Next posts? Comments welcome!

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Marc

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Please note, if you saw an earlier version of this post, that my normal email account is now working again. Which means I can also receive mail from the “contact” field by the right margin.

Here’s where I’m thinking of going next with the blog, Feedback welcome! I’ve spent the last 8 posts on Internal Family Systems and related content, using IFS as a model of mind and as a guide for psychotherapy (especially for people with addictions). This followed a half-assed attempt to survey well-known therapeutic approaches that can be effective for people in addiction. I covered ACT, psychodynamic approaches, and I don’t think much else. I was thinking it would also be useful to look at psychedelic psychotherapy (including ayahuasca) as an increasingly popular approach, finally starting to be recognized by mainstream psychiatry. I could also dig around for other approaches that seem promising. Maybe good old family therapy (the standard brand), maybe dialectical behaviour therapy. I’m also gearing up to present a few “case histories” — clients I’ve worked with whose stories I find inspiring. Any thoughts about any of this before I go on?

I could also review mindfulness approaches to therapy for addiction. Or maybe that’s old hat. If you follow this blog, you know that mindfulness/meditation is never far from my mind. But there are modes of therapy that are specifically adapted for working with “addicts”  (as always, I use that term without judgement. It’s just handy). I’m thinking of Mindfulness-based Relapse Prevention, which has been formulated especially for addiction treatment.  Comments? Thoughts?

Lastly, the thoughts that have been gathering in the murky backwaters of my brain involve trying to model the IFS idea of a “firefighter” — the part that just wants to get high, without giving a crap about leaving a mess, the stoner voice, as in Fuck it, let’s just get high (or drunk), completely ignoring the frustrated and exhausted inner critic…to model that in terms of brain activity. Neuroscientists see the fuck-it voice as pure impulse, mediated by one brain system, or as compulsion, mediated by another (closely related) brain system. From a neural perspective, it’s the excess of dopamine reaching these systems that elicits this kind of behaviour. Is that just the brain-level explanation of the sudden appearance of the “firefighter” — the capacity to act automatically, without caring? If so, how does it actually work? IFS points to an emergent part-self that rules for a few hours. Neuroscience points to sensitization (via dopamine release) to particular cues. How on earth could we reconcile these explanations? Or are these fundamentally different mechanisms? Maybe one is right and the other is completely wrong. I’d love to try to figure it out.

That’s all for today. Please give me some guidance as to what you’d like to see in upcoming posts. And I hope you are all staying Covid-safe. The vaccine should be available within another couple of months. Maybe things will get a lot better soon.

 

 

 

Comments

46 responses to “Next posts? Comments welcome!”

  1. Heidi

    Hi Marc, after being addicted to one substance or another (alcohol, sedatives, cigarettes, meth, food) for some 20 years I came across your book (Biology of Desire) last year – I found it truly profound.
    This lead me to start seeing a psychologist and begin mindfulness practice at her insistence, and finally make some headway into changing my long repeated patterns.
    Over the course of the last few months of psych and mindfulness sessions I have ‘met’ other parts of myself, which seemed completely bizarre at the time, but is so perfectly explained in your IFS blogs.
    At this stage of my journey I would love to hear more about mindfulness based relapse prevention.
    Thanks for your work!!

    Reply
    1. Marc

      Thanks for letting me know about your changes, Heidi. Mindfulness is indeed powerful, and I’ve come to see the “parts” denoted by IFS as a pretty natural extension of regular mindfulness practice. I mean, when I do a standard meditation, I become aware of emotional spouts or waves or needs or whatever, and then I notice that they each have a history, a sort of personality, a coherent identity in and of themselves. Anyway, point taken. More on mindfulness-base relapse prevention. Will do.

      Reply
  2. Graeme

    The “fuck it” button is something we all know well Marc! It takes over and suddenly the only thing that matters, that never ending yearning to feel out of it or to escape. I am a mature 4th year psychology student and I volunteer with an arts group helping those coming through the Criminal Justice system in Glasgow Scotland. We have recently made van album and had a project around “the fuck it” button. Is it just a huge flush of dopamine that occurs? It would be fascinating to explore that on a grand scale?

