In this episode we have Elizabeth Irias joining us to talk about the family roles in addiction. In order to cope the unpredictable behaviors from their loved one suffering from addiction. family members may adopt dysfunctional behavior patterns, even if they don’t realize it. You can find more information about Elizabeth and her work at ClearlyClinical.com. We then have Danita Coulter joining us to talk about FindHelpNowKY.org, a local resource that’s connecting people looking for treatment with local resources that will fit their needs.
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, Zach 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 podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.
We have guest Elizabeth Irias joining us today to speak about the Family Roles in Addiction. Beth is a California Licensed Marriage and Family Therapist and the Founder and President of Clearly Clinical, a national podcast-based Continuing Education company for mental health and addiction providers.
She also serves as an adjunct graduate professor at Pepperdine University and operates her private practice in Westlake Village, California where she provides therapy to adolescent/young adult clients, members of the LGBTQ+ population, and those with addiction disorders.
Beth, it’s an absolute pleasure to have you on with us today.
Beth: It is my pleasure to be here. Thank you for having me, Zach.
Zach: Just kind of jumping into, tell me a little bit about yourself and how you got to the field of addiction.
Beth: Yes. My journey to working in addiction was actually not a straight shot. I know some people are really passionate in one particular field when they go into masters or doctoral programs for Psychology. For me it actually was one of the things that really scared me. When I was in my masters program when I took courses in addiction I was kind of not terrified, but I was worried about it because it’s such a heavy subject. It’s so consuming for the people that are affected by it.
My first internship out of school was working for a facility that did what we call co-occurring disorder treatment or dual diagnosis. I was working with adolescents and young adults that had both mental health illnesses and addictive disorders that were occurring side by side. It was kind of trial by fire.
While I have been educated with it I hadn’t really worked in the space much and just really was moved by the power of the experiences of people that I worked with, understanding primarily the people I was working with were coming from very difficult areas in Los Angeles that were rife with gang activity, severe substance abuse problems, prostitution, just unbelievable problems that these young people have been dealing with. The intimacy and vulnerability to talk with somebody about things that have such stigma like addiction.
After that I never looked back. I feel really honored to do this work partially because there’s so much stigma associated with it and I think it’s very important to work with providers that have a sensitivity because there’s so much judgment like having been in meetings when we raise our hands and say, “I’m an addict.” No one doesn’t wince initially when you hear that word.
Zach: Right, right.
Beth: It’s about time we keep talking about it as a society and bring more attention to substance use disorders and the fact that this is just an illness just like anything else just like diabetes, just like heart disease. Contributing to the stigma is not helping it. For me it was staying in the field that I realized needed assistance and that I was honored to work in.
Zach: Yes, fun and interesting right now because we’re right in the middle of a political race. One of the biggest killers in this country right now is opiates. That is really just taking the backseat right now. I’m just scratching my head. I’m like, “Are we serious? Is this really happening?” Yes. That’s not to discount any other, whether it’s corona virus, whatever it is. Man, we’ve got our priorities a little whacked out I think right now with some of this stuff.
Beth: It’s so complicated. Treating substance use disorders to anybody who is listening that either has struggled with a substance use disorder or any addictive disorder for that that matter, or their loved ones, it’s so complicated and it’s so difficult to where do we begin. It’s easy to judge from the outside when you haven’t been…an experience.
That said, I think everyone has been touched by addiction one way or another, whether it’s ourselves or someone you know at work, someone you love, whatever it is we’ve all been touched by it and you bring up a good point about the current situation with opiates.
Zach: Yes. It’s interesting, too you bring up how complicated it is. We’re both professionals. We’re in this field. It can be confusing to us sometimes much less somebody who’s not familiar with it, a layperson who’s just maybe in the midst of a family member who’s going through it.
I’m surprised even at if you go up a level to medical professionals — doctors; we were talking to some just general medical internists that were basically involved in their practicum or internship, whatever in the hospital. I was just flabbergasted at how little addictions training they actually receive because it’s little to none. It’s very little. If we go to a doctor even, somebody who supposedly would know something about this we can’t guarantee any of that at all.
Beth: Absolutely. I had clients that have had addictive disorders that have gone to doctors and been prescribed things that have been really problematic because the doctor wasn’t aware that a certain substance could be ultimately a substance of abuse so yes, absolutely. Even among mental health professionals it’s pretty rare, at least in my area to find a therapist who had specialization in addictive disorders.
When you consider the breadth of addiction in the United States, there’s kind of a mismatch. We have drug counselors and other professional certainly that are enormously helpful but the kind of comingling between marriage and family therapy and addictive disorders is not an overlap.
They occur quite as often maybe as others and I think that might be part of the problem and part of why I’m here today to talk about this conversation about families and addiction because I don’t think in general we talk enough about how those things interplay.
