Addiction - part one

Husband and wife team, Eliza Pertz LCSW and Dr. Jason Rudolph, who have a combined 60+ years of expertise in the addiction field share some of their insights on addiction.  This is part one of a multi part series on addiction.

Transcript

SPEAKER_00 0:00

Hi, my name is Eliza Pertz, and I'm here with my husband, Jason Rudolph. And we're opening up a conversation about addiction, what it looks like from the outside, what it feels like from the inside, and ways to understand it. I've been in the addiction field for about 40 years and sober 35 years. Jason, do you want to say a little bit about yourself?

SPEAKER_02 0:27

Sure. Thanks, Eliza. I've been sober almost 30 years, and I've been in the field for a couple of years less than that. And a lot of my work rotates around addiction, treating individuals and sometimes the family and people connected to them. So we wanted to share some of our knowledge with you all today in terms of understanding addiction as a topic area.

SPEAKER_00 0:48

So why don't you start, Jason? You have some ideas that you know you've been percolating and thinking about, and I'll ask you some questions.

SPEAKER_02 0:56

Sure, thanks. I one of the things that occurs to me is just how long alcohol's been around. And we know that alcohol is referenced in the Bible, and that's a long time ago. So if alcohol's been around, my suspicion is that people have been abusing it for as long as alcohol's been around in some capacity. And so it impacts individuals, it impacts their family, their friends, their loved ones, their community, society. It's an individual problem with addiction, having a loved one, it's terrible to watch. We all societally have risks in terms of people drunk driving and crime and other things related to getting drugs and alcohol. And so I would venture, I guess, to say that although it impacts about 10 to 17 percent of people individually, that it impacts 100% of people in some capacity.

SPEAKER_00 1:42

Sure. It's uh a family illness and family can be a workplace, family can be a you know, community, and of course, family isn't also, you know, a nuclear biological experience. You know, it's funny you're talking about alcohol being around a long time, and there was a period of time, you know, in the medieval period where people couldn't drink water because it wasn't safe, and they drank alcohol all day, and people had at least, you know, eight glasses of wine or beer or you know, a fermented beverage that was would kill the bacteria. I don't know. I mo I wonder about that a lot. Like, was alcoholism rampant, or was it still only people who had the type of brain that couldn't stick to their eight glasses? Or, you know, exactly how it went. But clearly there was a lot of productive stuff that went on then, so it wasn't like you know, society was just a mess. Um Yeah, and I think your point is well taken that's been around a really, really long time. It's not a new illness or a new problem. And there's been but what has changed is treatment's changed, and there's less shame related to having an illness that needs treatment. That has definitely changed.

SPEAKER_02 3:04

Definitely less stigma. Even when I got sober almost 30 years ago, it wasn't something you bragged about. And now it's a little bit of a rite of passage in that people do sober October and people are proud to be healthy and not drinking, and it's kind of very societally accepted, and I didn't find that to be the case. Other parallels for it. I didn't know of gluten-free food 30 years ago either.

SPEAKER_00 3:25

Yeah, but I think you you may brag about being sober, but you're not gonna brag about being an addict or an alcoholic.

SPEAKER_02 3:32

No, for sure. But that sobriety to me is seen as an asset these days for a lot of people and not a liability. Sure. When I got sober, I felt like it was a bit of a liability. Um I also think that as you advance along in your addiction, people think of long-term sobriety as stable and short-term sobriety as iffy, right? That if somebody tells you they have six days or 30 days, that's great and it's an amazing start. And if that's you, all the power to you. But you might not hire that person right out of the bat. But if they have a year of sobriety or two years of sobriety, you might feel like, no, that's a person I want with me.

SPEAKER_00 4:03

If you ever talk about if you're an addict in a job interview, which I think most people would not do.

SPEAKER_02 4:10

I I have the the fortune of working in the addiction field in the last job interview I had rehab, so it was a it was a strength to be uh sober and in the field. Absolutely.

SPEAKER_01 4:20

Yeah.

SPEAKER_02 4:20

All right. So I actually could tell you that when I interviewed to work at Hazeldon, the director said, There's a little bit of a gap in your resume. Can you explain it to me? Which is like the death question in a lot of interviews. And I said, Yes, I was at rehab here, getting sober. And she just kind of laughed and she's like, Yes, you were. And uh it was an asset, probably only in that one spot.

SPEAKER_00 4:42

Yeah, that's great, actually.

SPEAKER_02 4:44

So to me, one of the things that we need to talk about a little is um what addiction is and what addiction isn't, and that even though alcohol and alcoholism presumably has been around for a long time, not everybody who drinks is alcoholic. And to your point of that when wine was drank and not water, for example, not everybody was alcoholic. So, you know, to me, one of the things we should talk a little bit about is the different categories of people's relationships with alcohol. And the the model that I use is a three-part model, and it's not created by me, but it's the social drinkers, the heavy drinkers, and the alcoholics. And in the social drinking category, it's the general public. It's people who have a take it or leave it dynamic with alcohol. It's not hugely important to them. If it's at a party, it's fine. If it's not at a party, it's fine. Someone may pass them a joint, they might say yes, they might say no. But the alcohol or the pot or the drugs don't play any type of important role in that person's life. And the dynamic of control is full control, and they can really take it or leave it. Anything you want to chime in about social?

SPEAKER_00 5:47

I mean, to me, addiction isn't, I don't like you're categorizing very specifically alcohol or substances. I think if we move into any of the process addictions or um more dopamine addictions, where it's really about being addicted to taking our brain to a certain place versus not, I think more and more we live in a culture where almost everyone's addicted to dopamine on some level. Every single person is addicted to their phone. And um so the substances are a very different subset around that because there are people who can say, if I drink more than two drinks, I have a headache, and so I'm not drinking more than two drinks. And there's people who definitely get a headache, but that's irrelevant. Sure. And they drink through the headache.

unknown 6:33

Trevor Burrus, Jr.

SPEAKER_02 6:33

But your point of process addictions. So within other addictions and by process, give some examples so people are aware of the language.

SPEAKER_00 6:42

Process addictions means things that you're doing and you do too much of. So that would be um video games, shopping, even being on your phone. Um it could be uh sex addiction or pornography as an addiction, shopping, gambling, spending, dating, um the way you eat.

