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Working in Addiction Treatment – the Highs and Lows

Working in Addiction Treatment

Episode 23: What Are the Highs and Lows of Working in the Addiction Treatment Field?

In this podcast episode Clare Waismann, RAS/SUDCC and David Livingston, LMFT address a listener’s question. Chris asks: What are the highs and lows of working in the addiction treatment field? We talk about the treatment approaches, the emotional investment of the work, and how sometimes the highs and the lows can be surprisingly related to each other.

Dwight Hurst, CMHC: Hello, everyone. Welcome back to 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, and I’m joined here, as always, by Clare Waismann and David Livingston. Today, we’re going to be answering a question that actually comes to us from Chris Reville, who is actually a podcaster himself that runs a network of podcasts. And he posed this question to us. What are the highs and lows of working with the recovery community? I happen to know Chris, and he actually is also a case worker and a large mental health hospital system as well. And so but not a specialist in this area. So he had based that question of when you are a specialist in healing and recovery, you know, what are some of the highs and lows that we run into as professionals?

Clare Waismann, RAS/SUDCC: Question. So let me understand this. So is the question regarding what are the highs and lows of working in this field or in this community?

Dwight Hurst, CMHC: Let’s see, working with the recovery community so we could take that away. Yeah.

Clare Waismann, RAS/SUDCC: In the community, right?

Clare Waismann, RAS/SUDCC: I think for me, in my experience and I’ve been doing this for, you know, quarter of a century, the highs is definitely because people are passionate about it, because people have one way or the other, mostly lived through it or know somebody that has. And because they are really willing to go the extra step to help somebody that are in a very familiar situation. And I think the negative parts about it, it’s pretty much the same.

Dwight Hurst, CMHC: That’s a good point.

Clare Waismann, RAS/SUDCC: It is! Because they have been most people in this field have have been there. They kind of share their experience in mirror to others. They don’t have the mental health education needed to assess. And when I say “they”, again, we’re talking about averages again, is most people working in this field because they do not have the mental health education to assess a patient – often they are misdirecting the patient, which can be harmful. Because again, they are relating their own experience to somebody else. So and because they are so passionate about it, sometimes they impose their experience that in their solutions, that might not be what’s the right one for that specific patient?

Dwight Hurst, CMHC: It’s a really good point. You mentioned is that the strengths can also double as the weaknesses in a way, and that probably applies to a lot of things in life. Reminds me of a facility that I used to work in where I had two colleagues, both where I had been in the field for a long time. Both had recovered from or had been sober from, however, I want to phrase it, alcohol and opiate addiction and had had quite serious, both of them had actually had experiences with the criminal justice system. They’d been locked up for charges in their past. Both had also been clean for decades and had gone back to school, gotten their degrees and were working as counselors. And it’s interesting, as you’re saying, that because one of them very much worked against projecting onto his clients. The other one was kind of known for projecting onto his clients. And because he responded well to tough love, he alienated a lot of our patients. And the other one was way more individualizing when he worked with people and then there were friends. But they get together even at meetings and give each other a hard time about the differences. And and so that passion applied both ways, which is really interesting that you mentioned what both were very passionate about, very different direction.

David Livingston, LMFT: Yeah, I would agree that I think that, you know, to kind of add to what you’re both saying, when people when someone is dealing with an addiction or family members and, you know, there’s a lot at stake, usually their lives are suffering and they’re suffering. And so it’s a real opportunity to help someone. And, you know, and when they come to you, they’re they really want help and they’re usually feeling pretty vulnerable or more. So one of the privileges of working in this field is having people who truly are looking for and often don’t know how to help themselves. And so it’s a lot of responsibility. But it’s also, you know, it’s an opportunity to be of use to someone. And I find that very engaging. I like that opportunity. And one of my frustrations, just to add to what you’re saying, Claire, is that at least for me, I really it’s about getting to know the person and listening to them and discovering what it is that is useful to them, I really don’t move into it with an agenda or a program per say, that isn’t to say that I don’t have a lot of ideas. I have a lot of experience at this point and I have a lot of knowledge about what can help people. And so certainly they’re there to gain that understanding and for my thoughts as well. But it’s the idea of imposing a process or an idea onto people and so forth is one of my biggest frustrations. And because you really don’t discover what helps somebody and you have to discover more than you can decided in advance. And so that that’s one of the frustrations. But it’s also where I think our program and our approach has been really useful to people. So that’s been I’ve enjoyed that. I continue to.

