I want to welcome you guys to the September 2024 CARES webinar. Tonight's webinar is called Making Decisions in Recovery, From Surviving to Thriving. Really brief description of what we're going to do here tonight. The course description is Substance Use Impairs Decision Making, and Rebuilding Decision Skills in Recovery is an important piece to long-term success. Recognizing the ability to prioritize choices, create plans, and set individual goals are all a part of empowerment in the decision-making process. This workshop will incorporate skills and informational resources to support recovery journeys, underscore the importance of creating interdisciplinary recovery support teams, either professional or personal, and encourage building recovery capital. A couple of objectives to discuss the impact of substance use and the ability to make healthy decisions, to explain neuroplasticity and how the brain learns, and to review surviving and thriving states and discuss evolution as a choice. Tonight's presenter is Andrea Gatsko. Andrea, after I give some brief housekeeping rules, you can introduce yourself to the team and take over. So guys, really quickly. Reggie, don't forget your elevator speech. Okay, hey, yeah, I forgot all about that. Guys, my name is Reggie Magruder. I'm the Peer Workforce Coordinator at the Georgia Council for Recovery. But way, way, way more important than that, I am a man in long-term recovery. And what that means for me, that it's been three years and eight months and some days I lost count of the days since I felt the need to put anything into my mind or my body to alter my reality. Because of recovery, my reality is actually okay with me today. Because of my recovery, I'm employable, as you guys can see. I have a wonderful job here at the Georgia Council for Recovery. I work with a wonderful team of people. I tell people every day I don't have to go to work, I get to go to work. Something I never thought I would say in my life. Recovery has given me back things that I so freely gave away during my active addition, things like my integrity, my honor, my dignity, my self-respect, my word. That was a point in time in my life where if I told you it was daylight outside, you better go look, because I might be up to something. But because of recovery today, you can actually believe what I say. I'm going to be where I'm supposed to be when I'm supposed to be there. I'm going to show up. I'm going to do what I'm supposed to do, and that's all because of recovery. So really quickly, guys, a few housekeeping rules. Those of you who stayed for the entirety of this webinar, that is until 6.30 PM, you guys will earn 1.5 CEUs. When submitting CEUs, please keep up with the month, the topic, and the panelists, which in this case is the September 2024 Making Decisions in Recovery Workshop by Andrea Jesko. You will receive a certificate for this training probably sometime next week from my esteemed colleague, Al Cotton, who's here with us today. We are asking that you remain muted throughout the entirety of this presentation unless called on. But you can put questions, guys. You can put your questions in the chat, and we'll try our best to get to the questions that you put in there. Again, this will be an interactive webinar, so there will be plenty of opportunities to share your experience. Please make sure that the name on your screen is accurate and that you are not logged on as anyone else, because we will send this certificate to the name that's on the screen right now. Hey, Reggie, please make sure your pronouns are listed to make sure that we address you properly. And please, guys, no vaping or smoking on camera. Now I introduce you to Andrea Jesko. So Reggie, let me say one thing first. Oh, yeah, the bus tour. Georgia Recovers bus tour. How many of y'all have been to see the bus? I know Artis has. Look at him. That's awesome. So yeah, we're going all over the state. 63 stops during the month of September. We want to make sure that you show up, get a t-shirt, and sign the bus. So go to our website, and it'll tell you where the bus is going to be. It was great. Yeah, I was down in Savannah this weekend. We had a wonderful time. Thank you. Andrea? Ready for me? Yes, ma'am. Fantastic. Well, welcome, everyone. I appreciate y'all coming and hanging out with me for the next hour and a half. We're going to talk about some good stuff today. Before I get into things, I want to just kind of do the brief overview of why and how I'm here in the first place is because of the Opioid Response Network. And they are in a position to assist states, organizations, and individuals by providing resources and technical assistance locally to address the opioid crisis and stimulant use. And everything that they do is supporting evidence-based prevention, harm reduction, treatment, recovery of OUD, and stimulant use disorders. They work kind of locally and regionally, as well as kind of across the nation with experienced consultants in each of their areas of expertise in prevention, treatment, and recovery, and utilize those consultants to do one-on-one work, to do trainings like these, CEU events. We're utilized in a lot of different capacities. And if you are interested in submitting a request, anyone can submit a request, individuals, organizations, agencies, and you'll get contacted by the local technology transfer specialist, which your region is, Cat House. She's going to see those requests. She's going to reach out to you. She's going to have some conversations about what you're looking for. And if you're interested in putting in a request, this is the information. You can go on their website. There's some links at the top to submit a request. You can email them. If you still like talking to people, pick up the phone and call them. You can connect with them that way. And everything is free, free, free to you. It's SAMHSA-funded, and other grant fundings keep it going. And so with that, we will discuss a little bit about the importance of the evaluation for today's link, or for today's training. So we're throwing it up there now. Alvin's got a link he's going to throw into the chat as well. We'll also put it up, obviously, again at the end, just kind of, you know, whenever something's free, right, nothing's free, they want something in return. They would like some data, some feedback, just to kind of understand what you liked, what you didn't like, how this is going. So please take a few minutes at the end of this training. The link will be open, usually into, you know, at least early next week. So take a few minutes. I'm, you know, part of me is a researcher at heart. So there's no such thing as bad feedback. It's all information. It's useful. It's important. So please, just the little plug there to keep these types of trainings free and available to everyone who can benefit from them. So thank you, Reggie. You did some of the intro here with kind of the training overview and some of the objectives of what we're going to be doing here today. And I believe y'all usually launch a poll, don't you, for the who's here today? Who's here? Yes, ma'am. I'll give you some space for that. I think now's a good place for that. So while y'all are answering the poll of who's here, I'll give you just the brief bit of where I come from. I am currently based outside of the Houston, Texas area. So I'm coming from Texas to hang out with y'all. And Texas is part of, you know, the South and Southwest. So even though we're a couple states apart, there's a lot that we can still learn from each other. Very excited to be spending more time in Georgia and getting to learn and meet all of y'all. My background is a mix of a couple of different things, psychology, criminology, criminal justice, worked behind the walls in corrections for many years up in Massachusetts, worked with youthful offenders and families in Vermont, and now currently I work in a space in Houston at UT Health Science Center at Houston. And we are doing a handful of kind of clinical research, direct patient care, working with a very diverse multidisciplinary team and kind of trying to tackle everything both directly by providing services that aren't traditionally available that well in Texas directly to people, more of that kind of on demand, no wait lists, you know, getting people plugged in and connected, but also looking to improve systems of care because I'm sure all of us in our spaces know that there's a lot of links in the chain, a lot of things that have to be kind of addressed and figured out so that we can support the patients, the clients, the populations that we're working with. So looking at the result of who's hanging out with me today, it looks like a good chunk of the CARES group. We got some aspirational CARES, love it, some clinicians, some allies and some others. So got everything covered here. So welcome. Thanks for coming and hanging out. And I love that you all have the CARES groups, it makes me, you know, it's like SEAL teams where it's like you've all been through some stuff, you've gone through things together and you've learned some awesome things. And there's that kind of cohort cohesion and it's just really awesome. It's definitely something I haven't seen elsewhere. So that's great. So did the poll results come off? I took them off. You want me to put them back on? No, that's fine. That's fine. Sometimes they don't go away. I just wanted to make sure I took them off. Awesome. All right. Well, let's jump into some good stuff today. So we're going to come at things from a couple of different angles. We're going to have some conversation, lots of places for us to kind of reflect and chat today. And I try and be in a space where I can appreciate what others may view about the field that we work in, the space that we're in, all of the things that presumably most of the people on the screen, we have a different understanding sometimes of what it means to be dealing with addiction and substance use disorder and all of the stuff that really goes into that. And we often wear a hat that's probably much more informed, much more comfortable, familiar and very used to being in this space. But I also try and make sure that, you know, we take a step back from time to time because not everyone views everything through the same lens that we are looking at, you know, specifically in the space that I work in. We're working with emergency departments and first responders and other health care and specialty courts and, you know, all these different pieces. And a big proponent of, you know, we're a big proponent of education and knowledge and combating stigma and really trying to get into a space where we're making sure that everyone knows all of the great things that we know about the field that we're in. But I can appreciate that from the outside, if this isn't