New Horizons

[Jaunty Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting and the Kenosha County Substance Abuse Coalition. I'm Mike McGowan. We've heard numerous times here about the need for additional substance abuse resources for underserved populations, and that includes programs for women and children. Well, it makes sense then to highlight exceptional programs that work and to shine a light on those programs for those who aren't familiar with them.

Mike: I have a trio of guests today. From the University of North Carolina School of Medicine Horizons program, a substance use disorder treatment program for pregnant and/or parenting women and their children, including those whose lives have been touched by abuse and violence.

Mike: One of my guests, Dr. Hendree Jones, is a licensed psychologist and an internationally recognized expert in the development and examination of both behavioral and pharmacologic treatments for pregnant women and their children in risky life situations. She was the division director of UNC's Horizons for a decade, stepped aside recently into an advisory role for Horizons in order to take on several new national and international policy projects. She consults for the United Nations in the World Health Organization and is a member of NIH's Heal Multidisciplinary Working Group and the advisory committee on research on Women's Health.

Mike: We also have with us Dr. Elisabeth Johnson, who's the interim division director and a clinical assistant professor at UNC, and is a primary provider for prenatal and wellwoman gynecologic care in Horizons' OBGYN clinic. And last but not least, Chrissy Dunn is an alumni of the Horizons Program, and I hear from Dr. Jones, a proud woman of recovery, you are Chrissy.

Mike: So that's a long introduction, but welcome to all three of you. Thanks for joining us today.

Dr. Johnson: Thank you for having us.

Dr. Jones: Yeah, thanks for having us.

Mike: Let's start with you, Dr. Johnson. Can you tell us a little bit about a Horizon program and what makes it unique?

Dr. Johnson: Oh sure, and I'll ask both Hendree and Chrissy to chime in for anything that I miss. UNC Horizons has been in existence for a little over 30 years, which is quite a long time. And I think one of the things that makes it unique is we are gendered, so we take care of female identifying people and their children and we are one of the few programs that actually has a licensed child psychologist on staff to really be able to provide the dyadic treatment that we know is so incredibly important for the people we take care of.

Dr. Johnson: And as you mentioned in the intro, one of the things that we also really bear in mind and treat is the experience of trauma that so many of the people that we take care of have experienced in their lifetime.

Mike: Yeah. Dr. Jones, you want to add to that?

Dr. Jones: Yeah, I think one of the beautiful things about Horizons is that it is truly comprehensive care. So when a patient comes to Horizons, they're gonna meet with Elisabeth as our medical provider. They're gonna get a case manager that will help them navigate the myriad of complex issues that people run into when they're trying to navigate all sorts of different social systems. They're gonna have the maternal child therapist that is gonna be there, not only for themselves, their child, but their relationship together.

Dr. Jones: They're going to be able to access, a five-star licensed child development center. That then, the child can be screened and assessed and get the services that they need as soon as those issues are identified, so that there's so much preventative care that can happen. There's transportation that's provided, there are therapists that are provided. And so truly it's kind of head to toe, full-person care done in a multidisciplinary team setting.

Mike: And Chrissy, this is a really good time to break this in, you went through it, right?

Chrissy: Yes.

Mike: I'm gonna assume, correct me if this is an incorrect assumption, that it wasn't the first time you accessed treatment at some point?

Chrissy: No, it wasn't.

Mike: Some kind of care, right? So what made it unique for you?

Chrissy: So I was able to take my daughter with me who was nine months, excuse me, she was two months old at the time, and it was a nine-month program. So I was able to like learn how to be a mom and a person in recovery and live like a normal life. I was able to get a job during that time and learn about who I was as a person without drugs and kind of have that safety net of staff and other women in the program going through similar things that I was going through.

Chrissy: And we talked about what life was like before we got into Horizons, when we were in group therapy. It was just a great way to kind of, I say it like I started my new life during that time, because it was like I was able to start over with no judgment and like people really wanted to see me succeed.

Mike: That's great. Dr. Jones, what are the advantages of women accessing a therapeutic environment for women with women?

Dr. Jones: Yeah, thank you so much for that question. You know, what the research will tell us in terms of outcomes, we know that women that are able to access a gender specific treatment program, they report feeling both psychologically safe and physically safe.

Dr. Jones: We know from the research that women that are in mixed gender programs tend to talk less. Men tend to get better, but women often have shorter retentions depending on which studies that you're looking at. And so when you come into a gender specific, women-only program, you get to talk with women or female identifying people about things that are uniquely specific to you. And oftentimes we'll hear, oh my gosh, I thought I was the only one that was feeling that way. Or I thought I was the only one that had experienced physical, psychological, sexual, and emotional abuse. And they find out that they're not, that they're in an amazing company of so many other strong and resilient females.

