In this insightful episode, Dr. James Flowers and co-host Robin French sit down with David Walsh, a board-certified Family Psychiatric Mental Health Nurse Practitioner specializing in addiction treatment. As the founder of Dripping Springs Healthcare and COO of CARMAhealth, David brings his extensive experience in treating substance use disorders to the discussion. The episode dives into the personal nature of recovery, the understanding that relapse is not failure, and how addiction is a disease. David emphasizes that while there’s no single “right” way to stay in recovery, the only essential rule is not using. This candid conversation sheds light on the complexities of addiction and how compassionate addiction treatment can transform lives.
Connect with David Walsh: LinkedIn | CARMA Health
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Listen to the podcast here
Normalizing Addiction Treatment With David Walsh [Episode 13]
Welcome, everyone, to Understanding The Human Condition with your host, Dr. James Flowers.
Hi, Robin.
How are you?
I’m doing great. How are you?
Introduction And VIP Guest Introduction
Awesome. We have a special VIP guest. Do you want to tell us who we have here?
He’s one of my favorite people in the world. David Walsh is a psychiatric nurse practitioner, which we’ll tell everybody a little bit more about. David, thank you for joining us.
Thanks for having me. I’m happy to be here.
David is joining us from Austin Texas, one of my favorite cities in the world too.
I thought I’d read a brief bio if you’re cool with that. David is a board-certified family psychiatric mental health nurse practitioner in the treatment of substance use disorders, He’s a graduate of the University of Texas, Hook ‘em Horns. David holds an adjunct faculty position at the UT School of Nursing. David is a published author, speaker, educator, and presenter at professional conferences. In addition to founding Dripping Springs Healthcare, David is the COO of CARMAHealth, an addiction healthcare company in Austin, Texas.
I have to say that I personally and professionally have used CARMAHealth for a few years now. I enjoy what you do and you bring so much to treatment facilities and so much of your expertise as a psychiatric nurse practitioner to the patients that I work with. I’m so fortunate and so happy that you’re willing to work with our patients at J. Flowers Health Institute.
I feel the same. It’s a joy and a privilege.
Thank you so much.
You’re very popular with the patients.
They always want to do a second session.
You have an inspiring story of how you came to work in the substance use disorder and addiction field. Would you be willing to share that with our audience as far as your journey?
I’m happy to share how I came to do what it is that I do. I’m closing in on 50 years old. When I was twelve years old in 1983, I went to a Police concert with a bunch of guys much older than me and I tried cocaine for the first time in sixth grade. It’s that classic story of I did it once and I knew the rest of my life, that was it. I was chasing that feeling for many years. Fast forward, through all the good, bad, and ugly that comes with alcohol and cocaine abuse disorder, when I was 38 years old, I had already been to treatment a couple of different times, and I hit what for me was the end of the road.
I was very sick and could not live any longer the way that I was. I was very fortunate to have parents who did not give up on me. My father came and met me in Austin and he was driving me back to Atlanta and we were trying to get to Atlanta for a detox. Were about halfway through Louisiana and I started having Delirium tremens seizures. My dad pulled over at some gas station in the middle of the Louisiana swamps and bought me a 24-oz. Beer. He went back inside and got a straw for me because my hands were shaking so much that I couldn’t hold the beer.
I wound up in a hospital in Tuscaloosa, Alabama going to the emergency department and all that stuff. I don’t remember it very well. People talk about DTs. I did experience that from what I remember. The outset was very frightening. I was in the hospital for a few days in Tuscaloosa and I had a call button so I could call nursing primarily for more benzodiazepines. I was hitting it like I was playing Jeopardy constantly.
The Life-Changing Moment That Led To Recovery
At some point, this guy came in and I always tell this story that it was a nurse. Honestly, that’s my memory of it, but he could have been anyone, tech or respiratory therapist. I have no idea. If he’s sitting across the table from me today, I wouldn’t recognize this person. What I do remember is that he came in he was very kind. He took the call button away from me, sat on the bed across from me, and said, “You can be as happy as you want to be or you can be as miserable as you want to be, and you have to make that choice.”
