Less Stress

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, and by a grant from the State of Wisconsin's Dose of Reality Real Talks reminding you that opioids are powerful drugs and that one pill can kill. I'm Mike McGowan.

Mike: When I speak to groups, there's a common concern across all ages and demographics: stress. Today I am fortunate to have as our guest, Dr. Gary Sprouse, or as he is better known across the country, the Less Stress doc. Dr. Sprouse is a retired primary care physician who retired from private practice in Maryland after 38 years. He now spends his time working with clients to help alleviate the stress in their lives with the goal of living in their happy place. He's the author of several award-winning books, Highway to Your Happy Place: A Roadmap to Less Stress and Mindset Matters. He has also developed his stress reducer loop model as a replacement for how we define addiction. And coincidentally, this is gonna air on tax day, appropriate. Welcome Dr. Sprouse. How are you?

Gary: Thank you for having me on, and I'm looking forward to this.

Gary: I'm hoping that we can help at least one person in your audience today.

Mike: Yeah. The tax day thing was totally accidental, but when I saw it, I'm like, oh, this is so appropriate for today.

Gary: My wife does the taxes for us, and she always is like freaking out about it. But this year she was very calm. We got our taxes done already, so I was like, yay! We didn't owe anything.

Gary: Yay! So it's good.

Mike: Outstanding. I would've kept introducing you, but we would've run out of time 'cause you've done so much. But let's start with the question that's obvious. Where does stress come from?

Gary: All right, so here's what I found. A lot of people talk about stress as external to them or internal.

Gary: And what I found was that, here's my definition of stress. So stress is our the work that we have to do to adapt our changing body to our changing environment. So my body's changing all the time. Like I'm not the same as I was yesterday. I'm not the same as I was an hour ago, and my environment's changing.

Gary: You said you have a foot and a half of snow like yesterday you had none. So we're always adapting and changing. That takes work to do that. And to me, that is what stress is. And so when people talk about good stress versus bad stress, I'm like, no, it's just stress. What makes it good or bad is you.

Gary: So the one thing that happens to you might seem bad, but then the next day, oh, that was a good thing, right? So I talk about a guy whose son breaks his leg and you're like, oh, that's bad stress. But then the next day the army recruiter comes, says, Hey, I need your son for the army. And you're like, oh, he broke his leg.

Gary: And you're like, oh, okay, he can't come. So now it's good stress. That good or bad part of stress is really up to the person and their mindset. So then what I realized is there's no way to get rid of stress. Give up that idea that you're gonna get rid of stress. 'Cause the only way you get rid of stress is if you're dead.

Gary: And I'm trying to help people before they get to that point. And so, what I tell people is instead of spending your time trying to get rid of stress, spend your time learning how to manage the stress that you have. And the way to manage your stress is to know where it's coming from. And so there's external, there's snow and rain and cold and hot, but we have incredible technology that helps us deal with that so much better, right?

Gary: We have air conditioning, we have heating, we have work, clothes, things like that. And then there's these internal stresses, like we have, illnesses or diseases and we have things like, we get older and that causes some stuff. But then that third piece is our mind.

Gary: There's a quote from Marcus Aurelius, right? I'm reading Marcus Aurelius. And he goes, look, you can't really control your environment. You can't even control your body, but the one thing you can control is your mind. And that's what I found. And so as a doctor, I'm used to writing prescriptions for people and say, Hey, here's a medicine for your blood pressure.

Gary: It works great. Ah, but it might have a couple side effects, might make you feel dizzy or might make your mouth dry. But we're gonna manage, we're gonna minimize the side effects and maximize the benefits. So when I started looking at our mind skills. Things like we can envision the future, we can use words, we can use tools.

Gary: We can tell right or wrong, we have the ability to choose. These are all these incredible skills that have got us humans to this incredible place. Like we're at the top of the pecking water, but they have side effects. So when you can envision a future, it's awesome, right? But the side effect is then you have to worry about it.

Gary: My 1-year-old grandson doesn't envision a future yet. He doesn't have that skill. So he is not sitting at the breakfast table going, dad, how are we gonna pay for college? It doesn't come up 'cause he doesn't have that skill. So he can't literally, he can't worry 'cause he doesn't have that skill.

Gary: But he's also, 'cause he doesn't have the skill, he is also very vulnerable. So he needs people who do have the skill to help take care of him. So when psychologists tell us, they say, Hey, just live for today and you'll be happy. And you're like, you know what? My grandson's really happy, but he's not very successful either.

