Asher Gottesman: Founder of Transcend Recovery Community

On this episode of Recovery X...

Dan Sevigny interviews Asher Gottesman from Transcend Recovery Community in Los Angeles.

They talk about...

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    The definition of addiction.
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    How to treat addiction.
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    How to find a trustworthy treatment center--and avoid bad actors!

...and much more! Watch the full video to find out.

Episode Transcription

Speakers:

Dan Sevigny (DS)

Asher Gottesman (AG)

DS:

Welcome to Recovery X where experts exchange recovery information to help solve the problem of addiction.  If you have questions about recovery, Recovery X has answers. My name is Dan Sevigny, and I’ll be your host.  Today, I’ll be talking with Asher Gottesman from Transcend Recovery Community. Asher, thank you so much for joining me.

AG:

Thank you for having me.

DS:

Tell me a little bit about yourself and the work you’re doing over at Transcend.

AG:

Transcend started about 10 years ago as the initial Recovery community.  Our concept and our belief is that it takes a village to help people help themselves, change, and relinquish themselves from the suffering of addiction.  And I, myself, if I make it to March 19, will have 10 years sober. Hopefully, I’ll make it. I think we’ve got about 17 days, so I think we’re in the clear.  And, it is kind of a passion – not kind of, it is actually a passion and a mission of mine – to help as many people help themselves. At Transcend, we have a philosophy that drugs and alcohol are the solution.  They’re a short-term solution to a long-term problem. And, only through helping others and working together as a community, having structure and accountability, can we release ourselves of this demon we call “an addiction.”  

DS:

I like that.  And, congratulations on the 10 years.  That’s really amazing.

AG:

Thank you.

DS:

So, first question I’d like to ask is, “What is your definition of addiction?”

AG:

My definition of addiction is, “Any maladaptive behavior that is preventing you from living your best life.”  So, I try to say, “There are two types of people in the world – those in recovery and those that can be.” The benefit of addiction, as we’re known as a society, is that you kind of hit a bottom pretty quickly and, whether it’s with heroin or whether it’s with alcohol, and you have to rid yourself of it.  However, addiction as a whole, so others can identify, is any maladaptive behavior that is holding you back from being able to live your life or using as a medication to prevent you from dealing with the underlying issues.

DS:

So, would you say addiction, like, a lot of people, I think, are confused about the difference between alcohol addiction, drug addiction, gambling, or any other behavior.  So, you would say it goes altogether as one thing and can all be under one umbrella?

AG:

I think that addiction can definitely be under one umbrella, and it helps the world to identify, as opposed to, separating to unify and understand that addiction can be food, can be gambling, can be sex, obviously can be drugs and alcohol, but it can also be cell phone usage, it can be gaming, it could be many things that are preventing one person from living a healthy life.

DS:

I like that.  That’s a good definition.  How would you say, what’s like the best course of action for solving the problem of addiction?  How do people go about solving that? How does the industry solve that? How does society solve that?  What are your thoughts on that?

AG:

I think that’s an incredible question and something that requires a lot of work from, as they say, both sides of the aisle.  And, I heard a noted economist speak at the Aspen Institute, and he said, he was talking about the Rockefeller Foundation, actually, and he said, until 1970ish, I don’t remember exactly, that they had one home run after another, one grand slam after another, hit it out of the park.  And, that’s because they gave the experts a problem and told them to solve it together. And, since then, they’re requiring immediate results and, as a society, we are reacting, we’re not responding, and we’re not looking at the problem. And, the problem is such that it takes the great minds from all sides to work together to rid ourselves of this epidemic that is in our country today.

DS:

Would you say that the government can do anything or that society as a whole can get involved in this?  How would you say, like, on the greater level people can get involved?

AG:

I think the first thing is everybody to identify that we all, every single person, can do better in life.  And, therefore, it is not a stigma or it is not something that is separate out to opiate addicted people, or alcoholics, or the dregs of society.  It is now throughout every household, pretty much, in America today and, worldwide, it’s the issue. So, that’s the first thing – recognize that the stigma’s got to go away, that we have a problem.  The government definitely can help. It’s the government getting experts in a room from, as they say, whether they see blue, whether they see red, whether they see red and blue. In the addiction field, probably would be medically-assisted treatment versus abstinence-based treatment, versus psychological treatment, versus Alcoholics Anonymous, versus Smart recovery, versus all this kind of, all the various methodologies that are being used to rid people of addiction.  Get them in a room and say, “We’re here to accomplish the same goal. So, why are we fighting about it? The goal is, how do we rid America and the world of these addictive patterns? How do we create safety in our communities? How do we help people live their best lives and not what other people are doing wrong? And, it’s not about getting rid of drugs. It’s about getting rid of the desire to use drugs and not needing it.”

