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Did You Fail Treatment or Did Treatment Fail You?

Honesty about Addiction Treatment

Episode 25: Honesty about Addiction Treatment Limitations, “Did You Fail Treatment or Did Treatment Fail You?“

An important part of understanding how treatment can help with dependence and addiction problems is recognizing the program’s limitations. What can an addiction treatment professional do to help? What limits do healthcare professionals and treatment programs need to be more honest about? Clare Waismann, RAS/SUDCC and David Livingston, LMFT discuss these questions and help illuminate how embracing limitations can actually be empowering to the patient.

Dwight Hurst, CMHC: Welcome back. Glad to have you with us listening again. This is a podcast to answer your questions on addiction, recovery and mental health by the Waismann Method Opioid Treatment Specialists and Rapid Detox Center. I’m your co-host, Dwight Hurst joined today by Clare Waismann and David Livingston. Today, we wanted to ask a question that grew out of one of our past conversations when we talk about how we can be helpful as professionals. And so our question today is how can we as treatment professionals maintain honesty about what we can provide and what we can’t? What is our offer to people who are coming in to get treatment and how do we stay, you know, honest with them about the limitations of treatment as well as the perks and the benefits?

Clare Waismann, RAS/SUDCC: From the people I’ve been speaking to in the last 25 years. I believe it’s really, really important for us as treatment providers to be honest about what we can and cannot offer, because so often I feel when patients say, you know, I failed treatment so many times, more often the treatment failed them, then they failed the treatment because they were promised, you know, and their families that their personalities would change their life, would change their reality, would change their mental health issues would be solved. And you can’t do that in 30, 60 or 90 days. So I think it’s really important as treatment providers to tell them exactly what you’re offering and exactly what your limitations are and what is your responsibility as a provider in what will be their responsibility as the patient, not during treatment, but after treatment. You know, we spoke about that before. We as human beings are always working on our health or mental health or physical health is not something that we do in 60, 30, 90 days. And then it’s over and, you know, the world will take care of us is a continuous process of staying healthy, staying well within yourself.

Dwight Hurst, CMHC: Yeah, I, I’ve thought before that the promise of sobriety is kind of like if you get a brochure for a really fancy hotel that just says, hey, just show up and it’s going to be great. And then you get there and they say, oh well, I mean, your room doesn’t have a bathroom and there are no beds and you have to work as a janitor. I mean, kind of right. Because you, I think sometimes we think I’ll just stop drinking, I’ll stop using and everything will be great. And it’s like, well, yeah, eventually it’ll be better. But at first you’re going to have to have a little more discomfort and pain and things and then it will then you can start to build something better. But when we over advertise it, I think so to speak, then we can set people up. It’s like bleak metaphor there, sorry if that’s a little too bleak.

David Livingston, LMFT: Yeah, yeah, yeah. You think there’s something bleak coming out of someone else?

Dwight Hurst, CMHC: David’s going to bring it home.

David Livingston, LMFT: Well, we’ll see. I know in our program because I think that’s what I can speak most to. People come in and we have, we have compared to most we have a shorter program because we get people detoxed quicker and they get off of the… And they feel better, faster. That is really the strength of our program, what we do and we get everybody off of it. So, you know, and we do it and try to minimize the length of it and the suffering involved, because, from my perspective, I don’t see that as existential suffering. I see it as neurotic suffering like it’s a suffering that does not help you grow. It’s just suffering to get something done that needs to get done. And we try to get it done as quickly and as safely and as so that you can get on to your life again and start to deal with the things that have to do with, you know, the conflicts and the problems that have to do with living better. So. So in terms of, you know, my goal, as is to give people real insight, personal insight into some of the specific things that are causing their compulsivity. Right. So so so that they can feel and see specifically for themselves what it is that that is making their ability to stay sober difficult.

David Livingston, LMFT: And then we try to put together, you know, a plan that will address that. And often that includes continued therapy, sometimes a psychiatric consultation. And we go through that and, you know, the positive and the negative. And I also talk about the positives and negatives of all of it, of therapy. I’ll even talk about sometimes people are interested in the 12-step or have had benefits. We go through that. So I try to give them a realistic understanding of what treatments are and the difficulties in them and what you need to look for in terms of finding and sustaining a successful treatment. So in other words, so one of the things you need is if you’re going to work in therapy, you need a therapist. You have confidence in, somebody who actually you go in and feels like they’re addressing the underlying concerns, the things that you’re struggling with in your life and where you feel like you’re learning something, you’re getting a greater understanding of yourself. You begin to have a feeling that you’re not only working it out in your life in the world but in the therapy specifically with your therapist. And so so that’s one of the things that I don’t think people even have an idea of how it can happen. So, for instance, let’s say people are full of frustration.

