Latest / Conversations with Cumberland Heights / Family Systems in Addiction Recovery with Dr Kristy Soloski

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Family Systems in Addiction Recovery with Dr Kristy Soloski · Conversations with Cumberland Heights

0:00
Doctor Kristy Soloski, welcome to the show.
0:02
Glad you're here.
0:05
It's been almost,
0:06
I think, maybe six years since we've seen each other in the flesh.
0:11
It's the first time I'm getting to see all this fantastic work in person.
0:16
Yeah.
0:18
So, before we dive in and get started,
0:21
I want to give you some flowers and ask you to introduce yourself. Yes.
0:26
My name is Kristy Soloski
0:27
I am a faculty member in the.
0:30
I guess I could say the place I'm in, Texas tech University.
0:33
I've been there for 11 years.
0:36
Wow. I'm also a licensed marriage and family therapist.
0:39
And a licensed chemical dependency counselor.
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And I've been practicing in Texas since 2017.
0:45
But if you see my training before then, that's also over ten years,
0:49
almost 15 years now that I've been practicing clinician.
0:52
So I work to both train clinicians and the future
0:56
generation and, a lot of different areas.
0:59
One of those being statistics, the other being working in,
1:02
culturally diverse communities and identifying the needs for them. And,
1:07
and among those many things
1:10
is the associate chair of the department and is being asked,
1:15
asked to lead, to continue to lead,
1:18
you know, like, no, I just mean, like being the associate chair.
1:22
Like, that's always that's different than, you know, being in that tenure
1:26
track role or being a tenure track or a tenured, professor and what that entails.
1:31
So, I'm a product of this programs that you work in, you know,
1:35
so I did my undergrad, my master's degree and my PhD, all in the same department
1:40
across different programs, some of them, but in the same department.
1:44
So we got to know each other really well through those years,
1:47
and then in particular in my PhD program.
1:50
Well, a little bit of masters
1:52
because I took stats from you think you were one of the first cohorts.
1:56
Program. When I came in.
1:59
That's right.
2:01
Hashtag stats excite for those that will remember that project.
2:05
That's a deep cut for like five people in the world.
2:11
And then
2:14
I office outside of your office typically are not inside of an office.
2:19
I was inside of a very nice cube, outside of Christie's office
2:23
for a number of years during my PhD program, which was,
2:27
you know, one of the things I love about MFT programs is
2:30
you get this introduction into research, you get an introduction to teaching.
2:33
So likely you'll have an assistantship where you're managing your own class
2:36
or helping a professor manage a class in addition
2:39
to your clinical responsibilities and your coursework,
2:41
which could be a myriad of supervision, live supervision, etc..
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Yeah, so I was in that cube like 12 hours a day for several years.
2:51
And, ultimately you became
2:55
a good mentor and my dissertation chair
2:58
who shepherded me through the trauma of figuring that out.
3:02
So I am grateful for Golden Child.
3:05
Well, you you
3:09
I think, impacted me as a professor.
3:13
Different ways I, I do joke about you being my pride and joy.
3:17
The journey that you've gone on and the way that you've taken
3:20
what you learned to go to,
3:24
go to a place where you can make a real impact and you traverse the,
3:29
pathway that nobody else had gone on before.
3:32
And I've always thought that that was so courageous.
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And it's been an honor to watch.
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It's gone.
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So thank you. Well,
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I remember processing that these decisions in your office, too,
3:45
so that I'm absolutely a product of that program.
3:48
And just a shout out to, like, the whole staff, you know, Nicole Morlock,
3:52
Sterling Shumway, Tom Kimball, you, Doug Smith,
3:56
Nicole Springer, and so many people I probably just forgot.
4:00
So I shouldn't have done that, but, Cynthia de,
4:04
Kitty Harris, Vince Sanchez okay, I'll stop.
4:08
Like, just all of these people that do a great job.
4:11
It's teaching people
4:18
how to grow, you know?
4:21
And so, yeah, help people be the fullest.
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Capacity.
4:28
Yeah.
4:30
Which is a good segue because,
4:34
look, this is a podcast put on by a treatment center,
4:37
you know, and the reason we put it on is so that we can,
4:41
I don't be a window into what we do and to help people understand,
4:45
maybe what behavioral health is,
4:48
and how it manifests in addiction treatment
4:50
and how that matters for somebody that's maybe looking for treatment.
4:53
So as an MFT, which is sort of like an arm of the tree in psychology,
5:00
you are taught in systems theory.
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So I just wanted to really ask you, like from the jump, like what is systems theory
5:08
and how might that be applied in addiction care.
5:11
Yeah.
5:13
There is a way of thinking about the world
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and how we are connected.
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So it's taking this perspective that instead of us
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being siloed individuals that are traversing the world, it's
5:24
this understanding that none of us are doing any of this independent
5:28
from other people, other networks, other situations, other societies
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that we are all living in and a connection to one another.
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And we take it down to the family level.
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It's this understanding that families develop
5:42
behaviors, patterns, interactions,
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together as a unit, not independent from one another.