your bread and butter, that, you know, when we view the behaviors of active addiction, right, like on the surface, they can appear reckless, careless, thoughtless, right? And we know, again, because we're in this space, that the reason that we see those types of behaviors isn't that those are reflective of the person, right? They're a symptom of the addiction. They're a symptom of the substance use disorder. And what we know about the brain and the science and the chemistry and biology and everything going on behind the scenes is addiction changes the brain's reward system. So it messes with a lot of things kind of and creates a lot of impairment in different ways. And so this impaired judgment that may present itself as reckless, careless, thoughtless behavior, right, is really just a symptom of the disease of addiction, because everything that's going on behind the scenes is what's influencing decision makers and behaviors. So it's that kind of standard analogy, right? You know, where there's smoke, there's fire, like the outside behaviors are the smoke, right? But if my goal is to come in here and bring a giant fan and blow all that smoke away, maybe that works for a second. But if the fire is still burning and we haven't treated or addressed or, you know, fix the underlying issue, then that smoke's going to be back, right? We're going to keep seeing those things. And so I like to just kind of be mindful that not everyone appreciates the nuances of the field that we all work in. And some of that's going to kind of come into play as we talk a little bit about what is going on behind the scenes, right? So let's talk a little bit about what's going on in the brain. They have, you know, just kind of common terminology. We have kind of this old brain and new brain. The old brain really is just that more primitive part of our brains. It's tucked all the way in the middle of our brain, you know, nicely, you know, kind of padded by everything else that's around there. It's also the part of our brain that we share with other mammals, right? So this is very important to our survival because it's going to regulate our basic physiological functioning, right? We don't have to think about, like, oh, I better make sure I'm breathing or I better make sure I'm, you know, blinking and keeping my eyes moist. I better make sure I'm remembering. Like, our body just kind of does these things, right? And so that's tucked in. Very old part of our brain keeps it going, keeps it moving. It's all on autopilot, right? It's also going to be very important when it comes to experiencing, you know, basic emotions. I mean, this is a whole range of them, right? Anger, fear, hunger, thirst, lust, pain, pleasure. I mean, just to name a few. And it's also got a very important memory component tucked away in here. And if you think about it from a very primitive standpoint, right? This is where survival stuff comes into play. I have to remember what things are a threat or a detriment to me and what things are helpful and rewarding to me. And my brain is able to sort through all of that so that we can increase our chances of survival, right? Our primitive part of our brain is still our default mode, especially in times of stress. So our brain is constantly kind of fluctuating and reorganizing and finding ways to prioritize whatever is going on. And when it's a crisis, emergency, high stress situation, the smart part of our brain that I call kind of our prefrontal cortex, we'll talk about in a second, that part of our brain doesn't get prioritized anymore. So we get very reactive with this old brain, right? So it's understandable that sometimes our best thinking isn't what comes out in crisis situations or high stress situations. And so to compare that, right, we've also got the new brain, which is right up here in the front, our prefrontal cortex. I call it the smart part of our brain. It's the part that we have that other mammals don't have, right? So there's a lot of things in that part of our brain that are very important when it comes to judgment, impulse control, self-monitoring, as well as all the coping, you know, when it comes to learning and empathy and problem solving and decision making. All this is coming from that smart part of our brain. And so this part of our brain is still developing kind of through a good chunk of our life, right, into our mid-20s or so. Our brain's still trying to sort through and figure all this stuff out and, you know, find ways that it can be helpful to us. But unfortunately, sometimes when, you know, substances get introduced in here, this is the first part of the brain that starts to be impaired and impacted. So, again, the most primitive, primal, old brain that's tucked all the way in the middle, that stuff is still pretty much, you know, it's the last thing to be impacted, right? So we kind of start at the outside and work our way in. So it kind of makes sense, right, as you're seeing, like, well, what types of behaviors and things are we noticing when someone is dealing with a substance use disorder or dealing with addiction, right? You know, decision making starts to get less, you know, we're not making the best choices. We're not able to control impulses as well. You know, there's a lot of emotional things going on. There's all this stuff that we start to see as a representation, right, of symptoms that are coming out of this. And so knowing kind of that we've got a couple of different parts of our brain, we know it's developing up until, you know, our mid-20s. With that, we've also learned a lot about neuroplasticity. So neuroplasticity, it's a fun word. It's a long word. Sometimes it's a tongue twister. But neuroplasticity basically is just looking at our brain's ability to change, reorganize, grow, adapt. It's pretty impressive of the types of things that it can do. For a very, very, very long time, we thought it was kind of like, you got what you got. You're at where you're at. Like, once you kind of reach that age of majority, like, you're done. Like, you're imprinted. You're wired. Like, there's nothing that can change. For many, many years, that's kind of where we were at. But it turns out that over time, and more recently in, you know, modern days, we found out that, you know, you can teach an old dog new tricks, so to speak, right? Like, that we aren't constantly, you know, just stuck with wherever we're at, where we're at. Like, it's very malleable and dynamic and changing and adaptable over time. And so we've seen that our brain is able to continue to grow, continue to change. It can shift functions around. It can adjust things to different regions, different parts of our brain. So it's pretty impressive with everything that's happening back there. So most people have probably heard the phrase, because it gets thrown into a lot of trainings, myself included, right? It's Hebb's rule, but we might not know it as that. But that idea that neurons that fire together, wire together, right? Like, so it's that idea of the more times neurons are communicating with one another, the stronger their bond and connection becomes. It means it kind of gets more efficient. Our brain kind of starts to protect these, making them like, you know, superhighways, so they're more effective, they're more efficient. And they've just got this stronger bond compared to other types of things that are happening in the brain. And so the connections that we use all the time get really locked in. And the connections we don't use all the time or don't use as frequently, right? They're not going to have these strong bonds. They're not going to be that kind of default, reactive, responsive type of thing. It doesn't mean we can't change these, but it starts to become... This is where the journey of what we're going to kind of chat about today, of how we undo some things, stuff that we have to think about, how we make some changes to what's going on behind the scenes. And so this idea of neuroplasticity and neuroadaptations, right, it can involve functional plasticity, meaning that different functions can be shuffled around to different parts of the brain. So if one area is not able to do the job, it can kind of divert it and bring in another area, kind of tag them in and help out. But it's also structural plasticity too. So the physical changes that are happening behind the scenes. So it's not just kind of this metaphorical change of stuff that's happening. Like it's tangible, it's measurable, it's physical. And this is where learning is going to come into play. So when we talk about neuroplasticity in general, right, there's a lot of things that neuroplasticity can be seen as improvements. So one of the obvious examples is traumatic brain injuries. So we know that sometimes when TBIs occur, right, the brain is an incredible, incredible organ behind the scenes. It can adapt, adjust, like I said, it rewires, structure, function, you know, whatever it needs to do. It can move critical functioning from damaged areas to healthier ones. It can recreate different connections that maybe we weren't using and now we need to be using. And so a lot of times when we talk about neuroplasticity, you know, we're talking about it in that sense. But since of course today's topic is much more in the addiction realm of things, right? I think it's important to talk about how neuroplasticity can also be negatively changing things behind the scenes too, right? And so this is where we know the impact of substance use on the brain, that it starts to shift and change this functioning and the structure and the responses to day-to-day routines and interactions because the substances going in there mess with that balance, kind of mess with this kind of equilibrium that was there. And we've learned a lot about how cognitive deficits start to come into play when addiction is present. And again, this is because the brain is adapting to what it's being shown, right? And so if substances are playing a regular routine occurrence in the brain, then that's going to have an impact on the structure and function of the brain itself. And so when we have substance use that's present, there's a lot going on in the brain, but the main areas that really get hit hard with substance use disorder is our reward pathways in the brain, motivation, conditioning, and then inhibitory control. So when you start looking at the types of things that are happening, we start to understand addiction a little more kind of scientifically speaking, where that reward pathway is where we see the substance has been shown to create a greater reward response in the brain, which means that if I'm seeing that as more enjoyable and more pleasurable, how do we expect the brain to adjust and adapt, right? It's going to prioritize something that's more enjoyable over something that's not as enjoyable