In Episode 302 of Through a Therapist’s Eyes, we unravel the complexities of Alcohol Use Disorder (AUD) and the consequences of misdiagnosing it. Hosts explore the blurred lines between social drinking, binge drinking, and AUD, shedding light on how stigma and misconceptions shape perceptions. With insights from past expert discussions and key diagnostic criteria, we examine the psychological and social impacts of mislabeling, as well as the importance of thorough clinical assessments. We will challenge assumptions, discuss co-occurring disorders, and explore best practices for accurate diagnosis and treatment—because understanding the full context matters.
Tune in to see Alcohol Use Disorder Through a Therapist’s Eyes.
Think about these three questions as you listen:
Three Questions:
- Have I ever assumed someone’s drinking habits were problematic without understanding their full context?
- How can misdiagnosing Alcohol Use Disorder impact treatment and a person’s self-perception?
- What are the key differences between casual alcohol use, problematic drinking, and Alcohol Use Disorder?
Links referenced during the show:
https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926
5 Subtle Signs You Might Have Alcohol Use Disorder | SELF
Intro Music by Reid Ferguson – https://reidtferguson.com/
@reidtferguson – https://www.instagram.com/reidtferguson/
https://www.facebook.com/reidtferguson
https://open.spotify.com/artist/3isWD3wykFcLXPUmBzpJxg
Audio Podcast Version Only
Podcast: Play in new window | Download
Episode #302 Transcription
Right. Right. I don’t either. So we should stay here. Yeah, we should stay right at this temperature. We’re not bad, right? It’s sunny. Yeah, it’s sunny. It was a little chilly out there with the
Chris Gazdik: wind today.
John-Nelson Pope: The wind was very bad yesterday.
Chris Gazdik: Yeah. Yeah. Oh, indeed. Yeah, we had a major storm come rolling through. Okay, so let me see.
What else do I need to say? Subscribe. Click the buttons. That helps us get found and get. Noticed we’re really asking for YouTube live to tell somebody a friend to subscribe, hit the panel to describe for us, tell a friend
John-Nelson Pope: contact give us a five star rating.
Chris Gazdik: John is always very personal. Oh, it takes that very personally with anything under five stars.
I, I try to hold him back from this thing to, to, to, to not shame people into it. But what are you going to do to him if they give us a three star? Oh he’s going to be upset.
John-Nelson Pope: No, I [00:02:00] won’t come after him. You’re not coming. for anybody. No, no. We’re not everybody’s cup of tea. Contacted
Chris Gazdik: through a therapist.
Eyes. com is a great way to interact with us to an email. We’d love to hear from you. Talk to you. Finally, this is the human emotional experience, which we do endeavor to figure out together. Mr. Reed Ferguson highlight him today. We haven’t in a little while is the man in the myth and the legend that created John.
You know what you remember the intro, the intro. Have you heard the intro in a while? You haven’t had. Yeah, with the music. Yeah, with the music. Yeah. Yeah, we don’t play it in studios, so I figure you haven’t probably even heard this for a while.
John-Nelson Pope: I haven’t heard it for a long time.
Chris Gazdik: Yeah, you need to tune it in on a show and just listen the first couple minutes.
Well, it How cool it rings in.
John-Nelson Pope: Okay.
Chris Gazdik: He created that specifically for us.
John-Nelson Pope: Thank you, Mr. Neil Ferguson. Read. Reed.
Chris Gazdik: Reed Ferguson. Oh, Neil Robinson. Neil
John-Nelson Pope: Robinson. Okay.
Chris Gazdik: The man behind the curtains. Right. Alright. Reedferguson. com. R E I D [00:03:00] T F E R G U S O N. Reedferguson. com. You can find him on Instagram, Facebook, and various places.
He’d love to come and play for you. He is an awesome musician. Three questions we’re going to talk about today, John. Have I ever assumed someone’s drinking habits were problematic without understanding their full context. It’s an interesting question, even for a
John-Nelson Pope: clinician. Yes.
Chris Gazdik: Right? How can misdiagnosing alcohol use disorder impact treatment and a person’s self perception?
And what are the key differences between casual alcohol use problematic drinking and alcohol use disorder? That third question right there, John. Yes. I think that’s the major source of my angst. Mm hmm. You follow?
John-Nelson Pope: Yeah.
Chris Gazdik: This is an unfair thing to do to you.
John-Nelson Pope: Like, like I [00:04:00] said. Don’t give you a Don’t put me on the spot on this one.
I
Chris Gazdik: have to a little bit because you’re curious where we’re gonna go. You’re curious what we’re gonna say. We’ve alluded to this being a little edgy. The title misleading diagnosis, alcohol use disorder, you know, you’ve heard me talk about the disease model and you and I oftentimes I think link up pretty good with what the traditional addictions field is and how that’s been, I think, really kind of impeded upon in recent times.
So I don’t know. I’m just curious if you, how you see that, how you, what is your opening sense about this whole topic?
John-Nelson Pope: Well, I think the waters got muddied, actually, with the DSM 5 a little bit, because it moved. [00:05:00] It, it, it seems to be For me, confusing in terms of determining what is exactly alcohol use disorder.
Chris Gazdik: Very.
John-Nelson Pope: Yeah, it’s very. Very.
Chris Gazdik: Like we’ve progressed backwards. Yes. And that’s my beef. Huh. Question, I don’t know the answer to this question. I’m embarrassed and actually I don’t have my DSM TR. I wanted to look at that today closely.
John-Nelson Pope: We have a new one.
Chris Gazdik: No, I lent it out. Oh, certain somebody has it. I know
John-Nelson Pope: she does.
Chris Gazdik: Yes, she does.
John-Nelson Pope: I’ve got mine.
Chris Gazdik: Do not. I should have asked. I think Victoria has one also. I probably could have done that. I actually, I’ve just been crazy busy today too. Is there any difference with AUD compared to DSM 5 to DSM 5 TR? Now, you listening at home understand that DSM is the Diagnostic and Statistical Manual.
It’s the book of all the mental health diagnoses we get and have. And we just have [00:06:00] a, what does TR stand for? Revised? Yeah, revised. What’s the T?
John-Nelson Pope: I don’t know.
Chris Gazdik: DSM TR. The T has to mean something. transcription revised. I don’t know, but we have a in between five and six, basically a revised version of our book.
