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Societal Chains & Personal Gains: The Ethical Quandary of Addiction Treatment

Concept of ethics in addiction treatment: Small man entering a huge mysterious maze.

Episode 54 Transcript: The Ethics of Addiction Treatment: Balancing Personal Freedom and Societal Responsibility

In this gripping podcast episode, join the thought-provoking trio: Clare Waismann, M-RAS/ SUDCC ll, David Livingston LMFT and Dwight Hurst, LPC as they dissect the intricate maze of addiction treatment, highlighting the delicate balance between ethical considerations, individual rights, and societal needs.

Embark on a narrative journey that delves deep into the core issues faced in addiction and mental health treatments today. The conversation takes you on a roller-coaster of emotions, diving into the blurred lines between behavioral actions and underlying mental health issues, the challenges of confidentiality, and the pivotal role family dynamics play.

Discover the nuances of integrating court-mandated treatments with personal choices, and how the judicial system, with its power, can either aid or hamper an individual’s path to recovery. Learn about the potent mix of structure and warmth that can transform treatment centers, and the enduring importance of confidentiality in healing.

Engage with these experts as they emphasize the cardinal role of self-control in addiction treatment and underline the paramount importance of a tailored approach in aiding an individual’s journey towards recovery.

Immerse yourself in this enlightening conversation, where the realms of addiction treatment are unfurled, juxtaposing the critical legal, personal, and ethical considerations against the backdrop of individual healing and societal well-being.

Dwight Hurst, LPC: Hello and welcome back to Addiction, Recovery and Mental Health, a podcast by Waismann Method Opioid Treatment Specialists. I’m your co-host, Dwight Hurst, and I’m joined, as always by Clare Waismann and David Livingston. Clare. David, it’s great as always to be back with you guys. How are you all doing today?

David Livingston, LMFT: We’re good.

Clare Waismann, M-RAS/SUDCC II: We’re good.

David Livingston, LMFT: Nice. Yeah. Ready to roll. Nice to be talking with you.

Dwight Hurst, LPC: I heard a rumor that you’re busy down there at Domus, David. Not that you’re ever not.

David Livingston, LMFT: Yes. Yeah, yeah, it’s good. It’s good.

Dwight Hurst, LPC: That’s good. Well, an exciting topic today that I think everybody who certainly has worked in addiction treatment and probably just about everyone who’s a consumer of services as well as a patient or whatever, has dealt with these very interesting ethical questions. So our topic today is the ethics of addiction treatment. How do we balance personal freedom with societal responsibility? Right. There are a lot of issues and dilemmas that do come up with addiction and treatment, like, for example, voluntary versus mandatory treatments. And a lot of times that involves not only medical advice and family feelings, but also the legal system sometimes is a big obviously, part of mandatory treatment. How patient confidentiality is part of that, the ethics of how do we balance people’s personal freedoms and choice and sense of agency? And then we got to balance that out with the societal responsibility and safety. And, you know, some of those times where people’s choices are being affected by their addictions. So there’s a lot there’s a lot of meat on this particular bone, if you will. Um, so what are some of your feelings about, the ethics of issues that are involved and that come up with treatment?

Clare Waismann, M-RAS/SUDCC II: So for me, one of the main ones is when you say, you know, personal freedom and court-mandated and societal responsibilities, it’s really important to understand what addiction is, is a symptom. There is a root issue that is usually mental health. The behavioral side of it is a consequence, again, of a condition that has not been treated. So I think the biggest issue we have in society nowadays is those who make the decisions for patients are not always trained to make adequate decisions. So people end up on these revolving doors, endless revolving doors to get nowhere, and the condition just progresses. So then you are faced with homeless people everywhere, crime. And, you know, most of it stems from untreated mental health patients out there. So again, when we start with, you know, who should be making these decisions, we have to think decisions regarding what behavioral issues, mental health issues, medical issues. And I think those things are not distinguished. And because the addiction business is worth, you know, 40, 50 billion a year, people continue to make money. But unfortunately, the vigils are getting hurt by the continuous lack of, I guess, individuality, assessment, diagnosis, and all the above.

