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When You're Done With Rehab: The Reality No One Tells You · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_01: Discharge, as ironic as it sounds, begins at admission.
• 0:16
  SPEAKER_01: Dr.
• 0:17
  SPEAKER_01: Sal Reichbach is an expert in behavioral health and addiction treatment.
• 0:20
  SPEAKER_00: How do you respond to someone saying, I've tried treatment, it didn't work for me?
• 0:25
  SPEAKER_01: I try to be as brutally honest as I can.
• 0:30
  SPEAKER_00: Welcome to Recoverable.
• 0:32
  SPEAKER_00: I'm your host, Terry McGuire.
• 0:33
  SPEAKER_00: This is the podcast where we bring in experts to explain complicated and intimidating things about mental health and addictions so that we all understand them in regular old language and can do whatever research and make whatever choices we need to make going forward.
• 0:50
  SPEAKER_00: We are in the studio again with Dr.
• 0:52
  SPEAKER_00: Cell.
• 0:52
  SPEAKER_00: Thank you for staying and continuing our discussion.
• 0:55
  SPEAKER_00: The topic is levels of care.
• 0:58
  SPEAKER_00: And last week we went through them all in some detail.
• 1:00
  SPEAKER_00: So if anybody didn't watch, please go back and do that.
• 1:03
  SPEAKER_00: And today I want to talk to you about some of the questions that people are searching the most online about levels of care.
• 1:09
  SPEAKER_00: But before we dive into those, can you just give us a quick recap, sort of for anybody who may have forgotten or didn't watch last week?
• 1:15
  SPEAKER_01: Sure.
• 1:16
  SPEAKER_01: So when we discuss levels of care, we like to mention the least restrictive to the most.
• 1:22
  SPEAKER_01: And that starts with the outpatient, which is traditional outpatient therapy, one-on-one weekly session, sometimes uh bi-weekly, maybe monthly, between a therapist and a client.
• 1:33
  SPEAKER_01: The next step would be an intensive outpatient program, which is regimented, is very structured, specific amount of days and times, moving upwards to a partial hospitalization program, otherwise known as PHP.
• 1:47
  SPEAKER_01: Once again, a very structured uh therapeutic environment runs a lot longer than intensive outpatient program.
• 1:55
  SPEAKER_01: It normally five, sometimes even six or seven days per week, four to six hours a day, group concentration uh in terms of therapy as well as individual therapy.
• 2:06
  SPEAKER_01: A step up from that will be the residential, which is a living in treatment, 24 hours a day, seven days per week for an extensive period of time.
• 2:16
  SPEAKER_01: And then we see in mental health, we see a level of care called inpatient, which is normally in hospital settings.
• 2:24
  SPEAKER_01: And if we're talking about substance disorders, the step up from residential care would be a detox level of care, which is the highest level of care when it comes to substance uh use.
• 2:35
  SPEAKER_01: And that is a medical stabilization unit.
• 2:37
  SPEAKER_00: It's a lot, and I'm glad you explained it in detail last week.
• 2:40
  SPEAKER_00: So I'm gonna start with some of the most common questions we checked on, whether it's Google or social media, to just see what people are asking so that I can ask you in their words what they're asking and save them from going down the rabbit holes, which are not only time consuming, but we can leave with really inaccurate or incorrect information.
• 2:59
  SPEAKER_00: How does someone know when it's time to get treatment?
• 3:02
  SPEAKER_01: If I am talking to the common person who comes into treatment, that common, and I mean common meaning more of than less of, the recognition is that I'm being told or I'm continuously faced with certain consequences that I think is because of my substance use, but I'm not a hundred percent sure yet.
• 3:32
  SPEAKER_01: And so how does someone know?
• 3:36
  SPEAKER_01: It's hard not to know when you keep doing the same things over and over again, expecting different results, yeah, and those results are not different.
• 3:47
  SPEAKER_01: That's when honesty comes in and you say to yourself, hey, I'm just gonna propose to see what this is about.
• 3:55
  SPEAKER_01: But a large part of this is others recognizing something about me that I'm doing or not doing anymore.
• 4:05
  SPEAKER_01: And they kind of gently push, and sometimes even more than just a gently push to say, hey, you better go get yourself some help.
• 4:12
  SPEAKER_00: And sometimes we should say that push is not gentle at all when it is legal or when it is, I can't even think of the word.
• 4:20
  SPEAKER_00: It's been so long since I've made one, an ultimatum.
• 4:22
  SPEAKER_01: Yes, it's exactly right.
• 4:23
  SPEAKER_01: It's just an ultimatum.
