Andrew: I want to welcome Dr. Constance Scharff, the
Senior Addiction Research Fellow and Director of Addiction
Research at Cliffside Malibu, to Serene Scene
Magazine. Thank you Dr. Scharff for taking the time to
conduct this interview with us today.
Dr. Scharff: Thank you for having me.
Andrew: I start these interviews off the same way. We
want to know your back story. Why is it that you’re at
this place in your life today?
Dr. Scharff: So I started my adult life as an alcoholic. It’s
really, where everything began. And I started the process
of getting sober when I was 22. I had another profession,
not addiction research, when I was sober, I was
initially miserable. One of the things that you’re told to
do when you’re miserable and sober is to help other
people and I was working a lot as a volunteer with veterans,
primarily from the wars in Iraq and Afghanistan,
and they were miserable too and they weren’t getting
sober. A lot of them were killing themselves. I was so
frustrated, because I thought, you know what - there
has to be something better out there than the recovery
track that we had. So I went to grad school and
I got a Ph.D. specializing in addiction recovery. Now
100% of my work life focus is on the therapies that are
being developed to help addicts have a more full and
Andrew: I know your developing these strategies. You
have a long history of this, and I would like to talk to
you about some of the fascinating discoveries. Some
of the programs that you put together that are really
effective in the treatment of this disease. Can you
speak to that?
Dr. Scharff: Sure. So, I partnered with Richard Tate who
is the founder and CEO of Cliffside Malibu Treatment
Center in Malibu, California and his interests have
always been in developing an evidence based treatment
protocol that will allow individuals to get a solid
foot hold on recovery in treatment, and to reduce
relapse rates. We want people to have a good shot
at getting sober on their first try, that’s really what
we’re looking for, and to be able to maintain that long
term. So, for years now, I have been going through the
latest research in a number of fields in psychology, in
biomedicine, in neuroscience, and in complementary
medicine, among other things, but those are the main
fields. I take the best therapies from each of these
fields that have application to addiction recovery and
then we use them in a highly individualized way. That’s
really the key to success. So we mix and match therapies,
sort of cafeteria style, to what an individual needs
in order to deal with their personal issues as related to
addiction and co-occurring disorders.
Andrew: That personal approach seems to be most
Dr. Scharff: Well it is. I mean, if you want to keep costs
down you, you put everybody through the same sort
of group type program. But can you imagine if you had
cancer, and that you were taken to the hospital and
everybody with every type of cancer, at every stage of
development, was put on to the same ward and given
the same treatment? I mean you’d lose your mind,
you’d be like “I’m not staying here, this is ridiculous”,
but that’s what a lot of treatment facilities do. And so
we really want to change the way that treatment is
done, not only in the United States, but around the
world. Because we have a great program. We have
a documented, industry leading, success rate, and
we’re a boutique facility. You know it’s estimated that
there are around 32 or 33 million addicts in the United
States and we can’t serve that population. So we want
to change the way everybody treats addiction so that
every addict out there has the best chance to recover.
Andrew: Now I know that you place a lot of emphasis
on the stages of change. Why is that?
Dr. Scharff: Doctor Prochaska, who really is one of the
world’s leading living psychotherapists/psychologists,
has taught us that change happens in a predictable
manner. My Ph.D. is actually in the study of change,
so Prochaska is one of our leading thinkers and what
Prochaska tells us is that not only does change happen
in a predictable manner in these stages, as he calls
them, but we can expect specific problems at different
stages. He gives us a whole host, of primarily psychological
interventions or therapies that we can do at
these different stages to prevent relapse. Because we
know from experience that is much easier to prevent
a relapse than it is to bring someone back from one.
So the stages of change is important to us because we
are preventing those relapses. This model is important
because of what we’re learning from neuroscience
which is teaching us that the brain is actually changed
in its physical structure - physically rewired by addiction.
I’ve been working with neuroscientists around
the world to try to prove or disprove this theory. What
we believe is happening with the brain in recovery is
that it is also being physically rewired toward health.
So if we have someone relapse early in that rewiring
stage it thwarts our efforts. So it’s very important to
us to prevent relapse, especially in early recovery, as
much as we can. It really gives us a chance to change
the way the brain works in order to give people that
Andrew: Okay, so if stages of change contributes to
the prevention of relapse, other things must also contribute
to the prevention of relapse.
Dr. Scharff: Sure. One of the most important things
that prevents relapse is highly individualized treatment
program that is based on intensive one on one
psychotherapy. One of the things that the research
literature teaches us is that addiction is really about
a response to pain. There is some sort of underlying
pain, trauma, anxiety, that the individual didn’t know
how to deal with and that drugs and alcohol at least
initially made better. And so to address only the addictive
process, is to miss the point of what’s going on.
