In this episode Zach is joined by Dr. Harvey Kaufman, the Senior Medical Director at Quest Diagnostics. Dr. Kaufman and Zach talk about notable findings from his recent survey on addiction and the pandemic, and what long-term impacts we can expect from COVID-19. Following his discussion with Patty, Zach is joined by Sarah Fletcher, the Clinical Director of Sandstone Care, Licensed Professional Counselor, and Licensed Addiction Counselor. They talk about how virtual sessions have impacted mental health and addiction services, as well as how individuals can provide themselves self care during the pandemic.
Welcome to Recovery Radio by Landmark Recovery with your host Zach Crouch. In this program we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields and help navigate the road to recovery. Now here’s the host of Recovery Radio Zack Crouch.
Zach: Hi I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcast. Don’t forget to subscribe to get the most up-to-date information from leading experts. We have guest Dr. Harvey Kaufman joining us on the show today. Dr. Harvey Kaufman is a senior medical director medical informatics at Quest Diagnostics.
In that capacity Harvey leads the information ventures health informatics analyst team. He also leads Quest Health Trends efforts. Harvey joined the company in 1992 as medical director in Cambridge, Massachusetts. He was the first chief laboratory officer for Quest diagnostics, the first Six Sigma Quality Leader and the first medical director of hospital services business development international and clinical trials as well as health and wellness. Harvey has been involved with Quest Diagnostics health trends since its inception in 2005 and has provided medical support for many of our informatics activities.
He earned a medical degree from the Boston University School of Medicine, a master’s degree in molecular biology from MIT and an MBA in marketing from NYU’s Stern School of Business. Dr. Kaufman that resume just about made me choke. I feel very inadequate at this point.
Harvey: Oh it does. Sounded terrific. Thank you Zach.
Zach: It’s a pleasure to have you on the show sir. Where do we start? I know the big survey on addiction and the pandemic came out recently. Can you share a bit about that? The background of this survey, who hosted and why?
Harvey: We’ve been doing this particular report on prescription drug monitoring for 10 years. Each year we sort of look for interesting stories and some years are easier than others. Everything changed so dramatically this year during the pandemic. Previously we put these out as white papers with press releases we’ve distributed at various conferences but the data was so different and the story so compelling compared to prior stories we had we had to publish it.
There’s two areas that we discovered. One is that the use of certain drugs has gone up dramatically during the pandemic in particular things like non-prescribed fentanyl has increased 35% from 4.3% to 5.8% and heroin by 44% meaning from 0.9% to 1.3%. These are startling differences.
Just to backtrack a bit these are patients who the doctor either had prescribed a drug or had previously prescribed a drug and they’re trying to see whether or not the patient is compliant. Every year for the past 10 years it runs around 50%. It used to be a little over 50%. Now it’s just under 50%. Half the patients are either not taking the drug that was prescribed or they’re taking a drug that wasn’t prescribed.
Zach: Wow. You mentioned that this data is so different. Compared to what though? I mean is there anything similar at all to this. We’re in the middle of right now of this pandemic. Anything that comes to mind?
Harvey: No and this is all driven during the pandemic. Previous years we’ve seen you know increases in the usually the single digits because things don’t change dramatically year to year. There’s been a surge in use of none prescribed fentanyl that’s been going on for a number of years. More recently gabapentin has been added to the mix and what’s happening is that people who are selling drugs are mixing in these other drugs to accentuate the impact of the first drug or the drug combination. Things like fentanyl are relatively cheap and so throwing that in makes the drugs that much more valuable.
Zach: Yeah it potentiates the effect.
Harvey: Exactly. In some cases it increases sedation but yes that’s the intent.
Zach: What do you think Dr. Kaufman is driving this increased use?
Harvey: It’s the loss of jobs. It’s the social isolation, anxiety, depression, anti-anxiety drugs prescriptions have increased dramatically during the pandemic. On top of that with the social isolation when people are having issues they’re often dealing with it alone. It adds to the stress and people are turning to alcohol and drugs.
Zach: Let me ask you something. You brought up the social isolation piece. Are you finding any statistics in terms of are more men social isolating more than women or vice versa anything like that? Are they reporting any of that?
