Andrew: I’m really pleased to have Joe Schrank, MSW, the founder and Program Director of High Sobriety in Los Angeles, California and operating a private practice, including authoring and speaking in Brooklyn, New York. Joe, thank you so much for joining us here at Serene Scene Magazine today.
Joe: Thanks for having me. I always appreciate a platform.
Andrew: Well, you’ve got over 20 years yourself in sobriety, but let’s back up a bit and tell us a little about your personal story.
Joe: Well, it’s always interesting, I think, that people find their personal story more interesting than it actually is. I’m no exception to that. I’m from an alcoholic family. My father was … I grew up in the Vietnam era. He had done a couple of tours, combat tours, was never right after. We didn’t know what was wrong, but we knew enough to know something was wrong, and severely alcoholic and traumatized. That was sort of my first experience with the world, and that kind of led me down that path. We always think we’re not going to be like our parents, and then somehow something happens. Then, luckily for me as a young guy, kind of my mid-20s is when I stopped drinking. That was just the best … it might be the best thing I’ve ever done, to be honest.
Andrew: Now, in your mid-20s, you just stopped. Did you get help? Did you decide one day, “I need to stop.”?
Joe: No, I had a lot of help, I mean lots of mental health professionals. Hazelden was part of my story, for sure. Lots of involvement in 12-step recovery. I was very fortunate to have fallen in with a great peer group in New York City. I don’t think that everybody’s experience with AA was as robust as mine, but I was very lucky, and great sponsor, great therapist, compliant with medication. I had a lot of help, for sure. I definitely understand the multidisciplinary approach to trying to help somebody stabilize with not just their alcoholism, but with their mental health in general.
Andrew: When did you decide to become a professional within the addiction treatment world?
Joe: I think the addiction treatment world decided for me more than me making a decision. I started back to social work school at a small Catholic college in Westchester, just north of New York City. It just sort of evolved. If anything, I was resistant to the whole idea of going back to school, and then I really liked it, and then the field placement was with a detox at New York Hospital, which I loved. It just kind of grew and grew and grew from there. I wish I could say it was a plan, but it was not any specific plan.
Andrew: Now, along the way, you have had some unique experiences within the industry, so tell us a little about your work experience.
Joe: I started as a residential therapist at Promises in Malibu, and that was a really great experience in a bunch of different ways. I loved it there. I thought it was a great organization. A lot of what’s written about Promises, that it’s indulgent and for movie stars and all that, it’s not really true. I thought it was a great place. I was married at the time, and when my then wife was pregnant, that was the end of the California experiment for her, and so we went back to New York. That’s when I started a Sober Living. At that time, there were no Sober Livings in New York City, which was a strange thing to me because transitional care … I always thought the rubber meets the road when somebody goes back into the community, that that’s where the real change is discovered because if people aren’t going to be sober in their life, they’re not going to be sober.
With eight million people in New York and no option for transitional care, that’s when I saw that opportunity and established a Sober Living in Brooklyn that still exists today. I’m not involved with it anymore, but I’m glad that it exists. Then from there, I started TheFix.com, which was another really interesting experience. Also still exists, which I’m proud of, though I’m not involved and haven’t been for a long time. That’s probably for a bunch of different reasons, conflicts with the investor, which we were both at fault, but I prefer to just blame the investor. As a good alcoholic, I don’t like to actually accept my responsibility. Really, the conflict there was that I never wanted The Fix to have treatment center advertising. I always wanted it to be what people would consume as stable people in recovery, which I didn’t know what that was. I thought, well, they must buy jeans or water or something.
Anyway, so that’s how that went. I’ve always been entrepreneurial. I’ve always had startup inclinations. I started a board for a recovery high school in New York, and there is a program in Staten Island, so that was a big project for sure. And so here I am.
Andrew: One of the things that it says on your website is treatment protocol that you’ve coined a term for; I’m interested in that protocol. You call it One-to-One In Vivo Treatment Protocol. What is that all about?
