In this episode Zach is first joined by Dr. Lorry Leigh-Belhumeur, a licensed psychologist, serving as CEO at Western Youth Services for over 19 years. Zach and Dr. Belhumeur discuss Adverse Childhood Experiences (ACES) and their impact on addition later in life, as well as the importance of treating past trauma. Following Dr. Belhumeur, Zach speaks with Melissa Atlas, is the Clinical Supervisor at Franciscan Outpatient Behavioral Health in Indiana and a contractor for ICAADA/MHAI. The two discuss her experience with Medication Assisted Treatment (MAT) in the field of recovery, and the different mentalities when it comes to an abstinence-only recovery program and an MAT recovery program.
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 so don’t forget to subscribe to get the most up-to-date information from leading experts.
We have guest Dr. Lorry Leigh Belhumeur joining us on the show today. Dr. Leigh Belhumeur is a licensed psychologist serving as CEO at Western Youth Services for over 19 years now. She received her PhD and MA degrees from UCLA. Western Youth Services annually provides integrated Mental Health Services to over 50,000 clients both directly and indirectly.
Lorry has led the charge that re-examines mental health in the context of Adverse Childhood Experiences or ACEs and offers solutions that not only treat the predictable negative impact of ACEs but that look upstream to prevent them from happening in the first place.
Dr. Leigh Belhumeur, it is a pleasure and I’m looking forward to getting into this discussion.
Dr. Belhumeur: Thank you so much. It’s great to be here and I look forward to our discussion.
Zach: Me, too. Share with us a bit about yourself. How’d you come to be interested in addiction recovery as well as mental health issues for youth?
Dr. Belhumeur: It’s funny because I think maybe you and some of your audience members can agree that many of us who gravitate toward this procession, whether it’s addiction recovery or in the mental health, behavioral health field is we sort of gravitate toward it to maybe heal ourselves in a way. I used to refer to my life as a series of adversities and it was happy most of the time but always, just always knew at the bottom of my heart even as a young child that I was put here to help people.
I initially went into college as a nursing major. I’m aging myself, but back then women were either nurses or teacher so I gravitated towards nursing but really bombed at science. I was sort of redirected to the field of psychology and knew once I made that decision that I was getting a PhD and that I was going to be a psychologist and that’s the trajectory of my life.
That’s how I went into the profession. I also knew at some point that it was really working with children because I think that the children definitely are our future. That’s sort of an adage, if you will but it is the truth. If we can go in and help bolster the minds and hearts of kids to know their true value and know what their strengths are and their superhero talents and really tap into those things then give them just support and hope for a better future in the face of adversity. That’s how I got here and that’s why I do what I do.
Zach: Love it. As you were talking, I was thinking about some questions. As you were explaining in the beginning I asked that question, a lot of people in this field get into it because they’re really searching to make sense I think of the experience or experiences that they’ve had. Does that still ring true today? You’ve been in this field for quite a while that there’s still a mystery in some respects.
Dr. Belhumeur: You know it’s very interesting and anybody who knows me also knows that I love data, like love, love, love data. I make sense of these things by really looking at what does the research say, what is the data out there. I stumbled upon something and I know we’re going to talk about adverse childhood experiences a little bit later but one of the things I became trained as a master trainer by ACE Interface so Adverse Childhood Experiences Interface which is a resource from the original researchers of the ACE study back from 1998.
A few of us were trained as master trainers here at Western Youth Services and we were giving these presentations about the ACE science and about the ACEs study and all of that. Our audience was typically teachers, counselors, other youth-serving individuals who wanted to know more about the adverse childhood study like the science behind it and the connection between the trajectory of the negative impacts of adversity with children.
One of the things that we found was we gave an ACE screening. We have these 10 original ACES and again, we can talk specifically about what those are. We’ve done some studies that kids have had, mental health diagnoses and we looked at the prevalence of ACEs in their life like we did the screener. We did ACEs screening with these audiences of teachers and professionals and youth-serving individuals.
What we found is that the number of ACE, the number that they endorsed of having exposure to these particular adverse childhood experiences, the number that the people in the room had mirrored the number that kids with mental health diagnoses had. In other words, they mirrored kids with adversity that had mental health diagnoses as opposed to mirroring say, the general population.
Zach: They were getting basically traumatized?
Dr. Belhumeur: It really just solidified…yes.
Dr. Belhumeur: Exactly. Those of us who have experienced this adversity we gravitate toward youth-serving roles because I think we’re trying to figure it out but we also have what I think really is a moral imperative to make an impact in the lives of kids to give them a better future because we’re resilient.
We’re the ones who sort of we’re in these professions so we’ve demonstrated that there’s something that we have that allowed us to overcome and be victorious over adversity so we want to pass that down to the next generation. That’s what I believe.
Zach: I’m going to back up just briefly because I think that most of the people in our field know what the ACE study involved, but can you just briefly explain what the Adverse Childhood Experiences study was and more importantly why is it the bedrock you think for understanding, let’s just say folks even adults today because it’s a long-term study still have problems both medical and mental health in their lives?
