Kristen
Welcome to this week's Close the Chapter Podcast. I am excited for today's conversation because it's the first really psychiatric nurse practitioner we've had on the show. So this is an exciting conversation, we're going to be talking about medication, different viewpoints on medication, different types, and how they impact you personally and relationally. So this is a conversation you're going to want to share with other people. We're not really talking about this that much in the therapy world, even though medication many people are on medication. So I really hope this is a transformational episode for you. So without further ado, I want to introduce you to today's guest. Justin currently has a private practice as a psychiatric nurse practitioner in Bend, Oregon. Justin has been practices as a nurse and or psych NP for a little over 10 years now seeing both children and adults for psychiatric medication management and therapy in the outpatient setting. Justin's practices primarily focuses on those who are functional, working attending school, but suffering with emotional distress, such as anxiety, mood disorders, and ADHD. He graduated from Massachusetts General Hospital Institute of Health Professions in 2011. And in 2020, self published book entitled The mental wellness diet, ancient wisdom, evolving science, modern day options TMW de book based on the idea that if we feed our brain, the nutrients it craves, as well as be better able to feel and function at our best. So Justin, welcome to the podcast.

Justin
Thanks for having me. I'm excited to be here.

Kristen
How do you say your last name because it wasn't in your bio, I realised as I was introducing you,

Justin
Bethany. Bethany is the name. So a character in the book is my grandmother and grandfather who emigrated from Lebanon. And so when they got to Ellis Island, it was Bethenny, they got to the window at Ellis Island and they said, huh, and they said, Okay, sounds like Bethany to me. So they changed it. That moment. changed. Yeah, like a lot of people's names.

Kristen
So tell me about your journey to become a psychiatric nurse practitioner.

Justin
Well, my mom was a psychiatric nurse for many years. I think she graduated with her RN degree in the late 60s. And so she had done that. And then she raised us three children. I was the youngest. And then about the time when I was in elementary school, she went back to get some certificate to re up and she went back to work. And so all throughout my childhood and adolescence, she was definitely an influence. Then I graduated high school and hit that quarterlife crisis. We need to do something really important with yourself, but you have no pathway, no clue, no idea and all this pressure. Then my mom suggested, well, you know, you could become a psychiatric nurse because I was into the helping field. I like teaching. I like teaching swimming lessons. I was coaching. I worked with kids. I had a first couple jobs out of college was working with kids who had emotional disturbance in specialised school. So I was a teacher assistant. And so that was a suggestion and scoffed at at first I didn't want to be a nurse, of course at 22. But the more I thought about it, and the more I learned about it, I realised it was a great career. So I applied to school, took me several years to finally get in. And I finally did the whole track. When you go to nurse practitioner school, you have to pick a specialty. So from beginning to end, for me, it was mental health and psychiatry. It wasn't so much into the blood and guts. But that was my track. And that's kind of how I got here.

Kristen
Wow, that's neat. Your mom was also a nurse practitioner.

Justin
She was a gastric RN, psychiatric RN, okay. Worked in an inpatient hospital for kids for decades.

Kristen
Wow. And here you are. So what have you seen over your 10 years in this profession, because I've seen so much change? Walk me through what you've seen?

Justin
I don't know if I've seen as much change as you I guess there has been a lot of change. I have observed so much with EMDR and brain spotting, and somatic experiencing and so many therapists coming into their own and specialising and highlighting trauma, I feel I think you're right about in the therapy field. So much has changed. As a nurse practitioner, we follow the medical model, which is UEFI of X disease, you look to the shelf for x, where it says whatever the disease is, that's the algorithm use those category of medications. Well, I think because of the way science works, because of the way the healthcare industry is formed, much of that won't change. Maybe there's been a few new medications, a few new anti psychotics if you know, antidepressants that have come upon the scene, but a lot of it is the same as it was when I graduated.

Kristen
It's interesting walk the listeners through for those that don't know the classification. issues of medication and what is their function? Can you give us a high level overview?

Justin
Sure. Well, some major categories for disorders would be mood disorders, namely depression. Bipolar disorder is a mood disorder. There's plenty of anxiety disorders, generalised anxiety disorder, PTSD, social phobia, there's more severe mental illness like schizophrenia, or Schizoaffective Disorder, some bipolar disorders can be pretty severe and pretty impairing, then there's substance abuse. And I think the final category that is really important is ADHD, which affects both children and adults.

