Episode 32

A Recovery Story with Anne. Many therapists join the field because of their own personal experiences. Our guest today is no different. Her own journey was supposed to be macro social work. We’ll hear the story of how she moved through her education, to sobriety, to becoming a therapist, substance abuse counselor and finding her place  running a residential treatment center. 

Helpful Links

https://lifering.org/ LifeRing Secular (non-religious) Recovery

https://womenforsobriety.org/ Women for Sobriety

https://sherecovers.org/ She Recovers (you can access the Facebook group here)

https://www.smartrecovery.org/ SMART Recovery

https://r20.com/ Recovery 2.0

 https://betsybyler.com/treatment-tool/ Free Treatment Tool


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 32. Today I want to share with you an interview that I did with a woman who is a therapist, substance abuse counselor, clinical supervisor, and an addict in recovery. This woman also happens to be  a childhood friend of mine from growing up in Chicago land today.

She makes her home with her partner in the Detroit area. She works and runs a residential treatment center for addiction. I personally hadn’t heard her story until we decided to do the interview. Over the years, I had gathered things from watching her Facebook and reading different posts that she wrote.

I hadn’t spoken to her though since high school, it was really great. Being able to talk with her. What are the odds that we would come from the same place and end up doing virtually the same job. So today I’m going to share my interview with Anne and we’ll hear her recovery story as well as some of her experiences in the field.

Here’s the interview with Anne

*Add approximately 1 minute to the times below to find the correct timestamp

Betsy: [00:00:00] Anne, thanks so much for being here today. 

Anne: [00:00:02] Thank you so much for having me. 

Betsy: [00:00:04] So I want to start with what your background is and what kind of work you do. 

Anne: [00:00:09] I got a bachelor’s in social work right after completing high school. So I went to the university of Wisconsin at whitewater and , at that point, I think  what interested me about social work was the concept of helping people, right?

Like even from a young age, I remember watching that show. I think it was called Rescue 911 . And like the EMT’s and the fire department would like jump out and go running to help people. And that really appealed to me. So social work was like a natural calling in that way. After I graduated I worked for a year, actually as a counselor, like a substance use disorder counselor at a treatment center, it was in Wakanda, Illinois. I don’t know  that it’s there anymore. And then after that I started working in child welfare in Milwaukee. During the course of working in child welfare, I ended up going back to grad school, I think about eight years after I graduated with my bachelor’s.

So I got my master’s from the University of Wisconsin, Milwaukee. That’s right about the time that my addiction was really in full swing. I actually finished my masters from a three-quarter house. So that’s a great part of the story. Then I came to Michigan, eventually became employed as a therapist.

I have a full clinical license in social work, and I also have two credentials for substance use disorders. I have my advanced practice credential and I have a clinical supervisor credential.  

Betsy: [00:01:47] What kind of work do you do now? Are you doing both supervision and clinical work? 

Anne: [00:01:53] Currently I am. 90% of my job is program management and clinical supervision, but the way that COVID has affected our ability to staff, there are absolutely times where I’m providing clinical services as a therapist.

Betsy: [00:02:10] Which do you like better?

Anne: [00:02:12] That’s a great question. I think there’s a split. There’s the moments when you’re with a client and it’s just the two of you and you’re doing the sacred thing called therapy. Those are really fulfilling, but also at the same time, being able to influence practices, to benefit clients and build better professionals is really rewarding as well.

So I think, I think in the beginning of my tenure as a program manager, I missed the therapy  but I’ve subsequently come to enjoy the opportunity to work with both therapists that I’m supervising as well as clients. 

Betsy: [00:02:54] I’ve done the same job. I have nearly the same credentials, but in a different state. I love clinical supervision. I love being able to help train therapists, but I also still love being able to connect with people and to have those moments and watch cool things happen. The path that you took in order to become a therapist, what led you towards that path?

Anne: [00:03:18] So I wasn’t really pulled or called to the practice of being a therapist. What I really wanted to do was do program evaluation, program development  more of the macro side of social work. I started using during grad school. I was not happy with the way that my life had been up until that point.

I was in a relationship that really should have ended probably before it started. And I was managing my emotions, my frustration, all of those things with food. So during the course of graduate school, I had gastric bypass surgery and I’m thinking that I’ll lose weight, feel great and things will be fixed by me not being overweight anymore.

We know that one of the most common problems that can emerge after gastric bypass surgery is switching to a substance alcohol drugs. What have you. And that’s exactly what happened with me. So during graduate school, after the bypass surgery, when I was using, I had a field placement at an emergency room in a hospital and I actually got drugs from a nurse at my field placement and used there.

When the school found out about this, this was a huge deal, huge breach of trust, responsibility, integrity, all those things. And so as part of my conduct review board, they insisted that I take additional ethics trainings and  it doesn’t make sense to me why, but here we are, they insisted that I do additional coursework probably to monitor me and see if I was actually going to get my life together.

 They had me start taking classes on the clinical side. And so even though more of my education, I feel like I was devoted towards macro practice. I ended up with a master’s degree in the clinical concentration.  When I was able to rejoin the field and usually the expectation is that you need to have at least two years clean or free from the obvious consequences of using you can rejoin the field.

And so when it was time for me to rejoin the field it felt really natural to want to do that in the substance use disorder area.  That’s what came to pass. That’s how I ended up working in the SUD sub-specialty. 

Betsy: [00:05:36] Would you say that food then was an addiction for you? 

Anne: [00:05:40] Absolutely. Yeah. I mean, there are still moments where despite gastric bypass, there are still moments where I have a bad day or something catastrophic happens and I’m like, I am totally eating peanut butter cups for dinner.

Even though my ability to overeat and do things like that, , when they’re stressed or things like that, my mind scans for like, what is an easy way to cope with this, that doesn’t involve managing the stress, feeling the feelings, things like that. So for me eating and especially eating unhealthy absolutely were, their own disorder in and of itself.

