[0:33] Stephanie Wittels Wachs: If you are just joining us for the first time, this episode will make the most sense if you start listening to Last Day from Episode 1. I might stop repeating this message at the top of every episode at some point, but obviously, that point has not yet arrived.
[0:53] Stephanie Wittels Wachs: Rewind to Episode 2. Not literally, just in your head. Or literally, if you want to, but come back. So it’s Spring 2009. Stefano was in Guangzhou with his MBA program and he was on the top of this skyscraper when he had a very intense panic attack. He called his mom, Doreen, freaking out and begged her not to tell anyone.
[1:20] Doreen Cordova: He called me and said, ‘Mom, I can’t move. I just can’t move and I can’t talk. And I’m afraid and I don’t want you to get off the phone. And I don’t want you to tell anyone.’
[1:35] Stephanie Wittels Wachs: But she’s a mom, so of course she panicked and of course she told Jess — her daughter, Stefano’s sister and our executive producer. And Jess is a Grade-A doer, and so she pulled some fancy Grade-A-doer strings and got her little brother home swiftly and safely.
[1:58] Jessica Cordova Kramer: We essentially had him evacuated by the State Department, put home on a plane and escorted home.
[2:05] Stephanie Wittels Wachs: See? Grade-A doer.
[2:09] Doreen Cordova: He was furious. Told me, ‘never talk to me again.’ There were many moments that he told me he would never talk to me again. And so it was rough. It was rough to be his mom and to be — try to live a life as well. Even now.
[2:31] Stephanie Wittels Wachs: When he got home, Jess and her family discovered that Stef’s panic attack was less of a panic attack and more of a withdrawal from prescription opioids.
[2:42] Doreen Cordova: I just felt that something was wrong, you know. And he said he had bad stomach problems. And that’s when I knew — that’s when we had the intervention?
[2:53] Jessica Cordova Kramer: Yeah, It was right after he got back from China.
[2:57] Stephanie Wittels Wachs: So, all of a sudden, their world was flipped upside down. They had to figure out what to do and how to help him, and they had to do it immediately.
[3:08] Jessica Cordova Kramer: I had seen A&E’s ‘Intervention’ and I sort of had a loose understanding that if someone is struggling with this, you have to really pull them aside — and this was like before Google was really big. I think it was like Ask Jeeves-era, potentially. So it wasn’t like you could Google ‘great interventionists near me.’
[3:27] Stephanie Wittels Wachs: Jess ended up calling a treatment center in Minneapolis called Hazeldon, which has now merged with the Betty Ford Clinic. They’re all over the place. Hazeldon gave Jess a few references, and she ended up hiring this youngish guy named Michael. Michael was based elsewhere on the east coast, so they had to fill him in on all the details super fast and then fly him to New York City, where Stefano had been admitted to a hospital to detox.
[3:58] Jessica Cordova Kramer: It cost five thousand dollars, which seems like both a lot of money at the time but like you just don’t really pause to consider the cost. You’re like OK, if this works, great. If this doesn’t, that sucks, but like we have to do this.
[4:14] Stephanie Wittels Wachs: And they did.
[4:16] Jessica Cordova Kramer: We did a full-on intervention in the hospital. Stef was on a hospital bed. And you know you go around, you say your piece. I think I had something written down about how much I loved him and I wanted to have him in my life, and this thing that he was doing, that he was not taking seriously, was going to turn into something worse. And we’re gonna give him this opportunity to go to Hazelden in Minnesota. It was emotional. Stef was — he looked frustrated — not, not at all at his rock bottom. He made a joke about how we could have sent him to Malibu, because I think at the time like ‘Celebrity Rehab’ was really popular and, you know, if you saw rehab facilities, they were on the beach and we were sending him to Minnesota.
[5:02] Stephanie Wittels Wachs: But he went the very next day.
[5:07] Jessica Cordova Kramer: The interventionist doesn’t take you. You just get on a plane, you go. I think Hazelden picks you up at the airport. He went over to the facility, checked in, started the program, checked himself out the next day and came home.