And I’m asking you, John, is there anything different with AUD from DSM 5 to DSM TR?
John-Nelson Pope: I don’t know.
Chris Gazdik: You don’t know either?
John-Nelson Pope: Mm hmm. I don’t know.
Chris Gazdik: I don’t know if they changed anything. I doubt it. I seriously, significantly doubt it. But I wanted to check. So you’re not sure either.
Neil Robinson: TR stands for text revision.
Chris Gazdik: Text revision. Thank you, Neil. Thank you. That would have bothered me tremendously. I could have
John-Nelson Pope: I might need to
Chris Gazdik: See if that’s the change?
John-Nelson Pope: Yeah, no, it’s text revision. I’m just trying to figure out what’s the, what exactly is the, the difference.
Chris Gazdik: Yeah, I don’t, I’m wondering if there is. I mean, a lot of things, they just leave the same.
I [00:07:00] mean, I, you know, that’s, if there’s nothing new research, we just leave everything the same so that it doesn’t really, you know, engage differently. So, well, we’ll look at that. I’m, I’m, I’m embarrassed to say I, but I’m, I’m pretty confident that, that, that it isn’t So let’s, let’s talk about why alcohol use disorder is often misunderstood.
Okay. What do you think? Well, gosh, how provocative do we want to be John? I was kind of surprised when I did my professional speaking engagements. That people in a case study, remember we talked about it. Right. You helped me design the case study that I used. I wanted to make it provocatively thinking about trauma.
But didn’t have enough to meet any criterion, right? And we ended up with acute stress disorder versus, you know, alcohol use disorder. Yeah. It was
John-Nelson Pope: a duration. It didn’t. Yeah. With
Chris Gazdik: the, with the pieces that [00:08:00] were in this, this, the little schematic that I created to help, by the way, you listener understand to, to, to train therapists doing therapy, like, you know, What diagnosis this case study would likely end up and a lot of them said alcohol use disorder John they did.
John-Nelson Pope: Yeah
Chris Gazdik: But I didn’t realize it and I didn’t have enough time to spend time on it Until we were done because I was really kind of scrambling at the end to get everything in they did not use the qualifiers
John-Nelson Pope: Huh
Chris Gazdik: mild moderate or severe. There was no mention of that. They just threw out AUD as a diagnosis.
Right. But it’s so inadequate and so incomplete. And it does
John-Nelson Pope: a disservice to the clients. Yes. I think very much because it can be very challenging with, let’s say someone, the subtle differences in terms of, of developing the, the, the full. Blown. I’m going to use the word disease [00:09:00] and please. All right.
Disease model. Yeah. And that is that it’s a progression. And so you have somebody with a disease model means what disease model means that there is in a sense, the organic condition of it. It’s not something that you can just change by right thinking. You can, part of that is the mental health aspects of it, but there’s also willpower, willpower, but willpower has never.
Has never cured doesn’t do anything, doesn’t do anything, has never treated effectively. Alcoholism, right?
Chris Gazdik: Absolutely. Yeah. There’s, there’s so much that goes into that and I, we’re just not going to have time. I think all for this show all day today to kind of go into misleading nature of what this is.
And it does
John-Nelson Pope: a disservice to the clients who, who come for treatment because they all have this idea. Of, [00:10:00] of, of, there’s a lot of judgment. I, I self judgment that they have. Many of my clients do guilt that they’re dealing with.
Chris Gazdik: Yeah. You know, it’s funny when I am assessing somebody’s relationship with alcohol and or drugs of any kind.
And I begin to get concerned about, you know, hey, there’s enough here for us to really explore this and, and get into understanding this applies to you or doesn’t. People do not understand very well the word addiction. Right. We’ve talked about that on the show before.
John-Nelson Pope: Right.
Chris Gazdik: And we just, you know, it’s funny to throw out into the, into the, You know, space with somebody, what is addiction?
You just get all kinds of crazy conversations that are awesome. I mean, they’re good, but they’re, it’s just fascinating to, to, to me. And I didn’t get to do that in my training a whole lot, unfortunately. But the reason why that is, is because there’s so many [00:11:00] misconceptions and myths within the field of therapy itself, right?
And alcohol use disorder completely misses the boat. Because when I’m talking to somebody and we’re identifying, there’s enough red flags, we’re concerned about this being a diagnosis, let’s get into this, like, I will purposely use the words addiction. Have you ever thought, Sally, about, you know, alcoholism being a thing for you?
And you should see the reactions, you see the wheels spinning. Because when you say alcohol use disorder, it doesn’t have that connotation, does it? No, it’s
John-Nelson Pope: something that they can get, you know, that, that it doesn’t do the full import of how it can absolutely bring havoc or wreak havoc in one’s life.
Dominate somebody’s life is what Physically dominate that they actually become so that their life addicted, their life revolves [00:12:00] around getting that X, that other drink to get the ever clear to get the, you know, the, the, to say, well, you know, I, I’m not addicted. I just drink beer or something of this sort that.
And I just do it on weekends and so lots of lots of rationalizations that are there and I don’t drink during I don’t drink at work That would be another one and then they come home and they get blotto and they black out
Chris Gazdik: but alcohol use disorder Means what to a lesser extent.
John-Nelson Pope: Oh, there’s something you can control
Chris Gazdik: Bottom line.
Bingo. Bingo. Yeah. And we know one of the things that substance abuse therapists understand very, very clearly is, is that you, you cannot control your use. That’s the, the big differentiator. And I’ve always kind of said a good way to understand that is that your relationship with alcohol and or drugs is predictable.
If it’s not really predictable. Then you don’t really [00:13:00] have control, meaning you might come home at 10, but you might not come home till two. You just really don’t know on any given encounter with alcohol or drugs what’s going to happen. So we can go, and I encourage you, please, I implore you, if you’re listening to the show, check out some of our older shows.
And, you know, I really didn’t get those prepared. I need the episodes to, you know, scan that and tell us, you know, what the episodes are, a few of the good ones. Because I really want you to take the deep dive with us on, you know, what is what is addiction? What is alcoholism? Actually, I lied, Neil. Episode one 95, a debate on drug addiction, recovery issues with Mr.
