Are you struggling with fears about entering a treatment program? The process of beginning treatment for opioid or other substance dependence can be scary. Fear is bound to the process of overcoming symptoms of addiction. Believe it or not, that’s not a bad thing. In this episode, Clare Waismann, RAS/SUDCC and David Livingston, LMFT talk about the effects of fear, how fear can hold people back from treatment, and how to embrace the healthy components of fear.
Episode 13: Fear: Its Effects on Seeking and Entering Treatment for Substance Use Disorder
Peter Capaldi as the Doctor in Doctor Who: I can see through your hands there’s so much blood and oxygen pumping through your brain. It’s like a rocket fuel right now. You could run faster and you could fight harder and jump higher than ever in your life. And you are so alert, it’s like you can slow down time. What’s wrong with scared? Scared is a superpower and it’s your superpower that is danger in this room. And guess what? It’s you to feel it.
Dwight Hurst, CMHC: That was Peter Capaldi playing the titular character Doctor Who from the well-known British sci fi series. Oh, and before you add me on Twitter, I know his name is the doctor, but you can call the character Doctor Who. There is precedent for that in the series. So back off, nerds. Actually, you can add me on Twitter if you want. I’d really like to have that conversation. I’m one of you nerds. It’s OK. We’re friends. That comes from a famous episode of the show called Listen. It’s Episode four in series eight of Doctor Who. This theme emerges with fear being portrayed as a form of a superpower or an ability to be respected instead of well feared. There’s more dialog later in that episode from a different character, the doctors traveling companion Clara, where she says fear is a superpower. Fear can make you faster and cleverer and stronger. And one day you’re going to come back to this problem. And on that day you’re going to be very afraid indeed. But that’s OK, because if you’re very wise and very strong, fear doesn’t have to make you cruel or cowardly. Fear can make you kind. We’re going to talk about fear today. We’re going to talk about the fears that keep people holding back from engaging in treatment, getting treatment and getting into a more sober and healthy lifestyle can be very, very scary when you have been opioid-dependent or when you have been lost in addiction. Many of you out there know that as you listen to this program, many of you know it so intimately that you might even be in the throes of that kind of fear right now. One of the reasons that we present this information here on the Waismann Method podcast is that we want people to be able to make well informed, wise decisions about their own treatment and their own course of health management. So this is going to be an important discussion in that way. I predict you’re going to enjoy quite a bit. So let’s get into that with Clare Waismann David Livingston, where we talk about the effects of fear.
Dwight Hurst, CMHC: Clare, you were saying how fears are different for different people when it comes to being afraid to enter treatment, right?
Clare Waismann, RAS/SUDCC: Yeah, I think especially based on where they are on, you know, their substance abuse. I think it’s different for those who never seek treatment before and those that have been through numerous treatments. I think the fears are very different. I think also. You know, based on the age and social level of people, I think things are also different so that there are a number of factors. I think if we want to start with people that, you know, maybe not just realize, but that they have a substance abuse issue, but just realize that they do need professional help. I think that’s two different realizations. And for those that just realize and never had that issue before, I think one of the biggest fears is being labeled.
Dwight Hurst, CMHC: Yeah, I think that’s a really good point. People fear that. I think one of the things that I’ve noticed and there’s no rule for everyone who gets into addictive behaviors, but I always say that people who are at risk. One of the groups of people that are at risk for dependent addictive behaviors are people who actually have really big hearts because they’re sensitive and they get worried about letting people down. And then, of course, with the addictive behavior, they do let people down and then they hide it. And it’s terrifying for many people to have that dynamic. And so that being labeled, I think I think goes along with that fear of being labeled. I don’t know if you guys see that in your on your side of things.
Clare Waismann, RAS/SUDCC: I do, but I was going to see that as a secondary issue of letting people down once they got treatment. But I think the first thing they have to say is, “Wow, I cannot handle this on my own. I need professional help.” And that’s even before the fear of not, you know, achieving full recovery, I think is truly being seen as a first by the your family and friends and second by society is, you know, a word I hate to use an addict or as a person that will need to go to a rehab. I think there’s there’s a whole sections in terms in this bucket, you know, ergative. Somebody needs to go to rehab, somebody with substance use issues. And I think once you say that out loud, it puts you in that bucket bucket, all those terms all around you.
