NASW Social Work Talks - EP81: Addiction and the Pandemic

Episode Date: March 1, 2022

NASW members Chelsea Laliberte and Jimmy Salyers talk about how the pandemic has exacerbated the addiction crisis in the United States.  Read the show notes for related resources and to learn more about our guests.

This episode is brought to you by the University of the Pacific's Diabetes Essentials Certificate Programs. From the National Association of Social Workers, I'm your host, Aaliyah Wright, and this is Social Work Talks. In today's episode, we're going to talk about the spiraling addiction crisis and how the pandemic has exacerbated it. We're chatting with two of our members, social workers who specialize in substance use disorders and co-occurring issues, Chelsea Laliberte-Barnes and Jimmy Salyers. According to the CDC, there were more than 100,000 drug overdose deaths in the United States during the 12-month period ending in April 2021. an increase of 28.5% during the same period the year before. The latest data also reveals that overdose deaths from opioids increased nearly 35% in April 2021 from the year before. NASW member Chelsea Laliberte-Barnes, a licensed social worker and certified clinical trauma professional,

supports and guides community members via her psychotherapy practice at Cherry Hill Counseling near Chicago, Illinois, as a non-profit and leadership consultant through CLB Strategies. In long-term recovery herself, she became an overdose education and naloxone distribution trainer in 2013 and received her SMART Recovery Facilitator Certification in 2016. She is co-founder of several treatment initiatives including Live for Lally whose mission is to reduce stigma and prevent substance use disorders among individuals, families, and communities. Chelsea has helped write and pass more than 20 Illinois and three federal laws that advance mental health and substance use treatment, harm reduction, and social supports and is now running for Illinois

State House in the 51st District. After earning his Bachelor's of Social Work with a minor in Chemical Dependency from MSU in 2020, NASW Kentucky Chapter Board Member Jimmy Salyers is a Licensed Clinical Alcohol and Drug Counselor Associate and Certified Social Worker. He graduated with a Master's of Social Work from the University of Kentucky in May 2020. He is the chair of the chapter's Legislative and Advocacy Committee. Welcome to you both. Thank you for having me. And thank you for having me. Great. Thank you. First, can you tell us why you both entered the profession and why you

specifically chose this area of expertise? Ladies first. All right. Well, I go by she, her, so I guess I'll go. So first of all, thanks again for having me on. I was a marketing professional before I became a social worker. And I saw so many ethically conflicting things when I was in the field. And I thought to myself, I don't know if this is the right fit for me. And on top of that, a couple of years, and actually in 2008, I lost my brother to an accidental opioid overdose. It was actually a polysubstance overdose. He was on a lot of different substances when he died. And that experience, as you can imagine, so many of us have clients and even ourselves who have lost people to overdoses was devastating and really

the cornerstone of my life. And it made me really evaluate what I wanted to do and what kind of mark I wanted to leave on the world and for my family and, and really for myself and in memory of my brother to try and live for him and fix the problems that affected him so that future generations don't have to deal with the same issues. So I started a nonprofit with my family, which I'm sure we'll talk about at one point. And through that process, I decided to go back to school and get my master's in social work. And I graduated from Case Western University, Pace Western Reserve University in 2008 with an MSW. So that's my story. Thank you, Chelsea. Jimmy?

So my story is really not too much from where Chelsea's story is. I, too, have a personal connection with social work. I, myself, I'm also an individual in recovery. I'm also a previously incarcerated individual. One of the first people I ever was introduced into the recovery field was a Kentucky social worker and they told me that if I chose to I never had to use drugs again and that was the first time anybody had ever put that kind of perspective towards drug use towards me and it sounded great you know because of that advice you know I ended up going to treatment and you know I've been able to sustain recovery now for eight years and my choice to join social work was to simply be to be able to give that back to be the man on the other side of this that helps

somebody else regain their life regain their stability regain the the will to live again so so definitely it's a personal thing to me um my my dealings with with policy and being on the board that that was more of a chance situation um my story you know I was talking with Brenda Rosen she's the executive director of the Kentucky chapter of the NASW and we were in the annex of the in the library talking about you know how I was previously incarcerated and all that and I actually got the opportunity to testify against the house bills that year in the general assembly and that's kind of what sparked my desire to go more into what's like the macro side of social work. And I know you've touched on this both but I want you to tell us about your organizations

where you work and your own issues with substance use disorder. Let's start there. Okay so in 2009 right after my brother died, I started with my parents, I lived for Lolly, which is my last name is Lolliberté. So my brother's nickname was Lolly. And we had only hoped to just create some awareness in our own community. Maybe we could at least do that because what we found out very quickly was like, if you said heroin or overdose or addiction to anyone, it was like at that time, what? That doesn't happen here. The NIMBYism was alive and well. And then over time, as we continued to become advocates. We met more families who wanted support, had needs, wanted help, wanted somebody to be a voice for them because they were so ashamed and so afraid to

use their own voice because of the stigma around substance use and mental health. It became very clear that we needed to really focus on what the community is telling us that they needed. And I carry that with me today in my current social work work. So now we are one of the largest recovery support providers in the state of Illinois. We have a four point model that focuses on education, community education, whether that's police and fire and social workers, or whether that's students and folks who are impacted. Harm reduction outreach, we are one of the only providers of safe supplies, a needle exchange service, and it's not just needles, It's all supplies that somebody might need to use and stay free of HIV or hepatitis C or overdose.

You know, it's that's a big part of our work and it's a huge need that we're getting a lot of support with. The third big piece is peer support. We offer coaching, one on one coaching, family support and groups and then advocacy and policy work, which is something that I've led over the last 10 years and have been just changed my life, learning about the macro side, like Jimmy said, of how much of an impact one person, one life, one story can make. And I now am focused on in my private practice, just helping folks with all issues. And I mainly work with teens and families in my private practice, but also lots of people who have co-occurring issues like substance use disorders. And like, as you said at the beginning, I'm running for the state house because I feel so passionate about making sure we

have recovery legislators and people who really understand the dichotomy of mental health and the lacking mental health services, which I'm sure we'll dive into at some point in the podcast. But yeah, so it's been a journey and I feel very privileged to be on it. So my addiction really kicked off in 2009 whenever I returned home from Afghanistan. I served with the United States military in the Army for eight years as a combat engineer. A lot of things happened in war that a kid, I mean, honestly, that's what it was. I was 20 years old in a third world country fighting a war. Experiences that most kids shouldn't have to go through.

