บทถอดความฉบับเต็มของ Ep. 59 - How Brain Function Affects Addiction and Recovery

very much. 00:02:37.280 --> 00:02:38.800 It really wasn't for me. 00:02:39.039 --> 00:02:41.759 Um, and I worked on Wall Street and I stuck with it for a while. 00:02:41.840 --> 00:02:44.000 I worked on Wall Street for a year. 00:02:44.240 --> 00:02:49.360 Uh and then one day uh one of the bosses came in and fired my whole department. 00:02:50.159 --> 00:02:52.639 Everyone was crying and I was smiling. 00:02:53.039 --> 00:02:55.120 And uh I knew I was done with that. 00:02:55.199 --> 00:03:00.879 So I kind of had to go back and sort out what I was gonna do because I never really got a liberal arts education. 00:03:01.919 --> 00:03:04.879 And I decided I wanted to pursue psychology. 00:03:05.120 --> 00:03:08.879 So, you know, the cliches I wanted to help people, right? 00:03:08.960 --> 00:03:11.840 And that's true, and I wanted to learn about what makes people tick. 00:03:12.080 --> 00:03:14.639 So I've kind of been all over the place in psychology. 00:03:14.800 --> 00:03:21.599 So my master's actually was cross-cultural psychology, looking at differences across cultures and schizophrenia. 00:03:21.919 --> 00:03:25.919 But then I decided that didn't really tell me that much about how people work. 00:03:26.159 --> 00:03:28.800 So then I went as biological as possible. 00:03:29.039 --> 00:03:35.919 So in grad school, I was working in a lab with cells uh and mice and rabbits and rats. 00:03:36.400 --> 00:03:39.360 And uh I wasn't very good at that. 00:03:39.520 --> 00:03:46.879 Uh so uh that's kind of how I got into neuropsychology was a more biological approach to psychology. 00:03:47.039 --> 00:03:51.280 And over time, I've actually I do a lot of psychological evaluations as well. 00:03:51.360 --> 00:03:54.719 And we can talk a little bit about the difference between neuropsych and psychopathic. 00:03:54.960 --> 00:03:57.840 Yeah, that's one of my questions in regard to that. 00:03:58.319 --> 00:04:01.599 So why don't we go into that now? 00:04:01.759 --> 00:04:06.719 What's the difference between a neuropsychological evaluation and a psychological evaluation? 00:04:06.879 --> 00:04:17.439 Because many treatment centers for substance use disorder initially do a psychological evaluation, and people really think that that's enough. 00:04:17.680 --> 00:04:28.720 But go into the depth of what neuropsychology Yeah, so the way I think about it, neuropsych generally applies more to people when they're having really cognitive issues. 00:04:28.879 --> 00:04:36.800 And so a lot of the people we see in treatment centers, they may have cognitive issues, uh, but they're not really so critical in the younger population. 00:04:36.959 --> 00:04:41.279 It's different in the senior population who are in treatment centers, and we can talk about that as well. 00:04:41.360 --> 00:04:50.240 Uh, but with neuropsych, I'm generally looking at learning and memory, executive functions like problem solving and judgment, processing speed. 00:04:50.399 --> 00:05:00.639 Um, getting they're doing cognitive tasks and I'm getting data to see how people are oper uh able to operate and by extension in the world. 00:05:00.800 --> 00:05:07.759 And so a lot of the patients I'll see for that are traumatic brain injury, or a lot of times it's does someone have Alzheimer's? 00:05:08.000 --> 00:05:12.319 Um, I see people, a lot of people with stroke actually at the brain injury program. 00:05:12.639 --> 00:05:14.959 And so, how are they doing? 00:05:15.120 --> 00:05:16.079 How are they recovering? 00:05:16.240 --> 00:05:17.600 Can they go back to work? 00:05:17.759 --> 00:05:20.240 And so that's more neuropsych related. 00:05:20.639 --> 00:05:29.120 Um, psych, what I and I really love doing psychovalis, uh, is what we see in a treatment center a lot of times. 00:05:29.279 --> 00:05:37.600 Someone's been a couple times and they've relapsed and gone back into treatment, and the clinicians feel like there's something else going on. 00:05:37.759 --> 00:05:41.759 Maybe there's something driving this, maybe there's a diagnosis that's been missed. 00:05:42.000 --> 00:05:49.439 And so that's when maybe I'll do a little bit of cognitive testing around IQ or ADHD, which is a very common question. 00:05:49.680 --> 00:05:57.839 But by and large, I'm doing a whole range of psychological measures to get at sort of what makes a person tick. 00:05:58.079 --> 00:05:59.439 How do they see themselves? 00:05:59.600 --> 00:06:00.959 How do they see the world? 00:06:01.199 --> 00:06:09.279 Have they developed any habits or coping strategies or defense mechanisms that made sense in the environment they were growing up but aren't working for them now? 00:06:09.920 --> 00:06:14.000 And have they collected diagnoses that they don't really have? 00:06:14.160 --> 00:06:15.199 That's a huge problem. 00:06:15.439 --> 00:06:15.839 Sure. 00:06:16.079 --> 00:06:21.759 And so that's sort of what I think is the the main differences between neuropsych and psych. 00:06:21.920 --> 00:06:32.160 And what a lot of treatment centers do is they'll give someone a questionnaire and they'll call that a psychological evaluation, and it is, but it's just not comprehensive. 00:06:32.319 --> 00:06:32.480 Sure. 00:06:32.639 --> 00:06:41.199 So that that's good, I think, for like people coming in, and then maybe for someone who has something else going on, you refer them for a more comprehensive evaluation. 00:06:41.759 --> 00:07:04.560 So would you start with the maybe the interview question question, the questionnaire, and then go to the psychological evaluation and then go deeper into a neuropsychological evaluation to get really the whole gamut up between what happened to them in their childhood, what's driving this, and then the executive function. 00:07:04.639 --> 00:07:12.879 And you mentioned executive function, let's talk about that because so many people probably don't know what that all means, even though we're doing it every day. 00:07:13.120 --> 00:07:13.439 Sure.

00:07:13.680 --> 00:07:15.600 So tell us more about that. 00:07:15.920 --> 00:07:21.120 Yeah, so executive functions are the ideas that we have a part of the brain that's kind of running the show. 00:07:21.199 --> 00:07:22.399 That's the executive. 00:07:22.560 --> 00:07:34.560 It's involved in things like abstract thinking, problem solving, mental flexibility, like jump uh juggling different things in your mind at one time, planning, and so on. 00:07:34.879 --> 00:07:48.560 And so, in some disorders like ADHD, some people think it's related to a deficit in executive functions, or maybe the executive functions are maturing more slowly in a certain child and so on. 00:07:48.720 --> 00:07:54.879 Uh, the truth is, though, and this is where you kind of get into what can be a little controversial sometimes. 00:07:55.040 --> 00:08:00.240 Um, a lot of times what's when people have ADHD, it doesn't really show up on the neuropsych testing. 00:08:00.399 --> 00:08:04.720 Uh, there's not really a test that's that diagnoses it. 00:08:04.800 --> 00:08:09.600 Although some people will say there is, okay, but I really don't think there are. 00:08:09.839 --> 00:08:12.720 Um a lot of it's by history. 00:08:12.879 --> 00:08:19.519 Uh, when it's severe, I expect to see things on cognitive testing, but more mild kinds you tend not to see as much. 00:08:19.759 --> 00:08:25.360 Uh, I tend to consider ADHD what I would call like a diagnosis of exclusion. 00:08:25.439 --> 00:08:32.799 You have to rule out anxiety, autism, uh learning disorder, something like that. 00:08:33.039 --> 00:08:44.480 Uh so going back to what you asked about diving a little bit deeper, sometimes I'll put executive function measures in uh to a more comprehensive battery, and sometimes I won't. 00:08:44.639 --> 00:08:47.120 Uh depends on the referral question. 00:08:47.279 --> 00:08:52.559 But a lot of times in ADHD, they're going to turn out okay, and they could still conceivably have it. 00:08:53.360 --> 00:09:11.519 So is there a possibility that someone comes to you and the parents think there's this ADHD or the person because they're older and potentially they were diagnosed, but it's trauma related and they're executive. 00:09:11.840 --> 00:09:17.679 So let's talk about how trauma actually affects your executive our executive function. 00:09:18.240 --> 00:09:22.320 Yeah, so I th I think that's what I see a lot of the time, actually. 00:09:22.480 --> 00:09:27.679 A lot of times people come in and they've picked out the diagnosis that seems to make the most sense. 00:09:27.840 --> 00:09:33.440 The problem with ADHD is that it's an attention deficit disorder, primarily. 00:09:33.679 --> 00:09:42.240 Well, problems with attention are part of the diagnostic criteria of depression, of anxiety, of bipolar disorder, of a lot of different disorders. 00:09:42.399 --> 00:09:46.399 Substance use issues can cause difficulties with attention. 00:09:46.720 --> 00:09:50.480 So it's very nonspecific having

