July 4th Alcohol Series: The Latest Science and Changing Attitudes with Dr. Mashal Khan

Mashal Khan, M.D. is an Assistant Professor of Clinical Psychiatry at Weill Cornell Medicine and Associate Program Director for the Addiction Psychiatry Fellowship. As the psychiatrist on the Liver Transplant Team, he evaluates organ recipients and donors and provides them with transitionary care. He utilizes his expertise and understanding of addictions to improve outcomes for individuals with Alcohol Liver Disease. His area of interest and clinical focus include technology-assisted interventions for substance use disorders and management of alcohol use disorder in patients with alcohol liver disease.

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Transcript

SPEAKER_00 0:00

Welcome to the Thriving with Addiction Podcast, where we explore how recovery is not just about surviving, but about truly living. Each week we'll dive into the styles, stories, and strategies that help people and families heal from addiction and build a healthier, more resilient lives. I'm your host, Dr. John Avery. Let's get started. I'm John Avery and welcome back to Thriving with Addiction. Today I'm joined by Mashal Khan. Mashall is an assistant professor of clinical psychiatry at Wild Cornell Medicine and Associate Program Director for the Addiction Psychiatry Fellowship. As a psychiatrist on the liver transplant team here, he evaluates organ recipients and donors and provides them with transitionary care. His area of interest and clinical focus include technology-assisted interventions for substance use disorders and the management of alcohol use disorder in patients with alcohol liver disease. And he's written and edited several great books on these topics as well. He's also a trusted colleague and friend here at Cornell. Masha, welcome.

SPEAKER_01 1:08

Thank you. Thank you for having me. This is very exciting.

SPEAKER_00 1:12

Now tell me a bit a little bit about your journey to become this expert in alcohol use disorder that you are. How did you how did you get here?

SPEAKER_01 1:21

Oh, it's it's been a long journey, John. Um I'd say a combination of life experiences and um clinical exposure led me down this path. You know, um generally I'd say the the path to addiction psychiatry was um was more obviated uh by my exposure to uh you know uh during residency years when um as you're treating mental health disorders you recognize and very quickly that you know people um tend to try to self-medicate or they have certain relationships with different kinds of substances um that either perpetuate or exacerbate their mental health disorders. Um so that put me on a path of uh wanting to learn more about treating substance use disorders. And with time I recognized how uh gratifying the work with um that patient population was and it's just uh snowballed from there on and uh you know you you've played a significant role in in helping me uh um uh you know find this niche and um and and we've done some work together in in writing a few books and uh putting some some educational content out. Um but now we have this very wonderful uh clinic that which is an integrated clinic um that serves this population um of people that have alcohol use disorder with any form of liver disease. Um and we're very proud of it. And there are a few of them in the city, in the in the country and in the city um that are doing some great work. So very pleased to uh be part of that as well.

SPEAKER_00 3:17

And we're very lucky you chose to specialize in that because you know, among all the substances, alcohol is still the number one thing we we treat as addiction professionals, and and we need great folks like you specializing it. And I always like to ask, because my journey was notable for people telling me not to go into addiction. Um what stigma did you experience along the way? Did family friends agree with your decision to become an addiction psychiatrist? What have you noticed through this process of becoming an expert?

SPEAKER_01 3:46

Yeah, I I'd say from a from from the start, I um I didn't really have the best support in pursuing psychiatry because they, you know, being South Asian background, um we have very um, and not to sort of play into caricatures, but we we, you know, family and friends, we have a different sort of um expectation around what you would do with having a medical degree, become a cardiologist, uh, or a surgeon or something like that. So when I chose psychiatry, um uh you know, it it did raise a few eyebrows.

SPEAKER_00 4:25

I can hear the collective groans, yes.

SPEAKER_01 4:29

But um, but yeah, it over time everybody uh understood the need for it. Uh the you know, the stigma towards mental health and substance use disorder, I think, is a very universal thing. Um and it's a bit more palpable in the developing world. Um uh there's a lot of taboo. Uh people don't seek help as much. They they often resort to um other, you know, religious counseling or something like that as as a as a as a means of addressing their issues. Um but I think with the world being as interconnected as as it has been over the past 26 years, um uh that that need has been better recognized over time and people have better in uh insight around you know seeking treatment and the need for providers. And um so yeah, and I now find family members and friends being a bit more proud of my choices.

