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7318 Multiple Pathways to Recovery
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Some of you may remember me. My name is Emily Mossberg. I'm a technology transfer specialist with the Opioid Response Network. We hosted a training for you all several months ago, but I'm honored to be back with you today. And before we get started, I do want to acknowledge that funding for today's presentation was made possible in part by a grant from SAMHSA. The SAMHSA-funded Opioid Response Network provides no-cost training and consultation with communities across the country on topics related to opioid and stimulant use prevention, treatment, recovery, and harm reduction. Through this work, we utilize a pool of consultants who are located all over the country and who can respond to local needs. Anyone can submit a request for assistance on our website at opioidresponse.net. So over the next two months, we are going to be providing a series of retraining sessions with our consultant and trainer Scott Ludgenow. Today, we will be covering the topic of multiple pathways to recovery. And just a couple things to mention, this session is being recorded and will be available for sharing within about two weeks. You can feel free to put any questions that come up in the chat box, and I will monitor that and share with Scott. Also, we will be sharing a link to a quick evaluation survey at the end of today's presentation, and we greatly appreciate you taking a few moments to fill that out. It does help us maintain our grant funding to continue to provide free services. So all right, I think that's everything. So with great gratitude, I will now pass it over to Scott. Awesome. Thank you so much, Emily. Thank you so much for being here today and tuning in. Apologies for the late login. I am traveling on the road, and the Wi-Fi was a little spotty in my room. So I'm in the little restaurant area in the hotel right now. So it's good to see you. Glad to see a Softail license plate up on the wall behind. Yeah, there you go. I got a 76 FLH in my garage right now. So right on, right on. I am so glad to be here with you today. A little bit about myself. My name is Scott Ludgenow, licensed clinical addiction specialist, masters of social work, or clinical supervisor. But I do a lot of different things. I've done a lot of work with the opioid response network, the addiction technology transfer centers. We're trying to get information out to the public around substance use disorders, how to support folks who are struggling, and everything that surrounds that. So I don't have to preach to this choir about that. I do a series of trainings for the Mississippi Public Health Institute. I've developed some curriculums on leadership development for the recovery movement, for Faces and Voices of Recovery. I've put together some opioid treatment courses for NC State School of Social Work. I used to run a large opioid treatment program, and we'll talk a little bit about that. And let's talk maybe just a little bit about recovery. Individuals who are in recovery know what it means to them, and how important it is to their lives, right? I think we can all agree to that. Where does this come from? Well, this comes from the Betty Ford Consensus Panel, which way back in 2007, when things were really changing about how we were talking about recovery and substance use in our country, you had a group of folks that got together, and they're like, we should probably define what recovery is. And so in 2007, they got together with clinicians, researchers, but most importantly, people with lived experience in recovery. We all know what addiction looks like. All you have to do is turn on the television, and like all of us know what of a nightmare active addiction is. But the country didn't know enough about recovery. So it was time for us to really start talking about it in a different way, right? So when people were struggling, and they thought that they might need assistance with that thing, it was visible, and not hiding in a church basement somewhere, right? But this was their first sort of crack at it. They said, however, recovery is not clear to the public on that point. Indeed, there is reason to believe that there is no complete consensus on the definition, even among those in recovery. And you might say that that's still true in a lot of different ways, right? Depends on who you're talking to, but we'll dig into it a little bit more. Who is this little kid with the giant watermelon head? Well, that's me. That's me when I was a very young man growing up in a small town called Hope Mills, North Carolina. It was about 15 minutes outside of Fayetteville or Fayette Nome. It's the largest military base in the world, which is why my father was there. He was an air traffic controller. He met my mom at Seymour Johnson Air Force Base about an hour from there in her hometown. And they were at a restaurant called the Chicken King, and they were eating some fried chicken. And dad was in a 57 convertible Chevy. And my mom, who was maybe one of the shyest people I've ever met in my life, walked over and asked my dad how the fries were that evening, and the rest was history, right? And so a few years later, they settled in Fayetteville. Dad got a job. He was the air traffic control tower chief. And, you know, we didn't have a lot of needs in our life, right? We were never hungry. We always had a place to sleep. We were very firmly planted, like a middle class. And despite sort of being in this really great environment, and this is my younger sister Kelly, I started experimenting with substances at age 13. And by the time I was 16, I had several full-fledged substance use disorders that had moved out of my family's house, and they didn't know where I was, right? So years, years later, after working in the restaurant field for almost 20 years, I was about 33 years old, and entered into recovery, right? And so what does that mean for me? Well, I went to school and got a couple of degrees. I never thought I was smart enough to have any degrees. And recovery really gave me the confidence in the community to think about myself in a different way, right? And, you know, it's hard to sort of talk about it without tearing up, because I owe so much to recovery. But I think one of the things that is most important about my recovery is it's reconnected me with my family in like a real meaningful way. And I think a lot of us can really relate to that, right? It's like this idea of a family that was hard to get along with, and now not so much. And so this is my mom now, and she's celebrating her recent birthday at her favorite Mexican restaurant. And this is my dad doing what he loves best, doing some deep bass fishing in one of our big lakes in North Carolina. And my dad and I, we didn't have the best relationship in my active addiction, I'll put it that way. And we're really close now. He almost passed away during my active addiction, because he was diagnosed with pancreatic cancer. He's a survivor of cancer. But we have the best relationship now that we ever have, we have a lot of respect for each other. And it's a beautiful thing. This is my beautiful little sister Kelly that you saw earlier, who is a remarkable person, I could be there for her, my mom doesn't worry about if I've overdosed or where I'm sleeping at night. You know, recovery, as we all know, just doesn't impact you, it impacts our families, it impacts our communities, our co workers, so many things. This is my little niece, Abby, like I can be a respectable uncle to her because, you know, of my recovery. So I'm so, so, so thankful for my recovery. What do we know about recovery? Right? And why did I just tell you my recovery story? Well, you know, I started out this by telling you my recovery story to tell you that that was my recovery story, right? And each of us for the millions of people in recovery, there's millions of different recovery pathways. And they're very, very different depending upon the person. And it really should be that way. Because we've been we've known through data and statistical analysis that the more options that we offer people on this thing called recovery, the more likely they are to get and to maintain long term recovery. So this is one of my favorite studies. It was done by Dr. John Kelly at Harvard University. And it was done in 2017 was the largest study ever done on recovery today. And this is what they found. And most of us who are in recovery would tell you Well, yeah, of course, right. So you look at this first five years, everything gets better. happiness, recovery capital, what's recovery capital? Does anyone want to chime in and tell me maybe a few pieces of recovery capital what that means? Like the stuff that you you get in life, like you're the things that you gain, like your, your community and things like that. Yeah, exactly. It's a really good way of saying it. And then it can also be those things that make it more likely for you to get into recovery in the first place, or to stay in recovery once you're there. So some of those things might be what like employment, insurance, a car that you have an actual like license for her, which was a big thing for me, right? Food, friends and family, you know, things like that really important stuff. So like, all of those things get really, really good self esteem goes up predictably, what gets worse, psychological distress, that's what we want to get worse, we don't want any psychological distress, or at least we want the small amount of that within reason, active addiction increases our psychological distress. But what did we find out when we started to look at the first six months of recovery? Well, for many of us, at least statistically speaking, the majority of us, things got worse. So those first six months of recovery, they found in their research that things actually got worse, as compared to