Their addiction treatment isn’t working–now what? A family’s guide to harm reduction (with Dr. Sheila Vakharia)
About the episode
Drug tests. Revolving doors of rehab. Judges and parole officers deciding what "recovery" looks like.
Maybe you've watched your loved one go on methadone or Suboxone and wondered if they're really in recovery, or just trading one drug for another. Maybe you've sat through a drug court hearing, or waited on a call from a parole officer, wondering why the system keeps deciding what "getting better" looks like for someone else's life.
When treatment is dictated by courts and external forces instead of the person who needs it, why doesn't it work and what does it look like when it does?
If the skepticism, the confusion, the exhaustion feels too familiar, this episode is for you.
Guest: Dr. Sheila Vakharia, MSW, Deputy Director of the Department of Research and Academic Engagement at the Drug Policy Alliance and author of The Harm Reduction Gap
Dr. Vakharia is a national expert on harm reduction and drug policy. Her path — from an abstinence-only outpatient counselor to a syringe service program provider to a PhD in Social Welfare — was shaped by seeing firsthand how one-size-fits-all treatment fails the people who need care most. Today she bridges research and policy, frequently cited by outlets like NPR, The New York Times, and TIME, and has helped shape drug policy conversations from local drug courts to the United Nations.
This episode will help you
Realize why addiction is the only health condition where people are expected to be "cured" before treatment starts
Understand the stigma around methadone & buprenorphine — and why they're not "trading one drug for another"
Shift your mindset on how the criminal legal system can be both a lifeline and a barrier to real care
Learn courts, insurance gaps, and fear-based messaging keep failing families
See what families can actually do — from pharmacy advocacy to sharing your story with lawmakers
Episode links
Dr. Sheila Vakharia’s book, The Harm Reduction Gap
More from the Drug Policy Alliance (DPA)
Resources
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[00:00:00] Dominique: When we talk about cancer treatment, if the chemo doesn't work, we don't say, "Oh, you didn't try hard enough," or, we didn't say,
[00:00:06] Dominique: That's the only option. We do that when it comes to substance use disorder, and that's what's really frustrating when families are desperate.
[00:00:15]
[00:00:21] Dominique: Welcome to FLOR for Love of Recovery, where I'm your host, Dominique Dajer. Sibling relationships can be so unique, but they can become more complex when there's drug or alcohol use involved. If you find yourself questioning how to help, you're not alone.
[00:00:33] Dominique: Join me on this journey in restoring hope and healing.
[00:00:36]
[00:00:41] Dominique: If a loved one is cycling through treatment, they're probably asking, "Why isn't this working?" And if they are, they're not alone. So today, we have Dr.
[00:00:48] Dominique: Sheila Vakharia with us, who's a researcher, social worker, at the Drug Policy Alliance. Sheila, you've seen it all. You've worked as an outpatient counselor, you've worked at drug court and needle [00:01:00] exchange programs, so you have a very broad and diverse range of perspectives.
[00:01:04] Dominique: Now you're also the author of "The Harm Reduction Gap," which I'm super excited to unpack with you. And why exactly the system doesn't always work for families, and what it could actually look like if we had a more human-focused approach to care.
[00:01:18] Sheila: Yes, thank you
[00:01:19] Speaker 13: i'd love if you could take a second to introduce yourself and some of the experiences you've had at all these different programs.
[00:01:25] Sheila: Yeah. When I was growing up, I wanted to devote my life to helping people, but I wasn't sure exactly how so I got my master's in social work, and it just happened that my second-year internship was at an outpatient abstinence-only treatment facility.
[00:01:39] Sheila: And it was an excellent opportunity to get a sense of what does addiction treatment look like on the ground? Who are the folks who are struggling the most? What does it look like to provide treatment to these folks? How complex are the issues that these folks are actually dealing with and grappling with on a day-to-day basis?
[00:01:55] Sheila: And so while I was there as an intern, I observed a lot of sessions, and then [00:02:00] I stayed on for another year, and then I actually got to, be the intake coordinator doing assessments for folks walking the first day into treatment being like, "I think I need help." And I would go through a questionnaire with them, determine what level of care they needed, how severe their problem was, and make some recommendations for outpatient, inpatient, residential, that sort of thing.
[00:02:18] Sheila: Simultaneously, I was running aftercare groups for folks who were phasing out of our program, who'd been in groups for maybe four to six hours a day, and after several months of doing that, were coming in maybe two or four hours a week just to stay connected.
[00:02:33] Sheila: And then the other role that I had taken on that year as well was being the representative to our county drug court. So any of our participants and clients who were involved in the drug court would appear before the judge on a periodic basis, and someone from the treatment facility would be there to speak about their progress and how they did.
[00:02:50] Sheila: So after doing that for about a year full-time paid I discovered a few things. I loved working with people who use drugs. I loved working with people [00:03:00] experiencing addiction because they were a slice of every aspect of life. I was working with people in all age groups, all racial and ethnic groups, different education backgrounds, white-collar workers, blue-collar workers, low-income folks,, all genders, and all different kinds of substances.
[00:03:17] Sheila: And so for me, it was such a gratifying way to, touch a different aspect of the work than a lot of my classmates had. Some of my classmates in social work school just wanted to work with kids, or they just wanted to work in hospice, and they were very particular. And I was like, "I kinda wanna be able to work with everyone."
[00:03:33] Sheila: And I was like, "Addiction treatment will let me do that." But on the other hand, while I saw the approach working for the people it worked for, I also saw a lot of people slip through the cracks. You know, a significant portion of the folks I did intake with never made it to the aftercare groups that I was running, right?
[00:03:50] Sheila: And a lot of times that was because they had a positive drug screen and got violated on parole or probation, or even on the drug court that they were involved in, [00:04:00] which often meant that they got sent back to jail or prison or they were referred because of child welfare, and they might have lost their kids.
[00:04:06] Sheila: And so, you know, on the one hand, I saw the many ways it could help people, the approach that we were using, but I also saw that there were people who weren't. And then later on, after leaving I went ahead and get a job at a syringe service program where I was working with people who were unhoused or unstably housed many of whom were on the streets living with HIV and injecting drugs.
[00:04:25] Sheila: And so they used to come to our program, get sterile syringes, naloxone, support groups, a laundry machine, a shower, snacks, and they could come and do one-on-ones with me. And so I kind of had that different approach as well. So I feel like, you know, here I am almost, you know, 15, 20 years later, and I'm better for all of those experiences because I really got to see the gamut.
[00:04:47] Dominique: Yeah, you got to see the process from the beginning when the person is at their most vulnerable and they might be walking through a treatment center to the drug court programs, the needle exchange programs, and being, you know, on the street or being in the action, like [00:05:00] every single day. What was your mindset like when you were making those career changes?
[00:05:04] Sheila: Yeah. So the drug court representative position was folded into my existing role, so it was like one of my three responsibilities when I was doing intakes and aftercare. So it was a good way to be involved in the continuity of care for folks who were already receiving services at our facility. And it was a good opportunity to say, you know, "I've been seeing this person in group," or, you know, "I spoke with my colleague who's primary worker, and here's what we're seeing and here's we're hearing."
