It’s Never Too Late

Mike: Welcome everyone to Avoiding the Addiction Affliction, a series brought to you by the Kenosha County Substance Abuse Coalition. I'm Mike McGowan, your host. Today I'm pleased to have as our guest, Dr. James Dimitri Topitzes, did I get it right? Dimitri

Dimitri: That's good, that's in the ballpark

Mike: Of the Helen Bader School of Social Welfare at the University of Wisconsin, Milwaukee.

Mike: Dimitri teaches trauma counseling to master's students and philosophy of science to doctoral students today, our discussion is going to be about substance abuse, adverse childhood experiences, and the wrecking ball that all those roads and alleys take us down. Well, welcome. And thanks for joining us Dimitri.

Dimitri: It's my pleasure, Mike, thank you for having me,

Mike: You know, I know we're going to go down a bunch of alleys, but before we start, could you just give us a brief explanation of what adverse childhood experiences or ACEs are?

Dimitri: Sure, sure. So ACEs at a very general level refer to potential traumatic experiences that people have when their children, before the age of 18 and by use of this term trauma, what we mean is.

Dimitri: Sort of trauma writ large. It's a, it's an expansive term in this context, we mean both those kind of dramatic big T traumas that one can point to as an acute experience, like exposure to parental intimate partner violence, where they have these discrete events that are violent in the home, but it also means it also refers to exposure to more subtle chronic experiences of adversity that really accumulate over time, like exposure to.

Dimitri: Uh, mental health problems within the household. So this term adverse childhood experiences was popularized by a study Seminole study that was conducted in the late 1990s in San Diego, California. And in that study, ACEs were defined as 10 distinct experiences, five forms of child abuse and neglect and five forms of household dysfunction, the child abuse and neglect experiences included child physical, sexual, and emotional abuse. Um, along with child, uh, physical and emotional neglect, and the household dysfunctions were five distinct ones, including exposure to household behavioral health problems like addiction.

Dimitri: My, my parents or one of my parents, has alcohol dependence exposure to parental mental health problems like anxiety or depression. Exposure to parental separation or divorce exposure to parental criminality and an exposure to intimate partner violence. So those were the 10 original conventional ACEs defined by this study in San Diego.

Dimitri: And since that time, a few research groups, including a group that I belong to led by my good friend, Josh Mirsky at UWM Milwaukee. We've identified. Additional ACEs that young people can be exposed to not just within the household, but also outside the household. Like for instance, violent crime within the community.

Dimitri: Like for instance, significant, fiscal or financial pressures, poverty within the household, like for instance bullying. So there are a number of different adverse childhood experiences to which one can be exposed, that can really alter the trajectory of one's life course.

Mike: Well, okay. So everybody who's listening probably goes, okay. That's me. That's a lot of us. That absolutely is me.

Dimitri: Yeah. So there's all, there's just a bunch of caveats to this Mike. I mean, number one. Very very common. These are much more common than we ever than we ever believed. So this Seminole study conducted by, two researchers, Vincent Felitti and Robert Anda doesn't much matter, but the Seminole study kept coming out of San Diego.

Dimitri: It showed us that wow, these experiences are so much more prevalent and common than we ever believed. Now, will they ultimately result in really significant behavioral health problems like addiction, mental health problems. Mental, uh, like depression or anxiety or physical health problems later in life, like heart disease or cancer, CLPD, cardio obstructive pulmonary disorder.

Dimitri: These ACEs actually increase the probability that I could experience any one of a number of different health-related challenges. And it increases that in a really interesting way with each additional ACE type ACE type, not ACE event, but ACE type that I experienced, I have an increased probability of these, of these different health-related challenges and other related challenges.

Dimitri: Now the question becomes, well, jeez I've had one or two or three of these different ACE types. Am I destined to a life of poor health, poor behavioral health, poor mental health. What have you? My, in my destined to a life of lower functioning than I hope, then I would want, that is optimal. The answer is of course, no.

Dimitri: And there are. Caveats and questions here, Mike. So number one. Well, how many ACE types did I experience? We often ask that question. The more ACE types I experience, the more likely I'm gonna have some trouble. Well, what was the severity of that ACE type? There's different levels of severity. And now we don't want to compare people suffering.

