Speaker 1: 0:31

Welcome to the Husband Material podcast, where we help Christian men outgrow porn. Why? So you can change your brain, heal your heart and save your relationship. My name is Drew Boa and I'm here to show you how let's go. Hey man, thank you for your interest in today's conversation about psychiatric medication for Christian men outgrowing porn. You are going to get answers to questions like well, how should I view this from a Christian perspective and what are some of these specific medications or approaches that I might consider? You are going to get amazing wisdom from Adam O'Neill, who is a physician assistant. He practices Christian psychiatry and he's the author of the book the Mind After Eden Psychiatry in a Post-Fall World.

Speaker 1: 1:19

I think you're really going to enjoy this conversation. It might bring up some deeper questions, which is why we are doing a live Q&A later this month, so that you can get more guidance about your specific situation and how medication may or may not fit into that. Enjoy. Welcome to Husband Material. I'm here with Adam O'Neill, a physician assistant, fellow graduate of Wheaton College, who is here to help us understand how psychiatric medication can possibly help men on the journey of outgrowing porn. Welcome to the show.

Speaker 2: 1:57

Thank you, Drew. It's an honor to be here with you.

Speaker 1: 2:00

Okay, who is Adam O'Neill?

Speaker 2: 2:03

That's a good question. I'm still figuring out. It takes a lifetime, I think, to understand who we are. But I would say that, if I had to summarize it, that I'm a person who's been very curious about the world that God has made from a young age. I was that kid who got in trouble for doing impromptu home science experiments that made a mess and microscopes and pond water and all that good stuff. But I knew that from a young age. I also knew that I really loved people. I loved working with them In the none weirdest creepiest way possible. I said I love studying people, I love understanding them and just seeing how they work. Combining those two loves brought me to where I am.

Speaker 2: 2:47

Initially I studied behavioral science. It's the field that looks primarily at certain behaviors and how do we change them, how do we adjust them. But it was really after I went to Wheaton and started studying more cognitive psychology and neuroscience that this interest in understanding the neuroscience of pornography and how it impacts men's lives very pervasively. One of my thesis projects was on the neuroscience of pornography. I really understood after that how prevalent this issue was and that I feel like every lunch from then on until the end of the semester was filled with some sort of a meeting from a friend or a fellow student who was like, hey, I need to hear more about that. I need to understand what's going on. This is a very important issue. I then got my medical training at Thomas Jefferson University in Philadelphia and it was only recently that I moved out of Philadelphia into owning my own practice just outside of the DC area. I find myself just outside DC and Virginia currently. Brief overview of who I am and how did I get where I'm at.

Speaker 1: 3:59

You too. Why is this topic so important?

Speaker 2: 4:04

I think honestly, three big reasons. First, it's pervasive. Your organization, other prominent ones in the field have really made it known that this is something that when you compare church populations to the general population, they're quite similar. This is an issue that needs attention. Secondly, we need, I think, as Christians and as a church, an increased understanding of addiction, of how do we think about this issue, not just from the perspective of our faith and our spiritual walk, but from a neurologic perspective, from neuroscience and some of the advancements that we've seen in those fields. Definitely that's an important component. Then, thirdly, there's some growing body of evidence, there's new studies and case reports coming out about the potential for medications to actually be helpful in helping men outgrow poor and men and women in the ways that they work on those specific receptor types. I'm sure we'll chat about those Because they can be stewarded well and I think you said it well is that it may be it possibly could be an important part of someone's walk that we should be talking about this issue.

Speaker 1: 5:25

You're working as a Christian in the field of psychiatry, so what are some of the common objections you hear from Christians about what you do?

Speaker 2: 5:39

Mental health struggles or specifically, as we're talking to today's struggle with pornography, is a faith issue and it should be addressed through increased prayer or faith alone. It's a prominent feeling viewpoint in the church. To that I answer that by saying you know, it is a faith issue. It impacts our spiritual walk, but it's also a physical issue, and one of my common phrases that I talk to my patients about when they say I'm worried, I just need more faith, is well, I need more faith. We all need more faith. I mean, that's part of what this is all about.

Speaker 2: 6:15

And simultaneously, the use of medications don't negate the need for more faith. We can pursue both. It's not an either or, but a both. And One of the other big reasons why someone might not pursue medications or might hear objections towards Christian psychiatry is because perhaps they distract from some of the hard work that should be done. You know, again, kind of leaning on that idea of these are faith issues. They should be answered with a faith response.