anymore. So we see the reward system starting to shift, and this is where substance use and being inactive use starts to get prioritized at the expense of other things that at one point were rewarding. So we're seeing that shift with that reward is going to be very closely tied to motivation. The things that drive our behaviors and what is driving kind of our choices and behaviors is going to be driven by the reward that I'm seeking and going after, right? And then conditioning is just that kind of repetitiveness that goes back to that what fires together wires together, right? So if now this starts to become the new norm, then the brain's going to kind of settle into this new space and everything kind of gets impacted. And so when we're putting stuff in there that's not normally there, we're messing with that naturally occurring system, and then we can't just expect there not to be a biological, chemical, physical response from that change, right? And this is where the brain then more dramatically is going to prioritize substance use over the day-to-day stuff, even stuff like eating and drinking and kind of maintaining the basic things, sleeping, those types of things become less important to the brain because it's now chasing the substance use because the substance use is changing the brain and kind of hijacking it, right? You've heard that term, substance use hijacks the brain. The systems that generally work for us are now being exploited and now used against us. And so it's one of those things, there's incredible things happening behind the scenes, but there's also things that can be very negative and impactful in that realm. And so when we're disrupting the circuits, the value of the drug becomes more important than any of the other day-to-day stuff. But again, that prefrontal cortex part of our brain, where the problem solving and decision-making and all these other things that are going on is the first to be kind of deprioritized. So we're no longer needing that, that's just getting in the way. We're going to kind of chase some of these more primitive drives because our brain has seen that the reward is more impactful. So we stopped doing the other stuff that we used to do. And I like to always talk about how like, you know, how did we get here, right? And when we're combating stigma and it's like, oh, well, you know, somebody is choosing to be active in addiction, it's always like, well, hang on, hang on, let's really think about that mindset, right? Let's challenge that myth. Let's challenge that type of thinking because even if you play that game of like the first time someone introduces a substance and maybe there's some voluntary choice and free will in that decision, but once we've introduced something, we're changing the brain, we're changing the systems, the functionality, the structure, that that first choice may have been voluntary, but everything after that is now going to be kind of an automated response that takes over and kind of takes control of the bus. And you're no longer driving the bus, but something else is driving the bus. I'll also say, you know, we just talked about that smart part of our brain is developing all the way up into our twenties, right? We also know that substance use more often than not is starting at a very young age, right? So we're coming in with a disadvantage. We don't have that higher executive order functioning thinking yet. So we're making choices that aren't informed, that aren't considering the risks and the benefits and the costs and the outcomes and playing everything through, right? So it's really important to kind of understand what is happening when somebody gets on this pathway of having addiction or a substance use disorder, right? It's definitely not a choice, even if there was a glimmer of a free will choice of that first use, there's so much more going on. And once everything starts to change and adapt and adjust and prioritize, now we're in that automatic compulsive behavior realm, right? Like the brain is going to do what it's doing. Like there's no longer a decision of like, I'm going to do this or not do this. It just gets on that autopilot, right? And so this is where we start to see when someone's really stuck in that groove of active use, right? They don't have the ability to just be like, hey, I'm just not going to do that today, right? Because everything behind the scenes is working at a very efficient, effective rate to support that addiction, that you can't just flip a switch and turn that off. There's good news though, right? I don't want to be all like, oh, you know, so yes, there's this negative, here's the things that's happening, hijacking, our brain's being kind of used against us, but neuroplasticity has two sides of that same coin, right? So it's also the key to recovery. So if there's been changes in adaptions and adjustments behind the scenes, that means it's malleable and that means we can then flip that script, right? And start using it in a way that's useful. When we understand what's happening, it can help us understand what types of treatments and behaviors and pathways are going to be effective to change things back around. And so if we are understanding that the brain and the body will figure some things out and adapt, that we just have to teach it new things, it has to learn new things. Then we start to be in a space where we understand that it's possible to change our course, right? That we're not just stuck, we are not just in that, like we are what we are, we just have to accept it, there's no going back, like none of that's true because neuroplasticity has been shown to be able to work back in the other direction, to get us out of the negative space that we may be in. And there's some really cool studies out there that look at the brain and how it learns. And I think this one's like really cool and really relevant to what we're talking about in recovery. So they had an experiment and they had two groups. And so group A was told that they were going to practice the piano and they were gonna exercise that piano practicing for two hours every day for one week. And group B was split off and told, all right, you're just gonna imagine practicing. So you're not gonna move your hands, but you're gonna sit there and you're gonna spend two hours a day thinking about practicing the piano. And so in group A, probably no surprise, right? What wires together, you know, what fires together, wires together. That the region of motor cortex that is linked and tied to the finger movements of playing the piano expanded. So the brain started to prioritize this pathway, the routineness of exposure to this behavior and this movement changes the brain. And they were able to see that expansion of that part of the brain, because essentially it's like you're working out, right? You're going to the gym and you're building your muscles. It's the same way in your brain, right? If I'm using this part of my brain, it's gonna get bigger and stronger over time. But what's really cool is they also looked at the brains right of group B who just had that imagining exercise each week. And they also saw that the same motor cortex that is tied to the finger movements expanded without any actual physical practicing of the piano, right? But that focused sitting there, thinking, learning, working out that part of the brain also created a physical response behind the scenes. And I see some of the faces on y'all's cameras of like, what, right? Like, I think that's just wicked cool of like, we have the ability to change and adapt things with any and everything that we're doing. And so this idea that mental training has the power to physically change something. I mean, think about how neat that is that somebody was able to go in there and do some brain stuff and figure this out to be able to show that like our thinking matters, how we approach our choices, decision-making, what we spend time on is going to matter. All of these things are really, really important. And so, yes, the behavior is helpful to train the brain. So I'm not saying that you were swapping one for the other, right? But behavior and mental changes, right? If we're combining these things, we're going to see that the ability to change thinking, behaving, develop new mindsets, new memories, new skills, new abilities, like all this stuff is what's gonna drive recovery, right? We are rewiring and telling our brain to do new things and to do different things. And the only way to get to the finish line is practice, practice, practice, right? You can't do a one day and not another day where you practice once and you don't pick up the guitar for a year, right? You're not gonna see measurable results. So what we know and have seen, right, is that practice does have an impact. Behaviors and mental can be practiced. And when we're doing those things, this is where we're training our brain, right? So that cognitive training is just as important as the physical changes that we're doing, right? Like physical changes being right, like not going to old people, places, things, not picking up a substance every day, not hanging around people who are still in a space of actively using, like we change those behaviors, right? So we can start reprioritizing things in our brain and we can do other things like having cognitive behavioral therapy and counseling and working with peer coaches and doing all of these things to balance the mental training that goes along in our brain. With the same, you know, kind of approach, right? It means that everything is impacting our brains. It's not just the behaviors. It's not just the thinking. It's also the environment that we're in. The environment is going to have an impact on what the brain is seeing, being exposed to and prioritizing. So they have a cool study with rats. And I know it's weird of like, we're humans, we're not rats. But again, we share that part of our brain with all the other mammals out there. So there are some conclusions that we can take from these types of studies because we're able to compare how that brain functions to the old part of our brain, right? The tucked in the middle part of our brain reacts and responds in a lot of the same ways. So I'm not calling anyone rats. I'm just making a correlation here of what we've learned again from the science of it all. So environmental enrichment is really important in this neuroplasticity realm as well. Is anyone familiar with the rat park study? A couple of people, okay. So the short and sweet version, if you haven't looked it up, there's some great little short YouTube videos. It's been worked into TED Talks. Like just do a little, you know, search in and you can get kind of more of that. There's also some like actual science reports. If you're into the researching nerdy part, you can look those up and do some