Life After Becoming a Doctor, Being Forced Into Sober Living, and Discovering the Real Reason People Relapse

Matt (00:00:03):
I am Matt Handy, and you're listening to my Last Relapse. Okay, so we are here, right? We're going to talk about some medical things, and we're just going to have a conversation mostly about your philosophy and your theory, but we are friends, so we can talk about whatever you want to.

Dr. Shah (00:00:23):
Okay, sounds good. So let's start off with the discovery and how we went about that, and how it sort of unfolded without me really being involved with it. It just sort of happened. And the way that it happened was I had a patient who was in long-term recovery, who really couldn't get more than three months of sobriety at a time. This was a patient who had come into my office several times over the last four or five years and couldn't maintain more than three months of sobriety at a time. I'd seen her at the park where I worked at and did my fellowship. I saw her at the Lovett Center where I was a medical director of the IOP. I saw her at meetings. I tried her on every single medication. She was the patient that we had a therapist watch her in the mornings, meet with her for half an hour every morning to make sure that she took her an antibuse, and before she would relapse, she would start cheating her an antabise. And it didn't make any sense because this patient was paying around a hundred dollars every morning to have someone make sure that she took her antabise. And so it befuddled me.

Matt (00:01:24):
And so she was paying and still cheating

Dr. Shah (00:01:26):
And still cheating.

Matt (00:01:26):
Completely against it.

Dr. Shah (00:01:29):
And it wasn't like anyone was making her do this. This was on her own accord and she really wanted to be sober. There was a sincere desire to be sober. And when you talk about the incomprehensible demoralization, right, this was the epitome of it, really smart, really intellectual woman built three businesses on her own and sold them off and was like, could not stay sober. She came into my office for an emergency visit and was like, Dr. Shah, we really need to see you. And I was like, okay, we don't really have medical emergencies for addiction medicine, but sure. She walked into my office and I was like, Hey, what's going on? And she's like, nothing, everything's good. And I was like, come on, what's really going on? And she said, well, I'm about to relapse. And jokingly, I joke a lot with my patients, I like to keep it light.

(00:02:13):
I was like, well, I hope it's not today because there's a Specs right across the street. And she said, with a dead cold face, no, in three days. And I was like, what do you mean in three days? It didn't make sense to me. And she said, it always starts like this. My anxiety gets worse and worse and worse, and then about six or seven days later I will relapse. And it didn't make sense to me because that's not how you really experience anxiety or that's not how in the medical field, we think of anxiety as something that crescendos and starts getting worse and worse and worse over the course of five days. When I think of anxiety, I think of something of like, it happens and then you switch your object of consciousness and it goes away. Or you go to a meeting and it goes away. You talk to your sponsor, it goes away, or something happens. No matter what this person was doing, it just got worse and worse and worse. And according to her, no matter what she did, in about six or seven days, she would relapse because she wouldn't know how to otherwise get rid of this particular feeling. And I tried every medication on her. I tried every SSRI, every antidepressant, every anti-anxiety medication, and none of them worked. And I tried a new medication.

Matt (00:03:20):
Were you trying benzos as well?

Dr. Shah (00:03:24):
So I don't prescribe anything in my practice that's psychotropic. So I don't give out any Adderall. I don't give any Vyvanse. I don't give out any benzos, right. That that's not my practice.

Matt (00:03:34):
No, that makes sense. And why is that?

Dr. Shah (00:03:37):
I'm an addiction medicine doctor, and so my entire practice is about getting patients off of the medications that they're on. And so I don't do anything that's controlled or that has the potential for abuse. So the entire practice is based upon what I learned in my fellowship, but what we use for those particular meds.

Matt (00:03:54):
What fellowship?

Dr. Shah (00:03:55):
My fellowship in addiction medicine. And so I tried her on a new medication that another patient was taking. And for her, the feeling that she was experiencing all of a sudden stopped. And I was like, well, that's really interesting, right? Why did that stop? I mean, she still relapsed three or four days later, but the feeling that she was having stopped. What happened was that same week I went to a meeting and I heard a girl share the exact same story. I told my sponsor I was going to relapse. I told her it was going to be in three days. Her sponsor told her to work the program harder, call her more often, and go to more meetings. This woman went to three meetings the day that she relapsed, relapsed on heroin for two days and came right back into the rooms and picked up a desire chip. And at that moment, because my mind works in patterns and it sees things that other people don't necessarily see, when I go to meetings over and over and over again, I realized that I'd heard the story before and I'd heard this story so many times that there was a pattern to it.

(00:04:54):
I just couldn't exactly put my finger on it. And that started the three year process of deconstructing what happens to a person right before the relapse. And this was right around the time that the pandemic happened. And so what was happening is I usually have patients at my clinic come in and relapse. Maybe once every two months I'll have a patient that relapses or they won't come in the clinic. But all of a sudden during the pandemic, I had a slew of patients, 4, 5, 6, 7, 8, all relapsed in the same week.

Matt (00:05:26):
Wow.

Dr. Shah (00:05:26):
And I was working in a treatment facility at the same time, and they were just coming in droves. And I had an opportunity to sit down with them and talk to them about what it was that was happening before them. And they all described this unrelenting sense of fear or anxiety that was happening beforehand. And I talked to my co-founder of the company and I told 'em, Hey, I think I might be able to predict a relapse. And he basically told me, I will fund it if you start working on this. So during the pandemic, we started working on this project and I started interviewing patients as they were coming into the treatment facility about, because it's all fresh in their mind, what happened right before you relapsed? And what they were finding was that as we worked backwards, we could kind of backwards engineered what the process was. And what we discovered was after this was about two years worth of researching and asking and interviewing patients, was that there's a five step process that occurs before somebody relapses. And that process is, step one is something will activate their fear, they'll get a whole,

Matt (00:06:28):
Which their fear is basically all centered around trauma. Right?

Dr. Shah (00:06:32):
So what a lot of therapists will equate it to is a trauma reactivation. So when their trauma gets reactivated, they'll go through these particular stages and that's having them relapse. But it's not just trauma reactivation. You can kind of see this five-step process of behavioral things that occur right before the relapse. And that first step is something will reactivate their trauma, whether it be a behavioral issue, whether it be family of origin stuff, attachment wound, financial issues going on. They'll get a surge of energy for a day or two. They'll get a whole bunch of stuff done almost in a hypomanic state. They will have confusion, paranoia for another two or three days, and then they'll have four or five days of unrelenting fear or anxiety that just won't go away.

(00:07:19):
Most patients will relapse in that fifth phase. And so as we backwards tracked it, we were seeing that patients were all having the exact same experience over and over and over again. If you're having the same experience and if you have that experience and this person has that experience and this person has that experience, well, there's probably some biological process going on that's similar for every single one of these patients. We're all different, but we're all the same. So the idea then becomes there's what was the biological process that was happening that was causing these particular patterns to show up in patient after patient after patient. And that's what we started looking at also.

Matt (00:07:57):
So with the development of those stages, there's obviously some research and development into this theory, and what do you think that the biological component is that triggers all this?

Dr. Shah (00:08:14):
So as we started looking at the reasons why they would have this particular pattern, everything as a neurologist, my background is in neurology and addiction medicine, the only addiction medicine neurologist in the country. And what happens with that particular thing is that fear and anxiety all localize back to one region of the brain, and that's the amygdala. And so as we started doing our basic research into things that kind of would point us in a direction as to what was going on, we found over and over and over again, amygdala and trauma, amygdala scarring, amygdala hyperactivity, and all of these things were kind of pointing us into a direction, a theory that reactivation of trauma is what leads to the hyperactivity inside of the amygdala.

Matt (00:09:01):
Okay, so you say scarring, and how does one scar their amygdala?

Dr. Shah (00:09:10):
So the reason that we called it scarring was that there was a paper that was done about war veterans inside of Afghanistan and the Iraq war when they had come back and they were doing research on PTSD and these particular war veterans. And what they had found was that these war veterans had scarring in their amygdala and that the amygdala itself didn't have these contours or these regions that were well surfaced. And so the idea was that anytime you tell a neurologist that there's a scarring in a particular area of the brain, that's a possibility where a hyperactivity can be localized to. So when you have somebody who is seizing in their cortical areas, those seizures that occur in the cortical areas are because most likely due to some sort of scarring that's occurring there, especially if they've had a stroke in that area, if they've had a tumor in that area, if they had a brain resection in that area, all those things kind of fold up on each other. And so there's a misfiring of neurons, and as those misfiring of neurons occur, they may affect the neighboring neuron or the neighboring neuron or the neighboring neuron causing a spread of hyperactivity through there. So that one area is a hotbed of misfiring that occurs.

Matt (00:10:24):
Okay. So is it like an oversensitivity or is it like a callous where it can't properly travel through the material?

Dr. Shah (00:10:31):
So the theory, the theory is that it's a overlapping or a folding of that area, which then leads to the hyperactivity. I can't prove any of that stuff because the amygdala is the size of an almond.

Matt (00:10:44):
Right.

Dr. Shah (00:10:44):
And in order for me to maybe do an EEG or an MRI of that area, I need a really high resolution MRI or an EEG that could actually get into the amygdala to see that hyperactivity. There isn't anything that exists like that unless you're doing a MEG and a MEG is a MRI plus an EEG together. But they only do that for brain surgery for when they're trying to figure out regions of the brain to resect. But what we can do is we can hypothesize that this is happening based upon the behavior that's showing up and based upon the clinical presentations that are happening with those patients.

Matt (00:11:18):
So I was labeled a chronic relapser, right? And a lot of what I was actually going through was I fully, I take responsibility for it because I just knew that I wasn't ready. I didn't want to give up my drugs, I didn't want to give up my lifestyle. And ultimately what it really comes down to is I didn't want to go back and deal with my family trauma. And so I then went through this entire process of didn't talk to my, I'm the oldest of 10 kids. I didn't talk to the majority of my family for over, it was somewhere around 14 years, but some of them, it was like 10. And so I went through, I mean, many episodes of treatment. I did a three year program, a nine month program, a seven month program, and a couple single month programs. And the reality was for me that every time I went into treatment, it was kind of my only choice at the time. And I've done three, I've done one full on prison term, one state local time, and another really long jail stint.

(00:12:33):
And it was always a situation where it was like, if I don't go to treatment, I'm going to go back to jail. And so I would go to treatment as kind of a last stop on the block before jail thing. And it was never, I want to get clean. It was, I want to escape the consequences of my decisions. And in that though, I always knew I'm not ready to get sober. So when you look at the history though, you would say, oh, this person's a chronic relapser. But the reality is I just had a bunch of unaddressed trauma, and even though it was broken up into different episodes, the reality is it's all the same episode with just me taking advantage of specific pathways to get out of the consequences of my actions.

