Episode 13

[Music]
well here we are back for another
exciting episode of finding peaks i’m
excited to be here again today
hosting after i think you tried to steal
the show last time
yeah tried no chris i was host chris
you right it doesn’t matter to the
viewers um welcome back
i’m excited to be with my pals my
colleagues here jason friesma
chief clinical officer clint nicholson
chief operating officer at peaks
recovery centers
and the topic that i want to bring to
the forefront today
is direction of care the continuum
in this regard and one of the things
that i’m energized in talking about this
it seems like in the
addiction treatment space that this
industry has lost a little bit of its
edge
it seems like at times um
clients are informing direction of care
and not taking clinical recommendations
medical recommendations and that sort of
thing and it feels like it’s uh
disruptive to outcomes now sitting
in the parent seat in this regard when
um and certainly in the harm reduction
principle sort of way when
somebody chooses to do something even if
it’s against the grain of the clinical
recommendation
at least they’re doing something and i
think you know families and treatment
centers and cultures really lean into
that that at least there’s some
direction about that care but
for me i feel like it’s important for
this industry to sort of
bring back that energy a little bit and
sort of take back that power
because we are the professionals um in
the way that we understand addiction so
uh
just curious in that regard jason will
start with you
what is your experience around like
resistance to the direction
of care and what do you see through that
so i mean here’s what i
think you’re asking brandon is like the
direction of care
um not just being directional but not
skipping steps along
the path is that kind of what you’re
talking about too
yeah not asking your questions yeah
questions back at me
not not skipping steps but taking
seriously so sometimes you get it you
know of course
individuals get into addiction treatment
they spend 90 days in it and they’re
exhausted with clinical care
or whatever the case might be and they
want something fresh and new or believe
they have the tools and assets to do
something otherwise
but it seems like there’s an ignoring of
clinical recommendations as they happen
great question i have a metaphor uh just
for clinton
yeah for me yeah for you uh because i
know how you love metaphor
i do um
when noah my son was going to that is
his real name by the way he’s not a
client right
um when he the summer before he’s going
to kindergarten he
actually broke his leg his tibia
and um and he had to get a cast all the
way up
uh to well his hip really
and he had to kind of get around on it
and then
um the doctor said he’d figure out how
to get around without it
without uh any help and he did he didn’t
need crutches he was too small for that
he just
started figuring it out and clumped her
wrong and then he got a cast down to his
knee and then he got a walking cast and
then he got a
brace and then off and
i often have thought about that when
considering your question
because you know the cast all the way up
to the hip was that hey the
the joint above and the joint below the
broken bone
needed to be stabilized and then that
provided some stability for the bone but
then
you know after a while they could lower
the cast down to his knee
but the the bone still needed some
support but not
as much it didn’t need to lock the joint
above it
um and then eventually you know the
walking cast the bone could sustain a
little more
pressure as people were walking or as
noah was walking
um but it still needed that support
and and i often think about that as a
process
uh you know and i apply to what we do
right when
when when noah’s leg broke i didn’t ask
the orthopedic surgeon like
can we just go from the the hip cast to
the walking cast
or like yeah can we just put an ace
bandage around it after we get it
aligned and just see how it does and
then
if that doesn’t work come back for this
like you know i
we i went to an expert and then i wanted
to rely on the expert all the way
through the process
and i and i often think about that in in
our field like
it’s your point like you know we we have
a field we’re well read in it well
studied in it and we
have watched um people be able to
progress through a process of detox and
doing residential
care and and then uh on down through php
and iop and even outpatient treatment
and and when people follow that
process especially if they take their
time and follow the process maybe even
over a year and do that entire
arc of care um usually they’re pretty
stable coming out the other side
and and that progression uh
is in place for a reason and and and the
earlier levels of care
just like the cast on my son provide a
bunch of stability and sometimes it
feels like i
know when when no it is cast on like it
seemed like his leg was healed
underneath it and in fact he reported no
pain
thought he was gonna be okay and like
and i remember asking
the surgeon for sure like can you know