    Anyway, I know this is a bit cheeky but as your at the top of the field and are thinking about “the fuck it button” I was wondering if you would consider spending 30 mins for our group to field questions to you? It would be an incredible experience for many of the guys and woman who are coming through the system. Many of whom have studied Psych/Socio/Crim/Philosophy while inside prison for extended periods.

    I hope you have a great day.

    All best,

    Graeme

    Reply
    1. Marc

      Hi Graeme. Sure, that would be a pleasure. My understanding of addiction continues to be fueled by interactions with people currently (or recently) IN addiction. Besides, I just like addicts. I’m serious. Or former addicts. My kind of people.

      And exploring the fuck-it phenomenon is surely the absolute centrepiece of where our thinking and therapy should go.

      Feel free to get in touch with me through the “contact” field on the right.
      Cheers,
      Marc

      Reply
  3. Mark

    Hi Marc,

    I would love to hear your take and approach on psychedelic psychotherapy, and mindfulness-based relapse prevention. As a former user and recovering ‘addict’ that is pursuing the counselling field, I am always interested in your angles of healing.

    Thanks so much for keeping this blog going ! I think I speak for many when I say it is incredible valuable to our personal and professional journeys.

    Reply
    1. Marc

      Thank you, Mark. That’s nice to hear. Okay, I’m making a list (and checking it twice)…and MBRP is definitely on it. Also, just read of a new study of psilocybin and MDMA run by the psychiatry dept at Hammersmith in the UK. The article also states that “Johns Hopkins University in Baltimore, Maryland; the University of California, Berkeley; and the Icahn School of Medicine at Mount Sinai in New York City have opened centres devoted to studying psychedelics.” Mostly seems geared to treating depression, but I’ll look into it. Here’s the link if you want a sneak preview: https://www.nature.com/articles/d41586-021-00187-9?utm_source=Nature+Briefing&utm_campaign=6c06d8c1f3-briefing-dy-20210128&utm_medium=email&utm_term=0_c9dfd39373-6c06d8c1f3-43239597

      Thanks for your suggestions!

      Reply
  4. Kevin Hicks

    Mark, Thank You for what you do. I do not know if this inquiry has potential for upcoming posts. I am on a bit of an information quest hoping that you will know of some helpful resource. I am wondering how many people use Methylamphetamine to get through the day. I have two close relatives who have been addicted to meth for many years. I know of a dozen or more people who have used meth for years and have no desire to stop. None of them live under bridges with no teeth and yet that is all I find when trying to research the down side of meth addiction. A Forbes Magazine opinion piece argued there is no downside. I live with it and I know that there is.

    I am 67 and part of me is saying I should just accept, say the Serenity prayer and move on. I simply want to know how this phenomenon fits; all these people doing a thing and no one talking about it.

    Reply
    1. Marc

      Hi Kevin. I hear about this discrepancy fairly often. And I personally know people who’ve used meth for years and function really well. It’s almost like coffee for them. I also know about the downside, and that’s not fake news. The downside can be devastating. I’m not sure I want to go on a statistics hunt, but I can describe some “case histories” that might help us understand where the divide really lies. Thanks for the suggestion.

      I’m pretty sure we know when our drug use is fucking us up to such a degree that it’s not worth it. To me, that’s the only standard that matters.

      Reply
  5. Annette

    I’m intrigued by your “Firefighter” description, as I’d see it as “Fuck it”, tbh. A recent international study has found that Brits and Scots tend to drink more to get completely hammered, than all the other 23 countries in the study.

    https://www.theguardian.com/society/2021/jan/25/english-and-scottish-get-drunk-most-often-25-nation-survey-finds

    Perhaps a series of posts for those who choose, regularly, to continue getting hammered/out of it, despite all the consequences, and any information on cultures who managed to help their citizens change. Iceland did a heck of a lot of work with their young people some time back…… A real Community project!

    I’ve most enjoyed your IFS posts, as they resonated with spiritual workshops I’ve attended. Recommended reading on IFS therapy please.

    Measurement: is there any international organisation pulling together data on addiction rates, which countries do best, and therapeutic communities with success rates > 70%, after 1, 3 and 5 years?

    I’m learning that recovery is a lifelong journey, so finding on and offline support groups without the proselytising is important! Community is #2 after a lifelong commitment to live life substance free. #3 is self-compassion as so many of us are very self-critical, which can tend to lead to lapses and the good old Fuck it! button being pushed.

