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Stephen Loyd: Physician, recovering addict, addiction healer


Jul 11, 2020: Compassion & Science in Appalachia: Healing Opioid and Other Addictions

Guest: Dr. Stephen Loyd

Host: Joe Houska

Moderator: Dr. Cynthia Li

Welcome to Awakin Calls. Every Saturday, we host a conversation with an individual whose inner journey inspires us and whose work is transforming our world in large and small ways. Awakin Calls are an all-volunteer-run offering of ServiceSpace, a global platform founded on the simple principle that by changing ourselves, we change the world to create a more compassionate and service-oriented society. Thank you for joining us!

Joe: Good morning. Good afternoon. And good evening. My name is Joe, and I'm really excited to be your host for our weekly global Awakin Call. Welcome and thank you for joining us. The purpose of these calls is to share stories that help plant seeds for a more compassionate society while fostering our own inner transformation. We do this by holding collective conversations with guest speakers from all walks of life who inspire us to live in a more service-oriented way. And behind each of these calls is an entire team of ServiceSpace volunteers whose invisible work allows us to hold this space. Today, our special guest speaker is Stephen Loyd. Thanks again for joining today's call. Let's start with a minute of silence to anchor ourselves into this space.


Welcome again to our weekly Awakin call, today in conversation with Stephen Loyd. As an all-volunteer offering, each Awakin call is a conversational space that is co-created by many invisible volunteer hands. In a few minutes, our moderator Cynthia Li will begin by engaging in an initial dialogue with our speaker, Stephen Loyd. And by the top of the hour, we'll roll into a circle of sharing where we invite all of your reflections and questions. At any time, you can submit a comment or question via the webcast form on our live stream page. You can also email us at ask, A-S-K, Please note that if you are watching the live stream from the designated webpage link, you can make the video full screen by hitting the marked button on the bottom right corner of the video box. To return to the webpage to submit a question, just click the same bottom right button or hit your computer's escape key to exit full screen mode.

And just a friendly little reminder, we're operating in a virtual space with the usual constraints of technology, overloaded bandwidth, audio issues, et cetera. Things can and will go wrong. Please just know that if there is a technological glitch or other issue for any of the active speakers, each will quickly come back on. We ask for your understanding in advance.

Our moderator today is Cynthia Li. Let me tell you a little bit about her. She's a doctor and author whose personal healing journey through a disabling autoimmune condition took her from public health in underserved communities to integrative and functional medicine. Her teachers include functional medicine experts, environmental health scientists, energy healers, and Qi gong masters. She serves as faculty for Rachel Remen's Healer's Arts program at UC San Francisco School of Medicine, and is the author of a memoir, Brave New Medicine, and a free eBooklet for COVID-19, "How to Strengthen Your Inner Shield." So Cynthia, I'm going to turn this over to you, and if you could introduce Stephen to us.

Cynthia: Thank you, Joe. It's a pleasure to be here today, and I'm really honored to introduce you to Dr. Stephen Loyd. He has been nicknamed the "Opioids Czar of Appalachia” for very good reason. He currently serves as the chief medical officer of Cedar Recovery which is an addiction treatment center outside of Nashville, Tennessee. From pregnant IV drug users to inmates, nearly everyone on Medicaid, each patient receives personalized and comprehensive medical, psychological, and social support. He has also served as the State of Tennessee's medical director for substance abuse services and as an expert witness for the U.S. Attorney, the FBI and DEA against doctors improperly prescribing addictive medications.

Stephen was born and raised on a small farm in East Tennessee surrounded by mental illness, alcoholism, drug addiction, and abuse. Somehow, some way he became the first in his family to attend college, went on to medical school, and became president of his class. During residency training, the pressures began to mount and his past came back to haunt him. He popped a Vicodin prescribed for a dental procedure which melted away all of his problems. And this was the beginning of a long, self-destructive addiction -- but being high functioning, he climbed the academic ladder serving as the chair of the Internal Medicine department at East Tennessee State University.

By the time his father intervened, Stephen was ingesting or snorting a hundred pain pills a day. And it's his personal journey through this dark night of the soul that has informed his work in addiction medicine, beyond the individual -- into systemic diseases like isolation, poverty, and violence. It's his personal journey that has also opened up his big heart to joy and gratitude while facing some of the toughest challenges in medicine today.

I first met Stephen when he was a keynote speaker at the annual conference for the Institute for Functional Medicine. This was attended by some thousand doctors and healthcare practitioners around the world. And what made Stephen stand out for me was how personable he was, especially at a formal medical conference where personal vulnerabilities are usually taboo. More so, I was astounded how he could speak about pain, addiction and stress -- the shadows of medicine and of society -- with such lightness and humor. Welcome Stephen.

Stephen: Cynthia. Thanks for that so much. I wasn't prepared for you to do that. As I sat here and listened to it, I had all kinds of emotions bubble up to the top. But I'm really glad to be here. I appreciate you having me, and the kind words that you just shared.

Cynthia: It's really our pleasure. I mean, this conversation is so timely given the political, economic, social, and medical unrest that is going on right now. There’s so much uncertainty -- especially this week, the last couple of weeks, with the spike in COVID-19 cases particularly hitting hard the communities like the ones you serve, people living in the margins of society. And that's going to be something I really want to make sure we bring into the conversation and we circle back to. But just to start off with, I would love for you to describe for me, for the listeners -- help paint a picture of what it's like, East Tennessee, Appalachia, this region. What was it like growing up and what is it like now?

Stephen: Cynthia, you know growing up it doesn't seem any different than anywhere else because that's all I knew. But some of the things I'll share with you guys today, I promise you are exactly like it was, and some of you may have only read about it in books, but that's what I grew up in.

I grew up in rural east Tennessee, which -- Tennessee is a pretty long state and it has a point up in the northeast corner that is really close to southwestern Virginia, eastern Kentucky and western North Carolina. So really, in the heart of Appalachia. And my father was a diesel mechanic and my mother was a rural postal carrier.

To be honest, in a lot of ways, I thought we really had everything. My house seemed huge and I never really wanted for anything, or it didn't seem like I did. But I grew up in a place that was incredibly -- what do I say? -- not diverse, how's that? I guess that's the best term I can use for it. Things that we see on TV now and racial slurs that have really come under fire -- as they well should have -- were commonplace. And that's what I grew up in. That's what I knew.

I had a young black friend in my kindergarten class and his name was Johnny and he was just my friend. The only thing I knew about him is he could outrun me -- and that used to make me so mad, but then I would get around others in my family and the terms they used to describe him, I didn't understand that. And really that's the way it was. It was commonplace -- slurs we see mentioned, and people lose their jobs for. I lived around that every single day of my life in just about every aspect of it.

I went to county elementary school and county middle school and I was -- and I'm just gonna tell it like it was -- I was physically and sexually abused growing up. My family, every time the church doors opened, we were there. We were exactly what you would think of in your mind as a Southern Christian family. My mom played the organ in the church and my dad was an elder. And we would go to church every Sunday, every Sunday evening, every Wednesday like clockwork. And, on the way to church, a lot of times, it would be World War III. But when we stepped inside the church doors, we looked like a great family, the perfect picture. And so that's how I grew up. But at the same time, I was being physically abused, in my home, by a parent.

