Episode 8 Navigating Harm Reduction Watch Now https://youtu.be/Wo0_e_vgpx8 Listen Now Episode 8 We dive deeper into what the Harm Reduction Principal may look like in a real life example, as well as why this new emerging model can a hard topic to navigate.
**And for our viewers, plus note, that as Peaks Recovery continues to endeavor down sensitive subjects, we want to caution our viewers that our goal for these conversations is to only bring deeper insights into addiction treatment topics that may seem new, complex, misunderstood, or even frustrating. But we believe that as our industry grows to understand how to better treat addiction, not only do we want to provide better understanding around it, but it is also our duty to appropriately grow along aside it in order to arrive at better outcomes for the individual, and for the family systems that are suffering through this process.
Topics:
Select Quotes There are no two addictions that are the same, so there is no one equation that you can just plug an addict into and expect only positive outcomes. So we get into this more open and understanding world where different intervention strategies are geared towards improving the overall wellness and quality of life for the individual rather than focusing on these hard definitions of what it means to be in recovery or what it means to be sober. Clinton Nicholson, MA, LPC, NCC - Chief Operations Officer Episode Transcripts Episode 8 Transcript [Music] all right welcome back to another episode of finding peaks excited to be here again today with our chief clinical officer jason friesma and our chief operating officer clinton nicholson welcome back fellas to another episode i've been talking a lot about what episode we're on and apparently the feedback is that i've lost count significantly so i'm no longer going to state what episode we're in because i actually don't know maybe just a sign in the title just like episode chair episode yeah we're a work in progress bear with us that's pretty clear yeah super clear yeah so today i want to that this industry you know going all the way back what to introduced from there forward started with a strong abstinence approach to care and this industry at least that in the way that i'm experiencing certainly i'm sure you guys are experiencing the same is softening around the edges of abstinence and moving towards a harm reduction model to determine outcomes and a story comes to mind about a past patient who was in our care several years ago the mom continues to reach out to us on a yearly basis just excited and ecstatic about how well her son's doing but she talks in a way that isn't really engaging with the abstinence-based concepts and so just introducing this story namely the individual came into our program abusing heroin intravenously left our program has since not used interventions in our uh how do i be iv i'm gonna let's go to iv there to make this more more uh convenient for the conversation not using iv heroin but is holding down his relationships has a baby in his life you know holding down a job showing up as a family member not stealing from mom or anything like this anymore but is drinking actively drinking and she states it's not an issue that you know at parties or whatever the situation is family gatherings that he's accountable showing up in all the ways that she sees you know um positively in the adulting sense of things um but has removed the heroine and so in this regard this story is revealing a harm reduction principle namely the major problem has gone away but use in some way continues and so i guess with my what feels like a poor introduction of a story there utilizing that story um and and coming from this large abstinence-based approach where are you guys at on this topic and before i ask too many questions i'm just going to rest it there okay jason oh yeah i mean this is this is a an emerging debate or an emerging discussion probably to have because i do think uh in a lot of ways creating very rigid success models i've actually called it worshipping at the altar of sobriety time when somebody's perfectly sober from all substances um and that's the only measure of success it creates an issue where if somebody then does have some sort of slip whether it's a beer or a joint or whatever and it isn't a return to iv heroin use from a pure abstinence-based model they've relapsed and they're at zero days of sobriety just like they were the day they last had a needle in their arm and i think that rigid model of thinking takes away any nuance and it and it says all relapses are the same all lapses are the same all drug use is the same and it just turns out that um that isn't always helpful it it and don't get me wrong it has been helpful at times to think in that way and it can be helpful to take away ambiguity and that is certainly the easiest way to take away ambiguity is just to say all drugs are bad any use of any drug is a relapse it's very black and white there's an easy way to measure success in that but i think we can be a little more nuanced maybe in our description of what is success like is this by all measures this mother that you just described would say that her son has successfully uh recovered from iv heroin use now he's chosen to continue to use alcohol i don't know how he's using it it doesn't really matter the mom is saying that he's functional his life is going okay um that would seem like a success and i it would also seem a little risky potentially too clinton over to you over to me wow right yeah well um i mean i think that the big book was very much uh sort of um from its time right like it's a representative of its time which was in a pretty conservative um not super sophisticated scientifically um era and it really rests a lot on the moral model of um of addiction and the belief that you know there is an element of um willpower and that there is a sort of uh a defect within a person that makes them an addict and because they have that defect they're an addict across the board right like it doesn't give you any room for um again like jason said for nuance or for differentiation or for the idea that you know just because you are a heroin addict physiologically does not mean that you are an actual alcoholic you know like those are two different things but from a moral standpoint or that old sort of the older models and that and that abstinence-based model specifically all substances are the same you know like addiction as addiction is addiction is addiction but the reality is that addiction is really when you talk about like the dsm-5 it's a it's about how is it negatively your substance use negatively impacting your life right there has to be that component to it um and this the um client that you were talking about it sounds like you know the substance that he was using that was messing with his life and disrupting him and creating turmoil and chaos that was eliminated and now there's another substance that he's using that does not