You have to address those underlying issues of pain
and the stages of change does that. Another thing that
is incredibly important is length of stay in treatment.
You know, we have this myth in our society that 28 or
30 days is supposed to be the optimal length of treatment.
But we have known from the research for more
than 40 years that really, individuals need a longer
length of stay, and it’s usually on the order of 90 to 120
days. And that improves outcomes no matter what
kind of treatment process you’re using. If you’re using
12 step based, evidence based, it doesn’t make any
difference - longer stay improves outcomes in around
that 90 to 120 day mark. The 30 day model comes
from insurance. Insurance says that’s what we’ll pay
for. But that provides the misperception that someone
should go to treatment and in 4 weeks be better, and
be cured. And that’s not what happens. So there are a
lot of things that can contribute to the prevention of
relapse, individualized treatment being one, a 90 to
120 day program being another.
Andrew: How do you address the physiological component
of addiction? I mean, somebody that’s had
a long-term substance abuse problem has a lot of
ailments going on within their body.
Dr. Scharff: Sure, nobody shows up at treatment
Dr. Scharff: We have physicians who make house calls
and consult with us. We, like almost everybody in the
industry, use a medical detox program, and then we
focus on trying to provide a model of healthy living to
get individuals back to the best state of health they
can attain. But I think for me the physiological aspects
are among the easiest to address. Because people
start to feel better physically almost immediately after
detox. So if you’re in a treatment center like ours which
provides healthy organic food provided by gourmet
chef, and we have a yoga, and a meditation program,
and personal trainers, and we have hikes through the
Santa Monica Mountains, etc. That return to physical
health is really the easiest to get on board with. Where
people leave treatment, is because they’re scared, or
they have anxiety, or they have some sort of psychological
issue that says I can’t do this anymore.
Andrew: My experience in working with individuals
that are trying to be well is that they have a difficult
time socializing with others. They have a difficult time
getting along with family members, and there’s a lot
of things like shame and willfulness and defiance going
on, that prevent them from really interacting with
others on an equal level. How do you approach that in
Dr. Scharff: One of the things that is very difficult, for
family members in particular, to accept is that we all
have a role in addiction. And there’s a lot of blame
that gets put on the addict. You know, we talk about
a disease model of addiction and we talk about a
behavioral model of addiction at Cliffside. But really,
in our hearts, the way most people see addicts is as
moral failures. That they’re ethical degenerates. I mean
so many people say to me, “I don’t understand why
he would do this to his mother, spouse, and children.”
I mean we see addicts as having this choice about
being better. And one of the things that we work with,
in terms of families, is to understand and call things
what they are. So you know, a lot of this has to do with
your blaming the addict for your feelings, and that
isn’t necessarily going to move these relationships
forward. The other thing that we try to point out to
family members is that addicts are responding to pain
that they have. They are not doing things to you. So
the addict doesn’t go to their daughter’s wedding, not
because they don’t love or care about their daughter,
or want to screw over the ex-wife, but because they
can’t make that choice. They know they can’t show up
for it. And people tell me all the time that addiction
is based on ego and narcissism and, I’m out for me -
number one. But really, I find that addicts are shamebased
and hyper-vulnerable and are crumbling under
the weight of their own feelings. So if we can look at
them like that and understand their behavior as not
coming from a spiteful or narcissistic place, but from a
broken place, we can often develop compassion. The
addict’s compassion for him or herself as well as the
addict’s family. And if we can change our world view
then we can change our behaviors and reactions to
Andrew: It’s a very holistic approach that you’re talking
about isn’t it?
Dr. Scharff: Extremely. We really are looking at why the
addict suffers physically, mentally, and spiritually. And
what can we do to aid them in recovery on all of those
Andrew: In the book that you published entitled Ending
Addiction for Good. One of the concepts in that
book is that addiction is not a disease. Now, that’s a
little controversial, and I’d like you to talk about that a
Dr. Scharff: So we do not use a disease model at Cliffside,
we use a behavioral model, and this is how I
explain it to addicts who’ve been trained to think of
themselves as having a disease. We say to them, “If
you come to treatment, and you have a disease that
most people will die from, and the best you can hope
for is to manage it for the rest of your life and expect
relapse,” they walk out the door. It’s too demoralizing.
