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Summary

Conversations at Lifeskills South Florida highlights new innovations in mental health and addiction treatment, the importance of customized treatment plans and more. Join us and our experts in the field as we uncover key topics to help bring more hope and freedom to recovery.

Episodes

Providing Space and Time to Heal with Klay Weaver

Individuals with complex psychiatric disorders are often siloed into one specific type of treatment that may not address all of their needs, and Lifeskills South Florida CEO Klay Weaver believes that’s a major problem. In this episode, Klay explains why a customizable approach to treatment, especially when paired with a step-down approach that allows individuals to gradually reenter society, tends to deliver the best outcomes. He also stresses the importance of evidence-based best practices.

Transcript

Klay Weaver: Government funding really tended to be in silos, it tended to be in very specific, unique boxes where individuals had to neatly fit into that, and they had to meet the criteria for that. And it really constrained how a practitioner, a physician or a clinical social worker or psychologist would develop solutions for those individuals because they were so bound by the chains of the payers. So, working in a facility where we can speak with the family and develop a comprehensive solution that’s not a one size fits all, but it may be very unique.

Host: That’s Klay Weaver, CEO of Lifeskills South Florida. He’s describing the importance of treatment facilities that can treat individuals with multiple conditions at once. My name’s Clark and I’m your host of Conversations at Lifeskills South Florida. It’s a new podcast where we’re covering topics like the importance of customized care plans, new innovations in addiction and mental health treatment and more. Lifeskills South Florida is a dual diagnosis treatment center that works with individuals who have complex psychiatric disorders, addiction, and significant comorbidities. They’re also part of the larger Odyssey Behavioral Health network, which includes 20 locations that are committed to helping individuals reach their optimal levels of health. In this episode, Klay discusses some of the trends he’s noticing in mental health and addiction treatment. He also shares an exciting update about the new expansion of Lifeskills, which will allow them to give individuals more space and time to heal. To learn more about Lifeskills South Florida and Odyssey Behavioral Healthcare, visit odysseybehavioralhealth.com. Now, let’s get started.

Klay Weaver: Well, hello, Clark. My name is Klay Weaver and I am the CEO of Lifeskills South Florida. I have now been at Lifeskills almost six years coming this May. I have over 30 years’ experience in the industry – I guess, that means I’m getting a little older now – and 25 years in leadership within psychiatric facilities.

Host: Well, thank you so much, Klay, for taking some time to just share with us a little about your journey, the work you’re doing, how important the work is. And we’re also talking about some of the things that you’ve been seeing recently. I mean, not only– there’s a lot of challenges in the world, but especially there’s been a lot more layered on top.

Klay Weaver: Oh, that’s true. The pandemic has just made– whatever problems that we all struggle with, it’s made everyone’s problems more difficult. And then, when you consider the psychiatric nature of the problem’s individuals have that come to us for treatment is compounded, the issues that they’re struggling with, being isolated. So, it’s a very difficult time.

Host: Yes. You got the pandemic, there’s the political uncertainty, the financial uncertainty, all of this. It’s just a perfect storm. How about we just dive straight into this. I really want to hear more about Lifeskills. For someone who’s never been there, how would you describe it? Let’s talk a little about the work that you do.

Klay Weaver: Sure. Thank you, Clark. Yeah. Lifeskills is interesting. This is our 31st year. So, we have been around a long time. Lifeskills began as an addiction treatment center years ago, specializing in underlying issues, specifically trauma. And that was the beginning of Lifeskills. In the early days of Lifeskills, they began to transition in their scope. They realized that they were getting calls for other underlying issues that were outside their expertise and trauma, and they began to develop other areas of expertise. And I began dealing with other significant underlying issues of mental health. And today, Lifeskills is known for the treatment of individuals who have complex psychiatric issues and significant comorbidity. Individuals treated at Lifeskills are adults, ages 18 and up, who present with a complex psychiatric and substance use disorders.

Host: So, it started off as just one treatment focus and now it’s expanded. How have you seen those play off each other and why have you seen an expansion of the offering?

Klay Weaver: I think as I spoke with the– several times– I know the founder of Lifeskills, who is a clinical psychologist in a private practice in Boca Raton, here close by. And speaking with him he said in those early days, it was his passion was just trauma, but he said the calls kept coming in. My loved one has addiction and underlying mania or my loved one has addiction and underlying depression. He said that he finally had to just realize that there were multiple impacts beyond just trauma and that he really had to widen his scope if he was going to meet the need of everyone calling for services 30 years ago.

Host: Wow. So, what you’re saying the founder could see it was not just one thing, there’s so much more to this. And in 30 years, we’ve learned so much, right?

Klay Weaver: Oh, it’s totally changed. And it works in maybe a very small program or a private practice where you see people one on one. Someone can probably get by in a smaller setting where you see people who have just one condition or one area of focus. But when you’re a larger treatment center, you begin to get calls that are not neatly contained in a silo or in a box. And individuals have multiple sets of comorbidities that are impacting their functioning. And that’s what the founder had to grapple with in those early days. And I’m glad he did, because, today, we really can offer solutions to families that aren’t just in a box and just one set of solutions, but we can get creative and build a unique and individualized plan around their loved one.

Host: When you say individualized, there’s not a one size fits all for this, is that correct?

Klay Weaver: Right. That’s it. So, Clark, in the early days in my career, I began in the public health and community mental health system. Very large systems that they were the safety nets, and they still are today, those large systems are the safety nets of our healthcare system for individuals who do not have the funds, or they rely on Medicare and Medicaid for their services. So, in those early days, what I saw in running those large programs is that government funding really tended to be in silos. It tended to be in very specific, unique boxes where individuals had to neatly fit into that, and they had to meet the criteria for that. And it really constrained how a practitioner, a physician, or a clinical social worker, or psychologist would develop solutions for those individuals because they were so bound by the chains of the payers, how the payers had specific constraints on how money would come to them.