It’s really hard to describe. Not spanking…. In corporal punishment, which I'm not a fan of at all, these weren't just spankings. These were whippings, belts, sticks, bottles. I mean, just about anything that you can think of. My mom, I’ve since realized, struggled with mental illness when me and my sister were growing up. It was untreated for a long time. We had a long history of it in our family on both sides. And then there was sexual abuse, starting at about age five and progressing from molestation to eventually rape. And so I wasn't the best student in the world, Cynthia, and, as you and I have discussed before, I was a discipline problem in school.

I was constantly in trouble. Corporal punishment was big in the late 1970’s and early 1980’s. And so when I was a discipline problem, I would be spanked at school. And one of the things that was particularly harmful was, when I would misbehave and act out at school, I went to a school where we didn't have separate classrooms, they were only partitioned. And so the teacher would pull me around to the edge of the partition so the other classrooms could watch me be spanked. And then when I went home and told my parents that I had been spanked, and then obviously something worse was coming from that.

So I learned pretty quickly just to keep my mouth shut. And that was really the message I got growing up. I learned to keep secrets really well. I learned to keep secrets from my dad about my mom and the other way around. And for the longest time, it's all on you.

Because I was a discipline problem, I was put in the classes that --- as kids, you know who the smart kids are and who the supposedly-not-smart kids are. And always I was in those classes where not very much was expected of the kids -- basically get through our day and that kind of thing. And that didn't change until I was in seventh grade.

We took a standardized test that year, first year that Tennessee had given a standardized test and, apparently, I did pretty good on it. One of the teachers came in the classroom I was in and pulled me out of there and put me where the smart kids were. And that really – Cynthia, I talked to you about that -- that particular teacher, that really started to change my life.

I looked around and knew that I didn't want to stay in that. Nobody in my family had ever graduated college and only a few had ever been for any amount of time at all. They were mainly mechanics. There was a lot of mental illness, a lot of substance abuse disorder, alcoholism, drug addiction, suicides.

We had suicides in my family and I just didn't want to stay there. I didn't want to stay in that little town. I was in Jonesborough, which is a really wonderful town. It's historic, but that's what I saw all around me. And so that began to change in the seventh grade. It was kind of when I drew the line in the sand where I started to change what my goals were.

I didn't have anybody to help. I didn't have that person out there who saw potential in me and was a mentor who had traveled that route before. And, you know, when you're that age, we’d get together at Christmas and different times of the year. It was a huge family -- seven or eight aunts or uncles on one side, seven or eight aunts or uncles on the other. And all those cousins, you can imagine. Your typical Appalachian family.

Relatives would ask me what I wanted to be when I grew up. And, after I got over the point of wanting to be a boxer — because Muhammad Ali was my hero -- I told them I wanted to be a doctor. And I remember the laughs.

I’d hear “Well it's really hard to be a doctor. You have to go to college and not everybody even gets in college.” And so I didn't have the support. And the truth is, Cynthia, I would like to tell you that I wanted to be a doctor because of something inside of me, but I got to go to a college graduation one year and the doctors were the last to graduate then. And it looked to me like they got the most respect. And so I thought, “I want to do that. I want that kind of respect.” I didn't put this on my MCAT application, by the way, but that's really the gist of it.

One thing about me that I've always had, and I love this. I love this part about me. I have a heart. I recognized early on, even in elementary school, in grade school, that there was a disparity. And I had friends who the school would buy their coats in the winter and buy their shoes. And, as I understood that, I started to see people that didn't have the things that I had, and I've always been like that, that part I've always had, even as a discipline problem, even after everything I've been through.

I've always cared about people. Drug addiction, as we'll talk about in a little while, took me away from that. I became more self-centered and angry and disgruntled. But the good news is, I got awakened back to that, through the process of recovery.

So that gets us up to basically high school. The place I grew up was a little farm, not a huge farm with huge tractors, but we had tractors and we had cows and horses and things like that.

And really out in the country. I didn't have neighbors and I worked in tobacco and raising tobacco, growing up, as well as putting up hay and all the things that you do to earn a living when you're a teenager. I did all of those things. And when I went away to college, most of that stuff stopped. I always accused my dad of his labor was gone. But a lot of that stopped when I went to college.

Cynthia: That's incredible. Thank you so much. I found myself, as you're describing your environment, your family, the social milieu, even the school and your behavior, and I’m just wondering about the secrets that you said you learned. You learned really well to keep secrets. I mean, certainly the negative ones, but I found myself really curious, what was 10-year-old, 12-year-old Stephen -- what kind of secrets were you holding within? How do you keep your heart open when that's the environment that you're surrounded by?

Stephen: When you started talking about the secrets, there's this one particular moment that I can point to. I was in about first grade, five- or six-years old. And no cell phones, obviously. The home phone rang and it was a lady from my church. My mom played the piano and organ and then another lady played the other one.

And it was her friend Jenny. And Jenny said, “Steve, I need to speak to your mama.” And I said, “well, she's in the shower.” And she said, “well, let me speak to your dad.” And I said, “well, he's in the shower, too.” And she said, “well, okay. I'll call back.” And we hung up. When my parents got out of the shower, mom said,” Who was that?” And I said, “it was Jenny.” And she said, “well, what'd you say?” I said, “well, I told her that you and dad were in the shower” and I got whipped.

Cynthia: Wow.

Stephen: That was the moment that really made a mark on me. I had no idea, Cynthia. I'm five or six years old. I’m a kid, right? And I learned to keep those secrets and I learned it really, really well.

Things that were going on inside of me. I would see things that would upset me or that I knew wasn't right, and I wouldn't say anything because of the reaction I would get from those that were close to me. And I can't remember if it was ‘77 or ‘78 and some of this, this stuff is going to be funny, but it's just kinda how I grew up.

But Roots came out, Alex Haley's Roots was on TV. It was a big mini-series. And I got to watch it. I was nine or 10 years old. And I just remember, people's reaction to that on a bigger scale, in the media. Yet in my life, I still saw that same stuff. Now I didn't see people held in bondage, but I still heard the black community talked about like that, in those words, those specific words and, at the same time, I'm going to church and the preacher gets up and says, “Well, you know, rule number one is to love me with all your heart, mind, and soul and rule number two is to love others.”

Well, I could never make that match. How is that possible?

And there was a time there, Cynthia, where I just separated it. The things that I was seeing at church, I just started to completely blow off because, in all honesty, I thought they were BS because I didn't see people acting that way.

And things that were going on inside of me as I am a pubescent teenager and things that we ran into, I just didn't talk to anybody about them. I was just confused about them. I am 53 years old, Cynthia, and I still don't think that I have had the birds and bees talk. So going through adolescence was very tough. And particularly whenever I started having girlfriends. I just didn't let anybody on the inside of me, but I was starving for connection and relationship because it's just how it was. It was how I was made.

Cynthia: So these were some of the many things that began to haunt you, right? You are externally breaking all these barriers, right from your upbringing and then you graduate college with honors, you go to a medical school and you become president of your class. There’s this joyful, buoyant force. Can you just share with us what that breakdown began to look like? You were in your residency, is that right?

Stephen: I was, yes. I have been so fortunate to have such great people help me, particularly in the last 16 years. But all this stuff that we talked about up to this point set the stage for that. I never in my life felt that I was enough. The next thing that I got to stick on the wall, or the next thing I could get checked off, that was going to be it, right? If I got to go to college and I graduated, then that was going to be the thing that would give me that respect or whatever it was I was looking for. And I piled all those things up. I played athletics in school. I worked really, really hard and made the All-Conference basketball team and I was voted the Most Valuable Player in my district.

