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Inter-generational Trauma

March 10th, 2020
Two therapists in a room talking about cognitive behavioral therapy.

In this episode we’re joined by Carolyn Ross. She is board certified in Addiction Medicine and a Certified Eating Disorder Specialist who has been working for over 30 years with people suffering from addiction. She recently had a TEDx talk on the effects of inter-generational trauma within families, which she and Zach will be discussing in this podcast. You can find more information about Carolyn’s work at AnchorProgram.com.We also have guest Ricky Mills, the Director of Nursing a Landmark Recovery in Louisville, joining us to speak to how nurses properly medicate patients with a wide range of physical and mental health ailments.


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 Carolyn Ross, a physician with 30 years of experience working with people with drug addiction joining us on the show today. She’s both board certified in Addiction Medicine as well as a Certified Eating Disorder Specialist. She recently did a TED talk on the effects of inter-generational trauma with families, which she and I will be discussing today.


Carolyn, I just want to say welcome to the show and it’s quite an impressive resume that you put together over the 30 years that you’ve been working in this.


Carolyn: Thanks, Zach. It’s truly a pleasure to be on your show.


Zach: If you don’t mind tell the audience a little bit about your background. How did you get started in the field?


Carolyn: Yes. First of all, I’m a medical doctor and I have for most of my career worked with women and recently have just focused mostly on addiction and eating disorders as you mentioned. I think what brought me into the field is my own family history.


I have a family history in which there’s quite a bit of addiction as well as eating disorders. I know this area both as a physician and also as a family member of someone who has struggled with addiction and looked at the addiction going back generations. That’s been really profound for me to see how addiction is a family disease and how it can affect the family.


Zach: Yes. Yes, it is interesting to do that sort of, I call it research me-search sort of stuff.


Carolyn: Yes, exactly.


Zach: When you went back did it provide some information for you that was just needed that you just have been kind of scratching your head out even though you’re obviously well-qualified with many years of training?


Carolyn: Yes. I think there were a lot of missing pieces because in medical education there’s a lot left out because we don’t get trained about addiction, hardly at all other than the medical complications like if someone is an alcoholic these are the things that are likely to happen to them medically, but we really don’t get trained much at all about the link between trauma and addiction, for example or the family systems that tend to have more addictions in them like how can you be a detective in your own family.


Yes, sure I know that my grandfather was more than likely a highly functioning alcoholic and I had a couple of uncles with the same problem; in my generation, in my family two brothers and one sister with addictions. I knew all of that and I kept wondering why is this happening but I didn’t understand how to connect the dots.


That’s where the new research that we’ve gotten through the Adverse Childhood Experiences Study has really been a light bulb moment for me just looking at the relationship between trauma and eating disorders and addictions.


The Adverse Childhood Experiences Study has shown that if you’ve had these kinds of difficult issues in childhood, whether it be trauma, abuse, neglect, having a parent with an alcohol or drug problem or a mental health issue then you are at much higher risk for substance use as well as mental health issues. I think that really helped me to see some of the connections.


Zach: Yes. Yes. You bring up an interesting point because in our facility here in Louisville and the other facilities that we run at least we do an ACE questionnaire. That’s part of the assessment process that we do.


I think of the ACE sort of score for some people it’s like they get like a five or higher on it, it’s like, “Oh no, man. You’re screwed.” I don’t laugh at that like in any way to make fun of. I’m just saying it’s like man, this is…I mean how do people work out of that stuff?


Carolyn: I think that’s a really important question, Zach because I do think a lot people feel like, oh it’s hopeless.


Zach: Yes.


Carolyn: “I have this high ACE score. I’m screwed.”


Zach: Right.


Carolyn: Actually it’s the opposite.


Zach: Okay.


Carolyn: The more I learned about trauma there are two things. First of all, you’re not stuck with the brain you have. We know that trauma affects the brain especially trauma when you’re very young. It changes the wiring of the brain. We also know now from a lot of neurobiology that you can change the brain. That’s what’s so cool about knowing your ACE score and knowing that there are things that you can do and being able to really understand why you are the way you are.


For many people when they really get it they, “Oh. That’s why I do this. That’s why this happened. It’s not my fault.” It can be very empowering to recognize because most of the time in families let’s say you have someone with an alcohol or drug problem, families tend to think of that as an individual problem and say, “What’s wrong with you?” What’s wrong with Joe? Why can’t he get his life together?


