If you could talk to a clinician-in-training about how they can better help people suffering from addiction, what would you say? A Q&A between Arjune Rama, MD, and comic Marc Maron.
While listening to Marc Maron’s WTF podcast in my office as I checked my clinic schedule for the day, I couldn’t help but smile when he announced that August 9th marked his 14th anniversary of being clean from alcohol and cocaine. However, I found myself completely distracted from my work when he reenacted an internal dialogue from his addicted past-two Mark Marons struggling to accept each other-a splitting of self that I am sure many of my alcohol-dependent patients have also experienced:
Who would want to accept meI certainly don’t. F--- me! F--- that! I’m going to f---in’ drink to that.Hell yeah! Now I can accept me because now I’m cool, I’m loose. Look at me making people cry and hurting myself!
–Mark Maron, August 12, 2013 (podcast link)
As a psychiatry resident physician, I treat addiction almost daily. However, my understanding of dependence will always be limited by the fact that I haven’t suffered from addiction first-hand. So I thought, “Who better to help me understand recovery than the brutally honest, 14-years-sober Marc Maron?” While talking to him for an hour from my office in New Haven, Connecticut, I felt like I was on a WTF podcast-except the roles were reversed.
Arjune Rama (AR): The intro to one of your recent podcasts got me thinking that you could help me get a better understanding about alcoholism. What was involved in your recovery? Meds? Therapy?
Marc Maron (MM): Let’s see . . . I was once diagnosed as dysthymic. I’ve been in and out of therapy at different points in my life. I went to rehab once when I was younger. Also, I was on Prozac briefly and then I was on Wellbutrin for a while. I could probably still use an anti-anxiety drug (laughs). Like I said on the show, I’ve also been in Alcoholics Anonymous.
AR: How did AA figure into you getting sober?
MM: For practical tools to deal with the addicted brain, the stuff I learned in Alcoholics Anonymous and the community of AA just totally worked for me. If you would have told me back then that I wouldn’t desire a drink or that I wouldn’t desire to do drugs at some point in my life, I don’t think I would have believed you. I still have my vices-I drink a lot of coffee and I’m hopelessly addicted to nicotine in the form of lozenges but those aren’t destroying my life or my health like other things would have.
AR: Yeah it’s not like you’re going to wrap your car around a tree because of some lozenges.
AR: I think a big problem for psychiatrists when it comes to understanding addiction is that many of us have no experience with it on a personal level. So there’s a built-in disconnect between the treater and the patient.
MM: Well, yeah, because you guys are just taught to medicate and suggest things. (Pauses) Have you even read The Big Book1?
AR: No . . .
MM: Why not?!
AR: I know, I should . . . I treat people who swear by it and I haven’t even looked at it.
MM: Yeah see that’s the thing with all you guys. Most therapists have never read that f---ing book. But you send people to AA meetings, don’t you?
AR: Yeah, I do.
MM: But you have no understanding of what the program is! I can’t understand why its not assigned to you guys.
AR: That’s a really good point. Looking at my shelf right now I see The Neuroscientific Basis and Practical Applications of Psychopharmacology, but when it comes to books that become part of what people in recovery use, I don’t have to read them. I could read them on my own, but they’re not part of the curriculum.
MM: I think a lot of you guys see it as some sort of goofy spiritual system. But there’s a certain brilliance to it. The program uses very simple language so it works for people who are geniuses or for people who are morons. And it works everywhere -there are programs going on in rooms all over the world and the feeling in all of them is the same. The emotional hunger, the need, the selfishness-its all the f---ing same! Everybody in those rooms has been to hell and back twice. They’ve f---ed up so much that now they’re these demons in exile.
AR: It sounds like you haven’t really found a lot of value in the conventional mental health care system. How would you describe your relationship with it?
MM: Oh not entirely . . . I’m in therapy now and it’s helping a lot. Even with therapy and AA, it took me 26 years to get 14 years in a row sober. I was in and out, in and out.
AR: You’ve said that there’s something therapeutic for you about simply doing your podcast. Why do you think that is?
MM: I’m just trying to connect with someone for an hour. People used to do that. It’s about community and interaction and helping people. People are designed to help other people. But we live in a culture where people are consumed by their own bulls--t and they don’t think they have time to help other people.
AR: A lot of people have said your podcast has helped them out-alcoholics included. What do you think about that?
MM: Yeah, you know, alcoholics-sorry, I’m getting choked up now-don’t know how to ask for help. They’re stubborn and rebellious so it takes a lot for them to ask for help. I can’t tell you how many times I’ve been in an AA meeting and I’ve been moved to tears just hearing stories where they ask for help.
AR: What was it like getting sober? What has it been like staying sober?
MM: You know, life is life. And life certainly doesn’t get any easier when you get sober. Look, alcoholics are hypersensitive, selfish people who are prone to self-pity and resentment, so very minor things can send them spiraling into chaotic anger and despair. For a year I went to meetings 2 or 3 times a day . . . which I could do because I’m a comic so I had a lot of free time. I can’t tell you how many times in my first year of sobriety that I’d talk in the meeting and say, “This is f---ed, I f---ing hate this, I’m out of my mind, you guys are idiots, this whole f---ing thing is stupid.” And after the meeting someone would come up to me and say, “You sound great!” (laughs). Because that’s what they were doing when they started.
As far as staying sober, I don’t drink or do coke, but I’ve still got problems. I have f---ing horrendous anger problems, issues with panic, and I am filled with dread a lot of the time.
AR: Working in a university setting, I’ve heard literary scholars say things like, “It was the opening of his mind via substances that helped him make his best work.” What do you think about that perspective when it comes to artists who are substance-dependent?
MM: What people forget, English professors included, is that those artists were probably geniuses-so to give that much credence to a substance is romanticizing and unfair. Would we not have that art if it wasn’t for drugs? I don’t know. But I guarantee you that at that moment in time, most of them weren’t thinking that way. They weren’t thinking, “I’m a genius. If I take this medicine or if I get strung out on this s-t, that’s when I’m doing to do my best work.” These were people who were sick and they couldn’t help themselves. Whatever the relationship was between their mental health and their addiction, you can speculate all you want, but it’s not a system built to generate brilliant things.
AR: If you could talk to a clinician-in-training about how they can better help people suffering from addiction, what would you say?
MM: [long pause] I would tell them to think about addiction the same way I tell alcoholics: “You’re going to die from this. Nobody survives this. One way or the other, it’s going to kill you. It may take a while, or it may happen in one night for a million different reasons-a bad mix of drugs, drunk driving, catching a bullet because you’re scoring drugs in a s---ty place, whatever. There’s a million ways its can kill you-but it will kill you. Even if you’re 65-sure, you’ve made it that far, but then your liver goes bad. I know guys who haven’t shot dope in 20 years but now they’ve got Hep C. You’re dealing with a chronic condition. And it’s going to kill you.” That’s what I would tell them.
Interview has been condensed and edited.
Editor’s Note: This piece originally appeared in the Slate Culture Blog, "Browbeat," on September 2nd, 2013 (reposted with permission).
Dr Rama is a psychiatry resident at Yale University School of Medicine. He lives in New Haven, Connecticut, with his wife and daughter. Follow him on Twitter: @arjunerama.
1. Alcoholics Anonymous. Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered From Alcoholism. New York: Alcoholics Anonymous World Services; 1955.