And because of that, I did develop mental health disorders. You know, things like complex post-traumatic stress disorder with dissociative features, major depressive disorders another common mental health diagnosis that comes from that area and I tried to self-medicate turns out alcohol worked really well for a while and then that slowly transitioned to opioids opioids ended up transitioning into methamphetamine back whenever my addiction first started you know Oxycontin was the thing back then you know you could get them everywhere and then eventually they cracked down on the prescription pain medication and then that's when we've seen an influx of methamphetamine come into the area.

And unfortunately for addicts, you know, I always had that question, you know, what is your drug of choice? Because I'm an addict. I'm going to do whatever it takes to make me not feel or remember the things I'm trying not to feel or remember. And that was the moment in my life that things started to spiral out of control. And eventually it got to the point that there wasn't enough drugs and alcohol in this world to keep me from not thinking about the things that I didn't want to think about. And that's whenever the suicidal ideation came in.

I actually attempted to end my life on November 19th of 2013. And because of that, I was placed in the psychiatric center. And again, that's where I met my first Kentucky social worker and actually turned my life around. I currently work for a company called Kentucky Addiction Centers. We're an outpatient MAT treatment facility. we do both regular outpatient and intensive outpatient programs we are currently working on relationships with our local government and the criminal justice system to where rather than

looking at an addict in a punitive mind frame why not look at them in a rehabilitative mind state to where we can actually get them in treatment rather than going to jail like i said i'm a previously incarcerated individual i can speak to the personal experience of there is no rehabilitation in jail. You stare at four concrete walls all day long, and you waste your time. If you're lucky, you'll get put into a substance abuse program there, but there's no guarantee that's going to work. And when you get out of prison, then you're just thrown back in the same environment that you were in before. In recovery, 85% of your success is who and what you surround yourself with. So that's the reason why outpatient programs are so important. It's the reason why

And sober living homes are important. That's the reason why AA and NA groups or any other type of self-help group is important to help build up that social network to get the person out of their same common routines that they're used to. And that's why I'm grateful that I work in an outpatient clinic to where anybody with a substance use issue can come in. We treat both Medicaid and Medicare. If somebody doesn't have insurance, we have a team of case managers that will help get them signed up for insurance. If they choose not to use insurance, they can self-pay. the options are pretty much endless when it comes to treatment in an outpatient setting and then we also have good resources and relationships with the inpatient side of

treatment as well because obviously not everybody's going to be a good fit for outpatient they're going to need that higher level of care now let's move to the heart of our conversation the nation was already dealing with an opioid crisis before the pandemic how has that worsened So I could, sure, I could try and speak for it. But I think nationwide, we are losing approximately 230 people a day. That's more than 100,000 people a day. So to put that into context, that's like two full plane loads of people, two full plane crashes every day. now if that was really happening what do you think would happen in the country there would be an uproar it would it would be protests everybody on the streets demanding an answer to why this was happening and here we sit in 2022 knowing that drugs have always been a part of the equation for humans we've been seeking pleasure and avoiding pain since we we landed here right

Or whatever you believe. And so what happened with COVID was isolation triggered lack of services and disruption of services. And if you, as Jimmy was so well articulate, so well describing, I mean, I think addiction is a lack of connection. And it fuels itself in isolation. And so this created a huge problem for people. People couldn't come out of their homes. People couldn't look at another person in the eye. Some people weren't able to touch physically another human being for a very long time. and talking about treatment, this entire field had to completely reverse course and try to operate on telehealth. I mean, it was a nightmare within a nightmare. In addition to that, over the last several years, fentanyl, which is a substance, a chemical about 20, sometimes 25,000 times stronger than heroin, depending on what you're getting in there, you're seeing it laced in most street bot drugs across the nation. And that's just increasing. So even if you're somebody who has used for years and years and years, you pick up a batch and it's new, you may not survive

that day. And if you're certainly a newer user or somebody who maybe has been abstinent for a while and you go out and use, I mean, it's a death wish. It really is without understanding. So we say things like safer use. Well, right now it's incredibly unsafe to use drugs, but we have hundreds of millions of people in this country using and seemingly no end in sight. And I think it's a dire, dire situation. It's dire. And this is now only tipping off really over the last few years, the government and private industries and public partnerships to say, we need to invest in helping to fix this crisis. Not to mention the fact that addiction doesn't exist linearly. Like it doesn't just exist in a vacuum. There are so many intersections all around addiction that are

at play. It's a symptom of things much greater, racism, poverty, oppression, lack of hope. I mean, And there was a perfect storm with COVID. And so here we sit, worse than ever before. And so, yeah, that's my take on it. Jimmy, and then tell me too, is there a way out of this? We've talked about why people are turning to drugs, but I want you to focus on what that previous question about, you know, describe the situation in your area as well. Right. So Chelsea brought up a really good point about the pandemic is, you know, addiction is an isolating disease and now you are federally mandated to isolate from others. So, of course, addiction is going to flourish in this day and time. Um, unfortunately, Kentucky ranks third in the nation for overdose deaths increased during the pandemic. Um, current statistics show that we actually show an increase of around 56%, uh, from according to the CDC of overdose deaths.

A lot of it in part is the influx of fentanyl. Um, there, there is current legislation in Frankfurt to try to increase the punishments for fentanyl, uh, trafficking. But at the end of the day, in our area specifically, we were already lacking resources. We had very few homeless shelters. We don't have needle exchange programs or other harm reduction programs. You know, city council, city ordinances, we've talked about it. We just haven't got it in, you know, actually here yet.