So, for large amounts of the population, the solutions are very difficult, and they only recognize one primary issue. So, working in a facility where we can speak with the family and develop a comprehensive solution that’s not a one size fits all, but it may be very unique, they may have to come into a treatment center with one-on-one nursing for many days until they stabilize medically. They may be non-ambulatory and in a wheelchair are coming in, or they may be on an oxygen machine and coming in to get treatment. So, we must get creative in treating the whole person, their primary needs, as well as their psychiatric needs.

Host: So, there’s a full continuum, it sounds like?

Klay Weaver: That is correct.

Host: A continuum of care. Could we talk about that next? So, we’ve talked big picture of all of this, how it fits together, but as you start to zoom in and you start to really see tangible examples of this care. Can we talk about that next?

Klay Weaver: Sure. So Lifeskills has a continuum that begins with a residential treatment center at the residential level of care. There are 52 beds. And we’ll talk in a few minutes about the expansion of an additional 16 beds for the North Campus. But we also developed step-down programming at the partial hospitalization level of care, intensive outpatient programming, and transitional living. And what research has shown us is that individuals who stay in treatment longer and step down in services, those individuals have better outcomes in their functioning and their re-engagement in life if they stay in treatment longer and step down in levels of care so that they step down more slowly to re-engage life.

So, one of the things we did several years ago was we opened the partial hospitalization level of care, which is a five-day a week outpatient level. And then, that is followed by the intensive programming at the outpatient level, which is three days a week for three hours each day. This allows people really the skills they learn and the stabilizing they gain from a residential level of care that they then begin to slowly– they have the training wheels on the bike and then they move through the system and take the training wheels off and they begin to experiment with the skills they learned.

So, it gives an individual a way to practice before they go directly back to– let’s say someone comes from New York. If that person were in residential level of care and went back to New York, going straight back to school or straight back to a job, they’re really taking themselves out of a cocoon where they’ve been able to heal and to grow and immediately go right back into life at a full pace. So, this slows the pace down, allows them to practice the skills, re-engage at a slower pace. And then, as they learn and experiment and they grow and their confidence grows, they’re able to take those skills at a better level when they go back home. So that’s the goal of having that expanded level of care for individuals.

Host: I think, Klay, I’ve heard you talk before about evidence-based best practices. And I think everything you’re describing right now, it all fits under that.

Klay Weaver: Yes. It does. So, yes, the evidence-based best practices are critical. How treatment centers and how healthcare practitioners market really is not regulated very well. So many people say, “We treat depression,” or “We treat anxiety. We treat addiction,” but they do not talk about the critical things. It’s the best practices that are used to treat an individual that has certain conditions. So, for example, within the federal government, there are a couple of bodies that are very important in healthcare that regulate and provide research and outcomes and tracking what is the best modality to treat individuals with certain disabilities or certain diagnosis.

So, we rely on the Substance Abuse Mental Health and Services Administration called SAMHSA. That’s relied upon for their guidance. They offer millions of dollars for research and the tracking of outcomes. And through that, they want to see replicated outcomes where individuals have improvement with certain modalities. So Lifeskills, we are very committed to using the modalities that are approved by SAMHSA and the National Institute of Health and National Institute of Mental Health as well. So, we’re committed to following those best practices for the treatment of conditions in which we treat. So, for example, we have seven clinical pathways at Lifeskills that an individual finds treatment within. We have a pathway for trauma, cognitive behavioral therapy for mood disorders, dialectical behavior therapy for personality disorders, cognitive remediation for individuals who have thought disorders, and then we have the substance use disorder pathway, and the greenfield video gaming addiction pathway.

So, within all these different pathways, we want to ensure that our clinicians– not only do we have licensed clinicians and clinicians who have the highest levels of education, but they are nationally certified in the best practice of that pathway. So, for example, in the DBT clinical pathway, we have used the best practice by Marsha Linehan, her DBT curriculum, which is widely known. We use that and our clinicians are nationally certified with Marsha Linehan for the DBT services that we provide. Currently on campus, we have eight clinicians who are certified through Marsha Linehan in DBT.

Host: And can you remind me quick, DBT?

Klay Weaver: Dialectical behavior therapy.

Host: So, it’s interesting because each pathway, it is different. All of this is different, but there are still some connections. However, in each of these, you have the best practices applied to each one, people who are specialized in that specific one, but you’ve also removed the silos because it is all in one place.

Klay Weaver: That is correct. Now, Clark, you mentioned something that’s very important, as you say, removing the silos. I like to think of the pathways as being almost like a college major and a college minor. So, think of an individual going to college and they have a major that they go after and a minor in college. Well, the pathways work very similarly. An individual typically comes to Lifeskills and they have a major issue. Let’s just say that issue is trauma. They have a minor issue that they have personality disorders, and they need to learn skills through DBT to deal with that. Well, that individual may begin with DBT so they learn the skills of self-regulation and how to deal with difficult situations so that they can then focus on trauma after they gain those skills.

That is correct. Now, Clark, you mentioned something that’s very important, as you say, removing the silos. I like to think of the pathways as being almost like a college major and a college minor. So, think of an individual going to college and they have a major that they go after and a minor in college. Well, the pathways work very similarly. An individual typically comes to Lifeskills and they have a major issue. Let’s just say that issue is trauma. They have a minor issue that they have personality disorders, and they need to learn skills through DBT to deal with that. Well, that individual may begin with DBT so they learn the skills of self-regulation and how to deal with difficult situations so that they can then focus on trauma after they gain those skills.

Host: It does makes sense. And it’s helpful to think about it as a major, as a minor. It is interconnected. And this might be a nice transition to talk about some news, right, that Lifeskills has been able to come out with this expansion. I know you mentioned this earlier, you’re going from 52 beds with now an additional 16 beds, there’s a North Campus expansion. Can you tell me about what that is and why you’re excited and why your team’s excited?

Klay Weaver: Yes. Thank you. I am very excited. This has been three years in the making. By the time you go through planning phase and then purchasing property and zoning and then the construction and, oh, and you’re constructing in the middle of COVID, it’s taken a long time. So, we are very excited.

