Rapid Detox Unveiled: The Science & Success Behind Waismann Method Opioid Treatment

In this insightful episode of the Waismann Method Podcast, Michael H. Lowenstein, MPH, M.D., and David B. Livingston LMFT discuss the real science of rapid detox, the physiological and emotional intricacies of opiate dependence, and the recovery process. Dr. Lowenstein highlights the importance of understanding a patient’s underlying health conditions and emphasizes the need for a thorough medical evaluation prior to detox. He also discusses the challenges posed by street fentanyl and the dangers of relapse after detox. David Livingston delves into the emotional challenges faced by patients and stresses the importance of post-detox psychological support. Both experts champion the holistic approach of the Waismann Method, where medical, psychological, and emotional aspects of recovery are seamlessly integrated.

In a world filled with exaggerated claims, it’s vital to understand what real, safe, and effective opioid detox looks like. Equip yourself with knowledge and discern fact from marketing fiction.

Dwight Hurst, LPC: The spinny circle has ended and we are started. Glad to be here with both of you and anybody out there who is watching or listening. Welcome back to Addiction, Recovery and Mental Health, a podcast by Waismann Method Opioid Treatment Specialists. This is a special episode where for one reason is because of who’s joining us, but also because we are recording the video and audio of this and it is being released on both mediums. If you’re hearing us on the audio podcast, just be aware, you can check the social media or you can go to our website opiates.com and check that out. There will be links and things here to be able to watch the video. Here we are at opiates on all the social media as well that you can find out there on your Instagram and your Twitters or whatever that’s called now. So glad to have all the people viewing as well as listening. And we are doing a little bit of a reintroduction. We’re here with you a couple times a month, but I’m going to going to let everyone know, especially if you’re joining us for the first time, who we are joined by, which is really exciting. I like to go you know, I like to start with the least qualified person in the room, so I’ll introduce myself first.

Dwight Hurst, LPC: My name is Dwight Hurst and I am the producer of this podcast as well as I’m a psychotherapist with experience in trauma and addiction, also a podcaster. So I spend most of my time doing public promotion, education and treatment and therapy as well. I’m a licensed professional counselor and glad to be here to learn from the individuals here. I also co-host this podcast regularly with David Livingston, who is here, Licensed Marriage and Family therapist. I’m getting your credentials right, David. You are. And you’ve got a really, really in depth experience and expertise with opioid, particularly in alcohol addiction recovery. And you, as you do to the program all the time, bring very personalized psychotherapy approach and understanding of how people people work. So David, glad to be here with you. Um, we also have Dr. Michael Lowenstein, who, you know, is really one of the premier authorities in the world on anesthesia, assisted opioid detox and also the medical director, if I get your title right here at Wiseman as well, working with that and very grateful we’ve had you on the podcast before and being together here for today’s topic is very exciting. So welcome, welcome Michael as well.

Dwight Hurst, LPC: Um. We had a little glitch. David, you’re back. So today we’re talking about a very important theme that is really near and dear to our hearts and to the purpose of this podcast and why we started it in the first place. But we’re going to be focused on opioid detox and really the myths versus the reality of that process. We’re going to dive a little deep into the process of medically what’s going on with detoxification. There’s a lot of exaggerated claims out there. On one end, you have people who will promise the world when it comes to treatment and detoxification. On the other hand, you have a lot of myths where people have a lot of fears or misconceptions about that as well. And we’re going to try to put some of those to rest. So let’s, uh, gentlemen, let’s let’s dive in. If you guys are feeling ready, I’m gonna pull up. We are driven by questions here on this program. And so we’re going to go into some of those with the Waismann Method Rapid Detox program. It would be good. Let’s start with kind of a definition of what does that mean when we say rapid detox? And Dr. Lowenstein, do you want to start us out? Yeah.

 Michael H. Lowenstein, MPH, M.D.: So the term rapid detox is used a lot when I talk about rapid detox and specifically what we do. Um, rapid detox is basically anytime you perform an opiate detoxification procedure where you’re using sedation or anesthesia in combination with introducing an opiate antagonist which blocks receptors and accelerates the detox. So, um, rapid detox is, you know, takes on a lot of forms in the media and on the website. But basically anybody that can introduce anesthesia, sedation or do the detox under those medications and accelerate the process with use of an opiate antagonist and therefore transition somebody to the antagonist, it’s pretty much what rapid detox is.