Zach: We’re going to talk about some of the family roles that are assumed when dealing with a loved one suffering from addiction. I want to go back just for a second though, when you were working with young teenage kids in some of these gangs did you see a lot of the similarities in these roles that we’re going to talk about within the gang structure?
Beth: Oh, absolutely. Absolutely. Absolutely. The studies are looking at the system that exists. Really what we’re calling the family, what we’re talking about is a system, an organizational structure of how people interact. Oftentimes when we’re looking at a structure of a gang, it’s offering things very similar to what a family would. In fact I’ve often heard comparisons between 12-Step, for example and the family system where the family is some place you could go be yourself and be loved and be supported.
What we’re calling it family therapy, what it really is is somewhat like organizational systems theory and its applications. These roles affect us. They can affect us in the workplace. They can affect us in the family. It could affect us in the organizational structure of a gang or something like a 12-Step group. It just is kind of we automatically start to sort ourselves into different roles and we unknowingly often grab a script and say, “This is my script and I’m going to play this part,” and then we’re off to the races.
Zach: Yes because there’s some security and comfort in that role, whether you know you’re in it or not. You mentioned unknowingly, I would say yes. Certainly unconsciously people do sort of gravitate towards these common roles. Let’s talk about those. What are some of the common roles that you see within the family structure when there’s someone suffering from an addiction?
Beth: Okay. Absolutely. I’m going to name six and these are the six they’re pretty commonly mentioned in the field; however sometimes they have a different interpretation or they use different words like one of them is what I call the mascot and I’ll explain that sometimes it’s called the jester, for example. People who are listening might have heard these roles that use slightly different words.
For the purposes of today’s talk I want to pose that I wince a little bit when I hear the word addict. One of the family roles is the “addict” but I’d like to reimagine that as the person who’s struggling with an addictive disorder. If you hear me use the term “the addict,” it’s not because of the labelling of the addict or a judgment of the addict, it’s just simply the way that that role has been assigned over a number of years.
Zach: I appreciate that.
Beth: I’m personally not a big fan of that word.
Zach: I’m not either.
Beth: I may say it both ways but for the sake of this discussion.
Beth: When we’re looking at family systems we know that in general family systems play a lot in to both the development and maintenance of mental health and addictive disorders. Obviously today we’re talking specifically about addictive disorders but when I say mental health I mean we know that basically there is a contributing factor for depression, for anxiety, another really powerful went to a lot of research into the development of maintenance of schizophrenia symptoms, really powerful stuff and not something many people know about.
When we’re looking specifically at the “addictive family system” sometimes there are six roles that may develop. As I hearkened to just a little bit ago, the definition of family is kind of fluid here. If you, for example are listening to this and you’re a person that has someone with an addiction in your family, you may not see all of these roles or maybe you see some but not others.
Keep in mind that this does not necessarily mean nuclear families who’s living in your home. It may be Great-Grandma Betsy and it could be the school principal that comes to dinner once a week. It can be whoever it is.
Zach: Anybody who’s closely involved, right?
Beth: Exactly, exactly. The roles that we commonly look at are number one, the “addict,” the person that’s struggling with the addictive disorder. The other roles just to name them off are: the hero, the mascot, the lost child, the scapegoat, and the caretaker.
Basically all of these roles develop in response to kind of an impossible problem. The impossible problem being someone you love or yourself engaging in a behavior that you know you “shouldn’t” be doing but you can’t stop doing it, whether that’s gambling or using substance or whatever it is. There’s this challenge to the other family members like what are they going to do about solving what seems to be an impossible problem.
Zach: Right, right.
Beth: In response to that we see the development of these family roles. To kind of just start kind of telling a little bit about them, as we already talked about someone who has an addictive disorder they typically have a great deal of shame. Nobody wants to self-identify as having an addictive disorder. You don’t want to raise your hand and be like, “I’m the one. That’s me.”
Beth: Typically that person has a lot of shame. They may have a lot of shame with past behaviors like deceit, stealing money, just shame about the substance in general as a process of addiction…
Zach: Beth, you’ll probably touch on this, but one of the underlying or overlying arches of the whole system is that you don’t tell the truth and you don’t talk about it.
Beth: Right, exactly. Yes and thank you for bringing that up. That’s one of the things that we see in family systems with addictive disorders. We often see a lot of chaos just caused by not talking about “the thing” or “the things,” whether that’s sexual abuse that occurred with one of the children or that’s a job loss or lack of money or whatever “the thing” is, another thing becomes the addiction itself.
Often there is a lot of secret-keeping that goes on in these family systems. There can be kind of gas lighting also so you might have people behaving one way at home. There can be a lot of chaos, a lot of arguing, a lot of yelling, hitting, whatever it is but then being out in the community and everything is fine.
