This episode explains what you should be thinking about after treatment in order to stay sober, and what the full continuum of care looks like for treating addiction and mental health.
Here are just some of the questions we'll cover:
Check out some of Sandstone Care's alumni programs and other helpful resources at Sandstonecare.com/alumni
If you'd like some support call (855) 958-5511 or live chat with us at Sandstonecare.com
This episode explains what you should be thinking about after treatment in order to stay sober, and what the full continuum of care looks like for treating addiction and mental health.
Here are just some of the questions we'll cover:
Check out some of Sandstone Care's alumni programs and other helpful resources at Sandstonecare.com/alumni
If you'd like some support call (855) 958-5511 or live chat with us at Sandstonecare.com
Well, I think coming up with a plan is the first step. So what's your plan? Not winging it right and knowing Okay, you know, there's going to be triggers. Welcome to the sandstone care podcast where we help teens, young adults and their families overcome the challenges that come with substance use addiction and mental health conditions. Welcome to the sandstone care podcast with me, Clint Mally. Today, I am so excited to talk with Jess Berry, she is going to explain the ins and outs of what does somebody do when they're leaving treatment? And what does it look like to find a community to stay sober after treatment? So if you're that parent, and you're wondering, okay, treatment is great, my kid is doing well. Or I'm I'm competent, that my kid is going to do well in treatment. But I want to make sure that it sticks. This is the this is the podcast for you today. So just Jess, could you just introduce yourself and your title? AdSense don't care? Yeah, absolutely. Thanks, Clint. My name is just Barry. I'm the Director of Business Development, aftercare and alumni services, here at sandstone. And I've been with sandstone for almost four years, I have more a lot of different hats. But my heart definitely lies in helping young people with the resources they need in the community to continue to be successful beyond treatment, which also includes alumni services. See, your title has a list. I don't know if you caught that. But like, you're this this? Like, how many titles out there have commas like that? Right. Okay, cool. So we're going to talk about a few different things. But one of the first things we want to talk about is the discharging process. Okay, so, in full transparency, I am not an expert in this, I'm going to be asking the questions that hopefully, your listeners or watchers are going to be able to be like, yeah, I've been wondering that too. So somebody goes to treatment, if they want their treatment to be effective, then they know that like, it can be kind of scary going out into the world after treatment. So um, what is the discharge process? Like when somebody leaves treatment, not just at sandstone, but anywhere? Yeah, it's a good question. Well, first of all, say that it's important to know that the more treatment a person can get, meaning, the length of time they're in treatment, we know it's the higher likelihood that they'll stay sober. And so, um, discharge planning looks a little different, depending on what level of care or what kind of facility that they're coming from. But the goal is the same regardless. And that is that folks are set up with a comprehensive plan back in the world. So whether that looks like being connected with an individual therapist, or psychiatrist, a family therapist, or other community resources, or even just outpatient care at another treatment center. And we want to make sure that it's really, really formulated for that person. So for example, it's not a one size fits all approach, we really want to make sure that people have all of the tools in their toolbox when they're leaving treatment, because treatments not like you go to trim, and then it's everything's fixed, right, and you go back to your life, and it's, everything's, you know, you got everything you need, and you don't need anything else. And I think that sometimes can be daunting in the beginning to think, Oh, my gosh, after treatment, there's more. But the hope is, is that if we do a really good job in discharge planning, and getting people connected to the resources that that address their specific needs, then it should be a seamless transition back into their community. So the hope is, is that service is titrate down in number of hours. So if you're in treatment, 20 hours a week, or 40 hours a week, you're titrating down to maybe one or once or twice a week, seeing a therapist or an outside provider. So our hope is to really find those providers that are going to be a good fit. And Samsung does a really amazing job with discharge planning. And in that are, we really want to make sure it's not just plug in your zip code and plug in your insurance and spit out a list of people but that we're actually providing resources to you and to your child, that our people we know in the community. We know them we have a relationship with them that they're vetted, so to speak. for quality and and therefore, you can know that you're going to get the same level, if not better care beyond sandstones doors, as you had received while you were in treatment. I think that I'm going to go on a tangent, Clint because so one of the things that I'm really passionate about is making sure that as part of our effort to ending the stigma of of, you know, the need for mental health and people getting mental health services, is to make sure they're getting to the right people. And the general public typically isn't I mean, it's not a we're not all educated on all the different letters behind someone's names, and what they specialize in. And a lot of times people go out to the Internet, and they're kind of chasing their tails, trying to figure out, okay, who specializes in substance use disorder who specializes in trauma, or that's, they're just looking for any therapist, and maybe they'll get linked up with a therapist that doesn't specialize in things that, that they're really focused on. And it can be a frustrating process, when you're doing that on your own. Or if you end up with a therapist, who, who does great work with you, but again, isn't somebody who specializes in your specific needs, then you may not be getting the most out of therapy that you could be. So what I'm really passionate about is being a matchmaker, so to speak in that in that realm, and helping people helping understand the full picture of what people's needs are, and kind of going into my my Rolodex or my bag of resources and, and, and saying, Okay, this is the perfect person based on what I know they specialize in and what your needs are to ensure that you have a really great experience with providers in the community after treatment. And I think that it's just a daunting process if you don't have someone guiding you through that. And that's something sandstone cares, really committed to see, I totally get that. Because, you know, I started here at sandstone, I think a little over a month ago. And obviously, I'm not a medical professional. I haven't been in the industry, right? I'm just like somebody who's been in marketing. And I immediately saw all these letters behind people's names. And I thought the same thing. I was like, What are the what are these people do? I'm like, if you have this many letters, behind your name, surely you must be a doctor. But that's