Host: Counting down the days

Klay Weaver: We really are. I think as someone would understand the current campus at Lifeskills, the South Campus now, and the clinical programming, as individuals live on the South Campus, it is much more of what we would call a forced socialization model. That would best describe how individuals interact as they come into treatment and live in that setting. While a person is there, there is space for them to get away individually for some period, but not for prolonged periods of time, just due to how the campus is constructed, how it’s designed. So, it doesn’t allow for a lot of private space in that regard. And the reasons behind that is when the campus was constructed in the early 2000s, the research is clear that individuals who recover had better recovery when they are interacting with each other.

And there’s the social component to treatment that’s very important. But for an individual who may be struggling and their symptoms are really acute and much more pronounced and it makes them difficult for them to participate fully and to engage and enjoy the benefits of that, that individual who’s struggling with psychosis or schizophrenia, that person would be better served in a setting that is quieter, that has more private space, and it promotes that individual space so they have the time and space they need to find healing and stabilization. So, the concept of the North Campus is much more space, much more openness, while the South Campus is more forcing interaction, getting to know other people, practicing your skills.

So, the North Campus was really thought about to help stabilize those individuals who really struggle as they come in, as they have a lot of issues going on and they need that space, and they need that time before they can fully participate in a treatment modality. So, for example, both of those buildings have double living rooms so that– just by thoughtful design. So, individuals have more space to get away from each other within the building. So, someone may be wanting to watch TV in one room and in another room, a person may be wanting to read a book or just sit and listen to music. So, they have space to get away from each other. On the outside, it’s very much the same. Lots of patios, unique features, sitting zones, areas for reflection, walking paths, water features. All of this is designed so that the individuals have space, and they can get away and take healing at a more natural pace as opposed to where they would be forced to socialize and practice skills.

Host: Right. So over time, your just made adjustments based on what the needs are. So that really speaks, I think, to the trends that you’ve been seeing. And I’m curious as well, is anything else you can add as you are thinking about trends, what’s happening around us in the world? Anything else come to mind of just why having this additional option, especially right now maybe?

Klay Weaver: Yeah. This is– interesting question, Clark. So, over the past several years, I think, within the psychiatric industry and within Lifeskills as well, we have seen the trend going that people are coming for help, having more symptoms, more difficulty, and struggling more. So, we’ve seen the type of individual that’s coming for treatment here. They’re more difficult to get stabilized. They need more space. Things are changing in our world. Maybe some things are changing for the better. We would all say there are some great things that happen, but even with great things that happen, there’s also a lot of negativities. And individuals that struggle when they interact with the negativity and the environment of the world. It makes it more difficult for them. So, we’re seeing that.

We’re also seeing that even though healthcare has changed, and the Affordable Care Act known as Obamacare, it opened a lot of insurance for people and opportunities, but also a lot of people who obtained that insurance weren’t able to fully utilize it until they hit a major crisis due to the high co-pays and things of that nature. So even though there’s a lot of good in the world, there’s still a lot of struggles as people are trying to find healing and trying to find hope. So, I think that has been a general trend, that individuals coming into treatment are coming in sicker, more acuity, and much more complex than they were years prior. And on top of that, I think just general trends in the industry, insurance companies are making it much more difficult. Of course, they’re in the business to make money, make profits.

But insurance companies really have had this history the last several years of really putting much more restrictive measures on how they reimburse and what conditions they reimburse for, making sure that individuals have failed at a lower level of care before they were authorized a higher level of care of service. Well, that’s very difficult when someone is struggling, when the insurance company says, “Well, before we refer you to a higher level of care, we want to make sure that your current level of care can meet your condition.” And if it can’t and you fail, well, a failure in our business is not good. So, individuals are coming to us with multiple failures that they previously may not have had. So that makes it very difficult as well. And then, Clark, you just add COVID. The individuals coming into treatment now are much more pronounced in their difficulties than individuals one year ago. So, the timing of the new campus is excellent in that regard, that it’s going to open at a time when individuals can really find better treatment for it, for what they’re suffering from at this time.

Host: This is my own perspective and my own thoughts, but it is upsetting to hear how some of the insurance and whatnot, whatever, the powers that be, will– you must fail – I hate that word, failure – before you can perhaps get the support that is really needed and being able to, in this case, work with you and your team. So with this new expansion, with the new services– I know you’ve already talked a little about the structure and support that’s offered, but how do you take someone who’s not been getting the help they need, now they have access to what you’re offering, how do you anticipate, with the new expansion, to help reverse that so they find success and they find the care and the healing that is needed?

Klay Weaver: Right. Well, I think one of the things, one of the functions of the North Campus is really it’s intended to break that cycle of individuals who struggle with a lot of issues, struggle with acute symptoms and do not have success. Maybe they cycle in and out of a psychiatric hospital and then they go back to community care, or they see their individual physician, or they see an individual therapist and they do not make great gains, and then they go back to the hospital. So that cyclical nature of failure. The North Campus is really designed to stop and break that cyclical nature. Given enough time, let an individual come and stay 60 to 90 days, let’s really stabilize. Let’s get on the proper medication. Let’s do genetic testing to make sure that we have the right medications, to make sure we’re following the right pathway. Let’s make sure that we have enhanced clinical support, that we’re gaining the skills we need.

So, we take our time to stabilize. So, the whole goal is to slow down the process where, typically, individuals going into psychiatric stabilization in a hospital may be there for five to seven days and then back home. So, we’re wanting to slow that down. Let’s take 60 to 90 days. Let’s really get this right. Let’s spend time and learn ourselves clinically. Let’s learn what went wrong, what went right, what medication we need to be on, what kind of family support we need, what kind of ongoing therapy we need. And as we do that and slow the model down and then have the opportunity to step down to lower levels of care and practice the skills we’ve gained, that’s going to give us the best recipe for a long-term success as we go forward.

Host: I love that. It all makes sense in slowing it down, let’s do this right. I’m hearing you loud and clear. So, my final question for you is, what’s the next step? How can someone get connected? And what’s that process like too? That’s something I’m also really interested in.

