Interviewer: Welcome to Radio Lifestyle and today we have a very special guest. He’s going to be talking to us about addictions. His name is Dr Robert Lefever. Now, Dr Robert is regarded as the pioneer of addiction treatment methods and rehab centres in the UK. For the last 26 years, he’s worked with over 5000 patients suffering from stress, depression and various other addictive behaviours and he’s also worked with well-known names, celebrity names including Clarissa Dickson Wright from the BBC and also David Yelland who’s the ex-editor of The Sun. So, thank you very much for joining us on Radio Lifestyle.
Dr Lefever: Thank you.
Interviewer: How are you Dr Robert?
Dr Lefever: In great shape, thank you.
Interviewer: Fantastic. Now, I’m sure you’re aware that we will have our own different interpretations or different meanings of what the word addiction really means. So for the sake of clarity, what do you mean by the term addiction?
Dr Lefever: It’s the inability to predict what will happen after you take the first use of a mood-altering substance or process in any day. So, there are those people who would say well, yes I always get smashed because that’s what I intended. But the addict is someone who says, ‘I don’t know whether I’m going to go off into a binge. I can’t just have two and then put the glass down. And I don’t know if I’m going to wake up in the street or in someone else’s bed or in prison. I just don’t know.’
Interviewer: Okay. There are various types of addiction – from drug addiction to alcoholism to gambling and workaholism. What is the most common type of addiction that you’ve worked with?
Dr Lefever: Nicotine addiction.
Interviewer: Nicotine, to tobacco smoking?
Dr Lefever: Yes. It’s the one that people don’t want to look at. They don’t mind looking at alcohol consumption after a time if it’s causing little damage. They don’t mind looking at drugs but they like to keep their cannabis, and they don’t mind giving up the heroin or the cocaine if they have to. They don’t really want to look at sugar and white flour as the basic underlying addictive substances in eating disorders. But, nobody wants to look at nicotine addiction, they just call it cigarette smoking. They don’t call it nicotine addiction which is what it is.
Interviewer: Why do people develop addiction to smoking? If that’s the most common one that people come to see you for.
Dr Lefever: I think there are three causes of addiction. The first is what I call the antecedent, the underlying cause. That I think is genetic. Some of us just have a genetic predisposition towards having an addictive nature. People talk about addictive personality, I don’t think there’s any such thing. We each have our own personalities, but some of us have an addictive nature.
It runs in families and if you look at my family, for example, my mother’s mother was alcoholic – that killed her. My father’s father was alcoholic as well. My mother was spherical. She was 5’2’ and 15 stone. I’m an addict myself. I’ve handed it on to one of my children and so on. So it runs in families. That’s the antecedent cause.
Next is the contributing cause: trauma. Something wakes up the need for mood alteration. With some form of abuse or abandonment or some traumatic episode that says, ‘Hey, I’ve got to change the way I feel. I’ve got to…I’ve got to…I’ve got to.’
And then the third is exposure. That is – we use whatever is available. I’m afraid it’s what’s at hand really. I’ve never used cocaine. There’s a very good reason for that. I’m too old. That’s what’s sad about it. It just wasn’t around in my childhood. In my children’s generation, it was all over the place and certainly now it is as well. In my generation, I had no choice. I couldn’t get blasted on cocaine or heroin or anything like that, it just wasn’t there. So we went into alcohol or nicotine or gambling or the things that were available.
If you want treatment, you have to do those three things in reverse. If you really want help with addiction, you want to get it nailed, you’ve got to be abstinent, you can’t afford just to try to drink sensibly. It doesn’t work for those with some kind of addictive nature. So you’ve got to start with being abstinent from anything that you’re hooked on. I’m sorry, that does include alcohol and it does include cannabis.
Interviewer: You mentioned that you had an addiction problem yourself?
Dr Lefever: Yes.
Interviewer: Could you tell us more about that?
Dr Lefever: Well, I didn’t see it. Everybody else saw it, but I didn’t. I was 47 when my wife was sitting in front of a divorce lawyer. I went straight round to my doctor and I said, ‘What’s the matter with Meg?’ He said, ‘No, it’s not Meg, Robert, it’s you.’ Well he could have fooled me. I still had a full-time job as a GP. I paid the mortgage, I gave time to the children, I didn’t beat them or whatever and I couldn’t think what was the matter. I thought, you know, because I was married then everything was fine.