not always the case. Right. But I want to kind of touch back on something you talked about right from the get go. You said, our first goal is to like help keep people in care as long as as long as necessary, because that's going to yield the best results. And so would you mind kind of going through, you know, the levels of care. And I've heard people talk about the continuum of care. Right. So what does that look like from the very beginning to where we started with this discharge process? Yeah, absolutely. So I think from the get go, it's important to know that a needs assessment is conducted for every client. And that really determines and that's conducted by a licensed therapist, and that they really are the experts in determining what level of care someone starts at. So not everyone has to start at the top right. Some people start in the middle, it's really based on the acuity of what's going on for them, and how, how much services how how much service they need at any given time. But the continuum kind of starts at the top with detox, and inpatient or residential services. And that's 24. Seven care. So you're living and staying at a facility, and you're sleeping there, while getting about six hours a group six to eight hours of group per day. And if you're going through detox, that kind of kind of comes first so that we can safely help you. You know, titrate off whatever substances you've been struggling with, and make sure that you're safely and medically cleared before continuing on with your sobriety. There are some substances out there that it's very unsafe to do that on your own. So having that medical oversight is very important, specifically with alcohol and benzos. So, from there, once you're medically cleared, inpatient or residential services is kind of the next level down, you're still in the same inpatient setting, you're still sleeping there, you're still staying there. But you are. You have the ability to participate in group because you're feeling good, feeling better, and really working towards getting some skills on how to navigate this new experience of Okay, I'm so burned out or Okay, I'm, I'm coming out of a fog of some mental health struggles and So that those out group therapy hours each day is really kind of the top of the, the top of the chain, if you will. So residential inpatient services is 24, seven care inpatient from there, again, but goal is a titrate, down in number of clinical hours or supportive hours. So from an inpatient setting, which is typically, you know, it's 24, seven, but typically around 30, to 40 hours of clinical care between group therapy and individual therapy, as well as other support services. From there, the step down from that is what we call partial hospitalization, it's often known as PHP, and PHP is outpatient, meaning you're not living at a facility, you're typically living at home, or in a transitional living facility or sober living facility, and endure attending day treatment. It's also known as day treatment. So that's about again, around still around 30 to 40 hours a week. But it is you're not living on site somewhere, you're still participating in group therapy, you're still participating in individual therapy, as well as other services at sandstone such as academic and vocational support, psychiatry and medication management appointments. But it's still that that beefy 30 to 40 hours a week. Our next level down is intensive outpatient, or IO, P, and I o p, is the same concept as PHP or partial hospitalization day treatment, only, it's about 17 to 20 hours a week. But you're still getting the same group, just a little bit less number of hours of group, and you're still seeing your therapist, but maybe less often. And family therapy is a big part of both of those levels of care. And it's just a little less frequent and intensive outpatient. Our lowest level of care, when we look at the continuum is outpatient services. And outpatient services in a treatment setting looks typically like a relapse prevention group that's attended weekly, it's the lowest level, it's that, okay, you're ready to fly, and we want to make sure you still have a little bit of support, you can still see the psychiatrist, if you need some services, you still have academic and vocational support. But you and you're still going to this group, but you're not seeing an individual therapist at this point. So now we want to transition you back into your community and getting those services established in your community. So at that point, we're, that's where we're looking for that perfect match for you for individual therapy, for family therapy, and for any medication needs for psychiatry. So that you can establish care permanently, or at least in the near term, near to long term, with providers that are close in your community that that you can continue your relationship with, for as long as needed. Now the continuum can definitely it's not, it's not top to bottom or, or bottom up, it can definitely change, right, if someone comes in at an an intensive outpatient level of care about 17 to 20 hours a week, you're really struggling with staying sober, or they're really struggling with their mental health and they need some more support, then they can they can bump up to, to the you know, partial hospitalization where they have, you know, about 30 to 40 hours a week. And if if more care is needed, then of course, going inpatient is available, too. So, so the continuum kind of moves around based on needs assessment and how someone's progressing through the healing process. Yeah, so it's not like this one size, fit all fits all type of thing. But at the same time, it seems like there is a gradual release, at least in education, we did what we called a gradual release whenever we were teaching somebody a new concept, right? So it would be like I do something, then we do it together, and then you do it. But the goal is to only add complexity when somebody has successfully navigated one of those steps, right? So you know, it's like juggling, right, you only add another object to juggle when you can successfully juggle one or two objects, then you can go into three, right? And can you give us like, you know, a rough estimate, because I know you said dependent, it all depends on the person, but can you give us a rough estimate of how long each of those different things so we have the detox period, then we have the residential or inpatient period, then we have the de trium in our PHP period, then the Intensive Outpatient period and the general outpatient think I'm nailing this I'm pretty impressive myself. Okay, so how long you know, might that spectrum be from beginning to end? Great question. I mean, So I'll start with saying that what what research tells us is that the closer we can get someone to a year of sobriety, the higher likelihood they're going to remain sober. And so I think all treatment is looking towards How can if they if they started the tap, how can we titrate them down? How can we get them at least as close to, you know, six months, nine months to a year as possible, with as much support as they need, so that then they can they can navigate on their own beyond that. But if someone did the whole continuum, you were looking at around six to seven months of treatment. And again, that can totally change as you mentioned. Um, you know, I think one thing to add here, that's a reality is that relapse happens. I like to call it lapse, actually versus relapse. I think it's a more positive connotation. But lapses happen, and