DS:

Absolutely.  That’s a great answer, and I’m glad you brought that up.  That’s exactly what we’re trying to do here at Recovery X, is bring in all the thought leaders and experts like yourself into this one place where we can all start talking about the actual solutions.  So, I think that’s great. You touched on the fact that there has been stigma in the past about addiction and now it’s affecting more and more people. You’ve got pretty much everyone addicted to their phones.  There’s a big oxycontin problem touching every part of American society. Where do you see those issues coming into play here, and how do you feel about solving those kind of things? They’re not necessarily what you would typically think of as like regular addiction, but it’s starting to grow in society.

AG:

That’s a wonderful question, and what we just did in the last two years is, we said, “We have an oxycontin problem.”  So, we went ahead and we tried to pull oxycontin out of the market. And, what ended up happening, heroin use went up, or fentanyl use goes up, or people are importing from China.  It’s because we’re focusing on the symptom, and we’re not focusing on the problem. And, the problem is “Why do people feel such a need to escape life on life’s terms?” So, again, whether we’re using work, whether we’re using phones, whether we’re using medicine, whether we’re using marijuana, it’s not about the substance.  It’s not about the actual use of that item. It’s about what is driving the behavior underneath. It’s what is it trying to solve. And, what are we not doing for our children? What are we not doing for our peers? What are we not doing for ourselves that is requiring us, and I mean “us” because every single person I know, at least, has a maladaptive behavior.  Many of them, it doesn’t affect their lives, or they don’t think it affects their lives, or it’s not obvious how it affects their lives, but everybody does have something. And, therefore, let’s unify together to understand, “What is that all about? Why are our stress levels so much higher than they were? Why are suicide rates so much higher than they are? Why is addictive behavior so much higher than it is?”  And, let’s look at the problem, attack it, understand it, instead of looking at every symptom, instead of trying to put borders in Mexico to not let the drugs in from Mexico so they can then come in from China. That’s not going to solve the problem. Yes, people do need to be held accountable, and we need to figure out where to get the resources to pay for them. So, those that benefitted, I’d say, from addiction, whether it was the manufacturers of oxycontin, should pay money to solve the problem.  But, we should not punish them and have fees paid to the government so that money goes into some big hole that’s not looking to solve the problem.

DS:

What would you say, if addiction is more the symptom, then what is the problem?  What is the cause of the addiction, the root cause, in your opinion?

AG:

I think there are multiple, multiple causes, and I think that people are disconnected.  In today’s society, where people no longer know even how to write an email, forget writing a letter on a piece of paper, that we don’t have enough connection.  And we’re desperately seeking connection. America, when it started, was a very religious society, and whether religion is right or wrong, I’m not here to debate that, but it offered a sense of community.  And people felt a part of something greater than themselves. It was a time where middle class people got a house, built a family. They felt part of something. They went to church. They went to synagogue.  They had Little League. Today, with cell phones not identifying, with lack of personal community, I think we’ve become so disconnected. And, I think that, ultimately, the problem is a lack of connection, social anxiety, a lack of self-worth.  I heard a wonderful thing somebody said the other week. He said, “When I came into the rooms of Alcoholics Anonymous, my ego was through the roof and my self-worth was subterranean.” And, I think in today’s world, we put on that Facebook life, that Instagram life, which is nobody’s real life.  And we don’t talk about the crap. We don’t talk about the struggle. We don’t share the struggle because we’re so busy saying how great things are. Well, sh*t is not always going to be good, but if we work together as a whole as a community, we can definitely start to solve the problem. So, I think, ultimately, if you ask me for one word, I’d say it is “disconnection.”

DS:

What advice do you give someone who, say, a parent or a spouse of someone who’s suffering from addiction?  What’s the first step they can take to solve their problem?