Daniel Gasser. That was a really cool discussion. Episode two 22, the battle, the panel battles. With what is addiction that I really want you to listen to to to to that’s actually an easy number to remember man I just I just get so concerned about this John. I get so concerned about how [00:14:00] fellow clinicians Arguably just miss the boat when it comes to people men and women that are their lives are crushed by addiction and we just say alcohol use disorder And move along and treat it as a side note, almost.
Yeah. Self medicating side note.
John-Nelson Pope: Huh.
Chris Gazdik: And adjunct to the main problem, trauma or depression or anxiety. Addiction
John-Nelson Pope: is so bad that it is, when there’s withdrawal, it causes greater physiological trauma to the fam to the, to the body, to one’s body than one would with with narcotics. Yeah. And that’s, that’s saying a lot.
Chris Gazdik: It’s saying a lot. Yeah. It’s, this is a dominating experience with somebody in their, in their, in their whole existence and [00:15:00] whatnot. I mean, you know, look, I was very, very confused when I was learning about addiction doing the DUI class in 1999. Seriously. That’s when I was doing the DUI class. No, check that 1996.
And that is when I got my first main gig after. And there was one line, John, in this. Paperwork and presentation I was giving, there was a line that said, addiction is primary. And I didn’t really know what that meant. I really was confused. I had to learn. And I went and remember asking questions to my supervisor, like all the time with different things to learn this stuff.
And it’s the way I got my basic understanding of addiction right from the get go in the field. Do you understand, of course, what primary, what that means?
John-Nelson Pope: That means above all others, it’s everything.
Chris Gazdik: If you don’t address the addiction. Issues first in therapy. Mr. or Mrs. therapist listening, if you do not address the addiction issues [00:16:00] first, you can’t get to the other stuff.
John-Nelson Pope: You can’t deal with the depression. You can’t deal with the anxiety. And part of this is the addiction aspects of alcohol because it does play so much. Literally pickling your brain is that your brain is damaged basically, and it can repair itself to a certain extent, but it takes months. And so one’s treatment has to be primarily the addiction itself.
Then work through that support systems and work through as one is recovering. One works through and it starts to be able to, well, this is get to the root of the depression, get to the root of the anxiety.
Chris Gazdik: And that’ll fix the alcohol use disorder. And it’s just, that’s backwards. That’s
John-Nelson Pope: backwards. You’re,
Chris Gazdik: you’re, you know, and even long before your brain gets pickled and all this type of stuff, and your, your, your systems are run down with heroin addiction and cocaine could be in a coke head [00:17:00] and whatnot, like very much earlier than that, but early late enough that we can identify.
Addiction, meaning alcohol use disorder, moderate, I’m going to talk about the different differentiations
John-Nelson Pope: here
Chris Gazdik: in a moment. You know, way earlier before your life is completely destroyed, it’s still primary and you can’t begin to address the anxiety OCD or the trauma related issues. Trauma is a big one.
You know, a lot of therapists are going to say like, well, we need to do trauma work. This is self medicating behavior and we need to kind of resolve the question. Here’s the question. I’m getting john worked up.
John-Nelson Pope: Can you truly be treated? For depression, if your mind is still, even though you are not having alcohol in your system, but you are, you are still recovering from the physiological and addictive aspects of alcohol, [00:18:00] would you be able to truly treat?
The trauma
Chris Gazdik: to listen therapists that don’t know this term. I want you to look it up because we don’t have time to cover all of these topics, but you’ll find them in our shows. We’ve done a show on post acute withdrawal syndrome, right?
John-Nelson Pope: Right.
Chris Gazdik: Paul’s post acute withdrawal syndrome. I mean, you’re asking me a question, John, I’m gonna say no, right?
If you’re in post acute withdrawal syndrome status, right, which is many months. After you attain sobriety, right? Right. No, you can’t treat brain fog thinking it’s just depression if you’re not aware of the alcohol issue.
John-Nelson Pope: Right. I have a young man that’s in recovery right now. He’s five years in, into recovery.
Five years sober. Five years sober. And one of the things that was, because he was a teenager when he would he develop this addiction and, and he started to begin the process of recovery. He had to actually be hospitalized for it. He said, one [00:19:00] of the things that was pounded in his brain was for the first year, don’t even get into a serious relationship with another person.
It’s a suggestion. Yeah. Yeah. Yeah. Strong suggestion. Strong suggestion. Yeah. Yeah.
Chris Gazdik: There are several strong suggestions. Yeah. Because you’re just, you’re not. You’re not geared into sanity yet, you’re really so consumed with the preoccupation of addiction and the actual lack of control and the, you know, the hiding of the supply and, you know, the, the brain fog that kind of gets up the, the preoccupation.
I think I said that already. I mean, it’s just all these different symptom sets are running through your life that, you know, you have to sort that stuff out before you can kind of be sane, right?
John-Nelson Pope: Got a question for you. Have you, in your experience, have you found any of the assessments to be helpful when explaining this?
Yeah, I’ve used them. Yeah? Yeah. You don’t do the mast or the audit, you know?
Chris Gazdik: Yeah, I, I haven’t. I, I’m, personally, I, I just You know, I, I, I feel like I’m able to [00:20:00] see a lot of the red flags in the, in the, in the warning signs that we look for. I mean, I’m really good about identifying this as an issue because I’ve been doing it since 1997, you know, for real.
And so I, I don’t, I don’t know, I probably should, I know I can be myself open for criticism. I
John-Nelson Pope: wasn’t trying to put you on that. That’s fine. That’s fine. I was, that was an authentic question. I understand. Do you use them? Yeah, I still use them, but it’s not for everybody. I kind of like assessments. So that’s, I’d love assessments.
Well,
Chris Gazdik: it’s the psychologist. Yeah. This whole research thing in you and I just want to get in there with the client and be on their level and just identify stuff that’s kind of my jam. So,
John-Nelson Pope: yeah. So, I mean, that, that’s just, that’s. That’s a little bit more of me, but it does seem to me that you have to be able to, to, you know, to just to lay out in terms of the criterion [00:21:00] criteria for what would show addiction.
And I think that’s the problem with AUD, alcohol use disorder, is that it kind of uses language. To soften the, the impact of what addiction truly is and how all encompassing
Chris Gazdik: it does a disservice. If that is what we are trying to do, I’m even more upset. Right. I’ve thought of that before, John. Why do you think
John-Nelson Pope: I’m sorry.