[00:05:30] Sheila: But what really made me leave the program was the realization that there was a misalignment with the way that we were providing treatment, and what I'd been taught in social work school was good care. So much of social work school is about supporting a client's right to self-determination, supporting their autonomy, being client-centered, fostering intrinsic motivation, following the client's lead, being involved [00:06:00] in building a trusting therapeutic alliance.
[00:06:02] Speaker 29: You know, I'm using all these terms, but, something about providing holistic client-centered care that treats the client as a collaborator and as an expert of their own experience, and as someone who, may have a lot of insights about what might work and what might not work for them, and what they need and what they wanna work towards.
[00:06:21] Sheila: And so I started feeling that disconnect because working at the outpatient program, in a lot of ways, while on the one hand in some way I was beholden to my client, was also beholden to our referral sources, to that PO who I was calling every week checking in to see how their, parolee or their probationer was doing, right?
[00:06:40] Sheila: And I use air quotes 'cause I don't use those terms myself, but these were terms that they used. Or, you know, being beholden to the child welfare system. Because they had such a good relationship with us, they would send their clients to us, you know? And don't forget, treatment programs are businesses, right?
[00:06:54] Sheila: And so I did feel that tension between Have I really created the conditions for a client to be able to [00:07:00] trust me if they know that what we talk about Could be discussed with an authority who is is the difference between life on the outside and life on the keeping custody of their kids, getting their benefits.
[00:07:13] Sheila: And I started to feel that tension, but I also started to feel the tension of the one-size-fits-all approach that we had taken to how we were delivering care, but also the only definition of treatment success as abstinence. And so I knew there had to be something else. And so part of going to the needle exchange program was wondering what could it look like to work collaboratively with someone who knows that they're struggling with their substance use, but without anyone else hanging over us, without anyone keeping tabs, anyone telling us what we ought to be doing, anyone telling them what was right for them.
[00:07:49] Sheila: What are the possibilities? And that's why I took the change.
[00:07:52] Dominique: I love that because when you're working at these other programs, they have their autonomy to make those decisions for themselves with the right level of support and [00:08:00] guidance.
[00:08:00] Dominique: I wanna talk about a topic that you brought up in your book. You start to talk about the D.A.R.E program, which was around from the '80s and the 2000s, which tons of people are familiar with. I'm sure lots of parents that are listening probably remember, and it was like so ingrained in all of us. Could you tell us like why it was working and why it didn't work, and there's been such a shift away from the D.A.R.E program?
[00:08:21] Sheila: Yeah. So, you know, the D.A.R.E program started with the best of intentions, right? This concern that in the '70s and early '80s, there were disturbing rates of substance use among young people, many of whom, you know, were too young to decide whether or not to put certain things in their bodies.
[00:08:43] Sheila: You know, young people who might have needed other support and care and someone to be there for them, and better coping strategies, maybe more extracur-curriculars, more things to fill and enrich their lives, right? And many of whom, who instead of getting that sometimes [00:09:00] found what they needed in substances, right?
[00:09:02] Sheila: And so the D.A.R.E program started off with the best of intentions to try to reduce, youth experimentation and youth substance use, right? Because we know that the earlier you start any habit the earlier it becomes entrenched, for better or for worse, right? Sometimes we discover our hobbies and our passions as young people, and those become careers or lifelong hobbies and interests.
[00:09:24] Sheila: But when it comes to substances too, you know, relying on a substance while you're young you may get into patterns and habits that follow you into adulthood that can escalate to become problematic. But the approach that was taken with the program was first and foremost that it would be a law enforcement officer coming into the classroom, not a public health educator, not a nurse, not a teacher that may already be in the school that the students know, but this idea of having a law enforcement officer coming in.
[00:09:50] Sheila: And what does that convey about drug use? Drugs are serious. Drugs are illegal. Drugs are bad. Don't do them. And if you do, you could get arrested. [00:10:00] Bad things happen, right? And so I think that was the first fatal flaw of the D.A.R.E program was that although the intentions were good, the person who was delivering the education was someone, an authority figure, who was meant here to come in and scare you and to tell you that drug use was gonna make you lose your mind, was gonna lead to jail, was going to kill you.
[00:10:21] Sheila: To a bunch of young people who may respect that kind of authority, who maybe haven't been exposed to drugs yet, maybe that's enough fear to say, "Oof, okay. I don't know. That sounds scary." But to a lot of other kids, including ones who may have seen their parents drinking at home on the weekends or watching a game, or who may walk down the street and know that, like, their friend, you know, puffs on a cigarette sometimes outside of class, or someone who's been offered a substance at a party by a friend who was able to take the answer no when they said, "I don't feel like it."
[00:10:57] Sheila: You know, These fear-mongering messages about [00:11:00] who people are who use drugs, what they actually do, and that they destroy your life can ring hollow for young people who already can say, "I know my friend smokes weed, but she's fine. She's nice, and when I said no meant no. I know my mom drinks on the weekend, but she loves me and she cares about me, and I'm always tucked into bed."
[00:11:18] Sheila: Right? And so I think that those were some of the shortcomings of the D.A.R.E program, is that it was so driven on fear and so driven on stigma that while there are a certain population for whom perhaps that is a deterrent it eventually becomes something that either hits an expiration date the second that you go on to experiment with substances or use them legally, right?
[00:11:41] Sheila: 'Cause we all waited until we were 21 to have our first sip of alcohol.
[00:11:44] Sheila: You're like, "That doesn't
[00:11:45] Speaker 13: You're like, "That doesn't apply to me."
[00:11:46] Dominique: At 13, 14, 15, 16 years old when kids are experimenting, If they believe that it's a big deal but they see their friend doing it, it can't be that big of a big deal. It must be fine, right?
[00:11:55] Dominique: The D.A.R.E. program must have not been true, or the police officers or whomever must have been [00:12:00] lying, must
[00:12:00] Speaker 29: An exaggeration There goes the credibility
[00:12:03] Speaker 29: Just jokingly but not jokingly, but like even after you become an adult and maybe go on to use these substances with a clear mind with your own life responsibilities in a way that's responsible and recreational, you have no tools on how to stay safe. You just gotta figure it out, right?
[00:12:20] Speaker 29: Many of us went off to college, binge drinking was part of that culture. We were getting close to legal age and we had to figure out how to stay safe with alcohol on our own. And when you insert any other drug name in that little blank and put in marijuana, put in cigarettes, put in heroin, put in MDMA, again, when the Just Say No message expires, there's nowhere else to turn to learn how to stay
[00:12:44] Speaker 29: safe.
[00:12:45] Speaker 13: and
[00:12:45] Dominique: They see that all these drugs are not allowed, they're off the table, but alcohol is something that you can use with permission, it's something that is regulated, they might be thinking, "Well, I can take advantage of this specific substance. It's not off [00:13:00] limits, but it's something that I should be proceeding with care," and they're not applying that same logic to any of the other substances that they're introduced to through the D.A.R.E. program or in their life.
[00:13:10] Sheila: We call that concept, drug exceptionalism. This idea that all drugs are bad except-
[00:13:17] Speaker 13: So-and-so
[00:13:18] Speaker 29: drugs ...
[00:13:18] Sheila: such and such drug, right? And so when we make the vast majority of drugs illegal, for instance, and we create this category for nicotine, tobacco, and alcohol as legal, and then pharmaceutically similar drugs as medications, all of a sudden, all those pieces of advice that we got get thrown out the window because we only think they apply to a certain drug category, rather than the fact that the strategies we should take to stay safe when it comes to all substances, whether a medication or illegal drug, are the same principles that we're teaching people who use illegal drugs how to stay safe.