Dr. Belhumeur: Right. The original study dates back to 1998. Drs. Felitti and Anda were measuring things like obesity I think originally or some other health problems and they started to ask questions specifically related to ‘before the age of 18 were you exposed to’.
There were ten different categories, questions that fell into ten different categories – abuse, physical, emotional or sexual abuse, physical or emotional neglect so abuse, neglect and then categories of family dysfunction in the household including parents or caregivers that were misusing alcohol or drugs, domestic violence, incarceration of parents or a parent was incarcerated or a parent had mental illness.
Those are the original ten and then what they found which is really what made it the landmark study is that they looked at the health, mental health and other conditions and they saw that the higher the number of exposure to these ACEs, every single condition – obesity, diabetes, smoking, heart disease, lung disease, cancer, depression, anxiety, PTSD they all went up in step-wide fashion.
I’m using my hands as I’m talking. If you had one, if you had two they all went up in step-wide fashion so that the higher the exposure to the number of adversities, the higher the risk, the higher the percentage of likelihood that you would have these conditions in adulthood when left untreated. I just want to make sure that I put that in there because there’s hope because when there is treatment early on we can change the trajectory. That was what it was.
If you look at the original study, there’s all of them and it literally made the original researchers weep when they saw it because why was nobody paying attention to this. That’s why it really when we draw attention to it, it’s really a public health crisis and it’s something that we can do something about when we’re looking what’s now called upstream. We’re looking at the things that are attributable to these social determinants of health.
We’re looking at what are these social determinants of health. Let me say. What are the things where we can predict a higher risk of health, mental health and addiction problems? That’s sort of why it’s a landmark study. I’m not sure I answered the second part of your question.
Zach: No, no. I think that was yes, it was great. I was curious as well, kind of belonged in the same lines. In the data that you’re collecting and reviewing, have you found at all any evidence that one subset of abuse within that ten categories can be more impactful than the other or is it more important to take into account the total number of ACE a person has versus these sort of aggregate scores?
Dr. Belhumeur: You know that is a really, really great question because first of all let me say it’s the likelihood of having…if you have one there’s a higher likelihood that you have more than one. They occur together in some cases. I would be remiss if I didn’t mention this particular thing that the original ACE study was some time ago, there’s a ton of research with the original ACEs.
Recently, under the great leadership of Dr. Nadine Burke Harris who did a TEDTalk a while ago on ACEs. If you haven’t watched it, you can definitely take a look at it. It really explains the study and she’s just really the trailblazer for highlight it as a public health crisis recently or at least in the last decade. Here in the State of California she’s added related life events to the screener and mandated screening for kids in the State of California.
It’s the original ten and then seven related life events. It is whether there’s food and security and housing and stability. There’s neighborhood community violence, bullying, discrimination, institutional racism or a caregiver’s serious physical illness or death. Now there are 17 as opposed to the original ten. There are ten and then there’s this other seven.
The interesting thing is that it’s not that one is any worse than the other in terms of what exposure to adversity does on the developing brain, if that makes sense. It’s really the toxic stress response that is the predictor of the health issues. The original study interestingly said, “No. One versus another isn’t worse.” Any particular kind of abuse is not any more or less stressful on the body or brain than a parent’s divorce.
Remember back in 1998 these were adults who were asked if their parents divorced. In their timeline in their life, divorce was something that was very stressful, not that it isn’t now but if they were an adult in 1998 that means that their parents were getting divorced in maybe the 1960’s or 1970’s when it wasn’t as common then. It was a more stressful event. I want to make clear that it’s really the exposure, the repeated exposure to the toxic stress over a period of time.
It could be even one of the adversities that’s repeated over consistently over a period of time. It’s having this toxic stress response to the developing brain. We have to be careful when we say whether it’s one versus four our whatever. It’s really that toxic stress response which you and I were talking about earlier that it’s this fight or flight that happens and they’re not able to kind of shut it off. They’re living in a state of fear and hypersensitivity…
Zach: All the time.
Dr. Belhumeur: Hyper-alertness all the time and that is what is the stress on the body that when it goes untreated can result in again, these serious health and mental health problems.
Zach: This concept of resilience because it’s being talked about a lot. I’m curious because you’re knee-deep in the data and in the study of ACEs. What’s your feedback or kind of conclusion on why some kids had better outcomes? Why is one kid able to develop this resilience versus others who maybe just think they don’t have that capacity, that capacity to deal with the toxic stress that we’ve been talking about? Is resilience even measurable?
Dr. Belhumeur: That’s such a great question. It really is. You think about all of the factors that can be sort of subsets of resilience. You might not measure resilience specifically but you say social emotional support and hope is a category that when provided results in a higher level of resilience. Interestingly in the ACE Interface sort of literature and all that that we were trained in, there are some specific categories.