Dr. Jones: And they also learn to trust each other. And a big part of that is also learning to trust yourself. And so I think that the gender specific environment allows that there's unique conversations to happen. We also know that female identifying patients have unique barriers to care, their stigma and discrimination, which we could talk a lot about, and I'm sure we'll circle back to. But there's also the issue of a higher proportion of patients having co-occurring disorders like anxiety, eating disorders, depression, post-traumatic stress disorder. And so when we know that there's a higher prevalence, then we're going to systematically and carefully screen and be able to have resources that are uniquely specific to being able to deal with those co-occurring disorders.

Chrissy: I'll share. Yeah, it was like a load like released from my shoulders because I was there, I started off by myself with my newborn, and I didn't have to like, pretend that I was something that I wasn't. Like for example, how Dr. Jones said like with men being around, I couldn't really be my true, authentic self out of fear of just, I guess just out of fear and of judgment. And with other women being in the same kind of space that I was in, we did learn to trust each other and we got very vulnerable in groups, which is something that was very new to me, because I was used to just like shoving my feelings and emotions down and not expressing them. So it was very therapeutic to have that experience and to be able to learn who I was without like hiding my emotions and my true self.

Mike: How long has it been Chrissy?

Chrissy: Four and a half years.

Mike: Dr. Jones alluded to it, they say that women who access treatment, the research says, come into that with lower self-esteem. Right? And you just alluded to that a little bit, how long did it take you to get back that sense of, I'm okay? That sense of self?

Chrissy: Sorry I get a little emotional, but.

Mike: Yeah, that's great.

Chrissy: So I don't think I ever really had true, like self-esteem. My self-esteem was always low, from as long as I can remember. So I never knew who I was until I went to Horizons and we did groups of - we did yoga class, and we did art class, and we really explored different areas of hobbies and like all about me type of things. And I share in my story, when I talk to other people entering recovery, about like, I used to not even be able to look at myself in the mirror, and now I look at myself a lot in the mirror 'cause I like what I see and obviously it's a chuckle

Mike: Oh god, a lot of selfies? Well, Dr. Johnson, that's not unusual, is it? To have that, and the co-occuring mental illnesses that come with it?

Dr. Johnson: Absolutely. And Chrissy, thank you so much for sharing that, and that's, I think one of the things that I love the most about this job is just being able to bear witness to those journeys and watching people really come into who they are, it's just a beautiful and amazing thing. Because the patients we take care of here, all of them are the strongest, most amazing people I've ever met. It's just amazing.

Dr. Johnson: You mentioned co-occurring disorders, I think that's a really important thing for us to be thinking about. Covid really sort of laid bare some issues that we have in our mental health infrastructure just across the board. But one of the things that we are not the only program seeing this, I think all programs,

Mike: Right.

Dr. Johnson: Just treatment programs across the country, definitely our sister programs in the state, are all talking about the fact that the people who are coming to us now, their mental and physical health, the acuity is so much higher than it used to be.

Dr. Johnson: So people who maybe have, you know, a thought disorder, whether it's a delusional disorder or whether there's some other kind of psychotic process happening. There's a lot more of that out there that we are hearing about and seeing, and so patients coming in, we're just dealing with a lot more issues that we didn't use to when I first started a little over 10 years ago.

Mike: Well, and Dr. Jones, you're all over the place, right? So, is it just our culture? What are you experiencing in other countries, other cultures, as far as the same issue with women's substance abuse?

Dr. Jones: Yeah. In 2018, I was in Nairobi, Kenya where we were training what's called the WIVES curriculum, which is our state department has funded that through the Colombo plan and it's this beautiful four courses of how to teach substance use disorder treatment professionals how to work with women. And we had people from 16 different countries in that room, and what was so incredibly powerful and disheartening at the same time, was that no matter who you were to from any country in every culture, women who have substance use disorders were more stigmatized and more discriminated against than their male counterparts. So it's unfortunately a universal thing that we see. And you know, so what do we do with that? And so I think that it just being able to work for women with women is an incredibly empowering opportunity. Because we can be on the front lines to see those 'ah ha!' moments. You know, there was someone from the African country who said, oh, you know, we've had women in our treatment programs for years, but I honestly, until you said this, I never thought of them any different than men. And so, we have now the opportunity to get the research out there, to be able to have those conversations, to train the professionals, to train our emerging workforce and our existing workforce so that we bring to light how women are not less than, but they are made more vulnerable, which is a huge distinction, by our different cultures, so that it makes it harder for women to say, I have a problem. And of course it would, because where are the places that are gonna receive them? And if they do receive them, they're treated with much less respect, with much less compassion, they're trying to be stuffed into a male model of treatment. And so I think that, you know, while, as disheartening as that might be, there's also great opportunity,

Mike: So male model of treatment. Relationships seem to be really important right? Is that part of the aspect of focusing on women only?