SPEAKER_02 7:08

Sure. Yeah, and and it's so where your relationship with X is off, but it's not just the substance itself. So let's talk about a social category for that, right? That let's use an example of shopping isn't inherently problematic, but for some people it is. So a lot of people can shop socially, let's put it in that category where it's adaptive enough, they have full control, they buy things only that they can afford, etc.

SPEAKER_00 7:31

Have you have you heard that saying it's the only addiction where the more you the more you do it, the better you look?

SPEAKER_02 7:38

I have not heard that expression.

SPEAKER_00 7:40

But but still could be a very serious problem.

SPEAKER_02 7:45

And could be true, yes. So in that first category, to me, what's important to say is that we're not talking about addiction here. We're talking about the adaptive people's relationship with either the process addiction or with drugs or with alcohol. It's take it or leave it, they have full control, and the treatment that's needed for social is nothing. There's no intervention needed because there's no problem. No problem, no solution. The next category, the middle category, is a heavy relationship. And in a heavy relationship, it's that the dynamic of control is impaired. It's no longer full control. The person has impaired control. Usually we're seeing an increased amount of kind or frequency. We're seeing much more time spent procuring it, getting it, doing it, recovering from it, talking about it, thinking about it. It's not just the 45 minutes that someone has two drinks in the evening, right? As we know. It's the thinking about it, planning for it, shopping for it, doing it, hiding it, recovering from it, stashing it, and all of those things factor in. And in that dynamic of heavy, we see limited control, and we start to see the inklings of problematic behavior. Anything you want to add with heavy or that that prompts?

SPEAKER_00 8:56

I mean, that's a perfectly good description of heavy. I think the other thing that's important to mention about heavy is that you know, binging and episodic falls into that. Whereas people can have long periods of time. Like I have a lot of clients who, because they can go a month without using substances, they consider themselves not to be addicts, even if when they use, they use for five days, they spend money they don't have, and they put their life, their relationship, their job, whatever, into in jeopardy. So, yeah.

SPEAKER_02 9:28

Yeah, and one of the dynamics with when you say jeopardy, it's a great word because one of the dynamics of heavy is that you start to see consequences, right? And consequence is a big term with an addiction. And you start to see consequences, and when you are in the heavy category, people have the opportunity to reel in the behavior related to the consequences. Consequences. You're laughing because I said consequences. It was pretty good. Consequences. Um, but so people can, you know, I have a friend who was uh driving when he probably shouldn't have, not a wreck and not all over the road, but got a DWI, leaving a dinner one night in the city. And his take-home on that was I should not do that again. I should not gonna drink and then drive home to the suburbs, and that was a good take-home. So when there were consequences, the behavior was changed, right? And that's different than in category three when we'll talk about addiction. But in that heavy use, you start to see consequences seep in, but people can usually curb the behavior related to the consequences. But just to clarify, the heavy drinker might look like someone who you and I, as non-drinkers, put out a pretty scarce bar if we put out a bar at all when we host, right? At a small dinner party, we tend to have no alcohol, but at like a larger party party. And I remember a New Year's Eve when we had just a few couples over and we put out a very scarce little bar, and a friend came over and took one look at it and said, uh, where's the local liquor store? Right. And that was an opportunity to say, hey, alcohol is more important to me than this. Um it's important to me. You and I also know some people who keep alcohol at a friend's house or a family member's house. It's the person who always has pot in their pocket, it's the person who is taking the lead on smoking the cigarettes, bringing the cocaine. The heavy person might even look alcoholic. And really the primary difference is that when the consequences come, the person in the heavy category can't stop still. They have some dynamics.

SPEAKER_00 11:21

What is the look? You said someone who's in the alcoholic might look like an alcoholic.

SPEAKER_02 11:29

Oh, uh, meaning that people with addiction, I mean, I can fast forward to that and differentiate now. The third category, people with addiction, by its most basic definition, continue the behavior despite the consequences, right? That if you caught me in an elevator and said, Oh, you're a psychologist, oh, you specialize in addiction, what's the one sentence? What's your elevator pitch? My one sentence would be addiction is continuing a behavior despite the consequences, right? And so Unmanageability. Yeah, addicts continue to use despite the consequences. People with heavy use relationship with substances, they might look like alcoholics in that it's lots of drugs, lots of alcohol, consequences, but then they can reel it in and kind of change in reaction to the consequences, where people with addiction continue the behavior despite the consequences. That would be the differentiator for me. Make sense?

SPEAKER_00 12:20

Right. Yeah.

SPEAKER_02 12:21

Okay. And so in that third category, people with addiction, we start to see powerlessness, we start to see continuing to use despite the consequences, we start to see increasing amounts, we start to see increasing consequences, we start to see lots of life areas unraveling, financial, emotional, educational, physical health, emotional health, spiritual health, everything. You know, I always joke that in my addiction, my active addiction, I had the opposite of the Midas touch, right? That everything I touched turned to crap, right? And that everything is altered negatively by it in active addiction.

SPEAKER_00 12:59

Yeah, I mean, I think what's important to remember also is that as diverse as uh humans are, so is disease. And even someone who is a heavy drinker, which is really what we're focused on, is sort of the heavy drinker or the alcoholic. Um you can't always tell. And some people can keep it together despite what the horrific inside experiences. Or they've gotten so good at and put so much energy into hiding it and keeping it a secret and keeping the the vodka in the left boot in the closet, and it comes out as soon as you know the partner goes to sleep at exactly 8 09, and they drink, you know, until one in the morning, and then they hide the bottle in the back in the house and take the garbage out themselves in the morning. And you know, like it eventually falls apart, as we all know. Yeah, but it doesn't always look like a wino on the street for the old school, and it doesn't always look a mess. And um but things do usually go awry at a certain point.

SPEAKER_02 14:09

Yeah, but people do have very different levels of functioning and very different levels of manageability, and that's inclusive of their addiction or not, and exclusive of their addiction or not. So if we talk about that third category of addiction, right? So we're gonna leave behind for the time being social drinkers because they're just socially drinking. We're gonna leave behind mostly heavy drinkers for the time as well, although it does apply in some ways, and we're gonna really look at that third category, addiction, and break that down because we are trying to kind of unpack the topic of addiction. And so we're really taking social out, taking heavy out, and looking at the alcoholics and the addicts, the people who continue the behavior despite the consequences. So there's a conceptualization of addiction that Eliza and I have had a lot of exposure to, um, in some ways taught primarily from a colleague Fred H. But but learned in AA and 12-step programs also, about the addiction being a three-part illness, an illness of the body, mind, and spirit.