extra reading. But the gist of it is, is if you put a rat in a cage with like a bottle that has illicit substances in it and nothing else going on, it is going to drink that bottle. It's going to get that big reward, right? You know, cause we're gonna overstimulate the reward system with an illicit substance. And it's just gonna drink and keep getting that reward, drink, getting that right. It's not gonna eat. It's not gonna, you know, drink other water. It's not gonna do anything else. It keep taking that drug until unfortunately it'll perish. Like it just gets stuck in this, you know, there's nothing else going on. I'm just gonna take this drug and I'm gonna enjoy it as long as I can. And then eventually it ends up in a fatal outcome. Now, if they take the rat and they put the rat in what they call rat park, if you think of it of like this giant amusement park for, you know, for rodents of different tubes and wheels and, you know, stuff happening and other rats that are in there and all this other stuff going on. The interesting thing is there's still a bottle, you know, with that illicit substance at their disposal that they can have as much and as often as they want even to their own demise. But the rats don't go to that. They engage, they connect, they are doing all these other things. If they do go to that bottle, it's occasionally, it's not used in excess and it's not used to a point of fatal overdose essentially. Right? Like, so the takeaway there being right of what's your environment. If your environment is only supportive of, it's me and this drug, right? Of course, I'm gonna keep taking the drug. My brain is gonna tell me to keep taking the drug. I got nothing else telling me that, hey, there's other stuff, there's other things, there's other people. Like this is really important. And I know we say in our field a lot, right? The opposite of addiction is connection. It's so true because we see the pattern, right? If there's nothing else going on, then we will engage in self-destructive behavior to our own end. But if there's other things going on, we get to kind of make choices, right? And reprioritize and decide how to spend our time differently. And so there's really cool stuff that's kind of come out of that. And of course they've done some parallels to groups of people and what that looks like and things. So really interesting things out there, but environmental enrichment is also changing the structure and function of the brain. And I think that's really important to know of all these things that kind of come into that. And then there's some real cool stuff in the cognitive side, kind of biofeedback therapies where you can see different kind of responses and readouts while you're having like therapy and working in recovery and treatment and all that. And so it's meant to kind of reinforce, there's so much happening up here. If I don't see it, I don't think about it and I'm not aware of it. So there's definitely some strategies that allow you to be more aware of it. And then that kind of reinforces and motivates the continued course, right? Cause now it's not feeling like, oh, I'm spinning my wheels, I'm not getting anywhere. You're like, well, hang on. I get to kind of peek behind the curtain and see that there is stuff going on. So neuroplasticity is our friend. It's very helpful in knowing how we get out of action, active addiction recovery. Yes, it's also some of the reason that we got stuck in active addiction and substance use in the first place, but it's all about kind of understanding and using that knowledge to our benefit, right? I know it's changeable. I know it's adaptable. It may feel like I'm stuck and it's hopeless, right? But it's not. And there's a lot that we can do in this field to make sure that we're kind of changing the game back and being like, no, no, no. I wanna take the control and the power back and I wanna be back to driving that bus and not just kind of be stuck in this space, right? So let me catch up on the chat here. Any questions? How are we doing? Got some thumbs up. Opposite of addiction is authentic connection. And there's some truth to that too. If you look at, you know, just being around people isn't enough, right? You have to be in meaningful relationships. You have to get some of that oxytocin being released in those interactions. Like those are the things that really drive it. So it's not just, you know, oh, I'm in a crowded room, right? Like it's gotta be more individualized for that. Bruce Alexander, he's responsible. All right. So again, do some Googling. Rep Park's pretty cool. If you're not in the reading, there's a ton of YouTube videos. Just Google them and some of them are, you know, just a few minutes long, get you in there. Andrea, somebody asked how long does it take? How long does what take? The changes? Josh. So yeah, so the changes, right? So keeping in mind with the Piano Study, we started seeing structural and functional changes as early as a week out, right? Like, so a week of doing something repetitively, routinely, we already start to see measurable impact, right? Now, if you're trying to relate, like how long in recovery is this process going on? It's not gonna happen in a week, I'll tell you that, right? But it doesn't mean we're not starting to chip away at it within a week, right? Like, so it's all about, we gotta get things started and then we gotta stick with it. And then, you know, there's a lot of different timeframes. Some of it depends on what your goals and your end games are. At a minimum, you know, you're looking at like post-acute withdrawal. So after the, you know, physical part of withdrawing, post-acute withdrawal is like 18 to 24 months. So like, that's a low end, in my opinion. Even then, it's not like at two years, you're like, all right, I'm back to where I was. Like, but we're much significantly further in at that point. So it is a slower process, right? But again, that reinforcing of what we're working towards of creating that change, it can happen very quickly, but we gotta stick with it to have it continue to grow and be meaningful. So yeah, that practice, practice, practice, practice makes perfect, right? Like, you know, so what else? Questions, comments? I had a quick question. Also, it was Denise Ridgeway, hi. In the research of the piano, the piano research where it showed that both sides, the A and B setting, they both had the brain growth. Yep. Was it one greater than the other? Like, was the control substance, like in part A was greater than part B, or was it? So yeah, the behavior, I believe, grew at a little bit bigger, larger, right? But both were significant growth. Like, so it's, you know, relative in that sense. So there was still a significant change from the memory only, you know, the just thinking, the mental training, that it was significantly different after a week's time of how they were measuring it. But there, I believe the difference was the behavior grew at a greater, higher number, but not to, you know, discount that structural changes happen from, you know, meaningful structural changes. It's not like, oh, it looks a little different. Like, you know, how they measured what they looked at, all the kind of parameters. It was meaningfully different in both categories, but behavior expedited it a little bit, maybe, right? Like, and if you pair the two together, then you're getting kind of the combined growth of both efforts. Like, so there's definitely, yeah, it's not necessarily one for one, but they all have meaning and value. And the more you use both, then the more outcome you're gonna be able to, you know, physically see on the brain. Thank you. Yeah, good question. Anything else up to this point so far? Feeling all right? All right, we've set the stage a little bit now, so we're gonna get into a space here. I am going to launch a quick poll for y'all. Let's see if I can find it. Oops. All right, let's see. Did you guys get a poll pop up on your side? All right, a couple of questions. If anyone played the game, would you rather? We're gonna do that for a second here as a group. So don't worry, nothing crazy. We're keeping it PG. Would you rather? Seven questions, pick some answers, and then we'll share the results and chat about it. And it is anonymous, so don't be afraid of like, they're going to know. I don't know it's you. All we're going to see is percentages. Ashley, we're gonna get to your comment. You're peeking ahead. About 80% of y'all give y'all another minute or so. 90% done give you guys another 30 seconds or so if you're finishing up. I have a question about the research, but it's more your opinion. I'm not sure it's appropriate for the setting. Can I ask anything I want? You can ask anything you want. Can I put it towards the end of our session if it's not related to what we've covered so far? It is related. All right, then go for it. What do you got? I'm curious if you think this research will minimize the addiction is a disease model concept or message that we've all learned. Why would it? Well, because it looked like a result of action, rather than something that we're born with. I see what you're going at. I hadn't thought of it in that context before. So we're complex beings, right? Like addiction is a disease because it does change the structure and the function of the brain. And even though we talk about neuroplasticity, I'm sure many of you have heard the once a cucumber becomes a pickle can never be a cucumber again thing, right? So once addiction has gotten to a point where, you know, you've met the criteria of physical, mental, biological, clinical criteria of being in that space, right? You've crossed that threshold compared to someone who hasn't found themselves in that space, right? Doesn't meet that criteria, doesn't get a diagnosis of, you know, having addiction or having a substance use disorder, right? So if you're in the camp where you do have a substance use disorder, right? There are some things that are going to be different behind the scenes, the structure and the function. There's a lot that we can swap, switch out, you know, you know, retrain our brain. But there's also some things that may be there permanently, right? And I don't want to put that in a way that it's stigmatizing of like, oh, now you're always be less than, right? Because we just talked about our brain being capable of rerouting and reorganizing and prioritizing different areas. Like, so it has the ability to kind of, you know, heal and maintain, you know, the new norm, right? Of what comes when you enter into recovery. And so I don't know that appreciating that the brain can still change, adapt and learn and respond undoes that. Like addiction is a chronic condition, right? It's a chronic medical condition that you have now. It's not like you're cured from it. It's not like it goes