Betsy: [00:06:17] Do you feel like that started before college? Was that something you think you struggled with in high school or as a kid? 

Anne: [00:06:23] Yeah, I think I found comfort in food. It was something that I could do on my own. Food was something that provided comfort to me. I was not that kid who found comfort in fruits and vegetables and salads and things like that. It was always craving like something short-term and junky carbohydrates, sugary. So yeah, even though my weight fluctuated, definitely during the period before I had the bypass surgery was when it was really apparent that I was not coping with emotions, traumas, things like that. And I was instead just eating to try to manage the way that I felt. 

Betsy: [00:07:01] So your story of developing a substance addiction is kind of later than a lot of people, and I’m sure you know that. A lot of addicts and alcoholics they start in high school or a little earlier and kind of move forward. But at this time,  it seemed like you were kind of without options after the surgery and met this nurse. Then it was opiates. How did the progression go from there? 

Anne: [00:07:27] I will say this the best therapist I ever had when I came in and I gave her my story. She listened to what you just heard and said, okay, so this is an atypical presentation and she was right. Addiction was something that I always kind of knew was in the family. In earlier phases of my life, I tried really hard to be responsible and cognizant of that. In my early twenties, I remember having to throw away beer because it went bad in my fridge.

And I don’t mean like I bought a 24 pack. I had friends over and there were 18 beers that were consumed. I’m talking about a friend came over, we drank two and six months later, four Heinekens went in the dumpster. Like it was something I was able to be aware of and manage in my earlier twenties.

But then later on, and especially once the ability to eat my feelings was removed. It was an immediate switch. And that nurse is actually later on during the progression of my addiction. When I was sent home from the hospital, after having gastric bypass surgery, they gave me a bottle of liquid Vicodin and within two days I was drinking it straight out of the bottle. It was absolutely immediate. 

Betsy: [00:08:42] How long did that last you had the surgery, you had that kind of switch into substances and were you using opiates and then what?

Anne: [00:08:53] So my using career lasted less than three years. It was quick, it was ugly and I’ve had people say, Oh, well you had a high bottom because I didn’t end up homeless. Although that was an option I did end up penniless. So people would say it was a high bottom because I had privileges  that still existed. And hadn’t been stripped away by addiction yet.

But ultimately what happened was. I, through the course of my using, I relieved myself of a job that I had worked very hard for and had nine years of experience with. The relationship that was a bad idea, came to an end. You know, it ended with me being unemployed, living in an apartment where I was single for the first time in five and a half years and ultimately I overdosed. 

But I overdosed while I was on the phone with a doctor’s office. And so I went unconscious, the lady who answered the phone, actually, I mean did an incredible thing because she kept me on the line, but also called 911.  EMS broke my door down, took me to the hospital. I came to in the hospital hours later, very confused about what was going on. And by that point they had called my family and said, you need to be aware that this is how bad this has gotten. 

I was in Wisconsin. My parents were in Michigan and my sisters were both in Chicago. My parents and my sisters had a conversation about what they were going to do. My sisters came to the hospital the next day and they basically said, look, we’re not going to help you do anything other than get in the car with us and go to treatment.

And they were like, if you want to come with us, we’ll wait, we’ll get you out of here. We will get you to where you need to be and we’ll get you in recovery. But they were like, if you don’t want any part of that, we are leaving now. And we will not hear from you until you go to treatment and get clean and stay clean on your own.

One, they made a really compelling case. They’re my older sisters. I love them very much. I knew that I was out of wind. Like I knew that I had absolutely nothing else going on in my life. I didn’t have a reasonable excuse, not to and even on the most practical level, it was winter. It was Wisconsin. I didn’t have my wallet. I didn’t have keys. I didn’t even have shoes. Like it was the perfect opportunity to be like, you have absolutely nothing else going on in your life. Let’s get your shit together. And so that’s what happened. 

Betsy: [00:11:25] So at the time were you upset with them for the way that they presented that to you?

Anne: [00:11:32] Absolutely not, no, no.  I had actually attempted partial hospitalization four or five months earlier, and I had been able to stay clean for two, maybe three months. But once I moved into my apartment and I was alone again with myself,  it was not recoverable without significant intervention.

They were absolutely on point. And when I get family members who try to call on behalf of a loved one and get the loved one into treatment.  I give them a similar speech, which is that people need to want it. People need to want to come to treatment rather than having family members call.

You know what I’m saying? Addiction affects you. It affects your family. It affects the people that you care for. If the addict isn’t willing to get help, then the people who are bystanders, witnesses and victims of it need to seek their own treatment. So, no, I’m absolutely not mad at them.

I am eternally grateful to them for putting into me in such a way. We went to get into treatment and it was over the Easter weekend. So I think it was the Wednesday before Holy Thursday, they came up, they took me directly over to the place where I had been to treatment before, except to get me into residential.

 They actually offered me detox, but there was something, something inside of me knew that the last thing my body needed was another freaking substance. And so I said, no, I don’t want to do detox here. They said, stay clean through the weekend, come back on Monday and you can start residential.

My sister took me to her home in Chicago. I think they had my wallet and my keys and stuff like that, but I wasn’t going anywhere. And they basically let me hang out with them. I remember waking up that Saturday morning and I was like, what are we doing? And she’s like, well, on Saturday mornings we get breakfast and we go look around at Starbucks and it was such a normal thing to do.

I just felt like such a fraud doing it. These are things normal people do on Saturdays. And I hadn’t been normal in so long,  there was a lot of shame going on because I knew that I had fallen so far from being a functional and productive member of society.

Betsy: [00:13:49] So you were going to grad school part-time and then had run into this to a nurse who had pills. And then how did the grad school find out and what happened next? 