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And so the system is the family.
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It's everybody that is living together within that family
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unit and, and maybe even the extended family as well.
5:57
But any problems that pop up aren't because of one member of the family.
6:02
It's, it's a
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an effect of the interaction patterns that the family has developed and created.
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And then they become self-perpetuating as well.
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So the most famous, explanation of this that we give is,
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if you think about a baby mobile that would go over a crib,
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they often have these little arms that reach all the little figurines
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that are hanging from each of the places on it.
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And if you pull any one of those legs
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of that baby mobile, the whole thing's going to shake.
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Shake. Right.
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And so that's what we see happen in families.
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If any one person stumbles and falls, a whole family feels it and reacts.
6:39
It could also be that one person stumbled and fell because somebody else
6:43
pushed them. Somebody else rocked the boat, right?
6:45
Something else happened within the system that then there was a reaction.
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That reaction was that person falling.
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So if we take that, then to addiction,
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I would say that anybody who's developing problems
6:58
with substances is doing so amidst
7:01
a system that is perpetually waiting, a problem,
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that is then coming out in the form of substance use.
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So I would say that that one person developed that problem not because of
7:12
just something inherent within them, but because of something
7:15
that was happening within the system that they then had anxiety, frustration,
7:20
something that led them to then make that choice to use.
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And that's the way they stabilize their feelings
7:26
was through the substance use.
7:28
Yeah, that's a perfect answer.
7:29
And not to be confused with like.
7:34
Addiction is caused by your family.
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That's not what that means.
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It just means that,
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like when we're unpacking and trying to understand the nature of some of these
7:42
individual problem and perhaps importantly,
7:46
how they build
7:48
a structure for success into the future, that the baby
7:52
mobile analogy is helpful, that you are not
7:57
change must be considered in the context to which you're developed and exist.
8:01
Yeah, yeah, but it's a reaction, from the system,
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not just one individual's choices of reactions.
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If I were to expand it and give an example.
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Let's say you have a unit and let's just pick a stereotypical thing.
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So you've got a mom and a dad and two kids.
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And let's say mom and dad are having trouble in their relationship,
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maybe from the different backgrounds they came
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in, maybe one of them experienced trauma in their family of origin.
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Whatever it is, Mom and dad are having problems,
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and one of the kids just stumbles upon that when they come into the room,
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when Mom and dad are fighting and they start, like dancing around,
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having fun, making jokes that mom and dad stop fighting.
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Then they learn and the family learns that
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this child can be our stabilizer, or the mascot for the family unit.
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If we look at family roles that people could fall into,
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and maybe then that child always is the mascot.
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So when other people get frustrated around them,
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they find a way to be the one that's going
9:08
to dilute the frustration that other people are experiencing.
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And so they act out and they're they're often the comic
9:14
there, the person who is the stand up comedian, they're the funniest
9:18
person around you that, you know, de-escalating the conflict.
9:21
Yes. Their role in de-escalating conflict
9:25
and maybe the family members needed them to serve that role down.
9:29
And what's funny about this, like talking about this,
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talking about examples, is like my experience because we're all
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we're everybody is the protagonist in their own story.
9:38
You are the main character,
9:41
right?
9:42
When you reflect on your own family, you're like, we don't do that.
9:45
You know, like we are vulnerable.
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We are authentic.
9:48
We maybe you maybe you do, maybe don't.
9:50
We we we are healthy,
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you know, and,
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my experience individually has been not to say because my parents,
10:00
God forbid, I don't want to get a text like whatever, but, you know,
10:07
it turns out we're somewhere there in the middle,
10:09
you know, and it turns out that though that way of thinking from a systems
10:13
perspective is very useful to sort of unpacked early recovery
10:16
in a family of like, oh, wow, I can see myself, for example.
10:19
I can see how my sister like, really
10:23
bailed on the family to survive when it again, like what I mean by that?
10:27
She went away for college.
10:28
We grew up in a college town, went away for college and was like a highly,
10:32
very academically successful.
10:35
You know, she was the hero,
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right?
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Whereas I was the victim in my own mind, not anybody.
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I'm not saying I was a real victim.
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I just played the victim role, you know, in
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my parents were just doing everything they could to figure it out.
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Everything in between.
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So, it tends to be helpful language, like in our family program.
10:55
Like that early like that initial, like new idea of, like, whoa, what is this?
11:01
Whoa. Am I involved in this?
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Because I was just coming here to support Christi.
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Who? Turns out there might be, like, this other level of.
11:08
Right.
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And it's probably that everybody in the family is struggling with something.
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And maybe it sometimes manifests as addiction.
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Maybe it sometimes manifests as just a normal standard.
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Where they're feeling anxious
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and nervous about something all the time and they just don't use,
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but they are still struggling in some capacity.
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Do you think
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Well I was going to ask you
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if you think that treatment centers, in your experience do this.
11:38
Well in terms of the acknowledgment of family care, I think they are working
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really hard to integrate that as a crucial member of family care.