SPEAKER_00 5:33

That's good. Well, let's hop into our main topic today, which is which is alcohol. What's what's the latest on how people are are drinking these days? Do give us an update.

SPEAKER_01 5:42

So the good news is that um it's there's less um less use of alcohol overall in the population. Um I think Gallup came out with its consumption habits survey last year saying that um I I believe 2025, in 2025 there was the um uh the the the least amount of consumption of alcohol reported by individuals in comparison to the highest amount of consumption, um, which was around 2023, 62 percent or uh of individuals and endorsed consuming alcohol. And that has slowly declined since then. So went to I think 58% in 2024 and then dropped to 54% last year. Um, and a lot has shifted. Um, I think just because of the awareness that people have around uh the impacts of alcohol and potentially having witnessed the um the exacerbation of alcohol, their unhealthy relationship with alcohol during the pandemic years may have played a role. Um, we're seeing Gen Z and the generations younger from the from them being a bit more mindful of um their alcohol consumption, gravitating towards other, you know, healthier choices. Um and um uh other than that, you know, you also see how the Surgeon General came out in 2025 um and he uh drew, you know, uh uh made this causal association of how alcohol contributes to different cancers, um, and recommended revision of guidelines around alcohol consumption and um you know uh reinforce the need for better screening and uh treatment uh recommendation resources. Um and beyond that, I I I I think there's also overall in in in America, there's uh now I believe around 53% of Americans believe that even moderate uh drinking is considered harmful. So that's a significant shift. Um, something that was to me a bit unexpected, but uh a welcome change.

SPEAKER_00 8:16

I know it's it's striking. And especially the younger generations and the ability for folks to be just sort of casually sober. It's no longer a stigma to not drink. You can sort of tell folks, hey, I'm being healthy, I'm taking a month off, or I don't drink just for health reasons. And it's that's a real big change. It felt harder to say no before for some reason.

SPEAKER_01 8:37

Yeah, and you you also hear about things like sober October and dry January, and there are these uh new trends. Um I don't know if uh we we can say that Joe Rogan starts uh sober October or where this dry January Did he start sober October? I I I heard from someone that you know his podcast following um you know started the sober October thing at some point.

SPEAKER_00 9:06

Let's claim another month on this podcast. Let's pick uh pick a third one. Yeah. But it's good. The number the numbers are are going down. And part of that, to your point, is the risk that even the recognition that even mild drinking can lead to to harms.

SPEAKER_01 9:19

The the research that we have available shows us that um and it's different for men and women. So beyond a drink in women, you start seeing some bodily effects that are considered liver injury and other bodily effects that are considered harmful. And for men, it's around two drinks or more. And, you know, um the uh the survey that came out from SAMHSA, the alcohol taken health study that SAMHSA posted in 2025, also sort of uh pointed out that any amount of alcohol consumption would result in increased risk, health risks.

SPEAKER_00 10:04

Aaron Powell When does it, you're sort of alluding to it, when does it become sort of alcohol addiction or alcohol use disorder? You mentioned some of the risk factors, maybe having a family history or history of other substance use, mental health trauma. Um tell us some of those risk factors and when it becomes uh addiction.