You can be as happy as you want to be or as miserable as you want to be. The choice is yours.
For whatever reason, that person at that time in that place said the right thing to me exactly when I needed to hear it. I was 38 years old, I’m sure I heard that before in some form or fashion, but had never internalized it. I wrapped up my stay at the hospital, got a ride to my parents, and drank one more night. My dad found me surrounded by a case of empty beer cans in his basement the following day after having been released from the hospital for ten days. He called a place in Atlanta called Talbott Recovery, and so I went there.
They have a wonderful program.
It’s fantastic. It was great. Nine of the best days of my life and then I went in there on January 14th, 2010. I’ve been sober for close to 11 years now. When I got there, I kept thinking about that nurse that I met in the hospital. I kept thinking if I could do something that impactful for someone else the way that that guy touched me, but not even doing very much other than being kind with some empathy, seeing what I was going through, and offering as much as I could stand at that point. I thought I could do that for other people and that would be a life well-lived.
I started looking into nursing programs and started taking prerequisites when I graduated college. I was an Art major and then I played in rock and roll bands and then I was in construction for a long time. This all pours into me, this healthcare stuff. I started taking prerequisites and then looked into a nursing program and then I found out about the psychiatric nurse practitioner program. I thought that sounded pretty cool. One thing after the next. I lived with my parents for about nine months and then we moved back to Austin, and then I got an apartment, and then I got a job. I rode a bicycle around for a long time and made $7 an hour, then worked at the psychiatric hospital. That led to the next and got accepted to the program at UT, and I got my nursing license.
It is not easy to get accepted into, by the way, at UT.
Yeah, considering where I had been 2 or 3 years earlier. That’s not like you even wanted to have a conversation with me. I started that program in 2012, got my nursing license, and then in 2015, I graduated with my psychiatric nurse practitioner license. That’s how I came to this field.
That’s so cool. What do you think was your biggest takeaway? Was there a defining moment at Talbot that you remember, or was it the overall 90-day experience?
I will tell you something. That’s particularly relevant to some of the folks that we work with at the Flowers Institute. I remember sitting in a group with a guy who was weeping and very upset because he had had to sell his beach house, and that was his bottom. I remember sitting there and thinking not kind things because I was consumed with interviewing the homeless, living on an abandoned bus, having no money, and all that kind of stuff.
Here’s this guy weeping about how he had to sell his beach house. I didn’t have much empathy for him at the time. I don’t know if I had this realization at that moment, but I had it pretty soon after that. I don’t know anything about that guy. I don’t know anything about the beach house. I don’t know what that represented to him. I didn’t know his childhood. I don’t know if he was first generation, higher educated, first person to make money and he built a beach house on a certain spit of land that his grandfather used to fish for their dinner. I don’t know any of that. I don’t know the depths of his pain over it. I have never broken a bone. If someone were to rate your pain 10 out of 10, on the 10 scale, I get a paper cut. It might be an 8. That’s my truth because that’s the worst pain that I’ve ever experienced.
That guy who was weeping over having to sell a beach house sounds like a high-level problem, but if that’s the worst pain that he’s ever experienced, that’s the worst pain that he’s ever experienced. I cannot judge that and I can’t compare it. It brought him to a place where he was making changes to pursue health and happiness than what it was. I don’t know that I realized it at that moment, but that was somehow a turning point for me to start recognizing that everybody has their path, everybody has their pain, everybody has their truth, and it’s not for me to judge. I’m here to help along their journey if I can and if they want it.
What made you decide to become a psychiatric mental health nurse practitioner as opposed to any other career in recovery or addiction? That’s a two-part question. The second part is for those who come from a non-clinical world, describe what you do.
Let me describe what I do first. I am a psychiatric nurse practitioner. A nurse practitioner is a nurse with an advanced level of training who can assess, diagnose, treat, and prescribe for conditions. There are family nurse practitioners who are similar to primary care physicians, and psychiatric nurse practitioners who do much of the same work as a psychiatrist, and there are some differences from state to state in terms of licensure and scope of practice and things like that.