I made All-State in baseball and basketball. And that good feeling, though, was always about that long and then it was off to the next thing. So that really became the pattern of my life. I remember when I got to go away from school to the University of Tennessee in Knoxville, which is an hour and a half from my house. So that's how far I went away to college. But that was a big deal and I made the honor roll. I did really well in class. Everybody felt that I would fail out immediately and I didn't. And everything I did, it was just me. I didn't have tutors. I worked really, really hard. My high school girlfriend's dad was a calculus professor and he helped me through calculus, but outside of that, I didn't have anything else. It became about stacking these lists of credentials up that was going to make me somehow whole on the inside and it never works in the end.

Chemicals started to come into play in late high school and then at UT. I never handled the party life like most of my friends did. It was always more. I wouldn't stop. I always prided myself on being able to get up the next morning and go take an organic chem midterm. That I was blessed with. I was good at school, but I worked really hard.

That became the pattern and I graduated from the University of Tennessee in four years. I was first one with my last name to have a four-year degree. And I really wanted to go to medical school, but from a maturity standpoint, it was not the time. Alcohol, anytime I started out, I had real difficulty in stopping. And I didn't know until later on that my genetics put me at risk to develop alcohol use disorder and then, later on, opioid use disorder. And I met a girl in college that I wound up marrying. She's still my wife today -- Karen. I felt like when I got married to her, that things would be okay. I would stop doing the things I was doing and somehow get my life in order and I didn't go to medical school. I took a job actually within the insurance industry. I was a claims adjuster for automobile accidents. I did that and really nothing changed.

My wife is wonderful and I love her, but there was a lot in the early years that she put up with. It is very hard to even think about today and the damage that I caused. And then I changed jobs. I went to work in the pharmaceutical industry which I think is humorous now looking back on it. We were making really good money and I was calling on doctors, and this is gonna sound so arrogant, but we call on these folks and, after a while, I was like, “I am at least as smart as some of these folks. I mean, I really am.” So I went and I bought the study materials to start studying for the MCAT. And I sat in my kitchen at my house. And for a year, every night when I got home from work, I studied for the MCAT.

Right as I was getting ready to take it, we found out we were pregnant with my son, Heath. So I am going to quit my job. Karen's going to quit her job. I am going to borrow money and I am going to go back to medical school which is actually what wound up happening.

Cynthia: Wow. That's incredible (laughs) There are so many different places to go. I am also just mindful of the time. I would really like to get into --- this real dark night of the soul. What happened? What was going on at the breaking point and what happened after that?

Stephen: To start with the breaking point, we have to start with the first day of med school because I showed up to the first day and we had a small class. There were only 60 of us. It was in my hometown and we had to introduce ourselves and I am sitting there and my classmates are introducing themselves. And -- oh my gosh, Cynthia -- I am this guy that almost led like a Forrest Gump-like existence who was just so fortunate to be there. One of our very first classmates was a test pilot for the Navy and the stealth bomber program. And I was so intimidated. I thought “I don't belong here.” Somebody's gonna bring me out, and on the third day of med school, those folks that I still love to this day, elected me their class president which I did all four years and it was the biggest honor I have ever had. And I made sure I did it right. I never wanted them to see me use any kind of chemical at all. I didn’t at all through medical school. The problem was residency. And then the last day of medical school, when we graduated and none of us really have a real feeling that that would be the last time we all will be together. And I told you, I am a relationship guy. And I think about them right now and they all know this, I love them, I love them to this day. And then they're all gone. And then just with a short amount of time, I was back into the chemicals, just a couple of months.

And alcohol, I never did handle well -- didn't get the DUIs, never got in trouble, but I just didn't handle it well at all. I was driving home from work one day and all the pressures as a chief resident were on me and I didn't like my relationship with my wife. I had two kids now and I was getting ready to step out into a job and what was it going to be like? And I had all this anxiety, this depression, and still that underlying feeling of “I am not enough. I am a fraud.” And so when I popped open the glove compartment of my truck that day in front of a liquor store where I was working. I saw Norcos, just as you said, from an old dental base over there and I looked at them and I thought, “My patients take these things all the time” and I broke one in half, just two and a half milligrams of hydrocodone. And I threw it in my mouth and within ten minutes, by the time I got home, just exactly as you describe it, all this stuff melted away. So suddenly I liked myself a little better. My world wasn't as bad. And I can start to deal with some of those realities.

The problem was -- probably a lot of people online know right now was tolerance. It took more and more to get less and less effective over time. And I moved into a faculty spot, did very, very well. My first three years as a faculty member, I was voted the most outstanding instructor in internal medicine by the residents and students. The year that I actually wound up getting help, the graduating medical school students voted me mentor of the year over their entire four years of medical school. So it's one of the things I like to dispel about any type of addiction is that you can still do well in your job and still have this thing out here. I had that secret, Cynthia, and we talked about my ability to keep secrets and it was there. I had this face out front that was a very successful doctor coming out of my hometown, the first one to go to college, all of this.

And then the underlying reality was I hadn't outrun my genes at all. And I had this other life that became increasingly difficult to try to manage.

Cynthia: Wow. I do want to, before we go on, I want to underscore that you have the genes that predisposed you to addictions and those have been very well researched and elucidated. But I just want to underscore what we know with chronic diseases -- and I mean, whether you want to call addiction a disease or not -- is the environment, the total sum environment, is so much larger in terms of that. And it's something I want to explore when we talk about successful treatment programs. So what happened at this point? At some point, it was your father who confronted you.

Stephen: And I really hope we get to this, Cynthia, because genetics are one thing. But as I learned, and you have a public health background, keep in mind I didn't have that, so words like "social determinants of disease" and all that are foreign concepts to me. But trauma, adverse childhood experiences, all those things that I've learned in the last 15 years, and as we start to put them together and look at successful treatment, it actually fits within that model and things start to make sense.

The thing that happens in addiction is that whatever it is out here that I'm addicted to takes precedent. It takes precedent over relationship, family, wife, kids, everything. And I had no concept of that. If I don't have this, I will die. That's really the mindset. I did things to acquire it. We talked a little bit about it, but, you know, taking medications for patients, taking them out of people's medicine cabinets, all things that are just horrible to say, but all of them happened. And it got to a point where that was the only thing. Whenever you're in the throes of addiction like that, that I was, you don't need the things that other people need -- food, water, sex, the basics. That stuff all went away.

And so I'm in my mid-thirties, withdrawing from opioids and benzodiazepines every single night and getting up the next day and going in and taking care of sick patients in the ICU and taking care of and teaching medical students, medical residents, pharmacy students, pharmacy residents. I was a leading producer in our practice from a patient care standpoint. And it was just this double life. But I was dying on a daily basis.