Dimitri: Not all experiences of physical abuse for instance are equal. Was it, how often did it happen? Did it result in damage? How chronic did it take place over a really long period of time or just a short period of time? Who was the source of that abuse? My caregiver was going to make it a little more consequential, much more consequential, or was it some, someone outside the house?

Dimitri: So we have to ask questions about the experiences themselves and dig into these ACEs. The second question, and perhaps more important question is what about corrective experiences or protective factors? Something that we could, we could talk about at length? Did I have corrective experiences over time?

Dimitri: Was there a loved one who took care of me and really protected me, or at least gave me, provided me solace? Um, over time, did I engage in relationships that were really, really supportive? Were there programs that I was able to connect with as a young person? Did I really love school? Was there a teacher that, that really connected with me?

Dimitri: Was there a coach that really cared about me and I, and I connected with, as I get older, did I have a romantic relationship that ultimately was corrective? Did I enter into recovery that ultimately was really corrective for me? Did I have a therapist that was really corrective? It did I, did I engage in a spiritual practice that ultimately was really corrective for me.

Dimitri: So these aren't life sentences, um, we're malleable, we're plastic, but these increase the probability that I could have some trouble. And then the question becomes. Can there be some protective factors that mitigate these, these, these effects, if that I hope that made sense.

Mike: Yeah. Well, you need those, right? Because if you're take us back to when the child is a child, if you're growing up in those sorts of circumstances, Where do you learn what a healthy relationship looks like? Healthy communication, intimacy, all of those sayings. So, you know, that's all behavior that a lot of people who don't live in these circumstances probably take for granted.

Mike: But if you live in them, you've got to learn them later than you would have observed them. If you live in a healthy family.

Dimitri: That's exactly right. So if I grow up in a household where there are a lot of these ACEs present, um, and I don't, my, my, my caregivers are the adults in the home. Haven't modeled healthy, relational, interactive patterns.

Dimitri: Um, maybe I don't have a strong or secure attachment to my caregivers in part because of the, the, the environment. Now all of a sudden, I've got to learn all of these skills, uh, perhaps outside the context of, um, of my immediate nuclear family and the good news is that it's possible. It's not, again, it's not like it's a life-sentence.

Dimitri: That. All right. I've been exposed to a lot of these adversities and now I'm doomed. No, not at all. It's a little more difficult to learn these, these processes later in life. Good, good relational habits, particularly good intimate relational habits. It can be more challenging to learn these, these skills and processes later in life.

Dimitri: Nonetheless, it's certainly possible because we are plastic. We are malleable. We are, um, uh, we can grow, um, and. So we can develop better intimate relationship skills, um, just by virtue of having really healthy, corrective relationships over time. Maybe those are formal relationships with service providers, maybe they're with loved ones that, um, you know, that we develop spontaneous and loving relationships with.

Dimitri: Maybe, maybe it's both. Um, but there's something in the attachment field. It's a really cool, really cool concept called earned secure attachment. It means that even if I didn't have a. Um, really positive experience as a, as a, uh, as a child in my household, I didn't develop a secure attachment with my parents.

Dimitri: I can still learn how to do that as a youth or as a young adult or as an adult, I can learn how to develop secure attachment, um, uh, behavioral patterns in my intimate relationship. It's it takes a little effort, um, but it's not impossible, so that it's a hopeful, that's a hopeful story we want to. We want to be sober.

Dimitri: We want to like recognize the challenges that face us while at the same time we want to do that with an understanding that growth and healing and transformation are absolutely possible.

Mike: You know, I, I work with a lot of, in a lot of schools. And so after I do a talk, I have tons of kids come up and talk to me.

Mike: And one of the things that I observe is, especially in early adolescence The difficulty with those relationships, you're talking about include boundaries. Then if they didn't see them, oftentimes they don't know where healthy begins and ends and unhealthy starts. And so it's not unusual for early teens to engage in unhealthy relationships because they don't necessarily observe what healthy looks like.