Chris Gazdik: Yeah, hold on. Is this, is this like Powers that be in our field that are trying to lessen the quote unquote blow of alcohol dependence. That’s what we used to call it. Alcoholism. Those terms are not nice. Those terms are damning to people. Those terms, you know shame people or whatever. Like I hope that’s not the thinking behind this, this, you
John-Nelson Pope: know, and I, when I was getting my doctorate, that the big thing was harm [00:22:00] reduction.
Yeah. And I have some, yeah, I have some issues with that too. Absolutely. Methadone
Chris Gazdik: clinics and suboxone treatments and reduction of harmful use. Yeah.
John-Nelson Pope: Vivitrol for shots in the butt to to, to help with That would actually
Chris Gazdik: be a fun show to do sometime, another one of these, you know, kind of edgy shows a little bit where you and I are a little cranky on what’s going on, you know harm reduction programs are not, are, are, are, they have some issues.
John-Nelson Pope: I, and I could see if somebody is so, so dependent, so addicted that the only way they can actually short well, you see, that’s why you have to go, why people resist so much going and going away for rehab, rehab, rehab. And you have, why are so many rehabs up in the mountains somewhere where you can’t.
Near [00:23:00] no towns or cities,
Chris Gazdik: the remote locations, you know, because they, when we answer your question, why,
John-Nelson Pope: why, because you don’t have access and you don’t, the only thing you can focus in on is your rehabilitation, your recovery, your
Chris Gazdik: recovery. Absolutely. So what is alcohol use disorder? You hear us talking about it’s a little different than the question we usually ask what is addiction.
So, you know, it’s funny. Episode 222. We dealt with that in depth, you know, the panel with Victoria here, we launched into like the answering that question. So we’re not going to do that today. But if you go to that show, you’ll get an in depth understanding of alcohol use disorder. cocaine, heroin and whatnot, the words just shift, which is the same thing.
Dependence is what we used to call alcoholism and addiction and stuff. It was alcohol dependence, and a lesser form of a problem was alcohol abuse. And again, [00:24:00] you know, the differentiation there, one of the big differentiations is sense of control over your use with that substance, right? So alcohol abuse, you had control over the substance.
Alcohol dependence, you didn’t. Well, they’ve just lumped everything together and said alcohol use disorder, mild, is what used to be alcohol abuse, right? Yes. And then moderate and severe are more alcohol dependence. Right?
John-Nelson Pope: Right.
Chris Gazdik: I mean, I don’t understand why we did that, John. For the life of me. Yeah.
Goodness, the goodness life in me. Why did we do that?
John-Nelson Pope: Again, I, I think it’s because we don’t want to have people think that that this is something that that I guess it’s the use of language that seems to I hope you’re wrong. Yeah. I
Chris Gazdik: really hope you’re wrong. Yeah. What do you think? I don’t know. I really am a flat footed here.
I am, [00:25:00] I am completely flat footed. I, I think you’re good chance being right. I thought that before, but I really hope you or we are wrong. I, I, I, I guess to take a stab at answering that, I think what’s happened is, you know, we, we, we, we’re, we’re beginning to develop science. Around brain imaging, right? And I know there’s some arguments about how we can see brain functioning on scans and they’re seeing some things with, you know, well known addicts and what their brains look like and how it looks similar to other people that are newer into use or have never shown any problems until later on in life.
I mean, I think there’s some. I’m going to call it weird science that we’re trying to learn about.
John-Nelson Pope: Yeah.
Chris Gazdik: You know, that, that makes, makes the researchers want to lump that in together. But I [00:26:00] just think that’s just so dangerous and misses the point,
John-Nelson Pope: right?
Chris Gazdik: Like I don’t know that we really have a good handle on brain imaging and what the heck that images are showing us, right?
And it’s dangerous to, as you say, water it down and just say, it’s just, well, it’s just a use disorder. My own modern or severe, right? That’s my guess. What, how does that sound to you? That sounds,
John-Nelson Pope: sounds very much on. On point for me, because, you know, even if you do these, these advanced MRIs and you could see the brain atrophy that occurs with with alcoholism or with the addiction aspect of it.
And you could see the physiological being the external. It doesn’t quite get into what does it do to the connections of the neurons themselves, and so I think you have to be There’s a lot going on and we don’t understand in the brain. Again, a disease process, right? Yeah. [00:27:00]
Chris Gazdik: Yeah. And that’s old school thinking the disease model.
And I don’t know, has that gotten,
John-Nelson Pope: I’m old, but I’m old. So,
Chris Gazdik: well, I am not. And, but it is still, I don’t know, has. How do I want to ask you that? Do you think the disease model has been criticized and destroyed by the field? You know, has, has, I mean, I know it’s been kind of controversed a little bit, you know, but
John-Nelson Pope: Well, I think part of it is Are we
Chris Gazdik: a dying breed, John, I guess Yeah Is my curiosity
John-Nelson Pope: Well, I would hope that we, that we would actually be able to help people get to get better, to recover.
Well, I’m saying clinicians. I’m saying with other
Chris Gazdik: clinicians.
John-Nelson Pope: Yeah, I think right now, I think that’s they’ll, they’ll go I think people will go to those practitioners or clinicians, clinicians that actually will give [00:28:00] them what they want. For example, the medication that they want and not have them do the The hard work, which would be this the therapy, which is I think in terms of recovery
Chris Gazdik: I don’t think you’re answering my question though.
I’m curious. I know that people in the field, other therapists. Professionals on a higher level, you know, researchers and whatnot have, has there been enough pressure on the disease model concept that has breaking that down and destroyed that?
John-Nelson Pope: Yeah. Do you think it has? I’m asking you, I don’t, I don’t, I really,
Chris Gazdik: I don’t.
I don’t think so. I don’t think so. That’s my main point. I think is I really, really hope not. Well, well,
John-Nelson Pope: when I, when I talk to people that are, are doing the, the frontline therapy. Okay. In the let’s say at the, you know, the residential treatment centers. Okay. They’re still doing that model that’s very effective.