Kristen
Yes, so now that we've kind of identified those, let's walk through the classification of medications and drugs. Sure.

Justin
So for me an outpatient practice, like you read in my introduction, people who are functional, but suffering people who are parents or keeping a job, going to school, they're getting it done during the day, but on the side, maybe more on the main plate, they're really suffering, it's ADHD, and they can't focus and they're chronically experiencing functional deficits in their life, or they're really depressed, they mustered the strength to get through their day and get their responsibilities done. Or perhaps they can't every day, or they have anxiety, and they do a pretty good job of keeping it a secret, but they're still functional at work and getting it done at home. Those are the people that I meet on the outpatient level, which tends to be the lightest level, the least intervention, the least strong, and as you go down, you can go to intensive outpatient or you can go to partial hospitalisation or you can go to inpatient hospitalisation. If there's a crisis, very few people, there still are some residential treatment centres for people with chronic schizophrenia or other major mental illness disorders. The people that I tend to meet most psychiatrist or nurse practitioners in psychiatry, in the outpatient setting meet, I would argue, are the functional but suffering. So they're pretty much functional. They're getting their jobs done. They're raising a family, they're keeping up their home, they're doing everything that they pretty much need to do. But on the side, they're really suffering. So in those categories, could be the ADHD diagnosis, which the main treatments for them that diagnosis would be the stimulants. And people have heard of these medications, adderall or ritalin, Concerta. Vyvanse, is one of the newer ones. There's other ones which are maybe not as effective, but maybe better tolerated that Strattera. There's a new one called Calibri, which is pretty interesting. And for some people is really helpful. That would be that category then depression or mood disorders, or pretty much depression. Those would be commonly the SSRIs. That's Prozac, Zoloft. These are all the brand names. Prozac. Zoloft, bluebox. Celexa, Lexapro is gaining popularity. These medications increase the availability of serotonin. And when they do that, they improve people's distress tolerance. They take a little bit of weight off of your shoulders, they kind of the way I describe it, they make you predict the negative, less intensely predicting the negative. And if you're less predicting the negative in your daily life, that is going to help you feel less depressed, less dark, that is going to help you feel less anxious. So also for the anxiety category, the generalised anxiety disorder, which is excessive worries, PTSD, social phobia, just general anxiety. Those disorders also respond to the SSRIs Prozac, Zoloft, Lexapro. Again, if they limit the negative predicting, they're going to help you not have so much is going to turn down the volume on the symptoms of anxiety and depression. Then, I guess the final category, if you have bipolar illness, or perhaps even schizophrenia, then it would be appropriate to try mood stabilisers, which many of them were old, repurposed, anti seizure medications, or anti psychotic medications and anti psychotic medication sounds scary, and they do have a lot of side effects, a lot more side effects, but they also make great mood stabilisers, and they can be really helpful for the certain patient when needed. What are those? That would be Risperdal is a common one. Seroquel. Seroquel is one of the most commonly prescribed medications in America. It's an anti psychotic. There's a new anti psychotic that's gaining popularity called RX salty. Abilify is another one, and then there's maybe 14 others. There's a first generation how though Thorazine which we don't really use anymore. Then there's the newer generation, Risperdal, Seroquel, Zyprexa and maybe the third generation which is kind of works like a dimmer ship dimmer switch for dopamine would be the Abilify and Rexulti.

Kristen
Where does Trazodone fit in? Trazodone was

Justin
the way we understand it a failed antidepressant to serotonin focused medication that didn't really prove itself very helpful for limiting depressive symptoms. But it made all the subjects in the study sleepy. Yeah, that's a good one too good. It's a good one.

Kristen
How about Ben's diazepam means Can you talk to us about those?

Justin
Sure, that would be the anxiety category. The appropriate use for benzodiazepines would be panic attacks, which there must be something really wrong. If you're having panic attacks every day, there might be some other underlying, maybe medical issue or major trauma that probably needs a bigger holistic intervention. But if you're living life, and you're generally doing well, but there's some moments, some days, some nights, some plane trips, where you get huffing and puffing and your heart is pounding and your mind is racing, and you feel that impending sense of doom, there'll be a panic attack. And so medications, the benzodiazepines would be appropriate as needed for those episodes. Those would be brand names, Klonopin, Xanax, Ativan is common to a number of others, but those would be the top three.