I’m so glad you asked this question because there are some specific categories where the research shows that when people who have been exposed to ACEs have these, have these resources available in these four categories versus those that don’t, there’s a significant difference in their resilience. If you’ll allow me, I’ll just kind of go through the four categories and give some examples.
Zach: Our listeners would want to hear that.
Dr. Belhumeur: Okay, great. The first one I just mentioned is feeling social emotional support and hope. If you think about those kids, what that means is that there are people, it could be a teacher, it could be a parent, it could be a grandparent where there’s somebody who is in the life really providing emotional support and hope.
For me, I know. I go back and I know exactly – my second-grade teacher. She was the one. I could have been one of those kids who really got in trouble in class because I would yak it up. I finish first and then I’d start disrupting the class. She’s like, “Would you be my helper? Would you go pick up the paper?” She really provided a level of emotional support to who I was.
I mentioned this in the beginning – who we are individually as children, what are strengths are, build on those strengths and that is sort of the beginning of the resilience. We have that social emotional and hope for a better future and whoever provides that.
When kids actually or adults if you ask them later in life, “Did you feel that you had someone who was providing social and emotional support and hope,” the risk of mental health, say people with four to eight ACEs are 40 times more likely to have mental health problems, but when they have emotional support and hope the risk is dropped down to ten percent. There’s a 30 percent improvement in resilience when they have emotional support and hope. That’s one of the keys.
Zach: Hope is not one of those tangible things. It’s there or it’s not I think with most people they would say that.
Dr. Belhumeur: Right. I think when you have social and emotional support that sort of inherently gives you hope for a better future. You know what I mean? You know that there’s somebody who cares about you, who loves you and supports you for who you are. What goes along with that is you’re looking up to somebody else like a mentor, something like that, just hope for a better future that’s kind of like communicated through those people that are around that provide that social emotional support.
The second category is literally having some practical help, having two or more people who provide practical help. That might be, for the adults that might be somebody who drops off some groceries. The category of practical help is different than social and emotional.
Zach: Pick up the kids from school or something, right.
Dr. Belhumeur: Yes, that kind of thing. Yes, exactly. When it comes to providing help again, for those that are experiencing I’m going to say hunger insecurity or food insecurity, if you have four to eight ACEs, you’re 40 percent more likely to have food insecurity but when you’re provided that practical help, it drops down to ten percent.
Depression, is you have no practical help you’re 14 percent more likely to be depressed but if you get practical help, it drops down to two percent. Again, it’s just like these dramatic increases in resilience. It’s kind of going the opposite the way that I’m describing it. The risk drops down. The risk of depression drops when you have access to practical help.
The third, you kind of mentioned picking up the kids but the third is community reciprocity. What that means is having a community where you kind of do things for each other. I know a group of single moms and they’re together. They just support each other. They pick up the kids for each other but it’s reciprocal. It’s not like you’re keeping track of ‘I do this for you and you do this for me’.
There’s like a community of that community reciprocity. Again, the research shows that when you have that it decreases the risk of these things.
The fourth is social bridging. That’s really like the kind of the end of the social support system and where you need to seek help outside. Do you have a primary care doctor? Do you have a place where you can go get mental health services? Do you have a place where you can get addiction services?
When you have access to those things so literally when you have the community reciprocity and the social bridging, it just dramatically increases things that are measured like happiness and physical activity and literally alcohol misuse decreases when you have those last two things. Other social or other health problems are also positively impacted when you have social reciprocity and social bridging, getting access to those resources outside of the social system.
When we talk about resilience, those are four resilience factors that make a difference. There are lots of different things in each one of those categories that can count as that, if you will. There you go. Yes, there’s research out there that shows what resilience is and what actually helps.
Zach: I’m curious. I want to kind of come back to a lot of people get into this field are trained in a certain program to become, whether it’s a psychologist, marriage and family therapist which is what I am, a counselor or whatever. I don’t know if this has been your experience. When I looked through my training, I did not receive a whole lot of training on understanding trauma. It wasn’t that long ago. It’s coming up on 15 years or so ago now. Why is that?
Have you found that to be true and especially for people who were trained back in say, the 1980’s, the 1990’s, early 2000’s even? Was it because the ACE study has not really been understood at that point and the aftermath of it?
Dr. Belhumeur: First of all, I graduated way before you did and I didn’t know about the ACE study that it occurred. I heard about it probably six years ago. I think that the whole and I have been running the organization, this organization Western Youth Services for almost 20 years and I can say that the concept of trauma informed care is something that emerged over the past couple of decades.
What I can say is that as therapists, we intuitively know that kids that have been exposed to trauma are more likely to have mental health problems. I think that we knew that. When you start talking about the ACE study, it kind of provides a language, if you will that everybody kind of translates the language…
Zach: Sort of vernacular.
Dr. Belhumeur: Yes, to be trauma informed. I would say yes there have been research and all kinds of stuff that over the years sort of continues and I’m going to take a wild guess, maybe in the last ten years that some of the really evidence-based treatment specifically identified as being for trauma kind of it became infused into…
Zach: Kind of became more mainstream.
