Episode Transcript
[00:00:01] Speaker A: You're listening to the Doc Lounge Podcast. This is a place for candid conversations with the healthcare industry's top physicians, executives and thought leaders.
This podcast is made possible by Pacific Companies, your trusted advisor in physician recruitment.
[00:00:21] Speaker B: Hello and welcome to the Doc Lounge Podcast. I'm Stacey Doyle, Senior Director of Marketing at Pacific Companies, and I'm so excited to introduce today's guest. We're thrilled to have Dr. Jason Giles with us. A true trailblazer in addiction medicine, Dr. Giles has dedicated over two decades to helping more than 10,000 patients overcome substance use disorders. Combining his clinical expertise with personal experience as the founder and medical Director of Addiction Doctors, a leading telemedicine practice, he has redefined patient outcomes, particularly in detox and dual diagnosis treatment.
Dr. Giles is also a best selling author, speaker, and passionate advocate for reshaping the public perception of addiction. In his book, Outsmart yout Addiction. And through his frequent media appearances, he brings groundbreaking insights into addiction recovery, including solutions for the fentanyl crisis and protecting families from addiction. Today, we're going to dive into the world of addiction medicine and explore the innovative approaches Dr. Giles is using to transform patient care. Welcome to the doc Lounge podcast, Dr. Giles.
[00:01:27] Speaker A: Thank you. Thank you, Stacey. Great to be here. Great to talk to your audience, which is physicians, I understand, and other healthcare providers. So I'm talking to my brothers and sisters today. Pretty awesome.
[00:01:38] Speaker B: That is right on. And I'd love to hear a little bit. Tell us how you initially got into medicine and became a doctor.
[00:01:47] Speaker A: Sure. Well, I grew up in Southern California and had always been interested in, I don't know, science and chemistry and that sort of stuff. I remember those things from when I was little. I was always begging my mom for a chemistry set or some electrical things from Radio Shack so I could do experiments.
And as I went through school, I stayed interested in science, ultimately went to UC Berkeley for college and then Davis for medical school. And then you have to pick a specialty. And I had a hard time doing that because I liked so many different things.
When I was on obstetrics, I wanted to be an obstetrician. And when I was in cancer, on the cancer wards, I wanted to be an oncologist. So I liked all sorts of things.
I did an internship in general surgery. I stayed at UC Davis, did an internship in general surgery, and then I was recruited into the anesthesia department. They had some openings. It was a weird time back then in the.
In the 90s with all sorts of uncertainty in healthcare.
And what appealed to me about anesthesiology was the complexity. I really liked that it was every kind of patient for every kind of surgery with every kind of medical problem.
So that XYZ coordinates of different and new and complex. I really like that. So I did a residency in anesthesiology. I did a lot of heart surgery and transplants because of what was going on. Then got really, really excited by that. But then along the way, I developed my own problem with substance use disorder. And for the, for the general public, not, not for this audience, but for the general public, whenever I was talking about what got me in trouble, I would have to say the name of the substance a couple of times. This is, you know, many years ago, but now I don't have to because everyone knows about fentanyl. But back then it was not a street drug. Something that you would only get inside of a hospital and curiosity and the pressure of work and some, some self doubt I think was part of it as well.
And all of that combined into me trying it and getting some relief from these feelings and then trying it again. And then pretty soon it had me in its grip.
Fortunately, I was a physician, so. So fortunately I got involved in the Physician Diversion program, which is what they do with doctors with this problem that saved my life, that opened my eyes to a completely different way of thinking about managing stress and pressure and burnout and the things that we see as doctors that no one else sees or understands, things that we see and do.
And I recognized that I needed to live life a different way in order to handle all that stuff. And I got on that path 25 years ago.
A few years after this, I went back to residency and finished. I was a resident when all that happened. Went back, finished, worked in the field, worked as an anesthesiologist. But I had this experience of going through my own recovery and fell in love with the idea of helping other people go through what I went through, right. Helping them get to the other side. So kind of as a. On a trial, I guess I'm still on a trial basis. Twenty years ago, I left anesthesia to take a job doing this. And it turned out that the fish met the water. It was the perfect match.
I've been fortunate enough to take care of some of the most famous and successful people, people your listeners, I'm sure, know, and just the average person and the average person who lost his health insurance and lived on the streets. It's been a. An entire spectrum of people in various stages.
