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Episode 41: Unfortunate Coping: Neurodivergence, Addiction, and Recovery

Feb 15, 2024
Divergent Conversations Podcast

Show Notes

When you are struggling with sensory overwhelm, social anxiety, feelings of not fitting in, and the many other common struggles that neurodivergent individuals experience, there can be a lot of appeal to turn to coping mechanisms that can temporarily reduce those feelings. However, these momentary escapes can lead to dependency, addiction, and ultimately the loss of connection.

In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, dive into the complex topic of the connection between neurodivergence and addiction and “unfortunate coping.”

Top 3 reasons to listen to the entire episode:

  1. Gain insight into the stigma and societal reactions associated with struggling to control legal substances like alcohol and gambling, and explore strategies for coping with emotional avoidance and regulating emotions.
  2. Understand the journey of overcoming addiction through Patrick and Dr. Neff’s personal stories, as well as learn about the importance of therapy, connection, and vulnerability, and challenge the clean recovery narratives, that often don’t work well for neurodivergent people, to acknowledge the complexity of recovery.
  3. Explore the concept of harm reduction, the importance of community and connection, and the shift from focusing on not doing something to adding something in life as part of addiction recovery.

As you consider the complexities of addiction, we encourage you to reflect on the need for new language and approaches to support those struggling with addiction. Remember to practice empathy and compassion, and consider how you can contribute to building a community that fosters connection and supports individuals on their journey to recovery.

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PATRICK CASALE: Hey, everyone. We are recording. And we're probably going to do this a bit differently today because Megan's not feeling great. But we want to record and she is here. But I asked if I could just keep my video on. So, we'll see how this goes.

We are going to start this episode off with a negative review that we got from Apple Reviews on our Apple Podcast because it's so poignant and specific about me. And we just got done with our three-part RSD series. So, it's perfect timing. And we are about to record on substance use and addiction. So, it feels even more perfect timing.

I'm going to read it and then we're going to talk about it, and yeah. So, the review is a four-star review, but it is labelled Patrick, thumbs down. It says, "Anna is good. Patrick is highly annoying with his F-bombs and latent rage. He is not endearing or relatable at all. If you do not boot him off the show, could you at least ask him to quit with the cussing. It is unnecessary." So-


PATRICK CASALE: And I screenshot that to you and sent it to you yesterday.

MEGAN NEFF: Yeah, brutal.

PATRICK CASALE: Yeah. I think, like, my initial reaction's, "Damn." Like, so specific to me, which is always like where it hits you the worst. I think everyone is going to experience negative reviews when you have a platform. Like, it's just inevitable. You don't exist in an echo chamber. But man, talk about stuff getting stirred up and triggered when stuff like that happens.

MEGAN NEFF: Yeah, what got stirred up in you? It was interesting when you first texted me. You were like, "No, it's funny." And I was like, "Wow, like, I would not be having that reaction. I'm so glad Patrick is." But I also wondered, "Will it stay there? Or is that going to sink in and tear some stuff up?"

PATRICK CASALE: Yeah, I think I tried to, like, minimize it at first because I was like, "Oh, like that hurts." Obviously, when you have an audience, and you have a following, I don't want to always have people that are just like, "This is amazing, this is great." Like, but you would like for it to be like, potentially, constructive or, "Hey, I love the podcast." Or-

MEGAN NEFF: No just potentially. Like-


MEGAN NEFF: …I think it's fair to say you'd like it to be constructive, like a calling verse calling out kind of thing, right? Of like, "Hey, this is how this impacted." Right? Like, I think it's fair to say you would like it to be constructive.

PATRICK CASALE: That's fair. I think I started to pick it apart, too. I was like, one, latent rage, I think that definition of latency probably needs to be explored. Two, I don't think I ever feel rage-filled. I think maybe sometimes I'm rage-filled at certain situations in the world, certain, you know, situations I experience. But I try to keep that kind of contained and within the container of friendship, and colleagues, and safe spaces. So, that came up.

Then what came up was like, "If you don't kick him off the show…" And then I started picking apart like not endearing, not relatable. And I think so often as humans we try so hard to ignore the negativity. But it seems like we're wired to be more focused on it.

Because you and I get so many DMs, emails, messages talking about how great this podcast has been for them or someone they love, how transformative, how powerful, how relatable, how affirming, so we could create that, like, stockpile, that list of resources to anchor into. When that happens, none of that stuff feels like it matters.

MEGAN NEFF: Yeah. There's some study of like, it takes, I think, in relationships, like, eight positive comments to make up for like one negative. I'm not sure if that's the exact number, but it's something like that. And then if you throw RSD, oh, gosh, it's probably like a thousand positive to make up for one negative. Yeah-


MEGAN NEFF: It's just those just stick, the negative stick.

PATRICK CASALE: They do, they do. Especially, when it's so specific to your person that's like, okay [CROSSTALK 00:06:08]-

MEGAN NEFF: …I'm really sorry.

PATRICK CASALE: You know, I'm glad we're talking about it. And you know, I posted it on my personal page just for feedback. And, of course, the feedback was overwhelmingly positive. But I didn't just want people to be like, "Oh, you're great." I wanted people to be like, "Hey, this is what I actually think about the podcast."

And I would say that the 500 people who commented were like, "We love the podcast, we love your dynamic, we love that you're so different from each other, and we love how you show up authentically, and how affirming this has been for me, my family, my friends, my colleagues, etc."

