Episode 29

Innovations in Addiction Treatment

May 28th, 2022

Announcer: Welcome to Addiction and the Family, “Episode 29: Innovations in Addiction Treatment.”

Casey Arrillaga: How has addiction affected your family?

Female Speaker: It robbed me of my father.

Female Speaker: Addiction's affected my family in absolutely every way.

Male Speaker: It has caused a lot of turmoil.

Female Speaker: It goes back to what I understand is at least three generations.

Female Speaker: It robbed my daughter of her mother. It robbed my mother of her daughter.

Female Speaker: Addiction has made our family quite challenging.

Male Speaker: Addiction has affected my family tremendously.

Male Speaker: It's affected my relationship with my sister where I wouldn't – I'd go for months without talking to her. It's a very difficult thing for everybody involved. It doesn't just affect the one individual. It's a disease that affects the whole family.

Male Speaker: Addiction is spread not only genetically through some of my relatives and I assume ancestors.

Female Speaker: It's generational.

Female Speaker: I think of him every day.

Casey Arrillaga: Welcome to Addiction and the Family, a podcast by and for family members of anyone with an addiction. My name is Casey Arrillaga, and I'm a clinical social worker and addiction counselor at both Windmill Wellness Ranch and InMindOut Emotional Wellness Centers. I'm the author or Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions.

Kira Arrillaga: I’m Kira Arrillaga, addiction counselor intern and recovery coach at Windmill. Casey and I were in our addictions together for over ten years and have now been in recovery together for almost twice that long.

Casey Arrillaga: I’ve led hundreds of family workshops, but just as important is that Kira and I have lived the experience of being family to addiction as both children and adults.

Kira Arrillaga: Join us as we offer experience, strength, and realistic hope about how you and your family can find recovery together.

In this episode, we have two interviews with leaders working on the cutting edge of addiction treatment. Psychologist Dr. Heather Ingram, owner and CEO of InMindOut Emotional Wellness Center, talks about how she and her team use neurofeedback and biofeedback to help people retrain their brains. Then Shannon Malish, LCSW-S, owner and CEO of both Windmill Wellness Ranch and Brain Frequency, explains how she and her team have innovated new techniques in the use of magnetic stimulation to help people’s brains to function more optimally. Both discuss some of the science behind what they do and how their approaches are improving addiction treatment outcomes. All this after a break to hear from one of our sponsors.

[Commercial]

Welcome back. Anyone who has worked in the addiction treatment field, is trying to recover from addiction themselves, or has a loved one who struggles with addiction has heard about one magic bullet cure or another, some breakthrough that will change everything. Most of these end in disappointment because addiction is a complex condition that is not easy to beat. Nonetheless, researchers and clinicians are working tirelessly to help those seeking recovery get any edge they can.

Today, we’ll hear from two such people who are using related techniques to assist people in working directly on their brain function in ways that can help them with many issues including addiction. Both have worked in addiction treatment and both talk about how their work can help someone recover, in some cases making the vital difference to help them achieve long-term sobriety.

Notably the techniques they describe are not meant as a cure for addiction but instead can help people stay engaged in recovery. This is very important because the biggest thing that trips up so many people is that they stopped doing their daily recovery activities and then fall prey to relapse. By improving brain function, both Dr. Ingram and Ms. Malish help such people stay on course and live happier, healthier lives. To learn more, let’s start with our interview with Dr. Heather Ingram.

Casey Arrillaga: Dr. Heather Ingram, welcome back to the show. It’s great to have you.

Dr. Heather Ingram: Thank you. I’m glad to be here.

Casey Arrillaga: What do you see is some of the most exciting new approaches for treating addiction today?

Dr. Heather Ingram: Hands down neurofeedback and biofeedback I would say are the most exciting for me personally and for the clients that I have seen use the approaches.

Casey Arrillaga: What’s exciting about those?

Dr. Heather Ingram: I guess it would make sense for me to share a little bit about what they are. What neurofeedback is it’s the ability for us to make the brain activity perceptible to the sense by means of taking EEG recording of the brain waves to start. How we do that is we put sensors on the scalp and that gives us an EEG recording. What we can do with the neurofeedback is compare that in real time to a normative database and we train to normative ranges. When we do that, we are basically going to the gym for our brain. We’re strengthening the neural networks that previously may have been underperforming or overperforming and we teach the brain how to behave differently.

