The Therapy Alchemist
Change is not just about the science and research. Mental health isn't just what we characterize as a disorder or not. It's also about the mystical ways in which we change and grow. Science can't study everything about our inner spirit/soul.
On this podcast, a Licensed Professional Counselor in Colorado dives into the spaces that science cannot go. Discussing what ACTUAL growth and change look like. Filling in the gaps that the pop-psychology world misses, completely ignores, or sometimes shames. Plus some tips and tricks along the way to help you achieve your own personal legend.
The Therapy Alchemist
#17: Beyond Psychiatry: Ketamine & Psychedelics with Dr. Craig Heacock
Today we have an enlightening episode as I sit down with my mentor and renowned psychiatrist Dr. Craig Heacock. Dr. Heacock, host of the 'Back from the Abyss' podcast, offers insights from his 20-year career in psychiatry, focusing on the therapeutic use of psychedelics, particularly ketamine-assisted psychotherapy. The discussion explores the profound effects of ketamine in treating severe mental health disorders such as bipolar depression and trauma-induced depression. We also delve into the promising future of psilocybin and its potential benefits for mental health. Dr. Heacock shares personal anecdotes, scientific insights, and discusses the challenges and risks associated with THC concentrates. This episode is a treasure trove for anyone interested in the cutting-edge intersections of psychedelics and mental health therapy.
00:00 Introduction and Special Guest Announcement
01:11 Dr. Craig Heacock's Journey with Ketamine
04:06 Ketamine's Impact on Mental Health
05:33 First Experiences and Learning Curves
08:34 The Healing Power of Ketamine
19:02 Exploring Psilocybin in Psychiatry
22:03 Ketamine vs. Psilocybin: A Comparison
22:27 Personal Experiences with Psychedelics
23:52 Psilocybin's Unique Benefits
25:52 The Love Project and Psychedelics
26:53 Psilocybin in Therapy and Terminal Illness
27:40 The Concept of Ego Dissolution
31:04 THC and Its Potential Harms
33:26 The Rise of High-Potency THC Products
34:13 Psychiatric Implications of THC Use
41:04 Harm Reduction and THC Concentrates
43:58 The Secret to a Good Life
45:01 Outro and Resources
Dr. Heacock's...
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*This is not a substitute for therapy nor is it therapeutic advice. If you would like to find a therapist in your area check out psychologytoday.com, goodtherapy.org, or therapyden.com
Hey guys, welcome back to another episode of the Therapy Alchemist podcast. Today I have a very, very, very, very, very special guest that I am so excited for you guys to listen to. He is my mentor and somebody that I fangirl over because of his podcast, Back from the Abyss, Psychiatry and Stories. I have on today, Dr. Dr. Craig Heacock, and he is a psychiatrist who has worked in the field for over 20 years. And he provides ketamine assisted psychotherapy. So we talk a lot about psychedelics, ketamine, psilocybin, things like that, how they help mental health. And at the end of this episode, there is a special little surprise. So you guys definitely need to listen because there's going to be something that's really going to shock you. All right, let's begin. Um, Transcribed by https: otter. ai Welcome to the Therapy Alchemist podcast. I'm your host, Katrina Austin, a licensed therapist.
katrina_1_05-31-2024_095408:Dr. Hecox, I'm so glad that you're on my podcast today. Thank you for joining me.
squadcaster-f3c8_1_05-31-2024_095408:Yeah. Thank you for inviting me, Katrina.
katrina_1_05-31-2024_095408:So today we're going to talk about psychedelics. Um, so you use ketamine in your practice. And so I want to start with figuring out like what it is that led you to use ketamine and psychedelics in your practice.
squadcaster-f3c8_1_05-31-2024_095408:Okay, well Ketamine is kind of a funny story. Uh, in 2016, I was working at the Holness Center in Fort Collins, which was started by Scott Shannon, a psychiatrist, and Scott's a real. adventurer and sort of, um, he's always looking for the new thing. And I remember this would have been, yeah, 2016. And he came up to me out of the blue and he said, we should start doing ketamine. And I said, what? I mean, I've heard of it. It was just starting to kind of become a thing in psychiatry. I said, well, isn't that seem a little sketchy? We're just going to start. He said, yeah, that's we'll figure it out. So we did maybe a 60 minute zoom call with a ketamine expert in California. And then he said, all right, let's do it. And so we, and I was thinking, I don't know. He said, yeah, we'll figure it out. So we just ordered a bunch of ketamine, got a bunch of syringes, and we just started doing it. And, you know, I, I think of myself as fairly skeptical. In some ways, I think part of the Western medical training is to teach us to be skeptical, like show me the evidence. So I first started using it, um, really only with suicidal patients because I thought, okay, there's some decent evidence that ketamine helps with suicidality. And then I found that most of them had radical improvement within 12, 24 hours. And so then I started thinking, well, maybe we should do this with people who are very depressed. But maybe not necessarily suicidal. And I found that many of them had really amazing responses. And then I thought, well, maybe we should use this with people with mixed state of bipolar and see what that looks like. And then maybe I should try it with people who have severe depression coming out of trauma. And then I just, so I just started expanding the palette and finding that it didn't help everything. But it actually, there were a lot of. Very difficult treat, to treat syndromes that were responding really well to ketamine. So now it's become a staple of my practice, you know, 2017, seven years ago when I started again, just for my suicidal folks. But now, uh, there's, it's one of the primary, I mean, I'm not a ketamine clinic. I do full, um, general psychiatry, psychotherapy and meds and everything. But, but we're using a lot because it is. it's, it's an amazing tool. And I often struggle to remember what it was like to not have ketamine available, you know, cause most of my career it wasn't available. And I think the answer was pre ketamine. I was hospitalizing way more people, people who were on way more meds. And I think a lot of my most ill people were just suffering a lot more. So,
katrina_1_05-31-2024_095408:shift. So what would you say, like, from your past 7 years of doing it, what's the biggest or the most significant mental health disorders that it treats?
