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Wise Counsel Interview Transcript: An interview with Morteza Khaleghi, Ph.D. on the Importance of Treating Emotional Trauma in Addiction

David Van Nuys, Ph.D.

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Dr. Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by CenterSite, LLC, covering topics on mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host. [musical interlude]

Dr. Van Nuys: On today's show, we'll be talking with Dr. Morteza Khaleghi about his book, "Free from Addiction: Facing Yourself and Embracing Recovery." Dr. Morteza Khaleghi has over 25 years of experience treating the dually diagnosed. Trained at the California Graduate Institute, he earned his doctorate in clinical psychology, and he went on to found Creative Care in 1989, a facility devoted to providing, highly specialized treatment for the dually diagnosed client.

He reports that he's an ongoing resource for the "Dr. Phil" show, offering treatment and creative care to challenging patients, and appears on the show to offer advice and updates on patients' progress.

Dr. Khaleghi argues that, within the medical establishment, the tenants of dual diagnosis are not well understood. Not only do many medical and psychiatric professionals view addiction as needing to be treated separately from underlying emotional issues, but he says our traditional health-care system is simply not designed to treat dual disorders.

Now, let's go to the interview.

Dr. Morteza Khaleghi, welcome to the Wise Counsel Podcast.

Dr. Morteza Khaleghi: Thank you, David. Thank you for having me.

Dr. Van Nuys: Well, you have such an interesting background, having been born in Iran. And I wonder if we can start with that. Tell us what you refer to in the book as "the evolution of Dr. K."?

Dr. Khaleghi: Well, I just finished high school when I left Iran, and before I left, just about 10 months earlier, I had lost my mother to cancer. And being the youngest of eight kids, it was very difficult to go through losing my mom at such an early age. And then, coming to the States, came straight to California, Los Angeles, and started my studies. And when I had been here for about four years or so, one of my brothers had developed alcoholism, and along with his depression, he managed to, intentionally overdose and die.

And I had just started at graduate school in psychology and really didn't know much about what was going on. And had I known then what, obviously, I know now, I'm sure I could have effected some changes in him so he wouldn't have to take his own life due to the alcoholism and depression.

So, once that happened, then I pretty much delved very much into psychiatric conditions and addiction issues. And it was shortly after attaining my license after graduating that I opened the facility called Creative Care, which dealt with psychiatric conditions and emotional issues.

And then, a couple of years later, we began dealing with people who had addiction, whether it's alcoholism, drug addiction, eating disorder, gambling addiction.

And because of the emotional dynamics, I felt very qualified to deal with those issues, what we call dual diagnosis, which, last 20 years or so, really has been a quite effective approach.

And what our premise is that beneath every addiction there is an emotional issue, what we call emotional trauma, that's unresolved an unexplored. And as long as those issues remain undiscovered or uncovered, then the individual really continues to struggle.

There are a lot of people who go through recovery and sobriety. And 12-step has a fantastic approach. We definitely believe in it, and we augment our program with the 12-step approach.

But, I think to have patients who have difficulty and continue to relapse; those are the people that we really want to address with emotional trauma.

We figure those are the people who cannot really only benefit from 12-step and just a program of sobriety; that they desperately need to address the emotional issues and the emotional trauma to give themselves a tremendous chance of recovery.

So the evolution of Dr. K, really, having lost a mother at such a tender age of 17, and then losing another brother to addiction and depression, really, I feel, strengthened my resolve to deal with these sort of emotional traumas, and especially when there is alcohol and drugs involved, and trying to avoid those kinds of tragedies.

Dr. Van Nuys: Yes. Well, I can certainly understand why, given that background. And you've given such a complete answer, [laughs] I hope I can draw this interview out.

Dr. Khaleghi: Absolutely. Absolutely.

Dr. Van Nuys: You've spoken to a number of my questions, actually, already. I want to talk about your center, but I'm going to save that more towards the end because there are more issues I'd like to explore with you around addiction and so on. But still, delving into your background, I was surprised to read that your graduate program required 50 hours of psychoanalysis. Was that actually psychoanalysis or psychotherapy? Because I've never heard of a grad program, outside of a psychoanalytic training institute, requiring psychoanalysis.