Chris Gazdik: In rehabs. In rehabs. I’m kind of [00:29:00] thinking outside of rehabs. Well, I’m, yeah, rehabs are a sanctity. They’re pretty, you know, they’re pretty, a lot of people are in recovery. There’s still a lot of that great divide, Uhhuh, . But I’m, I think, I’m actually, honestly, I, I should have been clear kind of talking about outside of the rehab centers.
John-Nelson Pope: Yeah. Okay. Like, I, I don’t want to, there’s clinics and there’s a prominent clinic that’s in Charlotte. Okay. Yeah. Right. And. It’s quite good.
Chris Gazdik: Yes. And they’re pretty solid in the disease model still, right?
John-Nelson Pope: They’re pretty solid in that. And it’s not residential. But I, I also know.
Chris Gazdik: Yeah. They have an
John-Nelson Pope: IOP.
I have some of my former students that work in agencies or in outpatient clinics and they basically aren’t, you know, they’ll, they’ll do a little check in, but let’s say a methadone clinic, for example. Okay. Here’s, they, They, they don’t do treatment. They don’t do they just basically say, [00:30:00] okay, we want to reduce the amount of methadone that this person takes over a period of time, like a decade, like a decade, two decades, three decades.
Then there’s the and, and then there’s the other is for, for alcohol. And they say, well, we’re trying to reduce, reduce the amount of drinking slowly and the desire for it and treat it as somehow that your de the addiction is ended once you stop drinking. And that’s, the addiction still progresses.
Yeah. And
Chris Gazdik: yeah, so I guess what I heard you say in the first half of that, and then you’re going into like, you want to talk about harm reduction, I could tell because it sounds like you’re saying, no, Chris, we’re good. You know, a lot of people out there in, you know, this prominent place in Charlotte and rehab centers.
We know it’s a disease model like you’re And I feel like I think
John-Nelson Pope: there’s significant number of those because
Chris Gazdik: you’re I’m seriously I wasn’t really sure at this point I’m a little I’m so engaged in my own [00:31:00] work here as you know We’re busy and I feel like I’d lose touch a little bit and I’m relieved
John-Nelson Pope: in the VA Which right you’re in tune with that Oh Lord and disease models good there right disease model is good And I feel happy and it’s gold And it’s gold in the services.
Okay. I feel much better to be honest with you. I really do. That is one that is the major issue that many of the treatments of of young men and women have is issues. So I have a provocative
Chris Gazdik: question for you, John. So, tell me not to put you on the spot, but you saw the show notes, I hope, in advance.
Yes, I did. So, maybe you’re a little prepared because I want to ask you, I’ve really been curious to ask Victoria this in her limited time dealing with the issues that we have on the show and her getting training because she is not really a substance abuse professional, but by golly, I think we’re getting her pretty geared into it, aren’t we, John?
John-Nelson Pope: That’s right. Trainings was
Chris Gazdik: same for me as well alcohol. [00:32:00] Drugs. So my curiosity is how, you know, we’ve just talking a little bit about the fields diagnosis being a little misleading with alcohol use disorder and how that’s changed over the years. I’m just really kind of curious how your attitudes about addiction and you know, the whole process of of progression and, you know, I mean, my views on this issue have changed a lot over the years, tweaked here and there with the main staples remaining the same, but I’ve, I’ve wondered things about addiction and alcoholism and whatnot.
Have, have your views changed over the years? I mean, yeah, you’ve been doing this a long time from where you started to where you are now. What are some things that
John-Nelson Pope: Well, you’ve met movement. I’ve had movement from the moral suasion type of, of it was a moral issue. Initially it was,
Chris Gazdik: okay. And now we
John-Nelson Pope: know it’s not, we know it’s not.
And that actually was when I went to seminary was because I [00:33:00] was, I was working with people before I even went to seminary and I, I w there was a a bit of that moral moralistic aspect to it and that has kind of moved away. And I think that’s a good riddance kind of thing. Yeah, of it.
Yeah. Cause I, that adds just so much more to the guilt and shame that a person has. I, I, I see more of an emphasis now on, um, the idea that there has to be sense that it’s not just a disease that affects an individual, it affects the person’s family, the employment.
Chris Gazdik: Oh, so you had change over the years where you, I guess you were very, when did you start practicing John?
I hate to ask you. So well, it
John-Nelson Pope: was 1979, 79. That’s
Chris Gazdik: great, man. Yeah. Cause Claudia black. I mean, you, you came in right when she was doing her stuff and nobody knew about it. Right, right. So in the [00:34:00] eighties, early nineties, we started really realizing that. So you didn’t know that at first. Right. And that’s funny.
John-Nelson Pope: Then I had a time when I was at seminary as well, when we started doing that treatment and with pastoral counseling. Then when I was in the Navy, I was very much involved with which was with their with the Navy’s alcohol and drug treatment.
Chris Gazdik: Oh, wow. You did a lot in there. Did that change your mind or mood or attitude a little bit?
Yeah. How so? With your time in the Navy or
John-Nelson Pope: yeah, well, part of it is, is that again, that was the move from moralistic moral to non moral in the sense that I had plenty of my own stuff that was was interfering and it would make me an obstacle as a therapist. Right.
Chris Gazdik: In the way that you viewed, you viewed people that had a problem, right?
So
John-Nelson Pope: I, I went through training for, it was it was intense. It was [00:35:00] it was eight weeks for basically I went through a recovery process. Oh really? Your own 12 step or whatever? Yeah, clinician? As a clinician, did 12 steps. Okay. And,
Chris Gazdik: very cool. I think everyone should, to be honest with you.
John-Nelson Pope: Well, I think life’s a 12 step.
It really is. But that was one of the most revealing. That’s
Chris Gazdik: another show. But I was
John-Nelson Pope: with folks that were having eating disorders, overeating. We had people that were dealing with alcohol. Drugs was not so much an issue because you wouldn’t be in the service. They would kick your butt out at that point which, and they would actually refer them to the
Chris Gazdik: VA.
John-Nelson Pope: I’ll give you another
Chris Gazdik: thing that’s really changed that I think you just on the touch tone there, but you haven’t said it out loud yet. The process addictions. Eating addictions, gambling addictions, sex addictions, and actually online video gaming addictions. We didn’t have 80s.
John-Nelson Pope: But we did have the eating and the [00:36:00] gambling addictions.
Oh, those two come first? I didn’t, I don’t think I knew that. Yeah. Yeah, I
Chris Gazdik: did, because sex addictions.