Dimitri: Really well said, Mike, I mean, I think there are potentially at least two dynamics going on here. Number one, I think it's the adolescent's task. To explore. So they explore their own, you know, their own boundaries, their own power and in doing so they make mistakes, they're testing. But I think what you're talking about perhaps is, is something a little bit deeper, um, where children haven't learned boundaries and perhaps what underlies that.

Dimitri: Is, um, an inability and inability to value themselves. And perhaps what underlies that is that they haven't necessarily been consistently valued, um, within their nuclear family. Not because they aren't loved, not because. Um, their caregivers don't adore them, but perhaps because their caregivers themselves, haven't learned the skills of, um, sort of a self-affirmation, um, and then affirm their children.

Dimitri: So I think a lot of times when I see boundary challenges in youth where they let other people in, in, in sort of incur on their boundaries, um, or they incur on other, other children's or other youths boundaries. Oftentimes what I think about it this is a child perhaps that might not have been shown the kind of consistent value that leads to good self image and ultimately then leads to good to good boundaries.

Mike: Yeah. You know, it just, as you say that we, you know, we have a pretty diverse audience from therapists to recovering people, to people looking for an answer. And I've had a lot of recovering people on here, and I know that they're, they just listen to your last response and their guilt response just clicked in for their own children.

Mike: You know, you teach, you teach a class, a in parent child interaction. So I'm, now let's say I'm recovering, right? How do you reconnect? How do you correct some of those, what can you do as the child perhaps is older or no matter what age a child is now that you're in recovery?

Dimitri: Yeah. So the, so the first thing I say, I'd say as I really, really great catch, and I want to return to something that I mentioned earlier.

Dimitri: It's not because of the caregivers, you know, lack of love for their child, that perhaps, you know, they, they may not have interacted with their child in ways that they would have, you know, are optimal or they would see as optimal. But again, you know, we can alter those relationships. And so I think there are three dimensions to consider.

Dimitri: The first is particularly for older children. The first is to consider myself as a model. So if I'm in recovery, like what a wonderful gift I'm giving my child, I'm giving that child, you know, this gift of, um, Uh, of transformation that recognition, that transformation is possible. You know, maybe I've made some mistakes, what parent doesn't, um, and maybe I've, um, you know, I've, uh, I've also engaged in, um, addictive behaviors and now I'm, um, I'm, I'm altering that I'm changing that with the help of others, with the help of the program, with the help of a higher power, whatever, whatever it might be.

Dimitri: Um, what a great message I'm sending my child without saying a word. But just by showing them that that transformation, that growth throughout the life course is not only possible, but wonderful. That's really attractive. It's really a Loring. So I think the first gift that we give our children is the gift of, of, of modeling to give them an example, um, and that I can rest in the, in the solace arrest in the notion that.

Dimitri: Well, I'm, I'm, I'm working my tail off, um, to engage in healthy behaviors, transformation, et cetera. And again, that's a great message that I'm sending to my child the second and third messages or the third sort of dynamics. Um, or sort of that I would identify number one, bonding. I want to think about, right.

Dimitri: How can I bond with my child connect with my child in ways that are absolutely, uh, um, developmentally appropriate. So it's going to be different for a young child. Versus an older child. And oftentimes we think that older children, adolescents, for instance, don't, they're there they're resistant to us.

Dimitri: They don't want our time and attention. I could not, I, I I'd really like to counter that message. They need our time and attention just in different ways than, than, than when they were younger. Um, So I think, um, if I can really creatively and authentically figure out ways to give my child my attention, whatever the age, um, I think that is an incredibly beneficial, um, a beneficial sort of activity, a beneficial idea.

Dimitri: There's nothing like parental attention. So for older kids, there's a, there's an intervention or a sort of a, an element of an intervention called special time where I just sit down with my kid. And I give them 15 minutes of my undivided attention without advice. I'm not, I'm not giving them advice. I'm just listening to them.

Dimitri: So if I can creatively think about ways to connect with my child and give them my attention, what a great gift aside from my modeling and third gift child is the gift of, um, High expectations and good and good boundaries. So, and I think all of these things together, all of these forces combined, no matter what, the age or developmental stage of the child, um, ultimately I think direct us toward really healthy parenting.