    4 suggestions here. I’m probably being greedy!

    Reply
    1. Marc

      Hi Annette. Yes, lots of suggestions here, but that’s okay. I don’t want to look up stats on different countries’ success rates. It’s so complicated, because there’s no standard measurement criterion. Therapeutic communities success rates? I’d do the same thing as anyone else: google around and try to peer through the bullshit to see which ones actually report outcomes. It’s a small minority, to be sure.

      What I do resonate with is your interest in why some people go all the way to getting hammered, while others are content to just be high. This is true with alcohol, but also very much with opiates, especially heroin — which is obviously highly related to overdose. Why indeed? That is something I’d like to think about. But at a first pass, I’d say that the feeling of being high can be intrinsically unsatisfying, especially if the internal critic is activated simultaneously — which it often is. I think that’s why people sometimes keep going to near-blackout. I’ll see if I can work more on that idea. It does bring IFSy thoughts to mind.

      Reply
  6. shiraz

    “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” — Viktor E. Frankl

    What do you make of it?

    Reply
    1. Marc

      Well yes, IF that space lasts more than half a second. Which is the problem with impulsive and compulsive behaviour. That space just closes up and disappears. Also, let’s not forget that thoughts themselves are responses, in fact mediated by output systems in the brain. So…once thoughts are fired, you may already be past that hypothetical “space” that Frankl points to.

      Aren’t these the central mechanisms in addiction?

      Reply
      1. shiraz kassam

        Thank you, Marc for your response.

        Perhaps, the most important, lever, which enable me to hold on to that fleeting half a second was your book, which I kept reading over and over again. It became my friend. Before meeting with your book, I had always seen my addictions as something terrible and shameful. What you proved was that my addiction was a necessary and indeed a rational stage, albeit contradictory one, in my struggle to befriend myself.

        Can you imagine how liberating it felt to have met with such a standpoint?

        ““Give me a place to stand,” said Archimedes, “and I will move the earth.”

        That standpoint empowered me to realize that, in fact, how much time I had was contingent on the choices I made.

        Reply
        1. Marc

          I’m so glad that my book provided that for you. There is no single outcome that I hold as dear, as giving people “a place to stand.”

          Reply
  7. Greg

    Hi Marc and blog community,

    I bought and read both books: Biology of Desire and Memoir, as well as follow your blog, and absolutely love them all.

    I’m just over a year free from an insane decade+ long crack addiction (multi day binges every couple weeks) with very problematic alcohol use – and have a few questions for you about changing “desire” and the facilitation of this process if possible. Would love to read a blog post on this topic – or maybe I need therapy to facilitate the change?

    I tried quitting 1000’s of times over the years with some success in 2017, only to slip back into the mess 8 months later when I gave in and had a couple drinks and then instantly felt defeated and said fuck it and immdiately chose do crack too. Finally in Jan 2020 I threw in the towel after going on an epic bender in vegas at a work conference – missing the entire event – and got fired.

    In the your book, you talked about your magic formula being writing NO on a piece of paper and reminding yourself over and over why you dont WANT to do drugs until the thought of using drugs repulsed you.

    I’m worried because from time to time I find myself fantasizing / romanticizing using crack – particularly when I’m stressed or feeling pessimistic about the future. These fantasies make me question whether deep down I actually still “Desire” to use and whether its only a matter of time until i’m back in the shit. I’m surprised that after all the disasters ive been through and now with a year free from the drug, why the fuck I still find myself fantasizing about something that has all but ruined my life.

    Do the fantasies ever go away? Is crack different? Can I make the fantasies go and stay away till I too am totally repulsed by thought of using?

    I will be honest, for some periods over the past year I was allowing the fantasies to play out in my imagination or by watching TV shows, movies, internet that portrayed cocaine / crack use – because it was giving me a pseudo high / dopamine kick just watching them or thinking about it. Over the most recent Christmas holidays I realised this behavior is risky and just leads to more prolonged cravings / fantasy and ultimately distress.

    After re-reading your biology of desire, I’m now working on trying to change my desire and stop playing with these thoughts in my head and remind myself of all the bad things that happen when I use and how my life is getting better by not using. The last few weeks have been better, but I’m still worried the fantasies will return and eventually lead to relapse.