• 4:25
  SPEAKER_01: But sometimes it's what you need to at least put your foot in the door and then let us do our job uh as trying to open your mind up to realize I think they're right.
• 4:37
  SPEAKER_01: I think they're right.
• 4:39
  SPEAKER_00: Wow.
• 4:39
  SPEAKER_00: So when you say that somebody may not be quite sure yet, does it really mean not quite sure if they're ready to stop?
• 4:47
  SPEAKER_01: Yes.
• 4:48
  SPEAKER_01: Yeah.
• 4:49
  SPEAKER_01: And or I'm not really sure or convinced that I am an addict.
• 4:55
  SPEAKER_01: Okay, so I use and I dabble.
• 4:59
  SPEAKER_01: But you know what?
• 5:00
  SPEAKER_01: You got to see the other guy across the street from me.
• 5:02
  SPEAKER_01: Now that's an addict.
• 5:04
  SPEAKER_01: You know, we always we i in psychology, there's a lot of defense mechanisms, and one of those defense mechanisms is called projection.
• 5:11
  SPEAKER_01: You're looking at me, you think I'm bad, that's even worse.
• 5:16
  SPEAKER_01: So it's not so much a denial, but you see a lot of minimization.
• 5:21
  SPEAKER_00: You've said that many people end up coming into treatment under sort of coercion.
• 5:25
  SPEAKER_00: And I'm thinking with adolescents who may not have full autonomy, that's even more so.
• 5:31
  SPEAKER_00: So, what's the difference between an adult and a child with the decision-making process to seek treatment?
• 5:37
  SPEAKER_01: The word choice is is is delicate.
• 5:40
  SPEAKER_01: Um, everyone has a choice, but the choice that they make may not be the best choice, which means that if you don't, then but you have a choice.
• 5:52
  SPEAKER_01: The choice is you can either, as an adult, for example, you have a choice to enter treatment or go to jail.
• 5:59
  SPEAKER_01: Some choose jail.
• 6:01
  SPEAKER_01: Some would say, I'd rather do that that than this.
• 6:04
  SPEAKER_01: There's a choice.
• 6:06
  SPEAKER_01: Although we would look at it as, well, you're coerced to come in because if not, you'll go to jail.
• 6:12
  SPEAKER_01: But some people choose the alternative.
• 6:14
  SPEAKER_01: Same thing with adolescents.
• 6:16
  SPEAKER_01: I managed an adolescent program where we had any anywhere from 14 to 17-year-olds, and they had a choice.
• 6:22
  SPEAKER_01: Either enter treatment or you're going to go to some sort of a juvenile detention center.
• 6:28
  SPEAKER_01: And some say, the hell, I'd rather go there.
• 6:33
  SPEAKER_01: Right.
• 6:33
  SPEAKER_01: I don't want to go to treatment.
• 6:35
  SPEAKER_01: So there is a choice, but not really a choice.
• 6:39
  SPEAKER_01: But because of their chronological age, that they they can't even sign for a consent for treatment.
• 6:45
  SPEAKER_01: It has to be signed by a guardian or by a parent.
• 6:48
  SPEAKER_01: If we are required to give medications, which some do, it's not just a client consenting to it, it's getting authorization from caretaker or a guardian.
• 7:00
  SPEAKER_00: So that raises an interesting point.
• 7:01
  SPEAKER_00: What is the difference in success rates for people who, maybe not initially, but early enough on choose to be in treatment and those who are there very much against their will?
• 7:12
  SPEAKER_01: Once again, it depends on the type of treatment as well as the symptoms of, for example, the diagnosis, I should say, that that will make it more clear.
• 7:22
  SPEAKER_01: Kids that are entering treatment right now, um, you'll see a lot of the lesser types of acuity.
• 7:32
  SPEAKER_01: So I I want to clarify for for people who may not know the difference between what acute versus chronic is.
• 7:40
  SPEAKER_01: I'm right in there with them.
• 7:41
  SPEAKER_01: Acute is an immediate need, something that is happening right now.
• 7:48
  SPEAKER_01: So my symptoms, my drug use, even my mental well-being is in an acute phase, which means that right now, I need to, and I'm presented with this, and this needs to be treated.
• 8:02
  SPEAKER_01: Chronic is longstanding.
• 8:05
  SPEAKER_01: So you have people who may have had depression for the longest time, who've been anxious for the longest time, but they were able to sustain themselves.
• 8:11
  SPEAKER_01: People who used substances were able to sustain themselves in some ways, but chronicity hit.
• 8:17
  SPEAKER_01: The difference between and the statistics show that for both adolescents and adults, an immediate response to an acute phase yields in a much higher rate of success than actually prolonging.
• 8:35
  SPEAKER_01: But what is success?