Dr. Shah (00:13:15):
I think what's really interesting about this particular model is that it changes and shifts the focus away from the using and the behavior itself and says, this is a consequence of this over here, and until this is addressed, these behaviors will continue on and on and on and on. So the idea is to shift the emphasis away from the drugs and the alcohol over into what are we doing to actually address the trauma while you're in those particular settings. So are those treatment facilities equipped to handle patients and their trauma? And how are they dealing with their long-term trauma? Are they even aware of their long-term trauma? Because a lot of the treatment facilities today are focused on steps one, two, and three. You go into treatment and it's all about, I need you to get into one, two, and three and accept that you're an alcoholic, realize you have a problem, accept that there's a solution, and then go accept that solution. And that solution for them, for most of them is you need to go find AA. And they do that over and over and over again. And that works for a majority of the people or a decent amount of people if you can actually get them into community. But the problem is, is that not a large percentage of them are going to be like, oh, yeah, that's a great idea. I'm going to go to AA. Or I'm going to go to community after that.

Matt (00:14:34):
So one of the things that we do here at Harmony Grove that is I think a little bit more in line with what you are proposing is that first of all, I speak from my experience and then built my whole company out from that experience. And it's 2025. We have medical advances, we have scientific advances, we have millions and millions and millions of dollars of research that's been put into this. And originally back when Bob and Bill were doing their thing, that was the only answer. And so they had massive success. And I'm not saying that there isn't massive success still in those rooms, but a lot more people have floated away and drifted away from the willingness to even accept that as a pathway. And I saw that in my own story. I went into the rooms, had a lot of negative interactions, had a bunch of negative experiences, and then told myself, well, if this is recovery, I don't even want it. And then went out for 10 plus years. And so meeting people where they're at and trying to treat the cause of the symptom rather than the symptom, that's I think, where we have a lot in common with that. I think that what you're actually doing is getting down to the biological cause of the manifestation of the problem, which is ultimately the behavior, right?

Dr. Shah (00:15:56):
And so the idea is that addicts and alcoholics have an unremitting sense of fear or anxiety when their trauma gets reactivated. And what they're doing is they're trying to figure out any method that they can to self-soothe. And that mechanism of self-soothing is the only thing that they know, and that thing that they know is to go out and use. If I go out and use, I know for sure this particular feeling that I have, I will be able to extinguish it, guaranteed a hundred percent of the time, no questions asked. Right? It's a guaranteed solution to what their problem currently is, and their current problem is the hyperactivity and the amygdala. If the hyperactivity and the amygdala never occurred, the patient would never want to go use. If I'm feeling good and I'm feeling right with the world, which is what happens to most people when they leave treatment for that first 1, 2, 3 months or so, everything's right as rain. They're in a safe spot, nothing's been re-triggered. But in those first six months to that year, something will happen along the way that will reactivate their trauma and they will go into this escalation and they'll want to go use.

Matt (00:17:01):
Okay, so what would the answer be? Well, first, can you give us a little bit about who you are?

Dr. Shah (00:17:10):
Okay. So I am in recovery. It's been around 11 years of sobriety from drugs and alcohol. I went to medical school, have a background in biomedical engineering, master's degree in complimentary alternative medicine. So my vantage point and my lens on addiction is very interesting because of all those components to it. And then I also did my residency in neurology, a fellowship and movement disorders and a fellowship in addiction medicine. And so all those things combined give me a vantage point that's different than everyone else's on addiction. And so what I have is a neurological viewpoint of addiction medicine, not a psychiatric viewpoint and not a family medicine viewpoint.

Matt (00:17:55):
Okay. So do you think that that component is left out all too often? Cuz I've come to that conclusion myself, based on my experience, that there was more than this, than the psychological and the spiritual going on. And what I talk about is that when I started eating better and working out, my trajectory completely changed. I started addressing the biological as well as the spiritual, the mental, and the emotional. And that really was the game changer for me. I was going to meetings and I would go into the meeting miserable, and I would come out even more miserable than when I went in, and I could not understand it. My sponsor was a big name in the area. I was doing step work. I was doing everything that they asked me to do. I was going to multiple meetings a day. And at the time, this last time when I got sober, I wasn't really doing anything.

(00:18:49):
I was just allowed to go to meetings. So I was doing four or five, six meetings a day sometimes, and I would just spend my time at the meeting places going from one place to the other to the other and trying to build a community or a network around me of sober people. But whether it's because of me or I was going to the wrong meetings or whatever, I never felt like I fit in. And because of that, that's why I kept going to all these different meetings in different places. I told myself I'll find where I fit in. And then my story and how I actually got to where I'm at today has actually nothing really to do with the rooms, other than that they kept pointing me in a different direction. I met my mentor who has a recovery story who hasn't used in years now, and all he does is help people, but doesn't go to meetings, doesn't subscribe to that philosophy, but what he does do is tell people, go to the gym, get your physical health in check, and it will help point you in the right direction.

Dr. Shah (00:19:56):
You said something that was really interesting though, right? Because you went back to he goes out and he helps people.

Matt (00:20:01):
Yeah, absolutely.

Dr. Shah (00:20:02):
So that helping people for me is the most important component to it. And that helping other people is where the oxytocin gets released. So the oxytocin that we talk about in terms of quieting down the amygdala occurs in for men in three different ways. It's when you've bonded with a group that you feel comfortable and safe with, when you are altruistically helping someone without wanting or needing anything in return, and then sex. But that has to be in the context of a healthy, committed relationship. Otherwise it's a dopamine release. And so what you just described was that your sponsor's going around and helping other people find that particular path, and that's probably helping him a ton, right? He is not doing it for the money. He's probably doing it because he genuinely wants to help these people.

Matt (00:20:45):
I mean, he has a business model around it. Ultimately, the exchange is much greater, for me, what I actually paid him over a year ago now, it was so minimal, and it's just been this constant, we talked to each other constantly. We text each other whenever, we get on a call monthly. He guides me through my workout regimen and my eating and helps me really curb in my, he really dialed in my physical. But once all that was done, we literally just talk about, he speaks all the time publicly. And he really pointed me on this direction where this podcast and then my ultimate end game goals of public speaking, and, not necessarily motivational speaking, but just speaking from my experience to help people who are having a similar experience that I come from, which I think is a lot of people, especially nowadays where it's more and more people are rejecting religious structures today than ever, I think, as well as accepting them too. But they see, they go into these meetings, they kind of see it as a religious structure, and they reject recovery as a whole instead of just that pathway. And that's what I did.

Dr. Shah (00:22:06):
And I think the thing that's beautiful about this particular model is that I don't need for you to find, God, I don't need for you to have a religious experience. I need for you to go into the rooms and get your oxytocin. However you go about getting that. That's up to you. But I need for you to bond with the group. I need for you to feel safe. I need you to go help other people and then do some process by which you're undoing the stories that you're telling yourself and the old patterns of behavior that you have underneath all that.

Matt (00:22:35):
Well, how would you point somebody to do that? What are the components that they would need to include in order to get what you need?

Dr. Shah (00:22:42):
So there's a three step process. It's quieting down the amygdala in a way in which it's not as hyperactive. So your first of all, creating a safe container for yourself, and that safe container is so that your trauma is not being reactivated all the time. So if you go into a really bad situation and you're living in that bad situation, and you are constantly being triggered over again, how am I ever going to get you to get out of a state of fight or flight long enough to find recovery,

Matt (00:23:11):
Which is why the meetings work.

Dr. Shah (00:23:12):
That's why the meetings work. That's why Sober Living works, right? I'm a big proponent of sober living early on and not going back to the scene of the crime, wherever that was, and having a safe space around you. Then it's bonding with the group and then going through the process of building trust and intimacy with that group. Once that's formed and you've got a safe space, that's the only way that you're going to be able to start building these prefrontal pathways back into the amygdala to quiet it down.

Matt (00:23:39):
Okay. So you're talking about the prefrontal pathways, right? Can you, just for a layman to understand, can you explain to me what that actually is?

Dr. Shah (00:23:49):
Yeah, so there's fear. The fear pathway has two pathways, right? There's a short pathway and a long pathway. That short pathway exists outside of conscious control, which means that as soon as your body reacts to something that's stressful or that's something that's fear ridden, it immediately activates your fight or flight response.

(00:24:11):
For instance, if I was walking down the street and I was about to be run over by a bus, I would want my fear system to be activated so quickly that I would just react to it. So that's the very first thing. That's the short pathway. The second pathway is the long pathway, which goes through the prefrontal pathway, which then allows for you to then recalibrate. Is that fear real or is it not real? Most addicts and alcoholics don't have a strong prefrontal pathway to say that fear is not real. It's made up. It's something that I'm making up myself. I'm not really in danger. I just perceive that it's in danger. And this goes back to the fact that addicts and alcoholics have a highly reactive amygdala. And so in order to quiet that down, you have to slowly start building these prefrontal pathways to quiet down the fear in real time. And once you've built those pathways, it happens almost automatically. So the short pathway gets activated, then the long pathway gets activated almost immediately, and then the fear gets quieted down.

Matt (00:25:13):
Okay, what does the development of these pathways look like? How does that happen?

Dr. Shah (00:25:19):
Practice, practice, practice.

Matt (00:25:20):
Okay, so it's actually thought patterns that rebuilds these?

Dr. Shah (00:25:23):
Yeah. It's thought patterns and then practicing through that. So when we talk about, I'm going back to my understanding a 10 step. Every time I go to a meeting or I do a 10 step with my sponsor, or I walk through some type of fear, then I've got an experience that in my brain that says, oh, you can do this. It's not that bad. And so that's the developing of the neuroplasticity of the brain to build those prefrontal pathways. But as you're building those prefrontal pathways, they have to be reinforced. I can't just go through the fear once I have to do that again and again and again. So each time I walk through something that was scary for me, I get better and better and better at it, and eventually I'm not worried about those things anymore. So for me, I used to have really bad financial fear. As a resident, I was broke, I got all these student loans.

(00:26:10):
And time and time again, I started building up these sober experiences of not being able to walk through these financial fears and not have them come up again or not have them be as intense. And so each time I walked through a particular fear, that feeling got less and less intense over time. Same thing with my relationships, the breakups that I go through. Every time I get into a relationship that doesn't work out, and I get into this fear spiral about I'm going to die alone, I'm like, nothing's going to work out. Each time I go through that, it gets better and better and better each time. So I'm building these sober experiences, allowing for my amygdala to know that I can actually get through these fears without it being catastrophic.