Dr. Khaleghi: Right. This program, called California Graduate Institute, is in West Los Angeles. And they don't really want to be known as a psychoanalytic institute, but they definitely have a psychoanalytic approach, if not a psychoanalytic bend. And the 50 hours was, for anybody going through the doctoral program, that was required curriculum.

Dr. Van Nuys: Yes.

Dr. Khaleghi: But if you were in the psychoanalytic program portion of the school, then there was a lot more requirements. You had to have case studies that you were supervised, and then you had to have two years of your own three-times-a-week analysis. But what I ended up doing - and I think that's, really, my education aside, in my own treatment, I had 18 years of psychoanalysis, which included three times a week...

Dr. Van Nuys: Wow.

Dr. Khaleghi: And that, really, to me, was the difference. I mean, education, I would say 75, 80 percent of my training came from my own treatment, and 25, 20 percent of what I understand about the field, really came from the books and classes and research and whatnot. But I credit my own treatment to really understanding and being able to not only empathize but fully appreciate the struggles a person goes through when they have psychiatric or emotional conditions. And 18 years of three times a week, really was a tremendous commitment and anytime I say that I wait for a Woody Allen joke to come up.

Dr. Van Nuys: Is there a good Woody Allen Joke that goes with that? Well I have a good friend,

Dr. Khaleghi: Perhaps not.

Dr. Van Nuys: Well I have a good friend, another mental health professional, down in your area actually, Dr. Ronald Alexander, whose in Los Angles, who I hope doesn't mind me telling this. I know he's been public about it, like you, he went through an extended period of psycho analysis and he said it was one of the best investments he ever made. Well people would say, wow, that would be very expensive wouldn't it? He spent a hundred thousand or two hundred thousand dollars, he still says it the best investment he ever made.

Dr. Khaleghi: [inaudible], if you find the right match, my mentor happened to be the school administrator and school cofounder, and quite wise and experienced. And I was lucky to not only spend time with him and his supervision, but later on became my analyst. Spending days, years, and the commitment he made, and I made financially, was a struggle as a student, especially as a foreign student. You have to pay tuition and expenses, and this was on top of that. But still, I credit everything I've ever been able to accomplish to that treatment and that relationship, without a doubt.

Dr. Van Nuys: And yet I've gathered you have no become a "psychoanalyst" yourself. At least it sounds like your therapeutic work is not set up in that model.

Dr. Khaleghi: Correct. I definitely utilize a lot of the concepts and approaches, but without the protocol. Obviously we have a residential facility, where we deal with these patients in recovery and two-thirds of our staff themselves are in recovery from alcohol, drugs, and what not? And that approach, obviously is not the clinical, classical, analytical approach. It is psychodynamic in approach and family oriented, and basically takes a tremendous family history and emotional inventory. And it is through that process that you are able to identify areas of vulnerability and more serious emotional trauma.

It gives you the material you really need to work with and work on to understand the dynamics and give the individual the tremendous chance of sobriety.

Dr. Van Nuys: I've been reading your recent book, which I should mention, Free from Addiction: Facing Yourself, and Embracing Recovery. And in there you say addiction does not happen simply because a person has a genetic predisposition. And I think many people do hold that belief. Could you tell us your opinion about that?

Dr. Khaleghi: Yes, I believe that research has shown that alcoholism and drug addiction certainly has a genetic component to it. We have witnessed and have been able to substantiate, that yes, you need to have the genetic component, but then the proper environment within which that addiction develops. It grows with stress, abuse, and the way the family dysfunctions, and you really cannot get to develop a strong surplus need, especially if anyone else in your household you grew up, is also practicing addiction, whether it is alcohol, drugs, or prescription medications, eating disorders, or gambling.

And you witness that, and it becomes your model, and you really do not develop a sense of self, and you witness these sorts of things, and then you have life's stresses on yourself. Whether you are struggling with in school and you're not able to socialize, and you're not very popular, and you become isolated and you're a loner.

Those components are what I call a ripe environment to develop addiction if indeed you reach for alcohol or drugs as a way to self medicate, as a way to not feel alone and isolated. Those components really have to be all present, they all have to line for you to develop addiction.