Dwight Hurst, LPC: It’s an interesting thing to look at. I know we it comes up all the time. That behavior is altered and affected, obviously by addiction, especially when people are, you know, actively using drugs or alcohol in a way that is self-destructive or abusive or out-of-hand. And those behaviors oftentimes end up interacting, obviously, with law enforcement or neighborhoods or communities. There’s all sorts of social rejections that come up as well. And man, it can be hard to sort that out when you have especially it can be a complication to treatment when you’re trying to satisfy. If I’m trying to balance out a lot of relationships, especially if you throw in legal concerns and trying to navigate through that while at the same time trying to take away my self-medicating coping skills, even if they’re unhealthy, they’re still there. Right. And then to strip those away at the same time that somebody hands me a packet and says, do all these things or you go to jail, it’s very overwhelming. Right.

Clare Waismann, M-RAS/SUDCC II: Right. And I think especially now, I think we are in a different level than we have ever been. I think we’re watching our society deteriorate, you know, right in front of us. We’re watching a whole generation of young people being poisoned by fentanyl right in front of us, you know, And our focus is on things that really

do not matter that much when we’re dying. The focus is so misguided at this point in society is vastly deteriorating.

Dwight Hurst, LPC: What are some feelings about mandatory treatment? I’ve worked a lot with people who have been in that one way or another. And I’ll tell you, I just have come away with very mixed feelings when I see that. Are there people who would be dead if they weren’t pushed into treatment? I think certainly I’ve witnessed that. Then again, are there lots of people whose treatment is complicated to the point where they don’t succeed because of those stress and pressures if it doesn’t work? Well, I mean, I’ve seen that too, so I don’t know. What are your guys’ feelings about that?

David Livingston, LMFT: I’ve never worked in a system in which people are mandated by, you know, legally. Maybe that’s not entirely true, but it’s mostly true. But very, very rarely. Certainly, that’s not how things are set up here at Domus at all. There is often family pressure or pressures that come in other ways that don’t have to just be legal to get treatment. But I think you can address honestly and sincerely whatever those conflicts may be within any individual, you know, by just talking to them about what part of them wants to be in treatment, what part of them doesn’t want to be, and really giving them a chance to kind of get to know that conflict within them so that they begin to understand themselves better. You know, that’s one side of it, one small side of it. Give given how dangerous things are these days, I think there’s a lot more fear and a and rightly so and a lot more push to get people into treatment early or into some form of it. So it’s it’s it’s complicated. Like all the things we talked about, like you said, Dwight, there’s there’s a lot to it.

Dwight Hurst, LPC: Yeah. And you know, we don’t always talk about the fact that there’s this great balance in treatment anyway, which is there’s always a balance between doing it for myself to get healthy, which we always hold that up as the ideal, obviously. But then there’s the doing it for others. And I’m going to say others can be anything external: family, job, legal, either a vague or direct threat of losing things. All of that is you know, I think we do a disservice if we pretend that that’s not there. In other words, I think sometimes in the world of platitudes and affirmations, we can say, you know, do it for yourself, not for anyone else. And while I feel like there’s a truth to that, if

we don’t have anything or anyone or any reason in our lives, I do feel like we are you know, we do need community, right? We talk about that a lot on here and we need reasons. It’s just trying to find the right balance for that person to say, yes, I want to be healthier because I ultimately probably won’t if I don’t want it. But on the other hand, if I don’t have any reason to, you know, there’s a lot of complicating factors there. If I don’t feel any compelling reason.

David Livingston, LMFT: Right. Right. I mean, not to be trite about it, but I think if anything, it’s more compelling to do it for everybody else than it is for yourself. Um, you’ll benefit eventually too, because you will feel good if the people who you’re doing it for you love and they love you, well that ends up being for you too. And that’s probably the most compelling reason. And maybe what holds society together more than anything I can think of is communities and families and friendships and people taking care of themselves in part because they want to be part of their group in whatever form that is. And even successful treatments, successful therapy. There is a bond that carries forward the treatment which is worth showing up for each other and we’re doing this for each other. And then it, then the effect for ourselves happens. I think it’s almost reversed is the more I think about it.

Clare Waismann, M-RAS/SUDCC II: But then I have to ask both of you, what do you describe as treatment? Because we’re talking about addiction, right? And societal responsibilities towards addiction. What is “treatment”?