away, but we've learned about it. We figured out how to be effective in responding to it. We're maintaining whatever our treatment plan looks like, despite the fact that I still have this medical condition. Like, so I think they can coexist in a way of like, I'm not saying you don't have a medical condition. But I'm also saying that our brains and our bodies can be reworked to support a life that isn't stuck in active use and a recurrence of symptoms forever and ever. Does that help at all? I guess that's a new question. I'm trying to figure out how to kind of marry those two worlds, but I don't think it has to be either or. I think you can be in both kind of contexts. Yeah, it answered me. Thank you. Yeah, no problem. Let's end this poll. We'll just glance at what kind of group we got going on here. Let's see. Do you guys see the results? Did I do it right? Are you guys seeing it? Yes. Okay. We've got a country crowd. So three quarters, country versus city. I always love the true love million dollars. You usually get a good split there. Would you rather sleep in or get up early? Oh, we got an early crowd wanting to get up and attack the day. Love it. Amusement park or national park skewed a little more to the national park side. So we like our outdoor stuff. I think as we get older, amusement parks were fun when you're younger, but now I overthink them. It's fun. I know too much. I've seen too much. Sporting event or music. We are heavy on the music side here today. I have suspicions. This one, the sing and dances, you're like, well, what's option C? What if I don't want to do either of those, right? And then we got, you know, a bit of a split there of the married versus single crowd. So, all right. Oh, I see how you worked to that there, Alexandra. Well played. So now we know how your brain works a little bit of how you rationalize, right, and went through all that. So why did I have you guys do that? I mean, obviously wake you up a little bit. I've been talking for a bit, but why do I have you do that exercise? What do you think? Connection. Yeah, I mean, you're not wrong there, right? Feel a little more connected to the group that we're in or, you know, comparing how am I the same or different from the group that I'm in, right? That comes into play. What else? Check our motives. Yeah. What's important to you, right? What's valuable to you? What's enjoyable to you? Were any of those introspection? Yep. Were any of those questions 100%? Everyone was on the same side of the fence. No. Right? Okay. So someone translate that to what that has to do with recovery. Why would I make us do something? Connect the dots. All pathways. Yep. Point of view. Like these types of things are going to come into play. Right? No judgment. Right? Like if you picked musical concert and I picked sporting event, it doesn't mean one's better or worse. Right? They're different outcomes, you know? Or maybe you were in that camp where I didn't like either of those outcomes. And how reflective of life is that? Right? Sometimes we don't have great options. And we still got to figure out what are we going to do with the less than ideal options out here. Right? So the point being, in some ways, right, we got to practice our own brain, like, thinking about what you like. Right? You weren't expecting these questions. You didn't study or prepare for them. Right? I just threw them at you. And so you had to think about each question for a second. Right? To figure out, okay, which one do I want to do? Which one do I like more? Which one do I just hate the least? And that's the one I'm going to pick. Right? You had to kind of work through that. And then, again, we talked about, you know, what's everyone else doing? What's the group doing? How we're the same or different from others. But the big thing, right, of how we tie this into recovery is this idea of, like, self-advocacy. Right? Like, if I have options in front of me, I should be able to choose what option makes sense to me, is working for me, is enjoyable to me. All those types of things. Right? So any real-world examples in recovery where you might have to choose between two good options? Anyone think of anything? That might not be two good options, but there are definitely two options. One maybe is more appealing than the other. Yeah, okay. What else? Well, I like that two recovery events that are at the same time. They may be very different types of recovery events, right? Which one am I going to choose? What's that look like? Ooh, choices of jobs is another good one. Like, what are my options and which one do I want more of the other? Exercise or relaxation. That doesn't just apply to recovery. That applies to day-to-day, right? You know, which one am I going to choose? So yeah, definitely other different destinations of vacation, go out or stay home. You know, that may be different for some people though, right? Some people may view those as two good options. Some may view them as one's stressful and one's not. You know, so thinking about those things, what about some options or maybe neither are that great? I kind of almost think the jail drug court, right? Both of those are going to be tough in different ways and for different reasons, right? But that's something that we might have to work through of like, okay, what's the lesser of the discomfort one or what gives me more of the things that I want and appreciate and value, right? So there's a lot of stuff in recovery, in life that we have to unpack. And I think especially in recovery, right, there's a lot of things that we probably have not been making decisions when we were in active use. Again, remember autopilot, kind of automatic compulsive behavior of that just supporting the substance use at the expense of everything else, right? That when you take something out, our decision maker is very weak, right? And it's not strong, it's not been utilized. And these types of things can start to be difficult in early recovery. And we'll talk a little bit more about that. But the whole point is to start thinking in this realm of like advocacy, self-advocacy, advocacy for the clients and the patients that we're working with. And I want to read an excerpt from this book, Rewired. I know it's a lot of words on the screen, but I really love it. I couldn't find a way to shorten it. So I've got a couple of slides here. I'm just going to run through it. But every living thing on this earth is evolving, sometimes slowly, sometimes quickly. They develop, mature and transform without questioning the process. They simply fulfill their biological destiny, continuing the life cycle and perpetuating their species. Man, however, is unique among organisms. He is both blessed and burdened by his intellect. He is prey to a thousand existential fears, fear of failure, fear of success, fear of mediocrity, fear of the unknown. He is deeply prone to paralysis, crippled by his enormous imagination, the very power that sets him apart from the rest of the beasts. To medicate his achingly self-aware brain as it contemplates the universe and his place in it, he turns to myriad intoxicants and coping behaviors. Through active addiction, man interrupts his own growth, withdrawing from the world and refusing to move forward. This experience of being stuck in a rut is a painful one as it goes against our basic nature to expand. When we are stagnant, we are at war with our own nature. Being enslaved in addiction is almost like being frozen in time. We repeat the same dead-end activities day after day as though in a trance. So someone reflect on that for me. Do you agree or disagree that addiction is being stuck or frozen in time in some fashion? Is this an agree in the box? I definitely agree. Why do you agree? Tell me more. You know, I'm a torrential reader, go by Mustafa. When you stuck in time, man, like when you're using or whatever, it's like you're never advancing at nothing. Like you're never making no kind of forward progress. Like you just stuck in that four, four, three, four world until you decide to, you know, get some recovery in life. But you would never, pretty much never evolve, is what I'm saying. You will get deeper and deeper in your addiction before you evolve. That hole's gonna, you know, the little image here, right? That hole's gonna keep going lower and lower and lower. We're no longer moving forwards, not even in the line of sight anymore, right? Like it gets further and further away. All right, Jennifer, you got a hand, what do you got? Can you hear me? I can, loud and clear. Okay, yeah, so I completely agree with that because I found that, I work in a treatment center and some with teenagers sometimes and also with adults. And what I've started to notice is, and even with myself, it's almost like when coming out of active addiction, our mindset is almost as if it was stuck back where it left off at. Like even these teenagers, 11, 12 years old, you see, you find 19 year olds that their maturity level is just down at the bottom. I couldn't figure out why I wasn't acting as grown as another 41 year old woman. And I had to figure out because I was stuck way back there at 15 to 16 years old, trying to get all, you know, because it's like time froze. I was in that addiction bubble. I wasn't advancing and my mind was just, wasn't maturing. Right, it wasn't, you know, it prioritized the substance use that all the other lessons and things that it might've picked up along the way, it's not picking up, right? Like it's prioritizing other stuff. Yeah, because I even find myself wanting to, you know, of course, when we come out of active addiction, we want to accomplish things that we've never done and different things. But I found myself trying to accomplish goals that I wanted to do as a teenager or wanting to go out and hang out and go skating and just things that I did that I missed out on, being 21 and 22, because I was in full-blown active addiction. And I've noticed that. And some adults, I guess, depending on their mental health, wherever, you know, that gray area with mental health, I see some that are stuck back there prior to active addiction. And even their maturity level is, you know, has the mind of a 15, 16 year old. And some of them, we can't even get them out of that mindset. It's like raising a 50 year old that's in, you know, a 16 year old man and a boy in a 50 year old man's body. So yeah, I completely agree. Yeah, you're getting a lot of feedback in the chat. Everyone's really, you know, appreciating your explanation of things. Seems like you're spot on there. No, yeah, I wasn't even reading them, but yeah, I appreciate everybody responding. Yeah, they, okay, yeah. Cause I mean, I've seen it. It's like the green just stuck back there and making poor decisions. I couldn't understand why being in that treatment center, why my clients kept