And again, that has to go on for quite some time. It's not that you do this for a couple weeks or even a few months. It has to become a pattern where you do the same thing and expect a different result. And when you become aware of the fact that this is not working, and this cycle of insanity develops, where you continue bang your head against the wall, doing the same thing, expecting the same result.

Then you can appreciate that "OK, maybe I've crossed the line and I've gone into a situation where I do not have control over this thing, as I would like to believe I do. And I really need to take a look at this, and confront myself, and take some steps to get some help."

Dr. Van Nuys: Now many people think of alcoholism or addiction more generally, as a disease. But I believe you are critical of the disease model. Can you say something about that?

Dr. Khaleghi: You know, I do think we treat it as something out of your control. And I think the disease concept certain applies when we reach the end stage of the development, and I think you must address it whole heartedly. I always say addiction doesn't happen in a vacuum, it happens in relationship to an environment, what's in your environment. Whether it's family members, how you react to stress and pressures of every day life, and you must approach this whole heartedly as far as your spiritual beliefs are, as far as the way you view yourself in the world, how you relate to others.

The disease concept I definitely think is valuable, it's not something that can be cured; it is something that needs to be managed. But it has to have a protocol, but you have to have a full understanding of what this is all about.

And how do I go about containing and managing it for a life time, because as we have seen people who have been sober for 12 years, something triggers them and they use, or relapse, and have a difficult time with it.

I do like the concept of disease, but again, it's not something you're helpless and victimized, you must take an active approach in containing and managing the problem.

Dr. Van Nuys: Again, I'm referring to the book, and what you just said was that you saw the disease model as having more applicability in the later stages. So I have the impression what you are referring to here is the impact upon the brain in actual changes that are happening in the brain. Can you tell us what sorts of changes the brain undergoes as a result of addiction?

Dr. Khaleghi: Well, it depends on what you're using. With alcohol, we know for a fact there are certain diseases that are even named after people who use a lot of drugs, alcohol for that matter. And the brain is a fantastic organ where you can, certainly do a lot of damage to it by excessive alcohol use and or drug use. And the beautiful thing about it also is if you stop using, if you haven't permanent damage yet, which we see a lot. I have a patient who's got serious what we call organicity [sp] which is a form of brain dysfunction due to his excessive and chronic alcohol use-

Dr. Van Nuys: Yes.

Dr. Khaleghi: -which is really irreversible. But if you haven't reached that point, if you have not developed that organicity, and if you stop using alcohol and drugs, you give your brain a chance to replenish itself, and the brain is a fantastic organ which is really capable of doing that. If you haven't done permanent damage, well, there is prescription medication whether it is for pot or cocaine or heroin or any of the hard drugs. You have to allow your brain to replenish itself and then you must stop.

If you do that then I think you're able to take a step back and prevent a disaster from happening and appreciate what it's going to take follow a program of recovery. And what we've seen a great deal of lately is that people who simply abstain from using, they're really not in recovery.

They're simply not using but they struggle with depression they struggle with anxiety, they struggle with rage and anger, and depression. And true recovery, really gives you an opportunity to not only abstain and learn how to stay away from alcohol or drugs, but how to not use on a daily basis.

Which quite a deal of has to do with establishing a program of fellowship. What AA provides, more than anything, is the fellowship and research has shown to be the most curative factor.

Regardless of the content, regardless of what goes on, and what is said in those meetings, it is really the fellowship that's developed and established on what they call a "home meeting." And you create a sense of belongingness and that seems to be really the difference maker.

Dr. Van Nuys: OK. Now, while still on the brain you note some recent research suggesting that some people are born with brains characterized by behavioral disinhibition. Can you take this to through that?

Dr. Khaleghi: Yeah. I think, obviously this position says the brain has a tremendous approach to what it has been exposed to. And of course, if you have a genetic component which you've been born with and you have susceptibility to certain obsessive compulsive patterns, then obviously you need to take extra measures. And first and foremost you must appreciate; you must find out if this is the deal, this is the case with you. Then you must take extra measures to make sure you don't fall prey to that dynamics.