are we sure we can’t take it off quiet
and he’s like no i don’t
it’s not stable and like i can
understand the frustration of that
um but recognizing that we can’t always
we aren’t always the best judges and
and of ourselves and sometimes we do
have to rely on experts
uh to trust us along the path i don’t
know if that answers your question
or not but uh seemed like it did yeah no
great metaphor as clinical culture often
does presents
strong metaphors it was kind of an
allegory too so there’s a little bit
yeah
oh that’s all right english major yeah
thank you for that no i think that
that’s really i
actually beautifully said um and the
problem with addiction is you can’t take
an x-ray of an addiction
right like there’s no way to have this
sort of like quantifiable like
look here’s the break you know this is
where everything went wrong and then
this is exactly how we’re gonna fix it
and then this is the whole process of
what that looks like
it’s there’s no way to capture that and
i think because there’s so
much misinformation stigma
shame around guilt around addiction and
and also a level of disruption that is
so systemic within a family system
um that the typical response is to go
the path of least resistance and
actually go backwards right
we’ll start with the brace we’ll see if
the brace works and then if when the leg
breaks more
we’ll go ahead and then we’ll do we’ll
do something up to the knee and then
when the
the break gets even worse well maybe
let’s try the brace again
and see if we can go back to the brace
there’s this it’s this really
um it’s counter-intuitive in so many
levels but
this but it is very unique to what we do
here in addiction and that
there are regardless of because the
expertise that people have to rely on is
through
personal experience and not through
something that can be shown
on a graph or in a picture it
it’s that much harder to relay the
importance of what it means to go
through
these sort of steps and processes of
of treatment yeah and i’ll add too sorry
but i’ll add that
the the process of starting with
too low of an intervention like that has
great risk
absolutely um and i also talked to
families too
i call it calluses conform or like okay
they start to hear the language but
they’re not immersed
in a high enough level of care and so
there’s a loss of i don’t know like
there’s other that creates other things
to work through when they begin to learn
the light when clients begin to learn
the language of recovery
but they’re not entering into recovery
that’s more of a barrier actually
it creates an inhibitive process and
clients get really good at telling their
parents how much pain they’re not in
right like oh no i don’t feel any pain
right now like my leg is totally healed
like
and they get real again good with the
language good with the lingo and
meanwhile and the parents or the family
hear this and they want to go and
advocate for their family member which
of course they do
you know they it’s it’s a a scary
and um you know there’s a lot of
unknowns a lot of variables that are
that are unpredictable
when you’re talking about addiction
treatment so of course they’re going to
go and advocate and trying to get the
least amount of
um uh you know negativity or resistance
in their life you know take that path of
least resistance
uh in the meantime the the damage is
just increasing and increasing and
increasing and eventually
you know you’re going to lose the leg
yeah and that’s the ultimate
and that’s and that’s unfortunately you
get to that point where you’re like
you’re like gangrenous at that and
and we have to step in and and try to to
not only um get people through the
treatment that they should have had
initially but undo
all of the damage that has happened in
the process yeah i would like to mark
real quick that this is the first time
gangrenous has been used
right on a peaks episode but absolutely
check that box
interesting direction of metaphors yeah
yeah or allegories whichever this yeah
yeah and and i and i certainly don’t
want to insist on
care has to stop it start at the top and
then end over here at some point i think
going back to your
track metaphor you know in the past as
well too that people are doing different
things and entering
treatment episodes at different times
and i’m thinking you know more strongly
certainly about you know maybe somebody
who’s been using
you know drugs and alcohol in an
addictive way
for multiple years it seems like an
error to state well i’m going to go to
detox and then i’m going to go do this
iop thing and also too as a direction of
care when we think about
you know coming off of a stabilization
model and let’s say you complete a
residential treatment program and the
next recommendation
is iop i mean it’s intensive outpatient
for a reason the intensity we’re trying
to get ahead of
is that craving state that’s operating
within it and we might
feel good as an individual coming out of
residential care feel like we have a
little bit of stability but
you know in the wellness way of things
that makes sense but we
like you said aren’t able to sort of pry
