HealthChangers Podcast: A Candid Conversation about Opioids and Solutions to a National Crisis

October 26, 2018

October 27th is National Prescription Drug Takeback Day. Turning in old medications ensures they’re disposed of properly, but takeback events can also prevent drug addiction and overdoses. The 2016 National Survey on Drug Use and Health found a majority of abused prescription drugs came from family and friends’ medicine cabinets. 

In this episode of HealthChangers, we’re taking a closer look at opioid abuse and the family and community work it takes to deal with this national crisis. Dr. Jim Polo, Behavioral Health Medical Director at Cambia, moderated a discussion at the Cambia Grove, a health care innovation in Seattle, and spoke with folks who’ve experienced opioid addiction, and recovery, first hand. Two regional experts, who are working directly with populations impacted by the opioid crisis, participated in the conversation.

The discussion began with Stephanie Lambert-Hisle, who shares how her family has been personally affected by opioid abuse and the battle to save her daughter, Jordan, from addiction. Ryan VanQuill, Executive Director of Battlefield Addiction, and Stacy Cleveland, Sr. Director of Operations and Outcomes at Tacoma Rescue Mission, offer additional insight into the different faces of addiction and the importance of support systems throughout – and into – recovery. In closing, Dr. Polo emphasizes that the opioid crisis is not someone else’s problem but something we all must work together to address. He also talks about the importance of ‘showing up’ for individuals and family members in treatment and in recovery.

We start with Stephanie Lambert-Hisle, an employee at Cambia’s regional health plans in Washington.

 

Stephanie Lambert-Hisle: I was a gestapo parent. I mean I was in there, checking grades. My daughter Jordan was very involved in school, track, cheerleading - every year. I was there. Unfortunately, they start to go to parties and Jordan was a person that smoked pot and went immediately to heroin. But I really didn't have any idea until I got the voicemail in the middle of the night from her boyfriend saying that she had OD'd. They had tried to do CPR and they had taken her to the hospital.

She ended up saying that she would go to treatment for 30 days, so she moved on into sober living. That worked out for a while, but she was dating someone that she met in treatment. They were both working at the same place, supposedly clean. I ended up finding some things in her car. And I told her she had to leave, because she can't do drugs in my house.

She left. They lived in her car for several months. His father would rent them weeks at a time at motels. He finally ended up getting them an apartment which let them be able to spend their own money on drugs. This whole time I was looking for her. I put myself in situations I never should have been in: knocking on people's doors, going into houses, talking to drugs dealers. All because I just wanted to find her.

 I went with a friend to have a drink, and I had overheard one of her friends talking about Battlefield Addiction and how they had a Facebook page. So I looked into it and it turned out they had weekly meetings. So I decided, "Okay I'll go to their stupid meeting." I had gone to Nar-Anon, and everything else that they have, but I thought it wasn’t my thing.

So I went to this meeting and I immediately loved it. You got to tell your story and then they said, "Just get a consultation, we'll figure out, you know every addict is different." What's going to work for my daughter isn't going to work for your son. And they said, "Just go get her." So the next day I went up to their apartment and someone let me in. It was a secure building, and I knocked on the door and they wouldn't let me in. So I sat down in front of the door. I mean, I was there for several hours just sitting in front of the door. And I think he was pulling her back because I could hear that.

Then for some reason, I don't know, she just walked out the door and just came right to me. And I dropped her off at Sober Living. And as a family member, you have to work on yourself. You have to get better. This isn't all on them; it's definitely not. I would say it's over 50% me. So, once I got better, things seemed to turn around.

Dr. Jim Polo: Thank you very much for sharing, Stephanie. I know that it's been a while. So, how long have you been struggling with the fact that Jordan has a problem? From the time that you got that first call?

SLH: For eight years.

JP: Eight years.

SLH: Yes.

JP: And if I recall correctly, she was a cheerleader right? And popular?

SLH: Yeah.

JP: You know, the successful high schooler.

SLH: Very successful.

JP: You would never have thought this was going to be...

SLH: Never, ever.

JP: ...your child.

SLH: Never.

JP:  In fact, most folks would have not have thought that their child is going to be the child.

