Today, Heather Tidwell returns, and we dive into harm reduction and the struggle to accept that the disease of addiction is a messy disease that we try to make black and white. Heather’s creative approaches when working with her clients reinforce the need to meet them where they are.
We also discuss the power of language regarding this disease.
Learn more about Heather and her team at B&G Counseling Services in North and South Carolina.
Trigger warning: there is talk of suicide.
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See full transcript below.
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00:01
You’re listening to the Embrace Family Recovery Podcast, a place for real conversations with people who love someone with the disease of addiction. Now, here is your host, Margaret Swift Thompson.
Margaret 00:26
Welcome back, in today’s episode, we return to the discussion with Heather Tidwell and discussing the role of harm reduction and how important this can be. Heather shares insights into language used in this illness. And we discuss why this must change to be more supportive to our loved ones and families affected by this disease, as a whole.
00:56
The Embrace Family Recovery Podcast.
Margaret 01:11
So, when we talked about harm reduction, I’d love you to tell the audience how do you see that? You know, with your motivational interviewing and the work you do, when you have clients who are maybe resistant to abstinence, or been through treatment can’t seem to have abstinence? How do you work with them? What’s your philosophy and approach?
Heather Tidwell 01:33
So, when I think of harm reduction, I think of it almost as like a tool that I have in my toolbox. You know, it’s the idea that and harm reduction has been around forever, I mean, like harm reduction in driving, seatbelts harm reduction in swimming, lifeguards. It’s this idea that people inherently engage in risky behaviors. And if we want them to be ideally as safe as possible, we need to be able to keep them alive.
Margaret 02:00
I want to stop right there. Because that’s so, so vital. You mentioned earlier that in the Er It’s treat them and street them.
Heather: Yep.
Margaret: You mentioned the fact that we have to have them alive to give them an opportunity to access something different. Like that’s the goal. That’s our baseline if you’d like because obviously, we’re losing too many people unnecessarily to this illness. It’s tragic. And I don’t mean just opiates, I mean alcohol, I mean, all of them, and mental health issues. So, what I love is what you just said, and I think it’s so important to put a full stop period right there or an exclamation point. The goal is to keep people alive to find their way to a wellness or a life that feels better for them. But if they’re dead, God forbid, if they die, they can never have that.
So, I just want to make sure we have out there. I always say to my families if they’re breathing, we have hope.
Heather: Yeah.
Margaret: And I don’t mean that tritely. Oh, I mean that, importantly, it’s so incredibly important to have on hand Narcan, if you know, you have a loved one who has an opiate addiction, because you don’t know if fentanyl is in something and having it on hand at home gives you a chance to intervene and keep them alive, so that they can get whatever care they need. If you don’t have it, you can even offer that. Sorry, went off on his tirade. Go ahead, take it away.
03:34
Heather: Well, I’m glad that you did stop because I kind of said it and just kind of kept going. And when you were able just to stop and make that distinction of they have to be alive. Like I had a physiological response. And I got chills, because it’s, it’s true. And it you know, it’s so important. And just to kind of understand that harm reduction isn’t saying, Yep, I’m getting permission, you know, you go do all the things. What it’s saying is, I want you to be alive, so we can get the treatment, the help and the space to get us to a healthier outcome. And it’s interesting, you know, when you were talking about Narcan, and when you when I first met, I actually just went and did like some research and things like that. And it was the coalition against prescription drug abuse recommended anybody whether they had prescription opioids or anything in their home, you know, and yes, if they knew about addiction, and they said it if we knew somebody was gonna get discharged, even if we don’t think that they’re using that substance and are using other substances, have it at your house because now with like fentanyl.
I mean, fentanyl is 50 to 100 times more potent than morphine. You only have a short period of time. If somebody is getting something where maybe they think they’re doing one substance. They’re like, I don’t need that. I would never touch that. You know, it’s kind of like the chocolate chip cookie analysis. Fentanyl only has to be in one little piece of that cookie doesn’t have to be in like the whole thing. Using it once or twice can kill you, like your first time. It’s scary.
Margaret 05:09
It is scary. And I also want to backup because you keep giving these great glimmers to use your word, the concept of if someone is in your world and you know they have the disease of addiction, it’s one thing, if you are coming home with a prescription or you know there is one in the home, that’s another thing.