squadcaster-f3c8_1_05-31-2024_095408:I would say people with, um, Number one people with any kind of bipolar spectrum depression. So People with bonafide, you know, depressive episode in part of bipolar one or two. And we can talk about the problems with those designations. Um, one way to think about bipolar spectrum depression, I think of it as people with hypersomnia, oversleeping, often seasonal worsening. The kind of people that sort of hibernate in the winter and just want to hide out till spring. Which is a very common kind of depression, and one that's actually fairly hard to treat. Cat does an incredible sweet spot of ketamine. I think people who are developing severe depressive symptoms and suicidality out of trauma, ketamine treats that really well. I think people that have the more traditional, what we call unipolar or major depressive disorder with more insomnia and, I think ketamine is often helpful. I think it's not typically as helpful with the people with hypersomnia. Um, ketamine is very stimulating, very activating. And there's something about that kind of depressive syndrome where people are to get them just all shut down and wanting to sleep 14, 16 hours. Ketamine is like a, it's like, it's like jumping the car on the road, just like wakes them up and pulls them out of it.
katrina_1_05-31-2024_095408:Woah, that's so cool. So what was your first experience like with like your first patient that you did ketamine on, or used ketamine with?
squadcaster-f3c8_1_05-31-2024_095408:Yeah, I was trying to remember that Yeah. Well, this is really funny. So, um, there are very delineated differences between what doctors do and what nurses do. So one of the things that nurses do, nurses give shots. Doctors don't give shots for the most part. So I mean, I gave a couple shots in medical school, but anyway, when we started, you know, Scott and I thought about doing this. I said to Scott, I said, I'm going to have to learn how to give an intramuscular injection. So I watched a couple of YouTube videos and then, uh, my medical assistant, I said, can you just show me how to do a deltoid intramuscular injection here in the upper arm? So she showed me, but Oh my gosh, the first, I don't know, 20 times. It's shaking like, just trying not to let the patient know like how nervous I was to stick this big needle in their deltoid muscle. Um, so, uh, yeah, but I got more and more confident. One of the things that was really cool, the first two years I did all intramuscular. I did it myself and I stayed in the room with the person the whole time. So now in my clinic. I usually do ketamine infusions and I have a medical assistant who's with people when they're deep in it. And then I come sit with them as they're coming out. But in those first couple of years, the hundreds of sessions, I sat there the whole hour, hour, 15 minutes with them as they were deep in it. So that was this kind of a crash course residency in ketamine treatment. I got to see what works, what doesn't, what to do, what not to do. Cause again, Scott and I were literally figuring it out on the fly. And Uh, that was really valuable. And now, uh, one of the things I've tried to do on my podcast back from the abyss is put the word out about all the things I've learned that work and that don't work because there were definitely some major mistakes made. Luckily, nobody got really hurt or died, but you know, ketamine is not without risks. And, uh, when we were getting going those early years, there just weren't many people doing ketamines and we just didn't, we would just try to figure it out on the fly.
katrina_1_05-31-2024_095408:Yeah, I mean, you're pretty much a pioneer of it, of using ketamine in a practice. You know, like one of the first group of people to start using it, it sounds like.
squadcaster-f3c8_1_05-31-2024_095408:Yeah, I think there were a couple other places in Denver in 2017 when Scott and I started, but yeah, there was very few places in Colorado then. Now it's, it's all over, but, and now there's training programs. In fact, there's three, I think, three or four different good training programs on the front range of Colorado back in 2016, nothing.
katrina_1_05-31-2024_095408:Yeah. Wow.
squadcaster-f3c8_1_05-31-2024_095408:Video, video call with an expert.
katrina_1_05-31-2024_095408:Yeah, well, I mean, it's so good that you were brave to try it out because I mean, it sounds like it's impacted your client's lives or your patient's lives so much, you know, and like, what would you say is the, like some of the most surprising or unexpected outcomes of using ketamine?
squadcaster-f3c8_1_05-31-2024_095408:Well, this still surprises me, you know, thousands of sessions later, but I regularly have people who are very suicidal, the kind of people that I think, if this doesn't work, we're going to have to put you in a locked psychiatric unit. And you know, 98 times out of a hundred, within 12 hours, the suicidality is gone.