After about 20 to 30 sessions, what we’re doing is solidifying the neural networks that we are creating or teaching how to behave differently. When we do that, people change because we are a system, everything is connected. The brain is the hub of who we are. When we are able to move the brain activity into optimal ranges, people get better in a whole host of different ways, including with addiction issues.

For instance, I have a client who has been doing neurofeedback now for 25 sessions and is reporting to me pretty consistently that not only has she noticed a change and other people around her are asking her what new drug she’s on, she’s noticing it as well and she’s in a different place cognitively and emotionally than she once was. That’s observable to other people. What’s not observable are the things that she’s reporting related to her addiction, like reduced cravings, feeling like she has better control over her urges when they arise to use, whether that’s in terms of her love addiction or whether that’s in terms of her thinking about using marihuana. What she reports is it’s just easier to let those thoughts come and go than it used to be. That’s what we hope for and that’s why I’m so excited about that.

There’s also biofeedback, which is gaining control over our physiological responses in order to produce cognitive and emotional change. For instance, oftentimes in therapy we teach these techniques for people, like learning how to breathe or something like that, which directly ties into our emotional health. For instance, if we’re having a panic attack, we can gain control over that through use of gaining control of our physiological response, same thing if we are doing something called urge surfing where a client may be struggling with an urge to use alcohol or drugs and what we oftentimes talk to clients about is learning how to ride that urge, how it doesn’t stay forever. It’s like waves in the ocean that comes and goes. Teaching people how to gain control over their physiology directly ties to our psychological state and can help us ride those urges.

In biofeedback, we show people what’s going on with their physiology, what’s going on with their breathing or their temperature or their heart rate and teach them how to look at their physiology and gain control over it to the point where eventually they no longer need the machine to help them do that and they can take those tools with them. Those are things that really excite me.

Casey Arrillaga: What do you think is the further promise of this approach?

Dr. Heather Ingram: I think there’s a view of addiction issues, for instance, as something that will maybe never go away in our brain. I think the brain is more malleable than we give it credit. I think there’s ways that we can teach it to strengthen, maybe not so that everything disappears but so that we have a different level of control over ourselves, our thinking, our emotions in ways that were previously not considered possible even with the use of medication, for instance.

Casey Arrillaga: What do you consider most important for families to know about all this?

Dr. Heather Ingram: I think what’s most vital for families to know is that this exists. I have had so many conversations with parents and clients who after a change are crying in my office telling me, “Why didn’t anybody tell me this existed? Why didn’t I know about this 20 years ago? Why did my doctors tell me that this was permanent when I’m seeing change that they told me was impossible?” That is important to me. That’s why I continue to spread the message because of the people in my office who tell me that. One of the reasons why I’ve done this work is to help people and to do what is effective and to seek out what can assist people to be their best and that is the power of neurofeedback and biofeedback in a similar way that therapy is powerful and AA and Al Anon is powerful. It has weight. We’re just at the beginning. It’s exciting.

Casey Arrillaga: Yeah, I can’t help but notice even when you’re talking about it seeing the emotion come up.

Dr. Heather Ingram: It’s beautiful. It’s hard not to be emotional when you have a parent in your office crying and telling me that they never thought what they’re seeing was possible for their child. That is very emotional. I’m human and it makes me overjoyed and it gives me motivation to continue talking about it and sharing it with clients and other people so that they know it’s out there. There’s hope.

Casey Arrillaga: Dr. Ingram, thank you so much for sharing your insights and your experience and your enthusiasm for this breakthrough and such an important technique.

Kira Arrillaga: If you want more information about Dr. Ingram’s work, visit www.inmindout.com. We’re going to take a quick break to hear from one of our sponsors and then we’ll be back with our interview with Shannon Malish.

[Commercial]

Welcome back. Here’s Casey’s interview with Shannon Malish.

Casey Arrillaga: Welcome to Addiction and the Family. Would you like to introduce yourself?

Shannon Malish: Thank you, Casey. I am Shannon Malish. I’m the CEO of Brain Frequency and Windmill Wellness Ranch.