If someone’s been in treatment, it doesn’t mean you think they’re going to relapse or return to us. And it’s not giving permission for that. It’s saying I have it, if I need it, God forbid something happens. And I like that because it reminds me of my prior work. Going back to my first passion, which was HIV prevention and sex education, when we were in the epidemic, pandemic of AIDS.
And it was treat everyone as if they have it to protect yourself from getting it right.
Heather: Yes.
Margaret: Same concept. It’s not permission giving. It is about teaching how to protect yourself in the event it could happen, or it does happen. And this occured to me, and I think that’s a really good reframe, for me professionally, to hear about harm reduction. I’m not opposed to it. I think it’s vitally important. I also am a proponent of abstinence model. Right. So, I believe in that to my toe. But I think that one doesn’t exclude the other.
06:27
Heather: It’s messy. You know, it really is. And I’ve worked with individuals where they were not ready for like abstinence whatsoever. But they knew like maybe they had three unintentional overdoses, they woke up and like the ER, they lost family members, I had one individual that lost their fiancée after having to give them Narcan for the third time. And I’ve worked with individuals where I’ve met them where they are, we’ve engaged in, you know, some semblance of harm reduction for I think this one individual, I’m thinking about like six to eight months. And now they’re two years sober. Came to me and said absolutely no way. I am never getting sober. Okay. I completely hear what you’re saying. I acknowledge it. Will you be open to listening to what some of my concerns are? How do we maybe make you just a little bit healthier? I mean, nobody wants to go to like the ER and get their stomach pumps, like, how do we kind of look at just safety? And what does that look like, and by that occurring, and this individual first met with me, was so anxious, didn’t want to do zoom didn’t want to meet in like person. So, we did a phone call, because he didn’t want me to see his face. And we were able to work our way from that phone call to two years of like sobriety by meeting him where he was at and acknowledging you are the expert on you. I’m your guide, maybe I make some observations. Let’s just talk, let’s have a conversation. You tell me what I need to know.
Margaret 07:59
When you look at clients who are maintaining use, they’re not an abstinence recovery, but they’re maintaining their use, and they’re seeking your services, because I can imagine a family is out there listening thinking, okay, so how do you work with someone who’s still using and make progress, if we know that using impacts their ability to function?
08:22
Heather: So it’s hard, and it’s so individualized, it really is. And it’s interesting, too, because I’ll get calls, you know, just because I have like the background of working in the emergency room. We all have emergency room, doctors that like knowing they know I like branched off. Where they’ll call me and they’ll staff it. If I’ll take somebody, I have other clinicians and peers where maybe they’re working with somebody, and they are concerned about their active use, but their active use does not warrant an involuntary commitment, right, they’re still going to be using. This clinician is like, this is outside of my scope. It’s not safe for me to work with you.
These are individuals I will usually get I will assess them on a case-by-case basis. And I will work with them while they’re actively using. We will talk about safety measures about what a relationship looks like from an ethical and like HIPAA standpoint while they’re using. And my main thing is while we are working, there has to just be you know, it’s almost like a boundary of some place that we are working towards to increase safety, whatever that looks like. Maybe it’s using fentanyl strips before using, maybe it’s not using alone. You know, but this idea of what does it look like when again, it’s a gray area, it’s not black and white. It’s not the same for any individual that calls me it’s very gray. And often when I do get individuals that are referred to me their acuity of use is usually more severe than what was reported to their primary care doctor or to their ED, or to their family.
Margaret 10:05
It goes back to the word messy, right, we’re looking for a black and white solution for something that’s gray and messy. And it’s important to know that there are certain standards for wellness out there that some people do absolutely get and are blessed through their work to be able to achieve that. And then there are others who are struggling so bad to even go there, may not even want to go there, and still want help. So how do you meet where they’re at? That’s what I hear you saying so well.