[5:28] Stephanie Wittels Wachs: Yep. All of that work, and money, and time, and toil amounted to one night in treatment. This isn’t unusual. In fact, it’s typical. And it’s precisely why these sorts of interventions can be so tricky. Because relapse is part of the disease. So being coerced into going to treatment before you’re ready doesn’t always yield the most stellar results. Don’t get me wrong, I understand with every cell in my body why they did the intervention and I don’t believe for a single second that they were wrong to do it. Stefano was sick. He needed help. They called the experts. They got him help. Simple. But, again, when you’re talking about addiction, nothing is simple.
[6:36] Doreen Cordova: I just didn’t know how to deal with it — you know, how to help him, what the answers were. You know, we did a traditional intervention and he stayed one day. And so it was all these things that I realized that I had no control or no cure. I just didn’t know what to do.
[6:58] Stephanie Wittels Wachs: I’m Stephanie Wittels Wachs, and this is Last Day.
[7:07] Stephanie Wittels Wachs: The last time I saw my brother Harris was December 2014 when he flew home for the holidays. I’d love to say that I went into it with boundless holiday cheer, but the real version is that I was notably pissed at my brother and his inability to stay sober and not ruin our lives on a daily basis. Which sucks to admit. It would be so much easier to act like my saint-like compassion never faltered, but honestly? I was just so sick and tired of all of it. By this point, he’d already completed two 30-day rehab programs, but I knew he had relapsed again. I knew he’d been using again. And I knew he’d been avoiding coming home because of it. He skipped Thanksgiving that year, my daughter’s first Thanksgiving, mind you. Sent a text to our mom the day he was supposed to get on a plane saying he wasn’t coming. He said:
[8:18] Maureen Davidson Wittels: “Mom, I love you and I’m sorry, but I don’t think I can come home. I had another relapse and was scared to tell you, but I’m dealing with it and just not in a place to come home and pretend everything is fine. I’m sorry I’m such a fuck-up. I really wanted to be with everyone. I’m not trying to hurt you guys. I’m so sorry.”
[8:44] Stephanie Wittels Wachs: That was my mom, reading the text. I remember feeling a lot of things when she read that to me over the phone, but rage was at the top of the list. I screamed and sobbed simultaneously. A scrob, if you will. And once the scrobbing started, any semblance of having my shit together completely fell apart. Harris promised us that he would come home on Dec. 2nd, so I put my rage on simmer and waited. Of course, he postponed to the 9th, then the 11th, and finally got on a plane and made it back to Houston on Sunday, December 14, 2014. I remember that night so vividly. He was moaning and writhing in pain. His body temperature was up and down. There was sweating, shivering, aches and pains, nausea and occasional vomiting. It was the worst thing I’d ever seen, worse than anything I’d ever imagined. I just sat on the edge of the bed, holding his hand, trying not to audibly weep. My worst nightmare was that I would lose him, and it felt closer than ever in that moment.
[10:27] Stephanie Wittels Wachs: We didn’t say much, maybe nothing. I remember I mostly just sat there and shared the space with him. And what I understood, what I finally saw, in this moment was that he was really sick. This was a physical response to withdrawal. It was horrific. And it warranted medical intervention. More on what that looks like, when we come back.
[13:26] Stephanie Wittels Wachs: We’re back. I’m Stephanie Wittels Wachs, and this is Last Day. What Harris was experiencing was opioid withdrawal. And it was so painful that he agreed to go to the hospital for a few days to get the drugs out of his system under medical supervision, a process that’s called detox.
[13:54] Dr. Nzinga A. Harrison: So to describe detox I’ll actually describe to you the phase of the illness that leads a person to need detox. And so in our bodies we have this system that’s really called receptors. And different receptors throughout your brain and your body send different messages. And so the receptors in the body that pain medications and other opioids attach to are the opioid receptors. And opioid receptors send a message that calms physical pain but also a message that calms emotional pain.
[14:27] Stephanie Wittels Wachs: This is Dr. Nzinga A. Harrison. And if you couldn’t tell by all of her fancy medical jargon, Dr. Harrison is a physician in Atlanta who specializes in adult psychiatry and addiction medicine.
