The Science and Spirit of Recovery: A Farewell Conversation with Marvin Seppala, MD

0:00:13 William Moyers
Hello and welcome to Let's Talk, a podcast series produced by Hazelden Betty Ford. I'm William C. Moyers, your host. And today our topic is well it's too expansive to offer in a snappy title. Why? Because my guest is none other than Dr. Marvin Seppala. The Chief Medical Officer at Hazelden Betty Ford. My colleague, friend, mentor of sorts, and fellow traveler. Welcome, Dr. Seppala.

0:00:40 Dr. Marv Seppala
Thanks, William, it's great to be here today.

0:00:43 William Moyers
You know we've never had you on this podcast series—we've had you many times but we've never had you in the context of this milepost. In your long journey. Would you share with our audience where you are today in terms of next steps?

0:00:57 Dr. Marv Seppala
I'd be glad to. You know I've learned the most from the most difficult parts of my life basically. [Moyers nods] And I'm—and it seems funny that way sometimes when I think about it. But the most difficult times have given me the most benefit. And COVID's one of those times really. For all of us around the world. And the blessing of it for me, 'cause there are both good and bad sides to such things, the blessing in it for me has been a chance to be home. For over a year. Without travel. I was traveling way too much, working way too much. And I've decided at 65 to retire from Hazelden Betty Ford. Which includes a lot of mixed emotions. I love the place. I've been there a long time. I love the people, you're a great friend. And yet, it's time for me to spend more time at home and with my family and figure out some other thing to do.

0:01:53 William Moyers
Well we wanna use this opportunity in the context of your retirement to really take a look at some of the issues that you've talked so eloquently and knowledgeable about. Over the years that we've been together as friends and fellow travelers. We've been doing this together for over 20 years I think. It's hard to believe that we've been together that long.

0:02:13 Dr. Marv Seppala
It is. [chuckles]

0:02:14 William Moyers
And we've been through a lot of high highs and low lows!

0:02:18 Dr. Marv Seppala
[tosses head back, laughs] We have!

0:02:18 William Moyers
In all those years. But let me ask you just for the benefit of our audiences, what got you into addiction medicine?

0:02:27 Dr. Marv Seppala
You know, it was basically my own recovery. I mean I went to treatment as a high school dropout at 17. I got sober in a Twelve Step program at 19. But then, when I went off to medical school, I was planning to be a cardiac surgeon. The person who influenced me more than anyone else to go into medicine was a Brazilian cardiac surgeon and I thought when I—I assisted him in surgery in this lab I worked in at Mayo, and he'd tell me these stories of healing. And I just wanted to be like Jaoua basically. That—that was my goal, I gotta be like this guy. And which was in early recovery that's how I was about people in AA too. You know, I just wanna be like John, my sponsor. You know. I just emulated these people and I had little in the way of self-concept. And so I was gonna be a cardiac surgeon when I started medical school. And two years in, I'm doing clinical rotation and seeing all these people with addiction. Underlying often the illness that got 'em in the hospital. And yet, we were not doing anything about it. We wouldn't diagnose it, we wouldn't provide referral for treatment. No consultation, nothing. And I started complaining about this at my home group, my Twelve Step meeting every week. And after a few weeks of this, two of the doctors in the meeting took me aside one night and put their arms around me and said, 'Marv, you have got to quit bitching about this and do something about it!' [laughs] And it opened my eyes to possibility.

0:04:04 Dr. Marv Seppala
[continued]
And I decided to take a look at what else might be available to work in addiction actually. And I did a psychiatry rotation shortly after. Loved it and—and that's when I changed my mind. And I specialized in Psychiatry, did an addiction fellowship before it was popular. You know when I left medical school, I was talking to one of the attendings at Mayo who I knew pretty well. And he asked me what I was gonna do and I said, 'I'm going into psychiatry and I'm gonna specialize in addiction.' [chuckles] And he said, 'You're throwing away a good career in medicine!' [Both laugh heartily] So it's not a popular choice, you know. And yet it's been a fantastic career.

0:04:47 William Moyers
Well I'm glad you threw away a good career to get a fantastic career. [Dr. Seppala laughs] Tell us, Marv, looking back over your long career, what has changed in addiction medicine?