their last few months of active addiction, which was probably pretty bad, right? And in of itself. So what does that tell us? That tells us that that first six months of recovery, and that's an average, it could be longer, it could be a little bit less, is a really, really, really difficult time for folks. And we're trying to ask them to make this like Olympic effort to do this thing, when they're not really operating at their best, at least I can speak from my own experience, I wasn't doing so great my first six months, right. But you know, putting one foot after another, the things that you hear in the rooms, right, you know, just, you know, keep sort of moving in the right direction, things will fall into place. All of that sort of makes sense over a period of time. And so I just point this out to say that recovery works. However, we have to be really sensitive to folks in that first six months. And that's when they're determining what their recovery pathway is going to be. And we'll talk a little bit about the psychology of being told what to do versus not being told what to do and sort of like, how we react to that as people just naturally, as we go on. So this is Southlight HealthCare. I did my internship at Southlight. And Southlight is over 50 years old now. And they've served their community in a very big way for a very long time. So they offer, it's a community-based mental health and substance use disorder treatment center, right. So they offer intensive outpatient, peer support specialists, opioid treatment programs, psychiatric services, primary care, just anything that you would like really need, like coming into recovery, assistance with transportation, assistance with houselessness, you know, a lot of different things. And so I was doing my internship there, and I was like, I really want to work there. I want to keep working here. I love this work. I was a intensive outpatient therapist working with folks who were like right under that inpatient level of care. So very complex, you know, a lot of folks with severe opioid addictions, as well as co-occurring disorders like anxiety and depression and a number of different issues around, like I said, housing, transportation, and those important recovery capital pieces. And I had been working there for a little while. And like I said, they had an opioid treatment program. And of course, for those of you who don't know, opioid treatment programs are programs that are, it sounds like a very generic thing, right? It's just like, oh, they treat opioid addiction. Well, it's actually highly specific. So they treat opioid addiction with either buprenorphine, suboxone, or methadone, or Vivitrol, or some combination of those, along with other supports. And I didn't work in that, we would call it a service line or department, right? I didn't work in that. But some of the clients that went there would come to my groups, and we had a little bit of interface. But, you know, I really didn't know how I felt about medications for opioid use disorder, because that wasn't a part of my recovery pathway, right? I hadn't been introduced to that or offered that due to just not going through formal treatment myself. And we'll talk about different treatment pathways in a few minutes. And, you know, I had heard a lot of things about, you know, this was simply replacing one drug for another. And I didn't know how I felt about it. It didn't make great sense to me, right? But I really thought based on my own recovery, that I knew the fastest sort of bus to recovery town, you know, like, hey, I've done it before, I know how to do this, I got you, let me help you, you probably don't need this. And some other things that, you know, in retrospect, that might have been quite damaging. And so we'll talk about that. We'll talk about different recovery pathways. We'll talk about this idea of our own experience being highly valuable when we're working with other people. But when can it get in the way, right? And not through selfish or sort of negative intent, but just because maybe we don't fully understand something, right? And that was where I was coming from with that specific scenario. So what am I talking about here? Well, what ended up happening is the opioid treatment program director moved on to another job, and they wanted me to apply for the position. And I was like, okay, this pays $30,000 more a year. So this is maybe worth sort of figuring out how I really feel about this, right? And so I went down the rabbit hole, I did a lot of research, and I found that there's a preponderance of evidence showing that medications for opioid use disorder can be very, very helpful. So this is just an example. I took the position. This is just an example of where my own ignorance really got into the way of me being able to really help people and being flexible around different pathways to recovery. We'll talk a little bit more about this as we go. Has anyone heard of the Dunning-Kruger effect? No? This is something I was introduced to recently, and it really sort of struck a chord with me. So bear with me and see if you can sort of connect with this. On the left-hand side, you have confidence, and then on the bottom, you have knowledge. And what we find is that when people get a little bit of knowledge about something, that's when they're most confident about how much they know. Do you think that could be true? It could be a dangerous combination. And have you seen that maybe anywhere, right? So I'm talking to Chris about motorcycles. I know a little bit about motorcycles, probably enough to get myself killed if I'm not really, really careful, right? And when we're talking about addiction and recovery, this truly is life-or-death stuff. But we have a lot of people that have a little bit of knowledge about something, and they're at their highest point of ignorance, and they're at their highest point of confidence. And that's something that we really have to consider because this is such a complicated issue around addiction, right? Here I am, a white man talking about multiple pathways to recovery. Well, what does that look like for other populations and groups, right? Am I really qualified to talk to everyone about what is their pathway to recovery? And even among white folks, white men in my own age group, right? Am I really qualified to talk to each of them as if I'm an expert on their personal experience? And the fact is, it's not true. I'm not. I'm not qualified. In fact, I'm there to learn more from them so I can put them in front of different options that may be attractive to them. So I can learn what may be attractive to them. Because if we put somebody in recovery for our reasons, how long is that going to last, right? It's not going to be sustainable. So we'll just sort of finish this on the Dunning-Kruger effect. What ends up happening is the more a person learns about the subject, the less their confidence is. They're like, oh, snap. I don't know as much about this as I thought. This is a lot more complicated. This was like me in geometry. I'm like, oh, shapes, no problem. And then like I'm three weeks into geometry and I'm like, I'm not going to go to class anymore, you know, because you get down to this point where it's like, they call it the valley of despair. That's what they call the peak at your height of ignorance. They call that Mount Stupid. And then you go down to the valley of despair and you're like, I'm never going to learn how to do this. And then you slowly start becoming an expert. But then once you reach the top of the expert status, realize the difference between the confidence at the top there and then the confidence at the very beginning. You will never have that same confidence as when you knew the least about a particular subject. Isn't that interesting, right? So like an expert is going to be a little bit more humble in their approach, which I think is very important in the work that we do, okay? And then also a red flag if you sort of see folks on the peak over there on the left, right? So this is really interesting. And I know I'm not talking to clinicians, I'm talking to peers today, but this is the same concept, right? In 2012, there was this landmark study that was done that showed that therapists thought they were much better at what they did than is absolutely possible, right? So they polled a hundred therapists and 90 of them thought they were in the top 10 percentile. So, you know, a hundred therapists, only 10 can be in the top 10 percentile. 