[14:42] Dr. Nzinga A. Harrison: I’ll take it out of the substance use disorder realm for just a second. If you eat breakfast every day at 8 a.m., at 7:45 a.m. your body will start to prepare itself for breakfast. And then if you don’t eat you will be ragingly hungry at 8:30 a.m. But if you don’t eat breakfast for a few days at 8 a.m., 8:30 a.m. will come and you won’t be hungry because your body has adjusted itself to that pattern. And so if you’re regularly using an opioid, your body actually adjust its receptors to expect that regular daily dose of opioid. And when that disappears you have a withdrawal syndrome, which is as a result of the opioids not being there. And it is it’s excruciating bone pain and joint pain. It is watery eyes. It is runny nose. It feels like the flu. It is nausea, vomiting, diarrhea. It is tremor. It is elevated blood pressure. It is elevated heart rate. And so you can think of it like if you had a severe flu, and there was a substance that could take away your flu symptoms in a matter of minutes, you are compelled to take that substance. And so we detox people by using opioids and slowly decreasing the dose so that the receptors in your body don’t fall over the cliff. They just slowly ratchet down that response and we can prevent that withdrawal response, which then makes it easier for a person not to relapse to using.
[16:13] Stephanie Wittels Wachs: That was legitimately the best description of detox I’ve ever heard. Truly.
[16:20] Dr. Nzinga A. Harrison: Well, I’m glad to be of service.
[16:21] Stephanie Wittels Wachs: No, I’m telling you. I mean, I witnessed my brother going through withdrawal and I have never in my life to date seen something as horrific.
[16:35] Dr. Nzinga A. Harrison: Yeah. It’s interesting when you see a person in a severe withdrawal syndrome — like, it is literally impossible as a human to see another human in that much pain and not want to do something. Like you’ll even find yourself thinking like, ‘is there something I can give you to make this pain go away,’ right? And then you develop the empathy for what it must be like to be inside that pain. And for so many individuals that have an opioid use disorder, there is a point at which it is no longer about intoxication. Right? It is about not being able to survive the pain of that withdrawal syndrome.
[17:16] Stephanie Wittels Wachs: Right. It’s like it’s a total survival instinct to keep using, because I mean, yeah — I mean I remember watching ‘The Basketball Diaries,’ you know, as a teenager, and seeing Leonardo DiCaprio play the character and thinking, like, ‘that’s over the top. You know, it’s not really like that.’ And then seeing it up close and be like, oh, it is exactly — actually, it’s worse. Actually it’s worse. So, how many days does it typically take to detox? I mean is there like an average?
[17:45] Dr. Nzinga A. Harrison: Yeah. So the short answer to that is three to five days. Like, your body is pretty resilient and can adjust to new conditions pretty quickly, so the general standard we use is that we’ll find the dose of medication that kind of stops the withdrawal syndrome in its tracks, and then taper approximately 20 percent of the dose per day. So you figure 20 times five gives you about a five day taper.
[18:09] Stephanie Wittels Wachs: FYI: She’s talking about medication-assisted detox, not to be confused with going “cold turkey.”
[18:18] Dr. Nzinga A. Harrison: The caveat to that answer is depending on which opioid was being used — and I should say the same concept applies to alcohol withdrawal, which actually is deadly. So one out of five people who develop delirium tremens — which is the severest form of alcohol withdrawal — if not treated, will die. And so the difference for the opioid use disorder is if you’re using a shorter-acting opioid like heroin, then you will have a short detox. If you’re using a longer acting opioid, like a sustained-release Oxycontin or methadone — because those take longer to come off the receptor and get out of the system — we may have to extend the detox to get fully on the other side of the withdrawal syndrome. But the short answer is approximately three to five days.
[19:09] Stephanie Wittels Wachs: So after that three to five days is done, that’s just the beginning. That’s just the beginning.
[19:17] Dr. Nzinga A. Harrison: Yes, that is just the beginning.
[19:24] Stephanie Wittels Wachs: Seeing how fucking terrible it feels to go through detox, it’s easy to understand why it’s such a tough sell. Like, yes, please take me off of this thing that feels as critical as oxygen so that I can voluntarily put myself through the horrific experience of what feels like I’m dying of the flu! That sounds awesome! Thank you! Said no one ever. So, knowing that, how do you get someone to voluntarily choose to go through it? Jess mentioned this show ‘Intervention’ when she was trying to figure out what to do about Stefano. My brother and I also used to watch this show, which is now in its 20th season. It used to be one of our favorite shows. Here’s how it goes down. In every episode, they feature someone who is majorly struggling with some kind of substance use disorder. They show their lives spiraling out of control. And they show how distraught their families are, and how they’re destroying everything, and tearing through the city and wreaking havoc and destruction along the way. And then they trick the person to come to some hotel conference room where their families are waiting to ambush them. And there’s an interventionist present, and everyone reads these letters they’ve written about all the ways the person’s addiction has hurt them. And then the interventionist basically delivers this ultimatum that the person has to go to treatment right then and there — be separated from their families, spouses, kids, jobs, loved ones, all of it — for however long the program is, and if they can’t agree to those terms, they can kiss their relationships with their family goodbye.