That's what I want to focus on, you know, because, ultimately, in the past, something like that could have really destroyed me. And I'm glad to just be talking about it with you.

MEGAN NEFF: Yeah, yeah, I mean, I think, like, if it had been inversed, and well, first of all, please don't send it to me.


MEGAN NEFF: But if it had been inversed, like I would be, it's interesting, well, and I can relate to this because I've had similar stuff on my Instagram, right?

Like, it would be a combination of shame, but then turned like anger, I think, which, you know, it's always interesting, like, how [INDISCERNIBLE 00:07:23] inversed my projected shame. And I would not want to be here today. And so this is one of the big reasons that I turned off my comments was because the 1% that are just nasty comments stick and the 99% of thank you's don't.

I started getting angry toward a community I love. And it was impacting how I showed up. So, I think if it had been me that got that comment I'd be showing up being like, "Ugh, our listeners." It's like we know listeners are amazing, but like that 1% could so easily have filtered how I see, "our listeners."

And yeah, that's why I turned off comments was I was like, I need to save my relationship to this community to do this work. I can be better toward the community I love. And because yeah, it's just really hard to show vulnerably and then get those kinds of comments.

PATRICK CASALE: Yeah, sure. I think that's spot on. So, I think that it's a good thing that it happened. I think it feels synchronistic with so much of what we're doing and talking about. And I'm happy to, like, process that. And I'm glad to have support because I tend to look at like analytics, but it's where my mind goes, and I'm like, "How many people are listening to this talk."

And, you know, we just hit like 175,000 downloads. I feel like it was just two or three weeks ago we had hit 100,000, so the podcast is growing exponentially, which is amazing. But it also means that there's just going to be more people who can pick it apart, and I will try my best to not get impacted as much as I could. So, that is my goal. So, this is a good transition point into our topic today.

MEGAN NEFF: Yeah. Can I segue? Or do you-

PATRICK CASALE: Sure. I think that's going to be your strong area today of [CROSSTALK 00:09:33]-

MEGAN NEFF: Sorry. I'm offering to do this social ligament thing which usually you do.

PATRICK CASALE: That's true.

MEGAN NEFF: So, we're going to talk about addiction. And I've shared on here before I used to have… it's so interesting, like, and maybe we've talked about terminology [INDISCERNIBLE 00:09:51]. The way I would describe it as an unhealthy relationship with alcohol.

And something like this would have absolutely triggered me to want alcohol because I'd feel the shame, I'd feel the emotions, and I'd want to numb, and pretty quickly it'd be like, I feel something I don't want to be feeling and then I'd start fantasizing about, like, drinking later that night. And that would be my cycle.

So, I think it's very connected to our topic today, which is unhelpful coping addiction, etc.

PATRICK CASALE: Yeah, I appreciate you sharing that. And I think so often, I default to that, as well. I did not yesterday, actually. I've been taking a break from alcohol because I've just noticed that I have increased its usage and frequency, so I've been taking a break. But I defaulted to watching Game of Thrones. And that's kind of escapism for me.

And that is typically when I know I'm in like a healthier place, when I'm not defaulting to reaching for something that can immediately take away the pain, or numb it out, or to kind of escape from it.

So, let's define it. I myself, for those of you who don't know, I'm a licensed clinical mental health counselor and a licensed clinical addiction specialist here in North Carolina. So, I have licenses for both. I'll talk about my personal history as well with substances and processes in a second.

But, you know, we don't want this episode to be about, like, necessarily so much about the research behind addiction and its connection with neurodivergence. Although I'm sure there's a ton out there, we haven't done it. Or at least we haven't done it to the extent where we feel comfortable showcasing that.

We want to talk about why it's so easy for neurodivergent people to reach for something or use something that is going to take away the pain, that feels like a coping strategy, which is really just a temporary strategy. It's not a long-term one, by any means.

So, when we talk addiction, I think it's important to define dependency, I think it's important to define both physiological and psychological dependency, I think it's important to find tolerance and the difference between dependency and addiction.

So, when we talk about dependency, physiologically, we're talking about our body's need for something to be able to function optimally. So, when you start to get to a place with alcohol, or any other substance and your body starts craving it, or needing it to get through the day, we're talking about dependency, psychologically, we're talking about what Megan just described, like, I'm going to rely or depend on something, psychologically, to help me through something that is happening to me, emotional tolerance gets built. The more the more we drink, the more we use, the more we gamble, the more we, you know, shop, the more we… And ultimately, that can really have significant negative impact on our being.

And the reason I wanted to talk about this is we get so many messages about substance use, addiction, and 12 Step isn't for me because it doesn't really help with the neurodivergent process. And I agree wholeheartedly, and I'll talk about that, too, and alternatives.

But I think what I want to talk about is why it's so easy to turn to substances or processes as someone who is neurodivergent. And I think it's because of all of our life experiences, our pain, our trauma, the way we move through the world, our sensory systems, our struggles, socially.

And Megan uses the word social lubricant or ligaments a lot. I think that that is exactly why so many people turn to substances, in the first place, is because they feel like they don't belong, they don't fit in. And in the meantime, in the short term, it is a temporary, and I want to highlight and emphasize temporary dopamine hit. It is a temporary way to let your guard down, and to not be so hyper-vigilant, and to not be so anxious, and to not feel so overwhelmed.

And of course, it's easy to reach for something that can just give us a glimpse into the normalcy of socializing in a neurotypical world when we feel like we just don't have a landing spot.