Gary: So it's so my goal is to say, Hey, let's keep the skill and lose the side effect. So that's where that first book came from the Highway to Your Happy Place, which is Hey, here's the skill so we have the skill of envision the future, side effect is worry. We have the skill of figuring out right and wrong.

Gary: So then the side effect is feeling guilt or we have choice. So the side effect is then regretting your choices or we have good and bad. So then you can have good or bad lower self-esteem. And then one of the things that I found is that my dog, one problem at a time. I'm hungry, I want to eat. I wanna go out, I'm scratching the door.

Gary: But humans can handle a whole bunch of problems at the same time. So our side effect is then we can get overwhelmed

Mike: And we do get overwhelmed.

Gary: And we do get overwhelmed. And that's what I see a lot, right? And so one of the things that came out of all that work, two things. One, a lot of patients would come to me and they'd say, Hey, Dr. Sprouse, I know where I don't wanna be, but I have no idea where I do wanna be. And I'm like that's a problem. We need to figure this out. So that's when I came up with this idea of a happy place. And I found that everybody's happy place is different. And I joke, 'cause I love the beach, you know the sand, the sun, you know the waves.

Gary: My wife thinks the beach is a big kitty litter box. I'm like, yeah, that's an issue, right? So what I found when I was doing the research is that people have the same rooms to their happy place, but they decorate it differently. So some rooms are big, some are small, some are pink, some are blue, some have pictures, some have posters, but they all have the same rooms.

Gary: So when you start figuring out what the rooms are, you're like, wow, that's a nice place to be. And it's in your pocket. You don't have to wait for the weekend. Or your vacation. Or your retirement. It's right there. So you can be yelling at your kids, but at the same time being grateful that you have kids to yell at, right?

Gary: So when you start looking at the happy place and gratefulness and being, having some pleasure in your life and feeling fulfilled and feeling safe and having connections and feeling appreciated like and a couple other rooms, but when you put them all together, ah, such a nice place.

Mike: Controlling your mind is not so easy.

Mike: That takes work.

Gary: Yes, it does. And I get that. But what I found is when you understand what it is, so here's the example I use. So a patient came to me a couple years ago and said, Hey, last week my spouse died. I'm like, ugh, that's horrible. And so it leaves this big, giant hole for this patient.

Gary: So I go, look, I can't bring your wife back, but what is it about losing your wife that makes it so stressful? So it turned out it was all those ingredients that we talked about. So he was feeling worried about what's gonna happen. He's feeling guilty, they didn't do something, he's regretting that it didn't do other things.

Gary: He's feeling overwhelmed. His self-esteem takes a hit. He's a little bit bored 'cause he doesn't know what to do with himself, 'cause he doesn't have his wife to be go to movies with anymore. I can't bring his wife back, but I can do something about those stresses. And those are things he can use his skills to reduce those.

Gary: So if that takes the hole from here where he can't function and brings it to here, it doesn't make it go away. But if it puts it in a place where he can function now, then he, then I've done him a service.

Mike: And that's your roadmap to reducing stress?

Gary: So the roadmap is, Hey, here's your happy place.

Gary: Great place to be. Here's the rooms in it. So you just, these, now you know where it is. And then you got these stresses that are keeping you from there. They are obstacles that you have to get around and when you understand, hey, I wanna keep the skills and lose the side effects, now it's easier to get there.

Gary: And then you get to live in your happy place all the time. Yay!

Mike: People always want to give you a drop, drop in a little advice, I we are going through a blizzard right now, right? And people say what are you gonna do? It's gonna snow. And it's that doesn't that advice doesn't help.

Mike: I know it's gonna snow, but it's still, my daughter has to drive back from her boyfriends, or my kids have to go to work. I have to be somewhere. So it's not just, there's, people aren't always helpful.

Gary: I get that. So here's the two tools that I've worked on for worry, right? Because what you're talking about is I'm worried that my daughter's gonna get in trouble driving home in the snow, right?

Gary: So the two tools that I talk about the most, the first one is called realistic optimism. So realistic optimism, what? So humans have been set up to try and keep our environment safe. And one of the ways we do that when future is a part of our environment, is to look into the future and see all the bad things.

Gary: So we tend to focus on the bad things that can happen and then react to them with fear. And there's nothing to make that stop. You do what you do this, they call it "what if-ing" right? So what if this happens? What if that happens? What if this? And you're freaking yourself out. So you were meant to have a fear reaction if a lion was trying to chase you and eat you, but after 10 minutes, you either got away or you got eaten. And either way, this fear reaction went away. But for humans, because we can just think of something to have a fear reaction, it can go on and on, and there's nothing to make it stop. So what I talk about then is look realistic optimism.