And then COVID hits. and we're already limited on the resources and now they're having to go by COVID restrictions to where homeless shelters are only operating at a 33% capacity. So that in itself is hard, but on the same token, even if I have a homeless shelter

that's willing to take one of my clients, how am I going to get them there? Because there's no public transportation where I live. You know, I'm from an extremely small town in Eastern Kentucky called Painesville. Our total population here is around 22 to 26,000. So, I mean, you know, like Jessie, she's from Chicago, Illinois. I'm sure that's probably just one like little tiny suburb for her.

But at the end of the day, I think there is hope. We have learned to adapt and overcome with the COVID-19 pandemic and as far as how we deliver services. Obviously, during the influx of COVID, we weren't allowed to meet in person. We did have to transition to telehealth. and yes that that was a mess you had entire service providers that went from seeing people face to face to having to use telecommunication device like zoom or google hangouts or me or all these other platforms and the biggest barrier to that is again i live in eastern kentucky in the heart of appalachia not all of my clients have internet access not all my clients even have a

home to go to. So how did we serve them? And it got to the point that at one point, our laboratory that does the urine drug screens, we would suit up in full biohazardous suits and get people in to get them treatment. You know, that's one thing I can say about the heart of Appalachia is we care about our own and we will do what it takes to provide those services. We still have a long way it go as far as making things good again. We are able to see people in person now where we're able to, you know, obviously we wear masks and, you know, with the CMS vaccine mandate, we're able to actually get people in person again. And that's helped out a whole lot because the clients are able to have that face-to-face interaction once again. They're able to go to self-help groups

meetings again it is getting better i will say that i do know though that we were hit hard especially here in kentucky and unfortunately kentucky's you know we're known for ranking on the high side of the list whenever it comes to things like overdose deaths or drug offenses and things like that and hopefully within this general assembly we'll see a swing in that to where rather than looking in a punitive mind frame or a punitive lens, we start to see a more accepting and more rehabilitative future for Kentucky. Now, do you think the legalization of marijuana has worked to decrease the number of people now using opioids, as some studies have suggested, and has this diverted people to something less harmful?

Such a good question. Such a good question. So I think that one of the things we still need generally nationwide is we need to remove marijuana from the Schedule 1, the scheduling of drugs, which is, you know, which is how the DEA ranks harmful drugs. Marijuana is still, or cannabis, whatever you want to call it, is still ranked the same as heroin. How? Nobody has ever overdosed on marijuana. How is that the same? And I think we take a look at structures like that that have been in place for several decades now, thanks to Nixon, that have failed us. And the intention of creating those types of barriers for people to, again, as I said earlier, avoid pain and seek pleasure, came at the expense of black and brown communities and low-income communities, Jewish people. I mean, there's a lot of ostracization and just pretty horrific roots of why that's occurred.

And so I think this revolution of working slowly, but across this country to legalize marijuana, make it safer to use, and same with medical cannabis as well, is really just a testament to the fact that Americans are sick of seeing people incarcerated, seeing communities harmed and neglected because of the fact that we're focused. We focused for so long on that people who use drugs are bad people. They do bad things. And instead, we have now, you know, this whole nation is realizing why that didn't work. Just say no didn't work because people are always going to want to change their brain. That's how human beings work. How can we do that safely with safety nets. I think that's what we're taking a look at right now. And then

you're starting to see things like Oregon decriminalizing all drugs and routing people to treatment. Oregon and D.C. also legalized the use of psilocybin, which is an LSD-based type of treatment that we're really seeing some strong research for. So if we don't de-schedule marijuana. We can't research it at the level that it needs to be researched in. And then we can't evaluate how that would look in the population. So until we're able to do that, and this is years and years from, I think, the way that a lot of people in this field believe that it needs to be. I don't think that this is the answer to the opioid crisis, though. I think that, and I hesitate to even call it an opioid crisis because of how vast it is in terms

of the amount of substances used, I call it an overdose crisis. But we don't have enough research that actually says whether or not cannabis would be effective for opioid use disorders. We have other medications and other substances that we know work like methadone and suboxone and naltrexone in some cases, but we have long ways to go. A lot of policy changes need to be made to get us to where we can actually affirmatively say, you know, we need this or we don't need this. Right. So before I start this, I will say I am pro-legalization of marijuana. Unfortunately, in the state of Kentucky, we seem to be behind everybody else in the nation, and it is still illegal on a state and federal level. So having said that, though, we have to

look at it in a behavioral context. I work for a BHSO, a substance use facility. So if one of my clients come into my facility and they have marijuana in their system, one of two things have happened. They've either grew it their self or they've bought it, which means that they've committed an illegal act, which speaks to the addictive behavior side of things. Now, me and my personal beliefs, I view it as a harm reduction more than anything. I would much rather see somebody use marijuana either medically or recreationally to help cope with things like stress and anxiety post-traumatic stress disorder because those are all things that science has already proven that it does help it's just getting like like what just the policies have to catch up

and being able to actually research these things do i think marijuana is the answer to solve any opioid use? Well, no. I think that treatment, like actual mental health treatment, is the solution to it. Producing healthy people is the solution to it. Rather than locking them up in a prison cell for 10 years because they made a mistake and sold drugs, why not get them mental health treatment? Because I promise you, if a person is on drugs, it's not because they woke up that day and said, I want to be a heroin addict. It's not that they woke up and said, well, I think I'm gonna be addicted to meth today. Usually, 90% of the time, they have some type of pre-existing mental health condition that has drew them to that drug to help cope with life situations. There's an old saying

in the NA rooms, and they said that basically, what is it about my reality that I think that it's okay to put a substance in my system that has the potential to kill me? What is it about my reality that i find so unreal to me or unwavering to me that i think it's okay to do this because that's the core problem drugs and alcohol that's not the person's issue it's what causes them to pick it up in the first place can i add one more thing to that i think another thing that and jimmy touched on it earlier is just like recognizing the importance of trauma and um and what that means for our culture. And now that most of this country now, great, believes that mental health and trauma are real things. We've all experienced collective trauma. Until we're