John-Nelson Pope: Yeah, and sex addictions. Yeah, Bill Clinton put that on the map. Right. I’m not saying any derogatory Well, we had sex sex people grappling with sex addiction in the military. Oh, man, yeah, did you? Yeah.
Okay.
Chris Gazdik: Yeah, that makes sense.
John-Nelson Pope: And there was a little bit more of a, of a, of, and I think this is the difference between those centers that are that are in the military itself is that there’s, you have to do it or you’re out. You know, that’s, that’s the sense that was the, that was how they would loop basically be discharged with other than honorable.
So would you
Chris Gazdik: say that your attitudes and understandings about addiction have changed a lot throughout your years? Is that a fair statement? Yeah, but
John-Nelson Pope: it’s still the disease model for me. But yeah, it has, I think I’ve a lot, a lot more compassion. Yeah, a lot more empathy, a lot more [00:37:00] sense that I, that, that there was the other myth that said that you can’t treat you can’t participate in a person’s recovery unless you’ve been a recovering, uh, addict.
I think you can do that and because if you’re immersed in that, in that you have a a, you, you know, this, you’ve got a more of an ability to do it. You have some insights that someone that may not. Come from an addiction’s point of view.
Chris Gazdik: Okay. I want to say a couple of these because I want to move us along a little bit and get us out.
But there’s a few things that I’ve really experienced, you know, changing over the years in my view. And one of those is really about, like, Where and how this begins, you know, there’s a genetic reality that I’ve always kind of believed, but there’s some very strange and I’m currently struggling with [00:38:00] very strange experiences that people have way later on in life is specifically and especially like in menopause, you know, are there open question in my mind is, is, are there, are there biological changes that can trigger What looks like addiction.
Cause it acts like a duck, walks like a duck, quacks like a duck, but it never looked like a duck. Until it was like, you were 40!
John-Nelson Pope: Yeah. So hormonal.
Chris Gazdik: I gotta wonder.
John-Nelson Pope: Endocrine.
Chris Gazdik: I gotta wonder about the endocrine system.
John-Nelson Pope: Yeah.
Chris Gazdik: Yeah. I would agree.
John-Nelson Pope: I would agree.
Chris Gazdik: It’s curious to me. It’s all get out.
John-Nelson Pope: But you know what the thing is with alcohol, in terms of addiction, is that it, it actually increases in males, estrogen.
And
Chris Gazdik: you. Okay. When you drink a lot, you get a lot more estrogen. Really?
John-Nelson Pope: Estrogen. Yes. So that’s a hormone.
Chris Gazdik: It is absolutely a hormone.
John-Nelson Pope: And, and so, and that’s one of the issues of why a person, [00:39:00] besides the effects of alcohol on the body, is the, maybe the person’s having difficulty with ED, for example, if it’s a male.
That’s true! Yeah.
Chris Gazdik: When you have alcohol troubles, you oftentimes also have erectile dysfunction troubles. Yes. And that’s hormone related. John, I wonder if addiction is a hormone related issue. Like, all told, biologically, from the get go.
John-Nelson Pope: Yeah. Well
Chris Gazdik: Is that possible?
John-Nelson Pope: I think it could be possible.
Chris Gazdik: You know, I’ve floated the theory for a few years now about, you know, Axis 2 personality disorder being endocrine system related.
Yeah. I never, it’s a total new thought I’ve never had before. Well, I think we should go back to Axis 2. Right. Well, yeah.
John-Nelson Pope: That’s for sure. This cross cutting stuff is just, you know, yeah.
Chris Gazdik: Well, that’s it. Yeah, I agree. But I want to, oh my gosh. Yeah. I have. One, oh my gosh, that [00:40:00] is amazing. I’m wondering if you’ve added a whole new conundrum to my thinking about this.
Is this an anything hormone related? Have you ever thought of that before, John? Or did we create that together? We created it together. For real? Yes, sir. You’ve never thought of that before?
John-Nelson Pope: Well, you and I started talking about it, and you stimulated my brain, so,
Chris Gazdik: and we figured that out together. We figured it out.
Would that not be amazing if, if 20, 30 years from now, if somebody comes back and hears this episode is the first time that anyone’s ever thought of this as a potential hormone related issue with the endocrine system. It’d be the
John-Nelson Pope: Gastric Pope
Chris Gazdik: model. Let me finish, that the disease model included is explained by them.
Huh. Yeah. Huh. That would be wild. Yeah, a Popekastic model, I like that.
John-Nelson Pope: Yeah,
Chris Gazdik: that’s totally crazy. I’m gonna be thinking about that a lot. Thanks, John. I’ll be up till two. Well geeking out on well Just
John-Nelson Pope: think about in terms of the genetic component to it as well. And in there’s the the [00:41:00] epigenetic aspect to it the aspect of growing up in a or your own parent being exposed to an abusive environment and they’re being in fear.
And then so one is raised in that kind of is born and maybe has more of a genetic predisposition to become addicted to alcohol. I mean, you Bowen, for example, Murray Bowen, you know, with family systems. Oh, okay. Okay. Well, he, he started out, he was an MD and he started out with the idea of, of, of dealing with addictions.
And yeah,
Chris Gazdik: with family systems, family systems, that was probably around the time of Claudia Black doing her work. She’s my all star when it comes to family dynamics. Yeah, but they were probably, yeah, they were about in Satyr as well. All the Satyr was. I think
John-Nelson Pope: Bowen was a little bit earlier, I think. Earlier as was
Chris Gazdik: Satyr.
And they weren’t really [00:42:00] addiction related though, were they?
John-Nelson Pope: No. But he, he did work with addictions and he had sort of a theory going on that. But I hadn’t read Bowen in years, so.
Chris Gazdik: I just am, am, am blown away by that. And, you know. Okay. So let’s move a little bit further. I’m going to bring it back in a second
John-Nelson Pope: research.
We could do research.