Klay Weaver: It’s one simple phone call or an email. If someone goes on our website, they can easily go on the Lifeskills South Florida website and they can send an email to inquire. It’s that simple. Or they can call. I believe our admissions number right now is 7542261572. Just an easy phone call. Our admission team works 8:00 in the morning to 8:00 at night. And if someone calls late in the evening after 8:00, they will call you back first thing the next morning. But our team works seven days a week, so a simple call any day that’s convenient. We have trained clinicians who are excellent clinicians working in the admissions department there. They’re able to assist someone in moving forward with seeing if this is the right place. And if it’s not the right fit, and many times people call for help and they find that, maybe I need something else. Our team has worked with so many other treatment centers across the nation, they can easily help someone get the help they need in another location, if that’s necessary.

Host: Well, thank you for taking the time to share some of the update, some of the process, some of the ways that this all works. I know it can seem really overwhelming and perhaps intimidating. I’m hearing you loud and clear. Your team is here and ready to help. So, Klay, thank you so much. I look forward to more conversations with you in the future.

Klay Weaver: Thank you, I appreciate that, Clark. I do as well. This has been very engaging. Thank you for taking time for us to share about the new North Campus.

[music]

Host: Hey, thanks for listening to Conversations at Lifeskills South Florida. Please be sure to follow, rate, and review the show anywhere and everywhere you get your podcasts. If you or someone you love is looking to turn second chances into new beginnings, start your journey at odysseybehavioralhealth.com.

The Science Behind Technology Addiction with Dr. David Greenfield

It’s no surprise that people struggle with technology addiction; our devices were designed specifically to make us want to spend more time on them. Dr. David Greenfield, author and Consulting Director of Lifeskills South Florida’s Greenfield Pathway for Video Game and Technology Addiction, explains how technology impacts our brains, and he shares some common signs of tech addiction. He also unpacks the difference between overuse and addiction and shares some helpful tips for decreasing your phone usage.

Transcript

Dr. David Greenfield: All good things aren’t always good. All good things can be powerful, and powerful things can be dangerous. I mean, the internet’s strength is that it connects people and businesses with things and information they need, so it’s a wonderful technology. The problem is that when it first arrived, nobody really dreamed that it would become addictive.

Host: That’s Dr. David Greenfield, consulting medical director of the Greenfield Pathway for Video Game and Technology Addiction at Lifeskills South Florida. Dr. Greenfield is known as the godfather of the tech addiction space, and he’s been studying it since the mid-1990s. My name’s Clark, and I’m your host of Conversations at Lifeskills South Florida, a podcast where we’re covering topics like the importance of customized care plans, new innovations in addiction and mental health treatment, and more. Lifeskills South Florida is a dual diagnosis treatment center that works with individuals who have complex psychiatric disorders, addiction, and significant comorbidities. They’re also part of the larger Odyssey Behavioral Health Network which includes 20 locations that are committed to helping individuals reach their optimal levels of health. In this episode, Dr. Greenfield breaks down the science behind internet addiction, explaining how our technology is designed to affect our brains in specific ways. He also shares some common signs that you or someone you love may be suffering from technology addiction, and he describes the treatment methods he uses with the team at Lifeskills. To learn more about Lifeskills South Florida and Odyssey Behavioral Healthcare, visit odysseybehavioralhealth.com. Now, let’s get started.

Dr. David Greenfield: Hi, I’m Dr. David Greenfield, and I’m the founder and clinical director of The Center for Internet and Technology Addiction and consulting medical director for the Greenfield Pathway for Video Game and Technology Addiction at Lifeskills South Florida. I’ve been working in the internet addiction and digital screen use space for about 25 years since the mid-1990s, and that’s about it.

Host: Well, Dr. David Greenfield, thank you for taking the time. I know you are a busy person, but we really, really appreciate getting a few minutes of your time here.

Dr. David Greenfield: Sure. Feel free to call me David, by the way.

Host: David. All righty. It sounds great. So since the mid-1990s– now, I guess I’m a little bit on the younger side, so I mean, I have some memory of there not being technology with screens and that sort of thing, but most of my life has been around that, so. You, though, have kind of experienced both sides, life before what we know now as technology and video gaming and all of that, and also present day, so you really bring two different perspectives to this.

Dr. David Greenfield: I do. I have a new book coming out at the end of the summer, and one of the things I talk about in the book is I call myself a digital half-native because the first half of my life, including all of my medical training, was done without computers and mostly without the internet as well. So I think I was still doing my internship and residency essentially without much computers. This was in the early- to mid-’80s. It really didn’t catch on in the personal computer side and certainly the internet, not till the early-1990s. So I’ve seen both. And I think there’s certainly pros to technology and the internet, but there are some cons too.

Host: But when we’re talking about those cons today, we’ve seen this rising trend. And this is your work, and I’m going to have you share a little bit more about those trends that you’ve seen and the challenges that that’s created and ultimately how we can overcome that, so I understand, yes, digital half-native. And I’ve heard you described before as the godfather of video game and technology addiction, so you’ve been in this space for quite a while. And when you reflect back on– when you think about that digital half-native life before this and life with it now, how do you put that in a nutshell of how you see that impact people?

Dr. David Greenfield: Well, let’s talk about the internet specifically. I mean, the internet’s strength is that it connects people and businesses with things and information they need, so it’s a wonderful technology. The problem is that when it first arrived, nobody really dreamed that it would become addictive and that we would have people spending four, six, eight hours a day or more surfing and scrolling on their smartphones and on their tablets or laptops and ignoring a large part of their lives. So it’s–

Host: Just like right now, we’re chatting and you’re getting hit left and right from all sorts of people.

Dr. David Greenfield: Just like right now, we’re chatting and you’re getting hit left and right from all sorts of people.

Host: I know the feeling, man. It’s okay.

Dr. David Greenfield: I got to turn that off.

Host: But that is a great– I think you couldn’t have planned that better though.