MEGAN NEFF: Absolutely, there's like so many, like, directions, my brain could go with what you just said. That was a really helpful way to set the stage. I think, yeah, there's so many reasons why we're more vulnerable to these unfortunate coping strategies, that unfortunate coping strategy. Someone in my community came up with that term last week, and I was like, "That is the perfect term." Unfortunate coping strategies.

PATRICK CASALE: I like that.


PATRICK CASALE: I like that.


PATRICK CASALE: So, of all of those directions, which way do you want to take it?

MEGAN NEFF: My brain is having a lot of associations, but nothing clear. Do you have a place you want to go?

PATRICK CASALE: Yeah. I'll just set the stage with sharing a little bit about my own story. Because I think it's important to highlight where I've been and where we can go to as humans. And as someone who has struggled with, well, one we also have to talk about, we won't talk about it on this podcast, genealogy issue, you know, correlation. There's the nature versus nurture, the biopsychosocial model.

But my family has a history of addiction on both sides. So, when your family has a history of addiction, there's a higher likelihood of you also having some genetic predisposition to struggling with substances, or alcohol, or processes.

So, that's a situation that I'm in. And very early on, I struggled with impulse control. And a lot of us probably do. I struggled with, you know, as a teenager and adolescent with just not feeling like I fit in or belonged socially. I didn't really have a good sense of myself at that time. Plus, I hung out with a lot of people who I would not associate with today. And we started drinking pretty early on. Probably, 14, 15, experimenting with alcohol. And that, obviously has… I'm 37 now, so 22 years of having that in my life. There's obviously going to be a dependency that gets developed both physiologically and psychologically.

Gambling is what really took over my life. My roommate and best friend when I was in high school, or freshman year of college, and I'll just use a trigger warning right now, committed suicide in my freshman year of college, in our dorm room suite.

And I think it would have been easy to turn to alcohol at the time. But I needed escapism. And we had multiple casinos in upstate New York, on some reservation land, and in Montreal in Canada. And both of them were about an hour's drive for me. And that's where I found myself going more and more frequently to the point of, you know, at first, it's $50. At the end of it 10 years later, it was thousands and thousands and thousands of dollars, and to the point where once you get into active addiction, that's the differentiation between dependency and addiction is it has full control over everything you're doing. That means all of your actions through the day, your thought processes, you're always fixated on it. You start to have these almost obsessive and compulsive traits and tendencies that come along with it.

I would obsess about going, I would obsess about sports betting, I would obsess about going to underground poker rooms while I was in college. And I just found myself getting into increasingly more and more dangerous scenarios and situations where, you know, just like the movies, just like getting in with the wrong sports bookie, owning them money, lots of bad things going on, and lots of emotional struggles there where you push all the people who care about you away. You start self-destructing. You know that it's ruining your life, but you can't do anything about it. That's also a part of addiction where you so badly want to get out of it, but you just feel like you can't. And everything you do just digs that hole deeper.

And it took about 10 years of my life. I haven't gambled since June of 2012. So, it's almost been 11 years of not gambling, but it was hard.

And I think as an autistic person, there's also this hyper-fixations on the inability to break away from the patterning within gambling with really seeing things. I was winning money constantly but losing quadruple it every single night. And it leads to just self-sabotaging situation where I so often would come home from the casino at like six in the morning, up all night, sleep deprived, disoriented, and then have to get up and go to work, or go to college, or whatever the case was.

It is such an unbelievably painful part of my life. And I want to highlight that fact that it's been 12 years without gambling. So, when I was in the throes of it, there was never a part of me that thought I would get out of it. There was never a part of me that could have thought that I would be sitting here and talking with you about some of the stuff.

So, I want to just really name that for those of you who are struggling with any sort of addiction that you can recover and recovery is possible. And it is hard. It is a long road. But it is absolutely possible.

And I just want to name that because I think for so many of us in those situations, it is so easy to feel like nothing is ever going to improve, this is going to be the rest of my life. When will my life inevitably? And because, ultimately, that's on your mind pretty often, especially, gambling being a completely psychological addiction, not a substance-induced one. So, it was very, very challenging.

And it started as a coping skill and it became uncontrollable. And I think that's how most addictions start and develop is coping. What did you say? I'm sorry, use the terminology that you said you-

MEGAN NEFF: Unfortunate coping, yeah.

PATRICK CASALE: Unfortunate coping, yeah. When you start implementing that, it starts as an unfortunate coping skill to deal with pain, suffering, struggle, trauma, anxiety, depression, socializing, whatever. And then all of a sudden, fast forward 10 years, and you're like, "How the hell did I get here?"

MEGAN NEFF: Sounds so painful, Patrick. Like, I know you've referenced this before, but I haven't heard you describe it in that much detail. And I'm so sorry. It sounds so, like, trap. Like to be trapped in the cycle of like, this is not what I want, but I also can't get out of it. I feel like that really does capture the addiction experience so poignantly.

And like you say, you feel like you lost 10 years of life to that. I definitely have had similar thoughts with my relationship to various addictions, and it feels like I lost myself. And therefore, it feels like I lost years or parts of my life, which is a really… talk about grief, like let's now talk about the grief of what these addictions take from us.

PATRICK CASALE: Yeah, that's a great way to think about it is there's a lot of grief there. And a lot of people may not understand this, of like, there's grief of actually what your life becomes after addiction because as unhealthy as it is, there are people, and places, and things, you know, the old cliché that have become foundational in your life in those years and times. And in order to break free from it, you kind of have to separate yourself from almost all of it.