they should be expected. And I know that that can feel and sound discouraging when, when you're trying to stay sober. But when lapses happen, it might extend the treatment period. And that's okay. The important thing is to not say, Oh, I had a lapse, I'm out of here, you know, is to Okay, we pick ourselves up, and we move on. And we have this amazing support system around us to do so. So, if lapses happen, that could of course, extend the treatment period, right. But to answer your question, it is most straightforward way as I can't, I'd say around six to seven months for the full continuum. If it was just that, cut and dry, start at the top, all the way to the end. And so that detox period, how long is that top and detox period? Yeah, I can break down each each section for Yes, so. So medical detox can be anywhere between five and 14 days based on the substance that, that you're coming off of. And, I mean, honestly, it could be as little as three days, but but really, that's determined by the doctor and what the medical necessity is. So I'd say three to 14 days, average is probably seven to 10 days or five, five to 10 days. for residential services for our adult, I'm over 30 inpatient program, that's two weeks. The hope there is to do some intensive group for 14 days, that's going to really help move folks up along with stages of change and get them prepared to face the fact that there's a lot of things that have to change and a lot of things that have to be rearranged and there's a lot of anxiety that comes with that in order to continue to stay sober. So for example, okay, I'm have to take some time off of work, or I have to figure out childcare or care for my dog while I'm while I'm in treatment, and that can be so anxiety provoking that makes people say No way, Jose, I'm feeling better from detox, I gotta get back to my life. The two week program is to help you address all of those overwhelms while you're in treatment, sort through all of those pieces, while having a lot of support and learning how to manage your own anxiety and, and the overwhelm that comes with totally changing your life. You know, you had a way to cope before using substances and now you don't have that coping any that coping mechanism anymore. So how do you cope now, and that's the purpose of the two way program is to help give you some of those skills and support you through that. For our teen residential program, that program is anywhere between 30 and 45 days in a residential setting. And and that can also include partial hospitalization, if somebody does need closer to that 45 days, so a typical residential programs about 30 days for teens, again, if they need the partial hospitalization, if they're local, and they're a young adult, they can do that from their home or from transitional living. This is where it gets, this is where it gets complex. So 14 residential 30 days is the average length of stay for residential care, and then for partial hospitalization. So that PHP component, we can look at an additional about two weeks, so about 45 days for residential and PHP combined. And then I o p is typically around eight to 12 weeks depending, again, I need but average is about eight weeks, and then outpatient actually through sandstone. You can utilize the relapse prevention, outpatient services as well as continued access to academic and vocational support. For about up to six months. Most people hang out forever. Three months, and outpatient, and at that point, they're establishing appointments and care in their community with those, you know, with an individual therapist, family therapist and psychiatrists that we've helped provide them with. And we give them I want to also say, we give lots of options, it's not just one of these. So we give about three to four each have individual family and psychiatry resources, so that you have the opportunity to make phone calls CP, like have free consultations with providers, and that can take some time, especially in today's world, you know, these providers are sometimes booked out to three months, so so you'll have that outpatient, weekly touchpoint at sandstone while you're establishing your care in the community, and then you transition into the community. And, and really, it's up to you how long you want to stay in outpatient services. I'm a big believer that, you know, I really would love to see us all have a therapist, like we have a dentist or a doctor, like preventative mental health care is, is super important. It doesn't necessarily have to be weekly, but having someone that you establish a trusting relationship with that you can check in with us, your life progresses and things Can't you come up against, there's just a real a real asset that I think more and more people are learning to, to, you know, utilize. So, um, you know, unfortunately, there are treatment centers out there that that may not have a real good pulse on the progression of clients and how they're doing and have more of a one size fits all like, Okay, if we have people in, you know, for two months of residential, and then you know, a month a PHP and then and everyone does the same amount of treatment, I think what's nice about sandstone is we really want to make sure that that the step down is appropriate for where you're at, but you're ready for it, you know, even the jump from PHP to IO p can feel like a lot, it's half the number of clinical hours. So sometimes we do an extended, like a middle, a middle like, you know, 40 hours to 30 hours to 20 hours, because we want to make sure people you know, are feeling supportive as they titrate down and, and the most important pieces, when you go to treatment, you have all the support and and usually it can be a lot easier to stay sober or to stay focused on your goals. But then when you get out of treatment, and you have all these things to face, like your job or school or your family life, or your friends, then I mean, I would argue that's when the real treatment begins. Right? So we try to integrate that into our treatment so that there's not these things waiting for you when you get out of treatment. And I think an important piece of that is being able to appropriately set people down as they're ready to be set down to have that reintegration be very smooth, and trend in transitional, that unfortunately, there are treatment centers out there that, that take a different approach. And they're really just trying to keep people for as long as insurance will pay. And, you know, it's it's, it can be an ugly, ugly look. And but it's definitely, you know, having a licensed person tell you where your son or daughter needs to be in terms of level of care is probably the most important piece of making sure they land where they're supposed to be. Yeah, and that reminds me of something that I've heard people talk about. And when it comes to parents trying to suggest how much exactly what type of treatment option works for the kids, right? So, you know, so maybe there's a parent out there listening, and they're like, Okay, I know that my child definitely needs x, right, like this treatment program. And so when they call her and they're trying to get them into the treatment, so they're saying no, no, I don't want to do this. I just want them in this. What would you tell a parent who's saying, hey, like trying to kind of press one treatment option over the other, instead of kind of letting a doctor you know, a medical professional, kind of gauge and assess their teen or young adult? For sure. Well, I think there's, we see that a