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Caitlin Whyte (Host): Welcome to Hally HealthCast, the wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic important to your health and wellbeing. Bringing in expert doctors, therapists, and specialists who offer advice and answer your most pressing questions.

September is National Recovery Month, a time to raise awareness about alcohol and drug addiction, and to learn more about the help that's out there, with the range of healthcare services and supportive resources now available throughout our communities, the journey of recovery can begin today. Here with us are two experts, Todd Beard is a Licensed Clinical Professional Counselor who holds a master's of arts in professional counseling. He's the Department Manager at Carle Addiction Recovery Center, part of the Carle Health System of central Illinois. Joining him is his coworker at the center, David King, who serves as the Community Outreach Manager.

Welcome to you both. And thanks for being with us today. Well, let's begin. Addiction is of course a tough subject to talk about, but it is so important to discuss. Many people deal with addiction or drug issues. But before we talk about the promising hope that's out there for recovery, it's probably best to discuss what exactly addiction is.

We'll start with you, Mr. Beard. Can you tell our listeners a bit about the disease model of addiction and how alcohol and drug addiction is actually a medical disease?

Todd Beard, MAPC, LCPC (Guest): Yes, I'll start off by clarifying that I'm a Licensed Clinical Professional Counselor. So I'm not a doctor, but I'm lucky enough to work with two board certified addictionologists and a team of nurse practitioners and doctors as well. So in addition to the training and education that I've had, I'm also in direct contact with medical professionals. And so they can sort of round out the information that I've learned and what we've found through science, over the last several decades is that through the use of what we refer to as a mood altering mind, altering substances, other people call them drugs.

When we use those, they, they change how our brain works and all people have a process by which their brain creates chemicals, those chemicals lead to our feelings and they impact the way we think and how we act. Most folks know about adrenaline for instance, but we also have other chemicals serotonin, epinephrine, norepinephrine, dopamine. And when we bring in substances from the outside, mood altering, mind altering substances or drugs, they change the way our brain rewards us. For a person who's not struggling with substance use, if they hop in the shower, they get some serotonin, some norepinephrine, some dopamine. They get out and they feel a little more energized and ready for the day.

When you add a drug to that mix, the boost of chemicals that occur within our brain are exponentially higher than they are from taking a shower or having a good meal. And through that process, our brain looks for that level of excitement and reward and over time, so through repeated use for ongoing use, that process in our brain becomes kind of hijacked.

And our brain doesn't really recognize what used to be a reward or a positive experience. It doesn't recognize it the same way anymore. If you think about the brain in the context of all of the stuff outside of us, comes into our brain and then it works its way through. And the first section that it comes into contact with, we refer to it here as the limbic system. There are a lot more scientific names of all the pieces of that system. But if you think about the part of your brain, that's attached to your spine, the autonomic nervous system, the limbic system, other ways to describe that, it exists there to keep us safe from dangerous events or situations around us.

And so it has a very important task to do that, to keep us safe. And it also does automatic things like it tells our heart to beat, and it helps us breathe when we're asleep. So, that part of our brain is super important and it's also the first point of contact with the world around us. And so when it becomes hijacked, the intensity of the need, or perceived need for these substances becomes overwhelming.

And when that occurs, we, we lose. I don't want to say respect for, but we de-value the things that used to be pleasurable, because in context of the substance use, it's far less pleasurable and this becomes a situation where now our brain without the substance feels very unhappy. When folks think about withdrawal, for instance, withdrawal is our brain saying, hey, something is really, really wrong.

I'm in danger. And when our brain believes us to be in danger, it gets our attention. And so for the person who has crossed over into what would be referred to as addiction, their brain without drugs is on red alert. It's, it's similar to being chased by a tiger or something that would really get your attention. And at that point, trying to tell a person without a substance use disorder, don't run from the tiger. You'll be fine. It's pretty hard to overcome that fear and that, and that desire to run and to, to satisfy that urge, to get to safety. And that's kind of a, you know, an understanding of, of what happens within the brain.

It becomes hijacked and the process of living without that substance becomes the perception, the feeling is that it's unsafe. It's and it's incredibly overwhelming and powerful.

Host: Well, just a great explanation. Thank you so much, Mr. Beard. You know, I'm sure all of us here would love to see a world where there is no stigma around addiction and no reason for anyone to ever feel embarrassed about seeking the help they need. So, Mr. King, with this focus on addiction as a medical disease, what does this mean for treatment? Can you tell us about some of the new approaches that doctors and healthcare professionals are taking?