When you really understand the impact of trauma in a person’s life especially childhood trauma then you can ask a different question which is, “What happened to Joe?” Joe can start to understand, “Oh okay. This happened to me. That changed the way that my brain works. It’s not just about me being a loser and making all the wrong choices. It’s about my brain not functioning the way everyone else’s brain does. Now what can I do about that?”


That’s a really powerful place to be because otherwise I feel like you’re more doomed when you don’t know this because people are so like covered in shame and guilt. You know how that is with addiction. It’s just like, “I’m just a horrible person. Damn. What’s wrong with me?”


This really shifts that and gives them a different, can give you a different perspective. It’s not blaming or shaming anybody else even. Things happen. We’re all doing the best we can. If you can look back and say, “Yes, this happened when I was two and this happened when I was 12. I wonder what effect that had on me and now can I change it?”


Zach: Right. Absolutely. With all that being said especially the pieces around how the brain can change and how trauma still has an impact on how we think, feel, behave, etc. Using the words of, I think it was Malcolm Gladwell who wrote the book Tipping Point, is there a tipping point that people get to this where they’re able to…it’s sort of putting the past behind.


They don’t forget it but they’re able to sort of not be controlled by it as much. It’s not the overarching theme in their life anymore. In your experience what’s the work that’s necessary to get to that point?


Carolyn: I see that all the time and it’s even more profound than what you’re saying because I’ve worked with some of my patients with alcoholism or opiate addiction for over a decade and now they’re getting married and they’re having children. Now they’re starting to see kind of this impulsive behavior in their children and recognize, “Oh my goodness. Well, that’s how I was when I was there.”


Zach: Right, right, right. Right


Carolyn: “How am I going to keep my kids from going down this road?” I think the understanding that you can gain by working through your trauma is amazing. It’s not like you have to go into the most horrible places in your life and relive them. It’s really about, as you said coming to terms with what the good is called radical acceptance.


At some point you understand and accept, “This is what happened to me. I can’t change the past but I can also now use the past to understand what’s happening to me now and then hopefully change my future and the future of my family.” I think that’s what’s so important.


I think a lot of people stay away from this because they are so afraid that they have to go back and feel like they’re going to be just overtaken by the emotions that they experienced when they had something that happened to them. I think most people don’t realize the emotions that happened at the original trauma were usually emotions of someone much younger.


Now if you’re an adult and you’re in a supportive environment with a therapist or at a treatment center, it’s a lot easier from your adult viewpoint to manage the things that happened to you as a child. I just think it’s so important to recognize not just for yourself, but if you are going to have children or you have nephews or nieces.


When I looked at my family it’s not just me and my children; it’s my brothers and sisters, their kids, the kids of those kids you’re going to have. I don’t want them to have to see the same pattern that I’ve seen. I’d like to break the cycle if that’s at all possible.


I think the only way to do that is to educate people about these important connections and to recognize that there’s so much you can do to help yourself besides obviously it starts with not using. Many people stop this and then they’re just stuck with, “I don’t feel right. Things aren’t going well but I’m still not using.”


Zach: “I’m miserable.” Right.


Carolyn: “I’m miserable,” exactly. If you can go deeper and understand your emotions, how these emotions can also be changed by your history and then understand how your past shaped your beliefs. Something may have happened to you and then…


Zach: Those are strong messages, right. Right.


Carolyn: Yes. “I’m a loser. I’m not worthy. No one will ever love me.”


Zach: Sure.


Carolyn: Those often come from childhood experiences.


Zach: Sure they do.


Carolyn: Connect all those dots and then ask yourself what is it that you want for the future. This is what I call your hook into the future. You must have something to live for. Right?


Zach: Yes, yes.


Carolyn: If you can identify what that something is, I mean for some people it’s a career that they never realized because they were stuck in addiction or it’s children, their children or it’s a loved one. Whatever it is that will keep you going, that’s what you want to hook into and then once you hook into that your beliefs will change. Your emotions will change and your behavior will change.


Zach: Is it usually in that order?


Carolyn: You know what? It’s not linear.


Zach: Okay.


Carolyn: It’s what I’ve learned in 30 years. Some parts it’s like the behavior get better and then they get worse. That’s why you say relapse is part of recovery, right?


Zach: Right, right, right.


Carolyn: If you know that that’s the pathway that you have to walk, you can zigzag around it. You can go up and down. You can do one and then the other and then come back to the others. It’s not a linear path but you know those are the things that you’re going to be changing and working on as it does give you sort of a direction.


Zach: You bring up some interesting points, too around, you brought up nephews, nieces, uncles, people in your family and the whole idea that comes to mind around raising a family is that it takes a village. I think the same could be said also about healing from traumatic experiences that had happened. Would you say that’s true?


