Pain pill addiction epidemic with Dr. Esangarajadoggi

Hello, I'm Julianne Good and this is Psych One-on-One. Welcome, we are here to make psychology understandable with tips for you and your family to make your life easier. Tonight my special guest is Dr. Esangarajadoggi. He is a clinical psychologist and the CEO of Endevo Treatment Partners. We are going to be talking about pain pill addiction and the epidemic that it has become in America. I would like to dedicate this show to two people. Two of my friends who have passed within the last five years of pain pill addiction. The first one is Rachel. She was a successful veterinarian and the other woman is Mary Lou and I worked with her for several years. This is a very deep subject for me having had lost two really good friends to something that should not have happened. So Dr. Garajadoggi, hi, how are you doing? I'm doing great, thank you very much Julianne. And thank you for being a guest again. Dr. Garajadoggi was on my show originally about four shows in last year and we were talking about couples sex therapy. So if you want to go back to that show, it's still in iTunes and it was a great show. I appreciate you being on again. Absolutely, you're very welcome. It's a pleasure. So Dr. Garajadoggi, can you tell us a little bit about your life? Sure. About your background please. Well, do you have about like three hours? We could. We could split this up into three shows. Three shows, yeah. Well, very quickly perhaps as it pertains to today's discussion. I'm a licensed clinical psychologist as well as a part-time professor at a few local universities. And I work a lot in the... I work in the field of addiction as being my passion actually to a greater extent because of a loss myself or in my family with my father. And so it's very close to my heart. And I lost a person and I know that how it feels where the whole family is really kind of impacted by... Besides the individual who is struggling. And so I've been working with whether it is prescription abuse or illicit drugs or even just alcohol. And so over, I would say that past eight years, I have worked with a lot of individuals, couples and families struggling with substance abuse. And it has been in various settings, whether it was at residential treatment centers or in the hospital. And I've been working with a lot of people. And I've been working with a lot of people who are in the mental health centers or intensive outpatient clinics or even recently in my own private practice. And so that kind of wraps up, I would say, my clinical experience within this field and also the academic part. You know, as part of the teaching experience, I oversee a lot of practicum and internship students. And I'm interested in the field. And I'm interested in the field. So I'm also rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather clinicians, or at least as they are going through their practicum and internship years. So that sounds like quite an impressive background that you have, that you're multifaceted and working with a team of different people, correct? Oh, yeah, absolutely. I mean, I have always loved the multidisciplinary approach toward helping people with, let's say, mental health disorders. And specifically when it comes to the field of chemical dependency, which is kind of the umbrella term for alcohol and drug use, because basically the body and mind become dependent on the chemicals. That we are taking in, it's really a systemic concern. It's not just, I would say, affecting a person's feelings and emotions and mind, but also every single area of their functioning as an individual, as well as a member of the family and as a member of the society. So having worked in the multidisciplinary approach has been very, very helpful. And, you know, has taught me a lot. And I have also observed how we can achieve a better effective, or level of effectiveness in treating chemical dependency. Now, a lot of times we know that chemical dependency doesn't present itself alone. But people who are struggling with substance use and abuse, they also, I would say, at least maybe even 50% of the cases, are also struggling with some kind of a mental health concern, whether it is an acute problem, or it has been established over many years and has become part of the personality trait or functioning. And currently at the in vivo treatment partners, we have put together 40 providers that we are working with, because again, going back to that systemic approach, it doesn't help to just help a client with getting rid of their cravings, let's say, as it relates to chemical dependence, or working on triggers only. You know, there is a whole lot to a person. We have to treat the whole person. And when it comes to helping a person holistically, we have to really take care, and we have to really make sure that they are not having a very comprehensive assessment of the person's strengths and weaknesses, and a whole history of actually how they have ended up being in this precarious situation. And there are multiple aspects such as, you know, their relationship with loved ones in their life, with family members, with their partners, children, parents, with even neighbors or coworkers, their medical conditions that they are