Then there's almost this grief of like, I remember what it felt like to drive to the casino by myself. I remember what it felt like to, like, convince myself I should go, like, flipping a coin in my dorm room, or like if I got above a 75 on a paper I would go, or all the rituals that come along with gambling or any addiction. And the manipulation that comes with it, the just borderline criminal behavior that comes with some of it.

I remember staying up playing poker until 7:00 AM before a trip to a maximum security prison for my… I was a criminal justice major in my undergrad class. I'm glad I distanced myself from that profession. But I remember going into [PH 00:23:08] Denna Morris Maximum Security Prison, sitting in a group with other inmates. It was like a processing group. And I actually fell asleep in that group. And one of the people, one of the inmates, like, tapped me on the shoulder and was like, "Hey, this is not the place you want to be sleeping." And I was like, "Oh, my God, this is horrible."

And that just spiral, you know, I have so many horror stories. And I'm not going to go into them because they are not that helpful.

But what happened is this realization, you know, you lose so much of yourself in this moment that when you come out of it, you almost have a newfound perspective on how you want to live the rest of your life.

And I committed then, like, to just talking openly about it because so many people have messaged me or reached out to me about their gambling addiction and their family, or their colleague, or their sibling, or their loved one, and just needing support. And there's just not that much support out there. And if you call that in terms with, like, process addiction plus neurodivergence, there's really not a lot of conversation being had, so…

MEGAN NEFF: Yeah, yeah. I mean, so like, there are, obviously, critiques of that model, understandably. But I think that's what they do well, is the vulnerability and the sharing, and the, "you're not alone in this experience." And, like, if we have one thing to think Brene Brown for it's this idea of the connection between shame and vulnerability, and that is what helps eradicate shame is when we connect over these stories. And I think it is so important.

And I haven't really thought about… you're right, the, like, lack of neurodivergence and addiction, thinking about how so many of us are already so shame-built that I wonder if it makes it harder to talk about the addictions we experience? Because it is yet another topic that invokes a lot of shame for a lot of people.

PATRICK CASALE: I think you're right? I think that's so spot on. And yeah, it is that shame component of I really don't feel understood. Now I have this like, extra layer of shame and stigma about behaviors or things that I can't control or things that are controlling me.

And I think that's a big struggle area for those who are struggling with addiction is, like you kind of said, as well, it is that complete and utter inability to have control over your actions or day-to-day even though you know everything is destructive. And I think that's one of the most painful pieces besides the alienation.

And so if someone had DMd us on our Instagram about alternatives to 12 Step, and I just want to name that now while we're talking, SMART Recovery is the way I would go and recommend for those of you who are looking for alternatives because SMART Recovery is just, oh my God, I need to look up the acronym to figure out what the… skills management and regulation tools. So, you're really just learning how to cope. You're just learning strategies and techniques to deal with triggers and urges. You're not going down, like, the war story path that happens in 12 Steps so often. There's also not the mentality that if you do relapse, that you're suddenly like, ostracized from a group until you can find your way back.

So, SMART Recovery is all evidence-based, and science-based, and is a nice alternative for those of us who really want like, the concrete steps, the rationalization, the ability to like, implement and incorporate strategies and techniques. I think it's a really good alternative. And it's everywhere all over the world.

So, you can look up SMART Recovery, and you can find meetings in almost any city or any state and a lot of virtual options as well.

MEGAN NEFF: I love that. Yes, that is such a great resource. And I love that they teach the regulation skills because that is so many of us, and like humans, not just neurodivergent people, but so many of us go to addiction as a… So, it's a form of emotional avoidance. And so I think learning that regulation piece of how do I handle sitting and distressing feelings, and then regulating is such an important part of that recovery process.

I'm circling back to earlier in the conversation about why are we more vulnerable, when I was doing research on alexithymia, this was really interesting to me. So, alexithymia is linked with more emotional avoidance, which makes sense because we're having a hard time to identify our feelings. And that's linked with addiction. And so alexithymia and addiction are very linked.

And so I think that's a huge piece of it. I think we are more vulnerable to emotional avoidance, which I would say is a pretty big driver when it comes to addiction is just the, "I cannot tolerate this emotion, I must escape it."

And then I would say until we address that, many of us will fall into that… I'm blanking on the word today, the not cross-pollination, but cross-addiction, when you hop from addiction to addiction.

I know for me until I finally really addressed my emotional avoidance, like there'd always be some sort of addicting object in my life, to some varying degree because I hadn't resolved the fact that I just could not tolerate to be with myself, to be with my emotional experience.

PATRICK CASALE: Damn. That's it right there. I think is that just complete inability to be with self, right? Like, and that could be in so many different environments and situations. But that's really the crux a lot of the time is the struggle to connect to the emotion or the desire to avoid the emotion, or sit with the emotion.

And I think about so many of these things that we talk about on this podcast, right? Like socializing and social situations, sleep struggles, sensory system struggles, sensory overload. If you are a part of a workplace where people are getting together in person, and you just really are having a hard time with how to show up or even being there, or being able to exist there in that situation, think about all of this stuff, and why that increases the likelihood that you would then, therefore, rely upon a substance to help you.

And I'm going to just highlight alcohol because it's the most commonly used substance that we can talk about besides nicotine and caffeine, and why alcohol would then therefore become the easily accessible coping skill and strategy.