SLH: Never.

JP: All right. Now, you said that when you first found out and went out there, that you felt angry. What were you angry about?

SLH: I was ashamed for people to know. I didn't want anyone to think that my kid was, you know, that kind of person.

JP: Were there long periods of time where you had absolutely no communication from her?

SLH: Yes, I was coming to work. Nobody knew any of this. I was just barely making it through every day. My family didn't talk to me for about a year. I'm sure no one knew.

JP: What got you through seven years of dealing with this?

SLH: I was so focused on just helping her. But anger got me through. Anything that I could do where I could get some anger out, I would. I've had this Battlefield connection and finally found something that worked for me. And they taught us so much.

JP: You've mentioned Battlefield Addiction a couple times, so I want to bring Ryan into the conversation. Ryan, you're from Battlefield Addition. You guys are all over in the community. Share with us a little bit about what you do, and what you see, and how this looks like from your perspective.

Ryan Van Quill: Typical contact is somebody like Stephanie saying, "My child is in active addiction." And they show up at our Solutions Group, which is our weekly meeting. A lot of times they're with us for three, six, nine months, or even a year before we actually even get to an addict referred into treatment. So what we do is really connect. We say, "Okay, here's the family dynamic. Here's the addict. Here's the age. Here's what's going on. What do we think the best solution's going to be?" We get them in treatment. Then we continue to work with the family and monitor the program and the treatment. And then our real value lies in the re-connection. Then we get into second chance hiring, job training, reconnecting with the family and then community service. That way, we end up with a self-sufficient, self-reliant, fully functioning addict, family and community.

JP: So first of all, it’s very family focused.

Behind each addict is a person inside who’s got great potential

“Addiction is for the family, it means showing up for the family and not the addict, much like cancer. These things show up and they are family and community involved.”

RVQ: Addiction is for the family, means showing up for the family and not the addict, much like cancer. These things show up and they are family and community involved.

JP: Right. And it sounds like one of the things that your organization really believes is that in all of these addicts, there's a person in there somewhere that's got potential. They're not these evil, horrible, terrible ...

RVQ: If you could see where these addicts come out on the other side, some of the most wonderful people I know doing the most good in the world have come out of addiction. It is definitely a life-changing learning opportunity that very few people get to have. And it's a good experience.

“Some of the most wonderful people I know doing the most good in the world have come out of addiction.”

JP: I want to bring light to another area that I think is pretty important, and this is where Stacy, I think can also shed light on just how big this issue becomes. Because what Tacoma Rescue Mission really focuses on is homelessness as an issue, in terms of helping folks. So why might that be something for us to kind of inject into the conversation? So Stacy, share with us a little bit about what Tacoma Rescue Mission does, and how you see this problem and where your perspective comes from.

The short-term and long-term effects of homelessness are often tied to substance abuse

“Addiction is a disease, but it's treatable”

Stacy Cleveland: I think that a lot of times people may assume that people experiencing homelessness are there because of addiction. Sometimes that's true and sometimes it's not. It's a lot more complicated than that. But what we have seen is that people experiencing homelessness, across the board, about one out of five report substance use. For people that have been chronically homeless that number increases to two out of three. So the longer that people are homeless, the more likely they are, they more at risk they are at becoming addicted to substances.       

So, we serve a population that's very vulnerable. And so we want to step in and work alongside them and provide a variety of pathways for them so that they can find the help that they need. And in giving them hope there's hope for recovery. You know, you're hearing a lot about hope up here today. And I've seen it myself. Addiction is a disease, but it's treatable. And it’s something that has to be managed throughout one's lifetime, so I think those community connections, community support, that's what we really emphasize in all of our programs and services at the Mission.

JP:  Stacy, thank you very much. You know, you're bringing up an issue that I think I want to just call out quickly. We talk about the social determinants of health, which is a very fancy way of basically saying there's things within the construct of society that contribute to people's health. So, it doesn't take a rocket scientist to figure out that if you're homeless, life is going to be a little harder. You're more likely to get a cold. You're more likely to not eat well. And it affects your health. But apparently, homelessness has a pretty significant impact on drug use.