• 8:37
  SPEAKER_01: If someone is in recovery, for example, goes into treatment after using every single day, having severe consequences, financial, legal employment, you know, the whole works, and goes to treatment and does 30 days, and then they go to a partial hospitalization program and they do another three weeks, and then they and altogether they've been sober now for six months because they're in treatment and they relapse.
• 8:59
  SPEAKER_01: Is that a failure?
• 9:00
  SPEAKER_01: No, it's not a failure.
• 9:01
  SPEAKER_01: It's a setback.
• 9:03
  SPEAKER_01: The failure would be if that particular individual said, the hell with it.
• 9:07
  SPEAKER_01: I've given it all that I could, and I'm I'm I'm just, I guess I'm I'm not supposed to be clean.
• 9:14
  SPEAKER_01: That's a failure.
• 9:15
  SPEAKER_01: A failure on a part of understanding that relapse is part of the game, unfortunately.
• 9:19
  SPEAKER_01: And it just means maybe coming back and reacquainting yourself with what worked for you for six months.
• 9:25
  SPEAKER_01: But both adolescents and adults, there are statistics that show that there are certain types of element in therapy that may work better than others.
• 9:37
  SPEAKER_01: So, for example, for adolescents, we highly concentrate on the development phase of that adolescent, because a 14-year-old is like a sponge.
• 9:47
  SPEAKER_01: It really is.
• 9:48
  SPEAKER_01: They absorb a lot and they are dealing with a lot of peer pressure, the experimental phase of growing up.
• 9:57
  SPEAKER_01: What do you mean I can't drink any alcohol?
• 10:00
  SPEAKER_01: So when I'm 21, but you're not 21, you're 14 years old.
• 10:04
  SPEAKER_01: If you can tell me right now that between 14 and 21, you will not drink any alcohol because you know you can't.
• 10:10
  SPEAKER_01: At 21, let's let's revisit this.
• 10:13
  SPEAKER_01: Because by that time, we hope that you would realize that alcohol should not be part of your vocabulary.
• 10:18
  SPEAKER_01: Why you particularly?
• 10:20
  SPEAKER_01: And we can get into a whole different subject on genetics versus predisposition and all that stuff.
• 10:25
  SPEAKER_01: But yes, if you are able to approach therapy in the immediate acute response, both adolescents and adults can show a good amount of success in terms of admitting that there's a problem, willing to do something about it, and actually staying sober.
• 10:43
  SPEAKER_00: So, doctor, you said relapse is part of the game.
• 10:46
  SPEAKER_00: And I hear that all the time, and I hesitate to use the phrase because I wonder if I should be saying relapse can be, so that it's not expected.
• 10:55
  SPEAKER_00: Is relapse an expected part of the recovery journey?
• 10:58
  SPEAKER_01: No one wants to talk about relapse, but you have to.
• 11:01
  SPEAKER_01: You have to be honest with a client, you know, that relapse is a potential.
• 11:05
  SPEAKER_01: It doesn't have to be in your vocabulary in terms of your outcome or expectation.
• 11:11
  SPEAKER_01: Because if you don't talk about relapse and you kind of say it's it's it doesn't happen and it should not happen, and it does, all that it does is really draw the person even further down into I can't do this.
• 11:23
  SPEAKER_01: You see, that's not what we want.
• 11:26
  SPEAKER_01: We want people to be aware and beware two different things.
• 11:30
  SPEAKER_01: Be aware and beware of the potentials, because if you don't recognize that relapse is and can be part of your early recovery, then you'll offset any sort of triggers that may come and just say, well, you know, the relapse is part of the game.
• 11:47
  SPEAKER_01: No, it doesn't have to be, but it is.
• 11:49
  SPEAKER_01: And if it does happen, don't let that set you back from doing what you're supposed to when it happens.
• 11:56
  SPEAKER_00: I'm going to go back to one of the most asked questions on the internet.
• 11:59
  SPEAKER_00: What is the difference between inpatient, outpatient, and partial hospitalization?
• 12:04
  SPEAKER_01: Inpatient is short-term.
• 12:07
  SPEAKER_01: It's very, very high structured.
• 12:11
  SPEAKER_01: It's for chronic and acute, severely acute symptoms, such as self-thoughts of self-harm, maybe harm unto others, inability to refrain from uh using substances that may uh cause a huge detriment.
• 12:29
  SPEAKER_01: But in the word inpatient as it relates to mental health, uh, we're talking about self-harm, we're talking about psychosis, we're talking about disorganized thinking, paranoia, the inability to function as we would want to consider normal, meaning day-to-day kind of living without putting yourself or others at risk.