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I think that because I haven't worked in one of those treatment settings
11:53
and I haven't been to many of them to see how they're doing it, I just know
11:56
that I've heard a lot of treatment centers integrating Family Week groups, etc.
12:02
into the treatment process, which I think is phenomenal and great.
12:06
I wonder from an outside perspective and someone who's not in any way, shape
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or form part of the treatment,
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whether the family members really get it, that they also need to change,
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or they might not also experience the benefits of the treatment piece.
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Or they might not
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fully really understand the role, that they might be part
12:26
of the development of the addiction itself is that takes a lot of responsibility.
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And, they themselves haven't sought treatment
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by by being the ones that aren't in the treatment setting.
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Maybe they have external, maybe they're going to their own therapy.
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But I'm just imagining that the majority
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of those family members are probably not also in their own treatment.
12:46
Yeah.
12:47
One of my favorite things about recovery, it kind of reminds me
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of what you're talking about, is that, recovery will invite
12:54
you to, to grow in ways that you least expect.
12:57
So, I think one way to say what you've said
13:02
that I'm thinking about differently in this moment is when you show up to rehab.
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The problem is addiction. And
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hopefully when
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you're leaving, the problem is,
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how can I better cope
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and problem solve with life on life's terms?
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And how am I going to continue to grow into,
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I'll just say, a better version of myself.
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Or I can be maybe happy, joyous, free,
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more vulnerable, more self-directed
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than my anxieties or my trauma or my depression might be disallowing me
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to do, you know, and and ultimately, that's what what you're talking about with
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families is like, it's it's really invitation to grow
13:50
beyond what you might think is related to addiction or not.
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That's ideally what somebody is going to walk out with.
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And change is hard.
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Systemic change is even harder.
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One person changing is one thing.
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But if the whole family is changing, that's a whole different piece.
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And that takes a whole whole extra amount of energy for that to happen,
14:12
everybody would have to be engaged in the process to make that happen.
14:16
Can you talk about what's unique?
14:19
Because because what you are an expert on
14:21
and you're part of an expert team, is this like
14:25
integration of your department?
14:29
I'm not going to rattle off what that means.
14:30
Yeah.
14:31
The different programs and the center.
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Can you unpack that a little bit?
14:37
Our layout of our program. Sure.
14:39
And how that, how that might,
14:42
equip a professional to
14:47
I mean, it's unique that you guys are so focused on addiction.
14:50
So talk about that. Yeah. Programs
14:53
that have such a strong addiction focus.
14:56
Are we the first person.
14:59
Yeah. And let me back up.
15:01
Let me just say let me set the table. Yeah.
15:03
Because most graduate level
15:05
psychology programs, LPC,
15:09
Social Work, MFT, I'll leave out clinical psych.
15:14
They want to be left out. It's fine. I'm just kidding.
15:17
I'm joking.
15:19
Nobody come at me.
15:25
But those professions, generally speaking, on average,
15:28
you are getting the exposure to one class associated with addiction.
15:34
One and all of your training program,
15:37
60 ish hours and a master's level program.
15:41
Right.
15:42
That is.
15:44
Yeah. I mean, that's like, oh, wow.
15:47
How much addiction do you see in your private practice over the last decade?
15:51
Actually, a lot.
15:53
So but like more than 5%.
15:57
Yeah.
15:57
You know, probably if we include behavior, you know, addictions.
16:03
Definitely. Yeah.
16:04
So one thing that's really unique about tech is there.
16:07
And this university in this college in this department is like
16:11
they're just like complete
16:14
embarrassment of addiction
16:16
and recovery to you talk about that if I can go back.
16:22
So I wrote a
16:23
paper on this one article I think, and it was partially on the marriage
16:27
between marriage and family therapy and substance use treatment.
16:31
And that's in part the field of marriage and family therapy was partially born
16:35
through the addictions work that they did, that the field itself
16:40
was legitimized by incorporating families into the treatment process.
16:44
And yeah, that's one of the first research grants that came to our field
16:47
was an addictions based, study that they were working on.
16:51
And so I personally love to see it at the core of our field,
16:55
because it is part of the birth of our field into modern day area.
17:00
Right?
17:00
Like we we were then eligible for different research grants.
17:04
We recognized in that capacity
17:05
that it opened the door for additional research grants to happen.
17:09
It opened the door for us to have,
17:12
insurance reimbursement for the clinical work that we do.
17:15
So we really were born from that.
17:17
And the program that I'm in, at Texas Tech, we have
17:22
within our department two programs, one that is marriage and family therapy,
17:25
the other intense addictive disorders, focused and recovery focused.
17:29
So we have both of those elements that are part of it, and we work together
17:34
and see ourselves really as a core that within addictions,
17:37
we understand that systems were part of where addiction came from within them.
17:41
And, within the family side of things.
17:43
We know that people will struggle with.
17:46
You're going to have clients that are struggling with addiction.