SPEAKER_00 15:07

Can I just interrupt for a second? Because I don't feel like clear on this, and I don't know if I agree with you. Um you're categorizing heavy use as not in the realm of addiction? I think of those people often need treatment too.

SPEAKER_02 15:24

As outside of the realm and not needing treatment at all. I think anybody in a heavy use category can benefit from every treatment intervention that people with addiction can intervene with. And the only differentiator between them is that when the consequences start to hit heavily, the people with heavy use can stop and the people with addiction can't. So we're not really talking treatment today, we'll do that in the future, but any treatment intervention and therapy, an outpatient, an AA and psychopharm, if it were needed in some capacity, anything that could apply to alcoholics can certainly apply to heavy drinkers. And the dynamic of control being limited with heavy drinkers isn't great. Um, that's true. And it's not a place that I'd want somebody close to me to reside, right? It's not a great place, it's not a healthy place, etc. I'm only thinking of when we break down addiction into the three-part, the illness of the body, mind, and spirit. I do think there's a bit of a difference between heavy drinkers and alcoholics that comes up in that, but not big enough that it has to be its own exclusive category. I'm happy to uh agree with you on keeping it as possible.

SPEAKER_00 16:31

Yeah, I just think it's a day, it's a slippery slope. It's dangerous because I think all addicts would like to put themselves as heavy.

SPEAKER_02 16:37

Every single one I've ever met.

SPEAKER_00 16:38

Yeah. And I think that that's almost if you are a heavy drinker, you probably have a problem with alcohol. So that or or substances, and so it's sort of a, I don't know.

SPEAKER_02 16:47

To Eliza's point, if it looks like a duck and talks like a duck and walks like a duck, it's probably a duck. And she's 100% correct that I've probably treated 5,000 people in the 27 years I've been doing this. Almost 100% of them would absolutely like to believe that they're a heavy user and not an alcoholic and addict, and they have their own journey and you know, like in 12-step programs. I'm a believer in that I can guide someone and shepherd someone and advise somebody, but ultimately it's up to them to identify, inclusive of my feedback, and I'm direct with them, but they need to own that that term and that label and that relationship with addiction.

SPEAKER_00 17:25

So back to uh Fred H. and Body, Mind, Spirit.

SPEAKER_02 17:30

Yeah, so when you think of addiction, you think of it as a three-part illness. And and by illness, um, and it's chronic, it's progressive, it doesn't get better if it's not treated on its own. And we think of it as an illness of the body, an illness of the mind, and an illness of the spirit. And it's certainly not the first disease to be thought of as a three-part model, and mind-body-spirit is a very kind of typical way to think of stuff. But there are some specifics related to addiction that are worth discussing that to me give us a universal language that we can understand. So with the body, and and chime in and and when you want, Eliza, but with the body, we think of that alcoholics respond differently to alcohol than non-alcoholics do. And the difference is that they have a craving for alcohol, that a little bit of alcohol triggers a craving in them that's physical that makes them unable to predict when they're gonna stop. And that's the same with drug users, and it's the same with people who are addicted to pornography, and it's the same with shopping, and it's the same with other things as well. That once they do a little, it triggers a physical craving. And I'm using that word on purpose: physical craving, physical craving, physical craving, right? It's physical at this point. That they have a physical craving that makes them unable to predict when they're gonna stop. And what does that mean? It doesn't mean that every time they do it, that they're off to the races, right? It means that this night when they do it, they say they're just gonna have two, but they end up having eight. And tomorrow when they say they're only gonna have two, they have two. So a little bit triggers a craving for more that makes them unable to predict when they're gonna be able to stop.

SPEAKER_00 19:00

You want to say anything about that before I um in terms of the cycle of cravings is what you're talking about?

SPEAKER_02 19:08

Yeah, and I was gonna just the physical part, and I was gonna segue into the allergy idea with it, but just that this is the root of abstinence in 12-step programs, right? That the reason for abstinence, uh, which seems harsh to some people to not use any, is that if a little bit triggers a craving for more, then you can't do a little bit. And so what we look at is the idea of that the craving is an allergy, right? And that's a little bit of an abstract concept for some people. I don't know how your clients respond when you use the term allergy with them. Are they kind of surprised or does it make sense to them, or do you use it?

SPEAKER_00 19:42

I don't actually use that term very much. I use the term powerless more, which is just to say that the way that you respond to that substance is different than the average person. And if you put yourself in an environment of people, places, and things, um, you're not going to be able to predict when your end time is or if there will be an end time. Yeah. And the allergy I don't bring up as much because people really do see it in a physical way, even though there is physical components to it. It's not physical for everybody.

SPEAKER_02 20:19

And when I think of powerless, I also talk about powerless to the people, and I use it a little bit as a conclusion of body, mind, spirit. So I'll I'll try to wrap that in, but I'm with you on the powerlessness. So when I'm thinking about allergy, um, an allergy can be defined as an adverse reaction to a common substance, right? And so if we think of things that are a normal reaction to a not normal substance, that's the opposite. And just to kind of make that clear, like if I drink paint thinner, what's gonna happen to me?

SPEAKER_00 20:50

I really don't know, but I don't think you should do it.

SPEAKER_02 20:52

I don't think I should do it either, right? I'll eat my stomach, I might vomit, something terrible. If you drink paint thinner, the same thing's gonna happen to you. Anybody drinks paint thinner, the same reaction. That's a normal reaction to an uncommon substance. That's not an allergy, it's just a bad reaction that you would expect. An allergy is the opposite. An allergy is an adverse reaction to a common substance, right? So when our kids were in school, you couldn't send certain types of nuts, peanuts in, for example, right? Because so many kids had allergies. And they could go into anaphylactic shock and something dangerous could happen. So the classroom had to be nut free. So the adverse reaction could be hives, it could be itchiness, it could be anaphylactic shock, God forbid, right? It's not it's an adverse reaction to a common substance. Peanuts are normal. And when we think of groups of allergens, I mean, you're more the physical health person, but what do you think of when you think of groups of allergens? We think of foods as one.

SPEAKER_00 21:47

I mean, really, you can be allergic to I remember uh my boyfriend in college was allergic to the cold. He would break out in really bad hives and have problems breathing. So it really, I think you can be allergic. Allergic to external things, things that you that are internal, and you can be allergic to behaviors.