Anne: [00:14:04] I think that they found out probably from my onsite field instructor. People who are in recovery sometimes talk about unmanageability. The exact details of my life during this time period are a little unclear at times. All I know is that in rapid fashion the school found out and I was obviously terminated from field placement. I think I was possibly suspended from taking classes for the rest of that semester and the process of gaining their trust to allow me to continue in the program was pretty lengthy and pretty intense. I remember conduct review  boards, meeting with the faculty from the social work department. It was pretty intense. 

Betsy: [00:14:53] You had mentioned that they had you taking ethics classes and then some clinical classes, which hadn’t been your plan, so to speak. As you finished treatment, what were you doing with school at that time?

Anne: [00:15:08] One of the things that I had to do during that Easter weekend, when I was waiting to get into treatment is that I had to call my faculty advisor and I thought that it was going to be the end of my social work career. So I psyched myself up, which given that I was going through multiple different forms of detox in this time, and generally coming to the realization of the complete and total disaster, that was my life at that point. I had to get myself together enough to call my faculty advisor. 

And I honestly thought that I was telling him that I was quitting school like that it was over, I was never going to get my MSW or I was never going to finish. And I remember calling him and saying, you know, I need to drop out of school. And when he asked about why I told him and he said, you don’t actually have to drop out, you can take a leave of absence. You can come back to it. And that was an incredible relief. And it was like that spark of hope that it wasn’t a completely wasted career. So I did, I took a leave of absence, which at that point, all I had to do was finish the last hours of the field placement.

So I took a medical leave of absence for the 28 days that I was in treatment. And I ended up going to a recovery house that was affiliated with the treatment center that I had gone to. The deal at the recovery house was you either need to be working volunteering or in school. I had no business practicing social work at this point, but I did get to go and finish the hours from my field placement. 

One of my biggest regrets about my education is that when I did graduate I didn’t attend my graduation. I was so ashamed and I felt so undeserving and absolutely imposter syndrome all over the place. So I ended up having my Master of Social Work diploma mailed to me and that is a huge regret. 

Betsy: [00:17:05] You’re graduated now. What was the next step for you? 

Anne: [00:17:10] So the next step was to try to re enter the field of social work while remaining in Milwaukee. But one of the biggest impediments I had against me was my reputation, which was that up until a certain point, I had been pretty bright, kind of brilliant, good at things and steadily promoted, but ultimately I had to resign my position because I could not stop using, and I could not practice any longer. 

The last nine years of my resume was tied up by an absence of recommendations. Where if I hadn’t used, I would have been extremely employable. So I tried to get work in Milwaukee and it was just clear that I was not going to be able to do it.

So I ended up having to move in with my parents who were in Michigan and in the process of relocating the recovery community that I fell in with in Michigan was a lot bigger and more appealing to the way that I was at that time. And so I moved in with them and I kind of came to the acceptance that there wasn’t going to be a quick return to the field of social work and that I needed to start with first things first, like finding a job demonstrating a good attendance record and basically just to rebuilding. 

 I ended up moving to the Detroit area in, I think, October of 2008. And that was a big point of economic recession and one that was especially felt here in the Detroit area. I had to find any job that I could get and I remember driving down  one of the more prominent roads of the Detroit suburbs. And I just drove down and I applied everywhere and literally it was either no one was hiring or no one wanted to touch me.  My first job after I finished my master’s in social work was at Walmart.

I got hired for $8 and 40 cents an hour and I worked there for one year.  I studied for my clinical license in the, you know how there’s like a subway or there’s always some kind of restaurant going on in the Walmart. On my lunch break I would study, at that point it was the DSM-IV tr I would study that do flashcards and shit like that in the Subway, on my lunches.

 It was a point of humility because I didn’t tell anyone else, like, Oh, you know, I have a master’s and when I can, I’m going to get the hell out of here. It was like, your job is to show up and be a good employee, get good recommendations, be on time, be where you’re supposed to be when you’re supposed to be there and then get your license. And then when you are able to get outta here, get outta here. 

So when I finally had passed my examination and  had enough time to return to the field of social work. I got a job offer to come be a therapist at a residential treatment center. And I went to Walmart and I told them what I was doing.

And they were like, I mean,  can I say what they honestly said? 

Betsy: [00:20:05] Sure thing. 

Anne: [00:20:07] They were like, how the fuck are you going to leave here and be a therapist? I was actually proud of myself because I kept this big fake ego in check. And I was like, I have a master’s and I’ve been studying in the Subway and I’ve done what I needed to do to get out of here.

So it’s funny. I go back to that Walmart from time to time and I see people who are still there and it’s a really cool experience because even though they may not have known and some people did, that I was in recovery and ultimately where I left to go,  it’s cool to go back there and see those people because they’re part of my story and I’m part of theirs.

That was my career progression, post addiction. Wal-Mart to therapist to clinical supervisor. Recovery is possible.

Betsy: [00:20:50] It is. When you were moving through recovery, what did you find that was helpful? As you look back, what did you find that was unhelpful or might’ve even pushed you in an unhelpful direction?

Anne: [00:21:07] Post recovery, and  even immediately prior to recovery?  I’ve had really good luck with therapists. There were occasionally group facilitators who wouldn’t exactly click all the way, but it was really fortunate with the therapists that I had. Specifically the outpatient therapist that I was seeing before I went into residential, she was amazing.

Sometimes people have this idea that they’re not going to benefit from working with a therapist who isn’t in recovery. To the best of my knowledge, Catherine was not in recovery. But she absolutely had all the skills that you need in order to connect with someone. She was really good with the absence of judgment and  I actually threw up in her garbage can on two separate occasions because I was too messed up to not throw up.

So those two incidents happened and during a period where I was supposed to be clean, I ran into her at a bar where I was completely shit faced. So despite having all of these things to be completely humiliated about, she never did anything, except be glad to see me and get me into the solution. And that’s another thing she did really well. 