Carolyn: Yes, yes. Absolutely. I love what the Center for Disease Control is doing. They run the Adverse Childhood Experiences Study now with Kaiser and their goal is really prevention. How can we prevent that thing from happening to children?


That’s a great lofty goal, but they also recognize that if you can just…even if something happens to a child if they have someone in their life whether it be a parent or a grandparent, aunt, uncle who is a strong, stable, safe person who can provide support for them then even if that thing happened they can get through it and it doesn’t have to impact their lives in the long-run.


Zach: Yes.


Carolyn: It’s really about…I’ve tried my hardest to educate my siblings so that they then can help their own children. I can’t be everywhere and do everything but I do try to serve as a resource that I am definitely a secure and stable and safe person that my siblings can come to if something has happened to one of their children and their grandchildren. I think that’s the village part.


I had my grandmother. She was my main support until I was 18 when she passed. For some people it is one of their parents. For others it could even be someone outside of your family who is just a secure, stable, nurturing person and every child needs that.


Zach: I want to talk about the TED talk that you did on inter-generational trauma. Can you explain to the audience a bit more about what you mean by that inter-generational trauma and how is it related to addiction?


Carolyn: Yes. The TEDx talk that I did was called The Gifts of Inter-generational Trauma. Inter-generational trauma was first studied in the 1960’s on Holocaust survivors and their offspring. At that time there was a thought that the reason that the offspring of Holocaust survivors had certain issues in their lives was because they were living with one or more parents who had…


Zach: Survivor’s guilt, right?


Carolyn: While that’s true now the studies on epigenetics which is epigenetics is all about the expression of genes. We know that trauma can’t change DNA, does not change DNA but it changes the expression of genes so that a gene for obesity or addiction or depression might be turned on by trauma when if that trauma had not been there it wouldn’t have been expressed. Now the science is catching up to that.


There have been even more studies looking at the epigenetics of Holocaust offspring and they’re finding real clear evidence that this gene expression for different genes can be turned on. If the father is a Holocaust survivor then the children have a higher risk for depression, for example.


It’s also been studied extensively by a woman by the name of Dr. Braveheart and American-Indians and Native Alaskans. Many of those children were put in boarding schools and experienced extreme trauma. Their cultures were taken away. They weren’t allowed to speak their language, etc., etc. Some of those children then had substance problems. Now their children are living with someone who is maybe a raging alcoholic. That’s how it goes one generation after another after another.


I think when we look at that I think AA has been pretty prescient in having adults, the ACA groups, the Adult Children of Alcoholics groups because we can look at the laundry list for ACA and most of the patients I treat who had parents who had alcohol problems can check off numerous things on that laundry list.


They weren’t calling it inter-generational trauma but they were already noticing this pattern that you have trauma. You cope the best way you can and maybe that includes alcohol or drugs. Your children cope the best way they can and maybe that includes depression or suicidality. It just goes from one generation to another.


I think it’s really important for us to reduce the stigma around addictions so that people can start having a conversation that doesn’t involve: you’re a bad person; you’re a loser; you have a moral failing. The conversation could be more like, “Here’s what happened to me when I was a kid and I stated drinking when I was,” some people start drinking when they’re 12 before your brain has even begun to develop into an adult brain, right?


Zach: Right.


Carolyn: I think we also need to tell stories of resilience. That’s another thing that I see in the 12-step groups where people are…


Zach: A hundred percent.


Carolyn: Talking about how they’ve overcome.


Zach: It’s just a normal person even if you don’t have an addiction. Okay. You’re in the environment that we’re all in here in the United States where jobs are tight and people are working more hours. There are a lot of unhealthy habits going on.


Carolyn: Absolutely.


Zach: To simply hear that this can be done, you can make it through life without having to harm yourself or someone else…


Carolyn: Exactly, yes.


Zach: That’s the repression.


Carolyn: I think that’s the kind of thing that grandparents used to do a lot.


Zach: Wow. Yes, yes.


Carolyn: I remember sitting at my grandmother’s knee and her telling about her son who was eight years old and got pneumonia and died and how she had to get through that. This happened and that happened. What I learned through listening was people can overcome. Bad things can happen but you can get through them. That’s what resilience is about. We know that resilience can be taught but if we’re too ashamed to talk about what we’ve overcome…


Zach: We’re too busy, right?


Carolyn: We’re too busy, yes. We don’t have time. Everybody’s on their phone or their computer. We’re not passing along and teaching the younger generation about resilience.