It was for me, but it wasn’t for Meg. And so she just got finally fed up with my craziness when I’d go off on one mad scheme after another. She just said, ‘Everything you do in your life always involves me in more work.’ And that was true. I took her for granted and that wasn’t acceptable.
But also, I did lots of other very stupid things. I bought a farm and became an expert in the early weaning systems of pigs. I never achieved anything. I stood for parliament. Well, people do and it’s a full-time profession, but I was doing it part-time – just trying to be the great, wonderful Robert – which I’m not. I went into the singing profession. I understudied at Glyndebourne and I sang for Sadlers Wells. That was fun, but again I was doing too much of it.
Did I want to be a real doctor or did I want to fiddle about in all sorts of other people’s work? So, I did a lot of addictive things and my eating disorder was the thing that everybody else knew, but I didn’t. My weight used to change by 50 pounds up and down every year. The most I’ve ever lost was 2 stones in 3 weeks. And the most I’ve ever been is 15-1/2 stones. Sometimes I’d sit down at the table and wouldn’t get up for about three hours. I’d eat whatever was there for my supper and then I’d go into the fridge and I’d eat leftovers from previous days even if it had icicles on it. Then I’d have a peanut butter sandwich and so on and so forth. I just couldn’t stop once I’d started.
Interviewer: That is definitely very excessive. Did you say you put on 2 stones in 3 weeks?
Dr Lefever: I took off 2 stones in 3 weeks. I just stopped myself eating and I exercised myself silly, then I came back to my secretary. She said, ‘You’re ill’. Well, I didn’t feel that way. I thought it was wonderful. I used to smoke 30 cigarettes a day when I was looking after patients on the heart ward. Now, if that isn’t absolutely plum crazy, I don’t know what is.
Interviewer: So, are you completely cured from your addiction? How have you helped yourself?
Dr Lefever: I think the only thing that ever helps an addict is pain. So, while other people are bailing me out from my problem, they’re covering up my messes, they’re covering up the times that I failed to do this, that and the other, they’re helping me with my financial situation. They’re not actually helping me. I guess we had bigger problems. That’s not helpful because the only thing that’s going to make me change is pain.
When I’m saying ‘Oh, I can’t go on with this. I really can’t go on with this’, then I can be helped because I’m listening. Perhaps with that I’ll find all sorts of rationalizations, excuses, reasons why it is perfectly okay. ‘I’m not an addict’ – I just didn’t see it. With pain I had to see it.
Interviewer: Do you classify yourself as somebody who is completely cured or would you say you’re still working on that in yourself?
Dr Lefever: It’s a continuing thing. I haven’t used any addictive substance or process for 30 years. That doesn’t mean I’m not an addict any more, I’ve still got the genetic predisposition – same as I’m still allergic to dust. Now for my short sight: I had an operation on both my eyes to take out my cataracts and put in plastic lenses. Wonderful, I’m cured insofar as I’ll never have to wear specs.
But there’s no such thing you can do to cure addiction. Doctors imagine that putting you on Methadone cures addiction. It doesn’t. More people die on Methadone than die on heroin. It’s a very dangerous drug indeed. They reckon giving people antidepressants is going to help them. It doesn’t. Antidepressants are major addictive drugs to people who have an addictive nature. Many people are not addicted to them – same as alcohol isn’t addictive to everybody. Lots of people drink alcohol, but that doesn’t mean they’re alcoholic.
Dr Lefever: We cannot afford to have to take antidepressants. They are major addictive drugs and they do a lot of damage.
Interviewer: I think you’re right. There certainly seems to be a common trend amongst people to be very casual with drugs – things like Nurofen, painkillers, as well as antidepressants. I think it’s because – I’ll get your opinion on that in a second – they’re so easily available. It’s so easy for people to be hooked on them. What’s your thought on that?
Dr Lefever: As far as these addictive prescription drugs are concerned, doctors are trained as I was myself. I had excellent training at Cambridge University and the Middlesex Hospital. We’re trained to prescribe. In six years in the university, I had not one lesson on counselling – and I’m a GP. Not one lesson. And I had not one lesson on addiction. I was told, you know, this is liver disease caused by alcohol consumption. This is what happens when you take a heroin overdose. I was taught all the medical side of it, but nobody ever taught me what addiction really is or what I could do to help people.