an attention problem. 00:09:50.720 --> 00:10:00.000 And then when you get to trauma, uh, I think people group a lot of things into executive functions, right? 00:10:00.240 --> 00:10:16.480 So um I guess if we call it making bad decisions, people will call that executive function problems, but it doesn't necessarily mean there's anything wrong with the brain itself, but there's a whole host of reasons, including trauma, that could lead people to make bad decisions for themselves. 00:10:17.120 --> 00:10:27.919 And we're talking about substance use disorder or someone who's either using alcohol or drugs or a combination thereof, how is that affecting the executive function? 00:10:28.559 --> 00:10:30.559 It can really affect the executive function. 00:10:31.200 --> 00:10:41.919 Beyond the time of their usage, be you know, beyond that, in regard to obviously when they're inebriated, their executive function is poor. 00:10:42.799 --> 00:10:48.320 And how over the years of using, what does that do to someone's executive function? 00:10:48.960 --> 00:10:50.240 That's a really good question. 00:10:50.480 --> 00:10:53.679 Uh I think it depends on the substance they're using. 00:10:54.080 --> 00:10:57.120 Okay, so different substances have different mechanisms. 00:10:57.200 --> 00:11:00.559 Um, and also it depends somewhat on the age of the person. 00:11:00.879 --> 00:11:07.279 So um almost all of them, I believe, can affect executive function. 00:11:07.360 --> 00:11:12.480 Certainly, alcohol can, opiates can, marijuana, I suppose it can. 00:11:12.559 --> 00:11:14.480 It slows processing speed down a lot. 00:11:14.639 --> 00:11:17.600 Uh, as anyone who's been around, people smoke a lot of marijuana know. 00:11:17.919 --> 00:11:23.039 Uh let's see, some of the other ones can affect executive functions too. 00:11:23.840 --> 00:11:29.440 Uh and most of the time, I find that people recover. 00:11:29.919 --> 00:11:36.639 Okay, especially if you're younger and you stay sober for a year or something like that, you're gonna get most of the brain functioning back. 00:11:37.360 --> 00:11:44.320 When I first started working with people in treatment, I was testing a lot of the people who are in their 20s. 00:11:44.399 --> 00:11:49.519 And first off, I found they really don't care if they have cognitive problems when they're in their 20s. 00:11:49.679 --> 00:11:52.480 When they're in their 70s, they're terrified of cognitive problems. 00:11:52.639 --> 00:12:02.960 And so it actually uh can make a difference in how they're thinking about getting sober and reasons to stay sober in someone who's in their 70s, but in their 20s, they don't they don't really care. 00:12:03.200 --> 00:12:09.039 Um, and then I think a lot of people who've been in treatment centers, they talk about how people clear after a couple weeks. 00:12:09.120 --> 00:12:12.720 So you'll start to see some of the cognitive problems start to lift. 00:12:12.960 --> 00:12:15.200 The younger you are, the faster

you clear. 00:12:15.360 --> 00:12:18.480 Just kind of like we don't heal as well with age and a lot of different things. 00:12:18.639 --> 00:12:20.320 The brain doesn't heal as fast. 00:12:20.960 --> 00:12:33.679 So I think for a lot of younger people, you're not gonna see a lot of lasting uh damage from some of the substances, but there's there's some exceptions, which are stimulants. 00:12:34.399 --> 00:12:42.720 So something like cocaine, um there's actually a physiological mechanism that can cause brain damage, right? 00:12:42.879 --> 00:12:45.600 So stimulants can raise your blood pressure. 00:12:46.000 --> 00:12:50.960 When your blood pressure goes up, it can affect the blood vessels in your brain and they can pop. 00:12:51.120 --> 00:12:55.360 And so you can have big strokes or little mini strokes, and that creates brain damage. 00:12:55.519 --> 00:13:02.559 So anything that's really going to raise your blood pressure a lot, that can that actually can cause lasting brain damage, and you see that sometimes. 00:13:02.960 --> 00:13:19.200 And when they have lasting brain damage such as that, what type of therapies or can certain types of therapies provide a recovery to some extent for that, just as much as someone who actually was in a car accident with a brain injury? 00:13:20.240 --> 00:13:22.320 Is it the same therapies or different therapies? 00:13:22.720 --> 00:13:26.799 Yeah, so I think different people come down on this differently and it's it's changing. 00:13:26.960 --> 00:13:30.080 I'm I'm a bit of a skeptic and in some of these things. 00:13:30.240 --> 00:13:33.759 Uh I think the number one thing that causes people to get better is time. 00:13:34.399 --> 00:13:34.799 Right. 00:13:35.120 --> 00:13:40.000 So you're gonna see just spontaneous recovery most of the time over the first year or two. 00:13:40.080 --> 00:13:44.720 And I've seen people continue to show improvements for longer periods of time. 00:13:45.120 --> 00:13:54.960 Uh, I think that when people have some sort of brain damage, one of the main things to do is you have to learn how to adapt to living with whatever changes you have. 00:13:55.360 --> 00:14:02.639 So when I work at the brain injury clinic, I see a lot of, like I said, I see a lot of brain injury and stroke patients there. 00:14:03.120 --> 00:14:09.519 That's the conversation I have with them every day, which is things are are different. 00:14:09.679 --> 00:14:11.519 You hate it, uh, and they hate it. 00:14:11.600 --> 00:14:16.000 It's the number one thing people say, I don't like not being able to do the things I used to be able to do. 00:14:16.240 --> 00:14:17.519 Um, how do you adapt? 00:14:17.679 --> 00:14:23.519 The people who can adapt, they do better than the ones who keep looking back and trying to go back to the past. 00:14:23.759 --> 00:14:35.120 Uh, in terms of treatments, I don't I I think in the in in the short term, you can do things like speech therapy to help you kind of get things moving again. 00:14:35.519 --> 00:14:40.559 But I think in the long term, I I'm not really impressed by the evidence for like the brain training. 00:14:40.879 --> 00:14:48.799 I personally am not a huge fan of quantitative EEG, as I mean, I think maybe it can help you focus a little bit more, but beyond that, I'm not really sure. 00:14:49.120 --> 00:14:51.840 I think sometimes there's claims for what it can do. 00:14:52.000 --> 00:14:58.159 I'm not really up on the hyperbaric oxygen treatment, but I haven't seen great uh results with that. 00:14:58.399 --> 00:15:04.159 So unfortunately, a lot of times with the brain injury, there's not so many effective treatments that I see. 00:15:04.559 --> 00:15:24.000 So this is really interesting because in Michigan, where we do work with catastrophic brain injury, we're always looking at the first two years of their injury as the most, the biggest window of opportunity for any type of rehabilitation needed in recovery. 00:15:24.240 --> 00:15:44.480 Whereas in Florida, and and because of the services that can be provided under the auto-no-fault law, less than that used to be, but the services can be started immediately in regard to speech therapy, occupational therapy, physical therapy, those types of therapies. 00:15:45.360 --> 00:15:58.960 But yeah, in Florida, if you don't have the resources, then you're waiting two to five years, probably more like five years, before you have a lawsuit potentially to have money to even afford those types of therapies. 00:15:59.279 --> 00:16:03.840 So I'm I'm just wondering if somebody would do a study at some point. 00:16:04.080 --> 00:16:05.600 I think there are studies out there. 00:16:05.679 --> 00:16:06.879 I don't, I can't name them. 00:16:07.120 --> 00:16:07.360 Sure. 00:16:07.679 --> 00:16:16.960 But um to determine those people that may recover within the first two years if they have the resources available. 00:16:17.279 --> 00:16:18.720 Yeah, I think you raised an important point. 00:16:18.799 --> 00:16:19.360 Let me go back. 00:16:19.440 --> 00:16:23.600 I I I work in a place with physical therapy, occupational therapy, speech therapy. 00:16:23.679 --> 00:16:24.799 I'm a big believer in those. 00:16:24.879 --> 00:16:29.600 I just think there's sometimes other things that are being marketed to people that I'm a bit skeptical of. 00:16:29.919 --> 00:16:30.480 Of course, yeah. 00:16:30.799 --> 00:16:34.159 Yeah, and I think there is a lot of research that the first two years are the most important. 00:16:34.320 --> 00:16:36.799 You want to get people into treatment as quickly as possible. 00:16:37.120 --> 00:16:52.080 Yeah, and um, I know that hyperbaric was uh was really, you know, became a private pay scenario, but people become very um they want to do whatever it can they can to make that recovery. 00:16:52.159 --> 00:16:56.320 And I haven't seen that recovery with brain, uh, excuse me, with hyperbaric. 00:16:56.879 --> 00:16:59.840 I haven't, but I I've heard some

