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Many Roads to Recovery: Celebrating Individual Paths This Recovery Month · Talking FACS

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  Welcome to Talking FACS, what you need to know about family,
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  food, finance, and fitness.
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  This nationally recognized, award-winning podcast is hosted by the University
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  of Kentucky Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  When you think about recovering, no matter what you're recovering from,
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  your experience is going to be individual, depending on what your illness is,
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  where you are in life, what types of support you have.
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  Welcome to Talking FACS, where we share research-based information that you
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  can use to strengthen your family, your community, and our state.
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  I'm your host, Mindy McCulley, Extension Specialist for Instructional Support
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  with Family and Consumer Sciences Extension.
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  My guest today, Dr. Alex Elswick, who is our Extension Specialist for Substance
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  Use Prevention and Recovery, is here to share about how there are multiple pathways
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  of recovery for everyone.
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  We need to recognize and celebrate everyone's individual pathways to recovery.
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  Amen to that. Okay.
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  So Alex, let's talk about, so what does the multiple pathways of recovery mean
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  to you? Well, okay. Thank you. That's a perfect introduction.
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  And I think for a little context, the reason we're gathering here in this virtual
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  space to have a podcast about this at this time is because September is recovery month.
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  And so like you said we're celebrating not just
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  recovery in general but celebrating the diversity of recovery
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  pathways and i like something that you said as we were doing just a little bit
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  of prep before we got on here which is really that basically there are as many
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  pathways of recovery as there are individuals who will take a pathway in recovery
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  because every single person's pathway is going to be different.
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  So when you ask, what does multiple pathways of recovery mean to me?
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  To me, it means that recovery is not a cookie cutter experience.
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  And that's especially for extension folks who like to bake.
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  That's an apropos kind of analogy. But really, it's a meaningful thing to say
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  because no two people are the same in terms of gender, race,
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  socioeconomic status, but also experiences,
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  things like mental health disorders that they may or may not have,
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  or trauma that they may or may not have experienced.
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  And all of those things are going to shape who they are.
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  How they've experienced an addiction of some kind, and what kind of recovery
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  pathway is going to be best for them.
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  And I think it's important to talk about the multitude of pathways in recovery
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  because we tend to talk about only one.
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  We tend to really over-represent one kind of straightforward basic pathway,
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  and there's nothing wrong with that one pathway, but it's important that all of them be represented.
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  Okay, so let's talk about the common pathways of recovery. What are those?
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  So I think the most commonly understood or most commonly represented pathway
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  of recovery is this kind of almost linear one where people hit rock bottom,
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  whatever that bottom looks like for them, and then they go to treatment or to
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  a 12-step program like AA,
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  and then they are abstinent for the rest of their lives.
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  And that is a perfectly legitimate pathway.
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  And that's a pathway we always want to support.
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  But that's the one that if you pull a random person off of the street and you
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  ask them to think about addiction recovery, that's probably what comes into their mind.
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  And what may not come into their mind are the many, many other ways that people
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  recover from addictions.
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  And so as it turns out, the most common pathway of recovery is not actually
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  the one I just described.
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  The most common pathway of recovery is actually recovery without any formal help. Okay.
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  And that's, that's kind of surprising when you think about like,
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  again, if you just pulled a random member of the public off the street and said,
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  hey, what does somebody need to recover from their addiction?
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  I think most people would say like rehab. That's the first thing that comes to mind, right?
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  Is some type of addiction treatment or clinical intervention.
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  So it's pretty surprising to learn that most people recover without any formal intervention.
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  And then beyond that, people can recover along lots and lots of different pathways.
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  Some people take a faith-based approach.
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  Some people will take secular approaches. Some Some people will take a 12-step-based approach.
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  Some people will take a SMART approach. SMART is an acronym that stands for
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  self-management and recovery training.
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  And so it's a little more secular and a little more based on like cognitive
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  behavioral principles and skill building.
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  And there are medically assisted pathways. And I think the point is,
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  as we said, there are so many different pathways.
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  And like so many other people, there was a time in my life when I was led to
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  believe that there was only one pathway and that everybody needed to follow that one pathway.
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  That ultimately can be harmful if we're trying to force people to take pathways
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  that may not be the best fit for them.
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  Well, as we've talked about on the podcast before, there are so many different addictions.
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  And if we only think about addiction as a substance, problem or a substance issue,
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  then we can really get our mind trapped into not recognizing that there are
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  different types of recovery pathways for all types of different types of addictions,
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  right? That's very well said.
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  We like to say that addiction isn't a drug problem. Addiction is a brain problem.
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  If you have a brain, you can become addicted.
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  And so just as you've said, there are all sorts of things from food to videos
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  and screens to technology to shopping to gambling,
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  you know, the legalization of online sports gambling here in Kentucky, all these things.
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  And so that's right, that recovery is going to look different.
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  For instance, for some people, their recovery from, let's say,
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  an alcohol addiction might be complete abstinence.
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  But if you're in recovery from an addiction to disordered eating,
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  you can't just abstain from food.