lot. We oftentimes will see parents call and saying, like, my kid needs residential, then I can't stay at home anymore. They're sneaking out of the house every night. You know, we need them in a facility where they can't leave. And sometimes those kids do need that. But but there is such a thing as necessity both medical necessity as well as needs this necessity that are determined and can only be determined by a license. There. Post or let you know a doctor. And, and so there's a couple of things like, the biggest piece is if you're using your insurance, if you if if, if basically the insurance company doesn't think that your child needs residential, then they're not going to cover those services, which can sometimes be really hard because it's what you know, what we want is this, but but based on how they define necessity or medical necessity or clinical necessity, they're saying, No, we want your child had to start at this lower level of care first. So sometimes what we see is kids having to fail up, so to speak, where, okay, insurance, we're going to go here at this level of care, and, you know, at i o p or PHP, and if they're not, you know, if they're not successful, then then insurance will say, okay, they're not in successful, so we're now we're willing to help them with residential services. So insurance does play a piece in that if you're using your insurance, if you're not using insurance, then it becomes less about what is going to make the insurance company, you know, say yes, or no, but more about, like, what is the true need of the client based on the medical professional and the clinical professional? And will of course, take into account what, um, you know, what parents are, are wanting, but, um, I guess my advice to parents would be, I know, it's hard, and I, you know, we know our kids best. And there is this trust process of knowing that like, hey, are our this, this doctor and this licensed therapist, like, they're in this profession, because they want to help, and they're gonna give you a true assessment of where your child falls in the continuum. And just trusting that that's, that's going to be an honest and sincere evaluation, I'll tell you why I totally understand that when it comes to being too close to something to where it's really hard to be able to see the mistakes or not even mistakes, but being able to see something that is obvious. For example, when I write something, I am unable, sometimes to see the very simple mistakes that I've made within my own writing I need is, I need a second opinion, I need somebody who's got a fresh set of eyes, who's not too close to this, who can who can give me an objective answer so that I have an understanding of what is actually good and what is real, right. And unfortunately, we are emotional humans, like we are people who react and have a carry a bunch of baggage and experiences into our situations. And so sometimes it's really refreshing to just have somebody who can come and look at it from an objective point of view. And it's super valuable when it comes to something that's as important as your child's mental health or substance use. So having that type of assessment is very, very helpful. I just wanted to say to and you're 100%, everything you just said. And it's also equally as valuable to really make sure parents are understood, what have they seen and been dealing with not just what their child's reporting to a therapist, but what has been happening at home. And again, being that they know their children best? What, what behaviors or have they seen that they're most concerned about? And it's something we want to hear we care about that as well. It's not an all or nothing approach, where it's just like, we're only going to go with these results from this assessment. And I think parents being heard understood is a huge piece of that as well. And, and certainly not something that is the experience everywhere. Totally. How do you, you want people to value your experience you want people to, to know it to hear your story. And if you are listening to like our first two episodes, we talked about how oftentimes when we're talking to kids, we come into the situation, like we already know what needs to happen, instead of just figuring out why your child is using substances or why their behavior has changed, like what is the reason for these differences. So coming in with that open mind that like really genuine curiosity is super helpful. And a good treatment provider is going to be a listening treatment provider, somebody who's hearing your story and kind of understanding all the experiences that led up to this point. And, you know, I was talking with a parent. And she's told me she was like, Hey, I just, I just wanted to have simple answers, right? I just wanted somebody to be able to tell me yes or no like to some key questions. And so for your help, guys, The show notes are in the description box below, you'll see a link to a quiz. It's just five questions. It was created by Sarah Fletcher, she was on the first two episodes, five questions that you can answer about your young adult or your teen, or there's another quiz where they can take it themselves, right? And they can see like, okay, like, do I need some support? Would it be helpful for me to have some support? by answering these five questions? And so that will just like set the ground, the groundwork for you to be able to be like, okay, is this something I need some help with? And if so, where do I go next? Right. And that's kind of where we've been leading to with all of these different levels of care. And we're, we're getting to this discharge, which is actually where we started. Let's circle back to this whole discharge situation. Tell us about the continuum for young adults and how that might be different from teens or adolescence. Yeah, absolutely. So for young adults, again, who go through detox, or residential detox can be anywhere from five to 14 days, on average, based on acuity and what what substance they're getting medically cleared from residential services are about two weeks, that short term residential program. And then from there, the outpatient services are the partial hospitalization, just about, you know, 20 to 30 hours a week, depending on need. And then, and that's our day treatment, or partial hospitalization, PHP, lots of lots of work, lots of names for that level of care. And then intensive outpatient is the same, about 17 to 20 hours a week, and then of course, General outpatient. So they're the same as well as teen services, except for the fact that PHP can be commuted to if you're living at home, or if you're taking advantage of our transitional living services. And I wanted to share a little bit about that, because traditionally, people are familiar with sober living. And in essence, that's what our transitional living is, but we call it transitional living, because it's really a opportunity to provide structured living for up to six months for clients who are in our PHP or i o p level of care that are in our young adult population, who need some help transitioning into launching into adulthood. So maybe they're coming from mom and dad's house living in mom and dad's house, or they have been unsuccessful living on their own. This is a great way to have a living component Well, in PHP, NLP that's going to teach life skills and just help provide some healthy habits and, and coping skills on what it's like to live on your own. So, so really, that's a really neat component. It's not required for PHP, or I o. p, but