• 12:47
  SPEAKER_00: So I want to acknowledge some redundancy in the questions I'm asking.
• 12:51
  SPEAKER_00: It is because I am trying to use exact words that somebody on the internet or some many people are using to search, just so I'm sure that they are getting the answers to the exact question they asked.
• 13:02
  SPEAKER_00: So this next one is how does someone know what level of care they need so that they are best able to advocate for themselves or someone else?
• 13:12
  SPEAKER_01: They don't.
• 13:13
  SPEAKER_01: Um, I'm nervous when I have a client who dictates what they need.
• 13:20
  SPEAKER_01: Self-empowerment and advocacy.
• 13:22
  SPEAKER_01: We definitely want to give a client a voice.
• 13:25
  SPEAKER_01: We talked about clients being well informed.
• 13:27
  SPEAKER_01: So one will argue well, Dr.
• 13:29
  SPEAKER_01: Hback, if you educated this person so well, if they ever relapse and they came back, they would be educated.
• 13:35
  SPEAKER_01: They would know what level of care they need.
• 13:37
  SPEAKER_01: Yes and no.
• 13:38
  SPEAKER_01: It needs to be a collaborative kind of a discussion.
• 13:42
  SPEAKER_01: You tell me what you think, you tell me how you feel, you give me as much information as you possibly can and willing, and I'm going to work with you on recommending the best approach possible.
• 13:55
  SPEAKER_01: Now, you may not agree to it, and that's your choice, but I'm not going to sway my decision and my recommendation because you think if you're going to seek my advice, that you take it.
• 14:07
  SPEAKER_00: As a provider, as somebody on the inside, what advice do you have for those of us out here navigating the system to get the best and highest and yet appropriate level of care?
• 14:19
  SPEAKER_01: Look, it's it's unfortunate that again, money sometimes plays uh a factor because if you have the ability to pay for a very, very good insurance coverage plan, you never have to worry about it.
• 14:33
  SPEAKER_01: And for those that don't or can't, they have to do what they can get.
• 14:38
  SPEAKER_01: But anything is better than nothing.
• 14:40
  SPEAKER_01: To mitigate through that, it's being able to ask as many questions as possible.
• 14:45
  SPEAKER_01: I'm gonna, I'm gonna, I I I like to use similarity so people can understand in the simpler terms.
• 14:50
  SPEAKER_01: Imagine for a second going to a doctor's appointment for the very first time and you're sitting there in a waiting room and you're getting this pamphlet that the person behind the glass uh has you fill out.
• 15:03
  SPEAKER_01: And it's uh pretty much a self-assessment that asks you, have you ever smoked, have you done drugs?
• 15:08
  SPEAKER_01: You know, they ask you a thousand different questions, what elements are you?
• 15:11
  SPEAKER_01: If you don't provide the information that is honest, you're not gonna get what you need.
• 15:18
  SPEAKER_01: You'll get half of what you need or a quarter of what you need.
• 15:21
  SPEAKER_01: And so to whoever is watching this or whoever's absorbing this type of information, the best advice that I can give is be as forthcoming as possible.
• 15:30
  SPEAKER_00: Back to the internet searches.
• 15:32
  SPEAKER_00: Can you move back up to a higher level if your symptoms return or worsen?
• 15:37
  SPEAKER_01: Absolutely.
• 15:38
  SPEAKER_01: Absolutely.
• 15:38
  SPEAKER_01: This is not a one-stop shop.
• 15:40
  SPEAKER_01: And stepping isn't always down.
• 15:42
  SPEAKER_01: It's a step, no, unfortunately, no.
• 15:44
  SPEAKER_01: Um, that's the I hate to use the word beauty because it's not beauty, uh, but that's the the ability, the convenience of having multiple levels of care, each addressing a different type of a severity level.
• 15:59
  SPEAKER_01: If you are unable to provide the care at a certain level of uh of uh severity because the symptoms are worse than they are, uh, or present themselves, yes, we have the ability to step somebody up, just like we have the ability to graduate the per a person and step them down.
• 16:18
  SPEAKER_00: This question is related to that ending our treatment isn't the end of our recovery.
• 16:23
  SPEAKER_00: What comes after we finish all the levels of care that we are being assigned or have access to?
• 16:29
  SPEAKER_01: Discharge, as ironic as it sounds, begins at admission.
• 16:34
  SPEAKER_01: Let's ponder on this for a second.
• 16:36
  SPEAKER_01: I'm just being admitted.
• 16:37
  SPEAKER_01: How am I being discharged?
• 16:38
  SPEAKER_01: Well, how am I thought of being discharged?
• 16:40
  SPEAKER_01: Clients that are coming in for treatment have a variety of issues on the outside.