in, and so on. So, we have to really take care of that. We have to really look at the people that they're struggling with, maybe level of disability that the person has to deal with on a daily basis, their financial health, legal implications in their lives, career planning, even environmental factors. So, that's why a multidisciplinary or team, as you mentioned, a team approach is really the most effective one, and that's what I truly believe in. So, it sounds like when you work with people, you're able to help them, and that's what I truly believe in. So, it sounds like when you work with people, you're able to help them, that you are really almost doing an overhaul of their entire life if you're working from that many different angles. Is that correct? Absolutely. I think that would be the best and most effective long-term treatment plan. You see, on the surface, when we look at the person who is using a certain substance, may tend to think of this as a temporary problem and, you know, look at it as a very isolated type of a predicament that this person is dealing with and maybe even characterize it as a character flaw or personality problem or a decision-making problem. But in reality, this chemical dependency as a habitual, I would say, form of coping with stressors in one's life, they have root causes that go way beyond a temporary issue and just what is happening today in their lives. So you said it very well. An overall and overhaul of the whole person is... Right. ...called for and also is really the only plausible course of action if we are to help this person on a long-term basis rather than just, let's say, over the next 30 to 60 days or six months. If we really want to help the person change their lifestyle, if you will, then we have to help them in all aspects of their functioning. Right. And then... How many people that you have worked with are... You sit them down after the initial visit and you start going through, well, maybe we can work on this or that or, I mean, what's an initial consultation like that a person would come in, they feel comfortable with the process, they understand it's going to take some time to make the change. Right. And then they can start to make changes in various areas of their lives. Very good. That's a very, very good question. And in order to answer that, let me just premise my answer with explanation of what is required actually in terms of the modality or approach of working with people who are struggling with substance dependence. And that is something called stages of change or a mindset. Right. And we have to have about stages of change. This comes from the empirical field and has very much a little bit of an academic as well as evidence-based aspect to it. And really what we have learned, if anything, over the past, I would say, century of understanding and dealing with alcoholism and also chemical dependence is the fact that when we are asking people to change their way of dealing with stressors in their lives, which is completely in contrast to what they're doing right now, we have to be very, very mindful of the very minutia and the detailed steps that it takes a person to actually go through that change process. That's why we call it stages of change. So rather than thinking that a change from... From one way of dealing with a stressor to a completely different way would be a one-step approach. You have to become aware of the fact that it actually takes five to six different steps to go from one state of the mind and being in this world to a different step or to a different stage or state of the mind. So that information is brought up within the initial session then. It's like, okay, this is not going to be a quick fix. Exactly. I hope that the clinician has that mindset, that they know they can't expect a lot more than what the client is capable of doing. And that is based on their motivation. In fact, the modality that we use in this field is called motivational interviewing. Or, motivational change. So an astute or skilled clinician would work with the client where they are at. And let's say they may be at stage one and there should be no expectation for the client to move to stage three. So we have to really work with them and help them to move from stage one to stage two. And then over time, moving from stage two to three and so forth and so on. So sometimes that might require, like, babysitting. Baby steps. Correct? I mean, it's just... Yeah. Change for a lot of people is scary. It's hard. It's, you know, it's facing the unknown. They don't know what to expect. They don't know if once they get to that next stage, if all of a sudden, you know, things start breaking apart emotionally and within their environment. I mean, for a lot of people, that's a scary process. Well, it's very scary. It is absolutely and understandably so because nobody likes change, although change is inevitable. And as you mentioned, nobody likes the unknown. We like the familiarly painful situation that we can control compared to unfamiliar variables that we have no idea about and may not be able to control. Right. So they're almost left out in the dark in a way. But so... So it's the clinician that has to instill hope in change and that it is going to get better. It might get worse temporarily, but eventually it will get better. That's kind of part of the entire, I would say, clinical process. Certainly, you're right that it's the clinician who would have to really just automate. I would say not necessarily almost intentionally try to instill hope, but it should be part of their personality and character and the whole approach that they take toward betterment and improvement. And there's always hope. There is always opportunity. And keep that energy going, that positive approach toward, again, increasing motivation of a person to achieve the things that they want. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. Right. like to achieve in face of all the obstacles that they are experiencing at the same time. So going back to what an intake, let's say what happens at an intake session, which is not necessarily too much different than what would happen in the subsequent therapy sessions, is the, I would say, very facilitative stance that the clinician would take in understanding the client, in helping them make sense and meaning of what is happening to them, discover aspects of their strengths, and really kind of gaining confidence and knowledge and skills in the patient. So that's the process of moving from almost a state of inability and helplessness toward this problem, toward a state of very motivated, to some extent excited and capable sense of agency that they can do this, they can overcome it, it will take certain steps to get there, but not only there is hope, but also there are opportunities. So there are actual tools, people, resources, and specific kind of a skill set, which we call a toolbox, to achieve what they would like to achieve. So get them really involved as much as possible, excited for making that change, excited for seeing possibilities in front of them, which they may not have seen before because they were under the influence of... And that's the whole point of the process, is to get them to start dreaming again. Yes, and also to add to that, tailor this level of motivation to each stage of the change process. To say that the clinician would have to have almost like a canned version of just increasing excitement. Yes. And that's the whole point of the process, is to get them to start thinking about what would be wrong, because each stage of the change process has its own challenges, very unique challenges, and has its own method of improvement that's different from the other stages. But sometimes at one stage, there isn't so much necessity for excitement as there is for maybe keeping an even keel throughout the whole process, almost like a cool mind. Mm-hmm. And at other stages, there is much more necessity for seeing almost like the ambivalence through the ambivalence of a person, rather than focusing on the excitement. With that specific knowledge of these stages of change, that each are uniquely different, which come with different markers, unique different markers, and as well as the necessity for a very tailored and customized approach that would really be helpful in the moment to help a person to realize how to move forward, not just the fact that they want to move and change from one way to another, but also how to do it specifically. Right. And then not be tempted to relapse and go back. And go back to familiar territory. Right. And then not be tempted to relapse and go back to familiar territory again, is a huge challenge. At this point, I would like to invite the listeners to call in and join Dr. Garajadaghi and myself, also known as Dr. G. The number is 800-893-9562. Again, that's 800-893-9562. And Dr. Garajadaghi, I would like to turn now to talking about the pain pill addiction problem. We're going to talk about the problem of the American American. Can you talk about that a little bit, please? Sure, absolutely. I would like to really address the problem from a little bit of a different perspective than probably has been addressed in the past. You know, I'm not a big statistician and I'm not that interested in numbers as much as I am interested in, you know, the ideology or the root cause of problems and then also into the solutions. How to come up with solutions. But generally, we know that prescription medication abuse now is actually the largest form of addiction compared to the illicit drug abuse and alcohol. So it's really overtaking the whole industry by leaps and bounds. And it is becoming such a nuisance everywhere, whether it is for families or individuals, for the industry in general. For the healthcare industry, for hospitals, that people are slowly and gradually becoming quite aware of the problem. So I think there's that the positive side is that it has become so huge that nobody can ignore it anymore. People should not ignore it anymore. On the other hand, it's really bad. It's really huge. It's really to the extent where we have seen, in fact, a few documentaries created about drug abuse. It's created about young people from anywhere between 13 to 30, I believe, that are mostly affected by this problem. And simply there are certain reasons for it. So prescription meds are part of the medical, you know, practice where when people have pain for various reasons, they can easily get prescribed pain