Just Get Help

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction brought to you by the Kenosha County Substance Use Disorder Coalition and Westwords Consulting. I'm Mike McGowan.

Mike: Just get help. That's a phrase often used by people who know or care about somebody with a substance use disorder. Like just getting help is a snap of the finger easy thing to do. Our conversation today is about the hurdles needed to be jumped in order to get Into substance abuse recovery.

Mike: My guest today is Nanci Schiman. Nanci has joined us before. She is a licensed clinical social worker with Arenda Counseling Services in Cedarburg, Wisconsin. Nanci has over two decades of experience in the mental health field working with adolescents, adults, families, and couples.

Mike: She works with clients on a variety of mental health and addiction issues. She's a National Association of Social Workers member and an EMDR International Association member.

Mike: Welcome back, Nanci.

Nanci: Thanks, Mike. It's always glad to be here.

Mike: Yeah, thanks for joining us. Okay, so I know you've worked extensively with substance use disorders.

Mike: I'd like to walk through the process. It's an issue, I think, and a topic that we we skip over sometimes, and it's a pretty big step, right?

Nanci: Yes.

Mike: And so first, now, this has been my experience, maybe it's not everybody's. Most people, it seems, are leveraged into getting help. They don't come begging you for help unless something big has happened and a lot of life consequences have finally piled up.

Mike: Yeah, or no?

Nanci: I think that's true for a lot of people, whether it's that they're leveraged by others, or they become so sick and tired or so scared of the direction their life's going. Something big has to happen to sort of be a catalyst for that change.

Mike: So somebody finally says, Fine, I'll get help!

Mike: Now, that seems like, oh, we're done. We're done? We're not even started, right? What's the next question? Where? Who pays? Insurance? All of the above?

Nanci: I think all of those questions, you know, when somebody agrees to get help let's take the first scenario where their family or friends are leveraging them.

Nanci: One of the questions I have in my mind as a therapist is, are they doing this to get people off their back or are they actually invested in this? And so I see my role as helping them to find some intrinsic motivation that they may buy into beyond just getting people off their back. Cause I think we all know people that like, fine, I'll go over, they do the 28 days and then the whole time they're planning when their first drink is going to be.

Nanci: But let's say that they've actually said, okay, you know, there's something to this then. Yes, I guess the good news and the bad news is there's so many options. Some people go into a inpatient or a residential treatment program, where they're completely isolated from the triggers and the temptations.

Nanci: And that comes with a whole lot of issues about finances, insurance, things like that. Other people try to use 12 step programs like AA. Some people try like an intensive outpatient program where they're going for a couple hours a day. Again, all of this depends on insurance and what's available.

Nanci: Sometimes places don't have availability and they're on a waiting list. So it's unfortunately it's not quite that simple as you alluded to.

Mike: Right. I used to watch this show. I haven't watched it for a while now called Intervention. Right. It was on Arts and Entertainment Network or whatever, and it was a group of loved ones gathered secretly and planned an intervention, presented their concerns, and then if the person said they'd get help, the facilitator would whisk them away, usually on an airplane to some place on a coast.

Mike: And they were greeted with open arms, right? And, and the production company would pay for it. Now, let's get back to real life. In real life, you talked about there's a wait time, oftentimes, between getting help. What do you do to bridge that wait time between getting into a therapist, even a therapist's office, because so many counselors I know have full loads, or a treatment facility?

Mike: What can somebody do who's listening to this, who's maybe waiting to get help?

Nanci: Well, I have my own biases, so I'll be very straightforward with that. You know, there's one place that doesn't have waiting lists. It doesn't cost anything. And that is. around here very accessible and that is, you know, a 12 step program, specifically AA or NA.

Nanci: There are other types of recovery programs, again, that don't cost anything. That can be challenging because it takes some courage to walk into this unknown place. I remember my own experience was, I was scared to death. I thought I had nothing in common with everyone. And I walked in there and I thought, why are all these people happy?

Nanci: You know, pathetic people can't drink. Very, very judgmental, which was just part of my disease. But you know, it's there at almost any time, you know, in the greater Milwaukee area and the surrounding areas, you can find meetings, you know, multiple times a day. And since the pandemic, we've got them online.

Nanci: You can go to a meeting in Ireland if you want. Yeah, it's very accessible, but that does require some self discipline. But I guess that would be my first thought is to connect with a community where you have people that are going to support you until you can get more structure.