David King (Guest): Sure. Stigma only exists if we allow it to. And of course, part of the process and new treatments is to educate folks, to reduce and eliminate stigma. And part of that includes the understanding and the impact of trauma, and a person's background. No one chooses to struggle with a substance use disorder and what we understand if it's not a moral failing, that it's actually a disease means that it's treatable. It doesn't necessarily require inpatient treatment, where somebody needs to be in essence, locked up and locked away for an extended period of time. And it also means that there's not a one size fits all approach to treatment. So with these new ideas and thoughts and philosophies about treatment, we know that there are multiple pathways to recovery and some of those approaches include things like medication assisted treatment, where medications are used to assist a person who struggles with addiction and managing some of the related withdrawal or cravings or other symptoms that they may be experiencing to support them while they engage in other forms of supportive services, like individual counseling. There are group formats and, and obviously, all of these approaches now are looking at being person centered with recovery goals developed by the client, and it also encourages other mutual aid support involvement.

Host: Thank you, Mr. King and Mr. Beard, anything else to add, any other examples of treatment approaches that healthcare professionals are using to help those with addiction issues?

Todd: You know, we, we refer to our department here as being focused on motivational interviewing and the way we use motivational interviewing is to really frame the work that we do as being supportive rather than directive. When Mr. King indicated that it's person centered, you know, people come to us at different stages of readiness for change or with differing levels of skill in the, in the process of change. And so what motivational interviewing really does is tells the clinician, the treatment provider to assist this person in understanding as many factors as possible that could be relevant in changing their relationship to substance use and how that manifests is, instead of my me, seeing myself as the solution to another person's problems, I really focus on them being the solution and me being the person who is going to support them and in recognizing and building on that.

Host: Thank you. Now, it seems that many of these treatment options depend on engaging the individual as a true partner in their own care. For those dealing with addiction issues, why is it so important that the recovery process involves their own voice, their own buy in, their own thoughts and opinions and indeed their own true partnership as they take the journey to getting better, Mr. King.

David: Exactly. And I think that this is a direct outcome of the change in philosophy that if it was a moral failure, you did something wrong, you're weak, you've done something immoral, and therefore you either need to be punished or you need to be fixed. And in the approach that we're describing, it really is a partnership. Every person's situation is unique as Mr. Beard was saying, and when we establish ourselves as knowing what's best for someone else, we create this power differential and we create a dynamic that marginalizes this person's role in their own recovery process. So having it be a partnership and collaboration with the person seeking assistance and the provider, it really does reduce shame.

It reduces hiding. There's no need to feel bad. And it helps us engage the person where they are rather than expecting them to be somewhere else. So it really does open the door for this honest and open communication that can establish goals that are achievable.

Host: Just a great explanation, Mr. King, it makes so much sense to have treatment based on each person's active participation and support. This is why, in my opinion, the practice of motivational interviewing works so well. Mr. Beard, can you tell our listeners a bit about motivational interviewing? What exactly it is and why it's often a great part of an individual's treatment plan?

Todd: Yeah, absolutely. As I said earlier, I, we approach motivational interviewing as a, really, as a framework for all of the individual skills and tools that we use in, in serving the people that we try to help. And it acknowledges, at its foundation, that there are different levels or stages of change. The five stages are identified as pre-contemplation. And that would be a person who doesn't yet see a need for change. Contemplation, a person who is beginning to consider that maybe there's a problem here. Preparation, somebody who's identified there's a problem and is preparing to make change. The action stage of change, which is where I'm, I'm learning new ideas, skills, concepts, and then I'm practicing them to put change into practice and then the maintenance stage, which is where I've developed and utilized, adapted these skills and am having some success.

And what's different about motivational interviewing than what a person might think of historically as substance abuse treatment is, is we can help the person who is in pre-contemplation the person who comes in because somebody else told them there was a problem. They're here because the court said they had to, or, or, you know, DCFS involvement or some external factors are sort of making them come here.

There was a time with substance abuse treatment where we would tell that person that they're not ready in, you know, in air quotes and basically ask them to leave, come back when you're ready for change. And motivational interviewing says, you're essentially putting that person back out into the world with no additional skills, no additional knowledge. And they're very likely to continue on the path they were on when they came to see you. So motivational interviewing really helps us frame the work that we do to say I can help a person who's in pre-contemplation to consider, if there might be a problem. And on the other end of that spectrum, when a person in the old days, when they would get into maintenance stage, we would call them a graduate and send them on their way.

But we've identified that this is a, a lifelong potentially relapsing disorder. And then we're telling them that they're cured. The motivational interviewing really puts the onus back on the provider to meet the person at any of those stages and assist them specific to the stage of change that they're in. And the only way we can do that is to focus our work on building relationships.