Dwight Hurst, CMHC: Yeah. It’s interesting how the flexibility that’s one of the words that comes to my mind. You get some professionals who absolutely have tons of experience, personal experience with substance use and intoxicant of use. And then you get some who just don’t. And they have the education maybe, and they’ve been through it. And for them, I think those that haven’t had the firsthand experience, it’s important for them to be flexible in the sense of listening and learning from colleagues as well as their clients. And then, on the other hand, for those that have had the experience, there’s the flexibility of being able to listen to their clients and to others who have a different experience so they can actually, you know, apply that to to different people.

Clare Waismann, RAS/SUDCC: I believe. And I could be mistaken that a lot of that lack of flexibility comes from an archaic train of thought where, you know, an addict is always going to be an addict. They know certain rules that a lot of people that have been in recovery for 10, 20, 30 years have lived their life by. So once they are working with somebody else, their sobriety almost relies on those rules to for them to sustain sobriety. So I think there is a fear for themselves as well if to change any of these rules and how they were treated and how they became sober. If, you know, if those rules do not apply anymore, they are scared of your sobriety and not being able to sustain those questions.

Dwight Hurst, CMHC: Makes a lot of sense to me. Yeah, I see that fear that people have. Am I going to first of all, is that statement true? I’m always going to be an addict. Then I’m I’m not going to really, you know, believe in in myself, in that kind of thing because I’m one step away from failure. Was that part of what you’re saying?

Clare Waismann, RAS/SUDCC: Exactly. Exactly. So I think they are bound by, you know, those meetings, let’s hold our hands. Because, you know, the old way of thinking was they had no control to directions, to their decisions, you know? So there is a need to support each other for their cravings and then all their thoughts where nowadays, I mean, we have evolved so much. Number one, patients are not do not have to go through that dreadful detoxification where then weeks after, that’s all they thought about. Two: We have pharmacological medications there are non-addictive that can pretty much almost eliminate physical cravings. So and most importantly, we have mental health professionals. And when I say mental health, I mean, you know, therapists, psychologists, psychiatrists that can assess if there is, you know, a underlying mental health condition that can be treated with certain medications or other therapeutical solutions. So the reasons why people crave those drugs and are not able to handle the unwanted emotions are there are many solutions nowadays that we didn’t have 10 years ago, there are a lot of answers of what happens to the brain of somebody in how after a detoxification, you know, the brain heals. So I think, A, we have evolved where we can understand physiologically what happens to patients. I think in medicine we have evolved where there are more solutions. And I think as a community and a society, we also have evolved on how we see people and the condition. There is not that tag, you know, the judgmental tag anymore. And that’s not needed anymore because people can recover. Because it’s not who they are, it’s a condition they’re suffering from.

Dwight Hurst, CMHC: One of the big strengths and pros, if you will, of working in the field is you get to witness that evolution of that understanding that’s grown even over the last few years, especially over the last 10 or 20 years, to say we’ve learned more about the brain, which is really that that’s really the organ, that failure in addiction, so to speak. That’s like I don’t have a broken bone, but I’ve got a messed up reward system. And effect and consequences are a lot of that has overshadowed is overshadowed by the addictive mental process. One of the things that I think is actually a real high point of working in this kind of field is you get to generate a lot of empathy. I think I feel like working with addiction more than any other facet of mental health that I’ve worked with has generated a sense of empathy to say, you know, when people do things that don’t make a lot of sense, people often don’t feel empathy for them. But when you’re a professional, you get to know them quite well and you get to know the context of some of the things people do, whether it’s self medication or fear of withdrawal or just reactions to different kinds of trauma and things like that. And when we’re having intoxicant abuse, generally speaking, our judgment is greatly impaired and things are definitely different within a context. And that’s promoted a lot of understanding of the way people work for me.