Essentially, I’m a nurse with an advanced level of education that allows me to assess, diagnose, treat, and prescribe for mental health conditions in adults. I came into this primarily because I wanted to be able to give back because I wanted to be able to help people in the same way that I had been helped. If I’m going to be truthful about it, I also was in my mid-40s. I had lost everything or given away everything or whatever, but I was in dire straits. It’s a good career to be a nurse practitioner financially. I don’t think that part should be ignored. As I said, it was that brief moment with that guy in the hospital. That is a moment that I can identify very clearly as being before and after, like the old me and the new me.
Do you know who else said that a nurse saved her life and there was a moment? It is Betty Ford.
Really?
Betty Ford was a severe alcoholic and tried multiple times to be sober and couldn’t be sober. She was at the Bethesda Hospital and Detox. A nurse sat on the floor next to her on the bed and Betty Ford got on the floor. Betty Ford said that was her turning moment. She said that the nurse was the most honest truthful person to her at the time because she was the first lady and this famous woman. People cuddled her and this nurse didn’t cuddle her up. That was Betty Ford’s turning moment.
That’s interesting. That was true for me.
Now you’re the COO of CARMAHealth. Can you tell our audience about CARMAHealth?
CARMA is an acronym. It stands for Collaborative Addiction Recovery Management and Assistance. When I was still in school at UT, I was very active and vocal in letting people know that I wanted to be working in the addiction psychiatry space. That was one thing. The second was that I intended to start a practice on my own. While I was still in school, I met a guy in, Dr. Carlos Tirado. He’s an addiction psychiatrist in Austin. Super bright guy and one of a kind. I was introduced to him and he was good enough to take some time and have lunch with me while I was still a student. I told him my story, my background, what I wanted to do, that I wanted to start a business, this that, and the other.
With his twenty years of healthcare experience, he was probably thinking, “It’s a little bit more work than what you think it’s going to be,” but he believed in me and what I had to say. Here in Texas, as a nurse practitioner, I have a delegating physician. It’s like a supervisory role that almost all practitioners engage with the position in that role. We talked about that. He agreed to be my delegating physician and he helped me start up Dripping Springs Healthcare, which is an outpatient psychiatry practice in Dripping Springs, Texas.
It was during that time that I met Dr. Flowers when I was over there at Dripping Springs Healthcare. While I was having that practice, Dr. Tirado, for a long time had this vision of bringing addiction healthcare into the primary care space. First and foremost, everyone needs a primary care physician. Lots of addiction can be treated in the outpatient space. Lots of psychiatric health concerns and behavioral health concerns can be treated in the outpatient space. Most importantly, a lot of the stuff can be treated by a good primary care provider.
There’s no reason for people to get in line for three months and pay a lot of money to get a little bit of Prozac. A lot of it takes thought and education, but a smart, engaging, and thoughtful primary care provider can and should be able to manage psychiatric addiction concerns in the outpatient space. Dr. Carlos was keen on starting this interdisciplinary clinic that is primarily a primary care practice but also employs psychiatric nurse practitioners, psychiatric physicians, case managers, therapists like LCSW, and things like that.
That was his vision. He started that with a couple of other like-minded investors in 2017, and then as they launched and things started to happen, they invited me to the management side of things. It’s a little bit less clinical at that time, but my role is getting to be a little bit more 50/50 now. I started with them in January of 2018 as the COO. In the three years that I’ve been there, I think we’ve probably gone from a few hundred patients. I think we’re closing in on 8,000 patients. We’ve grown from having one primary care provider at that time to having about fourteen practitioners between nurse practitioners and physicians. We have a staff of over twenty. We serve a number of facilities across Texas, in Florida, and even in Tennessee. We’re moving into Virginia. It’s been a very exciting experience.
Congratulations.
Growing CARMAhealth And Expanding The Practice
Thank you. We’re trying to normalize addiction, healthcare, and psychiatric care.