SPEAKER_02 22:05

You can. I I think of it for simplicity as there's environmental allergens. Cold could be in it. Sure. Um, wheat, uh, any any external. You could have foods, you can have medicines, you can have environmental. So there's kind of categories of allergens, but all the allergens fall into the idea that it's an adverse reaction to a common substance, right? Someone eats peanuts, it's totally fine. Maybe they're thirsty, at worse, if they're salted, someone else eats peanuts and dies from it, God forbid, right? That their throat swills up. That's an abnormal reaction. So when we apply the allergy concept to addiction, what we're essentially saying is that alcoholics are allergic to alcohol, and heroin addicts are allergic to heroin, and sex addicts are allergic to sex. And what does that mean? It means that they react to it in a different way than other people do. And the different reaction is that a little bit of it triggers a craving in them that makes them unable to predict when they're gonna stop. And that is not the case with most people. 90% of people who take a drink feel the desired effect and stop. And 10% of people who take a drink can't predict when it's gonna be done. Um, it explains a lot of behavior that kind of bewilders people in addiction, myself included. Um, why did I make three trips to a drug dealer in one night, spend an infinite amount of time and money on smaller quantities chasing drugs when I should have just accepted the fact that I was gonna use 3x the amount, not one x the amount. And really the intention at the beginning of the night was to use a little, but it triggered a craving for more that makes you unable to predict when you're gonna stop. So, enough said, I think, about the illness of the body and the craving and the allergy, but suffice this to say that you can't use drugs because once you start, you can't stop, and the whole abstinence theory comes from that.

SPEAKER_00 23:46

But I think, you know, another mm, I think important way to look at it is that I'm sure everyone here has had the experience of when you um are in your behavior or use your substance, you get a special kind of dopamine high. And everyone thinks the same thing. I want to keep this going. Sure. How do I keep this going? And some people will go and get a little more, some people will have another drink, some people will continue the keep doing the behavior and not interrupt it. But at the end of the day, there's only so much that our body can handle of any behavior or any ingestion of any substance that's you know a potent substance that creates an up, and then the down starts to happen, and then that's when the end comes and the consequences are, which is inevitable. But that's what addiction is, is not being able to notice that it's time to stop because the high is going away.

SPEAKER_02 24:42

Yeah, continuing to use despite the consequence, including the not knowing or the knowing somewhere but not paying attention to.

SPEAKER_00 24:49

Right. It's also where what kind of puts it in the some of the OCD uh category stuff, which is continuing a behavior that's um negative and not being able to stop.

SPEAKER_02 25:01

Yeah, and we're gonna get to that OCD stuff for sure today. Uh let me give one quick physical allergy example before we move on to the mind. Um I often tell the story when I lecture about a shrimp eater who goes to a restaurant on a Monday, orders shrimp cocktail at lunch, uh, has an allergic reaction, throat swells up, can't breathe, anaphylactic shock. A doctor at the table next to them saves their life. She performs an emergency tracheotomy, sorry for the gross visual, and saves the person's life, gets stitched up afterwards and is told to come back in three weeks for the stitches to come out. It should be pretty clear that the person has an shrimp allergy, they had anaphylactic shock, and that they shouldn't eat shrimp, right? And so it poses the question of is the person a shrimp addict because they have an allergy? And the answer is no, based on what we know so far. But just park that example in our in our brains for a little bit and we'll come back to it. So if you just have the illness of the body craving an allergy, are you an addict? And so, like with the shrimp example, the answer is not necessarily. We don't have enough info to know that. We need another component, at least, of the other two. So when we introduce the illness of the mind, we think about an obsession. That's the one thought.

SPEAKER_01 26:08

Yeah.

SPEAKER_02 26:09

It's the and an obsession in a basic definition is the one thought that puts all other thoughts out of your mind, right? I always say to people, pop quiz, what do you think the obsession of cocaine addicts is? Cocaine and the obsession out of shopping addicts is shopping and the obsession addict of anything, they're one thought that puts all other thoughts out of their mind, right? It's like tunnel vision. You can't see it on a podcast, but I'm holding my hands to the side of my eyes like horse blinders, right? It's like the one thing that you can see. And so with this obsession, the person can't get it out of their mind. And it is my assertion, but I'm interested in your opinion, that even though denial exists, deep down, every addict and alcoholic I've ever met, every person with addiction, they know on some intuitive level that they have a problematic relations with substances and can't use, yet they continue to do so. Is that your experience? You feel like people know that?

SPEAKER_00 27:01

I mean, I'm thinking about like eating disorders and shopping and some of the processed stuff in video games. And um I really think it depends on the stage, it's a stage of the illness. And I think in the beginning, 99% of the people I've worked with were love to reference how they were able to benefit and people like them and it went great and it didn't affect their bank account or their health. And so I think there is a a true period of time for not necessarily everybody. There's some people who literally the first time they use they have a problem, but not everyone does.

SPEAKER_02 27:40

Absolutely. There's a progression of use that starts often at social, works its way through heavy and to add it. But even separate from that, alcohol and drugs, fair to say, work for people in some ways. More social, more comfortable, more than a lot of people.

SPEAKER_00 27:54

And the and the process addictions, right? They're, you know, whatever. Listen, cortisol's a hormone that is created to create anxiety and push the body to function. Too much cortisol raises homocysteine levels, it affects our heart. There's lots of problems with too much cortisol. Dopamine, which is also a hormone produced by the body to create action, very similar to cortisol, but does not produce the same level of stress on the body. And so we actually want to produce dopamine. And stay working, exercising, even if it's shopping, even if it's sex addiction, at the beginning creates this flood of good brain chemistry that could actually productive for the body.

SPEAKER_01 28:46

Yeah.

SPEAKER_00 28:46

The ideal is how do we have a reasonable amount so that we don't bottom out and have none left. And, you know.