MEGAN NEFF: Yeah, absolutely, absolutely. I mean, there's so many reasons, especially, with alcohol. And I think that our systems, like the social piece, I know, like if I didn't start drinking, actually, I kind of think it's funny. I didn't start drinking until I went to seminary. And I often joke seminary's where I learned how to drink.


MEGAN NEFF: …which is just… Because, yeah, I went to a college where drinking wasn't allowed. I was raised evangelical. And then all of a sudden, I'm in seminary with all these other religious people who are drinking a lot. And I'm like, "Oh, well, they're becoming pastors, it's okay."

And I would get a lot of reinforcement. People would be like, "You are so fun when you drink." And I'm a pretty serious person. And because my filter would come off, my silliness, my playful side would come out. So, socially, there's a lot of reinforcement for my drinking.

And then sensory, I really realized that in the last decade that I can just take in, I don't get so sensory overwhelmed when I have alcohol in my system. Now, I'm not going to say that's a good solution because I pay for it later. But that, I think, became a big reason that I would drink was in social spaces to be less sensory overwhelmed.

But yes, like all of the reasons, alcohol just sits there as this like, I will solve your social anxiety, I will solve your sensory, I will help your hijacked nervous system feel more soothed. Like, it's this really seductive substance that, frankly, our culture has a really unhealthy relationship to, and the messaging around it just makes it so easy to go to that. Especially, okay, I'm diverging a bit, but the demographic where we're seeing, like, the most increase in drinking over the last 10, 15 years is women and mothers. And it's become this cultural message of like, overwhelmed with your kids. Like, then you get happy hour, right?


MEGAN NEFF: Think about all the neurodivergent parents parenting neurodivergent kids, like that's a stressful experience. So, there's just our culture isn't making it easy to decide to abstain from the substance. And there can be so many drivers that drive us to it.

PATRICK CASALE: So true. And so, first, you just said quite a few things that I want to touch on. So, this is [CROSSTALK 00:33:23]-


PATRICK CASALE: …is important, right? Like, so how many of us have probably experienced this situation, just like Megan said, "Oh, you're so much more fun when you drink. You can like let go. You can be silly. You can joke around. You don't like stare through my soul." Is what people often say to me who don't know me when I'm socializing with them.

And you know, I've been described as like a wet blanket by colleagues and friends in the past, "Looks like you're no fun to be around. You're so serious all the time." Like, bla, bla, bla, bla, bla, "You're so cynical." And then if I was drinking it's like, "Oh, you're gregarious, you're fun, like, you're the life of the party." My wife has often told me I have a Manson-like charisma. I had to look that up to be like, "What does that actually mean?"

But I think that for those of us that feels so socially isolated, or disconnected, or alienated, that becomes like, "Oh, my God, this is like something that can really change my life, and alter my world, and allow me to fit in."

So, you know, alcohol is a depressant. And for those of us who have really activated nervous systems and sensory systems, like it's going to dole those things out. And it allows you to kind of exist in a world where not every little thing around you is impacting you. And I think that we so desperately want that so often, that when you find this substance that allows you to then exist in that world it's like, "Oh, this is really wonderful." Couple that with the fact that it's legal. So, there's the ability to just have it everywhere.

Then, like you said, like, culturally, we promote the hell out of it. I mean, you can't turn the television on without alcohol commercials or marketing everywhere. And it's always glamorized. Like, "Let's go to this party and drink this cocktail, and like, we're going to have this wonderful time." Or it's always about connection, and partying, and having a great time. You never see the aftermath. You don't see like, the depression that kicks in intensely, like immediately after, you don't see the sleep deprivation that comes with it. Even if it helps you sleep temporarily, you're not getting actual restorative sleep in those moments. Like, there is so much destruction, physiologically and psychologically that come with alcohol usage.

And for those of you who are trying to abstain, or maybe have some sort of minimization, or harm reduction, which I'm a huge proponent of, it's really hard to start thinking about your world where it's alcohol-free.

I live in Asheville, you live in Portland. These are widely considered, like, some of the best craft beer cities in the world. People come to Asheville just to go to breweries like from all over the country. And it's really hard to start imagining a world where you can be social without having to go, and participate, and be around a substance that may be really destructive for you.

MEGAN NEFF: Absolutely, absolutely. And that goes back to like how they did. And I'll situate us, of like, we're in the US, and I think it's like probably the most unhealthy in the US versus some other countries where alcohol is more of a collectivistic… Okay, that will take us down a very different rabbit trail. But yeah, in the US, particularly.

One, I read this recently, and I was like, "Oh, my gosh, this was a helpful frame." Like, alcohol is one of the few things that you can't abstain from without a ton of questioning. Like, when I tell people I don't eat gluten, it's like, "Fine. Okay, cool. That makes sense." But when I tell people I'm alcohol-free, right? Like, "Why?"


MEGAN NEFF: And people have a hard time, like, when people say, "I don't drink." Like, that is the one thing. And we live in a culture where we say, we abstain from all kinds of things, whether it's gluten, sugar, but when people abstain from alcohol, it can get a really strong reaction from the people around you, which I think is one of the reasons it can be hard to go alcohol-free.

PATRICK CASALE: For sure. It's almost like, what's wrong with you?


PATRICK CASALE: Like, what do you mean you don't drink? Sometimes it's even followed up inappropriately for those of you who can become pregnant, "Are you pregnant? Like, are you trying not to drink because of that? Are you trying to lose weight?" Like, it's just, I think-

MEGAN NEFF: It's so intrusive, it's so intrusive., yeah. Versus like, yeah-

PATRICK CASALE: Oh, cool, [CROSSTALK 00:38:25]-

MEGAN NEFF: …versus the lifestyle. Yeah, yeah.