Zach: You’re up in the northeast there in that part of the country. I mean there’s a lot of obviously pretty high position jobs in that part of the country. Are people losing jobs at the same rate in your part of the country as other parts of the country right now?
Harvey: That is outside my expertise but there’s a lot of restaurants and bars and dry cleaners and spas and all sorts of businesses that are either out of business, temporarily closed that are likely to be permanently closed. It’s definitely having a wide impact on the economy and on people’s lives.
Zach: Besides what we’ve talked about so far what would have been some of the most notable findings from this survey?
Harvey: There’s really two. One, I mentioned the increase in the detection of drugs like heroin and non-prescribed fentanyl. Interesting, we didn’t see increases, significant increases at all in things like amphetamines and cocaine. That sort of gives us a nice anchor that there were certain drug classes that there weren’t significant changes.
The other key part and this is novel to this study is the combination of drugs. It’s the combination that tends to be the key contributor to fatalities. We talked about the accentuation of the effect but it’s also the impact on things like our ability to breathe.
Historically we focus on the combination of benzodiazepines and opioids which are generally contraindicated because they suppress respirations but other drug combinations also have bad outcomes. When I looked at specimens that were positive for amphetamines there was an 89% increase in non-prescribed fentanyl. For benzodiazepines was a 48% increase. For cocaine it was a 34% increase so it went from 48% pre-pandemic to 64% during the pandemic.
These are dramatic shifts again in terms of the drug combinations which are deadly. The Federal Overdose Mapping Application Program known as OMAP has been tracking this. In March basically a 20% increase in suspected overdoses, in April was 30% and May was 40%. It’s going in the wrong direction.
Zach: Yes, I’d say so.
Harvey: Likewise they pointed to an 11% increase in fatal overdoses and that was early on in this pandemic. We suspect that those numbers will only get worse in the fall into the winter.
Zach: Are people aware of this you think the ones that are taking these substances in combination with each other of the deadly effect?
Harvey: Most likely not. I think the folks who are selling drugs are mixing these drugs together and the people who are taking the drugs don’t know exactly what is mixed in. They fully are addicted and responding to the drugs that they’re purchasing but they’re unlikely aware of how they were prepared.
Zach: You’re a man that’s in the middle of this. At the very heart of finding out what exactly is going on. I have a question about what can we do, how do we respond to this so that we can have better outcomes?
Harvey: Great question Zach. There’s a couple of things here. One is the American Society of Addiction Medicine just reiterated their earlier recommendation to hold off on drug testing because of concern about exposing individuals both the patient and the healthcare providers involved with specimen collection. I think that’s misguided. The only way that one knows that what one is someone’s taking is by drug testing.
We know from our data for 10 years that this is an area where people tend to lie. They’re often taking drugs that they’re not sharing their position. I mean people generally don’t share that they’re taking heroin, cocaine and other drugs. Many of these drugs are obtained from family and friends.
One, drug testing is key and honestly going to a patient service center is safe. I went yesterday to have my blood drawn. Healthcare facilities understand all the precautions and are engaged in doing the appropriate procedures. There’s ways to have specimens collected at home whether it’s urine or saliva and mailed in. Then there’s the social aspect which is yes, we’re struggling as a country with job loss, increase in poverty, people struggling to get food on the table, anxiety, depression. We have an election which has its own level of stress and anxiety.
What we can do with our friends and family and neighbors is to just reach out and be socially connected and be there for each other through phone conversations, through walking socially distantly appropriate but getting engaged with people that are in our circle but also trying to widen that to others who really do need our support.
Zach: There’s been a lot of I think I would say success with there’s a program in Louisville in I’m guessing there’s probably one where you are too at the Louisville Health Department has a needle exchange and part of what they do is provide the education there on the substances and they provide anything they need basically to safely inject. Is there more education you think even at that level that could be done to help especially now with the lethality component of these substances that I’m not aware is taking place or maybe it is at the local needle exchange programs?
Harvey: Actually we worked with the CDC on a study last year looking at or two years ago looking at needle exchange programs. They’re more common in urban areas and less common in rural areas. There’s an issue just with access for some people but the other trend that’s specific to the pandemic is that many of these centers are funded through state governments and the states have been hurt financially during the pandemics and have already cut back funding of medication-assisted treatments and substance use disorder facilities just when the need is increased the most that resource is being pulled back.
