Matt Green

07/12/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 43

The AA Guru

A new patient, age 55, walks into my office for his scheduled appointment. He sits down with an air of confidence and crosses his legs, in the big oversized chair.. At first glance his face looked like Santa Claus, round with a white beard, thick eye brows and white hair. He was a heavy set man dressed in all black with black boots.

I welcomed him and asked my usual first question, “why are you here?”. He paused, looked at me for a second or two and then said, “ I am an AA Guru”. I was surprised by the answer, and at first did not know quite how to respond. I then asked him to tell me what an AA Guru is? He proceeded to say that he had been sober in AA for 20 years. He told me that he sponsored many new comers in that time and is usually the first to be called to speak at an AA member’s anniversary celebration and at national AA conventions. He said that when he speaks from the podium he is funny and tells stories that people can engage with which is why he is often called upon to speak.

I was unsure where this conversation was going so I then asked again, “ so why are you here?”.
My new patient paused before answering and then said, “ I think I am depressed and need some medication.”.He then told me that taking medication was frowned upon at the AA meetings he attends which was his opinion, as well, for a long time. He told me over time he has felt more and more sad, the meetings and his participation did not seem to help, so he thought maybe he needs something more. I told him that we could help him if medication was necessary, however, I wanted to meet with him 4 or 5 more times to get a better understanding of his state of mind and then we could proceed with treatment. He agreed to that proposal.

Over the course of the next couple of months it became clear to me what the problem was. I offered a strategy to him consisting of continuing to attend his AA meetings, but declining invitations to speak. I suggested that he sit in the front row and just listen, focusing on the speakers and their message. He agreed to do that, and his depression began to lift. There was no need for medication because he began to become part of the AA community rather than the entertainer on the stage.

Comments are Welcome: My new book, “The Spy, His Umbrella and The Secret that Everyone Knows” - Inside the Mind of the Addict; will be released this fall. The book is filled with stories based on my experience with patients over the years. More to come.
# ClinicalInsights

07/06/2026

Inside the Mind of an Addict

Thoughts, Comments, Observations- Number 42

Am I Really Listening?

New patients at our clinic are interviewed, assessed and given a treatment plan to follow. We talk with our patients at this first interview about the plan to form an agreement that they can realistically accomplish. Initially their goals are often in line with ours however their willingness to fully participate in the plan often falls short.

A 30 year old young man presented with a daily drinking habit. His goal was to stop drinking, to save his marriage and move on with his life. The plan involved 3 months of various therapies as well as daily attendance at Alcoholics Anonymous meetings for additional support. Typically when I recommend attendance at Alcoholics Anonymous, patients either refuse or they say they will go and then never follow through.

After the first month of treatment, I was surprised by the fact that this patient did not miss one treatment session and he had been attending Alcoholics Anonymous daily. That never happens! The patient stopped drinking and was beginning to feel better. I recommended the patient ask someone at AA to serve as a “temporary sponsor” . I suggested that he ask his new sponsor to arrange a time when my patient could call him daily to “check in” . Another surprise, my patient followed through on my recommendation, That never happens!

A month later the patient came to my office to talk about his progress with the plan. The patient talked about how he is integrating himself into the AA meetings, how he had continued to not drink. The patient had one complaint. He talked about how much he likes his sponsor. He also said his sponsor is a “recovering” he**in addict not “alcoholic” and in addition, when he meets his sponsor at AA meetings his sponsor brings his 2 small children with him who run around the meeting making it difficult for my patient to concentrate. My patient questioned whether this sponsor was a good match for him. My response was that I thought this sponsor was a perfect match for him and to give the relationship a bit more time so he could understand the benefit. My patient questioned me but agreed to give it more time. Why did I make that recommendation?

My patient was being distracted at the meetings by his sponsor’s children and the fact that his sponsor did not have the same history with substances as he did . My patient needed to recognize that recovery is about staying focused on his sobriety and not the distractions. Life and the world are full of distractions; pretty women, arguments over insignificant issues, a slow server at a restaurant. If one gives into the distractions, that becomes the focus and relapse will soon follow.

Comments are Welcome: My new book, “The Spy, His Umbrella and The Secret that Everyone Knows” - Inside the Mind of the Addict; will be released this fall. More to come.