medication. So that's kind of an ingrained part of our society and a part of our medical system. So there is some acceptability toward it, just as much as we have alcohol almost everywhere in, you know, in our homes and even offices or parties. Everywhere you go, there's alcohol. So is prescription medication in every household because a lot of people are struggling with painful experiences. And you know, this is the whole premise of the program. So it's a lot of people are struggling with painful experiences. And, you know, this is the whole premise of the program. So it's a lot of people are struggling with painful experiences. So it's a lot of people are struggling with painful experiences. So it's a lot of people are struggling with painful experiences. So as part of our appraisal process of pain management, our doctors more or less, and also hospitals, are more or less required to give pain medication in order to reduce pain as just part of our functioning. So there's a huge prevalence and availability of prescription medications or, you know, pain medications, and then they end up being kind of underregulated because they end up in these bottles every day that they're in our appraisal appraisal appraisal appraisal everywhere, whether it is in the medicine cabinets of some parents of certain younger individuals or just kind of stashed up somewhere in a drawer or a cabinet, somewhere in the home of people. And everybody can simply just have easy access to it because there's no other way of really getting rid of it or kind of controlling and regulating it. So we see more or less an epidemic. There are a few documentaries that have been made, such as Behind the Orange Curtain. Yeah, which I saw last week. Yes, that was shocking. It was a documentary about the pain pill epidemic in South Orange County. And for viewers or for listeners who are not aware of Southern California culture, South Orange County is very wealthy. And this was a documentary. It was a documentary specifically about parents talking about their children that they lost to pain pill addiction. They overdosed. They had heart attacks or strokes. I mean, it was painful to watch, but it was just, it was a wake up. I mean, the panel that you had, Dr. G, was incredible. There were about 10 people that were speaking out about their personal experiences, experiences that they have. And I think that's what I've had working with youth and the parents with trying to get off of these medications because they're so prevalent. It's part of the social norm in some circles down there. And it was heartbreaking to listen to the loss of some of the children who, you know, it was just an incredible experience, but definitely a wake up call. Yes, it was. It was. In fact, I mean, what stood out most for me was that one of the individuals, I think it was either the police officer or the EA agent who mentioned four people just died that week. Yes. I was just, and he said by the end of next week is going to be 20 people. It's just horrendous. And if you think about it, you know, what they were trying to convey at that panel as well was that. These are very small mistakes and we are paying high prices for such small mistakes that these kids or young people are making because they have absolutely no idea what they're getting into by just taking, let's say, a few pills, whether it is Adderall, that's more or less kind of the equivalent of methamphetamine or Opana or whatever other that's OPH or other types of meds there are that, you know, people anywhere. Young persons from 11, 12, 13 years old all the way to 30, 35, even nowadays even senior citizens are taking and without knowing really those severe consequences that these drugs can have. And like you mentioned, paralysis, strokes, death, overdose. And then it not only affects one person. I have a poster. I think one of the panelists, Jodi Barber, the producer of Overtaken. She brought a poster of 20 different young people from 18 to 24 who a lot of them were friends with each other. And one of them overdosed in a few short days. Two or three other people in the same group overdosed. Yeah. Very scary. So, Dr. G, we are going to come back and I'm going to take a break momentarily. We're going to come back and talk a little bit more about the epidemic. Okay? Let's do so. Thank you. The Chicago School of Professional Psychology offers numerous psychology, behavioral and health-related science graduate degrees at three campuses, Los Angeles, California, including branches in Westwood and Irvine, Chicago, Illinois, and Washington, DC, and online. The Chicago School prepares students to meet the ever-changing mental health needs of society through classroom experience and real-world training. The Chicago School Counseling Center's online training program is available at the Chicago School Counseling Center's website. The Chicago School Counseling Center's online training program is available at the Chicago School Counseling Center's website. University of Chicago University of Chicago University of Chicago University of Chicago University of Chicago caring, confidential, and affordable psychological services to individuals and their families. For more information, visit thechicagoschool.edu. And thank you to the