people who say that it helps them. 00:16:59.919 --> 00:17:00.559 So Yeah. 00:17:01.360 --> 00:17:32.799 And it could be it could be the type of brain that um interesting enough, I did have a client, not with uh motor vehicle accident, but um a long-term alcoholic who what did receive treatment at CARIN and was given hyperbaric oxygen, not for the brain injury, but for um some residual bone injury from his radiation therapy. 00:17:32.960 --> 00:17:33.200 Okay. 00:17:33.759 --> 00:17:45.039 And as he got the hyperbaric oxygen treatment for this residual uh bone injury, he did have improved cognitive function. 00:17:45.519 --> 00:17:55.039 But was that because he stopped drinking versus the in a combination of that um because it happened at the same time? 00:17:55.359 --> 00:18:05.440 Yeah, I had a I had a patient also who was an older adult who had been an alcoholic who did the hyperbaric and reported uh positive outcomes, but you always have that problem. 00:18:05.599 --> 00:18:06.720 Is it because of sobriety? 00:18:06.960 --> 00:18:08.400 Is it because of uh oxygen? 00:18:08.480 --> 00:18:09.119 It's hard to know. 00:18:09.440 --> 00:18:10.240 Right, right. 00:18:11.200 --> 00:18:22.319 So there are um obviously so many different areas for the neuropsychological evaluation, and you went through all of those. 00:18:22.559 --> 00:18:46.799 Um one of the reasons these evaluations are so valuable is they provide answers and maybe treatment going forward or ability to determine the treatment going forward versus um, or not even versus, and the psychological needs that they may have to, as you say, adapt to the injury that they sustained. 00:18:47.119 --> 00:19:00.000 Um somebody that is very high functioning all of a sudden has a stroke and they're only in their late 50s or early 60s and they were high functioning, that's a hard one to swallow. 00:19:00.640 --> 00:19:01.119 For sure. 00:19:01.599 --> 00:19:15.680 And um what what type of what type of um psychological care do you express for them to have for their adaptation to this injury? 00:19:16.960 --> 00:19:24.960 Yeah, I mean, so unfortunately I see a number of people who are 30, 40, 50, who have strokes for whatever reason. 00:19:25.599 --> 00:19:27.200 Um it is hard, right? 00:19:27.279 --> 00:19:34.240 So a lot of times they'll need to speak with a psychiatrist to get some medication to help them feel better or to help them focus. 00:19:34.480 --> 00:19:40.720 Sometimes you'll see Ritalin or a stimulant that can be helpful when they can't really focus that well. 00:19:40.960 --> 00:19:45.759 Often also after like a stroke, people fatigue more quickly. 00:19:46.000 --> 00:19:53.039 So something like a stimulant or another medication to help keep them awake uh can help them be more functional. 00:19:53.119 --> 00:19:56.000 So I think psychiatry definitely has a role to play there. 00:19:56.319 --> 00:19:58.960 And then speech therapy. 00:19:59.200 --> 00:20:06.799 So a lot of people, it's a lot of people don't realize that speech therapists are the ones who do a lot of the cognitive rehabilitation work. 00:20:07.359 --> 00:20:07.680 Right? 00:20:07.759 --> 00:20:12.160 It's not just talking, it's also the memory and all that kind of in the organization. 00:20:12.319 --> 00:20:15.519 So working with a good speech therapist is really important. 00:20:15.839 --> 00:20:18.480 Uh, one who has experience with brain injury. 00:20:19.119 --> 00:20:25.839 Um and then physical therapy is really important because you don't want people falling again and getting hurt, right? 00:20:26.000 --> 00:20:44.799 So uh and then in terms of psychotherapy, you wanna have you want them to work with a therapist if they can uh to help them adapt to the illness and sort of reorient and figure out how to get the most out of their life and do what they want to do. 00:20:44.960 --> 00:21:06.079 Like, for example, um just a little bit of a different example, but there was uh an older attorney that I work with who came to see me for an evaluation just independently, and he said, Look, uh we've all seen the attorneys who were really good attorneys, but they held on too long and they became a laughing stock. 00:21:06.160 --> 00:21:10.000 And we say, I don't want to become a laugh laughing stock, but I want to keep practicing. 00:21:10.160 --> 00:21:12.480 So uh let's see where I'm at. 00:21:13.519 --> 00:21:25.839 So we did an evaluation, and he was in his 80s and at the 99th percentile and a lot of things, 75th percentile and other things, 50th percentile, pretty good. 00:21:26.000 --> 00:21:39.359 When he compared them to someone in his 80s, when he compared them to someone in their 50s who he's gonna be arguing against, we said the second percentile on some things and the fifth percentile, because we just kind of slowed down in some ways as we get older. 00:21:39.599 --> 00:21:51.039 And so when I presented him the data, he said, you know what, I'm gonna step away from litigation uh because I'm not quick enough to think on my feet, but I can advise the younger attorneys on strategy and and so on. 00:21:51.200 --> 00:21:52.480 So he was able to adapt. 00:21:52.880 --> 00:21:55.359 That's incredible that he had the insight to do that. 00:21:55.519 --> 00:21:59.759 How many, how many people do that to determine where they're gonna go? 00:22:00.240 --> 00:22:02.400 At 80 years old in their career. 00:22:03.200 --> 00:22:03.680 Yeah, not a lot. 00:22:04.000 --> 00:22:04.720 He was an exceptional person. 00:22:05.200 --> 00:22:05.359 Wow. 00:22:05.599 --> 00:22:08.720 That's very, very uh amazing. 00:22:09.440 --> 00:22:15.759 Um so we did talk about substance use and how that affects the executive functioning. 00:22:16.079 --> 00:22:27.599 Um what um specifically can the testing do that a clinical interview doesn't cover? 00:22:28.240 --> 00:22:30.799 Yeah, that's one of the main questions I get, right? 00:22:31.039 --> 00:22:42.559 So uh psychologists will say to me,

like, Brooks, if I spent eight hours with a patient, because that's about how long in a valve is seven or eight hours, if I spent eight hours with a patient, I'd figure I'd know everything about them too. 00:22:42.799 --> 00:22:47.359 So why should they go see you uh and not just come see me? 00:22:47.440 --> 00:22:56.079 And and the answer is psychological testing is trying to get at what people can't tell you about themselves. 00:22:56.240 --> 00:23:03.119 Like that's the if if it were only about like what they knew about themselves already and they could tell us, then you wouldn't need to do it. 00:23:03.200 --> 00:23:05.440 But a lot of times we don't see ourselves so clearly. 00:23:05.599 --> 00:23:13.440 And so what psychological testing can do is compare someone to other people their age, sometimes by their their gender. 00:23:13.599 --> 00:23:16.079 So compare I say this all the time. 00:23:16.319 --> 00:23:30.000 So I'll give them a test, which will say the MMPI or the PAI or two very commonly used self-report measures, and I'll say, look, you're at the 10th percentile compared to other men in terms of uh being dominant, all right? 00:23:30.079 --> 00:23:32.000 So like a dominant submission kind of thing. 00:23:32.160 --> 00:23:34.960 So you're you're more submissive than 90% of men. 00:23:35.680 --> 00:23:36.000 Okay. 00:23:37.519 --> 00:23:44.240 Well, you came in here wondering why you're not at where you're why you are not where you want to be in your life. 00:23:45.680 --> 00:23:47.759 Do you think you give in to people too much? 00:23:47.839 --> 00:23:52.559 Because that's what the testing's saying, and that could be could that be part of what's answering your question? 00:23:52.799 --> 00:23:59.039 So I like to use the data that comes up on the the range of tests to spark a conversation. 00:23:59.200 --> 00:23:59.519 Yeah. 00:23:59.759 --> 00:24:05.759 And so if you see one finding on one test, all right, you can't make too much out of it. 00:24:05.839 --> 00:24:20.400 But if you see it across multiple tests that they're having a problem with setting boundaries and uh giving in to other people's and being a people, uh being a people pleaser and so on, then all of a sudden you feel a little bit more confident that maybe that's what's going on with them. 00:24:20.559 --> 00:24:21.839 So that's just one example. 00:24:22.160 --> 00:24:26.960 But you can use this data from a range of IQ. 00:24:27.599 --> 00:24:37.039 Okay, so even on IQ testing, I don't want to give away all my tricks, but like there'll be people who will say, uh, this test is so stupid when they have a problem. 