Clare Waismann, RAS/SUDCC: Yeah, I believe that’s in the health care profession. I think if there is no empathy, you know, it’s there is really no connection. And if there is no connection, then it’s hard to find a solution.

David Livingston, LMFT: If there’s if there’s no real understanding, then that that will to me, that’s the most empathetic thing you can do. Right. I was watching this show a few years ago and it was on I was just going through the TV and it was on was on football in Alabama. So there was interviewing this couple was probably in their 60s or 70s, married couple. One was for the University of Alabama and one liked University of Auburn. And the teams play each year. And I don’t remember who won or who lost, but the couple had spoken to each other for like a year because of that. OK, their identification with those two teams was so powerful that they could do that. And I bring it up because it has everything to do with addiction, a lot to do with what addiction is, because people become so identified with a substance that it takes on, it takes on like a like an archetypal role in their life. Now, these two people didn’t know anybody on the football team, any of the coaches, anybody. It was simply a way they identified. And so it was an aspect of themselves that they they saw themselves as part of something, OK, just threw their ideas of it.

David Livingston, LMFT: So this is this is a lot of what happens in addiction and addiction treatment. So what you see a lot is that people try to change the identification from one thing to the other. Right. In a sense, from from a from a less healthy dependency to a healthier dependency, which is a good thing, assuming it is a healthier dependency. But in essence, you know, you’ve got to repair the marriage. Right. You’ve got to you’ve got to find something. You’ve got to help people and learn what they want to be identified with. Because you have you know, part of what drives addiction is this deep need for us to be involved in something, something of, you know, and you you see a lot of people being disappointed over and over again until they find a substance they substituted. And so part of the treatment is helping them find other healthy places and people and things to be identified and dependent on in healthy ways. And so. Right. Yeah, sure. How exactly that relates.

Dwight Hurst, CMHC: Seems like they need a same team or something

David Livingston, LMFT: Right…

Dwight Hurst, CMHC: Or some version of that. Some version of that.

David Livingston, LMFT: Right. But a lot of treatment. So you just have to identify with what we’re doing. And if people who don’t or they don’t like it, they just become kind of compliant and then they leave and they’re defiant and they relapse. And that’s the cycle you don’t want to be in.

Clare Waismann, RAS/SUDCC: So I think, David, in a way that brings us down to the difference of, you know, when we talk about the community, the recovery community, it has to be a very clear understanding of what treatment effective and I put addiction is mental health treatment to peer support. And I think the peer support is where what you’re talking about happens, where people are supposed to identify with others, when sometimes they just don’t and they rebel and they leave and they are frustrated and they believe they know it just didn’t work for them where because they are asked to identify with a personality and the path in life that maybe is not the right one for them. So it’s really important for people to understand in recovery what is peer support that, you know, is a wonderful thing. I think any support of any kind, any healthy support is wonderful to treatment, to professionals providing treatment.