Kristen
What is the research on the addiction of a benzodiazepine?

Justin
Well, it's a cookie in a cookie jar, and it presses on the brake in your brain. So there's lots of neurotransmitters that are in lots of neurotransmitter receptors that will activate or excite the brain. And we need that we actually need excitation to for memory formation. That's called long term potentiation. But if you're having a lot of excitation, especially in the limbic, or emotional centres of the brain, that's really turning up the volume on emotions, and that can be overwhelming. So these other receptors gamma amino butyric acid, also known as GABA, and GABA is even like a supplement that people buy. So that is a neurotransmitter amino acid. And it fits into the GABA receptor. It's got a specific receptor. And so Xanax and Klonopin and Ativan, they will snuggle into that receptor and activate it. And when that happens, that causes inhibition. inhibition is the counterbalance, it's the brake for the gas that might be going on in various circuits. So when you step on the brake, that is coming in, that could be coming in a euphoric way. And that could be coming in a very relieving way. Unfortunately, they're the best medications, we have hands down for anxiety. Unfortunately, they're time limited. They only last so long. So it's that saying, what goes up comes down, or I guess the reverse?

Kristen
Yeah, what I've seen, so we're EMDR practitioners, and do brain spotting. And we notice, I can tell if someone's on a benzodiazepine, or even like a gabapentin, which is not a benzodiazepine, it's more for nerve damage and other things. It severs a part of the nervous the brain that I need to access to help them reprocess the trauma. Right. So it almost feels like and you tell me your thoughts almost feels like it pushes into the like, it keeps that trauma in the body instead of releasing it in real time.

Justin
Yeah, absolutely. That's discharging emotions, is what we're working on at my house with my kindergartener. He's a shy guy. He didn't really like preschool, and it's a really long school day. And so when he comes home, he emotionally discharges all over us. Yes, and there is that's very challenging for us as parents, but it's also probably healthy for him to not feel like he needs to hold an end all the time. Like I said, with the functional but suffering. Ativan, Xanax, Klonopin, can keep you tolerating toxic or dysfunctional, or harmful or even retriggering traumatic situations longer than you should. The villain in my book is modern day life. Modern day life is that thing that that whispers in our ear and sells us like, yeah, just keep going. Don't worry about it. Keep up with the Joneses. It's you gotta you gotta you gotta and so we have to, I guess, rob Peter to pay Paul, we have to smoosh it down so we can muster whatever resources we have left just to produce just a function just to get our get the job done. And but that creates this negative load that builds up in our body. And perhaps for some people, you might need more and more, you might have a breakdown, the panic attacks might get worse. Yeah, many, many negative outcomes from that process.

Kristen
Yeah, and we don't talk about the addictive nature, how you want to just not have to feel those intense emotions. Sure,

Justin
well say that addiction or addictive or some really charged words. And I think what happens, what precedes addiction would be maybe trauma underlying, but what precedes getting to the level of addiction with these medications, perhaps would be dependence. If you need to depend upon them, you can't tolerate how it's going in. So you use this medication and it makes it all better. The meaning you make out of that is like, Oh, this is a good vitamin for me. And so then you depend on that nutrient, so to speak. That means Maybe that's kind of the way that people can come to think of it and that dependence. It's got a short half life, but sooner or later, you'll let the pay the piper. So then there comes the addiction, then there comes the negative consequences, which are a main feature of addiction.

Kristen
Exactly. And it's interesting because you have these pros and cons of medication, oh sign, some clients are like, I am not going on anything. I don't want to suppress my emotions. And yet they have these, we've used EMDR, we've used some of the coping mechanisms and are not able to access, there's good work, right, that part of their brain to help the looping thoughts to not have the obsessive part of maybe what they're thinking about, to help use it as a tool. So then you have those folks that are, I want more than medication. So walk me through your view of medication.