    Is this normal? Do you know any good readings / books / blogs on the topic? What else could I be doing to facilitate this process. Im open to a few therapy sessions if this is something you could help with

    Reply
    1. Marc

      Hi Greg. We’ve talked about this, but I’m glad you’re sharing it with the blog community. I think those fantasies are not intrinsically bad, but it depends on how you treat them and what kind of shape you’re in. If they lead to mounting craving, then indeed I don’t blame you for wanting to avoid them. But if you take them as a dalliance, giving your “firefighter” a little walk in the park before taking him back to his room, then it might actually be a helpful thing. The urge, desire, wish, need to feel that kind of freedom is certainly not evil. It’s natural. So being friendly toward the part that feels this way, and that moves in these waters, seems that it can be helpful, not harmful.

      When I wrote my big “NO” on the wall, I was in the habit of breaking into medical centres and such one or more times per week, and I was taking really dangerous combinations of drugs, e.g., shooting Demerol and coke alternately. I was in really rough shape. So the sense of repugnance was extremely salient. I knew I was close to killing myself or landing in prison…which elicited my anger–at drugs themselves, as if they were external to me. It doesn’t sound like you’re anywhere close to that stage. I think it’s a different context for you, and may call for a different approach.

      The main thing: If you can live with the part that WANTS to get high, without damaging your life too much, then…you can give it a peace offering and reduce its determination to go crazy and defy everything you hold dear.

      Reply
  8. Terry McGrath

    i find the whole idea of relapse and its prevention a bit odd really – it only relates to abstinence and to whatever the particular drug or behavior is – it takes no account of how we invariably swap addictive behaviors, often to more socially accepted and more positive behaviors – from alcohol to work for instance – is that a relapse and if so should we ‘prevent’ it ? food for thought

    Reply
    1. Marc

      Yes, it is food for thought. But the tendency to return to tried-and-true self-destructive habits is not just some kind of word play. It happens all the time. In fact its commonality is why groups like AA have insisted on total abstinence. Perhaps the wrong answer (for many) but certainly a response to a real and often terrifying problem.

      Still, I see your point: I think the word “relapse” has what they call a focus of convenience, and it stops being meaningful outside that context.

      Reply
  9. morgan machen

    I had the opportunity to do two guided psilocybin sessions last year, three months apart. For a good month after the 2nd session I had no desire to drink alcohol. Granted, depressants like alcohol have never been a compulsion of mine. But when I did start drinking a couple glasses of wine or beers again I noticed that the downsides were amplified quite a bit. I would feel uplifted and relaxed for about 45 minutes then depression would set in and I would just want to go to sleep instead of enjoying the rest of the evening with my partner.

    Now, more often than not I just prefer a glass of sparkling water. Something about the carbonation gives me a sort of warm buzz for a short time. A few times I’ve poured a half glass of rose and topped it off with sparkling water and that was alright, I didn’t seem to suffer unduly from it.

    Reply
    1. Marc

      Excellent. I’ve had a similar transition after an ayahuasca ceremony or two. There’s a brightness to consciousness, that may be in the background rather than the foreground much of the time, but which just goes missing when you drink alcohol, at least more than a drink or two. And when it goes missing you really notice its loss. Thanks for your comment.

      Reply
      1. morgan machen

        I’m glad my comment connected with you. I second guessed the line about carbonation giving me a buzz and worried it might sound a little out there. Want I meant to say is the it gives a little warmth in the belly which I think is one of the things that appeals to me about alcohol. I like what you said about a certain brightness in the, sensorium (?). Alcohol tends to blunt that for sure

        Reply
        1. morgan machen

          One more thought. Santana says, “Medicines come from the Earth. Drugs come from the lab”. Not that medicines can’t be abused but Iike the implication.

          Reply
        2. Marc

          Given what we know about the placebo effect, I begin to think that the power of any mood-changing substance or activity derives from how we experience it, the sense or meaning we attribute to it. We are symbolic creatures. Everything from magic to politics….to fizzy water…seems a receptacle for the meaning we ascribe to it. Usually there is some bridge, via the “properties” of the thing itself…perception is the gateway. Otherwise, we’d be more or less psychotic. QAnon comes to mind.