Dwight Hurst, LPC: And I think when people talk about detox, the sort of old-school mentality is that it is we think of it as something that’s painful. We often use the term on this podcast of, you know, a basement, a blanket and a bucket. Right. I mean, that’s that’s the images that come to mind when people think about withdrawals. Very, very dangerous, obviously. And then, of course, detox. I find that people don’t know as much about it, particularly when you’re talking about the use of sedation. Could you talk a little bit about what are some of the benefits to that of doing it that way versus, well, certainly the basement version is not very good, but rapid detox versus some of the more old-school detox.

 Michael H. Lowenstein, MPH, M.D.: Yeah. So there are a lot I think a lot of the fears and misconceptions are that people just don’t understand what actually happens with Rapid detox. And there’s a lot of different things that are being performed in the community. So I can speak specifically to, um, what I do, um, at the Waismann Method. So the goal of Rapid Detox is safe, comfortable, effective opiate detoxification. Because a lot of people avoid detoxing because of the fear of the withdrawal and the horrible symptoms that they experience. And oftentimes that’s the reason patients will tell me that’s the reason why they continue to use because they just can’t tolerate the withdrawal or they’ve undergone detoxes where which you’ve described where they basically are, you know, just experience all the withdrawal symptoms. So the the purpose for rapid detox is to be able to control the physiology, to be able to avoid a lot of those symptoms. So with what we do, there’s I think there’s a few very key things. So I’ll bring a patient into the hospital the day before to really be able to evaluate their underlying conditions, right? So the majority of patients that show up, they’re dehydrated, sometimes they’re hypertensive, sometimes they have medical issues which they are not even aware of. So the day they admit to the hospital, we do a physical examination. I work with an internal medicine cardiologist who helps co-manage patients. So we do a significant evaluation where we’ll check blood work to check liver, kidneys, thyroid, pancreas. We’ll do an EKG, a chest x ray, and depending on the patient’s age and underlying medical conditions, we’ll even do echocardiograms or exercise stress tests.

 Michael H. Lowenstein, MPH, M.D.: So in order to be able to do this safely, you have to have a really good understanding of the patient’s underlying issues and physiology. And then by admitting a patient a day before the procedure, then we can actually optimize their their physiology so we can hydrate patients. If their blood pressure is out of control. We can manage that. If their blood sugars are out of control, we can, you know, help to manage those things. And then we pre-medicate for the first day to block the part of the nervous system that causes withdrawal. And that’s what allows me to perform the procedure to safely, effectively and to minimize, you know, the symptoms. And then the next key is that I actually do the procedure in the ICU setting where the patients are carefully monitored for a full 24 hours. And so I can introduce sedation so they don’t remember or feel anything because of all the premedication that they were given in the day of admission. Their physiology remains nice and stable because the majority of withdrawal is related to the sympathetic nervous system. And that’s why when patients are withdrawing, you see high blood pressure or high heart rate. It affects their gut, it affects so many body systems. So we, first of all, help to stabilize those with premedication and then use anesthesia or sedation so the patients don’t remember or feel anything. We can control their physiology and then carefully monitor them in the ICU setting for a full 24 hours.

 Michael H. Lowenstein, MPH, M.D.: So keeping the patients comfortable, we’re monitoring them closely. We’ve already optimized their physiology to reduce risks. So I think the combination of the the evaluation, the premedication, the optimization of their physiology and then the very close monitoring allows this to be a very safe, effective, comfortable process. And we are accelerating the process into a very short period of time as opposed to, you know, an unaided detox can last days to weeks to even months in some cases. So we’re able to accelerate this into a very short period of time. And when the actual opiate detox is completed, we’ve also transitioned them to a blocking medicine such as naltrexone, which actually helps to block the physical cravings. So once those first couple of days in the hospital setting is complete, then they can then move on to address all the other issues that are related to addiction and opiate use disorder and, you know, underlying psychosocial and environmental, all the other things that then have to be addressed. But the detox itself is, like I said, comfortable, safe, and effective. And we’ve got them detox. So we’ve essentially treated the opiate dependence. And that’s really what rapid opiate detox does is we’re treating the opiate dependence because I firmly believe you can’t move forward to address all the other issues until the opiate dependence is been treated and we’ve transitioned somebody to the blocking medicine to then treat their cravings.