Justin
Yeah, I'll give you my inside scoops, and some, I'm prescribing it all the time. I think therapy is numero uno. Even if you don't really have a diagnosable condition, therapy is gonna get you there, but it takes a while. If, in our modern day life, you need things to move along a little faster, because you're in emotional pain, that's totally valid. Medications can speed up the process. But most medications psychiatric medications, in my opinion, in plain English, are suppressing they smoosh us down. And a psychotics, even some of the SS most of the SSRIs are blunting emotional blunting if you use too high of a dose, but even the right dose is the right amount of emotional smashing down. So we can cope. And so we can tolerate and so we can move on. The benzodiazepines for sure are smashing us down the at ADHD medication, the stimulants would be the exception, they kind of activate the dopamine system, which is motivation and seeking and confidence and focus and all that that those are stimulating, of course, but most of the other psychiatric meds suppress us. There is a time and a place for that the patients that we see are not static. But hopefully they're not. Hopefully, it's a treatment course, hopefully it has a beginning, a middle and an end. Hopefully people aren't staying on medications and not really thinking much about it for 20 to 30 years, which does happen when there's a crisis or a breaking point why now, people come in, I prescribe medications to many people, some I don't some just choose a therapy that smashes down, it turns down the volume on the intensity of the emotional symptoms, we do some of the work, or they also see a therapist and they do some of the work there. They improve their diet, sleep exercise, and then after a period of time of doing better and feel more confident, then we take stepwise decreases until they're off, just like you would put a BandAid on a cut, that would be really helpful. It would stop you from bleeding everywhere, it would maybe give your body a chance to heal the wound from within. But of course after three, four days, you don't need it anymore.

Kristen
Here's what I tell clients when they first I'm not like pushing medication on people, because I want to see what can we work with what we have currently, can I help clear out some of the trauma. And then if we're still kind of like, okay, I need a little something extra, then we'll look at Zoloft or we'll look at whatever the client needs. It's not necessarily always Zoloft and I'm not the one prescribing it need to disclaim that 100% That is I'm out of my wheelhouse. And that always disclaim that. One of the things that I I'm curious about is when you start on medication, how long does it take for someone to really know if that medication is working with our nervous system or not?

Justin
Yeah, I always trust patients instincts, the first week on an SSRI, you might be going to the bathroom number two a lot. You might be having headaches, you might not be sleeping, you might be feeling jittery, in fact that for some people, when 1% or so that can be really dangerous. If you combine somebody coming to medications with intense depression and dysphoria and suicidal thoughts than that first week on the medication, they get that agitation and that energy, that can be a recipe for disaster for many people. But that first week tends to be different. And if you hang in there, which takes a lot of courage and for the prescriber to recommend it. You know, we're really putting all of our juice in that one recommendation because if it goes bad, you don't trust us anymore. So it's a really dicey first couple of weeks. So everybody out there at least three to four weeks with an SSRI with an ADHD stimulant. First couple of days with a benzodiazepine first couple of days. If you need to take a mood stabiliser, like an anti psychotic that's a week or two, just rough guidelines.

Kristen
And you have to try out what works for your nervous system because everybody's different and I will Want to disclaim this conversation that we are not giving any medical or treatment advice? This is simply just for educational purposes, this does not constitute replacing your own doctor or psychiatrist. In this conversation, I just felt really led to say that this. Yes. And what are some of the other ways or alternatives in terms of supplements, vitamins, food exercise? If someone doesn't want to go the medication route? What are your suggestions?