What they have in common is what I have in common with them, which is seeing the world in a certain way that required using things to manage my feelings. When you can see the world in a different way, you just don't do that anymore.
So I've been very blessed and fortunate to have found the right job for me. So for the last 20 years, I've been helping people through that early stage of recovery and into, into getting traction in their own lives.
And then with the, all the lockdowns and the pandemics, we had to come up with a creative solution to continue bringing care to people.
And you know, we're on this video podcast, used to have to do radio interviews inside of a studio and one of us would have to travel and so forth. But now, you know, through the magic of the Internet and high speed connections and technology and software, it's as if we're in the same room, right. We can have this face to face conversation that is the same way that we look after nearly all of our patients in the company, which is we provide addiction treatment to treatment centers using telemedicine as the vector or the vehicle for doing that.
[00:06:44] Speaker B: Well, thank you for your courage and sharing your own personal story. I think that's incredible and I'm sure that is going to resonate with several physicians listening today. So thank you for that.
[00:06:57] Speaker A: Might be going through it right now or, or has gone through it and you know, you're never through it because there's, there requires daily, daily maintenance and you have to keep paying attention to, to the important things. But yeah, I bet, I bet I'm not the only one tuned into this channel who has a similar story or, or something like it.
[00:07:18] Speaker B: So tell us, I know you said, obviously, you know, as an anesthesiologist you're, you have access to these type of drugs. You're kind of seeing it from a day to day perspective.
Do you think that that can kind of have a higher, you know, chance for some of those physicians practicing in that specialty to be more likely to fall into addiction?
[00:07:39] Speaker A: It's possible that for anesthesiologists and anesthesia care providers, that nurse anesthetists and so forth, still the number one substance that they get in trouble with is alcohol, just like everybody else. But they do have a heightened risk or frequency of getting involved with opiates. And you know, almost no one gets involved with the volatile anesthetics except dentists and anesthesiologists, just because they're, you know, not hanging out on the wall in most medical offices except those two.
So there are some features of the location and access that do change the use profile.
But you don't need to go to the hospital or to a pharmacy to get narcotics anymore. They're widespread.
Not really. Since probably 2013 and maybe as early as 2008. Have the regular folks, regular people now. Their most common first opiate use for people that go on to develop a problem is not a prescription from a doctor. It's from the streets.
So fentanyl has surged. It's. It's all. It's all over the place. But yeah, dentists get involved with nitrous oxide and emergency room docs get involved with opiates and sometimes ketamine because it's, because it's available. So there, there is. There's an access element to it. It's pretty minor, honestly. It's not the, it's not the main driver. It's the.
And not even the stress of the job. I thought that's what it was back then, but it turns out it's not everyone handles stress that way. So, so it's, it's, in fact, most people don't.
So it's, it's more complex than just. If you're at the barber shop, you are likely to get a haircut, or if you're hanging around the bar, you're going to have a drink.
But to take your point, there was some. I was very anxious when I went back to.
Back to the hospital, back to the. Or back to doing cases. This is a long time ago now because. Because of your concern. Right, because of your question, which is, well, what's it going to be like back there? What's it going to be like, you know, in the same environment? Is it the environment?
In my case, it was not the environment.
It was.
It was my understanding of myself. It was the, you know, I needed to go through a bunch of treatment and therapy. I needed to hear the stories of other people which completely erase the shame and embarrassment about it. Because when I first got help, I thought I was the only one. And no one had ever done this before and no one had been down this road.
Not true, not true. I was just another pilgrim. Fortunately, the trailblazers ahead of me left.
They left breadcrumbs that I could follow in terms of a program of recovery.
[00:10:32] Speaker B: In your book, Outsmart yout Addiction, you do take a unique approach to recovery. So share a little bit about how your personal journey really has shaped your understanding and treatment of substance use disorder.
[00:10:46] Speaker A: Yeah.
Yes, that's a great question. So it plays a huge role.
Listen, you don't have to be, you don't have to have diabetes in order to be an awesome endocrinologist and help people with diabetes. You do not have to be sober and in recovery yourself in order to do this job of addiction medicine.