Dwight Hurst, LPC: That’s a good question. Dave, you want to start with that? Um.

David Livingston, LMFT: Yeah, but how much time do we have?

Clare Waismann, M-RAS/SUDCC II: Listen, we’re talking about people getting treatment.

David Livingston, LMFT: Yeah. Okay, so.

Clare Waismann, M-RAS/SUDCC II: So and feeling good. I mean, what. What is.

David Livingston, LMFT: Treatment? Okay, okay, so here’s my way of looking at it. I’m going to sum it up as quickly as I can. In essence, treatment is building, helping, helping whoever, whomever you’re working with, build the life they want and in essence building a home inside of themselves and a home outside of themselves. And in so doing, their reason for going back to the addiction is so diminished and they so want to protect what they’ve built, that whatever compels them to act otherwise is so diminished. And there are safeguards in place and the safeguards are the building of a life inside and outside. And from my perspective, that’s how I approach “treatment”. Now that’s complex. There’s a million things that inhibit that from happening and are complicated, and people come to that with sometimes great deficits or conflicts and sometimes great strengths. So it’s varied. And so in terms of the substance or whatever that dependency is, it does inhibit the building of a home inside and a home outside. It inhibits healthy dependency on people, healthy interactions, the ability to play, the ability to have, you know, friendships that aren’t just related around addiction and things like that. So it is about building a life. Ultimately, I look at it far bigger. But, you know, you go a step at a time. And sometimes the major step and is just keeping somebody off of the dependency on a substance. Sometimes that may be the treatment for a long time and sometimes that falls to the background very, very quickly.

Dwight Hurst, LPC: I think part of what you’re talking about there, David, is do we have the freedom to do treatment planning as a patient? And do we engage in that as a professional? Right. And whoever that treatment coordinator or multiple coordinators are, is it my doctor, my therapist? Am I going through, you know, getting that feedback? But is the person listening to me and are we treatment planning together? Right. Because you’re talking about there’s a lot of those principles that apply of health and health care management. But, you know, from an ethical standpoint, I think that one of the biggest ways that that treatment industry can drop. The ball is in trying to fit people into a programmatic approach that is, this is treatment. We’ll tell you what treatment is when you come in. And I think you’re saying like treatment is something to be developed and invested in between the person and their their their, you know, treatment team, I guess is one of the modern terms, right, for medical intervention.

Clare Waismann, M-RAS/SUDCC II: What you’re describing, David, is probably, you know, the goal of what treatment should be. But when we talk about society as a whole, you know, the majority of people, they are they’re not going to get this individualized care or diagnosis. Right. So…

David Livingston, LMFT: No, you’re right. And, you know, primarily treatment is based on sobriety, as far as I can see widely. That’s the primary focus is on sobriety, and sobriety being maintained. And if sobriety is maintained, then it’s a successful treatment regardless of how someone’s living their life. And so and I can see that as a valid aspect of a treatment for many people, maybe most everybody. But there’s a lot more to it, what I was suggesting. But I think in general that when you talk about the ethics of addiction treatment, the overall standard is getting people sober. That’s the primary focus.

Clare Waismann, M-RAS/SUDCC II: Yeah, I see it more again, when you generalize most treatments out there, I see them more focusing on behavioral health, than mental health. And I think that’s a significant mistake is what someone should do, how they should behave, how they should live their life completely ignoring, again, the patient’s capacity to do so, you know, the ability to do so, want to do so. And pretty much ignoring the individual.

David Livingston, LMFT: Well, I couldn’t agree with you more. And while behaviors matter immensely and what people do is affects how they feel and on and on, you also have to understand how an individual is organized and what their conflicts are, what their deficits are, what their strengths are, what their, you know, what their life is like when they go home and so forth, so that you have a sense of really how to work with them. And I don’t think that is even thought about in treatment programs. I think it’s it’s brought down to a very baseline of “Are you sober?”, “What can we do to keep you sober?” And that’s just a primary motive. And then it’s all about what behavior, you know, is avoid triggers, avoid. And honestly, most of that’s impossible over time, if something makes you more vulnerable, yeah, you should avoid it. But over time you’re going to have to learn how to manage your inner life and your outer life. And that’s that’s if you’re going to maintain not only just sobriety, but build a life, you want that. That’s got to happen.