17:49
And so to think that you're going to do marriage
17:51
and family therapy without understanding how addiction might then be
17:54
part of the family process would be wild, because you're definitely going
17:59
to get people coming into therapy who don't yet know that they
18:02
are struggling with addiction, and that's why their marriage is on the rocks.
18:07
Out. Yeah.
18:07
And that's the element that's at play for them.
18:11
So for us, it's just integral that we're thinking about,
18:16
what's interesting, or a coincidence.
18:21
So the history of addiction
18:24
related to MFT and growing the field and,
18:28
but also the core components
18:31
and assumptions that exist and recovery
18:35
like almost like a transparency slide for those that are old enough,
18:38
like in middle, like in school where they would like write with these,
18:41
you know, on the saying that would shine up on the wall
18:43
and then they would change the sheet and then somebody's
18:45
job would be to like, squeegee it anyways, not to take that too far.
18:50
It was dark, you know. Yeah.
18:52
Is that
18:57
my brain is so strange because I was thinking about how things
19:00
overlay, and I went to transparencies in middle school, so it's fine, but the
19:06
when you think about the
19:07
core concepts associated with recovery, they overlay the core
19:12
theories and assumptions within systems almost perfectly.
19:16
Yeah. Like.
19:19
In order to participate
19:20
in recovery, you don't have to believe that it's going to work for you.
19:24
Okay.
19:24
So like in systems it's not any I Doug Smith's trauma
19:29
you know of taking it like reading cybernetics.
19:32
You know like which is like a wild thing to ask graduate students to do is like
19:37
the heaviest book you can think of, like completely not accessible.
19:41
He's going to hate.
19:42
He's not going to find this funny at all, by the way. But.
19:46
I love the book, I remember it, I'm talking about it now.
19:48
So it worked.
19:49
Doug. Yeah, yeah yeah yeah.
19:52
But it's it like.
19:57
Change doesn't care about what you think about it, right.
19:59
So like when you're approaching like a systems perspective, it's easy
20:03
to get sucked into, like, let me try to help you generate insight.
20:07
And in addiction care, I think there's an assumption that like
20:11
we're going to talk through this problem
20:14
and thus your behavior will change.
20:18
Right? Negative. Right.
20:19
Sometimes there's no amount of talking that that's part of my theory to the
20:22
I don't believe that talking is sufficient to create change.
20:25
I think doing is an integral part of change,
20:28
that we've got to do something different and experience
20:31
the outcome of that difference in order for us to do it.
20:34
And even sometimes the process of exploring my difference and doing
20:40
is the change in and of itself, you know, and so like recovery,
20:43
like think about it,
20:44
like you show up and you're confused and they're like chanting.
20:48
And there are certain readings and there's unique language
20:51
and there's like a structure to this thing.
20:52
And like, people hand out coins and you're like, what's going on?
20:56
There's a basket.
20:56
People put money in a basket and you're like,
20:58
wait a minute, am I in church, am I not?
21:00
Why is this happening?
21:02
and in therapy
21:04
for somebody who's not a therapist, likely you're here and you're like,
21:07
is this going to help me? I just showed up.
21:09
There's a unique language, you know, like, how is this structured?
21:14
Where are we going?
21:16
What exactly is going to be on my treatment plan?
21:18
How did you decide that? So
21:21
other
21:21
domains of psychology are very focused on inside.
21:25
Yeah. Yeah.
21:26
And MFT is not.
21:28
It's about adjusting the inputs and the outputs of your life.
21:30
And Doug always used the example of like this black box
21:34
in a science spectrum museum. Okay. Yeah.
21:37
Where like you pull on a rope over here and you don't really know
21:40
how it's connected because it affects something over here.
21:43
But that's not really our job.
21:44
Our job is to sort of just keep manipulating it
21:46
until we get the desired output, shake things up in order to create change.
21:50
You got us
21:51
is that if we go back to system theory, every system creates a whole new spaces,
21:55
a normal way of how they operate on a daily basis, what
21:59
the rules and the rules of expectations are for the family.
22:02
And so if we want something to change, we've got,
22:04
we've got to change the structure, really.
22:06
And so you've got to increase the anxiety and shake things up
22:11
and see if we can then rule out something that's different than what it was.
22:15
Yeah,
22:17
people probably haven't heard that before,
22:19
that in order to create change, we should actually increase the anxiety.
22:22
Can you like will you talk about that a little more?
22:24
And, I'm I'm gonna also say that anxiety is not always a bad thing.
22:28
I worry sometimes that we have gotten to a place where we think
22:33
that feeling bad feelings is something that should be avoided at all costs.
22:37
And and actually anxiety, I think, is a really important part of our lives.
22:42
Our bodies are built to feel anxiety.
22:44
They're it's, it's a it's a, informational process within our body
22:49
to tell us that something is going on that is either just new
22:53
or potentially even dangerous, that something is happening within it.
22:57
And so feeling anxiety is a very good thing.
23:00
It has a role and a place in our lives, and I hope that we can all accept that
23:04
as an important part of our lives, not something to be avoided at all costs.
23:08
So yeah, for a system to change, though, we've got to do something different.