Chicago School for sponsoring Psych One-on-One. We are back with Dr. Esan Garajadoghi, CEO of Endevo Treatment Partners. We're talking about prescription pain pill addiction and the high price of taking these medications. So, Dr. G, what are some of the signs for people who are under the influence of these medications that other people can sit there and see and kind of take note, and hopefully intervene somehow before this becomes an addiction and it goes full-blown? Well, unfortunately, those are hard to detect unless they are under major influence just because they have taken some of these pills. And it depends really on the type of pill that they have taken. But generally, for the general public out there, it's kind of the layman. If you will, who may not be clinically oriented and know exactly what to look for, I would just kind of suggest that they look for irregularities, irregular, unexpected behaviors, including way of thinking of an individual. So, if you are familiar with someone, if it is a family member or a friend, and then suddenly you notice these odd, irregular, unexpected ways in their functioning, then you should be concerned. One area that drugs can affect us is in the way of our thinking. For instance, hallucinations, delusions, so odd beliefs and way of irrational thinking, if you will, that a normal person, and specifically that person that you have known for a few years, shouldn't be thinking basically those, that type of thinking, or belief system is uncharacteristic of them. Then that should be a source of an alarm or cause of worry. How come that this person is suddenly, let's say, paranoid about certain things, or reports that they're feeling or sensing things that just don't seem to be real, or again, a very odd belief system. And also, in terms of mood, the best way to look for a person is to look for a person who is not a person. And that's the most important thing. And that's the most important thing. So rather than that, rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather through on, let's say, promises that they make or goals that they set for their lives. Specifically, I would say when people get into the later stages of dependence on drugs, they may go to extremes in terms of obtaining those drugs, including stealing, cheating, lying, manipulating others. Going from doctor to doctor. Yes. That's huge. Absolutely. Shopping doctors, going from doctor to doctor. Absolutely. And then completely almost having a personality change. You know, sometimes that's kind of the telling factor. You see, you feel like this person is not who they used to be. It's a completely different personality. It can be seen like very instability in their way of interacting with others. And, you know, lastly, I would say certain financial decisions, like risky financial decisions. Like we have had a lot of wealthy people in the past kind of, you know, squander all their wealth and other people simply because they were so deeply involved in drug use, even prescription med drug use, because these pills, they cost hefty dollars on the market. Very expensive, yes. Yeah. And that's why, and I brought this up. Yeah. Yeah. Yeah. And I brought this up in a previous show. That's why a lot of people are switching from pain pills to heroin now. And the heroin use has been skyrocketing over the last three, four years. From the stats that I saw on the LA Times, it was like doubled, which is very shocking. So now with the pain pills, the accessibility, like you had mentioned before, Dr. G, you know, somebody can go into other people's homes and just, you know, use the restroom or whatever and start going into their, you know, medicine cabinet or start looking around. And, you know, like with some of the kids, they just, you know, start grabbing pills where they can. And then they have, you know, pill parties. I don't know what they call them, but, you know, it's pretty well in the news now where, hey, let's have a good time. Let's throw. Let's throw whatever prescription drugs you have in this bag and grab a handful and off you go. And, you know, let's get high. Let's have fun. So. Yes. Basically, there are a few things that come to my mind, you know. Number one, and in trying to understand really the whole addiction, we also have to separate two huge phases, I would say, or, you know, aspects of it. One is how. People get entered, if you will, or they enter this problem in their lives is different than the part where they are already addicted and then are trying to get out but cannot get out. You know, first of all, nobody is kind of born with this problem. People are just born more or less healthy unless they have medical conditions or physiological, you know, abnormalities. So that's not our topic today rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather games or hanging out with others, etc. So a lot of these habits are just part of our upbringing and normal part of functioning. But then we get to a stage and age range where, as part of our developmental growth, we start pushing the envelope. Those are those formative early teenage years where every person tries to find themselves and find meaning and sense in who they are and kind of assert their individual position within the