Dwight Hurst, LPC: It’s interesting the concept you mentioned of things that are impossible, right? And not setting your whole goals around, like never being triggered, for example. That would be the extreme of what you’re saying is eliminate all triggers or well, for example, you know, I had someone tell me this years ago, I’ve thought about this where someone told me a turning point for them in managing their drinking that had gotten out of hand was they had to accept that. I can’t get mad at 711 for selling beer. I need to work on how I can engage with 711 or what if that makes sense. This idea of like, I can’t, I can’t I can’t bank on the world, you know, accommodating what I’m trying to manage. I need to figure out how to manage my addictive impulses and things like that.

Clare Waismann, M-RAS/SUDCC II: But again, I think I think if you go back to the same place, if you deal with the root of that compulsion of that craving, then you don’t have to spend a lifetime managing it, you know.

Dwight Hurst, LPC: Very much so. Yes. The internal work. Yeah.

Clare Waismann, M-RAS/SUDCC II: Correct. You know, I had a I had a very good friend that was the owner of one of the most famous rehabs in the country. And he used to say to me, we used to have lunch once a year. And he would say to me, you know, “If I had a pool of coke, I would do all of it.” And this is a person that was off drugs for 30 years. And I would say to him, “I don’t I don’t get it. Don’t get it. You have you know, you have gone so far in your life. You haven’t touched a drug in 30 years. You have a family. You have a business, you have grandchildren. Why? Why?” But, you know, you convince yourself that you have no willpower and that addiction is bigger than everything in your life. But it’s not. It’s really a consequence.

Clare Waismann, M-RAS/SUDCC II: Think getting the right perspective makes it less scary.

David Livingston, LMFT: Well, it sounds like this person could have a pool of it if he wanted. He or she wanted.

Clare Waismann, M-RAS/SUDCC II: He could.

David Livingston, LMFT: Say that’s more of.

Dwight Hurst, LPC: A feeling of if someone backed a dump truck full of coke up to my house versus I’m going to go buy one. He obviously wasn’t going out and purchasing it, which you’re saying like he could have. Yeah, that’s a good point. Yeah, that’s interesting, but.

David Livingston, LMFT: Right. But I actually do understand that because it’s a confusing thing because in one way, it’s the person is saying, you know, I’m going to be vulnerable in this way forever. And in another way, they have the capacity for whatever they want at that point and they’re not acting on it. So they have immense agency in the world and the two haven’t been really integrated, but somehow it’s working for them well.

Dwight Hurst, LPC: And there’s an interesting relationship between the external and the internal. And I think this ties into the ethics as well, because you can’t control stuff on the outside of you. But you have to understand that it’s there and the internal work, I mean, there’s the internal work of saying, I could walk right by that pool full of drugs or whatever. But there’s also the internal part of saying, I need to stay away from that house where I know someone keeps drugs in their pool. I’m overextending the metaphor at this point, but you get what I mean, right? Right. There is kind of like a relationship of the internal and external. And I think some of that also comes with knowing and trying to work on where am I at? Am I at a point that if I’m in the wrong situation, I might ingest drugs or alcohol? If it was present, then I probably need to work on my internal controls to avoid the external presence versus I think I think where you’re going, Clare, is that hopefully the goal that we kind of eventually, you know, should try to get to is that my internal is stronger, gets stronger over time to where I could have it presented to me and I could still get out and get away from it. At least that’s what I’m hearing is there’s a and once again individualized everybody’s relationship with their

own internal health. And the way they interact with the external world is going to be it’s going to be somewhat different, right?

Clare Waismann, M-RAS/SUDCC II: Yeah. And again, having tools to deal with it, you know, with cravings and wantings and that’s extremely important. But again, we’re talking about a very minuscule part of society nowadays that has the ability to have all these options. Most people nowadays don’t have any options when they’re sent to rehab is you go to rehab for 30 days because you’re mandated and there you sit all day and sit in meetings. You’re never really seen. You’re never really treated well.