[21:16] Stephanie Wittels Wachs: And like, during the whole show, there’s like, this super dramatic music that underscores every super tense moment, of which there are many. OK, so, it’s like this: ‘If you don’t go to treatment today, we will no longer have contact with you. You will no longer have a home to come home to. You will not be able to see your child or your dog until you test clean for 6 months and even then, you will only be able to have supervised visits. We will contact CPS today if you don’t go. Will you go to treatment today?’ We’ll get their answer — when we come back. Just kidding. We won’t get their answer. This isn’t real. But we will continue with our show, after the break.
[23:22] Stephanie Wittels Wachs: We’re back. This is Last Day, the podcast. And we’re talking about ‘Intervention,’ the TV show. Admittedly, it makes for really good TV. I mean, it’s gripping. Your eyes are peeled to the screen, watching this huge climactic build-up to a yes or a no. But in real life, not in TV land, there is some debate among experts about whether or not this is really an effective way to do things.
[23:58] Dr. Robert Meyers: No. That stinks. We had clinical trials and we brought in psychiatrists to be the supervisor, who believed in that type of intervention, and we brought in therapists. And then that was one of the groups we did, and the other group was CRAFT.
[24:14] Stephanie Wittels Wachs: That is Robert Meyers. He’s a doctor who came up with an intervention method known as CRAFT — Community Reinforcement and Family Training — and in his data-driven, science-y opinion, CRAFT is a more effective way of getting your person into treatment.
[24:32] Dr. Robert Meyers: We had clinical trials and what we found was that we get somewhere between 65 and 76 percent of the people in treatment. And those intervention styles you talked about — even when we looked at their own research — they never got over 30 percent of those people into treatment because that last confrontational day that they, you know, have that all that stuff written out about all the horrible things they’ve done. That’s not motivational for somebody.
[24:59] Stephanie Wittels Wachs: Right.
[24:32] Dr. Robert Meyers: You know, you tell him everything he’s done wrong in his life? He’s not stupid, he’s just using drugs, you know?
[24:59] Stephanie Wittels Wachs: Right, it’s like the worst thing you can do! Like, you’re a terrible person.
[25:10] Stephanie Wittels Wachs: I need to jump in here and clarify that CRAFT is not a treatment center or a rehab program. It’s like a long-form couple’s therapy approach to an intervention that Robert designed to help family members get their loved ones, who are often resistant, to go into treatment. But it’s equally, if not more, important for the family member who comes to Robert for help to deal with their own shit. And let me tell you, speaking from personal experience, there is plenty of shit that needs to be dealt with.
[25:45] Dr. Robert Meyers: Well, a big piece of CRAFT is helping the individual who comes in and who’s a total wreck from trying to help somebody stop using opiates or something, and finally somebody listens to her. And so she starts telling us her story and we work on that a bit and we help them learn new strategies and new techniques. One of the quickest and easiest things is when someone comes in and they’re stoned or they’re drunk or they’re nodding or whatever, don’t get into a fight with them, don’t argue with them, don’t call them names, whatever it is. Just say something like, ‘I’m glad you’re home safe. I think I’ll go to bed. Maybe we can talk later on.’ And just remove yourself and don’t get into that fight.
[26:26] Dr. Robert Meyers: Another thing we do is, even if this woman doesn’t get her son or daughter or her partner into treatment, somebody finally lets her know it’s not her fault. She’s just trying any way she could to try to get this person to go into treatment. And, you know, most people don’t really know how to do that. And so they yell, or they get into fights, or they make statements that they can’t keep, like ‘if you do it one more time, I’m going to kick you out of the house.’ And then they don’t do it and all that does is empower the individual who is using the drug. So they feel like, ‘she’s not going to kick me out, so I might as well keep on getting high.’