          Reply
          1. morgan machen

            The so called Qanon shaman has been a proponent of psychedelics. There’s a cautionary tale for ya.

            Reply
            1. Marc

              Omigod! Where did we (old hippies) go wrong?!

              Reply
              1. Morgan Machen

                Well, I’m a recovering wannabe old hippie, born in 69′. I read that people over like 60 are highly susceptible to believing conspiracy theories. Buffalo boy is in his 20s or 30s though, so I don’t know what his problem is. Terrence McKenna had something to say about conspiracy theories, btw.

                Reply
  10. Jaime

    MBRP and learning to make peace with discomfort, or get comfortable with it, and just plain sitting with it, and the resulting internal dialog.

    Reply
    1. Marc

      It’s on the list.

      Reply
  11. Peter Sheath

    Hiya Marc, as always a great, very reflective, honest and thought provoking blog and some great comments. Hope its going well back in Canada for you and your family, seems like you made the right move at the right time? Back to the thrust of your blog, you raise some very similar questions that float around in my mind. For me there are some very definite overlaps between all the different theories that seem to appear very similar but have very different terminology. You talk about the “fuck it button”, which I see mainly in ACT circles, being almost identical to the fireman, in IFS. But isn’t this almost the same animal as Kahneman’s thinking slow, thinking fast ideology and the chimp brain from Steve Peters’ chimp paradox? Maybe the old id from Feud or animus from Jung? Or even Goleman’s “Amygdala hijack?” For my mind there is definitely some part of our evolved psychological make up that enables us to unconsciously override all our higher sophisticated brain functioning for instant gratification and self preservation. The trouble being that it can become a very demanding master with an almost insatiable appetite.
    These days, recovery, a word I use for convenience, is more about developing some kind of relationship with your inner chimp, fireman, animus, addict, id, etc. Many years ago a wise man once said to me that this part of your psyche is really your best friend. All it’s tried to do is to protect you from things like pain, shame, fear, self loathing and even suicide. It can also get you what you really need instantaneously, but at the expense of everything else. It’s probably an integral part of our evolutionary psychology, meaning it has not been evolved out of us for a very good reason. Maybe, rather than looking at it as something that’s wrong, we could start considering it as something that is very strong and learn to live with it. Peters’ describes the inner chimp as being at least five times stronger than the inner human and you’re probably never going to win against it.
    Anyway, enough of that my friend. Lets try to get in touch shortly, it would be good to talk, I’ve got loads to tell you.
    Take care
    P

    Reply
    1. Marc

      Hi Peter. Great to hear from you. Yes indeed, let’s find the time to zoom with each other. Two busy people, but it can’t be that difficult. Canada…is cold, at the moment. But Toronto is a pretty good city, as cities go. I’m getting used to it. And of course we are all going stir-crazy until the lockdown is over. Well, disaster dealt with intelligently…even that creates a warm sense of community. It’s not all bad.

      Your point about the rapid-assessment-response part of the brain…inner chimp, amygdala hijack or whatever…I agree that this is a component of the process. Perhaps the trigger. But I think there’s much more to it than that. Kahneman’s “thinking fast” is just that: fast. Yet craving can go on for minutes, hours, days….and there’s nothing fast about that. This is why I see great value in understanding this “part” of us AS a “part” with a set of intentions or goals that are nothing like a flash in the pan. This is why I accept the IFS version (which, it’s true, has a lot in common with elements of ACT) that sees this as a sort of subpersonality. It has history, often many decades’ worth. It has insistence and determination. Over those years it accumulates precision and sensitivity. As you say: this is what I need. This will really help me. I know this. It is tried and true.

      So I agree strongly with what you say in the second paragraph. The trick is to develop a relationship with this part, accept it, forgive it, even respect and honour it for its unique intelligence, and then gently modify the relationship with it. A two-way dialogue is actually possible. I know what will help you! It insists. And then you can respond, well, do you? It really doesn’t help as much as you think. We’re just semiconscious after the first few minutes, and then, quite unhappy, So yes, you can help me, but let’s try reducing the amount, the frequency, putting it off from time to time. Let’s play with it, adjust it…see where that leads. And we can have that flash of freedom and defiance in other ways…here are some ideas that you might not consider very often. Something like that. I’ll tell you, I sometimes get the same kind of flash of freedom from defying (or ignoring) my wife’s criticisms as I used to get from drugs. It doesn’t mean I love her less…more probably, because I feel a kind of freedom and choice.