Speaker 2: 6:44

But you know, honestly, I think Mike Emlett, who's worked through the Christian Counseling Education Foundation and just recently was speaking at a conference, I think he said it best when he said you know, trying to do hard work while addiction, anxiety, depression, rage is on is kind of like trying to do a deep sea diving expedition while there's hurricane, force winds on the surface of the sea. So you know, really, in order to dig deep, in order to do the hard work that must be done, we have to calm those winds, we have to provide the soil on which we will grow. You know this, this important work that needs to be done. So probably one of the most common referrals I get in the field is actually from counselors who say you know, we really want to do the hard work. We just are finding that, with the level of various mental health concerns that are going on, that's just not, it's not possible. So we need some help and I'm glad to assist.

Speaker 1: 7:43

I'm hearing you say we don't have to choose between spirituality and psychiatry, that they can go together, and that this can also go together with the deeper work we do at husband material of healing our hearts and our childhood experiences.

Speaker 2: 8:02

Absolutely, absolutely. I would say that, although psychiatry, among all the medical specialties, is the most, if you did a survey of psychiatrists, more would report either having no faith or being identifying as an atheist than any other field. For me personally, I believe no field. Is it more important that we have a firm understanding of our worldview, what it means to be a body and a soul? So yeah, absolutely, like when, ideally, in a perfect world, a psychiatrist would be able to have the discussions with patients about what elements of this might be coming from a faith faith issue and what elements might be coming from a physical or biological issue. So, definitely, I think the combination of those two things is absolutely essential.

Speaker 1: 8:51

Adam. I want to read a quote from your book the Mind After Eden, the very beginning. You say there are differences of opinion in how best to incorporate, if at all, secular psychological theory into a Christian psychiatry practice. The biblical counselor might ask why should we look outward when we have been given everything we need for right and healthy living in the Bible? The integrated psychologist would respond because God made it and it is good. I loved that. Thank you for that.

Speaker 2: 9:25

Yes, absolutely. I know we both went to Wheaton and Wheaton does a great job of showing God's goodness and God's beauty through what he has made, and made well, absolutely.

Speaker 1: 9:39

Right. So part of my hope with husband material is to explore the many different beautiful gifts God has given us spiritually, psychologically, relationally, physically. And this is adding a really important dimension to the conversation, because I know that a number of guys have maybe thought about medication but have concerns, and others are taking medication and they have doubts and they maybe have a little bit of shame and wondering is this okay? So your voice in this conversation is so helpful.

Speaker 2: 10:25

Thank you, drew. I'm honored to be a part of it and I think if any of us would like to be more open about the struggles that we go through, I feel like the church as a whole would benefit to see. You know I'm not the only one. You know, and I have that unique opportunity and vantage point you know as accepting referrals from nearly all local churches to know that these issues are very much common to man and that you are not alone in your struggle and you're not alone in your questioning and in the uncertainties, and I would just encourage you to continue taking those concerns to God, continue working through them with your counselors and with your doctors, and trust that God is good in the midst of the struggle.

Speaker 1: 11:10

How do you view this issue of attachment to pornography from a Christ-centered perspective?

Speaker 2: 11:17

It's important that we understand ourselves as both a physical body and an immaterial soul, spirit, that we do believe in this dual nature of what it means to be human. And I've often said that. You know, god is very good at making beautiful physical things I mean, go to see the ocean, go watch a sunrise, go to the Grand Canyon. Like God makes beautiful physical things that display his glory, and he also, although I haven't seen it myself, have seen through scripture that he makes beautiful what is also spiritual, purely spiritual. You know there's angelic beings and things like that that are made a spirit and are glorifying to him. And yet when he comes to make humans, when he makes us the chief or crown jewel of his creation, he chooses to do it in this bimodal way and in being both physical and spiritual. And I think that's very purposeful.

Speaker 2: 12:15

You know I practice integrated Christian psychiatry and that's sort of how I relate to you know my faith and my medical work, and that you know one of the core tenants of that practice is that the mantra, so to speak, of all truth is God's truth, like if you find something to be true, if you find it to be true through the microscope or the telescope, or through his word, his revealed word, the scripture. It comes from him. He's the source of that truth. So, given that you know, we then look to the good gifts of common grace in medicine and psychotherapy and we look to steward them well. So I think it's a mixture of all those things that set the stage for understanding mental health and these issues from a Christ centered and a clinical perspective.

Speaker 1: 13:04

What would you say to someone who says God made us very good, so why do I need some other medication to supplement that?