[00:13:52] Sheila: And you know, when you think about the fact that we are currently in the midst of an overdose crisis, where some of the earliest [00:14:00] origins of this crisis started because people, were misled into believing that just because prescription opioids were prescription drugs, they were given by a doctor, they were made in a pharmaceutical laboratory setting, that those were somehow safer.
[00:14:15] Sheila: And on the one hand, they are safer than, say, street heroin, which we don't always know what's gonna be in every baggie you buy. But they come with risks, too. And so there is a danger to the way in which we talk about drugs and we exceptionalize and categorize drugs as legal, illegal, medication, street drug, what have you, because then people may inadvertently engage in risks that they didn't have to, that could've been avoided and prevented if they actually learned broader strategies around never use anything alone.
[00:14:47] Sheila: Always go slow. Always make sure that someone is around. Be careful when you mix different classes of substances. You should not be popping anything into your mouth and chasing it with a, an alcoholic beverage, for [00:15:00] instance. Right? Make sure that you, your body is hydrated and and that you're rested before you put yourself in certain situations and use substances.
[00:15:08] Sheila: Make sure you're in a right state of mind, because the state of mind that you're in can turn a night of drinking into one full of laughter or one full of tears, right? And so all of those kinds of basic strategies for staying safe with a substance are also completely missing from our broader conversation because of this DARE conversation that was so just say no, but also the way in which our society looks at drugs in these very different ways, when actually a lot of the ways to stay safe, a lot of the practices and principles are very similar.
[00:15:38] Speaker 13: And
[00:15:39] Dominique: we're already applying a lot of harm reduction strategies in our everyday lives for people who, don't have substance use disorders. If you casually drink alcohol, having a designated driver or, you know, maybe limiting yourself to one, two, or three drinks. those are all forms of harm reduction.
[00:15:54] Dominique: Or eating before you
[00:15:56] Speaker 29: Or alternating or double fisting with a water and a alcoholic [00:16:00] beverage- Yes ... so you're kinda making both, right? Yeah. Yes
[00:16:03] Dominique: you're kind of making both, right? Exactly. Right? Or even in other areas of our lives, like putting on a seatbelt when you car. It's like taking those calculated safety measures when you know that there's gonna be an inherent risk. But when it comes to drugs, that seems to go out the door.
[00:16:13] Dominique: Why is harm reduction like this gatekept thing? Or why is it so secretive, especially when it comes to families that are trying to support a loved one who is using substances
[00:16:23] Sheila: I think that's a really complicated and heavy question. I think
[00:16:29] Sheila: someone who's on a diet or someone who's diabetic, we understand that sometimes they're still gonna eat sugar, or sometimes they're still going to have dessert with a meal.
[00:16:39] Sheila: And we don't say, "Take that person out of diabetes treatment, cut them off their insulin, refuse to see them because they consumed this thing," right? Or someone who's getting nutritional counseling and support, and one day the scale's a little bit higher than it was last week, right? We don't say that, "Hey, it was only a pound, [00:17:00] and we've seen a lot worse.
[00:17:01] Sheila: And I looked at your food tracking, and your tracking actually looks really great. It looks like this is maybe because you had something really salty yesterday," right? we take an incrementalist approach when it comes to so many other behaviors. We accept people doing their best, aiming to work out three to five times a week.
[00:17:17] Sheila: We accept people in depression treatment who may still report feeling suicidal between sessions. We know that people in treatment for anxiety sometimes may still have anxious symptoms, even in the middle of a session may say, "I'm feeling really anxious right And we don't say that that means that anxiety treatment didn't work, kick 'em out.
[00:17:35] Sheila: You know, addiction became the only condition for which you have to be cured to start treatment. To be symptom-free before you start treatment.
[00:17:45] Dominique: That's so true. I never thought about it that way
[00:17:47] Sheila: Right? Because what is one of the symptoms if you're gonna talk about addiction as a disorder or a mental health condition? Use.
[00:17:56] Dominique: Yeah.
[00:17:57] Sheila: And for some reason, we expect people [00:18:00] to give up that thing that if they could already have done it, why do we gotta- get them into treatment? So some of this is cultural. Some of this is, again, looking at addiction as something uniquely different than every other health condition for which we do accept a little forward, a little backwards, a little up, a little down, a little incrementalism.
[00:18:22] Dominique: Yeah, absolutely. You're making a great point in, like, the segue into, like, the medication when it comes to treating people who are using substances, especially when it comes to opioid use disorder. There are medications available to loved ones like methadone and Suboxone, but they're stigmatizing medication and they continue to move forward with this ideology that maybe they're just swapping one drug for another.
[00:18:43] Sheila: Sure. So first and foremost, for the listeners who may not be familiar, there's three FDA-approved medications f-for the treatment of opioid addiction or opioid use disorder. One is methadone, one is buprenorphine, which is known by its brand name Suboxone, and then the third one is called [00:19:00] naltrexone, which may be known by its brand name Vivitrol, which is the most common one.
[00:19:04] Sheila: So we're really talking about the first two when we talk about the most stigmatized drugs for opioid use disorder, methadone and buprenorphine. And again, just to kind of make sure we're all on the same why would someone say that a medication is substituting one drug for another? Because methadone and buprenorphine do work like opioids in the brain.
[00:19:22] Sheila: Methadone is a full-fledged opioid, so it hits the same receptor sites in the brain
[00:19:27] Dominique: Mm-hmm.
[00:19:28] Sheila: as oxycodone, hydromorphone, heroin, and fentanyl. It sits on those same receptor sites in the brain. It activates the same effects in the body. But the difference is that with a drug like hydromorphone, oxycodone or heroin, which their effects wear off after four to six hours, right? You know, if you've even been prescribed an opioid before, they tell you to take it every four hours, right?
[00:19:52] Sheila: 'Cause the effects wear off. And with fentanyl, we know that it can be a couple hours. It can be very Very short-lived, [00:20:00] right? So whereas, like, someone who's dependent on a prescription opioid or old-school heroin might have had to dose themselves four to five times a day, when we're talking about fentanyl, someone may be at risk of facing withdrawal and going through the downs six to 20 times a day, right?
[00:20:16] Sheila: And the thing with methadone that's different from both of these other kinds of drugs that I'm talking about is you can take a dose of methadone and feel well for 24 hours.
[00:20:25] Dominique: Hmm. It's
[00:20:26] Sheila: Mm. long-lasting it's longer lasting. And so a lot of people will say, "Well, it's still an opioid." But I would say When your life is built around avoiding withdrawal,
[00:20:38] Dominique: Mm-hmm.
[00:20:39] Sheila: And just again, for folks on the line who d- who are not familiar with what opioid withdrawal can look like, it starts with clamminess.
[00:20:46] Sheila: It starts with feeling a little anxious, a little nervous, some palpitations, but eventually turns into nausea, diarrhea, you know, mood effects, impacts, effects that can last for two weeks [00:21:00] or so.
[00:21:01] Sheila: full-blown Yes, full-blown symptoms. And they can be alleviated just by using again, right?