Chris Gazdik: You love research. I’ll do the, yeah, let me do the, let me develop the brother. Okay. You get that done. Okay. So differentiating AUD from social drinking, binge drinking and dependency is, is something that we’ve kind of touched base on. So I think, I think the thing that I really want to just highlight here for folks is, is like when you’re beginning to wonder about your relationship with alcohol, we are not.
talking about coping, you know, using alcohol to cope. That’s only one little piece of addiction or alcohol use disorder. It very much, you know, is, is a, is a destructive coping mechanism. And, but, but that’s, that’s not. [00:43:00] That doesn’t rise to the level of alcohol use disorder, but that’s just a, a, a basic, I need to feel better because my boyfriend’s pissing me off.
Let me go drink a few beers or I’m stressed out because of work and I need to have a couple of drinks at the bar, you know, just to kind of settle down because this project is really on my mind. That is not what we’re talking about. That’s not good. And it’s one of the little things that we look at, but I just, that’s.
That’s, you know, social destructive coping is, you know, social drinking. That that’s not what we’re looking at. Does that make sense? That makes sense to say that. Well, so just, and it’s just,
John-Nelson Pope: it’s not like a, and it’s, it’s, there’s three martini. Yeah. That’s a, that’s a little social, but it, it gets, that starts verging on, on bothersome and problematic drinking, I think, or going into, you know, if you have three martinis during your lunch.
Oh, during lunch hour, sure. There’s some indicators there, [00:44:00] you know, getting all liquored up and go back
Chris Gazdik: to work, you know? Okay. So there’s an article from very well mind that I’ll point out that, that kind of. You know, I think was kind of cool. Five criteria for substance use disorders. So this is really, I usually don’t like, you know, the, the five this or the ten this or that, like, you know, but they actually did a pretty good job there and, but, but let me bring the, let me bring, John, the, the hormone thing back into this.
Look, look at the, look at the potential hormone impacts on these five identified substance use disorder symptom sets, right? Huh. So. Psychotic or bipolar depression, you know, up and down and, and the anxieties that you get. OCD, sleep disorders, sexual dysfunction, and delirium. These are, these are five criterion for the way that they talked about identifying substance induced.
Oh, no. I just, I almost want you to strike the last [00:45:00] four seconds out of my. I’m not going to get out of this, but you redo it, but because I just got confused there, the article that I was thinking is at the end where five subtle signs that you might have alcohol use disorder. Yeah. See, I
John-Nelson Pope: was, that was on the second page.
Yeah. I screwed
Chris Gazdik: it up, but I want to come back and then we’ll talk about substance induced disorders. But these are things, but, but, but again, look at like what happens with the hormones. I’m curious. The first thing they’re identifying is looking forward to social interactions. Alcohol is the only reason that you look forward to that.
Two, people in your life comment on your drinking. And then three, you start thinking your friends are boring for not drinking like you and then you’re constantly making excuses to normalize what you’re drinking is and fifth, you keep trying to quit drinking. So those are actually not hormone related at all, but there are good indicators.
I was impressed with the way the article laid that out. John saved me. Talk about Substance [00:46:00] induced disorders and what that is all about. I just need to recover over here. Okay, well, we’ll
John-Nelson Pope: go here and talk about this. So the question is, because there’s a list of psychotic, bipolar, depressive, anxiety, OCD, sleep disorder, sexual dysfunction, and delirium.
All these you could say, is it is it do you It’s chicken or the egg in the sense it was. And so you can start developing with very heavy drinking psychosis. You could also have a severe mood swings and all of that. That’s true. Depression. You get, you, you recover from the hangover and you’re depressed and you’re anxious.
I wonder why, because you were inducing
Chris Gazdik: that with substance use. Right, right. Have you ever, have you ever diagnosed X induced substance disorder? I don’t know that I’ve ever honestly diagnosed it. [00:47:00]
John-Nelson Pope: I, I, no. Yeah, you haven’t. No, I hadn’t either. In think I have in many years,
Chris Gazdik: have many years. I mean, I’m aware that the, the things are there, but I, I don’t see a reason why I, I think like,
John-Nelson Pope: yeah, I think more with somebody that might have, amphetamines and, and cocaine and yeah, that, that sort of Particularly bipolar.
Chris Gazdik: Bipolar,
John-Nelson Pope: yeah.
Chris Gazdik: So what we’re talking about let me take a stab at it, John as well, to say that, you know, there is this thing that you’ll hear in our field called substance induced depression, substance induced sleep disorder, substance induced delirium, or.
Bipolar disorder, you know, and and the thing is is these are the by to your point before when you were saying John This is a primary issue, you know, people will have problems like that, but it’s induced by addiction,
John-Nelson Pope: right?
Chris Gazdik: Basically, these are these are things that happen as a result of your relationship with alcohol or drugs being so dominant
John-Nelson Pope: how many clients?
Do you [00:48:00] have that ever had normal sleep with alcohol, you know, with alcoholism? Yeah. And sleep is so destroyed. But. But also I see more of the bipolar behavior and,
Chris Gazdik: With fluctuations. Dr. Jekyll and Mr. Hyde. Yes. See, that’s what I was excited about thinking. The article that I was quoting, it got me all off track a little bit ago because I started thinking about the hormone thing.
And I mean, think about John, all of those things that we know are a part of addiction that are Interacting with the endocrine system. I mean, you know, sleep, that’s a big one. Yeah. Appetite and the malnutrition that we have, like that’s a big hormone system. You know, what else your, your, your mood, you had the fluctuations we just identified, you know, are there, you know, sleep, that’s a big hormone kind of reality.
You’re like, there’s a lot of ender consistence in that
John-Nelson Pope: melatonin is a hormone, [00:49:00] serotonin. And I’m thinking that, that all that’s interrelated energy, energy. It takes years to get one system back.
Chris Gazdik: The endocrine system gets jacked up, right? And takes years cortisol
John-Nelson Pope: levels, cortisol, all those levels. And so it’s just
Chris Gazdik: curious, man, that is wild that we, and I’m going to give it to you.
I think you, you got to it first. Okay. I’m gonna give it to you. You got to it first. Thank you. You’re welcome. Alright, what else do we want to cover before we kind of begin wrapping up a little bit? I mean, I think the impact of misleading nature of alcohol use disorder is, you know, the, the, the dominating reality of addiction gets missed.
It gets It gets lessened and cheapened. Okay. That’s the primary beef that I have with this whole thing.
John-Nelson Pope: In my military experience as a, as a Navy chaplain and having gone through the [00:50:00] addiction courses, um, basically and working with Soldiers, I mean, sailors and marines. Yeah. Is that they’ll say, well, I started drinking because I, I I started having these nightmares.