SPEAKER_01 10:19

Yeah, we we clinically define uh alcohol use disorder or alcohol addiction as um uh through a different lens, right? We have a 12-point criteria that needs uh and you need to meet at least two of those criteria uh over a period of 12 months. But you know, those 12 points are uh broken down into uh categories of impaired control, impacts in um social functioning, risky use, and then there's also the element of tolerance and withdrawal. Um but I I would say the risk factors that contribute to developing a use disorder um often are things like, you know, it could be um uh you know being in an adverse environment, um, whether it's um um, you know, being in in having financial difficulties or like a stressful environment in general. Um typically we see that men are twice as more likely to develop a use disorder in comparison to women. That that gap is now narrowing um just because of uh shifts in use trends. Um also women tend to have a tendency of what we call have experiencing this telescoping effect, even though they start later uh in life um and and using uh but they can sort of um have a more expeditious development of a use disorder if they're using the same amount or uh heavy amounts. Um patterns of drinking are important uh if one tends to gravitate towards heavier consumption, which is defined once again differently for men and women. Um uh, you know, for men it's around um um I think five drinks uh per day or more. And for women, it's four standard, uh, three to four standard drinks uh a day or more. Um and the more prolonged uh that use pattern is, the more likely it is to develop a use disorder. Um then you know the genetic piece is it's not like if you um have a family member that has alcohol use disorder that you're going to seek out alcohol and become addicted to it. It's it's more um uh uh about having how your body processes um the alcohol and then how does your brain respond to the alcohol? Um so genetics can actually be also protective. Um, so I have this one deficiency in an enzyme that protects me from developing a use disorder because whenever I drink alcohol, I get very sick, I get very nauseous. Um so it it's sort of like this aversive experience, and so I don't indulge. Um, but for some people, the opposite is true. They metabolize much faster. So for them, drinking more um is required to achieve the same intoxication effect and uh as they've witnessed in their amongst their peers. And um, and then at the level of the brain, there are things like uh certain um receptor differences where um you could uh you could have a very euphoric response to drinking. Um and so you know, these are this is this subset in the population that reports feeling very warm and fuzzy and you know, elated in response to drinking. So as you can imagine, if you're having a down day and you drink uh a beer or two and that makes you feel warm and uh elated, then that's just a that's just you know plugs you into this self-medication pathway where uh you're likely to self-medicate your your way into forming a used disorder.

SPEAKER_00 14:19

I like that you highlighted the the heavy consumption patterns because I think people sometimes think when you have alcohol use disorder, alcohol addiction, you're drinking every day. But I think we're recognizing that that heavy consumption or binge drinking is one can cause you to have an alcohol use disorder, which really impacting your function, brain, and body. And people often say I only drink twice a week, but sometimes that can be enough to really get you into trouble.

SPEAKER_01 14:42

Yeah, yeah. For sure. Um, yeah, alcohol use disorder comes in all different shapes and forms, right? They're the the daily low-level drinkers that can't really remove themselves from it and they need it to function and and uh maybe go to sleep or to unwind, and without it there there would be an anxious mess. Um that's that might meet the criteria for a mild use disorder, perhaps, but it it's uh we would recognize it at that. And then there are those individuals that have to drink like eight to ten drinks because that's the way that they've always done it since they were in their college years, and they don't know any other way. And they haven't slowed down, and now that they're in their late 20s, early 30s, 40s, whatever you want to, whatever it is, they they continue to drink at that pattern and but they're seeing more consequences emerge from it. Whether whether it's like consequences at home, at work, um while being on the road uh and trying to drive with uh you know a high blood alcohol content and getting into trouble there. Um there's so many impacts in different shapes and forms that alcohol use disorder presents itself.

SPEAKER_00 15:58

And it's often co-occurring with mental health or other substance use disorders.

SPEAKER_01 16:02

Yeah, yeah. The the statistic we often talk about is that you know, mental health uh having a mental health use disorder, having a mental health uh disorder um makes you uh puts you at risk of uh three times more likely of uh risk of developing a use disorder. And having a use disorder makes it three times more likely of you developing a mental health issue. With alcohol, we see that, you know, um in the short term people find relief from low mood or anxiety or something like that. From but over time it develop they end up developing um um, you know, depression or anxiety as a consequence of the of their continuous alcohol use.

SPEAKER_00 16:50

And then when you have the severe alcohol use disorder, we talked about some of the mild impacts on the body, but severe alcohol use, it it does really impact the liver, hijack the reward pathway.

unknown 16:59

Yeah.

SPEAKER_00 16:59

When it's a severe condition, what what do we notice about what it does to the body overall?