Matt (00:26:52):
Okay. Do you think that there's a correlation between the difficulty of restructuring your brain and how long you used, or maybe how intensely you used?

Dr. Shah (00:27:08):
I think that everybody has the capacity for neuroplasticity. I think that the primary factor in being able to heal in the recovery space and in that process is how safe is your container? How safe is it not going back to things that are triggering for you over and over and over again. How safe can you be in a space in which allows for you to build those prefrontal pathways? Because you can't build them in a state of fight or flight. If you are in a state of fight or flight, you can't build and learn on those things. That's why when you go to treatment that first week, you're still in that fight or flight state. By the second week, you've kind of calmed down or into it the majority of the understanding and the reframes and the capacity to look at your stuff and to be like, oh man, the alcoholism was really an issue, right? Here are all my harmful consequences. Here's all of the money that I spent. Here's all the relationships I damaged. But in that first week, you're still going to state of fight or flight. You haven't calmed down enough to actually do the processing of process group.

Matt (00:28:20):
Okay. Because experienced that so many times. The first week, the second week, the third week, by the time I'm in my fourth week, it's like I don't even want to go.

Dr. Shah (00:28:27):
Yeah, no. Why would you want to go, right? Because you're in a safe space.

Matt (00:28:31):
So it happens that fast.

Dr. Shah (00:28:32):
It happens that fast, but it's because you're not being reactivated anymore, right? But as soon as the, let's say for instance, you get a call from your loved one, or it's family day, and all of a sudden your wife comes back in and is like, the house is being foreclosed on, you're getting kicked out. Your job's about to fire you, all of a sudden, then you're right back into that state of fight or flight, and you're elevated again.

Matt (00:28:56):
Okay. That's interesting. Alright. Do you advocate for family day?

Dr. Shah (00:29:02):
Yeah, absolutely. It's because I want you to be able to process those things in a safe container. So the thing is, it's not a matter of if you're going to be triggered, it's when you're going to be triggered. And how safe is your space to work through those things that you're being triggered in. I ended up staying in sober living for eight or nine months after I left treatment because work basically was like Dr. Shah, if you want to continue being Dr. Shah, you'll do everything that they tell you to do. And after I left, it was recommended that I go to sober living. I'm super grateful that I did because I was in a safe container as opposed to being home by myself. And so as things started coming up, the work, going back to work for the first time, not being sure if I was going to be able to keep my license, not being sure if my relationship was going to work out, having all of those stressors in a contained space where I knew I wasn't going to be drinking because I was in sober living and I was being monitored by the state of Texas.

(00:30:00):
So I had a sober link, and I was being tested twice a month with a urinalysis because this great state of Texas really wanted to keep me sober. And I was so mad when I went to the state board and they're like, good job. I'm going to treatment. Good job and all that stuff. We're going to monitor you for the next five years. And I was like, for what? I was suicidal. I wanted to kill myself. And I was like, I didn't get in trouble anywhere at work. I didn't do anything wrong. Why are you punishing me for that? But it was because they knew that if a person stays sober for five years based upon these airline studies or these Air Force studies about pilots staying sober for five years, they ended up with a 95% chance of staying sober for the rest of their life.

Matt (00:30:43):
So that's where that actually comes from, is from the Air Force.

Dr. Shah (00:30:46):
Yeah. So they did studies about, because it takes millions and millions of dollars to train a fighter pilot, right?

Matt (00:30:53):
Yeah. A single fighter.

Dr. Shah (00:30:54):
Yeah, single. They want those guys staying sober. It takes not as much because fighter pilots are super expensive. But I mean, I'm sure my training when it was all over was probably about a million dollars worth. So they want physicians to go back to work. They want you, but they also want you to be sober.

Matt (00:31:11):
Especially, because you paid for it. This was your investment, right?

Dr. Shah (00:31:15):
Yeah. Well, but not only my investment, it was also the state's investment. Because every residency program, every medical school is funded by the government.

Matt (00:31:23):
Oh, I didn't know that.

Dr. Shah (00:31:24):
So there's all these government grants and things and subsidies that fund higher public education, especially medical school.

Matt (00:31:34):
So you can go to many residencies.

Dr. Shah (00:31:38):
What do you mean?

Matt (00:31:39):
You can do multiple residencies?

Dr. Shah (00:31:41):
Most people don't.

Matt (00:31:42):
I mean, I heard it's a nightmare.

Dr. Shah (00:31:44):
But you have to at some point start earning money.

Matt (00:31:47):
Yeah. Oh, you don't get paid?

Dr. Shah (00:31:49):
Residency. I think I got paid. That was the other problem with it. I was getting paid $65,000 a year, and my monitoring from them was about $15,000 a year. So of my $65,000 I was making per year, I was paying $15,000 to get the sober link, monthly monitoring, and then meetings with an addiction medicine doctor, and then a meeting with some other doctor, and I was like, what am I paying all this money for? And they're like, well, you're a doctor, you can afford this. And I was like, I'm a resident. I'm not a doctor, but it didn't matter. And so today, I'm really grateful that I had the monitoring, but during that time, so resentful about it, cuz I couldn't afford it.

Matt (00:32:32):
Yeah. Okay. So you bring up a good point. In retrospect with my story, there is so much stuff that I went through where at the time, obviously I couldn't see the benefit for the future. And then I got to a certain point in my journey where I look back now and people ask me like, Hey, do you regret all that time? Because the reality is I came back to my family and I don't know any of my siblings. I know a couple of them, and I'm in business with one of them, and we're building a relationship and stuff like that. But I'm the oldest. When I left, I think there was a 3-year-old, there was really, really young kids. So I don't know any of them. There are things about my past where especially when people ask me, do you regret it? And I can't honestly say that I regret anything anymore. If it wasn't for every single painful experience I had, I wouldn't be here probably.

Dr. Shah (00:33:26):
Yeah. It's the butterfly effect. I don't really want to change anything because I don't know, I like where I'm at today.

Matt (00:33:32):
Yeah.

Dr. Shah (00:33:32):
I don't want to change where I'm at today. I wouldn't want to risk it.

Matt (00:33:36):
Okay. So as you developed this theory, do you have any proof of it yet, or?

Dr. Shah (00:33:44):
So we've been collecting data around the efficacy of the intervention, and we've probably seen about one out of three patients currently that come into clinic present in this way. And so what we do in a broad scale is we have them monitor their mood and track their mood based upon the mood meter. And we developed an app for that.

(00:34:09):
And that app basically has them enter in their mood every single day. And the mood meter is divided into four quadrants. It's a high energy unpleasant, high energy pleasant, low energy unpleasant, low energy pleasant. And what we've basically instructed them to do is if they ever get into a high energy unpleasant state for more than three or four days in a row, we know that that's just not your regular old anxiety. I'm not worried about regular old anxiety that you have and you can talk to your sponsor about, you can talk to your therapist about, you can talk to your support group about. What I'm worried about is a biological anxiety that just doesn't go away. And when that particular thing hits, what we do is we bring them into clinic and we do the aware scale on them. Based upon their score of the aware scale we will intervene as if it's a hypomanic episode, and then put them through a process by which we bring them out of the hypomanic state.

(00:35:03):
And then we've seen dramatic results in about four or five days of them coming into clinic and then leaving clinic. So they go from a state of, I'm about to relapse, and I totally want to go use to, I'm fine, I think I should go to some meetings. And we just had a patient probably about four or five days ago through this process, and I met with him today, and I was like, how are you doing? He's like, I feel great. And I was like, okay, but do you remember yourself seven days ago? And he is like, yes, that was really bad. And I was like, yes, that was not. And he was like, I probably would've used around that time, not on that day, but in a day or two, I probably would've gone out and used. And I was like, this is what we're treating. I'm not treating your anxiety. I'm not treating your depression. I'm preventing this particular state from happening as often. That's it. So I'm trying to manage expectations around what it is that we're treating and what is it that we're looking out for.

Matt (00:36:01):
Okay, so let's kind of hone in on this one person. They called you after a couple days, right? After three or four days of being in an elevated state.

Dr. Shah (00:36:13):
Yeah. So he left treatment. So I gave a lecture at the treatment facility that I work at. I explained to them the entire model to look out for these particular phases and these particular steps. And I taught them in about an hour what to look out for. And when they come into clinic, all we're doing is just reinforcing that one particular lecture. So I come in, he does the aware scale again, and I'm like, look, you're doing great right now. Your aware score is like 25. And I'm like, good job, right? Keep doing it. Comes in a month later, do the same scale, right? 25, good job. You going to meetings? Yes, you guys sponsor. Great. Awesome. Right? What's your recovery stuff? Amazing. Comes in another month later, and all of a sudden it's elevated. It's in the fifties. I'm like, Hey, what's going on?

(00:36:58):
He's like, oh, I had a really bad day at work. My boss was yelling at me screaming, and I'm like, okay, it's not that high yet. We're not really going to do anything about this, but if it gets worse, let me know. Call clinic. About a week later, he calls clinic, and I'm like, what's going on? He's like, I can't think straight, I'm confused, I've got this paranoia going on. I'm like, okay, let's do the scale again. And his score was like 120, right? That's the manic state that we're looking for. So the aware scale really hones in on the likelihood of someone relapsing in the next two months. That's what the scale was developed for. But what we're using it for is how likely is the person going to relapse in the next week, the next two or three days? And so based upon those scores, we're like, Hey, this is a hypomanic state right now, let's treat it. And so then we will then give him the protocol and we'll call him the next day, and then his scores will go down to 80. Like, Hey, not bad. You were at 120 before. We're at a hundred now, or we're at 90 now. Let's do this. Let's keep going. Day two rolls by, and he's like, he's in the seventies, day three roses by, he's in the fifties, right? Day six rolls by, and he's in the 20 fives again.

Matt (00:38:11):
Okay, so he

Dr. Shah (00:38:11):
He went from a hypomanic state to I'm about to relapse over the course of those five days back down to I'm feeling good again, let's go to meetings. But at that point, all the medications change because I'm no longer diagnosing him with anxiety and depression. I'm diagnosing him with cyclothymia.

Matt (00:38:29):
Okay.

Dr. Shah (00:38:29):
Which is a cycling mood disorder.

Matt (00:38:31):
Okay, so cyclothymia.

Dr. Shah (00:38:34):
That's when the diagnosis gets made, it doesn't get made in the first three months. It only gets made once this event occurs. But then once that event occurs, this particular patient was on Seroquel, Prozac, and something else. One other thing, I can't remember where that was. And over the next couple of months, instead of diagnosing him with anxiety and depression, I will diagnose him with Cyclothymia, and all of his medications will change.