Dr. David Greenfield: Yeah, that’s a perfect example.

Host: Yeah, that’s a perfect example.

Dr. David Greenfield: And we’re not meant to do that. We’re not meant to do that part. We–

Host: As human creatures. Is that what you mean?

Dr. David Greenfield: No. We’re not meant to be on call or on attention 24/7. We’re not meant to have that level of arousal in a high way all the time. We’re designed really biologically to have periods of peak attention and peak stress but then with a dip. But the problem is technology elevates that level of stress to a constant din of availability and attention. And the whole basis behind the tech business world is to keep your eyes on screen. So what that means is they’ll do anything and everything including brain science and behavioral conditioning to make sure your eyes stay on that screen.

Host: Just with the pings and notifications, I find that on– I had to start turning my notifications off on my apps on my phone because, in my mind, I see the little red like, “You’ve got messages,” and of course I want to open it up. But they want to sell your time and attention to the highest bidder.

Dr. David Greenfield: Well, and not only do they want to sell the information, they’ll either sell your data or your metrics or they’ll sell you something directly. I mean, if you look at the major social media feeds, I mean, they’re advertising directly, and those advertising systems are incredibly successful, incredibly successful.

Host: Right. I mean, they know who you are. They know everything. I mean, it’s only getting scarier. right? And of course, I think the whole basis of advertising is you need something, and an easy way to communicate that is there’s something wrong with you and you need to buy this product. And that probably is connected to some of the work that we’ve been talking about in this podcast because you’re being told all day you’re not good enough or you need to look a certain way or you need to be doing a certain thing, and you amplify that with the technology addiction, and it’s a slippery slope and it’s terrible.

Dr. David Greenfield: Yeah. Well, it is a slippery slope because everybody needs technology to do their work or to go to school. And of course, during the COVID pandemic, everybody was incredibly dependent on their screens for everything, from social connection to education to doing their work. In fact, I did most of my treatment via telemedicine online. And that was a godsend to be able to have that. But all good things aren’t always good. All good things can be powerful and powerful things can be dangerous.

Host: Well. So let me ask you this. So when you started this work mid-’90s, when you started to see computers and technology and this shift– because just like you said, as humans, we’re not wired to do this. We’ve been around tens of thousands of years, and now we have this new type of technology that we’ve never been introduced to before. I mean, this is just maybe, what, two generations maybe. So there’s a lot of changes happening.

Dr. David Greenfield: Barely two generations. Yeah. Yeah.

Host: So when did you know, when did you realize this was an important area that you needed to focus on and a growing trend that needed attention and treatment?

Dr. David Greenfield: Well, let me talk for a second about my background. My background, of course, is in addiction medicine. So I was trained in addictions. And most of the addictions that I was trained in were substance-based addictions, mostly drug and alcohol, with a little bit of work on the behavioral side which would be like gambling addiction. So I had that background. I also had a very strong interest and background in technology and electronics. So I put myself through school fixing televisions and electronics stuff. So for about 12 or 13 years, that’s how I supported myself while I did my training and education. So I always loved technology. So I have kind of a love-hate thing going on with technology. I love it and I’m fascinated by it. I love gadgets. I love technology. And at the same time, I kind of hate it because I know how much time it eats.

So back in the probably early- to mid-1990s, I was working with another colleague, and we were starting to do some writing around sex and the internet. And of course, sex and the internet are like peanut butter and chocolate. They’re kind of a perfect match. And I saw a small study that was published that was looking at internet use or overuse and comparing it to gambling addicts – and we had known that people could get addicted to gambling for quite some time – and they likened them together. So that kind of got my interest piqued. And I contacted ABC News and I did a project with ABC to put a study up on their servers, on their website to look at how people were using the Internet. And it took several months to design it, and we had a statistician involved, and we got about 17,000 good subjects that filled out this very extensive survey. And that survey became the basis of several publications in some medical journals and then the basis for my first book called Virtual Addiction which came out in 1999 if you can– so that’s a long time ago. We’re talking–

Host: So we were having– so you’re saying to me you could already see virtual addictions before the year 2000.

Dr. David Greenfield: Oh yeah. Yeah, I was seeing it in my office.

Host: Email? What is going on in the ’90s?

Dr. David Greenfield: Not email. I would say, in those days, it was chat rooms, it was– obviously social media didn’t exist. I would say chat rooms, some pornography, but not a huge amount. Video games were probably already an issue for some people even though they were not multi-user games and internet-based games at that point. That was still heating up.

Host: That’s a whole nother league when you go into the [crosstalk] maybe.

Dr. David Greenfield: A whole other thing. That’s like pouring gasoline on a fire.

Host: Certainly. Because then you’ve got– man, it is just a recipe for disaster.

Dr. David Greenfield: Well, here’s the deal. The internet is the world’s largest slot machine. And let me explain that to you. Every time you go online, and it doesn’t matter what you’re doing, whether it’s video gaming, your social media, or just surfing or scrolling, or looking up sports scores or porn. It doesn’t matter what it is. It could be anything. It could be shopping for anything. You never know what you’re going to get, when you’re going to get it, and how good it’s going to be. It’s completely unknown and it’s variable. So every time you go on, it’s like a new experience. And that’s how a slot machine operates. It’s called variable reinforcement. So every once in a while, you kind of get something you want or you get an email or some piece of information, or you might get an update, a social media update, or somebody like something you post, but you don’t know when that’s going to happen, so you keep looking. And every once in a while, you find something you like. So then when that happens, you get a hit of dopamine. And that small hit of dopamine is very reinforcing because it’s a pleasure chemical. But because it’s unpredictable, it becomes very resistant to extinction, which is another fancy way of saying you get addicted to it. You can get addicted to something that is variably reinforcing. The smartphone, by the way, is this world’s smallest slot machine. And it does all the same things, of course, that any screen that’s connected to the internet does. But it does something else that really makes it addictive, and that’s the notifications that you were talking about.

Host: You can’t escape it. I mean, you were talking earlier, we are so accessible, and we never go anywhere without a phone.