# ClinicalInsights

06/28/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 41

Controversy - Do We Need to Publish Warnings About Ma*****na Use?

Should ma*****na use come with a warning much like cigarette to***co use does? Are there States that have legalized recreational ma*****na use now filing legislation reversing that trend? Let’s think about these two examples.

Disclaimer: The following story happened several years ago. In the present day there is very little “he**in” available for street purchase; most of the op**tes available are pure fentanyl.

A 23 year old female patient at our clinic initially came in with a 4 year he**in addiction (dependency). She was injecting he**in several times during the day in order to avoid the severe withdrawal symptoms connected with stopping her habit. As her “addiction” progressed, each time she would inject herself, she would overdose, her heart would stop, and if not for her live-in boyfriend who was an EMT, she would be dead. Each time he would use Narcan to try and revive her, rush to the hospital intensive care and by “The Grace of God” she would survive. Her addiction was so severe that there were times she would wake up in intensive care and proceed to disconnect herself from monitors, find a small bag of he**in and dose herself again, nurses finding her lifeless next to her bed.

Eventually, she decided to use ma*****na to help her stop using he**in. She would use ma*****na multiple times a day for 3 weeks, then start using he**in again and overdose repeatedly. Even though she was convinced the ma*****na could stop her habit, she continued to use and then go back to her he**in use within 2-3 weeks. Something was not working.

A 44 year old male patient, who is a local college professor, has been coming to our clinic because of his alcohol, ma*****na use and his anger. He has been able to stop drinking but has continued to smoke ma*****na daily and is hiding that from his wife. The condition of addiction is still active. Recently, he became manic, delusional, talking about his ideas about “saving the world”. He was evaluated at the hospital for the purposes of a psychiatric admission. Has the ma*****na use brought on the delusion?

Please comment. # ClinicalInsights

In this episode of the Moving Medicine podcast, learn about cannabis use and psychiatric disorders.

06/22/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 40

An Unexpected Miracle!

An 18 year old patient is caught in the web of op**te addiction.

His cry for help is with his family. After doing some research, his father found our clinic but unfortunately, our offices were a 40 minute drive away.

After speaking to Dad on the telephone, he decided to bring his son in for an assessment.

Four months later, son is attending our group therapy program regularly 3 times per week and he is drug free, confirmed by urinalysis.

I was standing in front of the group room one evening waiting for the group members to arrive. I saw Dad walking down the hall in my direction without his son. He came up to me wanting to talk to me for a minute while his son was outside talking with some of the other group members. Dad looked at me pausing for a couple of seconds and then said, “Thank you”. I responded by telling Dad that there was no need to thank me, his son was doing all the work to stay clean and sober. Dad said, “No, you don’t understand. This is not about my son stopping his use of substances. This is about something else. I get to drive my son for at least 40 minutes to the clinic and then back home, three times a week. We talk in the car. For the first time in many years we are connecting with each other. You gave me my son back!”

Please comment.

# ClinicalInsights

06/15/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 39
Is Drug Testing Really Helpful During the Course of Treatment?

In working with my 26 year old male patient for several months, it seemed clear that his motivation to stop using substances was minimal. Part of his plan in treatment was to be drug tested randomly. Even though he was living with his family and they were insisting that he stop using all substances, each drug test was coming back positive for ma*****na, co***ne and alcohol. As a result my goal for his outpatient treatment was to try and influence him to enter a 30 day residential drug rehabilitation facility. He finally, he agreed to go.

After his stay in the residential facility for 30 days, he came back to our clinic for continued care. The plan was for him to enter our Intensive Outpatient Program which once again included random drug testing. My patient’s family insisted that the collection process for the urinalysis be observed, and he agreed to it.

The restroom at our facility is a small single room with one toilet and one sink. I understood that it was embarrassing for this 26 year old patient to have another man in the room while he was urinating. To help him feel more comfortable, I would stand behind him about 3 to 4 feet as he stood at the toilet.

On one particular day, we entered the restroom together, I handed him the specimen cup and took my usual position behind him watching the process. I heard him unzip his pants and I saw both of his arms in front of him. I assumed he was holding the cup with one hand and positioning himself with the other. I heard liquid enter the cup and then something unusual happened. Some sort of projectile flew across the room and hit the side wall falling to the ground. I looked and it appeared to be a plastic cap of some sort. I asked my patient, “what was that?”. My patient turned his head toward me and said, “what are you talking about?” We were the only two people in this small room, so it was unlikely that he was unaware of what had happened.