Dwight Hurst, CMHC: Well, you know, you’re absolutely right. I think that even just that identity, first of all, there’s the shame, right? But also just being able to say even just saying out loud, “I have a problem. This has gotten out of control.” I think there’s the fear sometimes of letting people down as well, saying, I’m going to go into treatment, I’m going to dedicate time and money to clean up, especially, as you pointed out, for some people, it’s the first time and they don’t know what they’re doing or they don’t know what it’s like for other people. It might be they feel like they’re in a revolving door and they’ve hurt their spouse, they’ve hurt their kids. And now I’m on that that track again. So I see those…
Clare Waismann, RAS/SUDCC: No doubts. But that’s why I was, you know, separating those who never received treatment to those who just realize that they need help. I think the shame and the hurt and everything else is usually more for those who have been through treatment numerous times because of the fear of being labeled. Does that make sense?
Dwight Hurst, CMHC: Yeah. So avoiding the label, putting, it’s kind of like kicking the can down the road further in a way. Right. A saying I want to avoid that label and so I won’t take care of it. And then of course it just just can get worse.
David Livingston, LMFT: On one level, we’re just talking about getting off some chemicals on one level, but that is a that’s a reality. If some chemicals that are causing problems, you just got to get off the chemicals. And once you’re off the chemicals, everything else can be worked out and just see it as simply as some chemicals that are screwing up your life. But you’ve got to get off of is really important because the overlay that is there and look. And so when you simplify it like that, often people feel like, well, you’re not addressing all these other things. And to some degree that’s true because you have to go one thing at a time. Right. And so the first thing is you have to address the need to get out, get the chemicals removed, and then you’ve got to understand how they were helping and how they were destructive because one of the biggest problems. And one of the reasons for chronic relapse is that nobody goes into why people like them and why and how they actually do help. OK, so it’s easy to sort of go in and everybody leads with how the ways they’re destructive. Right. But there’s also benefits as coping mechanisms. Now, they end up not being effective. They don’t end up working, which is why it’s it’s a neurotic cycle. It doesn’t lead anywhere. But but initially, there are needs that have to get addressed. And if those needs get addressed and there’s a sense of you seeing them as a human being, like a whole person who’s struggling with some aspect of their life, then then generally the fear goes down. But it’s hard for people to kind of pass all of that. You know, it’s hard to do that in a treatment. It takes time.
Dwight Hurst, CMHC: It’s really it’s really an interesting idea, you’re mentioning what a lot of people, I think we call a strength-based model where you’re trying to balance out you use the opioids for a reason right there. There’s a goal-directed behavior, which, as you put it, is it becomes very unhealthy. But acknowledging what someone’s trying to accomplish, a lot of times what we’re trying to accomplish when we get into addictive stuff is not bad. If I want to feel good, if I want to escape pain, if I want to a pain in the form of depression sometimes or, you know, those are good desires. It’s just the doing and the method that can become unhealthy, right?
David Livingston, LMFT: That’s right. So there’s neurotic suffering. Right to suffering that leads nowhere compared to sort of Texas suffering the suffering that leads to something better. Ultimately, part of a treatment is like working at anything. You know, it’s work. And so there’s a period, there’s a part of it that feels hard. But when you really start to feel the other side of it, when you can see the benefit and you can really start to do that, that’s what a testimony of treatment really starts to take hold. And often it’s only passed as an addiction, meaning this is that this is the problem. And like, you know, and it’s it’s so oversimplified that it’s not necessarily good. Even though some people struggle with sobriety, it can become so severe that that does become sort of the overriding concern for many people, maybe even most people. It’s not necessarily the case.
Dwight Hurst, CMHC: I know we’ve talked before about how once someone goes through the detox process, that’s when a lot of there’s a lot of work that begins at that point. Right. And what kind of fears pick up after they’ve gone through a detox process?
Clare Waismann, RAS/SUDCC: You know, I see the fear persisting if they are convinced that that bucket exists and that everybody is part of the bucket. I was speaking of so often times they have drug counselors that will tell them that relapse is part of recovery, that they need groups because their cravings will lead them to use opioids or they have to create abstinence of anything that can cause any mood alteration, sometimes even antidepressants. So…
Dwight Hurst, CMHC: I think that that can be very dangerous.
Clare Waismann, RAS/SUDCC: Of course you can, so when, you know, people are put in that box, I think they feel such hopelessness, such a sense of defeat, that whatever sacrifice they did to achieve sobriety, they will never be considered sober or part of normal society. And I think that’s absolutely horrible. And as David was saying, it is truly just it is just and is everything. But detoxification is truly just the use of a substance without being able to control. So that can be reversed without any major issues and without any long term commitment. But for whatever reason, those the substance worked for, if it is chronic pain or if it is emotional pain, or if it was a way that person found to deal with whatever distress they were dealing and helped them get through that distress, we need to separate what the physical dependance is, what the root issue is. And again, we fall back on the same conversation as always, and what treatment should be and what treatment providers, if not even offer, should promise or not.