00:24:37.200 --> 00:24:40.000 Or they'll say, I'm so stupid, right? 00:24:40.160 --> 00:24:42.960 So are they blaming something else, or are they blaming themselves? 00:24:43.119 --> 00:24:45.680 And you can already see a little bit of how they're dealing with stress. 00:24:46.240 --> 00:24:53.920 Okay, so um one thing that just going off on a tangent, a lot of people put a lot of stock in IQ. 00:24:54.400 --> 00:24:58.400 Uh, I think it's important, but I don't think it's important as a lot of people think it is. 00:24:58.480 --> 00:25:05.440 I give a little bit of IQ testing just to make sure I'm not missing something significant, like a low IQ, which has different implications. 00:25:05.920 --> 00:25:12.480 So, but I also give something called projective testing, which is like the most famous is the Rorschach inkplots. 00:25:12.559 --> 00:25:16.720 And some people are like, Really, Brooks, you're a board certified neuropsychologist, you give the inkplots. 00:25:16.880 --> 00:25:21.519 Uh, I do uh because sometimes that adds data. 00:25:21.759 --> 00:25:35.920 Um and sometimes I have people talk about uh early memories they have and so on, and then you can start seeing patterns in these more ambiguous uh tests, which is what projectives are. 00:25:36.000 --> 00:25:39.759 They don't tell you as much there's not as much rules about how to complete them. 00:25:39.920 --> 00:25:44.720 So then the person's idiosyncratic way of doing things emerges. 00:25:44.960 --> 00:25:46.960 So you can see their defense mechanisms. 00:25:47.119 --> 00:25:51.119 I mean, for example, the person who laughs all the time. 00:25:52.640 --> 00:25:55.359 They say something, it's not funny, they laugh. 00:25:56.000 --> 00:26:00.640 And maybe they often the people who laugh a lot, they say I'm sorry a lot. 00:26:00.960 --> 00:26:09.279 So you just start writing it down as they're speaking, how many times they're saying I'm sorry, and you're you show them, and they they don't even know. 00:26:09.519 --> 00:26:14.880 So the point is you're using the tests as a way to have a conversation. 00:26:15.200 --> 00:26:15.440 Right. 00:26:15.599 --> 00:26:25.440 And that conversation then can be can be taken into more in-depth psychological treatment for them if they care to work on those areas. 00:26:25.839 --> 00:26:26.640 Absolutely. 00:26:27.039 --> 00:26:39.039 And um what I find interesting is you that you're talking about IQ, and we are we also have the book out and talk about emotional IQ. 00:26:39.200 --> 00:26:39.359 Sure. 00:26:39.599 --> 00:26:49.119 And you're looking at emotional IQ and many other tests that will come out in in regard to the patterns that they've developed over their years. 00:26:49.759 --> 00:26:56.559 Yeah, you can really see if people are uh handling their emotions healthily or not, right? 00:26:56.799 --> 00:27:05.599 And so I don't have, unfortunately, a single emotional IQ test, but you you kind of uh can put it together from their test scores. 00:27:05.759 --> 00:27:13.200 Like on the MMPI, one of the things that's nice is if they're they have a section that's called internalizing test scores. 00:27:13.359 --> 00:27:16.480 So if they're all elevated, you know they're holding in their emotions. 00:27:16.640 --> 00:27:20.000 If there's another section, externalizing score scores. 00:27:20.240 -->

00:27:21.680 So they're acting it out. 00:27:21.759 --> 00:27:25.440 And you could see how people are dealing with their emotions. 00:27:25.759 --> 00:27:29.920 Now, can you come up with I know psychiatrists come up with diagnosis? 00:27:30.079 --> 00:27:38.480 Do they use neuropsychological evaluations to come up with diagnoses as part of their diagnostic um evaluation? 00:27:39.119 --> 00:27:49.279 So I don't think you some do, some I mean, I you don't need to to come up with a- psychiatrist doesn't do this testing, the neural psych testing, but would would it be beneficial for them? 00:27:49.359 --> 00:27:52.960 Because so many people are diagnosed, misdiagnosed, I should say. 00:27:53.279 --> 00:27:59.839 Yeah, I think for a basic depression or anxiety or something like that, you don't need to send someone for a psychological evaluation. 00:28:00.240 --> 00:28:04.960 But what about bipolar or um sometimes. 00:28:05.200 --> 00:28:09.680 I mean, I think the the more obvious bipolars, not as much, right? 00:28:09.839 --> 00:28:19.119 I mean, if there's a family history and there's really discrete uh separate episodes and so on, then you don't really need to have someone come in for a bipolar disorder. 00:28:19.200 --> 00:28:25.279 It's more when treatment's not working, the patient's stuck, they're making the same mistakes. 00:28:25.599 --> 00:28:30.640 Okay, uh, maybe it's time to have another set of eyes and get some testing done. 00:28:31.039 --> 00:28:36.319 And you're saying making mistakes, I'll go back to executive function and relapse. 00:28:36.480 --> 00:28:46.079 So um, why is it so important to have um a longer period of time in treatment? 00:28:46.319 --> 00:28:48.720 Well, I'm I'm actually answering my question. 00:28:49.839 --> 00:28:56.240 A longer period of time in treatment helps with your executive functioning, which helps with preventing relapse. 00:28:56.799 --> 00:29:00.799 Um but not everyone actually has that opportunity. 00:29:00.960 --> 00:29:11.279 Is there are there other ways staying sober, of course, but other ways that people can improve their executive functioning and improve their relapse? 00:29:12.000 --> 00:29:16.319 Yes, so I think a lot of things get lumped into executive functions sometimes, right? 00:29:16.400 --> 00:29:24.559 And so I actually see it all the time, like in the referral question, why does this person have uh such poor executive functions? 00:29:24.720 --> 00:29:33.680 Um, and it's sort of assuming that the executive functions is the problem when they're, I think the question, what it's really being said, why are they making such bad decisions? 00:29:33.839 --> 00:29:36.160 Why are they so disorganized, and so on? 00:29:37.119 --> 00:29:47.200 So if you look at something like emotion regulation, a lot of people aren't really good at regulating their emotions and they act impulsively when they're experiencing an intense negative emotion. 00:29:47.440 --> 00:29:55.039 Well, that's going to look

like poor executive functions, or maybe that is poor executive functions, that's like not helping the person manage those emotions. 00:29:55.200 --> 00:30:02.720 So I think if someone can learn to one of the best ways to make better decisions is to learn to manage your emotions better, better. 00:30:02.799 --> 00:30:13.359 So you slow down and you don't do anything impulsive and risky, which relapse in one way or another, or do something that's going to create more problems in your life. 00:30:15.279 --> 00:30:20.880 So uh how does trauma affect the executive function? 00:30:21.200 --> 00:30:31.680 Is that as the same as if somebody were in a car accident and or drug user, alcohol user? 00:30:32.319 --> 00:30:35.279 Um I think it's different, right? 00:30:35.519 --> 00:30:41.279 So in uh a car accident, there's actually damage to the brain, right? 00:30:41.359 --> 00:30:42.880 So that that's gonna be different. 00:30:43.039 --> 00:30:52.960 And then in someone who's using a lot of substances that impair how the brain's operating, that's gonna that's sort of like brain damage, even though it's mostly temporary. 00:30:53.119 --> 00:30:55.599 I I think I didn't get to it earlier. 00:30:55.920 --> 00:31:05.920 Older adults and people who've used a really long time, when they get sober, most of the time they'll come back, but then I they may not come back all the way. 00:31:06.240 --> 00:31:06.559 Okay. 00:31:06.720 --> 00:31:11.359 So I just younger, younger people tend to be a little more resilient in that way. 00:31:11.519 --> 00:31:21.039 Uh, but going back to trauma and executive functions, I think trauma interferes with the ability to focus and pay attention because you're you're you can be thinking about other things. 00:31:21.359 --> 00:31:25.920 Uh anxiety can come out of trauma, which interferes with attention. 00:31:26.480 --> 00:31:32.240 Uh trauma can affect, like we just talked about, how you deal with your emotions and the choices that you make. 00:31:32.720 --> 00:31:39.440 So I think uh those are the main ways I think trauma probably ends up affecting the executive functions. 00:31:42.720 --> 00:31:47.599 Um you talked about the impulse control and attention. 00:31:48.400 --> 00:31:50.640 So how can a brain heal? 00:31:50.799 --> 00:31:52.960 And you talked about time. 00:31:53.759 --> 00:31:54.240 Yes. 00:31:55.759 --> 00:32:12.559 Can we expect a particular period of time or is that individual per, you know, a person like a male person at the age of 70 is going to take longer potentially than a 20-year-old you you mentioned. 00:32:12.799 --> 00:32:16.559 Um, but is it all individualized as well? 00:32:17.359 --> 00:32:19.920 It's not totally individualized, I would say, right? 00:32:20.160 --> 00:32:30.160 So, I mean, the current thinking on, say, concussion, because I I work a fair amount with people with concussions, is that they tend to resolve uh within three months. 00:32:30.400 --> 00:32:34.960 So concussion is the same thing