Now, I think this is important because if there are any medical people listening, they might know that to see one case of Crohn’s disease, which is an inflammatory disease of the bowel, you have to be in general practice for six years. To see one case of a pheochromocytoma, which is a tumour in the adrenal gland, you have to be in general practice for 200 years. But every GP with an average list of 2300 patients will have over 200 people with addiction problems – and they just don’t see it.
I asked a senior partner of a group with approximately 11,000 patients recently, ‘How many people with alcohol problems do you reckon you have in your practice?’ And he said, ‘Well, we’ve certainly got two.’ In 11,000? 10 to 15 percent? Work that out. It’s something like 1500 patients that he’s got in his practice that he simply hasn’t seen or in the group practice, because we don’t talk to them. We’re not trained to do that. We’re trained to prescribe. We’re trained to prescribe. We’re trained to prescribe.
What’s the solution to this problem? Drop the drug. This isn’t just the pharmacy doing this, pushing it. It’s also we doctors thinking ‘What else could I do? – It’s what I’m trained to do. It’s what I’ve got to do. I’m going to help my patients.’ What I’m saying is, ‘Is it really help? Is it really the first thing to do?’
Now, what happened to me was that a patient of mine said ‘I’d like to find out if this drug is mood-altering’ and I said ‘What do you mean mood-altering?’ She said, ‘Well, I’m a recovering heroin addict’. I said, ‘What? You can’t possibly be, I know your father. We were at university together.’ ‘Well, I am.’ So I said, ‘What does “recovering” mean?’ ‘It means I don’t do it now, I go to Narcotics Anonymous.’ I said, ‘What’s that? Do you hold hands under Waterloo Bridge or something?’ And she said, ‘Oh, very funny, but have you ever been to a meeting of Alcoholics Anonymous or Narcotics Anonymous or Overeaters Anonymous? Any of those?’
I said ‘Well no, do you think I should?’ And she said ‘Well, I think you might attend it to start an education. To go see what actually happens.’ And so I did. I went to the Red Cross Centre in Fulham, to a meeting of Alcoholics Anonymous. The first thing was I bumped into three patients of mine. They said, ‘Hello, Robert!’ ‘No, no, no, not me – I’m just here to find out.’ They said ‘Oh’. But I said, ‘But hang on a minute – why didn’t you tell me that you had a problem? And they said, ‘Oh, come on, Robert, you’re a doctor.’
Interviewer: So the point really is that as people who had addictions, they’ve gone to see doctors and the doctors really can’t help them, so then they had to seek other help?
Dr Lefever: I’m not actually blaming the doctors at all. We’re going to do what we are trained to do. For example, I don’t speak Russian. I’m not going to be blamed for not speaking Russian. I’ve never been taught it. I could speak Russian if I really wanted to, but the point is that doctors are not trained to counsel. They are not trained about addiction. They are trained to prescribe and therefore what they perfectly understandably do is prescribe. So what I think is wrong is medical education. I think that’s where we’ve got to start. I’m not blaming my professional colleagues. They have a difficult enough job without having me on their backs.
Interviewer: Okay, so in terms of addiction versus normality, there seems to be some sort of fine line between a passion for something and then being classified and put in that category of being addicted to something. So, I’ll give you an example. For example, I really enjoy going shopping, for example, and from time to time I like having a little bit of retail therapy. Now, does that mean I’m addicted or is that perfectly normal?
Dr Lefever: Have a look at my website and you’ll see the ways in which we can diagnose specific addictive characteristics. For example – I’ll use alcohol as an example.
Someone who has an alcohol problem will always have it on his mind, either to give it up – or maybe to use sensibility. It’s always been a preoccupation.
Secondly, he’d be perfectly happy drinking on his own.
Third, he’ll use it as a medicine – to use as a tranquilliser or like a sleeping tablet.
Fourth, he’ll use it primarily for its mood-altering effect. My wife used to drink for the taste. I’ve got no idea what that was about. I don’t drink for the taste, I drink for the ‘yeah’.
Fifth, you protect the supply. This is the alcohol money that is ring- fenced. Over there is the money for the mortgage, the money for school fees, the holiday money and so on – all that is negotiable.
Number six, and this is what I mentioned earlier, the inability to predict what’s going to happen after you first start in any day.