MEGAN NEFF: So intrusive.

PATRICK CASALE: It's so intrusive. And again, I think the substances, specifically, that are legalized, and we can even talk about gambling being legal, like, that creates an additional layer of shame and stigma when you are struggling with something that is illegal and accessible to mostly everybody. Because it then creates this internal narrative of what the hell is wrong with me? That was constantly in my mind with my gambling because gambling is legal, and mostly everywhere if you're over 18.

Now with, you know, online, and like digital sports betting throughout the United States, it's even easier and accessible. But it becomes this narrative of, I already feel different, I already feel like other, I already feel like I don't belong or fit in. Now, I can't control this thing that in your mind, or rationally, you would say everybody has access to and like, I'm one of the only people who's struggling to moderate this. And in reality, like, obviously, not the only one, but that's what happens mentally.

And you can really go down these really dark pathways of, you know, just berating yourself and destroying yourself. Because it's like, how come I cannot control this thing that is glamorized, and like it's promoted, and marketed, and accessible, and legal? It's just really, really challenging.

MEGAN NEFF: Yeah, I mean, it can feel like a sign of weakness. I know I definitely felt that when I was kind of, like, navigating like, okay, can I have alcohol in my life in any healthy way? Like, what would that look like? If it felt like weakness if I was to say, "No, I can't." Because it means, yeah, I can't control this thing.

One of the things that really helps me in my process, I don't have the study in front of me, but I think it was something like 59% of people, and this is, again, US-based, who drink are trying to drink away. Meaning they are trying to get into a different relationship with alcohol.

And I thought that was so helpful to realize, like, this substance, it's a hard thing to have in your life and have it be, like… manageable's not quite the quite the word I'm looking for. But have it be something that you're not actively spending a lot of labor to manage how much is it in your life, just because of, I would say, the nature of it.

And so that was a really helpful thing for me to realize was, first of all, pretty much majority of people who have alcohol in their life are actively working to manage it.

The other framework that has been really helpful, so I think the binary that we've fallen into, and I think partly this comes from how the mental health world and addiction world, but either like you're an alcoholic, or you're not, either you have a problem, or you're not. And thankfully, we're seeing a shift away from that. But something can be a problem without your body being dependent on it. Like, earlier, you talked about dependence.


MEGAN NEFF: And so, I think, giving new language for people to be able to be like, "No, when this is in my life, I don't show up in the world the way I want to be or it's not healthy. But without falling into this, it means I'm in this bucket or that bucket. "I think that's so important.

PATRICK CASALE: So important. So, so important to try to break away from that black and white thinking, which is, again, I'm not a proponent of AA and a 12 Step GA gambling anonymous because of the binary, because of the black and white. It's either you abstain or you're barred, and you can't control, and I cannot get behind that mentality.

So, I'm a big proponent of harm reduction, I'm a big proponent of moderation management, you can apply moderation management into your life. I also believe, wholeheartedly, that addiction is the opposite of connection.

And there's an organization here in Asheville called Seek Healing and they have online programs, I'll put that in the show notes. My friend's, actually, one of the board members on it. And that's what they focus on is building community and connection that combat the desire to use any substance or allow that substance to control your life because the ability to have connection, the ability to have community, the ability to heal, that's really where this comes in and it starts to play a factor.

And think about, for those of you listening, who are mostly neurodivergent, community and connection can be really hard. So, if it's not there, if it feels like it's not existing, if it feels like it's hard to obtain, there's some likelihood that you're going to reach for something to replace that. And to deal with the emotional impact of having that lack of connection and community.

And I think the more we can promote community healing and connection, in general, and this is, again, what you said, there's a whole lot of talk about substance use addiction, and neurodivergence, trying to find those places where you can connect, where you can belong, where you can be a part of because it is monumental in combating some of these things where they may, you know, be taking over your life in a really destructive or negative way.

MEGAN NEFF: Have you seen that TED Talk where they do the mouse study with the…?


MEGAN NEFF: Yeah, okay. So, you can correct me if I get it wrong. It's been a long time since I saw it. But I think this is where I first learned that idea too, addiction is the opposite of connection, or connection is the opposite of addiction.

But where they had a mouse in a cage, and in the kind of drip feed was opioids. And you know, the mice would get naturally addicted to this. And then you put the mice in a cage with other mice and with lots of playthings. And so you create a vibrant community. And all of a sudden, now they're drinking the water instead of opioids because they're thinking and being like they're getting connection, they're getting play, they're getting the things they need. And so, actually, what they've been longing for is the water, not the opioids.

And I think the person who gave that TED Talk, I believe it's Brazil, where they've implemented like a lot of addiction recovery around this idea of building, like, it's about building an enriching environment, an enriching connected environment. Not more about like, "Don't do this. Don't do that." But it's about adding something to someone's life versus taking away, if that makes sense.

PATRICK CASALE: Yeah, and I think that's exactly it, right? And I want to say Johann Hari's TED Talk is all about addiction and connection. And it may be the same TED Talk. But Portugal has done a really good job of decriminalizing-

MEGAN NEFF: It's Portugal. I was-


MEGAN NEFF: …wondering if it was Brazil or Portugal. It's Portugal, yeah.