society, especially the family. And that can be very challenging given the fact that the human mind has not really even evolved as fast and as advanced as it should be at those early stages or ages, such as 11, 12, 13, 14, all those basically grades or ages where people nowadays get it. They're not really involved with drugs, whether it is at school or, like you mentioned, at pill parties or cocktails, you know, pill cocktails and things like that. And so that's the entry point. The entry point is that it has different reasons for people. Usually it's either curiosity or some kind of a method of fitting in or belonging, almost sometimes peer pressure, being liked or approved by others. And also just simplicity. Simply almost like a pastime. Let's feel good. Like you mentioned, you know, a lot of people have friends who simply assert that aspect of life more than anything else, you know, the pleasurable aspect of life. Let's just feel good. Let's do things that feel good. And it is kind of understandable because that's part of the growth of a person. But on the other hand, when there is so much easy access to substances that actually take over that responsibility of feeling. Feeling good. Then people get hooked. So whether it was by curiosity or peer pressure or fitting in or whatever other reasons, people get hooked. And then what happens is that's where the brain gets stuck in this whole system. You know, we have two different pathways, actually, within the brain. I'm not going to get into that. We can save that for another time. But there's more or less a motivational pathway and a feeling good pathway. And those get convoluted and entangled in this whole process. And if a person is genetically predisposed to fall into that trap, they're more likely to increase their use and frequency of their behavior and less likely to get out of it. That's where it becomes an actual almost brain disorder. Yeah. And it gets tricky when it's multigenerational and a person has grown up. Around people that that's normal. Let's, you know, let's let's not stress out about life. So we'll we'll drink or pop pills or smoke pot or something. And, you know, so they grew up thinking that that's normal or one or both of the parents are addicts. And it's like that. Like you said, that pre, you know, that genetic predisposition to get into it. Yes, absolutely. It's not only due to genetic predisposition. But if you also think about. It's part of the identity of a person. You know, who doesn't want to associate with the image of their parents? Generally, that's just part of our pride to to be proud of being somebody who is very, very close in terms of features and traits and so forth. And almost like a copy or clone of their of their significant people that have some meaning and importance in their lives, especially parents. So if a parent. Is a drug user or an alcohol, alcoholic or whoever was basically been growing up with that and condoned it over time, then we have a much harder time to put that image outside and kind of remove that from our lifestyle. So there's a cultural component and a family component to it, too. Yeah. And it always amazes me when I meet people, especially siblings. One can be an addict. The other one has never used at all. Because they just walked away. They they were almost like an outsider to that whole system. And they just said, nope, not going to touch it, not going to do it. I've seen the destruction that it causes. And it always fascinates me to see how, you know, two or more siblings can grow up in the same household and take completely different paths once it comes to drug use and abuse. That's very interesting that you bring that up, because clinically. This is. What I have seen to be the most effective and powerful way, if you will, of kicking the habit and for good. It's that discordance between a person's identity and the drug use. If there is concordance or simply being on the same page or frequency where the person feels that this behavior. Can easily fit into their identity and personality. They don't feel alien toward this behavior. They will have a much harder time kicking that habit compared to others who simply in terms of their philosophy, their worldview, their identity, the way they identify themselves. They have a harder time to incorporate the addictive behavior or substance use or abuse or dependence. As part of their reality. And that's what we call the discordance. So, you know, I've seen that many times, especially when it comes to one of the most difficult and complex addictions to get rid of, which is actually smoking cigarettes. As we know, you know, smoking cigarettes is really difficult. They're not only multiple cultural habitual components to it, but also they're two different. So that's rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather rather of smoking. I've seen that many, many times in my practice. Right. And it is, it is a social component. And any of this use is a social component. It's like if a person decides to quit or cut back, then all of a sudden they're almost an outsider within their group. What do they do then? Do they have to go and make new friends, hang out with new people, isolate themselves? I mean, there's, there's different components