Gary: You know what? I have a choice. I can focus on the bad things, or I can focus on the good things. So if I focus on good things, that makes me feel good right now. But the realism part is I can't ignore that bad things could happen. So that brings that second tool. And so this is where this comes in. So the second tool is called the Worry Organizer.

Gary: And the Worry Organizer is a place where you write down what you're worried about. But you then organize your thinking. It's in columns. So the first column is, what are you worried about? So I'll use an 18-year-old that was, that came to me the other day who said she was, she had gotten sick and now she had to go back to school and she was afraid.

Gary: So I'm worried if I go back to school, I'm gonna get sick again. Why are you worried about that? 'Cause there's been a big virus going around in our school, so I'm worried that it's going to, I'm gonna get sick again, and then I'll get even worse. So then the third column is how likely is it that you're gonna get sick again?

Gary: She stopped for a second and she thought about it. She says I don't know, maybe 50%, which is not an unreasonable number, right? And the second half of that column is how bad would it be if you got sick again? And she thought again, and she was like I'm 18. I'm pretty healthy otherwise, so you know what?

Gary: Probably only 10% chance that I get really sick. And you're like, okay, those are reasonable numbers. So then the fourth column is what can you do to not get sick if you go back to school? And so she could wear a mask, she can take medicines to prevent stuff from happening, she can get a vaccine, whatever.

Gary: And then that last column, and this is the one where I think is the most important, is what happens if you get sick. And here you're now, you're planning for that worst. You're doing it without fear. 'Cause now you're just thinking okay, if I got sick, I would go to the doctor, I'd get a chest x-ray, I'd take the antibiotic, I'd stay home, I'd wear a mask, blah, blah, blah.

Gary: And so now you have this, your thinking is organized. So instead of it two o'clock in the morning where it's rolling around your head and not letting you sleep. Now it's written down on a piece of paper and then you can show it to somebody and go, Hey mom, do I, is there anything else you can add? Hey, Dr. Brown, is there anything else you can add in here? Does that make sense? Because I've had people, like I had a lady with breast that was worried about breast cancer and she had in her mind that she had a hundred percent chance of getting breast cancer. 'Cause her mom and her sister both had it. And I said no, the real statistics are 15% if you have a family history.

Gary: And she's wait, that's it? I go, yeah, that's it. And you saw her body language change 'cause you're like, ah, oh my God, I just got my life back. Yeah. So it's so when you write all this stuff down, then it makes it more efficient, 'cause you only have to do it once and you can plan, but without fear.

Gary: And that's the key.

Mike: Who you? Okay, great point. Who you show that to? Makes a huge difference. If you could show...

Gary: Absolutely.

Mike: You can show it to your aunt who will increase your stress, right?

Gary: No, she's not gonna increase it. 'cause you're not asking her what to worry about.

Gary: What you're asking is, how do I fix this problem? You're going, Hey, I got like my daughter's driving home from, and it's a foot and a half of snow. What can I do? And you can go I can tell her to wait, or I can make sure she has tire chains and I can, there's a number of different things that you can write down and your aunt's not gonna go, oh, here's, so if she doesn't have anything to add, she's not gonna add anything.

Gary: What I find is, here's where people get into trouble. And I see this in husbands and wives, right? So the wife is I'm really worried that this is gonna happen. And you're like, oh, it's not gonna happen, honey. And she goes, that's what you said last time, and it did happen. So now they're fighting, right?

Gary: And so guys have a tendency to minimize to the point where they ignore. That's where they get into trouble. But women have a tendency to exaggerate to the point where they're freaking themselves out. So that's why they get together in the beginning, but over time, then they start like battling with each other 'cause it gets into trouble.

Gary: So when you fill out these forms and you go, so I did this with a kid and his parent, he wanted to go to a concert. He goes the chances of me getting in trouble are really unlikely. And even if I got in trouble, mom, you're here and dad's in your nearby, blah, blah. And so mom was like, oh, I don't know, you're young.

Gary: And then she goes, all right, fine, you can go. And then he goes, oh yeah, by the way, it's in another state. And she's what do you mean it's in another state? Ah! Now you can't go. And you're like, why didn't it change? How likely? But then what it did with change was. How, like how bad would it be?