as a mild traumatic brain injury. 00:32:35.119 --> 00:32:45.440 Uh it generally involves no loss of consciousness or loss of consciousness of less than 30 minutes, no blood in the brain on imaging, and so on. 00:32:45.599 --> 00:32:49.680 Uh so for that kind of injury, it's about three months or less. 00:32:49.839 --> 00:32:51.920 It can be a lot faster, a couple weeks. 00:32:52.160 --> 00:32:57.519 Uh, with a brain injury or stroke, it tends to take like a year or two. 00:32:57.839 --> 00:33:04.480 Um, is when you get most of your recovery, but you're gonna see most of the improvement in the beginning, right? 00:33:04.640 --> 00:33:08.960 Uh, for example, a lot of times in the hospital, right after injury, people can't speak. 00:33:09.279 --> 00:33:17.440 And within a couple of weeks, they're speaking again, or they can't walk in the first couple of days, and then they're walking with a walker within the first week to two weeks, sometimes. 00:33:17.920 --> 00:33:19.119 Those are huge improvements. 00:33:19.200 --> 00:33:21.519 Going from not walking to walking is a big deal. 00:33:21.759 --> 00:33:29.119 Um with substance abuse, I think you start seeing improvements pretty quickly. 00:33:29.200 --> 00:33:32.480 Uh, but in the older adults, uh, it it can take a while. 00:33:32.640 --> 00:33:37.119 It can take six to twelve months, I think, for people to kind of get back to normal. 00:33:38.160 --> 00:33:50.319 Is it uh appropriate to do a neuropsychological evaluation on anyone coming in, for instance, over the age of 60 with long-term alcohol or drug use? 00:33:52.000 --> 00:33:53.119 I don't think so. 00:33:53.359 --> 00:33:55.839 Because they're all they're gonna have impairments, right? 00:33:56.000 --> 00:33:59.440 So I just I think you kind of already know what you're gonna get. 00:33:59.599 --> 00:33:59.920 Sure. 00:34:00.079 --> 00:34:04.079 Uh it's more about is there a concern? 00:34:04.240 --> 00:34:05.839 Is the person a CEO? 00:34:06.160 --> 00:34:06.480 Right? 00:34:06.640 --> 00:34:12.800 And then before they're discharged and they're going back to work, let's take a look at it, see how they're up operating. 00:34:13.039 --> 00:34:21.920 Uh, do they have sometimes you can have more severe permanent impairments, or you can have maybe an Alzheimer's that's being masked by uh the alcohol use. 00:34:22.000 --> 00:34:25.679 And it's hard to tease it apart uh when someone's just recovering. 00:34:25.920 --> 00:34:28.719 But there's issues sometimes related to guardianship. 00:34:29.760 --> 00:34:37.119 Uh look, I see a lot of people who work their whole lives to build up some wealth and they want to leave it to their kids. 00:34:37.360 --> 00:34:42.880 And then at the end of their lives, they're not thinking clearly for whatever reason, and there's a lot of scammers out there. 00:34:43.039 --> 00:34:43.360 Sure. 00:34:43.599 --> 00:34:52.960 Like it's a whole industry targeting seniors, and uh they make decisions that they they jeopardize uh what they really work their whole life towards. 00:34:53.119 --> 00:34:55.840 So I think guardianship decisions are actually really important. 00:34:56.000 --> 00:35:00.800 So that I think when there's a specific reason, that's when you call in neuropsych. 00:35:01.519 --> 00:35:12.320 Uh so and like I said, sometimes when people are in their 60s and 70s, they get scared uh if they're having cognitive problems and it can help them stay sober. 00:35:16.000 --> 00:35:17.920 The um I had Dr. 00:35:18.159 --> 00:35:22.559 Stephen Klein on a little while back about GLP1s. 00:35:23.039 --> 00:35:36.559 And um and having that used to keep the uh the triggers or quiet the brain so that someone may not go back to drinking so quickly. 00:35:36.800 --> 00:35:48.320 And I'm wondering if that's going to be very helpful for older adults who have dementia and may not remember that you know that they're actually drinking. 00:35:48.639 --> 00:35:57.920 Um because I have we have had a client who doesn't remember when he last drank or how much he's drank. 00:35:58.079 --> 00:36:05.840 Um, so having that GLP1 would be able to potentially suppress some of the that for that person. 00:36:06.079 --> 00:36:06.960 I'm just wondering. 00:36:07.440 --> 00:36:07.760 I don't know. 00:36:08.159 --> 00:36:09.440 That's such an interesting idea. 00:36:09.599 --> 00:36:10.320 I'm curious. 00:36:10.480 --> 00:36:22.800 I mean, I've seen similar um, you know, there was I I used to do neuropsychological vows or psychological vows for uh spinal cord stimulators for pain management. 00:36:22.960 --> 00:36:31.679 So I don't know if there still is, I don't really do them, but they the insurance used to require an evaluation before someone had a spinal cord stimulator implanted. 00:36:31.840 --> 00:36:37.199 And one of the doctors I talked I talked to, I said, What are you looking for in terms of ruling out someone doing it? 00:36:37.360 --> 00:36:43.519 Do you do you not want to give uh a spinal cord stimulator to someone who has dementia? 00:36:43.599 --> 00:36:49.760 He said, No, no, I want to, because this is better than giving them painkillers that that are gonna cloud their cognition. 00:36:50.320 --> 00:36:57.280 Uh so I I do think sometimes there are these medical advances that can help us get around the problem. 00:36:57.360 --> 00:36:59.360 So I hadn't thought about that for GLP once. 00:36:59.599 --> 00:37:00.320 That's kind of exciting. 00:37:00.639 --> 00:37:03.360 I I really find it to be exciting, yes. 00:37:03.599 --> 00:37:05.199 They're used for so many other things. 00:37:05.360 --> 00:37:09.519 This would be a really, really good thing for them to be used for. 00:37:10.400 --> 00:37:15.679 So um what does this research tell us about neuroplasticity? 00:37:17.440 --> 00:37:19.440 That's a really popular topic. 00:37:19.519 --> 00:37:26.719 I I mean there is neuroplasticity, uh, I think in part throughout the life. 00:37:26.880 --> 00:37:30.559 Um again,

I I tend on the skeptical side. 00:37:30.880 --> 00:37:35.760 Uh, I think some of the claims out there for what can be done is a little bit oversold. 00:37:36.400 --> 00:37:49.519 Uh I have I I think when people have significant cognitive impairment due to brain damage, like I think you do your work in speech therapy and and on your own, and you try to get back as much as you can. 00:37:49.760 --> 00:37:57.760 But uh I think when you hit a plateau after a while, that's probably gonna be about where you are. 00:37:58.079 --> 00:37:58.400 Sure. 00:37:58.559 --> 00:38:03.119 And what I see sometimes is patients who are still just driving themselves. 00:38:03.360 --> 00:38:11.920 Like I'm playing hours of brain training games a day, or their family members kind of yelling at them, go I was gonna say the family members probably more so, right? 00:38:12.079 --> 00:38:15.840 Because they want them to return back to what they were. 00:38:16.159 --> 00:38:19.519 Yeah, and I think they're like, well, the neuroplasticity is gonna get you back. 00:38:19.599 --> 00:38:31.840 And I I think there's always this problem in rehab, especially early on, which is you don't know where you're gonna end up uh in terms of getting in terms of what you're gonna get back. 00:38:32.719 --> 00:38:42.000 And so I I think like the physical therapists and the occupational therapists are always telling people like, push, push, push, go, go, go. 00:38:42.079 --> 00:38:48.480 You want to get everything back, you want to get back as much as you can, which is right, you know, they they really push and motivate people. 00:38:50.719 --> 00:38:56.480 But at some point, it kind of has to shift to this is what I've gotten back. 00:38:56.559 --> 00:39:03.679 And that transition from hope to like acceptance is a tough transition for people. 00:39:04.000 --> 00:39:04.400 Sure. 00:39:04.800 --> 00:39:07.679 And that comes with a different type of therapy. 00:39:08.239 --> 00:39:08.559 Yeah. 00:39:09.280 --> 00:39:13.119 And a family that's going to support that as well. 00:39:13.840 --> 00:39:19.199 Yeah, I I mean the family is, I mean, you know, so important, right? 00:39:19.360 --> 00:39:24.719 The people who have family support versus people who don't, it makes all the difference in the world. 00:39:25.119 --> 00:39:25.519 Sure. 00:39:27.519 --> 00:39:30.320 I want to talk a little bit about the concussion. 