AG:

I think the first thing I would tell a parent is, “Firstly, find an expert.  Don’t try and do this on your own.” Number two, “Find a community so you feel supported.”  And that’s why we recommend people go to Al-Anon. Not because we say that 12-Step is the only answer.  But, we say that that offers you a sense of community. Go to a family group. Go to a parenting group. Go to a place where you have other people that are suffering from the same ill.  And, also realize that you cannot help somebody that doesn’t want to help themselves. You can create your own boundaries, loving boundaries. I also say, “Unconditional love doesn’t mean unconditional support.”  And, therefore, you must create crucial boundaries that you’re not going to break. So, don’t tell your kid, for instance, if it’s someone’s child, “I’m going to throw you out of the house for using drugs,” if you’re not going to throw them out of the house.  And, I’m not saying that’s the right thing or the wrong thing. I’m giving it as an example. But, somebody who is suffering from addiction needs professional help and not internet-based help. So, stop looking on the internet for a solution. Find experts that can help you navigate these waters that are so difficult.

DS:

Where are some places that people can find help?  I know you mentioned not on the internet. Where can people go?  Who can they talk to? How do they get their process started?

AG:

I don’t want to take the internet out of it because the internet is wonderful.  But, the internet is not the end-all, be-all solution. So, I would search… A. I would be open and honest.  So, let’s get out of the dark. Most people with addiction issue with a family member who has addiction issues, this goes to stigma, are afraid to tell their friend that “My child is suffering.”  So, let’s say you are afraid to tell your friend, or you don’t have a pastor, you don’t have a rabbi, you don’t have a community, you don’t have a therapist, you have nobody. Well, go ask a friend if they know anybody that has had experience in addiction.  Or, go on the internet and seek an expert. But, ask the right questions. Find out what questions to ask. And, then, start asking the questions. Don’t look for the immediate solution. Find out what questions you should be asking. Even if you went on the internet and said, “What questions should I be asking?” and find other like-minded people, not somebody who’s trying to sell something, who can therefore help you navigate where you should go.  Unfortunately, in addiction today, there is no one right answer. It’s not like cancer where it is, you have cancer, you go to the hospital, you get a treatment protocol, and that’s how it works. Addiction is a disease that has about 8,550,000 different opinions on how to handle it. So, it’s tricky. The one thing I do know is, looking for the same immediate solution is exactly what the drug addict is doing with using the drugs.

DS:

You mentioned asking the right questions to find somebody qualified who’s not necessarily just trying to sell something.  What questions would you recommend somebody ask to make sure they’re dealing with a professional?

AG:

A.  Let’s assume somebody has a specific addiction.  So, you call a phone number on the internet, let’s just say, and you say, “My son is suffering from opioid addiction,” and immediately, without any assessment of anything that is going on with him, “Oh, you need to go here.  I’ll connect you here. I’ll do this,” you need to find somebody who can help you do an assessment, an in-person assessment, whether it’s a therapist, a counselor, an out-patient treatment center, an assessment. Find out what’s going on.  What’s the underlying issues so you can have a prognosis and understand that it’s not about just sending him away for 28 days. This is about an entire change of lifestyle, change of way of life, and it is a long, chronic process. So, the questions are, “How long does my son or daughter or husband or wife or boyfriend or girlfriend or friend need to be in treatment?”  Another question is, “Do you understand some of the underlying issues?” If somebody’s not asking about their history, then they obviously are not treating your loved one. They’re treating whoever’s on the phone so they can get what’s called, “Heads and beds.” So, let’s find out and do a full assessment and understanding of what’s going on. Ask them, when they come into the center, “What kind of protocol?  What kind of assessment do they do? What kind of treatment process do they do?” Be careful of buzz words. Make sure that they treat the person as an individual. Make sure that there’s family work going on, because you need support, you being the family member calling. Make sure that, in today’s world, “dual diagnosis” is a big word, so what does that mean? Ask them. “What do you mean by ‘dual diagnosis’?  “Do you have a physician or a psychiatrist on staff that is trained in addiction, or do you just say you treat dual-diagnosis?” So, again, I think the internet has helped a lot because it has created awareness, but it has also taken away from people calling experts. I say, “Use an interventionist. Use a case manager. Use a therapist. Use a psychiatrist. Use a family member or family friend that has been through the process.  Learn from somebody else’s mistakes.” You wouldn’t go to a fitness gym and get a trainer who wasn’t certified. Yet, when you are dealing with drug addiction, you’re going to pick up the phone with a phone number, and just send your kid to wherever the h*ll the person on the other line will send you? I’ll leave it with that question.

DS:

So, what are some red flags someone can look for?  I know you said to ask about those buzz words, ask exactly what the protocol is.  What are some things that you can listen for that, if you hear them, you know you’re in the wrong spot and you need to find somebody else?