Dwight Hurst, LPC: That’s interesting because then we get into the ethics of availability, right? I mean, that’s the number one thing. Even when they do studies, it’s I’ve heard people laugh at this kind of study where they, you know, the number one predictive factor of success in treatment is whether or not you go. Now, people laugh at that and say, that’s silly. Why do they even need to study that? But that goes into a whole, once again, societal right, societal, ethical dilemma of what is access to treatment, How do we encourage it? How do we educate people on it? How do we facilitate that?

Clare Waismann, M-RAS/SUDCC II: But that’s where I was asking you guys, what is “treatment”? Just sending somebody to smoke cigarettes for 30 days with other people struggling with addiction and mental health. For me is not treatment. Well, for me is a way for them to feel unseen and heard, more frustrated. And when they leave there, they’re craving more.

David Livingston, LMFT: So the depth of a person’s enthusiasm and commitment to anything and and how good a fit, whatever it is that they’re committing to, I think has a tremendous amount to do with the success of of any treatment or any program, regardless of what it is.

Clare Waismann, M-RAS/SUDCC II: What if they don’t have the mental capacity period?

David Livingston, LMFT: They don’t have the mental capacity. In what way?

Clare Waismann, M-RAS/SUDCC II: Um, again, they are limited by IQ or by mental health or by any other issues that they might have. And and they are expected to be able to make these decisions in these everyday successes when they cannot.

David Livingston, LMFT: Well, I mean, that’s it’s harder. It’s harder. The less resources, the less capacities. I think things are harder, period. And so but you can pare down your expectations and you just work with people wherever they’re at. I don’t think it’s really not my even though I’ve said a number of things about what my idea of treatment is like in terms of building a home inside and outside. But what that looks like for one person could be an entirely different universe than it is for another person. And I think you have to account for all the things you just said and you work with people where they’re at. I do think one of the problems is that there is not really an ongoing relationship created that is sustained over time. And there is a lot of research says that that’s the best thing. I think you have to get off of a substance. You need a good experience, and then you need a process moving forward from there. I mean, sometimes there’s there’s longer processes that give people more time of being off of a substance and help them. But I do think you need a long-term commitment to learn and grow and pretty much anything.

Clare Waismann, M-RAS/SUDCC II: Yeah, no, no doubt. I just went back because, you know, we were talking about the ethics of addiction treatment period. Right. And the, the societal responsibility towards it. That’s why I keep going back to what happened in most cases where people don’t have that time, where people don’t have that individualized, you know, attention, I’m not even going to say diagnosed because that’s beyond.

David Livingston, LMFT: Right. I mean, I think I think, you know, AA has tried to fill that gap and does it well for some people and not well at all for others. But you look at the people who do well in that program, there are people who have profoundly committed to it. And I’d say the same thing for any therapy-based process. I know from my own experience that when there’s a real commitment, things tend to get better.

Dwight Hurst, LPC: It’s interesting, when I worked in community, a community mental health setting before moving into more private practice, we had a connection and some contracts and things that were with the court system. And when people were caught and charged with certain crimes, they were given sometimes even the opportunity to reduce the charges. But I will say, you know, community mental health with a low cost and with, you know, a lot of infrastructure struggles, let me say, of one kind or another without getting I don’t want to get lost in the weeds of some of that. But. Right. But the issue or one of the things that I thought was very interesting is although we saw all kinds of different people, I will say the vast majority of who we saw were people who were in a more indigent socioeconomic circumstances. Right. Those were frequent fliers, so to speak, through the criminal justice system or those who were impoverished or, you know, I mean, we had a few come in who were of maybe greater means, but we had a legislator that got a DUI during the time that I worked there. And we were all like, oh, you know, my boss was like, okay, who wants him if he comes in? And but he didn’t. We didn’t see him, you know. And so I think when we’re talking about ethics, I feel like one of the things Clare is bringing up is access to care. And to your point, David, you know, I think that the support groups, there’s a big difference between professional treatment and just having a support group. But the accessibility and the fact that many of those are free community groups does make something available to people if they can’t afford anything else.

Clare Waismann, M-RAS/SUDCC II: I agree. And again, not to undermine the support groups because I think they have tremendous value. You know, a of belonging. A lot of people that have been struggling with addiction, they isolate so belonging and again, feeling heard, feeling understood. I think all those are extremely important factors that make people go back to meetings, you know, and sit there and participate. So although they are truly not to replace treatment or detoxification, they do have their value for some for others. And I think, David, we hear that more often than not they could cause cravings. Some people just want to put their addiction issues behind and live a life without having to be reminded everyday of their issues. So again, everybody’s different and their needs are different.

