Dr. Drew Pinsky stopped by "Salon Talks" recently to talk about a new thriller called "Final Kill," in which he plays a therapist. Many will know Pinsky from his nationally syndicated radio show "Loveline," which ran from 1984 to 2016, and his many TV shows focusing on sex and addiction, as well as reality shows like "Teen Mom" and "Celebrity Rehab." He also hosts the advice-driven podcasts, "Dr. Drew After Dark" and "The Adam and Dr. Drew Show."
"Medicine saved my life, quite literally," he told me. "I woke up every day of my training thinking, 'I love doing this,' feeling like it was so important what I was doing." Pinsky began his radio career as a medical student during the AIDS epidemic of the 1980s. "No one was talking about it, particularly not to young people," he remembers. "That's what motivated me to get on the air. I thought I was doing community service for the first 10 years of going on the radio."
The desire to help people led Pinsky to get additional degrees. He originally trained as an internal medicine doctor, then later moonlighted at a psychiatric hospital and became a specialist in addiction. "I have noticed that I start to gravitate towards the big problem of the time," Pinsky said. "Right now, to me, it's homelessness. I'm deeply involved in big problems. Childhood trauma has been a massive issue for the last 30 years, so I got involved in that, and then drugs and alcohol became the problem, so I spent 20 years running a drug and alcohol treatment center."
Calling Los Angeles an "open-air asylum" for homeless people, within which diseases can spread rapidly, Pinsky expressed concerns about transmission of COVID-19, in a way no pandemic has been in many years. Pinsky also says he is working on a new book directed at young people, which he hopes will address a key important issue in sex and relationships.
To hear more from Pinsky on playing a real and pretend doctor on TV, and why he thinks millennials reject addiction treatment methods that have worked for previous generations, watch my "Salon Talks" episode with Dr. Drew here, or read a Q&A of our conversation below.
The following transcript has been lightly edited for clarity and length.
Is true that you love to sing opera or did at one time?
I did. Some people will know I was on "The Masked Singer" a couple months ago.
How'd that go?
Not so great. It turns out that in the intervening year, I've lost a little bit and I have all kinds of problems with my vocal cords, but I got through that show, which was the goal.
What happened? Polyps?
A hemorrhage and reflux and all kinds of good stuff. They wanted to do a bunch of laser, which I don't have time to do because I spend my life talking. The way I got the hemorrhage is I knew I was about to do that show. I thought, I better to do some singing. So I was down both at Stonewall and The Monster in the Village, and I started, I really pushed it. And also, my mid-range was gone. I thought, oh Jesus, something's wrong. It was.
But did they love it at Stonewall Inn? That's the famous gay club here in New York.
Yeah, and The Monster is another great gay club that has a pianist there. On the weekends, they do a lot of cabaret, karaoke stuff.
What is your favorite thing to sing?
Musical stuff. It's so easy for me, and you don't want to hear this whole story, but when I got into "The Masked Singer" I put the costume on and all of a sudden I realize it's a rock eagle. I have to sing rock songs, and had to change everything. It was a big mess and I got through it. Then I got kicked off so it's fine.
You're glad that you stayed in medicine?
Yes. Medicine saved my life quite literally. I mean I woke up every day in my training thinking, oh God, I love doing this. I felt like it was so important what I was doing and I was deep in the AIDS epidemic back in the '80s, and that's what got me on radio. I wanted to talk about it, and I realized no one was talking to it, particularly not to young people about it. I was like, are you kidding? We've got to talk about this. That's what motivated me to get on the air. I thought I was doing community service for the first 10 years I was doing it. It was a one night a week thing. I was talking about medical topics, a lot of HIV and safe sex talk back then, and suddenly became a huge part of my life.
It was a taboo topic at the time and people had so many misconceptions.
It was weird. Because yes, there were loads of misconceptions, but no one was talking to young people. Literally, I was 24 years old and I was thinking, oh my God, I know what 18- to 20-year-olds are up to, we got to tell them about this. That was considered outrageous. Why would you talk to them? They're not having sex. And I thought, oh my God, we've got a problem. I was there, I was elbows deep in it. And if you weren't there administering, you're not here now. You know what I mean? You forget how horrible that was. I get chills. It was the most tragic, saddest chapters. Wonderful people are lost. They're just not here to tell the story, so really the rest of us got to kind of tell it.
Do you have fun playing a therapist in films and on TV? What kind of allowances can you make there, as opposed to working with your real patients?