it is an optional opportunity for that extra support well in in that outpatient programming. But Thanks for clarifying that. And I think one of the things you alluded to is there are just a lot of abbreviations aren't there, there's IO, P, PHP, all of these different, it's like an alphabet soup of different, different terms. And I think sometimes whenever you're talking about anything medical or counseling related, that kind of jargon can be very intimidating. The cool thing is you don't kind of have to memorize these. So if you're the person who's writing all these down, and you're like, ah, Okay, which one should I use? Should I use PHP irlp, residential, which one's the right one for my child does, you don't have to so a good treatment program is going to take you in, they're going to listen to where you've been, what's the situation what your child, your teenager, young adult is going through. And then they're going to suggest the right programming and take it one step at a time. Because if you're not going one step at a time, it's very easy to just disregard that something is so complicated or too long or too short. And so having that taking it one step at a time thing is super helpful when it comes to just taking the first step right. I did want to also say, let me ask you this. So Jess, I've heard you throw around like teen young adult adolescent, one of those age groups look like what is the specific age groups for those. So our teen and adolescent program serves young people between the ages of 13 and 18, if they're still in high school or working towards a GED, or just generally might be better suited for an adolescent group. And our young adult program is from 18 out of high school or GED graduate At 230, at 30 years old, and the young adult population is really identified as emerging adult right there. And they're still trying to figure out how to launch successfully into adulthood. So, these two groups are separate tracks, they're not together. But really what they share in common is that they're both addressing the monkey is on the backs of this specific age group, which is the main things in common, what am I going to do with my life? How do I get through school? And how do I not fight with my parents have a good relationship with them? You know, and what, like, how do I navigate, like, what I'm going to do with my life, those are scary questions. And, and oftentimes lead people to substance use just to cope with that. So we try to unpack those those items, whether you're in the teen or young adult group, to to make sure that they get addressed and they're not waiting for you after treatment. That's such a good point about the differences between the two age groups. I remember in high school, you know, things, and even Late Middle School, things are challenging for a different reason than they're challenging after high school, right. So I remember being in high school, and there's so much stuff about peer pressure, and like trying to figure out who you are. And also just like the relationship dynamics of being in school, it's a very, like unique relationship, you become friends with people for your experiences, in between classes, or during classes or at lunch, in these very segmented time periods. And we're hanging out after school, right? But then you have a whole other set of challenges as a young adult, such as getting a job or, you know, growing in your career ladder, or building a long term committed relationship, right? Or, or just even being able to successfully manage school on your own, like college or work a trade, right. So these, these things are challenging each in their own way. And they require different types of treatment, because they are different challenges. Right. So I think it's important to recognize those distinctions, because they require different tools. Am I right? Absolutely, they do. And that's the main focus of our treatment approach is how do we help the family system? How do we help the young person navigate? You know, this part of human development, which is really tricky. This question, this next question is kind of posed to me thinking about the slow and steady decline of my parents relationship. Sometimes when they would fight, I would notice that one of my parents would do something nice for the other parent. But instead of being able to enjoy what that person did, they would i would say all of that was like a really nice thing. And they would say something along the lines of let's see if it lasts. Right, you'll see that. I know, that's like a very somber thing. But but I think it's helpful when we're thinking about how we think about treatment options, right. And one of the things that I noticed with parents is, parents don't just want a quick fix, because they want the treatment to last long term. And they're worried that after they get out of treatment, that they're not going to be able to maintain sobriety or maintain mental health. Right. So this next question is for that. Are there any tips just the way you would give someone for staying sober in that early sobriety? So maybe they just finished out outpatient services? How do they stay sober from there? That's a great question, Clint. And it's, it's one to not to really understand. Because it's it's difficult, right? Especially for this age population that we're talking about, where friends are so much more important than their lives, right? And so. So, for lost friendships are a big part of recovery and staying sober, especially for young people. Because their friends are typically people that they've used with, that they love that they've trusted, that they're trying to figure out in their minds, like, Okay, if I'm sober, and they're not like, how, how will they see me? What judgments Do I have about them? How do I navigate this? Um, you know, and I want to say that I want to speak to the fact that it is an incredible loss and a grieving time for young people when they realize that the people that they were spending time with maybe some of the people they were spending time with, they can't continue to spend time with if they're going to maintain sobriety Or at least as often. And that grief has to be understood and acknowledged and can't get skipped over. Because it is, it is truly so, so important at this at this time in human development, where community is just maybe more important than ever, in our human development. So, one of the things that comes to mind, I think is really, really important, is engaging in alumni services, whether it be through sandstone or somewhere else. But Samson's program is really cool, because the people that you went to treatment with were all in your age group, you can continue to maintain connections with by virtue of our alumni program, and the alumni program currently is for young adults, we hope to extend to adolescents here in the near future. But currently, the 18 to 30 population meets formally every Monday on in person, and does some sort of big group discussion, and fun activity. And it's led by Kelly butser, who is a four as an alumni of Samsung care herself. And she's awesome. And she has so much passion, and just really is very relatable for young people. And so, and there's a virtual option on Tuesday nights for folks that aren't local in Colorado, but both of these groups are an opportunity to talk through some of the big things and topics that come up in early sobriety like, okay, I've heard you're not supposed to date for the first year, but I really like this person, or I really, this person really