Matt (00:39:02):
So you get the Cyclothymia diagnosis, and let's say he leaves your care, what a different doctor understand how to treat that.

Dr. Shah (00:39:15):
Yes. Because I've already placed him on those medications and I've given him the diagnosis.

Matt (00:39:19):
Okay,

Dr. Shah (00:39:20):
So that's not going to change.

Matt (00:39:22):
Okay, so

Dr. Shah (00:39:23):
The thing that's unique about our clinic is that we watch out for that. So Cyclothymia is a diagnosis, there's a paper out there, and it was one of the seminal papers that I looked at that basically said, cyclothymia is a diagnosis that when made is usually made 14 years after the patient initially presents to clinic for the very first time.

Matt (00:39:45):
Wow.

Dr. Shah (00:39:45):
So to a doctor's office for the very first time. And so they'll go through this medication, they'll go through every SSRI, and you're like, oh, that didn't work. Let's try this one. Oh, that didn't work. Let's try this one. That didn't work. Let's try this one. And eventually the doctor will put 'em on a Lamictal or an Oxcarbazepine, and all of a sudden they'll feel so much better and they'll be like, oh, your diagnosis wasn't anxiety and depression, your diagnosis with Cyclothymia.

Matt (00:40:09):
Okay. So that second medication that you said right now starts with an O?

Dr. Shah (00:40:14):
Yeah. Oxcargazepine.

Matt (00:40:14):
Right. There is a thing that does as far as the neurogenesis, right?

Dr. Shah (00:40:21):
Yeah. So carbamazepine, I remember this from my residency training, and the epilepsy doctor, I just thought it was so funny. He said they should put carbamazepine in the water for everybody because it helps to produce the most neuroplasticity and neurogenesis of any other drug that's out there. And I always found that interesting. But once you put all the pictures together, it all makes sense as to why that is. And for me, it's because you can't learn in a state of fight or flight. When you're in a state of fight or flight, you're just surviving. You're doing whatever it is that to survive. When you get out of the fight or flight is when you can actually build new prefrontal pathways and new cortical pathways and actually generate new pathways because you're no longer surviving. You are thriving.

Matt (00:41:09):
And is that because when you're in a fight or flight, you are actually using those pathways?

Dr. Shah (00:41:13):
You're using the pathways to get the fuck out of there. How do I escape this? How do I not feel this way? What are my old character defects? What are all the things that I'm doing not to engage in or not to have this particular fear come up?

Matt (00:41:25):
So it's kind of like roadwork, right? You have to shut it down in order to work on the road.

Dr. Shah (00:41:30):
Hundred percent. No, that's a great analogy. And so what you have to do is you have to shut down this road and divert them over to this path, and then eventually this road will go away because of disuse, and then this road will become the dominant road because of use. So it's more, if I was to say it would be more of a river. And so what I'm doing is I'm, I've got a river that's flowing this way. I put a dam here, which is not going down this pathway, and then the river is forced to go down this pathway. Eventually this pathway will be the dominant pathway, and then this pathway will go away.

Matt (00:42:04):
Okay, I've never understood.

Dr. Shah (00:42:05):
But it's still there.

Matt (00:42:08):
Okay.

Dr. Shah (00:42:08):
Roght? It's still there. If the dam breaks and you suddenly don't have your support system anymore, and you don't have your support group around you, you're not getting your oxytocin, this dam breaks, that pathway is still available to you. It's not like it's gone away. You still know how to be an alcoholic, but it is, as long as this keeps dammed up, then you start to reinforce these pathways.

Matt (00:42:29):
Okay. So do you think that that is a preferred pathway? If the dam breaks and you have a choice to make one or the other, do you think that this is a preferred pathway?

Dr. Shah (00:42:41):
As time goes on and those things get reinforced over and over and over again, it becomes less likely to go down that pathway. So for me, do I still have a desire to drink? Not right now.

Matt (00:42:54):
Okay.

Dr. Shah (00:42:54):
Do I think about a drink? Yeah. I mean, I was thinking about a drink the other day,

Matt (00:42:59):
Really?

Dr. Shah (00:43:00):
Do I want to drink? No, I don't want to drink.

Matt (00:43:02):
Yeah, yeah. Okay.

Dr. Shah (00:43:03):
But there's the thoughts still there, but that thought, rarely, the thought for the last 11 years has not become an action. So those thoughts are still there. Those thoughts are still in my head, but we talk about a thought supercharged by a feeling.

Matt (00:43:18):
And then it becomes a desire.

Dr. Shah (00:43:21):
So we call that, so in AA, they call that the mental obsession.

Matt (00:43:24):
Okay.

Dr. Shah (00:43:26):
So not all thoughts are created equal. If a thought is super charged by a feeling and that feeling underneath it is fear, that pathway becomes lit up and is more likely to go down that pathway, because you know that if I go down this pathway, I can do something that will quiet this fear back down. And so you're doing whatever it is that it is that you have to do to quiet the fear down. That's the survival mechanism.

Matt (00:43:50):
So you know what primitive beliefs are?

Dr. Shah (00:43:53):
Yeah.

Matt (00:43:53):
Okay. Do you think that addicts have a primitive belief issue?

Dr. Shah (00:44:01):
Let's make sure we're on the same page about primitive beliefs. Right.

Matt (00:44:03):
Okay. When I'm three years old, I can tell an authority figure my name is Matthew. That's a primitive belief. And I think that part of the way that I've come to a lot of the conclusions for myself is kind of based around that, where it's like I destroyed my primitive beliefs based around who I am and what I am. And then I started to not be able to reach the same definitions as the rest of society when it comes to certain things.

Dr. Shah (00:44:29):
I don't think we're having the same definition of primitive beliefs, because that for me, equates back to the original trauma. Whenever the original trauma occurred, or whenever the original pain occurred, is when those belief structures were changed. What I'm talking about is the very first, I remember distinctly the very first sip of alcohol I ever took, and it was forged in my main, that pathway for me was so heavily reinforced because I was like, oh my God, this feels amazing. All of a sudden, everything that was in my brain quieted down, and there was no anxiety, there was no fear. And I was like, wow, this is amazing. I definitely want to do this more often.

(00:45:13):
And so that particular pathway, the very first time it was initiated, was so strong and overwhelming that every time I did it, it got reinforced. Is there any pain that's going on in your life? Oh, guess what you can do? This will take care of it. Is there any fear that you've got any indecision, any anxiety? This will take care of it perfectly. And so then that pathway just got reinforced over and over and over again until I forgot the real reason why I was drinking in the first place. If you had asked me when I got into recovery, why do you drink? And I was like, dude, I can't stop. I don't know why I'm drinking, right? I just can't stop. But once you stop for a while and you start undoing the layers that are underneath there, I realize, oh, I was drinking because of the unrelenting sense of anxiety, the uncomfortability in my own skin that I felt. And that's the very first time when I was 18 years old that I didn't feel that. And that just reinforced it for me over and over and over again.

Matt (00:46:10):
So you started drinking, you're 18 and you're a doctor. And I guess I had this misconception, well, kind of because some of the interactions that I've had with my life or whatever, but that doctors could just get prescriptions for whatever they needed.

Dr. Shah (00:46:30):
Doctors can get prescriptions for, I mean, it's not difficult, but it's like if it's a controlled substance, there'll be consequences for it.

Matt (00:46:39):
Okay. But could you go to a friend and say, dude, I'm having overwhelming anxiety?

Dr. Shah (00:46:46):
I want to say. So in my line of work, the answer to that is absolutely not.

Matt (00:46:50):
Okay. For me, I had never been prescribed, my addiction started way too young for me to go in and try to manipulate a doctor. And so I was using a lot of benzos off the streets.

Dr. Shah (00:47:05):
But you were in San Diego, so that was really easy to get because of the way that the benzos are prescribed in Mexico.

Matt (00:47:12):
Oh, yeah. No, no, no. It was very easy. There's an abundance of benzos on the streets in San Diego as well as heroin, and they kind of go hand in hand. One thing that I experienced though is I would black out immediately

Dr. Shah (00:47:28):
With the benzos?

Matt (00:47:29):
With the benzos, and I mean for days, blackout for days. And I never experienced a soothing effect from the drugs. It was always I would black out, and that was it.

(00:47:45):
Whereas a lot of, one thing that I do talk about often is that my relationship with heroin was a consistency thing, that it was the only thing that was consistent from the day that I took it to the day that I stopped. And because of that, I found, obviously it's telling me a lie that everything's going to be okay. I do know that everything is going to feel okay, but I know that everything's probably just going to get worse. And so I kept going back to that and back to that. And there was very little, I mean, through prison and incarcerations and stuff, constant use of it.

(00:48:27):
But then I got off of it. Obviously, I'm sober now, and one of the things that I've noticed for myself is that I thought that looking back on my state of mind when I was actively using, was that I had a fear that I wouldn't be able to find peace, that I wouldn't be able to ever level off and be a normal person again. Through having a little bit of time under my belt, I've realized that the peace really does come from me, that I have to do the work in order to get the benefits. But one of the benefits is that I'm okay with where I'm at.

Dr. Shah (00:49:09):
This goes back to the mind, body, and spirit. So if your amygdala is quieted down and you're not in a state of fear, it's really easy to have a spiritual of experience. It's really easy to have a sense of peace and calm when you're not in a state of fight or flight.

Matt (00:49:25):
So really the core of this is quiet the amygdala, quiet the amygdala, quiet the amygdala.

Dr. Shah (00:49:30):
Yeah, quiet the fear that's coming up inside the amygdala, and let's do whatever it is that we can, because working out has that same effect. So working out, one of the things that happens with runners all the time when they are in early recovery, and they're like, I found working out. And I'm like, that's amazing. What happens with the working out is that you start burning off the epinephrine and the norepinephrine, and you go into a state of, there's a feedback loop into the amygdala. And so it starts quieting down the fear response. And so there are certain patients that they'll come in and they'll be like, I need to work out for at least two hours a day, and I need to run for at least an hour a day. And I'm like, that's amazing. Keep doing that. Right? But as soon as they break their ankle or they break their leg, or they sprain something, right, their anxiety comes back full force.

(00:50:16):
And so what happens is that they're no longer having that feedback loop that's quieting down the amygdala each time, so everything comes back to the amygdala. So I still need for you to have those safe spaces. I still need for you to go and get your oxytocin. I'm fine with you going and working out and getting that at the endorphins from there and quieting down the amygdala that way through the feedback loop. But you have to quiet it down in some way, shape, or form, and then you have to start building prefrontal pathways because the long-term solution are those prefrontal pathways.