Casey Arrillaga: Wonderful, well, we’ve been working together for a few years. It’s such a pleasure to finally get you on the show.

Shannon Malish: Thank you, Casey.

Casey Arrillaga: We’re here talking today about innovative techniques that are being used, cutting edge stuff in dealing with addiction. There have been so many promised new here’s the amazing things that are going to revolutionize the field, but we know that new things do happen that start to make a difference that offer things that maybe weren’t available before. You’ve been working for a few years now on something that fits that bill really well. Can you talk a little bit about just overview what that is?

Shannon Malish: Sure, I first began being interested in the brain when I saw that we would have so many people that would come in and they would learn all of the tools and we would tell them what to do and yet they would still call me and say they were depressed or had anxiety or had relapsed. I’ve always been very interested in the brain. I began studying TMS with some of the best that there is out in Germany. They have a research facility there.

Casey Arrillaga: Should you take a moment and tell people what TMS is?

Shannon Malish: Transcranial Magnetic Stimulation, that’s been around for a couple of decades. That is treating one area of the brain that – psychiatry came together and said a lot of depression resides in this area of the brain. That’s true but that’s not where all the depression is. TMS works for about 20% of the population and that’s measured by a drop in psychometric scores such as the depression scale, and if they have dropped that score by 60%, they call that success. That’s with people being on antidepressants or off antidepressants. I also began to be interested in EMDR many years ago and saw that during that type of therapy you could actually neuromodulate memory.

Casey Arrillaga: Take a second for our audience members to know what is EMDR.

Shannon Malish: Okay, EMDR is Eye Movement Desensitization Reprocessing. What that does is work with the amygdala and hippocampus in your brain and we’re essentially as a therapist moving memories from one area to the logical side of the brain. That helps a lot of people with a lot of trauma or PTSD. When I saw that and then learned about TMS and then I had used an Alpha-Stim which is a device that came out about 20 years ago for anxiety reduction that you clip on your earlobes and delivers a little bit of a pulse, I saw that there could be some major changes in dealing with the brain. In doing that, I began looking at the brain differently. I started to look at the EEG, and if somebody is in a rested state but awake, what does the brain look like? We found many commonalities around especially addiction. Those that were chronic relapsers fundamentally didn’t have movement in the areas of the brain that govern judgement and impulse control.

Casey Arrillaga: An EEG for our listeners, what’s that?

Shannon Malish: What that is it’s a cap that you put on your head, and a technician does this. I have a 1020 cap which means it’s going to measure 19 areas of your brain along with your heart rate and we’re going to see what kind of electrical activity do we have in those 19 areas of the brain. That’s essentially what an EEG is. It gives you a summary of that data. We put the cap on for about five minutes and then it gives me a summary of that data on how it’s working in those 19 areas. When we look at those 19 areas, oftentimes, not all the time, but oftentimes, we can tell if they’re struggling with certain things, whether that’s short-term memory, impulse control, depression, have poor sleep, many different issues. We began using magnetic stimulation to essentially balance those areas of the brain for people that didn’t have the uniformity of neuromodulation in those areas of the brain.

Casey Arrillaga: I’ve gotten a chance to see you in action with some of this stuff so we can pull a client up who’s at the treatment center and look at a picture of what’s going on in their brain. It’s not like we’re looking at a literal image of a brain but we’re looking at a graph that will show the different areas of the brain and say, hey, this one’s really low, this one seems to be doing pretty well, this one’s doing okay but needs improvement. What makes Brain Frequency different than standard TMS to address that?

Shannon Malish: Okay, so standard TMS will only neuromodulate or bring energy to one area of the brain that is called the dorsal lateral prefrontal cortex. It’s a little area on the side of your brain. The way they decide how much energy they’re going to apply there is by taking a magnet over your motor cortex which is on the top of your head and they’re going to stimulate you and basically turn that machine up to see when your thumb moves. Once your thumb moves, then they know they made an action potentially. The math behind it is like this. If your thumb moves here at 100 hertz, we’re going to go ahead and make that 120 times that amount and apply it in the area where most of your emotions reside, the dorsal lateral prefrontal cortex.

Casey Arrillaga: Okay, so most TMS is doing that is zap it really hard with a magnet.