Zach: The piece that I was going to mention real quick is that we often talk about this idea of having a container where people are able to express their emotions in a safe environment. My take on alcoholic family systems is that the container is just not able to handle any sort of emotion that threatens the, I think stability of the dysfunction, if that makes sense.
Beth: It does. Actually what you’re talking about is something called homeostasis which is the maintenance of the status quo. This family system will self-correct to find homeostasis.
When I’ve worked with individuals and with families, it’s kind of like the game of whack-a-mole that if someone is kind of the lost child, we’ll say kind of the quiet one that doesn’t involve themselves much in family issues or family problems and then something changes and that person comes in to the fold. Another family member will, completely unknowingly distance themselves to take that role just to maintain homeostasis of the family. It’s kind of a trip when you see it in action but it does happen.
To go back to these first two roles in the discussion of the person with the addictive disorder and then the hero oftentimes when you have someone who has addiction there will be someone else in the family that takes on the role of being the all good sibling or parent or whoever and it’s like kind of, “I’ll save you,” like hands-on-their-hips with a cape waving behind them.
Zach: Captain of the football team, right?
Beth: Yes, exactly. It’s this person’s job to make everybody else in the family look good and make things look normal so they’re kind of the great equalizer.
Zach: I love that. That’s a great way to put it.
Beth: Yes. No one talks about so-and-so over there the one who has the issue with meth but have you seen our wonderful captain of the soccer team and she was also the homecoming queen and all of that. It’s like don’t look behind the curtain. You have the hero. It’s another role that can come in to play. They tend to be very perfectionistic. These are the people that often feel pretty awful about themselves because they feel so much pressure.
Zach: Usually first-born, no?
Beth: Sometimes. It depends. That’s the other difficulty is these roles while there’s been a lot of research about family birth order we see some tendencies like differences in personality type and intelligence and things like that but you’d be surprised who might step into the role of hero because it also depends who’s struggling with the addiction. You could have the first-born that’s struggling with the addiction so they are almost inherently not the hero, at least not in that moment.
That’s one of the things that I want to bring up. What’s really interesting about this is that the roles can change and when that happens it can really be odd for families. If you’re watching the homeostasis long enough you realize that unless something really changes, we’ll talk about change it will self-correct and like I said, someone else will take on a new role, will take on the role of the “addict” if somebody gets clean.
With the hero often feelings of guilt, of letting the family down, they feel a lot of pressure and it’s their job to kind of hold it all together.
Zach: I want to come back to these roles, but I want to ask you a question. In terms of when you’re explaining this to some of the clients that you work with and even their families do you see their lies, not their lies, their eyes just kind of light up? Just like, “Oh my God. You’ve named what it is that I’ve never been able to.”
Beth: Yes because I think these things feel so intimate and personal and obviously they are, but the knowledge that exists elsewhere when we get away from that, “Oh my goodness. I thought it was just me,” to quote Brené Brown. That idea like this is what happens with other people and there are words for it I think can be really normalizing and freeing.
That’s part of the value I think in going to Smart Recovery groups or Al-Anon or Nar-Anon, any of those family support resources because then you’re like, “Oh my gosh. It’s not just me,” because it feels like an impossible problem not just for the person struggling with the addiction but for the entire family.
Zach: That just nails it, too, as you put it the impossible problem because every single thing that I think people try to figure out it’s just like a feedback loop of going nowhere.
Beth: Exactly and that’s exactly how it feels.
Zach: Tell us about the other roles. Yes.
Beth: Yes. Moving from kind of the hero we next look at the mascot also sometimes called the jester. This is somebody that often distracts from family tension caused by the addictive disorder by being either really kind of off-the-wall and irreverent or being kind of like a little bit like a problem child.
I’m reminded of a story that somebody once told me. Something happened at the table and something really hurtful was said by a family member. The person telling the story picked up, I can’t remember what it was picked up a sandwich or something like that and really threw it across the room. It served to stop the family interaction by distracting it enough.
It’s basically like the responsibility of the mascot or the jester to kind of throw this Molotov cocktail that makes everybody looks elsewhere so that they’re not so caught in the tension. If you’ve ever witnessed a parent talking to a teenager let’s say who’s using substances or anybody trying to have a reckoning with somebody who’s using and is actively involved in addictive disorder there’s a heck of a lot of tension in that…
Zach: A lot of energy.
Beth: Yes and the mascot’s role is to diffuse it. They’re the class clowns. I’ve often wondered this when I see comedians and their stand-up bits. Oftentimes a lot of humor is very dark and is borne out of suffering.
Beth: I think it’s a perfect example that when you hear about comedians that have really painful mental health problems or painful addiction problems either with them or within their family…
Zach: Probably that’s right. Right.
Beth: Exactly. You see that some of these personality traits are born out of the system. It’s a way to survive where it’s like, “I’m going to be the funny one. Nobody looks too close. I’m going to be the funny one so that I’m okay and my family is okay because things are just super tense at home so I’ll crack a joke and distract from it.”