However, when speaking to the patients and having that connection with them, when they figure out that their doctor has been through this or their provider has been through this, their shoulders slump, you know, they drop, they go down. They're more at ease because they know, okay, this guy, I think because they know this guy gets it and there's no judgment.
Now, that doesn't mean to say that the other doctors are judging them, but this perception on the part of the patients, they, they feel like they're in safe territory. So ironically, that turns all this shameful, embarrassing, you know, detour through hell into gold. It's, it's very helpful to go, oh yeah, no, I remember doing that. I remember doing not being able to stop. That's probably the thing that, that where the relation is clearest, right? Where I kept breaking contracts with myself, I'd say, I'm not going to do this today. And then I would do it. And patients are like, that's happened to me too. And now we're on a level plane. So I think that's super helpful.
The point about. And then I had this program that I was in which was this Dr. Program, which had a 90 to 95% success rate at 10 years, which is the, you know, platinum encrusted diamond standard. There's nothing is even close to that in terms of recovery. So I was very lucky to be in that program.
Very lucky to have come to the attention of my chairman early, before I died or, you know, something bad happened before I, before I had become intoxicated while taking care of patients. I was still able to keep that separate. But it was not, it was not going to. Not for much longer. You know, that was going to happen for much longer.
The unique thing that I've come away with, what I've learned from this experience is the people that come in for treatment, they're the smartest, they're the most sensitive, they're the most empathetic, they're the most present people that you, that you ever want to meet.
Most of their brains and intellects are working at an extremely high level.
In fact, they have been co opted into the service of getting more substance and evading detection and managing all the craziness that goes along with that.
Their function actually oftentimes at very peak levels.
And so, and I was also, I mean, I was sailing as the, you know, this superstar anesthesiologist in the hospital.
But this one part wasn't working. And so I think that you can use the parts that work to help the parts that don't. That's the. That's the. That's the different approach, I think. Right. And that. That inventory process which the recovery community, you know, it's. It encourages and which all faith traditions encourage, introspection and. And confession and candor, that process of being honest about the parts that are faulty is like kind of like debugging a program. You know, debugging a program doesn't mean hitting delete on the whole program. It means finding where the problem is, using it in context to sort out the right instructions.
So that's. That's really what I'm trying to say with the title is you're better off than you realize. You have much more strengths and assets than you know, and you can use that to get this problem into submission, drive it into a corner instead of it driving you in a corner.
[00:14:37] Speaker B: I love that. And that's so different from, you know, I think what is commonly, you know, spoken about in. In terms of, you know, you know, anyone that is struggling with substance use disorder. So thank you for providing that insight and framing it.
[00:14:53] Speaker A: That's sure.
Well.
[00:14:55] Speaker B: And I know, you know, addiction is often misunderstood, and a stigma really continues to be a significant barrier for, you know, people getting treatment. So tell us a little bit about, you know, what you're doing. And obviously you're speaking with us today of really bringing more awareness to this topic.
[00:15:15] Speaker A: Well, I think the way to get rid of the stigma is exactly what we're doing now, which is to talk about it. It's to get the sunlight out.
When we behave as if it's something we can't talk about, then it gets driven beneath the surface.
And there's a funny thing about it. This is a paradox about it. If you.
I'll tell you personal experience. So when I. When I went back to the hospital and I was finishing my last year of residency, you know, back at the. Back at the place where it all went down, access to the things. And of course, you know, a thought would flit across like, well, you know, wouldn't it be something to just use a little. These are cravings or fleeting thoughts, and they're normal. And by the way, only people who are sober have them. So they're. They're good, but they feel scary at the time. And I remember thinking through that. That's one of the one of the skills they, they taught us in the treatment center was to think through these, these ideas and think it, to think it through to the end. Right in, in the recovery community, they, they talk about, think through the drink. Like, okay, I have a drink, and then what happens? Probably have another. Then what happens? Then you don't stop, Then you get arrested. You sort of think through the process and you realize, well, I don't want that, so I won't have the first one. And so I was doing this process and I thought about it and this is. Now it's all electronic and it's all done with like the air traffic control on a big board so that you know when your plane's coming in and which baggage claim. That's how it works in the OR now. But back then it was a whiteboard. And the board runner would write the name of the patient in the which OR and who the surgeon was and what the procedure was and who the anesthesiologist was and who the nurse was, and all that stuff would be on a thing.