making poor decisions. I tell, and I'm just going to use a name. I'm going to throw it out there. I tell Johnny, Johnny, go sit down, go sit down and pay attention in group. And next few minutes, Johnny's at the bathroom and then Johnny's in the kitchen. And then Susie's in the, over here in the bathroom looking at her eyelashes in the mirror. And I'm like, you need to go sit down and be in group. And five minutes later, back up again. And I found my, and I'm saying, why are these adults not doing what I'm asking them to do? And it was because of that mentality. They came out of that active addiction and it is their, their body and mind hasn't caught up with each other. To say, oh my God, I'm not 15, I'm a grown person. Boom, you know, and it just takes some time. I think for those, all that, that's where that holistic comes in. Putting all the body and mind together and everything catching up with each other. Great, well, thank you for your insight on that. I said a lot of head nod and a lot of people agreeing with that. Ashley, you got anything to add from your perspective? Yes, I do. I agree with everything that she just said. And another kind of viewpoint that I've had is, not only are we stuck and frozen mentally, but like physically, when I was in active addiction, I hit it, it's like I threw a Harry Potter invisibility cloak on all of my problems and it didn't matter. So everything was just getting worse and worse and worse, but I didn't care because I was in an altered state of mind due to my drug addiction. And then once I got into recovery, I'm like, oh, now I have to deal with all of this. So it's not like the world stopped and was frozen, I was frozen. And then when I came out, I'm like, oh, now I have to deal with all of this. It's exponentially worse now because I wasn't paying it, like I wasn't able to comprehend that I needed to deal with it in real time. Maybe what you were trying to escape, right, would have been easier to deal with that initially than to go on this journey of, you know, everything that you said exponentially kind of just compounding. I like to add, I'm frozen, but the world isn't frozen, right, that idea of like, everything's still going on and I'm the one in this hole, I'm the one in this rut, I'm the one who's stuck and not reflective of it being everyone else in my position, right? Yeah, I should have stopped at the one felony instead of adding more. Hindsight's 20-20, right? But now I get to be a forensic, so win-win. Exactly. So, well, then let's read the counter, you know, quote that goes along with this, another little excerpt. So just how shall we begin to embrace the growth process and gain the courage to change our lives? As a culture, we are not always comfortable with the idea of a process. Appearances and results seem to matter more than the journey. Instant gratification is the law of the land. When we don't get what we want, we are filled with frustration and turn to our drug of choice. Processes are messy and require investment, but if every caterpillar regarded as process is too sticky, time-consuming and ugly to deal with, there would be no butterflies and therefore far less beauty in this world. We have to learn how to go through a process without judging ourselves, accepting our growing pains as normal and healthy as we take steps towards our destinies. So, you know, she ends with the only cure for arrested development that halted, stopped development is development, right? Like we've got to now do the process that we stopped or paused for so long. We want to be sober, self-evolution is our only path. So being able to kind of get back in the saddle, so to speak, right? Of like, all right, I have to pick up where I left off. I've got to move forward. Any thoughts now of like, again, there's a ladder in this photo now, right? Like, okay, I'm going to get out of this hole and then keep moving on. But it's not like, you know, no one's picking you up and plopping you on the ground, you know, three miles ahead. It's like, no, now I've got to do the journey to keep moving forward. Even if the rest of the world kept moving, I'm still back here. Like, I've got to make up for some lost time, right? Any other thoughts, reflection? See Don in the chat. When I was frozen, I had to learn how to go into action. Right, no one's coming to get you. You got to do the action part, right? And then who unmuted? I did, sorry, Jessica Brown here. So I lost my complete train of thought. But when you said that, yeah, because basically emotionally and, you know, where we would have continued to grow had we not been in our active addiction, like we have to start where we're at and continue to make that progress and pull ourselves up. The future's not written and we do. We have to evolve into what we are born to be. I agree, I like the future's not written, right? Like that idea of like, in some ways, it's like you get to start with a blank slate. What comes next? What does that look like, you know? And it's frustrating if other people already have things on their slate and you're like, oh, why don't I have that? You know, so that's where our mentality and our focus has got to come into play, see it as an opportunity and not as like, I'm losing this race, right? I'm behind, like those are the things that get people frustrated in their recovery journey. Because they feel like, you know, again, they're losing a race, but it's like, well, what's the end game, right? It's the journey that we're supposed to be enjoying. So how do you change your journey to be something that you enjoy as part of this process? Alexandria, you got your hand up, what do you got? Yeah, I was just gonna say, in reading that quote and then considering this little blurb here, a little blurb here, it kind of, in my head, kind of ties it all back to the rat park and the connection piece. Because oftentimes that community aspect helps you kind of learn how to trust yourself again. And that way you can continue to make those choices. So like that accountability piece helps with that self-evolution, which then, you know, ties into this, this cure for arrested development is development piece. That trust for yourself is big. In a few slides, it kind of fits in well, like again, this isn't a skill we've been practicing or using in active addiction, right? So now I've got to start somewhere and I've got to trust myself in that problem. But if I have a track record of not making good choices and all the things that come out of activity, it's real hard to feel comfortable in that space, let alone have the ability for your brain and your body to kind of be efficient and effective in that space, right? So there's a lot of kind of internal rapport building. I know we talk a lot about connections and external, like we have to almost reconnect with ourselves in that journey of like, okay, what's going on inside? What's happening here? And I've got to figure that out in order for me to move forward. And so great, yeah, appreciate the feedback on that. Frederick, you got a hand, what do you got? The beautiful thing about having the opportunity to redevelop yourself, just like we were talking about the pros and the cons to neuroplasticity and the fact that the brain and the mind can reshape and restructure and reform itself if we change our disciplines to go in an opposite direction. So it's that type of thing where learning is the beginning of rebuilding a whole new development. So we have to learn how to forgive ourselves because that self-talk of sometimes us not being treated very well by others who are disappointed in our actions when we're in our addictions and us learning to be able to forgive ourselves helps us take out some of those hooks and some of those chains that have allowed us to be bound down. And then finding the disciplines to create affirmations for ourselves when we can begin to talk to ourselves and pour and encourage and pour into ourselves beautiful words of encouragement in a soft way that we can receive them from ourselves and start to visualize and imagine a new way of living, living in a new, just growth process. Sometimes we can't wait for somebody else to try to share with us that we're doing well. We have to see ourselves and imagine ourselves and feel ourselves in a beautiful world before we're able to even start to take the steps towards getting to that place. It's almost like we have to be in the end result before the body even gets there. I agree with all that. And you said it so beautifully and really ties into that visualization is so important, right? We talked about what helps the brain grow and expand, right? Thinking, mental training, visualizing, like that stuff's real. It's not just, oh, it feels good and it sounds good. Like there's science to back that stuff up. And that's why I get all excited. I'm like, the science shows that this stuff matters and it's important. And it's not just like, oh yeah, it's feel good stuff or I'm just checking a box right now. Like the brain needs that. It needs that visualizing skill and it needs to be able to build from that perspective and self-talk. And all those things are gonna just perfectly pair into how we train those parts of our brain. All right, one more comment. Tori, what do you got? You said earlier, I'm kind of piggybacking off what you said, I'm a Toronto read. And the key thing to the redevelopment and the building is definitely the people placing things. Because if you're gonna try to rebuild and you're still going to the same hangout, then it's gonna be stagnated. So that was a key component for me is to my redevelopment. I had to surround myself with people who was also building their lives instead of hanging around the same crew that I was hanging around. So that's definitely the key to me. I mean, I know it ain't the science, but it's just the common sense part of not being around people who are not thriving and surround yourself with people that are thriving. Thank you for letting me share. Yeah, no, awesome. And I think, again, that idea of, all that other stuff does matter personally as well as scientifically, right? Like it's not just, oh, science is like, it's important that you have buy-in. And that kind of goes to the next slide here. And I took a training recently and one of my takeaways, I loved it. There's this idea of we label sometimes people as like low motivation clients, right? They're not doing what we're telling them to do. And like, we kind of put that, like we stigmatize in a little way, right? Of like they're low motivation, they don't have it. And the best question we need to be asking ourselves or like thinking about, right, is that putting it on them and reminding ourselves, right, what's important for the client, right? And I know a lot of things that are important for you. I know what has shown to work in more