It turns out, my patient upon leaving the 30 day residential program had no intention of not using substances. After leaving the facility, he carefully filled a number of small plastic bottles with what he knew to be his clean urine. He then would attach the bottle to a string which he wore around his waist so that when he would unzip his pants, he could squeeze the bottle of urine into the specimen cup. On this particular occasion however, the plastic cap on the bottle was not tight enough, so when he squeezed the bottle it flew across the room.

What do we do now? Please comment.
# ClinicalInsights

06/07/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 38

The Effect Addiction has on the Family

Several years ago a young man, he was 18 at the time, had been asked to leave high school because of his poor attendance, disruptive behavior, and coming to school drunk. This young man was frequently in court for minor infractions but was not allowed to be on the school property.

One day the young man was driving around with two other friends looking for something to do. They began using co***ne in the car and were talking about one of their classmates who had reported to the authorities about the mischief they had been involved with. The more they used co***ne the angrier they became at this classmate. They decided to teach him a lesson. At the end of the school day they waited for him at the high school, forced him into the car and the young man held a screw driver to his throat, threatening him as they drove around the city for 2 hours. They eventually let him go. Being very frightened, the classmate reported the incident to his parents, and the young man was arrested for kidnapping.

The 18 year old’s parents were extremely upset at this event because they had spent years trying to influence and control their son without success. They appeared in court with their son who was mandated to a treatment program at our clinic.

We worked with the young man and his parents for months and eventually convinced him to go into residential treatment in order to stop using substances. His parents continued to come to the clinic for support and strategies on how to deal with their son.

During one of the parent sessions, the therapist suggested to them that while their son was in the safety of residential care, that they go out to a nice dinner together and not talk about their son but try and reconnect with each other. For years this couple had sleepless nights, meeting with many health care providers about their son. This was all they talked about.

The following week they came back to report to the therapist about their dinner. Their report was disappointing. They told their therapist that they went out to a nice Italian restaurant and sat through the entire meal in silence. They did not know what to say to each other.

Please comment.

# ClinicalInsights

05/31/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 37

Does Trauma Create Delusion in the Mind of the Addict?

A 30 year old patient who has been coming to our clinic for the past nine months recently had his final disposition in court. He had originally entered treatment because of a car accident as the result of being under the influence of crack co***ne. He was arrested for the driving accident as well as possession of an illegal substance. The court sentenced him to 1 year of probation and to continue mandatory treatment at our clinic.

The patient’s original intention for entering treatment was at the suggestion of his attorney in order to influence the court to give him a less severe “sentence” or disposition. The patient has a history of violence, anger and substance abuse/dependency. The patient has been attending treatment and now believes that he has a problem with addiction and is grateful for being referred to our clinic.

The patient has been attending and working well with all but one member of his treatment team. That one clinician is the only male treater. The patient refuses to attend his treatment sessions. The patient says that he hates this treater and can’t stand being in the same room with him. The patient does not give any specific reason for this reaction.

Upon entry into our clinic program, the patient talked about his family and how as a young man, his father would physically hit him repeatedly when his father was drunk. The patient had his nose broken repeatedly by his father. Despite this type of violence, if any disparaging words were said about his father, the patient would defend his father, dispute the criticism, and talk about how much he loved and respected his father.

The male treater, on the team, is the most skilled, seasoned and experienced treater at the clinic. Why does the patient have this reaction? Does the patient really hate the male clinician, or does the clinician represent, in the patient’s mind, his father when the male therapist walks into the room? Please comment.

# ClinicalInsights

05/25/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 36

What is my “addict” really thinking?

It was a bright sunny New England spring day. About 70 degrees outside. My 16 year old patient woke up for school after an evening of fighting with his parents because he refuses to stop smoking ma*****na. His parents have taken away all access to money and online contact with friends until he agrees to stop smoking.

My patient goes through his usual morning routine before school, eats his usual cereal for breakfast as his mother is preparing his lunch in the kitchen, collects his lunch, says goodbye to mom; dad has already left for work and heads out the door.