to that as to once they, once they cut back or they stop altogether, what do they do socially? Where is their support system then? Absolutely. I think that that is when I called for family therapy and a systemic approach. You know, that is the part that I wanted to really bring up. And I've talked about that in the panel last week. Right. We have a complex paradoxical phenomenon, which kind of skips or escapes most people. We are not aware of the fact that we have this clash of principles going on here in our society. On the one hand, we have addiction and treatment of addiction, which requires a very systemic and collaborative approach. That means, as we talked earlier, like a team approach or multidisciplinary approach. So our appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal appraisal of the members of the family that have grown up with a person who is struggling with addiction. Because as much as it is a chemical problem or a motivational problem or a decision-making problem, it's also a relational problem. The underlying deficits that ultimately lead to the symptom are problems in the relationships. People are suffering from disconnections. From being disconnected from one another. And as well as just the presentation of the significant people in their lives, which is signified by concepts that we call love and spirituality and humanity and so forth. A lot of individuals who are dealing with addiction, they can't get rid of it. They feel that emptiness inside. Emptiness from themselves, disconnection from themselves. From a meaning and making sense of life. As well as from people in general in their lives. Whether these are close friends or family members or just co-workers, neighbors and people in the society. And so that's the systemic approach we would have to take. But on the other hand, we live in a society that puts a lot of importance and value on individualistic or individual performance. We are very... We are very much driven from that aspect of a person's both failures and successes are attributable to their individual decision making and their merits and efforts and virtues that they put in as a person. So we have this dilemma going on. You're generally putting the blame, if you will, on the addicts. That they have gotten into it in the first place because of their own fault and decision making. And also, that they cannot get out of it because again, of their own fault and decision making. Whereas, you know, the first part may be true. But a person due to curiosity and peer influence or whatnot, or just wanting to fit in, has chosen to use something or kind of go with the flow. And that's how they got into it. But not so with the second part, which is getting out of the problem. People who are simply dependent on substances. They cannot just stop this thing or cure the disease, the brain disease that they're dealing with, by simply making a choice. A conscious choice. We have to come together systemically to help them. And that's a paradox that we have in this, at least in this society. Right. So as we're starting to wrap up, Dr. G, can you talk about the multi-team approach within the INDIVO treatment partner system? Sure, absolutely. Well, first of all, what we do, let me share with you what INDIVO stands for. INDIVO basically stands for independent development and involvement. And we have chosen this for a reason because first of all our goal is not just recovery. A lot of people say I am in a recovery. And our understanding is that a person in order to completely heal, they need to move beyond the recovery. They need to evolve. Yes, that's true. And in order to do so, they have to do two things. They need to gain independence from that coping style. And secondly, they have to develop themselves in multiple facets. And this is only possible if we bring in a team of professionals who know what they're doing and help the person from A to Z. And it starts first with a very integrative, holistic, and comprehensive assessment that really delves into all areas of functioning of a person, which is usually done by a clinical psychologist or psychiatrist that we have on board. And then it moves into a thorough development and treatment plan. That plan can be, you know, basically a few pages long that really go back to the strengths and weaknesses of the person, looks at what they need in each area of functioning, be it, you know, for instance, career planning, relationship repair, you know, dealing with a person's thoughts or feelings or behaviors, even spirituality and even sensory and motor experiences of the body. So we look into it. We look at a lot of areas of functioning, as I mentioned, and come up with a long-term, life-changing treatment plan that doesn't stop when, let's say, an outpatient program or the residential program stops. So we truly believe in this continued care, long-term, continued care. So we come up with a thorough report that includes psychological testing and shows from multiple... aspects of measurements such as, you know, projective, objective, personality tests, what this person is struggling with, and what they need to do overall in their life, whether they continue to do that at our treatment center or somebody else's treatment center or at home