able to treat that trauma, until we're able to find ways to heal, whether it's physical, emotional, spiritual, biological, whatever those issues are, we are not going to get out of this cycle that we're in. So to Jimmy's point, I mean, this is about cutting at the root of why we're here. So Chelsea, and we talked about this before we got on the podcast a few weeks ago, we talked about harm reduction in the framework of people who use drugs and how the expectation of abstinence is harmful um let's talk about that a little bit and and then let's talk too about the war on drugs which is really the war on race tied into the work that you do so first of all i just want to say jimmy i am so sorry y'all don't have needle exchanges in kentucky that makes my heart hurt

so bad and surprising kentucky is just my area specifically i see well we'll have to talk after this and we'll figure out a plan to fix that. But I think it's a travesty that people can't get clean needles without having to, I just think it's in 2022, after everything we learned from the AIDS crisis, you would think that this would be solved by now. So to me, harm reduction means meeting people where they're at, loving them where they're at, showing them empathy and compassion from day one, moment one, and not expecting them to meet us where we're at. And I think as social workers, we have these books, right, that tell us how to treat people. And I think that that sometimes gets lost in our ability to connect and be human. So to me, harm reduction is just

taking, is saying to somebody, I love you, I'm here for you, I care about you. And I want, but I'm also willing to help come alongside you, not tell you what to do, to help you, and in this case with drug use, live your life. And we see, you know, through harm reduction services across the country. And I will talk about the race piece of this in a second. And I want to just say I am a white woman. So I know that I'm coming from my own perspective. You know, I'm watching this happen in this country. But it took many, many years, even for Illinois, which is considered a very progressive state to actually attach itself to harm reduction. And now to the point where our entire Department of Health and Human Services is so behind making sure that people and communities

are able to access clean needles, clean snorting kits, clean crack pipes, condoms, lubricant, testing, prevention strategies, treatment, driving, even transportation is harm reduction. A doctor's visit is harm reduction. Getting methadone for 28 days during COVID and seeing the DEA lift their restrictions on that, that was an advancement move that we saw happen. That's harm reduction. So it's just loving people. I think people have kind of mixed up the word enabling with harm reduction and love in a really strange way. And I don't think any of it actually makes sense. But now, and I just harking back to a couple of weeks ago, what happened with the crack kits conversation nationally, I don't know if you all heard about this, but

there was a publication that got wind that the Biden administration was funding smoking kits for crack users, just like they did 10, 20 years ago with people who wanted to inject, who were injecting drugs, and an argument of why not to have taxpayers fund those services. And to me, it was such a slap in the face to the movement that we're in, to the recognition that we have failed at this. We are not winning this war unless we walk back the failures that have been implemented and try to do this in a new way that works. Every other advanced country in the world offers harm reduction services for free as a part of living in that place, except for America. And that is a huge problem. I can't say it any more clearly. And the link between that and the

war on drugs, I mean, you want to talk about the antithesis of harm reduction is criminalization and punishment for being human and for that lack of love, that focus on judgment and anger and and isolating people from communities, the harm that it has done, oh my goodness, we will never be able to calculate it. So I hope that was a good answer to the question, really harm reduction is love, period. And we need to find ways to love ourselves and love each other better in order for us to kind of get what that means. So I want to touch on to the expectation of abstinence being harmful. Can you speak to that, Jimmy? yeah i think i understand where you're coming from on that because um the type of treatment i

went through it was an abstinent based treatment you know it was 40 hours of clinical services a week there were seven a meetings a week and while it worked for me it only has between a five and ten percent success rate for somebody to achieve long-term recovery which in kentucky we consider long-term sobriety to be one year or longer. Whereas if you have a participant in an MAT treatment program, whether it be methadone or suboxone or naltrexone or any other type, statistics show that if they participate in that type of program for a minimum of four years, which is an outpatient program, that they have a 65% chance of achieving long-term sobriety, which 65 doesn't seem like a lot, but that is huge numbers in the recovery field.

and i think where they say that abstinence is harmful is because there is a a few set of people that are what we consider chronic relapsers without some type of mat medication they will continue to use and they use the mat medication is almost like an accountability thing vivitrol is a perfect example of that with alcohol use disorder vivitrol is a once a month injection that somebody would take, and it would prevent them from using alcohol, and if they did use alcohol, they would become extremely sick, and it's a huge deterrent, and some people, they may not be able to ever come off of that medication, and that's completely okay, and I think what happens is the stigma that comes with drug abuse, they think, oh, well, I'm just replacing one drug

for another, and that's not the case at all. You know, I like to use my son's diabetes as a really a good analogy for this. My son, he's a type 1 diabetic. He's on a specific insulin dose. His blood sugar is doing great right now, okay? That doesn't mean I'm going to start taking the insulin from him just because he's doing better. And it's the same thing with MAT medications. I give somebody a specific type of medication at a specific type of dose and they start doing well. They start stabilizing and get a job and start recreating connections with their family and their society that doesn't mean i'm gonna strip the medicine from them right away i mean eventually sure you know we'll get them to at least the lowest dose that's therapeutic to them but even

with that there is no standard of what is a therapeutic dose and i think at the heart of it the reason why people say that abstinence is harmful is because of the stigma that's associated with it i have clients in my mat treatment facility now that say that they don't feel like they're clean because they're taking Suboxone. Be it every other aspect of their life and every detail of their surroundings would point and indicate that they are completely stable and within remission from opioid use disorder.

I think it's a perspective thing and definitely stigma as well. So what can we take away from the criminal legal system and how they engage with this addiction crisis? Why is something we know is a legitimate brain disorder, a disease still criminalized in this country? Chelsea. Oh, my goodness.