katrina_1_05-31-2024_095408:Wow,
squadcaster-f3c8_1_05-31-2024_095408:And we see this all the time and it's become sort of commonplace, but it still surprises me. And there's people that come in, I think, okay, really I should be putting you in the hospital, but you know, a couple of hours we have an opening, we can put you in the chair and give you an infusion and see. And again, if given at the right dose in the right context with, you know, ketamine is, It keeps people out of the hospital. I mean, it's, it's really miraculous. Um, I think another thing that's really cool is, and again, I see this all the time, but it's, it's really wild to watch is that ketamine opens up the psyche. It's psycholytic, uh, and that's true at low doses of ketamine or big doses. So a lot of people that are doing ketamine treatment with me are doing it for serious trauma. I mean, specifically for the depression coming out of serious trauma. But after the sessions, they just open up and things just, you know, pour out of them, emotion pours out and memories. And, uh, they, and then for days after that, people are just, um, are very resourced if you will, but also just kind of broken open, but in a way that makes them, um, very, very good therapy candidates, you know, some of the most powerful. Therapy sessions, whether it's EMDR or talk therapy or somatic therapy or IFS can happen in those. It doesn't have to happen right after ketamine. It can happen days after ketamine. There's a window of five or six days, often after a higher dose ketamine treatment where people are again, very opened up, but very resourced and they can handle going deeper into therapy than they normally would.
katrina_1_05-31-2024_095408:When you say resourced, what do you mean?
squadcaster-f3c8_1_05-31-2024_095408:I mean, yeah, it's such a difficult word to explain psychologically. I, when I say resourced, I mean, um, their fight flight dialed down. So like they're in a calmer state where they can manage stuff. I also mean that their resilience is dialed up because I think we all have sort of at our healthy, state. We all have different levels of resilience, but even the most neurotic of us have some resilience. And one of the things that trauma and just psychiatric stuff can do is just wear us down and, and, just drain our, our trauma tank. You know, I'm sorry. I mean, our, our resilience tank. So one of the things I tell people with ketamine treatments, I said, we, if you could imagine like you with like filled up with the resilience and be able to handle stuff like Oftentimes you come to ketamine and your resilience is just, and there's nothing left. And that often inversely correlates with overwhelm, you know, sort of like overwhelm goes up as resilience goes down. And, uh, one of the things people say most frequently after ketamine is that they feel much less overwhelmed. And I think that's part of being resourced, if you will, is that the overwhelm is dialed down, the resilience is dialed up, the fight flight is calmed. And some people are in, it's sort of a, um, In a more present moment, peaceful place where they can do hard things, whether that's, you know, walk the dog and they've not been able to walk the dog, or whether that means to do some exposure and EMDR that they have not been able to handle because it was just too hot.
katrina_1_05-31-2024_095408:What do they say happened for them? Like, if there's like a theme that you've noticed, what happens for them during the ketamine treatment? Like, what is their experience?
squadcaster-f3c8_1_05-31-2024_095408:Yeah. Well, first of all, I think we should differentiate lower dose ketamine and higher psychedelic dose. Okay. So lower dose ketamine, we're usually talking about oral ketamine, trochies or lozenges, maybe 100, 200 milligrams ish. Uh, and that's very different what I'm doing in my office. I'm doing higher dose, what I would call psychedelic, or fully dissociated dose ketamine, IV infusions and intramuscular. What happens in my office with those psychedelic sessions is, as the ketamine starts to take effect, it affects people. Lose awareness of the room and their bodies and their ego and their past and future, and they move into a state of pure awareness, but as this is happening, there's a wild multidimensional journey that can be slow and peaceful and drifting. It could be spinning at a thousand miles an hour. You know, one of the main side effects, if you will, of higher dose ketamine is. is motion sickness because the ketamine experience, the psychedelic ketamine is a wild journey. And for some people can feel like the craziest rollercoaster on the planet times 10.
katrina_1_05-31-2024_095408:uh, Uh,
squadcaster-f3c8_1_05-31-2024_095408:as a floating, drifty, pleasant feeling, but, uh, it can be, it can be tough. And I think this, this, the other two big side effects of psychedelic dose ketamine would be, it can raise your blood pressure, but number three, it can get scary. And so we do a fair amount of prep around dose selection, getting people sort of psychologically ready for the fact that they are going often, not always often, on a pretty wild ride.
katrina_1_05-31-2024_095408:Uh, So,
squadcaster-f3c8_1_05-31-2024_095408:what happens in that wild ride, it's so different, you know, talking, I've done over 3000 sessions now, and I mean, it's so fascinating, the exact same dose, the exact One person says, Oh, I was just in this sort of purple, glowing, floaty river and the stars were twinkling over me and I just felt very held and loved and other people say, Oh, when the ketamine took effect, I plunged to the center of the earth. I splintered apart. I was stretched into infinity. I snapped back into, into like quark level size being and then I was spun on a centrifuge and then I was extruded into a volcano and, um, I mean, and other people, like I saw my dog, my dead dog, you know, it's, yeah, I, I think the only thing that ties it all together, the higher dose ketamine is that it's very powerful. It's very opening. It's, uh, and it's often very physical, you know, that you can feel your body being moved and stretched and squished and that you're, there's a ton of movement, oftentimes really wild movement.
katrina_1_05-31-2024_095408:are they actually moving, like, physically, or is this all mentally? So they're just like, laying still, and a lot is happening.
squadcaster-f3c8_1_05-31-2024_095408:Yeah, they could feel like, like, they are falling to the center of the earth. Again, like they're being stretched out like, like a 10 million light year long rubber band and then snapped back down to subatomic level or spun on a cosmic centrifuge or maybe just floating peacefully in an asteroid belt.