Today, for my patient, is different however. Heading out the door to walk to school, he turns in the opposite direction and catches the first train into the city. Once in the city, my patient stops at the bank and withdraws $500 from a savings account that is just in his name, almost depleting all his money and heads to the airport. My patient decided during the fight with his parents the night before that he was going to leave home.

Once at the airport, my patient bought a one way ticket to Chicago leaving that morning, got on the plane, and it took off, on time. Landing at O’Hare airport at about 10:30am (Chicago time), my patient debarked and entered the airport terminal. He stood there watching people rush by him into restaurants, airline gates and restrooms. “This is a very busy airport” he thought, and then it struck him! “What am I going to do now?”

With no solid plan in mind, armed with half the money he took out of the bank, my patient went back to the ticket counter, purchased a one way ticket back to Boston, and landed in Boston at about 3pm, Boston time. He made his way back home and when he got home his mother asked him how school was. My patient replied, “It was fine” and he made his way up to his bedroom.

Do we ever know what is in our “addicts” innermost thoughts?
Please comment.
# ClinicalInsights

05/17/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 35

Do Addicts Care about the people they love?

One of my 16 year old patients walked into the group. I admit that I am not an expert in clothing fashion. I knew however that what my patient was wearing must have cost a lot of money.

He was wearing what most people would call a warm up suit, all in blue, a jacket that zipped down the front and long pants with a gold stripe down the side of the leg. There was a logo on the waist of the pants but it was not familiar to me. The suit was shiny like silk. Around his neck were two gold chains one thicker than the other with a large gold cross hanging from one of the chains with what looked like a diamond in the middle. He wore a baseball cap that looked new with no logo on it. His sneakers were white with no marks on them also looking new. He strutted in like he owned the building and sat down.

What he talked about while in the group was very surprising. I had met with him and his single mother a week prior to understand what the most helpful treatment plan would be for him. Her complaint was that he was smoking pot daily, coming home late at night and missing school. She thought he might have a drug problem. Mom told me that she cleaned houses to make ends meet and they were living in a small one bedroom apartment with federal funds subsidizing the rent.

I asked him to talk about himself by introducing him to the group. He said he hated school which is why he didn’t go. He said he had a job which had him delivering packages to people around the city. He would pick up the packages from a man with instructions to where they were to be delivered. The man would pay him in cash, usually several hundred dollars. He said why should I go to school when I have $40 thousand dollars in $20 dollar bills under my bed. I asked him if his mother knew about the money and he said no and he had no intention of telling her.

Where do we go from here? How do addicts define love? Please comment.

05/10/2026

Inside the Mind of an Addict
Thoughts, Comments, Observations- Number 34

The Symptoms of the Condition of Addiction is Not just about Drugs and Alcohol

The telephone at the office rang on a Friday afternoon. The voice on the other end said, “Matt is that you?” I responded yes and asked who was calling. The voice on the other end identified himself as John who was calling. My answer was that I was happy to hear from him, but since I have been practicing over 40 years, he must understand that I have worked with quite a few John’s in my time. I asked for more specific information. John then apologized acknowledging the assumption that I would know him just from his name. John then went on to say that he had been a patient about 10 years earlier with a significant alcohol problem. He spent about 16 months in treatment at our clinic where he stopped drinking, was introduced to AA and left treatment feeling much better than when he started. I remembered John acknowledging that to him and then asked him if he had started drinking again. John reported that he had been clean and sober since leaving treatment 10 years earlier and still attended AA. I told John how wonderful that was for him but I still didn’t understand why he was calling.

John then told this story. “ I came home from work the other day and my wife greeted me at the door and without hesitation she said that she wanted a divorce. This was shocking to me, so I looked her square in the eye and told her that I was surprised to hear this. I asked her why she wanted a divorce given they lived in this big beautiful house, they had just gone on vacation together a month earlier and most importantly, I had not picked up a drink in over 10 years. “

His wife’s response was the wake-up call he didn’t see coming: “You aren't drinking, but you're working 18 hours a day. We no longer have a relationship.”
John had put down the bottle and picked up the briefcase. He had swapped one symptom for another to avoid the same underlying feelings. Addiction is a condition; substances are just the symptoms.
What do you think? Please comment.