Dwight Hurst, LPC: It’s interesting, like so many things, we play such an emphasis on the thing itself. When we say detox, we think of the actual process, which is very important. But you’re describing how at least as important is the pre- and post- reactions right to the actual procedure. I would say at least it sounds. To me like we’re saying that that’s at least as important. Do you do the proper prep and do you do the aftercare? Otherwise, the thing by itself is not the main it’s not the only focus.

 Michael H. Lowenstein, MPH, M.D.: Exactly. I think the pre- is of utmost important because you really have to understand the patient’s physiology and where they are medical because treating opiate dependence is opiate dependence is a medical diagnosis. Right. It has to do with the patient’s physiology. They’ve taken opiates for a long period of time. Their bodies become dependent. If they stop the opiates, then they develop a withdrawal syndrome, and that’s medical or physiologic. So you have to use a medical approach to understand the patient’s underlying physiology, understanding what what they’re using and how much of it, and to optimize their physiology, their blood pressure, their heart rate, their hydration status. You know, patients will show up with abnormal electrolytes like potassium and magnesium. So the pre- part is very important to optimize the patient, to prepare them for the actual detoxification process. Then I believe that you know, the process itself is important to be medically managed appropriately in the proper setting. And then the post is important, right? We’ve talked about using the antagonist Naltrexone to keep those receptors full and to block the physical cravings, and that’s what allows patients to move forward to to treat all the other issues that related to addiction and opiate use disorder and the all the neurobiologic, environmental, all those things that will then potentially take weeks to months or years to address. But you can’t address those until you’ve dealt with the physiologic or the medical diagnosis of opiate dependence.

Dwight Hurst, LPC: And for both of you, David, you may chime in on this, too, with an insight to some of the emotional or psychological prep for coming into a detox. What do you think are some of the things that are important to be prepared for in that realm?

David B. Livingston LMFT: Um, probably the most important thing is, is feeling committed to wanting to be off of the opioids and feeling ready to go through the process and then creating some sort of structure and understanding as to why you’re on them in the first place and what you’re needing to sustain staying off of them. And then all the other factors like Dr. Lowenstein is bringing up that can contribute to them. A lot of it has to do with I mean, one of the worst things from an emotional standpoint is when people are on opioids, especially long term, they lose a sense of agency. So the opioid starts to dysregulate them. It’s also a depressant long-term. So there are all these effects, which is why we treat them, we detox them before we start to work on the other things. Because once that is in place, you can begin to sort of bear down on some of the other issues. And so part of it is just coming in with an openness and a willingness to explore and try to understand.

Speaker4: Yes.

Dwight Hurst, LPC: And of course, there has to be awareness that there are going to be medical situations that maybe have been covered up by long-term opioid use. I may not know that I’ve developed other health problems that I didn’t have when I started to abuse opiates and being prepped for that, both from a standpoint of survival or lowering risk of the process, but also preparation for adjustment. Adjustment is a huge part of this, even pre-planning, you know, the word. Uh, go ahead, David.

David B. Livingston LMFT: Well, I was just going to add to what Dr. Lowenstein does medically is pretty amazing because people come in with all kinds of conditions that have been untreated and also sometimes on different medications and on medications, other medications that they even thought they were on. So the so what he assesses and puts together in terms of getting them off of it and then the work we do at Domus Retreat after the detox in conjunction with Dr. Lowenstein’s oversight in terms of keeping people safe and getting them healthy quickly, is is it happens pretty quickly.

Dwight Hurst, LPC: Yeah.

Dwight Hurst, LPC: It’d be good to highlight a little bit what are some of the effects on the dependence level? People have built up a tolerance oftentimes before detox. Can we talk a little bit about that? The physiological reality of reliance, dependence, all those kinds of things that come after detox.

 Michael H. Lowenstein, MPH, M.D.: So from the medical standpoint, you know, the patients have taken an opiate for a period of time. So there that causes changes or neuro adaptation in several different parts of the nervous system. So it affects your neurotransmitter production, it affects hormone production, it affects receptors. There’s a lot of different brain circuitry that’s affected by this. So the body becomes dependent on it, which means if you stop, you have a withdrawal and then a tolerance develops, which means that it requires patients will require more and more of the same medication to have the same effect. Um, and then there’s also with opioid use, you can get hyperalgesia where it causes changes in other parts of the nervous system where you’re more sensitive to pain and less tolerant of pain. It affects, you know mood and all those other other things. So there’s a lot of effects. And one other thing I might mention is that the patients, as we know that fentanyl, the majority of what’s on the street today is fentanyl, right? The heroin’s fentanyl. The fentanyl is fentanyl. The oxycodone is fentanyl. But with that, I’m seeing more and more patients showing up, when we drug screen them when they come into the hospital. They’re also positive for methamphetamine in the majority of time. We’re seeing cocaine, we’re seeing marijuana, we’re seeing alcohol. So in the majority of patients, we’re not just treating opiates. We’re treating all of those different dependencies. And the withdrawal from each of those looks a little bit different.