katrina_1_05-31-2024_095408:So how is, how is that healing? Um, Uh, Uh,
squadcaster-f3c8_1_05-31-2024_095408:I think,
katrina_1_05-31-2024_095408:Uh,
squadcaster-f3c8_1_05-31-2024_095408:think we have to be really
katrina_1_05-31-2024_095408:Uh,
squadcaster-f3c8_1_05-31-2024_095408:careful and humble about how we talk about healing because how is lithium healing? Well, you know, we can say lithium works on ion channels and it promotes new brain cell growth and stabilizes mood, blah, blah, blah. But at the core level, like how is lithium healing? That's very complicated. How is psychotherapy healing? Oh, it reestablishes trust and, and, um, kind of reworks transferential stuff from childhood. But when you ask people, how is your therapy, psychotherapy healing, people have a lot of trouble putting words to it. So then we get in the realm of, of psychedelics, including ketamine. How does ketamine heal? Again, we could say, well, It improves deep sleep, which is true, or it sensitizes endorphin receptors, which is true. It, it causes new brain cell growth and BDNF production's true. So we can talk about neurochemically, or we can say it allows deep material from unconscious to come to the surface, which we can work on, which seems true. It allows people to face things they haven't faced before. It fills up your resilience bucket. It dials down your overwhelm, but you see, we sort of, we either talk in metaphor. Are we talking psychological terms? Are we talking these neurochemical terms? But really, it's pretty mysterious. Like, like most everything in psychiatry, mental health, which is one of the reasons I love it. I think it's one of the reasons a lot of med students don't want to do psychiatry because they feel like this is so mysterious and black box. But I think people drawn to mental health and psychiatry and psychology love the mystery of it. So again, we can list all sorts of ways that ketamine quote unquote works, but I think it works in those ways and in ways that we just don't have words for, and I think it works in different ways for different people. You know, there's this kind of saying in Ketamine therapy that ketamine sort of takes you where you need to go. I mean, you hear that in a lot of psychedelic work. I think there's a lot of truth to that. Again, if you, if it's dosed properly. And preparation is good. And if the context is safe, I think that's true. I think it can also take people to horrible, scary places or to awful bouts of motion sickness again, especially if you're not adequately prepared.
katrina_1_05-31-2024_095408:Sure.
squadcaster-f3c8_1_05-31-2024_095408:But, uh, yeah, having some humility. And when we talk about how ketamine quote, unquote works or how psilocybin works, or even how psychotherapy works, that's complicated.
katrina_1_05-31-2024_095408:It is. And that's why I named my podcast The Therapy Alchemist, because I love that it's like, that's one of the main things I've learned about talk therapy is the change happens just magically. Like I could say the same thing to multiple clients and like one of them take something away from it and the other person doesn't, you know? So like, it's just interesting how the mind works. So I'm with you on that. Like, I love the art behind working with people because it's just never. consistently the same, but you get to watch people just like change and mold and grow. And so it's kind of cool that like you have this other thing that you can incorporate in there to kind of like fast track that, which is amazing. So speaking of psilocybin, because psilocybin is one of the things that I'm like a huge fan of getting to know more about. Um, and I've had several clients who have used, um, psilocybin recreationally. Um, but what are your thoughts on psilocybin?
squadcaster-f3c8_1_05-31-2024_095408:psilocybin, all things psilocybin or psilocybin psychiatrically, yeah. yeah, we'll say psychiatrically. I think psilocybin is going to have a really cool place in mental health treatment and psychiatry. I think we're still trying to figure out what that is. I think preliminary research and anecdotal evidence suggests that, that, that, that. That psilocybin is going to have a real place in treating trauma. That it has some really interesting utility in treating the OCD syndromes, including body dysmorphia and all things OCD. That it has a really interesting place in working with different kinds of existential despair, uh, including death anxiety and, um, disconnection and, um, The despair that goes with that. How, How, much is psilocybin gonna play a role in, you know, treating the endogenous mood disorders like bipolar disorder? That, that's not, not clear yet. So I, I'm really excited, you know, the decriminalization and now emerging medicalization of Colorado or psilocybin in Colorado is thrilling.
katrina_1_05-31-2024_095408:Mm
squadcaster-f3c8_1_05-31-2024_095408:And I do think the safe, the overall safety of psilocybin is, um. is encouraging. MDMA is hopefully coming online federally within the next few months. We're looking at FDA approval, hopefully within the next four to six months. You know, MDMA has a lot more potential downsides, medication interactions, cautions, warnings. Again, not that things can't go badly with psilocybin, but I do think in general it's pretty safe. And I think it's, it's not likely when used medically to make people worse.
katrina_1_05-31-2024_095408:Mm hmm. Mm hmm. Mm hmm. Mm
squadcaster-f3c8_1_05-31-2024_095408:Because that's a big deal, you know, some of the powerful psychedelics can make people way worse. Again, not to diminish that that couldn't happen with psilocybin, but it, you know, it's essentially non toxic. Can it trigger psychosis? Yeah, but mostly when combined with THC. I think you and I are going to talk about THC a little later. Uh, uh, And you know, one could argue that the legalization of of THC has brought on one of the most powerful psychoactive drugs and psych psychiatrically destabilizing drugs that, that we've yet seen.