I mean, we could be here all day going back to the history of, you know, prohibition and criminalization and mass incarceration. But I think the nuts and bolts of it is it was a way to control people. And what we know is that it just it didn't work. And it actually ended up having much more harmful effects. Again, we are the only advanced country that does this in the way that we do it. We have mass incarceration, mass incarceration. Hundreds of thousands of people right now are sitting in jails for, as Jimmy said earlier, low-level marijuana convictions from the 80s that they are still trying to get out on. It's just insanity. It really is. And so, you know, to give but to get back to your question, you know, I think we have to take a look at our systems and start really reforming them from the inside out.

Illinois just passed last year a sweeping number of bills to to really try and advance some of the idiosyncrasies of the criminal justice system. And even now, you know, we're heading into this like new election year here in Illinois. Some of some of that is being walked back and seen as too unsafe or too divergent from the intention of criminalizing someone for anything. And it's really profound. Yeah, sure. So there's this cash bail. The issue with cash bail, right, is that people are given a set amount, no matter what their socioeconomic status is, no matter how unsafe of a behavior they have caused. they get this bail, right? This is the system before. And in order to get out of jail, they have to meet that bail. So you could have somebody in there, a young black or brown man, for example, who maybe had a baggie of heroin, but his bail is set at $30,000. Yeah, he's not going to be able to pay that bail and he's going to sit in a jail cell for a really long time. And so the reform of cash bail was really meant to base it off of a completely different dichotomy of how safe or unsafe is this person in the community.

And so it's a different model. It's saying you shouldn't have to sit in here. It's harmful to you. It's harmful to your family. It's harmful to your kids. It's harmful to the community. It's harmful to your employer. It's harmful to you to sit in a jail cell for no reason, just awaiting a trial, awaiting. And they're walking that back. Yes. In Illinois, we are the first state in the country that has walked it back, but it's getting pushback. So there are these idiosyncratic things that unless you're a part of criminal justice reform policy changes, you know, it's hard to see how that impacts you day to day. But I think with drugs and with mental health, we have over-criminalized people because that has been where all the money and the resources for so many years has gone into those systems instead of the mental health treatment systems. And the mental health treatment system has been created outside of the general health care system.

So you have this like complete backwards approach to being able to address this appropriately. The first thing you do with a public health crisis, what did we do with COVID? Prevention and mitigation. That's not happening with drugs. And this is one of the biggest health crises of our time. And the first thing that happens to you is you have to go in front of a judge and talk about why you are actually a really good person. I mean, it's like, it's so backwards and we waste so much money. Could you imagine where we would be if all of the money that was poured into the prison system was in the mental health treatment system? Could you imagine where we would be as a society, as a culture, what I would be able to tell my three-year-old son about what's going to happen to him in his life and how to teach him about seeking help first, seeking safety first? I mean, it's mind blowing. So we have a lot of work to do in this country. And, you know, I just think it's just a matter of being bold enough to get out there and try and change it like Jimmy is doing. And I guess like me and other advocates are doing across the country. Jimmy, if you could wave a magic wand, what would you wish could be done to end the addiction crisis? you know it's funny me and some other professionals in eastern kentucky here we were talking about this question the other day and about how much we actually hate this question because obviously it's unrealistic but but at the same time though there are very much real

things that we don't need magic for to actually fix things my magic one solution would be to wave a wand and have an entire redoing of the infrastructure of what criminal justice is in Kentucky. Chelsea mentioned that her state is actually trying to push bills to where cash bonds are no longer a thing. My state's going in the opposite direction. House Bill 313, which the Kentucky chapter of the NASW strongly opposes, is actually trying to make it unlawful for organizations to use charitable funds to post bail for individuals that are incarcerated. Yeah, it's ridiculous. And you've got these wonderful organizations.

One specifically pops out in my head. It's an organization called the Louisville Bail Project. I have friends that work there. And what that whole organization does is they post bail for individuals who are people of color, who are economically in adverse situations that can't afford it, my bail on my charges was over $20,000. At that time, I was unemployed in eastern Kentucky. I wasn't going nowhere. I was going to sit in that jail cell until I got my court date. But these organizations like the Louisville Bail Project will actually step in and help bail them out. They have a 90% return rate of people going

back to court after they bail them out. So the problem is not that, you know, they're bailing them out and they're not going back to court it's just our criminal justice system looks at it in such a punitive manner that they're introducing a bill this year it's been introduced it's going to a committee that will make the charitable donations to post bail unlawful in the state of Kentucky so that means that's the question of the hour something that is common sense that everybody that would look well that's the problem with social work too though is we look at things as an entire environment, not just the person and the symptoms, whereas most people look at the person and the symptoms, and especially in the criminal justice system, they look at it in

a punitive statute. They think, okay, well, this guy, you know, like me, I sold drugs. I need to go to jail for that. I didn't need to go to jail. I needed help. I needed mental health help. I needed trauma help. I mean, all of these things that were causing me to pick drugs up in the first place. The problem is, is we have a very conservative power of the majority right now in Kentucky. Thank God for Governor Andy Beshear. That man has literally changed my entire life because I was a convicted felon all the way up until December 21st of last year. He gave me a gubernatorial pardon of my record, set me free of the chains and the bonds of this stigma that comes with having a drug addiction and a felony conviction, you know, I will forever be grateful

to that man. But the problem is, is the supermajority still view it in a punitive nature. And that's the reason why organizations like the LNA committee, the legislative and advocacy committee that I chair with the Kentucky NASW, that's the reason why organizations are so important. Organizations like Case One, which is the Kentucky Social Work Advocacy Network, multiple organizations are all meeting every other week or every week sometimes during this general assembly to try to help push some of these good bills through and then strongly oppose bills like house bill 313 and i'm not trying to get off on a political tangent i promise but things like that it just infuriates you because you have something like an organization that is doing something so