Dr. Belhumeur: Right, right, right, became more mainstream that’s a good way of putting it. I think that definitely there have been experts for decades in the area of trauma and being trauma informed and what trauma does to the developing brain and things of that nature.
Zach: Just briefly, my body keeps a score plugged in here. That is, it was, and continues to be as I’ve read it a couple of times now the book that transformed my life in understanding trauma at a very different kind of level by [Inaudible][28:40] His work is, I think been instrumental in the field in helping people really who are not even professional but laypeople who read that and they’re just like “Oh my God. I finally get it now.”
Dr. Belhumeur: Yes.
Zach: Anyway, I had to say that.
Dr. Belhumeur: No, that’s definitely, that’s definitely true and groundbreaking really.
Zach: Talk to me a little bit more just about how ACEs impact really the likelihood that an individual will experience substance use problems in their life.
Dr. Belhumeur: I think if I understand you correctly it’s kind of like what is that trajectory from ACEs to adult…
Dr. Belhumeur: Okay.
Zach: How it becomes so to speak, the coping mechanism that most people are likely to use when they have ACEs in life?
Dr. Belhumeur: Let’s look at it this way. I mentioned that when we have long-term exposure to adversity, it really impacts the developing brain. There’s a tendency because of the way the brain is developed sort of sequentially when they’re younger during the young ages. I’m trying to really say it to sort of the massive population as opposed to using scientific terms here so I’m stumbling a little bit.
Zach: I’ll translate when you get to your part.
Dr. Belhumeur: Yes, okay.
Zach: Go ahead.
Dr. Belhumeur: The developing brains we talk about they become hypersensitive, hyper-aroused, hyper-triggered. What that means is the way it manifests itself is like being startled, really easily or appearing to have a tension problem, concentration problem, kind of like living in a state of fear, like fight or flight.
There’s a documentary called Paper Tigers. It talks about ACEs and how kids that are exposed to high levels of adversity and the toxic stress response don’t know the difference between a real tiger and a paper tiger because everything is scary. If you think about going through life like you’re trying to cross a freeway where cars are coming at you in every direction, you think that you’re trying to do that and they’re going through life like that.
It makes sense that people who are experiencing that would want to numb it. They would want to buffer it. They would want to calm themselves down in whatever way they can. Some people choose work. Some people choose drugs. Some people choose alcohol. Some people choose sex. Some people choose all other kinds of things to sort of release that energy and numb the fear response. It’s like a normal reaction to an abnormal set of circumstances.
Again, the hope is and what we now know is that we can literally rewire the brain and reduce that toxic stress response.
Zach: That is the hope. Yes, absolutely if it’s not some sort of like death sentence if you’ve been through…
Dr. Belhumeur: No.
Zach: A tremendous amount of these adverse childhood experiences.
Dr. Belhumeur: Exactly. There’s a lot, a lot of hope there and definitely those of us who are a little bit older was taught that once you lost a brain cell it was gone forever.
Zach: I think Nancy Reagan had us convinced of that after their program. She didn’t mean it.
Dr. Belhumeur: Right. Now we know that the brain has neural plasticity and that it actually can be rewired and we can think differently and we can behave differently and it literally changes how we view the world. We can heal ourselves obviously with help. We can heal ourselves from the impact of adverse childhood experiences on the brain.
Zach: You’ve been in this a long time. You’ve been working with youth for over 30 years now. Today with this wealth of experience and knowledge, what can be done for kids who experience these adverse effects to really help them?
Dr. Belhumeur: I think I definitely want to refer back to the health that helps those four categories of building resilience. I’ll just kind of really focus on the first one which is providing emotional support and hope. I think that what we know is having a caring, dependable adult who believes in you, whether it’s a child or your inner child that you literally can be that person or a child to give them hope for a better future.
It doesn’t matter if you’re a parent or a teacher or a counselor. Even one interaction, seriously know that even one interaction can make a huge difference and change the trajectory of the life of a child. It’s really you hone in and again, this might be really simplistic but you hone in on the strength and really build it up.
If you notice that a boy or a girl is being a little bossy, for instance they’re a leader. They’re a leader. Give them something to be in charge of. It’s like look at the individual strengths of the child because you’re asking what can we do. I’m not talking to the therapist here. I’m talking to any adult who has a child in their lives. This is what you can do for kids who have experienced adversity.
Every child right now in the world has experienced adversity, every single one of us with COVID and all of the civil unrest and everything that’s going on in the world. They’ve been exposed to trauma right now. What we can do is just really see that strength in them and retrain them into this is who they are and just love on them and nurture that strength, see the things, catch them doing things right, honor the things that they’re doing right and who they are as an individual as opposed to saying, “Good girl, good boy.”
No. It’s, “Gosh, when you did that thing right there, when you did that kind gesture towards your little sister that was beautiful. That was a beautiful thing.” It’s really like pour the love and nurture into their hearts. That’s what you can do.