likes me, what should I do? Or it's the fourth of July, and I'm used to going to barbecues and drinking. And that's what all my friends are going to do. So what am I going to do now I'm going to just be alone. You know, and that goes for every holiday just about that. Because we know, especially holidays, were a big, big drinking time for people. So that's hard. And what's cool is our alumni services also addressed that. So we talked about it in a group setting, we have these weekly meetings, these process groups. But we also have monthly events that are geared around, especially around times of the year where those holidays or events can be very triggering, and we have sober events ourselves. So we're having a fourth of July sober barbecue, and it's going to be a blast. And it's going to be everything that any other Fourth of July celebration is it's just going to be sober. In addition to that we also partner with sober AF entertainment. And that nonprofit, led by Duke rumbly is an incredible community resource. And they post all kinds of sober events, get inspections. So you can go to a baseball game here in Colorado, and sit in the silver section with all the other sober people and not have people running into you and spilling their beer on you. Or you can go see, you know, a concert that historically, you know, or traditionally might be a heavy substance use sort of following and know that you're safe because you're you're in an area with other sober people. So we partner a lot with them and, and see monthly events there as well. So the alumni services is just a huge asset to Okay, how can I have some sort of normalcy now surrounded by people who aren't partying, and, you know, it's not a sort of fixed for the friends that you may have to separate from, but it's at least some step in the direction of community versus isolation. And that would be my most important advice is to not isolate. And it's easy to do when you feel you're alone. But it's the it's the most important thing not to do, especially in early sobriety. Bringing up friends is such a huge, huge thing, because in hindsight I can, at least for myself and high school. So both of my parents are addicts, and I saw myself going down that road, right? The people that I was hanging out with were always drinking or smoking or whatever. And I saw myself becoming more and more obsessed or centering more and more of my activities, the things that I did on day to day basis around that stuff, right. And so I decided that I was not going to like follow in my parents footsteps in that way. And I remember talking to one of my closest friends and I told him I was like, Hey, you know, we tried to hang out before when we were when not drink, right? So we would hang out. And I would say, Hey, I'm not drinking, or I'm not smoking. I'm not doing that today. And my friends would always initially support that they would say something like, yeah, that's totally cool. But then it would always be followed up with. Alright, can I hear you? I hear that you do not want to do this. But what if Just for tonight, this one night, you actually got hot, or you got drunk with us just this one night, right? And they felt uncomfortable. They felt uncomfortable being around somebody who is saying, Okay, I'm not going to do this. And I felt uncomfortable. I felt uncomfortable being around a bunch of people who were drinking and smoking, were getting high all this stuff. Because I was trying not to do that. And it got to the point of contention, where I told one of my friends, you know, one of my closest friends, I said, Hey, this is not what I want to do. Like, our relationship has been based around drinking and smoking. And I don't want to do this anymore. So I can't be friends with you. And you can imagine his reaction, he was super upset. And he was like, you know, he got really mad, you know, and he stormed off, he drove away. And we ended up not talking for a long time. At the same time, he went for years and years and years and had his own battles with addiction. And he ended up dying a couple years ago. And it was, it was one of those things, I felt so guilty, right, like I was, I felt like, I had let him down. That, that it was me, right, like I maybe I should have tried to pull him along with me. But the reality of the situation is that I couldn't, like I couldn't handle myself and help him. Right. Like, I didn't know how I wasn't equipped, especially because I was so young. And we have to have people around us to be able to understand or relate to the things that we're going through. So that so that we can actually handle ourselves. Right? Like, it's one thing when we've had some time to be able to be sober or to like, gain some new habits, right? To be able to then go back and to feel like talk to these folks. But for most of us, that is a super, super challenging and triggering time even still. Right. So I'm so glad that you brought that up. Let's touch on that a little bit more. Is that okay? Yeah, I was actually I wanted to add something. Because I, I have witnessed a lot of young people say, my friends aren't going to peer pressure mean, they're not going to do that to me. And maybe they won't. And that's a real reality, too. Maybe the friendship is so solid, and there's a lot of support. And, and, and there are plenty of relationships that can last through this. In early sobriety, it's up to the young person, the person that's, that's in recovery, to be able to set healthy boundaries for themselves around what they can and cannot handle. And so um, so I just want to be careful not to send the message that because you're sober, you're gonna lose all your friends, that could happen. Because that may, that's what has happens for some people. And there are plenty of friendships that will persevere. But if you're not getting care pressured, it doesn't mean that you yourself might not feel like I just want to have fun this one night. And that that can be or, or I hear a lot. Well, you know, I'll call wasn't my problem. So no, I struggle with this other stuff. So I can drink. And it's a slippery road. It's a slippery slide. And it's, it's walking a tightrope. And what's important in early sobriety is to figure out those boundaries. And, and having the support of sober people to process through that and figure that out, as well as a therapist is really just Paramount, because those answers aren't just, they don't just spontaneously up here, it's through processing and trying on different, you know, opportunities and things and experiences that we get to those, those boundaries in the end what, what you can and can't do with, you know, in feeling comfortable and safe. And, like you said, feeling like hey, this is where I want to be in this friendship or not. Just what I love about what you just did is you're bringing so much nuance to this. And that's so important, because what you're gonna find is there's tons of people who are very passionate about this subject and they're also very opinionated, but it is not a a one size fits all type of thing, right? Like, there are peer groups in which they will support you. And there are peer groups in which they will not support you and peer pressure you. And it's good to be able to have the tools and the experience and the guidance of at least a group of people who can relate to what you're going through regardless. So thank you for kind of, like checking that and being like, yes, that may be true. But that's not always true for everybody. Because I think that that's a really important