well getting people out on bail to where they can live a normal productive life and possibly even receive the services that will actually help them stop using drugs. And then you have your lawmakers telling you, no, you can't do that. And if you continue to do that, we'll cite you and put you in jail. We're going backwards and it's not right. Listeners, we'll be right back. Social workers often help people with diabetes, but how are you keeping up with it all? Do you know the current language and psychosocial approaches that actually decrease distress, the cultural considerations, and about all the medications, technology, and target numbers? The online self-paced Diabetes Essentials for Clinicians program is approved by NASW

for 100 credits and is taught by interdisciplinary experts to improve your competency. Visit go.pacific.edu slash diabetes essentials to get started. And we're back. Do popular TV shows such as Euphoria on HBO or the Ozarks on Netflix and Intervention on A&E glamorize drugs and addiction or make people aware of the pitfalls? So I'll be honest, I've never watched Euphoria. I am a fan of the Ozarks show. And yes, that show definitely glamorizes the use of drugs, even working with the cartel and all that other stuff. Um, I think that shows like intervention, I think they are well intended to kind of shed light on the realities of drug addiction. The problem is, is when somebody who is in recovery from substance use sees things like that, they can have biological reactions to these things. Um, give you a specific example out of my own life. During one of my college classes in my chemical dependency minor,

I had to watch a video it was called the Montana meth project meth was my drug of choice towards the end of my addiction and in the video they showed people you know shooting up with needles snorting the meth and everything else I had to stop the video halfway through because I got a knot in the back of my throat and my stomach started churning and my body turned real warm I was having a biological reaction to a visual trigger at six years clean and it floored me and it made me really think that if i can have this happen to me at six years clean an addict's never going to forget what it feels like to be high it is just it's not possible because the the the dopamine that's released from drugs it's the same as our survival mechanisms and

it honestly it becomes more important than a lot of the basic survival mechanisms like taking showers and eating is so when you look at a tv show and you see this and it glamorizes the fact that, you know, this person's making hundreds of millions of dollars working for a cartel who's also working for the FBI, and that's how they get away with it, or shows like Intervention where they're just showing these people haphazardly using drugs and alcohol, yeah, that's going to cause a lot of issues for addicts. I will say that there are some, though, that can watch that show and be okay, but it's like anything else. There's a really corny old saying in the AA rooms, and it says, if I hang out at a barbershop long enough, I'm going to get a haircut. So if I keep exposing

myself to that trigger, eventually I'm going to do it. It's as simple as that. Chelsea? Yeah, I think for me, it's a different piece coming from the patient advocacy lens. So shows like Intervention, I think, are in a sense a way to imply a process for how somebody can, should, and must get treatment. And I think it has helped promote these ideas of hitting rock bottom and getting clean and things that you don't, you don't need to hit rock bottom to ask for help. In what society do you need to do that? And I think shows like, and I don't want to just blame intervention because I think that's an easy escape, but it teaches people how to actually, what the process has been for seeking care. Now, when I was trained to diagnose with someone with

a substance use disorder and to advocate for an ASAM, which is the type of assessment criteria that we all use in order to dictate, okay, or to say, this person may need this level of care, this level of care, this level of care. None of that involves having a bunch of people sit around that person in a circle and tell them, if you don't, I will never talk to you again. In fact, it's the complete opposite. It's, I love you so much. And because I love you so much, I have this person that you can go and talk to, and maybe they can do an evaluation and figure out what type of care might be available for you, or what options are out there if you don't want to stop using. That is the antithesis of what happens on that show. And I think shows like

Dope Sick, I mean, I haven't seen it yet. I was going to talk about that next. Yeah. Sorry. Okay. Well, no, no, keep going because we were moving in that direction. So keep going. In terms of, so this is a podcast for social workers. Social workers are listening to this. I would just like to tell you, and this is not an attack on interventionists. I want you to hear that, please be careful about the way that you are talking about and shepherding people into treatment. It should be on their terms. They need to see the buffet of options. They need a scientific, right? This is an illness, a scientific evaluation of what that might look like for their particular case. Just because Johnny went to horseback riding on the beach treatment center

in Florida, doesn't mean you will do as well in that program. That doesn't mean that's what you might need. It means maybe that worked for Johnny, or there's a good likelihood that Johnny ended up, sorry to say this, in a trap house somewhere. So I think we have to be very careful when we're teaching people how to seek treatment and care. We have to advocate for them and educate them on the process that that needs to take. It also kind of, I don't know what other illnesses looked at in that same way. Literally, there's no other illnesses that where we look at that and say, oh, I've got to write a letter to my loved one and tell them that if they don't do what I want them to do, I will never talk to them again. What kind of compassion is that? So I think as social

workers, we need to be taking a look at all the models that could work and saying, well, what might work best for my client or my patient or my loved one? And we're going to, we were going to get into that too i was saving that for last but i'm glad you brought that up no no don't apologize because we're all we're all gonna have the same conversation um we are gonna talk about this and i'm glad that i'm glad that it's coming up because as you said this is a podcast for social workers and about social work um but i want to i want to circle back to um to dope sick on hulu jimmy have you seen it i have and honestly i don't think i've ever been that mad at a television show in my entire life. Really? Why? Tell me, I want to hear this. Well, as an addict in recovery,

looking at the truth behind how OxyContin was developed, the Reese, the, well, I don't know, it's a podcast. You can't see it, but I'm doing air quotes right now. The research that they did behind it, it's infuriating. And, you know, my wife, she kept reminding me that, you know, just because I'm yelling at the TV doesn't mean that they can't hear me because I have both sides the defense experience you know i'm an addict in recovery you know with 14 years of addiction and i'm also now a substance and mental health abuse specialist so when i watch shows like that and it's it's told that the research that they had where they said that only one percent of the people ever taking the medication would become addicted was nothing more than a three sentence

paragraph to a letter of the editorial of a magazine and that colleges across the nation we're teaching this as empirical evidence like my inner social worker wants to jump out of my body and fight somebody over that and then you've got the addiction side of it too that to know that terms like breakthrough pain and when you go into a hospital and you see those little placards with the smiley faces on it and the pain scale from one to ten this was all created because of the oxycontin epidemic and i guess when they said one percent they meant like one percent of the world not just the people in america because that's a more accurate number to it but to know that the sackler family and specifically richard sackler is responsible for the deaths of hundreds of