Zach: Something really very intentional about what you say.
Dr. Belhumeur: Yes.
Zach: I think that’s something that parents can really…it’s about noticing and being intentional specifically about certain things that they’re doing well.
Dr. Belhumeur: Yes. Yes, you’re absolutely, absolutely right there. Be intentional with your words. Words have power. What you speak into a child becomes what they perceive about themselves. It really does like the words get repeated. They’re going to remember regardless of how…whatever the words are they’re going to remember. It’s going to become sort of the tape that they play in their little brains with their identity.
Be intentional about what we say to children especially as it relates to their behavior but certainly about who they are as children. Again, this goes back to any time there’s an ‘I am’ statement that is the thing that we tell ourselves about who we are. Kids get a bad grade on a test and they start saying, “I’m stupid. I’m stupid,” then they find things in the world that makes that consistent and then they start to believe that about themselves. We can re-train…yes, go ahead.
Zach: As you were talking, I was thinking about…I don’t think it’s any as far but kids, our children are often, most of the time, probably all of these are a reflection of both me and Emily, my wife’s sort of attributes, our personalities. If we acknowledge and sort of [Inaudible][38:45] She’s probably mirroring from me and her attributes when we start to notice them at least, things within ourselves that we could probably nurture more ourselves, too which gets the cycle of just positive reinforcement going for both the kid and the parents.
“You know what? Boy, I just had a tip.” Lot of times that I tried to deny or repress that piece, the leer or whatever it is that is within parents myself, whoever it is because there’s real gold and opportunity there.
Dr. Belhumeur: I think you just hit the nail on the head with something else is that we as parents, we as influence leaders of youth regardless of whether we’re in a youth-serving profession, we do have an obligation to kind of heal ourselves first because kids are watching. They absolutely are. They do mirror. They mirror us. If they see us doing things that really are behaviors that ‘I’m really going to go here’.
If we’re doing things that really look like we’re not loving ourselves, we’re not taking care of ourselves, we’re not taking care of our partners or our significant others, our spouses, if we’re treating ourselves and others with a lack of respect and kids see that, they’re emulating. They are. They’re little mirrors.
If we see it in the kids, the first thing we can do is oh, not that we’re causing it but “Am I mirroring that? Am I role-modelling something that’s kind of emerging here,” because it doesn’t always, it’s not always the parents. I don’t want to say that. I absolutely don’t want to do anything that gives parents…we’re all doing the best that we possibly can given our own upbringing but to be aware, to be intentional about how we treat others and also how we treat ourselves. I guess that’s the point I’m making.
Zach: Fantastic. It has been a wonderful conversation, Dr. Leigh Belhumeur for us today and for our audience. I really do appreciate you coming on. This has been…we can talk for hours about this stuff.
Dr. Belhumeur: I know.
Zach: It’s fantastic.
Dr. Belhumeur: No. Thank you so much. I really appreciate the opportunity. As you can tell, anytime I have the chance to talk about building up kids or something I know a little bit about with the ACEs study, I can go on and on. You’re right. We could. It’s been an honor and a pleasure to be here. Thank you so much for the invitation and I look forward to potentially having another conversation or continue our conversation in the future.
Zach: Perfect. Appreciate that. I always have to say at the end here. Listen, if you know someone struggling who has an addiction and substance use problem and you’re searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.
Until next week, I’m Zach Crouch with Landmark Recovery Radio.
Zach: We have guest Melissa Atlas joining us on the show today. Melissa is the Clinical Supervisor at Franciscan Outpatient Behavioral Health in Indiana. She’s also a contractor for the Indiana Credential Association on Alcohol and Drug Abuse. She’s an LCSW, LCAC, and Medication Assisted Treatment Specialist. She has more than 13 years of clinical experience.
Melissa, it’s a pleasure to have you on. Welcome to Recovery Radio.
Melissa: Hi. I’m excited to be here. Thank you, Zach.
Zach: Tell us a little bit about yourself. How’d you get involved in this field of addiction treatment recovery?
Melissa: I went to college for something super useful and got a Bachelor’s Degree in English Literature. Yes.
Melissa: Yes. Not at all practical but it was a lot of fun.
Zach: You read a lot of books. Yes, yes.
Melissa: I read a lot of books; love Jane Austen, a lot of Chaucer and old English. I was a senior in college and the week of September 11th, my mom got sober in 2001. When I came home from graduating, she was sort of in the middle of being a newbie in the 12 Steps of Alcoholics Anonymous program. I was sort of directionless. She spoke up in a meeting and said that her kid needed a job. Someone who works at a local patient facility said, “I got a job for her.”
I wound up working as a tech. Even at that time I sort of knew I wanted to be in the helping profession but really didn’t know how to do that with a Bachelor’s in English. I found my way working with folks who are in early recovery and it just seemed to click. Two years later, I got my Master’s Degree and here I am.