Zach: Yes. I think that’s what we need to bring up where it’s interesting that you bring up the grandparents piece because I think that we’ve become much more disconnected from our families. That’s something I think that we can all benefit from it even if our families are maybe not close [Inaudible][23:16] to get connected.


Carolyn: Yes.


Zach: The question I have is before treatment how does someone go about realizing that they have this type of trauma. Quick question: how do they know?


Carolyn: That’s a great question, Zach because one of the things I’ve seen in using the Adverse Childhood Experiences quiz, which by the way people can just download online is that most people don’t think that the things that happened to them were traumatic.


Zach: Right.


Carolyn: They just think, “Oh that’s just the way it was in our family. My father was beating my mother. That’s just normal.” Often it takes a little bit of prompting. I think the first clue for me, I think the first clue for most people would be if you are experiencing a lot of addictions, eating disorders, obesity, depression, anxiety in your family there’s a pretty good chance that there’s some trauma in the past.


You know that Gabor Maté. I’m sure you know about him.


Zach: Sure.


Carolyn: Yes. I interviewed him on my radio show maybe eight or nine years ago. At that time I was struck when he said, “Addictions have their roots in trauma,” because nobody was saying that a decade ago.


Zach: Yes.


Carolyn: We were saying it was just genetic. It’s just your genes, too bad for you. It is partially genetic but that’s not the whole story. If you have those things in your family, if you have kids who are struggling to launch, that failure to launch — living in your basement who’s now 30 then more than likely they may have untreated trauma. It’s truly important to start to ask the questions and be willing and open to listening.


Zach: What are the best ways to treat the whole family then? If a person comes to you and let’s just say that the family is no longer really engaged with this person, they’re not engaged with the family, how do you draw them back in?


Carolyn: First of all, there’s a reason why treatment centers have family week. I know that because of economics a lot of those families have gone by the wayside. I think family therapy is the top line of treatment. You can start with going to ACA groups whether you’re a kid, a parent, whatever, have an alcohol problem or a drug problem go to those groups because that’s where you learn about the family effects of addiction.


It’s a great place to get educated about that. I can sit and talk to people till I’m blue in the face but it doesn’t mean nearly as much to them as being in an ACA group where another mother is going through the same thing they’re going through or etc. I think if you want to start some place that’s a great place to start. When the family is willing and ready then if that’s appropriate, family therapy is appropriate but oftentimes just working on your own personal stuff will change your family.


Zach: Yes. It’s amazing how that works.


Carolyn: Yes, it is. When you change everything else changes around you.


Zach: Yes, yes. It’s funny, too because it’s almost like the universe is playing a trick and that’s a little too weird. Basically you’re right. To a point it’s like you start to make changes in your life that maybe it was you used to call your mother or father and just complaining, complaining about this or that. You didn’t know it but you’re unconsciously sort of trying to lead them to some of your issues that you have or whatever.


Now you’re working through those and now you’re not calling them anymore. The relationship changes dynamically with of those changes.


Carolyn: Absolutely, absolutely.


Zach: That has an effect beyond just the mom and the dad and other people in your life.


Carolyn: It’s so true.


Zach: I want to switch gears a little bit because I know that you do extraordinary amount of work with people on everything from bingeing, eating disorders, compulsive overeating, food addiction, etc. I got to believe it’s just even if you don’t have those issues it’s extraordinarily difficult to be sort of healthy today anyway.


How do I make a decision, not just me but how do people make decisions on what foods and diets are healthy for them and what research do people conduct with their own sort of body make up to come to an understanding that it’s not some sort of fad diet just came out like the keto diet that was real popular.


Carolyn: Do we have another hour for that?


Zach: I know. I know. I know. I know.


Carolyn: That’s such a tough one because I think, I can’t remember saying but someone said, “America has an eating disorder.” I really agree with that to some degree because I think we’ve been bombarded with so much false knowledge about food and the $60 billion weight-loss industry is responsible for a lot of that. 60 billion.


Zach: That’s incredible.


Carolyn: You know why the fad diets are at the top of the news because they’re spending millions and billions of dollars to put it that way. I think it’s really about going back to basics. I have an online program for binge eating, emotional eating, food addiction and one of the hardest things we work on is…


Zach: That’s the anchor program, right?


Carolyn: Yes, that’s the anchor program. One of the hardest things for people to do is to let go of dieting because we are a diet culture. Nobody’s happy unless they’re making a New Year’s resolution to lose ten pounds or a hundred pounds or whatever. The first step is to stop dieting. Stop going on some plan. I use just a simple…you can use the Dietetic Association’s Plate Method which I think was in the news maybe…


Zach: What’s it called?