23:13
We've got to do something new.
23:14
And many times our bodies register that as being dangerous.
23:18
And it's scary because we're walking into a field
23:21
that we don't know what predators we might be experiencing.
23:24
We have no understanding of the path in front of us and what obstacles
23:28
we might be facing.
23:29
And so people will choose the path they know more frequently.
23:32
They know what dangers lie, they know how to avoid those dangers,
23:35
and they just want to keep going down the normal route.
23:39
But if we want something to be different, we've got,
23:41
we've got to do something different.
23:43
And we often don't do something different unless we are pressured to do so.
23:46
So that's also where the anxiety comes in.
23:49
And in addiction work, I think that shows up
23:51
where people are saying, I hit rock bottom.
23:54
Life became so,
23:57
and uncomfortable that I
23:59
couldn't do it anymore, that that was bad enough.
24:02
And I had to do something different.
24:04
So that anxiety can create
24:08
somebody then seeking help.
24:11
It's interesting because, one of the things
24:14
as an organization we challenge ourselves by is how to
24:18
communicate or be known that,
24:20
addiction care doesn't always have to be emergent.
24:25
Sure.
24:26
Like particularly detox and residential care,
24:29
you know, clinical indication of those higher levels of care.
24:33
So for those listening levels of care, you know, from detox, residential,
24:37
you know, intensive outpatient and outpatient, outpatient
24:40
being what you would consider like private practice.
24:42
We see somebody, you know, for an hour every week,
24:46
you know, residential care being that you're receiving
24:48
a certain number of clinical hours per day
24:50
and you're likely staying overnight at a facility,
24:53
and that might be eight hours a day or what have you, depending on the state.
25:00
Most people like
25:02
yeah, addiction develops into this place where it's like,
25:05
okay, now this is an emergency, a medical emergency,
25:10
you know, like I need to rest these behaviors and, and,
25:14
and we're going to provide a space for you to physically
25:19
and medically safely stop using.
25:23
And then right after that, it's recommendation of treatment
25:26
so that we can do some of the emotional,
25:30
dare I say, spiritual work that's needed to lay the groundwork
25:33
to change or be ready to change once
25:37
you leave this place.
25:38
What I think about, though, in you, in your experience in outpatient
25:42
care, is like,
25:44
how do you can you help people
25:50
exit into treatment before it becomes an emergency?
25:55
And how much of a challenge is that from an outpatient setting?
25:59
Because private practice
26:01
or like
26:01
me, maybe suggesting like you're seeing something unfold.
26:05
And how do you know when to recommend addiction care for those people are not.
26:09
Yeah.
26:10
Well, I mean, if we just look at the levels of care and the ASEM
26:12
recommendations, they're pretty clear on when we were making
26:16
that recommendation for someone to go to a higher, higher level of care.
26:20
But for me, it's when, number one, they have repeatedly
26:26
been unable to change the pattern that they're aging in.
26:30
So I don't always take just a abstinence only perspective in addiction recovery.
26:35
I'm in an outpatient setting, so I can
26:37
I work with patients that are always in a position where,
26:42
because of the substance, they just might have a problem
26:44
with changing their behavior. Right? It.
26:47
So something I'll offer at times, for clients
26:50
who are not in danger of harming themselves
26:52
or harming somebody else around their substance use, I'll ask them
26:56
just to not use for the next week,
26:59
and see if they cannot use before they come into the next session.
27:03
And let's say they repeatedly are unable to stop using within those weeks.
27:08
Well, now we know that they've lost control over that substance use.
27:11
And depending on the volume of the use and the potential impact of the use,
27:15
we might then start thinking about escalating that
27:17
to a different level of care.
27:19
Usually we would also be seeing, mental
27:22
health challenges for the individual as well.
27:25
So any kind of anxiety depression that they've been struggling with as well,
27:29
and maybe taking into consideration whether they want to change or
27:33
they don't want to change.
27:34
The interesting thing about the work that I'm doing is that they are
27:38
not mandated.
27:39
I used to work in a setting where most of the patients that I was working with
27:44
came to see me, because they got involved with the legal system,
27:48
whether that was a DUI.
27:51
These were
27:52
they got into a fight in a bar or something along those lines
27:55
that they then had a charge court mandated them to get an assessment piece.
27:59
I would evaluate what level of care they should be in.
28:02
But the patients that I see in outpatient, I don't have any
28:06
referrals at this point in time.
28:07
So everybody's voluntary.
28:09
They're there because they want to be there
28:11
or somebody in their family asked them to be there.
28:14
One of those two pieces.
28:15
And so depending on how much impact the substance use is having on their life
28:21
on a daily basis
28:22
and how much risk there is to that,
28:23
that we're going to elevate them to the next level.
28:26
I've seen people where they're drinking.
28:29
I'll reflect on some cases that I supervised in the past
28:33
where we had somebody come in and they were drinking
28:35
on a daily basis, multiple drinks every single day,
28:39
and start vomiting blood when they stopped using for a day.
28:43
That's immediate.