thing to know. And also, that speaks to group therapy, like having that diversity of opinion of people who understand what you're going through, or what you're talking about weigh in is like, the most helpful thing ever. Like it is it is, it feels so supportive to just feel understood, even if you don't take any like, this is what I'm going to do when I leave, just feeling understood is so helpful. sober friends, how do you recommend somebody making sober friends. So first and foremost, our alumni group, our alumni services is a great place to make sober friends, there's a larger group as well, that's a national group called t pass. And that combines all the alumni groups at all the treatment centers nationwide. And they host many events. So that's a great place to meet other people that are, that are in recovery themselves that are in alumni groups. I mentioned it earlier, but I'm getting connected with silver AF entertainment, that's a great you go to a concert, you send this over section, you're probably going to make some friends. The Phoenix is also another really cool community place where it's a it's a sober gym, and there are many locations. And for those that want to, you know, engage in healthy, active lifestyles, it's another great place to meet people. Um, I would also say that, you know, whether you're interested in whether you're interested in 12 step programming, such as a na, CA, or a smart recovery support group, or mindfulness and recovery support group, there's several others, continuing to work a program are continuing to reflect on what it what it means to be sober, you know, in a setting that is supportive, is just, I mean, that's the, probably the easiest place, if you don't know, you don't gravitate towards a traditional sober community, such as a 12 step program or a smart recovery, then the alumni services can definitely feel that you know, scratch that itch, so to speak, but I think there's a, there's coming to be a lot more resources, as we're seeing the the face of of recovery, world change, whereas it used to be pretty small, and it was like you're either an A or you're not. And if you don't like a then you're not going to have a sober community, we're really seeing that expand and in these new generations that are coming together and building community without these drugs and alcohol. So I'm gonna take a I'm gonna link up a lot of those resources in the show notes in the description box for folks, cuz you're like, there's a lot of resources and yeah, you just named a whole bunch of right off the top of your head. I just wanted to kind of talk about a for a second because some people think that all support groups after treatment are a right, like a 12 step program. How would you differentiate and what what would you say? is the difference between something like an alumni group and a like when, when would be a good situation for either? Yeah, so So A is our our oldest sober support group. And it's been around the longest and that's what most people are familiar with. And, and working a 12 step program is incredibly powerful work. And, you know, personally highly recommend it. And, and it's not for everybody, and that's okay, too. And so, um, so, whether you begin those support groups of 12 step or non traditional 12 steps such as smart recovery, or mindfulness in recovery, in programming while you're in treatment, or after, really there's no bad time to get involved. The difference between alumni And a traditional 12 step support group is that there, we're not working a program so to speak. So the alumni are getting together to discuss and process through in a group setting, the hurdles that come up, especially in early sobriety, and talking through and getting support on the things that you're facing. So there's not a curriculum to our alumni services. Whereas in more traditional unstructured support groups, there is a curriculum. Yeah, there's kind of like a way in which you talk like you don't, it's not like an open discussion, right? With a Alcoholics Anonymous, it's, you speak when it's your turn, and you kind of say, your piece. And you thank people for sharing, and you can discuss with talk with people before and afterwards, but it is it is a very structured program and an alumni group is going to be different in that there is a little bit more open discussion. Also, there's, though, there's not a structured setting for how the meetings go, every time, there are structured events that take place to support that kind of community engagement. So I know, with our alumni group, we don't just sit in a circle and talk. But we also go and do things and have fun. Like he said, the July 4 thing that's coming up. And so I think that that's important is that you can't just go to group, you're probably gonna need to make some friends. Like you're gonna need to be able to build a community of allies of people who understand you and know where you're coming from. And I think the other interesting thing about comparing alumni with with Alcoholics Anonymous, where A is that it's not necessarily age specific, right? So it's not necessarily 18 to 30 year olds. So sometimes you can benefit from having, like we said, a variety of opinions of people who have been through things that you have not been through and experienced life that you have experienced, right. But at the same time, sometimes it's also beneficial to be around people your own age, who know exactly what you're going through at that exact moment. Holidays, you mentioned this earlier. How do you survive the holidays in early sobriety? Are there any tips or tricks that you can give us to help prevent relapse specifically for the holidays? Well, I think coming up with a plan is the first step. So what's your plan? Not winging it, right? And knowing Okay, you know, there's gonna be triggers there. If it's your favorite holiday, and you you that traditions built around it, or what have you, or your your family that you know that there's going to be, you know, drugs or alcohol present, you know, what, really getting ahead of it, and coming up with a plan for yourself. And then I think probably just making sure you have somebody that you can check in with, in a more formal, you know, program, it could be a sponsor, or it could be a sober friend, or it could be Kelly butser, or alumni coordinator. Someone that you can, that can be your, your person that you can check in with, and plan a call be like, Hey, I'm gonna call you at four o'clock whether things are going well or not. And, and have an exit plan. So if you are going to go somewhere where there will be a drinking or smoking or what have you, um, knowing like, okay, when this if this if I start to feel this way, or I know myself well enough, because I know, if I start having these kinds of thoughts, then that means I'm going to leave. And sometimes that also means letting family or the people you're going to be with no as well, if that feels safe for you, like, Hey, I may not stay the whole time or what have you know, and you might go in really confidently and say, hey, it's not gonna be any problem. And it might surprise you, maybe it will, maybe it won't, but being okay with whatever comes and not judging it, I think is really important. Um, you know, I know some people in early sobriety they're like, really, they're like, they want the people around them to enjoy alcohol, because they know they can responsibly and they're like, hey, I want to live vicariously through you. That often comes later, later in sobriety when you