What people don't understand about reality shows we put together, that was real work. That was me and my team doing what we do, period. And how they put it together and edit it, and what you see is a little distorted because people would say things like where's the treatment? It's like, yeah, no kidding. It's just the drama is all you're seeing, okay, that happens in treatment. The reality shows we did, I just took my team and we just did the work. We always do.
On this movie ["Final Kill"], I find it interesting. It's kind of like Tony Soprano, right? I'm treating a criminal essentially, or maniac, and I'm trying to understand why he's so messed up. Why is he such a disturbed patient? That's an interesting challenge to put yourself in that spot and then try to imagine what that would be like. I enjoyed it.
Yes, tell us more about your role in "Final Kill."
Think Tony Soprano and his therapist. I'm trying to get him to take medication mostly. And then you find out as the viewer why he's so stressed out. He has a pretty, pretty violent life. Pretty violent, messed-up challenge ahead of him.
How many takes did you have to do to keep a straight face with Ed Morrone screaming in your face and being so crazy?
A bunch. And he was even supposed to be crazier in the script, and I said, look, if you got crazy like that, I would call law enforcement. That's what I would do in that situation. They were like, okay, we're changing it.
In one scene, the character Mickey has a long stretch where he berates therapists, including you, in saying that you're using people and giving them medication for all sorts of purposes, including one that he thinks makes him not perform as well in bed. In your real life treatment of patients, how much of your real advice about sex is based in talk therapy versus necessary medication?
I don't do a lot of day in, day out sex treatment in my clinic work. On the radio, many, many years of helping with that area. It ends up being talk, but I'm gravely concerned about psychotropic medications and their effect on our sexual functioning. And they can affect any stage of the sexual arousal and detumescent cycle. Doctors don't pay enough [attention]. I'm worried about hormones and their effect on that too. I'm worried about lack of hormones. On some of my streaming shows and podcasts, I will focus on those issues because people need to be informed. The doctors don't have the time, and aren't spending the time to educate them. And when a woman is put on a hormonal contraceptive, they should be given a ton of education.
I can't tell you how often it's vaginal dryness and decreased libido and no orgasm function. It's from these high-dose progesterones. By the same token, we were kidding about peri-menopause, but women are treated for depression when they should be treated for hormonal imbalances, and they leave out testosterone always. That's sexist in my opinion, because that's the "male hormone" — no, it's not. It's kind of a big topic for me, proper assessment and proper education, and time spent doing that, not available as medicine is practiced today.
That's probably the case in a lot of silos of medicine, right? There's too many patients, too much of a load.
Everything is funneled up to the doctors and we don't have time to do what we'd like to do, which is build a relationship and spend time educating you. That goes to paraprofessionals and physician extenders. That's sad. It really bothers me.
We're both parents. What kind of advice do you have on raising teens today?
The biggest problem right now is screens. I think within 20 years we will think of screens the way we think of tobacco now. Screens are the source of a lot of really serious distress for young people. It's bad enough dealing with it normally without the screens. But the screens have added a layer where it's 24/7, it's raining down on them all the time. There's no escaping whatever they're trying to escape. There's mistakes that we all make during adolescence that now exist forever. There are literally crimes they could commit unknowingly. In many states, just sexting or requesting a sext, both are felonies and can affect these kids the rest of their life. And there's just a whole layer to the experience that. I have friends that are therapists and mental health professionals that just focus in this area, and they only give their kids 30 minutes a day on the screen. I don't know how you do that. It's almost impossible.
All right, so you and Adam Corolla and "Loveline." I remember those early days on MTV, which of course evolved from radio and the awkward questions in calls. What made you want discuss sex and addiction on air?
I'm an internist by training. I do internal medicine and that's why I was doing AIDS patients. I was struggling with that epidemic. I was there when we brought out the first AZT, and I was in the middle of all that. Then I ended up moonlighting in a psychiatric hospital and got very involved dealing with psychiatric patients, both medically and through the addiction. And what I noticed is, is eyes start to gravitate towards whatever the big problem at the time is. Like right now, to me it's homelessness. I'm deeply involved in that problem. And at the time, it was HIV and AIDS. Then that translated to sex and relationships, trauma, childhood trauma has been a massive issue for the last 30 years.
I got involved in that and the treatment of trauma, then drugs and alcohol became the problem. And so I spent 20 years running a drug and alcohol treatment center. I finished that up, started thinking about other things. And now I've been involved with the homelessness epidemic. And this corona[virus] thing has been sort of a sidebar. And by the way, if the homeless start getting corona, in Los Angeles, we're going to have a big damn problem. It's an open-air asylum. These are open-air asylums with people rotting in our streets, dying three a day in LA County. If three a day were dying of corona, people would be running down the street with their hair on fire. Because they're homeless, dying three a day and drug addicted, everyone goes, oh well. This is unconscionable.