28:44
We're escalating that to a higher level
28:46
where they have to be in a higher level of care.
28:49
Or somebody who they're drinking
28:50
on, on a regular basis and they're having screaming matches
28:54
with their partner every single weekend, and they can't stop doing that.
28:59
And now they're starting to miss work.
29:01
And work is being impacted because they're substances.
29:04
Now we're seeing that impact and we're going to escalate
29:07
and make that recommendation.
29:08
But they go to a higher level care.
29:11
So recommendation is a good word.
29:13
What's the reality of how those recommendations are received.
29:19
Or like?
29:20
Because again, we're not in the business of like trying to change insight
29:24
from a systems perspective.
29:25
So how is that a challenge in terms of making a recommendation for somebody?
29:30
You likely believe that they could benefit from treatment?
29:34
And what comes along with that?
29:35
I think for I think there's a lot of systemic barriers
29:39
that make it difficult
29:40
for people to go to the care that they really need long term.
29:43
Some of those are societally based,
29:45
people who have those that they have got to pay.
29:47
And sometimes being able to take off work for 2 to 3 weeks, maybe even four weeks,
29:52
is something that would be an astronomical economic impact to them.
29:57
And being able to step away for
29:58
treatment is just an impossibility for their long term survival.
30:02
We could argue about that being an important investment in their
30:05
future or not, but some cannot see past the catastrophe
30:09
that that would cause if they were to step away from work for a month.
30:13
For some people, if they don't have health insurance.
30:16
And so to be able to be able to go is just larger than it would be.
30:20
And I think the probably the more minor issue
30:23
is just the stigma that people worry about what it means about them.
30:26
If they have to go to inpatient treatment for the substance that they're using,
30:31
the addiction they're experiencing. So.
30:35
When you make these referral, how often or not
30:37
is somebody taking you up on the recommendation?
30:42
So here's an ethical dilemma.
30:43
Yeah.
30:45
Let's say you know the individual that when they stop drinking
30:49
they're throwing up blood is like nope, I'm not.
30:54
That's not what I'm interested in.
30:55
I came to you to see you for care.
30:58
I want to continue to see you.
31:00
Sorry to ask you like the one of the most
31:03
difficult.
31:04
No. Classic, cleanser.
31:07
I have it.
31:09
I wrote a book chapter on really
31:13
non-scripted. Truth.
31:15
But I wrote a book chapter on medical family therapy
31:18
and how we apply that to substance use disorder treatment.
31:21
So it's essential.
31:22
And what can we do to, to provide an increased level of care for applying?
31:28
Can't go to inpatient treatment even if we want them
31:30
to go to inpatient treatment.
31:31
Now, mind you,
31:32
I might be every other session or every session telling the client you
31:36
you should consider this as an option that we can figure out
31:39
how to make inpatient treatment, residential treatment
31:42
be an option for you,
31:43
but in the meantime, here are the things that we might ask of you.
31:47
So I might ask a client to go to their primary care physician
31:50
and have I'm all done on them to see.
31:55
Are they medically stable at this point in time,
31:58
given the substance use that they're engaging in?
32:01
Are there any health care needs that they have that they could be
32:04
getting more done that I might consider, involving, especially
32:08
if something shows up on that blood panel involving a dietitian in the case,
32:12
because there are nutritional impacts for a lot of different substances.
32:15
And, in the food, medical impact that different substances could have.
32:20
But like alcohol use, for example, impacts the absorption
32:23
of other nutrients in your body.
32:24
So you might end up, well nourished
32:27
because either they've been replacing food with alcohol or,
32:32
absorbed the
32:33
nutrients that they need because of the alcohol use.
32:36
So I may also ask them to, see a dietitian to make sure
32:42
that they're getting the nutrients
32:43
that they need, the care in that capacity that they also need.
32:47
And then from there, other providers that we can integrate into
32:50
treatment is I can have the meeting or group therapy meeting.
32:54
So you if they can't go to inpatient treatment, I can say I can only treat you
32:59
under these conditions.
33:00
These conditions being I need you to go get, physical by your doctor.
33:05
I need you to go to a 12 step meeting three times a week.
33:09
I need you to also find a group that you're going to be going to.
33:12
And and we still acknowledge this is in the best care that you get
33:16
because you in a residential care where this is the only thing you have to worry
33:20
about is changing your behavior around the substance, around the addiction.
33:25
That would be best case scenario.
33:27
But this is our, our,
33:28
our best fix for the realities that some of the clients are facing.
33:33
That felt like a really, really good answer.
33:36
Felt like a cit,
33:37
like I was like, I, I should go to residential care.
33:40
I mean, I know it's all tongue in cheek.
33:42
It's very serious for some families.
33:46
Also, I, I wish that our society
33:49
made it easier for people to do it, like, Yeah.
33:53
Intensive focus on changing something for themselves.
33:59
Yeah.
34:01
It also has just struck me,
34:06
families are searching for these answers,
34:08
you know, how do we help motivate, change?
34:11
How do I protect, keep safe, my loved one?