And anybody who is born some genetic disposition to obsessive compulsive thinking, which really is the cornerstone of any addiction, would then be at risk. And you must do what you can to not only appreciate and understand that, but take steps to prevent you falling into being addicted.

Dr. Van Nuys: The behavioral disinhibition part. I take that to mean that some people maybe are born with a weaker ability to control their impulses? Would that be correct?

Dr. Khaleghi: No. That's where I think it becomes a question of character. And I've seen that has been an unjust charge to people who struggle with alcohol and drugs is that you're simply not strong enough, why can't you just stop? And those are really unfair, because this is not about a moral fabric of a person character. It's not about their desire, wanting to stop or not.

We see patients who come in desperately wanting to stop but, not really having the tools or not having the been shown how to stop and you go through the program and you take an emotional inventory and you're able to identify what is missing and what connections they haven't been able to make.

What I always do with patients is that they're going to put their thoughts and the goals for you and help you connect those thoughts.

We mention it in the book a great deal. Connecting the dots, the emotional dots, which are so important, that if you don't do that then of course the tendency for an addict or an alcoholic is to avoid, to deny, to minimize and when they do that they really disservice themselves by not looking at the emotional connectedness.

And so us it's not about a question of character but whether they were born with a weak constitution and are unable say no or are susceptible to those issues of falling into addiction.

If you do that then you really disservicing those people who struggle because it becomes a question of moral and fabric and character and we shy away from that because everybody really has a chance to get well, to get sober and continue to recovery with the proper program of sobriety.

Dr. Van Nuys: Yes, yes. I get that. Now you say that emotional problems are not the symptoms of addiction, but more often the cause of it. Do I have that right?

Dr. Khaleghi: Absolutely. You got that right correctly. Basically, the basic idea here is, we want you to peel the onion and see what's at the core of that onion and more often than not, surprisingly enough, there's emotional issue. There is what we call a trauma. You can define trauma a number of different ways. There's long continuum that defines a trauma. In other words, you could have an accident and be traumatized by it.

Or you can have a emotional issue growing up having been abused whether physically or sexually and slough that off and not feel as traumatized until and unless it is brought to your attention and you take a look at it and then, as an adult, you look back and say, "Oh my god. I can't believe that I went through that and I haven't really paid any attention to that."

That happens frequently when people simply ignore and avoid and deny and minimize, because it's too painful to admit what you've gone through.

And once you get into a program of sobriety, and especially if you've developed an addiction, then you continue to victimize yourself through that process of addiction.

And what we want to do is to help you take the blinders off and take a look at the reality as it is, what you grew up with, what you went through, what neglect and abandonment you experienced as a result of those emotional and physical and sexual abuses and traumas and put those in proper perspective, and stop sabotaging yourself, stop beating yourself by the process of addiction.

Dr. Van Nuys: So it sounds like you always see addiction in the context of a dual diagnosis, where there's both the addiction as part of the diagnosis, but there's also a more primary, underlying, emotional issue.

Dr. Khaleghi: Absolutely. And that's really the best way to describe dual diagnosis. To us, it's not really two different diagnoses. It is one and the same thing. And when you develop alcoholism and addiction, there has to be an emotional issue that accompanied it that really made it easy, if you will, to develop that addiction. And so, they're not two separate things. They're one and the same thing. But they happen to happen at the same time, and you must address those to give yourself a chance of sobriety and recovery.

Dr. Van Nuys: OK. And earlier you mentioned that your Creative Care centers, which I gather are residential centers. I think you have one in Northridge and one in Malibu.

Dr. Khaleghi: Correct. Correct.

Dr. Van Nuys: What's the approach that you've developed there?

Dr. Khaleghi: Well, when we began in Northridge, 19 years ago next month, it was pretty much psychiatric, and that was really my forte at the time and my expertise, and the people that work with us have pretty much a psychiatric background. And we started with a residential place in Northridge - very small, only six-bed facility. And then, four years later, we took up patients who also had serious addiction. There were alcoholics, and also a couple of patients we had with heroin addiction. And as we worked with them and detoxed them and went through the initial stages, then we began to deal with the emotional issues.