I remember when you guys were starting. I remember when you were at Dripping Springs, and then you said, “I’m going to this new role and it’s called CARMAHealth. Let me tell you about it.” I got chill bumps. I remember going, “Why didn’t I think of that?” It’s the entrepreneur in me. It is such a missing piece around the United States or probably around the world. Because of this “stigma” that sometimes family practice physicians have and primary care doctors and the general population, when you go in and say, “This is who I am. I’m an addict,” and what have you, they draw this picture sometimes.
You, guys, is a practice specializing in working with people and recovery. The amazing thing is that you don’t just work out on them after treatment or during treatment, but they can be there for a lifetime or a life span. It’s so amazing that they can walk in and it feels like home. It’s like, “I’m welcome here and I’m an open book and I can be an open book and there’s no judgment.” The idea was brilliant and it’s an amazing practice. I have begged and I’ve done everything but get on my knees to ask CARMA to come to Houston. It’s something we often talk about but I think what you guys do as a practice for this population is priceless. Thanks for doing it. I appreciate it.
I wanted to go back to your own life and your addiction and your recovery. Often what we talked about and what the title of this is Understanding The Human Condition and what is the human condition. I’d love to know your idea of the human condition, where you were, and where you are now. What was the state of your own human condition in your active addiction versus where it is now and that span?
I will try to answer that without sounding either clinical or 12 Steps
Either way is fine.
I would like to put it in my own terms and relatable. Being ten-plus years sober now and looking back on my previous life, that’s how it feels. It is a previous life. It doesn’t even make sense that was me. A lot of it doesn’t feel real. There, in the end, I was incredibly selfish. What I know now is that I caused a great deal of pain and fear for the people who loved me. I was living in Portland, Oregon. My parents were living in Atlanta Georgia and my mom changed the locks on her house.
Tough love.
It never crossed my mind that my parents offered. That was the level of insanity that I was broadcasting. At the very end, the last four weeks were an exceptionally frightening time. I remember feeling very alone and very dar. I’ll tell you about one other experience I had in 2009. I was in a treatment center and I think I was there for 28 days. I managed to stay sober for 28 days and then I had my girlfriend come pick me up.
I was drinking within about twenty minutes of leaving the treatment facility. We went back to this little house and this guy who was also discharged from the treatment center came over. We used drugs and I remember being in that room. I know for a fact that there was call it the devil, call it demonic energy, call it negative, or whatever. No one can tell me differently that there was a third being in that room and it was evil. It just was. I remember that feeling being so palpable.
I do remember that when I was getting sober in 2010, I would go back to that experience. I would think to myself, “If I know that there was real darkness, evil, fear, cold, empty, void, malevolent force, if I believe that existed, there has to be the opposite. There’s got to be the other side of it.” Not to get into like higher power, spirituality, or any of that stuff. Everyone has their own path to recovery. Everyone does their own. I have no idea what’s good, bad, or indifferent for anybody else. I only knew what my truth was.
To get back to the human condition part, I’ll relate these two. As I have been in recovery and as I abstained from substances, I have lived each day not necessarily making people’s lives better and my own life better. I do try to live each day and not make anybody’s day any worse. That’s my benchmark. If got through a day and didn’t make anyone else’s day any worse, that’s a good day.
What I have found is that things are lighter for me, things are brighter for me, and things are easier for me, which is not to say that life is easy, bright, and light, but I don’t live in fear anymore. I don’t live in lies any more. I can say it like it is. At the end of my use, there was a lot of very dark, bad, negative sh*t going on. Since I have gotten sober, it doesn’t mean that things are perfect. It just means that I am so much better equipped to manage my life and the world around me as it comes to me.
It’s like what you hear people say. If you keep doing the next right thing, the stuff builds on itself and it stacks, gets better, and flourishes. Someone told me when I was getting sober that at three years, you will have rebuilt x amount. At six years, you will have built x amount, and at ten years, you’ll have built x amount. On the one hand, I would have said, “Ten years, man. I don’t know about that time.”
It’s also that sort of thing that during your wildest dreams, you will see that what you get is going to make that stuff pale in comparison. There’s a lot of truth in that too. The mystery and the joy and the color, all the cool stuff. Not to cross it like you get sober and everything is going to be cool, but I got sober and everything is cool.