Mike: The nice thing, you're talking about a suburban area, but the nice thing is that structure, support group meetings are, well, as you said, online. But they're also available, it's the one thing that actually is available in many of the rural parts of this country, and not much else is sometimes.

Mike: Okay, since you volunteered that information, I've got to ask you, because... okay, I'll just make it up because I'm sure none of these take places in a church, right? You pull up to the church and the meeting's in the basement. How do you get yourself from the parking lot to the basement without turning back around?

Nanci: It's a great question. I think part of that comes from do you want it badly enough and the people that I've talked to who are in recovery whether brand new or you know decades of recovery say at some point they're so sick and tired of the way their life's going. They were sick and tired of hating themselves that they're like, I'll do anything just about.

Nanci: And so I think that can be a big push. I just moved. And so I'm finding new meetings where I am. And I went to one and it's listed, but it was a church and it was huge. And there's all these different parking lots. So I walk in and I'm like, I have no idea. So I just walked up to the receptionist and said, where's the AA meeting? Now I'm comfortable doing that, but I don't expect that somebody brand new is going to be in any place where they're able to do that. It certainly can help if somebody can go with them, you know, even if it's to find an open meeting, you know, because most 12 step meetings are closed meetings because of the anonymity and the confidentiality, but they're also usually every weekend, there's an open meeting somewhere where anybody can go.

Nanci: Somebody gets up and they tell their story. And it can really resonate and then you have access to people to kind of say, okay, we're here to help you.

Mike: And an open meeting is more like you can just sit there and listen to a speaker, right?

Nanci: Nobody's going to call on you. Nobody's going to look at you. You can kind of fade into the woodwork.

Mike: And if somebody goes to even a closed meeting thinking I have a problem, they're not forced to speak. They can say pass, right?

Nanci: Absolutely. Yeah. So, you know, a lot of times, you know, I couldn't figure out why everybody knew that I was new until I realized that everybody else knew themselves. And I walked in looking like an absolute terrified, you know, on the verge of tears, middle aged woman.

Nanci: And so they do what's called a first step meeting. And so I get whisked into this other room and but it was just the surrounding of support. But even in those situations, if somebody says, I'm not ready to talk, nobody's going to force them to.

Mike: Right. Right. Well, I, you know, what we're trying to do with this is just take away some of that uncomfortability because that would be part of it.

Mike: When I was reading your bio, it said that for you that therapy is a collaborative endeavor where the client is the expert on their own life. Okay. So given that now let's, we just talked about somebody who recognizes as a problem, but therapists, a lot of whom listen to this program, yourself.

Mike: You get people that come to you without realizing or without acknowledging that substance use disorders are a problem for them or the main problem. So at some point, you're going to bring it up to them. At some point, you're going to say, how do you say it? What do you say?

Nanci: Well, if the conversation... I'm thinking about, you know, some of the conversations I've had, and if they're telling me about a situation where some bad things happened, and I'm not talking like, you know, going to jail or anything, but they were embarrassed. They don't remember what happened. You know, we start talking about, well, how are you feeling about that? Has that ever happened to you before? What would you have liked to be different? Anything to sort of engage them in going a little deeper and then considering, is this something that you are concerned about because it's happened before or it might happen again?

Nanci: Or we'll talk about, so what would it be like if this happens the next time you go to a party? Or what were you afraid might have happened or what was it like to not remember? And once they are acknowledging that there's a problem at some level. You know, getting beyond the, Oh, that will never happen again.

Nanci: Because quite frankly, if that's their attitude, I don't think they're going to tell me about it.

Mike: Right.

Nanci: So the fact that they're bringing it up at all says I'm not feeling comfortable about this. So validating them really acknowledging their feelings, letting them know that they're not alone and offering them some alternatives.

Nanci: And that's where them being the expert on themselves is important because I can bring suggestions. But I'm always very clear that look, I'm going to throw out suggestions. Your job is to tell me what you think will work and what won't, because I'm not going to push something on you that you're absolutely against.

Nanci: So if I bring up, for example, AA and somebody's like, Nope, that's that whole God thing. I don't want to go there. Okay. Maybe we'll have a conversation about that and I'll check in on what they believe and what they've heard versus maybe what is reality. But I'm also going to be respectful if that's just not where they want to be.

Nanci: And then we look at other things, so that's not the only option.