And we found that, really, this was the best approach to use for them to appreciate their disease, their concept of addiction, and then become active in the process.

You cannot be sitting by the sideline and hope you get well, as if somebody's going to be doing this to you. You have to partake in the process, and you have to become curious about what has happened, how did this thing develop, and what do I do to divert the process and prevent this from developing and taking my life?

And that's really when we, I think, pioneered this approach. It had been there before, but nobody really had paid full attention. And for the last 15 years, we developed that, and then we went into Malibu about 10 years ago and started a one-house with six beds and continued to develop.

And we now have 60 beds in Malibu, and also 12 beds in Northridge. So we definitely have grown a great deal in the last 10 years and continue the effective approach of dual diagnosis.

And because of that approach, because of the fact that people get well, if you are able to come in and say "I need help," and be sincere about asking for that help, I assure you, you will get well. In other words, the cliches in the field are "Have you bottomed out?"

Which means "Have you reached the point when you say 'I can't help myself. Can you please help me?'" That's the best time for a person to come into treatment.

That doesn't mean that you have to be down and out and desperate and wanting to get help. We also can raise your bottom to say you don't have to lose your job, you don't have to lose your family, and you don't have to lose your marriage and the love of your children before you actually believe that you need help.

We can, certainly do an intervention and raise your bottom so that you get confronted with those issues, and then you say "OK. I am definitely ready for this help."

So we call that having bottomed out. If you're bottoming out, then you're able to surrender: "I cannot help myself. Please help me." And then you take direction.

If you have those components working for you, if you bang your head against the wall enough times trying to get somewhere on your own and haven't been able to do it, then this approach is the most effective, because you're able to take direction and follow on the protocol of recovery.

There's no reason you couldn't get well, especially when we peal the onion and understand the emotional dynamics and help you work them through. It's a painful process, but you gather strength and you become sober, and you have a lifetime of sobriety ahead of you with that approach.

Dr. Van Nuys: Well, the prognosis used to be rather gloomy when people spoke about addictions. It sounds like you're fairly optimistic. Do you have any statistics regarding your program's effectiveness?

Dr. Khaleghi: Yes. I think, while we say we do not give up on anybody, I have one patient right now who's had 28 rehab programs before he came to us, and he's only 30 years old.

Dr. Van Nuys: Wow.

Dr. Khaleghi: That, by far, is the most a patient I've had going through. Before that, the most somebody had gone through would be like 14 rehab programs. But this individual has done well. He's sober. We're working with the emotional issues. Bottom line is treatment is effective in the following manner. One out of three people who only stay in treatment for 30 days, within the first year, relapse. Relapsing within the first year is 35 percent.

But with our program, because we insist on you staying in treatment at least 90 days - because what research has shown: the longer you stay in treatment, the better your chances of recovery. Actually, last week, last Tuesday, "LA Times" ran a significant article showing the research that now everybody says 90 days is really minimum.

The 30 days, the reason they did 28 and 30 days was, because people who came from wars and needed to be in treatment for alcoholism and addiction, they had about four weeks away from their war duties before they could go back, and that's why they were off for 28 days.

And because the insurance companies also got on with that program of 28 days, it kind of stuck. Everybody felt "Well, you go in for 28 days, and you get out and you're supposed to be well on your way."

Well, that's obviously not the case, especially in California. With the proposition that passed, not this time around but previously, people got into treatment as opposed to being incarcerated, and they got better much more than having the previous 28-day program.

Then, of course, incarceration really doesn't do anything in terms of recovery and treatment for those individuals. For Long Island offenders you had recovery and treatment as opposed to incarceration.

So with our program, you asked me about any statistic that I might have. Now, if you stay 90 days the recovery rates improve drastically. Especially within the first year. And it's average relapse period for a person is 35 to 65 % of the time.

That number drops, drastically when you stay longer. In our program if you have stayed and taken direction the recovery for us is about 75 to 80% within the first year.

And we have continued program in terms of not just the intensive residential, but then there is sober living and there is outpatient program and if you continue that process you have a given yourself a tremendous opportunity to manage this for a lifetime.