Seven, having a higher capacity than other people. I remember my son saying, ‘Dad, I had 16 pints and 10 shorts and I still wasn’t drunk and that proves I’m not alcoholic.’ I said, ‘I’m sorry it means you are, you’re one of us.’ – We have a higher capacity.
Number eight, continuing without damage or without stopping – sorry I said that wrong. Continuing without awareness of the damage. We just don’t see it and if we do see it, we still don’t really worry about it. The chap who’s lost his wife, lost his job, lost his driving license doesn’t blame the alcohol. – He goes to the pub for comfort.
Number ten, cross-addicting into other things. You come out of the alcohol, you go into nicotine, you come out of nicotine, you go into sugar and so on. Sorry – that was number nine.
Number ten is continuing despite the repeated serious concern of other people. Lots of people expressed their concern to me, I just thought they were wrong. And then there are two more.
Number eleven: drug-seeking behaviour. You won’t get out of bed, but if somebody tells you there is some high-class weed, you’ll get that. You’ll get out of bed and you’ll run towards it.
Finally, the drug-dependent behaviour. You know, you can’t start the day until you’ve had your shot or fix of whatever it is. It doesn’t mean to say that you diagnose simply on somebody who drinks or uses in the morning. That’s not true. A lot of clergymen who serve Holy Communion first thing in the morning. A lot of night shift workers would have a drink before they go to bed in the morning. So, to have a drink in the morning, that doesn’t do it. To drink spirits rather than alcohol or wine, sorry, beer or wine, that doesn’t do it either. It’s why we use those things. Why? Why? Why? Not what or when or which or how much. That’s irrelevant.
Interviewer: In terms of the big why test – why people do it – would you say that a major factor is to deal with emotions?
Dr Lefever: Yes. Many people find other ways of dealing with their emotions as I do now. For example, my wife Meg died three years ago and I’m now married to Pat. We have the most wonderful time going to one opera after another. Now, that’s mood-altering. We went to the Curzon in King’s Road to see the live Met HD series transmitted from the Metropolitan Opera House in New York. We saw Parsifal, the Wagner Opera. We were in there from 5.00 in the evening until just after 11.00. We were in there six hours. Other people would say ‘My God’, but I would say, if that isn’t heaven I don’t know what is. I have my own way of being happy and looking after myself and my relationship with Pat is divine. That’s what really matters to me. – My values, my behaviour and my relationships. That’s what I have to look at. In the active course of my addiction, that would be all over the place.
Interviewer: Absolutely and Dr Robert, this will be something that you probably know very well, but interestingly nowadays, there seems to be this modern trend, especially among the younger generation, of addiction to technology. So, I’m talking about things like Facebook, mobile phones, computer games. There seems to be this trend of addiction to this technology phase that people are going through. What are your thoughts on this?
Dr Lefever: Actually, it’s all part of workaholism. Work includes hobbies and interests, cults and sects. And again, people who use work to change the way they feel or use some passionate interest to change the way they feel. That can be an addictive tendency. But, we shouldn’t confuse that with just doing something you enjoy.
Interviewer: But what’s worrying is that you’re getting very, very young children being addicted to computer games and mobile phones. When I say young I’m talking about five years old. Children are being exposed to—well I mean that’s a whole different debate as to whether they should be exposed or not. But these days, whether we like it or not, there seems to be this trend where children at five years and onwards are actually addicted to mobile phones and Facebook and computer games and Nintendo and all this kind of thing. Isn’t it worrying? I mean is it worrying? Should parents be concerned?
Dr Lefever: Yes they should. But they should be worrying about that and then we should do whatever we can to get people to understand the nature of addiction and how damaging it could be. But the very people to whom it’s most damaging are the ones who least want to look at it. This is a problem. You get problem families. Really, what we need to do instead of putting cigarettes in plain packets and putting up the price of alcohol, we need to identify those people who have the most likely problem of becoming an addict in their adult life.
Now, the Scandinavians did some background research on this on adoption. – What happened 20 years down the line after children were adopted in the first week of life. To know that, they have to actually know the environmental influence apart from just the birth parents. What they found was that the chances of somebody developing an alcohol problem were 60 percent in the same sex parent, thus the sons of alcoholic fathers and the daughters of alcoholic mothers. It went with the genetics and not with the environment in which they were brought up.
Interviewer: That’s interesting.