Zach: Was the entrance of your mom at that point into the recovery process sort of an impetus for you to pursue this particular field of mental health? Did that play a big part?
Melissa: It absolutely did and I’m sure that as she listens to this she’s going to love it that I gave her credit for my career.
Zach: She’ll be proud of that. She’ll be happy.
Melissa: She’ll very proud of that, yes. I think that my mom was in active addiction for much of my adolescence and childhood and I still loved her. Being able to be with someone who is dealing with a monster addiction and still see the humanity and the dignity and the struggle and learn how to not take a lie personally definitely helped me find a level of compassion that is sometimes hard for people who don’t have that personal experience when working with folks who are struggling.
Zach: When I say your background here, the question is about your upbringing and obviously being a trained professional is going to help a lot. Did your background growing up with your mom like that provide you with sort of the vocabulary now to be able to understand better other people’s experiences?
Melissa: It really did. I go back to that word of just dignity to think about things. I knew my mom had a tough life growing up. She would talk to me about when I was little and she would ask me what I wanted to be when I grew up. I was going to be a race car driver and president and all that cool stuff.
Zach: From Indiana, that makes sense yes.
Melissa: Absolutely. When I asked her, “When you were little what did you want to be?” She said, “All I wanted to be was a wife and a mom.” To have that be her life ambition and to be really good at it and then to just have her whole identity be eclipsed by a substance is really hard to watch and to know that that person is still in there while they’re going through that.
It sort of gave me that understanding of I wait for a miracle, as they say in the program. You got to be patient through that and keep showing up for them and in a boundaried way and take good care of yourself and those have served me well in my career.
Zach: That is an interesting word that you brought up about the dignity piece. What does that mean to you in light of the heartache and I’d say the pain that people put themselves through? [Inaudible][47:10] it’s not by choice. They often find themselves in the process of not having a choice. What does that word mean to you in light of everything that you’ve maybe helped people get through and families even? Has that word meant something even more to you now, continuously more to you now?
Melissa: Yes. I think that when somebody is in the middle of addiction and they’re actively using, they are one of the most stigmatized populations in our country. We think of people as junkies and addicts and drunks and all those other horrible things that get thrown at you. When someone knows you have, you struggle they hold on to their purse a little tighter or they change their expectations of you and there are reasons for that to be sure but at the same time if they could control it they’d be controlling it.
There is still a human being who loves and who laughs and who cries and who struggles and their minds have been taken over momentarily by something that wants to kill them. If that’s not horrifying, I don’t know what is. In light of the current opioid crisis, most of my clients regardless of how old they are, are dealing with just epic amounts of loss right now where they lost family members, friends, childhood friends, acquaintances to overdoses.
They’re not even sometimes given permission to grieve that in their own families because it was just another addict who died. It’s kind of how they feel about it or talk to about it. It’s still a person. It’s still somebody who added something to this world who isn’t with us anymore and that heartbreak deserves to be honored. Sometimes just sharing that with somebody while they’re just coming in helps them feel human, helps them feel seen and gives them a little bit of hope that “I am still a person. I can do this.”
Zach: Absolutely. That was beautifully said. I want to talk, as I mentioned in the introduction there, you’re a medication assisted treatment specialist. That obviously tells me that you believe very highly in that particular approach to treating substance use problems. What’s been your experience with medication assisted treatment in the field of recovery thus far?
Melissa: When I first started in the industry as I mentioned, I was actually living closer to Chicago when it was the early 2000’s so they were still dealing with the crack epidemic up there. I came off reading Chaucer and I was handed a bunch of SAMHSA documents to read on how to be a counselor.
Zach: Those should be good.
Melissa: Not so much. In the literature even then, they talk about methadone as just it’s key and it has these enormous success rates for folks who were dealing with opioid withdrawal in recovery and maintenance and they would talk about how it’s one of the more empirically-bolstered interventions that we have for substance use disorders.
I remember going to my boss at that time. I was like, “Do we do this methadone thing?” He’s like, “I’m not treating one drug for another.” As a new clinician I was like, “Cool.” I just close that, one less thing I have to study.
Zach: Abstinence background.
Melissa: Yes, very much an abstinence background and then went to graduate school, came out, wound up in another abstinence-based program and kind of that was how it was in my mind. They trade one drug for another. That’s all I need to know about it and that doesn’t make sense. Suboxone came on the scene, the buprenorphine.
Zach: When did it in your sort of purview come really as a viable treatment?
Melissa: Yes. That would have been, in Indiana anyway, in like 2007 when I started really hearing about it consistently as an option for folks with opioid dependence. I know it’s been around longer than that but it started to gain some traction. That corresponds of course with the major upswing in opioid use disorder developing out of the over prescription of opioid pain relievers and so people were desperate for a solution. They started to be more open to this concept of medication assisted treatment. That was my first introduction to it.