 Michael H. Lowenstein, MPH, M.D.: And so the monitoring that’s required and the symptoms that they may or may not experience afterwards. And then dependency also affects everyone differently. Everyone seems to have one body system that’s more affected than others. A lot of times it’s the gastrointestinal system, um, the majority of these of the patients I treat have sleep disorders and oftentimes they’re using the opiates because they’re not sleeping or they’re anxiety, depression, bipolar. Um, so we’re dealing with a lot of different issues. And so, um, it’s interesting in the pain patients that I’ve treat that I treat, they’ll stay on the same opioid dose for a long period of time and they don’t seem to get as tolerant. I think the tolerance in most of the patients that use opiates to treat underlying emotional or underlying issues such as that is they get very tolerant to the emotional component that they get or affect they get from the opiates. And that’s why I think the dosages escalate so quickly. And now with the new fentanyl that’s on the street, I’m seeing escalation unlike I’ve seen in my 25 years of doing opiate detox. Um, it’s just it goes from if they’re using the oxy blues, it goes from 1 to 2 to 10 to 20 to 40 to 50. It’s just extraordinary how addictive, um, the fentanyl on the street is right now. So I think all of that plays a role in, you know, the tolerance and the dependence.

Dwight Hurst, LPC: And opiates historically have always been overdose risks go up after someone is no longer chemically dependent because their tolerance is so low. They may use what they used to use and die. And you’re describing some of the social just elements out there with fentanyl and everything, the practical reality that that’s even more dangerous now. So, yeah, relapse becomes very, very dangerous.

 Michael H. Lowenstein, MPH, M.D.: Right? So you’re absolutely correct. Once the patient’s opiate dependence has been treated, their tolerance is back to the same level as it was prior to using opiates. So if they go back to trying to use a dosage that they were previously taking, the risk of overdose and death is very, very high.

Dwight Hurst, LPC: Yes. Okay.

Dwight Hurst, LPC: You hear the word holistic kicked around a lot nowadays. And I think that when you hear a word a lot, sometimes it loses a little bit of meaning. But that is one of the main focuses of the Waismann Method approach is to have a holistic practice. Can we talk a little bit about what that means so people know what they should look for when they hear that word?

 Michael H. Lowenstein, MPH, M.D.: From a medical standpoint. So we’re using medicine. You know, pharmacology, physiology, anesthesia for the actual treatment. But once the opiate dependence has been treated medically in the hospital setting and we’ve transitioned the patient to naltrexone to block the physical cravings, I think that’s where you need to take a very holistic approach to treating the issues once the dependence has been treated. And so in my mind from the MD standpoint, I look, patients will ask me what can I do to make the recovery quicker. You know, your neurotransmitters, your hormones, your receptors, all those things have to rebalance and they’ll find a new normal. Some people talk about pre opiate use normal. Well, you know, as we age, our normal changes once we’ve once people have used drugs normal we don’t know what normal is anymore. But to help people establish their new normal as quickly as possible from a holistic approach, you know, I will talk to them about, well, you need to address the psychological issues in our aftercare. David, you know, is is the first step in that process. Good nutrition is important. Um, vitamins, good, good nutrition. Sleep is very, very critical and exercise. And if you if you use that holistic approach of therapy, sleep, exercise, nutrition, that’s going to what’s going to help people achieve their new normal as quickly as possible.

David B. Livingston LMFT: Right… So when people say my I want to feel normal, what they really mean is I want to feel good because everybody remembers themselves when they felt well. And so and certainly that is the goal. And as Dr. Lowenstein pointed out, sleep, exercise, good enough nutrition. And then I might add to that good experiences with people. And then and then also, if you’re in therapy, you’ve got to deal with anything that’s inhibiting you from feeling well, right? So if there’s an underlying anxiety or sleep disorder or anything else and sometimes it’s just situational, sometimes people are overly burdened by the amount of responsibility and work and everything else. So situationally, they’re, you know, and that’s that can dysregulate you and overburden you. And sometimes people use opioids just to cope to sort of keep their life functioning. We see a lot of people where that’s so it’s it’s really dependent on what their need is. And from my perspective, holistically, I take the time to really understand and differentiate what those needs are.

