Episode 369: The Neuroscience of Addiction: A Game-Changing Approach with Dr. Paul Kenny - replay

Content note: This episode includes discussion of childhood abuse, domestic violence, and a suicidal crisis. If you’re struggling, call or text 988 (Suicide & Crisis Lifeline). It’s free, confidential, and available 24/7. For so many of us, staying quiet was how we survived. When a childhood is shaped by violence, abuse, and chaos, silence becomes a kind of armor. And that armor often follows us into adulthood, into our marriages, our careers, and our drinking. In this episode I sit down with Rich Dunning, a medical device executive, father, husband of 32 years, and author of Silence Was My First Language. Rich grew up in the Bronx surrounded by abuse, alcoholism, hunger, and periods of homelessness. He became, in his words, a father at 10 years old, caring for his siblings when no one else would. That survival instinct carried him a long way, into a successful 28-year career and a family he loved. But the pain underneath never left, and alcohol became the way he quieted it. Rich talks about how outward success hid a deep sense of shame, and how losing his brother and his job cracked everything open. He also shares the morning his story nearly ended, and the moment his son’s voice called him back. That was his day one. Rich is now more than nine years sober, and in recovery he found a new language. He chose to publish his story so a child or teen might get help sooner than he did. It’s a heavy conversation. But Rich’s story is a powerful reminder that childhood trauma and addiction don’t get the last word. In This Episode Growing up in the Bronx, and how silence became Rich’s first language The counselor who saw right through him and suggested he write down his memories Two fractures: the death of his 20-year-old brother and losing the job that defined him Being called a “dog” as a child, and the imposter feelings that followed him into his career Paranoia, isolation, and the made-up backstory he used to hide where he came from The unraveling: blackouts, hidden bottles, failed rehabs, and trying to control everything Rock bottom, surrender, and day one of recovery Why he wrote the book like a novel, and why abuse awareness still matters Finding his voice during COVID and deciding to publish Amends, rebuilding trust, and honest conversations with his kids about their family history Key Takeaways Silence can be a survival strategy, and it can outlive its purpose. Learning to read a room, stay invisible, and stay quiet protected Rich as a child. But carrying that armor into adulthood kept him from ever dealing with what happened to him. External success can mask internal collapse. Rich won national awards while drinking heavily, and strong performance made it easy for others to overlook the warning signs. When an identity rests on one role, losing that role can feel like losing yourself. Shame often sounds like an old voice. Called a “dog” by his stepfather for years, Rich spent most of his career feeling like an imposter waiting to be exposed. Naming where that voice came from is part of loosening its grip. Asking for help takes courage, and it’s the turning point. Rich’s recovery began the day he stopped hiding and said, “help me, I can’t do this anymore.” No matter how hopeless things feel, help is available. Trust is rebuilt through actions, not words. Recovery is an ongoing “redemption tour” of amends, self-awareness, and consistent behavior over years. It’s not a single apology. Honesty can break the cycle for the next generation. Rich talks openly with his adult children about their family history and genetic risk. He’s become a parent they can approach without fear or shame. “Your past doesn’t have to define you, brother. You know, what you do right now can alter your life for the rest of your life.” (Rich Dunning) Time Stamps 00:01 Welcome and introduction to Rich Dunning 00:52 A 15-year journey and nine years of sobriety 01:19 Silence as a first language: growing up in the Bronx 02:40 A counselor’s suggestion to writ