Dr. Jones: Yeah, no, no, I wanna make sure, Chrissy or Elisabeth, do you wanna talk a little bit about that?

Dr. Johnson: Yeah, go ahead Chrissy.

Chrissy: No, go ahead.

Dr. Johnson: I just, you know, one of the things that we really talk about a lot at Horizons is sort of healing a lot of relationships and then learning how to have a healthy relationship.

Dr. Johnson: And I think sort of, you know, across the board, I have strong feelings about the fact that I think we don't do a good job in our culture of just sort of educating people about what does a healthy relationship look like. I mean, a lot of people don't have those conversations with their parents, right?

Mike: Right.

Dr. Johnson: And then you take that just sort of general environment, and then you add anything that might cause extra stress for a family, and you can sort of have generations of patterns that aren't healthy.

Dr. Johnson: And so, I think for a lot of the people that we take care of, it's like, oh, so this is what parenting can look like. You know, it might be similar to some of what your own parents did, or it might be very different than what your parents did. And this is what it means to be in a healthy partnership with someone. You know, if you've grown up where perhaps violence or other kinds of aggression or what you see, and those are the models that you have for relationships, it makes sense that that might be what you find. And to even learn that it can be very different is amazing.

Dr. Johnson: So I think the healing takes place sort of across lots of different levels of relationships. Your relationship with yourself, your relationship with your family, your significant other, and your children. It's pretty amazing.

Mike: Well, and let's talk about that primary relationship. Chrissy, I'll ask you a loaded question, right? You said you came into the program when your, did you say son or daughter? Did you tell us?

Chrissy: A daughter.

Mike: Your daughter. When your daughter was two months old. So, I think an obvious question, do you think you would've accessed treatment if your daughter wouldn't have been welcome in the program also?

Chrissy: Well, that was a huge motivating factor, just because I was pregnant, didn't mean that I was just magically cured from my addiction and I couldn't stop using, I wanted to stop, but it was greater than me and it was greater than my daughter.

Chrissy: And then I kind of thought, oh, maybe once she's born, I can stop and I'll be able to change, and that wasn't enough either. And it was either, it was put my daughter up for adoption, or do something different and try and get help. And I chose to get help because I felt like, I had already did so much harm in my own life that the pain that I was feeling inside, I didn't want my daughter to feel that pain.

Chrissy: And there was people there to help, like when I just kind of let go and accepted the help, and it was very scary, not only for myself, but then I was looking after this little person. But they kind of just took me in and made sure I had all the resources that I needed, and the compassion was there, and just the guidance of this is what's worked for some other women, let's see if it can work for you.

Chrissy: They also listen to my needs of like what I've tried in the past that didn't work and really focused on me as a person and how Horizons could really help me grow from the trial and error of what I've done in the past.

Chrissy: It was just like they were a little guide next to me as I went through the program, so it was really, yeah, it was really nice.

Mike: What do you think you're gonna tell her as she gets older? Because she's only known you now as a recovering person.

Chrissy: Mm-hmm. Yeah. Mm-hmm. So Horizons reintroduced me back to the Narcotics Anonymous program, and so Delaney's been going with me since she was like in the carrier car seat, and she still goes to meetings with me today. She puts her headphones on and just sits there and watches her little tablet.

Chrissy: And she just knows, oh mommy, are we going to a meeting today? She doesn't really know what it is, but she knows that that's part of our routine. She's almost five and she doesn't know me any other way, and I don't think, hopefully she never will have to know me another way.

Mike: Yeah. What a great smile you have right now. Well, you know, and isn't that, that's the blessing, right? Dr. Jones? Of working in a program like this?

Dr. Jones: Yeah absolutely. To watch people transform. I've been thinking recently about the idea of alchemy, right, which is like taking ordinary things and turning it into gold. And I think the beauty of our families is that they're already golden, we just help give some of those little ingredients, and they're already in their jewelry box, to figure out how to make them shiny again and how for them to understand and tap into their own beautiful potential again. And as Chrissy just said, like what, she's a beautiful, shining example of ([inaudible) compassion, empathy, and structure, and you get, you know, recovery.