SPEAKER_02 28:53

Yeah, that there's a there is a role that substances and other process addictions can play that in some small cases is immediately problematic, and in other cases can be adaptive that becomes maladaptive. Right. I always tell the story of if you're a baby and you have your three needs, you either want to be changed or held or fed, crying is a useful communication at that point. It's adaptive when you're one year old. If you're 30 and you're hungry and you start crying, it's no longer adaptive, right? If you need to go to the bathroom and you start crying, it's no longer adaptive. It was once adaptive, it's become maladaptive. Um so with that obsession and with the illness of the mind, and with that, I agree with you that there isn't always a problem. But what I'm thinking of is when people come to us for treatment or AA or rehab, when they're in a stage of the consequences have started, they're in some kind of crisis. In my opinion, sometimes it's rolling off the tip of their tongue. Hey, I have a problematic relationship I shouldn't use anymore, even though I still want to and even though I might. And for some people, it's on the bottom of their shoe, but it's around, right? That at some point. And, you know, in our friend Nick Less's book with Walter Scanlon, he uses an expression that says, once a cucumber becomes a pickle, it can never be a cucumber again. You know, and I love that expression because, you know, it it's uh, it really references that when you cross over that threshold from non-problematic drinking or other behavior into problematic, you can't go back to it. As much as people hope that they're in that heavy category, once people progress to addiction, they can't go back for a bit. And it's why people need to abstain and need to abstain for life a day at a time, albeit but for life, because I just have not seen that you can rewire. As much as neuroplasticity is a thing that I believe in, I have not seen that you can rewire your relationship with drugs and alcohol from when you cross over a certain point. So, with that illness of the mind, it enters this idea of I know I have a problem, but I continue to use in in some way. And there's a cognitive dissonance, and that's the term I use a lot, which is it's the idea of having beliefs and actions that are not congruent with each other, right? An example that's a little, you know, potentially politically or religiously charged, but an abortion is the example that I usually use, right? Which is that let's say you don't believe in abortion, but you or your partner get pregnant, and in this particular situation you guys decide that the best course of action is to have an abortion. It's actually a very hard decision to make because your belief is that it's not a right thing, and then your action is that you do it. And so generally the way people resolve cognitive dissonance, that disagreement within their own head, is they either change the belief, which is that, hey, I no longer think abortion is bad, I'm okay with it, or they change the action, which is they don't actually do it and they don't go through with it. And that cognitive dissonance applies to addiction in that I know deep down I have a problematic relationship with alcohol and shouldn't use, and yet I continue to use. And it's also where all the defense mechanisms reside: denial, rationalizing, bargaining, minimizing. You want to give some examples of those?

SPEAKER_00 31:59

I mean, all I can think of is that when I'm talking to someone about their addiction and I see it like plain as day, and they are looking at me with wide eyes, like I can't believe she's calling me out on this shit, and I'm so not gonna give in. That sort of look in the face where the person is I'm speaking the truth. They know it's the truth, but they're in another universe of what their truth is, and they're not going there with me because they don't know how to get from point A to point B. Right.

SPEAKER_02 32:30

It's it's almost a gaslighting, if you will, but it's an interesting, like it's different than gaslighting in that gaslighting.

SPEAKER_00 32:36

I I believe you know what the truth is, you are trying to deny it. I think when you're in active addiction and someone's calling you out on something and you've no intention of changing your addiction, you basically are just like so is it their denial that they're not seeing it yet?

SPEAKER_02 32:53

Or do you think that that word from you breaks through their denial, but the wide-eyed is a not acceptance of it?

SPEAKER_00 32:59

I think the wide-eyed is what am I gonna say? You know, like how what's my narrative gonna be? But I also know that there's there is such a thing, which maybe you're gonna be annoyed I'm saying about, but is that I may believe you have an addiction. Everyone may think you have an addiction. But if you decide you don't, or this is an okay way to be, that is your choice. Sure. And we don't have to stay in your life, the people around. Or we can, whatever. But there is a space that exists where just because someone has a problem doesn't mean it needs to be fixed. That's up to the person.

SPEAKER_02 33:43

I don't disagree with you. I I think we can help someone identify a problem, but we can't fix it for them. And I'm we definitely cannot make them fix it. And I'm I've said to many a patient, and uh you've probably heard me say it, I'm willing to work as hard as someone is to help them, but not harder, because it's in vain if they're not on board. It's hard enough to get sober if you want to. Yeah, it's definitively impossible to get sober if you don't want to. Um, and that doesn't mean that if you're leveraged by the court or mandated by the court or that your family intervenes, that you can't have good treatment outcomes. Lots of people do have good treatment outcomes, but it means that at some point that person has signed on and said, Okay, I'm gonna do this, even if that's to avoid some negative consequences.

SPEAKER_00 34:23

Yeah, and listen, a lot of people get sober because what is true for them, their relationships, their job, their children, their health, um is waving a warning sign that they see and they do believe, even if they don't believe that they have a problem. Sure.

SPEAKER_02 34:42

External consequences and and hurting other people.

SPEAKER_00 34:45

And then someone's sober for a while and they're like, oh, my life is better, or I've stopped, you know, doing whatever was engulfing majority of my energy and time.

SPEAKER_02 34:56

Yeah. So with that illness of the mind, to go back to that obsession, and I reference defense mechanisms. Denial, rationalizing, minimizing, bargaining, the things that I hear often are I only drink beer now. I no longer drink hard alcohol. Hard alcohol's the problem. I only drink, I don't do drugs anymore. I only do pot now, I don't do hard drugs anymore. There's lots of negotiations and minimizing. Oh, I don't think it's that that's the problem. It's the fact that I was in college, that was the problem. Now that I'm not in college, I think it'll be okay. Can't hurt me on a full stomach if I drink only every other weekend, if I stand on one foot and drink. I've heard any version of that. Fred, our mentor from Hazleton, has said that when you act on a lie, you run into the truth. And that's an expression that I think of when I think of rationalizing and minimizing and bargaining and denial. All those, all of those defense mechanisms can boil down into lies, right? And when you act on a lie, you run into the truth. And so, with that obsession, the person can't get the thought out of their head. And although they've come up with a million ideas why their relationship with substances or behaviors is okay, it's not. And so they're acting on a lie by continuing the behavior. So let me go back to the shrimp eater for a minute, right? The shrimp eater had anaphylactic shock, stitched up, three weeks later they go to the visit. I joked, are they a shrimp addict? Not that there is such a thing, but not really. They just had the illness of the body. But what if, in this example, when they go to the doctor three weeks later, they say to the doctor, you know, I think it was that I had shrimp cocktail. Next time I'll have shrimps can't be. Or, you know, I had shrimp on a Monday. Everybody knows that's old from the weekend. You should only have seafood when it's fresh on a Friday. Or I think it was the people that I was eating with. I think they made me sick. Or maybe my allergic load is high from a lot of gluten and dairy. I I'll I'll eat shrimp next time when I'm not doing that, right? You would look at the person, even if you were like an eight-year-old doctor, and you looked like a person, Doogie Hauser, and you'd say to them, Don't eat shrimp, dude, you're gonna die. Right? It's just like a common sense all these thing. And if that person looked at you and said, No, no, I think it'll be fine. As much as it's silly, and I use this example as just kind of a silly illustrative example, they'd kind of be a shrimp addict, right? Because they'd have the illness of the body, which is the crap uh the allergy reaction, and they'd have the illness of the minding, of the mind, excuse me, which is they'd have the obsession. And if they can't use it safely because of the body, and they can't quit it because of the obsession with it, that's your addiction right there, right? It's an illness of the body and the mind. Any thoughts there?