I think this is true for all therapists is that sometimes we allow clients to stay longer in the problem before we talk about the solution. And I really feel like with Catherine, it was like a two to one ratio. It was like an explanation of what was going on or discussion of what had happened and then there was like two times as much time devoted to strategizing solutions, strategizing what we could do differently, things like that. She also did a really good job and this was kind of pre the advent of using the adverse childhood experiences, ACEs assessment for trauma. She did a really good job of assessing. I think that when clients first begin the process of talking about trauma or,  their ACEs score.

I think that the initial ACES score that people have versus how they would assess themselves later on is sometimes different. Because people entering therapy for the first time or entering therapy for the first time to deal with a specific issue. They may not code mentally things as being traumatic in that moment.

Whereas after the benefit of treatment and growth and experience, they may redefine and recategorize some of the things that they’ve been through. So those were some of the things that I thought were really helpful. I also appreciated that therapist that I had really understood the multiple pathways approach about recovery.

 The simplest way that I can describe it is two plus two equals four. But one plus three also equals four, right? So some people are really myopic  about what success in terms of recovery from substances are. And they have very specific ideas about how their clients should get there.

The therapists that I worked with didn’t impose those constraints on me. There was the opportunity for exploration and basically self-determination. What works for one person to get and stay clean, may not work for another. Another person’s goal may not be staying completely clean. They may be interested in harm reduction and if it improves the quality of life and function, then that’s legitimate regardless of what the therapist’s specific views are. 

Betsy: [00:24:44] So it sounds like even though she wasn’t necessarily, that you knew of in recovery, she seemed to have enough knowledge. 

Anne: [00:24:52] I believe if memory serves, she had a family member who experienced addiction.  When you talk about people who specialize in the SUD subspecialty the likelihood that someone either has a close personal friend or family member who’s an addict, or is a recovering addict themselves is pretty high. It may just be the prevalence of the way that we talk about substance use disorders now. 

Part of my story that we haven’t discussed yet is that I actually do have a co-occurring disorder. I have depression, and that is something that has been treated longer than my substance use disorder. But the two absolutely go hand in hand, although I will say that I have the benefit that for the last 10 years I’ve been either in therapy or very active in the recovery community, also medication it’s part of my story as well. So I’ve been relatively asymptomatic for depression for at least the last 10 or 11 years. So whereas it’s part of my story. It is something that has been managed really well for much of my recovery. 

So she was actually trained in both mental health and substance use disorder. I think that was also a game changer for my outcomes as well. 

Betsy: [00:26:11] Do you feel like it would have been different if she had been and addict or an alcoholic in recovery, or do you think that that’s not necessarily a prereq for working with people   with substance abuse. 

Anne: [00:26:23] I honestly think it’s one of the biggest misconceptions that a person needs to be in recovery in order to be an effective therapist. It’s absolutely a misconception. As someone who’s worked in the field for the last 11 years, I can tell you that some of the most brilliant therapists that I’ve worked with are people who are not in recovery but are just really good at what they do.

When they decided I want to be an SUD therapist, they paid attention, they practiced well. And they’re brilliant at what they do. So, no, I would say that’s actually one of the biggest misconceptions about entering the field of SUD.

Betsy: [00:27:00] I have found that as well. I think that even amongst chemical dependency counselors, there can be some question about it. As I have worked with people, I have noticed that their recovery status isn’t necessarily the biggest key. I have known people in recovery who were very adamant that their way was the only way to get sober. That is a real deterrent for people. At the same time, someone who isn’t in recovery, isn’t an addict or an alcoholic may be more willing to say that any way, as long as it’s moving in a direction that the client wants would be okay.

Anne: [00:27:41] Yeah. And  for me, my recovery is based in participation in a 12 step fellowship. Right. One of the things that I have to manage when I am meeting with the client is that, although that worked for me. That may not work for them. It’s not a matter of promoting one pathway over another, it’s helping the client identify what’s going to work for them and moving in that direction.

We do see people who come through the process of addiction and recovery and decide that they want to seek education and then join the field. And in those situations I have had to have those supervisions where you have to explain that therapy is not sponsorship, right?

Sponsorship is something that you do when you’re not here. And you do it in your specific way specific to your pathway of recovery. When you’re here, you’re a therapist and you need to remember the difference between those two things. 

Betsy: [00:28:40] Yeah. I think that is really important. 

One of the reasons that I started doing the podcast is that I no longer am a clinical supervisor as I’ve gone into private practice. And it’s a really weird transition for me to not be teaching really and consulting and those kinds of things.  I really did love that part of my  job. One of the things that I have had the privilege of doing is working with mental health professionals. So therapists who did not have training in substance use.

I have found that most of the programs that I’m aware of had that either as an optional or a very small part of the program or didn’t offer it at all. What’s been your experience with getting to know interns and therapists over the years. 

Anne: [00:29:32] I think we are getting better at least educationally about training for both mental health and SUD.

 There are times when we’ll have state conferences. We actually have a co-occurring disorder, state conference in Michigan. When there’s like group work going on or something like that,  it almost has like a Jets , the Sharks feel  between mental health and SUD. But I think it’s because most people, even when there is that dual ability to work with both, your heart just kind of goes one way or the other, right.

Educationally, I think we’re doing a better job of preparing people to be, almost proficient in both. But as people graduate and join the field usually people are going to start out in either mostly one or mostly the other. Then there will come a point in their career where they realize that the two really need to be blended.

For example, with SUD therapists there will be times where I’m working with someone and oddly enough, it’s often, sometimes I can’t even say that it’s mostly people coming out of school. But I’ll be working with professionals and we’ll be talking about is the client on medication? How do you spell that? What kind of medication is that? 

No, no, if you’re going to be the therapist for someone who is on a psychiatric medication, it’s your job to be the eyes and ears of that psychiatrist to see how it’s working in the client’s life. So we’re going to talk about how you properly spell the name, what are some of the side effects?