have that same effect so therefore he would not be diagnosable under as an alcoholic you know so for me it um the abstinence-based ideology is one of over simplicity and i think that it lacks uh a certain i think that it really does steep itself in shame as opposed to wellness which is what the the more um harm reduction models look at yeah absolutely i think sorry interruptions um but i do think like looking at where aa came from right like there is no predecessor to it absolutely nobody could get well and it was this grassroots movement in ohio if i remember right where people started to be able to stay sober and then tried to figure out how they were staying sober and this was to me just a great honestly a great description of how they managed to stay sober um and to your point it isn't a time capsule um but it probably needs to reform like any idea from the look at sigmund freud and say all of his ideas are absolutely true and we can't change any of them right absolutely everything is about uh the id and the ego and the superego and there's no other way to conceptualize how people think absolutely it was foundational and important and we do use a lot of concepts from sigmund freud and he needed to make those um do that writing and then we've grown a ton from it well i think actually in addiction it's one of those fields that didn't grow right it found one model that worked pretty well for a lot of people and then because there's so much stigma and misinformation around addiction and there was this sort of moralistic component uh that was kind of wrapped around it socially once once we found one decent way that helped a few people like we just kind of stopped as within that field looking for other alternatives and looking for different ways and really even exploring what is addiction like what is actually what does addiction actually mean and i think that we're still kind of playing catch up to other fields that would have like you know looking at like psychology as an example you know where they were able to sort of bust through those early ideologies and recognize very quick very quickly that there is more to the story and i think that we're still pretty early on in that process especially because the fact that we're having this conversation and harm reduction is in a lot of circles still considered pretty controversial well it is weird even sitting here i'm uncomfortable i'm going to be honest with you because i know certainly how i've been trained and how i've operated for a fair amount of my career it's it's been much easier to make this black and white issue absolutely to be honest with you like to just fall into that same pattern of thinking but really with the addition of like mat treatment like using medication to help people remain sober and and to be able to kind of regain control of their lives like it we have to begin to learn how to explore things that are uncomfortable even even acknowledge that uh perhaps the the lane of this absence-based model uh is actually maybe even a trap that we find ourselves in rather than even even a path forward at times so absolutely and the way that i see it the the new the the new language of a moral defect is the science of the physiological brain state that we call craving uh right now so i think you know i can i can just feel the tension building on the other side of the camera as it is for us too with families being like no you're not telling me right now that johnny has an iv heroin issue and he's gonna go and start drinking i think there's an important notion here to consider that if the craving state is iv drug use and the end of it i guess one step back i always have clients you know walking around you know our treatment center saying i can do this on pot do what are we talking about here and what i hear or the way that i translate that is that i have this thing called ib craving state and i'm just going to replace that state with pot i mean no wonder the abstinence culture has thrived so much because that's an error in thinking that it's not going to satiate the craving state which leads back to the relapse of this craving state and so what i think is really important here that i would certainly love for families to hear us out loud as we talk about this and i think it's worth more of a discussion here right now is when we think about the trade-offs let's say we can actually do some other drug or alcohol in the future that is this over here and remove this craving state it seems like when i think about drug use or alcohol or you know use anything of those sorts that there are these two words that i always use with clients in our care responsibility and sustainability right so when we're talking about okay well i'm going to use meth it i mean right when it comes out of the mouth it doesn't feel very responsible and we know it's not sustainable in our experiences due to um the likelihood that you will begin to crave that and develop an addiction yeah there are very few like weekend meth users right that's just not really a thing you know um you know cocaine there's some there's drugs out there that each time we say them it doesn't feel like we can get into responsible and sustainable lanes now with you know pot becoming legalized or at least decriminalized across the country it's a common go-to piece and we can get into it but alcohol is the other one there both of them have components of responsibility and sustainability at least in the general public sphere of things but what does it look like maybe to think about responsibility and sustainability here because it's not you know 10 bong rips throughout a day that makes this no okay to do yeah i think you're bringing up that craving state really resonated with me brandon and i really think um if somebody's using pot uh in lieu of heroin um i just don't see that really working right like i i think it makes the itch worse it doesn't scratch the itch it worsens the edge um and so i think there's a function of time a lot often right like deal with the craving walk through whatever is driving it and then maybe down the road um what would it look like to reintroduce some of these marijuana back in and then i frequently in in the new approach which is more uncomfortable i want to acknowledge that it's like well how will you know if marijuana if you want to do it and how will you know if you're losing control of it or how you know if it does seem to be leading you back to uh a place where you don't want to be into a craving state or into being triggered and so um and i and i don't want to just detract from that but like i do think some of our unwillingness to talk about um harm reduction is on our field that like this is a harder nuanced conversation it's easier to sit and tell a client don't do drugs they're bad avoid all that don't go to a bar really easy very telly very parental um and in the end shame based i think maybe not shame based but aspects of it are shame based for sure which really complicates