SPEAKER_00 37:25

Aaron Ross Powell What's interesting is that, you know, I think breaking it down for people into the way the external and internal problem feels and then the obsession around it is super important because that to me is the quintessential evidence of addiction. It's not so much that the use or behavior isn't working, but it's the person's obsession to engage it. And you know, what I always challenge my clients with, which you know, you've heard this before, which is it, if you're not an alcoholic, prove it to me. If you're not, if you don't have a problem with it, stop. Prove it to me.

SPEAKER_02 38:04

It should be easy. You should have a full take it over.

SPEAKER_00 38:06

And the person's always like, well, I mean, no, I don't need to, or you know, maybe next week, or I'll do that in a month. And you know, I always point out, well, you know, your wife has quit, or your husband's quit, or you know, your family's quit to show you that they'll do that for you. Sure. And it's not a problem for them.

SPEAKER_02 38:25

Yeah, if your doctor asked you to give up carrots for some reason, most people would be like, okay, no problem. Right. But if we ask somebody to give up drugs or alcohol or some other problematic behavior, the attachment to it is all information, as they say.

SPEAKER_00 38:41

You know, it's funny, I I have a client who's now sober like I mean probably 30 years. And she um she said a funny thing to me once, which was that, you know, when I walk by liquor stores, sometimes I just stand there and look in the window when she was first getting sober. And she said, you know, people don't do that when they walk by produce. They don't stare from outside at the strawberries. She said, you know, I'm different. I'm different. My relationship with alcohol is different than the average person. And, you know, I notice who's drank what at the table when we go out.

SPEAKER_02 39:19

And I notice very common in early sobriety.

SPEAKER_00 39:21

How many drinks or and and forever sometimes for some people, you know. So I think it's about the obsession of the mind to me is the key piece that in terms of if there was something to take away from this discussion that I think that people don't realize is such a big piece. It's not just that person drinks too much, they should stop. The person is obsessed with the experience of drinking. Right. Or the experience of, you know, sexual conquest or gambling or video games, you know, winning or losing or whatever.

SPEAKER_02 39:57

I'll give a quick case vignette of a of a patient. You know, her drinking many, many years ago, she was in an outpatient program that I was working at. She drank two glasses of wine each night after she put her kids to bed. And by an objective measure, it doesn't sound huge. It's not ideal that it's every day and you know it's imperfect, but it didn't necessarily on that just sound like addiction. And when I flushed out with her, kind of what's the day look like and what's the narrative of all of it, it was that her first thought of drinking upon her first thought about awaking is about drinking. And she sometimes dreamt about drinking. And she would do all her day routine with her four kids. But towards the end of the day, she could find herself getting irritable, waiting to drink. And she shopped at more than one liquor store in town because she didn't want the clerk to know that she was alcoholic. And she threw the empties in different recycling bins on her street, not just her own, because she didn't want people to see them all in her bin and didn't want the garbage men to know. And then when she did that two drink, that took the two drinks in the evening when her husband came home from work, they would sit on different ends of the dinner table so that he didn't smell it on her breath, and they no longer had a real physical intimacy because she was hiding the alcohol smell. And then he would pass out. She's drinking during the day or just No, drinking two drinks in the evening after the kids are to sleep. And so, by the objective measure, it wasn't enough to constitute was what was so worrisome. But she was in treatment, and I believed she was in treatment. I believed she was there for a good reason, and I've I have really never in my life questioned and said, Are you sure you belong here? Are you sure you earn your seat here? So when I really wanted to what I call assess for the obsession, it's when all this stuff came out, which is that that preoccupation, that obsession was the whole day. Right. It was in her dreams, it was upon awaking, it was the shopping, the getting, the planning, the drinking, the hiding, the recovering from. It's just an example of all the things you listed earlier. And that obsession is the difference between problematic drinking and not for a lot of people.

SPEAKER_00 41:50

Absolutely. I remember that person.

SPEAKER_02 41:52

Yeah. So the last category, just in, and we'll touch on it just quickly so we don't spend too much time, is the illness of spirit. And the punchline of illness of spirit is that people have a uh learned helplessness and a feeling of can't change. And if you're not familiar, uh Aaron Beck in cognitive therapy talked about learned helplessness is this idea of that if we think we can't do something, uh, and we kind of integrate that. The initial experiment, if I remember correctly, there were dogs locked in cages two nights, two full days and two full nights. And overnight, as the second night ended, they very quietly unlatched the gates while the dogs were sleeping. And what they found when the dogs woke up on day three is that they were no longer trying to get out. They weren't pawing and pushing the gate anymore. They had learned to be helpless. They had learned that they just weren't gonna get out no matter what they did. So there was a stuckness of surrender. Yeah.

SPEAKER_00 42:46

It's so sad.

SPEAKER_02 42:47

It's sad. And, you know, interestingly, it doesn't just apply to dogs, you know. Um, the human example I have is that I had an office that was on the fourth floor early in my career, and there was a doorman, and patients would just tell the doorman and come on up the elevator on their own and go to my waiting room and meet them there. But the doorman was not reliably there for my first patient of the day, 7 a.m. So I made a habit for my first patient of the day to go down, greet them, let them in the front door with me unlocking it with the key, ride them up the elevator, and you know, albeit a little awkward to start your therapy in the elevator or not, uh, it was what I had to do for that year of that office. And on one particular day, a 7 a.m. patient, which is the only patient of the day I had to do that for. After that, the doorman was there, people would let themselves up. Uh, a patient had to reschedule once, and they were now coming at 1215, and they were like 10 minutes late. And I called them. We're talking pretext just to date myself. And I called them and I was like, I just want to remind you, you're at 1215 today. And he goes, Yeah, I'm at the front door waiting for you. And I was like, Oh, of course you are, because I've conditioned him, right, to be helpless, that he can't open the door on his own, he can't ride the elevator on its own. He has a learned helplessness, which is that he could well open the door and ride the elevator, he just doesn't know it. And with addiction, people get really stuck in that groove, which is they just can't see their way out of it, right? They may not have the language for it, but they just feel like they're on this terrible. Cycle of I say I'm not going to do it again, right? What I refer to as the national alcoholic anthem, right? At night saying I will never do that again. And in the morning or the next day, doing the same drugs that we vowed not to do, leading to the same consequences, leading to the same vow I'm never going to do that again. And there's a certain type of stuckness and a learned helplessness and a kind of spiritual sickness of this I can't change. Right? Anything you want to add to that?