open the brain look in there and be like
no your craving state’s still active and
still going
absolutely and the data is clear you
know one year of recovery time
leads to a 50 reduction in relapse but
there is still a 50
potential right of relapse just in
within one year which i think informs
the direction
to toward the two-year outcome of 85
percent right
reduction in re-lapse rate so the more
that time goes on is informing this but
it
to me it it it really brings forward
this opportunity of direction and care
and we’ve got to take it seriously
and it’s interesting like you said too
in the medical lens like we lean into
the professionals
in any other arena of you know cancer or
broken bones or these sort of things
we’re not like
i’ll do that approach and then i’m just
gonna skip it move out to over here you
know we really take it seriously and i
think
that subjective state is really hard to
compete with and i can only imagine as a
family member too
your loved one finishes 30 45 days of
programming says i feel great
and i’m not going to take these
recommendations but i’ll do this next
thing maybe go to meetings and have a
sponsor
that can be reassuring but in that
regard
how can we empower families to hold a
boundary to that to say that i really
want us as a family system to really
lean into what the experts are stating
love what you’re stating about that but
can we do that and also what the experts
are doing
and you know how do we go about that as
a as a boundary with families
i actually think you said it really well
brandon and i think that
that literally is the conversation to
have with people of
of like you know i i love you
and you’re making a compelling argument
about why you should leave treatment
early
um but i need to kind of set that part
of me aside and just trust
the experts right you know because i you
know i
going all the way back to my metaphor
again about noah like i didn’t like
having him limp around in the cast like
that’s not fun as a parent to watch
my son struggling in this way and and
you know there certainly was a part of
me that
thought about taking a song cutting the
cast off myself because it’s getting
itchy and stinky frankly and like
um and i really think uh
but but learning just doing that piece
saying i i love you like
using affirmative and and uh empathetic
statements like i
i hear what you’re saying and i know
this must be difficult um but we’re
going to rely
on on the professionals because we would
do that if
in any other situation if you’re
battling cancer if you’re battling
any other thing we would just be relying
on the experts not
and but supporting you when you went
through the hard times of it
and emotionally difficulty in great
fashion jason leads into
the emotional component of it right and
i think that that makes why i’m here
exactly so i’m going to take up my token
as well
and so i actually the other part of what
you said brandon i think is equally as
important which is that quantifiable
data as well like looking at these like
all right let’s look at outcomes you
know like we have
some numbers to go by we can’t crack
open the head take a picture of the
craving state
yet it could happen you never know the
brain is the last frontier
tune in next week
but i think that being able to show
people like hey yeah at one year of
sobriety
it’s a 50 50 still but you have to get
to that year mark
just to get to 50 50. you know like what
you’ve done is
however many more days left on its math
is what you
do to get that yeah a lot more than 300
so yeah
account for
and a meeting here and there a sponsor
even completing your step work in a
is there’s there’s so much one of the
things that we do in treatment is
is walk people through like an actual
day in their life like a schedule
like what does your day look like and
when you go through it kind of hour by
hour minute by minute you realize
how much time there is in the day and
within that time frame and all of that
space
there that’s where the cravings start to
take on so if you add up not just the
days that you
that you need to account for for extra
support but that but the
hours and the minutes that that actually
accumulate over time
you’re in such a without that increased
support or that sort of step
down level of care your your
risk just gets so much higher and that
ability to really
work within uh the sort of limitations
of your craving state just diminish
considerably yeah i i one of the and
aren’t certainly in our experiences and
we’ve been talking about this week too
but
one of the feels like the major
challenges isn’t keeping somebody
occupied in treatment during the group
session or the individual session it’s
all of the
in between moments that a lot of
frustrations and craving state you know
we see come about and boredom and this
sort of stuff and can i have this and i
want my phone and then
all these things in between in a
continuum of care
also is not just about going to
treatment
and fulfilling those group and
individual session obligation i think
they’re an important component of this
but
all those other incremental things of