Zach: How do you imagine that these results will impact, I mean the addiction recovery field or just individuals themselves?
Harvey: The projections including from the Institute of Drug Abuse is that this is going to impact people for years and a decade or more ahead. The reason that this report has resonated with so many people is because they recognize that the pandemic is having a secondary adverse impact on society. It was mentioned in the second presidential debate as an issue. Raising awareness is one part and then getting the appropriate funding and support is the next step. We hope that awareness will lead to action.
Zach: I know I’m gathering at least that you guys are there’s a lot of emphasis on the person, the individual that’s using. Has there been any sort of data that’s been talked about or collected even on behalf of the family members of these folk and maybe what does that look like?
Harvey: No and that’s a great question because clearly it does impact families directly. Yes. Don’t have a direct answer but that’s a very important aspect to look at.
Zach: I appreciate that. Are you all planning any follow-up surveys to see the longer term effects and impacts of Covid on addiction?
Harvey: Absolutely. I mentioned earlier that this is our tenth report. We continue to look at the data to see where this is all headed. We didn’t have quite enough data to sort of divide it into states, into regions but that’s sort of the next step as well as look at the evolving patterns. We’re particularly concerned about this coming winter. The winter is going to drive a lot of people indoors who used to be able to spend time outdoors. The winters have longer periods of darkness each day. It’s colder and in itself winter brings on its own level of social isolation. Honestly, we’re all getting tired of the pandemic and hope it ended soon.
Zach: I was meeting with a gentleman for coffee this morning. He’s walking from the parking lot. We get to the front entrance of this coffee shop. John just says, he just says, I’ll say it outright. He says damn it. I was like what’s wrong john? He says I forgot my mask. It’s just one of those things. It’s where it’s an inconvenience at the very least. At the same time it’s something where it’s a necessary piece of everyday life now.
I’ve got a family member right now who has bladder cancer. She’s in her 70s. We have to be very careful because any kind of immunocompromised person that’s in our sort of sphere so to speak we got to be extremely careful with that stuff. They live really close to us.
Harvey: Zach, you bring up another issue which we also looked at which is the impact of the pandemic on screening for cancer and other conditions. As much as people are avoiding getting drug tested. People are also avoiding other medical services whether they be mammograms, colonoscopies, going to the physician for visits and laboratory tests for identification and treatment for cancers and heart disease, diabetes and every other medical condition. We need to engage people to be part of the healthcare system.
Telemedicine gets us so far but there’s some that you can’t listen to the heart or look in the ears over the phone. Part of this story gets into the larger story of having people return to healthcare facilities and offices for health care and dental care and eye exams so that things don’t progress to a point that it’s harder to treat.
Zach: Do you have any data on that? I mean you mentioned the idea of not going to your doctor. What did the data look like now versus pre-pandemic?
Harvey: Thanks for asking. In the first six weeks of the pandemic after it was declared so we’re looking at the last two weeks in March and through April, we saw close to a 50% decline in people who were newly identified with six common types of cancer in our database. The numbers revert back in May in the following several months but the problem with that is because it was such a gap those people should if they really return we would have a test number that was much greater than the baseline.
Baseline being comparison to 2019. That didn’t occur so there’s a missing group and then as we move into late august September and October we’re still seeing a decline relative to last year suggesting that there’s a large group of folks who are not getting their routine mammograms and colonoscopies and lab tests and office visits that they had previously.
Zach: What were the common reasons though? Like what were people reporting why didn’t they go? Why didn’t they do and participate in this?
Harvey: Early on meaning March and April most physician offices were closed. The CDC and others recommended that all routine care be suspended for good reason which is that all medical resources were allocated to treating people with Covid 19. We flattened that curve initially and the physician offices, clinics and hospitals reopened with the appropriate precautions but people are still fearful of returning.
I have four siblings, two of them are doctors and they both describe confirming appointments with patients a week ahead of time. They confirm the day ahead of time and yet a large number of patients don’t show up. They’re like oh, I couldn’t get a ride. I was concerned about the safety of who is going to drive me there or they’re just concerned about exposure in a health care facility to other people who might be sick. We’ve got this ongoing concerns.