Mr. King mentioned a power dynamic a minute ago, and you know, in, in the old days, people would show up and there was a very overt and even maybe was considered an important power dynamic. I am the expert and I am going to fix your life. I have a big desk and I'm wearing a, you know, a shirt with buttons on it. I'm the man, so to speak or, or I'm part of the system and I'm here to fix you. That's really bad for relationships. And what we find with motivational interviewing is if a person doesn't trust me and if I don't earn that trust by caring about them, considering their viewpoint, understanding all of the factors that impact their substance use patterns; then I really haven't really earned their trust. And it's a big change. When, as a provider, you see that I have to earn your trust before I should expect your trust. That shift really does change the way people work with us. In the old days, if a person was struggling, they weren't going to tell me because if they did, I would say, well, it sounds like you're not ready.

And I would exclude them from service. And now I say, how happy I am that they're talking to me about this. And it really is important for them to know that they can talk to a provider about struggles. And even, even then they may not, but at least it has been established and it is the intention is to say, I want to know where you're at for real.

And you can trust me with that information and I'm going to continue to earn that trust. So it really shifts that power dynamic. And the other piece of it is, you know, some people come in and they have, you know, three substances that they're using and two of them, they really want to stop using. The other one, they're not really so sure about.

I'm happy to help you stop any substance use or even decrease your substance use. But the treatment process, when it is predetermined, I walk into the facility, they tell me I have to stop all substances. And then I go about that. You exclude a lot of folks. In motivational interviewing, we say, I want to help you with what you want help with.

Host: I love that perspective. Thank you so much, Mr. Beard. Now, Mr. King diving deeper into the treatment and recovery process, can you tell us a little about different levels of care? What do health experts mean when they speak of levels of care, specifically with regard to those dealing with addiction issues?

David: Every person that seeks assistance with their struggle, brings a unique set of characteristics and circumstances, you know, with them. So their level of care decision, in other words, what level of treatment or intervention is required or needed or recommended all of, all of these risk factors these bio psychosocial factors need to be considered. Things like withdrawal, medical co-morbidities, support systems that are adequate and, and intact, family support, employment, geography. There, there are a number of factors. And so every level of care decision examines, those things and, you know, recommends what is in their opinion and with the participant's engagement, what gives them the greatest chance for success and what can help keep them safe? So levels of care, you know, can vary from individual one-on-one counseling weekly or more frequently if needed. Twice a week, it can include group format therapies. It can also be a partial hospitalization or an intensive outpatient environment where an individual would attend a combination of these modalities over an extended period of time. It can also, you know, mean inpatient treatment. Depending again, on what these comorbidities and other risk factors may be. Levels of care exist so that we keep the person safe, and that we maximize the opportunity for them to be in a place that has a, a stable baseline to continue the rest of the journey, the next steps that, that are ahead of them.

Host: Great. Thank you so much for that explanation. And indeed the level of care someone needs will definitely be different based on their unique circumstances and at the given point of time. Which just speaks to the much larger point that there are multiple pathways to recovery. Can you expand some more on this, Mr. Beard?

Todd: Yeah, absolutely. So there are three levels of care that substance use prevention and rehabilitation that the state of Illinois their, their team looks at and the ASAM, American Society of Addiction Medicine. We identify level one being outpatient treatment. That's anywhere from one to eight hours of treatment services in a week or less. And then level two is a minimum of nine hours of treatment in a, in a given week. And then level three is your inpatient and partial hospitalization. So there are kind of boundaries that are set, what meets those different levels or what makes up those different levels.

But the reality is, a person might meet the criteria. So I could diagnostically indicate that you meet criteria for inpatient treatment, but a person may not be ready or willing to go to inpatient treatment. So we can offer them level two, intensive outpatient and meet them where they are, you're willing and able to do level two, so we're going to start with level two. Their work schedule could change. And now when, when I'm offering IOP intensive outpatient or level two groups, now you're not available. So let's meet individually and work through those same psychoeducational services, develop concepts and skills, but do so for what works with that person.

And it's really through motivational interviewing that, that we turn the mirror back on ourselves and say, what can we do to meet this person's needs within the context of what they're either willing or able to do. Um, and uh what we see is when people recognize that we are going to be flexible, they will be flexible in return. And it really, we oftentimes see a little flexibility on our part, ends up resulting in more flexibility on the part of the person that we're trying to serve. And it's the reason that we keep using this program and this, this approach, because it is true whether we recognize it or not, that each person is different.

So simply recognizing that each person is different, really gives us a leg up on helping meet that person where that person is.

