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Helping the Helpers

August 24, 2020
All Points North Lodge

Healing the Healers - Dr. Michael Schwartz, MD (Director of Addiction Medicine at APN Lodge) interviewed by iCAAD

Video Transcript

iCAAD: It gives me great pleasure to introduce to you today, Dr. Michael Schwartz. Dr. Schwartz is a medical director with many, many years of experience as a physician. He graduated as a doctor from LSU School of Medicine in 1980 and has worked in a very diverse range of roles before becoming Director of Addiction Medicine and Medical Director of the Concussion & Depression Center at All Points North Lodge. Dr. Schwartz, it's an absolute pleasure to have you here.

Dr. Michael Schwartz: Thank you very much.

iCAAD: First of all, do you think you could tell me a little bit about your role at All Points North?

Dr. Michael Schwartz: I'm the Medical Director here at All Points North Lodge. We have an integrated medicine approach to treatment, alcohol, and drug addiction as well as other mental health disorders, trying to address the whole patient in terms of body, mind, and spirit, trying to help establish healthy lifestyles, exercise, healthy diet, proper hydration, and, of course, avoiding toxins, which sometimes we call alcohol and drugs.

iCAAD: Of course, and Director of Concussion & Depression - I mean, that's a fairly unusual role or, in fact, specialty. Could you tell me more about that and the reason you have such a department at APN Lodge?

Dr. Michael Schwartz: Well, we do a great deal of mental health work here. In so many people, there's so much interaction and coexisting disorders. When it comes to dealing with substances or mental health, the crossover is enormous. A lot of people have suffered not only trauma emotionally, but perhaps physical trauma, and that oftentimes will feed into the picture. We're one of the few centers, I think, that has a hyperbaric unit that's coming online within the next few weeks as well as Deep TMS, and we do that all in-house here.

iCAAD: Do you find that the majority of your patients need both sort of working on you ... I mean, you mentioned it being an integrative mental, well, integrative health, essentially. So do you find that most of your patients benefit from looking at all aspects, including, as you said, the hyperbaric sort of part of the work or chamber or whatever it is that you use?

Dr. Michael Schwartz: I think it has been an exciting part of what we do here. I do find that if we take that whole medicine, whole individual approach, so many people who've been stuck with a diagnosis or avoiding a diagnosis of alcoholism or drug addiction or a psychiatric diagnosis, so many people have neglected their basic health. We work very closely with our medical community here in the Vail Valley, and they're usually seeing our patients in referral for things that maybe they've kind put off for years in some cases.

iCAAD: In terms of an integrative sort of overall look at someone's health, would you do hormone tests, and various nutritional tests, and all levels of how the body functions on everyone who comes in to see what's working and what's not?

Dr. Michael Schwartz: It's more focused on the individual, but yes, that's available for any patient who comes in. Sometimes, it's an evolving need. Sometimes, what a patient may remember to tell us when they first get here might change a little bit. They might, all of a sudden, remember, "I saw a doctor six months ago, and he said I might have had a traumatic brain injury." We might do neurocognitive testing. We might do some special studies at some of the surrounding facilities that we have.

iCAAD: I mean, I find it fascinating. I mean, the whole integrative sort of look at a person's health, especially mental health, to be honest, I think it's the future. I'm currently really randomly monitoring my blood sugar with what ... something called a freestyle ... something like a blood sugar monitor on my arm. I found, in the last few days, I can't get it over four, so I'm constantly in, essentially, a hypoglycemic state. I'm wondering ... I'm obviously going to do more tests about this, but that could really have been impacting my, sort of my sleep, and my sort of moods, and my just general wellbeing, and also my tiredness, because I'm constantly tired. You know? I think, just like, if that's the ... If it's to do with my really low blood sugar, then I can, now having monitored it, I now might be able to do something about it, which having not done those sorts of tests on myself, I wouldn't be able to sort of change that. I lived with that for many, many, many months or years.