But if we say to someone, “You have a behavioral
disorder and any behavior, no matter how ingrained,
can be changed.” They say, “Yeah, I want some of that,”
and they stay. Now, that’s a nice story, right? And that’s
helpful for getting someone to come in to, and stay
in, treatment. But the science actually backs that up. I
spoke recently at the International Neuropsychology
Society’s Mid-Year meeting in Jerusalem and talked
about this very subject. You know, we’ve been taught
that addiction is essentially a genetic disease, but you
don’t treat a disease with prayer and meditation.
For most of the last 75 - 80 years the gold standard
of treatment has been the 12 steps which is prayer
and meditation: that’s not how doctors treat disease,
so clearly there’s a disconnect there. And geneticists,
as they’ve mapped the human genome, have found
more than three dozen genes that are associated with
addiction, but we don’t know how it works. Now, that’s
not to say that genes have nothing to do with it. You
know, we have eyes because we have the genetic
code to have eyes. So, obviously, we can have addiction
because we have the genetic coding to allow for
that. But what we have found, and what researchers
are telling us at Stanford and McGill and in Australia,
and all over Europe, is that addiction actually changes
the structure and the function of the brain. So that,
as researchers at McGill University tell us, we have a
disorder of decision making. The addict literally cannot
make a healthful decision after a certain point. So
what we’re really looking at is a brain disorder that is
caused by habituated behavior. Those are the reasons
why we use a behavioral model at Cliffside Malibu.
Because it supports the recovery of addicts. It helps
to encourage them, but also because the science is
telling us it’s closer to medically or biologically accurate.
Now on occasion we get someone who’s been to
half a dozen other treatment centers, and they come
in and they say, “I have a disease,” and we’re fine with
that. We’ll work with whatever model people want, but
the science is really telling us that our disease concept
Andrew: Can you talk about your work with Creative
Dr. Scharff: Creative Transformation, as it applies to addiction
recovery, is really born out of the positive psychology
movement. I was just last week at the Canadian
Positive Psychology Conference speaking on this
subject. Positive psychology suggests that rather than
focusing on what is wrong with us, our problems and
our diagnosis - not that we should completely ignore
them; but instead of making that our focus, what we
should be focusing on, particularly with addicts, their
assets and strengths, and the talents that they bring
to the table. We can help encourage them to dream
of, and work toward, happiness and joy in their lives.
We help people to take what’s best about them, and
that’s hard for an addict to dig down and find at first,
and to use those strengths to create a life they never
dreamed possible. That’s really what creative transformation
is all about. It’s using the best in people. That’s
one of the reasons why I like the behavioral model as
something to work from. Because it isn’t about disease
management. Recovery isn’t about disease management,
it is about having your absolute best life and being
encouraged in the harder times to use what’s best
about you to get through it. That helps us to promote
recovery rather than relapse.
Andrew: I would imagine that some of that philosophy
finds itself in the treatment setting as well. Particularly
in motivational aspects, like motivating people to stay
in treatment or motivating people to continue their
work in certain aspects.
Dr. Scharff: Oh, absolutely, it’s an incredibly important
part of, of treatment. It’s also a very important part of
aftercare because, you know, people are in treatment
three or four months at most. I mean, people are going
to be there around the first 100 days. We want to give
you a firm grasp on recovery, and then you’re going to
move on. Our goal at Cliffside, honestly, is to never see
you again in a treatment setting. If you want to come
to an Alumni thing that’s great, but we really don’t
want to have to see you again in a treatment setting.
Which means that we have to give you tools to use
outside of treatment. Because if you know what’s good
about you and you can identify your strengths and talents
you can use them to build the life you want and
to have the life you want.
Andrew: Now I’m thinking of somebody that has a
drug or alcohol issue. Their loved ones know it, and
they call together an intervention. This individual has
none of these thoughts in their head.
They’re thinking that they are a worthless individual.
They have nothing to give to society or to their family,
and our job is now to try to convince them to enter
into treatment. How do you go about doing that?
Dr. Scharff: That’s, again, the beauty of the stages of
change. Because Dr. Prochaska and his colleagues,
when they created this model, expect just that kind of
behavior. We have, in the first two stages of change,
pre-contemplation and contemplation. We have three
different types of people for the most part. One is the
addict who really has no idea they have a problem,
and we’re seeing that increasingly because we’re
seeing people with prescription opioid addictions
who got their medications from the doctor. They say,
“Since I got this from the doctor, of course I don’t have
a problem.” They can’t see the wreckage that they’re
creating. We have denial, or people who don’t know.