Gary: 'Cause now she doesn't have any resources to fix the problem. And but instead of him saying, oh mom, you're over controlling, bearing, overbearing, blah, blah, blah, and you're a snotty little kid, and they're yelling each other and calling each other names. They're not looking at a piece of paper and trying to give numbers to things, and they can argue about the numbers, but now they're arguing about numbers, not, belittling each other right.

Mike: I think, does it, you talked about the mind and the body changing. Does the stress and how we deal with it change as you get older or have children like your 1-year-old grandson, I'm sure his parents are having a little bit more different stress.

Gary: Parenting has changed. I'll say this right.

Gary: We have a vacation rental down in Florida and we invited our, my stepson and his wife and their two kids, and we say, why don't you guys go out for dinner because, we'll, here, we'll watch the kids and you guys have a nice romantic dinner, right? Nah, it's okay. It's routine, blah, blah, blah. I go, you realize we did raise kids on our own, right? (laughs)

Gary: We've done this before and everybody came out okay. Yeah, no. So here's what I found. So one of the reasons why... I just wrote this the other day. That we live in the most technologically advanced, the richest, the most pampered, the most educated society that literally has ever existed on the face of this earth.

Gary: And yet we're more stressed out than ever. And what, whoa, what is wrong with this picture? So part of it comes down to this what if-ing, right? So we're trying to keep our environment safe. So as I said, my dog's environment is just what she can smell. Hear or see, right? Big dog comes in the yard, she's barking, but the dog runs away and she's back on the rug of sleeping, right?

Gary: But for humans, our environment isn't just what we can sense, it goes around the globe because we have access through TV and social media to every bad thing that could happen in the whole entire world. But it gets worse, 'cause now we have the universe. 'Cause how much of our movies are made where they go, oh, aliens are gonna come and attack us.

Gary: Or an asteroid's gonna blow up the earth. And oh, and then it gets even worse 'cause now we have future. So now I gotta keep my future safe too. 'Cause it's it's not just what's going on right now. What happens next year? What happens two years from now? So when you're trying to keep all that safe, it's daunting, right? And there's so many what ifs. So one of the things that I found is the smarter you are, the more what ifs you can think of. The more aunts you have that can go, oh, you forgot to think about that. You're like, yeah, right? So we think of all these things and then it sets us off and we have these fear reactions and there's sometimes we don't even realize it.

Gary: So I call it stress blindness. So we're so used to a certain level of stress that we don't even pay attention to it. And I realized as a doctor, I was definitely a victim of stress blindness in that I'm taking care of patients. Basically every decision I make could hurt somebody significantly to leading to their death or could lead to a malpractice suit that's a million dollars. Every single decision, right?

Mike: Yeah.

Gary: But you can't think that every time you see a patient or you'd never function, right? So you have to sort of like just put it in the background and try to like, okay, it's just there, you don't even think about. So it's stress blindness.

Gary: So you really pay attention when something does big happen and you know somebody gets sick or you get malpractice suit or whatever, and then you go, oh, now I'm under a lot of stress. No, you've been under this much stress. Then you just added this a little bit more. Now you paid attention to it. So I think one of the things that happens to us is that we have this low level of stress that we've just gotten used to. Commuting to work, the kind of pressures that you have at your job. And it's only when it gets above that you even pay attention to it.

Mike: That's a great transition to your, and I was really intrigued by your stress reducer loop model because talk about that 'cause your success rate has been really good.

Gary: Yeah. So here's what I found.

Gary: So I, I did all this work on stress and I said, wait a second. People have been having stress for millennia. So what do people do to reduce their stress? Somebody asked me, doc Sprouse, what do you do for your stress? So I started making this list and I was like I exercise, I watch tv, I get on podcasts, I write a book.

Gary: I, read a book, or I watch, you know, and I go out and swim or whatever. So I had 50 things that I can do, depending on the circumstances, so I can't be in church doing pushups to try to reduce my stress.

Mike: You well, you could. (laughs) (laughs)

Gary: So my wife is so funny or I'm so funny.

Gary: Like it is 15 minutes before it's supposed to leave for church. I said, okay, just a second, and I have to do my pushups instead of, she's what the hell are you doing? She goes, we have to go to church. I'm like, she goes, is emergency pushups? I was like, yes. It's emergency pushups. (laughs) Anyway, so my point is you have to pick a number of different stresses that you can then pick and choose from which circumstances you're in.