90 of them thought they were in the top 10 percentile. So what does that tell you? We think we're a lot better at what we're doing than we actually are. Now, does this translate to peers? I don't know, maybe, right? Like, I don't see why it wouldn't. We're in a helping profession or we're helping others. We're told that you've gone through your recovery. So this now makes you an expert in this thing. So we can probably succumb to the same pitfalls that a therapist could, right? I don't see why not. And then they also saw this. They saw that no matter, first of all, they saw that the longer that you provide a therapy, the less effective you are. What? Can you believe that? Why do you think that might be? Anyone can just sort of chime in. When you say longer, do you mean like in a certain time period in a session or long game over the years? That's a really good question. Thanks for clarifying that. I shouldn't say that because somebody else asked me that. Over the years. So Douglas, if I'm like a therapist that's been doing therapy for six months, I might have better outcomes than somebody that's been doing it for 30 years. Either burnout or just maybe burnout or overconfident? Overconfidence is the key. What ends up happening is we're like, I've been doing this for 30 years. I'm a complete expert and people don't connect with that. People don't like that. I don't wanna talk to an expert. I wanna talk to somebody that's cool. Like I wanna talk to somebody that has like a good heart. And so here's what they found. They found that interns were getting better results that not only the clinicians, but the clinician supervisors who are also working with clients. So what does that tell you? Yeah, it's crazy, right? What does that tell you? I mean, just by the sound of it, it sounds like the people with less experience have a fire under them and they haven't, I guess, been through the barriers and the roadblocks that the people over 30 years have. And those people usually see what's coming down the road and they're like, oh, well, this is what's gonna happen. So we'll just go through the motions. Yeah, that could be very much a big part of it, right? And then also this idea of like humility, right? It's like that person who's an intern is gonna be much more humble and they're really there to serve that person. And they're really thinking in their mind, gosh, I really hope I get this right. Instead of thinking like they better get it right because I'm the expert. You know what I'm saying? We can do this as peers as well, right? And so I've seen it. This goes across disciplines. This idea of we wanna be helped by somebody that's genuine, that lets us be ourselves without judgment and that listens. And a lot of students are doing a lot better listening than folks that are working in the field for 30 years. That's why motivational interviewing as a style of engagement is really important. We'll talk a little bit about that as we go, but this isn't on motivational interviewing. But this motivational interviewing is congruent with this idea of how do we meet a person where they are? Because we say that all the time, right? You gotta meet the person where they are. We don't do it. It's real easy to say, right? It's not as easy to do. Why are peer support specialists so important? We don't even have enough time today to talk about why, but here's what we know through research. We know that they boost self-esteem and the confidence with the people that they work with overall. We know that they raise their empowerment, right? We know that we connect people with treatment, interventions and other resources where they wouldn't have had that before. We know that we increase their hope and inspiration, even if that's the only thing that we were doing. That's huge, right? I think we can all agree to that. Camaraderie, this idea of, wow, you know, Chris, Taylor, Douglas went through this and they seem okay. Like they're doing really well now. And that idea of just thinking that like, I'm not the other anymore. I'm a part of something that's gonna be doing something better. That's huge. Decreased psychotic symptoms and substance use. Not so bad. We like that. Reduced hospital admission rates. Very good stuff. So we know that peer support specialists are really, really important, but we don't wanna fall into that over-professionalization or expert trap of telling people what to do essentially, because that puts them at odds with us. And we'll talk a little bit more about that. And again, on the topic of motivational interviewing, there's a meditation or a prayer or a mantra that goes along with it. And what happened is, just the quick sort of version of the motivational interviewing is William Miller and Stephen Rolnick did research in the 80s on working with individuals who had alcohol use disorders. And they learned a lot about what works, what doesn't work when you're talking to people about making positive changes in their lives. Totally appropriate here for this conversation. And they were doing a lot of work with indigenous tribes from the Southwest. They were out of Arizona. Yeah, nope, New Mexico. And one of the tribe leaders said, you know what, if you have this philosophy or this style of working with people, you really need a meditation, a mantra, or a prayer, and you need a dance. And Bill Miller was like, you take care of the dance. I'll write this prayer. You can tell me what you think. And it's beautiful, right? It's guide me to be a patient companion, to listen with a heart as open as the sky. Grant me vision to see through their eyes, eager ears to hear their story. Create a safe and open mesa that we may exist on and walk on together. Make me a clear pool in which they may reflect. Guide me to find in them your beauty and wisdom, knowing your desire for them to be in harmony, healthy, loving, and strong. Let me honor and respect their choosing of their own path. And bless them to walk it freely. May I know once again that although they and I are different, there's a peaceful place where we are one. So this idea of let me honor and respect their choosing of their own path is so, so important to this conversation today about multiple pathways to recovery. Because what works for me is not gonna work for the next person, but may work for the next person. So what is motivational interviewing about? It's about being a patient companion. We are that person's partner through their healing process. And a lot of that is listening and hearing, right? Not talking as much. How do we be a safe and clear reflection, right? There's inherent wisdom in everyone, right? There's another quote from Rumi. He was an ancient Islamic theologian. And it was, you go from room to room hunting for the diamond necklace that's already around your neck. And that is so much of what recovery is about is these people already have the tools within them. The diamond necklace is already around their neck, but we have to lead them back to that place where they can discover within themselves the power to transverse active addiction. And then we wanna honor their path, right? We'd be respectful of their choices. And so what is SAMHSA's definition of recovery? All these years later, from the Betty Ford consensus of 2017, this is their working definition of recovery today. It's a process of change through which individuals improve their health and wellness, live a self-corrected life, and strive to reach their full potential. So it doesn't say anything about drug use in this definition, which I found very interesting the first time I read it. So, and that pondered me to think, well, what does that mean? And we're talking more about this than we've ever talked about. What does recovery look like to the individual? Does it mean that they've stopped using heroin, but they continue to use alcohol or cannabis? Is it up to me to determine if that's right or wrong? Does it really matter if I determine that that's right or wrong? Can I make them do something that they don't wanna do? And I think that's sort of the underlining here, right? We don't have the power to make people do anything, but there are ways that we can work with individuals to help them better understand how some of these behaviors may be hurting them and gaining their trust to the sense that they know who to ask for help when it comes time to say, I'm sick of this, I don't wanna do this anymore. So I thought we would just stop for a second to ask you, a room full of experts on recovery, what does recovery mean to you sort of personally? I think recovery means to me, freedom. Freedom, just freedom from all that fuckingness. You know what I mean? Love it. That was going on in my life, man. Sense of freedom. And what's better than, I mean, what is better than freedom, right? And living under the thumb of active addiction like I did for so many years. I know exactly what you're talking about. That's amazing, man. Thank you, Chris. You're welcome. Thank you. I think recovery is like, it's a multitude of so many different things that we also recover from. It's trauma and criminality and active addiction and the bondage of self and being stuck, you know, mentally in certain types of things, right? And we get to like, take a look at all those things and actually reinvent ourselves in that process. I love that, right? We have people that come in that we're working with and they're so down, right? And why wouldn't they be? Their lives have spiraled apart around them. Their family and friends have all turned their back on them. And it's our time to sort of inject hope and say, you know what? This looks like a big poop sandwich. I understand that. However, you have a painter's palette right now to figure out like, what do you want to rebuild your life to be? And we're here to help you with that. So I love that idea of reinventing yourself because maybe we were never the person we wanted to be in the first place, even before the active addiction started, but now we can really sort of work on that. And then trauma and all these other things, right? It doesn't just start and stop with not using substances, right? And you've got all these other things you get to look at and work on and recover from. Oh, it's amazing. And like, it seems like we can work on those things when we're not withheld by active addiction because you might work on something a little bit and then it's just like, it sort of, it goes away, right? Active addiction just keeps us from like really getting a foothold. All right, what else? What does recovery mean to y'all? It kind of, to me, it just means having control of my life. Totally. Yeah. Which is a big deal, right? Yeah. We want control over our lives. Yeah. I feel like I am now today. Yeah. That's amazing. I love to hear that, Sean. And then like also, you know, I'll bring up the serenity prayer, but like also realizing the things that I don't have control over and being able to accept that and set those things down. Talk about freedom. You know what I'm saying? Yes. Very cool. Kayla Douglas, you want to chime in? Feeling my feelings and being the light in other people's darkness. What a gift, right? What a gift. You know, sometimes I'll run into people and it'll be like the worst day. And I'm just like, yeah, I don't, none of this works doing anything. And I'll run into somebody and they'll say, you know, you saved my life. When I'm