[00:21:08] Sheila: So someone who's dependent on something like heroin or oxycodone or fentanyl, their life is built around those two to four to six-hour increments. I can't really think and plan too far ahead because I know I need to make sure that I'm well, otherwise I'm gonna need to find a toilet. Otherwise, I'm gonna be in a really rough state.
[00:21:30] Sheila: Otherwise, I'm gonna be in a really tough situation. And so you know, when we talk about people in opioid addiction specifically, their lives become very conscribed And when they use that opioid, it just makes the withdrawal go away.
[00:21:43] Sheila: There is no euphoria. When people get to the certain point of being that dependent and needing it at that increment, they're just doing it not to be sick, but it's not like they're feeling great. It's not like they're in the clouds. And so what I always like to say about methadone, and also buprenorphine, because buprenorphine [00:22:00] also lasts for 24 hours, but it has a ceiling effect, so it doesn't always meet people's withdrawal where they're at, whereas methadone can be titrated up to really get if you've got a high tolerance, is that imagine if you could take a medication so that you could look at the next 24 hours with a clear mind
[00:22:18] Dominique: Yeah. It's the stability that the medication provides you
[00:22:22] Sheila: physically well, right? There's no stomach upset, there's no clamminess, but your mind is well. You're not feeling anxious, you're not feeling nervous, you're not dreading what you're gonna have to do to be able to acquire that substance- to be able to get well again in the next couple hours, right?
[00:22:38] Sheila: You're not filling yourself with the shame and the guilt of what you might have had to do in the past to do that, right? So when I talk about the need for us to really acknowledge what these medications do, is that they keep people well, they give people clarity, they give people their lives back. That is when people can think about getting that job and keeping [00:23:00] that job, picking up their kids from school, going back to school again for themselves putting more time and energy into their relationships, you know, being able to focus on raising their children being that sibling that they've always wanted to be.
[00:23:14] Sheila: But it's hard to make a plan in your life when you're really living in these small increments of time. So I always push back against replacing one thing for another. We live in a world where technology has advanced, that there are medications that have really given people their lives back.
[00:23:32] Sheila: And instead of moralizing on people doing recovery whatever they think is the right way, acknowledging that there are multiple pathways to recovery, and that really it should be that we're in the business of saving lives. And one thing that we've learned from the research that patients with opioid addiction who are either maintained on buprenorphine or methadone, even if they accidentally relapse while they're using those medications, they're half as likely to die of an overdose in those situations because their tolerance is kept up high. [00:24:00] But they're also less likely to relapse than someone who had to do it cold turkey because they could hold out a lot longer. And then after being maintained on those medications, if they want to, you know, have a little less structure in their lives, we can talk about gradually phasing them down.
[00:24:15] Dominique: It's yeah, absolutely. I think it's-- what's so important that you're bringing up is the stability and the clarity in your wellbeing that these substances actually bring you. Because my brother, for example, he was on methadone for about six months before he tapered down and eventually got onto buprenorphine, and now he's been able to be in treatment, he's been able to build a community, he's been able to build new relationships and connect with people, develop new coping skills.
[00:24:44] Dominique: So while he's still on Suboxone, he's been able to develop the stability that he needs and slowly start that tapering and transition process. So I think it's important to talk about the stability that these substances are actually bringing people and their families.
[00:24:59] Sheila: Yeah. [00:25:00] Because when you're at that level of physical dependence, it's not just psychological, body is in a different state. And so these medications can really help your body recalibrate, right? And I think, you know, the other thing is that someone teetering on an abstinence-based, white-knuckled kind of recovery, right?
[00:25:18] Sheila: Just pushing through withdrawals, pushing through their tolerance starts going down, right? And so say that they get into that fight or argument, say that job interview goes badly, say that they lose their mother. Something happens, and in that moment, the one thing they want to soothe them- themselves with is to get high.
[00:25:41] Sheila: And they go to their old dealer, they buy what they usually bought, and they use what they usually used or even use a little bit less. Sometimes that one use can be an overdose, right? Because people's tolerance drops unpredictably, and it's different for everyone's physiology, everyone's metabolism, everyone's body [00:26:00] is different.
[00:26:00] Sheila: But also every baggie at your dealer isn't gonna be the same potency. And so what we see is that in the midst of an overdose crisis, why are we forcing people to white knuckle when we have medications that can help people really calibrate, get their lives back? And instead of kind of putting people in these positions where perfection and walking this straight line is the only way to do it, and then they fall off and that could be the lethal moment we
[00:26:27] Sheila: lose
[00:26:27] Dominique: Absolutely yeah, it's so true. And then there's also the question of the access to care and, like, where medications are actually readily available. We're based in New York, and I feel like there's tons of different resources that are available to a wide range of people, but there are people who in parts of the country who might not have access to a methadone clinic or might not have access to outpatient treatment where they can pick up, their medication.
[00:26:51] Dominique: What can families do to support them if they don't necessarily have access to it?
[00:26:55] Sheila: 80% of counties in the United States do not even have a methadone [00:27:00] clinic.
[00:27:00] Sheila: So methadone is one of those medications where it's only available in what's known as an opioid treatment program or methadone clinic.
[00:27:07] Sheila: These are licensed standalone facilities where the person actually has to go in and get dosed on the medication on a daily basis. Most methadone clinics are only open from 6:00 AM to maybe 1:00 PM, 3:00 PM.
[00:27:21] Sheila: So a clinic is a place where patients must come and line up outside, and they have to be there on time, and they have to walk in the door, and oftentimes they are given a little shot glass with the liquid dispensed methadone, and they must drink it in front of a nurse and then show that they haven't cheeked it or tucked it in, and then engage in drug testing so they make sure that you haven't been using other substances.
[00:27:46] Sheila: There may also be other counseling requirements. For people who get more stable in a methadone program, sometimes they might get take-homes. They might be able to pick up doses for a 14-day period, a 30-day period and then be able to bring those bottles back [00:28:00] and then get new ones. But a lot of people still have to do daily or near daily dosing, right?
[00:28:05] Sheila: And so absolutely that kind of service delivery looks very different than a 30-day rehab. It looks very different than an outpatient program. So if you want to be able to do methadone while in those programs, you have to go off-site to a clinic, and a lot of programs don't even have those kinds of relationships.
[00:28:20] Sheila: Buprenorphine, on the other hand, can be prescribed out of the office by a doctor as long as they have a DEA waiver and they can prescribe controlled medications. And so that's a lot easier. However, not all doctors prescribe buprenorphine. Not all doctors want to prescribe buprenorphine. And even if you find a doctor who will prescribe bu- buprenorphine, your insurance may only allow refills every exactly 28 to 30 days, or your local pharmacy may not stock it.
[00:28:49] Sheila: So these are some barriers that also exist for buprenorphine, which is an amazing
[00:28:53] Dominique: Why is there a distinction between methadone and how the buprenorphine is actually being accessed and provided to [00:29:00] people across the country?
[00:29:01] Sheila: The history is quite complicated. So methadone became, a medication allowable for heroin addiction treatment starting in the early '70s under the Nixon administration. Nixon was concerned about growing rates of heroin addiction in our cities, and he was also concerned about returning Vietnam vets, many of whom, while they were away, started using heroin, either to cope with the stress and trauma of being a soldier at war or because they were bored.