Dwight Hurst, CMHC: There’s a fear that you mentioned and touched on, which is not being accepted back into a society. And sometimes that’s a family or a faith community or a job even or a profession. Sometimes there’s just that fear. And I hope the stigma is getting better. But there’s that fear of being like I am the bad guy, right? I am the addict. I am the one that is broken. And I won’t be able to achieve a full-fledged citizenship of whatever societies I’m a part of. And being that person, because of the things that we’ve done in the course of addictive behavior or other things like that, that, yeah, I’ll never really be considered OK.
Clare Waismann, RAS/SUDCC: Yeah, there’s always, you know, the notion that serving wine or saying be careful with that person. Well, the person you know, it’s Mary that had that again, you know, seventy six years old and had four hip surgeries and went to detox. But Mary never had a problem with alcohol or drugs in her life. But then there is that “Be careful drinking beside her.” It makes that person this fragile, you knowmindividual that everybody’s walking on eggshells around, and that’s not a pleasant place to be.
David Livingston, LMFT: Well, right, right. So you might say that fear needs to operate, correct. And one of the things that I I ask the patients is are coming through when I’m talking to them and I try to notice asking them if they felt afraid, you know, when they were taking and what they felt afraid of, because fear is the greatest inhibitory factor we may have. So when we when we feel fear, right. Not not an intellectual idea, but when we feel fear, it inhibits us. So often what happens is that you’ll see people that everything around them, you know, or the people around them or their fear of, you know, how they’re going to be accepted and all these other things. And then they use the drug from pensively to compensate for all these other things. And they don’t actually fear the dangers that are inherent in the use of self worth the risk they’re taking and that we all feel fear appropriately because when we fear something, we’re far more likely to pause, put the brakes on and it’s probably the most or at least one of the most protective processes we have. And so one of the things that happens when people are on opioids is they don’t feel much at all, which is why people, when they get off of it. Right, and then they think they can go back and take one or just this or that. They can’t because because not only does the reward system get triggered in the brain, but also the inhibitory system of fear gets lessened and lessened. So there’s no fear there’s a reward system going and people end up relapsing. So to keep fear alive in the correct way, right? To know what is not good for us is also critical. So it’s a fear has so many roles in this that it’s significant.
Dwight Hurst, CMHC: We’ve talked about things like pain. We’ve talked about happiness and anger. What do you think are some of the healthy uses of fear?
Clare Waismann, RAS/SUDCC: I think fear at the right level is a protective feeling, and I think it’s extremely healthy. It just, you know, needs to be at the right level. What that warrants a response. Does that makes sense?
David Livingston, LMFT: Yeah. So totally right. When I when I asked someone if they feel fear and they say they they don’t feel any fear around it, I immediately said to them, that worries me immensely for you. Right. Because that’s a dangerous idea to to identify with. Right. And I think there’s a lot of confusion just in our society about the word fear, you know, as if it’s something to just overcome always rather than immensely important part of our sense of wisdom. And, you know, like Clare saying and you both saying to how to protect yourself and, you know, and how to gauge, you know, what’s healthy and what’s not.
Dwight Hurst, CMHC: Sort of like hyper-awareness is oftentimes associated with fear or with anxiety, and that could be sort of that’s one of the superpowers of fear in a way. Right. Is or also one of the big pitfalls, too, if it spins out of control. But you’re kind of talking about an appropriate enhanced awareness of what’s going on. It in a way, it’s a balance right there where there’s you talked earlier about the fear of relapse, which I would call that to say a relapse is an inevitable part of my recovery, which, you know, people are taught. And so then there’s that maybe unhealthy fear. Right? It’s it’s an unhealthy fear of relapse versus perhaps more like what we’re talking about now, which is to say, yeah, I’ve got to be careful. Like, I don’t overblow it, but it’s like, you know, I should have some, you know, some appreciation that that it could happen if I’m not careful. Right. There’s the healthiness versus the the overwhelming.
Clare Waismann, RAS/SUDCC: But I think if we go back to the subject here of the fear of treatment, I think most of these fears are due to fake promises when people seek treatment. Or, you know, or an opioid dependence or an opioid addiction or mental health issues. Those are very, very different conditions. And I think the fear that most feel is because most people will fail, not because they failed, because they were overpromised. And I think when you talk coming up to talk about fear, the feeling of fear itself is what we’re talking about in the fear towards treatment is two different things, the fear towards treatment I believe personally that more and more group treatment will become obsolete.