How to assess for side effects,  how to help clients keep track of and manage these things. So even though it may not be your specialty as the therapist, it’s still your responsibility. So let’s get you to the point where you can be of the maximum benefit to that client. 

Betsy: [00:31:17] So do you think therapists who don’t have training in substance use, do you think it is their business to be assessing substance use?

Anne: [00:31:27] Absolutely. In the same way that when I get a new client or one of my therapist has a new client come in, my expectation is that they’re going to ask some of the questions related to mental health. Do you have a mental health history? Have you been on medications, which medications worked, which didn’t. It’s not in our professional standards in Michigan, but there are a couple of pieces of paperwork that I encourage all of our therapists to use.

The first one is getting an ACEs score. On a client to assess for trauma some of the depression and anxiety inventories again it kind of comes back to clients may be experiencing something in their lives that they don’t immediately identify as being hey,  maybe that’s a symptom of anxiety, or maybe that thing that happens to me in my childhood actually was traumatic.

So as therapists,  it’s our responsibility to help them kind of mine through their experiences, sort through their baggage and properly identify things. So no, I think as someone who is predominantly a specialist in substance use disorders, It would be irresponsible of me to say, well, mental health is outside of my scope and I shouldn’t be assessing for it.

No, I absolutely should be assessing for it. If there’s ever a point where I’m called to practice outside my scope, that’s when we would bring in a mental health professional. But in terms of assessment and referral, absolutely, those are my responsibility. 

Betsy: [00:32:53] So you work in a primarily substance use situation  in a treatment setting, so you’re encouraging that cross. Not even cross-discipline, it’s just, yes, we’re assessing substance use and that’s the diagnosis that is on top because that’s what we’re billing for. But we also are assessing mental health and I did the same for my substance use counselors to teach them how to ask intelligent questions about mental health, so that we’re assessing what is going on here and what’s holding up their substance use.

 I have noticed that in primarily mental health situations where it’s just a mental health clinic, that I will get diagnostic assessments that have no information on substance use.  I wonder if you’ve had that experience as well.

Anne: [00:33:48] Yeah, I would say that sometimes the professional background of the assessor determines where you’re going to get a better diagnosis from, right. In thinking about things that I’ve seen therapists do that are not necessarily helpful. One of those things is just complacency, right?

I’ve been in the field for awhile. This is how I do it. This is how I’ve always done it. It works for me. That statement right there, it works for me is the biggest problem. Because it’s not about what works for us it’s about what works for the client. So yeah, I do think people  will diagnose based on their preference or whichever one they view to be their area of expertise.  That’s a downfall on the part of the assessor or the treating therapist.  If a client has both mental health and SUD both are equally important. And that’s where we as professionals really owe it to our clients to be as proficient in both areas as possible.

Because if you’re with a client who has co-occurring disorders, if we say, well, what we specialize here is substance use disorders there’s a whole subset of client issues and challenges that aren’t going to be as well addressed as they should be in order to establish some kind of recovery.

Betsy: [00:35:08] As therapists, there’s a few things we’re afraid of, right and one of them is practicing out of scope. Practicing out of scope might sound like not a big deal to non therapists. But for us, there’s very few things you can do that are worse. I think a lot of therapists who are mental health primary will avoid substance use discussions because they don’t want to practice out of scope or they feel ill-equipped or they feel like it’s not even in their wheelhouse, so to speak. What would you say to those therapists? 

Anne: [00:35:45] In the question that you just asked me, I heard the word assessing, right? We, as therapists owe our clients the ability to thoroughly and comprehensively assess them.  The definition of assessment  is kind of to determine what some of the issues and challenges are that are going on.  We owe our clients the ability to be properly and thoroughly assessed.

Now, we also owe them our professional responsibility to not practice out of scope.  That’s what assessment is for. Here’s what the client has. Here’s what they want to have. Here’s what we can provide. Here’s what we can’t provide. Right? If we don’t even do a thorough and comprehensive assessment, how can we say that we’re practicing out of scope?

The first thing we do is we figure out what’s there and what’s not. And then we figure out what we can do and what we can’t and where there’s a need that we can’t provide then we look outside. But it all begins with that assessment and that’s something each of us owes our clients. If it hasn’t been part of your training in the past, one of the things I really enjoy about Michigan is that it does do the co-occurring disorder conference, where it brings all of us together.

Because the marriage of mental health and substance use didn’t get talked about or addressed for a really long time. People just got lumped into one category or the other, depending on where the symptoms were more prominent. These two branches of mental health, the substance abuse and the commonly called mental health they’ve been married for a really long time and we just haven’t done necessarily the best job of addressing both of them together. 

We really wanted to kind of peel them apart and deal with them separately. But that’s not how it works. 

Betsy: [00:37:31] As I think about therapists who might be listening, a lot of them express to me that they don’t have training, haven’t had training and don’t want to overstep either professionally or feel like they don’t know what they’re talking about enough to help a client. 

One of the things we know about our clients though, is once they form a relationship, they don’t want to switch. They don’t want to go to a new therapist. I wonder what you would say to the therapist who haven’t had that training, but have a desire to know more. 

Anne: [00:38:09] There have been benefits to this whole COVID experience and one of those is that we’ve seen the ability to grow professionally, personally develop without having to make drastic returns to things.  People have talked about how I’m going to come out of this pandemic knowing how to do something that I didn’t know how to do before.

 So the accessibility of information that can build us as practitioners without requiring us to return to school, pay tuition and things like that. This has been the prime opportunity for us to broaden our experience. In the past, if we wanted to go to conferences, we had to get a hotel covered.

We had to get our registration covered. There are trainings, there are opportunities for learning that are entirely web based. These are things that can be done in the evenings, on your lunches, there’s information and ways to develop our practice that is more accessible now than it was before COVID even hit.