Dr. David Greenfield: Right. So every time you get a notification, it tells you that there might be something waiting for you. And the brain loves maybe. The brain loves might. And so then you go and check it and then you check it again and you check it again. So the notifications are interesting because they actually elevate dopamine even higher than the reward of finding something you like. So just being notified that there might be something you’d like to see will get you to look at it and will elevate dopamine in your brain.

Host: A couple of years ago, I was getting really interested in gamification, and you mentioned the happiness chemical, the pleasure chemical, right, dopamine, and so you’ve got – what is it? – I think it’s dose; you get dopamine, oxytocin, serotonin, and endorphins.

Dr. David Greenfield: Epinephrine or– yeah.

Host: Right? And so you mentioned a slot machine. This is the world’s biggest slot machine. So you’ve got your smartphone in your pocket. You’ve got all these notifications. You have the social component online. You’ve got now a whole new genre of video games. We’re not talking about the solitaire in the ’90s on your computer; now we’re talking about massive online multiplayer games that people are spending a lot of time on. So when does it go from, “Hey, this is a great way to be connected to other people,” and what you were saying earlier like, “There are good things about it,” when does it get to the bad point? And based on your experience, what does that really mean for families, for individuals?

Dr. David Greenfield: Yeah. Well, most of us, I would say, are not addicted to it. I think many of us, if not most of us, overuse our screens. And I mean, I’m certainly guilty of that, perhaps you are at times. I know I overuse it at times. So that’s one thing, that’s sort of one horse. But another horse of a different color would be somebody that gets addicted. And that’s a much smaller percentage, certainly, probably well under 5%. Some statistics say as high as 10. I would say it’s somewhere between 1 and 2 percent on the low end to 4 to 5, 6 percent. My research showed about 6% meet the criteria for addiction. I think it may be even lower than that. So what does that mean? What that means is that their Internet use, their screen use, whatever device they’re using, whether it’s video gaming or porn or social media or just general screen usage, overall, what it means is that they are using it to a point where it really interferes with their life and with their functioning. It’s got to have some negative impact on their living, otherwise you really don’t meet the criteria for addiction. Addiction really is a problem that– it’s a solution that creates another problem. So it might be fun to do it but then there’s another problem that’s created from it. And that’s what we see with substance use and alcohol use as well, that it’s fine to have a glass of wine or two, but probably if you’re doing 5 or 6 or 10 glasses of wine a day, you’re going to have some problems or some consequences of that heavy use, and that’s really what we see with internet. It’s not solely dependent on how much time you spend, although there’s a very strong correlation between having a problem and how much time you spend.

Host: Is there red flags that are obvious? Maybe it’s a parent that’s starting to recognize this in a child, or maybe this is someone seeing something in themselves. Is there a moment when you know it actually is being–?

Dr. David Greenfield: Well, I’m going to be honest with you. People who come for treatment, whether it’s at our outpatient center or for an intensive outpatient program or to the residential program down in South Florida, they are usually at a point where their lives have become kind of difficult as a result of their use. So nobody really ends up going without some real negative problem. I’m not sure if I’m answering your question.

Host: No, I think that makes sense. Also, is it fair to say there’s not a one-size-fits-all, there’s different scenarios usually? What do you see? Is there a common theme of the people you’re working with?

Dr. David Greenfield: Yeah. I think that there is a common theme. I mean, the common theme, of course, is that their productivity at work or at school is being affected. Their relationships with family and friends are being affected. Often their health and self-care are impacted, meaning that they’re not taking such good care of themselves, that their sleep is impacted. So you’ll see a lot of those features. But almost always there’s some real negative impact on their work or school work. And typically the problems that we see are mostly related to very heavy gaming use, heavy social media use, or online pornography. Those are really the three biggest. But we’re starting to see more people that are just– they can’t put their smartphone down, to a point where they really are not getting anything done. And I think that’s a relatively new thing. Smartphones are barely 12, 13 years old, but they’ve been a game-changer in terms of accessibility, and they’re becoming the dominant internet portal for many people.

Host: Right. Wow. Okay, so how do you treat a video game or technology addiction? How do you do this?

Dr. David Greenfield: Well, yeah. So treatment of internet and video game, it’s not that different than treating substance abuse. So one of the things that is absolutely necessary, especially if they’re doing a residential treatment is they have to be detoxed. They have to really leave their ability to access the technology on a regular basis. On a short-term basis, they have to have no screens or very limited screens. If they’re being treated outpatient, we would have our technology expert put blocks and filters and monitors on their systems so they would have a certain dose of internet access per day, and we might block problematic areas of internet. In other words, they might have no video gaming, but they would be able to use their email to let’s say their schoolwork or their job or what have you. And we would give an overall limit to their total daily use or their dose per day of their access. On the residential side at Lifeskills, at the Greenfield Pathway, obviously, they would be detoxed automatically because they wouldn’t have access to any screens. So obviously, they wouldn’t have their smartphone and they would not have access to a computer or a laptop or a tablet. They would have that detox naturally for the one, two, or three months that they’re there, and that would allow us to do the treatment that’s pretty much focused on psychotherapy, group therapy, learning how to manage their stress, outdoor education, getting them more in touch with living a balanced life as opposed to being so focused on getting all their positive reinforcement and all their positive good feelings from screens.

Host: It’s hard to probably move away, especially if you’ve been connected to this technology for so many years. And maybe this is the second generation that’s been going through this. This is all you know. How do you make that transition and still–?

Dr. David Greenfield: Yeah. Well, you’re a good example because, as you said, you’ve pretty much grown up with this technology, and of course, I sort of lived with and without it. So I think that, like any habit or behavior pattern, it can be changed. Our brains are very neuroplastic. We can learn new things at any time in our lives, and you can relearn patterns of behavior. So yes, although you may wake up in the morning and read your news feeds and spend time looking at TikTok and start your day with the four or five, six hours of smartphone use, that pattern can be changed, but it can only be changed if you’re conscious of how much you’re using it. So that biofeedback of getting that information is very important. So we will recommend using their screen time apps or will install our own software so people can find out what they’re doing and how much time they’re spending on it; not unlike writing down what you eat when you’re trying to become more conscious of what you’re putting in your mouth.