And one day in particular, the day that really stood out to me, was I came into work -- and we always started in the ICU because that's where the sickest patients were -- and we were standing there and a lady had come in the night before and she had overdosed on Tylenol. And the intern was presenting the case to me. And we were going to Life Flight her to Nashville. She needed a liver transplant. She was young. She was in her late twenties, early thirties. And I stopped the resident. His name was Scott. And I said, "Scott, how many did she take?" And the number he told me was roughly equivalent to what I was taking on a daily basis. And we can talk about that if you like, there's a neat story around it, but I couldn't -- we didn't have EMR (electronic medical records) back then -- I couldn't get my pen down to my paper to write the note. And I dismissed rounds right then. I told everybody to go round on their own. And I walked into the bathroom at the end of the ICU hall and looked at myself in the mirror and just started crying because I didn't think anybody was going to find me. I thought I was going to die. There was no way I was going to ask for help because I'd worked too hard to get where I was and it would all be taken away. I would go back to being that kid growing up in rural East Tennessee. And I just couldn't do that.

Luckily for me -- you would think that day would have the impact to stop it, but I went a few more months -- my dad noticed changes in me. I don't know what you guys can see of me from the chest up, but I'm six foot two. When my dad intervened, I weighed about 170 pounds. So I wasn't eating and he knew something was wrong. He saw me take a handful of pills one day, actually the day before he intervened, that I told him I didn't take. And he just saw me take them. And that's really, Cynthia, when my life started to change, when I told him, "Yes, I have a problem and I'm going to lose everything I have." And he listened. He was very kind. And he said, "Steve," he said, "None of that stuff's going to do you any good if you're dead." And I became willing right then to give everything up because I knew I had to get better. I didn't have any idea anybody could help me. I didn't know about drug treatment. I mean, really, how is it possible to go through medical school and residency and not understand any of that? But I didn't.

Cynthia: Would you say that you felt seen by your father at that moment?

Stephen: I would. That's a great way to put it. I felt like for the first time, in a long time, that I had opened up and said, “okay, here I am.” And Dad did see it. It was a struggle for him. We had some struggles that we'd gotten through and, outside of my son, my dad is my best friend. But yeah, he saw me at that moment and he was so kind. He had tears in his eyes and he didn't know what to do either. But one thing I took away from him, my dad was always a standup guy. I told you about the language I grew up around. I never once heard it from my dad. Never. My dad was the thing that, for me and my sister both, that he didn't let us get involved in that. He didn't take us down that road. And at that moment he stood up for me and he found help. And I'm very grateful for that.

Cynthia: Wow. I'm grateful for that, too. Incredibly grateful. So rehab? You checked into a residential program, right? It was for three months, eight hours a day. I calculated that 720 hours of being basically on some kind of retreat away from all the stresses. What happened during the 720 hours? And what's going on in your mind and your heart and your body?

Stephen: People have asked that so many times through the years, Cynthia, and that's right. I did the math too. I think our brains work alike. Seven-hundred twenty hours. So you would think that you go to treatment and you learn about drugs and alcohol, right? And out of all those hours, we probably talked about drugs and alcohol and sex and gambling maybe two hours. Maybe.

Cynthia: Wow.

Stephen: It was all about community, relationship. The opposite of addiction is not recovery. The opposite of addiction is community and relationship. Cynthia, when I started to wake up, because that's exactly what it was, it was waking up, I thought there's no way that this can be it. This cannot be it. You don't want me to go on doing the things that I'm doing now that I can't live without and this is your answer? I thought it was a joke. And the guy that saved my life, Chip Dodd, who I love to this day, Chip said, “Just keep doing it.” And I did. The more I did it, the more I got real and honest about what was going on inside of me and talked about some of the things that you and I are talking about right now, the more I stopped living a secret life, the more I got outside of myself and helped others. Oh my gosh. Then all of a sudden this world that was out there that I didn't know existed, I'm now in the middle of and I can't walk away from it. Not only can I not walk away from it, I don't want to walk away from it. And that's what treatment did for me. I said, we're going to get honest about all areas of our life. Well, Cynthia, I broke the law every time I took medicine from a patient. That's a class D felony. And I did it about, I don't know, 400 times. If you get eight years for every one of those, I should be in jail for 3,200 years. I wasn't going to do that. I wasn't going to tell that. But I did. I actually did tell that. And the ironic thing is I wound up working for the federal government as an expert witness to get folks who were harming people intentionally. What I saw was these things that were coming out of something that seems so bad that are now... I met you! I would have never met you without this. I mean, there are so many things in my life that started happening and they really started happening. It started happening quickly. I was able to put my relationship with my wife back together. I'm not telling you everything's been perfect over the last 16 years, but I'm happy where I am now. And I think she is too. It was all about being honest with myself, allowing myself to be vulnerable, and more importantly, getting outside of myself. It really changed everything and it continues to change it, even today.

Cynthia: Wonderful. And how old were your children during this period?

Stephen: My son, Heath, was nine and Haley was six. Haley is now married and has been. And I gotta tell you this one, Cynthia, 'cause I didn't tell you the other day when you and I got to talk. When I left that day, actually July 8th, 2004, today is the 11th. So I'd been in treatment detox for three days this time, 16 years ago, but I thought my life was over and didn't think I'd ever be walking back into that house. And I certainly wasn't the father that I needed to be to my kids. But during the middle of the shutdown here in Tennessee, back in April, we sat down to dinner and my son's getting married in October, and we sat down to dinner, and he looked over at me - "Say, Dad," he said, "Would you be the best man at my wedding?"

That's a great moment. And that moment, since it happened, has driven me as we deal with, not only the opioid crisis, but the COVID-19 pandemic. The people that I work with every day, that's what they want. And I have to make myself available to help them. One of the things I told you earlier was the thing that I was most proud of in my life was my classmates. It was up until that point because when Heath asked me to be his best man, to me, there was no greater honor. And something that 16 years ago I would have never thought possible. I think when I look at that and I look at what I see in the world today that that's what the mission is. Not everybody's going to get to do the things I've been blessed to do, but a lot of folks can have productive lives where they're good mothers and fathers and they care about others and help others. And that's really what my mission is on a day-to-day basis.

Cynthia: I’ve got to stop crying. It's so moving, and it's astonishing, this journey that you've been on, and that we're just in the honor of witnessing. But you've transformed that, and just sort of poured out this once-darkness into light, into the community you're now serving.

One of the things you said, in your keynote last year, was the most important person in the doctor-patient relationship is the doctor, because if we are not well, if we don't know how to heal, if we don't know how to self-examine - what are we doing, right? And so I'd love for you to shift gears a little bit and describe what kind of work you're doing. What does good or "successful" -- I don't even like that term -- but what does rehabilitation look like? I mean, that is a very clinical term, but it's really about deep healing. You talk about community and relationship and you've talked a lot in the past about purpose and that these are really the opposites of addiction, right? Addiction, where we're looking to satisfy some very profound sense of separateness. Could you describe a little bit about, or a lot about, your work in the community?

Stephen: You know, part of my work is reflected in how I met you. When I got asked to come to IFM, I didn't know what IFM was. I've since told you that, but when I got there and saw some of the other speakers, I felt horribly inadequate because I knew what I was going to talk about. And a lot of other folks were really accomplished in the academic world, but I was going to come in front of you guys and bare myself.

When I did that, I met you and I met a lot of others, a lot of other friends that I've made from that. And I think that's really the takeaway when it comes to recovery, Cynthia, is that whenever we get to the place that we can open ourselves up and bare ourselves to another human being and offer that human being a glimpse at us, and a chance to step into relationship, that's recovery.