have some time under your belt. And, and that might be where you're at. And that's cool, too. But, but you might be surprised as well. You might get blindsided by a trigger triggers are called triggers, because they come out of nowhere, usually, and just knowing what's in your toolbox and thinking about that, like, what are my tools for when that happens? And how am I going to navigate through this and, you know, reaching out for support if you if you don't feel fully confident in your existing toolbox, or you need some some more than wired. Yeah, and one of the things that you just talked about was going in there with a plan, not being surprised if you experienced triggers or things that that make you want to drink, or smoke or whatever. And I think it's also important to remember the type of relationships that you're going to be engaging with, right? So for some people going into a family environment is very welcoming, and warm and comfortable, and you feel empowered, and you feel confident. And then sometimes going, and being around your family is a trigger, right? It is a place that doesn't feel safe, it is a place that doesn't feel good, is it? It's a place that feels stressful, and you're going to want to cope. Right. So taking an inventory of the people that you're going to be around, and how that has traditionally affected you in the past can also be super helpful. When you're trying to create this plan. Am I right? Or is it? Or is there? Like, is there another way? No, I totally agree. I think that's absolutely right on. I mean, 100%, being able to be honest with yourself on in, you know, how do I think this is going to go? And, and what am I going to do if it goes a different way, and just thinking through that getting ahead it and being in being prepared for that is the most important thing, you know, and then there's also to say, like, other people are like, Hey, I, you know, I feel really good, I'm not worried about it at all. And for some, it's totally, it's, it's all good. And it's all good the first time, second time, third time, fourth time, fifth time, sixth time, and then oh, out of the blue, the 15th time, the 15th holiday, I'm having a hard time. So cool. So then you know who you can call, what you're going to do. And you have this like toolbox, right? Like this backup plan. And I think having that backup plan, even if you feel really confident, it's just a way to safeguard you no surprises when they happen, because they can really know when we get dysregulated or we get triggered, it's hard to to navigate in that situation. So if you have thought about it beforehand, it can just really help you say, Oh, yeah, I thought about this already. This is what I'm gonna do. That's such a good point that you brought up about something being the 15th time because I was I was just talking with somebody, you know, and they're on like, their third year of sobriety. And they're like, this year is so hard. This is like the most challenging year of my sobriety. And she said that she felt really stressful about issues. Like why is this so challenging, right, until she was able to talk to somebody else who had kind of been there and beyond, and they were able to affirm? Yeah, like that second, and third year can be really challenging. And sometimes it might feel like you're white knuckling it. That's not crazy. That's, that's pretty normal. You know, because you come out of treatment, and you're kind of on fire, you're like, yes, like, I'm ready to do this. I've been around these people, I've had these courageous conversations, and I have some, like clarity, and I'm excited to, to kind of change my life and to go in a different direction. And then when the mundane things of life kind of happen, and you've let your guard down, sometimes it's easier to fall into these, these feelings that you, you know, have been able to overpower, because you were so excited about it. So I'm glad that you brought that up. Because just having somebody tell you, hey, that's not crazy, can also be a helpful thing, and can allow you to go into this understanding that even if it's not the first time, second time, there's going to be a time when you're going to need some tools. So it's better to have those tools and not need them. Then to meet them and not have them like and healthy coping skills and replacing unhealthy coping skills with new skills is something you get in treatment. And it's something that you get after treatment and that you continue to, to find as you learn more about yourself. And so I don't think there's ever like anyone that's like I'm, I've got it all, you know, I think it's just the unfolding and, and, and everything unfolds, when it will, as it should. And you face it, you can be prepared, but you're not you know, it's going to what will be will be and those mobile knowing what you want to how you're going to handle handle those situations is just can be really powerful. Just Barry, thank you so much for taking the time to tackle these tough questions about discharge and the continuum of care and also long term sobriety I think anybody who's listened to the last three episodes of this podcast is going to leave with a feeling of clarity, right? Like a sense of, okay? This seemed like really confusing at first. But having somebody kind of just talk about it straight up and just give some answers is so refreshing. So, if you're that person, and this has been a thing, if you haven't listened to the first two episodes, go back, because they're gonna help you out. And if this has been helpful for you, you need to share this was somebody who's, you know, is going through something where this could help them out, right? This is not about trying to, you know, get more money or, or just grow our business with sandstone. But it's literally just trying to give some answers to help people who are in a very challenging part of their life. And just today, you were able to take a lot more questions that people had swimming around in their head and be able to resolve those. So thank you so much. Is there anything else you'd like to say? Before we, we dip out of here? I mean, I think I'm just I'm honored to be here today. And to be able to have this conversation, I guess, the one thing I want to end on is just that there's hope, you know, and like to be hopeful, because you can have a beautiful sober life and a much in most cases, much better life than you can when you're struggling with substances. So no matter where you're at, in your journey, it does get easier. And when you need support, it's here. You know, it's so funny is I asked Sarah, that question. And she said, be hopeful. And that's the thing that I see so much is, is like in order for us to be about this life, this recovery life, this helping and partnering with and supporting people who are trying to be sober long term, we have to put on a disposition of hope that things can get better, right, that you're not in this alone. And that even though it seems super difficult, right now that we can we can get through this. So thank you so much, Jess. This is Clint ingest, signing off, and we will see you on the next episode. Be well, bye. If you want to learn more about treatment options for you, your teen or young adult, men tell us about your situation on a confidential call using the number in the show notes or live chat with us at sans don't care.com we'll connect you with the treatment that you need. And if we're not the right fit, we'll get you where you need to go. Be well and remember that change is possible.