SC: It really does. If I was sleeping in a car in the dead of winter, I don't know that I would be clean and sober, right? Because it's pretty scary. You experience more trauma when you're homeless in addition to whatever trauma you experienced prior to experiencing homelessness. So you're going to have a lot of feelings, a lot of pain, a lot of fear - and many people cope with substances.

Coping mechanisms – your friends and family may not know they are being complicit

“And at its core substance use, at its core, it's about trying to feel something that you don't feel, or not feel something that you do feel.”

JP: Thank you. Stephanie, I heard you say that Jordan was homeless at one point. Describe that for us.

SLH: She was homeless in a car. Her dad was a ... He bought things for her. That was how he thought things worked. He would buy her a car; so she always had a car. I don't know, like they weren't sleeping in the woods or anything, but they were sleeping in her car.

JP: Were you afraid that could eventually be where she was?

SLH: Yeah, but I didn't think about it. I just pushed that aside.

JP:  Yeah, that's called a coping mechanism.

SLH: Yes.

JP: I'm going to ignore that because thinking about it's a bit painful. You know, Stephanie points out a key aspect of this problem, is that family members cope in different ways. And sometimes one of the ways of coping is trying to help in a way that makes you think you can take the problem away. You know, ‘if I give her a place to stay, at least she won't be on the streets,’ which is what her boyfriend's dad did. Your experience was that her dad gave her a car which at least maybe kept her off the streets. But that's actually a very fancy way of allowing the problem to continue. It's called enabling behavior. And we all do it in some way, shape, fashion, or form when the problem we're trying to avoid is very challenging.

And at its core substance use, at its core, it's about trying to feel something that you don't feel, or not feel something that you do feel. And even when it's a prescriptive opiate, it's about wanting to not feel something that you do feel: "I don't want to feel pain." Or feeling something that you don't feel on your own: "I want to feel happy." And that's where the addiction comes from, because it's a cycle.

So, in your experience Stacy, because you work on homelessness, share a little bit about what that really means. Because some folks may think that what the Tacoma Rescue Mission does is just provide homes for people and the problem goes away.

Recovery requires substantive, long-term relationships and genuine connection

“Recovery is easy. You only need to change one thing: everything."

SC: Yep, the solution is not that easy. For a lot of folks that do need homes, they are also facing a lot of other issues and barriers. And a home is important but for many of them it's difficult for them to stay in a home without first getting other support that they need.So, we provide some long-term services for people. From residential recovery programs for men and women that are coming out of homelessness, to the permanent affordable housing in a clean and sober living environment, so that we can support people 12 months out and even longer. This gives them time to really build healthy community connections, find support, and they get to start over. For some people, they need to completely start over. Their family and friends were a part of their addiction, were a part of the problem, and so for them they need to change a lot.

My husband is a chemical dependency professional, and he says, "Recovery is easy. You only need to change one thing: everything." So, it really isn't that easy, right? For a lot of folks, you know, having that additional time really increases their success. You know, if you can be clean and sober for a year you still might have some relapses but the relapses tend to be more of a slip-up - it's easier to get back up because you've got some good support around you.

It's really about long-term relationships and connecting people that we're serving to the community. Some of them have become really isolated. I think in addiction we become very isolated. So we help them connect in healthy ways and help them re-discover who they are and what their strengths are. There is a silver lining to addiction that Ryan talked about – we learn things about ourselves and get to grow in ways that others don't. So I think there are some real blessings for people that come into recovery and blessings for their family members if they can kind of work together to continue to heal.

JP: I want to clarify something for everybody that's listening because I think this is often misunderstood or at least misperceived by folks. You know we think of homelessness as an issue of, hey, folks don't have a job or folks don't have a family. They somehow become homeless and then they get into trouble because either they get into drugs, or other things, and so forth. And there's this vision, because I'm looking out in the audience and everybody's well dressed and clearly everybody has a home, there's a vision of, "That's not me." And I'm wondering if you've had people at the Tacoma Rescue Mission that never saw themselves as potentially becoming homeless. They were successfully employed, they had a family, they had a house - and somehow they lost it all.