katrina_1_05-31-2024_095408:Mm
squadcaster-f3c8_1_05-31-2024_095408:Um, but anyway, back to psilocybin. I'm super excited about it. A lot of my patients are asking about it. Uh, my take on psilocybin though is in general, if you have a significant psychiatric history. Psychedelic wise, I think it's better to start with ketamine. I think ketamine is better overall for quote unquote depression and depressive syndromes. I think there's more evidence. I think for sure ketamine has way fewer medication interactions. Ketamine's been used extensively now, millions of times, not just in psychiatry, but it's been used for 50 years extensively in anesthesia. So I think of ketamine as a better starter material. and and then possibly, you know, psilocybin later.
katrina_1_05-31-2024_095408:hmm. Wow. Um, yeah, it's a, I find them both fascinating. I mean, I, how I grew up was, you know, down in the Bible belt. And so like any kind of drug use was just so frowned upon. And then I get out here and I realized that there are so many healing properties to what humans used to do back in the past. You know, all of these like, you know, different psychedelics that, medicine men would use to treat people, you know, and it's, it's really amazing. And I think, especially with psilocybin, what you said about it being this, like, safer option, that has been huge for me because, you know, my fear is that somebody will get worse with doing any kind of psychedelic, you know, that's, that's obviously a big fear. But, you You know, I, people that I have talked to who have used psilocybin and gone on trips, even if they have a bad trip, there's still some sort of a powerful outcome. Like I had a roommate once who said that he had the, like this, he did a psilocybin trip his first time out in the woods, you know, and then halfway through the person he was with panicked. So then he went into a panic and like the next like four hours or whatever was just horrible. But he said that, you know, he was suicidal before using psilocybin. And even though his trip was bad, he was never suicidal again. And this was multiple years later that I talked to him. And I'm like, that is so crazy that you can even have a bad trip and still take away something beautiful out of it, you know? And, and even just like the microdosing of psilocybin, I just find wildly fascinating because it just kind of, you know, opens up your mind to see things as they are. That's kind of the best way I know how to describe it. It's like, Seeing the obvious, you know, like, really random. I know it sounds really weird, unless you've experienced it, but it's like, you know, people can tell you all day long, like, well, you know, if this negative thought is just causing you emotional pain, and you're like, yeah, yeah, yeah, I get it, but you don't get it, and, you know, I feel like psilocybin can kind of help in those ways of just, like, opening your mind to be like, Oh, I get it. I can, I can choose my thoughts and it just like, it takes away the muck of, I don't know, whatever it is that's like clogging the pores to healing. I don't know how else to explain it, but I just, I find it so fascinating and, and I love this, this, I don't want to say safety around it, but like the lack of, um, potential harm, I guess, around it.
squadcaster-f3c8_1_05-31-2024_095408:Right. I mean, you take an, if you took enough ketamine, you could die. I mean, people have died from, you take enough MDMA, you could die. You know, if you take too many mushrooms, I think you could throw up. Um, you could have a scary trip, but you're not going to die. So that, that's, I mean, again, there's other harms besides toxicity and death. But, you know, psilocybin mushrooms are not ever fatal.
katrina_1_05-31-2024_095408:Yeah.
squadcaster-f3c8_1_05-31-2024_095408:And by themselves, again, I guess you could run out into traffic or something. But, uh, but you know, that's pretty rare, like pretty, you know, ibuprofen at four times the therapeutic dose can be fatal. You know, Tylenol at four times a therapeutic dose can be fatal. Eight, maybe eight times the therapeutic dose, but, um, and then two, there's this whole other realm, which isn't really psychiatric. It's more of psychological, but the idea of reconnecting people to, um, To nature, to the biosphere, to the world, to others that I think psilocybin can do,
katrina_1_05-31-2024_095408:Mm-Hmm?
squadcaster-f3c8_1_05-31-2024_095408:uh, most powerfully. I had an episode of my podcast this year called Love and Therapy, where I talked to Adele LaFrance, who's a psychologist in Denver. She does something called the Love Project. It's a really fascinating study. Where she's looking at, um, experiences of love on psychedelics and she said the early results of her study showed that the note of all the kinds, the deepest experience of love that people described on psychedelics, the number one focus of that love was towards all other beings. And of all the different psychedelics that people reported using in her study, um, the, the number one that brought on. These incredibly powerful feelings of love, love towards all of the other beings was psilocybin and I thought she was going to say MDMA being, you know, the love drug or, but she said, no, that over the overwhelming winner, if you will, was psilocybin as the substance and overwhelming winner of the recipient of love was all other beings,
katrina_1_05-31-2024_095408:Wow. Yes.
