of the opioid epidemic, um, as much as I hate to call it that because I hate to focus on singular drugs, um, I do think that whole period of time forced people to sort of start looking at this as a problem that anybody could have because it became mainstream and like the media was talking about it, and people were, you know, the people who were suffering from opioid use disorder were like your neighbor or you know, people that you didn't typically associate like as that type of person. And so It did start opening the door for people who had been keeping it like inside because they had shame or whatever, like you know, advocating more and trying to do more. So I do think that we have moved the needle a little bit. I think I still think we got a long way to go. Um, I have, you know, I I on social media, I'm I have a large following on social media, and that means I get a lot of comments. And one of the most, in my opinion, one of the because there are there are people out there that are just like, no matter what you do, they're gonna be like no addicts or scumbags. Like there's nothing you can do to change their minds, right? But just like there's people out there that are gonna be like racist, and there's nothing you can do because they're just dumb, right? Okay, I can't change you. Um you the people that are the most stigmatizing to me are a lot of the people who had maybe problematic use of substances in their lives, but were able to just stop at some point. And they didn't necessarily have what I call like the true addiction, where they had the brain changes. And so they are using for years and years and maybe had some problems from their use, but ultimately at some point they're like, Oh, I'm done. I'm I'm not using any more time to grow up. And they put it down, and then they're the ones online going, I've been sober 20 years. I didn't have to use any program, I didn't go to therapy, I didn't have to do anything, I just found a better life, and I don't even call, you know, whatever. I'm in recovery for 11 years, and I'm always like, Well, what are you in recovery from then? Like, what was the problem? You you were choosing to use drugs and then you stopped. Like, yeah, where did the recovery happen? So, but those are the people that are the hardest to really get through to. Like, no, I understand you used cocaine for 20 years. I get it, I get that you were hardcore into the scene, but if you put it down and walked away one day because you decided enough was enough, you technically probably didn't have addiction. So you don't qualify in the same way as this guy over here who's in tears because he cannot pull himself out of the trap house. Like there's a difference.

SPEAKER_00 24:13

There's a huge difference, yeah.

SPEAKER_02 24:15

Yeah, and it's really hard to like. So I have better luck getting non-addicted people or people who don't really use substances problematically to understand that than I do the people who used substances and just think that they were, you know, they were magically able to get better, and therefore everyone else could too. So that's kind of where I feel like the stigma really it remains heavily. Um, and it's a hard that's a hard push.

SPEAKER_00 24:46

It really is. What do you do usually to bridge that gap? Have you ever had a successful situation where you were able to get through to someone in that way or in like the masses?

SPEAKER_02 24:58

I would say that there have been like individual cases, even like on social media, like in the comment section, if I'm like bothering to have the discussion where I've I've been able to kind of recognize someone being a little more open-minded, and I give them that information. Like, if I took you and I put you in a brain scanner, and I took this guy and put him in a brain scanner, you guys both used cocaine for 20 years, your brains are gonna look different because you were able to stop and he wasn't. Like there's a difference, and so sometimes I do think that they're able to hear that and go, Oh, okay, I guess I was just really lucky, you know. Um, but more often than not, they just double down.

The Stigma From “I Quit”

SPEAKER_00 25:40

So they just don't get it. Um, it is almost like um the same thing as racism, you know, it's like they don't recognize another physical condition. Like that they just don't see it. And um, yeah, how do you change that? But what we can do, maybe uh the what I love about this this new book too, which and and I have a bunch of things I want to touch on, but what I love about it is that it's almost like recovery isn't just recovery, it's living life on a level of of of uh connection and alignment that that makes it more deeply appreciated. That that joy becomes a larger component. I mean, are these people who say this are they really living life like that? I mean, that I wonder might be the way to connect people that if they could see that um that maybe they're not. I mean, maybe they were able to stop the disusing and they didn't they don't have the same brain as the guy who got addicted. But maybe there's other things in their life that they are just as fixated on and that are taking their joy and diverting them. Because I mean to me, the most joyful people that I've ever met. And I'm I'm sure you have uh like a guy that was a guru. Well, I knew this guy devoted his life to meditating and meditating with people. He's such a serene human being, always about being of service, but also with boundaries, you know. I love the way you say, you know, if you truly get your shit together, you're not gonna say yes to everything. Sometimes you can say no. All right now, I don't have time for that. But come back when I'm ready to hear it, maybe we'll talk. But I mean, um but that's a sign of a sort of a realized person, you know, an actualized human being. And um I don't know what these people that are talking this way, because if they were even close to being a realized human being, they would have empathy for these other individuals who are struggling. Because I think that's a big part of what happens. I think myself include I I I speak for a lot of people that I know who've been through recovery, uh, and uh maybe you I think you too, absolutely. A lot of this is is driven because we do empathize because we know what they're going through. And that's I always say that one of the best things about my past is that it's something I can use to connect with people. It's it's because you know, I always say you're turning the you know shit into shit into gold, you know. Uh are you able to turn it into something that can make connection with somebody struggling. And then they might get to the point where they'll listen to you, you know, and maybe, well, if you did it, maybe I can, you know. Um that's about the best usage of the crap that I went through I can think of. You know, it's not really something I want to talk about too much, except just for that reason. But um, it doesn't serve me any purpose to dwell on it, other than to realize that I'm grateful today for not having that burden.

Disease Model Vs Moral Blame

SPEAKER_02 28:45

I think it's a lot of like people don't know what they don't know. So if you know they never reached that point of severe desperation, like where they wanted desperately to stop and were unable to do so, they didn't have that. They reached the point where enough was enough and they wanted to stop and then they just did. So they don't know what it feels like to be that person crying with a needle in your arm because you fucking don't want to do this again, you know. Um, but yet here you are. Uh so if they don't know that experience because they've never gone through that experience, then they then they're not going to be able to relate. And yes, I would think that, and it's true, it seems like you know, um reasonably open-minded, um, intelligent people are willing to hear that and say, okay, yeah, I didn't have that. And so maybe it is something different, and I feel fortunate. But people just don't know what they don't know. And so I I try not to hold it against them. Um, you know, but again, to I I post a lot of videos that say things like, we know that the caption on the screen will be like, addiction is not a choice, addiction is a disease. And I talk about the brain chemistry and I talk about the fact that it's not like yes, you choose to use substances, but ultimately you don't choose whether you're going to have the brain change or not. And once it occurs, you can't just undo it. That's the disease part. And so, but just that caption alone invites people to come in and start, you know, um criticizing. And um, I I used for 25 years and I put it down. It's it's a choice. Um, it's totally not a disease. Stop giving people excuses, you know, and a lot of that. So I just think I'm making a moral issue. That's what they do. Again, people don't know what they don't know, you know.

SPEAKER_00 30:50

Out of the blue, the podcast, hosted by me, Vernon West. Co-hosted by Vernon West III, edited by Joe Gallum. Music and logo by Vernon West the Third. Have an out-of-the-blue story of your own you'd like to share? Reach us at info at out of the blue-thepodcast.org. Subscribe to Out of the Blue on Apple Podcasts, Spotify, or wherever you get your podcasts. And on our website, out of the blue hyphen the podcast.org. You can also check us out on Patreon for exclusive content.