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  And that it's important that really, as you said, that we acknowledge them,
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  recognize them, and celebrate them all so that they're all equally supported,
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  so that we're not unfairly only supporting certain people who take a certain
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  pathway, which unfortunately is what tends to happen.
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  How does one determine which pathway is the right one for them?
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  That's kind of the million-dollar question, and there are a number of things to say about that.
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  The first is that recovery is beautiful, but recovery can be messy.
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  Right. Sometimes recovery is a trial and error process.
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  It kind of depends on which data set you look at.
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  But some of the research would suggest that for people with addictions,
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  we take an average of something like seven to 10 quit attempts.
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  Okay and so it means oftentimes people
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  don't aren't successful their very first try to stop something
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  and what that means is oftentimes they're
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  having to try something else and see what what fits
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  better for their values what fits better integrated into
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  their life you know so just as one example it may seem obvious or maybe something
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  we take for granted if someone has let's say an addiction to alcohol as an outsider
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  it may seem obvious that that person should immediately go to a 30-day treatment
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  center and address their addiction.
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  But if you think about the real-world implications of that, if they have a wife
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  and kids at home, assuming this is a man.
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  If they have a job, if they have a dog, if they have, I mean,
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  these are very real things, considerations that might make inpatient treatment
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  not the best pathway for that person.
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  So maybe they're better suited for an outpatient pathway. Maybe they're better
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  suited for something else.
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  So trial and error, unfortunately, is for many people, an approach they have
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  to take to some extent, but really having an openness to try new things,
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  a willingness to try something else if what you've already tried hasn't worked.
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  You know, unfortunately, I meet people every day in the field who have been
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  to 15 and 20 inpatient treatment centers and just trying the same approach over
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  and over and meaning well and investing hard,
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  but not realizing that it may not be best suited to their needs.
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  So, you know, you can work with a peer support specialist or a therapist to
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  kind of help tease out different pathways.
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  But ultimately, it's a question of what's your goal, what are your values,
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  and what are your beliefs, and which kind of treatment pathways are best going
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  to align with those things.
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  Well, and as you said, it's a brain problem.
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  And so maybe it's, you know, it's not that you just don't have the willpower
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  to stop whatever you're addicted to.
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  So maybe you have to try on different pathways to recovery to figure out which
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  one is going to help your brain rewire itself to be able to overcome the addiction.
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  Exactly. I don't ever want to imply that people who have addictions are broken.
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  But one way of thinking about this is, you know, when you ask people to just
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  have the willpower to stop, what you're saying is use your broken brain to fix your broken brain.
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  That intuitively just on its face doesn't make a lot of sense, right?
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  It's part of the reason why different pathways work for different people and
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  also why having external support is valuable to having other people.
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  Well, we aren't a one-size-fits-all people, so why would we be a one-size-fits-all
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  recovery system? That's exactly right.
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  So are there certain pathways that are underrepresented or stigmatized that people shy away from?
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  Yes. So unfortunately, because we tell, I call it a single story.
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  So I'll give you a quick analogy. We tell a single story of,
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  in the West, we tell a single story of the continent of Africa.
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  Oftentimes we depict Africa as if it's one culture, as if it's one country when
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  it's a continent, right? As if it's one language, one.
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  And really that's a stereotype. And so we say the problem with single stories
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  and stereotypes is not always that they're untrue, but that they're incomplete.
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  They don't tell the whole story. The fact that Africa is something like 52 different
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  countries with a variety of different languages and cultures and histories,
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  and the same thing is true of addiction recovery. We really tell a single story
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  of addiction recovery that,
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  People have to hit rock bottom, and then they either go to treatment or go to
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  AA, and then they just are abstinent for the rest of their lives.
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  And that is kind of all that recovery looks like. And as it turns out.
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  Recovery looks a lot of different ways.
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  And for many people, that involves medically-assisted pathways.
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  For instance, in the context of an opioid use disorder, we have three FDA-approved
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  medications to treat opioid use disorder, methadone, buprenorphine,
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  which people know of as suboxone, and naltrexone.
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  And because of this single story we tell that says that complete abstinence
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  is the only way there's this stigma against using these medications because people will say well hey,
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  you may not be committing crimes anymore you may be going to work you may be
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  a good member of society but you're not really sober because you're still taking
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  a medication and it's right It's this really offensive view.
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  I always think of the connection to weight loss and to how.
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  Really rapidly and openly society has embraced the use of the GLP-1 agonists
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  and the semaglutide medications as an avenue of weight loss.
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  And I'm not being critical of that at all.
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  It's clearly been a new advancement in medical science and something that's
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  been really effective. and yet some of the very same people who might use that
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  as a way to aid their weight loss stigmatize using medication as a way to recover from an addiction.
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  And so my hope is that medically-assisted weight loss will help us to de-stigmatize
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  medically-assisted addiction treatment.
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  But it's just an example of one of the many ways that we think recovery has
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  to look a certain way and the consequence of that being we don't offer good
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  support or we actually cause harm and barriers to other pathways.