Matt (00:50:45):
Do you think that focus, because obviously running is a very individual thing. I know a lot of people that they get into running and they start off with music, and then towards the end of their running, they're running with just their thoughts. Do you think that there's something to be said for needing to hyper focus onto something?

Dr. Shah (00:51:07):
I don't know if I would call it hyper focusing on something. I think it's a way for them to quiet down there. It's almost a meditation for them

Matt (00:51:16):
Okay, yea.

Dr. Shah (00:51:16):
At some point. And so the running becomes the way that they process their day, or they process what's going on with them, and then they get into that state. It's really interesting what happens. I had a girlfriend that was a runner, and she would run every single day, and I would ask her, how much did you run today? Right? She was like, I ran 6.7 miles. And I was like, oh, why'd you stop at 6.7? She's like, that's when it hit. And I was like, what hit? She was like, the runner's high hit at that point, and I was done. And I was like, you were running just for that. She's like, yeah. And so she would do it consistently until she got that. And the problem is, is that then she became the person that was chasing it because it didn't come at 6.7 anymore. It came at 6.8, then it would come at 6.9, and then it would come at six point 10, right. Or whatever it was, however high she had to go in order to get it. But that's what she was running for. She was running for that endorphin release.

Matt (00:52:10):
So when it comes to identifying somebody with this issue

Dr. Shah (00:52:16):
With the hyperactivity and the amygdala?

Matt (00:52:18):
Yes.

Dr. Shah (00:52:19):
I think everyone's got it.

Matt (00:52:21):
Okay.

Dr. Shah (00:52:21):
I think everyone who's an addict or alcoholic has it. It's the differing degrees to it.

Matt (00:52:26):
Okay. So how many people can be diagnosed with that?

Dr. Shah (00:52:30):
I don't diagnose it until they present in that particular way with the hypomanic episode and the aware scale in the hundreds. And so I'm not diagnosing that with every single person that comes in. And so that is sort of the uniqueness of the process, because what I'm trying to do is I'm trying to say, these people can be super successful with whatever it is that they're already getting. Why would I change that? Why would I change the norm that's there? But let me address this segment of the population that's being under treated or misrepresented because they're not getting the special care that they need because they're getting put into this box over here.

Matt (00:53:09):
So misdiagnosed.

Dr. Shah (00:53:11):
Misdiagnosed.

Matt (00:53:11):
Okay.

Dr. Shah (00:53:12):
So the idea is you're, you have an underlying mood disorder that's gone untreated, and that's why you're relapsing.

Matt (00:53:19):
And this is why the 14 years is so typical cuz they're trying to fit them in a different box,

Dr. Shah (00:53:25):
The anxiety and depression box.

Matt (00:53:26):
Okay.

Dr. Shah (00:53:27):
Right. None of that stuff. But they may not be alcoholics and addicts.

Matt (00:53:30):
Right. Okay.

Dr. Shah (00:53:31):
They're just coming in because they've got anxiety and depression, and then the doctor is like, oh, you actually have cyclothymia.

Matt (00:53:37):
Okay, so you don't have to be an addict that isn't mutually exclusive.

Dr. Shah (00:53:42):
No. So the reason I'm diagnosing it as cyclothymia is that it has to fit into one of the DSM four criteria. Ideally, the disease process that I'm outlining here in those five stages will eventually become, or that's the hope will eventually become a disease process of its own. Watch out for this for addicts and alcoholics in early sobriety because they have a hyperactivity to their amygdala and they'll go through these five stages and then at this point they will relapse. This gets better treated with mood stabilizers than it does with antidepressants. So that's the dream, right? The dream is that then the work that we're doing here then gets put into the DSM five.

Matt (00:54:24):
Right? Okay. So the reality is science is always advancing that discoveries are always being made and sometimes there is information out there that it becomes negated with new information. So it isn't necessarily that you're trying to negate information, you're just trying to add to what's already existing.

Dr. Shah (00:54:45):
And that addition is addicts and alcoholics that relapse over and over and over again are relapsing due to possibly an undiagnosed mood disorder that's gone uncharacterized because they start using right when it happens.

Matt (00:55:02):
Yeah.

Dr. Shah (00:55:03):
There's no way, especially if it's only a 10 day period of time to come back and say, Hey, you've got this cycling mood disorder, because no one's been tracking it, no one's been looking for it. Right? If you're not looking for it, you're never going to diagnose it. The beauty of our system is that we're actually looking for it, and because I'm looking for it, I can catch it, and if I can catch it, then I can change it.

Matt (00:55:28):
Okay, so.

Dr. Shah (00:55:28):
I think that's really interesting. I think the light just went on in your eyes where you're like, oh, this is why this works. Right? No one else is looking for it.

Matt (00:55:39):
Yeah. Okay. So when you break it down, this is probably the third conversation we've had around this. So the education portion of this, and this goes back to, it's really hard historically, okay, I'll use me. I like to read, I like to dive into things when I'm exposed to it, and especially when I like what I hear or something, I can attach onto an idea and really kind of go down the rabbit hole on it, but without the language to express it, it's really hard to come to these conclusions. Correct?

Dr. Shah (00:56:17):
And so the reason why I was open to having as many conversation as you and I needed to have for you to understand this is because I don't know what's blocking you from accepting this as the thing that it is, because there's so much education that's out there and there's so many blocks that you're like, no, I've been told this. This is why I've been told this. Everyone that I've seen has done this or my experience is this. Everything that I've been telling you is based upon clinical observations and clinical experiences. So there's nothing in the literature about this. There's kind of things that are pointing to it if you put them together in a very particular way. But everything that we're doing is based upon what somebody identified to me and said, Hey, this is what my experience is this. And I'm like, that's so interesting because that guy's experience is this too, and that guy's experience is this too?

(00:57:11):
Are they all the same? And then I start talking to, I start giving presentations in front of 50 alcoholics and I'm like, Hey, here's the pattern. This, this and this. How many of you experienced that? And 75% of the room, their hands go up. And I'm like, well, then that means we're onto something. If I go and talk to a whole bunch of old timers with 40 years of sobriety and I'm like, Hey, I've identified this. And they come back to me and they're like, we already knew that. And I'm like, what do you mean? You already knew that? They're like, we see that all the time, right? No one's really expressed it the way that you've expressed it, but we see it all the time. That guy relapsed because of that, that guy relapsed because of that. We see it. We just don't have any words around it. So the goal is to put a vocabulary around it and to go out there and give people a whole bunch of awareness that, Hey, this is what's going on. Let's start tracking it. Let's start tracking this particular thing. And if you have this, here's a different thing that you can do. We can go down three avenues you can use, just don't use no matter what. Or you can come into clinic and we can treat you as if it's a cycling mood disorder and treat you as if you're having a hypomanic episode.

Matt (00:58:17):
Yeah, man, that is so cool. And I think I'm in a unique position to accept all this because it's not that I would just reject everything straight out, but I have a much more open mind to what recovery is than a lot of other people because of my experience. And I think that I can also pinpoint in my life where this just rings so true for me too.

Dr. Shah (00:58:44):
And I think it's really interesting because it's not the person that it's their first I'm in recovery because their awareness just isn't there. It's the person that's gone through this at least two or three times that had a sincere desire to stay sober that second time, that first time they were just like, whatever. No big deal. I got this right. That second time where they were really trying but couldn't do this, that's the person I want to reach. And for me, it's been the young people, the young people that don't have 20 years of drinking underneath their belt. They know exactly where their trauma is.

Matt (00:59:18):
Okay.

Dr. Shah (00:59:18):
They know exactly where their wound is. So they're coming into AA at a younger and younger age, and they know that this is their wound, yet they're going to meetings and they can't stay sober and they can't figure out why, and they can't figure out why, is because they've got this cycling mood disorder that has gone undiagnosed and no one's catching it.

Matt (00:59:37):
So younger people who haven't covered up their trauma so much, they're easier to treat this way?

Dr. Shah (00:59:43):
Yes, because they can accept the idea that it's their trauma being reactivated.

Matt (00:59:47):
Okay, so let me ask you this. A part of the education around what you are talking about doesn't necessarily mean a reeducation around recovery, but it definitely means an education around this.

Dr. Shah (01:00:01):
Around the thing that's happening and the progression that's happening and the reactivation of the amygdala. Lemme give you another point that I think you're really going to find interesting is that it's not just the young people, it's also the people with five or six years of sobriety that are also in this cycle. They figured out how to get through it and not drink, but they are miserable.

(01:00:26):
And so they're like, I dunno what's going on? I'm not on the right meds. This isn't right. Let's do this. They're escalating as well, but after five years of sobriety, they know they can't go drink, but they're still experiencing this. They would benefit from the mood stabilizers as well if we could identify that this is what's going on. That's why my co-founder was like, you work on this, right? Because he understood what the target market actually was and how big it potentially could be.

Matt (01:00:51):
I mean, possibly everybody in recovery because the reality is yes, we are not drinking, and yes, we understand the consequences, but there is still, how many people out there that are struggling with exactly this, right? Because that was me that was like, I was miserable, and I don't know, we would have to really talk through it to really pinpoint I think what it was, but I solved these issues by doing what you are suggesting just without the language behind it and just kind of putting it into action.

Dr. Shah (01:01:25):
Exactly. But what I like about your work is that it's not one, it's not just go to aa. It's not just go to meetings. It's like, Hey, let's figure out the solution for you. But if you put a framework around it and say, here's what you have to accomplish, and then put language around what it is that we're trying to do in terms of quieting down the amygdala, here are the three things that I need for you to do to make sure that the amygdala isn't hyperactive. Go do that however you want to. Oh, you're going to get your oxytocin. You're going to volunteer at the soup kitchen, you're going to go volunteer at the Humane Society. You're going to go volunteer at the food bank. That sounds amazing. Go do that. Right? You don't need to go and sponsor other people, but I need you to give back.

Matt (01:02:07):
Yeah, yeah.

Dr. Shah (01:02:07):
I need you to go altruistically, help some people. I need you to go do things that get you out of yourself.

Matt (01:02:13):
Okay, so gardening. Pets.

Dr. Shah (01:02:15):
Yeah, pets for sure. Gardening, I think of it more of a meditation than I do a service thing of getting your oxytocin from, and I could be wrong on that, but definitely pets definitely give you oxytocin. That bonding, that feeling good from that a hundred percent. I need to do a deep dive at some point into the literature just to be how many different things release oxytocin? Because there's probably a laundry list of them, and we're still at the beginning phases of writing the book because I'm still on the identifying the problem as well as I could because I just got something from you. The aha moment for you was when I said, we're tracking this with people that we wouldn't have otherwise tracked it with.