The other part is you and I and others sort of wake up hoping that today’s going to be a great day. What that does is we push off whether it’s the dental exam or the physician visit or the test to detect something that we don’t want to know about. None of us want to wake up and think about that we might have a medical condition or something as severe as a cancer but we need to wake up and think about how I can be if I have a medical condition, how can it be detected early when it’s most amenable for treatment and cure.
Zach: Give some suggestions then to our audience about how they could best re-engage these things that they’ve been putting off. What would you suggest to do?
Harvey: We need to encourage each other to get the appropriate care which includes the flu vaccines. We need to support each other and encourage each other because we are our best advocates for each other. Mothers and fathers and grandparents and grandchildren we all, we listen to each other. Two, yes doctors who tend to be somewhat passive and let people make appointments need to do a bit more in terms of reaching out to patients who haven’t had their exams and encourage them to come in. Some of that is telemedicine and some of it has to be in person. It can’t be virtual.
Zach: I think that we’re at the point now where we don’t know what’s going to happen three, six months, nine to twelve months from now. There is no point in waiting anymore right?
Harvey: Correct and as much as we all want a very effective vaccine and lots of people to take it and we all reach collectively herd immunity it’s still a guess. We’re definitely spending a lot of money in trying to accelerate research as fast as it’s possible but the outcome is still unknown. The likelihood of an effected vaccine is high but the likelihood that it will be available to the wider community in the next few months is low.
Things are going to probably get worse before they get better. Now is the time to pick up the phone and talk to our neighbors, talk to our family and talk to our doctors to get re-engaged if we haven’t been.
Zach: When you think to yourself about the vaccine what in your opinion from your perspective is a more realistic time frame for the larger group of folks in the United States to get that?
Harvey: Zach, that’s outside my expertise but I’m encouraged by the news that I read. This has never been done before at this speed. I hope that it’s done with the right safety measures and that the anti-vaccinators will not win this day that science and reason will win out.
Zach: I agree. Well Dr. Kaufman, thank you for your time today. This has been a pretty eye-opening conversation. I really do appreciate you coming on the show with us today and sharing your expertise. If people are interested more about the vaccine, just in general anything that we’ve talked about. Are there maybe one or two suggestions that you would give maybe a website or even a book?
Harvey: The two general websites for information are the Centers for Disease Control, the CDC, Centers for Disease Control and Prevention website and the FDA website are updated really with great information. Zach, I look forward to talking to you again in the future with our next study to look at trends in drug testing because I think it will be eye opening as well.
Zach: Fantastic. You’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find this online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts. We have guest Sarah Fletcher joining us on the show today. Sarah serves as the clinical director of Sandstone Care. She oversees all clinical services to the organization. Sarah holds a bachelor’s degree in psychology with a minor in sociology.
She also has a master’s degree in rehabilitation counselling with a specialization in substance use disorders. Sarah is a licensed professional counselor as well as a licensed addiction counsellor. Sarah has several years of clinical experience including individual, family and group therapy. Sarah began a journey with Sandstone as a primary therapist before making the transition to program director followed by her current position.
She’s trained in EMDR, mindfulness and she has extensive experience with both DBT, dialectical behavioral therapy and CBT, cognitive behavioral therapies. Sarah, it’s a pleasure to have you on the show today. Welcome to Recovery Radio.
Sarah: Thank you so much for having me.
Zach: Tell us and the audience for that matter a bit about how you got into the field. What was kind of your experience and how did you get interested in in the recovery field?
Sarah: Absolutely. Growing up I lost someone who was very close to me to a heroin overdose. After this experience I kind of watched my family and the world around me crumble a little bit and a lot of kind of healthy dynamics that I was used to fall apart. The silver lining of that was that I was able to see the healing process that was able to take place through a combination of consistent therapy, integrating the idea of safety and transparency and with that I became kind of fascinated with the human ability to heal.
I immediately wanted to learn more about the powerful experiences that I had growing up. That led me to become more interested in just human beings in general which is ultimately what kind of led me down the journey of looking at the addicted minds and how people are able to kind of demonstrate that courage and bravery to live a life of recovery.
Zach: You bring up an interesting point you mentioned with this close friend of yours that the family fell apart. Can you expand upon that? What do you mean by that?