0:04:59 Dr. Marv Seppala
Oh man. A lot has changed. You know, we have I think the biggest change has probably been in the scientific information about addiction that helps us found what we do—that gives us a foundation for what we do. In a different way than we had before that. You know? And I like to think we combined the two at Hazelden Betty Ford. I think that's necessary—the recovery and the science. And yet the science now—and we have medications for alcohol use disorder, nicotine use disorder, for opioid use disorder, options we never had in the past. We've got evidence-based psychotherapies that actually been proven to work for people that have substance use disorders. And in the past, we've just used our own experience basically, our own recovery. And suggested everybody goes to AA and work the Twelve Steps. Which—it works great when it works. But it doesn't work for everybody. And for some people it's just too much, they can't, you know, get themselves to do it when they leave treatment. Or they can't follow through or they don't do it over time. And so—and some would have you know distinct kind of negative reactions to some of the religious wording in the primary books of AA, you know, and NA even. And—and don't like even the spiritual aspect of it. So they can't get past it. And so there are people that need more and different things. And those options are necessary. Nonetheless, for most people and even you know worldwide, actually AA's growing faster worldwide than it is in the United States. So it—and it's growing fast in countries where you'd never expect it because the founders were basically a bunch of Christian guys. And they—these countries have very few Christians, you know? [chuckles] It's primary religions or both of them or others or lack of it, and it's—it works for people if you can continue to look at it as a spiritual approach and get past kind of religious perspectives that one might have that get in the way. 

0:07:18 William Moyers
So why is it that we talk about addiction being an illness, a chronic illness, an illness with its origins in the brain, but so what is it about the Twelve Steps that work for a substance use disorder?

0:07:33 Dr. Marv Seppala
You know I have a bias about that and it's based on looking at a lot of research over the years about the brain and what's going on there in regard to addiction. But also, this new school of psychology that's about positive psychology that's related to the positive emotions. And like negative emotions, like anger, they just come out, you know? Something happens and we react. And it's hard to control them. The positive emotions though like joy and compassion and love itself, I think that's the power of Twelve Step meetings. It certainly was the case for me. And the literature, the research literature about these positive emotions and what they do for people, fit with that understanding. Because when we express love more frequently, or any of the other positive emotions, but love is the most powerful of them. In order to make change and to test those changes and monitor them in a research study. We can—we think more broadly. We think more creatively. We're more open to possibility. We're more open to the differences that we have from other people that would sometimes get in the way. You know? Of establishing a relationship or going deeper in a relationship. They also—expressing love more frequently—increases resiliency. Which when we enter Twelve Step programs, coming out of addiction, we need resiliency really bad. We also need to be open to ideas because who would put up with all the stuff you gotta do to stay sober and to work a program without benefit of that? And they also—increased expression of these positive emotions—also improves us physically. That basic health measures actually improve. You know and so, we need that too, we're in pretty bad shape physically when we come in. [chuckles]

0:09:42 Dr. Marv Seppala
[continued]
And what happened for me, I walked into an AA meeting at 18 and they accepted me. And they—they actually validated my experience. Which that acceptance and validation was not happening anywhere else. They valued what I said which astounded me. I hated myself, I thought I was unable to you know—I was a high school dropout, I had been disowned by my family, I couldn't stay sober. And they valued my experience and validated that experience. In a way that I couldn't. And they cared for me. I—I say they loved me, you know, that—that's how it felt. I don't remember what they said. I really don't have a clue. What I do remember is how I felt. And how they treated me. And how they treated each other. And that's what got me to come back for a second meeting. That's what got me to keep coming back. Because I arrived at the first one completely out of desperation. And desperation is not lasting. [chuckles] Especially for a 17 or 18-year-old, you know? It was like any—any possibility that I could keep using and not be in such trouble that I could convince myself of even for a few seconds would allow me to, you know, relief of desperation. But how they treated me, the fact that they cared about me, that's what got me back.

0:11:24 William Moyers
When you look back at your career now, what are you most proud of, Dr. Seppala?

0:11:31 Dr. Marv Seppala
Boy. You know, when I think about it, I guess the thing I'm most proud of is—is a concept. And it is that I was able to bridge this gap between the spirituality of Twelve Step programs and the science of addiction. And bring an understanding to people on both sides of that and make sense of it. In a way that I think people respond to. That I was able to use all my training and all the information about the science of addiction in addition to my—my experience and understanding of recovery from—from, you know, my own experience, the experience of hundreds if not thousands of people in Twelve Step programs that I've known over the years, and all my patients, to bring all that to bear. To try to improve the outcomes for people that come into the Hazelden Betty Ford Foundation.

0:12:38 William Moyers
I'm intrigued to hear you say that. I thought you were gonna talk about one of the highlights of your career being when you and the team implemented COR-12, or the Comprehensive Opioid Response, to our patients who are coming to us with an opioid use disorder, and how we responded to that in addition to using the Twelve Steps. That's why it's called COR-12. Tell us a little bit about what COR-12 has meant to you as an addiction psychiatrist, as a Chief Medical Officer of Hazelden, and as a man in recovery.