      The sensitivity of the “get high/get free” response continues to amaze me. It really does understand our anxiety better than any other facet of our being. So making friends with this part, rather than trying to demolish it or imprison it, can have wonderful results. It can actually lead us back to the source of the anxiety, and then we can start to soothe those parts as well.

      Reply
  12. Eric Nada

    Marc, I am directly interested in all of the topics you bring up as possible directions to take your blog. I have been very interested in mindfulness/meditation as it pertains to addiction treatment. I have generally taken a consciousness approach to emotional healing in my life for a few years now. Along these lines, I am deeply interested in psychedelic therapy (as you know) and have personally explored this arena with both interest and awe as it has brought nearly miraculous benefits to my own endeavor to learn about what I call my personal story of pathology. And most recently I have been trying to learn all I can about IFS. I had no idea there was already an established modality that honors how I have been looking at trauma and its affect on emotional health. (I’m currently listening to a great podcast with Richard Schwartz being interviewed by Tim Ferris). Lastly, I see these topics as being easily related to one other. So basically, yes, any and all of it please.

    Reply
    1. Marc

      Hi Eric. Well it seems that mindfulness meditation and psychedelic therapy are of interest to many readers/commenters. So….I’ll try to brush up on both of these topics and find something relevant to add to our present intuitions. Indeed, IFS has a close relationship with mindfulness meditation, which isn’t always obvious from the start. This place they call Self (with a captial S) is very still, very clear, very central — a place from which we can extend compassion to all the parts that still hang out in the fringes of our minds but need help to resolve their (fixated) anxieties.

      I’m glad you brought up that podcast with Richard Schwartz, the founder of IFS. There are quite a few lectures and interviews with him on YouTube, and he both speaks well and radiates this soft wisdom which I find attractive. I’ll have to listen to the one with Tim Ferris. I’ve heard about it.

      So…thanks for bringing some adhesion to these somewhat diverse topics. I’ll see what I can do!

      BY THE WAY, PEOPLE: In the last few years I have put up two posts about the value of psychedelics, including both informal (https://www.memoirsofanaddictedbrain.com/connect/my-ayahuasca-trip-shit-happens/) and formal (https://www.memoirsofanaddictedbrain.com/connect/new-directions-in-our-understanding-of-addiction-the-role-of-psychedelics/) approaches to its therapeutic promise.

      And Eric — you asked for this — you may know more about the current state of psychedelic therapy than I do. So…in case you have some time on your hands, please feel free to do another guest post.

      Reply
      1. Eric Nada

        Marc, I thought I’d add publicly that on the Tim Ferris podcast episode I mentioned, Tim draws very important similarities between Therapeutic psychedelic work and IFS therapy. And I couldn’t agree more with his comments. Furthermore, Schwartz is helping therapists incorporate IFS into their psychedelic sessions with their clients. (Now through the MAPS related studies and sessions). And while I wouldn’t necessarily describe myself currently as having time on my hands, I would love to use some of what I’ve got to contribute a guest post. I’ll contact you privately for details.

        Reply
        1. Marc

          That’s amazing news, Eric. I didn’t know anything about a relationship or even connection between these approaches. I’ll definitely listen to the podcast now, and I would be very grateful for your contribution through a guest post. By all means, please email me!

          Reply
        2. Marc

          I finally listened to that podcast, at least most of it. As you’ll see from my next post, it certainly got to me. Tim F makes a great client. Seems to be able to be articulate and to move quickly and freely when it comes to exploring that inner space. And… Totally fascinating, this intersection between aspects of IFS and psychedelic therapy. So…I’m waiting for that email.

          Reply
          1. Eric Nada

            Marc, Tim is a good client, indeed. Almost made it seem too easy. I’m into the IFS textbook and am more excited about the approach than I have been for any other in a long time. I’ll email you now.