Shannon Malish: Yeah, really hard, it is, from what I’ve heard, painful, feels like a jackhammer. It’s loud and it’s one area of the brain. It does help some people. It really does.

Casey Arrillaga: Where is that different than Brain Frequency?

Shannon Malish: TMS does not do an EEG. They’re not looking at what areas are not balanced or what’s going on with that particular brain. They don’t do that at all. We have a roadmap so we can see what’s not functioning well. Then we apply the magnet to the areas that are not functioning well instead of just one area of the brain.

Casey Arrillaga: Okay, so it’s much more personalized.

Shannon Malish: Oh, very personalized, yes.

Casey Arrillaga: That does make a lot more sense.

Shannon Malish: It does. It does.

Casey Arrillaga: Let’s look and see – so those were some of the science and technical stuff going on behind it. What are you trying to accomplish with this? What is the point of making a map of the brain and hitting it with magnetism?

Shannon Malish: A lot of it is where I saw a lot of medications were falling short was there was a lot of side effects. It was difficult to watch. Then when I would ask somebody why they had relapsed, it’s usually one of four answers, but one of them being I stopped taking my medication or my medication wasn’t working any longer. I thought there’s got to be a better way to do this. When you wrap around trauma therapy, recovery therapy, we’re taking people’s bloodwork and make sure there’s nothing medical, the one place we are missing was the brain.

Casey Arrillaga: Seems kind of funny because the brain is the source of our problem with addiction.

Shannon Malish: Yeah, so if we can get that right, what would it look like? My initial statement is a little bold and grandiose. It is to help the globe heal from the toxins, trauma, and life, honestly. I mean, it’s a bold mission statement but I’d like to see this therapy everywhere. Try that first instead of putting other chemicals in your body. I’m not saying medications don’t do a good job and that – they help a lot of people, but I also know they cause a lot of side effects for people that they wish they didn’t have. It’s a more natural way so to say because your brain already runs off of your own electricity. A lot of people don’t know that you take glucose in your body, which can be strawberry sundae and it can be a potato, and that makes your brain run off of electricity. What we’re able to do in the EEG is capture what electricity do you have in your brain and how is it operating and how many times do you sample the environment per second. We’re able to apply that same energy in the areas that are not functioning correctly.

Casey Arrillaga: What I hear is it’s like seeing a personal trainer at the gym when somebody does this [00:22:26] says here are the muscles that are strong, here are the muscles that are weak. We’re going to put together and personalize your training or in this case a personalized treatment program for your brain just like you might for somebody’s body to say here’s what we want to tone up. Here’s what’s doing well already. Let’s go ahead and get you there as opposed to here’s the one workout that everybody does no matter what.

Shannon Malish: Exactly, and I alluded to this many times and I think to myself, oh, gosh, my phone needs another update, my computer needs another update, but yet nobody is really looking at their brain. It’s our biggest asset. It’s what’s taking us through life. I was listening to this guru the other day. He’s talking about the soil and how we’re not putting the nutrients back in the soil that’s feeding our bodies. An orange back in 1930 had a lot of nutrients in it. Today you need to eat eight of those oranges to get the same nutrients. It’s affecting our brains as a result, even the food we take in and the toxins that we take in from outside down to our deodorants, we are changing our brain chemicals. We have a solution in order to try to balance those back to give you a much better quality of life.

Casey Arrillaga: What kinds of effects have you seen so far?

Shannon Malish: I have seen amazing things happen. We do administer psychometric assessments. What those are is those are valid tools that a lot of researchers put together to measure certain things like anxiety, depression, ADHD, sleep, we’ve got 19 different ones depending upon the chief complaint. What I’ve been able to see is those drop at such a rapid level after 10, 20, 30, 40 treatments. Some people need 20 treatments. Some people need 30. Some people need 40, but what I’ve been able to see and hear the most is people tell me, “This is a thing that really helped my anxiety go away or I haven’t felt this good since I was a kid or I feel normal.” I hear that a lot. There’s no way for me to measure normal but it helps people in so many different ways.