treatment because a lot of actual addiction treatment is based in trying to eliminate shame correct so there is this contradiction that immediate intention that actually is created within that model and the treatment of that of addiction so um and but i mean jason's totally right this is as soon as you say the words harm reduction you have cracked open a pandora's box of gray like it is just there so all of a sudden it really is based on each individual has a unique addiction there and therefore has a unique recovery and our job as clinicians or as medical providers or is to actually try to figure out what that is you know so rather than giving one answer for all of the questions we actually have to really dig in and figure out who these people are what their needs are what the motivating problems and factors are how to actually eliminate that craving state and and then help them to to figure out their own path to what their future of recovery looks like and that is i mean i'm tired just thinking about it but at the same time that's the response that's the most responsible way to move forward it might and that's an opinion without a doubt and that's that opinion in no way shape or form is promoting um you know substance use for people who are in early treatment you know or early in recovery that's i think the antithesis of what we're actually trying to say um so there is there are edges and there are boundaries but they are they they don't feel familiar and they don't feel and they don't feel nearly as solid so yeah and the concept of at least in the medical sense of um neuroplasticity brain neuroplasticity is of the brain of course but in and without diving too deep into the science i mean the basic premise of it is right that new neural pathways can form and i think that's the brilliance of the time component that if you have this craving state the more distance you have from it and the more neural pathways that are developed in front of it um or on the other side of it you have what seems like a new opportunity to explore different things in a way that was limiting in this case absolutely so i think absolutely even though we're in a gray area time is really important and distance from the original craving state is absolutely needed um in this guard uh or in that regard in uh particular so uh and just real fast i mean that that reiterates the idea that recovery is not just sobriety like those are two very different things like not using substances is not the same as recovery uh recovery is about changing all of those aspects of your life the the social aspects the interpersonal aspects the intra-personal aspects managing and creating a life that in which you function completely differently which is reflected in the new and the way that your brain is functioning right because of neuroplasticity that transformation is somehow made permanent and more meaningful and you actually do live a different life i think that's a great point i mean i i do think of people that i've met along the way who maybe have been sober for years and years and years and go to three aaa meetings a day and are no more pleasant to be around when than when they were drinking yeah they're sober but they're not in any sort of recovery yeah that's a thing yeah and so it brings me to a future topic medication assisted treatment programming that um we'll definitely play out in a future uh episode but one of the things that dr volkow with nida the national institute on drug abuse came out many years ago in regards to suboxone this is around i think 2006 or so and felt as if this was a cure to craving states so there's tension on the mat side of things that i'm looking forward to talking to but just kind of leave the viewers with as a tail end of this conversation um that's limiting in our thought about this that we can apply an a drug objectively to all subjective craving states for intravenous opioid users and in relationship to suboxone that for me doesn't seem reasonable that it can't be the silver bullet that we depend on as an industry moving forward it's something within the tool kit that we can utilize um in all of this but i don't feel like suboxone in general or you know supplicate and the like are accounting for the subjective experience of craving states and this is why we get such a separation from the young adult being entirely not successful on mat programming where you get you know middle-aged 33 years old or higher largely seemingly becoming successful on those protocols so i don't know exactly what my question is here but i feel like it seemed like you were doing an outro yeah yeah maybe maybe it's an outro here um well you're kind of reiterating the idea that um you know silver bullet responses regardless of what they are whether they're based in a medication model or whether they're based in an abstinence model there is no silver bullet the real the real work and the real repair is done over time and it's uh actually done within the brain you know that's where the majority of the repair work is and it takes time it takes dedication it takes treatment it takes counseling it takes um several different dynamics and variable variables are involved in actually healing the brain so the silver bullet mentality in general and i think this goes for either abstinence-based or for harm reduction models is i think that's maybe what we actually need to walk away from yeah absolutely it's crazy because inside of me as we talk about this i i want to like put the disclaimer out there that like people don't walk out of peaks with the recommendation of like start smoking marijuana right i would explore your path absolutely not uh have your wife pick you up with a six-pack and see how it goes like that because of that time element people aren't walking out after a stabilization program right and right into that like there's a there's that element see and that's my own discomfort with this whole conversation but i feel like i need to say it yeah and it is a part of this outro that i that you rightfully pointed out i'm cautioning both sides of the the polar sides of the conversation that this isn't pure harm reduction this isn't pure abstinence that we have to sort of live in this gray area to arrive at better outcomes for the individual for the family systems that are suffering throughout this process and so um hopefully we've been able to provide a little bit of insights into the tension in this relationship you could probably experience it in just us discussing out loud that there is tension in this um uh topic and that definitely the goal isn't to just you know turn around and start using you know drugs and alcohol by any means in this regard it's it's sensitive but it's something worth talking about and this industry does need to talk about it and i'm excited that we're able to deliver small pieces of it today so thanks again for joining us here at the finding peaks and we look forward to the next episode with you all thank you thanks