Mike: I would imagine every counselor has their own style and the way they approach things. I remember the woman who my mom saw, as my mom was with her head in her hands in the hallway at a hospital, walked down the hallway, clickety click, took a seat next to my mom, and the first words out of her mouth were, Audren, you're an alcoholic. (laugh)

Mike: So there's everything in between, right? Whatever you're comfortable with.

Nanci: Yeah, and it's not to say that I won't be very blunt. It really depends on the situation. It's like, read the room. You know, you gotta know your client and see what's gonna work. And even in my own experience, my first sponsor was someone who was pretty blunt, and I needed that.

Mike: Well, I had a kid once say to me, and I assume this is also part of your therapy and everybody else's, is, okay, now that you're taking away my main coping mechanism, I know they don't put it that way. What are you gonna gimme instead? You're, you know, the guy said to me, you're, "Mr. Don't take something away unless you replace it with something." It caught me a little bit upside the head. Right? You need something else to take the, whatever that is. What styles do you find is effective? You do EMDR, right?

Nanci: Yes.

Mike: Does that work with substance abuse?

Nanci: It's a great, great question. So EMDR is eye movement desensitization and reprocessing.

Nanci: And it's used for treating trauma primarily. And what I have found the longer I'm in this field is that a lot of what people come in with is related to trauma. And trauma looks different on every person. It isn't the car accident, the, you know, being assaulted in a back alley. It trauma can be growing up in a household where you were expected to suck up your feelings and be the nice cooperative child and you didn't have anybody who you could talk to you about things that were were going on. Trauma can be not, you know, being exposed to violence and other people in the home. It's a whole range of things. So my experience for the most part is and you obviously, I'm sure you with all of the years you've experienced you have might have some other thoughts on this.

Nanci: We don't just drink and numb ourselves out just for the fun of it. We're usually trying to escape from something.

Mike: Right.

Nanci: And so acknowledging that and acknowledging that there is pain and discussing how do we go about healing that pain? Because a lot of people are like, we're not going to go there.

Nanci: I don't want to touch that. You know, you're not going to get into that yucky stuff. It's sort of a combination process of like, okay, so here's some of the stuff that's going on underneath that you're resolving by drinking or drugging. Or shopping or overexercising or whatever and we want to address that.

Nanci: It's going to be hard to address it if you're still anesthetizing yourself. So we got to help you come up with some other ways to roll through those emotional tidal waves that come in. And so teaching some skills for grounding, centering themselves getting through that wave. So I realize that didn't really answer your question about EMDR, but I guess that's a back up to that.

Mike: That's one of the techniques to do that, right?

Nanci: Yeah. I wouldn't typically start somebody out if they're brand new and starting to tackle recovery. I'm not sure that I would throw EMDR in there right away because that's an awful lot of stuff. They're just trying to figure out how to get through every 24 hours without drinking.

Nanci: And EMDR is going to stir up some stuff. And so I think giving somebody a chance to get a little bit of kind of get their sea legs before we go into some of that deeper stuff. But it is important. It's not going to go away.

Mike: Well, since you do family and couples as well, let's do the flip side of that whole therapy equation.

Mike: And you touched on it before. Some clients tell their family members, and it sounds just like, Fine!, I'll go to counseling, right? That sounds enthusiastic. And then go a couple of times and dismiss it as BS, ineffective, or the old gaslighting, I did what you asked! And then quit. Now I'm sure it never happens to you, but loved ones also here about the counselor.

Mike: She doesn't know what the heck she's talking about. It's a waste of money, right?

Nanci: Oh, I've had that happen.

Mike: Yeah. Well, I know. And it's like, yeah, we don't know what we're talking about. And then that's reinforced with, I was talking to my buddy down at the... And then the person quits. How does a concerned person respond to those diversion tactics?

Mike: If you're working with like the partner of somebody who wants to go through that, or an adolescent who says to their folks, there ain't no way I'm going back to that wonderful woman. Right?

Nanci: Yeah.

Nanci: I have an approach that others may or may not agree with, but I try to manage the expectations of the family members.

Nanci: I've had plenty of people come in saying, I really need my partner to go into therapy.

Mike: Yeah.

Nanci: And I'm like, okay, so they go to therapy, then what? You have no idea what they're talking about in therapy. You have no idea what their goals are. I recently had somebody who came in and specifically because their partner wanted them to go and I said, okay, that's fine.

Nanci: Why do you want to be here? Or do you want to be here? Because there's no point in going any further. So getting them invested in whatever is motivating for them. But I think letting family members know that you can't push them into it and expect that that's going to cure them.