That’s a good story, a great success story. For those tuning in, it really is.
I was very fortunate.
You work a lot virtually with all of our patients at J. Flowers Health Institute. Being a mental health professional, being a psychiatric nurse practitioner, and then working in recovery, being in recovery, What’s one piece of advice you’d give the audience that has a family member that struggling with depression or bipolar or even borderline and addiction together, that comorbid mental health addiction combination. There are lots of parents out there, moms, dads, brothers, and sisters who have someone in their family but they don’t know how to help them. What advice do you have wrapping up here?
Advice For Families Supporting Loved Ones In Recovery
There’s a strange balance that I have to encourage a family’s ill patient to strive, which is don’t give up on your loved one and provide all the support you can but hold your boundaries. I did not understand how much of a family disease addiction was until I went through it. I remember going to one treatment facility and after a day, I was like, “I need the phone. I have to call my parents.” Your parents need a break from you. Do not call them. They don’t want to be there.
There’s so much about addiction that impacts the entire family system. The non-using part of the family, out of a place of love, often winds up in this enabling profile and winds up being hurt and going through their own stuff. The advice that I would offer to families is to support your loved one, but first and foremost, love and support yourself because you can’t change someone else.
You can change yourself and look out for yourself. It’s the hardest thing in the world to do to love someone from a distance and to tell someone that you’ve done what you can do and this is the kind of support you’re willing to offer. Ultimately, that’s it. You got to take care of yourself first and your loved one is going to choose to get better or not get better. That’s very difficult, almost like a TV show that you got to watch.
Sometimes the hardest thing is loving someone from a distance. Take care of yourself first.
Sometimes a soap opera. I have no doubt that eventually, your family’s door was reopened to you. Not sure if your mother ever gave you a key to her front door again, but I know that door is probably open for you.
Better than I could have ever imagined.
That’s so cool. How do people reach CARMAHealth and look at your website, and how do they reach you guys?
Thanks for asking. CARMAHealth.com and CARMA Psychiatry. You can google our pages. We are in Austin, Dripping Springs, and Florida. If someone wanted to find us, I’m sure they could go through the J. Flowers Institute.
I can’t thank you enough for doing this and spending time. I know how busy you are in running CARMAHealth, your own practice, and everything that you do in your life. A huge congratulations on your sobriety and the life that you live today. I try to strive to be as good of a person as you are, David. Things for being a part of what we do and things for being a part of what we do today. Robin, how do people reach us?
JFlowersHealth.com or they can call at 713-783-6655 and please mention that you heard our podcast.
David, thank you so much.
If I can add one thing, Dr. Flowers. Thank you for having me and it should be acknowledged that when I started working with you, I was a relatively green practitioner and you have played a significant role in my professional development. I hold you very dear to my heart.
Thank you.
Important Links
- David Walsh – LinkedIn
- Dripping Springs Healthcare – LinkedIn
- CARMAHealth
- Flowers Health Institute
About David Walsh
Board-certified Family Psychiatric-Mental Health Nurse Practitioner, licensed and trained to treat behavioral health concerns across the lifespan. Graduate of UT Austin, published author, speaker and presenter at many Advanced Practice Nursing conferences, and member of the Sigma Theta Tau International Nursing Honor Society & American Society of Addiction Medicine.
My primary area of interest is in working with families struggling with addiction, and supporting those in recovery through smart medication management and ongoing therapy. My belief in the recovery model informs my empathic yet pragmatic approach to behavioral healthcare.
The providers of Dripping Springs Healthcare offer the opportunity to learn more about both mental health and addiction. Our informational presentation covers mental health incidents and prevalence for the local Austin area, as well as national level data. The disease of addiction will be discussed, as well as how to recognize the problem and where to find assistance. Please contact us today for rates and scheduling opportunities. Learn more about Dripping Springs Healthcare, our providers, and their specialty concentrations at www.DrippingSpringsHealthcare.com.