Dr. Michael Schwartz: The more information, I think, that anyone can get on their own health, I think the better off they are, especially if you work with a physician in a preventative medicine approach. I think that is going to make a difference that you can't really measure, because if you prevent something, you don't get it. So it's kind of a difficult thing to measure, but we know that certain healthy lifestyles will make a difference.

iCAAD: Absolutely, and I think, obviously, drug and ... people who have drug and alcohol addiction or even serious mental health conditions, they don't ... Self-care becomes the very lowest priority, so in terms of nutritional health and ... Well, everything that looking after oneself involves just goes out of the window. So there is a lot of work to be done on that, those aspects of their lives, which is so important and often not ...

iCAAD: The most important thing people think when you go into rehab or treatment is the drugs and alcohol, and of course, that's important. That's a life-sort-of-threatening condition, but it's all the other aspects of someone's life that then helps them build those building blocks and stops them from relapsing eventually, essentially. When we discussed this conversation that we were going to have today, the topic that you brought to the table really to discuss was sort of healing the healers. I was wondering if you could tell me a little bit about why that topic interests you.

Dr. Michael Schwartz: Well, it kind of involves my own journey. When I finished med school, I went into an OB/GYN residency and was very involved in women's health issues, including preventative health issues, for many, many years. Eventually, a little bit of mix of physician burnout and some arthritis kind of got the better of me, and so did alcohol. Initially, that worked very well for my pain, and then it worked very badly. I, myself, needed to get help, and I'm very grateful for the people along the way who helped prod me in that direction.

Dr. Michael Schwartz: So many times, physicians, like me, will be very resistant, or other healthcare professionals will be very resistant to getting help. I guess we think we're immune, we have a special knowledge that can help protect us from the pitfalls, and that just doesn't seem to work out that way. The brain can be hijacked by substances, and that's for anybody. It's not just somebody you might see under an overpass or hanging around on the corner. It could be literally anybody. Most everyone I know has a close family member or a close friend who's struggled with addiction or substances, and that includes physicians and healthcare professionals.

Dr. Michael Schwartz: When I was getting into recovery, I learned a lot about helping other people, and the idea of helping someone else who's in the profession I'm in, helping, basically, all their patients, I thought was a very attractive thing to me. I did not want to go back into a high-pressure specialty and do a lot of surgery. I wanted to focus more on still helping other people, but maybe in a different way. I've worked closely with the Oregon medical and nursing boards and their professionals' health program. I worked with other state health programs, and we're developing a professionals track here at All Points North Lodge that I think will deal with the whole individual in a very special way and kind of take a lot of the stigma out of treating healthcare professionals.

Dr. Michael Schwartz: A great deal of what we do, it's not a punitive sort of thing that ... Some different licensing entities do take kind of a punitive approach, and we know this has been a disease. The AMA has been calling alcoholism and drug addiction a disease since the 1950s. So we're learning more and more about this as a brain disease, and as we get better at treating that, we find that we can actually help preserve our resources. Especially in this time of pandemics and other health threats, I think we want to have good doctors and nurses, and we want to help them with their problems.

Dr. Michael Schwartz: A great part of what I do is not just treat healthcare professionals, but advocate on their behalf with their licensing boards, with their hospitals, with insurance companies, if need be. I don't know that you guys have that same sort of situation over there, but we have kind of a strange system over here. It's pretty unwieldy at times, but we've made a lot of progress with that. I think as time has gone on, more and more licensing entities and monitoring entities are becoming more recovery-friendly.

Dr. Michael Schwartz: I think that's important, because so many people just delay. They say, "Well, I'll take care of that later, or, "I don't want anybody to know about this so I don't have to deal with all the stuff that goes with it." If I have any regrets about my own journey, it's that I didn't get help sooner and I didn't have anybody to ask. And so I always like to take that approach to be very open to talking to my patients, but especially to healthcare professionals, because they don't have anyone to ask a lot of times.

iCAAD: How, if you don't mind me asking, how long did it take you from the moment you knew you had a problem to actually getting help?