Gary: But here's the other thing. When you start having stress and you pick a stress reducer, so I'm gonna use alcohol as the example just because it's easy, right? So you're at work and you had a bad day and things weren't going very well, and you're like, Ugh, you're stressed out. So you're driving home and you stop off at the local bar and you get a couple beers and you're like, Ugh, I needed these beers and that makes me feel so much better.

Gary: I'm now, I'm a little more calm. I can go home and relax. On your way home, the police pulls you over and you get a DUI. So now the thing that you did to reduce your stress, drink a couple beers, just cause stress. So now you get home and you say to your wife, oh my God, I had a bad day at work. I got some beers, I got pulled over.

Gary: Now I got a DUI. Ah! And your wife's honey, that's horrible. He goes, yeah, lemme go get a couple beers. And she's what do you mean you get a couple beers? You just got a DUI you right? So then what then here's the stress reducer loop. You have stress, you got a stress reducer.

Gary: In this case, beer, the stress reducer starts becoming the stress producer. And now the more stress, the more you drink beer, the more beer you drink, the more stress. And now you're in this loop, and here's what I found. The bigger your stress is, the more powerful the stress reducer has to be, and the more often you have to do it.

Gary: So the more likely you are to get in trouble from whatever it is that you pick. So there's a whole bunch of advantages to that model over, and, you know, as a doctor, I'm, I've been brought up on the disease model. That's how I got trained. And the disease model has its benefits. It makes it a medical thing instead of a moral thing.

Gary: And it makes us, gives us a code that we can charge and right, and gets people thinking that this is gonna be an issue that I have to deal with for a long time. Not just I'm just gonna fix it today and it's gonna be better. So it gives us some advantages, but the disadvantages to me, far outweigh the advantages because when I'm talking to a patient, I'll give you my example.

Gary: So I did a lot of work at nursing homes and this one patient came in and he was like in his sixties and he had pneumonia and he'd gotten pretty sick. So he came to the nursing home for a week to recover, right? And his regular doctor came in and saw him and said, Bill, we gotta talk. And he's what's up?

Gary: He goes you're an alcoholic. He's what do you mean I'm an alcoholic? Where'd you get that from? He goes it says here on your ER sheet that you drink four drinks a night every night. That makes you an alcoholic. So Bill's like uh uh. What are you talking about? You what? What? No, like I don't have DUIs.

Gary: I don't go drinking and driving. My wife's not complaining. I'm not having any liver problems. I just had this pneumonia. I just gotta get better. And the doctor's no, you have the disease of alcoholism and you're just in denial, so give it up. Stop drinking. You can never drink again. So Bill was like arguing and fighting and basically just fired the doctor and said, no, I don't wanna deal with you anymore because I don't wanna take on this label of disease for the rest of my life with this horrible alcohol thing that then says I'm brain damaged and genetically defective and weak willed and stupid, and right.

Gary: Who wants that, right? Nobody wants that. So I came in with my stress reducer loop model and I said to him, so what's going on? I fired my other doctor 'cause he kept calling me an alcoholic and that's not true. And I go, so why would he say that? He goes I have four drinks tonight.

Gary: So I looked at him and I go, okay, so you are drinking alcohol to reduce your stress. So really the alcohol is a treatment. It's a treatment for your stress. And he goes, yeah, all right, fine. I'll give you that. And I go, so do you really need four drinks of alcohol to reduce your stress? And he's ah, I don't know.

Gary: I go, do you think three would work? How about two, maybe one. So you could see that he was now engaged. So he was talking to me because he wasn't taking on some lifelong bad label. He's I could probably only do one, maybe two, like that'd probably be enough. Yeah, you know what, that makes sense because I said to him, look, you're drinking four drinks a night and that puts you in the top 10% of alcohol consumption in our country.

Gary: So that's a big number. And he is what, top 10%? I was like, yes, that's a fucking fair amount of alcohol. And you're in your sixties, so the chances of you getting into trouble from that quantity of alcohol is actually pretty high. So you can wait till your liver fails and you get yellow, or you can go, Hey, maybe I should cut back now or maybe I should stop. Whatever you wanna do.

Gary: The key was we were engaged in a conversation. I wasn't beating him up with these terms and call him an alcoholic and tell him his denial. And he was willing to hear what I had to say, and then could say, you're right, maybe I should cut back. Now, then he left and went home.

Gary: So whether he did or not, I don't know, but what in my office, what I do know is that I took care of hundred patients that had been on heroin and I was giving them Suboxone and I had a hundred patients. And out of those hundred patients, I had a 95% success rate, if not more. But because, and here's why.