00:39:30.400 --> 00:39:42.559 You said that um you work with the uh team and and being able to identify when a football player can go back to play. 00:39:43.119 --> 00:39:58.880 How many concussions or what is the the serial concussions and the issue with depression and sometimes suicide that some of these football players, once they retire, they continue to go on. 00:39:59.039 --> 00:40:01.039 Can you talk a little bit about that? 00:40:01.679 --> 00:40:03.920 Uh yeah, there's a couple things there. 00:40:04.079 --> 00:40:12.400 One, uh right now I work with the Panthers, uh, and I'm involved in the return to play decisions for the hockey players. 00:40:12.639 --> 00:40:15.519 Um that's one thing. 00:40:15.760 --> 00:40:25.840 Um with respect to the repetitive head trauma, I have to be a little careful what I talk about because I work with the NFL concussion settlement, and it's actually in my contract. 00:40:25.920 --> 00:40:28.960 I'm not allowed to talk about it too much. 00:40:29.119 --> 00:40:35.440 Uh I can't talk about the specifics of the concussion settlement, but I've seen a lot of former players. 00:40:35.840 --> 00:40:48.239 Um I think that um yeah, I think a lot of people and a lot of parents are worried about the big concussion. 00:40:48.719 --> 00:40:58.320 If there's if their kid comes in, they're 15 and they had a serious concussion, or they've had a couple concussions, they're really worried about long-term problems. 00:40:59.039 --> 00:41:02.400 I don't think that's what's going on with the football players. 00:41:02.639 --> 00:41:20.400 I think with the former football players, they've been playing ball since they're like 10 years old, and they've had practice where they're hitting for whatever practice is fall, spring, summer, it's like year-round now for kids. 00:41:21.119 --> 00:41:22.639 And it's all those hits. 00:41:22.719 --> 00:41:24.239 It's all the hits in the practice. 00:41:24.559 --> 00:41:31.519 It's not it's not the one or two big hits, it's the small the repetitive smaller hits that's causing the problems. 00:41:31.840 --> 00:41:38.400 And I mean, if you're playing since the age of 10 on up to I don't know, say 25 or something like that. 00:41:38.719 --> 00:41:43.360 I mean, you could have 20 exact, you know, concussions in a video. 00:41:43.679 --> 00:41:47.440 Yeah, 20 sizable and thousands of like smaller. 00:41:47.920 --> 00:41:50.719 Just on every play, you're hitting the person in front of you. 00:41:50.960 --> 00:41:53.599 So I think that's where a lot of the trouble comes in. 00:41:55.199 --> 00:42:07.360 For um someone who's feels discouraged because they're struggling with focus, organization, and decision making, um, what would you recommend for their healing? 00:42:08.480 --> 00:42:10.320 Well, it depends what's driving it, right? 00:42:10.480 --> 00:42:15.280 So, I mean, if we're saying it's due to, say, brain injury or stroke or something like that. 00:42:15.760 --> 00:42:25.440 Um first thing I would I would recommend is get to a physician who's an expert in brain injury or stroke. 00:42:25.599 --> 00:42:37.519 There's a lot of neurologists that are generalists, so they'll see a little bit of MS or Parkinson's and some Alzheimer's, but they're they don't see brain injury or stroke all the time. 00:42:37.599 --> 00:42:39.519 So you want someone with specialized training. 00:42:39.679 --> 00:42:46.880 A lot of times that's something called a physiatrist, which a lot of people haven't heard of, but those are the rehabilitation medicine doctors. 00:42:47.519 --> 00:42:52.880 Uh,

some there are people who are board certified in brain injury medicine at this point as physicians. 00:42:53.119 --> 00:43:00.159 So in general, I think that's supposed to be the captain of your ship when you're recovering from something like that. 00:43:00.320 --> 00:43:10.880 So if you can find someone who's an expert in brain injury, the medications are a little bit different uh sometimes that people use and or don't use. 00:43:11.280 --> 00:43:11.679 Sure. 00:43:12.000 --> 00:43:19.199 So, because right, I think a lot of people know it, but the benzodiazepines like Valium, colonapenzanax, they have cognitive effects. 00:43:19.280 --> 00:43:21.519 And there's a lot of medications that have cognitive effects. 00:43:21.679 --> 00:43:29.360 So you want to make sure that you're not taking something trying to help yourself, like often as someone to go to sleep, that's actually hurting your cognition. 00:43:29.599 --> 00:43:30.079 Right. 00:43:30.480 --> 00:43:40.400 Um, then they may refer you to a neuropsych just to get an evaluation to see what's going on. 00:43:40.719 --> 00:43:45.119 So uh people can have problems with memory for a lot of different reasons, right? 00:43:45.280 --> 00:43:50.159 So, one reason is uh you're forgetful. 00:43:50.320 --> 00:43:53.920 Like Alzheimer's, that's classically people just don't remember. 00:43:54.159 --> 00:43:56.400 But a lot of people, they can't focus. 00:43:56.559 --> 00:43:57.760 If you can't focus, you can't learn. 00:43:57.840 --> 00:43:59.119 You don't can't learn, you can't remember. 00:43:59.199 --> 00:43:59.599 Well, maybe. 00:44:00.239 --> 00:44:02.800 Can take a medication that helps you focus. 00:44:03.440 --> 00:44:11.679 Or you learn, you work with a speech therapist or uh a neuropsychologist who's more psychotherapy oriented. 00:44:11.920 --> 00:44:17.679 A lot of neuropsychologists just test all the time, and you learn strategies to minimize distraction. 00:44:17.920 --> 00:44:26.880 So I think there are uh things people can do, but it it does get people down when they are they're not thinking as clear clearly as they used to. 00:44:27.199 --> 00:44:27.599 Sure. 00:44:27.920 --> 00:44:48.800 I want to talk about the coordination of care because we work with you in uh getting the testing done and then getting the recommendations, and then and then you've talked throughout all of this in regard to a psychiatrist, a physiatrist, a psychologist, a speech therapist, an occupational therapist. 00:44:48.880 --> 00:44:53.039 There's a lot of coordination of care for all of these individual people. 00:44:53.280 --> 00:45:09.360 So once the testing's done, it's really what what starts that coordination of care at the at the evaluation summary that you describe to the patient, or how would that I mean, I I know how we start it. 00:45:10.000 --> 00:45:15.840 I mean, that's that's I mean, a big problem with our medical system right now is that everyone's in their different silos. 00:45:16.000 --> 00:45:22.000 I'll say that uh at the brain injury clinic where I work, we have team meetings. 00:45:22.239 --> 00:45:27.360 So we discuss the patients, so that that forces coordination of care. 00:45:27.440 --> 00:45:32.800 So I think you'll see a lot of coordination of care in the first few months after an injury, right? 00:45:32.960 --> 00:45:41.119 So people are in the hospital, then they'll go to an inpatient rehabilitation program, and maybe then they'll go to an outpatient rehabilitation program. 00:45:41.280 --> 00:45:43.840 In those settings, there's coordination of care. 00:45:44.800 --> 00:45:53.760 After you leave an outpatient rehab setting, I mean, there's at least in Florida, you were talking about this earlier, there's really not that many resources. 00:45:54.719 --> 00:46:00.559 And then you get doctors who are busy with their schedules, and so it is really hard to coordinate care. 00:46:00.639 --> 00:46:03.039 So, I mean, I think having a case management firm is ideal. 00:46:03.199 --> 00:46:12.000 Not everyone can do that, but I think that's ideal because I can write a report, I send it over to the doctor, the doctor may read it, may not read it, right? 00:46:12.159 --> 00:46:16.800 I try to make mine super simple, like a big box on the front page with the conclusion. 00:46:16.880 --> 00:46:20.079 So all they have to do is look at it for 15 seconds. 00:46:20.239 --> 00:46:23.440 And if they want uh greater depth, they can look at it. 00:46:23.599 --> 00:46:30.079 I this is an aside, I I tend to keep my report short because doctors don't have time. 00:46:30.880 --> 00:46:37.280 And also, I think a lot of psychologists who do testing write really long reports that no one reads and no one understands. 00:46:37.440 --> 00:46:39.360 Uh, I think that's totally unhelpful. 00:46:39.679 --> 00:46:53.440 So uh so, in terms of the coordination of care, it it really involves phone calls, I think is the best way from one clinician to another, but that doesn't always work. 00:46:53.920 --> 00:47:01.679 As a case manager, um we would start by sitting down with you, hopefully with the patient and the family to get the results. 00:47:02.159 --> 00:47:03.119 Well, you guys are amazing. 00:47:04.719 --> 00:47:18.079 Yeah, like when I work with you, you have I give the results to the patient, the family, and someone from here to then from there, then go to the physician for the prescriptions to start the therapies, and then you're right. 00:47:18.320 --> 00:47:43.920 Phone calls, scheduling, follow-up, everyone knowing what each one is doing and the progress and or potentially no progress, and maybe this would help versus this, and going back to a neural to you or another neuropsychologist to retest to determine, and let's talk about that because you can't retest in two months. 00:47:44.159 --> 00:47:50.159 So, what is the time frame that generally that you would retest someone to see where they're at? 00:47:51.280 --> 00:47:55.440 Well, you you