Host: Yeah. Man, I’m just taking deep breaths over here, David, because I feel reminded that, before I go to bed, looking at the phone. I wake up, first thing I do, I’m looking at the phone. You know what I mean? It’s–

Dr. David Greenfield: Yeah. Yeah. I do know what you mean because I’m not really any different. One of the things we recommend is not to sleep with the phone in the bedroom and not to keep it [crosstalk]–

Host: Really?

Dr. David Greenfield: Yeah. You don’t need an $800 alarm clock, dude.

Host: That is a great point.

Dr. David Greenfield: I mean, you-

Host: I’ve just thought about sometimes getting a– not a burner phone, but basically just something that if you need me, you could call this one number. You know what I’m talking about?

Dr. David Greenfield: Yeah. Well, the thing is, part of it is if you’re going to change your patterns, you have to educate people that you’re not going to be responsive in five seconds because we’ve developed this belief now that if you don’t respond in 10 seconds, somehow or another, the world’s going to end. But that’s not really true because 10 years ago or more, nobody responded in 10 seconds to anything. Even the email was not responded to that fast. So because of texting and the ability to communicate quickly via smartphones that we all carry has really distorted the idea of how accessible you need to be. The truth is, you do not need to be that accessible. And so you have to kind of reeducate yourself to realize that you could turn off your phone at 10 ‘o clock or leave it in the other room and say, “If there’s an emergency, you can reach me, otherwise I’m offline.” You can actually say that. And for the most part, it’s not going to change your life in a negative way. In fact, I would argue that it would change your life in a positive way.

Host: Man, my confession right here, and I got to make some changes here, just talking with you, it’s already helping in a way. But I’ve/ not [set anything?] out of office since my honeymoon in 2014. I just feel like I have to be accessible and available. And I can’t imagine– I don’t know. It’s just I feel like this problem–

Dr. David Greenfield: But I think that’s an illusion, Clark. I think that’s actually an illusion, that we have to be that accessible. I just don’t think we do.

Host: I’m not a doctor. I’m not doing any life-saving work, so anyway–

Dr. David Greenfield: Well, I am a doctor.

Host: You are a doctor. Yeah.

Dr. David Greenfield: Yeah, but even then, I think there are times that I could set limits and boundaries. I mean, I can have people be on call for me. I mean, you don’t have to be– and you certainly don’t need to wake up in the morning with your phone and go to sleep with your phone. You can leave it in the other room, you could read a book, or read a magazine before you go to bed, which actually is very good in terms of helping you fall asleep. By the way, looking at screens right before you go to bed actually keeps you awake because it elevates cortisol which is a stress hormone. So screens are the absolute worst thing to look at before you go to sleep.

Host: Wow. Well, let me ask you a question. As we’re starting to transition to the work that you’re doing now at Lifeskills, is there maybe a big sign that a child or someone in your life might need treatment? And that might go for an individual looking at themselves too.

Dr. David Greenfield: Yeah. I mean, I think that you kind of know you need treatment or your loved one. And typically, you’ll notice it more about a loved one. And I would say the vast majority of people that I treat, and that we would treat at the center at Lifeskills, would be people who– where their loved ones notice well before they do. In other words, loved ones would notice that their child– and when I say child, it may not be a young child, it most likely would be somebody in their mid to late teens or early 20s, sometimes up to mid-20s or early 30s; they’ll notice that they’re doing very poorly in school. A very typical scenario we’ll see is that they’ll flunk one or two semesters of college, often not telling their parents until the very end. And why do they flunk school? Because they never get off the computer. They never get off the screen. They’re either video gaming or they’re on social media or they’re looking at porn or they’re doing all of those things. Whatever they’re doing, they’re not doing their schoolwork. And so the way you’ll know that there’s a problem is you’ll get two Ds and four Fs on your grades. And that’s often when parents will contact us that they realize that there’s something wrong because they believe their child who was telling them that they were doing really well at school and then come to find out when the grades come in that they flunked everything or near everything. That’s very typical.

So the other thing is when you see your– you’ll see the person isolating themselves, or their relationships with their friends have deteriorated, or family members, that their self-care has deteriorated, in other words, they’re not taking showers, they’re not taking care of themselves, not brushing their teeth, eating poorly. And those are things that you would see with really lots of forms of mental illness or addiction issues. So they’re not all that different. You really have to just– but it’s pretty noticeable. You can’t really get into a difficulty with screens without spending a real lot of time on them. I’m not talking about an hour or two a day, I’m talking about 6, 8, 10, 12, 15, 20 hours a day. And you might say, well, how do you spend 20 hours a day on a screen? Well, you don’t sleep or you sleep very little.

Host: It’s debilitating. And this–

Dr. David Greenfield: Yeah. Should I go on with– should I go on without sleep or very little sleep for an extended period of time and I’ll show you somebody who’s pretty ill.

Host: It’s debilitating. It reminds me of– on the show, we’re talking with a variety of different people at Lifeskills about the types of addictions that they’re treating. So it sounds like what you’re describing, there’s a lot of similarities. And this is why, as I understand now, you’ve recently partnered with Lifeskills on the Greenfield Pathway for Video Game and Technology Addiction. So tell me more about those co-occurring conditions and how– nobody wants to be stuck like this, it slowly happens, right?

Dr. David Greenfield: Yeah, although most of the people that are addicted don’t really know they’re addicted. In fact, a big part of the treatment, especially in the beginning, is helping them develop insight and motivation into the fact that they’re kind of out of control. So very often, they’ll be in some degree of denial about it. And so we have to spend a fair amount of time, in the beginning, doing what’s called motivational enhancement or motivational improvement to try to get them to a point where they can see that their life has become somewhat unmanageable. And that takes some effort in the beginning. So very few people when they come in are like, “Yeah, my life has just hit the rocks and I’ve got to get help.” Some do, but many times they’re in some denial and they are doing it because their family or their loved ones are kind of making them do it or asking them to do it or telling them, “Look, we’re not paying for another semester at school. You better go get some help.”