[00:29:30] Sheila: Either way, they were concerned about people coming home with heroin addictions that were untreated. And this idea that Black and brown people with opioid addiction were scourges of society criminals who needed to be controlled created this idea that what if we created this system that we know this medication works really well, but because these are otherwise unruly populations who we do not trust, we are going to use this medication and deliver it as a crime reduction [00:30:00] tool.
[00:30:00] Sheila: And we're gonna deliver it in a highly policed, controlled manner.
[00:30:05] Sheila: Fast forward, we end up in an overdose crisis with a very different face, a white face, a rural face, a cheerleader, a football player, someone's lawyer, someone's doctor. And we remember there is this other medication, buprenorphine. Maybe this could be helpful because those kinds of patients may not may not be appro- appropriate for the clinic-type settings.
[00:30:26] Sheila: And because buprenorphine, as I said, has a ceiling effect, it's hard to accidentally take too much buprenorphine. At a certain point, the effects are no longer gonna get more intense. Whereas with methadone, sure, like y- higher levels of methadone have higher levels of intensity, and if I were to, for instance, consume a dose of methadone given to a patient who may have been on it for a minute, something like that could give me an overdose because I don't have the tolerance.
[00:30:50] Sheila: But in someone who has the tolerance, it's just enough to keep them well. And so in the early days when there were conversations happening, the Data 2000 waiver [00:31:00] conversations, maybe we need to make this medication available. When you read through the transcripts of the hearings,
[00:31:05] Sheila: Mm-hmm.
[00:31:05] Sheila: When they were arguing to FDA approve this medication for office-based treatment how they talked about it
[00:31:11] Sheila: it was very racially coded. It was very coded by class as well, and it was very much like, 'We can trust these patients, and they won't access this treatment any other way. You know, they can't be expected to go to the clinics.' And that was part of how this happened. And you know, now when you look at the rates of who's getting buprenorphine and who's not, there are significant racial disparities in, you know, studies showing that, you know, Black people are 30, 40, 50 times less likely, than white people to be getting prescriptions.
[00:31:44] Sheila: And one could almost argue that's by design. It's actually working as designed.
[00:31:51] Dominique: That's so scary. For people that are hearing this for the first time and they're wondering, "What can [00:32:00] I do?" Like, "How can I help person?" Knowing that those are the disparities, knowing that this is intentionally designed limitations in how we access care, what can families do, especially if they're feeling helpless?
[00:32:12] Sheila: absolutely. Last year, , there was a piece of legislation being introduced at the federal level to change federal policies around methadone. Something called the M-O-T-A-A, the Modernizing Opioid Treatment Act, something like that. And it was meant to replicate the model for methadone delivery that happens in other countries around the world.
[00:32:35] Sheila: The methadone clinic system, in the US is not how it's delivered in France. It's not how it's even delivered in Canada. It's not how it's delivered in the Netherlands, in Portugal, in Spain, in a lot of other parts of the world. In many of these other places, Canada included, you can go to your local pharmacy and simply get your methadone dose.
[00:32:57] Sheila: And in a lot of these places as well, there [00:33:00] are laws that allow methadone vans to drive around neighborhoods and simply just kind of open up shop for a couple hours. People know to go there, and then they can go on with their lives. They don't all,
[00:33:10] Sheila: all have to make their way to a clinic. Now there's a piece of legislation being introduced again to similarly kind of allow for pharmacy-based access to methadone.
[00:33:19] Sheila: So I highly encourage listeners and family members who've seen how methadone has saved their loved one's life to get involved in actions and advocacy to loosen the chains that we've got on methadone. My friend Helen Redmond just released a book called Liquid Handcuffs talking about not that methadone itself is liquid handcuffs, but the systems of delivery for methadone, a life-saving medication, are in, in fact, a form of handcuffs.
[00:33:47] Sheila: The other thing that we can do when it comes to buprenorphine is really to talk to doctors and prescribers that we know, 'cause nurse practitioners can prescribe buprenorphine physicians assistants, and several other disciplines can also prescribe it, [00:34:00] is to encourage your friend, family member, loved one that you know who has that credential to consider learning a little bit more about what it would take to be able to prescribe patients buprenorphine and to consider becoming a buprenorphine prescriber.
[00:34:15] Sheila: When I talk to addiction medicine doctors who treat opioid addiction with buprenorphine, they say it's some of the most gratifying work that they've ever done. They love seeing the transformation in their patients. Many of these doctors who otherwise worked with other patient populations or in other kinds of disciplines saying that there is something to being able to see the life-changing effects of buprenorphine that now makes me a believer.
[00:34:38] Sheila: And what's fascinating is that while the majority of doctors and prescribers are not prescribing buprenorphine, what we've seen is that we've got super prescribers. So when you look at whose licenses are actually the ones that the most buprenorphine are coming from, they're from a small subset of those hardcore believers who said, "I love this work I love this population.
[00:34:59] Sheila: And [00:35:00] so I think one thing that we can all do is offer education and resources to all of the medical providers we know saying, "Consider it. Get a training." But also, if you're connected to a university or if you're connected to a medical school or a nursing school, to consider asking them whether they've incorporated any addiction co-content.
[00:35:19] Sheila: If you're in recovery, offering to go talk to a medical school that's in your neighborhood or a social work school that's in your community or a nursing school and saying, "I wanna come in and I wanna talk to you about how life-saving methadone was, how life-saving buprenorphine was for me." And for a lot of people, you know, these students, this new generation, they're already, like, growing up in the thick of the overdose crisis.
[00:35:39] Sheila: Many of these young people coming up today are already more forward-thinking than past generations. They wanna treat addictions. They understand how important it is to save lives. But we know that for people who haven't really decided whether this is for them, sometimes actually meeting someone-
[00:35:55] Sheila: And hearing their story and hearing their story can really change minds. And it's the same thing for parents. You know, [00:36:00] so talking to your local lawmaker about, you know, if you've got a congressional representative saying, "I wanna support policies to loosen regulations for methadone," that is super important. But also thinking at the local level, like, how do I do this, you know?
[00:36:13] Sheila: Asking your local pharmacy, "Do you stock buprenorphine? Why don't you stock buprenorphine?"
[00:36:17] Dominique: Yeah, I love that because those are types of questions that I think a lot of families aren't thinking to ask or encouraging their loved one to ask. And I think especially with families, when you do have this relationship with your loved one who's using substances, I think we have a lot of positive influence, and I think encouraging them to ask questions, encouraging them to talk to their providers if they do have a provider that they work with.
[00:36:40] Dominique: And then also a lot of the times, if you're the one who's like seeking out treatment or seeking out support for your loved one, making sure that you're helping them explore all the options.
[00:36:49] Sheila: it's a menu
[00:36:49] Dominique: they might not even know what's available to them. Especially depending on where you live
[00:36:54] Sheila: They might not even know what's available to them. Mm-hmm. Actually, depending on where you live. Absolutely. Absolutely
[00:36:55] Dominique: There's another important conversation that this leads into, which is [00:37:00] sometimes when treatment doesn't work and unfortunately people are involved with the criminal justice system, sometimes the court system can work if they're mandated to treatments, sometimes it doesn't.
[00:37:11] Dominique: Could you tell us a little bit more about when it works and when it doesn't, and what some of the red tape around that might be?