It’s incumbent upon the therapist to want to become more proficient and able to better connect with a wider range of clients. So I think that there will be people who I kind of talked about when I said we get therapists who are complacent, this is how I’ve done it. This is how I’m always going to do it.

 Those people as we understand from the stages of change model they’re going to stay are. They are their consent with the way that they’ve been doing things, they’re content to keep doing it like that. And they’re going to keep referring clients who they consider to be quote outside of their scope somewhere else.

But then you have  the therapist who really wants to be able to address a wide range of needs for the clients that come in, and those are going to be the people who seek out these opportunities to enrich their practice and their ability to help. My argument would be that it has never been more accessible and easier to do than it is right now.

Betsy: [00:40:05] I agree. It’s been interesting to see how COVID has changed some things. Just the very basics of a year ago, I would have never thought that I would be doing tele-health sessions. I was pretty anti them. Not that I thought they were unethical, just that I’m a little old school, apparently in that way.

I’m a little old school that way. And I was like, no, I need to be with someone. Well I’ve been doing telehealth for a year now. I’m in my house in the woods and I have clients I’ve physically never met before. It’s totally weird. I do believe that things are more accessible and our views about online training and therapy  I think as a field are evolving as they have to.

When a therapist is meeting with someone assessing that they have some kind of substance use stuff going on, what do you feel like are the most important things for therapists to understand about addiction? And I know addiction is a huge topic, but I wonder for you, if you had to kind of distill it down, what are a few things that you feel like  knowledge or understanding that therapists must have in order to start moving into this place?

Anne: [00:41:22] I think that one of  the most important things that I think of when I have a client in front of me and we’re talking about their substance use, whether it progressed to a severe level or maybe teetering between mild and moderate. And one of those things is that. People who are using substances to the degree that it’s a problem are mentally  or emotionally on the run from something.

 The drugs and the alcohol, and even the gambling, the sex and the food are a symptom. We need to find what the actual cause is. Right.  Let’s say I’m working with a field student and we’re talking about why clients are acting and behaving in certain ways, or feeling unwilling to give up using what we’re going to try to focus on.

Not so much with the client, because the client’s like I’m going to smoke weed until I die. That’s just what I do. Okay. let’s look at what’s really going on. The marijuana is the symptom. It’s a little bit of a head fake, but there’s something really going on inside. You can call it the root, you can call it a problem, whatever it is. People who are using are on the run from something in a mental or emotional way.

And when we can get them to be willing to share with us what that is, or even be able to identify for themselves what it is then we’re starting to move in the direction of doing the best that we can for our clients. 

Betsy: [00:42:49] So that’s one thing that you want therapists to understand is that people are on the run from something. What’s another thing about addiction that you feel like is like core understanding of what people need to know.

Anne: [00:43:06] This is going to sound really elementary. But it’s a tripping point that I see for a lot of therapists. And I know that I’ve seen it in myself when I reflect on my growth as a professional. It sounds so elementary that I hope it doesn’t get dismissed, but the importance of meeting the client where they’re at.

I will have therapists come in my office and say these people aren’t ready for treatment. They don’t want it. They don’t want to deal with what the problem is. And really what’s going on is. They don’t want to deal with where the client is.  We may have a client who and I predominantly work with clients who are compelled or forced to attend treatment by order of a judge or a probation officer parole or something of that nature.

We may have clients show up in our building and be like, you know, I use pills. It’s not a problem for me. It’s a problem for the judge. Here are the problems that I’m having in my life, right. Client’s unwillingness to work on or talk about the use of substances does not preclude them from benefiting from therapy .

We need to meet them where they’re at. And if we do a really good job of meeting them where they’re at, they may change where they’re at, and that will open things up a bit. One of the most harmful things we can do is say that because if someone doesn’t arrive in treatment saying, I absolutely never want to use again.

A person who arrives in treatment, not immediately ready to give up drugs or alcohol does not discount them from the recovery process. And it doesn’t mean that treatment is not appropriate at this time or not effective, or anything of that nature. 

Another harmful thing that I’ve seen therapists do, and it’s so subtle. The most common place that I see it is with people who have SUD and are seeking treatment, who are parents is  and I’m going to say this and you’re not going to believe it, but it absolutely happens is when someone arrives in treatment and in the course of the assessment, that therapist is talking to them and the person discloses that they have children.

And then the therapist says something like, Oh, you’ve got to get it together. You’ve got kids, you’ve got to get it together. Don’t you want to be a good parent . For a parent who’s arriving in treatment, knowing that they have been coming up short as a parent because of substance use or mental health to hear someone say, don’t you want to be a good parent is one of the most shaming and destructive things that I’ve seen happen.

 And it happens with so much more regularity than you would like to believe that it does, but there are subtle ways that therapists communicate with addicts that demonstrate a lack of understanding. I think most people who become parents or are parents want to do the best job that they possibly can.

And so to have someone, especially a professional that you’re supposed to be engaging with, say something like don’t you want to be a better, or you need to get it together for demonstrates that lack of understanding. I think we need to be really cognizant about invoking any kind of additional shame when we’re dealing with addicts. Because addicts need shame, like a drowning person needs water.

 I do sometimes see people, professionals who aren’t mindful about the language that they use. People who are seeking therapy, who are addicts they don’t always come in completely honest, completely clear about their own story or their history. But they absolutely have good prospects for therapeutic outcomes, especially when they have a therapist who is willing to listen, not judge and give them the opportunity and the space that they need in order to fumble around and find out what recovery is going to look like.

Betsy: [00:46:55] I agree. I have found that there is some belief that love should be enough that love of family, love of children, love of self should be enough to get you sober. And in my experience, that’s not the right question. That’s not the answer to the question. Because I’ve worked with tons of adults who are parents as have you who do love their families and their children.

And they feel deep shame remorse, regret, helplessness, et cetera, about their abilities in those areas of their life, whether it’s them as a parent or them as an adult child of their parents, that they are also baffled by love not being enough to save them or get them in recovery. 