(01:02:59):
That's the key. That's why we built an app around. It's just to give them awareness that this could potentially happen. And so what we say in clinic is like, I don't know, dude, you might be one of the three maybe. I have no idea. But we're going to meet every single month for the first six months, and then after that we'll meet once every two months. And if it happens, call clinic. The patients that I have that have stayed with me for long-term have had this happen to them, and then I've treated it. And once I treat it, they're so on board with whatever it is that I want to do. They're like, oh, I get it now. It all makes sense.

Matt (01:03:33):
So what I think is interesting is that you're saying one out of three, I think it would be safe to bet that if you monitored everybody long enough that everybody experienced it.

Dr. Shah (01:03:43):
I would agree with you on that. I just don't think that they would've experienced it to the point where they needed me to intervene on it. So they would've experienced it to some degree, but they wouldn't have needed a medication change to then address it. They would've been able to address it in some other way.

Matt (01:03:58):
Talk to me about downregulating.

Dr. Shah (01:04:01):
For me, I know when I've been activated. I know when my fear has been activated, especially comes around when someone that I respect and trust yells at me or my financial fear is kicked up. I start having this sense of fight or flight, and I know because my thoughts start racing. And so I can feel in my body that surge of energy, which is the first phase, then I can feel myself getting a whole bunch of work done in that hypomanic state. I know for me today that I have to then switch over into the other phase before I get into the racing thoughts and into the paranoia that comes up.

(01:04:40):
So the goal for me is do I need to go to an extra meeting? Do I need to call my sponsor? Do I need to go sit with my sponsor? Do I need to go for an ice bath? Which is amazing. I highly recommend cold plunges. And the reason why those work so well is because you're basically doing micro trauma or you're doing a state of a way to burn off excess energy. Do I need to go run a little bit more? Exercise is not my thing, but do I need to go for a walk? Do I need to go, and just figure out ways to quiet yourself out of a sympathetic tone into a parasympathetic tone knowing that this escalation is happening.

Matt (01:05:14):
So that is one thing that historically addicts just are terrible at is the down regulation. I think that when I think about my past, specifically. When I was alarmed, there was one solution and that was it. And I think especially as clients come in to us and start working with this, so we worked with a client who was constantly in an elevated state because he had a girlfriend that was reactivating trauma constantly for him. So how would I vocalize to this person that you need to start recognizing patterns so that you can realize where your safe places are? Because I know that you talked about when you walked into this meeting, you would get greeted at the door and then you would see that side glance from that person that kind of says, Hey, we're here, kind of thing.

Dr. Shah (01:06:17):
And then you're getting your oxytocin from that. That's why I think that in-person meetings are vastly superior to zoom meetings and online meetings. I think you don't know what safety feels like until you experience it.

Matt (01:06:34):
Okay.

Dr. Shah (01:06:34):
I don't know the level of serenity that I had today I wouldn't have been able to tell my past self about because you don't know it until you experience it. And so I could tell people till I'm blue in the face, like build healthy attachments, build places of safety, but until they actually do it and experience it for themselves, I don't know if that's know how I would tell them that. But then if you go back to the biological side of it, I can tell them, I need for you to build this particular thing. And the way that you're going to know that you've built it is that if you can go into a room and name at least 10 people in that room, or if you can go into, you don't get the benefits of safety in a meeting until you can go into a room and at least half the people there know who you are and who half the people there. I just totally made that up. But that's a good enough arbitrary thing that you can say, did I feel safe in that meeting? And the answer to that question is no, you didn't feel safe. You only knew one person there. You're not getting the benefits of going to a meeting just by going to a meeting. You have to build up to that point.

(01:07:48):
And so it's like how many people in that meeting do you know and how many people know you? And then how many people have you talked to? We can set up criteria for that. I might actually put that into the book now that I'm thinking about it. You have to at least go into the room and know half the people there. What I tell patients is that I need you to get to the fifth step as quickly as possible and tell your sponsor everything, because that's when you'll first start getting the oxytocin is because you've bonded with your sponsor and been vulnerable enough with them, with the fourth and fifth step to tell them everything. I was taken aback by the people that told me that they had maintained long-term sobriety but hadn't done their fifth step in three or four years. And I was like, how is that even possible? It blew my mind. But then I realized it's because they went to meetings every single day, and so they felt comfortable there. So every day they would go to a meeting, not do their fifth step, but everyone knew who they were and they were welcomed in that meeting. And so they were getting the benefits of the oxytocin from that meeting, which was then quieting down their amygdala.

(01:08:50):
And so it all goes back to what are you doing to quiet down the amygdala? And when I frame it that way, that's where the dysfunction is and that's where the solution is.

Matt (01:09:01):
Okay. So when you talk about the history of the program, it's like when it really first started, they did the steps in 15 minutes and then immediately started helping someone else. And so when I tell people, I think it is pretty widely known that it has really significantly changed from the establishment of it to today where people are, they can really take years to do their steps, and within that framework, that's their thing. And I'm not trying to get into that or whatever. What I'm really trying to get to is in order to solve the biological, because we're being right, the spiritual, mental, emotional, physical, and as long as you can treat the physical, then it basically says, okay, take however long you need with your step.

Dr. Shah (01:09:53):
Yeah. I like the idea of when I'm talking to patients inside of detox, I'm like, look, right now all we're doing is freeing the body, right? Then we'll free the mind, then we'll free the spirit. We'll go in steps. But I think with the amygdala and the hyperactivity there, if patients are stuck in that fight or flight state, then they're still stuck in the body, and I haven't given 'em a chance to open up their mind and then open up their spirit. So it's how do I free the body? You're still stuck in the body. I can't do the psychological work in clinic. That's not what my role is. My role is a biological and the physical. And so that's what our focus in clinic is.

Matt (01:10:39):
So I know for me, at least the physical was the key to everything for me.

(01:10:45):
But I do tell people that there are specific things that I have learned along the way that if somebody would've told me them years and years and years ago, it might have changed the depth that I had went to. This could be one of those things. I think that really changes a lot of people's relationship with recovery because now you're telling them all of this stuff is important, but not because of why you think the real reason is because there's a biological manifestation of all of these things that are going on that we can treat if you go into that room.

Dr. Shah (01:11:21):
And that's the beauty of it, is because the idea is that spiritual principles for me exist on all planes. And so if they exist in the body, they have to exist in the mind and in the spirit. And so this is the manifestation of it existing inside the body, fear and love, and that's what it all boils down to. This is where all the fear is, and this is how you get the oxytocin. And the oxytocin comes from the we of everything. Oxytocin is only released when you're doing things that are involved in the we aspect of life. It doesn't get released in the I aspect, which is where the dopamine comes from. Dopamine is responsible for my survival. Oxytocin is responsible for our survival.

Matt (01:12:01):
That is so crazy. Like the cure for the problem is it's polar opposite then. And then the thing that harms the love part of it is the fear side of it. So it's literally just the battle between those two parts of you.

Dr. Shah (01:12:15):
So beautiful, isn't it?

Matt (01:12:16):
Yeah.

Dr. Shah (01:12:17):
When you really boil it down, it has this metaphysical component to it, which I think is beautiful.

Matt (01:12:23):
And it's so simple. It's like, this is a very complicated issue, and when you extrapolate it out, it gets messier and messier and messier. For me, the simplicity of it is what sells me on it. One thing that is not talked about enough is that you go into, people enter recovery the first time, and there's a good amount of people where you enter recovery and life gets worse. Now you've got all of these problems you got to deal with. You're going to lose your job. Now if you mess anything, if you take one step backwards, your family's gone, and now you're walking on eggshells, and now you're doing the step work that says you got to go get in front of these people that don't even want to see you right now. And it's forcing you to do all this stuff that's uncomfortable, first of all. So the way that it translates and feels is like, this shit sucks.

Dr. Shah (01:13:16):
Yeah, it does.

Matt (01:13:16):
But when you break it down to this where it's like, look, this is going to suck, right? This isn't going to be easy. The solution's pretty easy though. If you just do these things, not because you got to go get a sponsor or do the step work. It's like, these are all important things to do because it's an easy map to accomplish the things that I need you to do. I need you to get your dose of oxytocin

Dr. Shah (01:13:38):
Every day,

Matt (01:13:39):
Every day,

Dr. Shah (01:13:40):
Every day. And then we can talk about half-life of oxytocin, how it's better than dopamine, and that it lasts 16 to 18 hours on a half life, whereas dopamine lasts for five to 10 minutes.

Matt (01:13:51):
No way.

Dr. Shah (01:13:52):
And so once you get a dose of oxytocin, you're good for 16 to 18 hours, and then you start stacking that on top of itself. And then it stays in your system. And so when they talk about, my shelf life is about three days before I go really crazy, I need a meeting. And I'm like, well, that makes sense, right? You've diminished your stores of oxytocin at that point. But then I get the same release when I talk to a sponsee or intensive work with another alcoholic. I'm sitting there and I'm doing that thing. I'm getting the release of oxytocin. I know when I'm getting it today. I know when I'm getting ahead of oxytocin. I'm like, oh, there it is. And sometimes I'll go seek it out.

Matt (01:14:31):
Really?

Dr. Shah (01:14:31):
I'll be like, oh, my sponsees, they'll call. But if I'm in my head and I'm in fear, I'll will call them and I'll be like, Hey, how are you doing? What's going on with you? Let's talk. We should meet this week. Let's do some step work. Let's sit down and talk about it.

Matt (01:14:49):
Oh my gosh. Okay. This just made a bunch of things click for me about what I do and why I do them.

Dr. Shah (01:15:00):
So there's this guy that I know, so I know I, it's really amazing how as I was doing this work, the people that would come across into my life, and this is by no means bragging, but I know three billionaires, legit billionaire with a B. And

Matt (01:15:19):
I will say this, most people that are not doctors assume that you guys all know billionaires.

Dr. Shah (01:15:25):
Oh, really?

Matt (01:15:26):
I've always assumed that. It's like you're part of that upper class of people.

Dr. Shah (01:15:29):
No, no. They go to meetings.

Matt (01:15:34):
Oh wow.

Dr. Shah (01:15:35):
And they go to meetings. They have sponsees, they will come to their house, they do the entire deal. And I didn't understand it because at the beginning, I didn't understand why this was happening until I started doing this work, is because they're getting something that money can't buy.

Matt (01:15:53):
Oh my gosh.