Because there's meaning in that, and it's more than superficial, and it's what we were made to do. It's why the pandemic has been so hard. The pandemic says isolate, stay away from people - well, it's really, really hard to do that because that's not what we were made to do.

That to me is recovery. Whenever I have people to the point in their life that they can be vulnerable and allow others to step into their world in meaningful relationship. Now, the key is what is the path it takes to get there, right? We can't do anything about genetics, trauma. I explained it as a slot machine, as you well know. The first seven is the genetics, the second seven is the trauma, childhood experiences, all those things that affect who we wound up being. The third seven is just the social opportunity.

When I talked to you about sexual abuse, I never dreamed that I would be talking to somebody about that, right? That was the secret that was going to stay down there. But the healing power of that is when I'm able to get up in front of someone or you and I talk, and I share that with you, and you step into it and your kindness and compassion touch me. That's healing. So that sexual abuse is no longer the boogeyman in the closet that makes my heart rate go up and makes me want to crawl under my covers. It's something that I can stand up and address. And I love this. Those things are like obligate anaerobes. As you know, an obligate anaerobe can only live in the presence of no oxygen, right? It can't have any oxygen. So these secrets inside of me like that, and inside of my patients, that are eating them alive, that were eating me alive, that I was medicating. When I can let those things hit air, that's like an obligate anaerobe. They die, they lose their power. And the more times I walk through it, the less power it has.

I'm trying to do that with a population of folks that are very marginalized. Medicaid patients, Medicare patients, people that don't have insurance at all. Every time they've stepped out and asked for help, somebody's stuck it in. So it's very difficult to get them to do that. My goal there is to help them find the path to recovery that's best for them, not what I think is best. Because when I get in that place, that's my ego and I have to step back from that. That's why I've become a fan of medication for opioid use disorder, and I'm not a fan of medication for very much, but it gives people a level playing field to be able to start to address those things deep inside of them that we have to address, that I was lucky enough to get addressed with me.

And then the social determinants of health, the way we've approached things in the US with regards to something such as basic housing, is that once you do these things and you meet these check marks, then we will give you housing. But what I've learned is let's give you housing, and then we'll work on those things, right? That's a social determinant of disease that we have to look at. The criminal justice system and the things that I've been awakened to there. I grew up in northeast Tennessee, the faces that I saw in trouble in the news were always black. So my bias was well, it was the black people committing the crimes, so it's the black people that are going to jail as it should be. That's how I grew up. Then when I started working where I work now, the system is designed to get the results that it gets. And Michelle Alexander's book, The New Jim Crow, really awakened me to a world of what I was seeing in my day to day life, trying to help my patients.

There are things we have to do to help folks in the criminal justice system, because it's designed to keep them there. If nothing else, if you don't care about people, we can't afford to from a financial standpoint. From a basic human being standpoint, we're losing generations of people that want the same thing that I want.

I know that's a really long answer, Cynthia. I get really fired up about it, but it's not just “do this for 28 days” and then go back out into the world and go attend 12-step meetings. That is not going to cut it. We have to be able to open up and develop these meaningful relationships. When I read about Awakin, because you told me about it, so I went and researched, this is what I'm talking about, how fortunate we are to get to do this.

Cynthia: Wonderful. I think that's the real challenge for healers of any kind, or lovers of any kind, right? Human beings ... so much of what happens is on a much bigger social, political, economic, even global, or some would say on a cosmic level, but the responsibility falls so heavily on the individual. And that the only way to really overcome these is if we begin to expand the overlapping circles.

Can you explain a little bit about how the pandemic has manifested, what's happened to addiction rates in the community? What's happening to your patients during this time?

Stephen: Locally where I am now--I'm just outside of Nashville. And Nashville is a metropolitan area, a million, 1.2, somewhere and we have a lot of outlying rural counties. The pandemic has really wreaked havoc on this marginalized section of our population.

We all knew it was there. I mean, we work in it a lot. But it has further marginalized it. So when you're told on TV to socially isolate, to work from home, well, if you're making your living working at two different jobs where you're a cashier at a convenience store, you can't work from home.

Or if you're a server or you work in some of the service industries, those things get cut off as not essential. And those social connections that a lot of my patients had built they started to lose. They lost incomes. Stimulus checks are one thing, but those don't go on forever. And $1200 doesn't meet your needs over a multi-month period.

What I've seen, Cynthia, is patients that were doing really well early in recovery that are just heroes to me suddenly go from living in apartments and houses, and even bought houses, to living in their cars, to living in hotel rooms.

Tele-health has brought me into their life and so now I see where they are. I've seen kids asleep in the backseat of vans, because that's where they live Monday through Thursday and then hotel rooms for the weekends. Our overdose death rate locally, where I am, in the area that I take care of has arisen about 20% over the last four months. That's a huge number, because we were actually making headway with regards to that number. I love tele-health, and I love seeing you like this, but I think both of us have to admit if we were sitting across from each other in a coffee shop, it's a different feeling. This is close, but it's not quite. And I think that as we've seen that disconnect within our patients, that they have really struggled more.

So it's been very tough, Cynthia. I told you this past week when we were talking before we got started, it's been a really tough week because now we're going from month three to month four, and I'm starting to see more wheels come off. We're constantly trying to reach people where they are no matter what.

That's really the thing I talk to our employees about, the people I work with on a daily basis. I'm not the police. I'm not the cops. I'm not any of that. I'm somebody that's going to suit up, show up and meet you where you are, no matter what. Please run towards me, not away from me. And I think that's the message that we, that I'm trying to continually put out there.

Cynthia: There's this great distinction that I learned about several years ago between hope and optimism. Paraphrasing the Czech thinker, Vaclav Havel, he talks about optimism as being the sense that things will turn out right. It's results oriented. Whereas hope is an orientation at the level of the soul or the spirit that's held in the darkest of times. And you've always come across as someone who has both. Are you, do you remain optimistic and also, where does hope come from for you?

Stephen: The short answer is that, yes, I can be very, very optimistic and very hopeful with those definitions, for sure. My guiding force with regards to that is the Stockdale Paradox that I love. I want to address the current facts of our reality, no matter how hard they are to look at. We have to do that. We have to be willing to stand up and say our truth, no matter what it is.

At the same time, I'll retain hope and faith that we're going to win in the end. And Cynthia, I think that we do. I mean, for me and looking at the points in my life, I saw what happened -- that darkest moment for me of thinking that, “I'm going to die. I can't stop this. Nobody's going to find me.” That's a horrible place.

People said, “Well, Steve, your bottom wasn't very low.” I went to bed half the nights praying I wouldn't die, and the other half praying that I would. That's a low bottom. And out of that sprang whatever this is I'm living right now.

It's not just possible for me; I'm not special. Other people out there just need that opportunity. And that's why I remain hopeful. I don't care what things are on the national stage even in the recovery fields. I stopped following things on social media, Cynthia, because even people that I love are lobbing hand grenades at the other side. These people, they say horrible things about them, and like, "they've got some things that we need to enlighten them on and bring them to the table," but we can't get there when we're trying to kill them.

So I think that if I can remain a light, it's exactly what Dr. King said, “hate cannot drive out hate. Only love can do that.” I think that if I remain consistent and if I be that myself, I think it's attractive. It attracts me and I think it will attract other people. And I can't lose it. I can't kill it. It's impossible. I've tried to. I've wanted to a few times, but I can't kill it.