SPEAKER_01 17:04

You know, I I'd say we'll zooming out for a second before we talk about severe use disorder. As soon as alcohol enters your your body, it you know, it's an irritant. So it irritates your esophagus, it irritates your stomach, makes you more prone to gastritis, makes your GERD worse, makes uh, you know, more prone to ulcers. And then it causes uh, you know, as it go moves through the gut, it causes a shift in your microbiome and causes uh unhealthy biome to sort of flourish, which we call dysbiosis. And that dysbios, uh that unhealthy biome then causes gut leakage and um, you know, allows certain toxins to pass through. Now, these toxins, along with the alcohol as well, are going to the uh to the liver next to get processed. They damage the liver there. Um, the alcohol itself, as it's broken down, uh that uh one of its metabolites, the acetaldehyde, uh causes damage to the liver, but it doesn't stop there. It also you know causes these oxidative stress and reactive oxidative species to uh cause more damage. Our immune system comes in, uh views that as a as an attack and then sends in more attack vectors onto it and then causes more damage on top of that. The the lucky uh, you know, uh the the good thing about the liver is that's the only organ in the body that has the capacity to heal itself, but it can only do so if the inciting event uh or the thing that's causing the damage can back off for long enough. Um so people that have this moderate, uh severe use disorder, they tend to have higher levels of consumption and on, you know, the the insult to the liver can is quite persistent. So the liver doesn't have a chance to heal itself. Um and that's what results in some cell death and fibrosis, and over time that fibrosis accumulates and develop one can develop cirrhosis. Um but as you know, it the alcohol, alcohol sort of affects all organs in the body, right? So it uh right adjacent to the liver, you have your pancreas, it causes damage to that, can cause early onset diabetes, uh, causes acute pancreatitis, chronic pancreatitis. Um, and then, you know, at the heart, it can cause increased risk of cardiovascular disease, arrhythmias, um, at the level of the brain, you've experienced disinhibition, impact on motor control, motor coordination, and with prolonged use, you have like development of memory issues, you have like increased risk of strokes, other issues that emerge. Um, and then, you know, as the Surgeon General pointed out last year uh to the nation, that it also increases the risk of developing various cancers all across the body. Um and they identified seven major uh different organ cancers and and but others are also suspected.

SPEAKER_00 20:13

So if someone hears all that and they says, oof, I need to I need to scale back. Uh, even before we think about treatment, how does one decide on trying for moderation versus abstinence? Uh I guess it might vary based on the severity of one's alcohol use disorder, but what do you counsel patients around that? Because I imagine a lot of people come to you and they're like, all right, I hear I'm I'm it's hurting my body, but can I just drink less to start? Uh, what do you recommend?

SPEAKER_01 20:39

Yeah, I mean, we always meet people where they're at. We we never, you know, push for for one thing or the other. Um, I do point out to people that have severe use disorders that sometimes moderation without a gap of abstinence may be more difficult and challenging for them to achieve. And often that is the case. Um, it's it's very difficult to dial down from drinking 10 drinks pro sitting to drinking what we consider to be a conservative moderation use is um, you know, less than three drinks for women, less than four drinks for men. Uh, through the moderation management criteria, uh, the organization, not the the the consensus we have as a community, but the organization. Right. But the National Institute of Alcohol Abuse and Alcoholism, the NIAA defines moderation management as being limited to less than a drink for women, less than two drinks for men, which is significantly hard for people that are going from that heavy consumption use down to that. But we have tools that can help them. Uh Naltrexone uh is is is is my favorite tool for that. Uh topermate is also great. Um And uh GLP1s that now that are emerging as a um you know this new drug that we uh was a bit of a happy surprise for everyone in the field um can also serve in that capacity. But um uh I to answer your your original question, I I I think it it it's a it's a thing that requires individual assessment and then guidance with a healthcare provider um on the path. Cutting down too drastically can bring its own risks. Um so if someone's consuming 10 to 12 drinks a day or in person sitting and they they shifted down to two drinks, they they put themselves at risk for you know severe restlessness, tremors, um, you know, other consequences like seizures and tremors, uh delirium tremens or alcohol hallucinosis. Those are uh some of them are medical emergencies, and we we want to avoid them.

SPEAKER_00 23:01

That's a good point that we didn't mention in terms of the impact on the body, that when you're drinking a lot, you can end up with a withdrawal state that can be deadly, and you sometimes need medication assistance to get to to zero and then to to tackle treatment. Yeah. And and then when we want to tackle treatment, there's luckily good treatments and and more treatments than ever. You mentioned some of them there. Maybe let's start with the oldest and uh one that we know 12-step work or alcoholics anonymous. Who's that for? What do you recommend these days?