David Livingston, LMFT: Well, you ought to be able to titrate and discharge a lot of that feeling in the therapy and at the same time begin to think about things that you can say to other people, things you can do in your life that would help that, whether they’re very basic, like sleeping and exercising, or they’re about really addressing a concern with someone you’re working with whatever and the complexity of that. So so when you get into treatment, you get into like, what is it in your life that’s going on that makes this more viable, that makes you want to do it to, you know, use an opioid? OK, so that’s one thing. The other thing you need in terms of the treatment is enough time sober. Right. Because habits, habits are profound. Right. So we tend to be creatures of habit. And so having a break from a habit and having enough time to sort of reestablish a of their feelings and cope really is useful, too. So these are some of the things that I really look at in terms of what you know, and try to be honest and just clarify what is a treatment and what’s going to help someone get better as personal and specific to their life as I can. Yeah, I, I always talk too much.

Dwight Hurst, CMHC: Very much, not too much. No, not at all.

Clare Waismann, RAS/SUDCC: Not at all.

Dwight Hurst, CMHC: I was just going to say your phrase it in a really good way around as I was contemplating my depressing metaphor. It’s more like when there’s honesty upfront, you know, of like, hey, do you want to come to this nice place? But you have to work. You can get a pretty good job there. Sort of thing is what you’re describing is being honest upfront that this is going to be uncomfortable, there’s going to be pain involved. How can we help minimize the unhealthy pain and help you work on the healthy struggle, which is a struggle for health? That’s the way I’m hearing you describe it. And to a certain extent, probably need to be careful if you’re looking for treatment options and you’re not hearing the little bit of acknowledgment pretty upfront to say, yeah, this is hard work, we’re going to help you with it instead of we’ll take care of it.

David Livingston, LMFT: Let’s say you’ve got a regiment. So that regiment might be good for someone or it might be really bad for them. You have to understand how they feel about it. Right. So so compulsivity is driven from the inside. It’s not driven from the outside. It’s not a trigger that necessarily creates it. It’s more the conditions inside. Right. Because there’s stuff going on on the outside. But if you’re feeling good, if you’re feeling resilient, if you’re understanding how to put the brakes on and why you want to, and things like that. So but if you’re just getting pushed into things that don’t make sense to you, that don’t feel helpful to you, that you’re resenting, don’t want to do, will drive up your frustration. You know, and often people are kind of bullied into those things. It doesn’t help that I don’t see that as a productive treatment. Sometimes people will get into things and do things and say, I didn’t want to do it. But you know what? It’s helping me. That’s helpful. So what, you have to constantly be paying attention to this.

Dwight Hurst, CMHC: Hmm. Yeah. Yeah. Instead of being pushed into a kind of a mold, I got the opportunity to interview someone just the other day who runs a chronic pain facility where they approach it with cognitive behavioral therapy and things like that. And it crosses over with a lot of addiction. But one of the first things they said was if you run into someone who says this is what we do for Dick, Jane and Harry, and it’s the same exact thing, you should probably run away and go somewhere where they say, tell me about yourself.

David Livingston, LMFT: Right, exactly.

Dwight Hurst, CMHC: If I am a patient or a client coming in to get help, what kinds of things are good signs that I’m with a treatment provider who is being honest about their offer, who is being honest with me about what they can offer and what they can’t? What should I look for?

Clare Waismann, RAS/SUDCC: Well, I think I think the number one thing is a treatment provider that offers the same treatment for everybody – it’s already a red flag. Because now you’re not treating the patient. You are creating a condition, and I think that’s where a lot of people end up in this circle of one treatment after the other. Not every treatment is effective for everybody. And it’s really important to know, to hear the patient, to hear the patient’s history hear the patient’s needs, and make sure you know that there are different options. So, you know, people tend to push patients to receive what they have to offer. That’s a mistake. So that’s number one. Also, people that tell you that they can fix every part of your life. That’s impossible. That’s impossible. That’s unrealistic. And that’s a recipe for disaster because it’s going to get your expectations up there. And it’s there will be a failing result somewhere because they can’t fix everything. So and also, this is a team effort. So there are things that are unveiled during treatment that might need, you know, that will probably need long term care or assistance or, you know, a different plan than you had before. So A. is being flexible, being part of participation. And the expectation should be doing better than I am now and just going in the right direction. It doesn’t mean that you want an overnight solution. It doesn’t mean that you want a fast solution. It just means that you want to effectively do better every day,

Dwight Hurst, CMHC: As you put it. If they say I can fix everything about your life, you know, to a certain extent, there might be kind of a legitimate resentment to the implication that everything about my life is bad. I mean, I think sometimes that can be overstated in such a way to say everything about you needs to change. And I think what you’re describing of saying, like, I want to feel a little better than I am feeling, particularly in this one area of my life, not only is that more realistic, I also feel like it more acknowledges that a patient coming in with an issue has an issue not, oh, you’ve messed up your life. Well, we’ll try to pigeonhole, you know what I mean.