Dr. Shah (01:15:54):
You can't buy this.

Matt (01:15:56):
That makes so much sense.

Dr. Shah (01:15:57):
And so the guy that I used to work at Dr. Flowers is diagnostic, and it's really high end people that come in there. And their biggest problem was that I couldn't get them to go and help someone else. I couldn't get them to altruistically do some stuff. They're like, why? Lemme just throw some more money at it. I was like, you can't, you have to go and do this. And this one guy came in and he's like, the only times I feel really good in my life are when I give away money. And I was like, yeah, dude, go give more of it away. Go do that more often. Right? I'm pretty sure you'll stay sober.

Matt (01:16:33):
Dude. So Christianity, right? Religion in general, right? This is okay, so a lot of things are really making sense of me right now. I know some really, really smart people that buy into just crazy stuff. And it's, in my head, I've always been like, you're probably the smartest person I've ever met. How can you believe this is true? Besides all that stuff, they're involved in service work constantly, and they've got their family constantly surrounding them, and it's

Dr. Shah (01:17:09):
That's their oxytocin.

Matt (01:17:10):
And they're so happy.

Dr. Shah (01:17:13):
It's crazy.

Matt (01:17:14):
It really is.

Dr. Shah (01:17:15):
I know the other guy that I know is a CEO of a Fortune 100 company, and he spends an hour every day talking to sponsees, and I'm just like, it didn't make sense to me when I was in my early sobriety. I was like, why are you talking to me? You could be spending time with anybody on this planet. Why are you talking to me right now? I had this sense of unworthiness and this sense of, I'm not good enough. Why are you spending time with me? But today, I totally get it.

Matt (01:17:50):
I get it.

Dr. Shah (01:17:51):
He does that because he feels good after he does it. He feels like on top of the world, and that keeps him sober. He knows that that's what is keeping him sober, and he's bought into that, but he doesn't know why.

Matt (01:18:05):
Man, that's so funny. Because they even say it. It's a selfish program. It's like, yeah, dude, all this stuff makes so much sense when you put it in this context.

Dr. Shah (01:18:14):
Which is beautiful. So I don't know how, my biggest issue that I'm having today is how do I take this, so we're having dynamic content right now where you ask me questions, I answer them, and you're like, oh, that makes so much sense. How do I turn that into static content? Which is, if you read this from A to Z, you'll understand it. And I don't think that that's possible. I think it has to be a whole bunch of small dynamic conversations that are going on where they can be like, oh, that was a block that undid this. So it's having multiple conversations with people about the same thing. I don't know what's going to unblock you and have you understand this? I saw the light go on with you twice, which I haven't seen in our last two conversations. I think the first two conversations are just getting a, okay, I understand what you're saying.

Matt (01:19:03):
Wrapping my head around these concepts whole and yeah, yeah, yeah, for sure.

Dr. Shah (01:19:06):
And then reframing and being like, okay, what about this? And then the aha moments come later on as you start doing it, but it's really, it boils it down really, really well.

Matt (01:19:18):
Yeah, no, for sure. And I can definitely see why this has to be an outpatient setting.

Dr. Shah (01:19:23):
Yeah,

Matt (01:19:23):
Right?

Dr. Shah (01:19:24):
Yeah.

Matt (01:19:24):
Okay. I was like, why can't I got it, kind of that there was, what I assumed was that there isn't really enough time for them to kind of implement this because they have to do a bunch of other stuff. The reality is they have to be in a position where they're asking questions back.

Dr. Shah (01:19:45):
And they're experiencing when their anxiety starts, right? Because you don't get that in treatment.

Matt (01:19:51):
You can't almost, right?

Dr. Shah (01:19:53):
You told me you feel great, right? You're like, you're in a safe cocoon. Yeah, you're in a safe cocoon, a safe bubble. Everything's fine. There's nothing that's reactivating you as soon as you go out. That's when the real work starts.

(01:20:05):
But that's why I think the model that I really like is the IOP Sober Living and recovery coaching stuff. How do I shift the dollars over to that so that there's more investment on that side of it versus on the acute treatment side of it.

Matt (01:20:22):
And the crazy part, well, to me, especially knowing what I know now after talking to you all these times, it's like people have to pay for it themself almost. And how many people can A, afford that and B, be put in the right positions to understand these things, to say this is an important thing to do.

Dr. Shah (01:20:44):
Yeah, cuz they're living life, and they're out and they're doing their job and life's coming at them. I was in a very interesting position in that I was single, didn't have any attachments. I was new to Houston. I had zero friends in Houston. I was drinking by myself in my apartment to oblivion. And so when I went to treatment, and they were like, if you go to sober living, I was like, I'm not doing that, right? It's Dr. Shah. Are you crazy? And I went to Sober living, and I had a blast there because I finally was not alone. I was going to meetings, I was interacting with people, I was making friends. And I hadn't done that in so long because the end of my drinking was alone and isolated in my apartment by myself. But that is the model in terms of building foundational things for the rest of your recovery. So I really believe in you going to sober living close by to wherever you're going to meetings and wherever you're planning on living so that you're building up those healthy attachments while you are in a contained space. And then once you leave and you go to your house, you already have the meetings set up. That's why one of the most controversial things I say is, I don't believe in going to treatment out of state.

Matt (01:21:57):
Why is that controversial?

Dr. Shah (01:21:59):
Because so many people do it. That's part of the business model.

Matt (01:22:03):
So one thing that we have noticed, we've done feasibility studies in this area, and we've really kind of gotten to know the market, is that there are some options here, but not enough to service everybody that needs it, right?

Dr. Shah (01:22:14):
Yeah. No, but that's true everywhere though, right?

Matt (01:22:17):
No, dude, California.

Dr. Shah (01:22:18):
Oh, really?

Matt (01:22:19):
Heavily saturated. Heavily saturated in treatment. And that's what I'm used to, is that there's treatment everywhere. Not only is there treatment everywhere everybody knows about treatment, something that I've noticed here is that there isn't treatment everywhere. Like think about Austin heavily saturated in treatment, when people think about Texas and treatment, they think about Austin. They think about some places in San Antonio, but they're basically the same place. And so

Dr. Shah (01:22:47):
Do you think it's because they all do treatment outside of the Houston area?

Matt (01:22:52):
Yeah.

Dr. Shah (01:22:53):
Because they buy these big ranches in the middle of nowhere and have a true facility out there.

Matt (01:22:59):
Yeah. One thing that I've been told specifically is that because of what Houston is, right? Like an industrial city, it became a massive city. And a lot of people would come here for work and then leave to go back to wherever they're from. And so when the industry came to this market, it was more of an afterthought than anything that people were still leaving treatment and coming here. So there had been many, many, many treatment companies that tried to set up treatment here, and it failed here, and it is, because everybody leaves. Everybody leaves to go to treatment from here. So one thing that we're trying to do, we're trying to get 120 bed facility. We're trying to make waves in the market so that people, and we're trying to get into some EAP stuff so that people don't have to leave where they live to go to treatment. Because whenever I've gone to treatment before, I've literally gone to treatment down the street from my house most of the times. Or if not, it's still in the next county. It's right there. But trust me, I agree with you that you should not leave. So one of the things that my mentor says is that it's extremely hard to get well in the place that got you sick.

(01:24:22):
But if you do, you can. But there has to be certain things that are done in order for that to take place. And one of the things is the cocoon. The other thing is the social calibration of your moral compass within a given group. Because especially if you have a criminal mentality, those are the people that are calibrating your moral compass.

(01:24:45):
So it's already skewed from what society has said is true north. We have to come back into a new environment that says, we will help you calibrate these choices. Because for me, I know that I'm willing to do things and have done things that the rest of society just wouldn't even think of because I've done it. And because of that, it automatically just kind of moves what my compass points to. And so that is one of the things that I tell people that if you are not willing to accept the 12 step model, that's fine, but there has to be a social calibration. You have to have somebody that you trust telling you that that is a bad idea because I cannot, the self cannot critique self.

Dr. Shah (01:25:32):
That goes back to having a mirror. So I mean, these are all things that if you were to take the 12 step model and deconstruct it into a biological thing and said, you need to have these components to it, and I'm fine with you not going to 12 step, totally. Okay. But these are the things that 12 step give you that allow for you to then get better from a biological sense. That moral compass in that thing is that it was really interesting that what happened to me is that when I started practicing the principles in all my affairs, I stopped second guessing myself. I stopped that fear cycle that would go on or that, should I do this? Should I do that? Should I, is that okay? Is this okay? Is that I didn't have that anymore because I was like, this is true north. This is my moral compass. I've checked it in with my sponsor. I've checked in with my support group, and this is what I'm supposed to do. And then I do the action, then I leave the results up to the universe and then let that go. But that allows for me not to live in fear.

Matt (01:26:36):
For sure.

Dr. Shah (01:26:37):
And then this goes back to why that's so important.

Matt (01:26:41):
Were you drinking through your formal education? So it started at 18, and then it just progressed?

Dr. Shah (01:26:47):
Started in college, and then progressed to when I started working. And then I was, I was miserable in my 25, and I was, my dad always told me if I was a doctor, I'd be happy. So that's what the issue is. It's not about the alcohol, not about the other stuff it's cuz I'm not a doctor. So then I went to Georgetown to get my master's degree because my undergrad, GPA was a 3.1, which is good for engineering, but terrible for medical school. So I went to Georgetown. I did my master's in alternative medicine, and then got into med school, but I was drinking the entire time. I mean, Tulane was not a dry campus for sure.

Matt (01:27:28):
That's in Louisiana, right?

Dr. Shah (01:27:29):
In New Orleans.

Matt (01:27:30):
New Orleans. Oh, wow.

Dr. Shah (01:27:31):
Yeah. So they partied pretty hard there. And my drinking definitely escalated there. And I was really hoping that when I got to Houston after my residency, it would stop, but it didn't. I was even more isolated, more alone, didn't know anybody here. And so it went from drinking socially with other people to drinking alone by myself.

Matt (01:27:57):
So when you talk about what contributes to these patterns, especially, so I'm part Asian and I thoroughly buy into that whole theory that Asians are allergic to alcohol, that there's a processing thing.

Dr. Shah (01:28:19):
So I grew up in LA in Cerritos, and a bunch of my friends get the Asian flush. My friend Barbara breaks out in hives. She has a true allergy to alcohol. She doesn't have alcohol, dehydrogenate that breaks down alcohol. So the only way to clear it out of her system is for her immune system to clear it out.