thousands if not millions of individuals and he's not in prison that doesn't sit right with me it's infuriating it is chelsea you had a point my brother my brother is dead because of richard safflower. And I'm really glad that you were able to call that out, Jimmy, for what it is. Because I think as social workers, we have to do a better job of not protecting people who don't need to be protected in a sense. But you're right. They created this. They marketed a drug that they knew was addictive to doctors who then took that data and promoted it to their patients. and then we vilified the doctors for doing what they were told to do. And then we vilified the user. So it's just this. So to Jimmy's point, you know, I think stories can be harmful and they can

be helpful. Right. And so somebody is going to take maybe, oh, wow, I should really, maybe they'll take from that show. Oh, wow. Maybe I should really be like aware if somebody is going to, if a doctor is going to prescribe me a medication of what I am putting in my body and how much I need because I don't know if I trust them. So now we've gotten to this place where we don't trust our providers. We don't trust our social workers. We don't trust the systems that were set up to help us. And that was just a different, this happens in other industries. And this is the story that was told with the Sackler family. But the other big piece of this too, is that all the other manufacturers followed suit. They saw that model and they said, that's a cash cow.

they knew what was going to get people addicted and they did nothing but perpetuate it. And so here we sit and we're trying to make up for it. And all these states and the federal government are suing these manufacturers for creating this crisis that we're in. And where is that money going? That's my question. Where is that money going? I hope it's not going to back to creating treatments in jails. I hope it's going to the community, making up for what we lost. And so, so Jimmy, obviously I'm very passionate about it because I lost my brother to this illness. And so thank you for bringing that up and being brave enough to call it out. So one of the, I want to talk about the biggest issue with recovery. And we touched on this a little bit, but Jimmy, what

about the stigma that's attached? And we, like I said, we touched about this. We talked about this a little bit. What about the stigma that's attached to Suboxone or other drugs that help? Right. So even in the 12-step self-help groups like Alcoholics Anonymous, Narcotics Anonymous, and Celebrate Recovery, there's a huge negative stigma on the use of Suboxone and methadone and naltrexone because, again, they feel like they're replacing one drug with another. most of my clients that i see when they start to go to self-help meetings i tell them that what they do or don't take as far as their medical care is nobody else's business i tell them not to tell them in the groups that they're on this medication because there are a lot of

groups around here that would say you're not clean you need to get out the door and that that's horrible. A lot of religious organizations, I won't name them obviously specifically, but a lot of religious organizations and even the criminal justice side of things like our local police departments, the fire departments, and the EMSs, they have seen so many negative experiences with the use of Suboxone because obviously like any other drug, there's going to be some people who divert the medication for uses that are not prescribed. What they don't see is the people that are actually succeeding on it and that's the issue like they don't see people like myself I'm eight years clean I've got two state licensures to do behavioral mental health services I've got

a career I've got a family I've got all of these things going for me and that's why I'm here today and the reason why I've done the work I've done for the last you know six years is because people need to see me they need to see addicts in recovery who are succeeding because with the stigma that's attached to it if I'm on methadone or if I'm on MAT medications in general it doesn't matter what it is I'm not clean you know I'm just trading one drug for another or I'm going down to the clinic just to get drugs to trade it for whatever I really do want and 90% of the time that's not the case at all and the vast majority of our clients are being punished by the actions of a few and that's that's where a lot of the stigma comes from the the biggest thing I see

too as far as like Appalachia specifically is the whole religious trauma aspect of things I know you and I we talked about that whenever we had our personal call but you know religious trauma is whenever you grow up in a certain denomination they may be completely against the use of drugs any drugs there's some religions that won't even let you take Tylenol if you have a headache Me specifically, you know, I grew up in a Baptist home. My dad was a minister. Both my uncles was ministers. My papa was the deacon of the church.

I was voting business meetings and making wine for communion by the time I was 12 years old. Well, because of that way I was raised religiously, then I went to the military and then I went to war. And there were things I had to do in war that contradicted and conflicted with my religious beliefs at the time. And because of that, I thought I was going to hell. And that really spiraled the mental health out of control. And I wasn't willing to get help because I didn't think there was help out there for me. And even if there was, what would be the point? And it's because of that religious trauma that I didn't seek help from 2009 when I come home all the way to 2013.

And the only reason why I did get help is because I failed to kill myself. That's sad. i could have very easily become a statistic all because of the stigma of mental health the stigma of drug use and the religious trauma that comes from this area well i wanted to while we're talking about this and i want you to chime in to chelsea is we and we talked about this briefly before too is the length of time that a person spends on suboxone too or or other drugs that help um and And there is a stigma attached to that too, even for those who say, okay, yeah, this is a medication that can help me, but I shouldn't be on it forever. Because you have some people who are distressed that they may be on Suboxone for years. Let's talk about that just a little bit. I can't talk about the impact of how Suboxone works for the person who's taking it because

I've never been on Suboxone. My husband's an addiction medicine provider. He's a PA. And what I can tell you is, and I've worked with people on medication-assisted treatment, I've been promoting it for years, is when we see people try it, like Jimmy said, everything in their life starts to get better. They don't seek drugs. They're not going through withdrawal. They're not having to need whatever they were using, heroin or other opioids, because they're not, the parts of their brain that require that interaction are being fed. It's science. I'm on a blood clotting medication.