Dr. Michael Schwartz: I don't know. That's really hard to say. Denial is a big part of having a substance problem, and where the denial stops and with the realization starts is kind of a gray line. I'm sure, like pretty much anybody else, probably a couple years. It wasn't a matter of months. I imagine it was two or three years, and I thought, "Well, I need to do that, but I don't need to do that now." Like I said, I'm sorry that that's the approach I took. I wish I had reached out to other people.

iCAAD: Was it driven, as well, by not only just denial, but was there fear, fear of the stigma, fear of what might happen, fear of ... or was it literally that you thought, "This isn't a really, a big enough problem. I don't need help yet. One day I might need help, but not yet"?

Dr. Michael Schwartz: Absolutely. I think that was a big part of it. When we become adults, we have big responsibilities that go with that. Sometimes, we just see the responsibilities, and we do forget to do what you said, the very basic self-care and taking care of our own problems. I find that when people do get into recovery, they realize that if they don't take care of their own recovery themselves, they're not going to be able to take care of anybody else. They're not going to be able to support their family. They're not going to be able to be an active part of their community.

Dr. Michael Schwartz: It's a challenge, because that stigma is just ingrained for generations, that that's something no one talks about. That's the uncle no one talks about. That's the grandfather that you don't go visit. I think that, as time has come along, people are more cognizant of the risks that go along with it, and it has a huge health impact.

iCAAD: Well, I think what you're saying you're doing with the sort of insurance companies and with the licensing boards and making all of those sort of entities more recovery-focused or even recovery-understanding, I think that will have a big impact on the general stigma, because if they do ... If it's not immediate, you lose your license as soon as you come or you ask for help, basically, we will find, like you say, that these brilliant doctors and nurses who are struggling will be able to seek the help they need and then continue to practice from a much more informed and stable and a much healthier standpoint, because not only will they have sort of had the vulnerability and, at the same time, the strength to ask for help. they will also, then, be able to have experienced the recovery process, as well, which I think can add a whole extra dimension or layer to someone's ability to care for another person.

Dr. Michael Schwartz: I think that you've hit on something really there that's very important. I think that there's something that we sometimes refer to as professional distance, and I think that's fine. But I think you do need to have that connection with your patient, regardless of your specialty, whether it's addiction medicine, or whether it's any specialty. I would almost rather have a physician who's in recovery taking care of me than somebody I don't know about. That's not to cast dispersions on the average physician or anything. I think that most physicians, by and large, are very good about helping each other and helping their colleagues and maybe giving their colleagues a nudge when they think they might be struggling.

Dr. Michael Schwartz: I'd encourage them to do that. You're not being a bad person if you say, "My colleague is struggling," or if you talk to them themselves. It's something that doesn't need to be ignored. It's something that I think that, today, needs to be dealt with in a compassionate way. I think that healthcare providers need the same compassion that they give, and I don't think they always expect it. That's a shame.

iCAAD: Yeah. It really is. It's a real shame. Do you think, from your own experience and knowledge of the field, that there's a high percentage, higher than sort of average, I don't know if you will know the statistics at all, but of sort of burnout and mental health conditions and addiction issues within the healthcare provider industry, so among professionals within the industry?

Dr. Michael Schwartz: Oh. I think most studies do suggest that there's a higher risk of suicide, higher risk of addiction, higher risk of almost any stress-related response or an abnormal stress response. We all have coping mechanisms that are good, and we all have coping mechanisms that aren't so good. Alcohol and drugs seem to be part of that. Some of the behavior can be part of that. Mental health is a big part of that, as well. Some people struggle with certain backgrounds that have shaped them into who they are. They've developed unhealthy coping skills, and it's very hard to work with someone to have them release that as a primary first thought and to go with a better thought.

Dr. Michael Schwartz: Usually, I like to look at recovery as a big pause button. My first reaction and my first thought might not be a good one, but my second or third is probably a lot better after I have time to hit the pause button with my recovery and think about what I'm going to say or what I'm going to do next. That's different for me, and I think that's different for a lot of people. One of the things that amazed me when I got into recovery is how liberating that was. Now, there are a lot of people in the public, whether they're physicians, healthcare workers, whoever it might be who are in recovery, and you don't necessarily know that.