SPEAKER_00 44:27

Uh, I mean, the spiritual piece is so enormous, and to me, it's such an important piece to integrating um how AA has become the program it is, and how people do get through any kind of illness, whether it's an addiction or it's a physical illness or a mental illness, it's that believing that you're gonna be okay, and that there's a larger energetic uh being call it what you like, higher power, God, that is there for you to guide you, and people too truly do start to believe because they've been conditioned by their own addiction, that if they don't use, they won't have happiness, they won't have joy, because there's they feel so dysphoric when the substance wears off that they start to believe that that's the only thing that can give them really life, even. And as you move into recovery and you start to experience the beauty and sparkle of life again, you recognize that there's a power out there that's supporting you, and that's one of the major tenets in AA, whether you believe in God or you believe in AA or whatever, um that's what's held people, held the hand, held the heart of people who are struggling about if they're gonna be able to do this. Um and part of addiction is not just having a shitty behavior that is torturing yourself and everybody, it's also about the fear that you can't get better, so why bother trying? Right. And that spiritual malady is, you know, is a window towards spiritual support and spiritual wellness.

SPEAKER_02 46:25

There is a stuckness and a helplessness that prevents people from doing things. And I experience it with if I have a task to do and I've done it or I know how to do it, I'm on it. And if it's something like currently having to pour a cement set of stairs that I don't know how to do it, I freeze up, I get paralyzed. It takes weeks to kind of think it and plan. And some of it is to do research and kind of have due course and order materials and talk to people and learn. And some of it is because it's just hard to do what you don't think you can do or know how to do. And people really get caught up with addiction as I'm in this, on this merry-go-round, and I cannot see the exit, right? I cannot, I cannot see a way off of this. So here's a conclusion statement of the body, mind, and spirit. Right? People who struggle with addiction, that third category, not social, maybe heavy as we talked about, but definitely the addicts, have an illness of the body, which is a craving and allergy, which means they can't use substances safely, because once they start, they can't stop. Coupled with an illness of the mind, which is an obsession, which means they can't get this thought out of their head, so they can't quit. And an illness of the spirit, which makes them feel like they can't change, even though they can. And so the summary statement is an illness of the body can't use substances, an illness of the mind can't quit substances, and an illness of the spirit can't change. And if you can't use and you can't quit and you can't change, then what you really are is powerless. And Eliza alluded to that before. That in 12-step programs, step one of 12-step programs, we reads, we admitted that we were powerless over X, that our lives have become unmanageable. X could be alcohol, drugs, sex, gambling, deading, you name it. We admitted that we were powerless over alcohol, that our lives have become unmanageable. And that powerlessness is what we just described. The illness of the body can't use, the illness of the mind can't quit, and the illness of the spirit can't change. That is the powerlessness in a in a synopsis. Anything else you want to say there, Liza? Um, I mean, that least you have like a specific uh thing that you're I'd love to hear you talk a little bit about OCD before we finish. There were two other things, but OCD was one of them. You talk a lot about OCD and overlaps to addiction and comorbidity, and so I just wanted you to put that out there while we're talking about what addiction is.

SPEAKER_00 48:47

Uh yeah, I mean, I think that OCD is the umbrella. So that the you're gonna meet a lot of people who have addiction problems who you will see OCD behavior outside of that, or who had it as kids, or whose parents have it. And it's a it's it's so obviously cousins too, or the same as, because it's simply that whether you're tapping or you're repeating a thought or be behavior that you know is unnecessary and that you know is doesn't need to happen, you cannot not do it. And an example I a great example I have is I worked with a client for a long time who was very um, he was a slim guy, he always wanted to be a little bigger, a little buffer, and so he was always trying to raise his caloric intake, and he would um he would make a decision that he was gonna have a cookie after lunch every day. And every day that he bought the cookie, when he would pass the garbage pal, he would throw it in the garbage. And he could not not do it. And he would pass by, I mean, of course he could not do it, but he was stuck in that behavior. And um, you know, that was his and to me, that's the alcoholic walking past the bar, I'm not gonna drink after work today, it's not gonna happen, and not being able to get past that. And the only difference I would say is that with OCD, there's a relief, but there's not a high per se. And in addiction, there's a high. And so it is actually so much more toxic. In some ways, you can live with OCD and be annoying to yourself or the people around you, or very high functioning because it's your OCD is exactly what everyone needs.

SPEAKER_01 50:28

Yeah.

SPEAKER_00 50:29

But at the end of the day, it's not true for addiction around um behaviors that create unmanageability.

SPEAKER_02 50:36

I'm glad you think my OCD is what everybody needs. Thank you for that.

SPEAKER_00 50:41

Um Well, you said it, not me. Yes. But no, I mean, no, there's obviously being someone who checks stuff, being someone who double checks, being someone who has vigilance, it's useful.

SPEAKER_02 50:53

It is, but there's a loop that's hard to get out of and it causes consequences in people's lives, and it definitely has the repetitive nature to it and the motion to it, and there's there is a lot of kind of closely related cousin to addiction. Uh, the only other thing that comes up for me is that we also think of addiction as a lot of instant gratification, that they use the word dopamine-seeking before, and there's a lot of pleasure now, pain later in that. And when I think about instant gratification, I I always think it's important to clarify that I don't think gratification is problematic, right? That sex can be gratifying, eating can be gratifying, shopping can be gratifying, a little wine can be gratifying. There are any number of things that can be gratifying that are not inherently problematic. That instant gratification makes it quick and impulsive. And in doing so, what makes it problematic is that it's not just pleasure now, pleasure later, it's pleasure now, pain later. Right. And that to me, I think of addiction as having a real instinct gratification component, which is I use this or do this, I get that dopamine hit, I get the high now, but then it's followed by a crash and it's followed by consequences. And my lovely wife here is known well for saying that gravity exists, that what goes up must come down, right? And so if you get a high from something, you get a crash from something. And when people crash, irritable, edgy, nasty, gnarly, down, use again to repeat the pattern. Um, and so I I do believe in the instant gratification model of that it's a pleasure now, pain later, and that we need to break that.