I had a guy that had neuropathy in both of his feet from Vietnam. All of a sudden, he could feel his feet again. Now, that was not our objective. That was a secondary gain. He was here for anxiety, depression, and a substance use disorder, but the one thing that I’ve been able to see clearly is Windmill Wellness measured by a third party has the highest recovery rates in the nation and that is part in due to the incredible clinical model that we have at Windmill Wellness Ranch with the combination of Brain Frequency. What I’ve been measuring is what is the difference between people that get Brian Frequency and people that don’t get Brain Frequency. There’s quite a spread there. On average, it can be anywhere from 15% up to 20% depending upon what [00:25:31] we get in here. It’s a large amount.

Casey Arrillaga: You mentioned the psychometrics so in that case you’re looking at different well-known assessments to say what someone’s level of depression, level of anxiety, PTSD effects, quality of life, how much do they tune out [00:25:47] versus being present and we can really see those numbers change over time as they’re doing the treatments.

Shannon Malish: Right, so the first time you come in, you get an EEG and you take those assessments. Then you have ten treatments. We do the EEG again and then we take the same assessments. We’re able to see the progress as somebody goes through treatment and they can see that progress because there hasn’t been an objective tool that I know of where you can really combine with the subjective tool that we can see change over time. It’s been a good measurement tool for us in the clinical field to watch.

Casey Arrillaga: I know someone who might listen to this and say, okay, this sounds all really cool on sort of future is now kind of thing. You put on some cap. They’re going to use a magnet. They’re going to measure my brain, all this kind of stuff. We’ve talked about the technical stuff behind it, but what kind of research or science is there to back up what you’re doing?

Shannon Malish: I have four years’ worth of data. I’ve measured year over year and it shows the same drop in psychometrics percentage wise within a few percent each time. When you compare that to, let’s say, somebody that got CBT, which is a type of counseling, and they’re taking scores over time, as compared to Brain Frequency there is a much larger substantial drop in symptomology for whatever that chief complaint is. I’ve measured it against different types of therapies. I’ve measured it against TMS itself. One of the big differences is with TMS we have a larger drop in depression but it’s also durable, meaning that people so far we haven’t had to see them come back for ongoing treatment. TMS requires refreshers.

There’s a lot I don’t know. I don’t know when somebody starts to experience menopause, will the chemicals and the balance of the brain change? It might. I’ve treated some younger adults and younger kids in their teens. Will their brain change significantly enough? Once their brain is done being formed, for men it’s 26, females about 24, what do hormones and the brain change going to do? Will they require more treatment or not? There’s a lot I don’t know. What we do know is that this therapy works substantially as per the psychometrics and [00:28:28] report for a lot of people. We do start clinical trials actually next Monday. We’re taking on the biggest and hardest and baddest one, substance use. We didn’t start lightweight. We didn’t start with let’s measure the anxiety. No, we went for the biggest and the hardest. We’ll see what effect this has on substance use disorder.

Casey Arrillaga: That’s a pretty big deal. Thank you for that work. Somebody out there is listening as a family member or maybe somebody who is in or seeking recovery themselves. Where would they go to find out more and where would they go if they wanted to try this treatment themselves?

Shannon Malish: Thank goodness we’re on the other side of COVID because we had to stop treating so many out patients that, not that we’re going to be able to treat a whole lot during our clinical trials, but if they’d like to check us out and we can see if we can work with them, go to brainfrequency.ai or they can call 830-730-50100.

Casey Arrillaga: Wonderful, Shannon, thank you so much for the work you’re doing and thanks for taking the time to talk to us.

Shannon Malish: Thank you, Casey.

Kira Arrillaga: There we have it, two interviews with two innovators who are breaking new ground in addiction recovery.

Casey Arrillaga: Thanks for being with us through another episode of Addiction and the Family. As they say in many recovery meetings, take what you liked and leave the rest. Go out and explore the possibilities for recovery in your life and give your loved ones the space and dignity to make their own choices. If you liked this podcast, please subscribe. It means a lot to us. If you know anyone else who could use what we have to offer, please tell them about Addiction and the Family. If you have comments about this podcast, have a question you’d like answered on the show, or want to contribute your voice, or just want to say hi, you can write to us at addictionandthefamily@gmail.com. We’re also happy to be your friend on Facebook and we can be found tweeting on Twitter.