And that's the Shibuya. That's the interchange for the whole or. Right? So everyone's looking to see, are they done in room 16 yet? And what case is going on in room 5 and et cetera. It's the busiest place in the OR. It's where all the beds go by. It's where the whole nexus is.
I remember thinking that if I were going to relapse, if I were going to use again on fentanyl, I might just as well pull up a chair like this one, the office chair, and sit in the center of the board, right in the front of the board with everyone going by, and I might as well just use right there, because there was no hiding it.
There was no getting away with it.
If I were, if I were going to do it, even if I'd gotten away with it and didn't die, didn't overdose, if I was super careful, then I would do it again, then I would do it again, and then everyone would know and I might as well do it at the front of the board. And so for thinking, for me, thinking through the process helped me see that it's the secrecy, it's the keeping it to yourself, it's the stigma is actually where the problem grows.
So part of the service, part of the trying to pay it forward from all the grace that I was given from the doctors and counselors and therapists and, you know, and everybody, the medical board, my peers and colleagues at the, at the hospital, the university and the patients.
Part of the. Part of the responsibility is to.
Is to be out, if you will, is to be open about it. It's not dangerous to tell the truth about it. Maybe some people will be upset, and they're like, you should shut up and go, you know, keep your mouth shut. Don't talk about it. But I've never heard that. I've never heard. I've never. In 25 years, no one has come up to me and said, you know, it really upset me. You're telling the truth about your experience.
I'm just a human being like.
Like everyone else. And so having gone through that, having come out the other side, being able to speak freely about it, People. I mean, people reach out to me through all kinds of stuff, social media and whatnot. They're like, last night I went to dinner with some friends of a friend because their daughter is struggling, and it was one of those kind of curbside, hey, can you talk to my friends? Their daughter's really going through it.
And, you know, my wife and I went. We did the best we could to talk to them. This couple that's bewildered with their, you know, one of their kids. They've got three. Three kids that are totally straight and narrow and one kid that's completely recalcitrant and incorrigible. And they needed a different perspective. And so, you know, who better than somebody who's been through it? Who better than somebody who's had that experience?
So I. I'm honored to be in that position where my own foibles and then. And then study about them, board certification and all that. And addiction has led to being useful, being. Being helpful. So.
And that's true for most recovered people. Some of them don't want to talk about it, but most of them are like, oh, yeah, I used to have a drinking problem, or I used to be a smoker, or I used to be fat, or people don't mind talking about when they.
When they make a change.
That's my experience.
[00:20:29] Speaker B: Well, appreciate you sharing that. And obviously, I know that you have utilized all the things that you've studied, and now you're applying that via telemedicine.
And that really is a big way that you're expanding access to addiction care. So I know you're the founder of addiction doctors, and that is.
Tell us a little bit about how you're using telemedicine in that capacity to help with.
[00:20:54] Speaker A: Yeah, yeah. So it's very cool. It's a technology to leverage our reach and to see more Patients mostly because we can standardize a lot of the delivery of care. We can streamline a lot of stuff that's scattered in places. So for some of the listeners who have not had the rehab experience, what that. What that looks like for detox, for somebody who needs stabilization from their substance use, not just. Not just counseling and CBT and insight therapy. But they're physically sick from.
The classic. Is from drinking. But there are other drugs and substances.
They're actually in a bit of medical danger when they stop drinking, many of them, because the body is used to these suppressive sedative effects of alcohol. And when that goes away, you can get, you know, nervous irritability all the way up to seizures and hallucinations, delirium, tachycardia, hypertension, strokes. And so. So they're. They need medical intervention.
But the way we're able to do that is we. There's always on site staff, there's on site nurses and. And clinical people at the treatment center. But what we bring is the medical guidance and direction and leadership for getting the patients through. Right. So just. Just like you can. My children went to high school online before all the stuff. And they could take chemistry and they could take history, and they could take, you know, writing class from their various instructors.
And that's kind of what we do is we. We bring the medical direction layer into a treatment center, and we do that by telemedicine. And the couple of things that does.
It's weird. Strangely, you know, two thirds of behavioral healthcare is now delivered by telemedicine. So we were early adopters or pioneers, but now it's very, very. It's very common. It's more common than. Not that you would see a therapist or counselor or psychiatrist by video.