Mike: Yeah. Well, Dr. Johnson, we have that additional component with a lot of people, but women in particularly, talk about the socioeconomic component of the women who come into the program.

Dr. Johnson: Yeah. So I mean, we know clearly that substance use disorders cuts across, it doesn't care where you live or how much money you have in your household, it really doesn't matter. Our program primarily serves people who are eligible for North Carolina Medicaid. So we have a lot of people who come from areas that are more impoverished. They may or may not have grown up in a family like that, but we also know that a lot of times what comes with chronic substance use is people are unable to work, sometimes things get a little bit more unstable. And so there can be a lot of issues around sort of financial things and housing instability and those kinds of issues that our people will face and have to deal with.

Dr. Johnson: And that's another beautiful thing is when people come in to the program and learning more about themselves and just getting that confidence to go out and do something different, and looking for work and looking for housing. I can also say, our families face a lot of what all American families are facing right now, which is, housing is hard to find, being able to pay for your groceries is challenging, so you have these incredible people who are starting their recovery journey, who are working really, really hard on a lot of different fronts to stay there.

Mike: Well, Chrissy, you're nodding through that whole thing. So you must have experienced, I mean, you didn't have a job when you went in, or you had to leave it, right? So talk about the socioeconomics and how you got yourself back on your feet with that.

Chrissy: So I am very grateful where I have a little help from my family, which not many people do, so I'm very grateful for that. And at one point they totally cut me off from, I couldn't even come to their house or they wouldn't even answer the phone. But through recovery, we've built a strong relationship back, so I am grateful for that. But I know, earlier in my journey, and for a lot of other women and people in general, they struggle with finding housing, especially once they leave Horizons because we're here in a safe environment for nine months and now we're pushed out into the real world with like nothing.

Chrissy: And that's a huge r isk for relapse and for like losing children because it's like, okay, now I have this job, and I have this a little bit of stability, but I can't afford the rent in the area that I'm living in. It's just impossible. And then another barrier was like criminal records from substance use and possession.

Mike: Yeah. Mm-hmm.

Chrissy: Like for me, I didn't want to do those things to break the law, but it came along with my addiction. And then instead of offering me treatment, I was put in jail and treated like a criminal. But that's a whole 'nother story.

Chrissy: I'm lucky, today I decided to get my peer support specialist, so I help other people find their journey in recovery and share my experience with them, and kind of walk with them on their journey, and it's hard even with a job like this, like it's my passion to help other people, but it still, sometimes it's like, doesn't pay the bills all the way, and I still have to seek assistance.

Chrissy: So it is, it's hard. It's hard when you have the stressor of trying to stay sober and in recovery, but you have all these other things piled up.

Mike: And Dr. Jones, that's what we're talking about, right. Historically, treatment programs have, it's not that they didn't know these things, they just weren't addressed.

Mike: You know, I'm thinking back in the fifties, women in particular were given, what was it, Milltown?

Dr. Johnson: Mm-hmm.

Mike: And Mother's Little Helper, I think the Rolling Stones did a song about it, right? And then my own mom was overdosed on alcohol, and the doctor gave her a prescription for Valium. And then we move to Xanax, right? And now we have the opiates. Well, what's the common theme there?

Dr. Jones: Yeah. Oh, there's so many common themes, in that, and you know, I think so often, well, one of the things, one of the important pieces is that addiction medicine for so many decades has been ostracized. And that means that the patients who need help have been ostracized from society, as have the people trying to help. And that would be a whole 'nother podcast about those policies and how we ended up here,

Mike: We can do that one any day.

Dr. Jones: Okay, great, let's talk. So yeah, so, but I think that, there have been a lot of strides, especially during the opioid crises that we've had, to really work to get all medical students trained in addiction medicine, right? We need to make it mainstream so that any professional, any medical professional can be able to at least screen and know the resources of where to send somebody if they screen positive for a substance use disorder.

Dr. Jones: And you're right, I think in the idea of medications, you know, in our medical system, medications are quick, easy fixes, and that can work really well when you have an acute issue. But for long-term, chronic medical issues such as a substance use disorder, medicine can be helpful, but it is not the complete answer. Right? We need to really understand what started that substance use disorder in the first place, what were those contextual, biological, genetic, predispositions that led this person into engaging in this type of behavior? And more importantly, what do we need to do to help and support them? Do we need to address an underlying depression or an underlying anxiety? Do we need to work on family issues, relationship issues, or those social determinants of health that create a vulnerability for people? Elisabeth, did you wanna add anything to what I said?