AG:

The first thing you can ask is, “Are you a call center?  Are you the treatment center?” So, if you’re a call center, if they do answer, that’s a red flag immediately.  And, you can say, “Well, what treatment centers are you dealing with? What are their qualifications and how do you have them join your call center?  Are they reputable? Do you have somebody I can speak to that’s been in the program, or a family member that’s been in the program? Where are the reviews?  Who are the experts?” Those are the red flags. “How long have you been working in this field?” There’s another red flag. Unfortunately, people will lie to you so, therefore, you have to continue to ask the questions.  “What are your outcomes?” Outcomes being success rates. If somebody starts to throw out numbers that are ridiculous, and when I mean “ridiculous,” anything above 30% is probably ridiculous, ask them to qualify it. “How do you come up with those numbers?” Because, people qualify things in the wrong way.  Somebody immediately offering to take your insurance, and saying, “Oh, no, I can place you right away,” is a red flag, unfortunately. Somebody who’s going to immediately solve your problem without figuring out what your problem is. So, if their question is, “Let me run your insurance benefits,” and then once they run the insurance benefits, they stop asking you any questions about the client, that’s a red flag.  If they run the insurance benefits and then they come back to you and say, “Okay, now that I understand what insurance benefits you have, let me understand more about your loved one and tell me what’s going on so I can, therefore, make it a referral.” Lastly, another question to ask is, “Do you refer out to places that don’t pay you?” Or, “When was the last time you referred out a client to a different treatment center that is not affiliated with you in any way?”

DS:

I think a lot of people are confused about what the ideal treatment process would look like.  There’s rehabs. There’s detox centers, sober homes, and IOP (intensive outpatient programs). How would you describe the process that someone needs to go to in an ideal situation?

AG:

I’m one of the proponents of long term treatment.  I believe that it takes about a year in a recovery-related environment to effectually change, and I do think that even working in a recovery-related environment for period of time is very important.  And, it’s different for all. So, if somebody had a dependence on oxycontin because he got in a car accident, but he’s a CEO of a company, his life is all in order, he just has a dependence, then a short-term stay may work for him.  If somebody is a professional, then there’s a professional program that he or she should go to. However, most people, the first step is detoxification, which is the medical process, which is anywhere from 5 to 21 days, sometimes more depending on how severe the addiction is.  Afterwards is what you call a “residential treatment center.” That is the crucial period of time. And, a lot of residential treatment centers offer detox, as well. And, then, you mentioned there’s intensive outpatient. That sometimes comes before, sometimes comes afterwards.  An intensive outpatient offers various levels of care. One would be partial hospitalization which is a full day, six to eight hours of intensive treatment. Intensive outpatient is three hours a day. And, then, there’s outpatient which is one to two times a week for an hour or two.  

Then, there are sober living homes.  And, sober living homes are very unregulated, so they’re all over the board.  There it is really important to ask even more questions. So, what I’m saying is, again, that’s why assessment is so, so necessary.  It is also very important to know how much you have to spend on this problem because the more long term, the better. If you have $50,000 and the treatment center for 35 days or 28 days is going to be $50,000, I would recommend to figure out a way to stretch out that $50,000 to last 10 months.  Finding out the expert to say, “Oh, what’s… hold on a second. I only have $50,000 to spend on my kid. I got to figure out what that long-term solution is. I don’t want to blow all this money for a fix.” Because, that’s all it is. It’s a fix. It’s not going to help. It’s going to band aid the problem.  So, again, if you’re asking me specifically, I think that if somebody has never been to treatment, I think they go to residential treatment center. From there, they step down into sober living with an intensive outpatient, assuming that they need a residential treatment center. And, that’s something I’ll get to in a second.  And, then, after that, some sort of case management, a job in the recovery-related field for a short period of time and, then, reassess after getting one-year sober.

I want to address something.  In the younger adult population, or in the adolescent population, we’re very quick to jump.  And, sometimes we send children to residential treatment centers. I call “children” from 12 years old all the way up to 30 years old, for that matter, that have a dependence on certain drugs or alcohol but may be able to do better in an outpatient environment.  I can’t tell. And, we send them to a residential treatment center, and they learn worse behavior there. So, it’s really important to assess where the person’s at and to make sure that we’re helping them help themselves. So, if they have a marijuana dependence but they’re not quite ready for recovery, so you’re sending them away to a treatment center fueling their abandonment issues, fueling their self-worth issues, they find the wrong crowd there, they end up addicted to heroin.  So, it’s really important to make sure that you’re assessing the problem in its entirety.