Gary: This model, what it says is, Bill, you're normal. He's what? Nobody like I had a patient that came to me. He had been living in a tent. He'd been to 15 rehabs, and his mother brought him to me as a last resort. So it turned out a really bad anxiety disorder. He'd been living in a tent, 15 rehabs. He had horrible self-esteem.

Gary: So when I saw him the first time and we were talking, I'm telling him about stress reducer loop. And he is i've been doing heroin, I've been doing Xanax off the street, Xanax, and it's like that's the only way I function. And I am like, okay. So we started looking at where stresses are coming from and what I said to him is, you're normal.

Gary: And he's no way. He goes, I've been doing this for a long time. Nobody's ever told me I'm normal. I'm like, I'm telling you, normal. Everything about a stress reducer loop is normal. Like you had stress. That's normal. We all have stress. You found something that worked. We all have things. Things that, something that work.

Gary: And then your brain did what it was supposed to do, which is made it automatic because you did it enough and it was successful. It made into an anatomical habit track in our brain that says, Hey, when that trigger goes off, go do that. So when you start feeling withdrawal, you're like, whoa, there's that trigger.

Gary: Go get heroin. It'll go away, right? Or, Hey, I'm living in a tent it's cold outside, that makes me stressed out. Go do heroin and it'll feel better. Then you go, you know what? I need to stop this. So 15 times you've tried to stop, but it is actually really hard 'cause now you're trying to inhibit a track that's already there.

Gary: That's really hard to do. We can do it. I, if I'm trying to lose weight and I go to a, an outing and there's a whole tray of donuts and I'm like, oh man, they look really good. And I might walk past the donuts 10 times. That 11th time and I walk past and now I'm eating the donut, I'm like, dang it, I didn't wanna eat that donut.

Gary: So we can inhibit, but we're not that great at it. So I said, this is all normal. So the reason that we've never been able to find the gene that diagnoses alcoholism or the gene or the personality disorder that tells us you're gonna be an addict. We don't have any of that stuff. It cuts across socioeconomic lines, it cuts across age groups.

Gary: It doesn't matter, because it is a normal process. So literally any one of us could end up in a stress reducer loop or anything that we pick to be a stress reducer could turn into a loop. So when you think of those terms, then what happens is the stigma goes away. 'Cause you might say, Hey, I'm a heroin, I used heroin to reduce my stress. And I'm like, yeah, I use chocolate donuts to reduce my stress. But it's the same process. So if I'm driving home from work and I'm tired and exhausted and stressed out, I don't know, my car just drives into the local store and I'm eating a chocolate donut, and I'm like, what am I doing eating this chocolate donut?

Gary: That was not what I wanted to do. But that's the connection in my brain. When I'm stressed out, I don't have the as much ability to inhibit. Bang. I'm driving into the store and getting a donor, which is no different than the heroin addict. So I'm talking to one of my patients and my patients got it right away.

Gary: They go, yes, that makes sense. Think you know what, my sister has a loop. And I'm like, what's her loop? And he goes when she's upset and stressed out, she goes shopping. She goes, but now she comes home and her closet's full. Her credit cards are maxed out. Her husband starts yelling at her, which then stresses her out.

Gary: So guess what? She does?

Mike: Shops.

Gary: She goes shopping. Yeah, that's the loop. So it turns out you can find loops, a whole bunch of places. And when I started trying to organize it a little bit, what I found was there's chemical loops and that could be alcohol or nicotine or caffeine or whatever. There's behavioral loops.

Gary: Which can be things like gambling or sex addiction or working too much, right? Or playing sports too much. And then the third is what I would call coping skills. So in that category is things like lying, things like we use the word codependent. I don't like that word, 'cause we're all literally codependent.

Gary: I read the book on codependence and I'm like, wait, we're all codependent. That's, wait, why are you making that pathological? What I make is, I call it the self-sacrificing loop. So when people try to self-sacrifice, they go, oh, I'm gonna give up myself, because we give people a lot of self-esteem points for self-sacrificing.

Gary: But when the self-sacrificing gets too much, then you start building up anger and bitterness. That self-sacrifice and also gives you a sense of control because you're doing it the way you wanna do it. So when you can't give that control up, again you get into the same kind of problem. So those are the three categories that I look at.