Dr. Johnson: No, I think you captured it beautifully and it made me think, I recently had a colleague reach out and say, I wanna do a better job on the inpatient side of caring for people when they come and, I know I need all this training and all of these things.

Dr. Johnson: And my first thought, I haven't responded to this person quite yet, but my first thought was, not really, you just need to be kind. I think that, I mean, of course there's lots of, when you get into more complex withdrawal management and getting people medically stable and those things, of course there are ins and outs of all of that, but I think particularly for the patients that I take care of in the OB clinic, it is incredible the number of times when they've come to clinic and we get told, you guys are so nice. They're so surprised and it's such a low bar, like I feel like, you know, I'm a nice person, my amazing nurse Dion is a nice person, our front desk person is kind. I mean, but I think we're just normal. But for our patients to really pay attention to that and to comment on it, because that has not been their experience, a lot of times when they interface with healthcare. They can just come here, they feel safe, and they feel heard, and seen.

Mike: Oh boy, that is such a great observation, Elisabeth. And that doesn't just apply to this issue either, does it?

Dr. Johnson: No. No.

Mike: Well, Dr. Johnson, as long as you're still chatting, we'll go around the horn here for this one. I'm gonna quote one of your success stories on your website, and you know that the link is at the end of the podcast, for those of you listening, to the Horizons program, this is the quote: "I learned that recovery is more than just not using drugs. It is a way of living in an honest and real way." That's sort of what you were describing. So here's my question, we'll go around the horn. Dr. Johnson. What's it take to get there?

Dr. Johnson: For a person to get to recovery?

Mike: For a person to get to living in an honest and real way.

Dr. Johnson: I think the very first step is to feel seen and heard. I mean, I really think it's incredibly important for people to feel where they are is safe enough that their true self can be there. All that's happened, all that they do, there's no judgment. It's just part of the story, and that all of us here, we're ready to walk by your side. And do what we can to help you get there.

Mike: Dr. Jones, how do you get to an honest and real way of living?

Dr. Jones: Hmm. Well, I think, ultimately behavior change starts at the speed of trust, and so who are you gonna trust, right? So you walk in and you have to trust us, we have to earn a patient's trust. And the patient also has to trust themselves, and sometimes that's even harder than trusting us.

Dr. Jones: And so, once people can like, as Elisabeth said, feel psychologically safe, physically safe, can be authentic and not feel judged, stigmatized, ridiculed, diminished by their past or people they're interacting with and their past is thrown in front of them again, you know, we're about the here and now. Like leave the judgment and the shame and the stigma at the door, it's not serving you anymore. You can't change what's happened to you, or even what you've done, but you have every control to change what you do from the present and into the future.

Dr. Jones: And so really being able to focus on that and to be able to be kind to your future self, which are, what are the actions I'm gonna take today to move closer to recovery? Because you're either moving in one direction (inaudible) recovery or further away. So what are you doing, right? And hopefully Horizons patients are learning what they need to be healthy in all those different dimensions of physical health, emotional health, occupation, you know, higher power, if that works for them, social relationships, home environment, internal environment, external environment, things so that we're thinking about recovery not just as an abstinence from drug use or a cessation of drug use, but how (inaudible) are you each day?

Mike: We do this on Zoom, for those of you listening, and we all look like a bunch of bobbleheads during these things, we're all nodding up and down. Chrissy, I'll give you the last word. How did you learn to live in an honest and real way?

Chrissy: So I think this is a really tough question, but I had a little bit of faith that I was worth it in the beginning. Like I'm worth everything about living a good life and being happy and being successful and I didn't believe in myself in the beginning, but other people were there who believed in me and wanted to help me turn that belief into me wanting it for myself.

Chrissy: And then it came pretty quickly where I was like, I am worth it and I can do this. And it was, it was difficult in the beginning, but as the days went on, I was like, I really enjoy my life today and this change, and not having to depend on, you know, all the things that I was used to for survival. It was like I wasn't fighting that fight anymore and I could give myself a break and start a new life.

Mike: Awesome. You know, I wanna be respectful of your time since you've been so generous with it, so we'll let that be the last word. For those of you listening, you know that there's links to the Horizons program on the website.

Mike: There are programs out there that help the entire individual if you need help, get it. For now, thanks to Dr. Jones, Dr. Johnson and Chrissy for being with us today. We hope that you're able to join us again next time, and until next time, please stay safe and live honest and live real.