We have people who are like what you’re describing,
who believe they’re beyond hope. If you saw the 1995
movie, Leaving Las Vegas with Nicholas Cage you
know his character, who said, “You know what? Life is
too hard. I’m too sad. I’m gonna drink myself to death,”
and he does. So you have those people who believe
they’re beyond hope. I was one of those people. And
then you have, in the contemplation stage, the people
who know they have a problem. They’re the kind of
people who sit on the same bar stool every day and no
one wants to sit next to them because they talk and
they talk and they talk and they talk about the problems
they have, but they never do anything about it.
That’s because they’re scared to change, they’re afraid
that they will fail.
The stages have change have specific ways of speaking
to, and interacting with, these individuals that we
have honed over the years and have been using it to
help those individuals believe that they can recover
and that there is hope for them. We reinforce that, consistently,
through intensive one on one psychotherapy,
several times a week in treatment, and continued
intensely in aftercare for at least the first year. We do
that through different sorts of mindfulness projects.
Mindfulness meditation, which has also shown to have
a tremendous positive impact on brain redevelopment
and rewiring, with interactions people have with each
other to reinforce that’s there’s something good in
there. There have been a lot of psychotherapists, we
have Milton Erickson and we have the positive psychology
movement, and Seligmann and those folks,
and we have Victor Frankel who gives prescriptive
activities to help reinforce the finding of purpose and
of meaning in people’s lives. We start that at the intervention
and we continue with it throughout treatment
and in aftercare.
Andrew: One of the things you talk about in the book
is the idea that getting sober doesn’t have to be exceptionally
Dr. Scharff: Yes.
Andrew: All right, so now is the time to inspire. Maybe
somebody that’s listening to this interview has that
idea that it’s just too hard.
Dr. Scharff: The idea that it’s too hard and that it’s
constantly work to stay sober really comes from people
telling you that you have a disease. That there is
something intrinsically wrong with you, and you are
going to have to work hard to keep it together. That is
not my experience, and that is not the experience of
most of the people that I work with. Once we comfortably
get you through detox, and that’s what a medically
supervised detox is meant to do, it’s not a horrifying
experience. It can be like a mild flu most of the time,
is what people can expect. Once we get through that
process, recovery and treatment is about being held as
you work through the issues that caused you to use in
the first place and then finding what it is that you want
out of life. My friends were taking gentlemen’s bets on
how long I would live. I drank two liters of hard liquor
or more a day when I stopped drinking and nobody
expected me to live beyond 25: I’ll be 42 in ten weeks.
What I learned in my recovery, is that there is so much
life available to us that we cannot see in our addiction.
And what you’ll find as you start the treatment process
and start working with really good people who want
to see you grow and prosper, is that you will develop
ideas for what you want in life. Whether it’s a home or
a certain kind of job, or to go to the beach, or to travel,
or to have children, or a meaningful relationship,
whatever it is, that can be possible for you if you allow
yourself the first step, which is recovery.
Andrew: Let’s talk about Cliffside Malibu for a second.
Cliffside operates a little bit differently than some of
the other treatment programs around there. Maybe
you can elaborate a little more on what sets Cliffside
Dr. Scharff: So first and foremost, Cliffside Malibu is an
elite, evidence-based treatment program. We provide
outstanding service and amenities by industry leading
professionals. It’s on the higher-end of the cost
bracket. In terms of treatment, what we provide is
evidence-based, highly individualized care. What that
means is that we do not use a 12 step model of treatment.
We do offer access to 12 step programming, and
some people like it - about half of our residents participate
in that, and about half don’t. But the main focus
of our treatment is intensive one-on-one psychotherapy
to help the individual to uncover and work through
whatever issues caused the addiction to take root in
the first place. In addition to that, we provide a whole
host of proven complementary therapies to help the
individual get better on the levels of mind, body and
spirit. That might be equine therapy. That might be
meditation, that might be yoga, or that might be personal
training. It’s going to be a whole series of things
that will depend on the individual’s needs - they’re
customized. For example, in the morning, we have exercises,
everybody gets up and exercises: well we had
one individual who, physically because of his age and
his condition, could do nothing but swim. So we put a
solar heater on the pool so that he could swim every
morning. So, it’s that kind of hyper individualized programming
with proven techniques really sets us apart.
Andrew: Let’s switch gears for a second here and look
at your personal life for just a moment if that’ll be all
Dr. Scharff: Absolutely.
Andrew: You’re pretty involved with the volunteer
community. So, can you talk to me a little bit about
some of your passions there?