Joe: Cynthia, I'd like to interrupt just for a moment.

Cynthia: Yes, absolutely. Go ahead.

Joe: Thank you. I'd like to interrupt just for a moment and let our listeners know that they can ask questions on the livestream webpage. We're going to be soon switching over to the audience questions. You can click on that button down at the bottom on your livestream webpage, or you can send an email to Thank you.

Cynthia: Thank you. Are there questions? Have there been questions already? And we're at the top of the hour. I can turn it over right now if we're ready.

Joe: We do have some questions and, actually, I would like to start with one. Stephen, you just mentioned the Stockdale Paradox. Is that what you said? I didn't hear what it was. I'm curious.

Stephen: The Stockdale Paradox is from Admiral Jim Stockdale who was actually Ross Perot's running mate in '92. But the Stockdale Paradox is that we will confront the most brutal facts of our current reality, whatever they might be, not turning a blind eye to them, not doing anything, just confront those facts. And no matter what, we don't lose faith that we'll prevail in the end. That's the paradox.

And that's really what I try to do. We have a lot of things going on in our country right now, and I get excited because I think we have great opportunity, because we have looked at them. We're in the process of confronting them, sometimes in more healthy ways than others, obviously.

But whenever we're able to do that and name it, now we can start to address it. That's what worked for me in my life. When I looked at my life and I started identifying things that I had to really take a hard look at, that no matter how tough they were, but if I address those and I retain faith that I'll prevail in the end, the weird thing is that I have, and I continue to do so.

So that is the Stockdale Paradox. I'd like to take credit for it, but it's not mine.

Joe: Well, we can just give you credit for it. From now on, I'm going to call it the Loyd paradox!

So I have a question for you. There are certain things you said that really, really jumped out at me. One of which was how when you watched that graduation and the doctors graduated last, you chose then -- or at least it was a contributing factor to your decision -- to become a doctor, not to serve others, not because you wanted to be a doctor, but because you felt they got the highest level of respect and that jumped out at me. Here's a man who wants respect.

And you've mentioned that the opposite of addiction is relationship or community or connection. You also mentioned what a challenging childhood you had. Thank you for being an example of expressing to the world about your sexual abuse. I'm sure that's very hard, but it's by exposing these things, that vulnerably that we can work through them.

So what about a person who hasn't had a father like you, who sort of offset what your mother gave you. And I'm not trying to judge your mother, but you know how many of us are just simply lucky not to be born with two difficult parents where they both have mental illness, where they both have drug abuse going on while you're a young child. And I'm tying this together with your statement that you were wondering if anyone would ever find you.

Joe: You literally wanted help and hope. So if I'm a person who's had two difficult parents or I've got a friend, or let's say I'm a recovered parent and it's my own child who I know had two difficult parents or whatever, what can I, if I'm the person or if it's my friend, what can we do for someone like that to reach them to start the connection, the relationship, or maybe opening them up vulnerably?

Stephen: There's a lot there, Joe. I think there are things on multiple levels and obviously things that we don't know about yet. One of the things for me, outside of the nuclear family, is in our school system. I think there are things we can identify that we now know, and we can do a better job of addressing.

We have an elementary school here in Metro Nashville called Fall-Hamilton Elementary, and all their teachers and staff are trained in trauma-based education. So when you have that young student -- Steve Loyd -- that is such a discipline problem, the approach then was, "we'll spank it out of him.” Right? "We'll teach him." Now, whenever you start to look at this trauma focus of certain elementary schools around, it's looking at the deeper issue and figuring out that dad has been in prison and mom is struggling to make ends meet or there's abuse going on in the household, so I think there are some things from a systemic point that we can approach differently and in trying to identify these things that children are going through early on.

The other part, Joe, is just building that relationship so that at some point maybe you can start to see some of those cracks and vulnerability. It's what I do in my job now. I have a lot of young people and I want to build relationships with them to where they can trust me. They don't come in and tell me everything the first few visits. What I've seen over time is I've been consistent and I've suited up and I've showed up and I have met them where they are in a nonjudgmental way. The more I do that, the more I see them willing to open up and be vulnerable, and now I can start to meet their needs with other resources. So I think that for me and what I do every day, that's the key.

Joe: Thank you. Thank you. So patience and building relationships?

Stephen: Yes.

Joe: So we've got so many questions here. Here's a question from the Midwest, and this person wrote, "In so many parts of the country accessing emotions and sharing personal stories, even in a non-surface way, is so antithetical to social norms. How do we begin to offer deep healing practices for people who don't even see themselves or their communities as broken? Do we just keep working with those who see their brokenness or how can we begin to address the silent majority?”

Stephen: For me, it's about sharing my own story and letting other people make those connections and join me in it.

Joe: Once again, be a role model.

Stephen: Absolutely. I'm not somebody that's extremely well read, but one of the things that I read early in recovery was a quote from Gandhi that basically said, “Be the change you want to see in the world.” It had a tremendous impact on me. When I get up in front of a group like I did when I met Cynthia, I wanted . . . there were people in that audience that have some of the same experiences I do and have never said anything about it. I wanted to have the courage to open myself up so they could start to draw the connection and maybe do that, do the same thing themselves.

So I think that's where we start, because it's not the norm. It's not what we're used to. We don't have political candidates that start off their campaign by getting up and telling you their hurts and fears. If we did, I would buy in and be willing to listen and I really think that most of us are that way.

Cynthia and I have talked a little bit since I've gotten to know her and just little snippets have made me be in deeper relationship with Cynthia, as I learned little things about her and she learns little things about me and really, Joe, that's the connectivity part.

So I just try to be that example. And the weird thing is that I see it working. I see people doing that, a lot of times from places that I didn't think would ever happen. I want to continue to be that and I would encourage the person in the Midwest to do the same thing. I'm not talking about going out and falling on the sword and I'm not talking about sharing your life story in the grocery line. But I am talking about when the opportunity presents itself, to be willing to crack yourself open, to become vulnerable and allow somebody to get to step in and know you.

Joe: Yeah.

Cynthia: And if you don't mind. I'd love to just comment because, we talk about Stephen giving this keynote with a very personal . . . his story is woven throughout his presentation on addiction and it's incredible. You're courageous. But there was discomfort in the room. You've got a thousand people coming to this medical conference -- we're in a certain zone. Like this person's question -- we're not, it's not a culture or a climate that's prepared for this. I could feel it. I mean, all of a sudden, he starts … he's opening up his story. One of the lessons I took away from that was the courage. It's one thing to be vulnerable. That's a choice. But we have to go a step further and be okay with discomfort in the room and often that's the first barrier -- it feels like an energetic barrier -- and just be okay with it. Over the 40 minutes or so of his lecture, I could feel that just -- oh my God -- people easing into that discomfort and then suddenly it becomes, whoa, this huge opening, but the opening doesn't come immediately. It does not come immediately.

Stephen: I wished it did. I wished it did. I feel that, Cynthia, every single time and, it's like today, I know a little bit about what this group is about and so it's a little bit different coming into it, but there's still that angst when I sit in this chair and know what we're getting ready to talk about because it is, even whenever you're with folks who are pursuing this themselves.