Dwight Hurst, LPC: And that goes back to the ethical question too, of if I’m handed a packet upon my, you know, I don’t know, arraignment or just because I go into maybe even maybe I even go into my family practitioner and they hand me a packet or a flier that says, do these three things. That’s not really that’s not really treatment. Even if some of the things on that list are technically treatment professionals, it’s not a treatment at that point. And even if it starts there, it’s not a treatment yet. Right? It’s not really entering into anything yet. It’s just being told what to do. And I feel like that’s what you’re talking about, too. Claire, when you say behavioral, more than mental health, behavioral health, more say do this, do this, do this and that has a place because. Yeah, but, but yeah, it’s not really addressing anything yet.

Clare Waismann, M-RAS/SUDCC II: Correct. I think I think there is the side of it too, you know, when you are in court being sent somewhere, you know, are you a risk to society, are you a risk to yourself? What are you capable of, of in the situation you are? So sometimes people truly cannot make decisions or have options because they are so… how can you say… dysregulated, right? They are so not capable of making any healthy decisions that sometimes other people have to make those decisions for themselves. The problem is, again, is people being sent to places that are just taking that money from the insurance or the government and doing nothing for the patient, allowing them just to sit there and time passing by until that money is used. If you figure that we have over 5% growth on addiction businesses yearly in this country and the addiction…

Dwight Hurst, LPC:  Is pretty busy and are growing…

Clare Waismann, M-RAS/SUDCC II: And the addiction issues are not getting any better. They’re getting much, much worse. If you think about where we were three years from now and where we are now. So again, it’s, um, what our treatments and how long are we going to keep not treating people.

Dwight Hurst, LPC: I feel like sometimes when we say, you know, even today’s topic, right, the societal responsibility versus the personal, how much a societal risk do we take by not offering treatment, right? Or by not facilitating it or not doing it ethically?

Because I think sometimes we think of societal risk as in the old school mentality is get someone to knock it off or get them off the streets, you know, whether they’re on parole or locked up or something. And it’s like, well, that’s one method of protecting society. But better by far is having healthier people, right? Correct. That’s something.

David Livingston, LMFT: Right. And like like you’re both saying there can be too much freedom and sometimes people it’s more than than someone can manage. And so there’s there can be something positive about restrictions. I think the problem with the legal system is it can become very cold and punitive. And I don’t know that that necessarily helps a lot. And even though some of the restrictions, I guess, are going to feel somewhat punitive by nature, what do they say? The best way to raise children? I don’t think this is just about raising children. The best way run a treatment center, the best way to be a basketball coach and you could go on and on is high structure and high warmth. So if you have high structure and high warmth, people tend to do well because the structure limits the freedoms and it helps them find the edges of themselves. And it creates a process in which they’re held responsible, which is good. But often there isn’t high warmth and high commitment to the personal. If you have high structure and high warmth, people tend to do really well.

Clare Waismann, M-RAS/SUDCC II: I agree.

Dwight Hurst, LPC: I wanted to hit on this issue as well of confidentiality. Obviously a big part of mental health and really all medical treatment. In fact, it’s federal laws that are in place to protect that confidentiality. There are situations where it gets a little dicey or impaired, especially if we’re talking about these situations where somebody else has authority or something hanging over their head. What are some thoughts about the importance of confidentiality and what kind of ethical concerns come up with that in addiction?

Clare Waismann, M-RAS/SUDCC II: I think and I can say on the side of liability that the liability is so extensive that unfortunately, you end up sometimes not doing what’s best for the patient, but doing what’s required by law. Yes, we have, in David’s notes, oftentimes found ourselves in places where we would like to call a family member,

discuss this or discuss that. But you just cannot. I think I think any law pretty much it doesn’t matter which law there is going to be the downfalls, the moments where it just doesn’t fit the need. But we do have to have privacy laws. If we didn’t then there would be a lot of stigma, mental health and addiction would be used to harm a lot of people. So goes both ways, right?