Joe: Well, look, if you read the history of social work theory and practice, it’s be not idle, be not alone. That’s an ancient practice. Jung, when he had no idea what else to do, would just read to people. I think that human connection and change is often through relationship. For the wealthy … and again, I don’t like class systems. I wish everybody coming out of treatment could have their sober buddy and their recovery Sherpa to help them negotiate all the pitfalls of the world. For people who can do that, that’s one of the things that I’ve done is just either traveled with people or been with them, and it seems to help. It’s viewed as this indulgent thing for movie stars. It’s interesting because when Oprah lost weight, nobody disparaged her for being able to have a private chef and a personal trainer, but for some reason, America wants addicts punished, and they want them in some kind of deprivation.
I never really saw it that way. I always thought, well, look, I think it’s great if people can do it. I’m happy to do that with them. It’s a service that I provide. I can’t always do it now because I have too many other things going on, but in the past it’s one of the things that I’ve done for sure. I think it’s very valid. Like I said, I wish everyone coming out of treatment had that opportunity because I do think it’s helpful, for sure.
Andrew: We were speaking a little earlier, and you were talking about the things that you’ve been able to accomplish, but would not have been able to accomplish but for your sobriety. One of the things that came out of that was something that I think you’re very proud of and ought to be, and that’s the adoption of a child from Kenya. Tell us how that came about and how that has impacted your life today.
Joe: Well, it came about in a very interesting way. I really love the Jesuits, not so much for their theology necessarily, although somewhat of that, but also just their commitment to social justice and their commitment to helping other people. There’s a great Jesuit boy’s school in New York, and I want my biological son to go there, and so I figured I’d better start hanging around this place just sort of getting to know them. Very quickly they asked if I would take this boy that they were bringing from one of their orphanages in Kenya, to bring him to Xavier in New York. My girlfriend at the time, we discussed that. She had way more concerns than I did. I figured, kids are kids. They are. They are what they are. We’ll just take the leap of faith and do that. To me, it was always this part of recovery because we were both solid in stabilizing alcoholism, and for me, clinical depression and all those kinds of things.
People who are trying to get their footing, they can’t help another person, and so after all these years of being sober, it was a great gift to me to be able to do that. I never really even thought of it as virtue. I just thought of it as, well, this is what we’re supposed to do, right? We’re supposed to help other people as we go through the journey on the earth. It was awesome. It went better. Very few things in life go better than you can hope, and that was certainly one of them. I mean look, America is an interesting place from a kid from a developing country [inaudible 00:10:00] for sure. I mean it’s an interesting place for all of us. To sort of see the western world through his experience and just how indulged we all are as westerners was a great experience, is a great experience. Nobody knows why, but he’s very gifted academically, and so he did incredibly well, and now he’s a freshman at Georgetown.
It’s an unbelievable outcome given not enough food, now goes to Georgetown. It’s an amazing thing, and we’re very happy to have been a part of that. I feel like he did it. To get on a plane and go live with white strangers in a foreign place, that’s a big, big thing. It was a group effort, from the Jesuits to the teachers and the counselors at Xavier to the admissions department at Georgetown, the soccer coaches, everybody. That, to me, is a great way for the world to work. As we know, it doesn’t always go that way.
Andrew: I think your children have never experienced you active in your addiction, but do you openly talk about it with them?
Joe: Yeah, I do, and I think people should. I don’t give them gritty details or anything that’s going to scare them, but with Andrew, who’s the adopted one, he needs to understand what intoxication is all about, especially as a college freshman. To me, my thing is safety for sure. For my biological son, I don’t feel like he should be … if there’s diabetes in families, children should know. If there’s cancers, if there’s other chronic illnesses that people have from a DNA, just from an inherited perspective, I think people should know. I don’t think it’s anything that we need to conceal. They don’t need to know all the dumb things I did. At some point there’s generational boundaries, and that’s just a “none of your business” kind of thing. Sure, for them to know that, especially my biological son, like, “Look, it’s here. It’s in the family. It’s all around you, so you need to be aware of that.”