Clare Waismann, RAS/SUDCC: Listen, you survived whatever issues there are, so there’s definitely strength in there. There’s definitely resilience in there, there’s definitely something good in your life that made you look for treatment. So there’s hope. So those are all positive and strong things that you can build on,

David Livingston, LMFT: And so you go and go a step at a time addressing whatever the most relevant need is, right. So if someone just can’t sleep, you’ll figure out how to help get them to sleep because nothing really gets better until they’re sleeping well enough to address that from whatever direction is necessary. And then, you know, and then you go a step at a time which with needs as they surface and, you know, until people start to get their needs met more and more. And so if you understand what those needs are and you’re not loading them up on your own program, instead you’re helping them sort of meet their own needs and you’re talking about the limitations. So, you know, the idea that, you know, nobody can fix their own life, I don’t care how good your life is, but there are so many things in life that are out of our control, whether we like it or not, the most we can do is sort of “our part”, you know, and understand what that is and what that is and understand that the world operates on its own terms and so forth. But how do I participate in that? And given kind of all things considered, what do I do? Work and also just knowing the limitations of that is is an immense relief. I mean, that’s all I have to do is great. I don’t have to do any more than that by overwhelming people is this one of the worst things you can do. What you want to do – people often feel overwhelmed, which is why they turn towards drugs. So so the idea of really limits and the therapist knowing their own limits, talking about them really and keeping things simple. But but but moving right. A step ahead of the patient is a great comfort. So so like we’re talking about understanding the limits is not only it’s a great comfort, it actually aids in the treatment.

Dwight Hurst, CMHC: Yeah, yeah, and it opens up the idea that what we really do offer and how valuable that is. Right. I know when I have gone in to therapy and sat on the other side of the room as the patient, I remember being told once just very right out of the gate as we’re talking to two very important things that my therapist said to me is, well, this is a place you can come, you will always be heard and you’ll never be judged. And as simple as that is, and working in the field myself, knowing that both of those should be true, it made a huge difference right away, because that’s part of the offer that is legitimate, that, yeah, I can do that. And that makes a bigger difference than a bunch of promises someone might make that that they can’t keep.

David Livingston, LMFT: Exactly, I had someone who was they live in a different city, in a different state, and they wanted referrals to therapists and other people, and I said, I don’t know the therapeutic or medical community in the city and state your lives. So the process I go through with that, because that’s just people come in from all over the country as I start to go through. Do you have a doctor? Are you going to use your insurance? So there’s a process. So I’m participating with them like, OK, do you have a doctor you like? Call your doctor now, call him right now, see if he’s got a referral to somebody you like and respect as he know you. Yes. Great. OK. Is that something you think would be useful? So yes, that’s probably a good idea. But they’re still furious that I don’t know the medical and therapeutic community where they live. But that’s a limit I have. Right. It’s unusual that I happen to know somebody in a different state or city that I could give them confidence. And if they don’t have somebody, I’m like, well, why don’t we go online and why don’t we look and see what we can come up with and I’ll help you think about, you know, there’s limitations. So that’s “treatment” to me – it’s two people figuring it out together. Right. The need needs are real. They need to get met. And so what’s the best way?

Dwight Hurst, CMHC: Tell you the truth, it would kind of freak me out if I asked my therapist in California, do you know anyone in Cincinnati? And they said, Sam Jones. Oh, OK.

David Livingston, LMFT: Yeah, but that happens all the time. I get it. I get it constantly. And but at the same time, what they’re used to is just people saying, no, I don’t know what have done.

Dwight Hurst, CMHC: Right. Right.

David Livingston, LMFT: Exactly. Yeah, that’s it. It’s like, no, we’re going to solve this together. We’re going to come up with the best possible solution and then you’re going to start the process while you’re here. You’re going to make the calls here and the process is going to get started.

Dwight Hurst, CMHC: It starts out by that admission, I can’t really do that. But here’s what I can do. I think sometimes people, practitioners get weird about it. I mean, they get embarrassed when they can’t do something because they think they’re supposed to do everything. And then so they just shut down. No, I don’t know anyone in Cincinnati instead of well, I don’t know anyone in Cincinnati. But, you know, at being in the field, here’s what I would look for.

David Livingston, LMFT: So that’s one level is helping them get that need met and staying in with them on on a therapeutic process. What happens is if they get to be mad at me, they get to feel disappointed in me. And I don’t retaliate. I don’t make them feel guilty about it. I hang in there and assert what is healthiest and what and stay with their needs despite the fact that they’re having an experience of also feeling disappointed by me. So what’s therapeutic for them on another level, on a deeper level, is they actually get to feel what it means for them to have their needs and have some dependency on me and also have to handle their life. There’s a mold, which is what therapy is about. It’s about both of those things happening simultaneously. Yeah, we need other people and we need their help. But you’ve got to do your part to and let’s delineate and specify exactly what that is and then let’s make sure it’s getting done.

Dwight Hurst, CMHC: We’re going to take it out on that note, we can do what we can do. We can’t do what we can’t do, but we can do a lot. Want to thank everyone for listening and always being present to hear our show. You can check us out on Twitter @opiates or go to opiates.com. You can call our office at 800-423-2482 to get involved in the conversation, to ask questions or to get us talking here on the podcast. We love to hear your questions and we love to share whatever we know and whatever we can. I always sign off with the concept that when you ask questions, you find answers and if you find answers, you find hope. But that is really the foundation for what the show is based on. The song and music that we play is the song Medical by Clean Line Sounds. The show is produced by Popped Collar Productions for Clare Waismann and David Livingston. I’m Dwight Hurst. We will be at you again soon.