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  And it seems to me that if you...
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  are going to say that someone who is taking medication to help them curb their
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  opioid addiction, then you probably shouldn't take that aspirin to take care of your headache.
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  Well, Mindy, you're going to touch a hot
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  button issue here because even abstinence-based programs whose goal is.
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  For instance, a 12-step program, which might say, you know, the goal is complete
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  abstinence from all mood and mind-altering substances.
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  Well, if you think about your stereotype of an AA meeting in your head,
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  it's a group of folks sitting in a circle, drinking coffee and then standing
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  outside smoking cigarettes.
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  And I'm not saying that to be critical of that program at all.
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  I've benefited a lot from that program as well. My point is just,
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  even when we talk about abstinence as a goal, it's not even clear on how we
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  agree abstinence from what.
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  So many people will say once, this is a stigmatizing way to say it,
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  and we wouldn't say this, but others might say once an addict, always an addict.
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  Meaning once you've been addicted to one thing, you can't ever safely drink alcohol or use it.
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  And we know that there are such a diversity of experiences that many different
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  people have many different experiences with recovery.
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  So really any pathway that deviates from that single story that I told you experiences
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  a little bit of stigma or is definitely not represented.
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  So one way I mean that is like when we're educating doctors who are in medical
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  school and they'll have what's called grand rounds.
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  And as a part of grand rounds, oftentimes they might invite someone who is in
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  recovery to come and give a testimony so that they can learn from their lived
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  experience, which is an awesome thing, right?
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  The problem here is that 100% of the time, in my experience,
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  that someone's invited to come and give their testimony, it's someone who comes
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  from a 12-step background who's in complete abstinent-based recovery.
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  So what that means is that providers are always learning this idea.
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  This idea is being reinforced that recovery looks one certain way.
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  My hope is that over time, they'll hear more experiences
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  from people who use medication to benefit their lives
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  and the lives of their families and who've used faith-based approaches and
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  who've used clinical approaches and on that list yeah because we're not cookie
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  cutter people so why should we have cookie cutter approaches as you said that's
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  it so is there a pathway that is the best pathway and i think i know what you're
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  going to say well i'll still ask this question that's right.
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  It's kind of a rhetorical question, but it also reminds me of conversations
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  I've had with colleagues in the past where we say, what does that question even mean?
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  Like what, in terms of best, do you mean most effective at retaining people
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  at treatment, most effective at forcing people to be abstinent,
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  most effective at improving quality of life? These are all different questions.
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  I think the best way to put a bow on this conversation and to answer that question
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  is by making that comparison to weight loss.
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  If you wanted to lose 20 pounds and you went to your doctor and you said,
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  hey, I really just want to lose 20 pounds.
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  And your doctor says, well, look, you more than anyone else in my office should
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  be training for a marathon.
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  And if you're not willing to train for a marathon and go on a hard 90 diet and
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  cut out sugar and train for a marathon, then honestly, what that tells me is
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  you don't want it enough.
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  You're not willing to do the work. you're not sick and tired of being sick and tired.
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  And when you're really sick and tired of being sick and tired,
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  then you'll come back and train for a marathon, right?
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  Like there's an absurdity to that, but it's also not a complete ridiculous analogy.
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  It really is what we're saying to people when we say, the only way that we're
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  going to help you get better is if you go to an inpatient treatment center and
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  get completely out of it.
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  And anything short of that is completely unacceptable and doesn't represent
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  progress or improvements in health. And so.
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  You know, my ultimate weight loss analogy is it's like it's whatever works for you.
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  And for many people that starts with small incremental steps that builds momentum, little wins.
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  Sometimes you need a little win, right, Mindy? You need a little success and
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  get a little bit of wind in your sails.
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  And so you knew the answer. There is no best pathway. It's the pathway that
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  works for you, the pathway that meets your needs the best.
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  And we need to, as folks who work in cooperative extension, as clinical treatment
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  providers, as everybody in this space, really need to do our best to support
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  every single one of those individual pathways.
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  I always learn something when I talk to you.
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  And I appreciate the time that you give to the podcast because everything that
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  you have to share is so beneficial to our community and to individuals who are
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  in situations, in families,
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  and in the community with those who are living with addictions or living with
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  people who are living with addictions because it is a community issue. That's exactly right.
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  And one of the things that I love the most when I talk about multiple pathways
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  in a public setting is when people approach me afterwards and say,
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  thank you because I feel seen and heard for the first time because I'm in this kind of recovery.
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  And nobody ever talks about me and nobody ever acknowledges me and legitimizes my existence.
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  And so part of the reason that I really wanted to do this podcast for Recovery
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  Month is a way to lift up all the people and all the families who are in different kinds of recovery.
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  We're not in the business of telling you which one is best or in rating one above the other.
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  We just want everybody to figure out what works for them. Thank you.
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  Thanks, Mandy. If you are just tuning in, you are listening to Talking FACS,
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  Thank you.