Anne: [00:47:49] Currently our clients are having visits with their family as via zoom. One of the stations where people do visits is across the hall from my office and so I can hear people calling and doing these video visits with their children. It’s really humbling for me because when I’m at work at any given moment, I have almost an exact idea of where my child is.

I can tell you, Oh, she’s staying with Liz and they were going to play with sand today and I’m watching people try to parent their children through a zoom visit. . And I see how hard that is for them. And it’s humbling for me. And it’s inspiring for me because they do want to be the best parents that they can be.

And especially when someone makes a statement like, well, don’t, you want to be the best parent you can for your child. They don’t realize that the person that they’re talking to probably feels unworthy of being a parent to their child.  Oftentimes people oversimplify it like haven’t you had enough consequences for your behavior.

We wouldn’t have the addiction problem that we have in this country alone right now, if you could just experience enough consequences and stop. If anything, over a pattern of time people become accustomed to the unpleasant consequences of their substance use disorder and jail, isn’t really a deterrent. Like I’ve been here 15 times. This is no big deal. I can hang out in jail. I can’t sit and look at what brought me here. I can’t talk about the trauma. I can’t talk about the fact that I can not stop using until you put handcuffs on me. Some people really want to oversimplify it. If negative consequences worked, people would get clean a lot easier, right?

You would get arrested for drunk driving and then that would be it. If disappointing other people, if love was enough, these things don’t stop someone who is caught up in a substance use disorder. They don’t.  Having that awareness is one of the most important things that a therapist can bring to the table until that motivation is intrinsic it’s not going to have lasting effects. That’s where person centered planning comes in, because if all someone’s willing to change is I’m not done using, but I’m sick of going to jail. Okay. Let’s talk about the behaviors  that are sending you to jail. Let’s start where you are rather than where I think you should be or want you to be.

Betsy: [00:50:17] I’m curious about  how you view abstinence and harm reduction. I have spoken about that in a couple of podcasts that I believe that we need both in order to be effective. Cause a lot of times harm reduction is pitted against abstinence as though they can’t exist in the same place.

But  I feel like they’re on a spectrum. And that people move where they’re going to move.  I wonder what your thoughts are because  you have worked in a similar capacity to me, you’re also an addict in recovery and in following an abstinence based recovery plan as I am.

 I wonder what your experiences are as I know in a residential setting, it’s a lot of mandated people. It’s a lot of people just edging on sometimes pre contemplative to contemplative of and back and forth. And that, that’s a lot of the work that you guys are  doing. So what are your thoughts on abstinence and harm reduction?

Anne: [00:51:19] I think that the longer people have been in practice sometimes the harder it is for them to accept harm reduction, as opposed to abstinence. Again, we come back to the idea that there are many different processes to the same result. But not everyone defines the same result, the same way.  I came in and the choice that I made for me is that I can’t use anything that changes the way that I think, feel and experience reality. And so abstinence was the route that I chose. There are plenty of people and plenty of clients that I’ve worked with who came in and they just could not stop shooting heroin, smoking crack, whatever their thing was. And once they stopped smoking crack shooting heroin, they have been able to manage having beers on the weekend or, using medical marijuana, which is permissible in the state of Michigan to treat some other subset of symptoms that they have going on.

I think one of the most harmful things that we can do again is say that. One is more important or more desirable than the other, because it’s the client who’s defining what recovery looks like for them. What success looks like for them, what improvement looks like for them. And if we are so fixed on, well, the best way for you to do this is to not use anything at all.

We’re doing a disservice to them. There are a lot of people who get clean, you know, maybe people who were using heroin, they, you know, started with prescription pills. They got caught up in the opioid epidemic. They came to an abstinence based recovery program, but have subsequently migrated out of it because they have found that they are able to use alcohol without, you know, negative and disastrous consequences.

They are able to pick up a beer and put it down and not end up using heroin again. But by the same token, I think with medication assisted therapy, we see. Professionals who equate methadone or Suboxone with legalized drug dealing.  That’s harmful to our clients as well. 

I’m kind of the informal statistician at our treatment center. In the time since I been there, which is March of 2010, that we’re aware of, we have lost 126 former clients overdoses. If these are clients who hadn’t had had in the past abstinence as the primary goal, preached to them, and instead had been afforded the benefit of Suboxone or methadone, would I have their name on the memorial wall?

Maybe not. So we also have a responsibility to identify and respect the legitimacy of medication assisted therapy, because there are people for whom they cannot stop using and stay stopped using despite having tried. And then we need to move on. Okay. What’s something else that we can do to help you, because if you can be alive and be a functional member of society on Suboxone or methadone, that is improvement, and that can be a definition of recovery. Because you weren’t able to do it with abstinence as the goal, but you are able to do it with medication assisted therapy. That is absolutely legitimate and the science backs it up. 

I agree. And I’ve seen that as well. I haven’t had as much pushback I don’t think on recovery with Mat being a problem.  I know that it exists. I know that there are pockets of people, even within the recovery community who have really strong opinions about Mat and using stuff like Suboxone and I to see that, what would it look like if this person had that option?

Betsy: [00:55:16] One of my former clients overdosed two weeks ago, and I hadn’t seen her in years, but saw the obituary. It was clear from the obituary that she had died from overdose, which as, you know, as well as I do often the obituary doesn’t allude to any of that, but that was what happened.

And I just think, man, we have some options. We have Suboxone available. Now in our community here where I live, we haven’t always, it’s been very difficult to get buy in and get people to do it. I do think that the science does back it up that it’s a great option. I think that as therapists, what we need is the same thing we do with non substance abuse clients. Is that just because we can see what a potential problem might be when they come in doesn’t mean we tell them and, and try to convince them that’s the problem.

 We assess it, we have it in our head and we move forward and we step by step, go with them wherever they want to go. And we’re planning sort of,   if they want to go this way, we’ll do this thing. And if they want to go that way, we’ll do that thing. But recovery is sort of, well, we’ll see.