[00:37:18] Sheila: Yeah. So I would say, you know, looking at the last statistics that were released about who went into addiction treatment in the past year, studies estimate that roughly 25 to 35% of clients, people in addiction treatment in the past year were referred through the criminal legal system, either because it was a condition of their probation, so they could avoid jail.
[00:37:44] Sheila: So showing that this was an alternative to incarceration if the drug use was deemed to be the driving factor of the crime, or it was a drug-related crime. Sometimes they can negotiate that, let me go to treatment and stay outside and be-- [00:38:00] while I'm on probation. And the logic is that if we address the underlying substance use issue, we could prevent future crime and avoid incarcerating this person.
[00:38:09] Sheila: Parole is typically after someone's already served some degree of time for a felony charge in prison. Again, maybe drug-related, maybe you were under the influence, or maybe you,your addiction maybe was an underlying cause for the crime. And so you might be offered the opportunity to get released early while under parole supervision and also go to a treatment program, and if you can kinda get some stabilization, maybe you don't have to serve the rest of your time, and you can be out in the community. And then the other category being drug court, for instance, right? So someone who has a pending case for a misdemeanor or qualifying charge, depending on your county, and it's deemed that, again, there was an underlying drug addiction or mental health issue or you know, combined, that might have been related to the act of the crime or was substance-related crime.
[00:38:55] Sheila: And saying that they can stay under supervision, get connected to [00:39:00] housing, get connected to treatment, and as long as they kind of do all those things, maybe at the end of the time can get that charge taken off and, you know, not have a charge on their file or avoid jail or incarceration, right? So One in three is nothing to shrug your shoulders about.
[00:39:16] Sheila: One in three people are getting into a treatment program because of one of these systems. And again it's better to be out in the community than it is to be behind bars. We know that, right? Behind bars, in jails or in prisons is traumatizing, disconnects you from your support system, disconnects you from your life and can victimize you too, right?
[00:39:35] Sheila: And there are drugs behind bars, let us not forget, right? So, on the one hand, great. If the criminal legal system is a pathway for some people to get much needed help, I'm never gonna say, "Don't give people help." The problem is, though, is that once the criminal legal system gets involved in help, they do then end up sometimes getting involved in these medical decisions or decisions that should be between a client and their [00:40:00] provider.
[00:40:00] Sheila: For instance, on their goals. Criminal legal clients more so than any other client must be abstinent. The drug testing results that happen over the course of treatment are reported directly to the parole and probation officer in the drug court. And depending on if you are in the doghouse with your PO because you also missed check-in or, you know, you've been giving them a hard time, or they think you've been giving them a hard time, sometimes one drug test is all it takes for a violation and for you to get sent back, right?
[00:40:27] Sheila: No more chances. Or if you have a PO that's willing to work with you or a drug court that's willing to work with you, a treatment facility that's advocating on your behalf saying, "We think that she's almost got it. We know that she tested
[00:40:38] Sheila: positive, but let her stay out. We think that we can keep working with her," you know, can keep people out.
[00:40:44] Sheila: So, like, on the one hand, again, when they're stricter than the treatment provider, that doesn't actually mean that help can be help. As I said to you before, when they're so intrusive about, "What are you talking about? What's going on in these sessions?" They can only abstain [00:41:00] or, telling you that they're fraternizing with other criminals?
[00:41:03] Sheila: Are they telling you about other illegal behaviors?"
[00:41:05] Dominique: probing for questions that you probably wouldn't disclose on your own
[00:41:08] Sheila: Right? And then I think the third thing
[00:41:10] Speaker 29: is,
[00:41:10] Sheila: is that the criminal legal system does not unanimously have a positive feeling towards methadone and buprenorphine. And so a lot of clients referred to treatment, mandated to treatment, coerced into treatment through the criminal legal system don't always even get that access that maybe could have saved their life, right?
[00:41:29] Sheila: So there's a lot of people involved with the criminal legal system who have to white-knuckle treatment and recovery and detox and withdrawal because they're actually not allowed the option. So I think those are, like, some of the highlights that I would say in terms of some of the drawbacks and challenges of getting the criminal legal system involved.
[00:41:45] Sheila: But again, I mean, it's incredible. They're a pathway for a lot of people. But it makes me wonder, could we be doing something else to also create other pathways for people to get the help that they need?
[00:41:55] Dominique: Yeah, absolutely. Like, this shouldn't be the last resort for treatment. shouldn't be the [00:42:00] pathway that is the default for, to getting people into treatment. And I think what I've seen in some of the work that I've done is sometimes drug court programs, they actually have 12-step work as part of conditions upon release or part of the work that they have to do.
[00:42:16] Dominique: What's your perception on that? Like, do you feel like that's helpful? Do you feel like it's, it works? Like, what have you seen in 12-step being a requirement for probation, or for release?
[00:42:28] Sheila: I am a firm believer in individualized care, and I'm a firm believer in no one size is gonna fit all, right? I love the idea of people having options, but when they become mandates is when it becomes challenging. Because again, at the outpatient treatment facility I worked at, it was a 12-step based program.
[00:42:47] Sheila: So we read the big book in groups. People introduced themselves using like the AA type introductions start a group every day. We required clients to go to three to five meetings a week, and within the first month to [00:43:00] secure a sponsor to come in and show us their 30-day chip. You know, we were also part of that.
[00:43:05] Sheila: And what I will say is just like anything else, the people it works for, it can change their and save their lives. The problem is that it's not gonna be for everyone, right? Going into a room with a group of strangers may not be for you, right? You know, there's spiritual elements to it that depending on your own belief system or lack thereof, may not align for you.
[00:43:29] Sheila: And so it may not resonate- with how you look at things. You know, also one of the fundamental principles is powerlessness. And for some people who've been beaten down all their lives, told, "You don't know what's good for you. You've never been able to do this. You're not very capable," who are used to being told those things, sometimes they actually need a recovery pathway or a journey that makes them feel empowered, that lets them see they are the decider.
[00:43:55] Sheila: They can make choices for themselves. "Look, you already decided to do this. Like, [00:44:00] look, you are making good choices. You have power. You have control." You know, so there's a lot of reasons why people may not be interested in 12 steps, and I think that unfortunately, when we have such a conscribed, narrow approach to whether it's there's only one outcome, abstinence, there's only one pathway, whether it's 12 steps or the only kind of support group we lose a lot of people along the way, and then we make them feel like they're the problem when it's like not everything was gonna work for everyone anyway.
[00:44:29] Dominique: We other people- which I think is part of the larger problem in how we talk about mental health and how we talk about substance use and how we talk about treatment. When we talk about cancer treatment, if the chemo doesn't work, we don't say, "Oh, you didn't try hard enough," or, we didn't say, like, " "
[00:44:44] Dominique: That's the only option. We do that when it comes to substance use disorder, and that's what's really frustrating when families are desperate. People are really struggling with their health, and we start to blame people when they are [00:45:00] trying.
[00:45:00] Dominique: So it becomes something that there are too many chefs in the kitchen, and not the right chefs are in the kitchen cooking the right thing.
[00:45:07] Dominique: So it's interesting to hear how all of this plays a big part in the lack of care or the stress that's put on the treatment programs thinking that everyone should be able to do everything at once when they can't.
[00:45:21] Sheila: Yeah. Yeah. You know, and when I worked at that needle exchange program you know, so many of my clients were street-based or in shelters and coming to get sterile syringes. But the other thing that they were getting at our program was that we were part of a bigger organization that provided case management, medical services, housing assistance, helping people get started on their benefits.