Dimitri: And if I have, if I feel like. Um, I've um, I faltered a little bit to date. That doesn't mean I don't have the opportunity to correct course. Absolutely.

Mike: Well, you must have to throw in a healthy dose of patience because there's been burning in the pot, on the stove. It's going to take awhile to clean out the debris, right?

Dimitri: Yeah. And I think in part that's what the special time is all about. Maybe I'm going to have to listen to some concerns or complaints. Um, and if I can do so with an, with an open heart, um, uh, with, um, you know, a sense of forgiveness for myself first and foremost, um, that that would be wonderful. But even though, you know, particular, if I have an older child, even if that older child has concerns and valid complaints about, you know, what her, his, or their history has brought, that doesn't mean that.

Dimitri: I stop playing the role of a parent, including parent playing the role of a parent who has high expectations and who does implement boundaries when needed. Um, so I, I totally agree with you. I might have to, you know, I might have to, uh, employ some patience self-forgiveness, um, I think it goes an incredibly long way.

Dimitri: It isn't, it is, it is a critical part of recovery, um, in my estimation. Um, but, um, when I implement. Those values and those practices, I think it can direct me, um, toward really healthy parenting practices as well.

Mike: You know? Um, I, I worked as a family awhile back where the dad got into recovery later than you would have liked him to.

Mike: And so the children were, uh, late teens to early twenties and there were three of them. And in the dad's recovery, one of the children literally would not speak to him ever, ever again. Period. End of sentence. Another one, uh, met him on her grounds whenever she felt like she could handle it. And the third.

Mike: Uh, accepted him, uh, just with open arms and they asked me which one of us is. Right, right. I don't know. I said, uh, all of you.

Dimitri: Exactly right, exactly.

Mike: I can't set the boundary for you.

Dimitri: Right, right, exactly. Now for, for, for the, for the, for the parent, um, you know, if, if the parent can come to that conclusion also, like everyone is going on their own journey, just like the parent was on.

Dimitri: I believe it was a, is a, is a male is on his own journey. Um, everyone's on their own journey. And if I can, you know, allow that to the best of my ability to be present when, when, when I can be. Um, to that journey then, um, that then great, you know, uh, that takes a, it takes a lot of recovery. It takes a lot, a lot of recovery in my estimation, um, to get to that point, um, big heartedness again, self-acceptance self-compassion self-forgiveness um, but it's a good place to be in a good place to shoot for.

Mike: Yeah. That's a lot of serenity prayer, right?

Dimitri: Well said. Yeah.

Mike: You also, um, teach a class if, let me get this right. Uh, at UWM community building in mindfulness, right?

Dimitri: Yes. I teach that with my, with my wife, my partner, Debbie Davis.

Mike: Oh, I didn't know that. Alright. Uh, would be great to watch. That would be great to watch.

Dimitri: Uh, we love it.

Mike: Yeah. Do you ever argue over content?

Dimitri: A lot of, uh, yes we do, but it's also been, yeah, but it's also been, um, you know, a really great, uh, outlet for us to, you know, to, to work together and to develop our, um, Uh, our sort of relational skills or communication skills. So yeah, early on, particularly we had some disagreements about content, but now it's, I think we're in a place where we're really complimenting one another and really enjoying working together for the very most part.

Dimitri: It's really fun.

Mike: Okay. That is awesome. I used to watch a show on PBS on Saturday mornings where a married couple, uh, would remodel houses and watching them stand in the same bathtub and tile was just mind boggling. So I think it's great. If you can get to the place you're at, I think there's a lot of work there.

Mike: That's great. Going back to community, building mindfulness and especially given this time period, Dimitri, um, I'm, I'm an, as I said, in a lot of schools and what we have seen almost universally is a regression of social and emotional skills. I mean, uh, the most common. Statement that I get is our eighth graders are sixth graders.

Dimitri: Wow.

Mike: And, and I think that whether it's the isolation, the anger that we've seen expressed everywhere, the division, um, we've lost some stuff. So I think that class and community building mindfulness is, is critical. So what in communities do to build resilience and healthy lifestyles, not just for the kids who are experiencing ACEs but for all of our kids,

Dimitri: Yeah, really well said.