squadcaster-f3c8_1_05-31-2024_095408:how, how amazing is
katrina_1_05-31-2024_095408:So amazing. It makes me wonder because I know that, um, I've heard of, I think it's underground therapists who are doing this. I don't know if this is legal anywhere in the world, where for couples therapy, they're using MDMA and it's like kind of transforming things. I wonder what would happen if they used psilocybin with couples therapy, if that is, you know, like bringing about all of this love and this openness and like, you know, because what I've heard people say about, um, psilocybin is, you know, You know, you, you feel one with the universe, which, you know, makes me wonder if that's not why it's so helpful if you're like in a terminal illness, right? Because they've done those studies on people in terminal illness. Like, it takes away your fear of death because you're like, well, we're all one, you know, and everything should be, just be as it is. And like, there's so much love, you know, so
squadcaster-f3c8_1_05-31-2024_095408:And also I think there's something about psilocybin that, that we feel very small and insignificant, but in a way that's sort of an existential relief. We realize, okay, there is all this life in this planet and all these species and we're, and it's all churning and life and death and time. And we are so insignificant and it's like, ah,
katrina_1_05-31-2024_095408:yeah,
squadcaster-f3c8_1_05-31-2024_095408:What a relief because you know, we can all feel so incredibly self important in the, in the, movie of our lives, but there's something about psilocybin is that kind of ego dissolution and sense of oneness. I think that's like, yeah, I am, not only am I deeply connected to everything, but I am very small and that's good and that's actually okay. And when I, and when I pass and get churned back into dust to dust, that's okay.
katrina_1_05-31-2024_095408:mm
squadcaster-f3c8_1_05-31-2024_095408:That's because that's the natural order of things.
katrina_1_05-31-2024_095408:yeah,
squadcaster-f3c8_1_05-31-2024_095408:again, it's almost like, uh, psilocybin can be like this humility inducer in a good way. It's like, you know what? It's not all about you, Craig, or all about you, Katrina. Like you guys are just a little, little, little piece of something way bigger. And isn't that cool?
katrina_1_05-31-2024_095408:mm
squadcaster-f3c8_1_05-31-2024_095408:And isn't that's so
katrina_1_05-31-2024_095408:Yeah. Yeah, and I think it kind of gives up the freedom to go with the flow of life. You know, I think about Taoism, um, because I've been reading a little bit about Taoism this past year because I read, like, the Tao of Pu. Anyways, it's a great book, but, um, and, you know, it's all about just, like, the, I think it's called wu wei, like, just going with the natural flow of life, you know, and how, um, Everything, like, is as it should be. And just go with the flow of life, you know? And it sounds like psilocybin kind of does that in itself, where it's like it's just, you're just a part of this thing, and that's okay, and it's fine if you got that email. Like, it's not this bigger thing, you know, that we, like, all stress about and, like, have all these, like, mental health responses to, or mental responses to, you know? I mean, it's just it's just It seems very freeing and I think that's really cool because often, like, as a therapist, like a talk therapist, I see people get stuck at a certain point, you know, and it's like, man, if only we could just like expand your mind because you're only seeing You know, I, I explained it to one client once where I felt like he was trapped in like this spiderweb, you know, and he just, he desperately wanted to get out of his depression. And, and I'm like, I know you can see that there's something on the other side, but there's a spiderweb of thoughts, of negativity, of past history and experiences, and who knows, you know, biologically what's going on that like keep you trapped. And it's like, psychedelics kind of just like burst a little opening going on that like, Perception that you have of the world. So, I just, I'm so excited about where this is going. And, it's, surprising to me that I feel that way because, like, I hardly drink alcohol. Like, I just, I don't do drugs, you know, like, I just don't, that's just not my thing. But, like, learning about this, I'm like, oh, whoa, now this is on a different playing field. This is not what I thought was happening in the 70s, you know, field. So,
squadcaster-f3c8_1_05-31-2024_095408:I love that.
katrina_1_05-31-2024_095408:so, um, I don't remember if I heard it on
squadcaster-f3c8_1_05-31-2024_095408:Yeah, let's do that.
katrina_1_05-31-2024_095408:on your podcast first or if we had talked about it one of our during like one of our mentor sessions but um learning about THC's like the harm that can come from THC shook me. I had no idea. I kind of just believed what everyone said you know because it's It's been legalized, so there's like a lot of marketing around it, just being like, Oh, THC is great if you have cancer and you know, all this stuff like smokes and pot, but learning from you that that's not always the case was really surprising. So you can, you kind of tell the listeners like what you have discovered or like what the research is showing.