settings. I know what's paired with success. I know the numbers, all that, right. But that's not always the same as what's important to the client. And so this idea of evolution and all this kind of stuff, right, it's not my journey. Like my journey is my journey. Like someone else's journey is gonna be different. And it may, when I go right, they go left, right? And it's okay to have these kind of different directions and different things. But I think sometimes we get so caught up. You have to do this and you're supposed to do that and you need to do this. And like, if we're not pausing and flipping it around and making sure they get to weigh in on what's important to you. If I'm telling you, you have to do this, this and this, you're like, yeah, I'm not gonna do those. And then I turn around and label you, well, you're low motivation. You're not doing what I think you should do. Like that's problematic, right? Like we're now in a space where we're kind of setting them up to fail. Because I'm saying you need to do this and it's important to me that you do it. But I didn't ask you if it's important to you at all. So it might not be, right? And those are the things we're just framing and having those peer conversations, having motivational interviewing conversations, all these types of things to really unpack. What's their goal? What do they want to do? Like if we come in with the agenda, then we're not maybe doing our clients and patients a service, right? Like, because then it's all about what I want and thinks important. But if it doesn't fit, then we're not going to get anywhere. We're not going to improve anything. We're not going to help them be successful in the ways that they define that to be successful. It also then pairs, right? Who gets to be involved in decision making? And this is where it can really muddy the waters, right? Maybe you're court involved, and there's a little more voluntold as opposed to volunteering for things, right? But then you got to help them figure out like, all right, they may be some of the decision makers here. But what are we working towards? What do you care about? What's important to you? And then how do I kind of help bring those two together? Well, if this is important, then we got to play this game for a little bit. That's how we get there, you know, things like that. So that's really where the nuances of supporting people is trying to help them see that, yes, I know, you don't like this. And if you really do want this, and like this, here's some of the journey and what that might look like. And let's chat about that, right? You know, you'll see a lot of people have opinions, right? Family members, you know, court systems, you know, other things that everyone's deciding, you know, wants to play a role in that decision making process. So sometimes I think we need to take a step back and decide, like, who's actually supposed to be making decisions here? What control is available? Even this thing's like, I know Reggie started out, I love the not that I have to I get to like that mentality is very important sometimes in the decision making process, because there's a lot of things like I mean, yes, I have to go to work to pay the bills, right? Or my perspective can be that I enjoy going to work, I choose to go to work, I choose to go to this job in this place in this setting, because I enjoy this, that and the other even on the days where I have to deal with traffic or the alarm going off earlier than I wanted it to or all those other things, like, we have to kind of find where our decisions and choices are in there. And not just kind of feel like we're again being pulled along. And I think that's that difference of like surviving versus thriving, right? Thriving means I'm actively driving something forward. Surviving may just be going through those motions. You know, I know we're getting short on time, some of these things, you guys get the slide, some of this is pretty boilerplate stuff. So treatment plans, recovery plans, wellness plans, service plans, wherever you work, whatever you call them, whatever they're they're looking at, right, we want to help our clientele, our population, our patients work on these things from their perspective. If we've got it filled out before I've ever met you, then I'm not doing my job very well. Like I need to learn and appreciate you and your journey where you've been where you want to go. And then we should create something together. And so I really want that to be the takeaway of like, it's not my agenda. It's not what I want. It's not what I need. None of that should matter. We want to make sure that we're being kind of patient-driven here. And then of course, you've got recovery plan, maybe being like the snapshot, right? Treatment plan is the roadmap of how you get there. So then of course, it may be like, oh, yeah, I want to live in a mansion, have a million dollars. That's a great plan. And what do I do today? Like, is there something I can work on today? SMART goals, measurable things, right? Like always taking the big picture, breaking it down into smaller chunks, you know, kind of figuring out what have you tried, what have you not tried, what's worked, what's not, you know, really getting into that space. Something else that comes up a lot is kind of just generally, I know, we've talked a little bit about the brain and the disease of addiction, all these other things like medication is very much something that falls into this space with decision making, right? Like, so SAMHSA's got some stuff, the language is a little dated in this book, but there's still some really good stuff in there. It's still really relevant, of really embracing that ideally, everyone should have a choice, and options and alternatives and let them be in a space where they figure some stuff out. We use medications for all sorts of other things. So why is it not something that can be incorporated into treatment planning and decision making in this scenario, right? We stigmatize it, it differently. But even sometimes we'll get with our patients or clients, they don't know if they want it or not. Maybe they're a little intimidated by it, frightened, right? Like, so there's some good stuff in that book, too, with like decision making of like, all right, let's break it down, kind of pros and cons of going on a medication pathway, pros and cons of not going on it, building it all together, right? Like, again, so not just that you should do it like, oh, you haven't tried it before. Let's try it. Like, we want to be more meaningful in our space, so they can make a decision about it, get there on their own, get there to wherever they want to be, figure it out, and not just have us come in and dictating. And to tie it back into what's going on with the brain and everything behind the scenes, right? Like, there's a lot of decisions in early recovery, right? If you really think about it, there's a ton of stuff going on. And we know that part of our brain is out of practice. It's not been prioritized. It's not been active. And then we just expect people to like, here's all the stuff now you have to do. I need you to stop using, I need you to have recovery skills, need you to find a routine, get a support network, get a job, do these courses, meet these stipulations, come in for this, do all that, right? We just threw a ton of decision stuff at someone. And we have to appreciate that, hey, maybe for someone who's further in sobriety, or maybe someone who hasn't had that history, like, maybe that doesn't seem that intimidating. I'm like, I'm asking you to do three things. It's like, you're asking me to do three big things. You're asking me to do like 80 little things to get to those three big things. And maybe I don't know how to do that. And maybe I'm not comfortable. And that part of my brain's like, whoa, like, I don't remember how to do this. You're gonna have to give me a second. And we don't give them a second. And we just want them to kind of get into this mode of decision making. And you know, to get to a point where they're not just getting through and surviving or, you know, white knuckling their recovery, but they're getting in a place where they're actually thriving and finding things that are enjoyable and meaningful. And being in the driver's seat, right? Another quote on here, right? Recovery means I try to stay in the driver's seat of my life. Like I think that that's the important key of making decisions being in the driver's seat. Like that's the end game, right? Like that's the goal is to take the reins back that hijacking is over. I've taken this back, I'm back into control. I get to decide what things I want to work into my recovery that are helpful to me in my recovery. They're enjoyable to me in life in general, right? There's a lot of issues with you know, that we have to figure out what works, what doesn't. And one of the questions I always asked, you know, with with patients early on, because sometimes it seems really intimidating, but it's like, all right, if fast forward five years from now, everything's exactly the same, especially when I worked in corrections, right? They're like, well, no, I don't like that. I don't want this to be exactly what I'm doing in five years. You're like, all right, well, what don't you like? What is it enjoyable about where you're at now versus where you want to be, right? Because sometimes they don't know where they want to be yet. But they can articulate what they don't want to be, right? So that's decision making to that idea of the would you rather this or that? Well, would you rather be in jail or somewhere else? I can tell you, I don't want to be in jail. Great. I can work with that. That's tangible. Let's start with it. Now we'll figure out where you're going, what you're doing, what you want to try, right? You know, recovery capital, of course, is helping people build health, home, purpose, community. That means there's a lot of decisions in each of these boxes that have to be made of how am I building this? And what does that look like? So again, being mindful of what we ask people to do is a lot. And that idea of like, you have to change everything, like how you're thinking, how you're behaving, all your day to days, all this kind of stuff. And then I need you to just do this quickly. Everything needs to be kind of on a much slower responsive, understanding, compassionate pathway of where someone is trying to be a decision maker in their journey and in their recovery. There's a lot of stuff, there's worksheets that are out there to help them break down, ask some of these questions. There's a lot that shows writing stuff out is really important for solidifying stuff. We think we got it all figured out up here. And we're multitasking, we're asking things, but writing it out, again, thinking about that