Dimitri: Um, it's a great question. I think, uh, first, you know, first and foremost, and this is going to sound really quite familiar, you know, for, for those of us who are, who are really interested in recovery. Yeah, first and foremost, we want to be models of, of self care. Um, as, as adults working in schools, perhaps as, as a, as a, as a professor of students, um, who are learning, um, counseling skills, for instance, I want to be a model of, to some extent of self care, uh, of, um, So I, I, I fear I I'm sort of low to use this word, but, you know, striving to, to sort of optimize my functioning.

Dimitri: Um, so that, you know, I have, these are difficult days, you know, we're all, you know, we're, I'm working from home. It's, it's, it's easy to blur the boundaries between work. And, and personal life. And there was a recent article in New York times suggesting that many of us are experiencing not necessarily depression, but it's kind of sense of languishing.

Dimitri: Um, so I think it's a really good time for adults to, to put into practice very consciously and mindfully. Kind of, uh, our, our personal, our personal plans for wellness, for self care, whatever the term, optimal functioning, whatever the term might be. So we're, we're really, we're really modeling how to care for ourselves, um, how to value our lives, how to value our time.

Dimitri: Um, whatever that looks like, you know, there are in, in the counseling field, there are a lot of different, um, a lot of different recommendations for. Uh, for those types of self-care practices that really enhance functioning both within and outside of work, what does it include? Strong social connections, obviously.

Dimitri: Um, physical health exercise, eating well, um, Spiritual health connecting with a spiritual practice, whatever that might be, or a spiritual community, religious or spiritual, um, doesn't matter, creative outlets, um, et cetera. So just ensuring that, you know, we're mindfully consciously, intentionally taking care of ourselves, number that number two, um, that we are.

Dimitri: As adults that we are cultivating, um, good relationships with our peers first and foremost here to the best of our ability, you know, Uh, school environment, a departmental environment at a university. I think about my department, we set the tone for our students to some extent. So are we cultivating good relationships with our peers?

Dimitri: There's a process called community building workshops, which I've learned, which really helps staff. At schools or at social service agencies, it helps them enhance their communication style and their authentic connection with one another, whatever can strengthen an organizational school or agency culture, um, and strengthen the relationships between the adults, I think is a really good thing for the students.

Dimitri: For, for the children. It sets the tone. If you will, um, the CBW is one way to do it, but the community-building workshops one way to do it. And we teach our students this because they're going to go into schools or agencies, mental health clinics, et cetera. Um, and this is one way for them to strengthen their connection with their colleagues, um, and model good relational skills with their, um, with their charges, if you will, the people that they serve.

Dimitri: So strengthening relationships and then, and then obviously, Strengthening relationships with children like this is optimal functioning, particularly at the socio-emotional level takes place within the context of relationships. We all, we all know that. So to the extent that I have the energy and the skills to, um, to deepen my relationship or strengthen my relationship with my students.

Dimitri: Great. Now all of this is a really tall order when we're also asking teachers to go online. Some of the time like transform their material to online. Et cetera. So I, I'm not, I'm not trying to, uh, introduce imperatives that have to be followed in that. Just add more, add more weight to an already burdensome time period.

Dimitri: And I recognize we're asking so much of our teachers, of our parents who are staying home and, and helping their children. I get all this, but, um, perhaps, you know, just the reminder that self care and a focus on relationships I think is really where, um, optimal functioning ultimately comes from in my experience.

Mike: I think that's a great place to wrap that because the self care is what I think we are neglecting and a lot of places the anger, the rage, the anxiety is right underneath the surface. And if we recognize that we can do better, I think.

Dimitri: Totally agree.

Dimitri: Yeah. Dimitri, this has been, um, great. Next time. I'll have your wife on with you and we can watch you guys.

Dimitri: That'd be great. I will talk much less, uh, often.

Mike: Well for the listener, you know this, but, uh, Dimitri's contact information is attached to the podcast. Thank you so much for being with us today and the listeners, we invite you all to listen in next time. When, again, we'll discuss other topics regarding substance use disorders. We look forward to sharing the air with you then until then stay safe and do take care of yourselves.