SPEAKER_01 23:28

Yeah, I you know, I'm a I'm a big fan of the 12-step um uh interventions or the 12-step um uh phenomenons such as alcohol anonymous, uh alcoholics anonymous work, 12-step facilitation. They're great. Um Alcoholics Anonymous has a bit of a spiritual bent to it. Um that can be um at times uh a deal breaker for some individuals, but over time, but overall, what we see is that you know it helps individuals uh develop insight, take accountability. They connect with peers that have gone through similar a similar process. That community can really help them work through the process of you know having accountability, making amends, um, and just working through a process that allows you to sort of reconcile the damage that has occurred both internally and externally in your life. Um, and it's such a niche experience to have alcohol use disorder for some people that it requires having that community to relate to it because people around you sometimes don't understand it or don't don't understand why you keep on engaging in this um very problematic use despite all these consequences. So for that reason alone, I I uh you know, I find alcohol, uh Alcoholics Anonymous or other trust deaf facilitation groups to be really nice. And and um I recommend it to everyone to try it out. And if that's not for them, um then we send them to uh you know, either smart recovery or um if you know what we've been hearing some great feedback on um is uh women for sobriety uh as well. It's uh it's it's been uh you know, it's been very it's been a great intervention for many women that have come to our clinic and you know they they've reviewed it really well.

SPEAKER_00 25:29

Right. Luckily, there's an increasingly amount of online and in-person groups that are 12-step alternatives, but I always recommend to your point that they try a few 12-step because it is the biggest and and it does really resonate from people, even when they don't think in intuitively it will, it it can be a real game changer. But luckily there's other groups, and then there's other psychosocial treatments like therapies. Uh tell us a little bit about those.

SPEAKER_01 25:53

Yeah, I I view those psychosocial interventions or therapies as a three-step flow process where you know you break it down to step one is engagement, in which you have your motivational interviewing and motivational enhancement techniques and even things like expert um, you know, what is it, survey, brief intervention, and recommendation retreatment, right? That's what it stands for. Um, and then step two is skill building, in which you have things like CBT, relapse prevention, and dbt slash mindfulness. And then step three is sustainment, where in which you have um, you know, things like peer support AA, smart recovery, women for recovery, um, and family involvement through, you know, craft um and other things and you know contingency management and things like that. That those fall into and so uh the another way of thinking about these treatments is motivation ignites change, skill guides change, um, reinforcement sustains change, and then community protects change.

SPEAKER_00 27:05

And so if someone's struggling and they're thinking about do I go first to a group or a therapist, uh, what do you recommend? Like what's the when you raise your hand and say I'm in trouble, uh, how do you decide where to go first then?

SPEAKER_01 27:18

Um the ideal scenario, I'd that would be depending on your stage uh or willing you know where you are in in your stage of change, if you have decided that you need to make a change, then you know, um seek out, uh go attend a group, go attend an AA meeting and see, you know, attend a few of them. Um and uh but but you do need to have the right tools, right? So um nowadays you have so many, it's not like the old days where you had to go uh to a trained CBT therapist and you had to sit down with them to develop those skills. You have these technology assisted interventions nowadays where you have these apps, these chatbots that can help you through developing different skills. Um, so uh I just I I I one of my patients is uh uh is in in this sort of field and they develop they have an uh use disorder. And recently they used Claude to vibecode a CVT app for them, or uh um, and also an accountability app for them to track how much they're consuming and you know when their triggers come up and things like that. So we're in a very different era than we than what we were in 10 years ago. And you know, resources, if they're unavailable to you, they can be self-generated at this point, uh, which is wild to think about. Um, it's like we're we're literally living in the future now.

SPEAKER_00 28:50

Um I feel like we're part of the Jetsons or something, but um And you edited a nice book on tall technology assisted interventions for alcohol use disorder. And I guess you're sort of describing what Holly Whitaker said in our very first episode, which is start anywhere. Like if it's technology, if it's a tech it's an app that resonates, go there. If it's a group, go there, find a therapist to help build skills, just yeah, just get started because there's more good treatments and more accessible treatments than ever.

SPEAKER_01 29:16

Yeah. Yeah, 100%.