Dwight Hurst, LPC: Dr. Lowenstein, let me ask you this. Some of the post-care that people obviously have to part of this healthy adjustment is taking responsibility or taking ownership of their medical care. Do you you see people – what are the needs that they have to set up as far as with their own care professionals? Are there certain types of medical things they should be prepared to have checked or to do after asking a big question with a process that needs to be very individualized? But what would you say about that?

 Michael H. Lowenstein, MPH, M.D.: Yeah, so when people use or abuse opiates, they oftentimes will neglect their underlying health conditions. So part of the process when they come to see us is that, you know, we get the initial labs and EKGs and chest x-rays and oftentimes can identify the underlying medical issues that they’re aware of and haven’t actually taken good care of. Or oftentimes there are things that they’re totally unaware of. So, you know, that’s an opportunity to identify after the detox what needs to be addressed. And a lot of times patients don’t follow up with their primary care doctors when they’re on opiates because, you know, they have concerns about, you know, them finding out or having to discuss that. So we identify those issues and I’ll point them in the direction, you know, and I’ll share their laboratory results with them and say, you need to follow up with your cardiologist or your internist or your diabetes doctor because these really need to be optimized and controlled as part of your recovery. Um, so and then if there’s underlying apparent underlying psychological issues that need to be addressed or have been addressed in the previously and just been ignored, you know, I will encourage them to follow up with their existing treaters or maybe, um, you know, point them in that direction. And then David also will help them identify and, you know, from a from a psychological or behavioral standpoint, you know, ways that they can optimize their care.

David B. Livingston LMFT: Absolutely. Yes.

Dwight Hurst, LPC: Well, and I know, Dr. Lowenstein, you have to leave us. David and I can talk a little bit more about those, some of those things. But before you go, would you like to we’re in a sort of an anniversary time. It’s been about 24 years that Waismann Method has been around. Is there anything you’d like to say about, particularly to the tailored approach that you’re able to take in a clinic like this? Before you go?

 Michael H. Lowenstein, MPH, M.D.: Yes. So there’s one other thing I’d like to mention, which I haven’t, is that, um, part of the problem with people who are with Rapid Detox is that, um, there are programs that will tell the patients that they’ll bring them back to their, to the biology of their pre addiction state. And I think that’s very dangerous because I discussed, you know, we’ll bring you your body will find a new normal and will help you achieve that once you’re no longer on opiates. But I think that discussing bringing people rapidly to a pre-addiction state is very dangerous. Um, and it’s not, it’s very misleading because as we talked about, you can treat someone’s opiate dependence very quickly and safely using a rapid detox, you know, in the proper setting with the proper pre-evaluation and pre-medication and you can introduce the blocking medicine, naltrexone or the injectable form of Vivitrol to, to block the opioid cravings or the physical cravings. But you really can’t reestablish a pre-addiction biological state because I mentioned there’s a lot of neuro adaptation that takes place with chronic opioid use. You know, it affects your brain circuitry and it affects your receptors and your neurotransmitters and your hormones. And those take time to fix. So if somebody gets detoxed and think they’re they’re cured, um, then they’re not going to get the treatment and the help that they really need to be successful long-term, right? Because if you only treat the dependence and then tell them you’re fine, then it’s just it really does patients a disservice.

 Michael H. Lowenstein, MPH, M.D.: Um, so that’s, that’s one point I just wanted to get across after having done this for 25 years, I think we demonstrated that in the proper setting and the proper hands, that rapid detox can be very safe, effective, humane. And what we’re basically doing is we’re treating the dependence, transitioning the patients to the blocking medicine so that they can really address the underlying issues that are going to make a long-term difference, because addiction has always been known as the revolving door, right? So if we can really provide appropriate treatment and get them pointed in the right direction, then the goal is, is to, um, to stop that revolving door to, you know, to really give the people opportunities to address this properly. There’s nothing that gives me more pleasure in this. Well, number one, to get people off the opiates and get them pointed in the right direction, but get those calls a year later, two years later, that, you know, I’ve got my life together. I’ve got a great job, I’m married, I have children. And that’s what really makes this worthwhile. And I think being able to do this safely and effectively and comfortably is really what’s why I’m still doing this almost 25 years later.