Maybe someone you love is starting treatment for opioid use disorder and their doctor mentioned buprenorphine, or a monthly shot, and you're thinking, Wait... isn't that swapping one opioid for another? Or maybe you're the one struggling, and the idea of withdrawal feels so terrifying that treatment doesn't feel possible. Those fears make so much sense. And a lot of what we've been told about these medications is confusing, outdated or wrapped up in stigma. In this episode I sit down with Nick Casale, a pharmacist who has spent the last 15 years in addiction medicine, focused on opioid use disorder. Nick started out in a Pennsylvania Medicaid health plan in the early 2010s, right as the opioid crisis was exploding, and watched firsthand how inconsistent, and sometimes punishing, treatment coverage was. Today he works in medical affairs for a pharmaceutical company, talking with clinicians, researchers, and even sheriffs and jail medical directors about what the evidence shows. Nick breaks down how buprenorphine works in the brain (there's a great musical-chairs metaphor in here), why fentanyl has made opioid use disorder so much harder to treat, and what long-acting injections are changing, especially for people leaving jail. And we talk about the part medication can't do alone: counseling, support, peers who've been there. It's a hard topic. The numbers are heavy. But there's real hope here. Treatment works, access is better than it's ever been, and reaching out is a brave first step. In This Episode Nick's path from retail pharmacy to a Medicaid health plan to addiction medicine, and why he fell in love with this work Why insurance coverage for opioid use disorder treatment was "all over the board," and how kicking people off treatment for a failed drug screen made things worse What buprenorphine is, in plain language: a partial opioid agonist that holds the receptor, eases withdrawal and cravings, and blocks other opioids The three waves of the opioid crisis: prescription opioids, then heroin, then fentanyl and other synthetic opioids How fentanyl changes the brain by creating more opioid receptors, and why that makes withdrawal so brutal Tablets and films vs. long-acting weekly and monthly injections, and why steady levels matter now Medication for opioid use disorder in jails and prisons, and why the days after release are so dangerous How buprenorphine can be misused, and why naloxone was added to some forms What real-world research is showing beyond clinical trials: fewer non-fatal overdoses, fewer serious infections, people getting their lives back Access and cost today, and why so many people still aren't getting treatment.

Maybe you've watched someone you love do something that makes no sense, something that's clearly hurting them and everyone around them, and you've asked, "Why would anyone choose this?" Or maybe you've asked that question about yourself. It's such a human question. And the answers we come up with, the stories we tell about addiction, end up shaping how we treat people who are struggling... including ourselves. In this episode I sit down with Dr. Maria Cichosz, a writer, critical drug studies scholar and professor of literature and creative writing at Victoria College, University of Toronto. Maria isn't coming from a medical or therapy background. She has a PhD in literary and cultural studies, and she brings her own story: growing up as the child of Polish immigrant parents in a home marked by generational trauma and addiction, and her own relationship with substances over the years. Together we look at how our ideas about addiction have changed over time, from a choice, to a weakness of the will, to a disease of the brain, and what each of those stories gets right and what it misses. It's a big conversation, and Maria doesn't pretend there are easy answers. But there's a lot of hope in it. When you can see that our ideas about addiction haven't always been this way, you can start to imagine they could be different. More compassionate. More human.

In this episode of The Addicted Mind, host Duane Osterlind is joined by Joanna Conti, founder of Conquer Addiction and the Vista Research Group. Driven by her personal journey navigating her daughter’s severe alcohol addiction, Joanna set out to solve a major gap in the addiction treatment industry: the lack of hard, verifiable outcome data. Joanna shares how her background in software and engineering led her to launch Vista Research Group to track patient progress during and after rehab, as well as Conquer Addiction, a non-profit helping families find evidence-based care. They discuss what the data reveals about long-term recovery, why the 90-day care benchmark is critical, and how real-time patient monitoring can save lives. Key Topics Covered A Personal Catalyst: Joanna’s harrowing experience with her daughter’s severe alcohol addiction, six years of navigating rehabs, and her daughter's eventual 13-year recovery. Marketing vs. Hard Data: The frustration of encountering unverified success claims (such as "98% success rates") and discovering in 2015 that only five treatment centers nationwide were scientifically tracking and publicly sharing post-treatment outcomes. Launching Vista Research Group: How tracking patient progress during treatment—including cravings, depression, and therapeutic alliance—improves patient outcomes in real time. What the Data Reveals: Insights gathered from monitoring over 100,000 patients in treatment and following up with over 50,000 post-treatment. Factors Influencing Success: How primary substance choice (alcohol vs. fentanyl or meth), age, peer culture, and ongoing support impact recovery rates. Why Industry Data Has Stagnated: Why nationwide 1-year recovery rates have remained around 36% to 37% since 1993, and how systematic measurement can drive outcome leaps similar to those in cancer research. Key Takeaways & Data Insights The 90-Day Benchmark: Patients who stay engaged in care across various levels (residential, IOP, outpatient) for at least 90 days are twice as likely to be in recovery one year later compared to those who leave in 20 days or less. Support Networks: Active involvement in recovery communities (such as AA or SMART Recovery) or living in sober housing doubles the likelihood of maintaining long-term recovery. Real-Time Feedback: Self-reported patient surveys often surface critical mental health warning signs—such as hidden suicidal ideation or rising cravings—that patients might hesitate to share face-to-face with clinicians. Hope for Chronic Relapse: Data confirms that individuals with 10 to 15 prior treatment episodes for severe substance use disorders are still fully capable of achieving lasting recovery. Guest Message "Love them and help them find effective treatment. Don't give up." — Joanna Conti Resources & Links Conquer Addiction: conquer-addiction.org — Treatment centers with verified, above-average outcome data. Vista Research Group: Data-driven patient progress monitoring and outcome tracking for addiction treatment providers.