Sarah: I think when I saw like an overwhelming sense of grief and just trauma and sadness with losing someone that is such an intricate part of a family dynamic. It became very apparent to me that addiction touches more than just that person who’s struggling. It really is a full family disease. It impacts loved ones. It impacts friends, the entire community of that’s touched and included within that person.
When I say that I saw others fall apart through experiencing losing that person it really became more, it really gave me more of an understanding about kind of the grief process that comes along with addiction and I saw people who I was able to identify as healthy really just lose their own sense of self through that experience. That kind of gave me, it kind of opened a world for me where I wanted to learn more about just the larger impacts.
Zach: Is with you and really kind of perceiving as a healthy person before this happened? Can you describe a little bit about what you saw and witnessed with the deterioration? What went on?
Sarah: For me it was seeing my family who had really healthy hobbies and coping skills and really healthy communication patterns deteriorate in the sense that when we lost this person everybody forgot how to communicate with each other and everybody forgot how to engage in healthy self-care and coping skills because they were overwhelmed with the trauma and grief that they were experiencing.
It was fascinating to be able to see and myself was included in that. It was fascinating to see just how quick being, having healthy self-care and having healthy communication patterns is able to just deteriorate in front of you when you’re faced with an overwhelming sense of loss.
Zach: I appreciate you sharing that. I’m sure that people listening to this program have had people myself included my wife’s brother died in overdose at a very young age. One of the things that I’m going to ask you really is in the midst of what happened with your friend here I think a lot of people try to create meaning. They want to find out why. What’s the meaning? Is their meaning in any of this tragedy that happened? How do you help people know meaning in the midst of this happening with the people that you work with?
Sarah: I think a lot of that comes from just education and understanding that compassion and acceptance are two huge pieces of this process. I think a lot of times when people don’t understand the nature of addiction. They don’t understand. They’re searching for the why and I’m a big fan of educating folks. There doesn’t necessarily have to be a why. There isn’t necessarily a reason that some people struggle with addiction and some people are able to maybe dabble in substances and then don’t go down that path.
Then there’s also folks who don’t struggle with substance use or abuse at all. For me the process is really about education at a high level and teaching people that if we’re uneducated or we have questions that asking and coming from a place of curiosity is really the best place to be because a lot of times when we don’t know the answers to questions that we have we start to write our own narrative.
When we write our own narratives oftentimes just is a natural human mechanism. We come from a place of judgment and we come from a place of assumptions rather than coming from a place of compassion and leaving judgment out of the process. For me, it’s not much as much about like why did this happen but more from a compassionate place of this is the situation that we’re in. This is how we’re going to work through it. It’s okay if we don’t know how we’re going to do it but coming from a place of curiosity is going to make that possible.
Zach: I appreciate that. I was thinking too as you’re talking. When stuff like this happens in people’s lives, when they lose someone unexpectedly often I hear a lot of the times there’s this struggle that they have with, as I mentioned the media piece but you take someone for instance who has maybe had what’s the word here? Their life is driven by a deeper purpose. There’s maybe even spirituality. We’re going as religion and their walk with God so to speak.
The big questions that then come up for them is what why did this happen and why is this going on? I thought this would never happen to me but then this tragedy happens. You mentioned writing a new narrative. When those come up with you know really spiritual almost nature kind of things is there a different approach that you take with that beyond obviously not being judgmental as you said? I think that’s super important but when they come to you with those big questions. Is your approach different even?
Sarah: I think my approach is more allowing human beings to have their own experiences and to answer the questions that they’re asking depending on what their preference is. I do work with clients who come from a spiritual background and who have questions of why did this happen to me? Did I do something wrong? For me it’s really just breaking that narrative and that you can be exactly who you are and there’s no form of blame or frustration that is going to answer that question.
For me, it doesn’t matter what people’s spiritual background is or what their kind of human experience has been. It’s really just coming to a place of acceptance and that this did happen and it doesn’t mean that anything’s wrong with you. You’re not broken. You don’t need to be fixed. This is just like a human experience that we’re having and I’m happy to work through it with you. I don’t know if that answers your question.
Zach: I think that’s a great response. I was thinking too because we were talking before the episode about how your center works a lot with teens and young adults and I was an adolescent counselor at one point in my career. I often believe and still believe at least that the family can use as much work a lot of the time more so than the young patient can. Do you find that to be true too?