Mike: You know, there's an old saying, you can't con a con.

Mike: Can you tell when somebody is serious about recovery?

Nanci: I've been in family therapy and I've sometimes been the person to basically say, cut the BS. I've been in meetings where somebody has just, you know, let somebody ramble on and dig a hole for themselves and then go, okay.

Nanci: That's garbage. Let's start over again. Now tell me, you know, what's really going on. So yeah, I mean, you can't always, but certainly you can tell, I think it's easier to tell when somebody's serious about it than when they're just trying to go through the motions.

Mike: This may be a dumb question, but I think about it sometimes.

Mike: Does quitting therapy or treatment make it easier or harder to get back into it?

Nanci: Get back into therapy?

Mike: Yes, yes. Like if you quit something, does the shame, the guilt, when you realize you shouldn't have quit it, does it make it easier to go back into it because you now know what it's about, you know where it is?

Mike: Or does it make it more difficult because of your pride?

Nanci: I'd say both. It really depends on the person. I've heard people say, I don't think I have another recovery in me.

Mike: I hear that.

Nanci: I have heard people say, you know, I went to therapy and I wasn't ready to do the work, or I was in treatment and I wasn't ready to do the work.

Nanci: And then they come back around. So I would say if you spent any time in either, unless you've just had a horrible experience and there are, you know, therapists range in quality, just like any other profession. But if you've had any positive experience in there. Just because you leave you didn't unlearn the things you learned.

Mike: Right.

Mike: I used to have my counselor say and they used to list this is a problem. She's treatment savvy.

Nanci: Resistant?

Mike: No savvy like and I'm like why is that a bad thing? If they know what treatment is like, don't you expect more of them? If I know the offense, then go shoot the ball, right?

Nanci: Right.

Nanci: I wonder if their term of that was they know how to play the game.

Mike: Well, right. That's what they were saying.

Nanci: Yeah, that doesn't sound like that's a compliment. It's this is somebody who knows how to do what they need to do to get out of there. And we've all heard people who said, yeah, I went in there and I just did what I had to do.

Nanci: I've seen that a lot with adolescents and they're smart, you know, and that's where I try to play on that skill and say, look, you clearly have a lot of really great talents. To be able to, you know, figure out how to beat the system. How else do you want to use those talents?

Mike: Right. Yeah, I mean, because at some point, you never really know.

Mike: I've had arguments with people where they say, Oh, I always assume that the client is telling me the truth. And I'm like, really? I don't. Because you don't know, right? You never know if what you're getting is the truth. Or even if the truth as they see it might be different than the truth their boss, their partner, their children.

Nanci: Yeah. And I think, you know, the, I always am under the assumption that I'm going to get a filtered version. And it's one of the things I love about my job is, you know, especially as I get to know my clients and some of them I've worked with for years, I can just tell by the way they walk into my office or the look on their face, that there's something that they're struggling with.

Nanci: Am I going to tell my therapist this or not? And, usually they end up, but you know, there's that struggle. And then I've also had clients where I had no idea the degree to which they were fabricating. But yeah, the most part, I think you kind of know, but yeah, I don't expect people are going to tell me everything because they want to present themselves in a positive light.

Mike: I spent a long time working with adolescents and I would bump into them into adulthood and we'd start to talk in a Target or a store and they would just grab my arm and say, Oh, hey. When you were working with me, this, this, this was going on. Would that have helped if you would have known? (laugh) And, and I, well, maybe a little.

Mike: We certainly wouldn't have wasted all that time on other things that weren't the problem.

Nanci: Yes, I had somebody, it was a newer client, but the other day, you know, I thought we'd gotten through the whole history. We're getting ready to start. She's, Oh, there's this thing that maybe would be helpful for you to know.

Nanci: And I was like, when she got done, I'm like, yeah, that just became like the core.

Mike: Yeah. Right. But yeah, I'm, I'm cheating on my partner. I've embezzled from work and I'm on the run. Right.

Mike: Okay. If this is a disease it is and relapse is common. How do you talk about it without making it to the client sound inevitable?

Nanci: I usually don't bring it up unless it seems like that's a direction that needs to be addressed. Interestingly, I had somebody the other day was talking about a loved one and they said, well, I know they're going to relapse. And I said, well, we'll hold it right there. Don't assume that's an absolute.

Nanci: Yes, sometimes people relapse, but there are people that get into recovery and they don't.