Zach: That’s why I love Patch Adams so much, Robin Williams in that character. I think he did just a fantastic job in that role because he had so much pain in his life, but he was able to bring to that role just I think, as you named it here just an ability to make other people in that role happy but to deflect some of the most painful news that you’d ever hear. He was going to like young kids who had cancer and he was just perfect for that role. A lot of that was just probably fueled by his own experience of pain.
Beth: It is interesting when you realize that there’s also connection behind humor. This is an attempt to try to talk about something in an indirect way because talking about it directly can feel terrifying. If someone’s listening and they’re like, “Oh my gosh. That’s me. I’m the one that does the random thing or always just cracking jokes. I can’t be serious. If someone tries to get serious then I just make more jokes. I double down,” those are all coping mechanisms. Those roles develop in order to survive a really difficult and painful situation.
Zach: There’s beauty in that and brilliance. There’s also some sadness, too because you’re right. The person is constantly having to not…they’re not allowed. They can’t possibly feel some of these things that they deflect and it’s too hard.
Beth: Right. All of these roles while they serve functions it means that everybody in the family is suffering. Everybody is experiencing guilt, shame, disconnection. As human beings we are fundamentally designed to connect to other people and addiction can inhibit that. The family has to respond one way or another to get back to its very humanity so we kind of take on these roles.
Zach: Got it.
Beth: Moving from the jester or the mascot, the joker we go in to the lost child. This is the one; this is the person who is kind of forgotten. They’re not a troublemaker. They do what needs to be done. They’re reliable but they’re not the hero. They’re just kind of quiet.
It reminds me of an episode of Modern Family where Claire the mom is talking about the daughter Alex who is a super performer. Claire admits as a mom that she at some point started to just kind of assume that Alex was like a “self-cleaning oven.”
The lost child is kind of like set it and forget it. They just do their own thing. They take care of themselves. They tend to be very, very lonely. They don’t want to make the drama any worse. They don’t want to increase the amount of emotion that’s coming in to the family so they tend to be very quiet. They don’t express their needs. They just kind of recede into the background to try to not make things worse.
Beth: In family therapy that looks like the person that’s like quiet and just kind of shrugs and doesn’t have initially much to say because they’ve learned that role. It’s like, “I’m not going to get in the all-out screaming match. I’m just going to say, ‘sure that’s fine. We’re not going to a movie then,’”and not really have a place in the family.
Zach: Do personality types when you mention the lost child I think automatically of someone who’s introverted versus someone who’s not? Does that have anything to do with this?
Beth: That’s a really good question. It’s one thing that I’ve wondered. To a degree I would think it would have to; however, like I said I’ve seen people change roles over time within the context of the family. What I mean by that is you may have somebody who’s actually extroverted out in the world and they really like people and like a salesperson they’re very social, but in the family they might be very quiet. It’s more of kind of a learned behavior.
I would still assume personality has something to do with it but I think a lot of it is just finding the homeostasis of the family and returning to a comfortable baseline. It may not be healthy but it’s comfortable and familiar.
Zach: Got it. Did we talk about the caretaker?
Beth: No. We have two more. We have the scapegoat. The scapegoat is the person that makes all the noise basically. They are very rebellious. They’re another kind of distractor. They’re kind of a problem child.
The person who actually has the addictive disorder may not be the “problem child,” which is really interesting but the person who is scapegoat-ed it’s if everybody in the family is standing and pointing to that one person and saying, “If so-and-so could just get their grades together or could just show up for work then I don’t need to drink.”
Zach: “It will be all right.” Right.
Beth: Right, exactly. Everything would be fine if that person stops doing this thing. The person that is the scapegoat feels awful about themselves, a huge amount of shame and often emptiness because they want to fit in to the family. They want to be loved but they’ve kind of been cast as the black sheep. Having worked with people that identify with all of these different roles both as individual and as family therapy, the scapegoat is a really hard spot to be in because you are effectively blamed for the problems of the family.
Zach: Then you start to do things that sort of solidify that. You start to get in to trouble.
Beth: Yes, exactly. One thing that you probably heard before and anybody who’s listening that’s worked in addiction enough, in addiction there’s this phenomenon of the F it. I won’t say the word.
Zach: Yes. No, no, no. Sure.
Beth: It’s like, “F it. I’m going to be labelled as the bad kid so I might as well stop going to school.”
Zach: “I might as well have some fun.” Right.
Beth: Right, exactly. It feeds upon itself. If we’re talking about an adolescent or a young adult that has been kind of cast in the role of scapegoat the parents already perhaps assuming that that child is going to make “bad choices,” it’s just like, “I might as well. They’re just going to assume anyway.” Yes, it does feed upon itself.