[27:00] Stephanie Wittels Wachs: Quick time-out. You may have noticed that Robert refers to his clients as “her.” That’s because the vast majority of the people who come to him are women. He refers to his client as the CSO and the person with the addiction as the IP.
[27:16] Dr. Robert Meyers: The CSO is the concern significant other. So she’s concerned about a family member. And the IP is the identified patient. And the second thing you do with the IPs, of course, is when they come into treatment, you say things like, ‘you don’t have to do anything that you’re not ready to do here, period.’ And that’s a silly statement because I know from experience after 44 years — people only do what they want to do anyway.
[27:44] Stephanie Wittels Wachs: Right.
[27:45] Dr. Robert Meyers: But when you say that, it gets rid of some of their anxiety that we’re going to make them do this and we’re going to make them do that. Also with CRAFT we have things we call happiness scales. This is talking to the IP now. So we have a list of all kinds of items on that thing — you know, spirituality, money issues, relationship issues, anxiety issues — and we let them pick and choose what they want to work on. And we tell them that — ‘you don’t have to work on that, we’re going to make a list for you. And if you don’t like the categories, we’ll use different categories because it’s your program. And you can move at whatever pace you’d like to move. And I’m going to be here with you. And even if you make mistakes, that’s cool. You know, I’m not going to kick you out if you do something that we don’t like. I’m just gonna say OK, let’s find out why you do that as opposed to doing something different.’ Because a lot of programs kick them out because they get high. And the bottom line is the people who get high and can’t stay sober right away, they’re the ones who need our help more than anybody!
[28:45] Stephanie Wittels Wachs: That’s the disease.
[28:46] Dr. Robert Meyers: Yeah. So you kick them out! I mean how stupid is that?
[28:50] Stephanie Wittels Wachs: It’s ridiculous.
[28:46] Dr. Robert Meyers: It is ridiculous! And see in America, either you’re a horrible person because you drink or do drugs, or you’re great because you’re sober. So the bottom line is if you treat somebody with respect and dignity and let them pick and choose what they want to do — they know more about how they want to get sober or why they want to get sober than we do. Sometimes I ask a CSO to bring in a scrapbook of their 18-, 20-year old daughter who’s drinking every day or having other problems. And I’m looking at the book and I’ll say, ‘tell me more about this.’ And she says, ‘oh, she was so cute, and she was such a good kid, she did this, she did that.’ And they talk nothing but in the past tense. So I say, ‘well, did you potty train them?’ Oh yeah, yeah. ‘Did you teach them how to ride a bicycle?’ Oh, yeah, we did that, too. I say, ‘well, this is just another thing we have to help them learn, is to not use drugs.’ As opposed to making them out to be a horrible person. It’s the same person that you said was wonderful in this picture, in this picture, in this picture. Now you have to look at it like it’s the same girl — the same woman now. But the bottom line is you know we can’t throw her out just because she’s having a problem. Let’s solve the problem.
[30:02] Stephanie Wittels Wachs: So I want to know — somebody identifies that their loved one has a problem — what happens after a CSO finds CRAFT? Walk me through that.
[30:11] Dr. Robert Meyers: When they come in we let them talk about things. And sometimes we have to spend special time with them to let them know that it’s not their fault, that they didn’t cause the problem, and they’re not a bad person. And then once they kind of get over that a little bit and start to trust you a little bit, after a four or five sessions, you say I wonder if we could start looking at ways to let your IP know that you’re in treatment. Is that something that’s safe? Is there domestic violence? Before I ask you to go home and start changing things, I want to make sure you’re safe. Because you’re my client, not the IP.
[30:41] Stephanie Wittels Wachs: This is an important distinction. Yes, Robert absolutely wants to help his clients get their loved ones into treatment. But his focus is first and foremost on the well-being of the concerned significant other. The well-being of the IP stems from his work with the CSO.
[31:02] Dr. Robert Meyers: You know, the best thing that can happen to a CSO is that the IP notices that she’s changing something and she’s changing it in a positive direction. She’s not yelling anymore. She’s trying to get them engaged in some of the things that they used to do and try to connect back with family members. ‘Why don’t you come with me?’ And the thing about it is, let’s just try it one time. Come one time with me, see what happens. And it’s up to you. And if you don’t want to come back, you don’t ever have to come back. But if you do come back, just to let you know, no one’s going to give you a hard time here and you can work at your own pace. Basically, we’re trying to do an intervention and getting somebody into treatment but we’re doing it in a compassionate way, in a way that won’t harm people more by making them think of all the horrible things they’ve done in their life.