34:15
There's probably a lot of a lot of partners,
34:19
brothers, sisters, families of choice
34:22
that are worried because they have exhausted
34:25
their own individual or collective ability to motivate change
34:29
and are searching for, like, real pragmatic, you know, suggestions.
34:33
So I just want everybody to know I really didn't know
34:35
about the medical family therapy chapter.
34:37
I promise I because that was not the tip of the century.
34:39
It was just organic.
34:41
But is there anything you would add,
34:45
you know, speaking directly to families who are affected by addiction
34:49
in terms of how to best support somebody that's active in their disease?
34:54
So this is to the family members. Yeah.
34:56
So the person is struggling, make their own changes.
35:00
So what do they need to do to be a healthier version of themselves.
35:03
And family members start taking care of themselves
35:05
because they have a family member who needs taken care of
35:08
because of the addiction that they're struggling with.
35:10
And I think that they need to go on their own journey of making sure
35:14
their basic needs are met, that they're working on their own mental
35:17
health through that process.
35:19
And I think the wisdom that I would like to give them is
35:23
you are not going to create a disaster by setting boundaries.
35:26
You're potentially creating an opportunity for growth,
35:29
and growth that could be life saving.
35:32
And so although setting boundaries and saying no might not feel comfortable,
35:36
it may feel like you're into that person and that you're not helping them,
35:40
that you're deserting them.
35:43
But it might actually be the thing that saves their life because you stopped
35:46
protecting them from the need to recover.
35:49
Yeah, it's hard to do.
35:51
It's really hard to do.
35:52
It can feel and often it is very real, you know, and the danger is very real.
35:59
And but I like the way that that was framed instead of
36:02
you need to draw this type of boundary or you need to have this type
36:06
of conversation.
36:07
It's like go on your own, health
36:11
mental health journey.
36:12
I think people are afraid of consequences and giving consequences.
36:17
Like I've heard parents say, I really don't want them to get arrested.
36:21
Arrest would be the worst thing that can happen to them and honestly, know
36:25
sometimes is the best thing that happens because then they see I'm not invincible.
36:29
I can't get away with this behavior.
36:32
The system has said, no, I need to do something different,
36:35
and that I've seen it and be the catalyst for change for people,
36:39
especially since I worked in a coordinated setting.
36:41
I saw patients where maybe they had they were
36:44
they only need the level one level of care, maybe level two.
36:48
But they got and then they changed their life.
36:52
Yeah, that they didn't get in trouble.
36:54
Yeah.
36:55
Because it never would have been bad enough.
36:57
Do you think that there are common themes through people who get recovery?
37:02
Do you think that there are
37:02
common things that are shared among somebody who,
37:07
get to experience?
37:10
I hesitate saying make it.
37:12
But surviving an active disease like addiction,
37:17
I really don't know the answer.
37:19
I'm just or too.
37:20
And I really would love to know the answer.
37:22
I think there's lots of different opinions on what the answer is.
37:25
People need in order to finally get their.
37:29
I think belief in self and the ability to change is one.
37:34
Knowing that you're good enough,
37:37
I think is another.
37:39
I think that if you don't see yourself as capable of doing important things,
37:43
it's going to be really, really difficult to go through the recovery process
37:47
and do a lot of new things you maybe never did before.
37:49
Super interesting.
37:50
I like I heard Hope, yeah, like.
37:55
Do I believe
37:56
that maybe, just maybe, this can work for me?
37:59
Yeah.
38:00
Like not know not confidence but and
38:06
that hope is I honestly part of why community is so valuable.
38:11
Being able to like meet and see somebody who,
38:15
from a 12 step culture perspective,
38:18
can share that they have a similar experience,
38:20
and then you can see that they, like, are paying their bills.
38:24
Yeah, like holding a job and perhaps have a relationship
38:26
and you're like, wait a minute, I am not able to do any of those things
38:31
and feel completely unstable.
38:35
But maybe, just maybe, let's like that little like
38:39
tic tac size portion of hope.
38:42
I think that's a great thing for anybody to reflect on is like, does that exist?
38:46
And and if not, how can I how can I create that?
38:49
I, I was thinking as you were talking about that, about how,
38:53
embedded in a lot of recovery treatment centers are, the,
38:58
there's the peer model of how do we help people recover.
39:02
And there's also this piece where a lot of
39:04
patients want to work with somebody who went through consults.
39:09
And I wonder if it is part of it is hope,
39:12
is that this person understood what my experience is.
39:16
This person really knows it
39:17
because they lived it and they were able to do something different.
39:21
And maybe that is providing hope just by seeing that,
39:25
seeing that somebody else has done
39:27
it has gone through what they went through and able to change their life.
39:31
Yeah. Okay. I'll shift gears.
39:33
I want to ask you what you think makes a good treatment center like you been
39:37
working in the field for a long time, you're making referrals, i.e.
39:41
you're recommending that people go to certain programs.
39:45
Likely you're not just telling somebody to go to Google.
39:47
And best of luck, you're likely guiding.