The last family role is the caretaker. Another way this has been imagined, another iteration of this is the “enabler,” which I know anybody that’s in addiction that’s another one of those terms…
Zach: I was going to ask you, Beth if you hate that term as equally as much as the addict.
Beth: Yes and no.
Beth: One thing that’s really interesting for me is enabling quickly gets us into the category of discussion about co-dependency, which is a dirty word. It’s another dirty word. Enabling, addict, co-dependency — these are dirty words. Nobody wants to be labelled as co-dependent. That said I see those behaviors as survival strategies in response to what seems like an impossible situation.
When we’re looking at somebody who’s the ” chief enabler” as it’s called in one iteration of this idea, these six family roles or just for today we’ll say the caretaker, that person is in kind of an impossible position because they want the person who has an addictive disorder to be responsible and not have the addiction and they want to will it away.
That person comes to them and says, “Mom, I need a little bit more money. I’m going to get kicked out. I know I shouldn’t have spent my money the way that I did but I’m going to get kicked out.” That parent says, “Okay. Here, honey. Here’s the rent.” You have other proverbial siblings, one of their literal siblings or other members’ roles of the family looking on like, “There you are enabling again.”
Someone should be held responsible, whether they’re “enabling” someone like the scapegoat or caregiving the person that has the addictive disorder. It’s a tough role. I personally, while those are dirty words I don’t see any of them as inherently bad in the sense that co-dependency is the ultimate solution to trying to solve a problem that is so difficult.
The caretaker is often, the way I often see it is either a sibling or a parent and sometimes even a child if you have a parent that has an addictive disorder. It’s not uncommon for a child to step in and be the caregiver. I’ve worked with people that…I’ve had parents say, “I don’t want my child to go in to his role so I’ve been buying his substances so that he doesn’t go in to his role,” because they know that can be dangerous. It’s not because they’re trying to make their problem worse. They’re trying to solve the problem. It does solve some problems but just creates others.
When we’re looking at the caretaker, typically they feel very, very helpless. If the caretaker also happens to be the parent then they feel increasingly more embarrassed where it’s like, “Oh my goodness. If I had done the ‘right thing’ as a parent then this wouldn’t have happened. My child wouldn’t have developed addiction.”
Zach: “It’s all my fault.”
Beth: Right, exactly. “If I can love my way out of this then I’m going to do that. I’m going to over-identify the caregiver role because I don’t want to be held responsible for this.” We know it is not an “enabler’s'” responsibility if someone else has an addictive disorder but this role just kind of manifests and the reason that I’m saying kind of quote-unquote is because that’s all they are. All these are just labels that somebody has applied to draw attention, to highlight the fact that this is what commonly happens in families.
Zach: When you’re working with these families over the course of years, tons of therapy and you have sort of unpacked the pieces around alcoholism within the family but also these roles that we’re talking about today, how do you help or suggest people go about redefining their own roles within the family?
Especially when they have been so used to this role and it’s just become part of their fabric that as you begin to sort of challenge that role even its subsequent unhealthiness many people are going toprobably hang on to it even though it is like the addict trying to quit, they’re going to hang on to this unhealthy behavior. What have you found to be helpful in helping these people out?
Beth: Very good question and very complicated answer.
Zach: I ask those.
Beth: I find it starts with education. I’m a big fan of this conversation right here which is, “Hey. I’m noticing this thing lately happening in your family. Does this feel about right?” Talking about these roles and saying, “Do you see yourself in any of these? Do you see your family member or your loved one in any of these roles or your boss or whoever it is?” Even that is an initial light bulb moment.
The work really is “Okay. What small changes do I make now to this script to start wriggling myself out of my role,” with the reasoning being from a system theory perspective, “If I can wriggle myself out of this role then other people will invariably change, too.” I think of it like a dance. If two people are dancing and one person changes a step the other has to.
When we’re looking at change that occurs in family there’s something called first order change and then there’s something called second order change. First order change is when we make little shifts to what we do in a family. Let’s pretend you have spouses that are arguing quite a bit and they just have kind of an armistice, an agreement that they’re not going to argue anymore, but then they simply don’t talk about any of their issues.
They didn’t solve the underlying problem but the initial like “we argue a lot and we fight,” that’s what we call a first order change. It doesn’t change the underlying problem.
A second order change is when we actually…
Zach: The dynamic, right.
Beth: Right when we make changes to the actual system enough that a whole new system emerges. What we’re looking for in therapy and why family therapy can be so impactful and helpful with families that have addiction in the family is because we can start to make changes either to one person or to all of the people at the same time in a way that they relate so that second order change emerges.
It becomes not just a temporary Band-Aid but a real fix to the way that the family is communicating and it starts to shift the roles to the point ideally that the roles while they may still be there are just kind of whispers of what they were before.