            Reply
  13. Pavel Nepustil

    Dear Marc,
    I am greeting you from Brno, Czech Republic. First of all, thanks for your work and your writing. I admire it and constantly share it within my professional network. I was very intrigued by your writing about IFS, I have to confess that even if I have been practicing psychotherapy in addiction field for almost 15 years, I haven´t heard about this approach before. And it is close to me because my practice is based on collaborative-dialogic approach and nowadays more specifically on Open Dialogue that originated in Finnish Lapland in 1980´s as a innovative and very successful in dealing with psychotic crisis. The core of the Open Dialogue work is a team multi-professional work involving family and social network. It comes out from family therapy and broadens it with ideas of dialogue (primarily based on Bakhtin), intersubjectivity (Stern, Sheets-Johnostone, Trevarthen) but also mindfulness and neuroscience. I am very interested in finding a way how to apply this way of working to the field of addiction. I am doing some first attempts, i.e. now establishing a team with recovery coaches. There hasn´t been much written about Open Dialogue in addictions but general sources about OD can be found here http://developingopendialogue.com/ and my OD training thesis about working with recovery coaches in dialogical way is here https://dialogicalpractices.org/wp-content/uploads/2020/04/Pavel-Nepustil_Another-kind-of-connection.pdf

    Reply
    1. Marc

      Hi Pavel. Thanks very much for sharing these ideas and links. I just read your comment minutes after reading a comment on my subsequent post…the comment about the Friendship Bench method that seems to be emerging in Zimbabwe AND apparently in Canada and elsewhere. This made me think about Open Dialogue, as I noted in my reply. I wonder if you have any thoughts about their potential common ground.

      In the last pages of Biology of Desire I describe a community-based approach to addiction that came out in the UK, called the Birmingham Model, which Peter Sheath (see his frequent contributions to this blog) helped to launch. As far as I know, this method failed because it was too dispersed, or too extended across different players, without a common centre or explicit philosophy or methodology. But I think Open Dialogue is much more coherent, and I guess it’s grown from compatible interests and resources with good central support. Correct me if I’m wrong. Finland is so different from the UK.

      Anyway, I’ll get to your links when I can, and I encourage other readers to go there. The IDEA of a caring, communal approach to addiction (and other mental health problems) seems to spring up everywhere (Hari’s ideas, the Harm Reduction movement in North America and Europe, the Insite project in Vancouver)….but it doesn’t often live up to its potential. Your efforts in this direction seem timely and highly relevant.

      Reply
      1. Pavel Nepustil

        Dear Marc, thanks so much for your reply! I have to tell you one thing. It was thanks to your book that I met Peter Sheath and it was thanks to Peter Sheath that I am now collaborating with recovery coaches in Open Dialogue way. I was so thrilled by what you wrote about the Birmingham model in your book that I immediately started to search for Peter. It was not easy but after some time I got in touch with him. We invited him to Czech Republic and he made a huge impact here just by spending couple of days with us. We visited Manchester and Birmingham. And then we launched the first training for recovery coaches. And then, 14 Czech recovery coaches went to visit Manchester and Birmingham! So this is the way how ideas and practices are spread globally. Thanks for mentioning the “Bench method”. Yes, it has so much in common. The non-hierarchical, community approach. Finding natural resources in social networks and community. I want to thank you for all these connections you are making! Pavel

        Reply
        1. Marc

          Oh yeah! Peter told me about his trip to the Czech Republic, talked about it as a really positive experience, making contacts and so forth. I didn’t put that together with you until this moment, so, thanks!! It is fascinating and heartening the way good ideas spread, especially in this age when we are so confronted with the spread of really bad ideas. This makes me happy: I’ve learned a lot today from you, my readers: all these connections, Birmingham, Finland, Open Dialogue, Friendship Benches all over the world. Terrific stuff. Thanks for filling in some missing details. And yes, Peter is this motive force, hard to find, and incredibly impressive once you discover him.

          Reply
  14. Andrew

    Hi Marc

    Glad to hear that you’re planning to continue with the blog.

    One of the things I struggle with is the sheer variety of therapeutic approaches of uncertain efficacy. II mean, when I go to my doctor I don’t get offered a huge range of approaches to choose from. It’s been good to see your discussion of them, but, as some one maybe looking to try one of them, they’re all kind of expensive, so you don’t want to try too many, and ideally only one.