Dr Lefever: The opposite sex parents, that’s the sons of alcoholic mothers or daughters of alcoholic fathers is 40 percent. If both your parents are addicted, there’s 80 percent, but it’s still not 100 percent which is interesting. Genetics is not an absolute hard and fast rule, there are also environmental influences, there are also lots of other things. But, unless we look at the genetic influence we’re never going to begin to tackle this type of problem. For some people like me, I am an addict. My name is Robert and I am an addict. I said that at half past 7.00 this morning in a meeting where I was around lots of other people who also say ‘My name is – whatever – and I’m an addict.’ That helps us to learn from each other and to support each other.
Interviewer: Absolutely. You’ve been on a very interesting journey Dr Robert. You now have your latest book out which is called ‘Notes of a Private Doctor’. In your book, you talked about three main areas: betrayal, crisis and bereavement and these are all emotions, situations that most of us can relate to.
Dr Lefever: And things that all of us go through.
Dr Lefever: Let me look at betrayal for example which is the first section of my book. I think we all betray and we’re all betrayed. It’s important – I think – to come to terms with it. I think that my school betrayed me by not allowing me to study music. When I asked the headmaster, he said ‘No, music is for homosexuals and we don’t have any homosexuals in this school’. That’s not argument enough. But I think I also betrayed the school.
There are plenty of things I could have done to make much better use of my time. Whereas I would say I’m resentful there was that one issue that I let it damage everything else I was doing. So, people betrayed me. And the accountant who stole from me and ultimately led to my bankruptcy – well, it’s not the sort of thing you want to happen at the age of 72, and be living in an old people’s home. That’s not good news at all. Yes, she betrayed me.
But when I look at it. – Did I betray my children? Did I work too hard? Did I spend too much time away from home with all my grand schemes? I think I did. I mean you have to ask them that. I think I did in this respect. A lot of professional people do neglect their children when they’re building their businesses and creating security and providing income. But as I said, it’s a difficult situation. But do I think I’ve betrayed? Yes I do.
The second half part of the book is crisis. That was really the story of impending bankruptcy and then I was really bankrupt. I lost my home, I lost my cottage in the country, I lost my job, I lost my friendships – you know, people are not desparately interested in someone who is not able to provide anything. I mean I lost my medical practice, I lost my pension, I lost my insurance. You name it, I lost it.
I say ‘I’; my wife was right beside me. Meg was right beside me in all of that and so she lost it all too. It isn’t that she had no responsibility for her own self, looking after herself, but really I was so dominant. I can talk the hind legs off a donkey and I really did betray Meg over that. Not really caring primarily for her.
I was looking after my staff, I was looking after my ideas, I was generating this, that and the other, creating wonderful places and ideas and so on, but not looking after my wife and I’m ashamed of that. The crises that brought me down are the things that brought her down. Anyway then, three weeks after I came out of bankruptcy, my wife died. Bang. Just like that. She had a stroke when an artery in her brain popped and her skull filled up with blood and she died. That was not an easy time. I’d already lost everything I’ve described.
Interviewer: I couldn’t imagine.
Dr Lefever: We were married for 48-1/2 years. How do you come through that? Then I was living in an old people’s home 75 miles outside London. I lost my culture – I’m a South Kensington animal. I’ve lived here and worked here for 45 years and here I am back again. We come through, I think, with our values. That’s what helps us. It isn’t just being as fortunate as I’ve been to marry again and to find somebody who I’m happy with.
I was already on the way to really looking after myself again despite really terrible times. You know, I lost a stone and a half in weight, not because I wasn’t eating, I was eating well. I was trembling the whole time. I got a frozen shoulder, I got pain in the back, collapsed vertebrae from osteoporosis, my blood pressure went up, my pulse rate became irregular. You know, all these things are stress symptoms and I certainly had all of those and that makes me very understanding of other people. They know that type of symptom.
Interviewer: Of course. I think the three areas, they are in your book, it’s a very, very interesting story that you have we can all relate to absolutely. So, if any of our listeners are interested to get a copy of that book or find out more, then log on to www.notesofaprivatedoctor.com. If you’re interested to find out more information about Dr Robert or indeed want to contact him to discuss any addiction issues for yourself or for somebody that you know, then you can contact him through his website on www.real-recovery.com and his book, Notes of a Private Doctor is now available from Amazon.