Dwight Hurst, LPC: We had to be very careful when I worked with the court system a lot, especially in an agency, because there would be regular staffing, sometimes even with parole officers or probation officers, especially in a case that was like drug court or some official court program. But we had to caution all the staff, the clinical staff, therapists and different levels of counselors that in these staffing things we’re used to being very open with each other, with an inter in with a within an agency meeting. But when you had law enforcement there, even if they were trained somewhere more trained than others and some of them understood confidentiality and some not. We’d have therapists who would say, my client came back and said, “Hey, my P.O. told me, hey, good. Or you still dealing with all that family trauma” or “my abuse when I was a kid or something”, you know, that might have been appropriate for the treatment team, you know, the prescriber and the therapist and the guy leading groups or the the gal doing individual, you know, therapy or whatever that was appropriate for them to know. And you get someone who’s a member of the treatment team that isn’t a treatment professional, maybe doesn’t understand that. So we found that even within the technical allowable, you know, confidentiality sharing, we still had to like ethically be careful of where was this going, right? Did the person understand? And frankly, there were some that whether or not they understood they didn’t buy into the process and they weren’t under the same medical expectation. Right. For ethics. So yeah. And it can get I see that, you know, get pretty impaired when you have even family involved or when there’s a lot of people involved that aren’t just the patient. You’ve got to kind of question. Like you get used to just talking openly and you say, Well, hold on, I need to. I didn’t. Not only is there the legal liability, I need to ask what’s best for this person. I can technically mention this in this setting, but should I?

David Livingston, LMFT: I hold confidentiality as primary, I really do. And even in talking to even when they’ve allowed when they allowed me that I have verbal and

written consent which is a standard for me to speak to family members. I almost always insist that we do it as a conference call. That way everything is out in the open. What I’m saying, what anyone else is saying is clear and everything can be clarified. It is so easy for and I’ve seen this happen so many times over many, many years for things to be distorted or misinterpreted or heard the way a person wants to hear it. And so there’s something powerful about everything being open. And I do believe that it can be really helpful to have dialog amongst family members or people are interested, involved and where you can address their concerns and on and on. But I really believe in doing it in a group session. So there’s no there’s so that it’s all right out in the open and nobody’s going, “Well I heard you said…” That just is deteriorates things often.

Dwight Hurst, LPC: I think it’s a great point. I think that particularly when we’re dealing once again addiction is a broad umbrella that covers there’s a lot of psychological health issues, mental health kind of things. There’s questions of medication. There’s the if you take what we call a trauma-informed approach, you’re talking a lot about things that were very personal that may have happened in the person’s life, whether it be abuse or. And then also you go back to some of the actions that we do when we’re caught up in addiction and you get a family member in there. And if you haven’t made sure that they know about something that maybe the person wasn’t ready to tell them yet, you know, you could really complicate their dynamic without even intending to even with good intentions. And so, it’s always good to err on the side of being extra careful with confidentiality, I think. Yeah. And say, yeah, right.

David Livingston, LMFT: Maybe the last thing I’ll say since we’re talking about treatment. I think the first question or one of the initial questions I ask people is how good are you at putting on the brakes? And you can learn more from that one question about how to proceed with the treatment. And then I can tell you because first of all, whatever they’re coming in for, they have trouble putting on the brakes. And they’ll almost always tell you that immediately that whatever they’re being treated for, they’re struggling with. But some people can’t put the brakes on well, period, and other people can put it on well and most every part of their life and with maybe a few exceptions. And that has a lot to do with how you should organize in terms of treatment.

Dwight Hurst, LPC: And we’re going to leave it there. Thank you so much for listening. This show is created by Waismann Method Medical Opioid Detox Specialists and is produced by popped Collar Productions. You can learn more about our work at opiates.com. Please email us your questions about addiction, mental health treatment and such at info@opiates.com or follow us at any of the socials out there by following #WaismannMethod. The music for this show is the song Medical by Clean Mind Sounds. On behalf of Clare Waismann and David Livingston, I’ve been Dwight Hurst. We’ll be back at you again soon. And remember, in the meantime, keep asking questions because if you ask questions, you can find answers. And when you find answers, you find hope. We’ll be back at you again soon.