[00:45:43] Sheila: And so one thing that I often saw was that participants' behaviors and substance use changed just as all these other pieces of their lives started coming into place, right? So often I think we put the onus of change also unfairly, [00:46:00] fully on a treatment program without saying, "But where are they gonna sleep tonight?
[00:46:05] Sheila: What are they gonna eat? Where are they gonna go after this program is over, after they get released from this 28-day program? What's there to catch them when they walk out the door? Who's there to receive them?" Right? Or after they leave incarceration, how long until their Medicaid turns on? How long before we know where they're gonna stay that night?
[00:46:25] Sheila: So many people leave incarceration with nowhere to go. They leave incarceration homeless. They leave incarceration without insurance coverage. they leave incarceration without a family member or anyone turn to. And so one thing that I got to see working at the harm reduction program is that while we were simultaneously giving people the tools that they needed to engage in safer injection practices while also giving them a support system, they were also getting all their other ducks in a row.
[00:46:51] Sheila: And as all these other ducks got into a row, we already started notice differences. You know, our clients started gaining weight. They started looking healthier. They looked [00:47:00] rested when they showed up in the morning. They were coming to us after going to another appointment they had to do something else that day.
[00:47:06] Sheila: We started to see all of that, and we started to see- Yes. And so, like, you know, sometimes I think the problem is that we put so much of the onus on treatment to be the fixer when, like, people have other complex needs that also often need to be addressed. So again, if someone fails in treatment, it might have been that they didn't have the infrastructure for success the second that they walked out of the outpatient facility or the second they walked out of the 28-day program or the, you know, three-month program or whatever that they were in.
[00:47:37] Sheila: And so it's not always fair to blame the treatment when there's no infrastructure for the recovery as well.
[00:47:44] Dominique: Yeah, it's so important that you're saying that because sobriety is only one small aspect of treatment. You know, like what you're treating is, like you said, the foundation that families and people individually need. Because when they don't have that infrastructure, that's when everything else can fall apart [00:48:00] along with their sobriety.
[00:48:01] Sheila: And then we can't make them feel like it's their fault either, right? So we can't blame the treatment, and we can't individual. Sometimes it's the system and the structure that's not there, right? And it's the policy barriers at the systemic level that are the reason why now that I left a felon, I can't stay in this shelter.
[00:48:19] Sheila: Or now that I left incarceration, it's gonna be a lag time before my Medicaid gets started, so I can't fill that buprenorphine prescription. You know, one of the things that we've learned is that the risk of fatal overdose in the first two weeks after arrest can be anywhere from 38 to 200 times higher among people leaving incarceration than the general population.
[00:48:41] Sheila: And uh, one of those reasons is because they don't have a prescriber, they don't have insurance, they have nowhere to store their medications, or they get released in the middle of the night. Of the night
[00:48:50] Dominique: Yeah. And I can actually speak to that. All of those things have happened to my brother.
[00:48:55] Dominique: And where he was released from a 28-day program where he was [00:49:00] prescribed methadone, and then there was no aftercare set up for him. He was approved by my mom's insurance to go to treatment, but there was no accountability of him actually ever going through the door.
[00:49:10] Dominique: There was no one there to bring him into treatment. So there's a lots of other loopholes that need to be addressed for the person using substances, for the people that are supporting them, for families, especially if they do have someone on their insurance, between long wait lists, lack of aftercare lack of communication.
[00:49:28] Dominique: So there's a lot that needs to be addressed, and I think that's where, like, the infrastructure is so important and, like, having these conversations because families feel hopeless most of the time
[00:49:37] Sheila: Yeah. Yeah, and they don't know where these cracks are loopholes are until their loved one goes through them and falls through Yeah. And if you're lucky, your loved one survives
[00:49:50] Dominique: Yeah. It's just a scary place to be in. For families that are listening, what is one thing that they should be able to walk away with from this conversation?
[00:49:58] Sheila: You know, working [00:50:00] at a policy advocacy organization, I want to say that parent voices, family voices are incredibly powerful. You have the voice that your local politician or your state representative or your federal representative needs to hear. You have a level of expertise, even if you feel like, "Well, I've never been able to give a presentation, like I don't would begin."
[00:50:25] Sheila: Your tears, your joy at the success, your tears at the loss, your ability to paint a picture of like what helped your loved one succeed or what got in the way of your loved one getting what they needed, these are the kinds of stories that change hearts and minds, whether it's your local state or federal policy official who needs to hear from you, but also when it comes to the media, the press.
[00:50:49] Sheila: There is so much coverage in the news these days, you know, scapegoating your loved one, scapegoating the population that I've committed my life to as being the root of all problems on the streets, [00:51:00] as being a scourge, as being a nuisance, as a sign of disorder, rather than that was my son.
[00:51:07] Sheila: Yeah. That's my brother. That's my loved one. And being able to say, "I know exactly what got them in that situation, and they needed help."
[00:51:17] Dominique: Yeah, absolutely
[00:51:20] Sheila: And so what I would say is that I work at this really great organization called the Drug Policy Alliance. You can find us on all of the social media platforms, typically at drugpolicyorg.
[00:51:30] Dominique: Mm-hmm.
[00:51:31] Sheila: We work with parents every single day who want to share their stories, and there are great parent organizations that are pulling together parents who wanna be promoting solutions. Groups like Broken No More, GRASP, Truth Pharm. There are a number of really great solution-oriented, activating parent groups that are actually taking people, whether it's in their grief or in their joy of seeing their
[00:51:56] Sheila: one come out, sharing their story and painting a real [00:52:00] picture of like what it's like on the ground.
[00:52:02] Sheila: Because I think both sides of the story need to be there, and unfortunately, we're in a time right now where a lot of parents' pain is being weaponized to promote more harmful policies, more damaging policies, harsher penalties. And in their grief, I think a lot of parents have been manipulated into promoting or supporting or endorsing, implicitly or explicitly, solutions that would've hurt their loved one or are going to hurt others.
[00:52:31] Sheila: And instead, if you as a family member or a loved one can say, "We can help, we can heal, we can care, we can love people into getting what they need," offering that message of hope or at least saying, "We could do more of this," or, "We need this," or, This is missing," that's what we need right now.
[00:52:51] Dominique: I definitely think families should feel empowered to talk about the resources and support that has worked for them and their family. A couple of months ago, my family actually had the chance to go [00:53:00] with my brother's treatment program to Albany and advocate for funding for a diverse range of treatment programs theirs being included.
[00:53:07] Dominique: But we got to talk about how his program has helped him get an education, how helped him build a community, how it's helped families rebuild their family systems. And the look on these policymakers' faces when they got to hear how the dollar was not just funding that person's sobriety or their person's treatment, but also how an entire group of families were perceiving treatment, how they were responding, it, it was beautiful to hear.
[00:53:34] Dominique: And for people who are actually in their early recovery or beginning their sobriety journey, it gives them the opportunity and the platform to feel that their voices are heard and that their stories matter. My brother has even shared, you know, "For a long time, like, I just felt like I was just this random person where my story didn't really matter, and that I'd just be a drop in the bucket.