SPEAKER_00 29:19

And and then some people benefit uh from meds. Tell us the latest on uh you mentioned some of them already, but the latest on medications for alcohol use disorder.

SPEAKER_01 29:28

Yeah, the the conventional medications we have are the FDA-approved medications, right? So you have disulferm or antibuse, um, which basically uh is part of an aversion therapy. It protects you from drinking by um you know causing these side effects, which makes it makes you get sick if you drink, essentially. So you avoid drinking as a consequence, um, because you're afraid of the consequences.

SPEAKER_00 29:58

Right. And if anyone hasn't listened to the Dave Kechner episode, he talks about anabuse being the after trying so many different things, including rehab, anabuse was the thing that solidified recovery for him.

SPEAKER_01 30:08

Yeah, and big proponent of AA as well. Um so um, so yeah, that you know, he he captured that effect quite well in his uh in that interview with you. And um, and then there's Naltrexon. I think you guys also talked about Naltrexon in the same podcast, uh, where uh it basically Naltrexon helps us uh by reducing cravings, but also helps us reduce the amount of consumption by taking away, by bloke, blocking the reward pathway and reducing the the um reward associated with drinking. So oftentimes what we'd observe is that people one or two drinks into it would be like, Why am I drinking? It's not giving me the same, you know, feeling. And they would question um whether or not whether they should continue to drink. And the good thing about an altrexone is you don't need to take it every day. You could also utilize it through the Sinclair method, which is just take it on the day that you expect to be drinking a few hours before, and it would have a similar to the same effect. Um, and the other conventional medication we have is a campersate or camperole, which uh um essentially uh uh uh you know alleviates cravings associated with alcohol. Oftentimes the the people places things in situations that we associate with alcohol use um serve as triggers that provoke cravings in us, or and you know, cravings that we we talk about it differently clinically, it's a spectrum, which can be just the thought of drinking, that nostalgia of drinking, or that visceral feeling of drinking, uh, or wanting to drink. Uh and it helps with all the above for some people. Um, so these were the FDA-approved medications uh that we all prescribe, and then those are there are several non-FDA approved medications that we use off-label, such as Toperamate, Topamax, which basically helps with cravings as well. Um Gabapentin, which is one of my favorite non-FDA approved meds, uh, which helps with both, um, as it can help as uh uh for detoxing off uh when people have mild to moderate use disorder, and you don't want to detox alpatian, also helps maintain this um uh or address this imbalance that is um uh created over time with consistent alcohol use, where our body starts generating this more activating uh neurotransmitter to counterbalance the effects of alcohol and its sort of relaxing effects. Um and GABAPentin, uh therapy with gabapentin for the two to three month protocol that we all sort of subscribe to is uh helps sort of rebalance that seesaw um a bit. Um then there are other medications, but the the one that's really uh popular nowadays um is similar similoglutide, the GLP1, which is uh indirectly showing um effects on alcohol cravings and reduces uh as showing reduction alcohol use. Um and on the fringes, and but um things that I'm more excited for is the psychedelic interventions that are still being heavily uh you know deeper researched. Uh there's a lot of data associated with psychedelics such as um psilocybin, academy, and uh and others and MVMA. Um but you know, a lot of those are still unavailable to us as therapeutics, um still being researched and whatnot. So over I'm I'm I'm sure that in due time we'll have some therapeutics available to us to help our patient population.

SPEAKER_00 34:03

Right. And hopefully we're at the point where um, I mean there might be some stigma and lack of knowledge, but if someone's out there and they're struggling with drinking and they want to consider meds that an internist could potentially prescribe these, a psychiatrist could. And then to your telehealth interventions, again, there are sort of telehealth platforms as well that you can sort of in a discrete way, like people get Viagra, you can get meds for alcohol use disorder mailed to you, which I think is sort of a cool new thing.

SPEAKER_01 34:27

Yeah. Yeah. There's that. There's also other uh uh, you know, tech student uh tech assisted interventions like uh soberlink, a great device that helps build accountability.

SPEAKER_00 34:40

Uh sort of a breathalyzer that has that emails the results to everybody.

SPEAKER_01 34:45

Yeah, it has that facial recognition tool as well that really makes sure that it's you that's breathing in and not your dog or something like that.