10:37
Heather: Yeah, again, it’s rolling with their resistance. You know, most likely, I mean, if you go into an emergency room, and if you have tracks, you know, on like your arm, or if you’re, you know, with the, with the new analog Xylazine, if you have those type of wounds, and kind of things like that, oftentimes people don’t want to give you and again, this is not me saying bad providers, its culture, its systems. But they don’t want to give you the time of day you’ve been treated like you’re less than you’ve been disconnected. So, what I often do is right away, just kind of validate that, you know, and when I used to do some addiction treatment, it used to be all court order. So, you have to think about how resistant people there. Yup, yeah, you know, whatever, just sign my paper lady. Now I’m like, Alright, I’m like, you know, it sounds like you’re really frustrated. I get that. From looking here. It seems like this is your 10th time, you know, working with a different clinician, I personally don’t even know how you got through all of that with all different, you know, and it’s acknowledging them. It’s hearing them, it’s validating them. It’s using their words. And it’s kind of summarizing what they’re saying. So she heard me.
And one thing I always hear is, and again, this is not me saying bad clinicians, but when I work with individuals that have like moderate to severe addiction. They’re like, if you tell me just to get sober, like every other flipping person I’ve met with, I’m going to lose it. Like, yeah, that sounds because we use for a reason. It’s a coping skill. It’s not an adaptive coping skill. It’s a maladaptive coping skill. But there’s usually a reason that we’re using. Maybe we’re using to forget something maybe we’re using to numb ourselves. Maybe we’re using the only time that we feel that we can actually engage in social interactions, we need to be able to replace that maladaptive skill with something more positive and healthy, and it takes more than 24 hours.
Bumper: 12:33
This podcast is made possible by listeners like you.
12:36
I am so excited to announce a retreat that I am hosting in Nashville, Tennessee, in March of 2024.
This is going to be a lot of fun, myself and Dede Armstrong will be in Nashville at an beautiful recording studio called ‘Welcome to 1979’ who have graciously offered to host us and have this retreat.
And the retreat is about your ongoing recovery, how to lean in and gain tips and strategies to continue your growth and recovery.
This retreat is open to anyone affected by the disease whether we have the disease of addiction, or whether we love someone who has the disease of addiction.
It is going to be limited space of 30 people. So please get online. I will attach the links in the show notes below. And find out more about the retreat in Nashville, which is happening the first weekend in March. And we are so excited to be going to Nashville and venturing from the Midwest to the East Coast. And now heading into Tennessee.
Hope to see you there. You won’t be regretting the time you spend and building connection and learning new strategies for your own recovery.
14:04
You’re listening to the Embrace Family Recovery Podcast. Can you relate to what you’re hearing? Never miss a show by hitting the subscribe button. Now back to the show.
Margaret 14:15
So, I’m of the belief that the disease is a primary progressive, chronic and potentially fatal illness and that not every one of us has the wiring to be addicted. And those of us who don’t are spared. I do believe trauma can absolutely be an impact to and from addiction. I believe that when people use most often in the beginning it is for social reasons, it’s to be part of or it’s because it’s accessible. I just recently had a conversation with someone who’s written a memoir whose first awareness of pills making life better, was five years old. And so, we have a lot there to unpack. The thing that I can hear people saying was how do you do that if someone’s not clear headed and sober.
15:09
Heather: And again, I think it’s that intrinsic motivation for change, but also knowing and being flexible of when to work with like an individual. So again, this is that gray area.
I was referred in individual mid to late 40s, acute alcohol addiction drinking, at the minimum 15 drinks a day, a combination of hard alcohol, beer. Would usually start right when he woke up history of being detox, but no inpatient, constantly refusing had neuropathy, just a slew of stuff. He had a primary care doctor, he had a neurologist, his clinician then referred him to me because she was like, I’m stuck, like, there’s been nothing, I don’t think I can ethically work with him, because I think he’s gonna kill himself. So, him and I met for like two sessions, it became very apparent, you know, again, for him significant trauma, saw his dad shoot himself, lots of more trauma since then, and just felt like nobody ever really listened to him. And all he wanted to do was process the trauma. And how I met him was, wow, how insightful are you that you know that. A lot of times, we can’t even make that connection. That being said, I hear that this is your goal, I as a clinician cannot ethically get you there, because this addiction is so overpowering. If we start talking about trauma, it’s just going to explode. And then we’re talking about even more safety concerns. So what am and I did, is we met at the time, where he was the most sober that day, which for him was 9am, we did a lot of the work. I was able to kind of get him to for the first time ever to speak with like a medical treatment facility that would allow him to be on his medication and allow him to do a medical detox. And I was able to connect him with them. But again, it’s being able to meet people where they’re at.