Host: Right. Okay, so while I’ve got you here, I do want to dig a little bit more into what you’re just talking about on how do you know you should really reach out for treatment versus that just maybe being a mild issue. How do you navigate that?

Dr. David Greenfield: Yeah. So I mean, I think, as I said earlier, you’re not going to look for treatment for your child or a loved one or a family member unless there’s really some real problems in the way they’re doing their lives whether that’s their work or their school or their health or their self-care. And usually, it’s pretty obvious, in other words, it’s not a subtle thing. If your child is still living at home and they’re in their room 14 hours a day playing video games, that’s not that hard to notice. And generally, if you’re playing video games that long, they’re going to be some real imbalances in your life, and you’re going to be somewhat unhealthy because of it. So you’re going to notice that. If they’re at school or they’re living on their own, which is not uncommon either, you’re going to see that they’re not living their lives either, and the way it’s going to come through is by their work performance. They’re going to either get in trouble with their job, and I’ve seen that, and I’ve seen that even with professionals, including doctors and lawyers, who spend so much time on their screens, they get in trouble with their job. They either lose their job or they get put on suspension. Or you’ll see the problem that I mentioned earlier, which is that grades will just be horrendous. They’ll flunk out or near flunk out. And they’re going to end up wasting a lot of time at school without any benefit.

So it’s pretty obvious. The thing that family members and loved ones need to remember is that they’re always going to get some pushback and there’s always going to be some denial. And don’t be discouraged by that. Don’t ask the addict or the potential addict whether they have a problem or not because they probably will say no, because they’re just fine with living their life in an imbalanced way even though the world is sort of caving in around them and they’re not doing so well. They’re not noticing it because they’re filled with dopamine from everything they’re doing on their screens. So their life is good, but not really.

Host: Is it true that if someone does realize that they need help, they’re one of the last people to realize it? Everyone else around them sees it.

Dr. David Greenfield: Yeah, so that’s absolutely true. Because self can’t see self. I don’t know about you, but people will notice things about me far before I notice them. So we’re always the last to know about ourselves. Other people are like, “Oh, when did you figure out that?” And usually, people notice way before we do.

Host: Do you find that when someone is– okay, at that point, maybe that there are parent, maybe it’s an individual, they know they want to get some help, how can someone reach out to you all? I mean, are there any suggestions that you share? I mean, I don’t know, is there shame involved? Is there fear or doubt? How do you–?

Dr. David Greenfield: I mean, often, I would say the vast majority of inquiries we get, and they would call the phone number or email, the website, usually, it’s from a family member or a loved one. It’s not typically the addict. I would say the vast majority of the treatment I do for internet and video game addiction is instituted or initiated by a family member or a loved one. Rarely does the addict reach out themselves. And by the way, that’s not unlike what we see with substance use disorders too, although often, the addict will have to get to a point where their life literally becomes almost non-functional. Often, family members will notice way before that happens. So typically the inquiries come from family members or loved ones. And they would just call, call or email or go on the website. And there are people that either my– if it’s on the outpatient side, it would be my office manager who would handle the call. Or if it’s at the Greenfield Pathway at Lifeskills, we have a team that is dedicated to helping that family member or that person get the information they need to make a decision with regard to treatment, including answering questions about how do you know when it’s appropriate to even seek treatment. Sometimes it may not be appropriate for them to be in residential care. Maybe it can be handled on an outpatient basis. But we’ll match them or evaluate them to get the most appropriate level of care for them.

Host: So just take that first step is what you’re saying, just make that call. I mean, it might seem a little bit scary, but what you’re saying is just make the first call, right?

Dr. David Greenfield: Yeah. And you got to understand that the people that work with us, they’re all compassionate and interested in helping. And that’s really all we’re going to do is we’re just going to help you. And if helping you means just giving you a little information and sending you on your way, and then if things get worse, you call us back, or sometimes we’ll help you get in right away. So it really depends on where things are at. And sometimes they’ll just want to ask questions, and we’ll answer those questions.

Host: David, thank you so much for taking the time. How can someone get connected to your team? And then let’s talk a little about what’s coming up next for you. I understand you have a new book coming out soon.

Dr. David Greenfield: Yeah, I do. I have a new book coming out at the end of August through– I think the publication date is the end of August or early September. It’s called Overcoming Internet Addiction for Dummies. It’s actually a dummies guidebook. It’s about 350 pages. And it’s literally the most comprehensive volume that I’ve ever written. And actually one of the few, I think, that goes into every single issue that you can deal with with online addiction or Internet addiction, including social media and porn and video gaming and issues with children and teens and all the different things. And there’s chapter for parents. There’s chapters for loved ones. It’s all about helping people understand the topic. So if you want to know what the issues are, it would be a good primer for people to look at. And actually, our Greenfield Pathway is listed in that book. And there’s a lot of other information and resources that people can look at if they want to learn more about the topic.

Host: Well, I know you have dedicated your entire career to this, and it’s helping a lot of people. We’re all going through this together.

Dr. David Greenfield: Oh yeah. I want to give you the website for the– so the website for Greenfield Pathway is actually pretty simple. It’s greenfieldpathway.com. That’ll take you right to the website or the section of the website at Lifeskills that deals with internet and video game addiction.

Host: Well, David, I hope we can continue the conversation again in the future. There’s so much to cover, and I know we’re only scratching the surface, but thanks for all the good work you’re doing, and I’m looking forward to our next conversation.

Dr. David Greenfield: Yeah, me too.

Host: Hey, thanks for listening to Conversations at Lifeskills South Florida. Please be sure to follow, rate, and review the show anywhere and everywhere you get your podcasts. If you or someone you love is looking to turn second chances and to new beginnings, start your journey at odysseybehavioralhealth.com.

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