Carolyn: The Plate Method where you just divide your plate into quarters. You have protein in one quarter and starch in one or grains in one and salad or fruit and then vegetables. Just starting by doing kind of simple things: stop eating processed food; stop buying stuff in the middle of the store.


When we talk about going back to basics we’re also talking about cooking. It is shocking to me how many young people do not know how to cook just a simple meal. They can’t grill a piece of chicken or whatever they like. They’re stuck eating out all the time which is the most dangerous thing.


Zach: I’m going to do a little plug for my Instant Pot where it’s revolutionized my kitchen. It’s wonderful.


Carolyn: I agree. I love soups and you can really make good soups in those slow cookers. Yes. I have a young son who’s 27 and my older son they’re both kind of getting back in to cooking and they send me recipes all the time. There’s so much available online that are healthy recipes if you’re willing to spend 20 minutes even cooking. It doesn’t take much. We’re talking 20, 30 minutes. That’s how long you have to wait for DoorDash to bring you a meal by the way.


Zach: Exactly, right and God knows what’s in the food. Right, right.


Carolyn: Heaven knows what’s in the food. Yes, exactly. It’s not an easy solution but I think just starting to kind of look at cutting out the things that we know don’t work like highly processed foods including the things…just like when I started this process I just started eating more greens every day. It would be salads or whatever. You just pick one thing.


The fad diets want you to change everything at once and that never works. Just pick one thing like “I’m going to eat fast food less than I usually do. Instead of going every day, I’m going to cut down to every other day,” and then move on from there.


Zach: Talk to me about sugar. What does it mean for our health in this country?


Carolyn: Yes. I am not one of those people who demonizes food because I think we’ve already seen that that’s not very healthy in the past. In my career I’ve seen okay fat was the demon and then it was carbs. Now it’s sugar. Everybody’s on the sugar is bad. Sugar is addictive.


Interestingly the studies on sugar mainly show that people who deprive themselves will then binge on sugar. Even in the animal studies when the animals were allowed to just eat sugar freely, they didn’t become addicted to it. It’s when they were given sugar and then it was withdrawn and then they were given it again then is withdrawn. That’s exactly what our diet culture does to us. It says, “These foods are bad so you can’t have them.” You try, try, try. You don’t eat them until you can’t hold off anymore and then you binge on them.


Zach: Yes.


Carolyn: I feel there really should be no bad food. I think you have to determine whether you have reactions to sugar yourself. If you do then yes, avoid it. I think the majority of people aren’t addicted to sugar. They use sugar in an addictive way though. They use that food as a way to reduce their emotional distress, deal with their depression and their loneliness, etc. That’s what’s addictive.


Zach: You’re really getting at more of a healthy balance between emotions, eating. Really I think when you wrap your talk with me today is reframing what’s truly important in your life.


Carolyn: Yes and also recognizing that these problems are not about any particular food. They’re about how we use the food. You could say the same for drugs. Not everybody who has a drink of alcohol becomes an alcoholic, but oftentimes people use alcohol as a way to deal with their loneliness, their sadness, etc., etc. We need to start looking at how are we using food. When you’re craving sugar what are you really craving?


Zach: Yes.


Carolyn: Maybe it’s love. Maybe it’s companionship. Maybe it’s friendship. Deal with that stuff rather than the symptom of that.


Zach: I think what I’m hearing you say, too is that a lot of this stuff that going back in abusing whether it be sugar, carbs or whatever is getting at a deeper emotional issue for many people.


Carolyn: Correct.


Zach: They don’t want to feel, process through whatever it is.


Carolyn: That’s exactly right.


Zach: He told me trauma for many people is it’s a well of unprocessed grief for a lot of those.


Carolyn: Exactly. Yes, yes.


Zach: I think that there’s a lot of depth to that statement because…


Carolyn: Grief and loss or both, both very deep, traumatic emotions and if they’re not…I had a patient with opiate use disorder who had seen his best friend overdose in front of him. They used together and this guy overdosed. He had been to multiple treatment centers and nobody ever talked to him about his grief.


That was shocking to me because I thought that would be traumatic for anyone. I don’t care who you are. This was his best, best friend he had known for years and gone through so much together and then this guy dies and nobody talks about it. That’s the kind of thing that gets in the way and then those emotions come up and you just use something to keep them at bay.


Zach: Yes, yes. Yes. If you don’t mind in the closing, couple of minutes that we have here you’ve written about three different books. Is that correct?