Speaker 2: 13:17

I think that's where we do truly lament the impact of the fall on every aspect of what it means to be human. So from cognitive processing ways that we look at the world, we see faulty ways of thinking. There's lists of cognitive distortions, which is a very humbling thing to look up because I experience them every day. Things like mind reading, where it's like I know exactly what that person is thinking about me or about what I've said. Or black and white thinking, if it's always all or nothing. So that's just one example, or two examples of how it's impacted our psychology.

Speaker 2: 13:54

But then I don't view it differently that when I was in surgery rotations and participating in these intense surgeries that I would see tumors and sickness. That is also a result of the fall. I'm not saying personal sin necessarily, but absolutely from the impact of the fall. So I think God has made things that are very good. He made it and said it is good. But we also have to acknowledge the impact of the fall on not just our spiritual state and our relationship to God, but also in our bodies and minds as well.

Speaker 1: 14:30

And that's what your book goes into a lot the Mind After Eden.

Speaker 2: 14:34

Yeah, it was my initial exploration into a lot of those concepts. How do I think about this fallen world? How do I think about practicing as a medical provider in it and trying to continue that redemptive work that God is about? I mean, he is healing and performing miracles in and through these good gifts every single day, and I'm just honored to play a part of it in it.

Speaker 1: 14:58

Let's talk about some specifics. How can certain medications practically help Christian men on the journey of outgrowing porn?

Speaker 2: 15:09

Yeah, yeah. So I think we have to start out with understanding reward circuitry. It is very similar in the majority, if not all, types of addictions that we see. So deep brain structures towards the center of the brain are responsible for reacting to behaviors that we perform that are generally good for our species. So food, eating food, interpersonal bonding, sex these are things that are good for us as humans and are good gifts that God has given. Normally, the frontal lobe, which is our more higher order executive functioning area, helps us regulate these impulses and say okay, I may want or desire this in this instance, but perhaps there's a better way to accomplish that. Normally, when we do something that's good for our species, we're rewarded for it. We want to do it again.

Speaker 2: 16:01

The problem is when what we'd call supernormal stimuli, like pornography, come into this good circuitry that God has made in this good system and hijack it, they give a biologically supernormal, as I said, stimulus that mimics connection, mimics intimacy, mimics the procreation of our species, but is nothing of the sort. It's actually quite the opposite. So when we look at the use of medications and I'll certainly talk about specific ones, but we're looking at either impacting the reward circuitry process, this sort of hijack process or look at the ways that we may treat sort of a primary condition which pornography is actually the symptom of. So things like depression or anxiety or even trauma, which I know you've done work in these areas and have kind of explored some of that but treating those symptoms is effective at helping with pornography use, because pornography is not the main problem, it's the symptom. So if we treat it directly and we don't get to the deeper issue, we're really not going to make much progress. So let's talk about certain medications Some of the most common that I would prescribe, things like an agent called naltrexone.

Speaker 2: 17:27

It's an opiate antagonist or opiate blocker and it's gained in popularity for helping people with a variety of addictions, everything from online gambling to overeating alcohol use and compulsive masturbation, pornography, among other things. That has gained popularity and we're still in the case report phase, especially as it relates to pornography, so we don't have large scale randomized, controlled trials yet. Lord willing, I think that that's coming, but the data that is coming out in case reports is promising and it's been helpful. And then, if we're looking at treating depression or anxiety, some of the most helpful things that I look at are sort of the SSRI medications, the typical antidepressants and this is more focused on when we're seeing pornography use as a self soothing mechanism rather, you know, for things like untreated depression or anxiety, rather than it being a primary, like addiction, pathway concern.

Speaker 1: 18:31

SSRI, if I'm correct, stands for Selective Serotonin Reuptake Inhibitor. Right Boom, you got it, you got it, that's it, that's it.

Speaker 2: 18:43

Yeah, and they are very common and people oh my goodness, the looks I get when I you know various things I'm prescribing for and someone says, why are you giving me an antidepressant? I'm not depressed and you know much of psychiatry is producing a med and then finding, oh my goodness, this works for like five or six other things that we had no idea. So, yeah, these meds work on the serotonin system, so that's why they work as a selective serotonin reuptake inhibitor, as you said. But they don't just treat depression, you know, and there's a lot of off-label use. In fact, naltrexone, used in pornography addiction, would be an off-label use, meaning the FDA did not say, you know, rubber stamp this for being like, yeah, this is what this med is for, but that doesn't mean it's not effective, you know. So that's sort of what we're talking about when we are talking about these meds.

Speaker 1: 19:33

And with every medication there is also a downside. So what are some of the potential drawbacks with any psychiatric medication?