• 16:46
  SPEAKER_01: One of them is homelessness.
• 16:49
  SPEAKER_01: It doesn't mean that the person doesn't have a home to live in.
• 16:54
  SPEAKER_01: It means that their home that they have cannot be lived in currently.
• 17:00
  SPEAKER_00: Because it's not healthy.
• 17:01
  SPEAKER_01: It's not healthy, or part of the coercion was that I've had way too much tolerance for this crap.
• 17:07
  SPEAKER_01: You're going.
• 17:08
  SPEAKER_01: And if you're not, you're out.
• 17:09
  SPEAKER_01: So now, oh my God, I'm I may be faced with the inability to return back to my home environment.
• 17:15
  SPEAKER_01: We need to know that from the beginning because part of the discharge process, I mean, what do we do?
• 17:19
  SPEAKER_01: Do we just send you back in the streets?
• 17:21
  SPEAKER_01: Right.
• 17:21
  SPEAKER_01: No, this is not incarceration, where at the end you get your valuables back and, you know, uh a cab fare to go somewhere and you don't know where you're going.
• 17:31
  SPEAKER_01: Um, we call that case management.
• 17:34
  SPEAKER_01: We call that aftercare, we call we call that wraparound services.
• 17:38
  SPEAKER_01: What are we going to do and what do we need to do for you specifically when you actually are ready to leave our program?
• 17:49
  SPEAKER_01: Part of it will be possible outpatient.
• 17:53
  SPEAKER_01: Part of that will be home, uh, some sort of a supportive living environment, psychiatric care on the outside, medical care on the outside, even tie you down to some sort of an ability to get linked to job or um schooling, possibly even legal issues uh that you may have.
• 18:16
  SPEAKER_01: Now, we're not going to treat the legal, but we may be able to give you some referrals.
• 18:20
  SPEAKER_01: And so it's very, very important that the discharge process is identified of the needs at admissions.
• 18:28
  SPEAKER_01: And when you leave, if you're in a residential level of care and you leave the premises of the facility, you graduated that level, but seldom do we not recommend continued care.
• 18:42
  SPEAKER_01: Whatever that care is suited for next, which is either partial hospitalization or intensive outpatient, even if it means outpatient programs, you know, uh, and I don't say even if, because they're not important.
• 18:53
  SPEAKER_01: They're very important, but they're the least restrictive.
• 18:55
  SPEAKER_01: You never complete recovery, you complete a treatment episode.
• 19:01
  SPEAKER_00: How important you use the phrase supportive home environment.
• 19:05
  SPEAKER_00: Lots and lots and lots of people.
• 19:07
  SPEAKER_00: The environment was part of the problem.
• 19:09
  SPEAKER_00: So if you're released from care, how do you navigate maintaining your recovery while going back to the very environment that fed into it in some way?
• 19:20
  SPEAKER_00: So you use the phrase supportive home environment.
• 19:22
  SPEAKER_00: And obviously that would be ideal if we all left whatever treatment we were getting and went to that.
• 19:29
  SPEAKER_00: Lots of us don't.
• 19:30
  SPEAKER_00: So what happens or how how does someone maintain their recovery when they are going back into the exact environment that factored in?
• 19:39
  SPEAKER_01: It's not easy.
• 19:40
  SPEAKER_01: Definitely is a challenge, a challenge that we normally uh recognize in the beginning, and I'll tell you how.
• 19:47
  SPEAKER_01: One of the focal points of doing therapy is to include supportive services.
• 19:55
  SPEAKER_01: And one of those services is the husband, the wife, the son, the daughter, the husband, the brother, the sister, somebody who gently pushed, gently convinced and motivated someone to come in for treatment.
• 20:07
  SPEAKER_01: And if we don't identify a positive resource, but we also understand that environments cannot change.
• 20:13
  SPEAKER_01: We we we can't just tell the person to sell the home because their neighborhood is infested with with substance use.
• 20:20
  SPEAKER_01: Or um if they're going back to a uh a partner who is dealing with her or or his own mental health issues or uh substance use issues.
• 20:32
  SPEAKER_01: But we hope we would be able to provide for you in the immediate response enough skills.
• 20:39
  SPEAKER_01: See, we've given you the tools, we even put it around your waist, you know, uh the tool belt.
• 20:46
  SPEAKER_01: It's up to you to apply those tools, even if it means going back.
• 20:51
  SPEAKER_01: But if we do have a supportive network and we find out that um the husband is in treatment or the wife is in treatment, but the husband likes to socially drink and they don't they don't have an addiction.