Dr. Scharff: There are two things that I’m very involved
with and they sort of overlap with each other. One,
is that for me, after a dozen years having my spiritual
path be in the 12 step community, I moved to Texas
and found that my faith community, the synagogue,
was a better fit for me, so I do a ton of volunteer work
with my synagogue. Being in the synagogue, I found
a lot of people had addiction problems themselves
or among family members, and didn’t know where to
turn. Because it’s not something that Jews like to talk
about, like so many families - they find it embarrassing,
I have always been very open about the fact that
I’m sober, but I’ve been sober a long time. I’ve been
sober basically all my adult life, so it’s not something
I’m embarrassed by. So people started coming to me
asking for help. I finally got involved with Jewish family
services of Austin and consult with them and with other
individuals about where to get treatments, do you
need after care, do you need residential, you know,
what is it that you need to promote your recovery or
the recovery of your friends and family? So I do a lot of
that here in Texas, and I also speak a great deal internationally
at a lot of conferences all over the world.
Whenever I go to those conferences, I also try to book
myself with local hospital psychiatric centers, and so
forth, to talk about addiction and addiction recovery
and help to share the latest research.
What I’m really passionate about is sharing the research
that’s going on because I’m privileged being at
Cliffside Malibu. We don’t know of any other treatment
center that has a full time addiction researcher on staff.
I don’t see clients - all I do is addiction research, and
then as a public service we share the results of that
with anyone who wants to listen. In a few weeks I’ll be
going to South Africa for a conference in Durbin. In
Cape Town, I’ve been booked at a couple of hospitals
and they’re bringing in people who work at addiction
treatment facilities near the hospital so we can have a
dialogue about the latest research in addiction recovery.
So that’s really what I’m most passionate about.
Andrew: I just want to thank you for doing that important
work and sharing that important information
that’s not shared enough, particularly to the layman.
Dr. Scharff: Thanks. I am so glad to be involved with
Cliffside because of that. You know, Rich is an addict,
he shares his story in Ending Addiction for Good. I’m
an addict, and we both suffered so much not having
all these complementary therapies. I got sober in a
12-step program, and 12-step programs are great, I’m
never going to berate them - they’re wonderful - it’s
how I got sober. But they can’t address all of these other
issues. And the big book of Alcoholics Anonymous
is specific, it says if you need outside help for a physical
problem, see a physician, for psychological problem,
see a therapist, for spiritual problems, see a member
of clergy. So we know going in that 12 steps can’t do
everything for everyone. Rich and I and the whole
Cliffside crew are committed to helping people have a
better recovery. Because I truly believe we did not get
sober to be miserable, and I was miserable when I was
first sober. So there has to be something better. There
has to be some juice, some verve, something effervescent
in life, or why are you doing it?
Andrew: Yes. Thank you for that very inspirational
Dr. Scharff: Thanks.
Andrew: You are also a poet.
Dr. Scharff: Yes.
Andrew: And you have a book coming out?
Dr. Scharff: I believe it’s coming out on August 10th
and it’s called Meeting God at Midnight. It is a book
of Jewish themed poetry. I don’t write about recovery
explicitly, but I do write a lot about what it’s like,
and I think addicts would relate to this, what it’s like
when you can’t have your dreams. So one part of the
two-section book is called, The Jewish Mother Who
Wasn’t. I can’t have children which has been absolutely
devastating. I never have thought in all the sadness
and grief and depression that I’ve had around that, I’ve
never thought about picking up. I think it’s because
my recovery is very solid. It’s not something that I
manage, it’s because I look for the joy in my life, and
one of the reasons that I wrote this book is I thought
I wanted to have one right path, and I can’t have that.
So how then does one create happiness and inspiration
and, most importantly for me, meaning when you
can’t create what you wanted. So that’s what the first
half of the book is about. Then the second half, where
the title comes from - Meeting God at Midnight, is
about developing a spiritual path and a relationship
with the divine and having that really be the foundation
for not only getting through the dark times but
for experiences of joy. So yeah, Meeting God at Midnight,
my first poetry book, comes out August 10th.
Andrew: Well congratulations.
Dr. Scharff: Thank you.
Andrew: So to our readers out there, we have Meeting
God at Midnight that’s coming out August 10th, and
Ending Addiction for Good, which is already available
and you can get that on Amazon.
Dr. Scharff: You’ll be able to get them both on Amazon,
and Ending Addiction for Good, I’m very proud, is in its
second edition, so we’re very pleased with that.
Andrew: Congratulations. Dr. Scharff, I want to thank
you again for joining our readers and providing us
with such tremendous insight into the treatment of
addiction, and also telling us a little bit about yourself.
Thank you very much and I look forward to speaking
with you again in the future.
Dr. Scharff: Thank you for having me.