SC: Absolutely. And I'm actually one of those people, too. I experienced homelessness almost 20 years ago. So you just never know. We have people that come into our programs that have advanced degrees and they've just lost everything. Maybe through grief, lost a spouse, lost children in a tragedy and just couldn't come back from the grief or who couldn't do it on their own and just got stuck in a cycle…becoming more and more isolated. I love hearing the stories of people that we're serving. Because we just can't assume anything. The stories are just so varied and it just really shows us that there isn't a one-size-fits all approach to recovery or to addressing homelessness. We need to be person centered, and focus on the individual, and look at what's best for them.

Taking control of the situation…possible?

“A lot of what we do is literally teaching a family how to get out of the way and let recovery happen.”

JP: Ryan, I'm thinking that you have a very similar approach, because I can't imagine that everybody that you guys touch necessarily comes in with the same tools, or necessarily leaves with the same success. How do you help folks get into control?

RVQ: When we have families show up, a lot of times the first thing we need to do is just get them out of the way of the barriers to success they're having. Meaning, the typical family that shows up, we have a “hater” and a “sympathizer.” We got dad pissed off in the garage that his kid's using drugs, and he doesn't want anything to do with it. And he's just angry about everything, and he doesn't want to talk about it. And then we've got mom, you know chasing the kid down, taking him a peanut butter sandwich and making sure he's got a cell phone so she can keep in touch. And both of those things are detrimental to recovery. And they're both coping with things the way that they have been taught or the way that they are. So a lot of what we do is literally teaching a family how to get out of the way and let recovery happen.

JP: It sounds like part of what you do is you teach skills to parents, you teach skills to families that they never would have needed if the problem didn't come up in the first place.

“The solution seems to be personal accountability, self-reliance, reconnection to the family and reconnection to the community.”

RVQ: Yeah, I think that's a huge part of what we do. If you were to ask me to give you 100 examples of families we've worked with, I think I could give you 100 different examples, from all ends of the spectrum. If we, as citizens, sit here and say, "Poor parents, single moms, poverty…" if we blame this on any one thing, I think we'd be really misguided, because again, I could give you examples. We've got everything from veterans who were legitimately wounded, legitimately prescribed opiates that turned into a heroin addiction. We have, I mean every scenario you can think about is covered in addiction. And the solution seems to be the same. The solution seems to be personal accountability, self-reliance, reconnection to the family and reconnection to the community.

Also, you don't need a family to reconnect to a family. Battlefield is a Family First organization. We've got lots of members of our Battlefield family that don't have functional families. So, we’re wrong to think that’s the barrier, because a family is kind of what works for you. We do a lot to connect people – I have a number of adopted kids throughout the program. They're just part of my family now.

JP: Great. Now Ryan, in your particular case, I know you work with people that are in all stages of their potential recovery. And I'm guessing that they don't necessarily all turn out to be successes.

RVQ: Well, you're dead on. We just saw the new numbers, I think it's 179 overdose deaths a day in the United states right now. We have an organization that meets at our facility called Beyond the Battle and it's for moms who've lost kids to drug addiction. This doesn't turn out well always. In fact, a lot of times it is incredibly tragic and ends in death.

“A bit” of a good ending is more than possible in recovery…

“And I learned that drugs weren't my problem they were my solution. They were my solution for not being satisfied in my daily life.”

JP: We're lucky because Stephanie's family, Stephanie's daughter actually has a little bit of a good ending. A lot “a bit” of a good ending to it! And so, what I want to do is I want to invite Jordan up here. Jordan is Stephanie's daughter. Jordan, share with us, thoughts.

Jordan Lambert: First, I want to ask: a lot of you who haven't dealt with addiction in your families or in your personal affairs, do you believe that the drugs are the problem? Or do you believe that it could be something else? Because I always thought it was the drugs. If I got rid of the drugs, everything would be fine. And you know, I quickly found out that even after I didn't have drugs, I was still miserable. And I learned that drugs weren't my problem they were my solution. They were my solution for not being satisfied in my daily life.