SPEAKER_00 52:31

I think also what's very difficult is for is that the addict or the person in the cycle doesn't necessarily correlate the their behaviors, their aggressive, angry, depressed, whichever they are, with their addiction. They actually think of their addiction as curing that problem. And the people around are like, what? Can't you see what is happening here every time you do blank, blank happens. And the person's like, absolutely not, that's not an issue. Um totally normal, and compare themselves to other people, like you know, the heavy use kind of comparison, whether they're it could be heavy, you know, process stuff too. And to me, the key piece of you know, working your way to a place of I'm I realize I'm an addict, and the people that are around me are talking about me having an addiction, and I'm gonna make an attempt at this, is recognizing or getting to a place where you recognize what the addiction is causing in you. Because there's so there can be a real soup in terms of misery where you don't know what's what's causing what. And I've worked with so many addicts who just say, like, you know, the famous line is like, if only it were only alcohol, Liza. You know, that's not my problem. My problem is me, my problem is my trauma. And all those things are real, and they're real problems and they're real trauma. Yeah. But at the end of the day, the addiction and the dysphoria in the peaks and valleys is creating a playing field that makes it harder to heal from any of that.

SPEAKER_02 54:16

It is very hard to see it, and if you don't see it, you definitely can treat it, and you also can't treat it on your own. And the treatment part is beyond the scope of today. We're gonna get to that, but suffice it to say, I love the Einstein quote that the same mind that created the problem can't create the solution, and that often it requires other people to see it. And even the two of us sitting here, uh, I had about three years of sobriety when Eliza and I met, and I was still smoking cigarettes. And at one point, and I'm not even quite sure, Eliza is the biggest health nut I know, and healthy and eats organic and yoga and exercise, and so I'm not even sure how she engaged with me as a cigarette smoker, but she did. And the only thing she said to me was once she said, Have you noticed that every time you smoke a cigarette, you have to sit down because you're dizzy afterwards? Lie down, lie down, even. And I was like, I was like, I had not noticed that. And it was one of a few things that was a contributor that within like a couple months I stopped smoking cigarettes and haven't smoked since, but it really was eye-opening for me.

SPEAKER_00 55:16

I was like, How can you function if every time you smoke you have to lay down because you're so nauseous?

SPEAKER_02 55:20

I had not noticed that.

SPEAKER_00 55:21

And he didn't have anything to say in response. We just looked at me and I thought, I'm the first person noticing this.

SPEAKER_02 55:26

Like So as we wrap this up for today, um, we're talking about addiction, we're talking about drugs, alcohol process, you name it. We're talking about an important concept which we didn't really highlight, but I just want to say as we wrap up, which is that, explicitly to state it, we alluded to it, that it's not the substance that's the problem. It's the person's relationship with the substance. Alcohol is not inherently problematic, drugs aren't inherently problematic, pornography is not inherently problematic, shopping is not inherently problematic. There are a lot of people who can have an adaptive relationship with those things. But that addiction is a maladaptive relationship with something that exists within that person. And so I can't gamble because I have a maladaptive relationship with it. I can't use drugs because I have a maladaptive relationship with it. I can't drink alcohol, I have to gamut, right? And so those of us who have a maladaptive relationship with something choose to leave it alone because once we start, we can't predict when we're going to stop. And so we talked a little bit about the social category, the heavy category, the addict category, and then we broke down that addict category and potentially the heavy into that can't use, can't quit, can't change, body, mind, spirit, and we get to a place of hopefully helping people to open their eyes. You said that a few times in a few of your examples today, and I think it's a good example, which is that we hope that people can open their eyes to let in some of the truth, to break through through some of that denial, through rationalizing, minimizing, and see one's relationship with substances for what they are, and begin to ask for some help with it. And to Eliza's point, I'll just share one last anecdote, which is when I went to rehab myself, and I went twice, I thought I was mentally ill, whatever that means. I thought that I was crazy because I kept saying I wasn't gonna do this anymore, and I kept doing it more the next day. And I kept saying I was gonna quit, and I never quit. And I said I was leaving rehab, but I was gonna do it on my own, and then I got high four hours later. And it was easy to convince me that I was just crazy. That was what I thought I was, but I didn't see it as addiction. I thought I was crazy. And the first AA meeting that I went to, I heard other people share about their experience with alcohol and substances. And I don't remember the details, but I remember coming up with a sentence of it gives meaning to my struggle. And it has always given meaning to my struggle to hear people's stories and anecdotes and narratives in their relationship because often, because of denial, I think we can see things and experience it more through other people's experience than our own, or somebody seeing it in us and being able to illuminate and highlight it. And I think it's such an important part of why we don't just get ourselves sober and why we don't just fix this and remedy on our own, but we lean into many of the supports that are out there. Anything that you want to say in winding down?

SPEAKER_00 58:16

Yeah, I mean, to me, what's really important in conceptualizing the inside-outside addiction picture is recognizing that a person who has addiction is in a suffering soup. And if we want to help them or if we're struggling with being a part of that, we have to recognize that our truth may not be their truth, but not be afraid to talk about it. I mean, everyone's heard the and the concept of enabling, I would think. And so being able to have conversations with people, not accusing, yelling, fighting, is it the really the beginning? And whether the person agrees with you or not, to be able to call something out for how you see it and the problem that you see it posing in that person's life is really important because the key the secret keeping is what kills people in the end.

SPEAKER_02 59:15

Addiction definitely lives in the shadows.

SPEAKER_00 59:17

Yes. And you know, lies kill an addiction, like secrets kill. Like you have to call something out for what it is and let it fall where it falls, but hoping that the person gets there on their own without you mentioning it, without you calling them out, it's not gonna happen.

SPEAKER_02 59:35

We'll talk much more in the future about solutions and how to treat things and and what the counterpoint of solutions are to these problems. But hopefully today was a good introduction to the topic of addiction and and laid out some thoughts on it that hopefully will provoke some thought on your end.

SPEAKER_00 59:51

Yeah, and hopefully people hear some things that um uh created some answers to questions that they've had in the past about how it looks and that colored in some of the black and white of the photograph and made it a little more understandable.

SPEAKER_02 1:00:08

Nicely said.