In this episode of The Addicted Mind Podcast, host Duane Osterlind speaks with actor, playwright, and recovery advocate Ned Van Zandt. Ned shares his life story—from an exotic childhood traveling the world to studying under Olympia Dukakis and working alongside high-profile actors and musicians in the 1970s. He candidly details his descent into hard drugs while living at New York's iconic Chelsea Hotel, his first 13-year stretch of surface-level sobriety, a sudden relapse that led to an arrest in Texas, and his eventual surrender to deep, service-driven recovery. Today, Ned is the managing director of a NYC sober living facility and the creator of the one-man show Lost in Del Valle. Key Topics Covered Roots and Early Career: Growing up in a prominent Fort Worth family, child acting in The Music Man and Oliver!, and studying acting at NYU under Olympia Dukakis. The Chelsea Hotel Era (1978): Moving into the legendary hotel the same week as Sid Vicious and Nancy Spungen, accelerating a lifestyle of heavy drug use and rock-and-roll partying. First Sobriety Attempt & Relapse: Getting sober in 1987 following legal pressure, putting together 13 years of continuous recovery, and landing roles on Broadway and Law & Order. Ned reflects on how skipping the deeper step work left him vulnerable to a sudden relapse on New Year's Eve 1999. The Downward Spiral: Overdosing on cocaine, leaving New York to hide out in Texas, losing his life savings, and being arrested on a dirt road outside Austin for possession with intent to distribute. Jail at Del Valle: Navigating time in jail, where the head of the local Texas Aryan Brotherhood gang recognized him from his role on the soap opera One Life to Live. True Recovery in Hawaii: Entering treatment in Hawaii in 2007, embracing sponsorship and service work, and rebuilding his acting career with roles on Lost and film projects. Creating Lost in Del Valle: Developing a raw, humorous one-man play directed by Amir Arrison (The Blacklist) recounting his wild history, rock-and-roll encounters, time in jail, and path to redemption. Service as a Pillar of Sobriety: Working as managing director and partner at Transcend NYC, helping young men find direction and recovery. Words of Wisdom for Anyone Struggling Focus on the Single Frame: View life like a long roll of film. Instead of obsessing over the outcome or the end of the reel, focus exclusively on the single frame in front of you right now. Move a Muscle, Change a Thought: Physical action shifts mental state. Go for a walk or change your environment to break negative thought patterns. Get Out of Your Own Head: Engaging in service and helping others brings back the purpose and vitality that addiction strips away. Mentioned in This Episode Resources & Links for Ned: Ned's Play Lost in Del Valley at the Soho Playhouse Play Official Website: lostindelvalle.com Sober Living Facility Transcend NYC (Upper West Side, Manhattan) Podcast Websitetheaddictedmind.com Supporting Resources: Duane Osterlind LMFT CSAT If you live in California and are looking for counseling or therapy please check out Novus Mindful Life Counseling and Recovery Center NovusMindfulLife.com Shame to Resilience We want to hear from you. Leave us a message or ask us a question: https://www.speakpipe.com/addictedmind Disclaimer See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.