or in continued care of their therapist or psychologist or psychiatrist or even physician. It's basically a road map for healing. So you really get to know your patient. Yes. You know, you get to know your clients well and work with them on an individualistic planning concept and, you know, become, like I said, become treatment partners with them versus, you know, you sitting there and telling them, you should do this and you should do that, which, you know, a lot of addicts go through in their social circle. The should, the should, the should. Other people are sitting there and trying to diagnose them and telling them they... they need to do this, they need to do that. And it sounds more like INDIVO works with them and has compassion towards them going through a very crucial point in their life. You know, go and heal, get better, you know, and have a new life ahead of you once you are treated and can stay on the path. Exactly. We want to have that. We want to have... We want to help the person evolve beyond this problem. And the only way they can really do so is to realize who they are. Yes. Make a commitment to themselves. And the way we can do that is just by this thorough assessment treatment planning by a licensed, you know, professional staff and team of individuals because not every, you know, one person knows everything. So we have to bring multiple different practitioners together. To help a person, including giving legal advice. We have even an attorney on staff that puts, you know, puts together seminars and workshops in order to educate a person in terms of, you know, all those legal, you know, ramifications and aspects of life that a person has to deal with. So it's very much aligned with the philosophy of awareness raising, skill building, and like I mentioned, changing one's life from a... from a mental health perspective. Changing one's life from inside out. Yes. So important. So, Dr. Garajadaghi, if anybody would like to contact you about INDEVO treatment partners, how can they do so? I would just suggest that they go to our website. That is the best way of getting in touch with us. That is INDEVOTREATMENT.COM. That is I-N-D-E-V-O TREATMENT.COM. And the phone number? Yes. The number? I would just simply go with the website. Okay. We have multiple phone numbers for multiple practitioners that are listed and our executive director as well. I think that's really the best way to approach the treatment. And I do want them to actually kind of peruse the website to educate and inform themselves of who we are prior to even contacting us. Okay. And INDEVO is located in Irvine, California, correct? That is correct. Yes. We are in the city of Irvine, about two minutes from John Wayne Airport next to 405 Freeway. Yeah. The 405 and the 55 where they split off. That is right. Yeah. That lovely connection point. So, Dr. Garajadaghi, I really appreciate you being on again. Sure. Absolutely. You're very, very welcome. It's always my pleasure to be on your program. You're doing an excellent job providing all this needed information and education for the public. And if I can be of any more help, I would be very glad to do so. Thank you. I appreciate it. And also, we want to make mention that you have a comprehensive therapycable.com with many clinicians speaking about various subjects on psychology. And if you could do just a really quick promo on that, that would be great. Sure. Thank you very much for the opportunity. Therapy Cable is an online educational platform. We have created this website, which is a collection of therapy videos that delve into the whole aspect of benefit of therapy. And we want to break the stigma around therapy so that people don't see it anymore as threatening or negative and actually learn how easy it is to really get in touch with practitioners and learn from them. And that is something that everybody can do. It's very much on the positive side of, you know, self-improvement. So, we have collected more than 200 videos from 200 practitioners who talk about all aspects of self-improvement. And they range anywhere from acupuncture to psychotherapy, music therapy, dance therapy, horse therapy, to massage therapy, to yoga therapy. So, it's very varied in nature. And everything is available under therapycable.com. Very good. Thank you so much, Dr. Esangarajadaghi. And I will be talking to you soon. Take care. Thank you, Julia. And I'd also like to thank the listeners for tuning in to Psych One-on-One. Psych One-on-One is a free online course. Psych One-on-One is also available on therapycable.com. I'm going to be expanding the show via Dr. Esangarajadaghi. And also, I am excited to be a part of Cerritos Psychological Center. I have just been hired over there. So, if you would like to come and see me for therapy, please do so. I'm located in Cerritos, California, which is in Los Angeles County. My business number is 562-234-5255. And my contact by email is jgood8 at verizon.net. You can also access past shows of Psych One-on-One through iTunes Store and Twitter me and Facebook me. I would love to be your friend. So, connect up, okay? Thank you so much for joining me. This has been Julianne Good for Psych One-on-One. Take care of yourself. Take care of each other. Bye now. Bye.