Host: It's so true that each treatment journey is truly different. Another resource for people used more than ever since the pandemic hit, is virtual health care, specifically seeing a counselor, therapist or even a psychiatrist, from the comfort of your own home using a computer or smartphone.

So Mr. Beard, can you tell us a little about virtual healthcare and how it can be a helpful part of a person's treatment journey?

Todd: Absolutely. I've been in the business here for about 21 years. And for the first 19 of those years, 18 and a half, I wasn't really given access to virtual services. Wasn't allowed to do any individual or group work via phone or computer. And we have been given access to that. And it has been really a game changer. I've worked with people far too far away to drive here, four days a week, but they can attend four days a week from their house. And there are some challenges that come in into that. You have to use a format that is safe. That doesn't open people's information up to hackers or things of that nature, but it really, in the past a two, two and a half hour group, our IOP groups are, or two and a half hours that would cost a person three and a half hours generally. Cause they had to drive. They had to check in, they had to wait, have the meeting and then drive home.

And now it takes about two hours and a half. So, um, it has become an, an opportunity for people who couldn't get here from a time perspective to participate. And also there's the, uh, the difference in the cost of gas, uh, waiting at red lights, all of those types of things. Some people don't own cars and they have to take a bus. Virtual visits really opened the world up and allow us to, I've been saying all along here, meeting people where they are. We literally meet them where they are, and I'd be lying if I say it weren't a challenge at the beginning. I've been on the phone more in the last two and a half years than I have been in my entire life.

But it, it really has been an opportunity to open the door as wide as humanly possible and meet people in their living rooms, in their kitchens. And that allows us to treatment plan, the person who two years ago, couldn't come to group because they couldn't get here after work. They can log in at that time. And so it really does open up our treatment options to a wider group of of people.

Host: Um, That's so true. So true. Thank you, Mr. Beard. For those listening, who are members of one of our healthcare plans, there's a good chance you might have virtual visits included as part of your plan. If so you can connect directly with a licensed therapist or a board certified psychiatrist, 24/7 from the comfort of your home or anywhere you have a phone or internet connection in the US.

Using your smartphone, tablet or laptop, the virtual visits are private and secure and they can be one helpful piece of your journey to recovery from addiction. They can also help with other issues like depression, anxiety, trauma, and stress. Whether you're dealing with addiction issues or not to see if your plan includes these virtual visits or to get started or learn more about costs and other details, simply call member services at the number on the back of your member ID card. Now onto a bigger picture question, Mr. King, if someone, perhaps even one of our listeners is dealing with alcohol or drug issues, what's the best, first step they can take right now to start getting the help they need?

David: Sure first, what I want to say is that recognizing, you know, a person that's recognized that they need some assistance, that they need help, that they want their life to move in a different direction, takes tremendous courage and strength. Um, and so, uh, that's, you know, first, just to acknowledge that. Uh, secondly, is that as a person moves through this process, one thing to remember is that reducing the risks and maintaining their engagement throughout the process is, is part of the journey. And really their first step is the right step. So, whatever step they're going to take that could be making an appointment, that could be looking at something online, at an online resource to become educated, or to see what resources are available.

It could be getting a list of local resources and attending a, a mutual aid group. Any of those. Depending on where a person is at in their journey and in the change process that Mr. Beard is describing, any of those choices are, you know, are a great choice. The biggest thing I would say is the awareness. The acknowledgement. I need to make some changes for my life to move in a direction that I want it to move in, you know, in a positive direction. That is a tremendously huge step for anyone to take.

Host: Absolutely. So, so important. And Mr. Beard, what if one of our listeners isn't necessarily dealing with these issues themselves, but has a loved one who is, what's the best, first step they can take to get their loved ones started on their path to recovery?

Todd: Yeah, one important thing that can happen is looking for, uh, facilities that use motivational interviewing or harm reduction. And I say that because oftentimes people who recognize that a loved one is dealing with addiction do so before that person does. And that goes back to the, you know, the stages of change. That person may be in pre-contemplation or contemplation.

So looking for a treatment provider who uses motivational interviewing is important, I believe. But if that isn't available, really making sure that you're looking at a facility that is licensed through the state of Illinois or whatever state they're in. Because the licensure process has a layer of oversight that ensures that this is a quality treatment provider.

That may seem very simple, but if you just do a, uh, a web search, oftentimes the first things that pop up are not licensed providers. And so it really is important to look for a quality licensed provider who can assist their family member. The other piece of it is just opening that conversation. Motivational interviewing works with human beings too, not just with therapists. You know, if you, if, if you're talking to a loved one, uh, consider just asking them, like, how are you feeling about this? Like, I'm really worried. How are you feeling? And sometimes, that simple shift, instead of saying, you've got a problem, you need to fix it.