My favorite place to be -- and not that I don't love you guys -- is jail. When I do this in jails, it's some of the most moving experiences I've ever had. The people in the room are frankly . . . sometimes people just looking at them would think about crossing over to the other side of the street, walking by them . . . and watching them let that stuff down, just like happened in that room, it's one of the most moving things that's ever happened to me. I'll always jump at the opportunity to get to do that.

But you're right. At first, it's not and it is uncomfortable, but we all have things and I think that when we create environments that we can let people become vulnerable we'll start to move forward. As long as we're lobbing hand grenades at each other, then I start to lose hope.

Joe: And both of you are doctors. I would think that there's tremendous pressure having the authority of a doctor and you want to convey optimism and hope, especially hope to your patient, and you want them to trust you, and it can be a delicate balance, I would think to . . . how deeply and is now an opportunity to share vulnerably to someone who . . . you might undermine your own credibility as a doctor by sharing that way. And I'm a lawyer and there's something similar that happens and I think there's a tendency by a lot of us who have opportunities to serve to put up a facade as to who we are in our effort to serve. And I'm wondering if either of you have anything to say about that?

Stephen: I'll let you go.

Cynthia: I was going to let you. This is . . . you are the feature. I would just comment I think there's a difference between like, if you're working with patients, and what is appropriate to bring into the conversation per se, but I think it's more of an energetic presence, of just being in touch with . . . I think at this root of connection and relationship is really our connections and our disconnections to ourselves, to our authentic selves. So if we remain connected with that energetically, it's less about what we say or don't say. And it's also, I think, particularly now what I'm finding too, is not just on the working one-on-one with patients, but also counseling, places of worship, or schools -- I'm on a lot of task forces. "How do we open up?" or "Do we?" There's a tremendous desire to know with certainty what's going to happen. And I feel like so much of my role right now is -- I mean, part of it is presenting the facts that we know, but the facts, or rather the numbers that we have, change every day, every week. There's so much uncertainty and part of what I feel like I need to bring, not as a doctor but as a human being, is helping guide someone through uncertainty. So that we have, at least I know as a medical community, as professionals, we have often mistaken certainty for hope and just trying to parse out the distinction there. I don't know, Stephen, I'd love to hear your thoughts.

Stephen: That connection to authentic self, Cynthia, for me that's always the key. It is today. When I come in here and I do my quiet time before I get to share time with you guys, I want to bring my authentic self to you all today with my fears, my hopes, my shame, my guilt, my gladness. I want to bring that. And that's what I try to do with patients. The impaired state of fear is anxiety but the gift of fear is wisdom and judgment. In helping patients walk through their fear, when you have to give a bad diagnosis with a potentially bad outcome, we can't fix that. There are certain things we can't fix. We don't have a medicine for that. We don't have a treatment for it. So what can we do? We can show up and be present and I can bring my authentic self to that. When I was still doing a lot of hospital medicine, it's what I lived for. Anybody can go in and go up or down on a dose of ACE inhibitor for blood pressure, but to bring your authentic self into a situation where somebody is facing fear and uncertainty and step into that moment with them, to me, that's being a doctor. And I didn't have an answer. But I did have the presence to show up and bring my own emotional self to the situation and help them walk through that fear. And, to me, that's what being a healer is about. And that's not what I envisioned when I sat down to take the first part of the licensing exam.

Joe: Thank you. Thank you. So I'm going to pull together a couple of questions here. One was gratitude for your vulnerability that is continuing in your answers. And I appreciate it deeply as well. This person says that your story reminds them of the song, "Amazing Grace." And their question is, “Do you see grace in your recovery, in the work you do now?" And another question from a different listener is, they would love to know something about your spiritual beliefs and practices at this point in your life.

Stephen: I'll address the second one first. That continues to evolve. Where I grew up, anything outside of Old Testament Christianity and some New Testament, you were treading on dangerous grounds and likely to go to hell at any moment. That's really not where I am now. Where I am now is -- from a spiritual standpoint -- whatever I think God is or whatever I feel God is, I see God in other people all day long every day and I try to make sure that I'm present enough to see it when it's in front of me. I spend time multiple times a day in meditation, in readings, and various things that I do that center me throughout my day. But the biggest thing that I do is really just getting outside of myself. That's the thing. When I wake up in the morning and before I go to bed at night, those are my prayers. "Today, I want to get outside of myself. I want to look at the world in a way that it's not just about benefiting me." And that's the biggest spiritual thing that I do all day long every day in trying to figure out how to get myself there. And most of the time when I get sideways in my day, it's around that. And I've let myself get sideways some this week. And I have to be willing to sit down and get re-centered with the things that I use. From a religious standpoint, I go to church, but I go to a specific church and the reason I go there is because it's about meeting people where they are. And then the other spiritual stuff I borrow from everywhere. Hindu readings and Buddhist readings and Qur'an readings that I love and that I jot down and I keep with me. I know that's kind of a rambling answer. The first part of that, Joe, I'm sorry. I can't remember the first part of the question.

Joe: Your story reminded this listener of the song, "Amazing Grace." And they wanted to know if you see grace as part of your recovery in the work you do now?

Stephen: I do. And it's what I try to get across to my patients. When I was in active addiction, and even for a while after, I can heap tremendous amounts of shame upon myself and the thing is, walking through the shame is really how I deal with it. I know that there's been a tremendous amount of grace given to me, and I want to pay that forward by giving that same grace to others. It's one of the things that worries me about what I see in our world right now because we go back and we look at what somebody said when they were 14- or 15-years old and now they're 40 and we hold that against them. I hope that we don't get to the point where we can't have redemption and extend each other grace because I'm not the same person now that I was 16 or 17 years ago. And hopefully, I won't be the same person 17 years from now. I hope that we still allow each other to extend each other grace. A tremendous amount of grace has been extended to me. And I explain to my patients that what I try to do is pay that forward. So I agree with the connection to "Amazing Grace." In early recovery, one of the things that was important to me -- my wife wrote it down for me and she doesn't know that I still look at this. But she wrote it down inside of one of my devotionals. And it says, "Accept the grace." And I've looked at that so many times through the years and think, “You know, that's what I need.” Because my tendency is to not do that. My tendency is to shame myself. My tendency is to pile on myself and whatever I'm looking to do, and that doesn't work. "Accept the grace." And then I pay it forward by extending that grace to someone else.

Joe: Hmm. Thank you. And as for your answer to that first question, I know that Gandhi has recommended that we all practice the religion that we were brought up in, which is sort of an embracing of it all. There are so many questions here, and we just don't have time for them. I'm going to try to roll two together to see if I can cheat here again. We have a question from "Asha" who is starting her residency in psychiatry next week. And she's asking about any advice for new young physicians on how to serve patients better. And then I've got a very touching question here. And I'm just going to read this to you, and I'm imagining that especially a psychiatrist, a young psychiatrist is going to be facing questions like this and maybe you could combine them. She writes, "Thank you so much for your heartfelt journey and story. My boyfriend has relapsed into severe alcohol abuse these past few months. How can a spouse or partner help? He feels shame even in 12-step groups and feels the potential for being judged in many communities. You said it's the opposite of addiction. I, myself am feeling hopeless and not sure of the next steps." And she writes that she's in the Bay Area.