peer recovery coaches sponsors
meetings you know healthy activities
there’s a great not-for-profit in you
know denver for example
sober af um that we were talking about
earlier in relation to our iop program
and you know sort of working with them
to where
we’re creating you know incremental
moments in time that support
these craving states and provide that
community immersion aspect that’s so
important as well too
so certainly don’t want the viewers to
think like this is just
treatment focused and oriented but we
have to account in many ways for all of
those in-between moments and sober
living home is another great opportunity
for that
um as well too that’s not treatment
oriented so
um i think it really is starting to
interrupt it really is about
building a life around recovery yeah and
you cannot do that in 45
days you know that stabilization period
is just that it’s for stabilization but
as you tear down into these other levels
of care
what you get are those is that ability
to start
building a life within a community
building a life of recovery building
a um sort of action i guess it would
actually be rebuilding yourself within
this new way of living
and that’s that’s why it’s so important
to
follow those directions of care and to
follow those recommendations
yeah and it seems like as well too in
regards to addiction i mean some
certainly with you know opioid numbers
you can become addicted on the first go
of it intravenous heroin quite addictive
and so forth
um in that regard but other otherwise i
think more generally speaking addictions
form
the same way in time and then they’re
reinforced in time
and that energy that it took to get
there is sort of a
new required energy on the other side
that has to be constantly reinforced and
so i think about
okay well you know we hear you know
clients say well meetings don’t work for
me i mean how about we just look at it
through like a lens of we have a craving
state and we’re normally craving to the
you know heroin or craving to pot or
craving to whatever the substance is now
we have cravings and we’re inserting
you know the meetings we’re inserting
iop groups we’re inserting peer recovery
coach we’re in suiting
you know psychiatric media um you know
evaluations meetings with doctors and so
forth but
it’s that replacement phase that i think
is important from
because we can’t look under the hood but
conceptually
what what i believe is happening in my
light reading
as a philosophy major here is that what
what is happening there is we are
growing new neural pathways we’re
reinforcing a new way that the brain is
considering what that craving state
means
and over time we still get craving
states but it reinforces now for the
individual
meeting or i need support and that sort
of thing in time and
i think all of these connecting pieces
between the medical lens of
craving state to the wellness model are
important things to tie together
you know conceptually for you know the
viewers and anybody pursuing treatment
in that regard and
um you know sort of as we get to the
tail end of this uh have i inspired
any additional thoughts you know through
this language or things that you might
want to
drop on yeah the only other thing that i
i think
everybody’s alluding to but i just
wanted to put put a
i don’t know just speak it is that you
know at detox and at a stabilization
level of care like we provide literally
the schedule and
frankly some of the meaning and
directionality
um for our clients and then
uh i think clients get comfortable
and they feel like they can make it but
like we’ve been doing in the background
all of the little things yeah the making
of
of the food and whatever else it might
be and so
it is a precipitous drop off if a client
goes just back home
and doesn’t have any sort of structure
around them they go from
zero hours of free time a week to 168
hours of free time a week
and it’s a huge drop-off and so
building in significant steps down
to where smaller successes can occur
where
i just have to manage my evenings i can
man okay i can
how do i spend these three hours and how
do i do that and how do i successfully
find my meaning and direction and and
walk through any craving states that
come up
building achievable bites and then
building on that
like now i just have to go three nights
a week to iop
and yeah but i can build the rest of my
life around that but
it it just doesn’t happen right uh
overnight
i completely agree and i think that it’s
um
just to sort of reiterate i guess coming
back to where you started with this
for both clients and for families to
really take that to heart
and when there is a recommendation for
another level of care or there is a
direction of care that is laid out by
somebody who is a professional who’s
been through this process
however many times it’s intentional you
know it is
there is true meaning behind it because
the reality is you’re rebuilding a human
being you know you’re completely
rebuilding yourself
and to do that to think that that can
happen within a 30 or 45 day
program which i think has been the
narrative out there for quite for