Like my mom said, I was a cheerleader, I also did track, I did pretty good in school until I started getting really bad into it. But the problem was I didn't feel accepted. I didn't feel a part of anything - I didn't feel like I had any purpose. And I was really unsatisfied. I was really just uncomfortable with myself. I didn't like myself. I wasn't confident in the way I looked, or my personality, or anything. I didn't know who I was.  So my solution was drinking alcohol and smoking weed, but after that I went straight to heroin. And once I got that it was like every little thing the voice in your head says to you, disappeared. It wasn't telling me that I wasn't good enough anymore. It just wasn't there.

I started manipulating my family. I started, you know telling my mom that she was a bad mother and that I hated her. And it was all her fault that I was like this. And none of that's true. It was just my way of getting what I wanted. I was homeless for a couple different times. The first time after I overdosed, I was homeless for a while. And that overdose was actually intentional. I was trying to commit suicide. My ex-boyfriend came home from work early and found me. And he didn't even know what was going on. He didn't know I was using heroin at all. I was legitimately mad that I survived when I woke up in the hospital. And I don't know if any of you can imagine being pissed off that you didn't die, but that's how I felt about myself.

I stayed clean for about a year. I had an ex-boyfriend who was very emotionally and physically abusive, and he started using, and I wasn't at a point in my recovery where I could stop myself from using, let alone help him, so I just started doing it right along with him. And that's when things got really bad. I went through about a year of homelessness, living in my car. I was raped, I was beat, I was berated by the person that I thought loved me more than anything. And you know, when my mom showed up at that apartment she saved my life that day.

JP: Jordan, thank you so much. I know that was probably hard. And it's probably difficult in the sense that there's so many things that you probably haven't even shared with your mom that relate to your journey. But I think, I want to point out something that you said that's critically important. You said drugs was your “solution."

JL: Yes.

“Do I have people around me that I need to help? Am I having problems that I need to ask for help?”

JP: It’s important to think about that, because folks that are drawn to use drugs are surrounded by people. And it's those people that they look to and sometimes rely on when they're having difficulties. So, you've got to think about it from both perspectives. Do I have people around me that I need to help? Am I having problems that I need to ask for help? Now you've told us how difficult it was in the early part of your journey, and here you are seven years later. Is this where you thought you would be five years ago, four years ago, three years ago?

JL: No.

JP: What got you here?

JL: You know, when I was finally able to get into long-term treatment was the first step. Somewhere that I didn't just stay for 30 days and then get kicked to the curb with a "Well good luck." You know, I went to a treatment where I got therapy, which was amazing. I needed it, badly. I went to Sober Living, which I'm still in over a year later. And I have so many people around me that support me, and healthy relationships. I think that's probably the biggest thing - having healthy relationships with the people around me.

Relapse occurs. Take a consistent, active approach to recovery.

“This is not a crisis that's going on somewhere else. This is not a problem that belongs to someone else. This is our crisis. This is our problem. And we have to be part of the solution.”

JP: So I want to ask you one final question then. Even now, sometimes in the back of your mind, does that thought ever creep back? "Gee, it felt good. I wonder if I could do that again?" Or, "I wonder if it just might be okay once?"

JL: Definitely.

JP: Okay.

JL: That thought comes in my mind, but not as often as it used to. But it still pops up. The difference now is that I have the tools to deal with it. I don't have to just act on what my voice is saying in my head. I don't have to act on every thought that goes in my head. I can say, "Well that's a stupid thought. Get out of here." And I don't have to do anything about it.

JP: And that's the other thing that's critically important to recognize, that when folks have an opiate use addiction, it's there. And just because they're not using, and just because they're sober, and just because they're employed, and just because they've done well for a long period of time it's not like that risk is just gone. Which is why relapse occurs. So it requires kind of an active approach that's constant.

Stephanie, I want to thank you for sharing your perspective as a parent, struggling for eight years. Jordan, you've been phenomenal. The work that you did to get yourself here today is amazing. And the fact that you're able to share it with folks so that folks see it as real is important. Ryan, Stacy, I want to thank the two of you. Battlefield Addiction and Tacoma Rescue Mission, you've been our partners in this journey helping folks.

But what I want everybody to remember is that this is not a crisis that's going on somewhere else. This is not a problem that belongs to someone else. This is our crisis. This is our problem. And we have to be part of the solution.