Dr. Van Nuys: I believe you see relapse as part of the process. Maybe you can say something about that.

Dr. Khaleghi: Well, you always say relapse is actually, at times, an eye opener, because they realize that you're not over this and it is part of the problem. It is also part of the recovery, because every time you go through that you're able to identify the triggers; you're able to see what had triggered you to relapse and through that process you become more educated and sophisticated and prevent this from happening again.

Dr. Van Nuys: Yes. I recently interviewed proponents of the Harm Reduction and Motivational Interviewing approaches. And they take the stance that abstinence should not be considered the gold standard. What's your thinking about that? Do you think that it's possible that sometimes people become either social drinkers or they will relapse periodically but they have long periods of sobriety?

Dr. Khaleghi: Absolutely not. And I think there was a lady in Northern California that had really advocated for that awhile ago and she thought that she could do controlled drinking. And if I'm not mistaken in one of those drinking episodes she had an accident. I think a couple of people were killed. And then she converted; she reverted the approach, saying "That is not the case, that is not the way to go and total abstinence is the really the approach."

In my experience, I really have to tell you, I've never seen anybody who's been able to manage their addiction with occasional use. And the bottom line is even if you, let's say you're addicted to heroin and you're having a problem with alcohol, we always say you must not use anything that's addictive.

Because if you are a heroin addict and you're in recovery for heroin, and you drink alcohol even if alcohol is not your drug it is only a matter of time before you go back to using heroin.

Because your brain doesn't really recognize the difference. So once you introduce something that takes the edge off then it's only a matter of time before you go back to your drug of choice. So abstinence for us is absolute necessity in order to maintain long term sobriety and recovery.

And wanting to, occasionally drink and social drinking it really disservices not only you, but everybody else who's in the recovery center with you, because it is a double message and we've never seen it work yet.

Dr. Van Nuys: OK. Well as we begin to wind down here, what can families do to assist in recovery?

Dr. Khaleghi: A great deal. Absolutely. I don't feel, I don't think that addiction happens in a vacuum. It happens in a relationship in the environment. And family members have to take a look at their role in allowing a person in their household to continue to use and drink. A lot of times when you see someone in your household drinking and drugging, you feel the way, say, "OK, temporary phase and they're going to get over it." But if it goes on long enough and you continue to look the other way, you're actually not only enabling the situation but now you've become co-dependent and part of the problem.

So you must not only confront yourself and take the blinders off, but you must confront and care front whoever it is in your environment that you care about that's using.

Whether it's your parents, whether it's your sibling, whether it's your spouse, or your children: you must confront the situation and get enough people to confront the situation and do an intervention so that process. Otherwise you're simply allowing this to go on and you have become a part of the problem.

Dr. Van Nuys: OK. Well Dr. Morteza Khalegi. Thanks so much for being my guest today on Wise Counsel.

Dr. Khaleghi: My pleasure. Thanks so much for having me. [music]

Dr. Van Nuys: I hope you found this interview with Dr. Morteza Khalegi to be informative. I find myself wishing I'd remembered to ask him how he came to be a resource for the noted American TV. personality Dr. Phil. I got so caught up in the interview that that fact totally slipped my mind. Dr. Khalegi's book is quite readable and is available in paperback. It's filled with brief case histories, which make it an easy read.

I think it would be a good resource for anyone who's considering help for an addiction, as well as for families trying to cope with an addicted relation. You can find out more about Dr. Khalegi's work and his Creative Care Treatment Programs by going to his website at www.creativecareinc.com.

You've been listening to Wise Counsel; a pod cast interview series sponsored by www.mentalhelp.net. If you found today's interview interesting, we encourage you to visit www.mentalhelp.net , where you can add a comment or question to this show's web page, view other shows in the series, or simply page through the site, which is full of interesting mental health and wellness content.

Access this show's page and show archive information via the pod cast box on the www.mentalhelp.net home page. If you like, Wise Counsel, you might also like Shrink Rap Radio, my other interview pod cast series which is available online at www.shrinkrapradio.com. Until next time, this is Dr. David Van Nuys and you've been listening to Wise Counsel.