I have PTSD and all this. Right. A
Chris Gazdik: lot of military PTSD is a, is a part of this.
John-Nelson Pope: Yeah. Well, I’m gonna pause it with you. Is that I think that they were. That maybe part of the addiction is the culture that, that says we need to go out in town and go drinking and, and, and doing
Chris Gazdik: this. Yeah.
John-Nelson Pope: Yeah.
Chris Gazdik: I, I, I don’t know.
I don’t know what you’re saying there. I push back at the idea that, you know, it’s not the culture that causes addiction. It’s more of the biological genetic kind of reality. I agree. That the culture pushes a lot of use in everything. That, that maybe I’m not understanding. That’s what I was
John-Nelson Pope: trying. No, you understood at that point.
Chris Gazdik: Yeah. What, okay, what did I have to say?
John-Nelson Pope: That it’s, it’s not the culture itself that does it, it’s the, [00:51:00] it’s the fact that there’s that accessibility and ability to have it, and many young people, part of the rite of passage is to. is to drink to begin drinking. And so, you
Chris Gazdik: know, anybody that has a college is probably a very similar.
I mean, you know, we know that addiction is about 10 to 15 percent of our population, but let’s say they develop static number for a long time
John-Nelson Pope: and they noticed that it kind of scratches their edge or it just, there’s, wow. Anyway, what I’m saying is that it takes away some of the pain. Yeah. Yeah.
Chris Gazdik: And that is or isn’t addiction, you’re saying, to be clear.
John-Nelson Pope: Right.
Chris Gazdik: Is or isn’t.
John-Nelson Pope: No, that’s not addiction at that point. Isn’t. Yes. Isn’t.
Chris Gazdik: Right. It is not.
John-Nelson Pope: But it eventually becomes that.
Chris Gazdik: Yeah. What I was saying is, you know, there’s about 10 to 15 percent of our population has addiction. It’s been a pretty static number, as you know, John, for a long time. It hasn’t.
John-Nelson Pope: Yeah.
Chris Gazdik: Hasn’t changed. And so when you go to college or when you go to the military, I guess you’re saying Chances are you’re [00:52:00] going to be encouraged to drink a lot more, but because of the culture, and it’s going to grab you. Still ten
John-Nelson Pope: percent. Still ten percent. Still
Chris Gazdik: ten percent in the military. Still ten
John-Nelson Pope: percent.
Chris Gazdik: Yeah. A lot of people drink a lot, but only so many percentage of people. Tend to have addiction, which again just emphasizes the disease model and the genetic nature of all of this Yeah, if you drink like a fish, it doesn’t mean you’re gonna have addiction In fact, if you just don’t have the makeup, then you generally won’t unless though Like I said John it starts being different in midlife And I think that’s honestly more for women than men is that I would agree
John-Nelson Pope: with you on that You know, I think that’s yeah
Chris Gazdik: Yeah.
It’s really, really odd to me. I don’t, I don’t know. Well, you know, I,
John-Nelson Pope: I, I started singing to you a Rolling Stones song from the sixties. Mother’s Little Helper.
Chris Gazdik: Okay. Okay. Before the mics came on. Right. You’re going to have to explain to the listener what. Well, there was,
John-Nelson Pope: there was a song about women taking little it was [00:53:00] a big, big drug was Darvon and Valium and Valiums.
Yeah. Valiums.
Chris Gazdik: And that was mama’s little helper. Mama’s
John-Nelson Pope: little helper. Right. Help her get through the day. But that would also, one would think of, of of a middle aged.
Chris Gazdik: Okay. I see where you’re going. That drug’s, pardon? I see where you’re going. Yeah, that makes sense.
John-Nelson Pope: So, so I think maybe there is more something to it.
And I think men start sooner sometimes with, with the alcoholism. But that may be because. But not as much
Chris Gazdik: in midlife. Do you see that in midlife for men? No. Because I do not
John-Nelson Pope: either. No, I don’t.
Chris Gazdik: For, for women that feels different. It’s the anecdotally, the experience seems different. And I wonder if there’s a study
John-Nelson Pope: I’d like to see some studies that would, that would
Chris Gazdik: tackle that boy.
That’s a hell of a tackle. If we can tackle that and figure that out. All right. We need to wind in and wind down here. So [00:54:00] John, we are going to do the very first ever. It is time for The Shrink Wrap Up. And this is where we highlight in our mind what the biggest or catchiest or most important key today that we’ve talked about, the key takeaway.
And, and Neil gets to decide how we deliver that, which one is the biggest and whatnot between the three of us in this case. The two of us. So what might say you, John, what is the, what is the biggest key takeaway today for episode 302?
John-Nelson Pope: That alcoholism despite some changes that going on with in terms of diagnosis with the DSM 5 TR is, is still a disease model in my mind and that there is, uh, in again, my experience possibility of an endocrine connection to it.
Chris Gazdik: Oh, you got me. [00:55:00] You got the end there. You pulled the end in. I don’t know if you pulled multiple things, but you stole my thunder. Sorry. So no, I don’t know if you just did it for me. You just grabbed that into the end. I, cause I got to say the biggest takeaway in my mind by far. And I thought you were totally going to go there.
You went first. I thought, oh, I’m not going to get it because. You know, dang this whole endocrine system new thinking that you and I kind of created together with you being in the lead but still that that might be the coolest biggest most important takeaway because I Think if somebody literally hears that and goes and gets interested in researching it We have done serious service to the field all told because I’ve never heard anybody Mentioning or talking about that before and I think that we may have created an amazing new component of our understanding of addiction
John-Nelson Pope: But it would also explain.
Chris Gazdik: Okay. No, we, we gotta be done. Can’t do it. Neil, who? Who gets it? What are you thinking? We gotta get outta here. Where are you at?
Neil Robinson: It has to be John, because he covered his piece and then he got the endocrine first, so, oh, wow. This one is to me, hands down, John, just [00:56:00] because you made the mistake of letting him go first.Chris Gazdik: Very well. All right, John, you get it, brother. Okay. The shrink wrap up guys. You take care. Have a great week. We’re gonna keep riding with you, rolling with you. We got episode 3 0 2 in about seven days. See you then.