can occasionally retest in two months if you need to. 00:47:55.599 --> 00:48:08.800 I mean, what would be an example is sometimes in certain cases, like uh someone has a brain shunt because they have normal pressure, a hydrocephalus, and you want to see if the shunt worked or not, so you could see if there's change pre and post and something like that. 00:48:08.880 --> 00:48:11.119 But you're right in general, you don't do two months. 00:48:11.280 --> 00:48:18.159 Uh I think depending six to twelve months is what I generally recommend. 00:48:18.480 --> 00:48:22.559 Uh, and would it be important to follow up with that? 00:48:23.119 --> 00:48:36.639 How many how many times do you retest someone that potentially had um an assault to their brain, uh a car accident, or they were assaulted? 00:48:36.800 --> 00:48:44.000 And what is important for the retesting along the continuum of care as long as they're obviously getting therapies? 00:48:44.960 --> 00:48:50.159 Yeah, I tend towards a little bit less retesting. 00:48:50.320 --> 00:48:56.880 I think that uh going to doctors can be real burdensome on families. 00:48:57.039 --> 00:48:57.440 Sure. 00:48:57.679 --> 00:49:01.119 And uh they already got a lot on their plate a lot of the time. 00:49:01.360 --> 00:49:06.480 So I I only like to retest if I think it's actually going to be useful. 00:49:06.639 --> 00:49:12.559 I think a lot of times there's just a formulaic retest in one year that's in a lot of reports. 00:49:12.880 --> 00:49:18.400 Um I think at the beginning, maybe a little more frequently, right? 00:49:18.719 --> 00:49:25.039 So um to see how someone's doing, like, but often when there's a question, right? 00:49:25.119 --> 00:49:34.159 So if it happens to a young person who's in college, right, you want to test them before they go back to school, so you can work out accommodations, you can work out a plan. 00:49:34.400 --> 00:49:36.159 Should they take one or two classes? 00:49:36.320 --> 00:49:38.239 Are they ready for a full load? 00:49:38.559 --> 00:49:44.239 Uh and maybe you would if they're still having problems in a little while, you would retest them again. 00:49:44.559 --> 00:50:10.639 Um and I I had a yeah, like I had a case not that long ago where someone had a moderate head injury, uh, and they had to come home from school, and I tested them, and then they stayed home a semester and uh retested them right before they went back to school just to kind of see where they were at and they were doing a lot better, which was great. 00:50:10.960 --> 00:50:34.719 Uh, speaking of school, it would be very, very important to have the testing if they're having any type of um difficulty in school, um, to determine what is it that's extra tools that they may need, uh whether it be extra time or um tutoring or whatever that may be, whether they're in middle school, high school, or college, right? 00:50:35.039 --> 00:50:36.320 It's really important, right? 00:50:36.480 --> 00:50:50.960 So that they

get, you know, there is this whole thing that where I think accommodations are often exploited a little bit for people who don't need them, but they're really there for like the people who are trying to get back on their feet after a head injury, they need the accommodations, right? 00:50:51.119 --> 00:50:51.280 Right. 00:50:51.440 --> 00:50:56.320 And so I think it's really important before going back to school that you you kind of get that sorted out. 00:50:56.559 --> 00:51:05.840 Another issue I see sometimes are families who are like, okay, Johnny's back to normal, and they really want their kid to be back to normal, and the kid is not back to normal. 00:51:06.079 --> 00:51:12.639 They send him back to college and he's still having problems and he They can't do it, they can't do it. 00:51:12.880 --> 00:51:23.519 And then so I think the testing can sometimes help families get a realistic sense of what's actually going on with their child and make appropriate plans. 00:51:24.079 --> 00:51:36.960 So in our um milieu of clients, we've come up with sometimes some a diagnosis of neurodiversity from neural psych testing. 00:51:37.119 --> 00:51:37.280 Yeah. 00:51:37.440 --> 00:51:39.039 Do you see that more often now? 00:51:39.280 --> 00:51:42.000 And w what's what's going on with that? 00:51:42.480 --> 00:51:45.280 Yeah, I mean, that's what people are talking about right now, right? 00:51:45.519 --> 00:51:59.119 Um yeah, I'd say the past two years, I have so many people calling in uh for autism evaluations that that wasn't really happening, I don't know, a few years ago as much. 00:51:59.280 --> 00:52:02.800 And I think it's just social media is driving a lot of that. 00:52:03.119 --> 00:52:14.320 And uh ADHD is kind of similar, and now there's Audi HD, which is like autism ADHD is like another thing you're hearing about. 00:52:14.880 --> 00:52:20.880 And so I think it's very important to be cautious in diagnosis. 00:52:20.960 --> 00:52:22.960 I I it's something I really think about a lot. 00:52:23.039 --> 00:52:30.559 Like I see people accumulate so many diagnoses, uh, and then they begin to believe that they're really sick. 00:52:31.440 --> 00:52:39.920 And I do think if you go to enough doctors, like I saw a mother the other day who was saying, uh, yeah, my son, he was, you know, having manic behavior and manic. 00:52:40.320 --> 00:52:46.719 He wasn't bipolar, but he kept, she kept using the word manic, and he was on something like lithium, right? 00:52:47.039 --> 00:52:51.920 Because you tell the doctor you're manic, you're gonna end up diagnosed with bipolar disorder. 00:52:52.159 --> 00:52:58.400 So uh I take diagnosis very seriously in terms of like being conservative about it. 00:52:58.559 --> 00:53:02.639 Uh, and I I do think there's a pathologizing of everyday life that's happening. 00:53:02.880 --> 00:53:05.840 Like, yeah, like everyone gets bored and boring classes. 00:53:06.000 --> 00:53:12.480 Like that's and then people I hear a lot masking, right? 00:53:12.559 --> 00:53:13.920 That's a trendy term. 00:53:14.079 --> 00:53:23.679 And they say, yeah, I have to mask how I actually am, like when I go out in public, like okay, but we all kind of do a little bit also. 00:53:24.079 --> 00:53:34.960 So it's a continuum, but there is a pathologizing of everyday life that's happening right now, and so just grounding diagnosis in data uh is important. 00:53:35.599 --> 00:53:48.960 It's important not to just rely on checklists um because patients come in now and they're completely familiar with the diagnostic criteria for autism, ADHD, OCD, et cetera. 00:53:49.039 --> 00:53:54.559 So if I give something that says ADHD checklist, they'll check all the all the boxes. 00:53:55.360 --> 00:54:05.760 Um so that's why I I like giving these more complicated uh tests like the MMPI, it's just one I keep saying, but it's not the only one. 00:54:05.920 --> 00:54:08.639 It's a little less obvious. 00:54:08.960 --> 00:54:20.880 And another thing, this is a little bit of an aside, what but one thing that's really important is including what we call validity testing in the evaluation, which is just are people faking their problems or not? 00:54:21.119 --> 00:54:21.440 Sure. 00:54:21.679 --> 00:54:23.519 And you can fake in two main ways. 00:54:23.679 --> 00:54:26.880 You can fake that you have a lot of problems, or you can fake that you have no problems. 00:54:27.760 --> 00:54:33.039 And so a lot of ADHD evaluations I see. 00:54:33.280 --> 00:54:38.800 So someone goes into a treatment center for Adderall addiction. 00:54:39.039 --> 00:54:42.800 Uh, they'll be referred to me, they're in an argument with the treatment center. 00:54:42.960 --> 00:54:45.920 I have ADHD, you're denying me my medicine. 00:54:46.079 --> 00:54:48.400 How am I supposed to focus in these groups? 00:54:48.719 --> 00:54:50.400 They get sent to me. 00:54:50.559 --> 00:54:58.719 Uh, I have to include the validity testing to make sure that they're being honest because there is secondary gain and that they want uh substance potentially. 00:54:58.880 --> 00:55:05.360 And I look at the their old evaluations and they never included any tests to make sure that they were being honest. 00:55:05.599 --> 00:55:06.079 Interesting. 00:55:06.320 --> 00:55:07.440 And it happens a lot. 00:55:07.920 --> 00:55:14.639 And so yeah, that's well, we do have a country full of Adderall. 00:55:15.599 --> 00:55:16.159 Yeah. 00:55:16.320 --> 00:55:21.519 Um over the years it's just increased, increased, and it's become a problem. 00:55:22.000 --> 00:55:24.239 I think I have I have two teens. 00:55:24.480 --> 00:55:28.079 Uh they're under so much pressure, the kids, right? 00:55:28.159 --> 00:55:38.320 Like, I don't know what happened, I guess it's social media and being scrutinized, or I don't know, maybe my generation's uptight, but I think the young people are under so much pressure to perform and be perfect. 00:55:38.400 --> 00:55:48.719 And um and I see