Gary: And so when I see somebody that's in a loop, I go, okay, first off, we have to recognize you're in a loop. And that's not always so easy. So we had a patient at our church who was drinking too much alcohol and he knew that he was drinking. He knew he was having side effects, so he'd passed out. He was shaky. He couldn't concentrate real well, but in his head he was like, oh, I think I have Parkinson's, or I think it's one of my medications. And we're like why don't you try not drinking? No, No, that's not the problem. So it's sometimes it's not easy to get people to recognize the loop that they're in.

Gary: So that makes it difficult. But once they recognize the loop and you go, okay, now you're in a loop. So now what you say to them, instead of saying you have a lifelong disease, that the best you can do is struggle every day of your life not to do it. What I say to 'em is, you're normal and the treatment that you picked is causing problems.

Gary: So we have to do two things. One, reduce the stresses that you have, and two, find a different stress reducer that doesn't have the same side effects. So I was just at the Maryland State Senate, excuse me, the house. And they were in charge... there was a bill that was gonna make it mandatory for recovery residences.

Gary: That they couldn't turn people away who were on Suboxone or methadone because there are a lot of places that don't feel comfortable with that, and I'm like, why would you not feel comfortable with that? And they go, because they have the disease of opioids and so now we're just giving 'em a different opioid, so we're just keeping their disease going.

Gary: And you're like, yeah and they're right. But two, one of the things that they're missing is that it works. Whether it fits with our disease model, it doesn't matter 'cause it works. So we found significant improvement when people were using Suboxone, even if that is their disease.

Gary: In my model, it makes all the sense in the world, 'cause what I'm saying is, look, heroin works. When you're stressed out and you do heroin, you're not stressed out anymore. Yeah, you feel good, but the side effects are crazy. Here's Suboxone, it might not get you as high, but it'll keep you from going through withdrawal.

Gary: It'll keep you from having to stick a needle in your arm. It'll keep you from living in a tent. It'll keep you from going to jail. So it has way less side effects. Now, does it have no side effects? No. You still have to go to a doctor, get 'em to write it. You have to hope the pharmacist will fill it, that the insurance will pay for it, that they even have the medicine, that somebody doesn't steal it from you, whatever.

Gary: So it's not like it doesn't have some side effects. So what I say, here's my, what I would say to patients in my office. We're gonna get you off heroin and we're gonna put you on Suboxone because that's a treatment that has some benefits with a lot less side effects. And then we're gonna teach you how to have less stress because we're gonna show you how to not worry as much.

Gary: We're gonna show you how to not have as much feel overwhelmed as much. One of the biggest things that I've seen with those patients is three things. One, they either had some horrible post-traumatic stress. They had some event in their past that caused all kinds of problems and that was leading them to getting into trouble.

Gary: Or they had A. D. D., which made it really hard for them to inhibit, or they had a really bad anxiety disorder. And so those are the things that were keeping them in that loop. So I'm saying to them, look, we're gonna find ways to reduce your stress. We're gonna find different stress reducers, and then eventually we're gonna get you off Suboxone 'cause you won't need it.

Gary: Why would you need it if you don't have any stress? If you're a diabetic and you're 400 pounds, I can give you all kinds of medicine to get that sugar under control. But if you lose 200 pounds, you don't need anything 'cause you're back to normal. And that's what I would say to these people.

Gary: And they like that. They were looking for that. 'Cause now I'm treating them as if they're normal. I'm treating them with empathy. I know where they're coming from 'cause I know how hard it's for me to not eat a chocolate donut when I'm trying to lose weight. And so it, it makes it.... Okay, so it makes a lot easier to interact with the patient 'cause I'm treating them with respect 'cause I'm going, you know what? I'm one donut away from being where you're at. So I went to a methadone clinic just to see how they run. And there's 350 people lined up at 5:30 in the morning to get their dose. And they do that every day. Every day! We're like, what? Can you think a stress word? Like what? That's like cra... And if you're late, you're not getting your dose that day. And then I'm talking to the counselors and one of the counselors is a smoker, one of the counselors is 150 pounds overweight. They're telling me that the heroin addict has to get their life under control and blah, blah, blah.

Gary: And they're trying to do it on their own, and they fail and they laugh and blah, blah, blah. And I'm looking at them going, you realize you're in a smoking loop and you're in an obesity loop. Like you're no different than they are. Like if I said to you, okay, I'm gonna stop using heroin when you stop eating chocolate donuts.

Gary: And then let's see what happens, right? All of a sudden the playing field gets a whole lot more equal. A lot of people in the addiction treatment world are like, I don't know. I don't like this model. 'Cause that puts me down where they are. And I don't like that. I want to be up here and them down there.