for decades really you know people
family send their loved one in and they
expect them to come out cured and ready
to go
it’s it’s just not how life works you
know there’s nothing realistic about
that
so um really taking to heart that
we’re we’re doing this so they don’t
lose the leg
right like that well in and i guess i
uh you know as we as we wrap up here i
do want to give you know
some family some hope right because it’s
certainly
hyperbolic to state like get energized
hold the boundary and the client will
just go
through care you know in that regard but
there’s going to be resistance along the
way
so when that resistance happens it seems
opportunistic to go okay it sounds like
you want to come home
live in the basement do that you’re
going to get a job and do all those
things
and everybody feels good in that moment
because there is recovery time and we’re
communicating better
through family programming and that sort
of thing but it feels good in that
moment for families to
uphold a boundary in a way to say
something like okay
i’m going to allow for this to happen
but the moment
it stops happening in this direction
then here’s the other plan and do you
agree to this plan
it seems like we’re in a good position
to negotiate at that time
and then if relapse occurs or it gets
really you know the individual
gets really disregulated in whatever
fashion mental health or otherwise that
now families can you know return to that
moment and say
remember when we did this together you
know and kind of just opened a
you know feedback or maybe is there a
better way to go about that or is that
kind of consistent with
meeting that resistance where it’s at
well when you’re talking brandon all i
thought of is
going back to the broken leg thing again
if you
if somebody goes to physical therapy
then after
and your kid comes someone’s like it
just hurts really bad and like i get
sore and it’s exhausting
like as a parent you’re like that sounds
really hard and how do we support you
i’ll get you some advil
prop your leg up you know get you dinner
or whatever but you’re going tomorrow
right because like we want your leg to
heal right like so there’s
i think there’s tons of ways to align
support
and still with kindness and hold the
boundary
yeah and and if we we can kind of switch
it out
like this feels like one of the only
fields where like
yeah where you blame the intervention
right
right like damn the physical therapist
is messing everything up
yeah no they’re doing their job it’s
going to hurt like
you broke your leg physical therapy is
going to hurt i’m sorry
right yeah yeah that’s what i thought of
yeah i think
i tend to have a slightly less gentle
approach in general
um i think that there’s the conversation
of you know
the the kid wants to come home they want
to be in the basement they want to get a
job they want to
start their life back over they want to
get back on track and i think the
families want the exact same thing
and the path to do that is not to go
there yet
it’s to take this journey instead is to
realize that this
is a process and meeting you where you
are and recognizing that that’s what you
want
and that’s your ultimate goal that’s all
of our ultimate goal
right so however all we disagree on is
the timing
exactly yeah yeah so patience is the
hardest thing
to really reinforce but if you can
that’s what it really takes it takes
time and so
continually reinforcing the fact that
everybody has the same goals everybody
wants the same thing everybody has the
same end game
however the path to getting there is not
going to be easy
right yeah yeah absolutely so
i it’s a fascinating industry to work in
there are
extraordinary challenges there are the
subjective experiences of the individual
the objective sort of framework of
professionalism in the direction of
those subjective behaviors thoughts
craving states and so forth and
you know in this regard i just really
want uh to
also empower families with this
knowledge and education to know that
direction of care is so important and if
there are bad
treatment experiences i get it not all
treatment is going to be the same for
everybody and
treatment providers you know even
ourselves that time are going to make
mistakes along the way but that
can’t be the reason for stopping the
direction of care if this place
is not good let’s find that next place
if that next place isn’t ideal let’s
look for a place that is ideal let’s
keep the conversation going let’s
energize recovery
thanks for being with us today check us
out on the youtubes the instagrams
um email us at findingpeaks
peaksrecovery.com if you want us
to talk about something uh other than
what we’ve been generally talking about
um i think we got the spotify and the
facebooks and trying to read all these
things on the screen over here that you
guys can find us on in that regard
uh jason friesma will be the host next
week
bringing on something maybe a lot of
emotions bring your tissues
so we can cry together or your palms
it doesn’t matter but get excited more
exciting episodes to come and thanks for
being with us
[Music]
thanks