I got mental training up here, writing it out makes it a little more tangible behavior training. Now we're tying these two things together. So we're creating a stronger response, if we're really incorporating and not just kind of keeping it, I know what I'm doing, I'm figuring it all out. Like, where's the tangible stuff? Where's the behaviors? Where's the writing things down? Where's the kind of tracking of everything that's going on? And these, of course, is just, you know, kind of one examples of things. But I want and just a couple more slides here, I promise I'll give you space for q&a. Decision fatigue is real for all of us. You know, when you've had a busy day, and your brain has just been go, go, go and making choices and responding to things and all that, right, that's exhausting. But think about what it's like in very early recovery, if you don't have that lived experience, you might not appreciate how exhausting early recovery is. And so some strategies there, right, of, you know, appreciating that decision fatigue is real. And some of the things that maybe we're taking for granted of like, what do I wear in the morning? And what time do I set my alarm? And what am I going to have for breakfast? And, you know, those basic things have already exhausted some of our resources, if our brain is not if that part of our brain is not strong and efficient, right? Like, so a tired brain is going to look for shortcuts, and shortcuts usually lead to less informed decision making, and choices that have more negative outcomes, right. So being very mindful about decision fatigue, in early recovery, you know, there's some strategies in here that, you know, we don't have to go through mostly because we don't have time, but fewer decisions, make big decisions early in the morning, don't make them later in the day, late at night, your brain's already fatigued and tired, it's gonna have a harder time with things like that. Limit your options, right? If everything's like the cheesecake factory menu, like we'll never get anywhere. I got like 80 pages of what do I want for dinner? I thought I knew and now I have no idea. We need like three hours of this menu. And then maybe I'll be able to make a choice, right? Sometimes too many options is debilitating. And again, especially if that part of our brain is weak, because it hasn't been trained. Let's find ways to make shorter, easier, limited options to help keep things manageable. And then if you make a choice, there's got to be some commitment to it, sticking with it and seeing it through. So if you spend all that time second guessing, that's more resources that your brain doesn't have despair. Well, you're like, should I have maybe or what ifs like those aren't now if we made something, let's go through maybe it's not the best choice, right? But that'll show it over time versus trying to think of every possible scenario that's exhausting and our brain can't do it on a regular day, let alone on an early recovery day, right? Talking about what you're wanting to do all this stuff, finding the people to support you. This is that environment enrichment, definitely, you know, check out the slides, Al's gonna send a copy. Reality is, is the overdose numbers are real. And I'm the one who picked the football category or the sporting event category over the musical event. My Steelers stadium capacity is only 68,000 people. So it's a stadium and another two thirds of a stadium of people that we're losing every year for drug overdose deaths. It's easy to look at a number but when you start again seeing it in a tangible like that's a lot of people. We've got to be supportive and be available and help people understand what this journey of surviving to thriving looks like and really, you know, be an asset during that journey. The good news is there's hope. Lots of people in recovery out there. That means it's possible, right? Neuroplasticity is real. Figuring out recovery is real. There's lots of other people doing it who have done it who will do it. Like what is there without hope, right? So that kind of stuff drives what we're doing. Questions? What do we got? Final few minutes together. Who's got something they're like, if I don't ask it, I'm gonna be up all night because I'll be like, I really wish I knew. Don't want anyone losing sleep at the end of this. Throw this up for the last few minutes. Do the survey, please. Good, bad, the ugly. It's all fair game. Let people know so that these trainings can be made available or similar trainings. Questions, clarity, comments? Floor is yours. Nobody has any questions. I could ask a question. Hi, what do you got? Um, I am wondering how you find the balance between giving a client their autonomy and their right to self determination, while also understanding that decision fatigue is, is, like can be very, very hard on you mentally. So how do you how do you find the balance between that? Like, how do you how do you, I don't know, I guess kind of gauge? So that's kind of the million dollar question, right? The reality is, there's probably going to be a lot of trial and error in there. Both, you know, with the individual who's figuring it out, and us being on that journey with them as we figure it out. And sometimes maybe we're pumping the gas, and we need to pause occasionally and be like, Oh, wait, maybe I need to pump the brakes a little bit. Maybe I've gotten too far ahead of us. Like maybe I've gotten too far ahead of the patient, like, let me slow down. Let me make sure to stop, let him catch up, bring it, you know. So I don't know that there's like a hard and fast of when and how and what that looks like. I think it's that introspection, that reflection, that looking at treatment, you know, where are we at? Where are we? been? Where are we still going? Like, you know, and getting feedback from from them as well. How are you feeling about how this is going? If they're feeling like things are still going well, like that's something to take into consideration. But maybe they feel good. And that's that pink cloud. And we're like, well, I'm still a little nervous. So let me share why I'm nervous. Here's some things that, you know, I just want to bring to your attention, right? Like, so there's a window there, kind of figuring out with every patient we're working with, and maybe different, some can move a little faster pace, some really need to go at a snail's pace, like, but that's all right, you know, as long as we're moving a little bit forward, two steps forward, one step back is a perfectly okay space to be in, right? And there's constraints of where we work in our organizations. And of course, you know, we could do a whole training of how we deal with all those types of things. I'm like, I've got to this, then they're telling me after that, but my patients only here and they're not there. And it's a lot, right? So it's more about being aware of the need to put the gas, put the brakes as appropriate for that person. Thank you for that. Now it's 530. I appreciate time. If you have to bounce, definitely bounce. You guys will get a copy of the slides. I believe Al will send them out to everyone. So you'll get to have those. And of course, any questions, follow-ups, let us know. The link for the evaluation is in the chat. We would love it. And I will also send that link out when I send out your certificate and your power copy of the PowerPoint. Thank you for your time. It was a great training. Awesome. I appreciate all the discussion and feedback. I really enjoyed our time. It goes by so fast. So I hope to see you all in future things again soon. Thank you so much. Y'all were great. Thanks guys. Hope y'all learned as much as I did. Thanks everyone. Thank you. Wonderful. Thank you all. Everyone stay safe. Hey, excuse me. Yes, I'm sorry to bother you. So I'm looking at the evaluation survey link. What do I do if I'm on my phone? I'll put the link in the chat. You just click the chat link and you're able to go into another window. That's how I did it. So if you're on your phone, if you kind of hit the bottom, you should get your options. If you go to the chat, you'll see that there's a link in the chat that you can click and it'll open a browser on your phone. And if worst case scenario, stay tuned. It'll show up in an email in the future from Al as well. So we'll make sure that it stays open long enough for it to be available when certificates and follow up emails go out so that you'll have a chance to do it then if today isn't working for you. I'm going to try to get the certificates out on Friday, but it just depends. That's an aspirational goal. It is. I love it. I like it. Yeah, the email that you used when you registered for the webinar is what it'll go to. Okay. Okay. Well, I just sent you my email just to make sure because I know I might use the RCO email, but I just sent you my personal email just in case, you know what I mean? Okay. Thank you. Is it Toronto? Is that how you say that? Yes, sir. Torianto. Torianto. Thank you. Is it Toronto? Is that how you say that? Yes, sir. Torianto. Torianto. RCO, where are you at? I'm over here at Oasis. I spoke with you. I spoke with Alvin. I appreciate it, man. Thank you. I spoke to him on the phone and he got everything lined up for me. I appreciate both of y'all, matter of fact. Can I give a tip, Al? Yeah. So always use your personal email when you're doing stuff with your CARES. Yeah. Always your personal. And when you get sent the certificate, I personally take a screenshot and I put it in a folder in my phone. That way when we submit CEUs, it's super easy for me to attach those files. That's my favorite kind of commercial. That's great. That's good information I know. No doubt. Thank you. Good strategies. Love it. Thank you, guys. Al. Been good hanging out. Can I mention that our organization is looking for a peer? We're looking to hire a peer. Which organization is that? Motherhood Beyond Bars. We work with, yes, please go to Facebook and go to Motherhood Beyond Bars. If you are interested, the qualifications are listed in there. We just received additional DBHTD funding. Yes. That is an amazing program, guys. I am incredibly blessed to work with some amazing people. But yes. What city? So we work mostly remotely. And our home base is kind of in Atlanta. But we mostly work remotely from home. Is it gender specific? I don't know. I will say that we are a very small organization. All of the employees are female. I know we have some male on our board of directors. So I don't know. Yeah, I know Tara. And I know that I know what y'all do through her. And I just am beyond blown away by what y'all do. Tara is amazing.

decision-making

substance use

recovery

neuroplasticity

addiction

brain

judgment

support teams

recovery capital

decision fatigue

self-advocacy

client autonomy

Andrea Gatsko