PATRICK CASALE: Yeah, Portugal had such a rapid, rapid, like drug problem for years, and they decriminalized everything in the early 90s. And they started incorporating, like, harm reduction clinics, mobile harm reduction clinics, going out to community, building community, fostering it.

And you started to see, not only criminal activity decrease, significantly, but the rates of addiction dropping drastically because people had places to go without shame to say, I'm struggling with this thing. And then here are resources, here's counseling, here's connection, here's community, here are ways that you can become employed.

As human beings, this is what we're designed for is connection. And when struggle so much because we feel different than, or discriminated against, or we've experienced bullying or trauma from the way our neurology has been developed, it's so hard to then access it without that ability to have that safe place where you can feel understood because I think we all want to feel connected, valued, understood, affirmed. And without that, so, so easy to just default to all the things that we're talking about.

MEGAN NEFF: Yeah, yeah. So, I live in Portland, which has decriminalized drugs last year, and then I think Vancouver has done this, too, and there's a few other studies. I watched a documentary on this a while back about how it's not turned out like Portugal. And that's because we decriminalized but without emphasizing the additive, right? So, without adding in the structures of connection, belonging, employment stability. And I think it's pretty complicated, because we've done the one that without the other, and yeah, I mean, that could get us into like, politics in theory.

But I was sharing that to say, like, I think, in general, it's way more motivating when we're adding something in our life than when we're trying to not do something. For me and my journey, for years, for a long time, I was like, I'm going to stop drinking. There was a shift, and I don't actually use the language of sobriety, I choose language of alcohol-free. But when I realized sobriety was not the absence of drinking, but it was a choice for something additive in my life, once I made that mental shift from try not to do something to try to do something, it's hard to explain, but it totally changed my energy towards how I thought about it.

PATRICK CASALE: Yeah, I like that a lot. I think the attitude has to be there. It's, like you said, much more complex than just decriminalization. Especially, because our country is so damn big. So, you know, that's another thing.

But I like the way you reframe that language, because, first, a lot of you may be listening and thinking like I've been trying to be alcohol-free or sober from whatever, but I'm white-knuckling. That terminology is like, I'm not drinking, but all the same behaviors are still there, all the same emotions are still there. I'm still angry, I'm getting irritable, I'm getting frustrated with my partner, I'm reacting in a way that I don't like. And I'm thinking about alcohol or whatever the substance is all day, every day, although I'm not putting it into my body.

Nothing's really changed here, aside from the intake of substance. So, that's really where this community-based and connection-based healing has to happen. Like, I believe, wholeheartedly, to combat some of these struggles like, and to save our lives from potential addiction and destruction from it, we need therapy, but we need therapy from not only in our diversion of therapy, but who people get the substance use or addiction world, that's a hard combination to often find. We need community, we need connection, we need coping skills, we need strategies.

I learned a strategy where you just have to get through 15 minutes of that urge, of that trigger, of that sensation of I want to gamble, I want to drink, and then it will pass like a wave coming in and out.

And I remember driving past a casino like two years ago here in North Carolina, there's one 45 minutes away. And I was by myself, I was in a bad headspace. I drove past it. And I just remember thinking like it would be so easy at this stage in my life for me to walk in to gamble, to use my business debit card instead of my personal one. My wife would never know. I wouldn't ever have to tell her.

And then all of a sudden, like that heightened sensation of, "Oh, you could take out X amount of money. You only have to take out this much, you leave your debit card in the car." All the old habits and behaviors started resurfacing. All I did, I sped my car up, and called someone on the phone. I talked to them. I was very honest with them about what was happening. We talked for about 15 minutes. I got through it, continued on my journey, and on my way.

And for those of you who have that ability to just try really hard for 15 minutes, call someone, talk to someone, like anyone you can just to deal with that urge, that trigger that sensation that comes over you because it can feel so powerful, like you can't escape or you can't say no.

I had a similar situation when I was in New Orleans a couple of years ago with some friends. I was meeting a friend for a New Orleans Saints game. And I was walking down the street by myself. I saw the sign that said like Harrah's Casino left, Superdome right. And I stood there for like 15 minutes.

And again, that's the thing. We can't escape temptation, we can't escape these urges, we can't escape these triggers. They are everywhere in life. And just incorporating coping skills, and strategies, and being able to talk to someone, and walk right instead of left.

Because I know what happens is maybe the first time where you go back to that world it's fine. It's exciting. Oh, I had control over this. But then the urges, the thoughts, the emotions, the feelings start to resurface and intensify. And then it's like this snowball effect, and all of a sudden you no longer have control.

So, just trying to emphasize the point that we can learn how to cope with these things. We can learn coping strategies, we can incorporate and build in support systems, and just to use them instead of, you know, trying hard not to feel the shame and the embarrassment of reaching out for support when those things happen because had I gone left, you and I may not be talking today because I don't know where that world would take me again. But I know it would not be good. But I do want to emphasize that here we are, 12 years later. And life has changed significantly for the better. And that's not something that I had ever anticipated or expected.

MEGAN NEFF: Yeah, I'm curious. I know we're getting within the hour. But like, how did you get out of it?

PATRICK CASALE: Oh, man. I'm actually writing a book on that. I have like 150 pages of it that I keep avoiding it. I don't know why.

MEGAN NEFF: I'm interested. I'm curious about that.