Zach: Fantastic. Man, with this topic at least, with families because there’s so much there. We’re talking before the episode started about some of the things that can influence a family role adoption and I brought up ethnic and cultural factors. Do you see that as a big influence on how these roles sort of evolve and what happens with them? Is it pretty uniform across the spectrum regardless of culture?
Beth: I think there’s definitely some uniformity in the sense that we see this in lots of different family systems; however, I would say the way that it plays out in different families. Like I said one of the things with family there’s often a lot of secret-keeping. You don’t tell anybody about the financial problems or the substance abuse or whatever it is.
There are certainly cultural factors that are going to influence whether or not somebody tells anybody about that problem. We know that about certain family systems. We know that certain cultures have higher rates of substance use disorders and from a systems perspective we believe that part of the reason is that in certain cultures they’re a highly individualistic culture focus. In some there is more of a collectivistic culture like A problem is everyone’s problem or A problem is my problem.
How does that impact how a family responds to something like addiction? Is shame a way that is primarily used to motivate behavior change which actually can make addiction worse not better? You almost can’t tease them out. The cultural factors are invariably they’re just like inter-generational patterns of communication.
Zach: They’re embedded, right?
Beth: Right. It’s just the fabric of who a family becomes.
Zach: Got it. Beth, what do you recommend as the sort of a functional response to dealing with a loved one who is suffering from a substance use disorder?
Beth: It’s hard because they have to obviously respond as a family member to changing circumstances with the person that has the addiction. Are they getting help? Are they not? Certainly the reason the resources like Al-Anon or Smart Recovery for families, the reason those groups exist is to provide support because it’s so difficult. I always recommend if it is available for people to get into their own individual therapy.
Yes, family therapy is great and I love that, but sometimes it’s contraindicated. For example, if there’s any kind of intimate partner violence that’s going on. No we don’t want to do family or couple therapy yet. We want people to be in individual where it’s safe. Maybe people are like, “I’m not going to sit in the same room with you right now. I’m so angry about what you’ve done.” I do want then those people to be in individual therapy so that they have time and space to work through what their part might be.
Everybody is involved in the problem and no one is to blame. I think even that in and of itself can be a nauseating concept when it’s like, “No. They’re to blame. They’re the one that’s feeling for me. They’re the one that handles the DUI’s. They’re the problem.” It’s like, “Yes and how do we as a system work through that so that none of us are contributing to that problem that we’re doing as much as we can to try to reduce our impact that keeps the problem going?”
Zach: Awesome. This has been a dense conversation. It has been so good though. I almost feel like there needs to be a part two to this but we’re just about out of time. Beth, just for our listeners and maybe somebody who has identified with your message here and what you’re talking about are there things that you would recommend that they do take first steps on?
If I’m a person in the family who’s really, I don’t know maybe wanting to talk about this more with a therapist or have some resources, books to just kind of have more knowledge about the topic of family roles where should I look?
Beth: Yes. First of all if you’re going to find a therapist certainly try to find somebody that has a specialization in working with addiction and co-dependency because it’s such a unique kind of niche within the field. There are also YouTube videos out there. Dr. Gabor Maté has some really beautiful stuff about adverse childhood experiences. Even Brené Brown talks about addiction. There are really some beautiful books and YouTube videos, podcasts about it.
I think a lot of it is just kind of leaning in and first just educating yourself like, “Okay. This thing that I do is not because I’m a bad person or because I’m an enabler or any of those things. It’s because I’m trying to solve a problem. It turns out maybe I’m not solving it in the best way. Maybe I could do something a little bit differently.”
I think it starts with education and then having time and space to kind of work through it. Yes. Read things. Listen to things. Talk to people. Go to those group resources because even that in and of itself can be so healing to talk with other family members and loved ones that are like, “Oh my gosh. I’ve been there.” You’re like, “Oh I thought it was just me.”
Beth: Doing the hardest thing which is showing up as a family member and saying, “There is a problem and I need help with my part in how to make it better.”
Zach: Good stuff. Beth, your website Clearly Clinical, can you tell them where to go to access some of that information?
Beth: Yes, absolutely. I founded and run Clearly Clinical which is a podcast-based Continuing Education company for mental health and addiction providers. Actually a lot of our content is very applicable for your listeners, whether they are professionals or laypeople. There are people who are curious about mental health and addiction.
Beth: I interview people like Dr. Mel Pohl who used to be involved with ASAM, Dr. Judy Ho, lots of people that are specialists in the field. People can visit my website which is clearlyclinical.com and they can e-mail me. My e-mail is firstname.lastname@example.org.
We’re always trying to connect to both laypeople and professionals with more information particularly about substance use disorders and mental health disorders and just trying to reduce that stigma and raise awareness.
Zach: Fantastic. Beth, thank you again for coming on the show today.
If you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families. I’m Zach Crouch with Landmark Recovery Radio.