Dwight Hurst, CMHC: Wow. So you feel like you will see less of that as the medical kind of focus gets?
Clare Waismann, RAS/SUDCC: I think there’s a there’s going to be a focus on a dependence that should be treated by physicians, especially when you’re dealing with alcohol that is, you know, an extremely dangerous detox. And I think then you have the mental health condition, the emotional condition, whatever that is, and that needs to be treated not in 30, 60 or 90 days in most cases, but on long term. And what one person needs is not necessarily what the other needs. And often we see patients, young patients coming in that are so broken. And, you know, they do have personality disorders and they do have severe emotional issues. And putting them in a rehab is is not effective, is even cruel. We see that often. We also see the want the person that doesn’t have an emotional issue, but they do have opioid dependence due to whatever medical issues they have. So, again, having everybody in the group holding each other’s hands and telling themselves how weak they are, how broken they are, how unprepared to deal with life they are in, how fragile they are to all those monsters that live around them in a way that cripples them even further to face life on life’s terms.
Dwight Hurst, CMHC: I remember when I worked for a community mental health facility, there was a an inpatient and an IOP program where people would come in all day or they’d lived there for a while. And in that treatment program, the clinical director had to kind of sort of bust the program staff because a couple of them were the very, very, very old school kind of mentality to where the mentality was, you know, give the patients a kick in the ass and then they’ll get sober. And they there had that problems, like somebody had to wear a sign with their character trait flaws on it. And sometimes they thought, yeah, you know, things like that. And so, thankfully, the clinical director came in and said, you get to knock that off, you know, and I think you get into that the old school mentality where it’s like if you can, you know, get a get tough, then someone will stop. And my my my personal experience is that a lot of them had trauma or like you said, maybe they have personality disorders and, you know, they will respond to the right treatments, but they won’t respond to that in a healthy way.
David Livingston, LMFT: The basis for treatment is, listening, the purpose of listening is to learn and understand who you’re working with and to really see them for who they are and really understanding how someone’s experience has shaped them and how what their strengths and limits are, how they’re organized as an individual. All of these factors are critical in understanding how to go about helping them. None of that is taken into account. And most of the treatment modalities that whatsoever, in fact, not even considered. And to the degree that people are struggling with dealing with trauma, you would have to deal with trauma over a very, very, very long time. And you would not want to detox somebody and open up their trauma simultaneously. That would be too much for anyone or a lot of trauma. Is someone being overwhelmed by something that’s not good for them? So the essence of treatment is to move at a pace and with an understanding as to what the patient can handle to be, you might say, one step in front of them and to move slowly and again, people take opiates, particularly because life overwhelms them. The worst thing to do in a treatment is to overwhelm someone.
Clare Waismann, RAS/SUDCC: And for the treatment provider to know what to dig and how deep to dig and when to do so to get a patient down that is going through detox. So it’s physically suffering and put them in a group to talk about all the trauma in front of everybody else and everybody starts digging and going deeper. It’s irresponsible.
Dwight Hurst, CMHC: Yeah, I had a boss once who we were in. He was over an outpatient substance abuse program and there was this big staffing meeting we had once a week. And there’s the one patient who had addiction. Issues and other other things, and people were talking about, well, we tried this series of workbooks and we tried this kind of approach here and this program and, you know, we tried all these kind of and they were all basically programs that were made already and they were just kind of throw in the patient into it. And finally, he is a psychologist. He just spoke up and he’s like, “Well, I don’t know, guys, heaven forbid we need to try some psychotherapy and actually talk to this person.”
Dwight Hurst, CMHC: And it just kind of set everything down saying, like, we need to maybe we need to get to know the person before we say here’s the 16 things that we make everybody do. Yeah. And I think that scares people off. I mean, I think one of the mistakes or traps that people can fall into is when they try something and it doesn’t work, then they get the fear that that that treatment doesn’t work. And as you always say, Clare, they may they may give up on treatment instead of realizing that what they need to do is give up on that particular treatment program or facility and go find effective treatment.
Clare Waismann, RAS/SUDCC: That would be the good news. The worst news is when, you know, they’ve been through so many treatments that they feel like a failure and they stop getting treatment because they just feel they are untreated and treatable. You know, I think the system we have such a loss of opportunities to help people in so many ways. You know, David, how many times do we see parents saying this is his last treatment? I’m not paying for another one. How many times do we hear that?