Sarah: Absolutely. I think that family support and family counselling in this process is a must. It’s a non-negotiable. I know that we talked earlier that addiction as a whole is really a family and community struggle. There’s not one identified person. There may be one identified person who’s struggling with the addiction but there’s not one identified person who is the issue that needs to be corrected. It’s all about the dynamics of a family system, how the family communicates with each other, how they listen to each other.
A lot of times we see family members who are too busy preparing a response in the middle of a conversation with their loved one and so they can’t hear anything that’s being shared. For me family therapy and family involvement in the recovery process is a must. It has to happen and for folks who maybe don’t have, we talked about the difference between teens and the young adult and adult community perhaps direct family involvement is not part of their process or part of their experience.
In those cases then we look for a support system. If someone’s involved in the you know NA or AA community, if they’re involved in a church group, anyone in their life that is a support system for them we encourage to be involved in the recovery process because we’re social beings. We crave human contact. We crave which is one of the reasons this pandemic has been so incredibly difficult is that we crave connection. When we’re isolated in a silo and struggling with addiction or mental health we need support and we need people to be able to back us in order to get through that.
Zach: I appreciate that. This next question is kind of two-parters. The first is you brought up a very interesting point. It’s about the addictive mind and what is research showing us now about the mind and addiction. That’s the first part. The second one is really how is that helping to break some of the stigma around addiction.
Sarah: What the studies and the research show specifically with addiction and teams is that the prefrontal cortex in the brain and I don’t want to get too in-depth into this but basically the part of the brain that focuses on decision making and being able to process experiences in front of you is not fully developed in adolescence. It’s a crucial part of in development but it’s not fully complete.
When we’re going through an adolescent process and we’re growing when we’re exposed to situations that probably take a little bit more time to process through and make decisions around. Adolescents a lot of the time we’re seeing have a higher level of impulsivity. With that impulsivity comes longer term…
Zach: I was going to say they are still developing the brain and you throw drugs and alcohol and stuff.
Sarah: Absolutely. When we include drugs and alcohol into that it’s oftentimes causing a cognitive stunt. I don’t know how else to explain it but it’s stunting that progress in the growth of our decision-making portion of the brain. A lot of times when we see adolescents who are using substances in their teens when they move into young adulthood that portion of their brain that helps support decision making and weighing pros and cons and problem solving never fully develops.
It makes adolescents who are using and abusing substances at a much higher level risk for chronic long-term addiction just because they’re unable to ever form those problem-solving decision-making processes in their brain.
When we come to young adulthood and we see that chronic addiction most of the time the clients that we’re working with have started using substances at an early age. Now again we go back to the why, the reasoning that folks begin to use substances. To be honest if we talk about stigma there is no identified track that leads you to become an addict.
We see there’s a genetic component so kiddos and young adults who have a family history of addiction they do have a higher risk however that is not a death sentence. That doesn’t mean that clients who have family members who have struggled with addiction whether they’re now in recovery or not are for sure going to become an addict. We see early onset of substance use and experimentation be a risk but that also does not lead one set path to addiction.
For me to kind of answer the second portion of that question, the stigma that I’d really like to work on rewriting is that it doesn’t matter who you are, where you are, what kind of family dynamic you come from. It doesn’t matter the experiences that you’ve had in the past. I’ve worked with clients who have a really long trauma history. They’ve had really, really intense experiences and they’re able to lead a life of recovery and work through any struggles that they have.
For me, if there’s anything that I would like to do to help you know break the stigmas of addiction is that it goes back to early onset education, asking questions, being curious about things that you’re unsure about and being okay with not knowing all the answers and being open to hear someone else’s experience.
Zach: It’s interesting because this is a sort of common theme within recovery meetings even in the field but it’s common to hear that your development. When I speak in development I’m talking mental, your cognitive, even behavioral is you said stunted developmentally at the age you began to use or abuse substances. A 30 year old starting recovery, you started using at 12, 13 years old they’re operating with the fact of a 12 to 13 year old. How true is that?
Sarah: I wouldn’t say that when I say stunted it means stopped. When I say stunted I mean the growth, the cognitive growth perhaps slows down. I have seen clients who function at a similar age to when they began struggling with substances or dabbling in substance use however there’s no studies that show that there is full-on stopping of brain or full-on discontinuing of brain development.