0:13:13 Dr. Marv Seppala
You know, it's a great example 'cause that would be the specific program I'd be the most proud of. And it actually used exactly what I was talking about. Because we did use both a spiritual you know recovery-oriented examination of what people with opioid use disorder needed in addition to using the medications that had become available to treat opioid use disorders. And had been proven in the literature. And we were able to bring a team together at Hazelden Betty Ford. People across the organization. Counselors and doctors and nurses and we had people who work in our front end that help people admit to the system. We had a public relations person, we had someone from publishing, we wanted a lot of different perspectives on how to do this right. We had Fred Holmquist, one of our—like a Twelve Step guru on the team, you know? [chuckles] To be sure that we were founding it in a way that fit with the rest of our treatment. And this emphasis on the Twelve Steps within our system. And that program we—we figured out over a one-year period, implemented it at the end of that year, and then we studied it over three years and published in the Journal of Substance Abuse Treatment about the outcomes associated with it. And they were tremendous outcomes for people with opioid use disorder.

0:14:49 William Moyers
What's next for you, Marv? I mean you can retire, but as the eagles sang in "Hotel California," you can check out anytime you like but you can never leave. I mean, you live recovery. And you know recovery and the science of addiction. So what are you—what do you see next for you?

0:15:09 Dr. Marv Seppala
You know, I'm gonna take a sabbatical. [laughs] Of my own. Of my own. I'm gonna take a few months and just kinda settle myself and take care of myself and not work for a while. And then I'm gonna figure it out. So I can't specifically answer the question but I will tell you I wanna work for a few more years. Probably 'til I'm 70. So part-time, not full-time. And do some things that I really enjoy. And I'm not sure what they are yet. So I'm gonna probably go to a retreat and spend some time with friends and just discuss this situation and come up with an answer to that. That I don't have a specific answer today.

0:15:49 William Moyers
And as we close, I'm gonna ask you to leave us with a message of hope. Because your whole career has been about giving people the opportunity to find redemption and find recovery and you've managed to do that both as an addiction psychiatrist, a doctor, but also through your own journey. As a man in long-term recovery. So, with the minute or two that we have left, what is the message of hope that you want our viewers and people to hear from you and remember you by?

0:16:26 Dr. Marv Seppala
Oh, well I would say in another couple weeks I'll have 46 years of recovery. Completely abstinent from, you know, substances that can cause addiction. And I've been on a wild ride. [laughs] It's been wonderful in a lot of ways. And I've made my mistakes along the way and I've tried to live my life to the best of my ability based on some spiritual principles. And those things have stood me extremely well. And allowed me to have this career and, you know, I mentioned that I talked with a friend's son last week who's you know he has an alcohol use disorder by his description, I didn't do an evaluation, he just called me up. And I suggested he go to AA because he has no money and no insurance. And he's been going and he's sober and he's bonding with people and he's—he's making it. So it's—to me, that's a message of hope. Because even the most simple form of addressing this disorder, from the onset you know back in the forties, still works. And yet, now we've got this science that also can improve the numbers of people that get sober. And a higher frequency of people will get sober, a higher percentage. And perhaps someday, we'll even have tools that really work from a biological perspective on prevention. To eliminate the risk for those people that are genetically predisposed, I mean that's my hope. That we can stop it before it even, you know, gets established. Our children, our grandchildren, our great-grandchildren. So yeah I think the science is gonna change this field dramatically. And yet, the basics—the basics of AA, the basics of other, you know, psychotherapies for people are gonna still be necessary. You know, if you suddenly stop using and you hate yourself and you've done all kinds of crazy things and illegal things and immoral things, it doesn't go away quickly. And—and it can undermine the rest of your life if you don't take care of it. And yet, in recovery programs, recovery-oriented systems of care, you get that opportunity and we'll all still need that opportunity. We're human beings. [laughs] And we'll do, you know, we'll make mistakes and regret them and have to deal with them. And we have that—that chance as long as we're open enough to talk about it.

0:19:17 William Moyers
[smiles] Hmm. Well you've described your journey as a wild ride, we're glad that you have taken us along on that wild ride. For all these years. And Marv, thanks for your service to this organization, thanks to your service to the community at large, and most importantly, thanks for your service for those who still suffer. With addiction to alcohol and other drugs. You've made a tremendous difference in the lives of thousands and thousands and thousands of people. Including me. I appreciate it.

0:19:45 Dr. Marv Seppala
Ah, thank you William. [chuckles] It's just been a pleasure working with you like this and—and you bring out the best in me. So thanks again.

0:19:56 William Moyers
Thank you, Marv. [turns to camera] And thanks to all of you for joining us today for another edition of Let's Talk. And just a reminder, as Dr. Seppala so eloquently emphasized, if you or a loved one are struggling with a substance use disorder, remember that addiction to alcohol and other drugs does not discriminate, but treatment does work and recovery is possible. So don't wait if you or a loved one needs help. Ask for help and do it now. I'm your host, William C. Moyers, I hope you'll join us for another edition of Let's Talk. See ya soon.