squadcaster-f3c8_1_05-31-2024_095408:Yeah. Maybe we should first talk about sort of the terminology. So whether we're, you know, THC, weed, cannabis, marijuana, you know. Um, I think very specifically, I think what we want to talk about the next few minutes is weed. I'm sorry. It's TH is THC because, because, um, because the pro, you know, I grew up in the seventies and eighties with, um, very low THC weed, if you will. You know, the, the weed of the eighties was like three, 4%, 5%. Eighties was like three 4%. What that meant was there was in the plant. And, you know, back in the 70s and 80s and even 90s, you know, psychotic breaks, manic breaks with, with cannabis, with weed were very rare, very rare. Um, I mean, in my psychiatric training residency, 2001 to 2005, I don't remember a single case of cannabis induced psychosis. There might have been, I just can't remember that. Um, and in fact, we learned in my psychiatric residency training that if, when someone has a psychotic break, like you see that classic case of a young man with psychotic break, that you hope and pray that it's a substance induced psychosis, because that means when they stop the substance, the, um, the psychosis will go away. That was true until about 10, 12 years ago. So again, until about 10, 12 years ago, I just didn't really see much psychosis or mania that seems like it was being triggered by weed. But then, uh, Cannabis was legalized in Colorado. And what happened with that was very interesting. I don't think anybody guessed this, but there was really, I would call it like an arms race, if you will. To create the most powerful. Cannabis slash THC products that they could. And what happened was, with selective breeding, the cannabis strains got stronger, stronger, stronger. 24, 26, 28, 35 percent by weight THC. And then, also there became a whole market for THC extracts, pure THC, vape pens, concentrates. And more and more people, not only did they start using higher and higher concentration flour, but they started using THC concentrates. Then. This triggered what has been a total game change, or sea change in psychiatry in Colorado, is that now, in the last 10 years, Uh, again, I'm going to say THC induced psychosis or mania, because that's what it is. It's not, Marijuana slash cannabis, that's not necessarily the problem. I mean, some of those super strains are, but, but the people that are really getting into trouble are the people who are using the pure THC products and, you know, where they can end up using hundreds of milligrams a day. And it's triggering not only psychotic and manic episodes, but it's triggering chronic, psychotic illnesses that don't resolve. Again, in my residency, we learned that if someone has a substance induced psychosis, that's hopeful because they stop the substance, it will go away. Now I'm seeing in Colorado, someone has a substance induced psychosis, which again, it's usually now THC, often THC concentrates. It doesn't go away. In fact, what it is more often than not is it's the kind of the final straw that, uh, That seems to trigger an underlying bipolar or schizoaffective disorder or schizophrenia. And so now when I have, again, often young men in my office with their first or second psychotic break, and they're using a lot of THC products, often the THC concentrates. I'm kind of settling into this reality that what we're seeing now is that the THC has uncovered schizophrenia or some other devastating illness. And that, and now yet, I'm trying to convince my, again, often young patients, you cannot use any more THC because it will make your illness so hard to treat and it will make, um, It will make it much more likely that you decompensate into psychosis and mania. But the, you know, the problem is here we have not only medicalized THC slash, uh, cannabis in Colorado, but, you know, the dispensaries have green crosses and the dispensaries are called like green med and green cure and natural cure. And you can get a medical card in Colorado to, uh, So you can get cheaper THC products to treat your various illnesses, including psychiatric illnesses. So it's, it's like we are going against this whole industry in Colorado that is promoting THC slash weed as a medicine, as a therapeutic thing. And again, I, I know that there are people who are, whose medical conditions are helped by THC and cannabis. I'm not disputing that, but what I'm saying is in psychiatry, the people we see with some of the most severe scary life threatening, um, life wrecking conditions. THC is arguably the worst possible thing they could be doing. And so, you know, I spend a lot of my clinical time and energy trying to convince my people not to use any THC products, much less the, the concentrates. Yes.
katrina_1_05-31-2024_095408:that when you bring it up?
squadcaster-f3c8_1_05-31-2024_095408:Yeah. Well, I think there's two things. So one is that the, the culture, cultural acceptance of, of, uh, weed slash THC and that it's, you know, it's really advertised and promoted not just as a safe recreational thing, but as a medicinal thing.
katrina_1_05-31-2024_095408:Mm hmm.
squadcaster-f3c8_1_05-31-2024_095408:Um, you know, I've talked about in my podcast, if I were the health czar of Colorado, I would get rid of medical marijuana. I would just have recreational because I really think we should think about weed like alcohol. It's not evil or necessarily bad for everyone, but there are people who should not drink and there are definitely people who should not use THC, THC slash cannabis. Um, Um, you know, how, so yeah, so I'm trying to convince, so I'm working against that kind of social construct that, that weed is medical. But then, um, the other thing is, you know, most people, and what does that mean? 90 percent of people or more can use even the THC concentrates and not, um, develop a psychotic or manic episode. But, you know, there's some percentage of people, is it, you know, 4%, 6 percent ish, who are actually at very significant risk of developing. not only a psychotic episode, but a kind of breaking loose a chronic psychotic illness. And so I think a lot of my patients are looking at all their friends who are using huge amounts of THC concentrates and or flour and like, well, look at them. They're fine. Like they're, they're not going psychotic. And so I have to spend a lot of energy trying to say, you know, our brains are all different and they're actually, uh, we've identified at least a couple of genes that seem to predispose people to not just, um, psychosis and mania from THC, but developing bipolar disorder, schizophrenia. So there seems to be about three and a half percent of the population, at least, that has a genetic susceptibility to chronic psychosis. And those also seem to be the people who are at high risk of decompensating, including, you know, chronically with THC. So,
katrina_1_05-31-2024_095408:So,
squadcaster-f3c8_1_05-31-2024_095408:again, so these, my patients are looking around like, wait, the cultures is saying weed is medicinal. My friends are all smoking it. Nobody else is flipping out. So I think you're wrong, Hecock. I think it's not the weed. But then after, you know, sometimes we'll have two, three, four psychotic breaks. And then in hospitalizations, then hopefully I convince people, okay, can we try this with no THC? Can we just treat you? Can you lay off this? And what people usually find is they are much more stable and healthy and functioning if they have one of those diagnoses, if they leave THC behind. Yeah,
katrina_1_05-31-2024_095408:Because for me, as soon as I learned that, I mean, well, I've only tried to, you know, weed like twice and I had a panic attack one of the times, so I was like, never again. But it definitely put me off of it because I'm like, how do I know if this would trigger it for me? You know, so is there, is there anything that they can look into like their family history or medical
squadcaster-f3c8_1_05-31-2024_095408:that's right there. Yeah, I think genetic testing is coming soon that will clarify this further. But basically, no, what use family history is huge. And there's some really interesting studies on that. If there are people in your family who have had bona fide bipolar disorder, who have had psychotic or manic episodes with from drugs, and who have, um, had other psychotic illnesses, your risk of having genetic susceptibility to THC and THC induced psychosis and mania is probably significantly higher. You know, if you don't have a family history of psychosis or mania or substance induced psychosis or mania, you probably are okay. But again, in the interest of harm reduction, When I'm talking to people about weed, I'm constantly talking to people about THC and weed. I'm always urging people, like, look, if you're going to smoke weed, smoke weed, smoke flour. Don't use THC concentrates, because I really think THC concentrates are kind of the alcohol equivalent of Everclear. know, one of the things, like, we hopefully teach in our kids and young people, like, if you're going to drink, don't drink Everclear, don't guzzle vodka, don't guzzle tequila. You know, drink wine or beer or be careful because hard liquor can lead to really big problems. You know, can flour, including the high potency flour, can that lead to psychiatric problems? Yes, but I would argue not nearly as frequently as people who are using the THC concentrates. So a lot of what I do with people is saying, um, look, we don't exactly know how much THC might be worsening or causing your psychiatric situation if you're not willing to quit. Could you at least think harm reduction wise and lay off the THC concentrates? Um, but it's interesting. I've realized now, you know, I've asked everybody for years. Do you smoke weed? But now I've realized like, especially my young people. I mean, I could ask that question, but now I ask specifically, do you use THC concentrates? Because a lot of my people were saying, Oh no, I don't smoke weed. But they vape THC from their vape pen, you know, hundreds of milligrams a day.