We have Danita Coulter, Outreach Coordinator at the University Of Kentucky College Of Public Health. This is part of the Kentucky Injury Prevention and Research Center Project. Joining us to talk about her work with FindHelpNowKy.org, Danita will be explaining the importance of having publicly-available resources for information on substance use disorder and what the website offers people looking for help.
Welcome to the show, Danita. We’re so grateful to have you speaking with us today.
Danita: Thank you, Zach. I appreciate you having me.
Zach: Great to be on. Tell me a little bit about yourself and how you got in to working with substance use treatment.
Danita: Okay. My background is in social and community services. I have about ten years of experience in outreach focusing on issues that are sort of public-related and things that we can do to improve those issues. When I saw the advertisement for the position of substance use and disorder education and outreach coordinator it felt like a great transition for the work that I like to do in the community.
In this current position what I do, what I’m responsible for is for driving awareness to the Find Help Now Kentucky website and also increase provider participation in enrolment on the website. In addition to those things, I’m also responsible for educating the community on how the resource can be an effective tool.
Zach: Got it. You said in your experience you’ve been in the field for ten years. What were your previous positions? What were you doing before?
Danita: Specifically for substance use disorder this is actually my…I started this position in October. Prior to this position I worked for sort of a social service non-profit focused on helping individuals with lower income. This is just a transition for me that and also the people that I’ve worked with in the past substance use disorder is often a barrier for people economically. With that background and that support that is why this position sort of spit out to me.
Zach: Perfect. What is FindHelpNowKy.org?
Danita: Okay. What the tool is specifically it is a website that is providing…it provides near real time availability of treatment opening for substance use disorder for facilities that are located throughout Kentucky. It’s a user-friendly and easy-to-understand online referral-based intervention tool. The site is very intuitive so it’s very easy for anyone to access.
What an individual would do if they were searching for treatment there is like a basic search that they can do when you reach the Find Help Now landing page.
Danita: There’s a green bar at the bottom of the page. They could do just a general search and they will automatically pull up facilities that have current openings that are located near you. An individual can also do a real extensive search because we find that that is very important that people find a facility that best fits what they need at the time that they need it. We have lots of breakdown, lots of dropdowns on there so that people can be real specific about what they need.
Zach: They can kind of customize it to what they’re needs are?
Danita: Yes. You can customize it. You can customize your search based on the type of treatment that you’re looking for, whether it’s alcohol or it’s a specific substance. There are also filters where you can break it down on gender identity. You can break it down if you’re male or female, if you’re a pregnant woman seeking treatment.
There are also filters regarding the payment option. Each section on the website sort of breaks down to something that’s more specific to that individual’s needs.
Zach: As you mentioned, this is something that it looks to me like a family member or a possible patient can just go on and start searching for whatever it is that they need.
Danita: That’s another great point about the website is that the tool can be used by clinicians. It can be used by family members. It can be used by individuals. EMS can use this tool as well as your primary care provider. It’s a tool that anyone can use to go on there and do their search.
Danita: One of the things that we actually do is that we monitor who’s using our website. We do that by our Google analytics and it tells us that across the board all those people are utilizing this website. That can vary from month to month. Sometimes it’s more that we’ve seen the clinicians are doing the referrals, social workers. Other times we’ll find that it’s those individuals themselves that make up the highest percentages of searches for that month. That’s a good tool that we have to also monitor that.
Zach: That’s fantastic. I assume that this is a real time sort of tool like things change obviously with openings and people having openings in their treatment facilities or centers. Is that true for this as well?
Danita: That is true for this. When individuals are looking for searches, a person can go on to any Google website and do a search and you may land on many sites that have listings of facilities. The great thing about Find Help Now Kentucky is that our listings are not a static list. They’re moving and they’re a live beast. I say that because it is a part of my job responsibilities to work with the facilities on a daily basis so that we can find out exactly how many beds you have available so they update that.
When a person does a search what they can find is if you look on…if they have a specific center that they’re looking for, if in their search they come up with something like Landmark Recovery they will see that there’s a green button at the top that actually says that yes you’re taking patients right now. You have this many out-patient slots available. You have this many in-patient slots available.
That is what we would see on the back-end but the person on the front-end will see that there’s a green light which means go. I can contact this person and they actually have a bed or out-patient slot that’s available for me. People can also use their cell phones or tablets to actually…we have active links on there so if a person looks at Landmark Recovery then your information is there. It shows your phone number. They can actually click the link and call your facility.
Zach: Is there an app or something like that, Danita that people can use or can they just go on their web browser and just type it in?
Danita: It’s not an app. It’s actually you would go to your web browser. People can use it through their desktop, again through their mobile phones and their tablets. All of our links as far as the contact number are those that a person could simply click on the phone number and they can reach again, they can reach the facility.