Speaker 2: 19:46

Yeah, we are always looking at side effect profiles of meds. So you know, and it has to be a risk-benefit conversation with a patient, so we are basically assessing whether or not the potential benefits that we would get out of trialing the med are outweighing significantly any potential side effects that may come up. So you know, for things like naltrexone, you know there are and can be issues with sleep, maybe headaches. Any time we're putting something in your stomach from supplements to medication, there's a potential for stomach ache, there can be some mood fluctuations and then we need to be mindful if patients have liver or kidney issues, because that's where a lot of the processing of these medications occur. And then, as an opiate blocker, if a person needs opiates for severe chronic pain, we would not want to give them something like naltrexone which would block the effectiveness of that.

Speaker 2: 20:43

With things like SSRIs and the antidepressant category, you can see. You know more gastrointestinal issues, weight fluctuations, dizziness, headache. But again, with these meds, usually with time the side effects will remit and go away. So I would say 95% of the time side effects go away. But it's that time, you know that, 5% where it's problematic and we really need to consider whether or not it's helpful, and then more ethos wise, I'll say you know, medications don't do the hard work.

Speaker 2: 21:16

As I said, they set the stage for hard work. So if we were to look at these meds and say, you know, this is going to solve this issue for me or this is going to be the end, I'll be all of this, it's just not going to be there. It's going to hopefully create the stage on which to do the difficult hard work, as we talked about. So I would say, anytime we sort of swallow a worldview along with the pill of like this is going to cure me and this is going to take it away, that's when we need to be very cautious. So, in addition to side effects, I just add that piece about you know, we still need to do hard work, we need to be diligent about that.

Speaker 1: 21:50

That's so helpful in setting expectations. One thing I've heard from a few men is that certain medications will dampen or reduce the range of emotions that they feel, which can be helpful for calming the storm, and yet, at the same time, it seems like something is lost too.

Speaker 2: 22:13

It is true and I would say that the goal for my patients, what I tell them is, when I am assessing for the effectiveness of a med, I want to know that that med helps them feel more themselves, not less themselves. So if a med is making you feel less yourself, that's a problem. You know, I truly believe that when the fit is right with these medications, patients will say to me I got I feel more myself. Or a loved one will say I got my mother back, or I have my father back there themselves again. And that's what we're really looking for.

Speaker 2: 22:47

Sometimes it's a matter of changing the med, Other times we just need to reduce the dose. You know, one of the problems and I think in the field is we just frequently go to really high doses and because we want to see results and when a much lower dose could potentially be helpful. So I would say if anyone is experiencing sort of a dampening of who they are, who they've been made in Christ, that we should certainly be reassessing and looking at. Are there changes we could make?

Speaker 1: 23:15

And that's so helpful when setting expectations for a medication. What's the typical length of time people will use them for?

Speaker 2: 23:26

It does vary, of course, patient to patient, but there are general guidelines. You know, it depends first on what we're treating. But if we have like, let's say, a certain addiction or, you know, maybe we're treating anxiety or depression, we usually try to find the right fit and that can take some time, frustratingly long, and fortunately in some cases. But once we find the right fit, we like to continue that med for around six months to a year. That timeframe, the reason I think it works, is because that allows for significant brain changes, structural brain changes, to occur, so that once the med is tapered, what we're left with is all of those good thinking habits, all of those good structures, so that the med is not needed anymore.

Speaker 2: 24:11

Now there are cases where meds are needed long term and I've worked through that from a faith perspective, from a philosophy perspective, and I'm okay with that. You know, I think each person needs to work through how they feel about that. But, yes, some cases of resisted depression, anxiety and addiction may require lifelong treatment. So that's definitely a conversation that you know someone would want to have with their provider.

Speaker 1: 24:38

I really liked what you were saying about how we need to set our expectations appropriately for the result of potentially taking a medication For someone who's struggling with porn. What can they expect?

Speaker 2: 24:57

The case reports and the things that I've read, as well as the experience that I've seen with my patients, is generally a reduction in the frequency and intensity of desire to watch pornography. We're looking for both of those that they may find that there's still some desire there to pursue pornographic material, but it's not as intense as it was. What that allows for is just the ability to use all those coping skills and the things that have been put in place as safeguards to get that extra mile there. Then, in terms of frequency, we do see actual numerical reduction frequency. If a person is pursuing these meds, it's likely that they'll be asked to quantify in some ways the amount of time they spend number of sessions, things like that so that we can actually track that over time. I would encourage listeners to see these case reports and look at the charts and look at the graphs that have been posted of the substantial decreases in both frequency and intensity that occur on these meds.