    Am also interested in any take on the specific way any of these approaches might have to the neural level. I really struggle to make sense of the concepts in IFS, and constantly have think, “Hang on, which one is the firefighter again?” when I’m reading your posts. I don’t know if an explanation in terms of a lower level might help make sense of it, at least in general terms.

    Finally, interested in your take on Gabor Maté’s writings.It seems kind of dogmatic to say all addiction is based on childhood trauma (I may have misread him) but I’m finding his “Four Steps, Plus One” in the Ghosts book quite helpful so far. Simple enough for me to remember what at least the first 4 steps are.

    Anyway, apologies if I’ve been rambling, and thanks again for the blog.

    Reply
    1. Marc

      Hi Andrew. Not rambling, but it would take a book to explore these topics thoroughly. I mentioned in my request for ideas that I’m very interested in linking the IFS world of internal imagery with the neuroscience of addiction. The infamous “fuck-it” voice as an expression of the dorsal striatal (Pavlovian-style) response to sensitized stimuli. And thoughts are also stimuli. I’d like to think about this a lot more before trying to model it.

      As for Gabor Maté’, in a nutshell I totally agree with you. I’ve talked with plenty of addicts who swear (and I have no reason to doubt them) that their early childhoods were just fine. In fact that probably includes me, though my mom was depressed, I don’t think that took root until my middle-childhood. Lots of shit can erupt when kids become adolescents…and GM doesn’t seem to want to think about that as “causal”.

      Re the many types of psychotherapy, yep, that’s an issue and has been for years. About 75 years ago the behaviourists and psychoanalysts were offering wildly different cures. And both streams continued branching. Then came mindfulness, and experiential, and hey, what about access to emotions, mirroring, Gestalt, family therapy…and now each of these traditions has continued branching. Like evolution in that sense. I guess the mind is a lot harder to conceptualize than the body!

      Reply
  15. morgan machen

    I want to share a musical prescription to sooth everyone’s soul here. It’s an album titled Fourth World by the husband and wife musical shaman/healers Airto Moreira and Flora Purim. If it doesn’t get you high naturally maybe try a half gram of shrooms soaked in lemon juice then dance and or drum your butt off to some of the most uplifting music you’ll ever hear.

    Also, on another tangent I highly recommend listening to any and all interviews of Carlos Santana on Youtube. There’s one in which he’s amazingly candid about overcoming the shame of childhood molestation. If ever there was a man who could speak from the heart it’s Mr. Santana. Peace.

    Reply
    1. Marc

      Thanks for this. I’ll try your recommendation tonight. I might also try just listening to Santana again…it’s been years. For the last week or so I’ve tried doing my Tai Chi (good exercise for lazy people) to slow instrumental Pink Floyd tracks. Totally new experience. There seem to be abundant ways to get high, get loose, get free.

      Reply
  16. morgan machen

    Again, I’m glad I was able to offer something of value here. I started second guessing my espousing of a mind altering substance to a bunch of strangers who are struggling to ingest fewer of those kinds of things. I like the idea of practicing Tai Chi to Pink Floyd. Often when I’m moving to music I’ll get into a horse stance and do the slow back and forth hand sweep. It feels good to imagine moving energy around. I guess that’s more Chi Gung.

    I’d just want to add that even though I had several guided medicine journeys in the last 8 months I still have a part, or parts that are tormented. I seem to have alot of guilt and shame for, what, just existing. I’m struggling with the question of whether more high dose sessions are what I ‘need’ or should do. I guess I’m feeling a little disenchanted with the hype around the ‘psychedelic revolution’ and wondering if maybe I’m just one of those people that it’s not helpful for.

    I understand that the unfolding and healing can take 6 months to year to really be felt so I guess it’s a bit premature to be thinking about whether further medicine work is in my future. I’m meeting with a Somatic Experiencing coach every two weeks. She recently started asking around her network if there’s an IFS coach I could work with. I’m also meeting with an Alexander practitioner, on Zoom of course. Just seeing and interacting with someone who models a sense of ease really loosens me up, at least for the time I’m talking to her.

    Reply
  17. Donnie Mac

    I’m super late to this dance , I was wndering about the Sinclair Method for alcoholism ?
    Welcome home .
    D

    Reply

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