just in a restaurant eating breakfast and a server walks over and I don't even remember. And so like, that's the impact that you're having on folks. And just remember that, because we don't always get that feedback, but they remember. And of course I didn't save that person's life. They saved their own life, but I was blessed to be a part of that experience. What else? I was going to say just like picking up the pieces of my life and just recovering from all the trauma and just recovering from all the damage that I've done and starting a new life. Love it. That's amazing. Such inspiring, such inspiring stories. Thank you so much for sharing that. Does anyone else want to share? I would say maybe repairing the damage when I was younger, right? And then learning the new way of life, the new way to live, the new habits that you create and not having to react on old behaviors because you have these really new tools to move forward. Absolutely. I can really connect with that. Like I was on autopilot for so many years, just reacting to my feelings. And now somebody spoke about control and I don't always have 100% control over my mouth or how I feel, but it's a lot better. And now I don't have to deal with picking up the pieces like Taylor said, but yeah. Great. I appreciate that, Brittany. Thank you. And if I was to put one word I'd like to add in my recovery, it's healing. Like all across the board, just healing. You know, that's the mission I'm on. I love that. Yeah. It's like, it's so multifaceted too, right? It's just like so many things to heal from, feelings, perspectives, and just when I felt like things were never gonna get better, like, and they did. And it's a fascinating process. It really is. That's awesome. Is it Shaina? Thank you, Shaina. Well, that's inspiring stuff. Okay. I love these presentations. So these are the perceptions of recovery that we've had as a nation that have been sort of not very helpful, right? Historically speaking. And we could really go deep down the rabbit hole on unhealthy feelings around addiction that we've had as a country. It's getting better, but a lot of racism. There's a lot of things tied up in our problematic relationship with substances in the United States. Some of the most damaging have been this idea that addiction treatment is short-term, or recovery is this like, oh, okay, you're done, right? It's like you came into the ER and you've got a broken arm and it's like, oh, okay, we're gonna reset your arm and you're gonna be good, you're good, you know? And we, those of us in recovery, understand that it's a lifelong process, right? Like I have a much higher chance of returning to use than another person would have at something else, right? And so it's not acute treatment. It's not like a one-time thing and it's done. There are a lot of us that are in recovery that never went to treatment, right? This is very complicated stuff. It's not always institutional, like I said, right? It's not always happening in a treatment center. Sometimes it is happening in a church basement. That was the only place I could afford to go. I could cough up a buck or two for the basket that went around, but it all depends. Like what community are you from? What does it look like? We'll talk to someone about it. There's one sort of standardized care, and we know that more now than ever, that there's not, right, there's multiple, multiple pathways to recovery. Some positive shifts that we're starting to make in our country, longer-term treatment that's based on the chronic nature, right? What I would like to see is, okay, you're in recovery now. What does a recovery care plan look like for you? So my father, who I said had pancreatic cancer, he had this wild operation for 12 hours. That was like 12 years ago, and he's still going back and getting checkups. How's it going? Any symptoms? What are some sort of things that we can connect you with? Or is there a different community? Because they actually connect those folks with other folks that have gone through that specific operation to have community, right? Wouldn't that be cool if we did that with recovery, like in a more regimented manner, where we have a recovery community organization here, we have one over there, they're doing all different things, but what if we had a more formal process where we were linking folks to informal supports and formal treatment supports, right? That would be cool. So we're sort of, that's what we would like to do. Community-based, we know that a lot of recovery happens in the community. It's based in self-determination and choice. We could not make anyone recover. Like we can never do that. We can put them in incarceration that has sort of not worked, right? We have more people under criminal incarceration than we have ever had in history. And they're all in, most in the United States. And most of the folks in incarceration would qualify for a substance use disorder. So prison and jail is not working, right? This is a public health catastrophe. It's not a criminal justice problem. So we'll keep moving through. So what are the different recovery pathways? Well, if you had three big buckets of recovery pathways, and we're still learning all the time, and also I'm happy to share these slides if that's helpful, but we have clinical pathways to recovery. We have non-clinical pathways to recovery. And then we have self-management. One of the things from that big, big study from 2017, the recovery study from Harvard, is they found the majority of individuals who identify as being in recovery did it without any formal supports. No 12-step programs, no treatment, nothing. They were just like, I have a horrible issue with addiction, and I'm just not gonna do it anymore, and they stopped. That's not saying that people who needed other supports are any different. That's just saying that they're different, right? And we don't know a lot about those people because they don't talk a lot about their recovery. So that's one thing that we found out, right? Self-management or spontaneous recovery is what you'll sometimes hear that described as. And so let's talk a little bit about the first. We'll talk about clinical pathways to recovery. So I'm sure you've heard of some of these. We have different levels. These are the American Society for Addiction Medicine's levels of care. You have level one, which is outpatient. You have level two, which is IOP, intensive outpatient, typically three, three-hour meetings with a group a week with individual sessions at the patient's choosing. You have level three, clinically managed high to low residential inpatient services. Then you'll have medically managed intensive inpatient services. So these are kind of our very formal like clinical pathways to recovery. And when I talk about treatment, I typically talk about it as a blip on the radar. So what does that mean? Well, Shana gets in recovery. Let's say Shana goes into treatment. Let's say that Shana's lucky and Shana's in treatment for six months. What is six months in the course of our lifetime? And we act like treatment is such a big deal. And it is, it can be for many, many people, right? But if Shana's in treatment for six months, what happens after that six months? Where does Shana go then? Back to the community that Shana came from, right? So recovery is this long-term thing and we have to sort of respect it as such. And then treatment, if you talk to people in treatment on this white ivory sort of castle on a hill, they would say, come to treatment where you find recovery. We'll fix you, you know? And it's not like that, right? It's an introduction to a different way of living. Sometimes it works, sometimes it doesn't. Our motto in the field used to be treatment works. And my motto now is sometimes it works, sometimes it doesn't. Typically it takes somebody six months in treatment before, like on average, before they reach long-term recovery. That doesn't mean they have to, of course. Please, please know. But that's what we're talking about, okay? So I just want to sort of level set expectations around treatment, very important. Blip on the radar. We'll keep moving. So what are some examples of like evidence-based practices or clinical treatment methods for substance use disorders? Well, motivational interviewing, that's my favorite. That's like the best thing that we can do is really check how we're talking to people about their addiction. If we do that right, we have our best chances, right? Because remember the student who was getting better results with their client than the person who had been in treatment for 100 years? Why is that? Because they were taking more of an MI approach, which is what? Humble, asking, listening, asking questions, listening to the answers, right? Making decisions alongside the person, right? There's contingency management. I didn't know what I thought about this when I first found out about it. It's this idea of like, oh, okay, so Tayla's coming in, she has a stimulant use disorder, methamphetamine, and comes into treatment. And if Tayla can abstain from meth for two weeks, I will let her go into this closet and pick out anything that she wants. What could that be? Like a gift card, a stuffed animal, like just literally a variety of different things, you know? And I was like, are we bribing people? But here's the thing. I did a training on that, and I heard from a person who had done it in their treatment center, and they said, you know what happened? This lady, she was there, she had sort of this really strong addiction to crack cocaine and alcohol, and she had lost touch with her children. She had very small children, lost custody. And after a few weeks in treatment, she had sort of built up a period of abstinence, and she was able to pick something from the closet. So she did. She picked a stuffed animal from the closet, and it was the first time she had been able to give something to her child when she saw them