Mike: Yeah. My mom didn't.

Nanci: And yeah, or they don't for 20 years. So I wouldn't build that in as being an expected part of the recovery path, because now you've set somebody up with an out. So the only thing I really bring up is that if you feel like you're going to pick up any or use. Let's talk about the safety plan. What are you going to do? And then and if for some reason you still end up picking up you got to come right back in. And that's why I always say it's so important to go to a lot of meetings because you see people come back after a relapse And you see that they are not shamed.

Nanci: They are not rejected. They are not criticized. They're supported and they're welcomed back in. It doesn't mean that they're coddled, you know, if there's stuff going on there, people will say it, but it's important that they know that that's always an option. Because some people are too scared to go back in because of the shame.

Mike: Yeah, I think that's really an important point, which is once you know that, you know, if something does happen, it does take away a lot of the shame of going back in, knowing that you're going to be accepted because we're just all human, right?

Nanci: Right.

Mike: So long term, you know, if somebody's been relying upon substances for everything.

Mike: Celebration, coping, grief, whatever, anger. Learning new techniques takes time. Patience is gotta be an essential part of therapy too.

Nanci: Yeah, I think managing my client's expectations is important. Sometimes they're very hard on themselves. And I have had so many clients sit there and say, why is this taking me so long?

Nanci: There's something wrong with me, I'm failing. And so we break it down and look, the first thing is to introduce the idea that you're open to change and let that sink in. And then we look at the next step and the next step. But if you think you're going to go from here all the way over to here in a day or a week.

Nanci: You're going to be disappointed. You didn't get here overnight. You're not going to get out of it overnight.

Mike: How long do you think, I know it's a ballpark, but how long does it take before you feel comfortable? The analogy I use all the time is if I lost the use of my right hand and I had to start doing everything with my left hand, I might be able to do it.

Mike: But before I could feed myself left handed, it would be a quite a while for it felt comfortable that that's who I was.

Nanci: It's building new pathways in your brain. And it doesn't matter how old we are, you know, our brains have a lot of plasticity. So it's kind of like, if you keep cutting across your lawn in a certain path, you know, over time that grass is going to wear down and the ground is going to get flat and it's going to look differently.

Nanci: And if you stop that, and you start walking a different way. It's going to take time for that first path to grow back, and for that other one to form. I used to use the analogies of, you know, all the construction that was happening like on I-43 or whatever, you know. It becomes, you know, eventually you get a nice smooth road again.

Nanci: So, to know that it'll take time, and yes, it will be hard at first, but it's going to get easier and easier and easier. And when we're talking about small to moderate behavioral change, like if you do this consistently for a week, you're going to find that you're not having to do it in such a focused manner, it's going to become automatic.

Nanci: It's like, how many people think about brushing their teeth or what they do when they get in the shower? They just do it.

Mike: Right.

Nanci: And you will get to that point.

Mike: Right. And you don't even know you're there.

Nanci: Right.

Mike: And you know, the well, I'll let you go away on this. There's happiness at the end of the tunnel, right?

Nanci: Yes. Yes. From my own experience and that of people I know both personally and professionally and granted, I only see the people that, you know, keep coming back.

Mike: Right.

Nanci: I don't see the people that fade away, but I hear things like, I never knew my life could be this good. I never knew that I could navigate through problems without, you know, completely imploding.

Nanci: My relationships are better, the way I feel about myself is better, and that's a big one. You know, we start to like ourselves again. So, yeah, people will say, I had no idea that I could have so much fun without alcohol. Or without drugs or whatever. And yeah, because you get to experience it all and remember it all.

Nanci: You know, I think you had said once, why would people go and spend a ton of money on concert tickets and then be obliterated?

Mike: I don't get that.

Nanci: And not remember the experience, yeah. So yes, I think, and for the families too, you know, you know so well that it takes time to rebuild that trust. But once it's rebuilt, it's pretty darn solid and it feels really good.

Mike: Great. Well, this has been terrific. I thought about four different little areas we could dive even deeper in. So maybe we'll do this again shortly.

Nanci: Absolutely.

Mike: As you all know, there's links to Nanci's contact information attached to the podcast if you want to ask her more. Thanks for being with us and sharing your expertise, Nance.

Mike: And for everybody listening, listen anytime you're able. And until we talk to you next time, stay safe, keep going. The destination is worth getting to.

Nanci: Thanks.