David Livingston, LMFT: A lot.
Clare Waismann, RAS/SUDCC: And the sad part is this person really never received treatment. The parents paid for treatment, but the person never really received treatment. He was in a rehab for 30 days, you know, hanging, smoking cigarettes, sitting in a group. But this person has severe mental health issues and he’s never received treatment for that. So families give up on them. They give up on themselves. And that’s that is a tremendous loss of opportunity. You know, people that overdose and go to emergency rooms. What happened to those people, you know, medical help the next morning? They are out there again. So I think when somebody calls for treatment, we have to be very careful what we are promising them.
Clare Waismann, RAS/SUDCC: We have to be very honest with ourselves, what our limitations are and what they are receiving. And I think that at that point, they you know, there won’t be there will be less failures from us and from them. Nobody can give you a decent 30, 60 or 90 days. And it’s unfair to promise.
Dwight Hurst, CMHC: So as we’re drawn up to to wrap up for today, I thought it might be good to maybe throw out one or two things that can help overcome that fear that holds people back. And maybe the first one is that I’ll throw out is information getting good information from calling a program, I mean, like Waismann or calling someone who would know. And sometimes it’s talking to loved ones who’ve been through it. I think information is a form of self-care in a way that can combat fear, especially if we try two or three sources and see what is out there.
Clare Waismann, RAS/SUDCC: You know, I think we as health care professionals need to be humble enough and honest enough to be very clear of what we are providing and what our limitations are. You know, I am very clear with patients. We offer them the best foot forward. We offer them a detox, a medical detox, so they can be emotionally present and hopefully in the short amount they are with us. David, you know, can start assessing them and have a plan forward. What they will need if that is put at risk, if there is long term psychotherapy, if that is, you know, finding something that is going to keep them productive in life and giving give them the feelings of feeling good enough for being part of society is understanding that, you know, the moment they are in. Is not exact, is not who they are. It’s just a moment.
Dwight Hurst, CMHC: That self-insight, that kind of self reframing is another good, good way to battle fear, right, is to say this is something I’m going through. This isn’t me, it doesn’t define me correct.
Clare Waismann, RAS/SUDCC: This is distinguishing the person from the moment they are in.
Dwight Hurst, CMHC: Yes, David, what do you think is a way to combat that fear?
David Livingston, LMFT: I think, like you’re both saying and, you know, information and a realistic understanding of what you can expect and then and then delivering on that. What we do is we get people detoxed, we get them feeling better. We look after them physically and provide a really respectful and kind experience in which we remind them of why they made such a good decision to try to move their life in a good direction and the people that we work with are oriented that way and understand things that we’re going to do. And then my job really is to help them, get to know them, understand them well enough that I can provide some insight into what it is that’s driving them to want to do or needing to do the opioids. And in that varies greatly depending on lots of things. But that insight then, you know, and then sitting with them, figuring out a course of action to take what they’ve accomplished and move it forward and continue it in the ways that make sense. That’s really that’s a that’s a profound and successful process. If you can if someone can walk out having had that experience, that is significant. And because not only is it helped them feel better about who they are, not only they accomplish what they set out to do, not only are they off of whatever they came in on, they’ve had an experience in which they have been reminded of why they did it and who they are. And then they can, of course, forward, if you can provide those things for people, which is really how I look at it. And I think what the two of you are saying is significant. And that’s that’s that’s what we try to do. Certainly what I try to do.
Dwight Hurst, CMHC: And we’re going to leave it there, but it’s a fascinating discussion that were able to have. I know I learned a lot about fear and facing that before we can make major life changes. You know, as we said, information is a great source of self-care and a way to face your fears if you or anyone that you love or that you know is looking for treatment but is holding back because of fear and anxiety. Make sure to gather information places and people who are confident and competent professionals in that area maybe gather from a few sources. You can, of course, always get information from Waismann Method®, call 1-800-423-2482 or check out our website opiates.com. You know, you can always hit us up on Twitter at opiates, especially if there are questions that you would like to see us talk about here on the show. Our music for the show is the song Medical by Clean Mind Sounds. Waismann Method, as always, is produced by Popped Collar Productions, a company specializing in the creation of your next podcast. Check us out at poppedcollar.net to learn more. Well, for Clare Waismann and David Livingston, I’ve been Dwight Hurst. We’re so grateful to have you as always. Once again. Remember that when you’re gathering that information, you want to keep asking questions. If you get information, if you answer your questions, you can find some hope. Have a great week. We’ll be back again soon.
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