Speaker 2: 26:08

What's helpful in some of these studies is that they used what we call an ABA design. They put the medication on, that'd be the A portion. They watched the improvement. Then they withdrew the medication and they watched the frequency increase. Then they put it back on and watched it go back down. That just shows us that the med is actually doing what we are looking for it to do. Now someone might say, well, does that mean I'm going to need to be on this for life? Well, no, but using frameworks of over time and creating good habits and things like that coping skills yeah, we will see long-term remission.

Speaker 1: 26:48

It seems like this can be scaffolding or a helpful crutch when you're building a building or rebuilding your body after a big injury. You need extra support in order to get to where you want to go sometimes.

Speaker 2: 27:09

Yeah, the imagery that comes to my mind is my dad likes to watch those wilderness, like people who build cabins in the woods and things like that. I know nothing about that, but people will go out and purposefully build these cabins using only primitive tools and it takes them forever. It's a beautiful end product and they get that end product. But then we have other resources and there are things that we can utilize these tools and good gifts that could help. But I'm often the one looking at the screen saying you could use a power saw and things like that. I look at them as very helpful.

Speaker 2: 27:50

We can brute force a lot of things in life. But sometimes I wonder if God is saying I've given you good gifts in this difficult walk that you have as a Christian. Will you faithfully steward them? Even to push a little bit on some people? It's like, is it maybe a pride thing? Like I don't want to take anything because that would mean something about who I am. It's like that should be worked through, because if there's one thing that is needed to be weeded out of us as Christians, pride is the top of the list. I would say so these are good gifts. To bring it back around. These are good gifts and we can steward them well. To help get to the same end product.

Speaker 1: 28:30

Adam, what is your best advice to someone who's considering starting or stopping medication?

Speaker 2: 28:36

Yeah, first prayer. It seems very obvious, but I think it is an important piece that anytime and I view this as a clinician that anytime I'm handing over a script I should be in prayer that this is the right thing for my patient. I hope that my patient is accepting it prayerfully and saying is this right in my walk with Jesus? Secondly, talk with your doctor If you are interested in some of these, as I mentioned, off-label uses of these good medications.

Speaker 2: 29:09

Perhaps even bringing some of these case reports to physicians, because many are going to be unaware, they're going to not have searched in their databases pornography and medications, because the secular world is often not asking those questions. So you may have to come prepared and that's okay. Informed patients are good patients. Then, third, include your support network in the decision-making process and in tracking progress. Medication does not exist in isolation to the rest of your mental health care team. So whether that be the local counselor, accountability partner, a pastor, elderboard, whatever, that is, as much as you are comfortable I would say welcoming them into that process and making sure that they are all in agreement, that everyone is comfortable with how we're moving forward.

Speaker 1: 30:00

And thankfully Adam has provided those case reports for us and the links to them are in the show notes. So if you want to check them out, go down to the description for this episode and you will see five case reports.

Speaker 2: 30:12

Yeah. So these case reports are good because they do cover a variety of things, but primarily they're looking at compulsive sexual behavior, pornography consumption or use, as well as one of them, combined alcohol use and subsequent pornography use, and so each of these is one particular person's experience, as documented by their treating physician, of the use of these meds and how it worked for them, the pros and cons, and so they're good tools as you consider whether or not it might be helpful. Nice part is there's some lingo that might be more medical in nature, but a lot of it is very approachable, so these are good resources for your listeners.

Speaker 1: 30:58

Wonderful and if you have more questions about this, adam and I will be doing a live Q&A in the husband material community later this month, very excited about that. Basically, this is your chance to talk to a Christian who is a psychiatrist and go deeper into some of the specific situations you might be dealing with.

Speaker 2: 31:23

Yeah, I'm really looking forward to that and I bring your questions and we'll see what results from that.

Speaker 1: 31:30

Awesome, Adam. What is your favorite thing about freedom from porn?

Speaker 2: 31:33

You know I have loved seeing people find Jesus to be more sweet, more rewarding, more fulfilling than a lot of the shallow wells that we all run to. We often cry out when God takes something from us, we really want it, but it's because he has so much more for us in Christ. So my prayer is that, for myself and for your listeners, that we find him to be our deepest, most satisfying and abiding joy.

Speaker 1: 32:03

Amen. May there be healing and growth and redemption using everything good God has made. Amen. So thank you so much for being with us. Guys, if you want to get a copy of Adam's book the Mind After Eden Psychiatry in a Post-Fall World, then go down to the show notes and you'll find a link for that. Gentlemen, always remember you are God's beloved Son. In you he is well-placed imagecom.