at family day. And it was just this heartwarming story where the woman really broke down into tears, and that really kept her in recovery going forward. So I was like, you know what? Perfect example of judging a book, discovering not really knowing a lot, but thinking I was an expert on something. So contingency management can be a good thing. Community reinforcement is another model. I'm an expert in acceptance and commitment therapy. I love that. Cognitive behavioral therapy, dialectical behavioral therapy. So what are these? These are different modes or modalities of treatment, different styles that are evidence-based, that have been shown to work for certain things. Motivational interviewing, which peers can do. I think is the most important. And then there's this idea of not being able to get treatment when you need it, right? Like I really wanted to go to treatment, and because I had insurance, they were like, okay, your co-pay for IOP is gonna be $300 a week. And I was like, I don't have $20 right now, and I don't know how I'm gonna do that. So that's where I sort of went through my recovery pathway through the rooms, right? And then you look at our sort of situation with opioids right now, which has never been worse. And only 20% of people with opioid use disorder receive any treatment whatsoever. And only a third of those, which is about 7%, based on these numbers, of people with any sort of opioid addiction receive the option to have medications for their opioid use disorder. And we know that that can be the standard of care for people with opioid use disorder. And we know not everyone has to do it either. It really needs to be up to that individual, but they have to have access, and they have to have that option to do it, right? What are some other different approaches in terms of recovery pathways? Well, acupuncture, aromatherapy, guided imagery, massage therapy, mindfulness and yoga. I think if I had access to these things on a daily basis, it might help my recovery. What do you think? So what clinical pathways to recovery did we miss? Anything that we're missing here? I feel like this is a setup, Scott. No, to be honest with you, I really don't even have an idea of an answer here. It's a legitimate question. It's solid. I have some clients who have used like exercise and stuff, like going to the gym and working out a lot. When you said that, it made me also think of equine therapy. So I guess if you have a million dollars and you can do that, like I feel like that would probably be pretty cool. Like with a horse, having therapy with a horse, there's a lot of trauma survivors that get a lot out of that too. Okay, yeah. Oh, clinical, please. We also have some people that are using sweat lodges. Oh, that's brilliant, right? Sweat lodges. I tried that one time, was not my clinical pathway. I needed air conditioning very quickly. However, the guys that I went with, that was their jam. Like they did it every week. They invited me back and I said, I'll meet you on the outside of that tent. How about that? But such an important thing, like different pathways. And we don't have to talk about this, what's missing. So let's talk about, hold on, let me change my screen here because it's not letting me even see what it is that I'm presenting on. Give me a hot second. I'll put this down at the bottom. There we are. So non-clinical pathways to recovery. And maybe, Glenda, that would be more of an example of that non-clinical pathway to recovery, right? Is this idea of like sweat lodges or, and we'll talk more about some different non-clinical pathways to recovery. Recovery does not always have to happen in an office somewhere is the point. I think a lot of us know that through our own personal experience. So boom, boom, like how could we forget mutual aid supports, right? Such a big part of so many of us in our recovery. So like I started out in my recovery, really engaged in mutual aid supports, sort of got into some other sort of aspects of recovery, some spiritual thought. And then I know that these are here whenever I need them. And I go to them when I need to, right? And then some people go three times a week. Some people go six times a week. It really is. Dr. John Kelly, we talked about from Harvard earlier. I love his quote. He said, this is public health's closest thing to a free lunch that we've ever had in society, right? Am I right? Are there some problems with some of these groups? Probably, yeah. Are there problems with some restaurants? Does that mean I never go out to eat again? Are there problems with lawyers? Does that mean I don't use them? There's are the problems with some doctors, right? Do we know if we go to one of these groups and it's not for us, we'll try a different one, right? Or if community isn't the thing for us, we could do it online or we don't do it at all. Like it's up to the individual, multiple pathways. So we have NA, women for sobriety, smart recovery. Life learning is one of my favorites. Really, really cool stuff. It's secular recovery. And so a lot of people bristle at the idea of God. And I know, right? It's up to our own determination of how we sort of conceptualize that, but they still don't wanna hear it, you know? And for them, they have other sort of recovery pathways and that's cool. And then on the flip side of that, you have celebrate recovery, which is a Christ-centered approach to recovery. So it's like whatever you wanna do. So I had a pretty bad addiction among other things, but to cannabis. And so one of the beautiful things that happened out of COVID among the many yucky things is this proliferation of online meetings. And so LGBTQIA plus meetings, like so many like inclusive safe spaces. And I work with so many people that have agoraphobia or like fear-based anxiety, depression. They don't wanna turn their screen on. They don't wanna put their name out there, but they can zoom into that meeting and they can soak it up until they're ready to take the next step, right? It's a beautiful, beautiful thing. So, and it's become a bit fashionable to like poo-poo these meetings, I think a lot recently. And again, they're missing the point. It's like, if it's not for you, it's not for you, but you know, let's not yuck my yam and vice versa, right? There's room on the recovery bus for everybody and it needs to look different, but being divisive and pointing fingers at different contingents is not the way to go, right? Tells me a little bit about your recovery, really. So anyway, recovery residences, what does that look like? Well, I think a lot of us know, right? You know, out here we have a lot of Oxford houses, but it's these sober living facilities. And so I help a county with their opioid litigation settlement planning. So they've got millions of dollars and it's like, what do we do? And it's like, oh, okay, well, there's a lot of things that we can do. We talked about recovery residencies and afterwards somebody said, hey, what's a recovery house? And I was like, oh, it's very simple. It's a house where a group of guys or a group of women can live without sacrificing their recovery and they can support each other and those things. And I told her about women and children's homes, right? So it's like, you know, you have mothers with young children and they're trying to navigate early recovery. They're living with mothers, with young children trying to do that too. And it's like this beautiful, beautiful community. And so that's what a recovery residence is, right? It's like we want people to, we want people to stay in recovery, but they're in this sort of like really difficult environment. So when I would work as a person in recovery and I was supervising doctors and clinicians and an opioid treatment program, and they were like, why is this patient always late? It's like, do you know how many buses they had to catch to get here? Do you know that they might have walked through a foyer and their duplex that's ankle deep with crack vials? Like, do you know what they're going through just to try to fight for their lives right now, right? And so this just makes it a little bit easier, right? We love recovery residences, understanding that it's really hard to stay in recovery or navigate that process without a safe place to live. Recovery community organizations. I think we all know what these are, right? These like proliferated out of the Northeast. They started like in the early nineties and it was this idea of a safe space in your community to go to, go to a meeting, freshen up your resume, talk to somebody about how you're gonna talk about your recovery in your next interview when you have to speak to the gap of employment or a criminal record or whatever that looked like. But just like really equipping people with the skills that they need to move into a different sort of phase of life. And we want these everywhere on Main Street, USA, right in the middle of town, because we know, again, what addiction looks like, but we don't always know like the beauty of recovery, right? We still have a lot of this NIMBY stuff, not in my backyard. We don't want a recovery community organization in our backyard. I'm like, yeah, you do. And let me tell you why, right? Because it might be your sister or your son who is struggling at some point. You're gonna want to know that they've got a safe place to go. There's education-based recovery. This was a little bit of my recovery pathway. When I got a few years in recovery, I was like, ah, I think I might be able to go to school. So I did that and ended up going to NC State University. And I was like, you know what? This is a really abstinence-hop style environment. Problematic use of alcohol and other drugs is normalized. So what happens? Well, 90% of people graduate, and then they have a different relationship to substances after they graduate. 