• 21:03
  SPEAKER_01: You know, there are certain cultures and certain types of um holidays that where wine is popular, you know, uh drinking is part of the theme of the celebrations where the client, the identified client, we call the I the IP, the identified identified patient, is the person with the obvious problem, but they're going home to an environment that needs to change as well.
• 21:27
  SPEAKER_01: And some environments can.
• 21:29
  SPEAKER_01: People are willing to not drink anymore at the home or not welcome any types of a rattling of a of a pill bottle uh can trigger someone who who is in early recovery.
• 21:41
  SPEAKER_01: Uh, maybe not having a medicine cabin that's so readily available so anyone can, you know, uh can go in and see it.
• 21:49
  SPEAKER_01: Um but yes, there are circumstances where clients do leave and return back to an environment that may not have been conducive, but it's upon them to be able to recognize and use whatever we gave them and still be involved in treatment to support them while they're on the outside.
• 22:06
  SPEAKER_00: So, in terms of aftercare, how important are groups, whether that's 12 step, peer support, family things?
• 22:14
  SPEAKER_00: What's the role of groups?
• 22:15
  SPEAKER_01: It's extremely, extremely important because one of the things that I mentioned earlier is the word forgot.
• 22:21
  SPEAKER_01: And we know when you go for or get involved in self-help groups or self-advocacy groups, peer groups, peer support groups, um, group therapy, it takes away from the stigma, it takes away from the shame, thinking that you got a problem that's unique.
• 22:39
  SPEAKER_01: It also uh provides networking.
• 22:42
  SPEAKER_01: You get the chance to meet others who have long-term sobriety.
• 22:48
  SPEAKER_01: So if you're a 22-year-old, young, young man or woman who now has to ponder on how am I going to be going out and still enjoying my youth?
• 23:00
  SPEAKER_01: Yeah, how can I have fun?
• 23:02
  SPEAKER_00: Okay.
• 23:03
  SPEAKER_00: What daily habits help maintain recovery?
• 23:06
  SPEAKER_01: Oh, uh, self-reflection is one.
• 23:09
  SPEAKER_01: Uh, you know, you hear a lot about people who are meditating, uh, and meditating is not doing, you know, one of those, you know, mmm kind of thing.
• 23:17
  SPEAKER_01: Not everybody's into that.
• 23:18
  SPEAKER_01: Uh, but self-reflection, uh, reading, you know, um, being able to sit quietly and enjoy um being alone, but not feeling lonely, surrounding yourself with positive people, putting out positivity in order to gain positivity.
• 23:35
  SPEAKER_01: Take your medications.
• 23:37
  SPEAKER_01: People, if you are prescribed medications and you're starting to feel better, it doesn't mean you need to stop.
• 23:45
  SPEAKER_01: It means you need to continue.
• 23:47
  SPEAKER_01: Medication is not a cure, it's a treatment modality.
• 23:51
  SPEAKER_01: It's an tool.
• 23:53
  SPEAKER_01: And so put that in perspective: healthy eating, healthy lifestyle, uh, uh exercise, surrounding yourself with people, um, reading, uh, self-reflection, attending therapy, taking your medications are all factors that can go into making a big difference between not doing it and doing it.
• 24:12
  SPEAKER_00: So I'm asking you questions that come out of my own mind and also from the internet, but you hear questions that come into your facilities where people are calling and asking because they're considering going into treatment there.
• 24:24
  SPEAKER_00: What are the types of questions that you hear asked at your own call centers?
• 24:29
  SPEAKER_01: The most notable question is, of course, length of time.
• 24:34
  SPEAKER_01: How long?
• 24:35
  SPEAKER_01: Followed by, can I, can you what?
• 24:40
  SPEAKER_01: Can I bring this?
• 24:42
  SPEAKER_01: I can't sleep well without my pillow.
• 24:45
  SPEAKER_01: Can I bring my own pillow?
• 24:47
  SPEAKER_01: I mean, all important things.
• 24:49
  SPEAKER_01: Um, can I bring uh my phone and how often can I use it?
• 24:53
  SPEAKER_01: And can I bring my laptop?
• 24:55
  SPEAKER_01: And I also need to call my kids every single day at 12 o'clock when they get home, or at 4 o'clock when I get home, or at 5 o'clock when they go to eat dinner at seven.
• 25:04
  SPEAKER_01: All these things that are part of what they've done normally, every single day.
• 25:10
  SPEAKER_01: Um, and we take every question and we answer every question as honestly as we can uh without jeopardizing the need or your hesitation to come in.
• 25:21
  SPEAKER_01: And let me explain that so people don't think that we're coercing or lying to people.
• 25:25
  SPEAKER_01: We're trying to be very honest.