[31:48] Stephanie Wittels Wachs: This is how CRAFT is so different than the old-school form of interventions. No one’s saying the IP hasn’t done horrible things or that the CSO doesn’t have the right to be sitting on a mountain of anger and hurt as a result. And those horrible things can and should be dug up and dealt with. But if the goal is getting your person into treatment, leading with the horrible things just isn’t the best sales pitch.
[32:29] Dr. Robert Meyers: That’s certainly something we can talk about, but let’s wait a little bit until you have some stability with — you’re not using drugs for a couple of months, and then it’s easier to deal with those kinds of things. And then maybe we can send them off to AA or a self-help group, you know, but once they get their selves together. You know, being mean to people and yelling at people and arguing all the time, that’s just not going to cut it. It just doesn’t work. That’s the thing, I mean, when we get papers and read scientific papers from Europe, it’s heroin ‘misuse,’ cocaine ‘misuse,’ as opposed to talking about drug ‘addicts’ and, you know, ‘junkie,’ and you know — they don’t use those terms over there. But in America? You know, carry a big stick and they use it with them.
[33:10] Stephanie Wittels Wachs: Shame city. Shame city.
[33:12] Dr. Robert Meyers: Exactly. Exactly. I don’t care what you’ve done. So what? You are a human being. So let’s talk about it. You know, a lot of confrontation. You know, ‘you gotta do it my way or hit the highway’ stuff. I mean, come on. This is the 21st century, you know, so you’ve got to start treating people the way they deserve to be. I don’t care if they’re homeless, I don’t care what they’ve done. If they’re in and they want to try to help themselves, they want to change their lives, then we need to help them, period.
[33:41] Stephanie Wittels Wachs: In theory, that makes all the sense in the world. We love them. They need help. We give it to them. Period. But it’s complicated. Your person has to want it. They have to be ready and willing to go. And once they’re actually there, how does it all work? How long does it take? How much does it cost? Where does it happen? How does it happen? What’s the best kind of program? In-patient, out-patient, 30 days, 60 days, 90 days, locked in a basement for eternity?
[34:21] David Sheff: We talk about, you know, if someone’s addicted you’ve got to send him to rehab. But there really is no definition of what rehab is. I mean, there are programs right now that cost a fortune and some that are free that are appalling. They do things like 12-step programs, walks in nature, you know, I mean stuff that is not how you treat a disease. And so you know rehabs are unregulated, and in many places anybody can open a rehab without any credentials. I could go open a rehab and then take people’s money and offer treatments that include, you know, I mean in some places you go out and — you know there’s there’s one where they give patients Nerf noodles, I guess they call them. And you know, you confront a horse with them.
[35:07] Stephanie Wittels Wachs: Um, what? I mean, listen, not to beat a dead horse with a Nerf noodle, but what a fucking rollercoaster. For the CSO. For the IP. For everyone. One go-round in treatment isn’t typically enough. It often doesn’t “work.” And you can’t see me but know that I’m saying “work” in air quotes because this language isn’t super helpful according to Sam Snodgrass from Episode 3, who knows everything. So, what does — air quotes — “work?” In our next episode: Treatment.
[36:02] Stephanie Wittels Wachs: Last Day is a production of Lemonada Media. It’s produced by Justine Daum. Jessica Cordova Kramer is our Executive Producer. Jackie Danziger is our consulting producer. Kegan Zema is our technical director. Our music is by Hannis Brown. Special thanks to Kat Aaron for all her help this season and Westwood One, our ad sales and distribution partner. You can find us online @lemonadamedia. That’s Lemonada, spelled L-E-M-O-N-A-D-A. If you liked what you heard today, tell your family and friends to listen and subscribe, rate and review us on Apple, Spotify, Stitcher or wherever you get your podcasts. And check out our show notes for a deeper dive into what you’ve heard today and how to connect with the Last Day Community. I’m Stephanie Wittels Wachs. See you next week.