The Way We Live Now Podcast with Dr. Randall Dwenger



Dani Shapiro: I’m Dani Shapiro and this is The Way We Live Now. Today is day 70 – 70! – since face masks became ubiquitous and now seem to be turning into a fashion statement, and day 26 of this podcast. I’ve been thinking a lot about the jokes that a lot of us are making about numbing ourselves during these terrible times. You know, Zooming with friends over “quarantinis” or tweeting about “wine ‘o clock.” But for people who are struggling with addiction or in recovery, it’s no laughing matter.

My guest today is Dr. Randall Dwenger. Randy, thanks so much for joining me to talk about the way we live now.

Dr. Randall Dwenger: I’m glad to be here. Thank you for having me.

Dani: Let me begin by asking: where are you right now? Where are you sitting, what are you looking at, what does life look like?

Dr. Randall Dwenger: Well, I’m in a beautiful place right now. I’m in God’s country in the northwest corner of Connecticut, and I’m literally sitting in my private office right now looking out on Highway 44. We call it a highway here, but it’s a road (laughs). But it’s a beautiful day and I’ve been telecommuting mostly, doing telephone and video sessions with patients in my private practice today.

Dani: So you’re a psychiatrist who specializes in addiction and recovery and you’re the Chief Medical Officer of Mountainside, which is a nationally acclaimed alcohol and drug rehabilitation center. It actually has a café connected to it, doesn’t it?

Dr. Dwenger: It does, absolutely.

Dani: I love that café! I’ve driven by it many times and the first time I pulled in, it was just a revelation. It’s a very special place that’s run by people who are in recovery in the rehabilitation center.

Dr. Dwenger: Yeah, it’s so nice that you mention the café because it’s a wonderful part of our kind of work therapy program that we do for people who have finished our rehabilitation and have continued in what we call Extended Care. Being in recovery is so difficult. Your addiction has consumed so much of your life that getting back to those basics of getting up on time and putting on your uniform and showing up to work on time is a real therapeutic thing for these young people.

And during this COVID epidemic, the café is doing delivery to the community and curbside pickup. It’s been a disruption in their lives as well and it’s been a big challenge for everybody in recovery. But those young people are very dear to me. Thanks for bringing them up. It’s a great café.

Dani: Yeah, I’m thinking about that too and the times I’ve stopped in there, and there has been a quality – just in the young people waiting on the tables, or behind the cash register, or making the coffee – of gratitude and cheerfulness. I can imagine in the early days of becoming more independent in recovery – you use the word “disruption” and it seems like disruption is the order of the day for many of us – I wanted to ask you: what have these months since the pandemic hit been like in your community? What are you noticing that people are experiencing?

Dr. Dwenger: If you think about recovery, what we ask people to do, what they ask us to help them do, is to give up their drug of choice – whether that’s alcohol or heroin or Xanax or cocaine, and what do we replace it with, right? So this is the thing that made them feel good, released the dopamine receptors in their brain, and they felt better than they’d ever felt in their lives, and now we take that away. They ask us to help them be without that. And so, what do we replace it with? We replace it with a connection, a connection with other people.

So I think this socialized isolation and self-quarantine is just counter to everything we’ve given them in their recovery. That’s the exact wrong thing to do in your recovery, right – to stay inside and watch videos or whatever comes up. So it’s been a huge challenge, both in the recovery community and in the treatment community. How can we now reach these people who are now sitting in their apartments, told that they can’t go out, or if they go out, they have to wear a mask, they have to wear gloves. Isolation is the wrong thing for people in recovery to be experiencing or to be exposed to. So this has been a real challenge, both in terms of providing virtual help, whether that’s through therapy or self-help groups or online meditation groups where sober people can get together. We actually are doing a sober Jeopardy group, which has actually been pretty popular.

But also for those of us who are running a detox and rehab program, making a program that’s safe for people to come, and that’s been a real challenge, too. Making sure that we screen things and the testing and the barriers in place so that people can come in and do the work they’re meant to do rather than feeling like, “Okay, I’m goining to get exposed to this virus because there’s strangers coming in every day.”

Dani: Right. I mean this is really precisely addressing why I wanted to speak with you, because I’m so aware that people are struggling. Days blur one into the next and folks are more isolated than usual without the mechanisms that usually keep us busy and distracted and afloat. And at the same time, in terms of the recovery community, there are these subliminal – and not even so subliminal – messages that are everywhere on social media, in advertisements, people making jokes about “quarantinis” and “Zoom cocktail dates” or “wine ‘o clock,” and businesses booming in liquor stores, which are deemed “essential businesses.”

Dr. Dwenger: Right!

Dani: So for those who are vulnerable to addiction, it just seems like it’s a perfect storm. I think it’s difficult even for people who are not identifying as addicts. And of course, in-person meetings – whether it’s 12 Step meetings or therapy or group therapy – have had to be put on hold. So, what are the challenges of not being able to physically gather? Like do you find that when you’re doing therapy or running group therapy, that it can be effective to be managing it on screens?