Can I for a long period of time keep meeting was somebody that’s under the influence? No, but is there a gray period, ethically, and with my licensure? I believe so. And if I can enhance that person’s ability for change, where they haven’t been able to do that in 15 years, I’m going to work with them. So, I feel like I legally shouldn’t.
Margaret 17:30
What was the outcome for that gentleman?
17:33
So, the outcome was that he went to inpatient treatment for a week and checked himself out. And when I met with him afterwards, I was like, wow, 15 years, you’ve been sober now, for seven days. Holy, gosh, talk about a glimmer. Now what? Now how do we use that? And say, we got here? So, we know we can. But maybe that there was something that treatment center maybe needed to do a little bit differently? Or maybe I needed to look at some resources, or maybe, I don’t know, like, what are your ideas? Like? How can we maybe take these seven days and build on? So again, kind of reframing it in a way of seven days? Like that’s a lot? Yeah.
Margaret 18:19
Yeah, and I think that’s a place to put another exclamation point or pause. For someone who is chronically using life consequences, physical consequences, spiritual consequences, losses all over the place to achieve seven days sober after decades of use is tremendous. Yes, to the families. They see returned to us after that as a failure, which I believe is the worst word we can use when we’re dealing with the disease of addiction. Because if we truly believe it’s a disease, how can one fail? How can one succeed? And how can one fail? We don’t talk like that around cancer.
Heather: No,
Margaret: If somebody’s in remission, and then the disease comes back, we don’t say they failed. So, I think we have to change our language as a society to look at, like you say, the accomplishment of that and acknowledging how hard that was, and how much that person did. And you checked yourself out and all people would go, that’s it, back to use, all bad. What I love is your way of thinking and reframing was okay, how do we build on this? How did he build on it?
19:30
Heather: So, he wound up again, going to a different treatment facility, and he did some more group work. So before again, addiction can be so isolating and this was an individual that was very, like, oh, no, I’m not listening to those other addicts. Like they’re the crack, you know, again, it’s these stereotypes but once we’re able to maybe say, you know, we need to meet people where they’re at but kind of really be open to offering out of the box suggestions. I have one 25 year old I work within it was very difficult for her to get sober from alcohol and benzos. One of the best resources she found on her own, when I kind of encouraged, I was like, you know what, let’s both look. Because there has to be other stuff out there than these online AA meetings. She found it was a neuro divergent, sober book club, in Charlotte, where it was, you know, just all these, like, ranges of individuals that looked like her, that thought like her that we’re all on this path of like sobriety that were able just to kind of meet and that was her group. You know, that was her version of my sober social support, especially as a young individual today trying to get sober.
Margaret 20:42
And I appreciate it, we’re talking about different people with different substances. And I would assume, in that case, with the young woman, you’d really have to be careful of the withdrawal. Because as we know, alcohol and benzos are the most lethal. And a lot of families do not realize. We hear all of the talk about opiates, and how awful it is to withdraw from and it is, they feel horrible. They also have all of their neurons changed to be completely unable to tolerate pain.
The alcohol and benzo withdrawal will kill people. And so it’s so important to us that if your loved one is saying I want help, to not try and force them to enter help sober, and try and detox them yourself, but to allow them that medical detox to keep them safe. If they need to drink to get there, let them. If they need to take benzos to get there, let them and have it medical monitored, you won’t have to go through that. And they may not lose their life.
21:49
Heather: And they’re hard conversations to have. But the more that we have them, it becomes easier. It’s almost it’s like exposure therapy, when we expose ourselves to difficult things. It becomes like our bodies and our brain and our synapses, we become more calm, and agreeable to them as we expose themselves to them more. So, the more that we’re able to have these difficult conversations about things that we don’t want to it becomes easier.
Margaret 22:18
I agree. And let’s look at the compassion to the families again, right? If I’m a loved one, and I’m watching my person slowly die in front of me, at least disappear, at least isolated, you know, whatever the consequences that are becoming more and more prevalent. The thought of pouring out enough alcohol to get them to help, feels like I’m hurting them more. So, it’s really hard to imagine, and put myself in the place of family. I like to try and be compassionate with like, Okay, I want them off this so bad. But I need to do this to get them there safely. That’s like, what am I doing? Right? And, and yet, it is so important to do that.