Dr. Michael Schwartz: I don't particularly make a secret of that, but it is something that's personal. I think some people, it's not that it's a big secret. It's just, that's not what they want to talk about or not what they want to be seen as. Me, I'm happy to be seen as a doctor who's in recovery. But not everybody wants to wear that, because we do tend to label each other. I think it was Søren Kierkegaard who said, "When you label me, you negate me. You don't see who I am." I think that that's part of the stigma that we've been talking about. The sooner we can release that, the better.

iCAAD: I completely agree, and I'm just going back to the sort of higher rates of suicide and mental health conditions and addiction within the industry for the providers. You talk about All Points North Lodge being a sort of fully-integrative healthcare provider and therefore preventative. Are there ways of preventing the obvious abnormal stress responses that clinicians and providers will inevitably come across in an extremely high-pressured and stressful job? Is there anything you can say from your experience of working with a vast quantity of clinicians who struggled with mental health and addiction issues? Are there things that you've learned that you could say, "Well, actually, perhaps, this, this, and this could have been done differently in order for the journey not to have ended up where it ended up?"

Dr. Michael Schwartz: I'm not really sure that that's possible. I think that, as long as humans exist, I think we're always going to have behavior outside the norm, coping skills outside the norm. I don't think there's a way to control that. I think education is the best thing that we can do. I think the more people know, the less stigma there is, the less fear there is if they are struggling themselves. They don't have to worry what someone's going to think if they see them in a recovery support meeting. That person's there, too. Why would you worry that they're going to think badly of you?

Dr. Michael Schwartz: I think that's probably the key to everything, is just more public awareness and education in terms of how to maybe better get help and access the services that are available. So many places in the world, the services are available, but they're underutilized. I think that's all about fear, which is part of the disease. The disease of addiction, we find the things that cause relapse are most likely to be, number one is resentment. Usually, it's a resentment of the person themselves. They just resent themselves, that they can't control their, themselves.

Dr. Michael Schwartz: The second is fear, fear of the unknown, fear of what may or may not happen. Once you can work toward moving past those things, I think you can reach a successful recovery or a successful life. Many of the principles of recovery are principles of many of our major religions and belief systems. There are four basic principles. I know people talk about 12 steps and different things, but it's really four basic principles. It's forgiveness of the past for others and for yourself, faith for the future, or optimism for the future, if you prefer. Trying to do the next right thing is what they call it in some recovery circles, or what I like to call acting with integrity in the moment. I don't have to worry about yesterday or tomorrow. I just have to do what I know is right at the present time. Then, the fourth thing is selfless service to others, and those four principles really make up the backbone of most major religions that I'm aware of.

iCAAD: I think you're absolutely right there, to be honest. Also, when you say that education is key, not only education about the fact that there are services available and that accessing recovery is not and shouldn't be something that is stigmatized, but also, I think of my son. I think of his schooling, and I think if only, at school, instead of assemblies and the, I don't know what they do, the Lord's Prayer or anything that they might do in their assembly in their morning, perhaps they could have a check-in, like a simple check-in. They sit around in a circle, and they ask how each one is doing.

iCAAD: If that could be a prerequisite to just the day, every day, where, as you get older, the same thing happens in university, and then, the same thing happens at work. You just all, everyone is used to having that sort of check-in, "Where are we? Where are you?" gauge the sort of mood and the feeling of each other, I think. Then, that is part of education, that just, as in yeah, just, that check-in is a really, just a normal part of daily life. That and meditation, for example, meditation practice or just a practice of sitting with yourself from school, like primary school-age children, I think that would be ... Personally, I think that would be such a great preventative measure for a lot of mental health issues and addiction issues for many, many people, personally. I don't know what you feel about that.