[00:53:52] Dominique: But getting up there, as scary as it was, and getting to use my voice is what made me want to really share my [00:54:00] story," seeing their reactions. I think especially for young people, giving them a platform to feel empowered to be someone that they might never have thought that they could be might never thought that they could be.
[00:54:09] Sheila: Yeah. Yeah, and so I highly recommend if listeners are feeling like, "I don't even know where to start," you know, to consider some of the groups that I listed, and I can share their information with you so you could share it. To reach out to my organization, we are always here to help provide support.
[00:54:25] Sheila: If you see a stigmatizing or negative news story that misre- represents something that you yourself went through or your loved one went through, you know, we can help you write an op-ed or a letter to the editor saying, " Oh, we gotta get the this." But also, if you wanna share your story, you know, media and journalists wanna talk to parents every day.
[00:54:46] Sheila: at a time right now where a lot of federal funding cuts are being discussed, and we're already living through the consequences of the federal funding cuts from last year. And more so than ever, we need to put a face and a name behind who is being impacted by these federal [00:55:00] cuts and who's been impacted by the ones that happened and who already foresees what harms are gonna happen with these upcoming cuts.
[00:55:07] Sheila: And so, we help people get connected with journalists who want to talk to them and quote them in stories so that they can help challenge these myths and misconceptions because your experience is your expertise
[00:55:21] Dominique: Absolutely. Your story matters and there's so much information out there, I think people just need help finding it.
[00:55:28] Dominique: And with that being said, I wanna start closing out you share a little bit about your upcoming book that should be out next spring, if I remember, and tell us what readers can expect to hear and what you'll be covering in that book.
[00:55:40] Sheila: Absolutely. So my second book is called "The Case for a Harm Reduction Approach: Beyond One Size Fits All Addiction So whereas my first book, "The Harm Reduction Gap," really talks about the broader system and the continuum of care that we have from abstinence-based treatment and just say no drug [00:56:00] prevention and where harm reduction fits into it.
[00:56:02] Sheila: This book really digs deep into what does it look like in a harm reduction setting from the perspective of providers and the perspective of clients and what happens in those conversations that helps people work towards change. I think that a lot of people have ideas about what they think happens in a harm reduction program.
[00:56:19] Sheila: Well, you don't tell them to quit, so you must- You're enabling it
[00:56:22] Sheila: You must be-- What do you even do in there? You just say, "Oh, you're still using? Fine. Great. See you next week." Yeah. When actually, a lot of meaningful work actually happens in harm reduction programs. So both client and provider interviews were used to write this book, so we use a lot of their own words.
[00:56:41] Sheila: About 50 interviewees 32 clients, and 18 providers. They talk about, from both of their sides of the table what made a harm reduction program feel different from the moment you walked in the door? What was the culture? What were the norms? How was the level set so that when you walked in, it felt different?
[00:56:59] Sheila: How did you know you [00:57:00] felt safe? How did you know you felt comfortable? What did the providers do? What were the policies? How did it feel when you walked in? How did you know what goals you wanted to set and that you were achieving them? So there's a whole chapter on outcomes, how the clients themselves said, "I noticed that I started cutting down.
[00:57:14] Sheila: I noticed that I was starting to take my psychiatric medication, and as soon as I got connected with that psychiatrist, I wasn't feeling as depressed, so I was less," right? All of those kinds of things, like people connecting the dots, saying, "I got to come in and talk about how my real problem is alcohol and cocaine, but like I learned that like I could smoke marijuana on occasion.
[00:57:34] Sheila: But like if I go somewhere and someone's drinking, I gotta leave." But I've learned that through my harm reduction program. Instead of a treatment facility telling me, 'If you're addicted to one drug, you're addicted to them all, you can never use any of them ever again,' clients saying, 'I developed that insight in the safety of a space that actually helped me.'
[00:57:51] Sheila: 50% of the participants in both programs achieved abstinence in their harm reduction settings. So I think that what's exciting about this book is that [00:58:00] it demystifies what harm reduction is, what it feels like, what it looks like as a provider, as a client, but it also shows that for many people, harm reduction is a pathway to abstinence on its own, or it's an on-ramp to treatment until you're ready to get to treatment, so it's a holding place for you.
[00:58:17] Sheila: For some, it's a safety net until they decide to go back to treatment again because they just left treatment, they used again, and now they needed to be caught somewhere harm reduction was that catching for them. For some people, it's a supplement to treatment. So a lot of these participants talked about, 'I'm in a methadone program, but I also come to the needle exchange,' or, 'I go to 12-step meetings 'cause I like the support, but I don't feel comfortable working the steps, so I go when I feel lonely.
[00:58:40] Sheila: I like being around those people. They're all really nice. There's always coffee. It's a safe space to go. But, you know, I still go to the needle exchange because I want support and I'm still drinking a little bit on the side.' And so hearing how it's not like people on the ground see harm reduction as anti-abstinence, but it's also not that harm [00:59:00] reduction is anti-treatment, but it's also that harm reduction is not anti-12-step and AA.
[00:59:04] Sheila: So what I like about the book is you get to hear about all of these different trajectories that these clients have gone down and the ways in which they've built their own menu of what works for them because they've been able to see that they had so many options in front of them.
[00:59:19] Dominique: I love that. And I think the name says it in and of itself, harm reduction. It's not just one specific thing. It's reducing the harm that's associated with a plethora of things that come with substance use. And I think for families too, they can practice harm reduction in their own way. You don't need to follow a one-size-fits-all approach.
[00:59:35] Dominique: You don't need to do 12-step or nothing else. You can use a combination of different support groups. So I want families to feel empowered that they can also be active participants in harm reduction.
[00:59:45] Sheila: Yes. and I have a whole chapter in there, which I forgot to mention, with parents, family members, and loved ones, I call them concerned significant others in the book, who actually found harm reduction as a helpful substitute or supplement to [01:00:00] Al-Anon groups. Many of them were simultaneously getting harm help while their loved one was getting harm reduction help, and they talked about how harm reduction helped them learn that they did not need to completely detach with love or give their loved one tough love, but it helps them navigate and
[01:00:16] Sheila: negotiate
[01:00:16] Dominique: Yeah.
[01:00:17] Sheila: relationships with their loved one
[01:00:18] Dominique: Absolutely. Absolutely. It's not a one-size-fits-all approach for your loved one, but it's also not a one-size-fits-all approach for you. When I was going to Nar-Anon meetings with my family, I learned the importance of boundaries, I learned the importance of accountability, but I also took the opportunity to learn more about harm reduction and what that actually means and how to implement it into our lives.
[01:00:38] Dominique: So want everyone to walk away with understanding it's a yes and approach.
[01:00:42] Sheila: Everyone's gonna maybe need different things, so like let's have more options rather
[01:00:47] Dominique: Yeah, absolutely. And at different points in your life, you might need different things.
[01:00:50] Dominique: With that being said, I wanna thank you so much for coming onto the show today, sharing your expertise, talking about all of your experiences and how families can play an active role [01:01:00] in harm reduction.
[01:01:00]
[01:01:05] Dominique: Thanks for listening to this episode of For Love of Recovery. If you enjoyed this episode or know somebody who might, please leave a comment and share it. You can also join our Facebook group, siblings for Love of Recovery. If you're looking to have deeper conversations around your siblings drug or alcohol addiction. And remember whether there's hope, there's healing.