Dwight Hurst, CMHC: And that can be so easily conflated to where, especially when you’ve got a lot of emphasis on that to say, you know, you got to do this. This is the way it looks. And I guess that’s one thing that is a low point, I think is sometimes there can be an idea, almost kind of a cookie cutter approach when people say you need to get some treatment and there’s a there’s a blurred line between that and like you say, peer support groups, whether that’s a 12 step group or, you know, there’s other forms of that group out there that people get support or whether it’s a church group or just some friends or a good friend who got clean. And those can be very important and they can be of varying degrees of help. But evaluating them sometimes when we think of treatment, I think especially if people aren’t as familiar with thinking of addiction as a medical problem, we can think of treatment and almost look at it like the same way you’d say, I’m going to go get some milk, I’m going to stop by the store and get some milk on the way home. It’s like I could just I just go get some treatment and yeah, there’s different, you know, there’s two percent or one percent or whole or skim whatever. People know what milk is. But you think of that as just different degrees of treatment. And I think to your point, Clare, that low point is when we don’t see things for what they are and we expect peer support to provide what treatment would provide. And I’ve also seen the other side where people kind of expect that that thing they get from peer support, from treatment as well, and they can get kind of confusing for them if that makes sense.

Clare Waismann, RAS/SUDCC: Yeah, and I think a lot of people run away from that. Let me give you a perfect example. So an hour ago, I had a call of a young lady, a veteran that broke her back while in service. She has been for years and years taking opioid medications for her numerous back surgeries, never taken more than she was prescribed. She’s not taking horrendous dosages, very stable on her dose. Now, she does not have the pain that she originally had anymore. There is no need for her to be on opioids that are causing her secondary effects and she wants to come off them. What would happen if she went into the Internet search for a drug detox, drug treatment and rehab? What would they tell her?

Dwight Hurst, CMHC: You know, depends on what website? There’s a lot of different information, some of which is not great.

Clare Waismann, RAS/SUDCC: But let’s talk about 90 percent of the rehabs. What would they tell her and what would be her treatment? This is somebody they know never had a drug issue. This is somebody that went to college, served our country respectfully. So this is somebody that would not identify, as David is saying, and she would be not forced but expected to identify with a group that she would be sitting with 30 people. Right. With addiction issues and mental health issues and behavioral issues. And for 30 days, you know, be in there. So this is what I’m trying to say to you. I think we need to stop treating the condition and start treating the patient right.

David Livingston, LMFT: And really understand who they are and what their struggles are and what’s going to help them and, you know, and not walk into it with with an agenda already in place and just really pay attention to to what the needs of the patient really are. But that’s what the treatment should be from my perspective. It’s really about meeting the needs of your patient, and that includes understanding their limits and vulnerabilities and strengths and how they’re well developed, whether they’re struggling in their development and on and on. But you don’t want to put somebody into conflict, right? The goal is to get people to help people become uncomplicated. So if you put someone who doesn’t need to be in a situation, in a situation in which they feel conflicted, you’re making them worse. So I was talking to someone not long ago, was talking about a sponsor they had who was saying, you know, you have to go apologize to these people. And then the person was saying that was totally against what I felt I did. I was open to doing in a couple cases, but these were not right for me. You send somebody into conflict and into frustration who is genuinely trying to sort of get help in any way. They get worse. You know, they tend to drop out. They lose a sense of who to identify with because we do need identifications, we just need healthy ones, but that’s a two-way street. So whoever’s treating you has to be able to be responsible for having a healthy relationship with you, meaning that they don’t put you in conflict with your genuine and authentic self. Someone says that’s not right for me. You’ll have to pay attention to it.

Dwight Hurst, CMHC: Yeah. So that’s and that goes along with the idea of the kind of that low point or off the field is witnessing people getting put in that box. And sometimes one of the hard things is you come across a situation where someone got put in that box, one box or another related to the problem and ignoring who they were. And they go for years thinking that. And especially I find that that ties in, especially when there is criminal charges or those kinds of involvements. A lot of times then people are really treated within a certain very specific box and they can really, really suffer in their own self concept for a long time of, “Oh, this is this is who I am! – kind of a feeling even beyond what’s even even to the point where if they had been a career criminal, you wouldn’t want them to have that kind of shame because it’s not productive. But, you know, someone who is just I don’t fit in that culture and that. But now I feel I’m a part of a certain culture. And I feel that this gulf between me and society for addiction and then for whatever complications that addiction brought up, and that’s hard. It’s hard to see that it kind of on the flip side of that, it is a nice thing. And a high point is you get to see when people shed themselves of that identity in a way that’s healthy and they start to realize who they really are and feel more authentic. I think that’s one of the biggest high points, is being able to be a part of the…

Clare Waismann, RAS/SUDCC: People that transition – how fast and how bright, you know, that light that falls into somebody’s life suddenly being able to be part of that is incredibly rewarding.