Dr. Michael Schwartz: Well, I think you're right, and I think not only does it help with, perhaps, mental health and with addictions. I think it helps with a lot of folks who struggle with chronic pain and some physical challenges. I think that taking time out ... I mean, our society has gotten so that if we have a feeling, we take a pill. What we're about is getting away from that sort of thinking, and you've hit on that exactly. What can I do instead? Can I sit quietly? When you let your body catch up with what you're experiencing, very oftentimes, your own endorphins kick in. That pain is not quite as bad, and maybe it goes away. Maybe you don't need two Tylenol. Maybe you need one. Maybe you don't need to reach for a narcotic, because you have other tools use.

Dr. Michael Schwartz: So I think that that's a very big part of things, but not just for mental health and not just for substance problems. I think finding your center is very helpful to so many people on so many different levels, regardless of the challenges they face, whether it's an orthopedic challenge or whether it's a cancer, and that's still with us. I think that there are a lot of people who've already discovered that at cancer support groups, meditation plays a big part of how they deal with their pain and with their fears and their worries.

iCAAD: Absolutely. Meditation, and then you just reminded me, is also like bodywork as well, massage. That really is really helpful for feeling a kind of connection and grounding, and it's something that I've also really benefited from, is that. Sort of, also, many, I don't know, for people with body issues and trauma, I think somatic work is really, really important. So that's another thing I think is kind of part of the recovery journey or could be part of someone's recovery journey. Is there anything else you wanted to sort of bring into the conversation about sort of healing the healer? Is there anything else that you ...

Dr. Michael Schwartz: I think that I'd just encourage people to not be afraid to talk about it with their family or their friends. Doesn't have to be in a punitive way or in a challenging way. It can just be in that, "I'm worried about you" sort of way, "What can I do to help? Is there something you need to talk about?" I think reaching out for another person, even though we're supposed to be six feet apart or two meters, I think it's still very helpful to have that heart-to-heart with another person. That's at the very essence of human beings in their interactions, and I think when you can express your genuine concern for another human being, amazing things can happen.

iCAAD: I completely agree, and you just mentioned the whole two meters apart rule and the sort of consequences, I suppose, of the pandemic that's happening right now. Are you noticing that, well, the fallout from it yet in the States, in terms of the mental health fallout, in terms of the ... I mean, there's ... There is, without doubt, going to be a rise in people seeking help. Interestingly, this being a conversation about sort of clinicians and professionals and healers within the industry, what's your sort of opinion on the levels of PTSD that we're going to see them sort of coming out of this with? I don't know. I don't know how it is in the States, really. I don't know the levels of crisis that you are seeing within the hospitals.

Dr. Michael Schwartz: I think that varies from place to place, as it does, I'm sure, in every country. There are some States, most recently I've heard that South Carolina is really struggling with people having a relapse and with overdoses. I think the overdose deaths that we see with certain drugs are certainly, have been excessive, probably greater than the losses we've had in the pandemic, would be what I've heard. I think that there are a lot of people who are maybe fearful. They don't want to go to a hospital if they think they have a problem.

Dr. Michael Schwartz: I think we may have all heard about the story of the person who may have had a heart attack because they wouldn't go to the hospital because they were afraid they'd catch a virus. So I think it's had a real impact on healthcare worldwide. I wish there were a better way to deal with it, but I know we've seen it in people struggling with mental health crises as well as people struggling with relapse for alcohol and drug addiction. It's just, it's been tragic. The PTSD you mentioned, we're already seeing it. One healthcare worker I'm treating currently comes to mind, who's been on the front lines and who just, he can't go back. The impact has been so severe on that individual that it's painful to see another person's struggle that much.

iCAAD: Bet it is. I can just, it just doesn't bear thinking about really, the seeing, I suppose, the continuous death, the people sort of struggling to breathe, even. You talked about fear, and you mentioned that fear is, is one of the driving factors of addiction. I completely agree, resentment and fear, fear of what's to come, fear of what you've done. Then, you talked about learning to sort of sit with yourself and be with yourself and that ... We then talked about connection, and the check-in, and how it all sort of links up to the ... Perhaps, if you can do that, you might take just one Tylenol instead of two, and I think ...