Another great thing is that we partner with Operation Unite. If you go on to the home page, when you go to FindHelpNowKy.org in the upper right-hand corner you will see a phone number that is in red. That is the number for Operation Unite who has also live people there that can help people. Sometimes an individual might not know exactly what their searching for or what they need so they have those trained individuals there that can help them break down what their specific needs are and assist them with reaching a facility.
Zach: Danita, what if people are searching for something specifically and maybe even they want to try to find some place out of state does FindHelpNowKy.org help even with that?
Danita: Okay. I can answer that question in two parts. As far as when a person is searching for treatment with very specific needs, the way that the platform is set up is that an individual when they do their general search, they will see different categories that are there available for them.
Those categories can include the type of treatment that an individual is looking for. It can include the ability to pay. It breaks it down really specific. There’s gender, if a person is seeking in-patient or out-patient or it even breaks it down as far as a specific need if you’re looking for opiate, if they’re looking for alcohol.
Zach: Got it.
Danita: It’s very extensive. The search could be very specific to what that individual needs. When we talk about the other states actually one of the things that Find Help Now is currently in process of working on is we’re trying to build this platform to be a national platform. We recently in November we had our first peer-to-peer meeting which we invited 14 different states to that meeting to try to either encourage them to come on to the Find Help Now platform or to create one that is similar to our platform within their own states or jurisdictions.
Danita: We have had some extensive interest from at least five of those states and we’re actually in the process of bringing those on as we speak. One of the things that we do find is that some of our facilities that are listed at Find Help Now Kentucky actually have facility locations in other states so it makes sense for us to spread it to a nationwide platform.
Zach: We certainly do at Landmark that’s for sure. Yes.
Danita: Yes. Yes, you are one of those states.
Zach: That’s great. That’s fantastic. Going back to what I was asking you at the beginning part of your role as driving awareness and also driving enrolment, what are some of your daily or weekly activities that you’re doing to drive that awareness? What does that look like?
Danita: Okay. What that looks like for us is we do outreach at individual facilities. We may go to primary care providers. We actually get out in to the community and spread the word about Find Help Now. We have resources that individuals can also just go on to our info at Find Help Now and request. We have posters. We have brochures.
We have what we call our clinician guide which is it’s sort of a guide for people that are treating. Maybe they go see a primary care provider and they’re not specifically the person that they would see for their substance use disorder but they will notice that these people have the traits. This clinician guide sort of guides them on how they would approach their patient.
In addition we also have what we call the pocket cards which are very discreet cards that an individual can put in their pocket, their wallet. That Find Help Now number, that logo is there so they know where they can seek treatment. The other things that we do is partner with people like our local health department. In the University Of Kentucky they have different events that we partner with people that are having events that focus on the people that we want.
I recently went to an event in Ashland, Bridges Out of Addiction that basically the audience was it included those social workers, the clinicians as well as individuals that are in recovery. We try to target events like that so that we can get the word out about Find Help Now and drop people to the website.
Zach: Awesome. You guys are going to have a lot of data. What do you hope to do with this data once you sort of condense it and crunch it? What purpose will it serve?
Danita: The overall in the outreach…the overarching goal of this tool is that it will improve clinical workflow and increase timely access to the treatment and provide the information that those audiences that we’re speaking of that those audiences will have this information. We want people to be able to obtain treatment at that critical stage of readiness, not only to just obtain the treatment but the overall aim is to find the most accurate treatment that fits that individual’s needs.
It’s a tool that we can find that will…it will help with the extra workflow that our clinicians have. It also potentially can save an individual’s life. If finding treatment is a barrier, a person can actually give up. We want to make sure that that barrier is removed. Again with our data we track. We have Google analytics that we track where people are when they’re seeking treatment, what different types of people are actually using the website. With all this information we hope to overall improve the community as a whole.
Zach: Got it. You mentioned also the piece around enrolment. You touched on several different provider types, primary care clinicians, addiction facilities. What’s the big need right now for FindHelpNowKy.org in terms of enrolment? Who are your professionals that you’re seeking to enrol more of?
Danita: Okay. Right now on our website we have about 600 active facilities with around 300 providers that are actively participating. The real need that we have right now we are trying to do as much outreach for those met providers, those data waiver providers, those that provide medically-assisted treatment for those that are seeking the treatment for substance abuse.
Zach: Got it. Awesome. We’ve touched on a lot during this conversation. If you had to add anything else why it’s so important to have this public resource available to people, is there anything else that you would say?
Danita: I believe that the most important thing for providing this resource is that we again have a tool that’s going to cut down on barriers that people might reach when they are seeking the treatment, that it cuts down that barrier for those individuals and it also again I’d like to reinforce that it’s here as a tool that’s going to improve clinical workflow.
Zach: Excellent, excellent. Danita, thank you. I really do appreciate you taking the time to come on the show with us today.
If you know someone struggling with an addiction and are 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 wishing you well.
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