The behavioral health piece of it is both. There's a little distance because, you know, we're not in the same room.
But there's also a sense of closeness or connection with the patients because we're looking face to face at them on the camera.
And so there's this nice. Nice would seem like a contradiction, which is you're closer but farther at the same time. But I think it provides a nice space for connection because, remember, these patients are very intuitive. They're. They're.
They're present. They usually have been through trauma. They're very wary. And if you don't. If, as a provider, you aren't present and don't care, you. You know, I mean, we care to the extent of completing the job, but you have to actually care about the person.
If you can do that, and all the people on my team do.
Then the patients will feel safe and heard and like the doctor or provider cares.
And then they relax and they're more forthcoming. And then they'll let us help them because they're afraid of medications. They're afraid of feeling bad. They're afraid of their friends finding out. They're afraid of losing their job. They have enormous amounts of fear, plus the anxiety from the alcohol withdrawal.
So I bring.
Our philosophy is we try to make the patients as comfortable as possible. Safely, as comfortable as possible. And that I'm sure you could trace those threads back to anesthesia. Right. So we're not shy about giving medications. We're very narrow and skinny about our scope of medications. We don't throw the kitchen sink at them.
And I think that's super important, because if they have a good experience with detox, they're more likely to connect with their treatment team, and that's where the real work is done.
No, what we do is give them maybe the first step, you know, the good night's sleep and able to eat and get through this safely.
Listen to their fundamental concerns about, I feel terrified or I've got a headache or that sort of stuff. And when we can fix those things for them, then they're more likely to be honest with their roommate about their similarities. They're more likely to participate in group.
And what we see when we come into a center is that we see the average length of stay, which is a good indicator for how well the patients fit with the treatment center.
It goes up. So on average, we add 10 to 12 days of authorized length of stay because the patients are participating, because they're. Because they're not so sick, they leave. This happens a lot in treatment centers.
So those are the big things. It's my personal experience, my experience as an anesthesiologist. And then, I don't know, I've learned a thing or 2 In 20 years of doing this about.
About what works. Some of it is just stuff you pick up.
[00:26:01] Speaker B: And I do know that one of the major challenges in addiction medicine is, like, you're saying, the patient retention. So are there certain strategies you deploy to get that retention rate up?
[00:26:14] Speaker A: Yeah, so most of it is what we discussed, which is taking the patient seriously, treating them with dignity and respect, and solving their problems in terms of medication management and the ickiness of withdrawal.
But then the rest of it is through our communications platform, we're available.
So one of the hard things is when the patient starts to have Problems and got some bad news from home or some, you know, triggers. You never know what it is that sets a person off or gets them spiraling on the thought of using if, and this is one of the things about, about in person visits. If the doctor's not going to be there until next Monday, then it's pretty hard to make a medical intervention.
And so what we have set up is very tightly coupled communication with the treatment center. So they're, they have one of our staff on, you know, our standard is within an hour, but it's usually a lot faster than that. And so as a patient may be struggling or having, you know, feelings of overwhelm or fidgety or antsy and they've got to get out of here, they can reach out to us.
And not uncommonly, there's something we can do. Usually from a medication or a conversation standpoint, our nurses will hop on with the patient and have a chat.
You know, sometimes it's just information that they need or an explanation about something.
And so because of telepresence, we can intervene quickly before these things spiral into, you know, or snowball and you in the momentum, the patient's gone.
So, you know, ultimately the patients decide. But sometimes they don't have all of the information.
And our team can provide it on the spot, if you will.
[00:27:57] Speaker B: Thank you for that. I want to go back to now, our audience.
If there is, you know, physician or, you know, an app out there that's listening and that is struggling with addiction right now.
Tell, tell us, what can they do? What are the steps that you would recommend as someone who's gone through this yourself?
[00:28:18] Speaker A: Well, first of all, there's nothing wrong with you. You've just probably picked up a habit of managing your feelings or managing your stress or anxiety with a substance that works, works, works initially or, you know, if they had, if you got an adverse reaction initially, you wouldn't keep using it. So these things, they work for a while, but then they have accumulated side effects like difficult to quit or they create more anxiety than when you started.