23:03
Heather: Well, and I think to what can be so helpful is just education. And education is out there. If there’s anything I mean, Margaret, I feel so blessed to be on here because I have learned this whole new slew of just tools out there that I can share with my families. I mean, when I was looking up just like harm reduction and North Carolina, you know, I found some coalition’s where there’s family support groups with like the Narcan. There are all these free videos by medicinal providers on how to administer it, on when to like administer it. There’s all this stuff you’re on like tapering. You know, it’s also being able to work with a clinician, if you are trying to wean off of prescription opiates, benzos, things like that. That’s also something that that provider should legally be, you know, helping you with as far as what’s safe, and what’s not safe. What’s adverse. What do we look for? I found so many just blogs from like individuals that have lost people that said, I wish I knew about harm reduction, and hearing some of these, they’re heart wrenching that they almost feel like a person’s life was taken from them because they didn’t know that there was other ways. And that I did a disservice by saying, you stop or you’re out of this damn family. And then that’s it. It’s hard because it’s a gray area. It’s messy. It’s also case by case, it’s individualized.
Margaret 24:30
Absolutely. Absolutely. And the tragedy of loss of illness, any illness, absolutely addiction. Is so complex. There’s a grief. There’s a secondary grief. There’s tertiary grief. There’s the reality of woulda, coulda, shoulda and working with families to understand that they’re doing the best they can with what they know abd reaching out for help, who they get it from and what they learn and do. I don’t believe any family member has the power to make a person with the disease of addiction, use or not use that is intrinsic to teaching families, because they will always feel guilt, if they’re addicted person is yelling at them saying if you didn’t do this, I wouldn’t have to use. That’s the disease lying to them and to you. And I think that families have to have that awareness to then say, okay, if I know that’s true, even though it’s really hard to believe, what options do I have to help me navigate this torture that I feel about what’s right or wrong, how to help, how to not help? What’s healthy for me what’s not healthy for me, because I’m so preoccupied with someone else, I don’t even register what I need.
25:53
Heather: It’s interesting, you know, and I love that this is geared towards families. Because even whenever I’m working with any individual in addiction, and if I’m able to engage with their family, and especially if the family wants to engage for me, you know, like with me, or they’re, like, you know, just at a loss.
I always start by saying, you know, this is so huge that y’all are even here. I can’t imagine how hard this has been for you. And the fact that you’re still here. And I’ll say that in front of the family in front of the person with the addiction, and I put that out there and even right, then it’s a place for me to meet them where they’re at. And sometimes I’ll also hear from families, like when I call them brainstorming sessions. I’m like, y’all, I need your help, because I’m not in the home. So, what we’re going to do is we’re going to brainstorm some ways, and sometimes and I’ll hear just probably, maybe 30 – 40% of the time. Oh, my God, I can’t believe I didn’t think about that. How have I been doing this? And I said, and I’ll say, stop. You must be kidding me. And I’ll say you’re actually triggering me, talk about triggers? Absolutely not. We have gotten this far, how we all have done it on your own, I have no idea. Now, here I am. I’m just another tool. I’m like a resource. But it’s you guys and you’ve made it, we’re just looking at maybe a way to make it a little bit easier.
Margaret 27:17
Heather, I love that because it also takes the professionals and the work off of this pedestal that are often put on and say, you know, I’m a tool in your toolbox. I may have skills and knowledge you don’t have. I’m also more objective because I’m not living in the system. You all the experts of your family, and you’re letting me in to understand the system so that I can throw different suggestions that you can look at. If you weren’t courageous enough to walk into this office and put yourself out there, we wouldn’t even have this opportunity. And you made it to this point. And it’s so important to validate the effort, the tenacity, the resilience, the love that families have for each other, even if it’s messy, even if there’s even if mistakes are made. It’s incredible to me, the people that survive this illness, and how it impacts every family member when the disease becomes a family member.
Outro: I really appreciated this conversation with Heather. As we discussed care and being client centered it was a great reminder that any care, treatment, outpatient counseling, coaching has to be individualized and driven by the needs of the client. Though we desperately want black and white because it’s so much less complicated this disease is gray and it’s important to remember that as we move forward in our recovery. Come back next week when Heather and I will talk about new and fresh emotions that come with recovery and how to cope with these as a family.
I want to thank my guest for their courage and vulnerability and sharing parts of their story. Please find resources on my website.
This is Margaret Swift Thompson.
Until next time, please take care of you!