39:51
So what's important to you?
39:55
Aspirationally I wish
39:56
more treatment centers.
39:59
Really did care about their patients and listened to their patients.
40:02
I worry that I've had a lot of clients
40:05
come back from those experiences and say nobody really cared about me.
40:09
I was just kind of another number to them.
40:12
And that was my experience. And
40:17
sometimes there's people that come back from those experiences,
40:20
and they didn't really feel like
40:21
they worked on mental health issues that they needed to have worked on.
40:26
They felt like maybe the psychiatrist changed things up in their medications
40:29
just to change things up
40:31
and try something different, which certainly that can be effective.
40:34
But sometimes it's just changing things when they didn't
40:37
need to be changed.
40:40
I think the thing that
40:41
I have had the experience up here at Cumberland High,
40:44
has been seeing from
40:48
lots of different levels, lots of different professionals
40:50
that are here, how much they care about the patient first.
40:54
And I don't think that that's always the case.
40:56
I think patients need to feel like they are valued and not just in the number.
41:02
And if they don't feel valued,
41:03
I don't think they're going to experience that.
41:06
Yeah, yeah.
41:07
Will be hard to engage in a process some whatever you're asking to be done.
41:11
Why I'm here, if I don't really think that you're invested in my well-being or,
41:17
you know, if there are ulterior motives to which we're all here, then I'm like.
41:21
And people that experience addiction are uniquely gifted
41:24
to sniff out fraud.
41:28
Or insincerity,
41:30
you know, like, are you being genuine with me or not?
41:33
You know, like, are we are we meeting in this place of,
41:37
and maybe a product of that is like, just like the hard life
41:40
that somebody might live related to addiction.
41:42
So it's like, I don't want to fluff.
41:45
I don't want to check in, like, let's like, go, you know, like, let's connect.
41:49
So that's that.
41:51
I can do some research on and test and thus far have accessible
41:57
methods.
41:57
But I wonder if people who are struggling with addiction,
42:01
are super healers, like, more receptive to the
42:06
if the reactions of the people around them that they can feel personal energy.
42:10
So if the person next to them is anxious that maybe
42:13
they are more receptive to that than
42:17
this other person over here that doesn't have addiction,
42:19
that maybe they're super feelers, and then when they're in this environment,
42:23
they're affected by it even more, which then in recovery
42:26
means they are going to need authenticity,
42:29
to be part of the care that they're receiving for them to trust it.
42:33
Yeah.
42:34
Yeah.
42:34
That's super, super interesting.
42:37
I'm so glad you're here.
42:41
I think it's like a really it's been a,
42:45
grateful day for me.
42:47
I mean, most days I'm grateful that Cumberland Heights, don't get me wrong. But,
42:52
we spent so much time together.
42:53
It's an interesting process.
42:54
Like when you go through school and they're like, he's.
42:56
We've spent thousands of hours together working on research projects
42:59
with everybody else.
43:00
You know, Nicole and Doug and the whole gang and my fellow,
43:05
cohort mates, you know, and especially the center for me.
43:09
And then all of a sudden, you're just like, that is over, you know?
43:13
And where can you find and generate,
43:16
that's kind of an interesting topic for yourself, you know,
43:18
where are you going to be able to find a culture like that?
43:20
You know, where you can share ideas and all that.
43:22
So anyways, it's a pleasure.
43:23
I'm so glad you're here.
43:25
Thank you for coming during Dead Day.
43:29
So. Well. Okay.
43:30
Whatever. Yeah. So
43:33
I'm sure you have student emails to to follow up on
43:35
and all that, but I'd be really excited if you were able to come back.
43:38
The training today was stellar.
43:41
Rave reviews, maybe even figuring out a way for us to get more
43:46
of the Texas Tech crew out here to do something unique and special.
43:49
You know, so loved being here, loved
43:52
in the trees.
43:54
Shout out to the trees.
43:56
Shout out to the trees for those that are listening.
43:58
If you ever been to Lubbock, Lubbock is almost completely flat
44:01
and all the trees are not native to Lubbock.
44:04
Which begs the question where exactly did all the squirrels come from?
44:09
Nobody knows. Yeah, probably on the truck.
44:11
Truck by truck, squirrel by squirrel.
44:14
On my drive is.
44:15
There was a nice winding road through the yes River road,
44:19
and I reflected on how all of the driving I do is in a straight hahahahaha.
44:25
Lubbock is literally situated on a perfect grid, perpendicular.
44:29
Parallel. Yeah, so that's not.
44:32
You have to like really pay attention. Like grab the wheel.
44:34
You're probably like, oh yeah, yeah,
44:38
yeah.
44:39
That's funny.
44:40
Well we will thank you for listening.
44:41
We will link Christie's contact for information in the episode.
44:46
More resources perhaps associated with what we talked about.
44:49
We really appreciate those are listening.
44:51
I hope it's helpful.
44:52
If anybody has any questions, you can always contact us.
44:54
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44:58
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45:01
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45:03
Thanks and we'll see you again next time.