What we show and a lot of this also is around emotional regulation and emotional development as well. We see clients who they just never, when they start using and they develop an early addictive mindset that the way that they learn to survive often comes from a place of manipulation and dishonesty. That’s not an intentional. From my experience I don’t typically see that as an intentional development.
I see that as this is how I’m going to survive. Manipulating people into getting my needs met is the only way that I know how to do this and so it’s the way that I’m going to lead because it’s worked in my favor so far. I think that also leads back to the stigma that people or folks who struggle with addiction are highly manipulating. They’re dishonest and they’re criminals.
If we just go back to our basics of coping skills and how we communicate this is just how folks who have struggled even with mental health and substance use have gotten their need met in the past. I think there’s a personal aspect to it that I like to educate on around someone who’s struggling in active addiction is not the same person who is leading a life of recovery.
They’re the same body. They’re the same brain but they’re not the same person and part of that comes from learning how to emotionally regulate and learning how to communicate with healthy patterns as opposed to reverting back to these are my coping skills. These are my basic coping skills of manipulation and dishonesty because it’s how I’ve been able to remain in my addiction for an extended period of time.
Zach: Obviously we’re in the middle of this, still in the middle of this pandemic. It’s November and I’m wondering how did virtual sessions impacted I guess the accessibility to mental health and addiction services for your patients? Do your patients like it? Part of the reason I ask that is because in person meetings you can often see a lot more about what’s going on with the person, their body language, their tone of voice, all that. You don’t see that as much with the virtual sessions.
Sarah: Absolutely so like you mentioned with the nature of the world right now and being amidst the global pandemic I think that this actually created a beautiful opportunity to explore and develop virtual services at multiple levels of care. At the company that I work for at Sandstone we’ve gotten extremely creative with offering virtual services and telehealth services so you’re able to see the therapist on the screen.
To your point it is still difficult to read some of those nonverbals but it still brings a sense of community. We have all sorts of technology devices that have allowed us to become interactive with the clients that we’re working with. Do screen shares so clients can still engage in experiential activities.
What’s been really cool is that in addition to providing that higher level of safety with the pandemic that’s happening we’ve also found that we’ve been able to reach clients and have access to clients who struggle with engagement in face-to-face communication without a pandemic. That can be high level anxiety, agoraphobia, trauma, content depression and that has been able to provide more accessibility to folks to receive care from that aspect because it’s just not something that we’ve been able to get creative enough to do before.
We’ve received positive feedback from clients on our virtual services to the point where again, we’re hoping to launch this long term. We’re hoping to continue with a virtual track to support clients who struggle with coming in person even after the world becomes a safer place again. Because we really want to increase the accessibility to reaching folks who perhaps coming into an office terrifies them. They can actually receive services from the comfort of their home and still be able to get support.
Zach: Talk to me a little bit about your state and how they have made telehealth accessible to therapists just in general? Have they worked with crossing state lines even or what’s kind of the pulse on that in Colorado?
Sarah: For Colorado our regulation agencies have been really wonderful in the sense that they have created specific exceptions to providing services across state lines, providing virtual services with clients who aren’t able to come into a facility or therapists who have to work from their home environment for safety reasons or to protect loved ones who may be at a higher exposure risk.
As far as the regulations go we’ve been able to partner and collaborate with the states really well in my opinion to be able to support virtual services. I’ve also seen an increase in insurance companies supporting coverage for their clients and the clients that we share in virtual services as well which is not something that we’ve seen before. Historically, it’s been really tough to get virtual services covered through clients’ insurance companies.
Now within this pandemic that we’re seeing insurance companies and the regulation boards are showing up and being really supportive. We’ve been able to provide services across state lines. Now the states have to be able to talk to each other to make sure we’re in regulation in both states but we have seen a lot of collaboration there which has been, it’s been really helpful. It’s been really cool.
Zach: I know that you do a lot of mindfulness work. Talk to us about the importance of self-care right now. I mean we all kind of know it’s important in recovery and I would say especially during this pandemic but can you talk to us a little bit about how folks can maybe even determine what types of self-care are best for them?