Justin
Yeah, I got interested in that. And that led me to functional medicine, if anybody has ever heard of functional medicine, you know what it's all about. For those who haven't, it's looking at more prevention than fixing or carrying. It's a philosophy that doctors practice many doctors and nurse practitioners and other providers nutritionist practice, it's figuring out what's the underlying mechanism. So if you have blood sugar ups and downs, or insulin resistance, or blood sugar dips, that can affect brain chemistry, and that can affect your mood. They have tonnes of stress, obviously, that's a no brainer that can affect your mood and emotional well being. If you're not sleeping, that's definitely going to negatively impact your emotional well being. Those are three big ones. And then there's other ones, if somebody has an underlying thyroid condition, want to get that checked out. If you have an underlying anaemia, an iron deficiency, there's more and more research coming out about gut bacteria. So dysbiosis means a bad balance of bad bacteria, inefficient, good bacteria, insufficient good bacteria, and maybe some inflammation producing bad bacterium, at the centre of it is for many people, chronic low grade inflammation. And that can be poor sleep, that can be stressed, that can be toxins that can be the gut dysbiosis, there can be so many different causes for diet of that inflammation, that inflammation tends to overexcite the brain, it tends to push on that gas. And if it does, that can affect those emotional centres we talked about earlier. So moving towards health, it's not very sexy, but sleep diet, exercise, stress management, is gonna be the thing that will is before all the these underlying imbalances is going to be the thing that that gives you the most bang for your buck, unfortunately, to say, doing the hard work of taking care of yourself and slowing down and challenge yourself with exercise and setting a bedtime and sticking to it. And avoiding sugar and too many processed foods. These are simple, not very exciting things. But I tried to make it as exciting as possible in the book.

Kristen
Here's one of my philosophies. This is so big when we're looking at this conversation, because I'm pretty passionate about the benzos, stunting, folks, overuse of benzodiazepines, because I've seen it, getting off benzos drinking while they're taking medication. I also can see ADHD medication can be very addictive and hard to get off of, in my opinion, this is all just my opinion, has the trauma therapist, and I really feel you gave an example of your son like he's so true. Like he's coming home, he's had all this stimulation at school, right? So now he's like, letting it all out at home. And one I feel like what we're not teaching people is in family systems because I'm a licenced Marriage and Family Therapist, how important it is for us to be able to tolerate, be with hold the space acknowledge and offer empathy for those big emotions. And then when we're regulated, that's how they start learning how to regulate over time, and it's hard as parents been there. You're like, Can I get a pass, please, this is I'm exhausted. But when we can teach people about emotions about emotional management, and I'm not saying people don't sometimes need medication at all, I'm saying that feels like the first entry point into working with trauma and emotions. And then the second entry point is when we see someone is like, it's I think of it as like a tire keeps going around and around in the mud. And I'm like, Okay, now that we've done all this, the foundational work of identifying and being with your emotions, noticing it in your body, okay, now I can see we might be needing some, uh, something for serotonin something for whatever that that looks like. And even if we start on a small dose, they will report those folks that I know okay, we've done all the things and now let's try this. Come back into like, I have clarity of thought. I am not so dysregulated I can calm down now I can be with my kids. I'm making this up but I can be with my child when they're good. have a big feelings. It helps, like you said kind of, I would say more regulation in the nervous system and within themselves to access that prefrontal cortex, the executive function of the brain. What are your thoughts on emotions and emotional education as it relates to kind of being important step in mental health?

Justin
My appointments are for most of my patients and our and I build insurance and so I build the the e&m code for doing the medication. And then it's a 45 minute add on code to cover the rest. Not everybody's has the wherewithal to kind of do that hour with me kind of semi frequently. But yeah, this is therapy. There's so much of therapy is psychoeducation. In teaching people, maybe helping them unlearn some ways of coping with emotions, we learn like, Oh, don't cry, Oh, just blah, blah, blah. Our parents are fine. Yeah, do a number on us. And then we do that to our kids. And the cycle continues. So there's a tonne of such as psychoeducation, about that. I really liked the frame, that depression, anxiety or any kind of feeling is information, especially if it comes from the body bodily sensations is communication to us that something is amiss. Something's off for anxious allows a little anxious about this interview. Because, hello, this is important to me, my voice, my profession, being lied to having a good message. If I didn't get anxiety, maybe that would be more weird. And so ways to frame and compartmentalise and put away and experience emotions, but then you got to get on with the task of living life. Yeah, that's a big part of the education, the therapy that comes with the process. I guess my I do have the conversation with people who have those conversations with people. And then I guess it will come to that point, like you're talking about some people, I guess the instincts are all wrong. And the people who don't want meds are the ones that probably really need it. And the people who are seeking it too fast or too soon or too often, maybe need to do different kinds of work in connection with that.

Kristen
Yeah, there's two questions I have on following up on that. If someone doesn't, they're afraid to take the medication, they're afraid of stigma, they're afraid of how that's gonna make them feel they're afraid of maybe it impact their sexual drive? How do you handle those folks that are scared?