Carolyn: Correct.


Zach: You also developed the anchor program which is a 12-week program, an out-patient sort of thing that you do online. Is it all online? Is it all online?


Carolyn: It’s all online. It’s a 12-week non-diet approach to working with people with food and body image issues like binge eating, compulsive eating, food addiction or emotional eating.


Zach: I love it. Carolyn, I guess if someone is interested they could look at your online program at anchorprogram.com and then also carolynrossmd.com. That’s Carolyn, C-A-R-O-L-Y-N rossmd.com, correct?


Carolyn: Yes. They’re able to message me and I do offer a free 30-minute consult if anybody wants to talk to me about their issues and even if they don’t end up joining my program I’m usually able to give them some resources that can help them.


Zach: Absolutely. Just a follow-up question for you, just curious; you’ve been doing this for a long time, what do you still love the most about the work?


Carolyn: Oh my goodness. That’s a great question. What I really love is seeing people change their lives and that is just so rewarding to me to see someone come in like to my program who’s obsessed with food, always on a diet and never able to be present with their family or someone with an addiction and who’s been to multiple programs and still struggling and to see them get married, have kids, start being more present, reconnect with their families. That’s amazing. You got to admit.


Zach: It’s special.


Carolyn: It’s probably why you do what you do, too. Right?


Zach: I remember I had a supervisor when I was going through my Marriage and Family Therapy masters program. Mary Cudens, she’s living out in Santa Fe I think now living the life. She’s retired. Mary told me and this stuck with me ever since I got done with the program she said it’s truly sacred space to go in there and someone shares with you their story and you are able to hold space for it and support them through it.


Carolyn: It’s powerful for me, too because it’s not a feeling of power for me. It’s just a feeling of gratitude that I have that people are able to trust me and to share stuff and to change in that way. It’s extremely moving for me to see them do that.


Zach: I’m going to close with saying 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.


Ricky Mills, you are the now appointed Regional Director of Nursing for Landmark Recovery. Congratulations by the way. That’s a newly appointed title.


Ricky: Yes. Thank you.


Zach: That’s fantastic. You come from a very extensive line of work within the field of mental health and substance abuse where you spent looks like over ten years at Our Lady of Peace. During that time you helped with project development. You did a lot of stuff and you saw a lot I’m sure during that time as well.


What I’m interested today though is a lot around this idea though that when our patients come in to treatment they are often diagnosed with a mental health problem. Have you found that some of the mental health diagnoses were maybe misdiagnosed because they have been under the influence of using substances for a long time?


Ricky: Yes. You could definitely say that misdiagnoses are pretty common. For me I’d like to think it’s not necessarily misdiagnosed but it makes it a lot more complicated. People I guess often use drugs and alcohol to ease the symptoms of some sort of mental disorder they might have. It’s a fairly common thing that people come in with sort of depression and anxiety that has been using for a long time that either were not diagnosed, maybe they were under-diagnosed or misdiagnosed for something else altogether.


We find that most of our patients come to us and they have been abusing alcohol and drugs kind of as a way to self-medicate a lot of the symptoms of some of the disorders they might be having which then just make things a lot worse. It could even make the symptoms a lot worse. Substance abuse can increase or even trigger new symptoms of some sort of mental disorder. It’s definitely a common thing.


Zach: Yes. It’s interesting, too because I was talking to a person earlier today and she was calling in about a family member of hers. She had mentioned that this particular family member of hers had bipolar disorder. He had basically been sort of I don’t know, manipulating his medication but this was prescribed medication that he had actually got from his prescriber. It’s legit.


Even then people can sort of manipulate and try to get an effect from medications that are prescribed for a legitimate mental illness, right?


Ricky: Absolutely, yes. We see that every single day. Somebody is diagnosed for something, Seroquel is very common for some sort of bipolar disorder somebody might have, Geodon, risperidone and they can all be abused. Just because it’s prescribed by a doctor doesn’t mean that it can be abused.


Zach: Talk a little bit about that, Ricky just the Seroquel piece because that is becoming…it seems to me like more and more abuse in circles with people who are using and abusing substances. What is Seroquel? Why and how can it be abused?


Ricky: Yes. Seroquel is an anti-psychotic medication. It can treat schizophrenia, bipolar. It’s been used for depression. It can even be used for sleep. It gives you a very sedating effect. We have an issue with abuse. If you take enough of it, it will definitely knock you out and we see that even inside of treatment. We see people sometimes try to I guess what you would call cheat those medications in order to get a high enough dose where it may knock them out or give them some sort of head change.