10%, you know, me being one of them, don't graduate. Like maybe we make it to the second semester, or we graduate and we continue using in a way that completely tears our lives apart, right? So that's why collegiate recovery programs are important. And that's why I talk about education-based recovery. I started one at NC State. We got a nice little grant and got one going. But the idea is like we could go to a sober tailgate and go see a football game and not sacrifice our college experience or our recovery, but we could have both alongside each other, right? And that's what we need in all spaces. And there's recovery high school supports now too. So employment-based supports. A lot of this really looks like educating employers around recovery and active addiction and letting them know it's okay to hire Scott, even though he had a background in active addiction. In fact, going back to the education, what we tell folks when we're advocating at the school level was students in recovery have much higher GPAs than their, you know, quote, unquote, normal counterparts. They do, right? So it's going to make your school look better. They didn't want to admit that they had alcohol and drug problems on campus. And I'm like, you have half the alcohol and drug problems like in our city. So like, let's just get real with this. So employment-based workforce development training, I like to go in and do a lot of training with folks around, you know, anti-stigma around medications for opioid use disorder, it's none of your business what your employer, what kind of medication that they're taking is, helping employee assistance programs. So let's say Stephanie is diagnosed with cancer, God forbid, and what do we do as colleagues? Like we rally around her, we like give casseroles to her family, right? What happens when she has a return to use or a real problem that she needs to address around her relationship with alcohol or other drugs? Well, everyone sort of hides, maybe they let her keep her job, maybe not, right, if we're being honest. So how do we change that whole dynamic? And that starts to become a disability rights issue and a liability for organizations as well. So I like to tell organizations, you can do this out of the kindness of your heart and because it's the right thing to do, or you can do it because you're going to be sued if you don't, you know, eventually speaking, like that's what's going to end up happening. And then we have this, you know, we talked a little bit about faith and spirituality based recovery, but celebrate recovery, right? A Christ-centered recovery program, recovery Dharma, Buddhist-centered. We have Maladi Islami, which is the path of peace or the Islamic sort of approach. Jewish alcoholics, typically dependent persons and significant others, what a name that is. But anyway, it's out there, right? The Jewish Board of Health and Human Services for all New Yorkers, that's in New York, obviously, but they've developed their own community because there's a high density of Jewish folks in the New York City area around folks that are really struggling with issues with alcohol or other drugs. Culturally specific recovery. I think some of us probably know folks who are part of the Wellbriety movement or use that as their recovery pathway. Absolutely beautiful recovery pathway. And Don Coyus is amazing, who does a lot of work with them. Outcry and Debario, which is Latino and Hispanics, National Compadres Network, another culturally specific recovery pathway and support system. Did we miss any non-clinical pathways to recovery? Any that I'm not thinking about? Something that I found that was kind of cool is I ended up working my steps through Alcoholics Anonymous, but I had a drug problem. And I found out in my community, there was something called Heroin Anonymous. And they take you through the big book of Alcoholics Anonymous, they just changed the word alcohol for heroin. And it was right up my alley. So when I found out about it, it like, boggled my mind. That's amazing. Yeah, because doesn't it feel so much better to be able to address like, what was your experience? Because, Shane, I did the same thing, like there was just a more robust AA community where I lived. And I was like, okay, I'm doing this. And I didn't really talk openly about the full extent of my experience. And I was like, this is okay, I can do this, you know, but then when something more appropriate came around, I was surprised at what a relief that was for me. Yeah, yeah, definitely. I love to hear that. And now we're seeing like, you know, and again, I'm a big advocate for even though this wasn't my recovery pathway, but people with medication, who use medications for their opioid use disorder, because I've seen it save so many people. There, there are, there are great meetings for folks that do that, because don't you know, they felt ostracized in a lot of meetings as well. Right. And so just a sort of quick point on that, right, it's like, that's a, I do a really, one of my favorite presentations is on the history of mutual aid groups, and how we have sort of ostracized different people over time, inadvertently, right? Because that's, that's just what we do as human beings. It's not a, an AA problem. But it started with AA, when folks with narcotics issues were starting to come to meetings, and they were like, actually, you're not welcome here, right. And I've got some interesting letters and documentation that was going back and forth between Bill Wilson and folks. It's really, really interesting. He was being very kind. But he was saying to this person that was trying to advocate for their partnership with them, for folks that were dealing with narcotics issues prior to NA. And he was very, very kind. But he said, you know, I'm not sure that I could ever really fully guarantee that folks with narcotic addictions would be openly welcome to our meetings. And you know, and that would be different, right, from meeting to meeting, depending on where you go. And, and then we saw with Narcotics Anonymous, of course, like that proliferated, as soon as addiction treatment centers started to make a safe space for them. And then in the 1980s, we saw a lot of folks in Narcotics Anonymous that were telling individuals that were coming to those meetings, you can't take Zoloft, or SSRIs, or depression medications, because you're trading one substance, or you're, yeah, you're trading one substance for another, right. And so there's a lot of bad information that was there. In addition to all the amazing things that were happening there, and all the lives that were being saved, right, it's very nuanced and complicated. So now we're sort of dealing with the next phase of that, which is folks that elect to take medications as part of their recovery pathway, on the opioid use disorder side. So it's, it's very interesting, right. But anyway, I digress. So we get back to that idea of motivational interview. And it's like, how do we open our ears? What's the quote from, from Abe? And it's take the cotton, well, maybe this is a South thing, because I'm down here in the South, but take the cotton out of your ears and put it in your mouth, right? Like, how do we start, how do we start listening more to the individuals, and then understanding that we're to learn from them. And we'll talk about that. Because I think this is, we get some really sort of like, quick bullet points on how to conceive this. Well, beware of the following. And I talked to this, I do a lot of training for doctors, too. And don't you know, I'd love to be able to tell doctors what to do. So when I train doctors, I'm like, when you go into a room with a patient, I want you to think in these terms, I want you to beware, beware yourself of the following, because we have this expert sort of bias where we feel like we know everything. And here's the thing, as far as doctors go, we in America and many other countries, we put a lot of trust in doctors, like wholesale trust, where it's like, they went to school for this, they're a doctor, like clearly they know, well, they haven't always been trained around issues on addiction, right? So they're still learning, too. So we've got to give them some grace. But beware of the following peers and clinicians and doctors, I can help them know, I can make them see, I can teach them, I can scare them, or I can guilt them. We'll talk about reactants in a second. But those of us who have parents or children, which is every single one of us understand this idea of we hate being told what to do, to varying degrees. But overall, every single one of us hates being told what to do. As soon as Shauna starts telling me I have to do this one thing, even if that I was thinking about that already, there's a little voice in the back of my mind that's saying, you don't have to do that. Right? There's a lot of that that happens in addiction treatment. My clinical supervisor, who was an expert in motivational interviewing said, Scott, don't take away your patient or your client's best line for change. What does that mean? Well, when it comes out of my mouth, and if it doesn't come out of their mouth, it takes away all the power. But if they come to a conclusion, share my screen here, sorry about that. It's always scary when the presenter disappears. So can you instead ask these things, right? Can I listen enough to help me understand? We have a lot to learn from our clients. And it's not saying that you have a lot to learn from our clients. It's saying that you have to learn a lot about these folks individually so that you can help them. Right? So there's a lot of listening that needs to be done. So as clinicians, we spend three hours with people doing a clinical intake, where we're listening to them, we're asking questions. I am so, so sorry. Give me one second. So sorry for the inconvenience. I just got booted off because the Wi-Fi at the hotel boots you off every 24 hours. So relog back. Oh, no worries. We're glad you're back. I am so glad to be back. Give me just one second. I'll