I think we know much more now than we did previously. To me, the first exposure of any kind of intoxication, the longer it’s delayed, the less chance there is for a chronic problem. He doesn’t seem to have the discomfort in the world that some people do, that I did at his age, but I don’t want to be in denial, like, “Oh, this could never happen. He’s such a good kid.” He is. I don’t want to impose my problems onto him. It’s always a balance. We’re all just doing the best we can. Yeah, absolutely, I feel like just as a health issue, children should know, for sure.
Andrew: I want to step back a moment to your Sober Living enterprise that you had founded in Brooklyn. I’m curious. Did you have the harm reduction risk minimization philosophy for that Sober Living, or was it an abstinence-based Sober Living?
Joe: It was abstinence-based. We asked people to be abstinent while they were residents. We counseled them about all of their options. If they did use or they did relapse, it was always dealt with therapeutically. Coming full circle to a harm reduction model was in fact a process. I could never get my mind around Sober Livings that would discharge people for using because I thought, “Well, didn’t they come to us for help with this problem? How can we shame and banish them from the kingdom for having the problem that they came to us for help with?” It didn’t make any sense to me. Lots of these guys would say, “Well, I used.” Now, okay, look, if you’re reporting accurately to us, then we can roll with that. We can help. I always thought, “Well, look, if you were using every day previous to treatment, and you used once in the last 90 days that you’ve been resident here, that’s pretty good. Why don’t we figure out … let’s keep going.”
There always was an element of harm reduction, but the culture around recovery frowns on harm reduction. I started taking a lot of heat for doing that, you know, the, “Oh, everyone at the Loft relapses.” I just thought, “Well, they do. Let’s not hide from it. Let’s not be afraid of it. Let’s see what we can do about this.” I don’t know. There’s a disconnect between being a 12-step guy and being a clinically trained social worker. First of all, as a social worker, we have the code of ethics. One of the biggest ones and one that I’m always cognizant of is that people have the right to self-determine. They’re making their decisions, even if the people around them don’t like the decisions. They need to have informed consent. They need to have the benefit of experience and training. We need to be able to say, “Look, here’s why we think this is a bad decision. It’s yours. There’s nothing we can do.”
My hopes for people are very different than what they … sometimes my hopes for them and their decisions align, sometimes not. Anyone, any social worker, will tell you that their clients don’t always do what they’re advised to do. I think that that was part of the challenge. It’s always been part of my challenge. It’s that science and ethical practice often clash with 12-step life and the culture of 12-step recovery moves very slowly.
Andrew: Well, you founded High Sobriety, which is in Los Angeles, California, in 2017. Now, High Sobriety is unique in that it uses marijuana for patients addicted to alcohol, heroin, and other substances. You have a kind of phrase that goes along with it, which is, “It’s a gateway drug, but it can be a gateway drug out of harder substance use.” That’s a really interesting philosophy.
Joe: Well, right. I think that it’s an interesting thing, and it’s contrary. It’s challenging for a lot of people. I always thought if you were a heroin user, and you were able to stabilize and replace with cannabis, as a cannabis user, that that was a major, major victory. Any time someone can keep themselves safe, I think that that’s a start. No one finds any kind of recovery if they’re dead. I think that safety first is one of my mantras. One of my interests in cannabis is that there is no known lethal dose. There are theoretical lethal doses, but it’s impossible to … you can’t smoke 20 pounds of the stuff in 15 minutes. Nobody overdoses using cannabis. There are anecdotal examples of people who have accidents while impaired by the stuff. Different story. There’s anecdotal evidence about it impairing people with schizoaffective disorders, which is maybe true. Maybe it’s not. We don’t really know.