Dwight Hurst, LPC: Yeah, that’s one thing. Speaking as the outsider who just I’ve come in to Waismann, my introduction has been doing this podcast and one of the things that I’ve really enjoyed and believe strongly in is the, the approach you guys take of, on the one hand, providing here’s the treatment that’s going to get you where you need to go, but also explaining the both the limitations and the opportunities of the reality of detox and post detox. And so yeah, it’s something I really appreciate as well. So glad that you could share that and glad you’re able to be with us. I know that you have things that you’re taking care of and it’s always it’s always great to be doing things. So just talking about them so it’s good that you are there and working. Thank you so much for joining us.

 Michael H. Lowenstein, MPH, M.D.: My pleasure.

 Michael H. Lowenstein, MPH, M.D.: Thank you for the opportunity.

David B. Livingston LMFT: Thanks, Michael. Thank you.

Dwight Hurst, LPC: And so for David, now that I wanted to focus on a couple of questions about some of the emotional transition. One of the questions we have is what are some of the emotional challenges of even just imagining and picturing that my life will no longer involve opioids when I’m coming in for treatment?

David B. Livingston LMFT: Um. It takes a little while to to for so so one of the things that happens is a patient will after the detox they’ll be just regulated and usually have some trouble sleeping and have some level of feeling uncomfortable. It’s it’s impossible even though they’re fully detoxed right? There’s no there’s no titration of the opioids left. They’re the only exception to that could be with some methadone which we also detox people from. But some of that there is a small amount of titration left, but with regular opioids, it’s over. But they don’t feel that necessarily immediately because the nervous system and the whole system has to adjust. But what happens is as soon as we start to get them to sleep, and that’s usually the biggest hinge in terms of the recovery shifting pretty dramatically as soon as they start to get some sleep. And we also assist with that Dr. Lowenstein does with medications because at this at point in time, the goal is to get people feeling more like themselves healthier, quicker. So the use of medication truly is medicinal. Otherwise, the suffering tends to be, as I like to say, neurotic rather than existential. Right? Suffering that’s leading nowhere rather than suffering that’s actually getting us somewhere. Um, so, so we assist in that. And the program is meant to get you back on your feet and feeling like yourself as quickly as possible. Safely, obviously. So. And what Dr. Lowenstein does is frankly pretty amazing given the complexity of the patients he sees and which is why they take great care even before the detox to check everything out. And so by the time they get to me at Domus after, you know, the hospital, they are tired, feeling a bit wrung out. And then we use medications to help them get back to themselves and wean them off those. And that they’re going to develop any physical. Dependencies from what they’re being given. It’s really just medicinal. And and then what I hear is like a few days later, they’re like, I can’t believe I’m off of it. It’s it’s like it’s they can’t believe it. They’ve been on it. And then then thereafter, the emotional life, our emotional life learns slower than our intellectual life. So I could tell you something. It could be completely true. But until you’re feeling it, until emotionally, there’s been enough time till you felt, well, without an opioid, it doesn’t sink in deeply. So as time goes by, they actually there’s even further improvement psychologically. Is that because they start to relax more, they realize I’ve been off it for two days, three days, four days, five days. I’m going to be I’m fine. And right. And even so, then there’s a progression just from that perspective.

Dwight Hurst, LPC: Yes. Yeah.

Dwight Hurst, LPC: What are some of the emotional obstacles or the strong presenting emotions when people are going through that? You mentioned? They’re all wrung out, they’re tired, there’s hope, but there’s also, you know, there’s also emotional feelings and cognitions that get in the way as well, or that can be mixed feelings, let’s say, or whatever. What are what are some of the things, the emotions you see presenting themselves?

David B. Livingston LMFT: That’s so individual and so broad. But one of them is, you know, it depends. It depends significantly. And I’ve seen so many people and worked with so many people, I, I can usually tell when someone in the first 5 to 10 minutes when I’m talking to someone where they’re at in terms of wanting to be off the opioids. The correlation, Dr. Lowenstein was suggesting earlier on the correlation emotionally to wanting to be done with them, wanting to move on, it affects their physiology of how well they do. So people are still conflicted about it, are unsure and so forth. And usually, by the way, as they feel better, I mean, you have to understand, many of the people we treat have been on opioids for, you know, years and years and years and even decades. So, you know, the idea that I’m going to be okay without it is not something that’s really been reinforced. And so time being off of it all that stuff reinforces an emotionally they can begin to feel more confident.