Benzodiazepines like Valium, Valium or Ativan or Xanax are probably the classics for started taking because I felt anxious. Now I have to take to feel normal or even, you know, still anxious.
But any substance can do that, any substance, over time, if you use it regularly enough, and especially if you're using it to manage the feelings of withdrawal. So if you're drinking to deal with the effects of withdrawal from alcohol, then you're in trouble, right? You're, you're physically dependent on.
I would say that if you come to that conclusion, if one of your listeners is listening and comes to this conclusion about him or herself, that's actually good news because there's great help for this problem.
There's terrific help for it. This is not an incurable situation.
It's also almost never professional death. You know, it's almost, almost never that you can't get. Well, this is in 20, you know, 2025.
Back in 1975, before the physician health movement had taken hold, doctors would just get fired and they drove everything underground and there's just too much risk. And, and then there was scuttlebutt and, and rumor and then, you know, patient doctors would be, would be out of, out of the field. We recognize that doctors are people too. They have, and you know, I say doctors, but doctors and, and apps are people too. They have problems and there's treatment for them. So if you, if you've gotten to the point where hearing some knucklehead addiction doctor who went through it and you're going, you know, actually I need to talk to somebody there, there are people to talk to for sure. So there are people inside and outside of the hospital.
All states have some kind of program in place where you can talk to the, there's physician and mid level diversion programs in almost all states except California, ironically. And that's a story by itself. Why that was the first one and then they got rid of it some years ago and haven't been able to put together. But even in California, there's a version of it that even though it's not through the medical board, it's connected to the medical board.
So there's help. But you can also talk to your department chairman, you can talk to your HR director, you can talk to eap.
And if you have trepidation about talking to people inside the hospital because of fears of reprisal or loss of job or that sort of thing, then talk to somebody. So you can talk to a clergy member, your rabbi or your priest or your minister. You can talk to somebody in Alcoholics Anonymous. There are Alcoholics Anonymous meetings everywhere.
And if you listen, if you attend a meeting and you listen, you'll find someone there that's safe to talk to. They, they will, they will keep the secret.
And then as you start to talk and as you start to learn, if you'd like, you can, you know, read my book and read my experience going through it, there's some, there's some help in there too. Some, some guidance. It's not just a memoir.
And as you learn about this problem, you'll see, I hope, that there's a. That there's a way out.
Sometimes it requires medical detox, sometimes it doesn't. Depends on the, on the nature of the substance and the habit and so forth. But it's.
So bottom line is that it's. If, if, if this is the problem, that's very good news because there's a solution and your life can be fantastic afterwards and you can keep your job and then get free from this, you know, get the monkey off your back, as it were.
[00:32:22] Speaker B: Thank you for that and that's great advice. And I want to give you the opportunity to tell our listeners how they can ob a hold of your book. So outsmart your addiction and then also learn about your platform, you know, addiction, doctors.
[00:32:41] Speaker A: So I'm a newbie at this whole thing, social media and, and, and podcast and all that kind of stuff. But probably the best way to get what's on my mind is through my substack newsletter. So Dr. Jason Giles is where you'll find me on Substack.
I'm learning I'm supposed to communicate more through X and things like that. I'm not very good at it yet, but I'm sure I'll get better at it with time. Uh, so eventually look there and you know, I wrote, I wrote that book and, and then I've done a bunch of these podcasts. So you can, if you search around, you'll find, you'll find me chatting about these things. I may start my own at one point. I'm not sure. I'm having a really good time, meeting interesting people, talking with them, learning about their, you know, their world and so forth. And so for now, this, this is, this is pretty fun, but who knows, you know, who knows as things go on?
[00:33:31] Speaker B: Well, it was a pleasure to have you on today. Thank you for sharing your story. Thank you for sharing all of the latest innovations of treatment for anyone currently dealing with substance abuse disorder. So we really appreciate your time today, Dr. Giles.
[00:33:50] Speaker A: Thank you very much, Stacey. That was really fun. Thanks for having me.
[00:33:52] Speaker B: Thank you so much.
[00:33:54] Speaker A: Thank you to all of our listeners. If you would like to be notified when new episodes air, make sure sure to hit that subscribe button. And a big thank you to Pacific Companies. Without you guys, this podcast would not be possible.
If you would like to be a guest, Please go to www.pacificcompanies.com. thank you.