that in the eating disorder treatment centers when I when I work with those, you see a lot of that. 00:55:48.880 --> 00:55:54.159 Uh, a lot of the people who are actually in the substance use treatment centers, some of them have that. 00:55:54.559 --> 00:56:02.079 Um and so I think stimulants make you focus, they help you perform. 00:56:02.480 --> 00:56:07.119 But they also rob people of their sense of being able to do things on their own. 00:56:07.440 --> 00:56:10.639 They think they really need the stimulant to perform, right? 00:56:10.800 --> 00:56:13.280 Which is a shame, and it also helps you not eat. 00:56:13.360 --> 00:56:18.400 That's an aside, but that's why it's popular among one reason it's popular among the eating disorder patients. 00:56:18.639 --> 00:56:25.360 So, yeah, I do think there's a real problem with perfectionism among uh teens right now. 00:56:26.159 --> 00:56:44.960 If there's anything that we missed throughout this uh that you want to tell the listeners right now of the importance of and when would be the most important time to do neuropsychological testing or summarize what we've just discussed, what would you like to say? 00:56:45.599 --> 00:56:45.840 Sure. 00:56:46.000 --> 00:56:51.360 I think what I'd like to say is I think it the testing should have a point, right? 00:56:51.519 --> 00:56:53.360 Like, what do you want to know? 00:56:53.599 --> 00:57:00.079 And so I always ask patients and families and referring clinicians, like, what do you hope to get out of the evaluation? 00:57:00.400 --> 00:57:05.039 Uh one way of doing it is saying, do you have any questions about yourselves? 00:57:05.280 --> 00:57:07.920 Uh sometimes it's about diagnosis. 00:57:08.000 --> 00:57:13.519 Like, is there I think let me put it differently, there's two main things I think psychological testing can do. 00:57:14.320 --> 00:57:19.119 One is diagnosis, uh and that's really important, right? 00:57:19.360 --> 00:57:24.800 So let's take borderline versus bipolar, right? 00:57:25.119 --> 00:57:32.960 So both present with impulsivity, mood that goes up and down, and also relationships. 00:57:33.039 --> 00:57:35.599 Okay, there can be a lot of problems in relationships. 00:57:35.920 --> 00:57:36.239 Okay. 00:57:36.960 --> 00:57:44.079 So distinguishing between the two is really important because the treatments are are different, right? 00:57:44.400 --> 00:57:54.000 So if you have bipolar disorder and you've been diagnosed with borderline personality disorder, you can sit in groups for years. 00:57:54.159 --> 00:57:56.880 You're not going to get better unless you're on the proper medication. 00:57:57.599 --> 00:58:00.079 And then the converse is true. 00:58:00.320 --> 00:58:13.199 So if you have borderline personality disorder and they're giving you medications for bipolar, you're you're on medications that can affect your body and you're not getting the coping skills and treatments that you need. 00:58:13.360 --> 00:58:15.679 So diagnosis is obviously really important. 00:58:15.840 --> 00:58:24.320 But for a lot of things, it's really more what we talked about, which is the bad mental habits that people have accumulated over the years. 00:58:24.480 --> 00:58:37.599 So, like a lot of it's whether it's big T or little T trauma, but whatever environment you grew up in, you developed your idiosyncratic way of dealing in the world, you get out into the real world and it doesn't work anymore. 00:58:37.760 --> 00:58:48.239 And maybe your strengths carry you for a while, but then you just you hit a wall and you don't see yourself, you don't see the problems that you're having. 00:58:48.400 --> 00:58:59.760 And if we can kind of show you like what's going on with you that you're not aware of and can make a real and make a really big difference, and then you make treatment recommendations based on that. 00:58:59.920 --> 00:59:02.159 So that's the psych side. 00:59:02.559 --> 00:59:13.280 On the the brain injury stroke side, uh I I think the they're hard conversations, right? 00:59:13.360 --> 00:59:25.199 Because you're you're uh you're giving people a realistic assessment of where they're at, and they don't often or not often, they don't always want to hear it. 00:59:25.440 --> 00:59:27.599 Some do and do great. 00:59:28.159 --> 00:59:36.320 And I've seen others who are physicians or accountants who go back to work and they shouldn't be going back to work. 00:59:36.880 --> 00:59:38.880 Uh well, driving is another one too. 00:59:39.039 --> 00:59:40.320 Oh my goodness, driving. 00:59:40.800 --> 00:59:40.960 Okay. 00:59:41.599 --> 00:59:42.800 Or in South Florida. 00:59:42.960 --> 00:59:43.199 Yeah. 00:59:44.000 --> 00:59:48.480 I don't know how many times I've seen cars speeding through the red light, like recently. 00:59:48.559 --> 00:59:51.440 It's it happens at least on a daily basis. 00:59:51.760 --> 00:59:53.280 Oh man, it's terrible what's going on. 00:59:53.679 --> 00:59:53.840 Yeah. 00:59:54.079 --> 01:00:00.079 Uh and there's a lot of we there's a lot of people who are driving who shouldn't be driving, and it's really hard. 01:00:00.159 --> 01:00:02.400 Some people give up the keys and other people won't. 01:00:02.639 --> 01:00:02.960 Sure. 01:00:03.119 --> 01:00:08.880 Uh, and so part of my job sometimes is really to be the bearer of bad news. 01:00:08.960 --> 01:00:10.559 Like you really shouldn't be driving. 01:00:11.360 --> 01:00:13.840 Uh you can't live alone anymore. 01:00:14.159 --> 01:00:14.559 Right. 01:00:14.719 --> 01:00:19.360 And so, and then sometimes you get in situations where the kids disagree. 01:00:19.519 --> 01:00:19.840 Sure. 01:00:20.000 --> 01:00:20.159 Right? 01:00:20.239 --> 01:00:23.679 They're like, no, dad can't do this, or no, he can. 01:00:24.000 --> 01:00:29.280 And and the and I think um these are all like hard life decisions. 01:00:29.360 --> 01:00:31.920 Uh, and most of the time everyone's just trying their best. 01:00:32.159 --> 01:00:40.079 And I think having a little bit of accurate data, like numbers to compare, really can help people make the best decision for their family. 01:00:40.639 --> 01:00:41.599 Well, thank you so much. 01:00:41.760 --> 01:00:49.360 This is a wealth of information, a lot of information, then I but I appreciate you coming on and talking about this. 01:00:49.519 --> 01:01:01.440 And maybe we can talk about some more psychological evaluations and how we how bring you back on to talk about some more specifics and of that. 01:01:01.679 --> 01:01:04.239 Um, today I was focusing more on the neuropsych. 01:01:04.559 --> 01:01:15.440 But I think the having the ability to have the psychological evaluations and turning someone's life around from where they are that's not working to where they would like it to be. 01:01:15.599 --> 01:01:17.599 I think that's a really important thing. 01:01:17.840 --> 01:01:22.079 If people can realize that that may be something that they can work with. 01:01:22.320 --> 01:01:27.039 So thank you, listeners, for coming today and listening to this podcast. 01:01:27.199 --> 01:01:29.039 I really appreciate you. 01:01:29.440 --> 01:01:37.599 And you can reach Feinberg Consulting at FinebergCare.com or 248-5385425 and Dr. 01:01:37.679 --> 01:01:38.639 Larry Brooks. 01:01:39.039 --> 01:01:40.639 How can listeners reach you? 01:01:40.960 --> 01:01:45.840 I think the easiest way is just to go to my website, which is Larrybrooks PhD.com. 01:01:46.320 --> 01:01:47.039 Very simple. 01:01:47.440 --> 01:01:47.840 Thank you so much. 01:01:48.639 --> 01:01:50.239 Thanks a lot for this opportunity. 01:01:50.719 --> 01:01:51.760 It was great. 01:01:52.159 --> 01:01:54.559 Thank you for joining the conversation today. 01:01:54.719 --> 01:02:05.119 If you are seeking help for yourself or a loved one, please reach out to our Feinberg Consulting Team at 248-538-5425. 01:02:05.599 --> 01:02:10.239 That's 248-538-5425. 01:02:10.639 --> 01:02:14.239 And check out our website at feinbergcare.com. 01:02:14.960 --> 01:02:18.320 I'm grateful for our guests and all who have joined us today. 01:02:18.480 --> 01:02:23.840 Make sure you follow us on Apple, Spotify, or anywhere you listen to podcasts.