Matt (01:28:41):
Yeah. It's the same thing for me. I will get drunk off of a beer and I get extremely puffy and red and uncomfortable, and if I drink too much, I'll get itchy. So anyway, I have always stayed away from alcohol.

Dr. Shah (01:28:59):
Okay. You're still going to find something that's going to help alleviate that fear.

Matt (01:29:06):
Oh, yeah.

Dr. Shah (01:29:07):
And so when we talk about drugs of choices, it's not about whatever you find that quiets it down for the first time and it's the most effective, that's what you're going to stick with. And so why would I change that when it's something that's working? Or if I find something that's better than that, it all boils down to the same thing. But this is a human experience. When we start talking about food, we start talking about work, gambling. They're all ways in which we quiet down our fears. Everyone's got their own escape hatch. It's just an addict and alcoholics are dying over it.

Matt (01:29:43):
Oh, wow. Okay. Everybody deals with this. Alcoholics,

Dr. Shah (01:29:50):
Everybody deals with it. It's their degree of scarring in the amygdala. They find a way to quiet down that fear. That's the human experience.

Matt (01:30:00):
Okay. Let me ask you this. I have sexual trauma in my past.

Dr. Shah (01:30:06):
Same.

Matt (01:30:11):
And this was when I was really young, and now when I look back, I can really kind of point to things that, because I tell people that I was exhibiting addict behavior way before I ever used the trauma that I experienced. And then I later on in life got diagnosed with an antisocial personality disorder. And so I always wondered, why don't I experience depression the same way that everybody else talks about it? Why don't I experience anxiety the same way that other people talk about it? And why did this trauma not affect me the way that it affects other people? But then I look at some other things that had happened. A lot of it is my relationship with my mom.

Dr. Shah (01:30:57):
Wait, wait, what do you mean? Why does this trauma not affect me the same way it does other people?

Matt (01:31:01):
So I've gone to a lot of therapy around this, and my therapist does agree with me that my sexual trauma was not the root of, it might have started a process, but when I talk about my trauma that I used over and all that stuff, that wasn't it. Whereas when this stuff happens to other people, that is typically the epicenter of their trauma.

Dr. Shah (01:31:29):
Okay. Yeah. I've got theories around all of this stuff.

Matt (01:31:33):
Really?

Dr. Shah (01:31:34):
Yeah. So I've done deep dives into that just because of my own stuff. You're always wanting to understand, understand myself better, and to see what's going on. I have this theory that if you remember your trauma, so a lot of people don't remember their sexual trauma.

Matt (01:31:51):
I do.

Dr. Shah (01:31:51):
If you remember it, it means it happened more than once, because if it happened once, your cortisol levels went through the roof at that moment in time and it burned out your hippocampus and you're not going to remember it. You'll still experience the emotions around it, but the prefrontal processing stuff won't happen. But if it happens repeatedly over and over and over again, then each time it happens, your cortisol level goes down lower and lower and lower, and so you remember what happened.

Matt (01:32:20):
Okay.

Dr. Shah (01:32:20):
So it goes from the people that don't remember it, and it's happened once, are the ones that are avoiding it. They're not really sure why they're avoiding it, but they're kind of staying away from that particular thing. The ones that are reenacting it are the ones that repeated it, or it happened to them multiple times so that they're aware of it consciously, and then they're recreating that stuff. It all depends upon the timing of when it happened also. So there's a lot of patients that I've had that when I ask them, I'll ask some patients this question, and it'll be very telling. I'll ask them, what is your earliest childhood memory? And if they tell me their earliest childhood memory was the age of nine, I'll be like, some shit went down between the age earlier than that. Right? Then that's all because they don't remember because their cortisol levels were so high and they're in a state of fight or flight. So like we said before, if you're in a state of fight or flight, you are just surviving. You're not learning new things since you're not processing all that information.

Matt (01:33:19):
Okay. Do you think that this could also tell us why kids have developmental issues?

Dr. Shah (01:33:30):
If I go down that rabbit hole, it ends up being so controversial that it's the,

Matt (01:33:38):
Okay, we could talk about it after.

Dr. Shah (01:33:40):
It's not even worth doing. But what I do believe is that nobody escapes their childhood unscathed. So everyone's got their own wounds. And so where the work really begins is after the age of 18. So there's a spiritual journey that occurs. So between the ages of zero and 18, you are unconsciously picking up all these patterns and you're being programmed unconsciously. And so whatever your experiences that you develop or whatever you get is what you're going to get. Then you lead the second half of your life operating unconsciously out of these particular programmings. The real magic happens in your third portion of your life when you wake up and you're like, I am operating unconsciously out of all of these particular processes. I need to undo it and live consciously as opposed to unconsciously. And that's the addict's journey.

Matt (01:34:32):
And that can exist in a microcosm too. So then this can happen before all of those processes can happen. Yeah. Okay. Because there's those philosophies out there, and it's a lot of eastern philosophy where there's the three phases of life.

Dr. Shah (01:34:46):
Yeah.

Matt (01:34:47):
So did you just boil it down and apply it to that?

Dr. Shah (01:34:51):
I don't know if I've ever heard about the three phases of life from the Eastern philosophies.

Matt (01:34:55):
Yeah. There's your childhood and then there's the learning, and then there's your working, and then you're contributing to the generations after you.

Dr. Shah (01:35:06):
Okay. I didn't know that does that.

Matt (01:35:08):
I forget which philosophy it's around.

Dr. Shah (01:35:10):
I can see that. Right. I think for me, it's more of the journey of awareness where there's four stages of learning where it's unconscious incompetence, conscious incompetence, conscious competence, and then unconscious competence.

Matt (01:35:32):
Okay.

Dr. Shah (01:35:32):
Where you're just doing things. And so I'm unlearning, I got taught to do things incorrectly, or I never got taught. I just did them. And I did them because I didn't know what else to do, and I was operating on, I was parenting myself from a very, very young age. And because I didn't get taught these particular things, I just figured out, oh, this worked right. And I will continue to do them until I get taught that there's a different way or something better that's out there. But that's why I need mentors in my life. And that's where the mentorship and having the men in my life that show me these particular things has been so vastly beneficial, but now I get why they're giving back.

Matt (01:36:09):
Yeah. I kind of have the same experience where it's like I learned a lot of survival skills on my own, and I think this may be true for everybody, but we all understand that there's probably a better way to do things, but I don't know what they are, so I'm just going to continue to do what I'm going to do. And then I came into conflict with myself too, because then I experienced at some point, I experienced a better way of doing things, and then I still went back to what I knew, and then there was a divergence.

Dr. Shah (01:36:43):
That's the conscious, conscious competence. You have to actually work towards staying in that zone. Otherwise, you'll very quickly go back into conscious incompetence. But you're awake now, so you're not doing things blindly. You're not just doing it, cuz your're doing it. You're like, when I go out, if I ever went out and drinking, I know exactly what's going to happen. You can't do that. I couldn't even fathom that today. I have to be in a lot of pain to go down that route. But I could see that happening if I wasn't in enough pain. But that's why I stay so close to my support group and the people that are around me, right? Because that offers me a level of safety and comfort.

Matt (01:37:25):
Okay. So you said something interesting that if, okay, so yeah, I do believe that everybody still thinks about using, right? It doesn't matter if you're 50 years clean, probably there's still that thought of use, but the desire and then the acting on that desire. Does it ever get strong enough to act on it? And you just said you'd have to be in a lot of pain to go down that road again.

Dr. Shah (01:37:54):
A lot of fear and a lot of pain. Or I'd be super isolated and not have anyone around me. So my sponsor drank with 36, 37 years of sobriety and had a drink while in Ireland, had one, I think it was a pair of cider or something like that, drank it, consciously drank it, and then stopped. That was it, right? And he told me the next day, and he was like, I had a pear cider. And I was like, well, that's interesting sponsor wasn't expecting that from you after 37 years. And he is like, I don't know what happened. And his wife was in pain. This was bringing up all of his stuff from his previous wife who had died of pancreatic cancer. And so they were traveling in another country, didn't really have access to doctors. He wasn't alone. He just went into the bar not knowing he was going to order a drink, but when the drink, he ordered a pear cider or an apple cider. When the drink came out, he read the thing and it said, alcoholic, and he drank it anyways. Right? So could that happen to me? Yeah. I'm not immune to that, but I watched him walk through it, and watching him walk through it means that if it ever came up for me before or ever in the future, I would know what to do.

Matt (01:39:15):
Yeah. Hey, you know what? My Last Relapse, that's actually where the name of this podcast come from, is my last relapse. Probably the most pivotal and most important moment in my life, historically, my shortest relapse. And also put me on this path. But I had had three years of clean time and working at a treatment center and all of these things, a lot of success in that three years. And I no longer wanted to deal with the consequences of poor decision making. And so it was really easy. Plus my best friend had overdosed and died. And there was a lot of reasons why I could be like, I just don't want deal with, I don't want to deal with the consequences. But I always looking back on it, it's like, yes, it's very easy for me not to use because I know that there's terrible consequences that come with it. But I still wanted to get high because heroin feels amazing.

Dr. Shah (01:40:13):
It would've fixed whatever pain you were in immediately.

Matt (01:40:16):
Yeah, that too. And so then I moved to Houston and I can't find a job, and there's all of these things that stacked up, and I had a bunch of free time, and I wasn't really doing anything. I stopped working out and I relapsed really, really quick. And it was only 11 days, and it was caught really quick. And I went to treatment, and that's actually where I met you. But now that relapse has given me a lot of clarity about I don't even want to get high anymore. And that gave me a real, yes, it sucked. And yes, I wish that I could have come to this realization differently, but it was very important. And I still do have consequences that I'm dealing with from that really, really suck. But I still, looking back on it, it's like, that was so important. It was so important. So that's actually where this comes from, where this podcast idea comes from too.

Dr. Shah (01:41:23):
Oh, I like the title of it. I didn't realize that that's what it was called.

Matt (01:41:26):
Yeah.My Last Relapse. Thanks for listening to My Last Relapse. I'm Matt Handy, the founder of Harmony Grove Behavioral Health, Houston, Texas, where our mission is to provide compassionate evidence-based care for anyone facing addiction, mental health challenges, and co-occurring disorders. Find out more at harmonygrovebh.com. Follow and subscribe to My Last Relapse on YouTube, apple Podcast, Spotify, and wherever you'd like to stream podcasts. Got a question for us? Leave a message or voicemail at mylastrelapse.com. If you're feeling overwhelmed or struggling, you don't have to face it alone. Reaching out for support is a sign of strength and help is always available. If you or anyone needs help, give us a call 24 hours a day at 8 8 8 - 6 9 1 - 8 2 9 5.