One of the reasons we don’t know is because marijuana is a Schedule I drug, the same as cocaine and heroin, and so clinical trials and research is illegal by law. A lot of the stuff is we’re guessing. We are. There’s no two ways about it. We’re able to do some research, and there is some really good research out there in states that have medicinal cannabis. At High Sobriety, we believe in research. We have on our website a supporting research page, and we have Dr. Amanda Reiman, who’s a professor at Berkeley, available by email to answer any questions about the existing research, and she’s designing outcome studies. I always thought, well, look, again, people have the right to self-determine. There’s very little evidence empirically, if any, that marijuana is in fact a gateway drug. That’s a cultural fallacy. The reason is, if we’re going to talk about gateway drugs, why don’t we talk about nicotine and tobacco as a gateway drug?
Most people, their first experience with illicit drug use was sneaking cigarettes. The phenomenon of withdrawal and craving might start with sugar. Most people, their first high is with nitrous at the dentist. Alcohol is then introduced into the picture. There’s all of these things that happen before most people smoke marijuana, and when they do, there really isn’t any evidence that marijuana use is a causal relationship to harder drugs. Millions and millions of people smoke marijuana. Most of them don’t ever smoke it again. They don’t like it. They don’t like the smell. They don’t like whatever it is. They don’t do it anymore. There are other millions of people who are cannabis users, either recreationally or medicinally, who are unimpaired. They go to work. They meet their obligations. They live their life the same way there are people who drink wine. They go on, and they live their life.
It’s a very difficult thing because recovery has an adversarial attitude with cannabis. The culture certainly has an adversarial attitude. Just consuming it is viewed inherently as pathology and/or crime, and it’s neither. It’s not necessarily pathology, and in my view, it’s certainly not criminal behavior. It might be a bad health decision. McDonald’s is a bad health decision. We don’t shoot people or put them in a cage because they ate McDonald’s. I guess it’s ironic in some ways, and I think that maybe this is the most difficult part that people have, is that I am not a consumer of cannabis. I’m a totally abstinent guy. That’s worked for me. It’s gone well. I’m not looking to change that, but I’m also looking to help millions of people who fall through the cracks in the existing model of treatment. We have found that cannabis can be an exit drug.
First of all, it helps tremendously with detox. Our rates of retention … nobody really leaves. Nobody, “I can’t tolerate it. I can’t stand the bone pain. You’re making me miserable,” you know, all the stuff that people have seen when they’re in a state of detox, and they run off into the night, and they use their drug of choice. That doesn’t happen when you can soften the corners with cannabis. There are lots of people who have been successful in using it as a replacement drug. I have lots of clients through the years who have not used heroin in many years but continue to use cannabis. Sometimes they go on … especially with the younger people, my hope is that they do go on to cessation of all drug use. This happened last week. A young guy came to me, hasn’t used heroin in three years, and things have gotten much better. He went back to school. He has a job. He pays his bills, you know, all those sort of life things, those indicators that somebody is doing well.
He said, “Well, my girlfriend doesn’t like the pot.” I said, “Well, then you have a choice. Do you like the girlfriend, or do you like the pot? I don’t know.” What I do know is that if that young guy had continued to use heroin in the years that he’s been practicing harm reduction, there would be no girlfriend, and there would be no decision about, “Do I give up the pot?” That’s really where I am now in my journey with a practitioner, is that harm reduction is valid. It’s not valid for everybody. We’re not trying to say we’ve solved the problem of addiction and everybody should do what we offer. In fact, we probably say no more than we say yes when people want to come in to treatment. It’s a pretty extensive screening process. We want to make sure that people are viable candidates, that they can be helped. Look, I think harm reduction is part of our daily lives, whether it’s a bicycle helmet, an airbag in the car, or a condom.
It’s all around us. Abstinence-only drug education is about as effective as abstinence-only sex education. It needs to change, and so somebody has to be the first to ring the bell. I guess my role as provocateur and my zero need for popularity has brought me to be that guy.
Andrew: You mentioned millions of people for which abstinence-based treatment does not work. Can you speak to that a little bit and why non-abstinence-based treatment may work for them?
Joe: Well, look, the current paradigm of drug use is gone in 30 days, and you’ll become a drug counselor. We all love that beautiful story. If you look at the millions of people, and SAMHSA says there’s 20 million Americans in need of treatment, that can’t be the story for 20 million people. It can’t. If we’re honest as practitioners in the rehab business, and you see people … and I was shocked. I said, “Look …” We have a young guy. We just admitted this young guy. He says he’s been in seven treatment centers, and somebody at a conference in San Diego said, “Well, that’s normal.” My thought was, “Well, it shouldn’t be.” It should not be normal because every time he discharges, he’s vulnerable to hurting himself or killing himself. My thing is, well, look, harm reduction can be a stepping stone. It can be a stepping stone into that beautiful story of abstinence that the world wants so badly. It can be maybe they stabilize.
There’s a bunch of different things, but dead is dead, and nobody is going to find any recovery if they’re dead. There are so many people who just don’t make it. If you look at the data, and it’s bad, we don’t really know exactly how many people come to AA and don’t drink or don’t use their drug of choice anymore. A lot of it is speculative, but we know people fall through the cracks, and we know that there are lots of people who don’t respond to that. I’m not disparaging the people that do. I’m one of the people who did and does. I like AA. I think it’s helpful. I think it’s been a great thing for me. I also like Catholicism, but I’m not expecting 700 million Hindus to become Catholic because I am. There’s never any easy answers, and I think that we’re very naïve about our approach with drug policy and addiction. It’s too simplified. We can’t get out of the rut of treating it as crime.
The Trump administration is taking us backwards. The idea that the task force is headed by Chris Christie and not a physician or a social worker or a multidisciplinary board of people is wrong. Chris Christie started his career in the Justice Department. The mindset is still, “Well, this is something for the Justice Department.” It’s not. It isn’t. As long as we approach it that way, we’re stuck in the mud, and the outcomes are poor. That’s my thing about harm reduction. People come at me all the time, “Well, what research do you have?” There’s some. What research do we have that 1930s folklore is the solution for all people? There’s none, and there never will be because we empirically can’t have one approach for all humans.
Andrew: There’s a stigma attached to medication-assisted treatment, but I think that stigma is exaggerated when you start talking about cannabis as a form of medication-assisted treatment. Why do you suppose that is?
Joe: Because first of all, there’s a cultural implication that the gateway drug theory is a giant beast to slay. It doesn’t ever seem to really go anywhere. People buy into that. It’s not based on science. It’s based on culture. The truth is, Nixon didn’t like people who used cannabis. That’s really what it is. It’s that the prevailing and the ruling class, they don’t like the people who use cannabis. It isn’t that the cannabis in and of itself is worse than other drugs. It’s not. It’s actually much safer. 88,000 people a year drink themselves to death in one way or another. No one does that with cannabis. Really, if something were to be illegal, it should be alcohol. Not that I’m a believer in prohibition. I don’t think that that works. I think that the stigma with using cannabis is based on that, on the culture around it, on the cliché of Cheech and Chong, that these people are inept and bumbling and they are inert and they don’t function in the world.
That’s not really true. You know that a drug user is a drug user. The DARE program helps our children. “Drug users are losers,” all this kind of stuff. Jeff Sessions says nice people don’t smoke marijuana, but he seems to drink plenty of moonshine. It would be like me as a reformer saying, “Well, I don’t like people who wear blue blazers in golf, and I don’t like martinis. Anyone who drinks martinis, we’re just going to have to arrest them or shoot them or put them in jail,” or whatever it is. That’s crazy, but that’s effectively what we do with cannabis users. That’s what I think. I think that it’s stigma. It’s shame. It’s stereotype. For whatever reason, the stereotype of drug users prevails. It’s still acceptable to call people junkies or those kinds of disparaging, pejorative comments. Nobody would say retard in the modern world, not that I think they should, but that’s effectively what we do, this shame-based thing with drug use.
That’s really what’s got to go if it’s going to change. It’s also interesting because I’m not … and I’m a certified care giver, so I can go into a dispensary. I’ve done a lot of research with this project, and I’ve gone into many dispensaries. I find them to be a little crazy in a lot of ways. Well, it’s like, well, what can’t it do? There are people out there, “Oh, it can cure cancer. It can this. It can that. It can the other thing.” I don’t know what it does or what it doesn’t do with other health issues. What I know is that it is an additional layer between these young guys … and actually, and I was surprised the older people that we’re getting at High Sobriety. It’s an additional layer between them and something that’s killing them. That’s my interest in it, and I do believe that it works for that. The current climate of it’s a cure-all for everything, I’m not in that camp either.
Andrew: Let’s talk about a typical day in treatment at High Sobriety. What does it look like?
Joe: Not what people would expect, I think. Part of it is we collaborate between all, whether it’s the physician, the social workers, the family therapists, to continually refine the program and the clinical interventions. I’m very big on a movement practice. I think that that’s incredibly helpful for people with depression and anxiety, you know, keep it moving. Everybody has nutrition counseling, and they have to do something not less than four days a week. We can add more, whether that’s yoga. Some of the older people that we have, even if they just walk on the treadmill and breathe, that’s all a start. Movement practice is critical. Individual therapy. There’s an assessment based on their need. One of the things we discovered that cannabis can be very helpful with is people with trauma. One of our missions is combat vets, and we can take combat vets. I wish we could take them all.
We can’t, but we can take a combat vet periodically pro bono. That’s a population that does really well on cannabis. If you can get them off pills and alcohol, that’s a major, major, major victory, but leaving them naked and afraid, sweating, nightmares, disconnected from everything, that’s not compassionate. Cannabis can provide a bit of a cocoon for them that’s not going to hurt them. That’s one of the needs that we identify, is trauma. It’s always a process of discovery, and so we try to resource to everybody’s clinical needs based on what we find out. Also, family is a big issue. I’m always very big on the family and the systems around people. Even if it isn’t a biological family, if it’s work or whatever it is, there’s a big ripple effect with mental health, as we know. The system around the person needs to change as well as the individual person, in the identified patient.
That is a day at High Sobriety. The other thing that people find really interesting is I make all these young guys shave, and they all have to wear a jacket and tie to individual and group clinical sessions. The reason is not because I have any sort of belief in fashion. It’s just practice. It’s just, look, this is how people live. They get up. They brush their teeth. They dress appropriate for whatever they do in life, and they go about it. Some of it is just like the repetition and the practice of doing that. Once they move into a more independent phase of care, they determine their own clothing, but for initially, look, you play scales before you play jazz. People find that interesting for some reason. I’m like, “I’m just sick of looking at boxer shorts hanging out the back of the pants.” Maybe I’m old-fashioned. I don’t know.
Andrew: For those interested in finding out more information about this, where can they turn?
Joe: HighSobrietyTreatment.com. I’m very responsive to emails, love to talk to people. I’m not expecting everybody to be happy or pleased or agree. I’m okay with dissent. For some reason, in the modern world, we think that disagreement is a bad thing. I don’t see it that way. I think that that’s how we can solve problems, is if we discuss them, and if we disagree, that’s okay. I’m happy to have all people, anybody, send me an email or call me and let me know. With your particular readership, it sounds like it’s mostly clinicians, so I’m happy to hear from peers as well. As much as I do believe in that paradigm, that individuals have the right to self-determine, I also believe in do no harm. We don’t ever want to … I want to hear from what everybody thinks. It’s not always pleasant or easy for me, but that’s okay.
Andrew: Joe Schrank, founder and program director of High Sobriety in Los Angeles, California. I want to thank you for joining us here at Serene Scene Magazine today.
Joe: Thanks for having me. I really appreciate it.