• 25:26
  SPEAKER_01: Yes, you can bring your phone.
• 25:28
  SPEAKER_01: However, you may have a blackout period where we don't want you to use your phone because your phone may trigger you.
• 25:35
  SPEAKER_01: You you may kind of scroll through and see that you got a message from your dealer uh or that you just got a text from someone who has put you in such a depressive state of mind uh that require you to say, I need to do something about it.
• 25:49
  SPEAKER_01: And so any question or or any of what people want to bring or what to expect uh is okay.
• 25:56
  SPEAKER_01: We just want to give them as as most truthful answer as possible.
• 26:01
  SPEAKER_00: And that's the kind of information they can get by calling the treatment center, by looking online.
• 26:06
  SPEAKER_00: You know, can I bring my dog?
• 26:08
  SPEAKER_00: Yes.
• 26:09
  SPEAKER_01: And I so they can they can definitely uh again, it depends on this on the program and how enriched they are in the information given on the internet.
• 26:19
  SPEAKER_01: But absolutely, when calling and asking, uh, you should be able to get any and all information possible.
• 26:27
  SPEAKER_01: And in terms of bringing a pet, I can tell you right now, no.
• 26:31
  SPEAKER_01: Uh that would be it would be a hard no at most places.
• 26:36
  SPEAKER_01: Uh pets obviously have to be uh taken care of.
• 26:41
  SPEAKER_01: And right now you need to be taken care of.
• 26:43
  SPEAKER_01: We can't take care of your pet, we could take care of you.
• 26:45
  SPEAKER_00: So, as a provider, as a psychologist, how do you respond to someone saying, I've tried treatment, it didn't work for me?
• 26:54
  SPEAKER_01: I I try to be as brutally honest as I can.
• 26:57
  SPEAKER_01: What do you mean you tried?
• 26:58
  SPEAKER_01: Define to me what trying means.
• 27:00
  SPEAKER_01: Did you follow some recommendations?
• 27:03
  SPEAKER_01: Did you go through the buffet line and say, Wow, there's a lot of things here, but I'm only going to choose this and that and that.
• 27:13
  SPEAKER_01: In therapy, you can't do that.
• 27:15
  SPEAKER_01: You know, and so when somebody says, I have tried over and over again, I'm gonna say this to you.
• 27:20
  SPEAKER_01: You're obviously meeting with me.
• 27:23
  SPEAKER_01: If you tried and tried and failed, why are you here?
• 27:26
  SPEAKER_01: Because if you convince yourself that you can't, I wouldn't meet with you.
• 27:31
  SPEAKER_00: So I'm thinking of that proverb, the fall down seven times, get up eight.
• 27:35
  SPEAKER_00: And I hear often people say they went to a program and it didn't work.
• 27:40
  SPEAKER_00: It failed them.
• 27:41
  SPEAKER_00: And later, they may go back to that very same program and it now worked.
• 27:46
  SPEAKER_00: How do you explain that?
• 27:48
  SPEAKER_00: The program didn't change, did they change?
• 27:50
  SPEAKER_00: Is it just circumstances?
• 27:52
  SPEAKER_00: Is it sometimes it takes that getting up the eighth time?
• 27:55
  SPEAKER_00: How is that?
• 27:56
  SPEAKER_00: Because for somebody who hasn't been in treatment, that's hard to understand.
• 27:59
  SPEAKER_00: It's like, oh my God, you've been to treatment five times.
• 28:02
  SPEAKER_00: What is wrong with you're not even trying?
• 28:05
  SPEAKER_01: Sure.
• 28:05
  SPEAKER_01: There's a jargon that is loud and clear and very popular amongst the rooms.
• 28:11
  SPEAKER_01: And when I say the rooms in the recovery world, keep coming back.
• 28:16
  SPEAKER_01: It works if you work it.
• 28:17
  SPEAKER_01: So work it, you're worth it.
• 28:20
  SPEAKER_01: Try that five times, you know.
• 28:21
  SPEAKER_01: Uh, and that's an important element to emphasize that there is no cure for mental illness, and there is no cure for addiction.
• 28:31
  SPEAKER_01: There's treatment.
• 28:34
  SPEAKER_01: Depression and anxiety is a symptom.
• 28:38
  SPEAKER_01: It's a title that defines how someone is feeling.
• 28:42
  SPEAKER_01: If I'm going to cure you of anything, I'm getting rid of it.
• 28:48
  SPEAKER_01: How do I get rid of a feeling?
• 28:50
  SPEAKER_01: Because anything can trigger that feeling, right?
• 28:53
  SPEAKER_01: And so my goal is to take you off that ledge.