DS:

So, the average stay in rehab is usually about 30 days.  Is that right?

AG:

Today, the average stay is 28 days.

DS:

28 days.  Would you say that’s enough, typically?

AG:

Absolutely not.  

DS:

No?  Given that that’s sort of what’s covered by insurance, what would you say is the best option for families that are looking for that option?

AG:

I think that they have to find resources in their community or outside their community for sober living and for intensive outpatient.  And, if the answer is, “Yes, insurance only covers that,” but they have to push their insurance to continue to cover intensive outpatient, partial hospitalization and, unfortunately, we have to start talking to insurance companies.  We have to start talking to the government about paying for a longer-term solution.

DS:

I want to ask you really quickly, moving to another subject, about medically-assisted treatment.  We briefly touched on it earlier. But, just for those that don’t know, what is medically-assisted treatment and what are the different options within that?

AG:

Medically-assisted treatment, I think, falls under two different categories.  One category would be whether it’s an abuse for alcohol which is a non-narcotic blocker so alcohol becomes poisonous to you, basically.  Whether that’s something called “Naltrexone” which is a non-narcotic opiate blocker or, in the injectable form, it’s called “Vivitrol,” which, again, is a non-narcotic opiate blocker.  And, then, there is something called “Suboxone,” which is Buprenorphin mixed with Naltrexone, or Subutex which is just Buprenorphin. And, lastly, Methadone. So, I would break it down that way.  Those two are narcotic solutions. I’m not saying they’re not appropriate or inappropriate, but it is very important to differentiate between the narcotic solutions and the non-narcotic solutions.  So, medically-assisted treatment is not psychiatric medication for people with psychiatric issues. It is strictly medicine being used to block, whether it’s the cravings or when you inject it, the effects, injested, not injected.

DS:

Have you heard of these marijuana medically-assisted treatments?  Would that fall under medically assisted, or is that, like some treatment centers are opening up in certain states that are advocating the use of marijuana?  Do you know anything about that? Have you heard that?

AG:

I sure do.  I think it’s kind of funny.  And, somebody asked me about that the other week, “Well, wouldn’t you say it’s better for my kid to smoke marijuana than to use heroin?”  And, the answer is, “Absolutely, I think it is much better to smoke marijuana than it is to use heroin. However, it’s not called ‘treatment.’”  So, if I’m getting high on marijuana, there is no way that I’m in a position to receive the therapy that is in treatment. And, what I’m doing is, I’m replacing one with the other.  I have no idea what the long-term prognosis is, but that’s my bottom line belief and feeling.

DS:

Do you have any advice for mental health professionals, like therapists, anyone that may be working in a sort of parallel field, not necessarily in addictions, for how they can help their clients?

AG:

I think they’re uniquely gifted to help their clients because they do definitely have resources and panels and boards that they can go and ask opinions and advice.  And, they can then ask further questions, and they’re educated to ask those questions. So, I say, “Mental health professionals, ask questions, learn, get educated, because my guess is, most of your clients, in one way or another, have addictive patterns and behaviors.  Please don’t tell your client to go find a resource elsewhere. Please assist them in finding the resource. So, mental health professionals, make sure you use your colleagues who are familiar with addiction to be resources to you so you can be resources to your clients.”

DS:

That’s all I got.  Do you have anything else that you’d like to discuss today?

AG:

No.  I’m very grateful for you, and I want you to know that it’s going to take an army, and we all got to work together.  So, medically assisted, abstinence, red, white, blue, orange, green, all of us, let’s get together and know that, ultimately, we’re seeking safety for our clients, we’re seeking safety for our family members, we’re seeking to rid ourselves of addiction so that, ultimately, we’re all on the same page at the end of the day.  So, let’s not get caught up in how we’re getting there. Let’s stop reacting, and let’s respond together to this problem. Thank you.

DS:

Awesome.  I love that.  Asher, if people want to learn more about Transcend, where can they find you guys?

AG:

Please go to TranscendRecoveryCommunity.com or TranscendRC.com.  That’s “T-r-a-n-s-c (as in “Charley”)-e-n-d-R-C (Recovery Community).com.  And, please note, call us, ask us for resources. Say, “I have no interest in coming to your program.  I want resources. I want help.” We’d love you to come to our program, too. However, we want you to know that we are here to be a resource for help.

DS:

Excellent.  Thank you so much, Asher.

AG:

Have a beautiful day.  Thanks, Man. Bye.

DS:

Bye.

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