iCAAD: I read a really interesting article not too long ago, which was discussing the fact that pain medication, be it Tylenol or just even Paracetamol, you ... A lot of people, they start using it for a broken leg or a bad back or something, but it becomes a medication that can actually, it's ... I don't know how, but it can help feelings of loneliness. It can help feelings of discontent and depression, and this pain medication, the pain is not only physical. Pain is emotional, and pain is also ... Emotional pain can be visceral, therefore, can be physical. Therefore, taking a Paracetamol or a Tylenol for emotional pain, it will still actually relieve it and reprieve it. Do you think that ... Have you come across that, that people take these prescription medications for their emotional pains?

Dr. Michael Schwartz: I think that that's a large portion of what people do, or at least how they get started and develop a habit. You know? So many people say, "How could that happen?" or, "How could that happen to me?" or, "How could that happen to you?" But it is that sort of thing. We might turn on the television and see, "Have a feeling, take a pill. You have a problem. We have a solution." Not every solution comes in a bottle, but we do get in that habit, and I think it's very widespread. I think that so oftentimes, we will see someone who ... I know, for instance, opiates. You mentioned if someone has surgery or has a broken leg, and they're taking some pain pills for a period of time.

Dr. Michael Schwartz: Opiates really don't do that well for pain. They might help a little bit with acute pain, but they don't really treat pain as well as they just kind of make you groggy, and they ... They are a great antidepressant, except that they're habit-forming antidepressants, so they're not used for that. That would be a bad idea. But so many people say, "Gee. I feel better."

Dr. Michael Schwartz: When I was doing surgery. I usually had a little clue. I would see people back for an incision check a couple of weeks after their surgery. Some patients would come back, and they'd say, "I sure hope I don't have to take any more of those pain pills. They ... terrible." They cause people to have all sorts of GI effects and stuff. Those folks I wasn't worried about, but the folks came back and said, "Those pills make me feel great," that was kind of a little warning sign. And so I've been dealing with addiction for many years, even before I subspecialized in addiction, and it's just a variation that we have from person to person.

Dr. Michael Schwartz: Some people are very sensitive to things. Back in the early days of AA, they called it an allergy to alcohol. Now, that's not exactly a bad analogy. It's not exactly that, but it's kind of similar, that some people have a tolerance and some people do not. If we could predict who had that problem, that might be interesting. There are some folks who I think are working on that may think they know how to predict that, but I don't think you can really predict what's going to happen. You might be able to predict a potential. What, actually, the future holds, I don't think anyone knows.

iCAAD: Do you think that we ... it's possible to predict a bit more, because if we're talking about the people who came back to you after they'd had the surgery and said, "Wow. I feel a lot better than I did before the surgery, and not only because of, obviously, you fixed my leg or my arm or something, but actually, I feel mentally a lot more, a lot better, a lot more secure," those people possibly had some sort of emotional pain prior to the surgery. So that, I suppose it's emotional pain that is a predictor of potential addiction, or could be one of the ...

Dr. Michael Schwartz: I think that's one factor, for sure, and we do see a lot of crossovers. What starts first, the substance problem or the emotional problem that's attached to it, I don't know. That varies from individual to individual. Some people have a primary diagnosis that's more substance than mental health, and so many other symptoms, situational depression, drug-induced anxiety, or hyper anxiety states, all those things are real. But so are some of the mental health problems that we see, generalized anxiety disorder, PTSD.