I say, how do you feel about this? Or do you have any concerns? It really allows that person to not feel attacked and to be more insightful.

Host: Just some great, great advice. Thank you both so much. Now we've talked a lot about treatments and the great medical expertise that's available for those dealing with addiction. Thinking beyond this important medical help, what other resources and support are available for people facing difficulties with alcohol or drug use? I'll let you weigh in first, Mr. King.

David: Sure there, there are local resources that you can research online. There's the Illinois helpline. If you're an Illinois resident. Every state has something similar to that, uh, through their state division of substance use services, whether that's prevention or however it's identified. There are peer recovery support services that are available.

Mutual aid support groups like Smart Recovery, traditional 12 step group, Celebrate Recovery. So depending on what a person's orientation is or background to the recovery process, there are support groups that they can take advantage of. And then there are, you know, national organizations that are advocacy groups. For instance, there's a group called Shatterproof. There's another group called Faces and Voices of Recovery that offer tremendous resources from an educational standpoint, understanding what the disease concept is, understanding about stigma, the National Institute of Drug Abuse, SAMHSA, again, other federal resources that can provide up-to-date really current information.

Host: Absolutely. And Mr. Beard any more to add?

Todd: Yeah, I, I, um, I've been a licensed clinical professional counselor for a while now. I've been in, in mental health for 21 years. And, uh, I, I, I wouldn't say I was the first person to get on board with phone apps because there's a degree to which the person is able to really build that relationship that I've been talking about all along.

And the phone app is already there. Like it's already loaded. And so it it's a little less complex. And yet there are some really great phone apps out there that use motivational interviewing as a, as a framework. And by that, what I mean is they really help people understand how much of a substance am I using? People might be surprised. There are a lot of people who are using substances and they don't know how much. And so some of these apps can help you just say, okay, today I used this much of this substance and then it is, they also provide what we call psycho-education right. They help you understand the disease model.

They help you understand why, when you start having withdrawal symptoms, it's so incredibly hard to fight that urge. So I guess I would just say that it's worthwhile looking in your phone to look at some applications that might help you in learning to better understand your relationship to a substance and getting some education through there.

The great thing about these is they're in your phone, they're in your pocket, everywhere all day. If your phone is available to you, you can use that resource. And, uh, uh, I see a lot of people who are engaged in treatment and using phone apps. They're certainly worth considering.

Host: Well, just some great resources, always wonderful to have a long list. Thank you both. And our final question, I'll ask both of you to respond. If there's one big takeaway message from our chat today, what is it? What do you want listeners to remember most? We'll start with you, Mr. King.

David: Yeah. And I, I think there are a number of great takeaway messages, but maybe along the same theme, which, you know, one is recovery is possible. You know, there's, there's hope, don't give up. And that isolation and disconnection harms us, but being connected helps us. It helps heal us. And so finding resources that can connect us with others along the journey. Absolutely essential.

Host: Very important words. And Mr. Beard, same question.

Todd: Yeah. What I would like to encourage people to think is that a person struggling with addiction has a relationship with their substance of abuse and like any other relationship, those dynamics can be shifted. They can be shifted through intention, which is my therapisty way of saying, like pay attention to it and think about it, apply some energy towards it. And change is possible. Our relationship to substances is just as adaptable and moldable as our relationship with ourself, our relationship with our boss. Our relationship with our neighbor and that change process when we take ownership of it and we invest ourselves in that process, it is a completely doable thing. Many people every day change their relationship to substance use and they do so in powerful, unique individual ways that, uh, I can say um, empower me when I hear these stories, they energize me and they make me, um, appreciate the bravery and the resilience that human beings possess to make change in their lives.

And it's a, it's a joy for me to be hold. And, uh, I gain respect for the people doing this difficult work everyday when I come in here and, uh, try to support them in that process.

Host: Well, thank you both for such powerful and inspiring final thoughts. You've been such expert guests today, and I know this episode will help so many people and thanks as well for all that you do day in and day out at Carle Addiction Recovery Center to bring health, healing and hope to so many individuals and families.

That concludes today's Hally HealthCast. Tune in next time as we tackle yet another topic important for your health and wellbeing. And remember Hally Health is your partner in helping you live your healthiest life. Visit hally.com. That's H A L L Y.com for resources, information, tips, and much more. Let us help keep you and your family healthy and well.

Thanks for listening. We hope you tune in again.