Dwight Hurst, CMHC: And one of the things that I have also learned is that many people and not to paint with a real broad brush, but when we get into an addictive process, many people actually get very creative in the way they survive with that that addiction and that pattern, you know, they get clever in a way of how do I procure drugs or opiates when I you know, either either I figure out a way to do it. I figure out a way to evade detection. I figure out a way to be able to pay for it or whatever that is. And there are lots of things like that. And it’s interesting because, you know, chicken or the egg, I don’t know. That translates when people do find and embrace that health. There’s many, many times where I see people, they’re able to adapt and take that with them and say, oh, I’m clever. Actually, look at what I figured out how to do, you know, without thinking about it. Now, if I’m trying, I can probably figure out ways to live my life, you know, in ways that are going to be very productive. And I don’t think people talk about that as often as maybe I do about some of those strengths that people take away from that sometimes.

Clare Waismann, RAS/SUDCC: Is gearing, you know, that wise… you know to something productive in your life. You know, drugs are not that easy to find. In order for you to maintain that life, you need to be wise. You need to be, you know, have some kind of ability to get what you need. So when somebody gets over the addiction issue and switch that effort and that energy, you know, that wise energy to productive things in their lives, they can really succeed.

David Livingston, LMFT: Yes, that’s right. You make important, important point, because one of the things to you know, and one of the ways that I don’t like the approach of I think the general approach of the of the you know, the idea of addiction being a bad thing to be gotten rid of is that within us is first of all and I’ve told this story, and I’ll tell it again. But, you know, if you look at the development of a human being, the way we get high is through good experiences with people. And if we’re not getting high, you see this with the pandemic where people were isolated, where they didn’t have enough, especially people who are really isolated, they would their mood would go down and they would really get isolated because we’re meant to give high of good experiences with people. You see that in infants, the minute mom dad walks in the room, the baby’s mood elevates. Otherwise it stays the same or goes down. So we’re meant to get high. That’s a real thing in life. Now, the best way to do it is through varied experiences and as good as possible. So we’re meant to get high. We’re also meant to forget about things, right? We’re meant to want to check out, to go play, to go to a concert, to get lost in a movie, to read a book we are meant to go into fantasy we have to check out, right, so all these elements, healthy elements of what exist within addiction, like you’re both saying, like all the creative aspects of figuring out how to maintain a life like that and the necessity of having that. The problem is it just doesn’t it’s a harder life. It’s a worse life. It doesn’t have because it gets narrower and narrower and smaller and smaller over time and top of the dangers and everything else. So it’s not the best answer. But within it are so many elements that you can’t get rid of if you’re going to have a healthy whole human being.

Dwight Hurst, CMHC: And we’re going to leave it there for today. Thank you so much for tuning in. Thank you. Special thank you to Chris for the question that you gave us today. If you would like to throw a question at us. We’d love to try our best to answer it. You can reach us @opiates on Twitter or you can email info@opiates.com. Visit opiates.com. Also to learn more about the Waismann Method Detox Center. This podcast is hosted by Clare Waismann and David Livingston addiction specialists and co-hosted by me, Dwight Hurst. Our music is the song Medical by Clean Mind Sounds. This show is produced by Popped Collar Productions, a company helping you to start up and produce your podcast. Learn more at poppedcollar.net. Remember out there to keep asking questions, especially questions that have to do with hope, addiction and treatment and all of those important things. Because once again, as I always like to add, when you have questions, you can find answers. And if you find answers, then you can find hope.