Zach: Got it. Yes. You and I were part of the meeting earlier today with a very large health care organization here in town. Part of the reason we met with these folks was that we wanted to make sure that when people leave us they are connected to resources that they can provide medications like we were talking about a particular drug today that actually helps block the opiates that people take.


My question is how do you work with other medical professionals whether those are…even doctors and APRN’s to find the correct medication regimen for people, as an example with dual diagnosis that we were talking about bipolar?


Ricky: Yes. I guess it starts from just getting a solid health history when they come in. Sometimes it’s difficult. Sometimes it’s a story. Sometimes they don’t have all the information.


Ricky: We can’t always get that information. What we like to do is try to get as much of a baseline as we possibly can. With someone who’s abusing drugs, they may not know what their baseline is. They may not know the lifetime they actually felt normal and it may be 12 years ago, seven years ago, six months ago but they don’t know themselves.


We’ll have to detox them first here in-patient through one of our protocols that we have, try to make sure the patient gets as much sleep as possible and then we will work on getting them to that baseline as fast as we can so we can actually work with the providers that we have here. We all meet together: their therapist, the patient, our doctors that we have here, myself, the clinical director; and we all sort of talk about some of their diagnosis and talk about their course of action, the medication they’re going to be taking.


Zach: It allows you to get a real thick description of who that person is by doing that, by having that?


Ricky: Yes, we do our best.


Zach: Yes.


Ricky: We definitely do our best underneath the time restraints that we have. It’s sometimes not always possible to get a true baseline from somebody in the first 35 days. It’s pretty much next to impossible but we do our best to get as clear a picture as we can for sure.


Zach: Got it. In this health history piece that you’re talking about, where are some of the more important pieces that are gathered during those questions? What are you all really looking for?


Ricky: First we’re going to ask if they’ve ever been diagnosed with something before. It sounds something that’s simplistic but we have to go back to the basics: see if they have ever been treated before; see if they had been diagnosed with major depressive disorder, some sort of anxiety disorder. There might be something there that may trigger their drug use in the first place.


We’ll get a good solid sort of body of health history. Are they taking medications for the blood pressure? They have diabetes and anything like that. We’ll start with the basic questions and work our way to more complicated ones. We’ll even get blood work on them to see if some of the labs may affect some of the medications we can give or maybe some of their labs might be the reason for some of the issues they’re having.


Zach: Makes sense, man. Just a simple question and kind of follow-up to that do most of our folks that come in have dual diagnoses? What thought goes into the sort of proper medication for these patients?


Ricky: Yes. I would say most of our patients have some sort of dual diagnosis when they come to us for treatment. According to reports published in the Journal of American Medical Association, about 50 percent of individuals with severe mental disorder are affected by substance abuse. That means that most of our patients that come in have some sort of dual diagnosis.


When we start, like I said we use our treatment teams here. Once we get as much of a baseline we can we’ll bring the patient in and we’ll talk to the treatment team. Our provider often does the diagnosing and prescribing of medication. It’s sort of a teamwork here. If a patient lies sometimes to providers and to us as well, we monitor the behavior. We get reports of how they’re doing in group. We factor in a lot of things.


We also factor in placement when they leave us. There are some places they can’t take certain medications. Maybe they’re going back to a job that won’t allow them to take a certain substance or if they’re going to a halfway house that wouldn’t allow them to take a substance such as Seroquel. We need to factor in all those medications because we do not want to start them on a medication that they cannot continue when they leave us.


Zach: That makes a lot of sense, man. It’s also in terms of this piece around people coming in front of you and the treatment team and whoever that is I was thinking about some of the factors that I would think could be important to consider with trauma being up there as a big piece of this and also there are other issues.


Has the person been poor their whole life? Have they struggled for housing and things like that? Have they cultural issues that have prevented them from seeing a mental health professional? Is there shame around those? Are there other factors that you consider to be really important when you’re asking those questions about if a person’s been diagnosed?


Ricky: Yes. Education level plays into that. The population varies. We have everything from doctors that come in for treatment to people who are just 18 years old and on their parents’ insurance, too. A lot of things factor into how much they actually know about their health history. With permission we will ask some of their loved ones for some information as well.


We also request medical records from maybe their other providers they might have had or doctor’s appointments they might have had before. It takes a lot of things to paint a real picture of what the patient actually is.


Zach: When you ask those other folks that their loved ones as you point to family members, etc., “Does Johnny has he had a history of depression,” those kinds of things and they say, “Oh absolutely they have,” do you also find in your time in asking those questions that there is typically a history of mental illness in these folks as well?