Dr. Dwenger: Yeah, well, I have to say that’s been one of the pleasant surprises of this for me because I’m a little bit older (laughs). I had not been doing any Skype or Zoom calls in my practice, and I’ve found it is a really good way to connect with people, particularly one-on-one. I think the groups are a little more challenging, but I have a very talented group of clinicians who are good. We actually have more facilitators in an online group so they can help manage the questions and those sorts of things. But I actually find a really good connection in the one-on-one therapy and psychiatric sessions that we have.

But it isn’t the same. As a doctor, you like to have that patient in front of you, to examine the patient and have that connection. When I go into Mountainside, we’re doing everything according to the CDC recommendations, so we’re wearing masks, and I find how much I miss people’s mouths (laughs). I miss seeing them smile and that way of connecting with people. At least I’m looking at their mouths when I’m doing virtual meetings, so I think that’s been pretty positive.

Dani: You know, that’s so interesting. One of my best friends is a therapist and she was saying that if when she is able to go back to being safely in a room with her patients, if masks are a requirement of that, that she would rather continue to Zoom with them so that she can see their faces. There’s something that’s very disorienting about not being able to really see one another. For all of us, I think, not just for mental health professionals and patients. I was actually looking at illustrations of masks that doctors wore in the 14th century. I don’t know if you’ve ever seen them, but they’re really extraordinary!

Dr. Dwenger: No! (laughs)

Dani: They had huge beaks like birds and the beaks were to maintain social distance. They wouldn’t have had that language for it, but I’m just imagining from the patient’s point of view seeing these beaks coming at you (laughs). It’s just surreal. Anyway, but I digress. For listeners out there who are struggling or who are worried about substance abuse who aren’t in treatment, but in this time of so much social isolation, who are just struggling or consuming more than they would want to be of whatever substance, what advice would you have to offer?

Dr. Dwenger: I think that’s such a great point because it’s not just someone who has already identified that they are an alcoholic and they are in recovery. I think that this is such a high-risk and slippery slope time for people. We know that after 9/11, there was a huge increase in the number of people that developed alcohol problems nine months after 9/11 because this is the way that they were coping.

And I think particularly that when you see all this time in front of you, you see yourself drinking earlier in the day, cocktail hour moves earlier, and the bottle of wine that used to last three and four nights – now you’re opening up a second bottle the second night. So I think it is a time to self-reflect and look at your drinking. If you tell yourself “I should probably cut down,” you should probably cut down. If people get annoyed with you because of your drinking or you start feeling guilty because of how much you’re drinking, or if you find yourself drinking in the morning trying to treat withdrawal symptoms – I mean this is someone who’s getting themselves in trouble with alcohol and probably should be looking at getting some support and getting treatment, because withdrawal from alcohol can actually be deadly. So you want to make sure you have the proper support before you get that far.

Dani: Right, so you’re really talking about reaching out and asking for help I think.

Dr. Dwenger: Absolutely. And there is a lot of help out there, not just from Mountainside but online support, like your primary care doctors. People are not seeing their primary care doctors because they’re involved in other things and a lot of those appointments are also being done virtually. So I definitely think to reach out for some support but also use the time to do some self-reflection.

Dani: What’s bringing you hope or solace during this time that can also feel so hopeless or difficult, globally, for everyone?

Dr. Dwenger: Sure, so you kind of mentioned it when you were talking about the café. I work with an incredible group of people, not just my coworkers – the nurses and clinicians and the housekeepers and the people in food services are so dedicated to what they do in helping people with addiction – but also the clients themselves that I work with. When you mentioned that sense of gratitude…I have this great job because people actually do express gratitude for the things you do for them and how their lives might change.

So I think my hope comes in very individual ways. That if I can help one person that day, then I’ve had a good day. I realize that I’m not going to change the entire global epidemic of opioid addiction, which by the way, the opioid epidemic has not gone away during this whole pandemic. Just that sense of – you know, this kid said to me earlier today, “I’m so content with my life, it’s ridiculous.” And it’s like, what a great feeling. And this is someone who had opioid addiction and has really been helped by our program and by the skills he has learned.

Dani: That must be an amazing feeling!

Dr. Dwenger: It is. It’s worthwhile.

Dani: My last question to you is: have you reflected at all about how you hope we might learn from this time? You know, this time when we are – like it or not – really being forced into a place of slowing down and of self-reflection, of kind of meeting ourselves wherever we are because there’s no tentpoles or plans or distractions. Do you have any thoughts about that?

Dr. Dwenger: Well, yeah. A couple of things: I think the first thing that came to mind was we really need to listen to our scientists. We really need to follow the guidance of science and use common sense for this. I think that’s going to prevail because I think we’re going to be in this for a long time. But one of the things I also thought about is: one of the places I do takeout in New Marlborough, Massachusetts, the host added a packet of cookies to our last order with a handwritten note that said, “Be safe. Be kind.” And I think that’s what I want us to get out of this. This sense of kindness for each other, and I think that’s what’s going to get us through.

Dani: That is a beautiful note to end on. I’m so thankful to you for making the time to talk to me about such important issues. I think this will resonate with lots of listeners, so Randy, thanks for everything you do and for taking the time.

Dr. Dwenger: And thank you for what you’re doing, Dani. I think this is a great project, so good luck to you all.

Dani: Thanks! Take care.