Are you able to drink on occasion? I don’t know. I don’t know. We’ll see. And if they are then, we just watch that and if they’re not then, okay. So what do you want to do about this then?  I understand when we’re talking about programming it’s a little different of, can you have people in a group who are drinking casually or smoking weed or whatever in with people who are working on abstinence?

I don’t know, that’s a different conversation, but in their own personal lives, us as therapists, being able to accept that this is what they’re willing to try and that we are just curious with them on if this is going to work. And if it doesn’t, what would that look like? And if it does, what does that look like?

That we aren’t trying to necessarily get everybody to the same goal post and that that’s where it ends. We’re working on what they give us in this moment so that they end up alive. So that they can keep going. 

Anne: [00:57:34] Yeah. I think that a lot of this, maybe not a lot, hopefully not a lot view clients as bringing them problems and then the therapist has the solution or that it’s their job to have the solution.  It’s really not. It’s to help the client identify and elicit their own solutions and help them figure out how to get there. I think therapists feel a lot of pressure to quote, fix people and that’s kind of a misidentification of their role.

The role is to explore and travel, see what works with the client and if something doesn’t work suggest things that might. And go along with the client as they self explore. When I go to the doctor and the doctor tells me that I need to eat less carbohydrates. I’m not as motivated for it because he told me I needed less carbs. It’s when I look at my life and I’m like, you know what, I’m eating too many carbs and not enough protein.  That’s when change happens. . 

So if I enter into a professional relationship with someone and I feel like they’re guiding me rather than allowing me exploration and  my own self identification of challenges we have better results  when I feel like I’m the one in charge, but I have  this helper, this asset, you know, this guide right next to me, as I do these things.

Betsy: [00:58:58] I think that initially when clients come in, they struggle with the idea of being really forthright about their substance use. And that’s fine. Our job is to present a place that they can be themselves, that they can build a relationship. For me I find success with my clients to be when I know they’re being pretty much a hundred percent straight with me and not telling me what I want to hear, but sharing whatever’s going on.

And I find that that’s when we can do some really good work and with substance use, it does come out eventually. The truth does come out eventually. And even with my mandated clients, it’s a matter of  how much trust you can build,  that you’re not calling their PO every five seconds or whatever. But I find that meeting that client wherever they’re at and okay you want your PO off your back. Okay. All right. So let’s figure out how you’re going to do that.  

Anne: [01:00:04] Let’s figure out how to stop going to jail. 

Betsy: [01:00:08] Right. If they want their PO off their back, all right. Then that’s where we’re starting. In the reasons that people start treatment, I don’t believe are the reasons that they stay in it. Our recovery reasons change over time.  In the beginning, it might be, I don’t want to go to jail anymore. Okay. And then eventually it’s like, well, you haven’t been going to jail.

What else might, might want to change?  Well, I’d like for my kids to trust me more. Okay. That’s a great goal. Let’s work on that. Having that curiosity about, well, I tried this and then this happened, and I know you told me that this was going to happen.

I hear that a lot. You said this was going to happen. I said, no. I said it might. And I’m not happy that it did. I don’t need to be right about that. It was a possibility. So now that it happened how do we make sure it doesn’t happen again? Keeping them engaged is the most important piece to me of building that long-term recovery.

I really appreciate your perspective and talking with you about what your experiences are. I know that you didn’t plan on being in the clinical realm. But it seems like you fit there. Do you feel like this was sort of what was meant to be? 

Anne: [01:01:27] Yeah, I really can’t argue. There were no, there were no accidents and this didn’t happen by coincidence. I think I ended up exactly where I needed to be. And I think it’s pretty telling about being a person that recovery that where I wanted to be, or where I thought I would end up was different.  I don’t regret the road that I had to take to get here because at least like I turned that mess kind of into its own self for other people. And I try to be generous with my experiences being in recovery on a day-to-day basis. I look like a responsible productive member of society and so I try to recover out loud so that people see that addicts do get clean, they do stay clean and there’s great potential inside of them if they have the proper opportunity to define their own recovery and pursue it with support. I’m grateful that just for right now this is where the story is. 

Betsy: [01:02:24] Well, thank you so much for letting me interview you today and I appreciate the work that you get to do out there. I know that having such a high acuity rate can be really taxing at times.  I am sure that the support that you provide your staff is huge for them and teaching them how to manage this illness that we treat and all of the consequences that happen around us, in our people that can be really challenging. I’m really glad that they have you so that they have the support they need. 

Anne often talks about living her recovery out loud so that others can see that recovery is possible. And I am grateful that she was willing to share her story with me so that I could share it with you.  I’m inspired by her views of meeting people where they’re at, of being willing to hold space for people and whatever stage of life they’re in.

She has true respect and empathy for people who are still suffering from this disease of addiction. So, Anne, thank you so much for doing the interview.

One of the things I wanted to highlight from what Anne had said is something that I hope that you will hear as a therapist. Even if you are not an addict or an alcoholic in recovery you are welcome and needed in this space in order to work with alcoholics and addicts sometimes it can feel like if you aren’t one of the people in that group, then people aren’t going to listen to you and that’s not true. What we need are people who are willing to learn and to hold nonjudgmental space. 

In the coming months, I hope to bring you more interviews from addicts and alcoholics in recovery who are in our field and some who aren’t.

Next week, we’re going to be covering synthetics or “legals” as it’s called in some places. Many places these types of drugs aren’t legal anymore, but they were for quite some time. Specifically, we’ll be talking about K2 or spice, which is marketed as synthetic marijuana. And bath salts, which is marketed as synthetic meth. These drugs have been in the news over the years, and recently, at least in my area, the prevalence of them has gone way down. But for a while, it was quite a huge deal and caused a lot of problems.

Until then have a great week. 

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.