Ricky: A lot of times mental illness does run in families in circles but it doesn’t have to. Sometimes it’s more difficult for us as professionals when the family member can’t relate. If the family member doesn’t understand what it’s like to be depressed or doesn’t understand what it’s like to have anxiety then sometimes it’s hard to know what your kid’s going through. Yes, we do find that it definitely runs in families but not always.


Zach: If we’re talking about mental health and on the flip side of that being mentally healthy versus being mentally ill having problems, struggles, etc., if you have to point to one single factor or one thing that you’ve seen that’s common across most people who struggle with, you brought up anxiety and depression, is there anything that comes to mind?


As you’ve mentioned you’ve been in front of probably thousands of people at this point, is there anything that comes up that you see across the board like, “Oh this is present almost in every case of someone who has a mental health condition?”


Ricky: Yes. You talked about a lot about social cues or even markers that may have been out there that sort of give us indication. Honestly from my point of view the thing that is most common is there is nothing because mental health can affect everyone. It doesn’t matter if you were well-educated and rich or poor and you don’t have any schooling or anything like that. It doesn’t matter. Anxiety can attack anybody anytime, depression as well.


Zach: Yes. I think that one of the things that I think comes up for me and I don’t know if this is a single factor but I think it affects a lot of people with mental health issues is that they often don’t think that it’s okay to reach out for help. This is something, whether it’s anxiety, depression, whatever it is, it’s one of those things where even today it’s getting better but there’s still I think a decent amount of stigma attached around going to a psychiatrist, going to a therapist on a regular basis.


I think what we are beginning to discover about the brain is that there are imbalances that happen; that these are not things that many people have control over. People are born with this stuff.


Ricky: Absolutely, yes. You’re definitely right. There are a lot of posters out there and some social issues with maybe reporting that you feel a certain way. I know that in general where I grew up to be a man you didn’t cry. You stood tough. You didn’t feel those kinds of ways. That was definitely ingrained in me from early on and it took me a long time to realize this. You know what? It’s okay to feel sad sometimes. Those are normal things which sometimes you need to reach out for help for some of those issues.


Zach: Absolutely. Currently at Landmark Recovery what are the different drug trends you’re seeing locally in our Louisville facility?


Ricky: As far as some of the drugs that I think patients come in on, alcohol and heroin, those kinds of things will always be around. We have tons and tons of alcohol patients, tons of patients that come in using heroin but polysubstance sort of are in trend these days and the like. People are coming in on more than one medication or more than one substance.


Fentanyl and meth in themselves are becoming more prominent in this area. Fentanyl is a synthetic opiate and it’s about 80 to a hundred times stronger than morphine. It’s definitely contributing to the increase of overdoses that we’ve had.


What I’m seeing right now that this meth that is in town people have no clue what is in it, not that you really know what’s in meth but meth used to test as meth but now when we run these tests on our patients meth is coming back with sombianase, psychotropic and it’s coming back with benzodiazepine in it.


These people are swearing that they’ve just used meth and they all become upset because no they just smoked meth. This is actually what is in that meth that you’re smoking. We’re able to point those drugs down and what is actually sort of in there. There are some scary things out there right now.


Zach: Wow. This stuff, do you know where it’s being manufactured and made? Is it coming from just all over the place?


Ricky: I don’t really know myself but I know that we have definitely a population that produces its own meth here in the state of Kentucky. We definitely have some issues with that. Some of the cartels are obviously still around and operating. You always have your big cartels that bring drugs in because it’s still popular.


Some of these synthetics, that’s the scary part because you can order them off the Internet. You can go to the black web sort of the dark web and you can get these things anywhere. You don’t have to go to a street corner anymore to get drugs. It’s pretty sad that you can just order them and wait for them to come to you.


Zach: Got it, man. I really appreciate all the work that you’re doing with our patients, Ricky. I’m sure that they appreciate all the work that you’re doing with them because I think that a lot of people who come in for treatment and just kind of think that they’re just messed up; that they’re not going to get better. Once they get off the drugs then they got this other thing to deal with. They’ve got this other mental health condition that they’re now going to have to struggle or come to terms with or battle, seek some help for.


I think that you’re starting to lead the way on our side to create good amount of awareness and transparency that there’s a lot of ways to help people with that mental health conditions once they get off the substances. It’s good stuff, man.


Ricky: Yes, appreciate it.


Zach: I want to say 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 saving lives and empowering families.


Until next week, I’m Zach Crouch with Landmark Recovery Radio wishing you well.


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.

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