Gary: Because what we do with that difference is we tell people you have to do this or else. You if you don't do what we say exactly, we're kicking you outta rehab, or we're gonna put you in jail, or we're gonna take away your kids, or we're gonna whatever. And it's like. What? Like, but yet on our end we can do all kinds of stress reduce, we get and get all kinds of stress reduce loops and they're like, they're not that bad.

Mike: So ultimately if you get into a healthy choice loop, that's where you end up in your happy place.

Gary: Yeah, absolutely. So here's the other thing that comes outta this. It's like people, because you have this brain track. The risk of lapse is really high.

Gary: And so what I did is there's a thing called SMART Recovery and they differentiate lapse from relapse. So lapses. So I'll give you an example. A patient had been on cocaine and had lost custody of her kids. So kids lived with her husband. So she was with some guy and they go to a park and they're hanging out and she's relaxed and she's enjoying herself.

Gary: She hasn't used in a long time. But across the park, she sees her kids. But she can't go talk to 'em 'cause she's court ordered that she can't be near them. Guess what? That freaks her out! So guess what she does? Her system gets overwhelmed. The track goes off. She's like, God, I gotta go do some cocaine.

Gary: So she lapse, but the key is she didn't relapse. So lapsing is okay. Used it one time or two times. Relapsing users back to doing it all the time. So my job as a treater is to find somebody when they lapse, not when they relapse, like I wanna find 'em when they've only done it once or twice. Because like in the AA and the disease model, what we say to 'em is, you failed, you suck! You're so stupid, you're so weak willed, why did you do that? Why did you choose to go back on?

Gary: In my model, what I say is, look, you've been really successful at inhibiting that track. It's been gone on for a week, a month, a year, whatever, how long it's been. So what happened that you weren't able to inhibit that track?

Gary: Which is such a different question. 'cause now I'm saying, Hey, you were successful. Yay! And we're gonna get you back to being successful. We just have to figure out what happened that time. Then we can build a little wall around that. So the next time you see your kids, we're gonna build a little wall around that experience so it doesn't trigger you again, and we're gonna give you something else to do when that happens, so that you don't have to do that. Go back to cocaine.

Gary: So again, it treats them so differently. It gives them that feeling. I had a lady, I was at one of her talks and she'd been sober for 25 years. And you're like that's awesome. But she introduced herself as Jane, and I'm an alcoholic and I'm like. What? She goes, I went to Italy and I was at a restaurant and the menu was in Italian and I ordered something to drink and I didn't realize it, but it turned out it was a glass of wine and I had a glass of wine.

Gary: And I'm like, okay. So when I got back to my AA group, they go you gotta start all over again. And I'm like, what? You had 25 years of sobriety and because of an accident, like you didn't even plan on this, now you're gonna go back to zero? What, why would we do that to anybody? That's, no, that's not nice. So in this model, what it says is, yeah, there's gonna be a loop in your brain, but that loop, that track, it doesn't define you.

Gary: As I kid with my patients, I go, Hey, I'm Dr. Sprouse, I'm a bed wetter. And they go, what? And I go when I was two years old, I wet to bed all the time, but I haven't done it in 67 years, but one night of bedwetting and I'm back in, right? So it's it doesn't make any sense to say that. So why would we say to somebody who's been sober for 25 years, you're an alcoholic?

Gary: It doesn't make sense. It reminds them that they're an alcoholic and they have to pay attention. But why? Why would I want them to take on this label? That's not a good label. I, what I say to 'em is, look, you got this track in your brain, but you got thousands of other tracks too. So I'm not gonna label you that track, but I want you to be aware that the track is there and all it takes is one instance and you can get back on that track.

Gary: But I don't need you running around telling everybody you're an alcoholic just 'cause you were somewhere in the past.

Mike: Outstanding. Doctor, I wanna thank you. If you're watching this on YouTube, you can see his book behind you. I'm not sure how you organize that. Is that a poster or is that just AI?

Gary: Or, yeah it's a pull up thing that you can.

Mike: Oh, it's great.

Gary: Yeah, it's nice.

Mike: All you get is my living room behind me. (laughs) Dr. Sprouse, thanks for your life's work, your dedication.

Mike: For those of you listening, watching, you know, we always hope you find love, courage, support wherever you are. Thanks for listening, watching, be safe, be well. And I think we would all say, we hope you find your happy place.

Gary: Yeah, absolutely.