Sarah: Absolutely. My recommendation is self-care is one of the most important aspects of the recovery process. If we’re not taking care of ourselves there’s no way that we can show up and learn coping skills to communicate with others. My number one recommendation for folks who are interested in developing their own kind of self-care regimen is really trial and error.
I know that sounds simple. To be honest it is a pretty simple process. I would identify what brings peace and happiness to an individual in their everyday life. I’m talking this can be very simple stuff. Some folks start with taking a hot shower. If that’s something that you look forward to in the morning. Start there and identify what specifically about that brings you peace and happiness.
Is it a tactile thing? Is it just having peace? Is it the sound of running water and then really digging deep into what keeps you in the moment during that process? It doesn’t have to be necessarily a hobby but when we talk about self-care we’re really focusing on the five senses. If you notice something that brings you peace and happiness again, doesn’t have to be a specific hobby. It can be listening to music. The next step in that is figuring out what specifically about that is identified for you that is bringing you joy.
Is it the type? Is it the sound of music? Is it just having again a tactile feeling of headphones in and that feeling of disconnect from kind of what you’re focusing on in the world? For me self-care is all about what makes us feel safe and remaining in the present moment and really giving ourselves an opportunity to slow down because we know that our society moves at such a fast pace. My recommendation is start small and really just identify day-to-day what is something you look forward to and then what about that activity brings you peace and makes you feel comfort.
Then finally building off of that so what other things can correlate with this activity and then that’s how we create a self-care regimen. Then just practicing every single day even if it’s for five minutes, even if it’s for 30 seconds, taking deep breaths before you go into work in your car. Start very small because the idea of self-care is to not become overwhelming. It’s kind of the opposite effect. Just trial and error and starting small and working your way up.
Zach: What makes you think most people just give up?
Sarah: What did you say?
Zach: What I was asking is obviously if most of us participated in self-care would probably be a lot better off which tells me most folks probably give up before the sort of miracle so to speak happens in their life.
Sarah: Oh absolutely. I think it’s really easy to feel overwhelmed and it’s really easy to feel like you somehow have failed. There are also different levels of engaging in self-care and finding peace. What works for me is not going to work for somebody else and that’s okay. It’s not supposed to because we’re different human beings. Different things are going to fill our cup and bring us peace.
My recommendation again is that there is no right or wrong way to engage in self-care. It’s all about what works for you. I know a lot of times I see clients kind of exchanging ideas on what others find to be self-care. For me meditation is not a form of self-care. I can’t sit still long enough. I can’t shut my mind off. It brings me increased anxiety. For me meditation is not something that I would identify as a self-care practice however I know tons and tons of people who meditate every day, who find it extremely beneficial and that doesn’t make me right and that person wrong or vice versa. It just means that we’re different and we find different ways to find peace in our lives.
Zach: Just out of curiosity what does work for you Sarah?
Sarah: For me my self-care is adult coloring books. I love Mandalas. I love coloring. Listening to music is really big. I do a lot of squared breathing which squared breathing is just counting four seconds on an inhale, four seconds for holding, four seconds on an exhale and four seconds of holding. It really just slows your heart rate down and allows you to just kind of feel a sense of calm.
Then spending time with my family and my dogs is probably my highest piece of self-care. Spending time with the people that I love and taking my dog run walks and hanging out with them is something that I find really valuable.
Zach: Do you get a couple pups? What kind of dogs you got?
Sarah: I have a pug. He is a total clown. Then I also have a Rottweiler. She’s a mix and she’s a rescue. Her and the pug are the best of friends. They smuggle all the time. It’s a pretty hilarious animal couple.
Zach: Very cool so big dog and a small dog. Very cool.
Zach: Sarah, this has been a great conversation especially around I think the stigma piece and also understanding a little bit more about self-care that folks who go through this don’t have to do it alone. I appreciate you coming. I really do.
Sarah: Thank you. Thank you so much for having me. I just I want to do everything that I can to help support people who are struggling or who think that they don’t have an outlet so I really appreciate you letting me come on today.
Zach: Awesome. Listen, if you know someone’s struggling with an addiction and you’re searching for answers visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families. Until next week I’m Zach Crouch with Landmark Recovery Radio.
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Nov 25, 2020
Posted in: Podcast