• 28:57
  SPEAKER_01: And so if you're not ready, despite of what is being said, despite of looking at the reality of what your world has become, unfortunately, hopefully, it's just a temporary setback.
• 29:11
  SPEAKER_01: Uh, but it may not be a decision that I'm going to be able to make for you without you wanting to make the decision for yourself.
• 29:19
  SPEAKER_00: So, since we're coming to the end, I cannot end on that.
• 29:22
  SPEAKER_00: So the other end of the spectrum, you see people all the time who are what I would describe as so far down, so far, so deeply in it, whether it is, you know, depression or a mental health thing or it's an addiction.
• 29:37
  SPEAKER_00: And they do get someplace better.
• 29:40
  SPEAKER_00: They do find a life in recovery.
• 29:43
  SPEAKER_00: And I'm still, every time I'm, I don't know, humbled isn't the right word.
• 29:47
  SPEAKER_00: I'm shocked by it in the nicest possible way.
• 29:49
  SPEAKER_00: I'm always like, you are kidding me, because you hear resilience and you know, people can do all these amazing things.
• 29:55
  SPEAKER_00: I would love for you to share the reality of recovery and the possibility of it.
• 30:01
  SPEAKER_01: I can't even begin to explain how many success stories we have.
• 30:07
  SPEAKER_01: It's amazing to hear.
• 30:10
  SPEAKER_01: I'll take a step back.
• 30:11
  SPEAKER_01: If you walk into uh rehab facilities, you'll see that a very large portion of the people that are working in those facilities have their own stories.
• 30:22
  SPEAKER_01: You know, they almost feel such a sense of gratitude and owe to what was given to them, either the program itself.
• 30:31
  SPEAKER_01: We've had people who are alumni who have a year, two years, three years, and decided to want to come and now work and give back what was given to them.
• 30:40
  SPEAKER_01: As many stories as we hear on television about this person relapsing again.
• 30:47
  SPEAKER_01: And it's unfortunate that, but it's reality that you're not going to hear about the common person that's walking the streets.
• 30:53
  SPEAKER_01: You're going to hear about the notorieties, the sports celebrities, and the movie actors, and all these people that that you can only wish that you had some of what they had, and you almost get angry at them.
• 31:03
  SPEAKER_01: Like, what are you depressed about?
• 31:05
  SPEAKER_01: You got all of this and all of that, which goes to show you that it's not just about materialistic things that make people happy, but oh my goodness, I I can't tell you how many stories I can share about people that I even scratched my head and said, Oh my God, this is like his 14th time attempting to get clean this year, for them to turn around and something just triggered.
• 31:27
  SPEAKER_01: Something just, just, just, just entered their mind and said, you know what, this time I I got it.
• 31:34
  SPEAKER_01: And this is why I can never professionally, morally, and ethically, ever look at any individual struggling with mental health or with substance use or both, and say, this person doesn't stand a chance.
• 31:48
  SPEAKER_01: Because you never, never know when that one thing that is being said is heard differently or heard for the very first time.
• 31:57
  SPEAKER_01: So I am absolutely optimistic.
• 32:00
  SPEAKER_00: As a provider, as a psychologist, how do you explain that it worked?
• 32:05
  SPEAKER_00: I get it now.
• 32:06
  SPEAKER_00: I I'm ready.
• 32:07
  SPEAKER_00: Is what what is it?
• 32:09
  SPEAKER_01: For those clients that are even in treatment and have some ambivalence and say, I hate this group.
• 32:15
  SPEAKER_01: It's a worthless group.
• 32:17
  SPEAKER_01: All they talk about is this crap and that crap and blah, blah, blah.
• 32:21
  SPEAKER_01: And they go on and they kind of give you every excuse I say to them, just go, never miss one, never miss one, because you never know what profound message you will get that you will miss if you didn't go from someone who you never thought will be able to give you, and just like a light bulb.
• 32:40
  SPEAKER_01: Oh my God, I never thought about that.
• 32:43
  SPEAKER_01: But it takes participation and it takes willingness.
• 32:45
  SPEAKER_01: Unfortunately, sometimes that willingness is not there.
• 32:48
  SPEAKER_01: But again, I'm very optimistic.
• 32:51
  SPEAKER_01: Um, and the message that I give to others is to never close their mind.
• 32:56
  SPEAKER_01: Thank you so much for your time.
• 32:57
  SPEAKER_01: My pleasure.
• 32:58
  SPEAKER_01: Thanks for having me.
• 32:59
  SPEAKER_00: So that wraps up our exploration of the levels of care for mental health and addiction treatment.
• 33:06
  SPEAKER_00: And we will explore another topic starting next week.
• 33:08
  SPEAKER_00: So please join us.