Stephen: Well, for our young psychiatry resident, you're exactly right, Joe. It's a great question to tie together because these are things that we're faced with in medicine a lot of times. And my answer here -- and it's pretty close to always being the same -- is to take care of yourself. When we have somebody in our life that's struggling like this, the thing that I have to start with is taking care of myself because we can't change somebody else's behavior no matter how close I am to Joe, I can't make Joe do things. If I get into that, that's going to increase my anxiety when Joe doesn't do things as I think he ought to or take the guidance that I'm giving him.

For the person who is in a relationship with someone struggling with an alcohol-use disorder, I would tell you to take care of yourself. Provide a path and an opportunity to meet him no matter where he is and no matter what. That's the path. That's the loving thing to do. The other part of that is to take care of yourself because when we're involved in relationships like this, when I'm involved in relationships like this, the only thing I can do is the old 12-step adage, “I can clean up my side of the street.” So for me, I would be looking at what is bothering me about what I'm watching him go through and how that's affecting me and what can I do to better take care of myself in that area so that I can be healthy whenever he's ready to step into relationship. And that's really where it is because I see folks doing exactly what he's doing right now. It becomes almost self-fulfilling. You listen to this feedback, you feel bad about yourself, 12-step groups. There are multiple 12-step groups. Some are healthy. Some are less healthy. So you get involved in those and start defining yourself by, "Well, you know, they've made me feel this way," or "They made me feel that way." That's really not true. Those are things you're imposing upon yourself. And so I would just tell you to keep in mind the fact that you cannot change somebody else's behavior, but what you can do is be present to meet them where they are and take care of yourself and make sure you're doing the things that you need to do to stay healthy. And for the young psychiatry resident … And, Joe, I want to say something about that. That answer becomes unfulfilling because I didn't give you a solution. Right? I didn't say, "Do this and he'll get better," because there are no guarantees there. It's part of the Stockdale Paradox. And the current reality is that he may do what he's going to do and there's absolutely nothing that you can do about it. And that is something that we have to be willing to face at the same time, providing an avenue for him to step into relationship at any time and being healthy to receive him in that relationship. For the young psychiatry resident, I don't have a pat answer for that and I would be shocked if Cynthia did, although she might. I tell all the young folks that are entering residency that asked me this question. It is this: “Stay true to who you are.” Residency has a way of scarring us, has a way of changing the way we look at things and to become jaded at certain circumstances and become judgmental. My prayer for you would be that you would stay true to the heart that you had when you answered the questions for your AMCAS application because if you can do that, you'll separate yourself out really, really quickly.

Joe: Thank you. And it's the Loyd Paradox. Okay.

Stephen: Absolutely. I think Admiral Stockdale has passed away now, so I may be able to get by with it.

Joe: We're running low on time, but could you talk briefly about your treatment programs and how your center is organized?

Stephen: Yeah. You know, there's multiples. I'm the medical director at several in-patient facilities, everything from commercial outpatient and people who have resources to inner-city programs that deal with strictly women a lot of times that come out of trafficking situations. So ironically, the approach is pretty much the same in both of them. It's about meeting people where they are and helping them find the path to recovery that's right for them. When you look at substance-use disorder, no matter what substance you're talking about, a lot of times, it's highly dependent on the philosophy of wherever you go. We are abstinence-based. We deal strictly 12-steps. If you don't get the program, you didn't want it bad enough. Go back. All that stuff. I never get into any of that, Joe. My job is to meet my patient where they are and help them find the path that's right for them using whatever tools are at our disposal. And I take that to the same in the commercial side of the world, as I do when I'm working at our downtown facilities. The other thing is, we treat patients on an outpatient basis, mainly for opioid-use disorder, which is where I am today and really bring in that same mindset. We talk about it all the time. First of all, I have to help my patient feel better. Whenever you're doing some of the chemicals out there, you have the withdrawal syndrome that you really can't do anything until you get through. So, number one, I've got to use the tools at my disposal to help them feel better. Once they feel better, now I can help them to start to get better by addressing the things that Cynthia and I talked about today. I got better today because I got to talk to my friend, Cynthia, about some things inside of me. And I had help with those for a long time. So that's the second part of the program -- to help people start to step into some of those realities of their life and be able to start to form those relationships that are going to help them to heal going forward. And then the last part of that, Joe, is we want them to stay better. And how do we do that? We do that by connecting them with people that have shared goals, that have shared interests, and also can share their own experience, strength, and hope. If you look at a comprehensive treatment program, I think you would be hard pressed to top that. There are things that rely within there, as far as social determinants, failed housing, all those things. That becomes a part of it, but that's all on an individual basis. I hope that answers your question.

Joe: And what's the name of your program? Yes, it was. Thank you. What's the name of your program?

Stephen: The one I'm at right now is Cedar Recovery here in middle Tennessee. And then our inpatient and downtown facility is Journey Pure. And the downtown facility is called The Next Door. And then Renewal House. We actually work at two different ones. Those are all separate things that I'm involved with.

Joe: Thank you. So, we heard it again, the Loyd Paradox, previously-known-as the Stockdale Paradox, in action. And so one final question. How can we, as the larger Service Space community, a global ecosystem committed to voluntary service, compassion, and creating change in the world by changing ourselves, how can we support your vision and work in the world?

Stephen: When Cynthia reached out to me and invited me to do this today, and I started looking at you guys and doing my research, to be honest with you, Joe, I thought you all were a recovery organization. I did. I was reading and I was like, "Well, what you're doing, this community this morning from all across the country, you guys are on the west coast. I'm in the deep south. I'm sure we've got folks from the east coast. This, what you're currently doing, is that. Right? You're building community where people can step in. I looked at some of the other speakers and watched some of the previous speakers on the website. That's the kind of thing we're talking about. You're already doing that. The only thing I would tell you I would do differently is to try to become more known, right? I mean, that's it. When people can step into communities like this and be met with what I've been met with today, we'll start to see change and we'll start to look at things differently. I think that what you all are doing, and I see Cynthia. Cynthia has things that I want when I see her in action. And I met her husband, Dave, the other day. They have things that I want and I want to be like that. And we get like that whenever they open themselves up and we're allowed to step in relationship and learn from them. So I think that's what you're trying to do with Awakin and I applaud it.

Joe: Thank you. Thank you. Well, we've had quite the journey together today. As I think back upon this, I remember you talking about bringing your authentic self without being attached to outcome and with the hope that through mutual sharing vulnerably, we can all help each other. And also to see beyond what we see on the surface. Like you mentioned that you used to think, "Well, the blacks are committing the crimes. Therefore, they should be in jail." And now it's almost the other way around. The blacks are going to jail and committing the crimes. Therefore, they're the ones who need our help the most or whatever group it is. So thank you for that. And, Cynthia, would you like to say a couple of words before I close with a minute of silence?

Cynthia: Yeah, absolutely. In one of our conversations, I asked Stephen what his favorite book was. He listed many, but at the top was Salinger's The Catcher in the Rye. So he got me actually back to reading that and then a quote just jumped out at me and I thought it would be a beautiful way to close this hour and a half. He says this. "Many, many men have been troubled morally and spiritually. Happily, some have kept records of their troubles. You'll learn from them if you want to, just as someday, if you have something to offer, someone will learn something from you. It's a beautiful reciprocal arrangement and it isn't education. It's history. It's poetry." Thank you.

Stephen: Thanks, Cynthia.

Joe: Why don't we go straight into our minute of silence on that? Thank you.


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