Back in 2012, Indiana brought this medication assisted treatment specialist or MATS certification from Connecticut to Indiana and I was getting some CEUs. That was the first time I actually ever sat in a room with other people who worked at methadone clinics. All of a sudden I was like, “Oh man, I was really ignorant about what this is all about.” There’s so much good being done in those OTPs or opioid treatment programs that they’ve been doing wraparound services for decades since the 1960’s.
They’ve been doing all this really hard work with really tough populations saving lives and here I was looking down my nose at it because I didn’t understand it. Once I went through that training and kind of really took that mantle with how I approached it and why I think it’s so important is I really tried to live that ‘meet people where they are’ all the time.
One of my earliest interactions within opioid withdrawal was at that first place I worked at and I was responsible to drive her to the emergency room. Wouldn’t you know? She took off because she was in active opioid withdrawal. We weren’t doing anything for it. That was devastating to me. If you’re not going to help someone through that acute withdrawal phase in a very, very strategic way, they’re at really high risk of death and overdose.
Whatever it takes to get someone invested, to get someone feeling hopeful, to get someone thinking clearly is what I’m about and I feel like medication assisted treatment is a very viable way of doing that, certainly not the only way. It’s not for everyone, but if that’s what gets their butt in the chair in my office so we can talk about this stuff and talk about strategies and all the other things you do in therapy then that’s what I’m going to do.
Zach: I want to come back to what you said. Obviously it makes a lot of sense ‘meeting someone where they are’. What do you do though when someone is really dead set on going abstinence-based recovery course of action for their treatment but you know professionally and perhaps [Inaudible][54:51] suggest the MAT is really the best course of action? How do you approach that conversation with the person?
Melissa: I will do whatever the client thinks will work is what I’m on board with. Now I might be doing what I call the Colombo method where I know what’s going to happen at the back of my head, but I don’t need to communicate that to the patient in that moment. If they’re like, “I’ve got a plan.” I’m like, “Cool. Let’s write this plan down. Let’s talk strategy. Let’s wean out how we’re going to know it’s working, how we’re going to know it’s not and check back with me tomorrow.” Again, whatever it takes to get you coming back I’m with that.
Melissa: They say absolutely.
Zach: You can’t lose that work. You really can’t. You can’t lose. The patient can’t lose on that in there.
Melissa: No, no. I would rather have somebody to try something that they thought would work and not work and be able to come back to a safe space where they’re not going to be judged for it than for me to go all ‘I know what’s best’. Whatever they’re going to do is what they’re going to do anyway. They might as well feel supported and cared about. I may voice concerns.
Usually what happens in my clinical space is that somebody wants “My family is pressuring me to come off of this.” I say, “Okay. If coming off is your goal then that’s my goal, too. I will tell you these are the indicators that someone is ready to come off. These are the indicators that somebody is maybe not so stable. What do you think based on that?” We go from there. Yes.
Zach: Yes. What is the different sort of mentality when it comes to an abstinence only recovery program and an MAT recovery program? You mentioned a couple I think, already.
Melissa: Yes. I think there’s very much a…I think there’s less wiggle room in an abstinence-based recovery program if that makes sense. There are a lot of folks who and by folks I mean people who are working in the industry at abstinence-based industry where they have their opinions and they take those as facts which is the whole podcast I’m sure. The way that I got sober or the way these other people got sober is the way you need to get sober.
It’s become a bit of a cookie-cutter approach and a little bit more ‘either you’re going to fall in line with what we do here or we’ll not work with you’. I get that. You got to serve who you got to serve. Those beds and those outpatient chairs they’re going to be taken up by somebody who’s willing to do what your program has to offer. I think that’s good.
I think that just that SAMHSA and NIDA and everybody else will recommend there are many pathways to approach recovery. If yoga is going to save you, if mountain climbing is going to save you, if medication is going to save you, whatever it takes to keep you here and getting your life to where you want it to be then I’m going to honor that.
If that means to you going to an in-patient program where you detox on your own with maybe just a little bit of comfort care and come out the other side then that’s your choice and I’m going to honor that.
Zach: The thing that you mentioned, too because I’ve heard that said especially coming back to your comment about the less wiggle room piece where people say, I’ve seen people do this where ‘someone’s only smoking weed now and drinking but they’re not doing opiates and they’re not doing benzos’. Is that still recovery?
Melissa: If they call it recovery then I’m going to call it recovery. I think that that’s where…I’m not a great patient either. If I’m going to go to the doctor, I’ve got amoxicillin in my cabinet right now that I took for a few days and didn’t finish. You know that the doctors say I’m supposed to finish it. My level of medical compliance is malleable depending on what I’m feeling that day, just like any other human being on the planet.
I might be working with somebody who I can see has decades of trauma that they haven’t processed. They have other medical issues. They have lots of things going on in their lives and I can see that if they stop using substances altogether including caffeine and nicotine and they go to trauma-focused care and do eye movement, EMDR I can see that their life will be infinitely better and their recovery will really be enhanced.
Maybe that’s not what they’re wanting to do right now. If smoking some weed and not being at risk of overdose where they’re happy and that’s working for them, that’s enough recovery for them then I’m not in the position to judge that.