Dwight Hurst, LPC: What do you say about family and the role that family plays? There’s there’s there’s some important ways they can help right after detox. And there’s probably some important limitations there, too.

David B. Livingston LMFT: The main thing I say is, you know, look, again, that’s complicated. You know, you have people who are sometimes family members are really supportive and happy that the individual is doing this. Sometimes they’re upset for a very, you know, a various reasons. And so it depends. But you address things as you need to. But overall, you want to emphasize or I try to emphasize the fact that this is positive now. Now the things that have been a concern or in some ways associated with the opioid use can be addressed differently and try to give the person some time. You know, this is this is a time for some understanding, some patience generally.

Dwight Hurst, LPC: Yeah, yeah. It’s one of those things where health in this regard and some people use sobriety as an overarching term. I know we like we prefer on this program to usually talk about it in terms of health management because it gets into this idea that what is health look like? Health isn’t perfection, health isn’t. Oh, I got off the opiates, now everything’s fine forever. It’s like, well, no, that’s not what we’re looking for. What we’re looking for is having the tools to do the hard work in life. And that’s one of the things I enjoy, is I see patients who are able to peel away that comfort level and then you have tools to really dig in and find ways to be healthy in your life. So that’s one of the things that that’s rewarding. As we’re wrapping up, I wanted to ask you, what are some of the things that you particularly enjoy about the environment and the patients that you’re able to see through the Waismann Method Clinic?

David B. Livingston LMFT: There are so many things. First of all, it’s a big leap of faith coming to see us. You know, usually they’ve researched and listened or read and so forth, and nonetheless, they don’t know us. It’s still a leap of faith. And, um, and there’s something so honorable and so good about being involved with people who want their lives to be better and then allowing you to get to know them to help with that and participate in that. And it’s fantastic. And I meet people of every type of person you can imagine. And so it’s just and yet everybody’s the same. And in most ways, right, They all want to feel better. They want a better life. They want their relationships to work well. They you know, things like that. So it’s I feel privileged and I’m working with a group of people who have been in. I’ve been here for. I’ve been working with them for 20 years plus myself. It’s been a and I never was oriented towards this field. It was not going into this field initially. I’ve been doing this for close to 30 years, but I was not headed towards this. I was trained more in a psychoanalytic perspective, which also really helps me understand how people are organized and put together, and it’s been very useful. And then, you know, behaviorally working out the things that they need to do to stay well.

Dwight Hurst, LPC: Absolutely. Yeah. The courage and the ability to be around and get to know individuals who there’s such a huge balance there. It’s amazing to see that balance between both the individualized person and how different people can be and their different walks of life and things. And then yet also the universality that we have when it comes to what makes us human and our emotions too. That’s very just a very powerful part of this work to be able to see that, that everyone’s different and yet we’re all united as as people. So a wonderful thing.

David B. Livingston LMFT: Yes. And maybe the last thing I’ll say is that this is for many, many people and maybe even most it’s a major transition in their life. It’s not a small thing. And so to be able to help someone through a major change in their life and when they really that’s, I’m lucky to get to help them. And so it’s and I’m lucky to work with the people. I do.

Dwight Hurst, LPC: Yes.

Dwight Hurst, LPC: Well, and I’m always, as always feel lucky to be here with you and talking about these things. I, I know for me personally, just even doing this podcast and I’ve spent so many years working in psychological treatment and addiction treatment, but I feel like I’ve become a better clinician and a more well-adjusted person just by being around you guys as well. So it’s something I am grateful for and really enjoy. Thank you so much, everybody who’s out there who’s been able to listen and who’s been able to watch, we want to encourage you to please share this information and to share this program with people. If you have whatever your podcatcher of choice is where you do listen, please make sure to like to give us good reviews, especially because that does help people to find the show. This is a production, of course, of Waismann Method Opioid Treatment Specialists and Rapid Detox Center. And as we go, I’ll leave you with the thought that I always do, which is make sure that when it comes to these issues as well as anything with your own health and happiness in life, make sure you keep asking questions. Because if you ask questions, you will find answers. And whenever you can find answers, you can find hope. So goodbye to everybody out there.

David B. Livingston LMFT: Great advice. And thank you, as always, Dwight. Thank you.