katrina_1_05-31-2024_095408:Yeah.
squadcaster-f3c8_1_05-31-2024_095408:And that's, again, way more dangerous. So it's just the way we ask about substance use, I think, has really had to change in Colorado because, uh, the way so many young people are using, uh, THC is not what we would expect.
katrina_1_05-31-2024_095408:Yeah. Wow. That's so helpful for me too, as a therapist, you know, to figure out like what, what it is that my clients are using and things like that, you know, cause sometimes I see, you know, like hallucinations or things starting to pop up and I'm like, Ooh, how much of this is substance use and whatever. And, you know, um, I don't ever ask about THC concentrate, so now I know to ask that, so thank you for that one, because I will definitely ask, uh, because, you know, they'll just be like, yeah, I don't do anything, I'm fine, you know, and I'm like, actually, um, okay, so,
squadcaster-f3c8_1_05-31-2024_095408:Katrina, when people talk, uh, About vaping because a lot of my young people like I vape, you know I think the follow up question which I've learned needs to be do you mean nicotine or do you mean THC? Because a lot of times now used to vaping used to mean nicotine, but more and more vaping means THC means a THC pen and Again, though with those THC pens, you can sometimes get hundreds of milligrams in your system a day, which Is, uh, potentially destabilizing for a lot of people. But again, if you have any kind of genetic susceptibility to serious psychiatric illness, I mean, you're playing with fire.
katrina_1_05-31-2024_095408:Mhm. Yeah. Wow. Very helpful. So as we're nearing the end, I have one final question for you. Um, I am a huge fan of Carl Rogers and I love his book on becoming a person. And one of the things that he talks about there is the secret to a good life. So what do you think is the secret to a good life?
squadcaster-f3c8_1_05-31-2024_095408:think the secret to a good life is connection. And, and I mean, in all senses of that word, of that word, I mean, connection to nature and to your pets and to your loved ones and your friends, and. You know, they often talk about in 12 step programs that the opposite of addiction is connection. I just love that because, you know, people show up, uh, I mean, addiction just disconnects you from everything, including yourself. And when people get healthy and recovery, they get reconnected, reconnected to themselves and their families and their loved ones and their friends and their community. So I think the key to, to a good life is connection.
katrina_1_05-31-2024_095408:Perfect. I love that. Awesome. Well, um, how can people learn more about you? So can you kind of talk a little bit about like your website, your podcast, um, anything else that you might have going on?
squadcaster-f3c8_1_05-31-2024_095408:Sure, I'd love to. I have a psychiatric storytelling podcast called Back from the Abyss, and that's on all the podcast platforms. We just finished year five, published the, yeah, the uh, final episode of season five just published today. And, um, my website's craighecockmd. com so people can learn more about me there, and also access Back from the Abyss. And, yeah, I hope people check out the podcast. It's, uh, it's a little bit like This American Life meets, uh, Psychiatry. Or The Moth meets Psychiatry. Because while there is a lot of information about psychiatry on there, there's also a lot of beautiful, moving stories.
katrina_1_05-31-2024_095408:I love the stories that you have on there. I, that's how I met you is through your podcast and it's been amazing. I love, I love it. So you guys should definitely check it out. All right, well, thank you so much. Yeah. For having me or for having me. Thank you so much for being on here. It was awesome. So.
squadcaster-f3c8_1_05-31-2024_095408:loved it. Thank you.
Thank you guys so much for joining me on today's episode. Don't forget to hit that subscribe button so you don't miss out on more interviews like this and more episodes where I talk about a whole bunch of stuff related to mental health and the healing journey. As a reminder, I am a therapist, but I am not your therapist. Therefore, this is not therapeutic advice. So if you would like guidance on that, check out the links below. See you guys next time.