PATRICK CASALE: Yeah, I'm sure. I'll send it to you. How did I get out of it? Lots and lots of failures, lots and lots of relapses, lots and lots of blips of abstaining from gambling, lots of therapy, lots of lying to my family, lots of enabling for my father who just kept bailing me out financially. And then I moved to North Carolina in 2011, was still gambling really heavily. I was running out of money, though. I came here, I have been trying so hard. I think this is the big thing that when clients used to ask me, like, how did you stop? You have to want to stop, that's first and foremost, and you are actively trying to get out. And you keep trying and you keep trying. And a lot of the times it's just you keep falling back into the same pattern or behavior.

And the more work I did on myself, and the more I came to just try to love myself, or at least feel like I was worth saving, every time I relapsed became that much more painful. But it also became that much more of an internal challenge of like, I have to stop this.

And I remember the last time I gambled, I had driven to the Cherokee Casino, in the Cherokee Nation over here. And I spent my last $250 that I had to my name. And I had no money for rent, I had no money for gas, I had no money for anything, I didn't have a job. And that was it for me. It was that long, isolating lonely one-hour drive back in the mountains at 4:00 AM where I was just like, "I cannot do this to myself anymore, because I'm 25 and if I continue on this path, I'm not going to see 30."

And that was just the lightbulb moment. I know everyone I've talked to has different times where that aha or epiphany moment has kicked in.

I had abstained for two years in Gamblers Anonymous and like went right back to it. So, there were so many moments where I had abstained or where I had really meant it. And I think it was just a combination of so many things. And just saying like, if I continue on this path, I don't get out of it, I don't survive it. And I really want life to be different. And I feel like I deserve for life to change.

And it was still really hard. I mean, those first couple of years without money, without resources, with a lot of damaged relationships, but I think it's just about there were still some support systems in place, and in my corner, and utilizing therapy services and being really honest about what was going on, not lying, not manipulating, not telling them what they want to hear. And just really come to terms with the fact that I had done so much destruction in a decade's time.

And even the process of rebuilding credit, you destroy it, because you just take out loans, and credit cards, and all the things. That was like a seven to eight-year period where I finally have gotten it back to like a 750, 800. But it took almost a decade to right all of the wrongs and bad decisions that I had made from 15 to 25. And I wish I had like a clear answer. But I think it was just a combination of all of those things in combination of just trying for a decade to get out.

MEGAN NEFF: I actually like that you don't have a clear answer because I think sometimes the, like, recovery narrative and again, even the recovery narrative can be harmful because it doesn't normalize harm reduction, which sometimes is somewhat narrative.

But okay, whether it's a harm reduction narrative, a recovering narrative, it [INDISCERNIBLE 00:57:28] complicated, but sometimes the ones that get told are this, like, I had this one epiphany, and then I never went back. Or actually, one I've seen in the neurodivergent world is like, I learned I was autistic or ADHD, and I got clean.

And first of all, I think that's so powerful. And I love that. And I it makes sense to me that it can have that impact. But for some of us, that's not our story. And so I think that can also be like, "Oh, well, I learned I was autistic, but I kept struggling."

So, yes, these really clean narratives, I think can set us up for motion. So, that's a long way of saying I liked that your story is not clean. And that it was a process, a process of relapse, and persistence, and support, and rebuilding, rebuilding.

PATRICK CASALE: Thank you. I appreciate that. Yeah. I hope all this was helpful for all of you. And, you know, I think, again, we could go in so many different directions and different pathways. But I just want to normalize the struggle too, and that things can change, and things can get better, that therapy works. And community and connection are important and crucial. And again, trying to work through that shame, that complete and utter desire to have that control back. So, the more you can talk about it, the more vulnerable you can become, the more you can kind of take that power back from that shamefulness too. So, my voice is almost gone. I-

MEGAN NEFF: Like, that's our, you know, [CROSSTALK 00:59:13]-

PATRICK CASALE: That's probably our cue, yeah. I appreciate you having this conversation today. I just want to thank you personally, like live and on air because I know I've asked you to have it a bunch of times. And I know it's a vulnerable one, and one that is just a challenging one to sometimes talk about so I just want to thank you, again, for doing this today.

MEGAN NEFF: Yeah, no, absolutely. I'm glad we did it. And I'm glad you pushed me beyond the like, "Megan Anna you don't need to have all that. That's ready to go [INDISCERNIBLE 00:59:45]." Because you're right. Like, I don't, we don't.

PATRICK CASALE: Does it bring up like the desire to figure out how something that we could offer for people that incorporates like, neurodivergence, and just recovery, and harm reduction or whatever that looks like, but…

MEGAN NEFF: Maybe that's the community we build. I know we've talked about building a community. But one thing I want to plug is there's a lot of really cool, sober queer spaces. And I know a lot of neurodivergent people are queer. So, I think that would be another place if people are looking for places to plug in that might be more what they're looking for and if they're queer, there's some really thriving queer sober spaces.


MEGAN NEFF: Or queer recovery spaces. But yeah, I think a neurodivergent base. Yeah, that would be… I don't know of anything like that.

PATRICK CASALE: Well, if that resonates for those of you who are listening, let us know. Because if there's enough demand, then we will figure out a way to build it.

MEGAN NEFF: Or maybe they can build it. Maybe [CROSSTALK 01:00:57].

PATRICK CASALE: Maybe we don't have the energy to [CROSSTALK 01:01:00]-

MEGAN NEFF: But we will amplify it if someone else builds it.

PATRICK CASALE: [CROSSTALK 01:01:03] I like that. All right, you all. For everyone listening to Divergent Conversations, new episodes are out on Fridays on all major platforms and YouTube. Like, download, subscribe, and share. And we will see you next week.

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