Dr. Michael Schwartz: Bipolar disorder is very interesting, and I think that's probably overdiagnosed. For some reason, the sound of it appeals to some patients, I guess. I don't know. I am not a psychiatrist. I work with some excellent psychiatrists, and I leave that to them. But I work with them side by side, and we do help a lot of folks with that sort of struggle. Sometimes, it takes quite a while to tell where the primary is. It might take a couple of months before we really know what someone's like without substances in their system and what their real baseline mental health status is.

iCAAD: Well, that sort of brings me to another question, I suppose. If it can take so many months to know where their baseline is, how many months would you recommend, or how long do you recommend someone spends in treatment? Because, obviously, the typical time is 28 days, but that, as we know now, was sort of put in place by insurance companies and because of, I don't know, something to do with your military, or I can't really remember the story of why it was 28 days. But how long would you recommend?

Dr. Michael Schwartz: I think that's going to be based on the individual and based on their problems. If they have a coexisting disorder, it could be longer. If not, some people, that's a good start. They may start with 28 days of residential treatment and then go to intensive outpatient or partial hospitalization where they go home, but they do come at least three to five times a week for hours at a time. Sometimes, they spend full days, sometimes half days. I think that the third-party payers do try to push people out the door when they can, and I guess they don't want people to abuse the system. But the problem is it hurts some of the people that they kind of push out the door.

Dr. Michael Schwartz: Unfortunately, I've also seen systems where it doesn't even make it to 28 days. Some programs only keep people 12 days, 14 days. I don't think that's enough time. I can tell you that. But if you think about how the body heals, I used to do a lot of surgery. Well, I know that if I did a surgery and I made an incision, that incision was going to be, at six weeks, four to six weeks, that incision would have been about 30 to 40% healed. That's at four to six weeks, only 30 to 40% healed. When we're talking about the brain, not your abdominal wall, now, at six months, that incision in your abdomen is going to be 90% healed. Then it's what, about 1% a month after that. So it takes two years for a scar to fully mature on your abdomen, and your skin cells aren't nearly as specialized as your neurologic cells. And so I think it takes a long time.

Dr. Michael Schwartz: I do like to see people get the treatment that they need. I wish there were fewer barriers to that treatment. I know if we can get somebody to stay 56 days instead of 28 days, their chances of a sustained recovery go up if they have been, particularly if they've been traumatized, which is a big part of what we do. So many people who struggle with substances are medicating away the emotional pain from months before or years before. If we don't treat that underlying trauma, it's almost a setup for relapse, and so we focus on that a great deal and have a real strong trauma track here.

iCAAD: That's brilliant. I think that's really important, as well, and also, I just want to say thank you so much for that analogy relating sort of recovery to the recovery from surgery. You're absolutely right. I've never had anyone sort of link the two, and it makes so much sense. It takes that long, two years, you said, for our abdominal wall to scar well, to heal properly, albeit slightly changed, perhaps, but still to heal, and of course, that's what our brains have to do. I've never heard anyone sort of relate it to that, and so that was really interesting. Thank you very much.

Dr. Michael Schwartz: Well, an old term that used to be used before is if you reach two years of sobriety or two years of abstinence, you may have reached longterm sustained recovery. That's not really something, the terminology we use anymore, but I think it certainly did ring true for me, that when you reach that two-year stage, if you can stay with your healthy habits, if you can do the things that you need to do to stay healthy, pay attention to your self-care, try to help other people do the same. I think that's kind of what it's about.

iCAAD: I've heard that, as well. I've heard that the neural pathways in your brain take that long to change from all the maladaptive things we were doing and all the dysfunctional things we were doing in order to simply survive, because that's what it was when you're in active addiction. I think it's, you're trying to survive with whatever coping mechanism you've got. But that, then, changes those neural pathways, and you're doing things to survive that are dysfunctional. If you can start doing things that are functional and change the neural pathways to something that works, but it takes that, though, that period of two years. I think, personally, I think I would agree with that, as well. You say it's not something that we discuss or talk about much anymore, but that's a shame, because I think that's been my experience, too. Well, I mean, thank you so much for this conversation. It's been an absolute pleasure talking to you. It really has, and I very much look forward to seeing you, well, again.

Dr. Michael Schwartz: Thank you so much. I really appreciate the time. It's been a delightful time for me to spend with you. Thank you.

iCAAD: Speak to you later. Thank you so much.

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