If I don't take that medication, I'm going to be in the hospital because my lungs are going to be shutting down from a blood clot. It's prevention. It's prevention. In the simplest word, it's prevention. And I feel really sad for people who don't get the conversation about the benefits of medications for opioid and alcohol use disorders, because people are sitting there in such stigma towards themselves and shame towards themselves for having a brain that behaves in a certain way. and just to have that medication to stop that craving, to stop that behavior. Oh my gosh, it's like so freeing when I talk to people about it. I don't have to worry today. I'm okay today. And so we really have to do a lot of work as a field to bring people alongside folks who are

utilizing medications. You are not weak if you use methadone to not use heroin. You are strong. You are worthy of that methadone that you're going to take every morning. You are worthy of that. And it's because the field fought so hard to have those medications. Now we just want to hold on to them. But there's an attack on it coming from within the field, which is what's really interesting about the whole thing. And so I'm a harm reductionist. So I'm a big proponent of MOUD or MAT, whatever you want to call it. I think if everybody had the opportunity to be on buprenorphine, to be on methadone, oh my gosh, it would have changed the game. We would be in a much different place. So I think that the government needs to do like a FEMA drop of

of methadone and buprenorphine into all communities across this country and making sure that we have enough providers to be able to help those people along the way. So you're not going to get any pushback from that on me, just more promotion. Jimmy, did you want to weigh in? So I think that MAT is not for everybody, obviously. You know, there are certain diagnostic criteria that we utilize at the office I work at to assist. And can you explain what MAT is for those for our listeners who may not be familiar? Right. M.A.T.G. is it's an acronym. It stands for medically assisted treatment. That's the use of suboxone or naltrexone or methadone while teaching the psychoeducational piece. And the whole purpose of it is to stabilize the person because whenever

you're on drugs, your brain's overproducing dopamine. And that's what causes the euphoria and the high from drugs. Well, the things like methadone and suboxone, they go into those opioid receptors and they block them they fill up the ones they have to and the rest of them specifically with suboxone the naltroxone will fill the rest of the blockers to trick the brain to think that 98% of the opioid receptors are full now what actually happens in that though is they're getting the same amount of dopamine released in their brain over time as what a normal person would that doesn't use drugs or doesn't drink coffee or smoke cigarettes so basically what it's doing is rather than taking somebody completely off drugs and having them do

that roller coaster ride of you know i have dopamine one day not the next dopamine not next it's stabilized puts them on a flat plateau and that stabilizes them enough to where we can actually teach them the psychoeducational piece to recovery that basic foundation of knowledge help them regain stability in their work environment their social environment the recreational environment a piece that for somebody who goes to a treatment center like i did where it was completely abstinent. I didn't do that. I had to go through the withdrawals. It was six months before that mental fog lifted off my head and I could even make a good decision for myself. But we're able to actually give this person the medication now to where that happens on day one.

That mental fog is gone. They're stable. We're able to teach them this stuff. Now, as far as timeframes, as far as like how long somebody should be on that medication, there's no good answer to that it's dependent on the person in their situation and that's why i love social work because we don't just view the person and the symptoms again i've said that once already but we look at the person in their entire surroundings we see them as a system with the environment and that allows them to be stabilized i'm glad you brought up social work because we're going to move to that last. So lastly, what is your advice to social workers working in this difficult field? And I want Chelsea to talk about the political ramifications

and what social workers can do. But please go ahead. You have no idea how powerful you are, social workers. The way we think, the way we're trained, all the work and the CEUs and everything that we have to do to be a social worker, at the end of the day, you're going to hit roadblocks, right? You're going to hit issues with reimbursement rates. You're going to hit issues with having to say, I'm so sorry, but I can't treat you because we're full. I mean, and issues like that. You have to get in the game if you want to change those things. If you really want to make a difference in the long run for your clients, for your community, for your family, for our future. I highly recommend that you learn how to advocate for policy, whether it's locally

in your own school board or your village, whether it's your county, maybe running for a county board seat or doing work with a coalition in the county. I've developed a couple of those. Whether it's creating an advocacy coalition for the state that focuses on legislation or whether it's actually having the gall and the tenacity and the grit to run for office, like I have chosen to do on behalf of my participants and for them and for my brother and for my son and for myself and the future that we want to see. You can do it. And don't let, and I think my biggest advice too to social workers, we tend to come from this very clinical educational framework, clinical educational ground when there's good reason for that. But we're also told don't be

too loud. Don't ask too many questions. That's not your lane. Stay out of your lane. And the message I have is be loud. Ask the questions. Walk out of your lane. Be inquisitive. Be curious and do it. Do the things that scare you. There's a phenomenal author, Lovey, who wrote this book, Professional Troublemaker, and I've been reading it for the last year. We got to get comfortable with being uncomfortable. We are the chain. That's what we're called to do. It's in our ethics. It's in the code. It's in the code, man. It's in it. Very inspiring, Chelsea. So this is my call to action for social workers across America and the globe. Do it anyways. If it scares you, look it in the face and do it anyways. Or email me and I'll try

to talk you into it so that's that's my that's my call to action for the podcast yeah so chelsea hit the nail on the head um all macro issues start on a micro level the micro social worker is the one that realizes the administrative dilemmas or um the the problem with the krs or any type of state regulatory statute and that is where the macro piece comes in. Be the squeaky wheel. My biggest advice for everybody, and I've said these two words probably a hundred thousand times since I started on the board, is advocacy and education. You have to be the person out there telling the people what the problem is because if you don't, you don't know. There's a really good saying. It says a closed mouth does not get fed. So if I don't ever speak

to my issues, nobody's ever going to hear them. The one piece of advice I have for social workers working in this field is don't forget the fire that started your journey in the beginning. That fire is what fuels you and it's what's going to keep you going through those long nights and that overbearing caseload that's probably above what your state's regulations really are anyway. And it fuels you to walk through that fear, to testify even in a house of representatives against a house bill that's going to harm the people that live around you. Don't forget the fire that started everything. I love that. That was so on point, Jimmy. I couldn't agree more. Chelsea and Jimmy, thank you so much for joining us.

Listeners, you can find resources about this conversation in the show notes on our website. you have been listening to nasw social work talks a production of the national association of social workers we encourage you to visit nasw's website for more information about our efforts to enhance the professional growth and development of our members to create and maintain professional standards and to advance sound social policies you can learn more at www.socialworkers.org. And don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode.