The Zac Clark Show - Expert Explains What Trauma Is And How To Face It | Dr. Carrie Wilkens

Episode Date: April 30, 2024

In this episode, we explore groundbreaking approaches to substance use disorder, mental health and trauma with Dr. Carrie Wilkens, founder of Center for Motivation and Change (CMC), award-winning author, and a psychologist with over 25 years of experience in the practice and dissemination of evidence-based treatments for substance use and post-traumatic stress. Dr. Wilkens champions a compassionate, evidence-based methodology that challenges traditional treatment paradigms. She emphasizes individual needs, advocating for non-confrontational approaches at the intersection of science and kindness. Dr. Wilkens delves into the profound influence of trauma on personal narratives and shares strategies to confront and conquer its effects. We also address the urgent need for societal dialogue reform surrounding these critical issues, impacting millions of individuals and families.  This was a fascinating and refreshing conversation with an expert clinician willing to challenge outdated ideas about treatment and recovery modalities.  Please join in as we delve into innovative solutions at the intersection of science and kindness. RESOURCES CMC: Foundation for Change (CMC:FFC), envisions a world where everyone who cares about someone struggling with substances has access to information and tools based on science, grounded in compassion, and tailored to the needs of their community. https://cmcffc.org/ Check out our powerful community of family support groups - Invitation to Change Support groups and access our inspirational and educational videos from any computer for free. https://cmcffc.org/community-groups-hub/itc-support-group-directory https://cmcffc.org/resources/videos The Beyond Addiction Workbook for Family and Friends: Evidence-Based Skills to Help a Loved One Make Positive Change (New Harbinger Publications, 2022). All the book proceeds go toward scholarships for family members and professionals to attend ITC workshops. https://beyondaddictionworkbook.com/ Beyond Addiction: How Science and Kindness Help People Change https://www.amazon.com/Beyond-Addiction-Science-Kindness-People/dp/1476709475 LINKS https://linktr.ee/thezacclarkshow SPOTIFY https://open.spotify.com/show/23bzbSdy0C2LAUPkB6kjqY?si=x92OgyFDSW6pgUR8b5SBRg APPLE https://podcasts.apple.com/us/podcast/the-zac-clark-show/id1741605552 Instagram https://www.instagram.com/zwclark https://www.instagram.com/thezacclarkshow

All right, so today's episode of The Zach Clark Show is probably one of my most respected colleagues. Dr. Carrie Wilkins is coming on to talk about all things trauma, all things family recovery, and most importantly, how to slow down. It's going to be a good one. Thanks. All right, so welcome back to the Zach Clark Show. I am here with the person who probably guides my work more than anyone, Dr. Carrie Wilkins. a psychologist with over 25 years of experience, which is a lot. She is an expert in providing treatment for substance use disorder, PTSD, and a whole host of other things. We're going to jump into a lot today, Carrie. Hi. Hello. How are you? I'm super happy to be here with you.

Yeah. So I like to kind of jump right into it because we want to keep people's attention. And I think for me, when I think about our relationship, one of the things that you've opened my mind up to the most when it comes to substance use disorder and treatment is this idea that there's not just one way to get well. And there's a, I'll use foul language, bullshit narrative that, you know, kind of like AA is the only way to do. it or and then certain people don't support other methodologies. So I'm just curious to hear how you would respond to that. I won't call it bullshit because I think people fall into the their way for all sorts of such personal reasons. It's worth respecting that. I mean, I think for a lot of people the this is the only way to do it comes predominantly out of a lot of fear actually because like if you've been in a terrible place with your addiction and this way got you better, first you

want to share that, right? It's a completely reasonable thing. I want to share that. I want somebody else to benefit. And usually by the time you've found the thing that works for you, you've tried a lot of other things that didn't work. So when you land on that one thing, it feels like this must be the way. And so people get scared because there's a lot of damage done in I'm trying this, I'm trying that, and I'm on my journey and I'm getting hurt and things in my life are not going so well, so when I land here, it feels like this is a message I want out in the world or what worked for me. And so I try to respect where people are coming from because there's a long journey typically for most people. But the damage it causes when we do that

is pretty profound. So I don't think it's bullshit. The potential damage is pretty profound. So those are two slightly different things. This is why I love Carrie. And this is why we have people on this show that are smarter than me because she said it in such an eloquent way. And that was me early on. Like in my first couple years, I got it a certain way and I was going to go out and make sure that everyone else heard it that way. And throughout the last 12 years, you've been a huge supporter of mine and just have impacted the way that I see this work that we do in such a positive way. Yeah, can I actually say something about that? Because I was thinking fondly about the first time we met. I mean, you were, I think of you as.

like young back then. I was dating myself. But you came into the office and you guys were talking about the sober living that you were working at. And remember, one of the guys was very skeptically asked me if I was in recovery. They were talking about sober living. I was talking about what we do at CMC. And he asked me, so were you in recovery? And I said, why does that matter? And then he proceeded to tell me that, you know, he was skeptical that I could understand somebody with a problem, a substance use problem. And I said, well, what are you assuming about me in making that assumption? And kind of let him answer that question in, like you said, in a very black and white way. You know, he had very strong beliefs about how that was supposed to work. And

I said, well, so what you don't know about me is that for a big chunk of my late teens and early 20s, I had my head in the toilet four times a day with a terrible binge eating problem. And when you have a terrible eating disorder and you have to get better from that, you can't not engage with your substance, right? Like you actually have to figure out food every single day, multiple times a day. So this idea that abstinence and completely cutting yourself off from the thing that you struggle with is the only way to get better actually just doesn't resonate with me because I've had to figure it out.

It took a long time. It took lots of practice, lots of failed attempts. And I have a healthy relationship with food now. Yeah. Yeah. But I don't think of it as like I'm in recovery from, you know, like I think there's just so many different ways to talk about things and respect people on their journey and respect that they might be able to help you from a different angle, from a different experience.

And it just doesn't have to, again, like you said, be one way. We get trapped in that one way thought a lot in lots of different ways. Right. And when did that start for you? What would? I was probably 18, 17, 18. Do you remember kind of? No, I was kind of screwing around with it in high school and I was an athlete and, you know, so I was an athlete and running and doing all sorts of stuff. So I didn't struggle with my weight. And then I went to college and was a masterful binge drinker. And that puts weight on, which I didn't like.

So learned how to throw up my food with a sorority friend. I was like, oh, that's a interesting way to be able to do both, right? I can binge drink and have that fun and then not have to gain weight. So I got into it and really struggled with it pretty intensely for four or five, six years. And you had control. I mean, that's what I'm when I think about my like the drugs and the alcohol for me at the end were the last thing that I had control of. It's like the last thing that I actually could control. And that was I was going to hold on to that until I got sober until I died. I mean, that's kind of the way I say it. And how much of your personal, because I want to get into your work,

how much of your personal experience fuels who you are today or the work that you do? Because it's so impressive what obviously you've built. Well, it's interesting. I mean, I don't think the eating disorder I struggled with actually has anything to do with where I mean, it does in terms I understand what it feels like to be out of control. I understand what it feels like to feel really ashamed about something. I mean, it feels horrible to be engaged in that.

I mean, that's just really feels pretty awful. So I understand that. You know, I grew up in the middle of Western Kansas in the middle of nowhere. There was no treatment. And, you know, 55, 50 years ago or whatever it was, nobody understood what was happening with a couple of family members who were very close to me who, in hindsight, I now know had horrible PTSD and were struggling with substances to manage their PTSD symptoms. But nobody knew what that was.

It just looked like they had a terrible drinking problem. and just watch them be shamed and watch them, you know, be told they were bad people. It was a pretty religious community and, you know, just lots of judgment about the substance use. And so I think I've kind of, it's a little ironic that I end up being a substance use and trauma expert. I think I've spent my whole life trying to understand why they did what they did because it was actually impactful to me as a child. You know, I mean, it was scary and had all sorts of impact on me. but I always wanted to understand it because the reaction people had to it

didn't make sense to me. I mean, I think even as a little kid, I was like, why are people treating that person so meanly? Like, why are they mad at them? You know, like, I could just, I think I've always known they were suffering and I just didn't know how to describe it or put words to it.

And that's what I do all day now. I mean, I'm guilty of. I'm guilty of assuming I know what's going on with whoever it might be, you know, and that's when I have to kind of check myself and say, I don't know anything. Yeah. I don't have any. But the word trauma came up there, and I feel like we're seeing that word more and more kind of in mainstream media and people are talking about their trauma. How, what's your relationship with that word? How do you define it? How do you talk about it? Because I'm just so curious. Yeah, well, I have, I mean, I'm really happy people are talking about it. I mean, I think it's like with anything that ends up in mainstream media, now people are throwing the word around in all.

sorts of ways that do it a little bit of a disservice, but I always land on the side of the fence of like, I'm just really happy people are naming it and putting words to it because I think it shows up in so many people and so many communities in such profound ways. And we just don't understand. And it contributes to substance use and a variety of other problems. So the more we name it and the more people are curious about it and want to understand it, then there's only good to come from that. But I do think people toss it around a little bit recklessly to explain. explain themselves. And I'm always like, what do you mean by that? You know, because when you ask people, it's like any of these words that people use like codependency or trauma or all these

things. I'm like, so what do you mean by that word? Like, because what the culture says and what we think it means is often very different when somebody slows down, like you said, and tells you, okay, for me it means X, Y, and Z. And that's where a discussion can start. And there's no, I mean, is it accurate to say, I'll keep it to myself, like, My trauma is my trauma, no matter how big or small it is. Like I didn't get the friend that I wanted in fifth grade or, you know, I'm a heroin addict or whatever it is, like, and everything kind of in between. Is that accurate? Because I think a lot of people kind of compare their traumas or like, oh, I'm not as good as that person or I'm not as bad as that person.

For sure. Yeah, no, this isn't me saying we need to take that word away from some and give it to others. For sure. No, that's why I'm saying, like slow down and say, like, what do you mean by that? What are you trying to tell me by labeling this experience of trauma? I do think people who, I mean, my experience is people who have massive trauma are the ones who typically compare themselves. And they're often saying, I'm not as bad as this other person.

And they're not actually able to acknowledge how deeply they're wounded. They're like, ah, you know, my friend, this or X, Y, and Z happened. And we're like, but this happened to you. And that's significant and painful. and you can see how it's tracking through your life and they want to get away from the fact that their trauma or don't want to call it that. So it is an interesting way that people,

some really profoundly traumatized people are like, no, that's not me. And what do you do? Like when that person shows up, what are you? I'm fascinated by how you break through that first level of... Slowly at their pace. I mean, I think that's part of addiction treatment and how we talk about it in the press

and how we are in the world with it. and like everybody wants the sound bite. Everybody wants to be able to say it's this or it's that. They want to be quick about it when it's like, no, you got to slow down and talk to the person who's in front of you and understand them because they're very different than the person next to them and the person next to them. Same with families. Like trying to help a family, they're very different than the one next to them.

So we actually have to really figure out how to do individualized, meet people where they are, help them understand themselves. And that's a slow process. and the problem is you map that onto addiction, which is causing crisis and really wrecking people's lives. They want to move fast. They want a fast solution. They want a fast, fast answer. And it's like, if I could give that to you, I would. We actually need to slow down and understand why you're doing what you're doing. What do we need to do to support you? What got you here? So you understand yourself better and start from there. And that's, it's just hard. Right. You know, we always,

And then I want to get into the families, but we always talk about that here, or at least I do. And my thank yous, my, I love you, Zach, or you save my, you know, the stuff that we hear that you save my life never comes in a month. Never comes in six months. It's two years down the road. And you get the text or the note or the, hey, I'm thinking about you. And then that's when you really acknowledge yourself for doing for doing this work and showing up. Because even for us, I think it's hard to hang in there sometimes. Yeah, and I don't know about you, but sometimes I don't get those thank you notes.

They might have stopped seeing us or stopped working with us, and it pops up two years later, and they'll say, I wasn't ready for what you were telling me at the time, or I wasn't up for it. I couldn't make those changes, and I wasn't ready. Your kindness, the way you approached it, stayed with me. I continued to make changes. Thanks for starting me on my path, right? So even when you're working with somebody, you may not know that you're helping them, because they're so in the throes of it.

And then how you treat them actually really shows up later, which is really. So for people listening, I probably am underselling Carrie and her work. She, so you have the Center for Motivation and Change in the Berkshires, which is a 14-bed residential treatment. You have your group practice.

Outpatient. Here in New York, the Center for Motivation and Change. And then a beautiful nonprofit that is helping family and the tagline, I think, is the intersection of science and kindness. Did I get that right? You did. Can you talk about that?

Yeah, well, we just celebrated 20 years for the outpatient. And really, like 20 years ago were, and you know this. I mean, the substance use treatment world was very abstinence only, 12-step focused. You know, it was one, this is the one way to get better. And 20 years ago, there was, so there was treatment. And then there was what was happening in research. And there were all these, like, really effective strategies for helping people. And they weren't getting into the treatment world.

So we really wanted to kind of prove you can provide high quality treatment. You can treat people at all stages of change, right? You don't have to start with, because, I mean, I joke around sometimes, but we really, we got most of our clients because they were being rejected from other treatment programs. They would seek help from other treatment programs. and they would say, I'm really ready to stop drinking, but I don't know if I want to stop smoking pot or I really want to stop doing cocaine, but I'm not sure about this. And other treatment programs would say, you have to be abstinent to be with us if you want

to do something else, go to CMC, which, you know, I'm like, okay, great. You know, so because our platform was and motivational interviewing, which was one of our foundational approaches, is really about helping people identify their internal reasons for change and using the therapeutic relationship to turn that on and to amplify it and be able to really be like, we're going to find why you want to change. It's not about what I want for you. It's about what you want for yourself and how to get you there. And there's all sorts of strategies to kind elicit that motivation and work with it. So that requires that you're comfortable meeting people where they are, which they might not want to change so much. But you can still have a conversation with

them and so much can happen in that relationship that eventually gets them to making more significant changes. And so that's part of it, you know, that we started doing 20 years ago and then added really became more aware of like the importance of treating addiction, I mean, treating trauma. And then the thing for families is also just like, so we've just wanted to, we've been like, there are evidence-based ways to help people. There's not one way. We need to give people multiple options. And then the families are in a whole different bucket in terms of like what they get told and it's still pretty black and white for them. You know, most traditional treatment programs are still telling them to have the disease of codependency and all these kind of things that get

thrown around for families of tough love, you know, distancing yourself with love, letting your loved one bottom out. Like these phrases that get, again, tossed around are massively impactful for family members and for the most part make them feel really bad. and do them a disservice. So about 10 years ago, we started working towards developing an approach for family members so that they could be helpful

and be effective in helping their loved one change. Yeah. The language for me has probably been one of my biggest pivots, I think. You know, I use a lot of my own experience and then the experience

of the men and women we work with and I know anytime it's you have to or you can't or don't do this, what's going to happen? Like, I'm going to go do that because I'm rebellious and I want to take, like, don't go on a date. Well, I'm going to go on a date and then I'm going to lie about it. And then it's going to start this cycle of dishonesty that I'm trying to avoid.

What would it sound like to have a conversation like, hey, you can go on this date. And I really hope that you can be present and then we can talk about it afterwards and see what felt good and what didn't. Right. You know, it's like, and that little pivot for me has changed the way that I think I see a lot. of this stuff. And it's trial by error, right? Like I've told plenty of people, you have to go to a meeting or you have to see a therapist. And it's like, you're not going to tell me what to do. Right. Yeah. Yes, I'm glad you've made that change. And I'm sure it's much less stressful for you to be able to help people. But that, again, I think it's just coming out of fear, right?

Like we want to tell people what to do because we're scared about what they're doing. You know, they're harming themselves. They're wrecking the family finances. Like, it's completely understandable that we want to, like, shake him and say, stop doing what you're doing. You're hurting me. You're hurting yourself. Please stop. But what we know by lots of research is that those strategies actually just don't work. I mean, it's really fascinating.

There's so much confrontation with such a big piece of addiction treatment historically. And family members really, I think, fall in that trap of feeling like I need to confront and I need to get them to accept that they're an addict or all these things that they've kind of soaked up from the culture. and there's not a single study that has ever shown that confrontation is an effective strategy. It actually just doesn't work. It causes people to get rebellious. It causes people to go underground. It causes people to lie. There's a study done years ago that actually a single confrontational episode session with a therapist predicts relapse down the road.

So it's actually like we got to kind of wonder, why are we thinking that's what we need to do with people with substance use problems? Because it just, but I think we want to punish. We're in a culture that wants to lock people up and punish them, and we don't want to actually acknowledge the degree of mental health problems we have in this country. We don't want to acknowledge the trauma that leads to those mental health problems. So I think we've got a pretty significant issue on our hands in terms of... Well, the families, I mean, I just even think about, you know, the parents of a 14-year-old that are told, your only option is to kidnap your child in the middle of the night and throw them into a

wilderness program or a therapeutic environment. and we see those folks 10 years later. Right. And the trauma and disdain they have for their parents and the inability to kind of move forward with any type of healthy relationship, it's heartbreaking. And the truth is, like, those parents were taking advantage of. I believe, like, in that moment.

Yeah, and again, I'm always going to be, like, respectful of people's journey because I think any parent who's gotten themselves to the place that that's what they're doing, they've been trying really hard, you know, they don't have the skills that they need. Because what parent, I say to parents all the time, like, I went to college for this. I got training in how to do this. You didn't. Why would you expect yourself to have the right way to cope with this, you know?

But being open to learning new skills, that's a really big piece of this because how to talk to your loved one, what do you want to reinforce, what limits do you want to set? Like those are all things that are probably going to be new to you. So can you be open to learning some new things instead of just thinking you're kid is the problem. It's usually a, we've got to help the whole system here, but people who get to that point where they're kidnapping the kid in the middle of the night, they're freaking frightened and doing what somebody has told them to do. And they've not probably along the way been coached to do a variety of other things that could have mitigated that problem. So that's what

we're trying to do with the foundation is help families and friends, frankly, and siblings and anybody who cares about somebody with a substance problem, realize that there's a bunch of strategies that you can, first, it's like how you understand the problem really matters, because if you're understanding the problem from the lens of, this is a bad person who doesn't care, who's got a moral issue, who is lazy, or, you know, all these other labels that we put on people who are using substances, if that's how you understand the problem, you know, or it's an addiction that they can't do anything about, right? You know, this powerless idea. Like, you're going to approach the problem in a particular way, right?

But if you understand the problem is like, oh, that substance works for them in some way, like they're getting something out of it. And if I understand what that is, maybe I can like think about other ways to help them get that, especially for parents and teenagers. It's like, okay, your kids smoking pot, be curious about why. Ask them what they get out of it. Have a conversation with them about it. Maybe they're anxious.

Maybe they're overwhelmed in their social situation. Maybe they don't actually know how to busy themselves. They're bored. you know, maybe it's peer pressure. It could be a hundred different things that you could help them with. But if you just label them as a bad kid who's just messing with you and just trying to do the opposite of what you want, you're going to approach your kid in a way that is probably going to create conflict instead of how do we solve this problem together. I don't want you smoking pot. It's against the family values. It's not good for your brain. I understand you're doing it for X, Y, and Z

reason, which lowers defensiveness, right? You want to lower defensiveness and get the person talking to you. One of the things I say to people all the time is like, I can make you defensive in a nanosecond depending on how I talk to you, the tone of voice, the question I ask you, or I can create a space where you're going to want to tell me more. And then I can go do stuff with that information that could potentially be really helpful. Yeah, I mean, it's fascinating. And I want to really dig in on the family piece here because I feel like they're the ones that are being left behind in a certain way. Or they're sure the ones without. you know, I even think about all, you know, I go to treatment, my friend goes to treatment,

the family's left at home kind of like if the treatment center, wherever they end up is not doing a good job with the family, they're not going to change. And then that person comes home. Right. And it's a coin flip, right? And that's, we want to avoid that. And it's interesting because I have this social media thing, this platform. And I put stuff out there to kind of test the waters and see what people are interested in. And I did something around families, I don't know, like a month ago. And it was incredible to see how many times that post was shared and commented

and then the messages that came in. And what that told me is that we have a lot of work to do around providing the education and the tools to the family members because they just, they're in the same groundhogs day that I was in, right? Like they wake up and they don't know what to do. And then they're, so can we talk about, where you start, like for the family member that is listening and they're thinking about their brother or their mom or their cousin or their friend, where do you even start?

I mean, where are you, what do you, what do you tell that person or I don't know if I'm asking it in the right way, but. Yeah, well, I will say things can get better for you and your loved one, but you're going to probably have to learn some things that you hadn't anticipated, both about your loved one and about yourself in order to be an effective helper. So one of the things that we did with the Foundation for Change, so it's CMC Foundation for Change, that's a nonprofit, is the mission of it is to get these evidence-based ideas out and into the hands of family members because, like you said, like they're really out there not getting

that much support, and when they do get support, it's pretty, it's mixed in terms of how effective it is. And addiction and mental health issues are stigmatized problems. Addiction in particular is an incredibly stigmatized problem. You know, people think bad things about people who have have substance use problems, right? They think bad things about their families too. There's a lot of studies that, you know, family members feel embarrassed about their loved one. Parents think it must be my fault, you know, my kid's struggling. I must have been a bad parent, you know, and this is typically all sorts of internalized stigma, but then they're actually are blamed for the problem. They're told, yeah, you're too lax, you're too strict, you're all these things, right? So they just go underground too

instead of feeling like, oh, wow, I got a, I'm concerned and I need to figure something out, right? And then they don't talk about it. So they're isolated. So that's also terrible. So we started with craft. So community reinforcement and family training was one of these evidence-based. Yes, you were one of the first. I mean, first in terms of when we were doing the training.

But so Bob Myers was this awesome, just awesome saying, like, we need to be training parents, right? So he developed this approach, community reinforcement, family training. It wins the horse race. So when they were doing randomized clinical trials with Kraft compared to interventions compared to Al-Anon, you know, craft gets your loved one into treatment. So Al-Anon, for those that are listening, is like the 12 SOx, the 12, like the AA for the family member, right? That's the easiest way to say that. Yeah.

And it's an unbelievably supportive place for family members. Most family members want their loved one to change and they want their loved one to get into treatment. Al-Anon is a self-help support group for family members, right, so that you're not alone in this journey. A lot of advice gets given in those meetings of which some is not so helpful, but it's not designed to get people into treatment, right? So in the clinical trials, like the people who got assigned to the Al-Anon, the family members who got assigned to the Al-Anon, like less than 5% of their loved ones intertreatment. Then you have the interventionist who, you know, interventionists are always like, 100% of my people get better, you know, or I get, 90% of people into treatment, they quote these massive numbers. They don't tell you how many family members drop out and don't do the intervention because they're like, I don't actually want to

do that to my loved one. They don't tell you how many people land in treatment pissed that their family did an intervention and they're mad the whole time in their treatment. And then when they get out, they're afraid from their family because their family did an intervention. Even though it might have been a life-saving thing, it just causes conflict. Interventionists tend to not disclose that part of the experience. But interventions got people into treatment, you know, like 40% of time. And then Kraft got people into treatment like 60 to 80% of the time, which that's a big difference. And then what they also found is with Kraft, when the person entered treatment, their substance use was already down. And the mental health of the families was already

up. So we're like, why is nobody talking about craft? We trained people in it for years. And then we wrote the book Beyond Addiction, How Science and Kindness Help People Change. That was our attempt to kind of get it out in the world. We were like, please family members, you learn this approach. It's going to be helpful. And there just wasn't a ton of uptake in the last, I don't know, probably five years. I feel like states and lots of, you know, federally funded places are actually mandating that treatment providers use craft, which is awesome. We were out in the world training family members and craft. And one of the things that we realized is that it was just missing some elements that family members really struggled with because it was actually very hard

to teach family members craft skills if they kind of had this old, stigmatized understanding of addiction because craft is all about positive reinforcement and connection. And if I'm walking around thinking my loved one's a bad person using drugs, they need to be punished or I need to cut myself off or all these things that are typically walking around in family members' heads, it's hard for them to do craft. So we developed something that we call the invitation to change approach, which is basically all of craft, but with this preamble of, like, how you understand the problem. So, you know, the first part of it is like behaviors make sense, like, really, like, what's your loved one getting out of that substance? Because whatever they're getting it out of it,

that matters because you're ultimately going to be asking them to give it up, right? So respecting that you're asking them to give something up that is working for them in some way. What do they get from it? Because then you can take that information and then, like I said, think about the environment, think about how they might be able to learn strategies to replace the drug. We help them understand ambivalence is totally normal. I mean, all of us have ambivalence. We want to go to the gym.

We don't want to go to gym. We want to be on a diet. We don't want to be on a diet. When we say ambivalence in a substance user, we don't like it. We want them to stop. And we are like, nope, you can't be ambivalent. I'm going to kick you out of the house if you're ambivalent. We want to get really rigid with people's ambivalence when it comes to substance use.

Again, because it scares us. It's scary. So we help them understand ambivalence and actually how to work with it because, again, how you respond to it can cause somebody to dig in or you can respond to it in a way that causes them to be like, okay, yeah, let me, let me go back to what I was doing, right? So we teach family members how to actually work with somebody's ambivalence. What you mentioned before, the one size doesn't fit all. Like really, maybe your loved one's going to go to meetings. Maybe they're going to talk to their rabbi. Maybe they're going to get a job.

There's so many different ways. And it's okay. Yeah. There's so many ways people change. Most people don't seek treatment. Most people who meet criteria for a substance use disorder never go to treatment. And their disorder goes off, you know, they don't meet criteria at some point because they do other things in their life. You know, those people are just not as vocal. Do you think that stat is more based around lack of resource, like insurance or cash? Or do you think that's because? No, there's something called natural recovery, you know, where like people just naturally recover.

But again, like if I'm somebody who's had a serious problem of some sort, you know, and my husband wouldn't mind me saying this, you know, like there's a lot of people who like are like, yeah, I had a terrible cocaine problem in the 80s. And I just stopped using cocaine. Like I just, my job, my family, like, you know, whatever. Like, you know, but they met criteria. And like, I'll say that about my drinking. I met criteria for an alcohol use disorder as a 20 year old.

Once I got into school and once I got busy and once I had other things that captured my attention and was in therapy for my eating disorder, I don't struggle with my alcohol use. I drink socially occasionally and it's not a thing, you know, but I met criteria at one point, right? So we get locked in this idea of like if you have an addiction, then you're always going to have an, you know, you've got to approach it a certain way. And I think that's just worth being curious about. And it's okay for me like to believe that I can't safely drink and do drugs. represent. I mean, like, that's, I think that's where a lot of my growth has come. Like, it's okay for me to have that thought, but it's also okay to allow someone to be ambivalent and have their process. Yeah. And that person who's in their journey struggling with whatever it is,

like, you don't know where they're going to end up. You don't know, I say to people all the time, I don't know what's going to work for you. My job is to help you, like, keep assessing is what you're doing working for you. What might work better? What skills do you need? to learn and that's the other big piece of the invitation to change approach is like there's a whole component of it of um we call it understanding with self-awareness because it's like understanding your values like why do you want to change like what do you care about you know and this is for the person with the problem and the person and the family member like why are you want to help you know like why are you doing this difficult thing um you know so what do you care about

how are you doing right so are you on your last nerve are you so anxiety ridden you can't use any of the communication skills because you're having a panic attack, all right, we need to slow down and help you with panic attack. And then we'll help you learn those communication skills. So we help family members with the helping with, you know, understanding yourself better as a helper, then how do you, like what are the strategies you need to learn that will help you make changes, you know, and that's like the communication and behavioral strategies. But the biggest piece of it is like this idea of practice. Like you actually have to practice these strategies. And so going to your point of like, you came to the point where you're like, I can't ever use

those things again, right? It took you a lot of time to get there, right? You tried lots of different things. So you practiced getting yourself to the point where you know you can't do it. And now that's a well learned. It's a well learned thing, right? You know that deeply. So we have to give people time to practice getting to what they know about themselves, right?

Like I know to this day, whatever, 20 years ago, I can't have. snacky stuff in my house. Because if I'm in a, if I've had a bad day at work, I haven't eaten so well or taken care of myself. I know you call me. I want to send you cookies to your office. You're like, Zach. It's actually just not good for me, you know, but like it's not particularly rigid. It's not like I'm like I'm like, but I'm like, but I just know what I shouldn't have around. And again, that's practiced for me, right? So we just need to give people the time to get to the point where they understand themselves and understand what they need. And I say all the time, like somebody like yourself, sobriety is a learned behavior.

You learned to be sober over lots of years, right? You didn't just decide to be sober. You learned to be sober. And we don't give people the time to learn and that, you know, or kind of appreciate that that's what's happening for them. When they make slips or they fall off course, there's learning to be had there. But if we punish them, if we scold them, if we make them feel like a piece of garbage, because they slipped, that's going to shut their learning process down.

If you approach it with like, oh, wow, what happened? Did your goals change? Did you experience something you underestimated? What's happening for you? Then you can have a conversation and potentially be helpful to the person. So it's just, again, it's how you approach the problem. I'm very curious about something. The people that show, so when I look at the work we do it,

release and the way that our family show up, it is predominantly mom and sister, not husband, brother. And so I'm just, it's something that fascinates me. And I know we've talked a little bit about it in the past. I just, who is showing up to these trainings and what's up with the men? You're the dude here. You should tell me. Well, I try.

I mean, like, you know, I try. And, like, I try to make these conversations more comfortable. for my friends and the people like the men in my life but I don't I don't feel like there's been much traction yeah and I'm joking around with you it's actually quite painful the our trainings do predominantly still I mean it's it's shifting a little bit but they almost the craft studies I was referencing almost all women you know it's mothers who show up and when you look at these kind of support groups so for our foundation that we have all these free support groups started by family members who have learned the invitation to change approach and then you can come

to a support group led by them. They're almost all moms, like, who are just fired up and are like, I've lost my kid or my kid, you know, like. So you have moms showing up that, like they've lost her loved one. Oh, yeah. Yeah. Yeah. And they want to give back because they have learned a lot and want to help other parents not go through what they went through. So, so yeah, it's mostly moms. And I, you know, I think it's just a whole host of issues related to kind of men acknowledging how vulnerable they feel. You know, a lot of the dads that I work with, and this is completely stereotypical, but stereotypes hold to some extent. It's very hard to ask for help. You know, you're supposed to have the problem figured out. You know, it's the dads I work with. It's so hard

for them to not want to just fix the problem, you know, to try to slow them down and like understand the emotional underpinnings of it or what's going to. on or just acknowledge how vulnerable they feel. It's just painful. It's painful. Um, you know, and it comes down to time. It comes down to availability. You know, if you're a household where dad's a provider and working, it may be that mom's the only one that has time to show up or vice or, you know, I mean, it's just like, so it's a time commitment to, to try to help your kid. But I do think men actually struggle with some of the vulnerability involved. Because it's just not a linear process. I mean, part of the other thing that's in the invitation of change approach

is this whole idea of self-compassion because being a helper is so freaking painful. And you and I've talked about this sometimes. Like, it's hard to help people. It's hard to help people who are doing dangerous things. You have to be able to tolerate your own fear. It's hard to help people who don't want to be helped in that moment. And you're like, I can really help you and you're not letting me, right? That's just hard to sit with. We get all sorts of training and support for family members don't. And it's their kid who might die. Right. So that's incredibly scary. So introducing this idea of being compassionate towards yourself of like really knowing like this is painful to try to be a helper. It's not going to go well at times. It may not have the outcome that

you want. So can you go on this journey as a helper with all your vulnerability? Right. Which is hard for men. Yeah. I think so. Yeah, I mean, would it make sense to do, like, do you think men are better working with just men? Like, is there an element of, if these trainings, if we did adjust. Let's do it. Let's do an all men's training. Try it? Yeah.

Yeah. Yeah. That might be interesting. The cycle of this thing is always crazy to me because you start working with these families. And a lot of times we get them prior to treatment and we try to help them. work their way into wherever they're going. And then, you know, they come back. And then six months later, their loved one is doing okay. But then it comes, they have to get a job. They're not making money. They're not supporting themselves. Like then this like the secondary kind of

things start to rear their heads. And I think, again, that's probably where these trainings come into play. Like being okay with them being where they are. Is that? Well, but being okay with a learning process. So yeah, trainings help people do that, being in a support group where you've got another parent who says, yeah, you want them to have a job, but don't forget they're doing X, Y, and Z as well, right? And I'm just going to go back to my broken record point, which is all of this is learned behavior and learning takes time. You know, like if your love, if your kid is learning a Chopin etude, you don't start them there, right? You start them with easy piano instruction. They practice. They have their early piano teacher. They learn pieces. They practice them.

They memorize them. They maybe get another teacher. You know, they're going to screw up stuff along the way and have to relearn a piece. You don't get mad at that. And you give them time to do it, maybe years to do it, right? So like if somebody starts playing the piano when they're 10, you wouldn't expect them to play the Chopinetude when they're 15, maybe when they're 23, right? So we give people long runways to do stuff. When it comes to behavior change, we don't really respect the learning that's happening. So yeah, maybe your loved one needs a job, but maybe it's actually really hard for them to stay sober. So they're learning how to tolerate a panic attack. They're learning how to be social for the first time without having substances

like kind of massaging the whole experience for them, right? So you just don't underestimate that stuff that might look easy when somebody's trying to do it without their substance of choice. That's hard. It's hard. So they're learning something. So you got to give them that and then add the next thing and add the next thing and add the next thing. And that's just the pace is hard for people sometimes. Yeah, I mean, like, I guess I'm thinking about my first conversation with a family that's coming to us. Is it, because I'm really trying to be helpful to the listener here.

Like, like, what is, because I get all these messages and they come in and it's, I don't have a stock response because I like, what's going on? Like, I need a little bit more information. And it's almost like saying to them something along the lines of, hey, look, I know you're not probably feeling great right now and I know this probably feels really chaotic but we are at the very beginning of a learning cycle here or however you would however you would frame it and this is going to take time so like level setting and giving them the understanding that they don't need to feel guilt shame remorse they didn't do anything wrong we assume that they've done the best

that they possibly can and they're finally like calling and reaching out for help and I take a lot a, I take a lot of responsibility. Like I get very, like when I, when someone reaches to us, I feel this, this weight. And I'm working on that. We talked about it. But letting him know, it's probably not going to be a day or a week or even a, you know, like it's going to take real time to. Yeah. I have freaked a lot of parents out, you know, like when I've said to them, your kid's going to relapse. They will return to substance use. That is what's going to happen. I don't, I'm not saying that because I'm pessimistic. I'm not saying that because I don't think they're trying. I'm saying that's part of the learning process. How you respond to that matters a lot.

So that's what we need to think about is like how do you, how can you start to respond to your loved one in a different way so that you can keep the change process going. You can keep the family healing going and you can give them the time they need to learn stuff and the encouragement that they need to learn stuff. And and there's no reason why you would know how to do this stuff. there's no reason. Our culture talks about it in a particular way. Our culture like jams our heads full of all sorts of quick fixes, you know, and stigma, right, about how bad this problem is to have. So we got to get all that stuff squared away so that you understand the problem from a behavioral perspective so that you can then slow down and be helpful to yourself and to your

loved one. So we keep coming back to this like, we actually have to slow down here. And it's the opposite of what people want, which is completely understandable because it's scary and maddening this problem. So to speak to the emotions and be able to say it's, it's terrifying. And I understand how fast you want to move here. We're going to go banging into walls if we move too fast. We actually just need to give us, give ourselves some space. And there'll be times when I take phone calls and I'm like, actually we do need an intervention because I actually really am, I'm really scared for you or a loved one. Let's, let's do it this way. There's a time, of course, you know, so that goes back to the one size doesn't fit all. Like, I think if people

embrace the idea, I always used to say if like, you know, middle school parents would learn these strategies, like when stuff started to pop up, like they'd be able to deal with it effectively and maybe we could reduce substance use problems in general, right? But that hasn't happened yet. I think it should be required reading for middle school. Yeah, I mean, I have some of thoughts on what you just like, one, I think relapse. I mean, I don't know how you. you feel about that word. I don't. The second I came out of my mouth, I'm like, I don't use that word anymore, but it's just

habit. Well, I mean, like, I feel like it keeps people high. I like, however you want to say it, like, because they, they discount or discredit the work that they did to get to that point. And so in their mind, they, the whole idea of sober time is flushed down the toilet. And for me, it's like, no, man, like that, that doesn't go away. Like, you did a lot of really good work in that time. And yeah, let's, and we just had a family that, you know, it's one of these cases.

that you kind of hang in with for years and years. And they've done their own work and there was just a return to use or however you wanna call it. And, you know, the kid asked for help and they said, I'm really proud of you. Yeah, yeah, that's awesome. Great job, you know?

Like, and like that was a totally different response than four years ago. Yeah, and I'm gonna practice what I preach here in terms of using some compassion for myself for even using that word. I mean, I'm like the word police. I'm like, you know, and just speaking to like, this is like deeply,

this is how people talk about stuff, like for decades. So it's, it's in all of us, you know, and we're just like to stay vigilant. I appreciate you noting that I use that word because had you used it, I would have said, Zach, I don't really use that word anymore. But, you know, so I mean, I think just being compassionate in like we all have stuff to learn. We all fall into these like little, I don't know what you want to call them little ditches of like old stuff. I just got to get back out. I mean like I think about some of my experience with you and working with your programs and some of the lessons I've learned I mean I it's a business right like we can acknowledge that and we do this because we have lives to live and I remember you know five six years ago whenever it might have been the timings might be off but you know in our world we make referrals right so you go and you call the treatment center you say I have this family or this person they're ready to go and I remember talking to someone on your admissions line saying like well we don't

don't do admits on the weekends we don't rush people in like there's a process here i was like what do you mean you know like it's this guy that's just like let's get people in let's get people in and it changed my perspective because whoever it was maybe patty or whoever i was talking to on the front end was kind of just like it's going to be okay if we need to have our process and if it's meant to happen it will and it was just it was it meant so much to me like set aside that like you're not like money hungry grabbing whatever like that's we all need to keep our doors open but it just showed me that it really was patient and family focused and centered and you were committed to your to your process which I think in this world that we operate in we know there's a lot of

bad actors and folks that are probably doing more harm than good so yeah and again if somebody needs to go that day they probably need to go to detox right like there's a medical It needs to be sorted out, probably. So it's just, we're just going to keep saying it, slowing down to kind of consider your options. And, you know, we have these videos that we made for the foundation to kind of help people, help family members understand what happens. And one of the little videos about one size fits all is, you know, like a little video of a mom and a kid with a kid's got two biggest shoes and she's calling complaining to the shoe company

about like the shoe doesn't fit. The shoe company is like pressuring her to accept the shoe. And it's kind of like a funny little ditty. And at the end of it, we then switch to a dad calling a rehab about his son who, you know, doesn't, like is saying, he really wants to work on his trauma and doesn't really, you know, it's just like what a normal family experiences. And the rehab is pressuring the dad. Well, if your son doesn't want to do it this way, he's not really serious about recovery and blah,

blah, blah, blah, blah. And so just trying to draw note to how people talk to you about this and just noticing how does it make you feel? You know, if you're talking to a treatment provider or you're talking to somebody who is trying to box you into one size fits all and isn't really listening to you about your loved one or your family, your financial limits, your family history, the generational trauma, your community, whatever it is. If they're not really listening to you and taking that seriously, it's probably worth trying the next person. If somebody's making you feel bad, there's literally no need for that. Right.

Okay, I have two more questions. First, I get a lot of, so the word boundary, right? Like, that's another one of these words that is just in our world. And there's a lot of folks that will say, I have to kick my son or daughter out, put them on the street. or I can't keep funding. Is there ever a time in place where you say, okay, it's time to ask your loved one to leave the home?

Oh, of course. And then how do you do that, I guess is like the home. Well, but that's just it, how it's done, you know, how you get yourself there, what's communicated along the way. You know, a lot of upset parents when you're kind of on your last nerve, you'll be like, if you do this, I'm kicking you out. I'll be like, okay, so if you're going to say that, you really need, you need to be prepared to do that.

That means like changing the lock on the door, whatever. And most family members are just upset and they're saying the thing that they think is going to cause them to be taken seriously. You know, so we just try to get them to realize like, okay, you may end up there. You may decide this is too destructive for our family to have you living here. But we want to get there in a different process. We want to have you feel differently when you get there. Have your loved one actually understand they might have had a bunch of options before getting to that point. And then you're not closing the door. I mean, because I think that's the, you're saying to them, you know, it's clear to me you're not ready to do this. It's too dangerous what you're doing

to have this happen in our house. So we're doing this now. I love you. I will support you. Being in treatment, I'll support you in whatever way you decide works for you. But you're never like having that belief that you have to cut someone off. The foundation has a podcast called Rethinking Rock Bottom and one of the really showcases families talking about. parents, most of them are parents talking about their journey and trying to help a loved one. And one of the mothers was talking about her daughter. And she had a lot of the tough love, kick you out, kind of messaging, you know, had struggled, but kind of got to that place and had been estranged from her daughter, learned the invitation to change approach, got back

in touch with her daughter, they were reconnected, and for about eight months were in contact. her daughter was still struggling with substance use. Her daughter ultimately died from an overdose. But, and Becky talks about, like, how being connected and having her daughter know that she was loved, even though she was really struggling with her substance use, dramatically changed her grief process. You know, that's the other thing that we're doing with the foundation is we're starting a whole grief support group for family members who've lost loved ones, you know, because it's a particular it's called disenfranchised grief because it's like it's grief that is typically not spoken about um you know because it's attached to substance use and all those

stigmas that we were talking about so um you know just i think finding ways to be connected even though you're setting a boundary are very powerful um and and necessary because it's ultimately our connections um that help us decide to change um you know whether that's a kind of with somebody like yourself or a connection with a family member or a friend, that's what moves us along. So cutting people off is, is we humans need contact. Yeah. Somebody go out there with this last one a little bit because I do feel like in our world, behavioral health care, there's a lot of competition naturally. And I guess what I would want to ask you is if you had a magic wand and you could do one thing to kind of bring

bring us closer together in this work that we do because I feel like there's just so many opinions and so many viewpoint what would that be like how would you solve some of the issues that we see in the behavioral health care field I mean like and I also think about like you know good treatment costs money your good treatment requires really good insurance and do you see a future where like we're kind of because you go to one of our conferences right and there's there's 75 brands there like what other world do you see that in and they're all they all have their own thing you know so I guess like

do you see a world someday where we're kind of closer together or able to that's a that's a whole line of questioning about an industry that is in my mind problematic for sure. Going back to treatment is expensive. I mean, I think actually our government needs to fund treatment more extensive. We actually need to honor that we could be preventing substance use problems if we helped kids who were in abusive homes, if we helped substance users so that they, with parenting and like this the pile up of trauma, which is generationally, I mean, there is a reason why substance use is increasing in this country. Our schools are not funded well, parents paid time off. I mean, there's just so many ways that families are suffering and that is directly

showing up in how we're self-medicating, right? So we actually need, it's, for me, it's not the addiction treatment industry so much as we actually as a country and as a community need to be talking about why are people needing to self-medicate what is wrong like they're self-medicating and we need to be honest about that and talk about what's happening in our culture more than anything i think well i'd like to see you be the person to lead that charge yeah as you're not already so busy um so we covered a lot uh obviously i want to make sure that people are able to find Carrie and the work that she does, how do people find you? I mean, I don't want you giving your contact information out, but obviously, like, you have a website and we will get that

out to the masses. Yeah, I mean, I think the, you're doing with the foundation, I think, is really going to touch our listeners and hopefully we'll make sure that that's accessible. Well, and I think that's how we change the industry. Actually, going back to your question about the industry. I think educating consumers, so your listeners, being able to know the resources, being able to learn, you know, things like the invitation to change approach, being able to challenge stigma and how people talk about addiction. Like, that's how, that's how things change. You know, people becoming educated enough to say, you're boxing me in and giving me one option. I don't want that for my loved one. And moving on, right? So just trying to, it's awesome what

you're doing in terms of trying to give people information that just changes their perception about all of this. I just want to say thank you for that. I think for your listeners, CMFFC.org is the nonprofit. That's probably the most important place to go because there's all sorts of free resources there. We're building it as a platform that hopefully over the next couple years there will be more and more free resources, whether it's educational videos, reading. We have a workbook called the Beyond Addiction Workbook for Friends and Family. It's got lots of user-friendly ways. to kind of just think about what's happening in your house in a completely different way.

And then on there, there's a resources page. And there's all these free support groups of started by parents and mostly mothers who've learned the invitation to change approach and are offering that in their community. And they're lovely. I mean, they're just such nice. And that's the other thing that I say to people all the time.

There's never going to be enough treatment providers to address this problem. We have to get late people to understand the problem in a different way and feel like they can have an impact. So we're hoping that, first, responders, teachers, you know, faith-based leaders can learn the invitation to change approach because a coach, a high school coach, if they were able to respond in an effective way, that could change the course of a kid's life. You know, faith-based leaders, a lot of people

will never go to treatment. They're going to talk to their rabbi. They're going to talk to their priests. They're going to talk to their pastor. If those people had like ways to respond that were effective, again, we could be really changing entire community. So I'm just, I'm trying to get out of the treatment world, actually, and into the hands of lay people. Yeah, yes, yes, let's do it. That's empower a whole bunch of people. Yeah. Yeah.

Well, I'm inspired. I'm fired up. I have a weird feeling that we will probably be having more of these conversations, but I want you to know here that I'm just grateful for you and all the work that you've done to help me and just so many other people. Well, thank you. And thanks for this platform. Thank you.

Thanks, Carrie. Bye.