Justin
Yes, this happened to me the other day, a parent and a 17 year old, and the 17 year old was more interested than the parent, the parent was really nervous about some vague, negative, life altering side effects, which tend not to exist. And I began explaining that it's a trial. Yes, I admitted that psychiatry is not very good. We're not like maybe orthopedist that can replace a knee. And you're better in six weeks, we don't know exactly what we're doing, I think partly is that we don't have access to the brain, we can't cut it open and then stitch it back up, and then send people back home. So we have invented a term in medicine called empiric. Trial, then it sounds fancy. But basically, it means trial and error, you give it a try. And if it give it some time, and if it works, it works. If it doesn't, you switch, you try something else. So that's a negative and a positive. The negative is we don't really always know we're doing. And we should always admit that the positive is, what are you committing to other than a trial. So my message to them was, you could just friggin try it, which got a good laugh out of it and broke the tension a little bit. But it really you don't have to try medication, there's really no rule. When people come to authority figures like us, there can be that sense, like whatever you think Doc are? Well, Doctor, do you think I need to, and that for me that process a little grey line of ethical, moral, it wouldn't be on me to decide for you what's best I can give you the information can present you the options, I can make my recommendations, we can think into the future, but you got to do what's right for you. And oftentimes, I've patients haven't chose medication in or haven't chose a residential treatment. And it worked out fine. Sometimes it didn't.

Kristen
Yeah, that makes sense. So I do a lot of couples therapy, and someone will say I live with this person, and they really could benefit from some medication SSRI of Zoloft or Wellbutrin or Lexapro or something, what do you say to those folks that see because they live with the person and the other person refuses to even have a conversation about it.

Justin
It's another really important limitation of psychiatry that what I know, air quotes, what I know, is filtered through what people are willing to tell me. You know, think about the conversations between you and I, if we share a patient, the patient might give you a completely different report, probably more honest about their medications. And maybe the patient might share certain things with me because there's low less maybe perhaps less of a risk that I'm going to dive into it. So that happens all the time, because it's such a scary, unsafe thing to go get help with such a personal thing. And I guess if there was a two partners, husband and wife or whatnot, and they one was like I live with this, I guess it's up to the one with the symptoms to kind of take the leap. And I think a great phrase that I always share is caring about somebody is a combination of support and challenge, it's a challenge would be needed here, we challenge you to do a little better to have the courage to try to give it a whirl to work on these things. And then typically, my response in that situation is whoever in the family wants help, should go get it. So that in your vignette, that would be the wife, what does she need to do to improve her coping with the situation, given the possibility that it might not change, only the people who are seeking help can get it?

Kristen
That's what I say it's hard to when they come into therapy, and they're like, they're the problem. And I'm like, Well, you got three fingers pointing back at you, and and you each have your contribution to where you go. And there are still legitimate cases where the person really does need some assistance. And I think the clinician can speak into that if they're in couples therapy, hopefully, and a compassionate and curious way. The other thing is, people will come in, and they're like, I just stopped my medication, like cold turkey. So big a little bit about that, how you either transition from a med or get off of medication. I know, it depends on the medication. But in general,

Justin
well, I'm not the inventor of any of these medications, and we don't make any money off of any of the medications we prescribe. I don't think we ever did. It doesn't matter to me, there's that phrase, you know, there's multiple ways to skin that cat. It was a real educational moment, for me, the first few patients that came back, and they're like, oh, this Alexa, actually, I stopped that months ago, like, but I've seen you every month, since you're just telling me now. And they were doing fine. So who knows, this is a tough job, you have a tough job, we have a tough job to face uncertainty and the problems and the pain and try to make a plan a treatment plan and try to make it better. And it's really tempting and good of us to try to take ownership of that, and try to with that comes seeking control. So we have to be careful of that. And we can be afraid for people and we can maybe mandate or dictators say that they have to or scare tactics. And often those warnings are rational. But again, there's those people who just stopped their meds and then change their attitude or therapies working or something changed, or the financial problems went away and everything got better. The phrase I use is that I try to focus on from the beginning with patients is raising the tide. So think about low tide, like the dirty boots and the fishing rods and the trash is sticking out. And it's an eyesore. But then when the high tide comes in, and the water raises up, all that stuff is underneath water, you can't see it's like it doesn't exist. So I think stacked from the bottom of the sea floor up above the water, it's financial pressures, marital stress, stress of raising children, poor diet, or sleep, the stack enough of those boxes up, they're gonna poke through the top of the water. And so working on each one of those boxes may be enough, but you don't need to get rid of all of them. You just need to lower some of the boxes just to be able to raise the tide to cover it up to get to below the threshold where some of these emotional symptoms start to take over.

Kristen
I know if abused benzodiazepines, for example, and you just stopped those cold turkey, there can be some serious impact to that, is that correct?

Justin
There's the known risk. If you've ever had seizures, and you're taking benzodiazepines and you suddenly stop, that can lead to a seizure. That wouldn't happen for everybody. But you know, a seizure is an electrical storm in the brain. So you're just switching back towards that direction towards over excitation of the brain, it's going to be uncomfortable. So a slow taper is always recommended.

Kristen
This is a powerful conversation, because there's so many different opinions on this topic. And they're the other piece that I can see with clients is if they're on medication, they're drinking heavily. Let's talk about that. What's the impact of that? I know it depends on the med but in general, if they're drinking, often,

Justin
it's not going to be good for the brain. It'll be destructive for the brain. It will mix with medications for many medications, like I said about the smushing thing. You can have a double dipping sedation, an alcohol and a benzodiazepine combined together can in more of the extreme state but there's plenty and famous people this happened to alcohol and a benzodiazepine combined together can suppress the respiratory Centre in your brain. So you go to sleep and you don't wake up, that would be the most extreme.

Kristen
And it's real ones. Yeah,

Justin
maybe below that would just be your life's more chaotic. And it's hard. Those GABA receptors, alcohol tickles those as well. Alcohol helps calm people. And the first couple of drinks does for many people give a bit of a dopamine response. So if you need a little more dopamine in your life, you need a lot more excitement and confidence and feeling good and seeking rewards and being goal oriented. Drinking might fit right in that for you. If you're really anxious, and you're stressed out or you can't sleep, drinking will have an effect that will be temporarily helpful for those things. So it's really tough. It's really tough out there.

Kristen
Sorry, are you condoning drinking? I've just what is just added, like more of a positive like, not on the medication. But what are your thoughts on that?

Justin
I guess anti stigma, these things happen. And they're common, because they do have these neuro chemical effects. And live in life. It's hard. And so when we, you find somebody coping in these ways, but for the grace of God, go i We're all built with the same machinery. We all have the capacity for psychosis and depression and anxiety. And you know, we never know what somebody's facing. So when we see him drinking, it's time to ask them more questions.

Kristen
Yeah, you're going at it with more compassion. But you're not endorsing that. That's a healthy coping mechanism. Correct? Is that what you're saying? Okay, I just want to make sure we're getting what you're saying, because I find that drinking creates more depression, ultimately, for for research shows, for sure. And I'm like, Okay, how much are you drinking, and then it might come out, I'm having one or two a night, and then they may confess to well, I'm actually having 789. Or they may have a dependency on that, rather than medication, which is not moving the needle on them finding the healing that they need. So I find that they can swap going from one, oh, if I'm not going to use this medication, then they start drinking more. Or maybe they've drank their whole life. And then they've added medication to the mix. And now we've got it. Now we're really not moving through the emotional piece and releasing what's held in the body. I find alcohol does the same, it pushes it into the body. And so I'm not making a whole lot of progress with someone because we have this piece that we need to nurture caretake tend to once we can get that freed up, freedom comes I mean, they start clicking, we start making a lot of progress in therapy. And it takes a lot of courage to say, hey, I have a dependency on whatever it is, whether it's alcohol, food, gambling, sex, drugs, pick your poison, to even just come with the courage to say, Hey, I'm using this to cope with the overwhelm I feel or the stress or the trauma, I think is so courageous.

Justin
Yeah, many people might not word it that way. I would add another factor of time, too. Many people who drink tend to drink at night, and they drink can go to sleep, and then it's in the morning, which in their mind may be far away from the drink. Yeah, terrible. You know, it's kind of like, again, what goes up comes down across those number of hours. And there may not be that connecting of the dots. So yeah, we got us a good thing. We got to start with the plain English and connect the dots and help people see it's in the overall it's really not helping.

Kristen
Exactly. It's one of those so normalised ways that we socially acceptable ways. And when they say I just wake up, and I feel like crap, I'm like, Well, let's talk about the night before, let's talk about your day. Let's talk about what so we can really explore with curiosity. Why every day, you're waking up feeling so yucky and bad. And we've just rationalised it so much. And I think it's a tough conversation to have in a lot of ways. Because we don't want to socially put ourselves in this box. And yet, it's not helping us heal. So it's an interesting conversation.

Justin
Yeah, one that I think for the therapists out there does get easier with time. If you're a newer therapist, and comfortable with the suicide conversation or the alcohol conversation or drugs or other kinds of things. Just know that it gets easier in time.

Kristen
Yeah, and I want to normalise this for family systems to talk about this. Yeah, not having to have to therapy to get to this conversation. I think is so empowering. Like my friends. I care. She comes with her deep conversation. It's just part of who I am. So tell me about what you just it's not me being therapist is just authentically me. And I'm like, what if we could Open the gates to more of these kinds of conversations. So it doesn't have to just be therapy, it can be normal. It can I hate the word normal, but it can be widely utilised, that we're able to not feel so uncomfortable with deep.

Justin
Well, I think we'll have to buy an island and just all of us each other, we'll have to move there. And then we can have that Shangri La.

Kristen
I know my listeners crave it, because they're like, I'm doing this work. And I want to start having these deep conversations. And then people are like, I'm out of here. And so it's interesting when you start the healing journey, how you crave depth. So I know we're taking a little bit of a detour. But it makes sense. Because when you're on this, and I think sometimes when we circle the waggon, back to holistic wellness, part of the conversation, are these components, mind body, spirit, emotions, and how do they all work together? So if someone's interested in learning more about you finding your book, how can they find more Justin?

Justin
You're unlicensed, in Oregon only. And so if anybody was seeking to become a patient, there's a limitation their state licence yet they'd have to physically be in Oregon. But otherwise, there's a book on paperback and Amazon, there's a website, the mental wellness diet.com, www the mental wellness diet.com I try my best to get some blogs going and some Instagram posts, there's an audio book that you can purchase through the website $10. Me there's a newsletter, you can sign up for just the book is, it's a great reference to paperback. It's got a lot of great ideas about diet and our modern day life, and how to reconnect with our essential needs. And that kind of wrote it in a way that hopefully it's fun and digestible and helps people feel that they can.

Kristen
That's so important. What are the top three most helpful tips you have that put you on the spot? But

Justin
yeah, I should have wrote down some notes. Well, number one, emotions are information. Whenever we have one, it's going to be uncomfortable. And that is true. However, it's also probably trying to tell us something in what do we need to do to adjust kind of like bumper bowling, the bumpers are there are emotions trying to keep us on the straight and narrow? That'd be number one. Number two, if you've essential premise of the book is if you feed your brain, the nutrients it craves, you're going to feel and function better, and who couldn't use some of that feeling and functioning better in our modern day life. And then, you know, modern day life being the villain, there's so much pressure on us to be exceptional. And there's a good chapter in the book about stress and the pressures of modern day life to be exceptional. And how they're not really, that's not really working towards helping us feel better. It's actually tearing us down over time. So yeah, give yourself permission to just be regular.

Kristen
Very good. Thank you, Justin so much. Is there anything else you wanted to add that we didn't get to today?

Justin
No, that's a great conversation. I'm glad we got to talk about medication and what it's like and take off the mask to make psychiatrists not so scary, and more approachable and just human to and just there to listen and not paid by the pharmaceutical pharmaceutical industry. And just wanting to help. That's the majority of psychiatry people out there.

Kristen
That's good to know. Because I do think there's a misnomer that there's some cut that you guys are getting on the side.

Justin
Yeah, well, we're all weird, but it's good paid by insurance. And that's that.

Kristen
Yeah, that's good to know. So thank you so much, Justin. I enjoyed our conversation.

Justin
Me too. Thanks so much. Thanks.