SPEAKER_00 34:54

Right. So luckily there's there's great outpatient options, the therapies, the groups, the medications. When do you consider inpatient for somebody? I guess one is inpatient for detox. If they need that withdrawal management, that can be deadly. When do you send people to inpatient for rehab?

SPEAKER_01 35:09

It really depends on what the individual's needs are. And they're not always that you have a severe use disorder and now you need to go into a monitor setting so that we can both safely detox you and then keep you in a um in an environment that is observed and offer you um in you know therapies and interventions that can then equip you to deal with the world um that was triggering or um uh you know uh made you more prone to use. Um but you know, sometimes it it has to do with um you know understanding what a rehab would serve in this person's uh treatment journey. Is do they need a break from those people, places, things, and situations that even though they go through like an outpatient detox, sort of pull them back into using again and again. Um and by giving them that break, you then instill them with those resources and the the skills and um uh that allow them to sort of better counter um those triggers. And you give them enough of a break that their brain sort of uh becomes a bit more um equipped and capable of like saying no. Because you know, early on into your recovery, you're a bit more impulsive and compulsive and just returning to use. Um so there's that. Um and also, you know, if the rehab is doing their job well, they they're also connecting you to an intensive outpatient program right after that maintains the the your learning journey and and um you know continues to help you work on the skills you had developed in rehab. And over time it helps you to form a community around a community and supports around um your recovery.

unknown 37:10

Yeah.

SPEAKER_00 37:11

And the nice thing in my mind about the inpatient and outpatient rehabs is they they have everything we were talking about all in one spot. They have the groups, they have the therapies that do the CBT DBT, they can prescribe the medications. They also have 12-step groups right there. And so it's it's a one-stop shop for for early recovery. And sometimes that makes it easy. And then they set you up with those resources when you leave. So it it can be a helpful introduction, although a scary introduction at times uh to treatment. And then let's not forget about the family. Addiction, you know, it doesn't happen in in isolation and and drinking really can impact the family across generations. What supports do you recommend for families as they see a loved one going through this?

SPEAKER_01 37:54

Yeah, um the uh, you know, there are there are different approaches, but uh essentially Al-Anon is my go-to. The first thing I recommend to families that are being impacted. Um Al-Anon is great. Uh it has family groups um that um essentially help you understand where, you know, what your role is, and it helps you sort of understand um, you know, differences between enablement and um, you know, the different interpersonal elements that contribute to their use or um also their things like uh smart recovery, family and friends, um parents of addicted loved ones, families anonymous, um, community and craft. You know, craft is great. Uh craft stands for community reinforcement and family training.

SPEAKER_00 38:50

Um and sort of a therapist-led intervention for family.

SPEAKER_01 38:54

That's a therapist-led intervention. Yeah, indeed. Um, and that helps um with the more, you know, um uh treatment-resistant family with uh treatment resistant or avoidant uh addicted individuals that have had difficulties engaging and and family members that have certain dynamics in place that um uh that may be also serving as barriers or or you know, it's so it helps like refresh and sort of see things through a more therapeutic lens that that would be more conducive towards getting them better.

SPEAKER_00 39:30

I'm so lucky to count you as a friend and colleague, and your expertise in alcohol use disorder is is so appreciated. I appreciate you coming on today.

SPEAKER_01 39:37

Likewise, we're we're all very lucky to have you as uh you know, as as leading our addictions department and you know, also being such a leader in the field, um, addressing stigma for many years and spraying the good word on Narcan and um and you know uh you've inspired multiple generations of people to take on addictions training, which is also amazing because there's a huge need for addiction-trained uh professionals in the field. So thank you. And now thank you for doing this podcast or starting this podcast uh because it's gonna spread the good word even further.

SPEAKER_00 40:17

Thank you. And I couldn't do it without you, and I'm so grateful for our collaboration through through all these years. So thanks again for coming on today. Thanks for listening to the Thriving with Addiction Podcast. If you found today's episode helpful, please follow and subscribe wherever you listen to your podcast and share it with someone who might benefit. You can also connect with me on Instagram, LinkedIn, and YouTube, or visit thrivingwithaddiction.com to learn more. Stay tuned for next week's episode, and remember, Thriving is possible.