pull this up and we'll get this finished up for you today. So, so sorry. I bet you couldn't wait. You were on fire, man. I'm just kidding. I'm just kidding. You couldn't wait for it to be over, is what I meant to say. Oh, I see. Perception's everything. Perception's everything. Exactly. But we are getting close to the end here. Let's take a look. All right. And that was an important point that we were on is like this whole different sort of like perspective on what is the approach that we want to go into with clients in that first sort of contact with them. And there's this idea of we want to get them on our time frame for making the things happen. You got to get your driver's license fixed. You got to do this. You got to go to a meeting. You got to do this thing. But at the end of the day, it's like we've got to build rapport with them. And remember, we talked about the intern getting those wonderful, wonderful results from people simply because they want to learn about that individual. They're there to serve. They really care. And that's sort of the attitude that we want to go in with that curiosity, that humbleness, that I am here for you right here, right now. Nobody else in this world matters, right? So, can I listen enough to help me understand them? Can I try different approaches to helping them communicate? Because everyone has different communication styles. Sometimes it's really hard for people to open up. I'm sure I'm preaching to the choir there. So, how do I get them comfortable enough to where they can open up, right? Do I understand that I'm to be taught by them? Really, really important to know. Like, because until they teach me what they're about, I can't possibly know what to make suggestions about. Or I'm going to be taking my own recovery experience and extrapolating it onto them. And that's not always a good thing, because what works for Douglas might not work for me, and vice versa. You know what I mean? Really, really important to understand where they're coming from there. And what happens when you start making a bunch of suggestions that don't jive with that individual? What do you feel like happens with that person? You get pushback and they do the exact opposite. Yeah, they're like, this person does not understand me. They're just another person in a long line of people who don't understand me. What does that do about their perception of people in recovery? It feeds their distrust. It makes it more unattractive to them. I don't, yeah, I don't know if I really, that doesn't look so good to me. Am I going to be like that? Am I going to be telling people what to do and how to live my life and do their own recovery? And it could deter them for a long time, and they may not come back, you know? That's such a really good and important point. I'm so glad that you made it because I would tell people in treatment that as well. You give them a bad experience in treatment, that's what they think of when they think of treatment because you did a bad job, right? Now we have to clean up the mess. And how do we get them to a place where they trust us and are engaged anymore? What do they do? They disappear back into the community, never to be seen again, right? So let me ask a couple of questions here as we're finishing up. How do you work with folks to determine what may work for them? Have you had any sort of thoughts about this or your own, I don't know, just sort of realizations around, oh, maybe putting my recovery pathway on everyone else isn't the right way to go. How do you work with folks to determine what may work for them? What works the best for me, man, is I go straight to the point and ask them what they want to do about their recovery. You know, when I got this job with absolutely zero experience as a mentor, like when I asked somebody that question for the first time, the light came on that they actually had a choice in their own life. That's so profound, right? Because it's just like, it really is this idea of number one, open-ended questions. And what better question to ask than that? I don't know, right? Like, what do you want to be about going forward? Like, why are you here? What is it that you want to work on? Another might be the miracle question where it's just like, hey, I know that things are tough right now. Like you get people to come in and it's just like everything is wrong at that point, right? And then you can put them in a different place and say, I get it. Like to the extent that another person can get it, I get it, right? I've been in those places where I didn't feel like I could get out of it, but I want you to think about something different for a second. If you woke up tomorrow and everything was exactly how you wanted it to be, how would you know? What would things look like there? That's called the miracle question. And what happens is I asked Bethany that and Bethany says, well, you know, I would have my kids back, right? I wouldn't wake up and need a shot of bourbon or I would be able to finish a semester of school. And then I would say, well, how would your relationships look, right? Well, I would be getting along better with my family and my parents who are now watching my kid because I can't get my stuff together, right? And then it's just like, oh, now I'm getting an idea of what's important to you. Maybe what some of your goals might be, right? It tells us so much when we ask the individual to tell us what they want to do. What else? Very good. Thank you, Douglas. I sometimes ask them, like, if they've been in recovery in the past, like what they were doing then, you know, what's worked for them before, if they have been successful in the past. I love that because, you know, what just like jumped to mind, as you said, that is sometimes we take for granted that some of these people may have had more experience in recovery than we did, right? And so if we got a few years of recovery, maybe they had a few years of recovery too. And maybe some stuff went sideways in their life as it does sometimes, right? And we start talking to them as if they're sort of, you know, day one in recovery town. And they're like, you know what, actually, I've been here and done that, right? You can learn a lot from them by just asking them, what have you, have you ever sort of abstained or been able to control use before? What does that, what did that look like for you? And, you know, we get a lot of great information there. That's awesome, Sean. What else? How do we work with folks to determine what may work for them? I think sometimes we just have to give them like our suggestion or maybe what works for us as an example, and then allow them to see what works for them. Sometimes they don't want to take our suggestion. They just want to do it their own way. Yeah. Yeah, I love that. You know what I love about that? And I'll just piggyback a little bit onto what you're saying is I like to remember, because we want to make sure that they understand that they're in control is what I'll say is, you know, this is for Brittany, like, this is what worked for me. And this is what's worked for a few other people that that's different than what you're sort of offering about your own personal experience. Does any of that sound, does any of that sound sort of like helpful or like it might be worth learning more about? So you've given them not only sort of your experience, you've given a couple of alternative experiences based on things that have worked for other people and also based on what you've learned from them by asking, you know, that question of what is it that you want to do? What's important to you? You know, and then you make those suggestions, but always ask first is this, the question should be, you know, we've talked for a little bit. I've learned a lot about you. Thank you so much for opening up to me. I know that that can be hard. Is it okay if I give you some of my own experience and maybe talk about the experience of a couple of other people? When you get their permission, just that gesture in and of itself can mean everything to them. What does that mean? That means that they're in control. That means, and that might be the first time they felt like they're in control of their lives in a very, very long time. And that probably feels really good to them. And they're going to really respect you for asking that first before you tell them about your own experience. Sound good? Excellent. And some of the stuff you're, you might be like, well, that would be hard or that wouldn't feel good. If you try it, I think you'll see the results and you'll be like, oh, I can incorporate that into what I'm doing because it gets good results. You see people that you see their whole perspective change. And sometimes we have to push ourselves into these sort of weird places to get good results. So a lot of acceptance commitment therapy that I do is when I first heard about some of the things that you do in this line of this type of therapy, I was just like, oh my gosh, I could never do that. I would be so embarrassed, but it's like, now I do it. And it just opens people up in a way where it's like, oh my gosh, I couldn't imagine doing it any other way. So we push ourselves to do things differently and that's motivational interviewing. It's sort of a different way of doing things. So how do you ensure you're not on that point boxing in folks into the boundaries of your own personal recovery program? Is that something that you think about? Nobody. I like to allow people to make their own decisions, even if I know it may not be, if I don't think it's a, how can I word this, it doesn't matter if I think it's the best decision for them or not, they need to make their own choice to let them find out for themselves, because they're not going to know if they don't have the experience. Why is it important for them to make the decision for themselves? They, you know, like you said, that sometimes they've never been, they've lost control of everything in their entire life. They made the choice to do something and failed can actually still give them the motivation they need to be successful. That's it. That's it. And there's also on the flip side of that is this idea of like, if they're doing it for their own genuine reasons, they're much more likely to stay in recovery and to keep Trump, right. Or if their way fails, you know, quote unquote, it was really just a learning experience. And they're like, okay, I tried that. Maybe I'm going to try what Douglas had mentioned as an alternative the next time. So it's a really good point. Somebody raised their hand. Yeah. Hi, I'm Leah. Hi, being from a small town to, you know, a lot of people know us that before we were in recovery. So, you know, once they do see what it's done in our lives, you know, I'm coming up on 19 years and I've been doing this for almost 16 years. And being able to share my hopes and the things that I've accumulated during my recovery, a lot of people will, will right away will ask, well, how did you do that? And that's what the, with a lot of us here too, because this is a small town. Love it. So yeah, thank you for saying that. Very important points. Number one is they, I'm working in a smaller town now where I supervise some peers clinically and, and it's the same thing. Like I work with one peer, he was like, this is where I used to run and gun. He was like, people see me who I am now. And they come to me and they say, what happened to you? You are, you look great. What is, what did you do? And he can, he can tell them. So the second point on that is when people ask us, that's when we tell them. Absolutely. Without hesitation. Right. Because like they've given us the permission already. It's like, because like no motivational interviewing to be done there, right? The idea is they want to know, they want to know how you did it. And so tell them, tell them how you did it. And then maybe tell them how somebody else did it too. You're like, okay, you know, and that was just one way. That's just me. Like everyone's different. And here's something that somebody else did. And here's something that we have so many resources. What are you into? And then you, you sort of engage a little bit more deeply. But it, maybe it is the exact recovery journey that you want on that, that they want, or at least that's, they feel good because they're like, yeah, they did it for them. I see the beautiful things that it's done in their life that it can do it maybe for me too. And that's why we, we live recovery out loud now. Whereas like 20 years ago, we were like, you did not talk about that stuff. Right. And that's why we live it out loud now, because when we're visible, people notice and then they have hope. So thank you so much for saying that. Very cool. 19 years of recovery. Yeah. Go ahead, Shana. Um, so it's, it's kind of, uh, a while back, I had this specific client that I was assisting with tenancy and through the HUD process. And it was actually Shauna who really helped me in this moment, but I could see the clear path. I could totally see the clear path, you know, but like, he really wanted to go his own path. And I like, we'd made so much progress. We'd put all these things into work. And then like, he wanted to veer way off. And I was like, I was meeting with Shauna and I was trying to like correct him because I could see the path. And she told me to stop. I'm so grateful for that because it woke something up in me where I really realized like within my role, I'm going to go all on path with them. That's my responsibility. That's it. What a great like summary to everything that we've been talking about, like, because the idea is just like, you can, you can clearly see. And sometimes when we're in active addiction or navigating early recovery, our brains are fogged and we're sort of taking the long way around, but guess what? We're all taking the long way around life. You know what I'm saying? And like, each of us has our own personal journey and we can't push people into a box or they'll sort of repel from that. And so you could have like really had a disrupt, a disrupture in your relationship with that individual. And they probably wouldn't have done what you said anyway. You know what I'm saying? Even though like what you said is like perfectly, or what you're thinking is probably perfectly viable and right. But when you think about human beings, it's not because we know that we have to make our own mistakes, do our own things. All we can do is put the options in front of somebody, right? And then say, make that next step. So very, very good points. We want to ask open-ended questions. We want to affirm, we want to look for the positives in people. It's so strong for you to have shown up today. You are such a strong person. I have so much confidence in you, right? Genuine affirmations, reflective listening. We want to be empathetic. We want to summarize what they've told us. We've had a whole long, deep conversations with them. Let me just summarize this back to you. I want to make sure that I'm understanding this. You know, you came in, you've really been struggling, you're sick and tired of living this way. These are some things that you think might work. Your relationship with your spouse and your child are the most important things to you right now. These are the things that we're going to work on between now and next week. Is that right? And then they're like, wow, they're listening to me. And it gives them a chance to say, yeah, that's right. Or no, you know, actually all of that was right except for this one thing. Let me help you understand. Last thing I'll leave you with. And there's one, you know, I need you to take a survey before you go, but I love this quote from Dr. Carl Rogers. He's a big deal in therapy. I won't tell you all his credentials. He's long since passed away, but if I could provide a certain type of relationship, the other person will discover within themselves the capacity to use that relationship for growth and change and personal development will occur. It's all about the relationship, right? It's all about the relationship and then letting them know you're a concierge to recovery. What's a concierge? It's the guy that sits in the front of the hotel and you're like, I'm in Nashville. I've never been here before. And he's like, well, let me tell you all this stuff about Nashville. Like what kind of music are you into? What, you know, what do you like to do? And he listens to that individual. He's not like, you know what I did last weekend. That's not what he does. He listens to the individual and what they might be interested in. And he's like, if you like to do that, this is what you might want to do in this city. What do you think about that? And he makes sure that they're happy with the decision-making process. They do that together. You want that type of relationship. You are the concierge to recovery town, right? Multiple, multiple pathways, be knowledgeable about them. We know that you have your own personal pathway. It's all good. There's millions of pathways, right? Let's just get sort of adept at learning about all of them. Take this survey. If you use this QR code and let me just tell you, I hate taking surveys. This is the easiest survey you will ever do in your life. It literally takes less than one minute. It's like clicking a couple of things. I hate looking at my phone with things like this, but literally it is so, so easy. It'll take you less than a minute. I promise. I don't even think you like have to type anything out. I also put it in the chat and yeah. And we will be meeting again with you all on July 10th. Yeah. So I 10th and talking in that session on MOUD, harm reduction and stigma. Nice. And I'll be in an area that has robust wifi and I will not click out. And that's one of my favorite presentations to do. And I know you'll love it. I think you'll get a lot of good information out of it. So, all right. I appreciate y'all. Thank you so much for spending this time with me today. It's really put a smile on my face. All of y'all are amazing. Thank you. You guys are awesome. I wish I could be out there with you, but I look forward to seeing you next time and hope you have a good night. Thank you. Okay. Bye-bye y'all. Thank you.
Video Summary
In the video, Emily Mossberg from the Opioid Response Network leads a training funded by SAMHSA, focusing on free training and consultation for opioid and stimulant use prevention, treatment, recovery, and harm reduction. The session stresses diverse pathways to recovery, including self-determination and clinical and non-clinical approaches. Participants discuss concepts of recovery, such as freedom and healing, and share personal insights. The training emphasizes humility, active listening, and individualized support in the recovery process. Topics like motivational interviewing and contingency management are covered as well. The importance of individualized care, motivational interviewing, empathy, and building strong relationships with clients is highlighted in the discussion. The need for concierge-like support and knowledge of various treatment options is mentioned, with an emphasis on affirmations, reflective listening, and summarizing in effective communication. The session concludes with a call to complete a survey and an invitation to the next presentation on medication-assisted treatment, harm reduction, and stigma.
Keywords
Emily Mossberg
Opioid Response Network
SAMHSA
training
opioid use prevention
stimulant use prevention
recovery pathways
motivational interviewing
contingency management
individualized care
empathy
medication-assisted treatment
The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.
Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 and grant no. 1H79TI085588 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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