It sounds like you tend to focus your energy on where the problem is.
Yeah, that's where I tend to go and because I've had this crazy broad experience in medicine where I did general medicine and infectious diseases and then I did a whole lot with psychiatry and drug and alcohol, I have kind of a broad experience that young physicians don't have. They don't get that training. I'm trying to use as much of it, give as much of it back as I can.
This is one of my little policies since I got involved in media. I was like, these guys know how to create media that people listen to and I'm just going to inject myself into it. That's always been my policy. If you need to go somewhere crazy, you go, I'll try to make it meaningful at the end.
And inject the medicine.
Yeah, inject some of my message. "Teen Mom" is another model of that. When they came to me with "Teen Mom," I was like, this is going to work. This is going to affect teen pregnancy in this country. I know it. Whenever you have a dramatic story with a relatable source that helps young people, attracts young people's eyes and so they could see what happens if you make certain choices, my job is just to explicate and they'll get it.
How do you yourself mitigate stress?
I noticed early on in my work at a psychiatric hospital that certain personality types and addicts were having their way with me. They could really manipulate me and get me to do, respond in the middle of the night and try to help them and do all these crazy things that always ended up in catastrophes. So I went into therapy for a long time and it's just essential. Doing your own work is just a key part of being effective in all cases. You have to be able to just be present on behalf of the patient and not let your s**t get in the way of it.
How do you define yourself in the field? Years ago the New York Times called you Gen X's answer to Dr. Ruth, with an AIDS-era pro-safe sex message.
That was then. Now again, I have this broad medical and psychiatric experience, and I'm just trying to use the media to do good. That's it. I'm a medical professional with lots of extraordinary experience, and I'm trying to inject myself into the media in places where people are watching, to try to shape things. My naive little idea back in the beginning was, oh my God radio has been such a negative influence on people's sexual behaviors and drug and alcohol and they've been encouraging all this stuff. I wonder if I climbed into that vehicle, if I could move the battleship in a better direction. That kind of idea has been with me ever since, like just shaping the culture. I may not be able to get every case we're dealing with, but there'll be somebody listening and that will kind of move things in a healthier direction, which these days is hard, hard, hard, hard.
Do you get a sort of a sense of the zeitgeist, if you will, about what people, at least in the world of addiction and sexual challenges, are looking for these days, especially with the internet?
I'm very, very concerned about the impact of pornography. We don't even know what it's doing to our brain development and I'm concerned it's doing something. Obviously it does a lot of things to our attitudes and our feelings about men and women, and what's appropriate behaviors and whatnot. And the drug and alcohol issue is completely out of control right now. We have just been through this opiate crisis and we're mostly getting the prescription opiates under control, but fentanyl is still massively a problem. Meth, massively a problem.
A publication [coming out] in a few days that shows that mutual aid societies, free services, are as effective or more than professionally managed services when abstinence is your goal. More effective than professionally managed services, and it's free. That should not be under attack, ever. Now there's an evidence basis for it, and it's been under attack and people reject it, in particular young people reject it. That's been one of the challenges lately, is they just won't engage the way previous generations have.
Why do you think that is?
I don't know. We can't figure it out. None of us can figure it out. It's literally like, "Hey, that's not for me. It's not something I can relate to." And it has something to do with the spiritual piece. Like the idea is anathema to them. It's not the God thing so much as . . . millennials really don't perceive hierarchies.
They either don't perceive them or don't like them. And lot of these communities have hierarchies. They're old timers, or people that have long periods of time there. And you're supposed to look to them for guidance and help. A lot of the millennials are just like, I don't even know what you're talking about. That was just some old person.
We're talking about narcotics anonymous, NA?
Any of the 12-steps.
What about moderation therapy?
It doesn't work, but really what you're talking about is harm avoidance, right? If you got opioid addiction, or any addiction, we would not be doing moderation therapy, we'd be waiting for abstinence. But there are people for whom that is appropriate, and for whom nothing better is likely to work. Harm avoidance and replacement therapies of all kinds need to be used, but they need to be deployed appropriately. One of the problems in my field is, we don't know which cases to select for which treatments. There tends to be enthusiasm one way or the other rather than good science. And my thing is, I use replacement where we should be using it, use abstinence where we should be, and let the science direct us, and that's it.