Zach: Yes. I get that.
Melissa: What we do here at Franciscan, what I’m really, really proud of is taht we just try to make sure that we’re always in the conversation. Whatever you do, just tell us. If you’re still slipping up, you’re using weed…
Zach: That’s the hallmark of recovery right there is just be honest and feeling safe, too.
Zach: Be able to share this with someone.
Melissa: Absolutely. If someone is drinking a whole bunch, I’m going to be like, “Yes, that’s still pretty unsafe with Suboxone so we’re going to need to keep an eye on you, a little closer than we would otherwise.” Sometimes that’s the natural consequence of needing; you’d like to be on Suboxone prescription. You only have to come in once a month but if every time you come in you got alcohol in your bloodstream then that’s not going to be safe and we’re not able to do that.
Again, that seems to be as much of a motivator, ‘it’s not my drug of choice, it’s not my problem’. It’s still a problem for the doctor because it’s something that’s going to potentially put you into respiratory arrest so we just need to be safe with it. That non-judgemental but direct approach I think is really what’s required for folks.
Zach: Yes. I think that the engaging piece that even family members could probably learn a lot from just on how to engage one of their loved ones in where they are, in opening up that dialogue so that the person who’s using can feel like they can talk about this stuff and that’s a huge step forward.
Melissa: Yes. When I was first here at Franciscan a number of years ago, we didn’t have a MAT program. It was abstinence-based only and part of that meant we didn’t really do a lot of drug screen consistently. I was just taking people’s words for it. [Inaudible][01:02:45] “Oh yes. I was clean for 90 days.” “Sure. Great. Congratulations.”
This is harder because I thought you were doing so good and then there’s a lot of…we’ve been at it for six months and you’re having more slip-ups. That’s in one way disheartening and in another way incredibly hopeful because they’re staying engaged so much longer. We’ve got people who have been in our program…
Zach: They’re staying alive. They’re staying alive.
Melissa: They’re staying alive and they keep coming back and they keep seeing us as an ally in their recovery for two years after they first entered our program. They’ve stepped down in terms of intensity and things like that, but overall they’re stabilizing. We’ve got some people called alumni now. It’s great.
Zach: Has it been challenging for you in your role to…I was thinking about doctors because I used to work in a hospital setting. Working with physicians, internal doctors just in general can be challenging because doctors know a lot and many doctors are not afraid to let you know that here. Has it been challenging to have an open dialogue and conversations with doctors when you have different opinions about things?
Melissa: I mentioned that my mom’s in recovery and if anybody listening to the show remembers their family role from the addiction family. I am firmly in the hero camp. I am more than happy to make someone feel like they’re the smartest person in the room if it gets my client stable.
Zach: I got you. Yes.
Melissa: That’s going to sound far more manipulative than it really is. I know that they know things. They went to medical school. They’ve been practicing and it’s all really great and I think without them our clients aren’t surviving. If they’re a necessary and wonderful part of the treatment scene and I don’t have…honoring their expertise while being grounded in my own is the way that I navigate that forward.
It’s not about a contest. It’s not about I know more than they do even though I think our positions here at Franciscan of course I’ve worked really hard to getting additional education and experience with addiction so we’re really lucky in that regard. There is less training for physicians in most medical schools than someone who has a social work degree and who has additional training getting that degree.
It’s just they know what they know and I know what I know and there’s somewhere in the middle that we can get that client where they’re in.
Zach: Again, I don’t think you can lose when you stay grounded in your own…and you’re really not afraid here to talk about your own professional opinions when they’ve been backed up by years of experience and training and honoring also the person that’s in front of you, whether that’s a doctor or a person who’s struggling to get off of substances.
Melissa: I think knowing my lane as well. I’m not going to try to, I would never dream of telling a doctor what medications to prescribe or how or what dosage is the right dosage. I can tell them this person continues to appear like they’re experiencing some withdrawal symptoms and they need to be aware of that because I’m seeing them three times a week in group and they’re seeing them once for 15 minutes every two weeks so I have more face time with them.
If a person continues to experience cravings, I can tell them that and then the doctors are going to do what they know is best in terms of treating them from the medicine side. If there are issues around are they still testing positive for things, they need to be told. If I go into those interactions with yes-ands, they are going to work and they are participating in their kids’ lives and they’re getting here on time.
If this is the way the client is choosing to self-medicate their anxiety, whether I agree with that or not, their recovery plan has to come up with anxiety reduction strategies that are going to be successful anyway. You’re making a choice. To me, it’s an okay choice for the moment. It’s not a great choice long-term to how to get you where you want to be. Again, every doctor, every nurse practitioner that I worked with before and here at Franciscan have all been happy with that.
Zach: Good deal. Melissa, this has been just a great conversation about different approaches to recovery, your experience and I appreciate you coming on the show today.
Melissa: Happy to be here.
Zach: Listen, 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.
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